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Summary

This on-demand teaching session is relevant to medical professionals focused on understanding the processes of critically appraising studies. The session covers important topics such as selecting, and citing, good quality and relevant studies, presenting an organized paper that flows well, as well as providing a critical analysis of the case. The course lead, Magdalena, will be available to answer any emails sent by participants. They will gain insight on what to look for in studies, how to decipher correlation and causality, and how to use the study findings to suggest potential treatments.
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Description

First In-Course Assessment coming up? Imperial College London Medical Education Society is delighted to host our ICA 1: Written Assessment Talk where we give you guidance, tips and tricks on how to tackle your first BSc ICA.

The event will begin at 7pm on the 17th of October, with Joshua Killilea and Chhavi Nashier giving you a comprehensive run-through of the ICA. The talk will finish with a breakout room Q&A, where you will be able to join your BSc-specific Q&A for individual advice.

Slides will be accessible to all attendees immediately after the talk and it will be recorded and uploaded for viewing.

Learning objectives

1) Explain the importance of critically appraising a study. 2) Describe the elements of critical appraisal including publication date, quality of papers used, structure of the paper, and citing papers. 3) Recognize what Magdalena, the course lead looks for in a critical appraisal paper. 4) Demonstrate an understanding of the concepts of correlation vs causation. 5) Generate ideas for how the study results can be used to develop treatments, provide prognosis and assess risk.
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lines. They can be very short. Um And, um, yeah, when you're when you're critically critically appraising, um, it's always good to making sure to make sure that they started the study that you're using to critically a place. The case that you're given are quite recent, um, and of good quality, Um, and yeah, just when it comes to the grading, Um, it's just what they're looking for is to show is for you to show that you've fully understood the subject. Um, and the critical analysis of the case, um, that you've organized your ideas, Um, perfectly the course lead, um, continuously said that she she really likes when there's good flow throughout the paper, which means even just using connecting words just like further, more throughout. Although, um, will, um, improve the flow of the of the report. And I know it sounds obvious, but sometimes, because we, um, we tend to be more technical. Um, on how we we write the report, we tend to forget that we need to have some, um, connecting sentences. Um, make sure that the citations that you use are good quality and quite recent, That doesn't mean that if you find the citation. That's pretty pretty. Shouldn't use it. Um, if it supports the argument that you want to make, um, and it's of good quality. Otherwise, um, by all means, use it. And then the overall presentation, um, of the report? Yes. And if you have questions, so let me stop sharing. There we go. Yes. Is it just me? Is this Sorry? Is it just been the know there are people. There are more people in the in the group. Um, ask any questions that you have. I'm sure I didn't cover everything. Um, yeah, Don't be all right. If you don't have any questions, Um, you can you can if you If you come up with any questions later on, you can email me. Um, I can write my shortcut in the in the chat if you want to. Um, but also, Magdalena herself, the course lead really respond to all of her emails. And if you have any specific questions about the reports that you want to, right, she's going to respond within minutes. Um, sometimes she's really good with it. Um um, one thing to point out about this report is to be able to do some good critical appraiser appraisal of the study that you're given. Um, they're really looking out for this. Um, bring up a lot of Don't spend as much time describing the study, but more time bringing up different papers that can either, um, contradict the case that you're given or or agree with it. Um, and sometimes, if you have, um, the words in the space, you can do some very quick critical appraisal on the study that, um uh, that you're using to control the case that you're given. I don't know if George has anything else to add. Mhm. All right, we're going to see you. Good. Yeah, it's mostly just what Georgia said already, Like what we're looking at here is your ability to appraise the paper. So, like the the task is not, you know, describe this paper what we did, what the methods were. What they're looking for is the in depth analysis that you are adding that is not necessarily said in the paper again, the paper will reference some of its own limitations. But don't just like, you know, regurgitate those limitations. Come up with your own like don't