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Yeah, And this should be available on YouTube. If any of you ever want to go back just to make sure, Like just to see anything if we missed or anything, do you mind? Just for the purpose of recording, Do you mind just quickly reintroducing yourself? Okay. Yeah, I'll start again. So high. I'm on a, um the FPs in East Midlands, currently based in capturing, went to Brighton Medical School. And that's a quick intro interested in cardio thoracic surgery. My email is there. If you have any questions after the talk, if you wanted to get in touch and hi, everyone, my name is, uh, Lovaza sheriff that I'm you can graduate. I'm doing s f B in East Midlands, and I'm interested in surgery. You have prepared these slides with, you know, feel free to ask us questions. You can see our emails down there. Yes. Yeah, I think there's only six of them. So if you have any questions that you just put them in the chart or feel free to interrupt us because we're not scary, we'd like to think we're not, um so this session in particular, we're just going to go through a quick a good way to approach a research paper because sometimes I need to get it looks quite scary, and it's quite intense. Um, we're going to go through how to kind of clear praise an abstract or a paper, because different degrees will give you different. So you might either gap, just nap, strike like, half an hour before you're supposed to have your interview, or you might get a full paper. If they give you a full paper, they usually give it to you the day before the interview. So, um, we're currently and Ellen are So Eleanor likes to give you a whole paper on the day before, so you can kind of have the whole 24 hours to go through it, appraised they ask questions and then present before you discuss it with researchers. Um, do you think we could go to the next side is okay. It's still on that side. Also, um, so, uh, since coverted, the interviews have been on teams, which I think is brilliant because it saves you so much time having to travel especially, for example, who have, like, you're emptying to you in Scotland and you're like down Southern Brian. It saves you so much time, but also it gives you a really good opportunity to practice. So because we know that it's going to be on teams, it's really good for you to just record yourself practicing. And then when you do practice, make sure that you're not looking at the screen itself. But look at the camera just to make so you have my contact. Um, you're allowed to make as many notes as you want to make sure you kind of color coded because sometimes it's stressful when you're flicking through like tons and tons of notes. And in the actual interviews, you might have to wait quite a bit. So I think in in my London one, I literally wait for, like, three or four hours between when they showed me the abstract. And the clinical scenario is when I actually have my interview. So just make sure you bring like drinks or snacks if you want to. In terms of when you actually approach an academic station where you have to critically appraise something, the best thing is to make sure that you have a structured approach to it, so it doesn't seem like that you're all over the place. So, um and then PICO itself is not a way to critically appraise the paper. It's just a way to quickly summarize it. And the final tip that we had is just make sure that you're confident fake until you make it. Absolutely. That's That's a very important point as Mama raised to try to have a smiley face and try to make sure that you sound confident if even if you're not confident, basically, you have a general understanding of academic topics unless, um, you are not prepared. So basically, try to sound confident and try to approach them with a smiley face, even if you're like shutting your pants like it doesn't matter. Just right question. Okay, so I wanted to kind of go through the the article, um, that we had to do for interview last year. So it is the recovery trials. Quite big, you might know about it, so this one in particular is use of dexamethasone and hospitalized patients with co bid. What we've done is we've put the QR code, and it's on all the slides of point. You wanted to look at the whole paper or just like the abstract. You can do that at any point. And that disclaimer, just this was just something that happened last year. They may change that. They most likely change the paper this year and in anyway. We're not involved with interviews, and we don't know what's going to be in the interviews this year or in the future. So just just use this as an example, and this paper it's freely available online. Yeah, so I think the reason why they use this one is because it's such a big trial last year, especially with the cold. And these things usually they don't tend to use because this one itself is a whole lot. They tend to use more our cities because they're quite easier to go into. But this paper was so huge that that was what for interviews last year. So if you click and I think you should give us a little introduction, so, um, just kind of reading through it. So, um, so reading through the background. So when you look at it, I would if you would just give it an abstract before you critically appraise it. I would just read the whole thing in one go before I start analyzing it. So for this one itself, Cove in 19, it says associated with diffused lung damage. Uh, cortisol is moderate inflammation mediated lung injury there to reduce