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Year : 2021  |  Volume : 33  |  Issue : 2  |  Page : 217-218

Are we missing out on critically appraised topics in ophthalmology journals?

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission22-Nov-2020
Date of Decision25-Dec-2020
Date of Acceptance25-Dec-2020
Date of Web Publication05-Jul-2021

Correspondence Address:
Kiana Hassanpour
Ophthalmic Research Center, Paidarfard St., Boostan 9 St., Pasdaran, Tehran 16666
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joco.joco_199_20

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How to cite this article:
Hassanpour K, Ahmadieh H. Are we missing out on critically appraised topics in ophthalmology journals?. J Curr Ophthalmol 2021;33:217-8

How to cite this URL:
Hassanpour K, Ahmadieh H. Are we missing out on critically appraised topics in ophthalmology journals?. J Curr Ophthalmol [serial online] 2021 [cited 2021 Oct 21];33:217-8. Available from: http://www.jcurrophthalmol.org/text.asp?2021/33/2/217/320696

Dear Editor,

Since the introduction of evidence-based medicine (EBM) in 1992,[1] it has gradually become an inseparable part of the scientific literature. The ultimate goal of EBM is the incorporation of well-designed, high-quality studies into routine clinical practice. Evidence-based practice (EBP), the idea of clinical decision-making based on scientific evidence rather than heuristics, personal experience, and tradition, requires tools on the ground of daily practice. Critically appraised topics (CATs), first introduced in 1998, are one of the tools used to implement EBM into clinical practice.

Conducting a CAT starts from a real clinical scenario. The question is constructed using the Patient, Intervention, Comparison, Outcome (PICO) acronym. Validated databases including Medline and Embase are thoroughly searched in the next phase. The retrieved results are then critically appraised based on scientific thinking. Predesigned checklists can be used at this step. The results of critical appraisal are presented as a summarized piece of evidence in the bottom line, with more details available in the discussion. The positive effects of CAT on enhancing EBP have already been reported.[2]

CATs share common features with systematic reviews and critically appraised papers, including question formation, systematic assessment of evidence, quality assessment of publications, and a conclusion based on the best available evidence. Systematic reviews are based on data obtained from high-quality publications, particularly meta-analyses, which are usually available on certain topics backed by considerable research and randomized controlled trials, in particular. At the same time, there are numerous important issues that deserve to be critically appraised, despite the lack of high-quality papers. This is the gap CATs are targeted to fill. On the other hand, conduction of systematic reviews is time-consuming, and they also need to be critically appraised. Therefore, we think that CATs can be used in parallel with systematic reviews in medical journals.

To provide an example, after visiting a patient with a history of corneal graft experiencing a severe episode of graft rejection, the question is developed: Does this patient benefit from other routes of steroid therapy? After literature review, there exists no systematic review to answer this question with high-quality evidence. At this stage, an ophthalmologist can conduct a CAT. The PICO question can be constructed as follows:

  • Patients with corneal graft rejection, “P”
  • Intravenous pulse therapy or subtenon injections, or oral corticosteroid, “I”
  • In comparison to topical corticosteroid alone, “C”
  • Improving the success, “O.”

After PICO development, the literature should be searched in a repeatable method. The retrieved articles should be critically appraised, and finally, the answer to the PICO should be written as a conclusion. We suggest that if this process is published as a type of paper, the other clinicians can use them upon encountering the same clinical question. On the other hand, CATs can be conducted using existed systematic reviews after their critical appraisal or when there is more than one systematic review for one specific clinical question.

Regarding the present status of CATs in ophthalmology, we came across only one topic published in a neurology journal.[3] In a survey investigating the use of EBP, only 26% of all respondents used a CAT report as an assessment method.[4] There are some ophthalmology topics in the Agency for Healthcare Research and Quality, an American platform intended to improve health system quality; however, these topics mostly focus on health system research.[5] Several controversial issues surround daily practice in medical ophthalmology such as the prophylactic use of antibiotics intra or postoperatively, steroids, or erythropoietin administration for treatment of optic neuropathies, steroid use in corneal infections, and anti-vascular endothelial growth factor dosing and timing in vascular retinopathies. This high amount of controversial topics prompted us to propose the application of CATs in conjunction with systematic reviews in the field of ophthalmology. More specifically, we think that the allocation of a space in ophthalmology journals to CATs, as it is occurring in other specialties,[6] can enhance EBP in ophthalmology.

We acknowledge that CATs were first used for local journal clubs. Therefore, they might be ranked lower than systematic reviews in terms of their research value; however, publishing CATs can provide a platform among specialized ophthalmology journals, with the ultimate goal of clarifying gaps in medical knowledge and filling them with the best available evidence.

  References Top

Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-5.  Back to cited text no. 1
White S, Raghavendra P, McAllister S. Letting the CAT out of the bag: Contribution of critically appraised topics to evidence-based practice. Evid Based Commun Assess Interv 2017;11:27-37.  Back to cited text no. 2
Dumitrascu OM, Shen JF, Kurli M, Aguilar MI, Marks LA, Demaerschalk BM, et al. Is intravenous thrombolysis safe and effective in central retinal artery occlusion? A critically appraised topic. Neurologist 2017;22:153-6.  Back to cited text no. 3
MacDonald KA, Hrynchak PK, Spafford MM. Evidence-based practice instruction by faculty members and librarians in North American optometry and ophthalmology programs. J Med Libr Assoc 2014;102:210-5.  Back to cited text no. 4
EPC Evidence-Based Reports. Content Last Reviewed in September 2020. Rockville, MD: Agency for Healthcare Research and Quality.  Back to cited text no. 5
Sladden M. Critically appraised topics in the British Journal of Dermatology. Br J Dermatol 2014;171:910.  Back to cited text no. 6


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