Finding Empirical Evidence
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The document provides an overview of how to find empirical evidence for clinical research projects, outlining key strategies and resources for developing effective search techniques and evaluating different levels of evidence, from systematic reviews and clinical practice guidelines down to individual studies. It includes examples of searching databases such as MEDLINE, Embase and the Cochrane Library, as well as searching for grey literature and critically appraising the evidence found.
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Finding Empirical Evidence
- 1. Finding Empirical Evidence PUB5757 – Clinical Epidemiology Research Workshop Finding Empirical Evidence PUB5757 – Clinical Epidemiology Research Workshop Lucia Ravi, Librarian Medical and Dental Library Lucia Ravi, Librarian Medical and Dental Library
- 2. Workshop Purpose •RCT Research Proposal – Background research of the evidence – Research methodology •Journal Article Critique – Study characteristics, critical analysis tools PUBH5757 Assessment Summary:
- 3. Research Skills – Construct an effective search strategy – Know what types of medical resources are available and how to search them – Understand the different levels of hierarchies of evidence; – Focus your search strategy on high level, synthesised sources of evidence Relevant Search Skills:
- 4. Search Strategy What are the causes of poor diet in Australia? Identifying key concepts, terms: Unhealthy Eating Impact Australia “poor diet” causes consequences reasons Western Australia WA
- 5. Search Strategy Your turn – activity 1 •Write out a broad research topic you are interested in researching •Identify your key concepts and other similar terms that could be used to describe them Use worksheet provided.
- 6. The Grey Literature Finding grey sources: Guide link
- 7. Grey Literature Searching Grey Literature sources: •Australian Indigenous – Health InfoNet •AIHW – Australian Institute of Health & Welfare •WA Health Department – Health for… •wa.gov.au – global google search of WA Government •ABS – Australia Bureau of Statistics Topics @ Glance •WHO – World Health Organisation Heath Topics •Jessica Tyndall’s “Databases for Research in Health”
- 9. Search Tips Grey Literature Have a go: Search one of the sources •AIHW •ABS •WHO Identify one possible item, share with a neighbour
- 10. Grey Literature Searching Your turn – activity 2 •Look at one of the suggested Grey Literature sources or identify a source from the database listing •Browse the site to identify if they have broad topics of interest to you, or carry out a simple search (try boolean) •Think about how you might join them together to form a search string Use worksheet provided.
- 11. Hierarchy of Evidence A key concept for your literature review.
- 12. The purpose of a literature review is to identify the existing body of research that has addressed a problem and clarify the gaps in knowledge that require further research. 1 The term levels of evidence refers to what degree that information can be trusted. 1 1 Buckingham JB Greenhalgh T. Searching the literature. In: Greenhalgh T. How to read a paper: the basics of evidence-based medicine.5th ed. Hoboken: John Wiley & Sons; 2014. Levels of Evidence
- 13. The Hierarchy of Evidence Decision support systemsProblem focused, multiple questions Simple, single questions
- 14. Hierarchy of Single Studies Randomised controlled trials
- 15. A new proposed evidence-based medicine pyramid M Hassan Murad et al. Evid Based Med doi:10.1136/ebmed- 2016-110401 ©2016 by BMJ Publishing Group Ltd
- 16. Hierarchy of Evidence The hierarchy of evidence is: •A hierarchy of the likely best evidence •Designed to be used as a shortcut by busy clinicians and researchers to find the best evidence •Assists researchers to conduct their own rapid appraisal University of Oxford, Centre for Evidence Based Medicine. (2011). The 2011 Oxford CEBM levels of evidence: introductory document. Retrieved from: http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-Introduction-2.1.pdf
- 18. Key Players: Australia JBI Connect Produce systematic reviews and best practice guidelines. JBI COnNect+ Database
- 19. Key Players: International Cochrane Collaboration Systematic Reviews and RCT’s Cochrane Database
- 20. Evidence-based guidelines & summaries • Developed by synthesising the highest level of evidence available on treatment choices • Guidelines provide recommendations supported by that evidence • May take into account resources and practices relevant to the organisation • Concise and clinically relevant
- 21. Where do I find evidence? • PubMed/MEDLINE • Embase/PsychInfo • Cochrane/JBI • TRIP/OvidMD • BMJ Best Practice • ClinicalKey • UpToDate • ETG Complete See: Resources for Answering Clinical Questions
- 23. Guidelines and Protocols Resources that aim to provide an overview of diagnosis, prevention and treatment of a specific conditions to be readily used by clinicians. • Some claim to be evidence based (look for references) • Some are editorial based (professional backgrounds) Guidelines: suggest current best practice but encourage further investigation by practioners of range of evidence given. Protocols: Generally promoted as the core treatment method. Sometimes listed as Point of Care resource.
