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Let's first start off by looking at what is critical appraisal. So the the standard definition for critical appraisal is the systematic examination of a piece or body of research to judge its trustworthiness and its value in the body of evidence or to basically put it in layman's term. It basically is when you look at our paper and you just see how, how good it is or whether you know, we should be making uh our clinical decisions and treatment plans based on that, on what that paper has said. So why is why is it important to have or to do critical appraisal? Well, if you think back to what we were taught in medical school, right? From the beginning, we're always taught that we're practicing evidence based medicine. And what does evidence based medicine basically means it means that we base our treatment and the options. We give our patients related to their treatment and their and their plans. Everything is around that area is basically based on the research that's been done. So whatever the research says, the scientific research say we base our protocols and our treatment guidelines based on that. So when you think about it. Our treatments and our protocols and guidelines are only as good as the research papers that's out there. If you're going to be producing a lot of, you know, rubbish research, then basing your treatment based on research. Again, it just completely will reflect on how the quality of the treatment that you're delivering to your patients as well. So it's important, um we as uh you know, physicians or um allied health care professional stuffs, we need to be able to understand whether when a research paper is published, whether we're able to look at it and we're able to see whether it's a good quality research or whether what they're trying to say is true because at the end of the day, whatever treatment that we give our patients is entirely based on this research. So when we look at critically appraising it, there are a couple of things that you can look out for when you're trying to examine the word of the paper. So I'm going to be basically giving you an idea about the things to look out for. Um and the checklists you can follow. So when you're given a paper or when, when, when a consultant or your supervisor says, try to critically appraise this paper for me and see it's worth what are the things that you can look out for. So the first thing that I would start off by looking at is the title. So although the title is just, you know, a couple of sentences, it gives you an idea of what that paper is about. So look at the title, what it is and what does the title basically say? Is it purely descriptive of some sort of an event? Does the author, you know seem to be making any claims in that title? Like for example, um you know, um things like calcium channel blockers are better than Ramipril in terms of preventing um high BP or hypertension in CKD patients. So does the author seem to be making some sort of a claim related to what his research is about? And sometimes titles are sort of designed in a way to just grab some attention. Like I have come across some papers where they've just, they've used quite a bit of uh punt and word plays. So just to grab the authors attention and, and get people to read more about it. So look at the style of the uh title, how it's worded that gives you an idea of how worthy or the quality of research that might be uh produced by that paper. Now, the next thing that you can look out for when you're critically appraising a paper is the journal. So see what sort of a journal that the paper is published in a journal is nothing but basically a book that contains all the research papers that have been published. So if you, the paper is in a, you know, well established, um you know, those holy grails journals, like the, the lancet or highly reputed papers, you can get an idea of what sort of research that might they, they might have done to make sure these papers are published in these well established journals. So always having a look at the type of journal gives you an idea about the quality of research. So, is it a journal that's well known or is it a journal that you've never heard of? Uh is it quite a reputable journal? So again, completely reflects on the type of research paper that's been uh published then. And another thing for you to go and read about is the impact score. So every journal has an impact score or impact factor and it's usually a number, it can vary from 20 to 100. So they say that lower end impact factor is, you know, higher the reputation of that paper. So when you are as a research, you're trying to publish your paper, always look out for the impact factor of that particular journal before, you know, uh approaching the journals, approaching the publishers to help you with uh publishing your paper. So impact factor is something that you can go away and read more about. And another thing is always look out for whether that journal is appropriate for the articles that they have, you know published. Like, for example, if you're reading about mental health in a journal that's nothing to do with mental health. Like for example, it's completely based on trauma and orthopedics and there's no link between it, try to see why that, that particular um paper might be published within that journal. So just by get giving, getting an idea about what that journal is about, it gives you an idea about what kind of paper um you know, that, that it can be as well. The next thing is have a look at the setting. So where is the paper set in, you know, where is it set in a population studying Northern America? Is it set in maybe studying a small population in Italy? So try to find out the context of the study and see where it's taking place. And then from there, you can sort of get an idea of where the authors are. So if you've got an author who's maybe sitting in England, but trying to study about population in India, it, it sort of gives you an idea that maybe the author doesn't know the clear idea because it is not quite local to that area. So try to see where the population is being studied and who the author is and where the patients are basically from. Which hospitals are they from? Are they from one particular site or is it a multiple sites that they are taken from? So all this gives you an idea about the quality of the paper as well now, this is really important authorship. So, as