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Alison Day Lead Librarian alison.day@poole.nhs.uk

Alison Day Lead Librarian alison.day@poole.nhs.uk. 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

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Alison Day Lead Librarian alison.day@poole.nhs.uk

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  1. Alison Day Lead Librarian alison.day@poole.nhs.uk Grand Round Introduction to Critical Appraisal 20th March 2014

  2. What is Critical Appraisal? Weighing up evidence to see how useful it is in decision making

  3. Evidence Based Practice

  4. 5 steps of EBP • Question • Evidence • Critical Appraisal • Application • Implementation and monitoring

  5. 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

  6. Framework to In a man with depressive symptoms… …Is cognitive behavioural therapy… …compared with fluoxetine… …better at improving depressive symptoms? Patient/Problem Intervention Comparison Outcome

  7. Alternative frameworks ECLIPSE, Wildridge & Bell (2002) Expectation, Client group, Location, Impact, Professionals, Service, Evaluation • SPICE, Booth (2004) Setting, Perspective, Intervention, Comparison, Outcomes

  8. 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

  9. Great you have identified some abstracts of “best evidence” research articles what next...

  10. Step 3 • Validity: How trustworthy is it as a piece of research? • Results: What is it telling us? • Relevance: How useful will the research be to my situation (to my patients)

  11. 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

  12. 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?

  13. Levels of Evidence Pyramid From Evidence Based Nursing website http://ebp.lib.uic.edu/nursing/node/12

  14. Quantitative or qualitative? Quantitative - numerical data • Methods used include Randomised Controlled Trials (RCTs) Cohort studies Case control studies Case series

  15. Qualitative • Examines people’s opinions, beliefs, experiences and behaviour. • Methods used include • Focus groups • Interviews • Observation

  16. 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

  17. Systematic Reviews • A thorough search • Synthesised and summarised • Meta-analysis

  18. Homework http://www.nutritionandmetabolism.com/content/pdf/1743-7075-3-2.pdf

  19. http://www.casp-uk.net/wp-content/uploads/2011/11/CASP-Systematic-Review-Checklist-31.05.13.pdfhttp://www.casp-uk.net/wp-content/uploads/2011/11/CASP-Systematic-Review-Checklist-31.05.13.pdf

  20. 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

  21. Archie Cochrane, British epidemiologist 1992 set up the Cochrane Collaboration International organisation producing and disseminating systematic reviews of healthcare interventions

  22. 6 databases in one • Keyword or MeSH search • Combine search terms • Detailed abstracts or full text to see the meta-analysis • Plain language summaries

  23. “Practice doesn't make perfect. Practice reduces the imperfection.” ― Toba Beta, Master of Stupidity

  24. 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 library@poole.nhs.uk

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