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What to learn and How to teach it: Critical appraisal of the Literature Michele T. Pato, MD AAP-9/2011 (no conflicts of interest –funding, data or otherwise)

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Presentation on theme: "What to learn and How to teach it: Critical appraisal of the Literature Michele T. Pato, MD AAP-9/2011 (no conflicts of interest –funding, data or otherwise)"— Presentation transcript:

1 What to learn and How to teach it: Critical appraisal of the Literature Michele T. Pato, MD AAP-9/2011 (no conflicts of interest –funding, data or otherwise) Michele T. Pato, MD AAP-9/2011 (no conflicts of interest –funding, data or otherwise)

2 Research Literacy and Scholarly Activity Research literacy is the ability to critically appraise and understand the relevant research literature, and to apply research findings to clinical practice.

3 Scholarly Activity = EBM “In a broader sense, Evidence Based Medicine’s goal is to regulate the way in which physicians gather, analyze, and use clinical information in their treatment of patients” Fauman MA, Psychiatric Times Feb 2002 “In a broader sense, Evidence Based Medicine’s goal is to regulate the way in which physicians gather, analyze, and use clinical information in their treatment of patients” Fauman MA, Psychiatric Times Feb 2002

4 Scholarly activity  What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.

5 “Teaching Scholarly Activity in Residency Training” IoM in 2003 addresses 3 overarching issues important for the Future of Psychiatric Training. 1.The importance of having better and more data regarding the research workforce and society’s need for psychiatrist-researchers. 2.The need for more outcome data in ongoing and novel patient- oriented research training efforts. 3.The need for a national effort to promote, implement, and monitor the training of psychiatrist-researchers IoM in 2003 addresses 3 overarching issues important for the Future of Psychiatric Training. 1.The importance of having better and more data regarding the research workforce and society’s need for psychiatrist-researchers. 2.The need for more outcome data in ongoing and novel patient- oriented research training efforts. 3.The need for a national effort to promote, implement, and monitor the training of psychiatrist-researchers

6 The Endgame- in 5 minutes  In the end the real issue in any reading you do will be to judge the applicability to the population YOU are treating.  So at first look judge an articles by: 1.Title 2.Authors 3.References 4.The “Pictures”-(tables and figures) 5.The Abstract If you’re still interested READ ON!  In the end the real issue in any reading you do will be to judge the applicability to the population YOU are treating.  So at first look judge an articles by: 1.Title 2.Authors 3.References 4.The “Pictures”-(tables and figures) 5.The Abstract If you’re still interested READ ON!

7 DV Cone, EB. Lerner, DM Yealy, Prehospital Emergency Care 2002 Critical Appraisal 1.Does the INTRO tell me WHY they are doing it? 2.Does the METHODS tell be WHAT they are doing in enough detail for GENERALIZABILITY & REPRODUCABILITY 3.Do I understand the RESULTS? 4.ARE their DISCUSSIONS/CONCLUSIONS clear? And Do I AGREE or DISAGREE? Why? 5.Will it change my Practice?-Should this be the FIRST question? 1.Does the INTRO tell me WHY they are doing it? 2.Does the METHODS tell be WHAT they are doing in enough detail for GENERALIZABILITY & REPRODUCABILITY 3.Do I understand the RESULTS? 4.ARE their DISCUSSIONS/CONCLUSIONS clear? And Do I AGREE or DISAGREE? Why? 5.Will it change my Practice?-Should this be the FIRST question?

8 Critical Appraisal form for Journal Club Adapted MT Pato from (E. Brooke Lerner 1999-version1.1) Name:_________________________Journal Club Date:____________ 1 st Author, Title, Pub Date____________________________________________ Introduction: Hypothesis: ______________________ Are objectives clearly stated? No Yes Methods: Study Design: Correlational Case Report Case Series Cross -Section Cohort Case control Experimental Meta-Analysis RCT Review –if yes-Where selection criteria specified? Yes/No Other_________ Time Frame: Prospective Retrospective Not Applicable Randomized: RandomNonrandom Not Applicable Blinded: UnblindedSingle Blinded Double Blinded Not Applicable Enrollment: Convenience Consecutive Other________________________ Name:_________________________Journal Club Date:____________ 1 st Author, Title, Pub Date____________________________________________ Introduction: Hypothesis: ______________________ Are objectives clearly stated? No Yes Methods: Study Design: Correlational Case Report Case Series Cross -Section Cohort Case control Experimental Meta-Analysis RCT Review –if yes-Where selection criteria specified? Yes/No Other_________ Time Frame: Prospective Retrospective Not Applicable Randomized: RandomNonrandom Not Applicable Blinded: UnblindedSingle Blinded Double Blinded Not Applicable Enrollment: Convenience Consecutive Other________________________

9 Methods continued SUBJECT+PROCEDURES: Subject Source (population)_________________________________________ Inclusion Criteria:_________________________________________________ Exclusion Criteria:_______________________________________________ How are controls different from cases?__________________Not applicable_____ Descriptive Variables:_________________________________________________ _________________________________________________ Outcome Variables: _________________________________________________ _________________________________________________________________ Main Dependent Variable______________________ Parametric Non-Parametric Main Independent Variable:_____________________Parametric Non-Parametric Statistical Test T-test ANOVA Kruskal-Wallis Mann Whitney (check all that Chi Square Fishers Exact Logistic Reg. Linear Reg. apply): Survial Analysis Other_____________ Not applicable Correlations Is There a Power Calculation? No Yes Alpha:_____ Beta:_____ Smallest Detectable Difference___________ SUBJECT+PROCEDURES: Subject Source (population)_________________________________________ Inclusion Criteria:_________________________________________________ Exclusion Criteria:_______________________________________________ How are controls different from cases?__________________Not applicable_____ Descriptive Variables:_________________________________________________ _________________________________________________ Outcome Variables: _________________________________________________ _________________________________________________________________ Main Dependent Variable______________________ Parametric Non-Parametric Main Independent Variable:_____________________Parametric Non-Parametric Statistical Test T-test ANOVA Kruskal-Wallis Mann Whitney (check all that Chi Square Fishers Exact Logistic Reg. Linear Reg. apply): Survial Analysis Other_____________ Not applicable Correlations Is There a Power Calculation? No Yes Alpha:_____ Beta:_____ Smallest Detectable Difference___________

