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JM2010 CE: Understanding Healthcare Literature: Advanced Critical Appraisal

Posted on February 4, 2010 by kcarlson | No Comments

By Hella Bluhm-Stieber, MLIS, AHIP, Santa Clara Valley Health & Hospital System

Ann McKibbon, MLS, PhD, from McMaster University, Faculty of Health Sciences started the CE class “Understanding Healthcare Literature” with different definitions for evidence-based medicine (EBM). A simple definition is: “evidence-based healthcare (EBHC) is the integration of best research evidence with clinical expertise and patient values.” Ann focused the presentation on three steps of the 5-step process for EBHC:

  1. Framing the question appropriate to the needs of the patient/situation…
  2. Evaluating the evidence (critical appraisal or reading the article)
  3. Making and doing the decision.

One of the goals for the class was to learn how clinicians look at articles. A big component of this is critical appraisal. Critical appraisal is the reading and understanding of an article. It is a three step process:

  1. find good evidence
  2. find good results
  3. figure out how the patient matches the study


Ann also talked about different categories of clinical literature: original studies (e.g. case report) versus synthesis (e.g. systematic reviews, practice guidelines). She then went into details of the similarities for these different kinds of literature and showed us where to look for this information in an article. All clinical literature has certain components. They are all question based, preplanned, and comparative, etc. For example one can find information about the patient/participant group of a study in the method section, in the first part of the result section, or in Table 1. The setting of a study can be found in the abstract or method section, etc.

One method to visualize a study is to map it out. The Equator Network compiles standards for writing articles and reporting guidelines. One of their standards is the Consort Flow Diagram that is a standardized presentation for randomized controlled trials. The STARD Statement is a diagram for diagnosis studies.

Ann showed us how to map out the playground article using the Consort Flow Diagram and by reading the abstract and the flow chart. She then explained statistics, e.g. the significance of P-values and confidence intervals by analyzing Table 1 of the article. She also mentioned the importance of the conflict of interest disclosures in articles.

Ann also talked about other techniques to represent articles, e.g. GATE by Rod Jackson at the University of Auckland, School of Population Health in New Zealand. We practiced putting in the information from several articles into the GATE frame. The GATE frame uses a method similar to PICO, called PECOT (Participants, Exposure Group (Intervention), Comparison Group, Outcome, Time). Randall developed GATE further and added some additional questions in regards to resources needed, responsibilities, and success.

Critical appraisal can be done in 3 different ways:

  1. Group led with assumption that no one has read the article
  2. Group led with division of labor among groups
  3. Do it yourself

I learned many things in this class about what to look for in an article, where to find certain information, and how to find out if there are significant differences in the results of the study. This helped me to see how clinicians look at articles.

I would like to thank the NCNMLG for the professional development grant that made it possible for me to attend this class and the conference.

  1. Equator Network
  2. Howard AW, Macarthur C, Rothman L, Willan A, Macpherson AK. School playground surfacing and arm fractures in children: a cluster randomized trial comparing sand to wood chip surfaces. PLoS Med. 2009 Dec;6(12):e1000195. Epub 2009 Dec 15.
  3. GATE

Posted 2/4/10

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