Critical Appraisal Process Research Articles

Evaluation of salivary flow rate and composition in hypertensive patients taking antihypertensive drugs consuming

Background: Hypertension patients are recorded by WHO to increase continuously along with the increase in population, accounting for 29% of the world's citizens suffering from hypertension. Most people with hypertension take hypertension drugs. The use of antihypertensive drugs varies and can cause several side effects on the oral cavity, especially the salivary flow rate. The purpose of this study was to evaluate the flow rate and composition of saliva in hypertensive patients who take hypertension drugs. This study uses a systematic review method by searching for articles related to evaluating the flow rate and composition of saliva in hypertensive patients who take antihypertensive drugs that have been published in journals. The literature search was conducted in April 2023 through google scholar and PubMed. Journals were selected based on inclusion and exclusion criteria through a critical appraisal process. Result: The use of antihypertensive drugs, such as captopril and amlodipine, significantly decreased the salivary flow rate compared to the control group. In amlodipine users, 93.33% experienced a very low reduction in salivary flow rate, while in captopril users it was 83.33%. Conclusion: Regular use of the antihypertensive drugs captopril and amlodipine may decrease salivary flow rate.

The revised JBI critical appraisal tool for the assessment of risk of bias for cohort studies.

Cohort studies are a robust analytical observational study design that explore the difference between two different cohorts on an outcome, differentiated by their exposure status. Despite being observational in nature, they are often included in systematic reviews of effectiveness, particularly when randomized controlled trials are limited or not feasible. Like all studies included in a systematic review, cohort studies must undergo a critical appraisal process to assess the extent to which a study has considered potential bias in its design, conduct, or analysis. Critical appraisal tools facilitate this evaluation. This paper introduces the revised critical appraisal tool for cohort studies, completed by the JBI Effectiveness Methodology Group (EMG), who are currently revising the suite of JBI critical appraisal tools for quantitative study designs. The revised tool responds to updates in methodological guidance from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group and reporting guidance from PRISMA 2020, providing a robust framework for evaluating risk of bias in a cohort study. Transparent and rigorous assessment using this tool will assist reviewers in understanding the validity and relevance of the results and conclusions drawn from a systematic review that includes cohort studies. This may contribute to better evidence-based decision-making in health care. This paper discusses the key changes made to the tool, justifications for these changes, and provides practical guidance on how this tool should be interpreted and applied by systematic reviewers.

Evidence-Based Practice Quality Improvement Critical Appraisal Tool.

Optimal quality improvement in health care is based on research and other types of evidence. Critical appraisal of evidence is a fundamental component of evidence-based practice (EBP) and is also needed to evaluate the quality of quality improvement (QI) projects. Currently available EBP or QI critical appraisal tools can be challenging for students learning the critical appraisal process and for practicing clinicians who desire access to a standardized EBPQI approach to inform health care decision-making. The currently available tools are incomplete, too brief, or too complicated for ease of use in education and practice. This article introduces the first combined EBP and QI (EBPQI) critical appraisal tool, which is aligned with the new EBPQI mountain model. This newly developed appraisal tool may be used in appraising evidence for an EBPQI initiative and to appraise the quality of disseminated EBPQI.

Psychopathological and Organic Features of Atypical Anorexia Nervosa in Developmental Age: A Systematic Review.