be too afraid of suggesting your own limitations. Like like I said in the talk, you know, that's the whole point of science, you know, they want this open discussion on what limitations could be and what future work is important. So don't be afraid to speak your own mind as long as your points are well developed. They like it because, like George had, the structure is really important. So the main thing is to praise of paper, not to just comment on it. Mhm and try and make everything concise in the beginning when you're describing the paper because that's going to give you a lot of words, which you're going to need for the critical appraiser. Yeah, yeah, of course. Leads Magdalena. She's really on it, and she's really supportive. Like, do not hesitate to ask her questions. Yeah, I come back with yours. That she literally applied to a question I had is very responsive. She's really nice as well. She cares about the students. That's yeah, that's a, um and when critically we send you recently draft, we can we send you drafts of our of our of our of our country's for you to critique yourselves? Yeah, Yeah. If the thing is if I If I have time, by all means, yes. Um, but also, I don't think we're expert experts in the field, so I don't know. I wouldn't want to give you some advice. And then that turns out to be not what Magdalena is looking for, If that makes sense, Yeah. What's the sort of paper they've given you to read? So the paper is on looking at, uh, there's a There's an accident. Market colors, neurofilament light. Um, and they're looking to see whether that can, uh, that can sort of that describe long term prognostic. Um, long term prognosis of TV I traumatic brain injury. Yeah. So let's discuss it like, Okay, who are the investigating this in? Uh, that's a good question. I don't read the paper myself, but the investigator there's a There's a bunch of them. Um, I don't know whether, you know. Are you asking for the authors themselves? No. No. Just like which are they doing in human subjects? They do it in rats, for example. It's like, what's the what's the study? Population? Uh huh. Oh, sorry. Hey, that's a good one. Yeah. He hears key Harris. Yeah, Yeah. Um, So what was your question? Question was like in which study population will be investigating this link between the external marker and TB. I Was it rats? Was it humans? So they were. It was it was a multi center. Costly patients after tea. Yeah. Let's see what's up. I'm sorry. Yeah, that's a perspective court study. Prospective? Yeah, perspective. It's good for cardiology. Mhm. Yeah. Um, yeah. Uh huh. Sorry. So that's okay. That's great. So the top of my head take twice a day. So a pinch of salt? Yeah, I know. It's a it's a pinch of salt, but like, the main things to potentially look out for this type of study would be how on earth to look at other confounder between the two albums interest. You know, this accident, a marker and TBI. How are they sure that the accident a marker came for the TB? That makes sense to check the check. The follow up period. You know, TBI is a latent disease, right? It's degenerative, so it manifests later in life. So if you're looking at the study for two years, you're going to see much or potentially nothing much that's relevant to make sure the follow up period is good. And make sure like that the time points of the analysis are, you know, adequately spaced out and robust enough you're doing like, yeah, take one snapshot like time point X and then one snapshot 20 years later because you've missed out 20 years of data that could explain it. A follow up period. Yeah, um, type of population. Like, are they looking at, You know, athletes only. I don't know. Um, so I don't I don't think so. I'm just reading through the method. Um, no, there's no, there's no specific type of, uh, they're They were, um, were moderate to severe. TBI had moderate to severe TBI recruited trauma centers. Right. Okay. Okay. I guess another thing to look out for is like, be careful of the conclusions. I have not read this paper, but sometimes they may say, Oh, this this action, a marker causes more damage. It may just be correlated. Be very careful that they mix that up as well, you know? Is it just correlated, or is it actually involved in the pathway of further damage? How how can you Is there like a method of proving causality that they should be using. It's hard because it's hard to be certain, but by being perspective, that's a good sign. Okay, but like, it doesn't automatically mean it's positive. It could just be correlated. And you're not looking for something else that actually is positive. And I guess at this point for future trials would be like a nice future. Study here would be literally. Is there a way to develop some sort of inhibitor of this pathway? Is there a way to reduce like this actually market going up, for example, is there a way to use it to stratify, which patients require more urgent treatment? So I'm trying to see how you can use this market in future work, either to stratify patients into at risk groups or to design future