1. Alison Day
Lead Librarian
Grand Round
Introduction to Critical Appraisal
20th March 2014

2. What is Critical Appraisal?
It is about weighing up whether the research evidence is robust and relevant to your situation (for drs this could mean relevance of recommending a particular treatment, for managers it could mean if introducing a service change is appropriate, for librarians it could mean the adoption of different training approaches or resources)
It is not: finding fault, inaccuracies or finding the problems with a piece of research, however this may be part of the process.
Think “critique”
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 Patient/Problem Intervention Comparison Outcome
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
Initial critical appraisal as we would do for any source including information from the internet – e.g. HON standards
From Portsmouth NHS Library Services Quick Guide to Critical Appraisal.

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
Quality and quantity of main research designs. Gold standard is a systematic review – plus a cherry if it is a Cochrane review.
For more information describing features of different research study designs see Gosall(2012)
From Evidence Based Nursing website

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
CEBM Oxford checklists for reviews and RCTs

17. Systematic Reviews A thorough search Synthesised and summarised
Meta-analysis
For definitions and descriptions of features of other research study designs please see Gosall(2012)

18. Homework

24. Ready-made critical appraisal
Reviews in Clinical Evidence
Cochrane reviews and DARE abstracts
Summaries in Bandolier
Critique of media stories in Behind the Headlines
Good critical appraisal can take a long time so there are some sources that have done the hard work for you

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

26. 6 databases in one
Keyword or MeSH search
Combine search terms
Detailed abstracts or full text to see the meta-analysis
Plain language summaries

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

28. Want to know more?
Check out for details of books about CA
View the library blog to link to resources
For help with searching or facilitation of a journal club/CA ask a librarian