much as, uh you know, it's important to have the number of authors. It's important to know who your authors are as well. So, have you heard of those authors before? How many authors are there in a paper? So that's quite important because if you've got one or two of them, you know, reading a paper about it, you can, you can see that the entire paper is made by effort of two people. Whether if you've got a team or a group of people, then every single one of them will be putting in more effort. So there's more effort gone into that research paper, which is, which you know, likely means that there's more quality and more work put in that paper. Hence higher chances that that paper is much more of a quality type. So having a number of people in the team just goes to show that that research is, is done in a much more refined and not much more quality manner. And do they ever mention things like they've collaborated with any famous authors or any famous scientists? So that again, increases the weight of the weightage of that paper as well. And it's also important to find out the professionals. The type of professionals does it include like for example, um say, for example, I'm uh a British male doctor working in the NHS. But my paper is about uh female doctors in the NHS and the type of mental workload that they suffer. So when I write up that paper, obviously, I'm going to find, find base my findings on the statistics. But when I interpret it, when I give my own conclusion to it, it does tell me that I might not have an entire idea of what I'm talking about because there's always gonna be that gender gap. I will not completely understand what a woman goes through in the NHS being a man. So it's important to have a look at who your author is. Also to find out whether that research paper can, is, is, is, is quite worth reading about. Because if the author is going to be slightly biased or, or you feel like this author may not really connect with the, with the topic. It might be just quite a waste of time to just sit and read your paper and base your findings and change your protocols and your guidelines based on a research paper like that. The next thing you can look out for is language. So always look to see what language the paper is written in. And many times what happens is usually it's written in English, but sometimes there can be other languages that's written and it gets translated. And this is very commonly seen in like systematic reviews where, where you collect a lot of papers on that particular topic and you create your own paper on it. Sometimes it's very hard to find only English specific papers. Hence, people have to uh gather paper from different sources and it can be from different languages. However, bear in mind, there's a lot of limitations to it because you the English language that's translated is only as good as the translation. So sometimes uh if the translations are not accurate or if they're missing out on the important things, uh you know, we might be missing out on the important gathering as well. And we're completely basing the research paper based on translated copies. So there's always that limitation to be looked at. But um just by looking at the language and the style, the quality of writing that gives you an idea of what sort of a paper is. If it's, if it's a language that's, you know, written in very poor grammar and it's quite rubbish written in a very simple or two layman terms. And again, that just shows that there's not much effort put in that research or writing that research up. So the language of the paper gives you an idea about the quality of research as well. The next is presentation. So basically, this looks at how the paper is presented. So do they follow a particular order or is it all written in a hop hazard manner? And D does, does the paper have an abstract, is the abstract easy to understand? Does it explain the entire paper and all the structure of the paper. So these are all the things that you can look out for when you're looking at a paper and you're trying to judge whether it's quite for good quality. And also always looking out for diagrams and tables because you more, you have them, the more attention is going to draw. And it's easy for um you know, for the writer to put his, his or her point across through diagrams and flow charts or just graphs. But if it's just going to be all written out, then again, it just shows that they haven't, may not have put in a lot of effort or creativity into that paper. So just by looking at the layout gives you an idea about what sort of a paper it is sometimes and it, this is quite common to be honest, every paper has its own um structure, they have their own way of structuring things, own headings and subheadings. So when you look at a particular paper and you're trying to see whether this is a quite a good paper, you might actually, you know, uh recognize the format and see whether it's, it's, it's from a very reputable journal or it's not from a not so famous journal. So that also gives you an idea the presentation, how the words are done, how the paragraphs are structured and how the diagrams are sort of structured around the paragraphs, that also gives you an idea about how much of a quality paper, the paper is when you're critically trying to appraise it, next is detail. Now, this is quite an important one because it's quite tricky to understand as well, but it, it's tricky to write. So a good abstract or a good manuscript should be written in such that both a subject expert and a novice can understand and find value within. So it's important to make sure that your paper signs sounds scientific, it sounds authentic and it sounds medically professional. But at the same time, if a nonmedical professional background person reads it, they should be able to understand it as well. Because at the end of the day, the research is for everybody. If you're not writing it, for one particular group of team, you know, research should be made available for everybody to assess regardless of their profession as long as it's written in Good English. So any paper that's written in highly complicated with high technical terminologies that again goes to show that is not really useful because if that paper can only be interpreted by, you know, professors and consultants, then it's not for everybody, the research becomes very restricted and limited to that particular target population. So it's again, goes to show that