the progression to respiratory failure and death. So then just read the methods. So in this controlled open label trial, comparing a range of possible treatments in patients who were hospitalized with coated 19, we randomly assigned patients to receive oral or IV Dex. Six mg, once daily for up to 10 days, receive usual care alone. The primary outcome was 28 day mortality. And hence we report the preliminary results of this comparison. I think if you click, it will give you results. Okay, so now these are all the results. Feel free to take a minute and read them, but it's quite a lot of numbers, okay? And then you can just click to the conclusion. Okay, so and then the conclusion is inpatient hospital with codeine 19. The user, dex, resulted in lower 28 immortality amongst those who are receiving either n i V for oxygen alone. I randomized randomization, but not amongst those who received no respiratory. support, and then you can see that who funded it. So it was funded by the M, R C and the National Institute of Health Research. And then you can see at the end it's also a registered trial. So you read the whole like abstract, and I was just thinking, How am I going to actually break it down? So the way that it was a really good structure to have when you're kind of trying to quit it critically appraise which which we got taught last year, is this the monarch? So it's Q r P i c a peacock Rambus r p f E c. So the pneumonic that stands for the QR is So we're going to go through each of these individually for this paper, but just kind of going through what it stands for. Q. R is question and relevance like what are they actually asking? What is their clinical question and how is it really relevant to the population? Peacock is basically just a summary of the actual study. So population, what intervention did they views? Was there was there a control? What outcomes were they the primary secondary outcomes? Um, and then the key findings. So what did the trial actually report? Rambos is away just to look at the eternal validity. So internal validity is Are the results of the study actually valid or are there because of bias? And the way you can look at it is you look at the recruitment. So how are the participants? As you recruited So in this way, it just that everyone with who was admitted to hospital So what was the process of actually recruiting them to it? Did they volunteer where they just allocated? Got studies usually just take the data for them. If it was in our CT like where they did, they volunteer, What was the way uh, allocation is like, where they randomly allocated Or did someone manually do it? Was it based on how well they were? Main maintenance? Um, and then baseline characteristics outcomes. So what outcomes. Where there's a primary secondary, we'll go through all of that. And statistical analysis R p is the way that you can kind of break down external validity, which means that how are your results generalized able to the population and you can look at that with the resources so the treatment that they used. It is so expensive that more hospitals can't even afford, um Or is it something that's readily available? And then populations? What population did they necessarily target? Or was It was the inclusion exclusion criteria just so strict that that it only applies to a certain demographic, and then the last one is F E C. So that's funding. So who actually funded the project and did that actually impact on the results of it? Um, e is for ethics. We can go through that later and then see, it's just to conclude the whole thing and the way I did it is because usually when they ask you, they will ask you for the strengths and weaknesses. So when I was structure my answer, I would just put external entity. These are the strengths on one side, and this is the weakness is on the other side. Um, I don't know if you want. Yes, absolutely. So very good introduction and very good structure to basically putting your answer. Um, just make sure when you, um like are preparing for sfp interview. Just get papers from sometimes abstract, sometimes through text papers from Pope med and, uh, try to critically appraise in this order, you can develop your own way of presenting. That usually will be given 2 to 3 minutes to present the abstract, and they usually tell you to present the main findings. And then they tell you the main finding. Just don't go like just and tell them the conclusion only do this properly. Use pick a model peacock model and use a framework to basically a structure answer they're not looking at what was the conclusion was it was like one sentence, the message of the paper. No, no, that's not the key findings, so they might phrase it differently. And sometimes you can clarify your understanding if you are not sure what they mean. Really, If they're like looking for a 52nd answer, you shouldn't give a four minutes answer and vice versa. You can just clarify your understanding. You can ask the interview. Would you like me to critically appraise the paper? Would you like me to go through the paper in terms of, uh, Coumadin? Or you just want me to give the main findings? You can, but usually they're looking for a framework and a structure too critically appraise the paper. Yeah, that's very good. I'll go next line. Yeah, and I think it's a really, really good point about not just saying the conclusion, because a lot of the time researchers and I know like a lot of people have no not guilty of this. They'll put what they want you