This study aimed to comprehensively report the epidemiological and clinical features of atypical anorexia nervosa (AAN) in children and adolescents. In May 2024, a systematic review was performed using Medline, Cochrane Library, ClinicalTrials.gov, and relevant websites. Following PRISMA guidelines, 234 articles were screened for studies on DSM-5-defined AAN. A standardized checklist-the JBI critical appraisal tool-was adopted in assessing methodology, and 13 retained studies passed the screening and critical appraisal process for the final review. The Newcastle-Ottawa Scale was utilized to assess the risk of bias in cohort and case-control studies, ensuring a comprehensive evaluation of methodological quality. AAN prevalence in young age groups is 2.8%, with a cumulative 2.8% incidence over 8 years. Incidence is 366 per 100,000 person-years, and the average episode duration is 11.6 months, with a 71% remission rate. Diagnostic persistence for AAN is less stable than other restrictive feeding and eating disorders (FEDs). AAN individuals exhibit higher EDE-Q scores, more severe distress, and distinct BMI differences compared to those with anorexia nervosa and controls. The diagnostic transition from the DSM-IV to the DSM-5 shows that AAN patients are predominantly female, slightly older, and with higher weight. This study yields concrete insights into the features of AAN in the developmental age, highlighting demographic variations, clinical presentations, and treatment outcomes. Recognizing the unique challenges faced by AAN individuals is vital for tailoring effective interventions and improving overall care within the FED spectrum.

Dissecting Through the Literature: A Review of the Critical Appraisal Process.

Critical appraisal is a crucial step in evidence-based practice, enabling researchers to evaluate the credibility and applicability of research findings. Healthcare professionals are encouraged to cultivate critical appraisal skills to assess the trustworthiness and value of available evidence. This process involves scrutinizing key components of a research publication, understanding the strengths and weaknesses of the study, and assessing its relevance to a specific context. It is essential for researchers to become familiar with the core elements of a research article and utilize key questions and guidelines to rigorously assess a study. This paper aims to provide an overview of the critical appraisal process. By understanding the main points of critical appraisal, researchers can assess the quality, relevance, and reliability of articles, thereby enhancing the validity of their findings and decision-making processes.

Application and impact assessment of an interactive journal club format among endocrinology fellows-in-training in a tertiary hospital academic center: a case study.

Background: The interactive journal club is designed to utilize a new approach in appraising research in order to maximize the benefits of the traditional journal club. In this new approach, the participants are actively involved in a structured process of critical data appraisal rather than just being passive listeners. In this case study, we applied the interactive journal club format and assessed its impact among our endocrinology fellows-in-training. Methods: We conducted four interactive journal club sessions within a four-week span, one per each week via a virtual platform. The 12 participants were the same throughout all sessions. Each session was recorded following informed consent. At the end of all sessions, feedback was obtained, tabulated and compared. Results: Sessions lasted from 59 to 83 minutes (mean, 67.75 minutes). Participants became more active and spontaneous as the sessions progressed. All participants found the format more fun and proactive. This approach allowed more critical thinking and processing of information. Salient features include increased self-esteem and confidence, additional learning from other participants, better retention of information, and utilization in future practice. Conclusions: Traditional approaches are transformed from passive presentations of recent developments in medicine into an interactive discussion while allowing the retention of the spirit and essence of a traditional journal club, as well as exploring new and improved approaches in clinical training and education.

Step 3: Critically Appraising Evidence: Case-Control Studies.

Critical appraisal of the evidence is the Step 3 in the evidence-based practice (EBP) process. This column, the fourth in a multipart series to describe the critical appraisal process, focuses on the critical appraisal of a case-control study.

The effect of periapical lesion size on the success rate of different endodontic treatments: a systematic review and meta-analysis

This systematic review evaluated the effect of periapical lesion (PL) size on the success rate of different endodontic treatments, including root canal treatment (RCT), non-surgical retreatment (NSR), and apical surgery (AS). Cohorts and randomized controlled trials investigating the outcomes of endodontic treatment of permanent teeth with PL and its size were identified electronically through Web of Science, MEDLINE, Scopus, and Embase databases. Two reviewers independently conducted the study selection, data extraction, and critical appraisal process. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale and the 11-item Critical Appraisal Skills Program checklist for randomized controlled trials. The success rates of the endodontic treatments (small lesions and large lesions) were estimated using the rate ratios (RRs) with an associated 95% confidence interval (CI). Out of 44 included studies, 42 were cohort, and 2 were randomized controlled trials. Thirty-two studies had poor quality. For the meta-analysis, five studies in RCT, 4 in NSR, and 3 in AS were considered. The RR of the endodontic treatment success in PLs was 1.04 in RCT (95% CI, 0.99-1.07), 1.11 in NSR (95% CI, 0.99-1.24), and 1.06 in AS (95% CI, 0.97-1.16). Only sub-group analysis of long-term follow-up of RCT showed a significantly higher success rate in small lesions than in large lesions. Considering the quality of studies and variation in outcomes and size classification, our meta-analysis demonstrated that the PL size had no significant effect on the success rate of different endodontic treatments.