not much effort has been put in research and it's very much made peculiar to one particular targeted group of audience. Whereas if a research paper, although it might be explaining complex terminologies and complex concept, but if it's explained in simpler terms, for everybody to understand it again, goes to show that that research paper was made and it was targeted for everyone, regardless of their profession, regardless of their level of competency to understand the field or, or, or to understand the context. So again, just by reading at the details, the language that they use. The, the the the sentences, the words, the choice of words that they use goes to show the extent and the amount of efforts that's put by the authors to make sure that the papers can reach across a very broad spectrum of audience. So the next thing is definition. So again, whenever, whenever the writer or the authors trying to define words and terminologies, key terminologies, they should be very clear with it with their descriptions of process or their methodology. So basically, in short, the abstract should sound, should describe anything that took place without any overloading detail. And this is again, something that we've touched upon which is the the po um format. So all E element of that should be included in your definitions as well when you're trying to explain um like for example, group X was compared with group one. So although it's it's very simple and easy to understand, but at the same time, it's very clear we've got two separate groups. Another example would be like the group was then pseudo randomized using X protocol. Again, simplifying the terminology, simplifying the process and then group, Z received intervention X, which was compared to control on. So again, it gives you an entire idea of what the paper is about. But at the same of that one sentence tells you about, the intervention tells you what's being compared to, tells you the, the treatment group and the control group. So again, just simple sentences, but giving the uh the reader a clear idea of what your research is, what the method you use and how you went on about it. And another thing to look at is when you're reading a paper, always look at the age of the paper to see when it's been published. Because if it's been published many a couple of decades ago, it might not be accurate to use that paper. So maybe today's uh modern medicine because we might have, have got much more advanced medications or much more advancements in technologies that we use when it comes to treating it. So, always try to look at when it's been published and has there been any new advances or there has been new, uh you know, uh further updates in the research paper since then and always try to see whether that paper can be clinically relevant to our current practice or to your current practice at your practice in your hospitals today. So the age really matters. No, before we sort of finish this session, II want to uh let you know, I wanted to show you or at least teach you how to critically appraise the people using the pa frame work. So whenever you're a, you know, looking at a paper, seeing whether it's quite a good quality, we use this strategy P IC O the pe basically stands for population. So when you're looking at a population, what um who basically studied, who's being studied? So who was involved, um are, are we looking at a group of adults or are we looking at a group of Children or is it a mixture of both adults and Children that we're studying? Are we particularly focusing on females or male or is it again a mixed of both? And have we got any ethnicity that we're targeting? Are we reading Black Caribbean population? Are we looking at South Asians? Are we looking at a Filipino race? So what sort of ethnicity is that population about? And then sample size? Have they, you know, are they studying a small group, for example, a sample size of 100 or are they looking at someone like for example, a case study where they just got two or three people affected with the disease? And they're just talking about that and then when they've got that sample size, ha uh uh do they all have something in common? Like for example, is there a preexisting health condition or a co morbidity? And again, that's really important because that affects the results when you're, when you're giving an intervention and you're expecting a result. It affects because we need to understand your population's uh you know, health condition, preexisting condition before you intervene and you're trying to test out your new drug. So just by analyzing your population that's being studied in that research group, that gives you an idea about how specific and how particular they were about choosing their samples when it comes to doing their research. Now, this is literally the main golden aspect of any research, which is intervention. So what are you trying to test? Is that, is it a drug? Is it a treatment? Uh is it a surgical treatment? Is it a non surgical treatment? What is your actual intervention? What is your treatment and how are you dividing your population based on that? Are you dividing it in based off on things like this sort of group gets the treatment? This doesn't get the treatment. Um you know, are we dividing it into treatment arm and control arm or are we trying to say this receives the treatment? This will not receive anything at all like a placebo? So it's really important to understand when you're reading a paper, what their intervention is, what they're trying to test and what they're trying to achieve because of that. The next one is comparison and control. Again, when you've got the intervention, how is the intervention being tested? Is it being compared to, for example, a team that's not receiving any medication or a team that's receiving a medication, but it's a placebo or maybe you're trying to compare two types of research, uh, uh, uh, surgeries. Like, for example, do I think, um, osteoarthritis pain can be managed surgery versus physiotherapy? So, again, it's just trying to compare and see which one ways. So whenever you're reading a paper, always looking to see how the comparison is being made, how is it being divided and what's being used to compare the one another? And lastly the outcome. So again, when, what, what are they trying to achieve? What are they trying to measure from comparing and, and seeing the differences, what are the main outcomes? Do they have any