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I comfortable uh doctor, you have the flu now you can speak, sir. All right. Thank you so much for the kind and introduction. I almost thought I was listening to somebody else when you were speaking about that citation and um I appreciate the invitation. Can you hear me properly? Yes, we can. So. Ok. Awesome. So, yes, sir. Yeah, we can. Ok. Thank you. So, um without them wasting much time now, we just want us to dive into the, the topic uh for consideration today because we have uh a lot to discuss in under one hour. So we're here to discuss how to critically appraise the scientific paper. And although I place some emphasis on, on students because uh I see that that may be the majority of the audience today, but these um principles will apply to um all specialties and across board. Uh even though there will be some cir bias, I'm sure you understand because I spent most of my youthful life during surgery and that's most majority of what I know next slide, please. So I do not have any disclosures regarding this, but II would like to thank the different uh individuals and that contributed the information for me to put this together. I'll mention them at the end, next slide, please. So again, I also want to acknowledge the m uh General club for inviting me to speak about this and grape food. Also for GMR persistency, make sure that this uh happens. And um I hope to have more interactions with the, with the club as we go ahead next, like please. So I'm going to go with this outline. I'm going to print a background and give some preambles to set the tone for the discussion. And then I'll dive straight into my 10 tips and they all start with CS in how to critically appraise a scientific paper. Uh I've been told that I need to speak about an example and it, it makes sense to make it a bit practical. So I will really highlight on a particular example and for us to consider, I shared the, the article with um Jeremiah, which we could reflect on after this presentation, we don't have to go through them because there's no time to do that and also share some other material that uh we can have access to. And of course, I expect these slides will be available, able to, to focus uh on request. And of course, I know that this has been the recorded, uh I will mention some a personal controversy regarding this topic and then we'll have it here in the next slide please. So the first question we have to ask is that why do we critically analyze scientific research? This is the background I want to start with. So there are three main reasons. One, we need to be sure that whatever information is coming out from the scientific community is valid because there are times when we know some people will go behind one room and con cut some data together and present it as published research. Uh And we need to be sure that the information that is being brought out is valid and test has a set meets standards. The second main reason is to be sure that this information we're getting is valuable, not just that it is valid, but is it, is it valuable for, for our, our setting? Is this something that Elvan to us? And is this something that has been done before done in different way? And of course, that relates down to the relevance of the topic in improving patients outcome next slide please. And in terms of experience for surgery, surgery, we always pay attention to the in in things regarding scientific research because it helps us to give our patients the best care in their practice. There is this concept of evidence based medicine going are the days where people will do things based on their own room and caprices, we need to have surgery backing for whatever we do. And I'll mention some things as we go along and also it helps to advance your own interests and abilities. Because as you practically analyze a science paper, you also develop the skills to, to write your own papers and have your your name published inside and become recognized and also influence in practice and put your name on the signs of time. So it also has a personal benefit too. And more and more people have realized by that being able to sign and critical paper is part of prescribed training requirements. And the the report I mentioned the fact that I don't remember fellowship exams to be able to practice across the globe. Many of these exams required me having to analyze papers in an exam setting. And even for many of people provide exams, even for the for our local colleges, there's way that aspect of being able to critically analyze papers. So definitely something that people will have to encounter as you go along in their medical training. And of course, we need to realize but that there is no country that is small in in in research. You can always add in some information that will pull things forward next slide, please. And that's why I II mentioned this slide. I know it sounds a bit cartoonish and because there's a cartoon in there, but there is could I put in there that I want to realize it really for those who of us who are just starting in this journey. And I feel that this may be very overwhelming and stuff. It's never too early to start clinically uh and analyzing scientific research. I remember as a as a medical student, I never had access to this kind of information. The first join club I attended was when I was already in training as a, as a surgeon. And you guys are already having this exposure at on a level which gives hope for the future. So because we need to start now to develop those skills, to be able to, to, to get this um this um input on how to analyze the papers. And there's, there's nobody who is too small for your project, get involved in this kind of stuff. General courses are very, very good avenues to discuss papers and no matter how big the project is, you have a compas to play and there is something new for you if you're interested in science. So I just want to use as a client called to encourage us to have this um mindset. And that's why most of the countries