Step 3: Critically Appraising Evidence: Systematic Review or Metasynthesis of Qualitative Studies.

Critical appraisal of the evidence is the third step in the evidence-based practice (EBP) process. Many questions in nursing cannot be answered using quantitative methods. We often desire a better understanding of people's lived experiences. In the NICU, these questions may be related to the experiences of families or staff. Qualitative research can provide a deeper understanding of lived experiences. This column, the fifth in a multipart series describing the critical appraisal process focuses on the critical appraisal of a systematic review of qualitative studies.

Critically Appraising Evidence, Step 3: Quantitative Evidence—Quasi-Experimental or Nonrandomized Experimental Studies

Critical appraisal of the evidence is the third step in the evidence-based practice process. This column, the third in a multipart series to describe the critical appraisal process, focuses on critical appraisal of quasi-experimental or nonrandomized experimental studies.

Health literacy and self-management in people with coronary heart disease: a systematic review protocol.

The objective of the review is to assess the association between health literacy levels and self-management behaviors in people with coronary heart disease. Initiating and maintaining self-management behaviors following a coronary event can be challenging. The capacity to initiate behavioral changes requires adequate health literacy, which is the ability to understand and use health care information to make appropriate health decisions. This review will consider studies including individuals at any age who have been diagnosed with coronary heart disease. Studies that used a standardized measure of health literacy with the primary outcome of self-management behaviors or an element of self-management (eg, medication adherence) will be considered for inclusion. The review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases to be searched include CINAHL, Embase, PubMed, APA PsycINFO, Cochrane, Scopus, ScienceDirect, ProQuest Dissertations and Theses, Google Scholar, and OpenGrey. This will be followed by a forward and backward search of relevant articles. Cross-sectional, case-control, cohort, and mixed methods studies (quantitative component only) will be included. Studies will be screened by 2 independent reviewers and undergo a critical appraisal process. Included studies will be assessed for methodological quality, and data will be extracted using a JBI data extraction tool in the JBI System for the Unified Management, Assessment and Review of Information. The results will be presented as a narrative synthesis and, where possible, a meta-analysis will be conducted. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to assess the certainty of evidence. PROSPERO CRD42021257407.

Non pharmacological therapy for anxiety of a child with cancer During chemotherapy : Literatur Review

Anxiety in cancer patients is a psychological disorder caused because the patient faces uncertainty, worry about the effects of cancer treatment, and fear of the development of cancer resulting in death. A child's response to anxiety is varied, influenced by various factors such as the child's developmental age, gender, length of treatment, and previous experiences of pain. Non-pharmacological therapy is a treatment therapy without the use of drugs. Non-pharmacological therapy has significant benefits for reducing a wide range of side effects of chemotherapy including, anemia, thrombocytopenia, leucopenia, nausea, vomiting, alopecia, stomatitis, reactionallergy, neurotoxic, and extravasation. The main focus of this review literature is nonpharmacological therapy for anxiety of children with cancer During chemotherapy. To optimize this interpretation, researchers used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guide. From the Google Scholar database found a number of journals a total of 20 results, PubMed found 10, Science Direct 22. Then, the literature is screened whether it is in accordance with the inclusion criteria that have been set in this study. At the final stage only five journals were used for the synthesis process. All five articles are of such good quality that no one is eliminated from the critical appraisal process. Non-pharmacological therapies have significant benefits for reducing various side effects of chemotherapy including anemia, thrombocytopenia, leukopenia, nausea, vomiting, alopecia, stomatitis, allergic reactions, neurotoxicity, and extravasation. Various interventions such as music, autogenic exercises, mindfullnes programs, virtual reality, guided imagery and progressive muscle exercises are considered necessary to be applied in Indonesia.