to hear in the conclusion and not necessarily say the key key stuff. So just by mentioning other things, you kind of show that I read the paper and a and be don't add up, for example, um, so just going through the framework that we went through so QRS question and relevant. So the recovery trial is on this pyramid of hierarchy of evidence that kind of at the bottom, you have editorials and I just go up. They get the bias that they have reduces. So then above it, you would get case reports, and then it's cross sectional studies. Then it's case control cohort are CTS and then the top top of the systematic reviews and meta analysis of our CTS that has pulled like loads and loads of data. Uh, so it's really good when you show that you have an understanding on it. So when this case, I would just say, Oh, so I know this is a cohort study. Um, and then how is that relevant to the now in here? So this looked at patients who are hospitalized with co vid 19 in the middle of a pandemic. So that's quite relevant. The here now, because Cove, it has a really high mortality rate and they're looking, especially giving someone dexamethasone is going to help with that mortality. And patients who who survived coated necessarily have the best quality of adjusted life years as well. And they can get things like long coverted. Um, so yeah, so you're thinking, Oh, this clinical question that they're asking it's quite relevant, Which was the rest of the slides. Okay. And right, So this is a little summary of the paper. So we said peacock is just pee is population. So how many patients were hospitalized with codeine? 19 across the UK intervention was dexamethasone six mg once daily, either orally or IV for 10 days against usual care. And then the outcomes that they measured was the primary outcome that measures the 28 day mortality and the key finding that they had was that there was a reduction in the incidents of death, especially with patients who required who had an increased oxygen requirements. The patients most patients who had n i b but also those who required oxygen. So just to kind of summarize that I would just say something along the lines of stuff. This is a pragmatic, controlled open label cohort study that evaluates the impact of receiving dexamethasone in patients who are hospitalized with co vivid in in the UK in comparison to usual care. And then the key findings would be the The authors suggest that in patients with oxygen requirements for the use of dexamethasone, results and reduction of mortality, does that kind of make sense? So far. So yes, that's a very good way of summarizing and also like in terms of outcomes, um, usually different types of trials courses. Studies have like more than one outcome that they're going to measure, so there's usually one primary outcome, which is the most important thing. So in this case, mortality, there could be other secondary outcomes, which you could potentially need to talk about if you were given the full paper or if you were given the abstract, sometimes they might mention that even in the abstract as well. So secondary outcomes are like other, um, important factors you would consider if you're introducing an intervention or a procedure or uh, drug, which could be potentially, uh, beneficial so it can be like length of hospitalist. A. It can be about the cost of treatment. It can be about other factors. So there's a secondary outcomes, and primary outcomes is usually sometimes mortality. In this case. And, uh, in terms of key findings, you can mention both key findings of basically primary outcome in terms of primary outcomes and secondary outcomes. How the paper address them So you can discuss that as well. If you have secondary outcomes, yes, and then sometimes it's good to critically analyze to see if there is relevant outcomes are relevant as well, because sometimes if they don't get a significant enough result, they'll do something called a composite, which is when they combined loads of outcomes and reported like Wow, Um, so yeah, so the next thing that you want to look at is the internal validity of the paper and then the monarch for that is from both. So just looking at the recruitment. So, he said, How are these patients actually recruited? So from the abstract that we know is consecutive within a certain period of time and everyone was admitted was kind of registered for it. It's multi centered. I think it's like over 100 and 70 trusts is tertiary. This is just in the hospital, um, and then and you want to see stuff as an allocation. So they said that it was randomized, but they didn't necessarily say how it was randomized. Was there a computer? What was the method of it and where the patients actually blinded? So with blinding you want to see it? Obviously, um, if it's single, double or triple, the single would be just the patient's double would be patients and the clinician's treating them and the triple would be everyone's blinded, including the person who's crunching the numbers as well. Then you want to look at the maintenance, that kind of how many patients, and it's really important that we look at nutrition bias as well. So how many patients dropped out from the trials? It could be like, for example, not necessarily this. But in another trial, patients just didn't receive good quality of care in one arm, and they just dropped out. But then that means that everyone who has dropped out has not necessarily received the good quality of care. So then the results will be skewed towards one