in the West and in Asia are progressing far ahead of our own country, country because there's that drive towards science even at a very early age next like this. So again, just to buttress my point that there are many discoveries in medicine that have been driven by medical students who critically analyzed the available research and bought in progress. Things II won't mention all the examples but Heparin that would know as an anti coagulant was by medical students, insulin was done by medical students. This essay not was scribed by medical students. The center of UD was described by uh R OD who was a medical student. So these are these are examples of medical students contributing to their quota in driving scientific research and that has to evolve from being able to prescribe it and analyze the existing information and literature. Hand next slide please. So to the means of discussion, enough of the background, what are my top 10 tips in analyzing critically scientific paper? They all start with C and I'll go through them in, in the GP. So I'll talk about the caption. I'll explain what that means. Look at the collaborators, the category of the study, look at the checklist, clinical questions context. How correct the information is the consistency, the clarity and the contribution of this and information. Let'sl this. So what do I mean by the caption actually refers to the title of the paper? So whenever I have a paper presented to me, whenever I'm sent from some top journal to look at a, a paper, the first thing I look at is the title and the title lets me know what kind of study we are dealing with. And if the type is already wobbly, maybe they are grama errors or I can't even figure out what kind of study we are dealing with already. It's a red flag to me that there's something wrong with this, this study. Of course, if you are given not to manage to be, but you already published and to critic in a general club for your own personal interest, it's always good to have a look at the journal. What kind of journal are we looking at? Is it a top end and tier one journal or is it some motion journal that nobody has heard of before? Because again, even though there's some selection bias for journals having published, having your paper published in the, in the top journal means that, you know, most likely I have gone through a very good peer review. Uh and that adds more weight uh to it. So it is always important to have a look a at it and then I look at the collaborators who are the authors and where are they? So a a again, these things are very important. There is some policies around it, but it's always important that, that you have an idea of what the authors who authors are because if somebody who has, who has never done some high fancy procedure before N starts talking about the experience about that procedure, it becomes very difficult to, to trust that information. Let me give an example. Now somebody comes and wants to write um a, a case series or write some information about um intrauterine surgery, trans in, in fetal surgery. And you know that person does not practice that in that, in that part of uh of the world and does not have access to it, it it becomes very dodgy to be able to accept that kind of information. So even though there's a lot of products around it, it's always important to look at the co collaborators. And that's why many people, when they put their papers together, they make sure that they, they carefully select the team of os so that those Os will carry weight and they will carry strength re regarding that. And if you notice many times the last or tends to be the most senior author and many journals now put the last author as a guarantor, the person who who will stand as a guarantor to see that this paper has actually been conducted is actually valid and I have experience which like, yes, this is something that, that, that needs to be paid attention to. So it's very, very important to know the authors and where they're coming from. And like I mentioned before, the type of the the journal, the paper I beg your pardon will, will be seen from from the title. We need to figure that out. And that is very, very critical in our discussion. And I talk about the currency. That means how recent is this journal article? Because if the publication is over 10 years in, in, in, in, in age, it becomes very difficult for, for it to be scienter even it may be a landmark paper, but it's possible that there may be other studies that may have built upon this existing foundation. So always important to note how recent the study is. So those are my initial sees. So just by looking at the the title of the the the first page, the title of the of the paper, the the collaborators their centers, the type of journal the when it was published gives me a rough idea of of what's actually happening in the next slide, please. So I mentioned the fact that the type of research is very, very key. Again, we we may not have time to talk about types of research. I assume that members of this audience may have heard of the types of research before you may have heard what it means by case reports, case series uh about a retrospective and prospective ablation studies about ener controlled type and and course stories and the like I II will not go into details because again, that may be beyond the scope of the discussion because we may get bogged down in the details. But it is important for us to identify from the word good. What kind of study are we dealing with? Because if we do not know what kind of study we are dealing with, it becomes difficult to make an objective inference in going forward next slide please. Now, from knowing the kind category of study you are dealing with there already laid down checklist of information you need to see from the kind of study that you, you, you that's in, in front of you. And those checklists can be formal and the informal checklist, like I mentioned at the, at the beginning, I have sent uh an informal checklist. I feel relevant for folks on the call