On lis-medical in June 2013 David Chamberlain appealed to the list for suggestions of papers to use during critical appraisal training. His summary of responses follows. There is some variation in citation format. Also attached are some supplementary documents
Dear all,
Thank you for your replies and extremely useful articles, links and suggestions. There is plenty I can use so thank you.
I have inserted the replies below. I could not add the attachments but indicated where they were added. If anyone wants one please e-mail me.
Thank you all
David
David Chamberlain BA Hons., PG Dip FCLIP
Lead Librarian
Redditch Health Library
Alexandra Hospital
Woodrow Drive
Redditch B98 7UG
01527 505773
Papers to use in Critical Appraisal training – lis-medical request 12/6/13
1)I helped our FY1’s set up their own journal club and we started a blog – unfortunately we only managed one session, but the article that they chose was really good for them as they have a vested interest in the outcome.
They chose not to use a tool as there were 20 in the group so we split into 3 groups: methods; results; and applicability to practice – the discussions, article and presentation used are listed here http://uhmbtjournalclub.wordpress.com/category/journal-club-sessions/week-1/
2) For general groups I use this paper:
Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial. Kelly AM et al. Emergency Medicine Journal, Jan 2008 25(1): 26-9
I have a link to it here: http://broomfieldwarner.wordpress.com/critical-appraisal/
It's a good paper to use with groups as it's short, not too complicated and is good apart from one thing - not a big enough sample!
I attach the ppt I use when teaching this paper. ONE POWRPOINT ATTACHMENT
3) Longer ago than I care to admit (OK, 2003) I attended a CASP workshop in London and amazingly still have some of the paperwork.
The 2 articles we worked on were:
Fahey T et al (1998)
Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults
BMJ 316 pp906-910 (March 21st)
This one was for the quantitative research (obviously)
And for the qualitative research:
Armstrong D et al (1996)
A study of general practitioners’ reasons for changing their prescribing behaviour
BMJ 312 pp949-952 (April 13th)
4) I haven’t got the CASP sheet but I have done a very interesting session using the MMR/autism paper http://www.ncbi.nlm.nih.gov/pubmed/9500320
5) I use this one http://www.biomedcentral.com/1471-2458/9/196 which is really good example for qualitative research. I tend to use this for nurses, AHPS etc. but should be ok for junior Drs. Sorry I don’t have any answers to send you. I just use the standard casp checklist.
6) The attached article is one that came to me originally via John Blenkinsop's virtual journal club. When we discussed it as librarians locally we found plenty to comment on, so I have used it in my training sessions a couple of times since. It seems to have gone down reasonably well with my groups, and it does have the virtue of being fairly short. Also attached is my cribsheet of (possible/plausible) answers for the CASP on trials.
Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: metaanalysis of randomised controlled trials
João Costa, Margarida Borges, Cláudio David & António Vaz Carneiro,
British Medical Journal, 2006;332:1115
Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial
One general suggestion - if you can get whatever article you want to use out in advance and if your trainees will read it before the session, it will save huge amounts of time. I used to let people read the article in the session, but it took up far too much time - people read FAR FAR SLOOOOWWWEER than I expect them to. Now I send it out and tell them to read it before they arrive. People have generally done that, and it does allow way more time for discussion. Also, having told them to read in advance, if people haven't done so that's their problem, and I feel I can legitimately only allow a few minutes of "refresh your memory" time before we get down to business.
ONE PDF AND ONE WORD ATTACHMENT
7) Here’s a useful round up sent to the list a couple of years ago https://www.jiscmail.ac.uk/cgi-bin/webadmin?A2=lis-medical;4cdad1be.1011
8) I’m assuming you have already done some critical appraisal otherwise some of the notes I’ve attached may be a bit too much shorthand.
We run our training by doing a straight teaching session then having a second session where the people appraise a paper. For that we use 3 papers, all RCTs - notes for them + the version of the CASP checklist we use are attached. It might be worth you appraising them yourself before you look at the notes - the queries you raise as you do it might be a pointer to what other people might ask.
