Critical Appraisal of the Medical Literature

Critical Appraisal of the Medical Literature James A. Hokanson, Ph.D. Department of Preventive Medicine and Community Health University of Texas Medical Branch jhokanso@utmb.edu 3 United States Crude Death Rates 1900-2000 4 Survival Manual Questions to ask of every paper you are willing to read 5 Quality of Medical Evidence United States Public Health Task Force Guide to Clinical Preventive Services 6 Quality of Medical Evidence I. Evidence obtained from at least one properly designed randomized controlled trial 7 Quality of

Medical Evidence II.1 Evidence obtained from well designed controlled trials without randomization. II.2 Evidence obtained from well designed cohort or case control studies, preferably from more than one center. 8 Quality of Medical Evidence II.3 Evidence obtained from multiple time series with or without intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatments in the 1940s) could also be regarded as this type of evidence 9 Quality of Medical Evidence III. Opinions of respected authorities, based on clinical experience, descriptive studies, case reports, or reports of expert committees 10 ABSTRACT Should I Spend My Time Reading This Paper ? States the Purpose of Article, Major Procedures and Methods, Main Findings, and Conclusions More and More Journals are using Structured Abstracts 11 Structured Abstract Objectives Study Design Methods Results Conclusions 12 ABSTRACT, cont’d If properly designed and analyzed, is this study, important and worth knowing about? 13 ABSTRACT, contd If the results are statistically significant, do they also have clinical significance? If the results are not statistically significant, was the sample size sufficiently large to detect a meaningful difference or effect? 14 Introduction Why is this study needed ? What is the purpose of...

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