side. But that's only because people on the other side had dropped out. And usually in a trial, you want to drop out rate of less than 20%. So then you can preserve the power of the of the whole paper. Um and then the next thing you want to look at is outcomes. But we're going to go through that the pneumonic trade. Oh, and then, lastly is statistics weight. I feel like I forgot baseline. And now I did. Yeah. So with baselines, you want to look at the baseline characteristics. So I appreciate sometimes you won't get that table, um, in an abstract. But the baseline characteristic table is quite a good way to see if the patients are well balanced in both groups and if your randomization has actually worked. So if the patients are similar and there's no significant values and baseline, uh, core morbidities and and things like that. So, for example, when this case, um it's really important that you look at this table because is it that the patients who have more capabilities are more like to require oxygen requirements? And then perhaps that's why they have. The results are more secured this way so you can see from that table that there's no significant differences in the patients in different groups. And if you want to critically appraised any paper just before, like looking at, there's almost always a table of characters of patients who were studied, uh, including the demographic information. Always keep a list of demographic information important ones in your in your mind's like age. Sex, um, ethnicity. These are important ones. Like if one of these was missing from the paper, hopefully, Agent sex should be there. But if ethnicity was not miss, it was missing. Like there was no mention of, uh what sort of proportion of white and nonwhite, um, in fact, population were included or or other like chronic diseases that there was no information that just be a bit suspicious and raise it, raise it as a concerning like value. It could be biased to basically try to, um, keep an eye on those sorts of demographics. There should be information on them to basically make sure there's no basic confounding factors involved in the studies. So basically always mentioned that because it needs to be balanced out in terms of confound. If you have had effective randomization, the effect of differences should be minimized. And they should almost be equal number of in the car basically different population in terms of ethnicity, age and sex in both intervention and control groups. If you have had good randomization. So you always always make sure you mentioned those things. If any of those are especially with Kobe, because the data shows that coated mostly impact people of color. Worse what they have worse outcomes and people who are other people. So yeah, like you just said, is quite important that you look for that. If you do get a whole paper and you don't find that information, sometimes they like they hide it away in the supplementary, um, data. So I would just have a peek there just to show you that you kind of went and you had a look at everything related to that paper. Um, so yeah. So the way that I looked at Outcomes was with the pneumonic tried Oh, City is types of what kind of outcome is it so, like college, as I said before. So there's always a primary outcome, which is the main goal. So in this abstract, they just said the primary outcome. But they will have secondary outcome, which is other things that they will also look at. See if dexa medicine made a difference for that. And then you want to look at, uh, outcomes if they're subjective or their objectives, Is it something that's fixed that won't change? Or if it's something that's more like what the patient feels like? Quality of life would be more subjective. Whereas in this paper it's quite an objective point. You either die or you don't like the mortality is quite fixed. Um, and then you can say if the if the outcome is clinical, if it's composited composited, then you combine a few of the outcomes together, and then surrogate is more biomarkers outcomes. Uh, so things like BP and things like that. Um and then you could just say relevant. So the relevance of that outcome to, um, the clinical questions again with this outcome, it was 20 day mortality, which is quite relevant when it comes to give it, because initially, when the pandemic started, that was the thing that they were most worried about because so many people were passing away, unfortunately, when they were getting coated. Next thing you like to look at is if the trial Sorry, I know this is our CT, but it's the trial it says yourself registered, and it's really, really good if it is because that means that they have published a whole protocol and they can't really deviate away from that protocol because they set their outcomes and they set their whole methods and they can't really deviate away from them. And then the next thing is the duration. So how long would the patient's followed up? And was it really appropriate? So in this case, 28 more mortality is good, but then it will be good to like, kind of go above and beyond that and see if that impacts as well. The next thing is observation, bias, so not necessarily in this case, because it's more. It's 28 day mortality, so that won't be really affected. But in some case, uh, if you know that someone's watching, you tend to do things that you wouldn't otherwise do. Um, so let's say like if it's a study about if it's an answer to you something to do with nutrition or something and you know that