Clinical Practice Guidelines Clinical Practice Guidelines Instructions: 300 words Search and locate one systematic review or practice guideline in your

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Clinical Practice Guidelines Clinical Practice Guidelines
Instructions: 300 words

Search and locate one systematic review or practice guideline in your topic of interest (Include the citation). 
Evaluate the following: 

The systematic review or practice guideline relies primarily on studies conducted in the last five years. 
The review provides support for the importance of the study 
The authors have use primary, rather than secondary sources. 
Studies are critically examined and reported objectively 
The systematic review or practice guideline is organized so that a logical unfolding of Ideas is apparent that supports the need for the review 
The systematic review or practice guideline ends with a summary of the most important knowledge. Critical Appraisal of Systematic Reviews: Where Do You Start?

Critical Appraisal of Systematic Reviews: Where Do You Start?

Objectives:
After the presentation the student will be able to:

1. Recognize the value of systematic reviews in clinical practice
2. Understand the methodology of Systematic Reviews
3. Applied previous knowledge to identify the parts of a systematic review.
4. Organized the steps to conduct a systematic review.
5. Appraise Systematic Reviews based on it’s validity, and applicability to practice

Systematic Reviews

A review in which evidence on a topic or research question has been systematically identified, appraised and summarised
according to predetermined criteria. Systematic reviews may incorporate metaanalysis, but don’t have to.

High-quality systematic reviews are considered the best possible sources of evidence for evaluating treatment effectiveness.

Meta-analysis A statistical technique. Summarises the results of several studies into a single estimate, giving more weight to
larger studies.

Publication bias When only studies with positive results are published, not the neutral or negative studies. If only published
studies are included in a systematic review, it may overestimate the effect of the treatment or intervention.

Critical Appraisal of Systematic Reviews: Asking the Right Questions

A critical appraisal is basically a detailed examination of published research for the purpose of making a decision about
scientific merit and, therefore, for making a decision about the use of the evidence in practice.

What is a Critical Appraisal?

Critical appraisal is also known as a research or evidence critique.
Critiquing the literature, appraising the literature, or critically evaluating the literature are phrases that refer to
a deliberate examination of a published research study and making a judgment as to the validity of its methods, importance
of the question and results, and application to practice.
A critical appraisal is basically a detailed examination of published research for the purpose of making a decision about
scientific merit.

Critical Appraisal Steps
A critical appraisal of a systematic review starts with asking questions about each of the which are
related to validity and reliability of the methods used to produce the systematic review; the meaning
and importance of the synthesized recommendations; and, finally, the ability to translate the findings
into clinical practice.

There are critical appraisal tools available to specifically appraise systematic reviews that you can find
from a variety of organizations.

DOES THIS REVIEW ADDRESS A CLEAR QUESTION?
Remember that this first set of subquestions is related to the methodological rigor of the study.

You are assessing whether the question was focused and important and whether the study methods reduced the possibility of
bias and minimized error as much as possible

Did the review address a focused clinical question?
What was the specific question (should include population, exposure/intervention, and outcomes) and was it sensible – that
is, was it too broad to be useful?
You should find this information in the introduction and background sections of the

Did the authors look for the appropriate sort of papers?

The ‘best sort of studies’ would · Address the review’s question · Have an appropriate study design.

Were the criteria used to select articles for inclusion appropriate?
Which criteria were used to select the articles that were reviewed.
Did the systematic review only used randomized trials or if non-randomized trials were also included.
Reviews which use only high-quality randomized controlled trials (RCTs) are less likely to have biased results and the
likelihood of random error is reduced.
If nonrandomized trials are included, then you would expect that the findings from the RCTs and nonRCTs are separated out
for analysis .
You should find inclusion and exclusion criteria in the Methods section of the article.

Do you think the important, relevant studies were included? Look for

Which bibliographic databases were used
Follow up from reference lists
Personal contact with experts
Search for unpublished as well as published studies
Search for non-English language studies

Did the review’s authors do enough to assess the quality of the included studies?

The authors need to consider the rigor of the studies they have identified. Lack of rigor may affect the studies results.

ARE THE RESULTS OF THIS REVIEW VALID?
Were the individual studies assessed for validity? The methods section should give you this information.

You want to know how the researchers determined the studies were of high methodologic quality –

What were the predetermined quality criteria?
The use of independent reviewers that showed good agreement (the kappa statistic is usually reported) would be a good
thing to report.
There should be details given so you can make your own assessment of how well they did their job.
If the results of the review have been combined, was it reasonable to do so?

Consider whether ·

The results were similar from study to study
The results of all the included studies are clearly displayed The results of the different studies are similar
The reasons for any variations are discussed

WHAT ARE THE RESULTS?
The “results” in these critical appraisal of systematic reviews questions refer to the conclusions made as a result of the
synthesis of the evidence sources selected for this systematic review.

What is the overall result of the review?

Consider · If you are clear about the reviews ‘bottom line’ results ·
What these are (numerically if appropriate) ·
How were the results expressed (NNT, odds ratio, etc)

Are the results of the included studies clearly presented and discussed?

The purpose of the review is to summarize the data from the individual studies into a bottom-line answer.
Remember that not all systematic reviews are meta-analyses, so the results may not be provided as a numerical answer, but
as a qualitative summary.

How precise are the results?

Are the results presented with confidence intervals?

CAN I APPLIED THE RESULTS OF THE SYSTEMATIC REVIEW TO PRACTICE?
Can the results be applied to my patient care?

This question is fairly self-explanatory.
The critical question is “How like your patient were the patients in the review?”

Were all clinically important outcomes considered?

Are there outcomes that are associated with the outcome under review that you should be thinking about or would want
information about?
What are the costs associated with the therapy?
What are the adverse effects associated with the therapy?

Are the likely treatment benefits worth the potential harms and costs?

Your patients need to be informed of the risks and benefits of all potential therapies.
Patient decisions will change patient-to-patient.
You cannot make assumptions about the patient’s beliefs.
The patient’s values and beliefs must be taken into account when making clinical decisions.

Resources

Evidence-Based Practice: Critical Appraisal Tools for Systematic Reviews/Meta-
Analyses
Foley Center Library

Systematic Reviews & Meta-analyses: Critical Appraisal
Virginia Tech Library

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