to use for any kind of paper. So it's probably pan universal but those that information at least will will get to you. So far. Ideally, if you want to do a good job in analyzing the paper, you need to match a specific checklist to the kind kind of um study. So they are, they are the common checklist II brought them out in in in this slide and in the sequence slides too. So for randomized controlled trial, which means RCT S there's what is called the consult standard of reporting trials, checklist, consult um checklist. It has a number of points that you just look at from the title to the references that you just you and see whether the autos have applied that or not. For observer studies. There is true for schematic reviews. There's a pragmatic reporting of systematic reviews and meta analysis. So these are examples of of checklist that we we need to be aware of. So when you know what kind of study you are dealing with, the next thing to do is to have that checklist and available to see whether the authors have done that or not. And it's important that anybody wants to quickly a uh appraise the paper should have access to this checklist. They are free of charge available online. Just do a Google search and you see all those things, download them and have them store for you to use when you need them. Next slide, please. So again, most of the studies that we end up that we end up seeing in our environmental observational studies. So that's why II singled out the the strobe checklist, the strength of reporting of A and studies in ph So this is just an example of the stroke website uh on the left side of your screen, on, on the right side, it, it's a screenshot of part of the checklist that you see starting of the title and running down there. And the idea now is that many authors when they put their papers together as a manuscript submission, try to follow this checklist because that is what you will be judged against to see if their, their research is actually valid or not. So everybody must be aware of the checklist. If there's one information you must take away from this presentation is that there are checklists are, are are available to help you analyze papers. And by the time, the more you do them, the more you become conversed at this. So when you now want to write your own papers, you do your own research, you can easily flow based on those checklists. Next slide, please. Again, I just uh highlighted this again for case reports because many times as uh students or as uh as trainees, if uh first venture into writing papers solo may be a case report or some interesting case. So there are the care guidelines that gives you information on what you need to do as writing and case report is very easy to, to follow. And once you stick to that these guiding principles, your paper is likely to to proceed through next slide, please. So once I've been identified the kind of study I'm dealing with and I've selected the check I want to use. The next thing I want to find out is what exactly is the middle of this discussion? What is the kin question that is being addressed? What is the hypothesis that needs to be answered? And I look at two things, what are the final details about this study and what is he analysis? So the final details is in Pneumonic four, five items, the feasibility of this study, this other that they did, was this something that was actually feasible? They, they, they said they did a, a study involving 300,000 or 1 million people? Was it possible for them to actually have sampled 1 million people? Was the beginning of this study? Is this study actually interesting? Does it, does it strike according like this? Oh, this is genius to think about it kind of idea. And is in novel, are there any ethical issues regarding it? And is it relevant? So I look at the final details and I also look at the po analysis, what's the patient that was, that was studied? What intervention was, was deployed? If there was any, what would, what did they compare with? And what were the outcomes both primary and secondary? And usually I can get the information from the type and from the abstracts, actually the background me results and then the conclusions. And sometimes I may just go through the introduction and conclusion just if I'm not sure that the actually has all the information. So if I see the abstract, I see the introduction and I see the conclusion already. I have an idea of the final details and the analysis. And that gives you an idea of whether this, this study is actually what's push, pushing or not. And that's how editors go when they crystal ana it would have been submitted for, for publication for review. They just do a first pass. They look at the title, they look at the collaborators, they look at the abstract and then they look at the introduction and the con and see, OK. Is this actually what, what are our time? If it is? They did not do an in depth analysis? So I want to put that uh in uh put that in mind. Next slide, please So again, I'll explain what the final uh details are now. Is this idea feasible? Is it I interesting? Is it Nobel? And what are the ethics, ethics and relevance of which I mentioned later on next slide? This because of trying now. So I've mentioned that my initial impression to get a pic final detail and the pic analysis is the first pass. I look at the abstract, I got the introduction and look at the conclusion once I have done that and I feel that it's worth my wife to look at this study. I go back again and I now do a second pass this time. I know I focus on the method, the results limitations and the references because that's actually the heartbeat of the study to see whether this study was actually carried out the way it was supposed to or if there are any flaws that I identified. And then I now do a thought part. We are now look at everything together from the abstract to the introduction with results and the discussion. So I usually look at every paper at least three times initial first pass to get a great group of our own idea what the paper