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Critical reading made easy: effectiveness and experience


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  • 1. Critical Reading Made Easy: effectiveness and experience Linda Ward Clinical Librarian / Deputy Librarian Education Centre Library Leicester General Hospital
  • 2. 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
  • 3. 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
  • 4. CRME: content  Research methods and levels of evidence  The Checklists  The questions  The article
  • 5. Primary Research Experimental observational Secondary Research 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 Quality For quantitative studies
  • 6. Judging the quality of research  JAMA articles  Checklists e.g. CASP A framework for thinking about the quality of research NHS Critical Appraisal Skills Programme
  • 7. 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?
  • 8. 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)  CASP training week  MSC Health Services Research
  • 9. 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 programme O&G research and evidence programme Medical house officer teaching programme Neonatal Unit multidisciplinary Journal Club Staff in genetics, family planning, surgery, renal nursing and mental health pharmacy
  • 10. 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 proposal Supported staff doing research modules evaluating RCTs e.g. of escitalopram vs citalopram for major depression – mental health pharmamcist
  • 11. 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.
  • 12. 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
  • 13. The evidence base  Systematic review of critical appraisal teaching Parkes 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
  • 14. 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
  • 15. Opportunities for librarians 2  Marketing  Individual email effective but no longer possible  Intranet  Posters / flyers  Word of mouth  Structured postgraduate teaching  Journal clubs
  • 16. 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
  • 17. 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. 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.