An easy-to-use template and guide for Critical Appraisal useful for Journal Club Presentations

1. EBM: Critical Appraisal of an Article on Systematic
Review
Sudan Evidence-Based Medicine Association Template
Developed by:
Dr. Imad Salah Ahmed Hassan
MD (UK) FACP FRCPI MemAcadMEd (UK) MSc (UK) MBBS (U of K)

3. Clinical Scenario

4. Formulate a Well-Built Clinical
Question
Patient
Intervention
Comparison
Outcome

5. Outline your Search Strategy:
Search Terms/Keywords/Mesh terms
Search site/Search Engine
Pubmed via PICO
Pubmed Search Box & Limits
Pubmed Clinical Queries
Pubmed Advanced Search
Cochrane Library
Other

6. Outline Current Practice
 Tip: From the Introduction Section or from a
Guideline

7. Select a Reasonable Piece of
Research
Tip:
Paste the title, authors, journal details
here
Type of Study: Systematic Review
Date published:
Number of Pages:
Quality of journal i.e. impact factor (get from Google!)
Linked-In: Author Details/Picture

8. Reason(s) for Selecting this Piece of
Research
 Tip: Common Reasons
Answers my QUESTION
Free article
Recent Article
Reputable Journal
Other

9. Summarize the Results of your
Article
 Tip: Paste the Abstract/Conclusion from the
Abstract here
 Paste Abstract here: use several slides if it is
long-remember the 6X6 rule in power-point
presentations!

10. My Appraisal Map
 Appropriateness of chosen Title?
 Trustworthy Authors?
 Truthful Abstract?
 Comprehensiveness of Introduction section?
 Relevance: Importance for Practice
 Validity: Appropriate Methodology (Validity:
Internal)?
 Results: Trustworthy Results?
 Applicability?
 Impact of Findings on Current Practice and
Future Recommendations?

11. Apply Your Appraisal Scheme
 Tip: Use the RVRA Scheme: Based on the National & Gulf
Center for Evidence-based Health Practice
Relevance
Validity
Results
Applicability

12. Apply Your Appraisal Scheme
 Tip: Use the RVRA Scheme
Relevance Personal Knowledge
Validity Methods Section
Results Results Section
Applicability Personal
Interpretation/
Experience

13. Apply Your Appraisal Scheme
Relevance
Does the study
address a
common problem
in your practice?
Does the study
address an
important
outcome to you or
to your patient?
(DOE vs. POEM)
Assuming that the
study conclusion
is true; would it
lead to a change
in your practice?

14. Apply Your Appraisal Scheme
Validity
Did the overview
address a focused
clinical question?
 Patients?
 Exposures?
 Outcomes?
 Therapy?
 Causation?
 Diagnosis?
 Prognosis?

15. Apply Your Appraisal Scheme
Validity
Were the criteria used
to select articles for
inclusion appropriate?
Tip: From Method Section or Copy the Method
Summary from the Abstract.
 Copy the Inclusion & Exclusion Criteria
 Copy the Study Flow Chart to your
Presentation
Copy the Inclusion &
Exclusion Criteria

16. Apply Your Appraisal Scheme
Validity
Is it unlikely that
important, relevant
studies were missed?
1-Bibliographic
databases?
2-Reference lists?
3-Personal contacts?
4. No language
Restrictions?
Was the validity of the
included studies
appraised?
1-Validity criteria?
2-Risk of Bias

17. Apply Your Appraisal Scheme
Validity
Were
assessments of
studies
reproducible?
1-Blinded
reviewers? 2-
Inter-observer
agreement?
Were the results
similar from study
to study? Tests of
heterogeneity?
Visual Screen
(overlapping CIs)
& I2 Test
Is there any

18. Apply Your Appraisal Scheme
Results clinical significance (in MP : Magnitude &
Precision)
What are the
overall results of
the review?
1- Overall ORs,
RRs
2- Or WMD
Tip: Copy the Forest Plot
Precision of
the effect:
How precise
were the
results?
Confidence intervals? Narrow or Wide

19. Summarize the Study Biases
Selection, Attrition, Performance,
Detection Biases, Conflict of
Interest etc.

20. Summarize the Study Strength
Tip: From the Discussion or
Letter to the Editor/Editorial
Comment etc.
E.G.: Number of Patients, Randomization Method,
Least Biases, Statistical Tests used, Outcome
Measures, Ascertainment, Drop-outs, Length of
Follow-up etc.

21. Summarize the Study
Weaknesses
Tip: From the Discussion or
Letter to the Editor/Editorial
Comment etc.
E.G.: Number of Patients, Randomization Method,
Least Biases, Statistical Tests used, Outcome
Measures, Ascertainment, Drop-outs, Length of
Follow-up etc.

22. Summarize the Study
Tip: From the Discussion or
Letter to the Editor/Editorial
Comment etc.

23. Unanswered Questions from the
Study
Tip: From the Discussion or
Letter to the Editor/Editorial
Comment etc.

24. Apply Your Appraisal Scheme
Applicability I (in IPPP: Intervention – Population -
Preferences-Potential Benefits - Harm
Can the results be
applied to my patient
care?
1. Can you do the
Intervention exactly
as it is described in
the paper
2. Is your Patient
similar to the
population of the
study?
3. Did you examine
your patient’s
Preferences?
4. Are the potential
benefits outweigh the
 Were all clinically important outcomes
considered?
 Any substitute – surrogate or intermediate
endpoints?
 NNT for different outcomes?

25. Applicability
System
Preparedness:
Availability, Cost
etc
Staff Preparedness:
Knowledge, Skill
etc
Patient Factors &
Acceptability:
Similar to study
population,
Preferences, Values
etc

26. Resolution of your PICO
Question
Narrate/Write your PICO Question & Why is it important.
Summarize the Study Findings
Summarize the weaknesses, biases, NNT and NNH, Sens.,
Specif., LR etc.
Indicate the Level of Evidence & whether you are going to
apply the findings to your patient.
Which Implementation Tools you are going to Use:
Education
Pathways, Protocols, Order Set etc.
System Redesign/Quality Improvement Team

27. Resolution of your PICO Question:
Recommendations
New Research: Is there a need to do more
research of the subject? Y□ N □
Suggested research if the answer is yes:
Audit: Is there a need to audit your practice?
Y□ N □
Suggest an audit cycle.
Publication: Is it worth publishing your Journal
Club presentation in an EBM CAT journal or
website? May be start your own JC website?

29. Useful Links
 EBM Glossary of Terms: http://www.cebm.net/glossary/
 EBM Calculators:
http://ktclearinghouse.ca/cebm/practise/ca/calculators
 EBM NNT, LR etc. Websites:
 http://ktclearinghouse.ca/cebm/toolbox
 http://www.thennt.com/
 EBM Critical Appraisal Worksheets:
http://ktclearinghouse.ca/cebm/practise/ca/worksheets
 Diagnosis worksheet
 Harm worksheet
 Prognosis worksheet
 Systematic review (of therapy) worksheet
 Therapy worksheet