- 28. Searching Evidence in Practice Your turn – activity 3 •Select one of the resources that allow you to hone in on the synthesis of evidence for clinical practice •Search for a topic of interest to you and evaluate its value (any ideas for additional concept terms?) •See if the guidelines and references that underpin the decisions promoted are easy to find and follow •Share your findings with a colleague. Use worksheet provided.
- 29. Clinical Practice Resources Have a go: Search one of the sources •BMJ Best Practice •UpToDate •eTG Complete •ClinicalKey Share with a neighbourResources for Answering Clinical Questions
- 30. Search Tips Clinical Practice, Guidelines, Protocols Have a go: Search one of the sources •AIHW •ABS •WHO Identify one possible item, share with a neighbour
- 31. Search Strategy Risk Factor: impact, causes, context in Australia Identifying key concepts, terms: Unhealthy Eating OR Impact OR Australia OR “poor diet” Nutrition Obesity causes consequences Reasons Epidemiology Aetiology Western Australia WA • Use AND to combine concepts and identify results that include both
- 32. Boolean Logic AND retrieves all the articles with both ‘Diabetes’ and ‘Indigenous’ OR retrieves all the articles containing either ‘Aboriginal’ or ‘Indigenous’ or both NOT retrieves all the articles containing ‘Indigenous’ but not those about ‘Canada’
- 33. Search Tips Phrases and Truncation: smok* = smoke, smoker, smoking Austral* = Australia, Australian, Australians, Australasian 4. Use Quotation Marks for Phrases “cigarette smoking”
- 34. Search Strategy Risk Factor: impact, causes, context in Australia Adding Boolean logic, truncation and phrases: “Unhealthy Eating” OR Impact OR Australia OR “poor diet” Nutrition Obesity Obes*e/ity causes consequences Reason*s epidemiology Etiology Western Australia WA Austral* ia, ian, s • Use quotations “…….” to search for a phrase • Use asterix * to find all term derivatives • Use OR to search for/identify all similar concepts • Use AND to combine concepts and identify results that include both AND AND
- 35. Search Strategy Constructing a search string (“unhealthy eating” OR “poor diet” OR obes*) AND (“austral*) AND (impact OR cause* OR epidemiology OR etiology OR aetiology) In most databases enclosing terms in brackets will help order how concepts will be searched.
- 36. Study Type Search Tips Randomised Control Trial Questions: Patient/population/problem = who or what is of interest Intervention = what intervention is being investigated Comparison group = what alternatives can be compared to the intervention group Outcome of interest = what should the intervention achieve, what improvements? Useful References: CEBM Study Design and PHCRIS Formulating a Question http://guides.library.uwa.edu.au/systematic_reviews
- 37. Search Strategy Population/ Problem Intervention Comparison Outcome Body mass index In Children 0-4 Physical Activity in Nurseries No exercise Reduction in BMI Weight Exercise Not in nurseries Physical activity to prevent obesity in young children, cluster randomised controlled trial. DOI
- 38. Search Strategy Your turn – activity 1b •See if you can build on your search strategy concepts. • Think about how you might join your concepts with AND, OR operators to refine your search to build a search string. •Are there any particular interventions or comparators you want to focus your search to at this stage. Use worksheet provided.