is all about. Then the second part to look at the engine of the study, which is the method, the results, additional references. And then finally, I do a third part where I look at everything I put everything together to see if it can make, um, sense. That's the context I look at when I, I'm looking at the study. Next IDE please. Now I got in that context and I start looking for any flaws and any, and any issues regarding the statistics, every study has a tendency to have bias. There may be selection bias, they may be, um, design bias, there may be confounding bias bias. Again, there is no time to talk about bias because that is a separate topic entirely that may take um a number of hours to discuss. But what you want to look at is is there anything that or that have made their conclusions invalid in terms of this, the authors in or in terms of hematology to cause some form of bi bias. And we'll be looking at uh out for it. Again, if the authors were actually treated themselves in the discussion aspect, part of the, of the paper, they would have mentioned those limitations and potential bias. So you don't really have to search far for it. But if you now see a study that does not measure any limitation, does not mention any potential bias and how they try to for it, then it means that there's a red flag in there. So we try to look out for those biases in, in there. And again, we need to have an idea of some basic statistics and we need to understand that what it means by ap value, what it means by odd ratios, what mean by risk, absolute risk. Because there is that you used to judge the validity otherwise of, of the, of the study. Again, there's no much time to talk about this. Uh We have to talk about that at another time. If, if um we, we feel that is necessary. Next slide, please. Now, once I've looked at the, the consistence the correctness of, of, of the, of the info of the article the next time to look at his consistency because it happens sometimes when people do what's called salami slicing the fragments, their their paper walk into different sections and they now put them together like a chime chimeric monster. And ultimately, if that happens, there may be some inconsistencies. So it's possible that they might something in the abstracts and there is something different in the main paper in the methodology or they may something in the methodology I said much different in the results. So you want to look for any inconsistencies in in in the in the in the paper to see whether there are issues that need to be raised. And of course, ultimately, you need to also s you know, find out how clear it is to read the information. Again. We I found out that whenever II get man submitted to me for a review, people who are not native English speakers actually struggle to pass across the information. I get a lot of articles from, from from Asian countries. And English is not the first language for many of these countries. And so um do not mention any country. But, but when you get those articles, you now see Grammas s that now make a different context of what they want us to say. So sometimes if one has a struggle with English, it's always good to have an, an English language um editor I in in play. And there are many good in um um um materials or resources for that. Again, not to advertise anyone, but I typically use grammar as my go to to um be sure that the English that I'm I'm presenting is legible is clear. There are no, there's no ambiguity and I'm able to pass across the information. So it's always important. So if I see Grammas, er if I see topographical errors, if I see a repetition of information or missing missing things, it becomes like a red flag, it becomes very difficult for you to make sense. And that kind of issue is already a reflection of, of how it grows. The study was carried out because if you don't write your paper properly, it means that you may not have connected experiments or research properly too. So always pay attention to the clarity of the language being used next slide, please. Now, finally, once I've gone to that whole aspect, the question is what exactly is this contributing, what is the relevance of all of this and what level of evidence will I use to judge this information? Is it a very low evidence or is it very high evidence? Because ultimately, you don't want to just do research for any, for just doing research, but you want it to contribute to the body of, of, of knowledge. And, and there are many hierarchies of, of evidence in there. The most um objective evidence. The highest level of evidence is when one does a systematic review of properly conducted randomized controlled trials, that is the highest quality of evidence you could have. So if somebody has a review, that means that there are many randomized controlled trials that have been carried out. And somebody goes to look at all those RCT S and put them together to get a prescribed information to answer a question or address the hypothesis. That is the best level of evidence. The worst level of evidence is an expert opinion. Somebody causes that based on my own, my own practice, based on my own experience. What I think I should do expert opinions, they may give guidance but they are not in the highest level of, of uh body of evidence. So, and of course, II don't want to go to the detail, but I can see all of those hierarchies of evidence in there. So whenever you see a paper, we want to find out what is the body of evidence and, and what and what is the, the strength of the evidence that, that you've seen and that helps to inform judgment. Um most of the landmark papers that you see are randomized controlled trials. And the example we will talk about Uber an RC that's influenced in practice next slide please. Now, so the example, so the example I'm I'm going to bring in here is a, a drug called the Crash Two trial. So it was published in the Lancet in 2010 if I'm not mistaken. And it was supposed to talk about the effects of acid on death, vascular events and um and blood transfusion. Now, you