Prevalence of Eating Disorders and Disordered Eating Attitudes in Students in Arab Countries: A Scoping Review

Anorexia nervosa, bulimia nervosa, and binge-eating disorder represent the specific eating disorders. Although eating disorders (EDs) are a rare psychiatric problem globally, millions of people are exposed to severe health consequences including impairments in health, psychosocial functioning, and quality of life. Young people and adolescents, particularly females, are associated with a higher rate of disordered eating attitudes and EDs than the general population. The aim of this scoping review was to provide an overview or map of ED and disordered eating attitude prevalence in students in Arab countries, both female and male, and to identify contributing factors. Arksey and O’Malley’s six-stage framework for scoping reviews was used to guide the process, which returned a total of 20 relevant articles covering 12 of the 22 member countries in the League of Arab States. The average prevalence of ED was 31.4% in a sample of 17,679 students aged 12-33, with a range from 9.6% to 74.5%. Prevalence was higher in female students compared to male students, and the key contributing factors included age, gender, BMI, eating habits, and academic attainment. Given the limitations of this scoping review, especially the lack of a formal critical appraisal process for the included articles, future systematic reviews can use it as a baseline, while empirical researchers and policymakers might pursue its preliminary conclusions.

Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol

IntroductionPeople with fetal alcohol spectrum disorder (FASD) encounter a range of health and allied health providers and require specialised support to ensure health services are provided safely and effectively. Not...

Bell's Palsy and COVID-19 Vaccination: A Systematic Review.

Background: Bell's palsy is a rare adverse event reported in COVID-19 vaccines. Given the importance of neurological manifestations, the necessity to highlight and scrutinize the incidence of them following COVID-19 vaccination is needed. This study aimed to systematically review the reported cases of Bell's palsy following vaccination against COVID-19. Methods: This systematic review is conducted based on the Cochrane Collaboration Handbook and PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and using the Joanna Briggs Institute (JBI) methodology for systematic reviews. The inclusion criteria for the included published studies were patient age ≥18 years, history of Bell's palsy after COVID-19 vaccination and established diagnosis in the patients with COVID-19 vaccination. The exclusion criteria were repeated cases and missing clinical information. The search strategy aimed to find both published and unpublished studies in August 2021 and updated by hand searching in May 2022 using the identified keywords and index terms in Cochrane Library, MEDLINE (PubMed), Web of Science, Scopus, ProQuest, and Google scholar. Finally, the reference lists of all identified reports and articles were searched for additional studies. The JBI critical appraisal tools for case reports or case series were used to assess the risk of bias in the included studies. Results: During the electronic search, hand search, and reference check, we identified 1281 citations, and in hand searching, we detected additional 15 studies. After omitting duplicated citations and assessing the title, abstract, and full text 15 case-report and two case-series studies were included for the critical appraisal process and were included in this study. Pfizer and Moderna vaccines were the most common vaccines among articles that reported the cases of Bell’s palsy. Left-sided paralysis was more common than right-sided paralysis. The interval between receiving the vaccine and the onset of facial weakness was between 1 and 48 days. Conclusion: Further studies with larger sample sizes are necessary to assess the association between Bell's palsy and the dose-response of the COVID-19 vaccine.

Step 3, Critically Appraising Evidence: Quantitative Evidence-Randomized Controlled Trials.

Critical appraisal of the evidence is the third step in the evidence-based practice process. This column, the third in a multipart series to describe the critical appraisal process, focuses on critical appraisal of randomized control trials.

