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Good afternoon. Good evening. Good morning from wherever you are joining. Uh welcome to the first Zoom academic meeting of 2025. And uh I'm really happy um uh to, to welcome Doctor Sachet AnAnd from New Delhi in India, who is going to talk to us today on the topic from evidence to impact strategies for critical appraisal of pediatric surgery, journal articles. Doctor Arnold uh don't go by his age. He even though he may be young but he is really well studied. He uh is assistant professor in the Department of pediatric Surgery at India Institute of Medical Sciences, which is one of the pioneer and prestigious institute in the national capital, New Delhi. He has more than 100 and 43 publications. I'm sure by this time, publications have probably gone up to 150 many of them in journals. He is a principal investigator for technical resource center and Center for Evidence for guidelines of Ministry of Health and Family Welfare Government of India. He is a member of Cochrane gut group and Cochrane collaboration. His interest in the clinical field are urology and minimally invasive period surgery. His research interests are evidence based medicine, systematic reviews and meta analysis. And he is really an expert in that study methodology, ergonomics, and laparoscopic surgery microbiome based biotherapeutics, something really coming up and, and getting the due um credit and precision medicine in, in um he will have to tell us what CK U means. Uh But luckily he finds time to spend with his um busy wife and a little daughter and he enjoys swimming and traveling and reading and listening to music. And I'm very glad to inform the audience that he is one of the guest speakers for our conference uh in the first week uh week of May, uh we will uh have a look at that a bit later. So uh today, I'll be talking about the strategies for critical appraisal of uh pediatric surgical journal, journal articles. And I think uh not only pediatric surgical, uh these strategies will help you to critically appraise or analyze any published article. So I have no financial interests. Uh Although I hold the uh editorial uh posts in, in journal of repute, I am not supporting any journal or any publishing company. Uh During this talk, the things which I'll be talking about includes the definition of critical appraisal in this current era of evidence based medicine. The need for critical appraisal. Are there any uh checklists or other tools that are available for this critical appraisal? And actually, it's not the process of critical appraisal. It's, it's the art of critical appraisal, which I'll be talking about and the domains that need to be addressed while you are uh assessing any published uh article in the journal. Then the questions that need to be addressed while critiquing and the examples from uh current uh pediatric surgical um papers, then a practical guide to the trainees and residents on how the journal club presentations should be made and how efficiently they can be presented. So what is the current definition of critical appraisal? It is basically the application of rules of evidence to a study to assess the validity of the findings, completeness of reporting the methods and the procedures, the conclusions and the compliance with ethical standards. Nowadays, conflicts of interests is also included in this. Why is there a need for a critical appraisal? The publication landscape of of the current literature is changing enormously day by day. And as on Jan January 2025 we have more than 37 million citations and abstracts in public. Uh This is definitely uh the mindset or the ideology of publish or perish which we all um unfortunately or fortunately are following. And in the recent years, uh almost 1.5 million new articles per year are published in PUBMED, which is more than double than uh those which are published in 2010. So there has been an explosion which is witnessed during the pandemic and the post pandemic period. If you talk about the publication landscape of pediatric surgery. It is no different when we search the search term, pediatric surgery on PUBMED, then there are are more than 55,000 results and this is only one search term that is relevant to pediatric surgery. More than 5000 articles are there every year with this search term. And let me tell you that the four major journals are the most common journals of our speciality, which includes journal of pediatric surgery, pediatric surgical surgery, International European journal, and Journal of pediatric Urology. They alone contribute to around 11 to 20 12% of these publications. Why these publications are increasing. Uh There can be another reason to it because the standard textbooks are very difficult to update and those cannot be updated periodically. So one has to focus on journal articles uh to update the information and and as clinicians or researchers, we also look up to these articles for for updating our knowledge. So this is the current structure of medical literature as a purest perspective. If I have to tell that from the outside, it looks like a shiny pyramid made of marbles, but from the inside, it may not have studies with have a rigorous methodology or which are very good quality, have a very good methodological uh um rigor. So those are uh the decision is not so rosy in terms of the medical literature. Let me give you an example. This is one of the articles uh which I which I often uh give an example that uh this is an article which should not be there in the publication. And there are numerous examples. So this suggests the article is titled that parachute used to prevent death and major trauma related to Gravitational Challenge. A systematic review of randomized controlled trials, see that the article has been cited 1003 times and there were no randomized controlled trials as found by the authors. And as we look at the conclusions, it suggests that the effectiveness of parachutes has not been subjected to regress evaluation by using randomized controlled trials. So the story didn't end here. And there were a few authors which conducted a randomized trial on this and they concluded that parachute use did not reduce death or major traumatic injury when jumping from the aircraft in the randomized trial. However, the trial was only able to enroll participants who can jump on a stationary aircraft on the ground and not in the sky suggesting cautious extra polluting to high altitude jumps. So this is an example where first the randomized first, the systematic review was not to be conducted and second, a randomized trial should not be conducted. Why? Because when beliefs regarding the effectiveness of an intervention already exist in the community randomized trials, mild selectively and role individuals with a lower perceived likelihood of benefit. So the applicability of of these two articles was not uh so much that they could have found a place in a reputed journal like B MJ. So there are numerous examples in pediatric surgery. And I want to give a recent Cochrane evidence uh methods, uh meta research study, which suggested that in pediatric surgery, more than 50% of the randomized trials and almost all of the systematic reviews have a high risk of bias, an out of 100 odd studies. Uh sorry, 278 studies, the authors could, could find only one randomized trial and four systematic reviews which were adequately reported. So now moving on to whether there are any checklists or any guidelines or any tools that are available to assess or critically appraise these publications or articles. So our job is made a little bit easier and there is a tool which is known as CP Critical Appraisal Skills program.