- 39. Searching for Evidence Research
- 40. Cochrane Library • Search Trials Central - largest collection of RCT’s • Cochrane Database of Systematic Reviews (CDSR) Can browse by topic or carry out an advanced search
- 41. Developed by US National Library of Medicine (NLM) this life sciences and biomedicine database uses specialist Medical Subject Headings (MeSH) to index highly reputed medical journals. Ability to map to MeSH search terms and to build up your search strategy with inbuilt Boolean operators. A range of ways to refine and limit search results based on types of studies, cohort study groups and more. MeSH topics and sub-topics provide a range of ways to focus in on very specific medical areas of research.
- 42. Developed by Elsevier, Embase aims to provide the widest possible coverage of biomedical literature incorporating many conferences and journal titles not covered by MEDLINE. Ability to map to Emtree search index providing a comprehensive vocabulary to describe biomedical data. Use of Ovid interface to build up your search strategy with inbuilt Boolean operators. A range of ways to refine and limit search results based on types of studies, cohort study groups and more.
- 43. Search Systematic Review Databases for Interventions Have a go: Search one of the sources •Cochrane •Medline •Embase •PsychInfo Save searches and items Share with a neighbour
- 44. Your Search in OVID Your turn – activity 4 •View one of the short videos or guides about constructing a search in Medline, Embase or PsychInfo • Build your search in Ovid for one of these databases, mapping to search terms and join concepts with AND,OR. •Use the additional limits to limit your dates and select a specific type research evidence. •Create a Ovid log-in and save your search and some of your search results to a personal folder.
- 45. DoPHER – Health Promotion Reviews TRoPHI – Trials for Health Promotion Interventions Evidence for policy and practice information centre.
- 46. Search Databases Australian Context Have a go: Search one of the sources •AUSTHealth •Heath & Medical Complete •CINAHL Plus Are they of relevance to your topic? Are any of the articles unique to Medline/Embase. YouTube Link
- 47. Critical Analysis –CASP – Critical Appraisal Tools Checklists –JBI – Critical Appraisal Tools Use to evaluate different types of studies; RCT’s, Case control, cohort, diagnostic, systematic reviews etc. –Cochrane Methodologies Register Research focussed on an analysis of methodologies. (Last update 2012) CAT’s - Critical Analysis Tools
- 48. Contact the University Library http://library.uwa.edu.au 9346 7570 – Medical and Dental Library hmslibrarians-lib@uwa.edu.au http://facebook.com/UWALibrary @UWALibrary
Notas do Editor
- Hi, My name is ……… and I’m one of the Science Librarians at the Barry J Marshall Library.
- Aim of this library workshop is to support you in the research requirements of your two major assessments for this unit, specifically in identifying the research evidence in support of your RCT Research proposal.
- This workshop will focus on developing these research skills so as to support you in answering the questions about your risk factor for your promotional review. Be able to identify and effectively search a range of medical/health resources to locate information relevant to addressing each of the review requirements. Construct an effective search strategy Know what types of resources are available and how to search them Understand that search results will deliver different levels of evidence and focus their search strategy on high level, synthesised sources of evidence. Understand the different levels of hierarchies of evidence available to them; Have strategies for limiting to and evaluating these
- Before you start any search, it’s important to spend a little bit of time: Breaking down your search topic identifying the core concepts important to your research, Coming up with other keywords/terms used to describe your topic and thinking about how you combine them. Other terms you could add: Nutrition Obesity For impact: Do you know of any medical terms that could help: Epidemilogy – study of the distribution and determinants of health related states or events Aetiology It is worth putting some thought into what your concepts are and how you might
- Who is familiar with the term Grey Literature and can tell me what it is? Often used to refer to government or non-government, organisation or agency sources of information (reports, data etc) that are gathered by them and that may not otherwise be able to be located in bibliographic databases which have as their greater focus published items such as books, articles and research… sometimes reports are captured in some databases. Can represent the most direct route to information about a specific population, especially in a country like Australia. Population health guide: Statistics, reports and website page: Explain what a subject guide is and what it is.. Direct to the guide and to search for their specific risk factor or topic of interest. Example: AIHW
- Site links to important sources of grey literature.