you you're going to be followed up like every so often you're more like to stick to it, which people might perhaps not doing a general like general everyday life. So then that adds kind of observation that so you kind of do things that you wouldn't necessarily do in a normal setting. Just because you're being followed up every so often or you just know that someone's watching you, um and then always be sort, of course. Like, what are they actually not measuring, which might be important when you look at outcomes? And then how many of those outcomes are also safety outcomes? That's what I have to say. Uh, yeah. Brilliant. Yeah, absolutely. You need to look at what sort of, uh, primary and secondary outcome. They first initially basically decided to investigate. And if they're meeting those or not, and that can be directly related to the internal validity of the paper. Have they answer the question they initially raised? So that's essentially the message. Um, and you can you can go through, Uh, it depends. It really depends if you have the full paper or the abstract. I think to be honest, a lot of places do full paper. So basically, you should be able to address that question. Yeah, Yeah. Oh, yeah, that's it. I think it's only handful that will give you an abstract like London will give you abstract. But most people mostly stay outside London will give you a whole paper, and you've got time to go through it as well. Um, these are kind of So I made a table of all the definition for sats that I would recommend that you just learn because they're 100% ask you. Um, so they will be like, Okay, so the outcome is, let's say odds ratio. What is that? And then they'll be like, Oh, right. Okay, so you're saying something about placebo, but what does that really mean? And then, oh, then you might say, for example, or this is a registered protocol and they went by intention to treat. And then we're like, Okay, so what does that mean? So they will ask you these questions to make sure that you know your definitions for all of them, because they were 100% ask you Because I think in our interview last year, we got asked what P value was what confidence interval was. And then one more thing I remember, they asked the definition of I can't remember what it was, but they're 100% ask you. So it's just better that you just have a quick law because it's an easy mark, isn't it? If you learn it. Yeah. In addition to asking like general qualitative assessments of papers, they were also some specific, like kickbox questions like multiple choice or like single answer questions. So sometimes they might ask you about levels of evidence. Sometimes they might also stood just that pyramid that we should have the beginning also just, um, dermatology about what's the difference between odds ratio or relative risks so or hazards ratio. So just try to be, uh, very succinct in your explanations, and also try to memorize those or learn those uh in fact definitions before going to interview you. Absolutely. Um it's also the same for, like, the tables that they make as well. So then they might like, Look at the consult patient flow diagram and be like, What is that? Or they might give you like it there Met analysis Be, like, give you a forest fire out and be like, What is that called? Like I remember being asked that both of my things. Actually, they were like, What is that called? And they just wanna test you to see, like, are you actually interested in Do you know your stuff? But this is all you can learn in the day. Um, yeah. Next. So this is kind of my rahmbo structure for it. So what I wrote for is this is this is the recovery trial is consecutive multi central trial in the UK involving 176 centers. All participants were randomized, although we're not sure exactly how it does reduce selection bias and the effect of confounding factors on a result how it makes it difficult for us to maintain a rigid study protocol. Um, I would like to check the inclusion exclusion criteria and then the methods of randomization. And then this is a registered trial, um, which increases the risk of data dragging, and then the outcome is 28 day mortality, which is relevant given the high mortality associated like, Oh, it's kind of I've done all of that. Um, and then the next bit sorry, I'm just reading whatever. But the next I don't know if you can. Yeah, um and then the primary endpoint was a great story about the, uh, type O which reduces the which showed the incident of death was low in patients who receive dexamethasone in comparison to usual care. So the patient on N I v a s a noninvasive ventilation benefitted the most, with the reduction instant being 36% and the confidence interval did not pass one. So it's quite important that you show that I've looked at the stats. But then I also looked at the p value and I also looked at the confidence interval and this is what that means. So it said the confidential did not pass one, which means the results are significant. However, there was no p value in the actual abstract, so I would and then Also, I would like to check if the if the anonymous status statistical analysis that they did was intention to treat or as per protocol, Does everyone know what that means? Like intention to treat or as per particle analysis, you can amuse yourself. Talk, please. Anyone? There's only eight of us. You can type in the chat. Yeah, or we can tell you to, um so intention to tree is basically if someone has already been allocated to a specific groups in this case, if