can see an in depth analysis of this paper in the website. I've, I've put on the screen here and to me, if you want to have a, a flare of what it means to critically analyze the paper, going to this website called the bottom line.org dot UK gives you an idea of what exactly you should be looking out for. So they select very important papers and they analyze it critically and once you see how they, they, they go through the analysis, it gives you confidence on how to approach it together with the checklist. So next, likely. So I just run down the story of course, of time. So the they want to address was that if the pain has trauma and you give transam acid, does it reduce the risk of bleeding? And does it, does it reduce the mortality from bleeding? Do and does it affect vascular events as well as the need for blood transfusion? Now, for those who are not aware, acid is an anti agent. So usually whenever there is bleeding, a clot forms, now there is a a fibrillating system that is meant to break down the clots. So that doesn't become excessive if you can give an agent that will block the effect of that fibrillating agent. Pla blood conversion of pla to plasmin, you can make a clot has been formed to stop bleeding to stay for a longer period of time. And theoretically reduce the incidence of bleeding. Reduce nipple blood transfusion, reduce mortality because the major cause of death or major cause of death from trauma is excessive bleeding. But the challenge there is that if you are given an agent to reduce the breakdown of clots, can the clot become so much that it now becomes a problem itself. It can cause occlusion of ves ves b blood vessel as a thrombo or could get dislodged and become an embryon that can affect other parts of, of the body. So they want to see if it has both beneficial effects and also the adverse effects in trauma. Now, this was an advance controlled trial that was done in 274 s across 40 countries. So it's actually a big trial and the aroma side in May 2005. But it took a number of years to get this done, which is another issue about this study. Next slide, please. So in terms of the context to understand, so they randomized patient patients using a 24 hour service and um it was more center, they what they called a double blinded placebo control, meaning that they control, they give some uh part of patients trans acid and gave another group of patients placebo mean that it looked like an acid but it not enzymic acid to see if there was any improvement with the transam acid. And they had some some fast acis to see um how many patients would will be able to give us the exact the power and inference for the study. Let's slide this. So in the P analysis, they use adult patients with trauma, they had some I index inclusion criteria and they also had definitely ex exclusion criteria and they were able to randomize very large number of patients uh over 4 40,000 patients and almost clear, distributed into, into um to uh arms next slide please. Now the intervention for the was I intervention was to give acid um as a a standard protocol over 10 to 10 minutes. Uh And um and we that given as 1 g every eight hours, the placebo was no normal saline and the primary outcome was to see if patients died within four weeks of injury. And is there any difference in the in the and the secondary outcomes were blood transfusion NHO intervention, any vas Glucos e events, no blood units transfused and any patient required to stay in, in hospital after the day 28 or not next like this. So this is just a, a snapshot of the of the results they got in in the study. I want us to pay attention to the deaths by subgroup group. So if you look at bleeding, which is the next. Uh so I don't, I can't, I don't have my question here. So I can't um point out but if you see bleeding um and death by bleeding, yes, somebody's been moving your. So thank you. Yes. Yes, exactly. So you could see that on that TX just move to the right a bit. So T Xa the potential um bleeding was 4.9%. Whereas the control of the placebo normal saline, the of those who had bleeding was 5.7%. So based on relative risk and a reduction, they felt that there was significant reduction in the amount of bleed that occurred if patients were given a trans acid. And based on the statistics, it was quite significant and less than 0.05 which is the regular or the usual, the statical inference, we used to see symptoms of, of an, of an event. So based on that information, it became practice or standard that anybody who has trauma and is bleeding is given trans acid, especially within three hours of the onset of the injury. Of course, they found out that uh in terms of the vasovic event because the fear is that if you give acid when patients have thromboembolic s from it. So that's where the next um line after bleeding comes to play. So they had 0.3% vascular events in in taz acid in group and 0.5% in the control group and it was not cancer. So there was actually no difference in the vaso ee events. So they felt that based on this information, it was safe to give triac acid to patients who are bleeding from trauma. And that's why crash two is a landmark trial in trauma. Anybody who has major hemorrhage and I and from trauma, we receive acid routinely and even for those that have emerged outside of trauma too, they receive trans acid. Although the information on the the data from that is a bit debatable. So based on this study, people started giving a so it didn't it changed practice. Um Next slide, please. So the authors conclusion was that tan acid was safe, it reduces the risk of death in patients and it should be considered for use in in trauma patients. And that has been the standard of practice. Of course, based on the in depth analysis of the paper itself too, every paper will have some strengths and limit limitation of the weakness. So the strength of this paper was that it was a randomized trial, the most um objective form of study you can do. It was a pragmatic study mean that it was done. And if there are any