Critical reading made easy: effectiveness and experience
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Transcript of Critical reading made easy: effectiveness and experience
Critical Reading Made Easy:effectiveness and experience
Linda Ward
Clinical Librarian / Deputy Librarian
Education Centre Library
Leicester General Hospital
Presentation outline
Format and content of Critical Reading Made Easy (CRME)
Librarian CPD Who has participated Evaluation & Future plans The evidence base Opportunities for librarians
CRME: format Workshops
A series of six workshops introducing research methods and tools to help appraise:Clinical Trials, Systematic Reviews, Qualitative studies, (CASP)Guidelines (AGREE), Patient information (DISCERN)
Overviews Research methods and introduction to CASP
One : One
CRME: content
Research methods and levels of evidence
The Checklists
The questions
The article
Primary Research
Experimental
observational
SecondaryResearch
For qualitative studies? No consensus about the relative rigour of different methods
Levels of evidence
Systematic reviews &
Meta-analyses
Randomised controlled trials
Cohort studies
Case control studies
Case series and case reports
For quantitative studies
Judging the quality of research
JAMA articles http://www.cche.net/user
Checklists e.g. CASP
A framework for thinking about the quality of research
NHS Critical Appraisal Skills Programme
http://www.phru.nhs.uk/casp/appraisa.htm
Three questions
Valid?Is the methodology appropriate to answer the question.
Is it carried out in a sound way, eliminating bias and confounding?
Reliable?Are the results real or because of chance?Introducing / revisiting probability or p-values and confidence intervals. Interpretation of odds ratio diagrams
Applicable?Will the results help locally?
Librarian CPD ScHARR training Personal research & interest
leading to pre-2002 sessions (RCTs & Systematic reviews)
CASPfest & CASP workshops e.g. Training the Trainer
Sheffield Evidence Appraisals From ShEBaNg (ShEAFS) http://www.shef.ac.uk/~scharr/ir/sheafs/
CASP training week MSC Health Services Research
Who has participated? Workshop programme
Approximately 100 staff since 2002, representing a range of clinical specialties, health professions and organisations
Overview sessions presented to:Neonatal postgraduate teaching programmeO&G research and evidence programmeMedical house officer teaching programmeNeonatal Unit multidisciplinary Journal Club Staff in genetics, family planning, surgery, renal nursing and mental health pharmacy
Evaluation 1 Evaluation following sessions
has been very positive “Excellent and interesting, even for a beginner like myself”“A very helpful ‘revisiting’”“Came away learning lots”“Now understand confidence intervals”“Made trials understandable”
Supporting workplace research, education and clinical practice
Generated ideas for qualitative research proposalSupported staff doing research modulesevaluating RCTs e.g. of escitalopram vs citalopram for major depression – mental health pharmamcist
Future developments LEicestershire Appraisal Forum (LEAF)
Regular group to evaluate locally relevant research and develop appraisal skills
LEicestershire Appraisal Forum Locally Appraised Topics (LEAFLETs)Appraisal summaries on the Intranet as an educational / EBM tool.
Evaluation 2 Recent questionnaire to workshop attendees
2002-2004: Response rate 15% (12/82)
Overall very positive views of sessions A majority have used CASP or similar checklists since Most report being ‘fairly confident’ in appraisal skills A majority would make time to attend the proposed
LEAF and could see value in LEAFLETs. Of those who couldn’t attend, barriers were time & geography.
Basis to take the LEAF forward
The evidence base
Systematic review of critical appraisal teachingParkes et al. 2001. A cautious “Critical appraisal teaching has a positive affect on participants’ knowledge” Generalisable?
“Highlighted the poor evidence in this area but it is not evidence for stopping critical appraisal teaching”
Skills, attitudes and behaviour?The holy grail: impact on patient care
Opportunities for librarians 1 Start small Work in partnership with clinical staff - sharing
knowledge and skills CASP checklists are new to most Don’t assume participants have high levels of
knowledge. Be adaptable Have a good stats dictionary handy Put statistics in their place
Opportunities for librarians 2 Marketing
Individual email effective but no longer possible Intranet Posters / flyers Word of mouth
Structured postgraduate teaching
Journal clubs
Opportunities for librarians 3
Demand for support in other related areas e.g. SPSS
Endnote / Reference Manager
Care needed not to overstretch ourselves
But librarians need to develop their roles, not least because of national developments e.g. NLH, NCC, e-journals & document delivery
Useful references Critical Appraisal Skills Programme. Evidence-based health care: an open learning resource for
health care practitioners. Oxford. CASP, 2002.
Critical Appraisal Skills Programme. Evidence-based health care workbook: including the Evidence-based Health Care CD-ROM. Oxford. CASP and HCLU, 1999.
Crombie, Iain K. The pocket guide to critical appraisal. London; BMJ Publishing, 1996.
eBMJ. How to read a paper. http://bmj.com/collections/read.shtml. Accessed 08/08/04
Guyatt G. Rennie D. (eds). Users’ guides to the medical literature: a manual for evidence-based clinical practice. sl. American medical Association, 2002.
Pereira-Maxwell, F. A-Z of medical statistics: a companion for critical appraisal. 1998.
Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons Ltd.