they were allocated to usual care and then further on, they got really done well and then you gave them dexamethasone. They will still be categorized as the first group that they were allocated to which is used. Okay, so the outcome will still be on that. So that is intention to treat. So you're treating them as you intended to treat them when they join the trial, even if they later on moved group or dropped out per protocol analysis is the analysis that they already pre defined in the protocol which you can find. Um and then they kind of stuck by it, and it's quite important that you know, which which one they went with. Um okay, so that's internal validity. The next is external validity. So, like we said, external ability just means are your results generalize a bubble to the general population. So the pneumonic for that is our piece of resource availability. So you can say something like, in this case, the use dexamethasone that's quite readily available. Quite cheap, easily you can get in any any hospital in the N. H s. So it's quite an easy intervention that you can make, um, with p population. So you just kind of look at the population and see if that population is representative of of the population that you intend to tree, or was the exclusion inclusion criteria way too strict? So sometimes in our CTS, they're really, really good because you've got a specific group and you can compare that to control. But then that's the downfall of it as well. So it's two specific, and then, outside that those results might not be generalized to any single patient. Uh, so with the population, like I said before, you can look at the age, gender, the PM I high ethnicity, the lifestyle of the patient. So is there a bias against older people or people who have core mobilities are the patients in this trial They just not as well as the patient that you would see in who walks through the hospital? Are there more or less and well, And then are you giving the same level of attention to these patients that you would in general life as well? Or is it too much? And you can look at other factors that might impact someone as well, Like smoking alcohol, other drugs, um, at the yeah, and then what did they actually compare it to? So was it placebo that they compared it to which a lot of the trials will do. Or they compared to gold standard. Because that's ideally, what you want to do is compare your treatment to call Standard because if it's a placebo, then it's just comparing against nothing, isn't it, Um, and then just look at yeah, that's it. That's all I've got to say. Also consider like external validity. If if that particular purpose was done, like in the country that has a different demographic population to UK, for example, you might be doing an interview. Let's say investment lands and the professor from Birmingham they were talking about. They can also do some specific questions about the paper after you presented that as well, By the way. So uh, they might ask you is this is the outcome of this paper likely to change your clinical practice? And that's quite a common question that you would come across. And it's an important question because your first a clinician, then you're an academic clinician. So it's important to use your academic knowledge in your day to day, uh, the clinical practice as well. So you can argue that that population in Iceland probably be quite different to the population that you see in Burbank, Um, due to, uh, certain ethnic groups that may be more present in Birmingham compared to Iceland and that that's a valid conclusion. And they would like to see that basically, first of all, it tells you it tells them that you are and academic clinician. You can interpret data, and you can use that in your clinical practice. And second thing, they are aware that you have done your homework. You have basically, uh, studied about the population, the local population of the area that you would like to work there. So it's quite useful to have an idea of the population that you're going to be treating as a doctor in that area before applying. Yeah, yeah. And then usually they love asking that question of residence, right? And usually they give you in our CT. The thing that you would say is like one paper wouldn't necessarily change your clinical like practice. Like one paper, wouldn't you need Multiple are CTS. You need systematic reviews. You need met analysis, so always be, Yeah. I mean, obviously, the recovery trial changed a lot, but usually they'll give you our CT. And you just have to be like one paper wouldn't necessarily change my clinical, uh, like practice. Absolutely. That's a very valid response to that. The common question. Or you can even argue that further and you can take it to the next level. So in cases of like emergencies, like during Covidien, you know it usually takes months to years to develop a nice guidance. But during Covina, a nice guidance was being developed overnight. So like every couple of days, there was a new nice guidance and they were developing that, like, I think they were calling that a specific category. I can't remember what exactly was, but it was like a type of, like an urgent emergency sort of guidance. For now. At the moment, currently, it might change in the future. So you can add that argument as well if you get any covert related paper, uh, in your interview. So it's quite a valid point to be discussed as well. Yeah, and that's just me, right in the external issue. But we already talked about