Introduction to the check lists

每一篇文獻多多少少都會有一些缺點，但有些缺點是很微小的。因此重要的是要看，這些缺點是不是會對研究結果造成重大的影響。而導致不同或甚至相反的結果，我們在評質一篇文獻就是要挑出這樣的缺點。

有時候因為一些研究設計的缺陷導致錯誤的判讀。因此我門可以用best case / worst case / likely case的情境去思考所有其他的可能性是多少，進一步來評價一篇文獻的好壞。

The standard appraisal questions

應該要包含的問題包含下列:

Are the aims clearly stated?

A good study comes from a clear mind with clarity of study design.

Was the sample size justified?

The study should be large enough to give an accurate picture of what is really going on.

Are the measurements likely to be valid and reliable?

A valid measure is the one which measures what it is supposed to measure.

Are the statistical methods described?

The statistical method should be described for the reader to assess whether it is suitable for the result.

Did untoward events occur during the study?

Some unwanted events are truly unpredictable but sometimes it also indicate a study of poor quality.

Were the basic data adequately described?

The basic characteristics of the participants give the reader an idea of the extent to which the finding can be generalized, and whether the result can be relevant to the reader’s clinical application. 

Do the numbers add up?

The effect of lost of follow up should also be taken in to account.

Was the statistical significance assessed?

Confidence interval is better than P- values because it allows an assessment of just how large, or how small, the true effect might be.

What do the main findings mean?

The author’s conclusion cannot always be relied upon because researchers are often more concern about their findings that is them regard important. But a bias and confounding should be carefully considered. The reader should not just accept the author’s interpretation, but should have their own opinion. Even am imperfect evaluation is better than passive acceptance of the results at ace value.

How are null findings interpreted?

Null findings need to be carefully interpreted, because it may be due to too small sample size or due to weakness of the study design. è Lack of evidence of an association is not the same as evidence of no association.

Are important effects overlooked? How do the results compare with previous reports?

When evaluating a paper we should take in mind that the results which do not fit the researchers’ view are tended not to be commented.

How do the results compare with previous reports?

Be careful that some authors may tempt to overstate previous findings which support their own, and may omit mention of contradictory results.

What implications does the study have for your practice?

After reading a paper the most important thing is to evaluate the applicability of the result to our clinical practice on our patient.

In my conclusion: The central importance of study design to research cannot be overemphasized, because most serious problem or mistakes at this stage cannot be rectified in subsequent stages of the study. In particular, no type of sophisticated statistical analysis will salvage a poorly designed study.

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