- Explain Boolean and Brackets. Explain that you use broad terms at this early stage, can increase specificity if retrieving too many results. Would not necessarily use all of the terms developed, you are starting a process of seeing which work best in the different resources we will search. ASK STUDENTS TO SPEND SOME TIME DEFINING A EPIDEMIOLOGICAL TOPIC OF INTEREST TO YOU – Activity 1
- Example: View Subject, Publication and Data tab to see if there is information on your topic OR try searching your terms within a website
- Explain Boolean and Brackets. Explain that you use broad terms at this early stage, can increase specificity if retrieving too many results. Would not necessarily use all of the terms developed, you are starting a process of seeing which work best in the different resources we will search. ASK STUDENTS TO SPEND SOME TIME DEFINING A EPIDEMIOLOGICAL TOPIC OF INTEREST TO YOU – Activity 1
- Show of hands. Who feels confident with their understanding of the hierarchy of evidence and how to find research at different levels of evidence?
- There is so much medical literature published you need to know how it is organised and the quickest way to find the information you need. In Medical research it is particularly important to you are familiar with notions of evidenced based practice – that you base your practice decisions on the most up to date and high quality research on the population focus group you are working with in order to determine the best treatment. Click link to OneSearch record of this eBook (will need Pheme credentials to read it), also shows the Multiple Versions feature. Show contents and discuss briefly use of ebook platforms and of bookshelf. Look at contents.. Focus particularly on break down of how to assess different papers that evaluate particular studies and in particular systematic reviews and guidelines. Ask if students are familiar systematic reviews and Evidence based guidelines (hands up) and then to discuss some of the differences between them? Ask for feedback on these? Greenhalgh, Trisha. 2014. How to read a paper: the basics of evidence-based medicine. BMJ Books: Hoboken.)
- “The term ‘level of evidence’ refers to what degree that information can be trusted based on study design”. (Greenhalgh 2014) As you can see from this pyramid the higher the corroboration of different types of evidence, the higher it is on the hierarchy. You will come across many different forms of the hierarchy as it is continually being contested and evolving – so you will have to get used to interpreting it at a critical level. This is the pyramid at its most basic level.. With single studies being considered the least reliable, moving to systematic reviews that undertake a robust review of studies undertaken on specific interventions, through to evidence based guidelines.. (however need to question if these latter do belong at the top of the hierarchy – in trying to provide an overview of current best practice of a condition as a whole) We don’t have access to decision support systems at this time. They are systems that directly link to patient records. Do have a EBM Lib Guide that provides links to the resources we offer to support EBM.
- The bottom layer of the main hierarchy – single studies – has its own hierarchy depending on the original type of study performed. This is where – if you are doing your own literature search or systematic review of treatment/disease research for a specific cohort – you would need to critically assess the research/studies/case focus for their research vigour and relevance to your area of health and cohort. For single studies RCT are considered the most robust and unbiased and they are often the focus on systematic reviews.
- Here is a new revised pyramid, (Developed by Dr Murad and his team at the Evidence Based Practice Centre, Mayo Clinic in Rochester USA.) to take into account the need to think critically about the design and development of individual studies – replacing a straight line with a wavy one to indicate that some research lower down the hierarchy may actually be better if designed better than RCTs. The separation of systematic reviews from the pyramid emphasises that they themselves are a filter through which evidence is viewed and also subject to critical review in their overall design and development. The studies into your specific intervention or research focus area need to be available in order to undertake a systematic review. The proposed new evidence-based medicine pyramid. (A) The traditional pyramid. (B) Revising the pyramid: (1) lines separating the study designs become wavy (Grading of Recommendations Assessment, Development and Evaluation), (2) systematic reviews are ‘chopped off’ the pyramid. (C) The revised pyramid: systematic reviews are a lens through which evidence is viewed (applied).