Moscati, R.M et al (2007) A multicenter comparison of tap water versus sterile saline for wound irrigation. Academic emergency medicine. 14(5) p.404-409
There are further notes for this in the CEM document attached + there is a Cochrane review on Water for wound cleansing that this trial was part of.
Wake, M. et al (2009) Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial. BMJ 339:b3308
Ford, A. et al (2010) Treatment of childhood obesity by retraining eating behaviour: randomised controlled trial. BMJ, 2010;340:b5388
If you want something other than an RCT the other pdf I’ve attached from the College of Emergency Medicine can give you a starting point.
Let me know if you have any questions about any of it. If you do get suggestions of other papers it would be nice if you could post them to the list. Even with out the appraisal notes it’s nice to have details of papers that work well. Someone did ask a similar question a couple of years ago and I’ve forwarded her summary on to you as well.
THREE WORD ATTACHMENTS
9) Here are the summaries of the papers we’ve being using recently – article citations included. They don’t exactly follow a checklist but should be able to be rearranged into such a format.
Randomised controlled trial of an occupational therapy intervention
to increase outdoor mobility after stroke
P A Logan, J R F Gladman, A Avery, M F Walker, J Dyas, L Groom
Cite this article as: BMJ, doi:10.1136/bmj.38264.679560.8F (published 25 November 2004
TWO WORD ATTACHMENTS
10) In the past we used the following paper (it's not really applicable to junior doctors, but quite good for the principles):
Randomised controlled trial of physiotherapy compared with advice for low back pain [RCT]
http://www.bmj.com/content/329/7468/708
I don't have the answers written down, but there is a very basic appraisal of this article in the PEDRo database at http://search.pedro.org.au/pedro/browserecord.php?recid=8834
11) This one is a favourite of mine which I use with the CASP checklist for RCTs:
paper: http://www.bmj.com/content/334/7590/409
checklist: http://www.casp-uk.net/wp-content/uploads/2011/11/CASP_RCT_Appraisal_Checklist_14oct10.pdf
Results from a similar question 2010
Thank you to everyone who replied to me and requested the answers to be shared. There are some brilliant suggestions but I am going with Paul Manson’s (No 7 in the list) very easy to read short papers, and as he has very kindly included his worked examples, there is an added bonus!
1. Two possibilities:
http://www.biomedcentral.com/1472-6963/8/92 is a really good read but may be too long
or perhaps http://ukpmc.ac.uk/articles/PMC2770359;jsessionid=AAD1983CDC6E6CE469A0FA4EFACBE162.jvm1
which is a bit shorter and also very interesting.
Tell me what you think!
2. I wouldn’t call this brilliantly exciting but we did this at a journal club and it was a surprisingly suspect piece of research, not least because the authors had vested interests in the company and we couldn’t get the figures to add up!
http://www.bmj.com/content/340/bmj.b5388.full?sid=0a2028d4-1df2-4737-9413-f4bcca99d45c
3. This is probably not relevant, but for sheer entertainment value, how about this – giving spiders drugs and then seeing how they spin their webs? A 15 year old article that still makes me laugh.
^ Noever, R., J. Cronise, and R. A. Relwani. 1995. Using spider-web patterns to determine toxicity. NASA Tech Briefs 19(4):82
^ "Spiders on speed get weaving". New Scientist. 29 April 1995. http://www.newscientist.com/article.ns?id=mg14619750.500. Retrieved 2006-09-08.
4. A search on Chocolate I did a couple of years ago gave a possible candidate - only 2 pages long, and found using HDAS!
Title: Behold the Power of Cheese--and Chocolate and Meat.
Citation: Best's Review, 01 August 2003, vol./is. 104/4(32-33), 15275914 Available in fulltext at EBSCO Host
5. You may find this one useful – if not too controversial! It stimulated a lot of discussion when we used it recently at a LIHNN Clinical Librarians’ Group journal club. It is only 2 pages long, and not at all technical, though it is a quantitative study. It is also included in a 2010 Cochrane Review which I found it useful to have a read at before using this for the journal club. I wouldn’t use this one in all situations, however if you know your group well it might be suitable. It is also freely available on PubMedCentral. The title below links to the search screen in PubMed Central from where you will need to search for the article. There has been a lot of online discussion and controversy about this one which you might also want to have a look at.