therapies. That's normally what it is right, But you can be creative with that part. There's no like, that's your own opinion, be done but related to clinical guidelines or treatment, because that's how you're going to use as a doctor. Yeah, I got you. I got you, uh, treatment. And so sorry. Just coming back to the come back to the entire, uh, correlation causation. Um, how how do you know? Like, when the paper says the paper says, um, this, uh, this proves that they like the marker is elevated after attribute. TBI. How how do you How do you How do you critique that? And you know what? What are what are like the how how does like a paper, you know, conclusively conclusively prove that that marker is elevated through TB? Is it like a Is it like a sort of a guideline that they follow? Or is it just off their own their own opinion? I think it only through again. So that's the thing, Is it? Is it only through critiquing that paper? Do you? The authors realize that, you know, if there is a correlation, not causation, it's it's really hard to decide. So the best thing you can do is just before and after before your TBI, your this marker is low. Then, after a TBI, it's high, and that's the case of those different patients. Again, it's it's the fact that it's so well correlated may imply it's costly linked, But yes, it's like more experimental to decide if it's causing the linked whereby you take this market out and you get less severe. TBI, That's not That's not what they were trying to do in the first place. So it doesn't matter if I don't get too stressed with that. The point I was trying to make was be careful, exaggerated conclusions where they have not approved. It's caused the linked, Sure, but this definitely is like because it's really it could be causing it if they don't approve that with, like, an experiment and you don't know Yeah, in terms of in terms of Yeah, I agree with everything I just said, Um, another question I have in terms of like, um citing papers and, you know, papers that look at sort of different aspects of the the main, the main paper. I think that was I think this is said in the earlier talk, but I don't think I got around to it. But when when you're when you're describing, uh, comparing to papers, do you add the limitations of the paper of of both papers during the comparison or towards the do you put that in the discussion aspect of the commentary? Do This is what I'm getting out. I didn't. But I wasn't in the previous talk as well. Would you mind repeating it if you want to. So So, basically, if I there's paper woman paper to and they're both using different methods, Do I Do I highlight both methods and give my opinion of both methods in that particular section? Or do I leave that to the limit, leave a little further down the document or further down the commentary where I talk about it in a separate section, I think you you bring it up in the limitations for it, Um, in the limitations of discussions for it, because when you're describing the paper, you're just describing what they did. You're not describing whether, um, whether what they did was correct or right or the wrong thing to do. This is for your discussion. Yeah, Yeah, I agree. I agree with your gyn that. Hm. Very good. We just actually go back to the thing you said about the follow up period. I didn't quite catch. Like what, You guys What? I think it was Joshua talking like what you were saying exactly about why the follow up period would be important. Yeah, so, like, so like, this comes from like knowing what TBI is right. The TBI is obviously like a long term disease. They often manifests or potentially manifest many years after the initial trauma, right? So, like if they're only looking at this marker within the first two years after a trauma like that, doesn't that that may not tell you too much as to how it determines the severity of the disease? But it presents, you know, 10, 20 years later. That makes sense if they did not follow that up. So this is going to be useful as a marker, as a as a prognostic marker you want to see? Okay, you've had your injury. That's a TBI. In a few years after the TBI, this market goes up you and your follow follow up period too long enough so that you can say 20 years down the line. These patients do a lot worse to those with, like a lower level of this marker. If they have not done that, because it's very hard to do that, you know, it's not like you're going to get the funding for such a long study early on into the research like If they haven't done that, then in your future implications, you can say, Well, you know, the fact that they've not followed up for so long means we can't be too sure as to the full, like clinical, sexually of related to this marker. So to be to be more certain that it's going to be useful to implement into clinical guidelines we need, we need to study with a longer follow up period that can track the outcomes many years down the line. Because TB I, you know, like chronic traumatic traumatic encephalopathy they manifest decades after the initial event. So if they're