1. Critical Appraisal วิจารณญาณ
โครงการการจัดการปัจจัยเสี่ยงและปัจจัยเอื้อต่อสุขภาพ
ตามผลการวิเคราะห์ภาระโรคในพื้นที่เขตสุขภาพที่ 12
Critical Appraisal วิจารณญาณ
ดร.นพ.วรสิทธิ์ ศรศรีวิชัย
มูลนิธิสุขภาพภาคใต้
สถาบันการจัดการระบบสุขภาพภาคใต้ มหาวิทยาลัยสงขลานครินทร์

2. Research Objectives
Is there a clear statement of research objectives and/or hypotheses?
Does the study address a question that has clinical and/or public health relevance?

3. Study Design
Does the study design appropriate for the objectives/hypotheses?
Does the study represent an advance over prior approach? How?

4. Outcome Variable What is the outcome?
Is the outcome variable relevant to the objectives?
What criteria are used to define the outcome?
Is the determination of the presence or absence of disease accurate?

5. Independent Variable How many exposure variables are being studied?
How many potential confounders are considered, and why?
How is presence or absence of exposure determined? Is the assessment of exposure likely to be precise and accurate?
Is there attempt to quantify the amount or duration of exposure?

6. Method of Analysis
Are the statistical methods used in the analysis appropriate to the type of variables being studied?
Is the sample size adequate to answer the research question?
Have the assumption underlying the statistical tests been met?
Has chance be evaluated as the potential explanation of the result?

7. Possible Source of Bias
Is the method of subjects selection likely to have biased the result?
Is the measurement of either exposure or outcome likely to be biased?
Have the investigators considered whether confounders could account for the observed result?
In what direction would each potential bias influence the result?

8. Interpretation of Result
How large is the observed effect?
Is there evidence of dose response relationship?
Are the effect biologically plausible?
If the finding is negative, was there sufficient statistical power to detect the effect?

9. How the Result Can Be Used
Are the findings consistent with the other studies of the same question?
Can the findings be generalized to the target population in general?

10. Selection Bias E+ D+ D- E- E+ D+ D- E- E+ D+ D- E- E+ D+ D- E-

11. Misclassification Exposure misclassification : non differential
Bias toward the null or dilution of effect
D D-
E+ a b
E- c d

12. Misclassification Exposure misclassification : differential
Bias toward/away from the null : Recall bias
D D-
E+ a b
E- c d

13. Misclassification Disease misclassification : non differential
Decrease power
D D-
E+ a b
E- c d

14. Misclassification Disease misclassification : differential
Bias toward/away from the null
D D-
E+ a b
E- c d

15. Causal Criteria Strength Consistency Specificity Temporality
Biological gradient
Plausibility
Coherence
Experimental evidence
Analogy

16. Hierarchy of Population and Inference
External population
External Validity (Generalizability)
Issue of population difference
Target population
Internal validity
Issue of bias
Actual population
Statistical inference
Issue of chance
Study population
(Sample)