A Proposal of Revised Curriculum to Circumvent the Impact of COVID Restrictions on Final Year Medical Students

Medical education has been extraordinarily disrupted during the COVID-19 era worldwide. The pandemic limited routine ward or patient-based medical education. These limitations have resulted in new challenges for medical students, especially the final year students in completing their mandated curriculum. We are suggesting a revised curriculum for final year medical students, by following which we can address COVID restriction while making sure all competencies have been achieved by students. This revised curriculum centers around the usual placement of students in Surgical Assessment Unit (SAU), however all students will be posted in simulation wards/labs on their turn to enhance and consolidate their understanding and learning of common surgical cases in these wards, so that they can replicate these skills in SAU and wards on their turns. This article highlights how the proposed curriculum addresses the learning needs of final year medical students in their surgery rotation. The article will also summarize the critical appraisal process of our curriculum in the context of curriculum design theories. Finally, the article will highlight the quality assurance measures adhered to while developing the curriculum.

Readiness of Application of Electronic Medical Records in Health Services (Literature Study)

Background: Information and Communication Technology is advancing rapidly and has a major impact on all life, especially in the health sector, especially medical records. This is manifested in the Electronic Medical Record (EMR), which has now been further developed into an Electronic Health Record (EHR). This technology is used to replace or complement paper medical records. The purpose of this literature study is to determine the readiness to apply electronic medical records in health services.Methods: This study uses a literature study obtained from searching scientific research articles from the 2010–2020 range. Keywords used in this study is readiness and DOQ-IT. The database used comes from Google Sholar, Garuda, Neliti, and One Search. The search found 130 articles, then a critical appraisal process was carried out to produce 10 suitable manuscripts.Results: Various literatures found that the readiness to apply electronic medical records using the DOQ-IT method was influencedby 4 factors including the readiness of human resources, orgnizational culture, insfrastructure, and leadership governance. It can be concluded that the readiness for the application of electronic medical recors in health services with the very ready category is 30%, the moderately ready category is 50%, then the unready category is 20%.Conclusions: From the discussion above, it can be concluded that EMR readiness in health services is categorized as quite ready (50%), very ready (30%), and not ready (20%).

The good, the bad, and the less than ideal in clinical supervision: a qualitative meta-analysis of supervisee experiences

ABSTRACT . With qualitative studies increasingly published on different aspects of supervision, this qualitative meta-analysis synthesized existing qualitative research and explored what aspects therapy trainees find helpful and unhelpful in individual supervision. A sample of 29 studies (755 participants) was selected by conducting a systematic literature search and a critical appraisal process to ensure a suitable level of methodological rigor. Data analysis followed a descriptive and interpretative framework. Results yielded 6 main meta-categories: three in the helpful aspects domain (i) Supervisor establishes a secure learning environment, (ii) Supervisor demonstrates ability to facilitate learning, and (iii) Supervisor demonstrates willingness and ability to acknowledge and negotiate differences; and three in the unhelpful aspects domain (i) Supervisor demonstrates behaviour that lacks sensitivity, accountability, and ethical consideration, (ii) Supervisor fails to create a safe and supportive environment, and (iii) Supervisor demonstrates limitations in the appropriate maintenance and sharing of knowledge and skills. Influenced by the quality of the supervisory alliance, supervision can be helpful, but it may also be experienced as unhelpful and potentially harmful. Issues of power and diversity need to be negotiated in a manner that maintains ethical and professional standards of practice and care. Implications for supervision training, practice, and research are discussed.

Step 3, Critically Appraising Evidence: Quantitative Evidence-Systematic Reviews or Meta-Analyses.

Critical appraisal of the evidence is the third step in the evidence-based practice process. This column, the second in a multipart series to describe the critical appraisal process, focuses on critical appraisal of systematic reviews or meta-analyses of randomized controlled trials.