not accounting for that, then it's severely limits how utility is as a prognostic marker, If that makes sense, Yeah, that makes a lot of sense. Yeah, and I don't I don't like That's not necessarily a limitation. That's something more I talk about in future implications because obviously it's hard to do a study that's going to be like 30 year follow up because, like, it's hard to get funding for that. So it's not their fault, really. So yes, mention there's limitation, and there's like a future implication, but like to design further studies, but don't bang down on it too much because, like there's not much they can do about that as well. You want to also comment on the things they could have control, but didn't. It's really hard to get approval of, like a 30 yesterday, because there's just so much money it takes so long a really good understanding of the of the study that you're given on what exactly they did, how they went about it, why and then like whether they went about it, that sometimes they obviously can have good stuff and bad stuff that you can comment on. Make sure to bring uh, both this up. Um, and there's a There's always a plethora of, um of limitations that you can you can find. There's never going to be, um, one or two. Um, but make sure that, as you said that there are things that could have been changed, um, easily, not easily per se, but like not a 50 year old study, because it's just almost impossible. Exactly what is the question saying so in this paper? They say it's a curiosity, but the starting population already had the disease, TBI and fold them up to monitor biomarker rather than find the incidence rate. Would you still say this is a cohort? Mhm. Mhm, I guess, I guess. Just perspective, right? Yeah, I think so. Just get the exactly finish. Yeah, because I think when you're getting that Kevin is that could be a case. Control is what you're trying to say, Kevin. It's just like the definition says a cross section at intervals three times. So technically it is. Yeah. Yeah. Okay. Yes. So I can get why you're thinking it's a case control. If you treat TB. I like a disease. TB. I could also just be the initial injury, right? But the actual concussion event itself. So it could Also, it could just be a risk factor, like the dementia for CT. Maybe that's why they call it a cohort. I get your point right if you're calling it a disease and technically is a case called Control. But stick to what they say, You know, I don't think it's been published in the journal. I'd like to think that in the review stage, they said change it to a case control. If it was a case of control I doubt that. That that stuff for your net is it on brain again from Yeah. Okay, so they have people with TB high. Both of you. You're welcome to leave at any point if you need to. Equally, you're also welcome to continue answering people's questions if they still have some. But just so you know, there's no obligation to stay if you've got something else. Have a lovely evening, both of you. If I don't see you before this ends and thank you so much for all of you for coming and participating the Q and A. Um I'll see you guys need to go to break rooms. Yeah, so they just checked TBI, and then they marched it with with case controls as well. Yeah. Is there any other questions, please? I'll take that as a no. Mhm uh, I hope this was useful for everybody. Um, if you have Josh, do you mind hopping? Because it says that I need to verify my account to join the conversation. Do you mind popping in my story? It's G m uh, D m. So George McCracken's GM 1819 19. I see. I see. Yeah, Yeah, the 1819. Sorry, I have one last question. Yes, of course. Um, one last question. Uh um, how how helpful is the program? Uh, cast that? That that, like just much thing that they were talking about helpful in in scientific commentaries. I think it's pretty useful for you to use it. It's definitely going to help you out when you're critically a patient. Yeah, like in the talk, like it literally tells you what the strengths and weaknesses of each C type is. So yours is a cohort city. Get the cast. Check this for a curiosity. Say, if they If the strength in the checklist correspond to what they've done in the research, then say what these things they did are strong and the good. If, uh, in the weakness, they've, you know, not addressed certain strengths. That's a limitation. And then they talked about some of the key limitations, like in the in the checklist, and it's present in the paper. Then you know for sure it's limited, and it's not just making that up. It's like it's a good way to ground yourself into what's good and bad about custody and can really help you appraise the research. It's like it's not. It won't give you all the answers, but it's probably It's probably the best place for, like, a good backbone and sort of like blueprint. Yeah, your analysis on. Okay, that's fantastic. Thank you so much. How are these guys? I hope everything was would help. Thank you, guys. Evening. Thank you. Bye. Bye. Bye. Best of luck. Thanks, guys. Thank you for your help.