Transcript Introduction to Critical Appraisal

Alison Day
Lead Librarian
[email protected]
Grand Round
Introduction to Critical Appraisal
20th March 2014
What is Critical Appraisal?
Weighing up evidence to see how useful it is in decision making
Evidence Based Practice
5 steps of EBP
1. Question
2. Evidence
3. Critical Appraisal
4. Application
5. Implementation and monitoring
Step 1 – The Question
Broad questions are easy to understand e.g. What is
the best treatment for depression? But return too
many search results
Framework to
Patient/Problem
In a man with depressive
symptoms…
Intervention
…Is cognitive behavioural therapy…
Comparison
…compared with fluoxetine…
Outcome
…better at improving depressive
symptoms?
Alternative frameworks
ECLIPSE, Wildridge & Bell (2002)
Expectation, Client group,
Location, Impact, Professionals,
Service, Evaluation
• SPICE, Booth (2004) Setting,
Perspective, Intervention,
Comparison, Outcomes
Step 2
• Choose a database
• Broaden your search with thesaurus
terms
• Use boolean operators (+ OR NOT)to
combine terms together
• Use clinical query limits to locate best
evidence
Great you have identified
some abstracts of “best
evidence” research
articles what next...
Step 3
1. Validity: How trustworthy is it as a piece
of research?
2. Results: What is it telling us?
3. Relevance: How useful will the research
be to my situation (to my patients)
First steps
• Title: Focus. Does it clearly indicate what it is about?
• Authors: Credibility. What are their qualifications,
experience, affiliations?
• Abstract: Summary.
Does it give a clear overview? Does it look relevant to
your practice?
Is it worth reading?
If NOT then STOP
From Portsmouth NHS Library Services Quick Guide to Critical Appraisal.
http://www.porthosp.nhs.uk/Library-Downloads/Guides/CriticalAppraisal2012.pdf
Next step…
• Assess the kind of study /research you are
looking at
• Use the most appropriate tool/checklist to help
you ask the right questions
Is the study valid?
What are the results?
Will the results help locally?
Levels of Evidence Pyramid
From Evidence Based Nursing website
http://ebp.lib.uic.edu/nursing/node/12
Quantitative or qualitative?
Quantitative - numerical
data
Methods used include
Randomised Controlled Trials (RCTs)
Cohort studies
Case control studies
Case series
Qualitative
• Examines people’s opinions, beliefs,
experiences and behaviour.
– Methods used include
• Focus groups
• Interviews
• Observation
Which checklist?
Annotated checklists for reviews, RCTS,
qualitative studies and more
http://www.casp-uk.net
CEBM Oxford checklists for reviews
and RCTs
http://www.cebm.net
Systematic Reviews
• A thorough search
• Synthesised and
summarised
• Meta-analysis
Homework
http://www.nutritionandmetabolism.com/content/pdf/1743-7075-3-2.pdf
http://www.casp-uk.net/wp-content/uploads/2011/11/CASP-Systematic-Review-Checklist-31.05.13.pdf
Ready-made critical appraisal
• Reviews in Clinical Evidence
www.clinicalevidence.org
• Cochrane reviews and DARE abstracts
www.thecochranelibrary.com
• Summaries in Bandolier
www.medicine.ox.ac.uk/bandolier
• Critique of media stories in Behind the Headlines
www.nhs.uk/News/Pages/NewsArticles.aspx
Archie Cochrane,
British epidemiologist
1992 set up the Cochrane Collaboration
International organisation producing and
disseminating systematic reviews of healthcare
interventions
• 6 databases in one
• Keyword or MeSH search
• Combine search terms
• Detailed abstracts or full text to see the metaanalysis
• Plain language summaries
“Practice doesn't make perfect.
Practice reduces the imperfection.”
― Toba Beta, Master of Stupidity
Want to know more?
• Check out www.swims.nhs.uk for details of books
about CA
• View the library blog to link to resources
http://eastdorsetnhslibrary.wordpress.com
• For help with searching or facilitation of a journal
club/CA ask a librarian [email protected]