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Critical Appraisal of health literature
1. Dr. S. A. Rizwan, M.D.
Public Health Specialist
SBCM, Joint Program – Riyadh
Ministry of Health, Kingdom of Saudi Arabia
Critical appraisal:
Discussion, funding, conflicts of
interest
2. Learning objectives
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Critically appraise the following elements of a
research article:
• Discussion, funding, conflicts of interest
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4. Things to consider in discussion
Critical appraisal of health literature SBCM, Joint Program – Riyadh
1. General rules
2. The content
3. Organization and structure
4. Overall objectives
5. Problems to avoid
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5. Discussion: General rules
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Do not be verbose or repetitive
• Be concise
• Avoid using jargon
• Follow a logical stream of thought; significance of
findings in the same sequence described them in
your results section
• Categorize your interpretations into themes
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6. Discussion: Content
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Explanation of results
• References to previous research
• Deduction
• Hypothesis
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7. Discussion: Structure
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Organize the discussion from the general to the specific
• Use the same key terms, narrative style, and verb tense
• Answer all of the research questions underpinning the problem
• Describe the patterns, principles, and relationships
• Analysis of any unexpected findings
• Identify potential limitations and weaknesses
• End with a concise summary of the principal implications of the findings
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8. Discussion: Objectives
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Reiterate the Research Problem/State the Major Findings
• Explain the Meaning of the Findings and Why They are Important
• Relate the Findings to Similar Studies
• Consider Alternative Explanations of the Findings
• Acknowledge the Study’s Limitations
• Make Suggestions for Further Research
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9. Discussion: Problems to avoid
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Do not introduce new results in the discussion section
• Use of "bridge sentences“
• Too much use of the first person can actually distract the reader from the main
points
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10. Section 2:
Role of funding
Critical appraisal of health literature SBCM, Joint Program – Riyadh
11. Why evaluate the funder?
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Studies of research sponsored by the industries show
that such studies are more likely to produce findings
that favor the sponsor’s intervention
• A recent Cochrane review has shown that
pharmaceutical industry-sponsored studies
overestimate the efficacy and underestimate the
harm of their treatments
• Study funding sources considered as risks of bias
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12. Example of good practices
Critical appraisal of health literature SBCM, Joint Program – Riyadh 12
13. Section 3:
Conflicts of interest
Critical appraisal of health literature SBCM, Joint Program – Riyadh
14. What is COI?
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Researchers have a tradition of free inquiry and
free exchange of ideas
• But, sometimes
• The researcher has a financial interest in the company
sponsoring the research
• The researcher holds a position in an enterprise (e.g.
as director) that may wish to restrict (or otherwise
manage) adverse research findings
• A conflict of interest is a situation in which financial or
other personal considerations have the potential to
compromise or bias professional judgment and
objectivity
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15. Why is COI important?
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• COIs increase the risk that studies
may be biased
• In design, conduct, or reporting
• Study sponsorship and the industry
ties of investigators
• Affect ability of consumers to use
research to make good evidence-
based decisions
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17. Take home messages
Critical appraisal of health literature SBCM, Joint Program – Riyadh
• Discussion is an important part of the
article which gives the research context
• Role of funding agency and COI are
important for interpreting the biases of a
study
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