that. Okay, so we have another paper, second paper. It's a retrospective study. So title is prolonging hospital time to appendectomy from that that name from appendectomy. Uh, you can say you can say it's from the US is associated with increased, complicated appendicitis in Children. So it is from the annals of surgery. I'm sure a lot of you may have heard of a lot of surgeries, one of the very well respected surgical journals that we have around the world. So this paper was published quite recently, and you have the objectives you can have a read through. That and the summary background data and the method mhm. So just familiarize yourself. Ideally, within a minute or two, you should be able to have a read through that. Just give me a second. Uh, I just have a quick call. Sorry for that. Yeah. So then we have the results, and we have complications as well. So from the abstract alone, you already know that this paper is to do with appendicitis. And the objectives is to examine the association between prolonging hospital time to open the appendectomy, or appendicectomy, as we call it in the UK and the risk of complicated appendicitis. And the country of a study is us A. And the journal is 10 hours of surgery. So it's the most cited, uh, surgical journal impact factor of 13.787, um, and the type of history as well as a retrospective study. And they reviewed records from the American College of Sessions. So it was a database, uh, basically record review paper. So and then they had a targeted appendicectomy database from 16 2 4018. And in terms of primary versus secondary outcome, the primary outcome was operative. Findings of complicated appendicitis and secondary outcomes were fair today. Comp complications and resource utilization so that that is what you have as primary and secondary outcomes, and you've got the reference as well. So in terms of peek a model of peacock model. So you have the population as patients who underwent appendectomy within 24 hours of hospital presentation. Uh, so that initially tells you the inclusion exclusion criteria you can name it different, uh, terms. It's up to your choice. How do you want to present it and then pick a model? You don't necessarily have to follow that, but it's a good framework. Is a good a structure to follow. And in terms of intervention, appendicectomy or appendectomy was the intervention and in terms of, uh, comparison early versus late appendicectomy. So they classified, um, early appendicectomy as appendicectomy within the 1st 16 hours, and anything above that was the late one. So up to 24 hours, or 16 to 24 hours and then in terms of outcomes, surgical complications, uh, in fact, amongst the primary outcomes and in terms of key message, uh, basically avoid delayed up in the sector me whenever possible, So anything above 16 hours should ideally be avoided to reduce complications and in terms of sample size, you have the samples. But just remember, this is the data from the abstract. If you go to the main paper, if you are provided with the main paper, uh, can it slightly different? Because some some patients usually drop out of the study due to various reasons, they may no longer be keen to continue with the studies. Some people may be rather consent to be included in research, or they have. They might have missing data or, like a failure to record the data or I T issues and then missing data loads of reasons. So usually that is different with the number of patients who were included in the final analysis, just make sure it's usually 5 to 10% different. So just if you were provided with a full paper, just make sure you quote that number as well. Is anything else you would like that? You know, um, you got your music? Sorry. That's why I would look at the patient flow console diagram because that gives a really good summary of how many patients are actually recruited. How many do you have now? And at what point did they start dropping off, because if a lot of patients like I just said, are dropping off at a certain point, it could be a little bit more cynical and be like what was going on there. And now they're not included in the final analysis. Why would that be? Absolutely. And usually it's, uh, the second or third figure in such a paper. So just make sure you review as many papers as you can potentially access. Um, And then you can familiarize your eyes because just as I was doing a Cochran review with a team of, um, basically, Cochran reviews in, uh, my previous university. So they were doing loads were doing loads of like, uh, in fact, reviews of literature reviews and in fact, our city, Well, potentially. After a couple of papers you have looked at, you can quickly find where that figure is where that, uh, in fact, uh, flow chart is or concert diagram. So just make sure you families yourself your eyes with, like, seeing many of those. So until the next slide, um, we have the reference and yeah, so we have references for both the studies that we use that just as an example in this study in this session and feel free to refer to stone website and medal for the recordings. I believe these recordings will be available on YouTube as well. And in terms of next session, we have already advertised that on, uh, instagram and other social media pages. It's going to be 24 for October, and the third one is going to be on the 31st. Uh, I believe 34. 30. So we have a feedback form, so I'm just going to stop the recording now and then you guys can answer questions and, uh, option literally ask anything.