CRITICAL APPRAISAL

Amany Rashad Abo-El-Seoud

Prof.Community Medicine, Zagazig University, EGYPT

BENEFITS OF CAT Proper selection of references used in

review and in discussion. Evaluate any scientific paper in journals

or on web sites. (for reviewers)

STEPS OF EVALUATION OR CAT Guidelines of CAT are arranged in the

same sequence of any paper (thesis) to facilitate criticism for each item i.e. authors, institution, title, abstract, introduction, objectives, methods, results, discussion, references and recommendation.

TITLE Is it interesting? Not too long, not too short title (average

10-12 words). Centered , all nouns are capital

No abbreviations or formula in the title Should inform about what will be done in

that paper, on whom (subjects), where (the place), when (the time).

After finishing the paper I have to check the title again to verify its consistency with the included information in the paper.

TITLE’S COMMON WORDSAssessmentEvaluationOutputOutcomeImpact

EXAMPLE FOR TITLE:

A bad title :"Exam grades"

A weak title :“ Sleep vs. Exam Grades“

A good title : "Amount of Sleep Affects Student Performance on Biology Exams“

Excellent title: Effect of sleep pattern on biological examination achievement in

Cairo Faculty of Medicine . A cross sectional study

EXAMPLES OF TITLES Epidemiological study of pulmonary

Tuberculosis in Abbaseia chest hospital.

Determinant of low birth weight in Cairo governorate.

Attitudes of nurses towards HIV patients in Cairo governorate.

AUTHORS Who share in the paper, their

qualification Has the institute or university they

belong to a proven academic records? Authors from different specialties are

recommended

ABSTRACT

The Abstract should be written in past tense and Not Contain :

• Lengthy background information.

• References ( literature ).

• Incomplete sentences.• Abbreviations or terms that may be confusing to readers.

• Any sort of illustration, figures or tables.

INTRODUCTION Does the introduction address the

relevant points? The importance of the subject and the rationale of selection:

-To improve current situation -To fill gaps /solution -To give new products /solutions -To improve old ones Is the study original?

OBJECTIVES Are objectives clear and SMART?

Specific, measurable, attainable, reliable and time limited.

After finishing the paper I have to check if authors reach all the stated objectives or not.

SUBJECTS & METHODSShould cover: Technical design (study design) Operative design Administrative design Statistical design (Data management)

SUBJECTS & METHODS What is the type of study? studies are

arranged from up downwards according to type of methodology into (meta-analysis, systematic review, randomized controlled trials, cohort study, case-control and the last is the cross-sectional or case series studies).

Keep in mind that the results and conclusions are limited in case series, cross sectional.

Is the selection of subjects in the study sample based on the rules of probability sampling? (proper selection by random, systematic, stratified etc.)

What are the inclusion and exclusion criteria of cases selection?

Is the sample size properly calculated and justified?

Is the power and significance levels stated? Are the study groups comparable?(there must

be no significant difference between groups in

demographic data before intervention)

Are the outcome measures stated and relevant? Are the measurements valid and reliable?

(questionnaire, laboratory tools, instruments..) Is there many missing data? (refusals to co-

operate must not exceed 10-15% and they must be compensated in sample size from the start. If refusals exceeds that there must be an explanation and description of their characteristics, what was done in statistics to overcome this problem.)

Is there side effects or adverse outcome documented?

Is the time suitable for completeness of the study and follow up?

Are the ethical rules followed?

STATISTICAL METHODS Are the methods of statistical analysis

suitable for the type of data and correct in interpretation?

Are the methods described for each step?

Are the tests used parametric or non parametric?

How missed data are handled? Is the level of significance stated? (p <

0.05, 0.01)

RESULTS What was the treatment effect? Or the

intervention action or the difference between cases and controls? Is this information clearly stated?

Are the tables and graphs suitable and clear to illustrate the results?

Does each table or graph add benefit to the result?

Is the comments on results scientific?

DISCUSSION Were the objectives of study fulfilled? Were the sources of errors discussed? Are the relevant findings justified and

compared to other studies? Can the results be generalized to other

populations? What is the impact of that paper? Is the benefit of treatment used worth

the harm or cost? Is the discussion handled all the results

obtained?

CONCLUSION The conclusion must be deduced from

results of the paper The conclusion must be brief but

summarize all the findings

RECOMMENDATION Clear points and deduced from the

results and discussion Must be practical and can be done Should include recommendation for the

patients (subjects), for solving the problem (or disease) and recommendation for further studies in the same subjects.

Recommendation for how to overcome the faced difficulties

REFERENCES Must be recent Must be written in the same format Either alphabetic or as their site in the

paper (both are right) Each reference is written in full details

(book name, publisher, author, year, pages). Web cites must be clear and full provided that anyone can reach that cite easily.