alison day lead librarian [email protected]
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Alison Day Lead Librarian [email protected]. Grand Round Introduction to Critical Appraisal 20 th 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. Question Evidence - PowerPoint PPT PresentationTRANSCRIPT
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
Intervention
Comparison
Outcome
In a man with depressive symptoms…
…Is cognitive behavioural therapy…
…compared with fluoxetine…
…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 includeRandomised Controlled Trials (RCTs)Cohort studiesCase control studiesCase 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 RCTshttp://www.cebm.net
• A thorough search
• Synthesised and summarised
• Meta-analysis
Systematic Reviews
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 abstractswww.thecochranelibrary.com• Summaries in Bandolierwww.medicine.ox.ac.uk/bandolier• Critique of media stories in Behind the Headlineswww.nhs.uk/News/Pages/NewsArticles.aspx
1992 set up the Cochrane Collaboration International organisation producing and disseminating systematic reviews of healthcare interventions
Archie Cochrane, British epidemiologist
• 6 databases in one
• Keyword or MeSH search
• Combine search terms
• Detailed abstracts or full text to see the meta-analysis
• Plain language summaries
“Practice doesn't make perfect.Practice reduces the imperfection.” ― Toba Beta, Master of Stupidity
•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]
Want to know more?