changes, they, they kept on adjusting to meet with those challenges and they had very large numbers. Thousands, 100s of 10,000, tens of thousands of patients were recruited for it across many countries, across many hospitals. So it was, there was a lot of strength in that but the weaknesses were they found that there was, there was no standard in randomization, there was no of injury severity. So somebody who had a broken toe and was losing some amount of blood, maybe 10 minutes of blood and somebody who had splenic injury, I was losing liters of blood, nobody stratified on terms of injury severity. So if you give somebody trans acid with a broken toe that may probably stop on his own without trans acid. So because of that, that was a a weakness in, in, in, in, in that study. And the follow up period was just for a month. So we don't know what happened after a month. The patients, they bleed after the they have problems from thrombotic events after the the the 28 days, we don't know. And there was some level of bias too and that was was done in there. So based on all that, we have to also be sure, look at the fact that there may be need for further studies. To, to uh eliminate or to address these limitations. But these are actually a an in depth analysis and it is a different analysis on how to quickly analyze this paper and see that you have influence practice next like this. So I'm almost to the end of the discussion and we are actually keeping to time. So one major controversy about eyes of paper of papers is the rule of A I. People are now using different form of A I models including your GPT to analyze papers. So the question now is how ethical is this and to how validate this information, I've taken some time to study intelligence and there's a concept in A I that we need to be aware of. It's called A I hallucination. If you give information to A I, it is what you give the in A I that you, you produce back to you. So it's like Gaba garbing garbage out. And if the information you are given to, to A I, whatever A I stand you are using is not accurate. A I will try to make sense out of it. And sometimes we confabulate information. And so so sometimes if you ask AAA I to give you a reference regarding a particular study that you're talking about A I can go and bring references that will exist or patch information together that I have to or or or some level this information. So it's very, very, very, very, very very um we, we are very careful about using A I to help in, in, in um in a, in a analyzing papers. Some journals use A I to, to see um manuscript to see those that will be valid for their review or not, those can be used for for the so up process. But if you are not talking about the an in depth analysis of I A, there is no way you can A I can at least at the level of the A I modest that can match the human intelligence. And given the inference of the crash two trial, the fact that because there was no standardization of the injury severity, you could not really tell if somebody with a mild injury was just getting trans acid when there was no necessary or not. And it's only somebody who's involved in trauma care who understands and talk about it in depth that we actually bring out this information. So ultimately, even there is, there may be a room for A I. We still have to be very cautious in using A I in crypt analyzing paper. But this is actually something that is coming up more and more in the coming in. So people are using A I to do literary review to draw diagrams, to even write papers, to even help and journals are using that paper sub to sort out the manuscripts. So, but we need to be aware of, of this, this is, this has come to state and it's going to be in influential as, as years come by. So next slide, I think we are almost done. So I would like to thank us once again for, for, for listening. II hope I did not speak too fast. I'll try to keep the time because I know there may be some questions and to, to bring out next line and that should be the last s so I'll be happy to take questions. OK. Thank you very much, sir for um your teaching. So uh at this 0.1 to take questions. So if you have questions, you can raise your hand and you'll be admitted and given the opportunity to ask your questions. Thank you. Or rather you can type your questions in the charts box in case you have a question also. Yeah. OK. Yeah. Yeah, you can ask your question, you can omit and answer your question. Got you. OK. Thank you. Good evening everyone. Um Thank you for the class regarding this critiquing um or critiquing literatures and scientific pieces, right? I feel like we need to, for somebody to do that. They need to know what they are doing. In essence, you need to understand like the outcome variables, right? That you are trying to measure or the background or the basis of the study that you are trying to critic and stuff like that. So I'm just curious as to the best way to achieve this because you know, everything can look so simple when it's theoretical, but when you have a paper and you have to analyze it, what are the, you know, things you need to look at. If it's the method, do we dwell on the methodology? Do we dwell on? What, what aspect of the research paper should at least a common medical student? You know, look at when um assessing a paper for its quality and relevance. Thank you. So, thank you. Thank you Claire for Claire for, for the information and the question. So, um so, II think the, the question you asked has many parts to it. The first part is what exactly should be the background order. You need to have to be able to critically analyze the paper. So, um and that is very important because when I get sent um send manuscripts to review, they send manuscripts based on my speciality. So they don't, people don't send me manuscripts that involve in human physiology or human anatomy because that's not my specialty. They rather send me manuscripts that involve general surgery or surgical oncology or disorders uh or sometimes A I um for my review. So it means that you need