primary outcomes and secondary outcomes? And most importantly are the outcomes relevant to the clinical practice. And when you're reading that paper, you can always just connect yourself and link it to your current hospital practice and see whether can do you, do you think whether you this um you know the outcome of this research paper, can it change your clinical practice? And finally, when you look at the paper itself, does the outcome measure, does it actually match the claim that they made in the title? So it's just all just links it back to a circle when you've got a paper in front of you and you're trying to critically appraise it. It gives you an idea when you're going through all these different checklists because it helps you to analyze it and, and see whether, what sort of a paper that you're reading basically. So just to, you know, do a quick summary of everything the way you critically appraise or way, the way you basically look at a paper and see if it's really worth, you know, your attention. Is it really worth changing your treatment practices for, based on that research is basically by looking at the title, looking at uh what the title is trying to say, uh what sort of a journal it's being published in? Um third thing, who's the author, what's his background, what's his interest, what's his profession? And what, what's he like? Basically as generally as a person or what's his interest is? And fourth thing is looking at things like um you know, po what population are they studying? What's the intervention, how are they comparing it and what's their outcome? And I think this is all really important to know and there are a couple of examples that's happened in the past. Um Like, for example, there was a paper that was published a couple of years ago in Lancet, which is a very well known reputed journal. Um It, it was called the Wakefield journal article which basically tried to link the Mmr vaccine to autism. And the research paper came out saying that there was a link between kids who take Children who have Mmr and them developing autism uh later on in their life. And because this paper was done by a very famous author, a famous writer uh Wakefield and he published it in a well reputed journal. Lancet. It grabbed so many attention. A lot of people turn their attention to it, including the general public. And because of that, a lot of the parents restricted their kids from taking the mmr but years later, it was found out um that the research had a lot of fraudulent data. So a lot of the datas have been fabricated has been manipulated and lancet had to come forward and apologize for putting out such a jeopardized research paper published out there. So it just goes to show that the author the paper, sometimes it all doesn't matter, it really matters about what they're trying to say and trying to cross cross check, cross verify it with other papers of similar topics as well. So this just goes on to show the effect. And I think till date, there is always a, a set of um there has been a population within the community who have been against vaccines uh regardless of the benefits from it, only mainly because of all these bad histories we've had with bad research papers being published in very well known, well established research papers, um journals. So it's again, very important to, to understand what critical appraisal is and how you can critically appraise a paper before trying to see whether it's really worth reading and, and, and you know, putting your attention in it. So a quick summary, always follow the PCO. So just giving you some an example, if you are given a paper, if you were to just go through it and how can you basically sound really smart when you're trying to summarize it and say I a critically abra the paper, this study is looking at X patients from Y Democrat effects. It compared the intervention X to control or to comparison why the primary outcomes were this, this the secondary outcomes were da da da and the major findings were so on and so on. So if you sort of follow this template, it gives you an idea of what that paper is. It gives the, you know, the person, you're trying to convey the paper, what what they're trying to say. So it's just an easy way of just summarizing an entire paper. And it's really nice, especially when you're doing systematic reviews where you're comparing loads of papers. Um When you've got an idea of what each paper is about, very easy to go through, gives you an idea of all the key points you need to know in a particular paper. So I hope p what a critical appraisal is uh and the importance of particularly appraising a research paper and how that reflects our clinical practice. So that brings us to the end of today's session. Um We do have one more session that's about how to write up a research paper coming up in our teaching series. And then after that, we'll be completing our teaching series. So, if you've got any questions, I'm happy to answer them. Now, please put them in the chat box in the meantime. Um If you could scroll down your chat box, you'll be able to find a feedback form. If I could kindly ask you all to fill in the feedback form, um It would help us to just get an idea of what we can improve on. So Janica has asked, um, what does it mean to do a critical appraisal for a junior doctor in the NHS? So I think if you're working as a junior doctor or basically at an sho level or even a reg level, it's important to know what critical appraisal means because if someone hands over a paper to you and says, can you tell me if this is a really uh unauthentic or is it really worth a high quality research? Um You should be able to just look at the title and, and, and, and, and follow this checklist just to get an idea of what that paper is. So I think it is important to understand what it means, but it's the more you, you go read papers, the more you, you'll be able to understand what a high quality research looks like compared to a research. But that's not been put in many efforts or it's just been copied and pasted off or used some sort of an A I to create like for example, chat GP team. So I would say it's quite important to understand what critical appraisal means. Any other questions? OK. So I think we can end the sessions today. If you've got any more questions, feel free to send me an email. Um I'm happy to answer those as well. So thank you for your time, everyone today and I'll see you in the next session. Take care.