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ABERDEEN 2040 Informing Practice and Policy - Critically appraising literature to assess evidence Dr Amudha Poobalan School of Medicine, Medical Sciences and Nutrition University of Aberdeen 24 Nov 2022Who Am I?? • Trained in Medicine at Christian Medical College (CMC, Vellore) in South of India - 2500 beds with 28 specialties • Medical officer - Leprosy in a remote and rural South India …..Interest in PH …… Moved from infectious diseases to NCDs…DM and Cancer • PH academic • Senior Lecturer – Teaching (MPH); Healthcare Education Research • Systematic Reviewer and Qualitative ResearcherWhy are you here??Why do we need to assess evidence You have been given a question OR rumbling in your head!!! • Does aspirin (painkiller) help treat arthritis? • What are the barriers for regular dental check-ups in adolescents? • Is there an association between vegetarian diet and dementia? • What is the best intervention to reduce teenage pregnancy?Where do I start???? Literature as SCOPING… Literature Design Data analysis Context Problem Topic Data / issue collection Question(s) Answer questions Adapted from: Punch, K. F., & Oancea, A. (2014). Introduction to research methods in education. Sage.What do you do next?? • If there are no studies at all…. (effects of Aspirin on Arthritis) do another primary study (design, data collect, analyse and answer your question) E.g. Survey, Randomised Controlled Trial… Studies done in other Populations and Countries…nothing in XXXX…primary study • If there are studies looking at related question already • Look at the published literature around the world…Collate evidenceSystematic Reviews helps collate eviden ce “Does aspirin (painkiller) help treat arthritis?” • having a clearly formulated question • systematic collection of relevant primary studies • critically appraise relevant research Nigeria All women RCT n=500 • analyse data and summarise all known evidence Australia RCT India BRCT n=140rs BCCT n=1250s PULLS IN THE SYSTEMATICALLY…systematic review EVISTUDIESROM ALL Abu Dhabi Christiansd USA CCT n=400 RCT n=1650 UK Only women RCT n=5000Purpose - Differences LITERATURE SCOPING/LITERATURE REVIEW SYSTEMATIC REVIEW Identify Knowledge gaps Collate the Evidence Not as rigorous search Rigorous search….and MORE Precursor to Systematic Review Inform practice, policyWhat does one do??.... Literature!! • Back in the day!! NOW in modern world!! • exploding literature! • So….in this overwhelming literature, what is the answer to your question???Think wider to narrow your question “Does aspirin (painkiller) help treat arthritis?” P Participants I Intervention C Comparator O Outcomes Other considerations: • Where will you search – databases? Medline, Embase etc • Study Designs: RCTs… surveys (self reported) • Time period to search • Any Exclusions - With specific conditions??Focussed Question • INITIAL “Does aspirin (painkiller) help treat arthritis?” P Participants (adults, men/women) I Intervention (Aspirin …? dosage etc) C Comparator (? Paracetamol) O Outcomes (pain, inflammation) • FOCUSSED “Does aspirin reduce pain and inflammation in adults with osteoarthritis??” Is there an association between vegetarian diet and dementia? ( ??PICO)Developing search strategy “Does aspirin reduce pain and inflammation in adults with osteoarthritis??” MAIN CONCEPTS /KEY WORDS • Aspirin • Pain • Inflammation • Adults • OsteoarthritisDeveloping search strateg y…cont’d Compiling a list of alternative terms for the key concepts E.g.. What are the alternative terms or synonyms for the term ‘Aspirin’ • Acetylsalicilic acid • ASA Create a block of related terms by combining with OR/AND (Boolean operator) OR OR OR OR AND Aspirin Pain Osteoarthritis Adults Acetylsalicylic acid Inflammation Degenerative arthritis Grown-ups ASA Degenerative joint disease DJDSearch strategy 1. Aspirin/ 500 2. Acetylsalicylic adj1 acid.tw 1200 3. ASA.tw 200 4. 1 or 2 or 3 1900 5. Pain/ 40000 6. Inflammation.tw 5000 7. 5 or 6 45000 8. Osteoarthritis/ 15000 9. Degenerative adj1 arthritis.tw 20000 10. Degenerative adj1 joint adj1 disease 21000 11. DJD.tw 2000 12. 8 or 9 or 10 or 11 58000 13. Adult$ 680000 14. Grown-ups.tw 15000 15. 13 or 14 830000 16. 4 and 7 and 12 and 15 482PRISMA flow diagram 482 citations….scan these citations with your criteria in mind (12 included)Critical appraisal Varied quality: Good, Bad and Ugly!! Need to appraise the methodological quality of all included studies Varied evidence: Strong Weak Inconclusive Crucial: Affect the interpretation of findings Several validated tools – Joanna Briggs Institute – Critical Appraisal Tools http://joannabriggs.org/research/critical-appraisal-tools.htmlSummary Synthesis • Data extraction (note the results) - Relevant data to answer your RQ • Pooling of the data - Meta-analysis - Narrative summaryInterpretation • Main findings • Strengths and limitations of the review • Strength of the evidence – quality of the studies • Direction and effect size • Applicability of the findings of the review • Implications for clinicians and policy makers • Recommendations for future research PRISMA checklist – standard way of reporting any reviewStages of Systematic review - Summary R.Q: Is Aspirin effective than Paracetamol for Osteoarthritis to reduce pain and inflammation in adults ? USE PICO concept • Inclusion and Exclusion Criteria • Develop a Search Strategy • Screening search results • Selecting and obtaining studies • Critical appraisal and Quality assessment • Data extraction • Analysis and synthesis – Meta analysis or narrative summary • Writing up/interpreting resultsReferences • Developing search strategy: http://rmit.libguides.com/c.php?g=335973&p=2263995 • https://www.students4bestevidence.net/ in general • https://www.students4bestevidence.net/topic/systematic-reviews/ focuses on SR • https://www.cebm.net/ Oxford CEBM • https://www.york.ac.uk/crd/guidance/ Free text book on SR from York CRD. • Green S, Higgins J, eds. Glossary. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1 [updated March 2011]. https://training.cochrane.org/handbook • Glasziou, Irwig, Bain and Colditz. Systematic Reviews in Health Care. A Practical Guide. University Press CambridgeAny Questions??