to have some basic information and I always regard the process of quick and uh uh a paper like a journey of discovery for you because you also should improve your knowledge base after quick that paper. So if there's certain information that you are not clear about, you could always read, read around, read around it. However, a very good paper would have presented the background to the information, the important point you need to know as a background in the introduction and as well as the background section of the abstract. So by reading the introduction and the the abs the background section of the abstract, you should already have at least a good understanding of what is the current information, what are the gaps that are existing and what the paper aims to address to fill up that gap? So it's not, it's not meant that you have to go do in. But if things are not clear, then you can always go to do research regarding the other aspect of your question that what exactly should be the medical student. I think like I mentioned, the first thing you should be able to identify is what kind of are you dealing with? So, II know this is a randomized control trial. This is a study, this is a case report, this case series, this is a retrospective study, this is a prospective study and I know what kind of checklist needs to be used to a to address it. The other thing that is also important is being able to identify the po if it's imp applicable, what are the patients that are involved? How do they select them? What intervention was deployed? What comparator was used? What were the outcomes. And then finally, you need to be able to understand the methodology and the results and the results will come towards statistics, theology will depend on the kind of study you are dealing with. Unfortunately, results require you to have some basic level of statistic which I felt that if I go in depth with that, we may find that uh uncomfortable, there was a slight on statistic II decided to skip because I felt some will not be happy about it. But Martin once said that there are lies and there are lies and the statistics. And he said that because he feels that is so boring that sometimes you feel as if they are just concocting things out of the air in an abstract manner. But there are some basic minimal stats that we need to be able to understand. II alluded to them, things like the P value, things like the power of the study, things like the um the odd ratio, the relative risk, the absolute risk which you could and have information about about that. And then that brings me to that point again. And PMA remind me I can just send a small uh pamphlet about a page or two that has a summary of all of these basic statistics for, for a medical student that you can use to be able to understand the, the things that you, you need to do. And the thing that is just starting once you start and start getting to do it. You, you, you start getting used to the information and get better and better at it. Just like driving a car. The very first time you want to drive a car, you can be nervous about it. You may not be sure of yourself, but the more you drive, the better your, your skills can be uh get reflect and become more comfortable with that, with that uh aspect of, of, of life. So I hope I've been able to address the question in, in a way. Thank you again for the question. Ok. Yes, sir. Thank you, sir. Ok. I think we have some questions from the um chat box. Um, but we'll address that later. We'll take um questions. Ok? Yeah. Um I think he had his wrist. You can just have and ask your questions and then subsequently we take the questions in the chat. All right. Thank you very much, sir for the presentation. And thank you. Um, if you research and for organizing this quickly, I wanted to ask, um, a although, um I don't know if I miss, I think I missed out on some parts of the presentation. Um So you talked about systematic review and they talk about um, the, the part I rem I I II was before being locked out and I was, when you talk about the importance of critically app prison in general, you know, in order to, um, and you talked about systematic reviews, ran randomized control trials and all of this. So I wanted to ask that. So what and apart from, let's say, one, probably you want to write a paper and then you also talk about, let's say, um giving the example like giving the example that you showed to us about the use of tranexamic acid in patient care. Um Apart from those a apart from those two, apart from those two, what is it called? Now, those two reasons who are present in the journal, which is maybe directing doctors towards the use of probably a particular medication, like when we are talking about OK, drugs or maybe a particular um technique. If we are looking at maybe surgery or maybe someone will probably write a paper. Are there other um other other end goal as to why one should appr critically appraise a scientific research? Thank you very much, sir. OK. So thank you again, uh GMA for your for your question. So, um again, this is a very important because any before you embark on the journey, you need to find out why do we need to go through this hassle? Uh what is in it for me? Uh And is it worth my time? I think the starting point is that if you are in this on this call, it means that you probably have been exposed to some level of science or you are interested in science. So if to the curious mind, the scientific mind will always see that there is some need for this, that's starting point. And the second point in there is the fact that being able to analyze the paper will make you, if you are, if you are really, really interested in science, will make you be able to appreciate the record that goes through the process of producing an article. It's not something that one does over the night, many articles take months, sometimes years to, to put together in terms of the experiment or the study and then to publish it and to get it reviewed, it takes AAA long process. So you need, we need to appreciate, appreciate