Critical Appraisal : The Librarian’s Role Andrew Booth and Louise Falzon

What is critical appraisal? Weighing up evidence to assess: its validity (closeness to the truth) its usefulness (clinical applicability). Sackett and Haynes, 1995 FIND  APPRAISE  ACT

Can librarians get involved? Resource provider Evidence locator Appraiser Digest Producer Appraisal Tutor

Some familiar roles Resource provider –Critical appraisal tools –Critically appraised resources Evidence locator –Search skills –Search filters Appraiser? Digest producer?

Appraisal continuum Searching filtering digests appraising teaching appraisal

Why should librarians get involved? Extends and demonstrates existing skills. Other information sectors do it. Area of research expertise Value-added service Improved profile/prestige

How are we getting involved today......Producing an evidence digest

Critically appraised resources Systematic reviews –telling the full story –e.g. Cochrane Library, NHS CRD, NHS HTA Guidelines –implementing the full story –SIGN, DEC, AHRQ, NIH Digests of evidence –giving a pointer in the right direction

Evidence-Based Digests Study based NHS CRD DARE NHS CRD NHS EED EB Journals Best Evidence Topic based ARIF Clinical Evidence Jnl of Clinical Excellence Evidence Matters

Aims To define a clinically relevant topic To draw together a body of relevant evidence To identify key messages from the best available evidence

Key messages Structured format Indicative title One line summaries Levels of evidence and grades of recommendation

This afternoon’s workshop Producing a JCE style topic-based digest Format and content Techniques Over to you!

Format Why important? –Relevance of topic, ‘burden of disease’ (to health service, society, individual), incidence and prevalence, key issues What is required? –Nature of the intervention Cost –Cost consequences of implementation

Format (cont.) Who is involved –Identification of interested parties Evidence –Key messages –Quality References –Of all sources consulted

Techniques Match evidence to message –Background = stats, official publications –Effectiveness = RCTs, systematic reviews Authorise messages –Consider context –Keep wording from original source –Refer to source

Techniques (cont.) Keep it brief –Use ‘bullet points’ –Break down complex ideas Make a start –Statements can be developed - or replaced by better statements!

Over to you... Support for Breastfeeding mothers Why important? What is required? Cost consequences Interested parties Evidence of effectiveness References (Author, year, study type)

You have to help you... Search results Examples of JCE digests Facilitators Pens, paper, overheads Time!

Resources for Producing Digests

Matching the evidence Background Clinical effectiveness Cost effectiveness

Background Official publications –Government and professional bodies Statistics –StatBase, WHO ‘Burden of disease’ to individual, health service and society –Cohort studies

Clinical Effectiveness Sources of systematic reviews, guidelines and digests TRIP database SumSearch PubMed Clinical queries Medline filters

Cost effectiveness NHS CRD NHS EED and HTA INAHTA Clearing House Health Economics research units –University of York CHE links page Medline filter