Citation: L. Leibovici, BMJ, December 2001, vol./is. 323/7327(1450-1), (2001 Dec 22-29) Type of study: Randomised Controlled Trial Critical appraisal tool used: CASP RCT Tool
6. we were recently sent a sample copy of the British J of Wellbeing, and it had an article on the benefits of singing. I’m not involved in training/teaching now, but I can imagine it could be used for that. It went down well with a Senior OT who has run music sessions for elderly patients.
7. I have attached two papers that might be useful to you - though I'll admit upfront that they are not "brilliant" or "exciting" (nor sexy nor funny - sorry). However, they are short and easy to read & follow. I have also attached the appraisal notes I have made in case they are useful.
The article by Mousavi is on homeopathic remedies for mouth ulcers. This paper has some good points and a few important flaws and its very simple so it's quite good as a gentle introduction to appraisal. I have the luxury of a whole day session for critical appraisal so I can ease staff in gently. I do emphasise that we are appraising this single study and its methods, not homeopathy itself (some people have made comments about homeopathy as a topic).
The article by Crawford is on collar vs exercise for whiplash. (Appraisal Notes) Again this is very easy to read and understand. On an initial reading it seems quite well conducted and reported but digging a little deeper shows some problems, especially with the measured outcomes.
If these are useful I'd be very happy for you to share them with the lists: getting just the right article is time-consuming and if these can help someone else that would be good.
Your comment about papers about chocolate struck a chord. In my presentation I give a fictitious example of two news reports, 'chocolate is good for you / chocolate is bad for you' and show that one report might be supported by better evidence than the other, including the 'fact' that one study is sponsored by Cadbury. Shortly after creating the slides there was an article in the Daily Express, 'Dark chocolate can reduce stress'. This was appraised by NHS Choices (here if you are interested) who noted it had a small, healthy study group, only ran for 14 days, measured biochemical markers not stress levels, and it was sponsored by Nestle. I thought it was tailor-made for the class but when I got hold of the paper it was extremely technical and deadly dull. I have managed to work part of it into the presentation, though.
8. An alternative strategy that I have applied is to give them the paper to discuss over lunch; that way they somehow don’t seem so long.
9. We're just starting to teach critical appraisal so I'd be interested in answers to this too. I'm not sure if these count as short or dynamic enough but the Health Knowledge site (www.healthknowledge.org.uk) has some really useful stuff, including 'guided critical appraisals' of an RCT (firmness of mattress & backache, 6 pages), a systematic review (stretching before and after exercise, 6 pages) and an economic evaluation. We're intending to use them to refer people to after they've had a basic intro to CA but they can be used in teaching sessions as well.
10. I run three CA sessions and use the following papers. I haven't ventured beyond these three yet because I haven't been running CA for very long and they are the ones I am most familiar with because they were used on the CA training days I went to.
Systematic reviews
Guevara J, Wolf F, Grum C & Clark N. (2003) Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis. BMJ , 326: 1308.
There are a number of different formats/lengths of this paper, I use the 6 page one available free here:
http://www.bmj.com/content/326/7402/1308.abstract
It's a good one because there's quite a lot to say about it. Being a systematic review it is quite long so I break up the reading - all to read abstract, split up reading of the participants and methods section so some read the paragraphs that answer q3 of the CASP checklist and others read paragraphs that fit with q4. Then start facilitating a discussion, with guided reading of the results section pointing out where the relevant info can be found for qs 5 - 7.
RCTs
Fleming D, Jacober S, Vandenber A & Fitzgerald J. (1997) The safety of injecting insulin through clothing. Diabetes Care, 20(3): 244-247.
A bit old but a nice length to get them to read the full paper. Lots to say about it.
Qualitative research
Yardley L, Donovan-Hall M, Francis K & Todd C. (2006) Older people's views of advice about falls prevention: a qualitative study. Health Education Research, 21(4):508-517.
No takers for this one yet, so I'm running it for the first time on Monday. It's quite long so I will break up the reading of part of it and have guided reading for the rest, I haven't worked out the detail yet.