that. But ultimately, if you ask me, the main reason why we should do science, we should study science is because we knowledge is boundless. And by discovering more information, we advance ourselves, we make ourselves better. Let me put it this way. Y your generation and my generation, I'm not too old, I'm not that old. But I remember a time when the internet was not in existence and I remember a time when it was strange to find a computer in any institution in Nigeria were in most parts of the world, but also live in a time and we live in a time now when it is ubiquitous to find the internet everywhere, it's always become a necessity of life. There's, it's almost strange for some, for someone not to have a smart device. It may actually be like somebody who was going out to the, the cave. And in fact, we have this, I'm sure you may have heard about it, but we have this um joke that we call those who were never exposed them to, to this kind of technology and who are very shy about this. We call them B BCB before computer. So the thing there is that we did not get to this level just by accident, it took scientific research, it took steps to advance knowledge. And the way things are going on knowledge explodes is is is is coming out at very explosive rates that if for each way to catch up with it, if you are really interested in science and driving your, your career in a scientific manner, you need to be able to understand the latest trends in there. More importantly, in my practice, I see many patients go online and they read articles, they read journals and they ask me about it when they come to the clinic. If you do not have an idea of how to critically appraise that if you have not even read it before or you do know how to address information, you may not look as if the patient has more information than the than the patient himself too. So definitely, if you want to be at the top level of your practice of your game, you definitely need to have an idea of, of this information. So both for the general need of, of uh driving or driving and knowledge and research, both for the need to improve our practice for our patients. And even for our own personal needs too. Because like I alluded in the introduction, many prescribed medical exams insist now that you have an analysis of the paper as part of the exam. So it has almost become like a course on its own, a, a station on its own to actually analyze paper, doing an exam. And if you've not done that before, it becomes very difficult to do that at the exam level. So I hope I've been able to address the, the, the question and to an extent, I'm sorry, you were able to see part of it, but I'm sure this, but I believe for your review later, I may catch up some of those things that you missed out. Thank you. Thank you, sir. II think um Abraham has a question. I don't know if he still wants to ask this question. Um It can mute and then take this question before we finally take the questions. Hello, good evening, sir. And um good evening everybody. Um, let me just start by. Thank you. Um If I, if I made um for organizing this program because I've actually been um in the middle of a review and it's been quite difficult for me like, um getting everything together in one place and having access to information in a structural manner as it has been put together by um doctor into this presentation. So I'm very grateful for the timeliness of this um of this program. So sir, um my question is just concerning um mentorship for students who are interested in um reviewing um people that naturally um want to get started considering the importance of mentors in things like this. Uh um How do we um join your or how do you subscribe for your mentorship? That was just my question. All right. Thank you, Brian for the kind words and for, for this um request. So um a a again, I feel I'm, I'm always open to, to mentorship. The only challenge I have is that II because I run a very busy schedule and I'm a man of many parts, it's always sometimes difficult for me to have a one on one discussion. I know how much uh Jema have to track me down to get me here. And, and actually I'm on call once I leave this, um this um this meeting, I have to go to the US for, for surgeries. So it is out of time that we're getting this done, which I'm happy to do. So what I can, we can do is we can always have collective mentorship. And since if ma has introduced me to, to your organization, I always be happy if you have a virtual platform to disco, just gonna disco on us to, to join in and see how it can help. And from there people who now have individual needs and I can always find a way to, to reach out based on, on that platform. I think it will actually um which actually work out. And um well, in that way, I tried to create a research group. I actually did some time back and I want somebody to help me run it. But that, that has not been um fruitful and I hope to revive that. And if, if that happens, I will definitely let folks know true Jeremiah, I breast assured that I'm always keenly interested in, in medical students and trainees being involved in, in ventures like this. And as a habit was a room majority of the studies that I do, the ones I've done recently. Now I've always involved medical student or trainees in, in, in, in research of that. I I've done so II think the l study where I was really practicing doctor amongst the list of people who were, who were the authors. The other two were, were medical student. And I was happy about it because I feel that this is a way to bridge the gap and, and make our gen your generation better than ours. Because that is the, that is the essence of all of this, that your generation should be an improvement of the previous generation. If that doesn't happen, it means that we have failed in our, in our endeavors. So I'm always happy to do things that are student centric. So I'll try my best to be available, but I'll walk through the FMA platform to get this done. I hope I'll be able to address um that question. Thank you is um.