10 Results+ Discussion Results: Is there a difference between Groups: No Yes Not applicable Magnitude of the difference between groups?_______ 95%CI________ P Value____ List any other relevant findings?____________________________________________ ___________________________________________________________________ Percent of subjects lost to follow-up or non-response:_____% Are participants different from non-participants? No Yes If they are different: How are they different?___________________________ Discussion: Was there bias in the study? No Yes Where:_____________________________________ Who can the results be generalized to ?_______________________________________ Conclusion: So What??? Did the results support the hypothesis? No Yes Will you change you practice from this study? No Yes Results: Is there a difference between Groups: No Yes Not applicable Magnitude of the difference between groups?_______ 95%CI________ P Value____ List any other relevant findings?____________________________________________ ___________________________________________________________________ Percent of subjects lost to follow-up or non-response:_____% Are participants different from non-participants? No Yes If they are different: How are they different?___________________________ Discussion: Was there bias in the study? No Yes Where:_____________________________________ Who can the results be generalized to ?_______________________________________ Conclusion: So What??? Did the results support the hypothesis? No Yes Will you change you practice from this study? No Yes

11 Statistics to Define (So they aren’t afraid to read the methods section) 1)Reliability = Reproducability 2)Validity= truly measuring the concept 3)Power= will you detect the difference if it exists 4)Kappa- can two people agree: >.7 5)T-tests-as simple 2 group ANOVA 6)Correlations- If one changes does another: same direction (+) or different direction(-) 7)ANOVA-Analysis of Variance- Is the change due to what I did or just do to randomness of population? 8)Parametric vs Non-parametric- Nominal vs Ordinal/categorical 9)Chi squared- expected versus observed 10)Relative Risk and Odds Ratios- predictor to outcome 1)Reliability = Reproducability 2)Validity= truly measuring the concept 3)Power= will you detect the difference if it exists 4)Kappa- can two people agree: >.7 5)T-tests-as simple 2 group ANOVA 6)Correlations- If one changes does another: same direction (+) or different direction(-) 7)ANOVA-Analysis of Variance- Is the change due to what I did or just do to randomness of population? 8)Parametric vs Non-parametric- Nominal vs Ordinal/categorical 9)Chi squared- expected versus observed 10)Relative Risk and Odds Ratios- predictor to outcome

12 Looking at any type of Article Sackett et al,Clinical Epidemiology: 1991, Little Brown and Co

13 Keeping Track-Know your Gaps 1.Keep it simple 2.Decide ahead what types of articles and statistical methods you want covered 3.Use Critical Review Forms to ID Types of research and Types of statistics 4.Review what has been covered periodically  Biannually, Annually, Quarterly  Pick articles accordingly 1.Keep it simple 2.Decide ahead what types of articles and statistical methods you want covered 3.Use Critical Review Forms to ID Types of research and Types of statistics 4.Review what has been covered periodically  Biannually, Annually, Quarterly  Pick articles accordingly

14 Tracking articles week to week PGY Discussant ArticleDate read Research design used Statistics Used 1)Pato Faculty + PT-pgy-3 Pato-CMI and Buspar in OCD /5/03RCT Anova,T- test, ICCorr 2) Course Director SA-pgy2 Fairburn- Risk factors Bulimia Nervosa1997 3/12/03 Case-controlLogistic regression and chi-sq 3) Training Director- CP-pgy-4 Nurenberger -DIGS /19/03 Diagnosis- Experi- mental Chi sq, Kappa(corr coeff)

15 Journal Club Master Sheet (topics you want covered-YEARLY) Article Types # read 1.Case report 2.Case series 3.RCTI 4.ExperimentalI 5.Cohort 6.Case-controlI 7.Cross Sectional 8.Correlational 9.Meta-Analysis Article Types # read 1.Case report 2.Case series 3.RCTI 4.ExperimentalI 5.Cohort 6.Case-controlI 7.Cross Sectional 8.Correlational 9.Meta-Analysis Statistical Methods #noted 1.T-test I 2.ANOVA I 3.Chi-squared II 4.Linear regression 5.Logistic regression I 6.Kruskal-Wallis 7.Mann-Whitney 8.Fishers-exact 9.Survival Analysis 10.Correlation coeff II Statistical Methods #noted 1.T-test I 2.ANOVA I 3.Chi-squared II 4.Linear regression 5.Logistic regression I 6.Kruskal-Wallis 7.Mann-Whitney 8.Fishers-exact 9.Survival Analysis 10.Correlation coeff II

16 You can promote reading the literature as a life-long Pursuit rather than a chore. But REMEMBER: YOU CAN’T WIN THE LOTTERY IF YOU DON’T BUY A TICKET!!! But REMEMBER: YOU CAN’T WIN THE LOTTERY IF YOU DON’T BUY A TICKET!!!

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18 Scholarly activity  What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.  Scholarly Activity includes a broad range of activities from being able to critically appraise the scientific literature to participating in research that actually contributes to the literature.  What is it- Scholarly Activity is an RRC requirement of residency training programs and includes promoting an environment of scholarship and inquiry within every training program.  Scholarly Activity includes a broad range of activities from being able to critically appraise the scientific literature to participating in research that actually contributes to the literature.


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