- This pyramid represents the hierarchy of evidence that can be used to answer clinical questions. It will help lead you to the best resources where you can find evidence for your question. The higher the level of evidence (clinical importance) the less information out there for you to find. Higher levels of evidence are problem focused. In your exploration of EBP and hierarchies of evidence you may come across slightly different hierarchies, this is the UWA FMDHS endorsed hierarchy of evidence.
- Middle level: Systematic Reviews. Systematic reviews analyse and appraise primary studies on the same question. This is a simplified version of the process. (There are UWA as a well as a number of resources for this) The final report will include their search strategies, keywords, subject headings. It is good to look at this to enhance your own learning/searching on your topic. Finding a systematic review on a topic can save you a lot of time. A well structured systematic review will include the databases searched, search strategies used and a detailed analysis of studies included in the review – their quality and strengths, can see also the reasons why certain studies were excluded or considered questionable.
- One consideration in the evaluation of evidence is who has produced it and how good their methodology is? One of the key highly reputed players in Australia is The Joanna Briggs Institute who collaborate with Australian and international research institutes to produce systematic reviews and from these best practice guidelines available through their library JBI Connect. They also produce methodology guides and software to support critical appraisal. This link is a good one for quick checklists on how to appraise different types of studies as well as systematic reviews.
- One of the most robust and trusted producers of systematic reviews is the Cochrane Collaboration. Because systematic reviews have traditionally been built on RCT’s they have Cochrane Central which aims to bring together all randomized controlled trials from core databases such as Medline and Embase and from other sources. The Cochrane Reviews (like JBI) also work in collaboration with International research bodies to produce systematic reviews and have a number of specialist resource databases such as their SR Database and database of Randomised control trials. Like JBI they also produce and collate methodology reviews and critical appraisal of research tools which have been collated into a number of Handbooks. This link is a good one for quick checklists on how to appraise different types of studies as well as systematic reviews.
- The top levels This section of the literature will become important later in your course when you begin clinical practice. Can you trust the synthesis of the evidence that has been completed – who has been involved in it, how recent? Is it comprehensive and based on appraised high level studies and systematic reviews or in providing a comprehensive overview of current best practice is it compromised. http://ebm.bmj.com/content/21/4/121.full Pyramids are Guides not rules: the evolution of the evidence pyramid.
- These are the key databases where you can find studies and systematic reviews, guidelines and individual studies See our guide for access to them: Resources for Answering Clinical Questions: http://guides.is.uwa.edu.au/ACQresources?hs=a Go to this site and And Dentistry – EBM tab http://guides.is.uwa.edu.au/c.php?g=324873&p=2177834 We will be looking at some of these in more detail in the upcoming workshop. Take a bit of stretch and break now or have a look at the websites of the Joanna Briggs Institute or Cochrane Collaboration or our LibGuide link here.
- Shown them how to navigate to this Guide from the UWA website. Library’s guide to resources for answering clinical questions. The second tab in the guide that you can see here lists EBP resources available through the library catalogue, and tells which level of evidence you will find within. You can see a table of different resources we have, and the level of evidence you can find in each. The green button next to each connects to a database-specific guide that lists tips for searching, tips on how to broaden or narrow your search, the best clinical use of the information, and positives and negatives of that particular resource. Includes tips on how to broaden your search and how to narrow your search, and tips on using truncation and wildcards.
- Guidelines and Protocols come in a range of different forms - there are some database products we provide that specialise in providing these such as BMJ Best Practice and UptoDate.. Some claim to be based on a comprehensive analysis of the evidence and demonstrate this, some are put together by expert panels linked to medical associations and their evidence may be more selective. Sometimes they are highly structured database resources such as the BMJ Best Practice and UptoDate, sometimes they are found within larger databases that collate a range of information from single studies through to systematic reviews and guideline summaries. Sometimes they are referred to as Guidelines, sometimes as protocols and sometimes as First Consults. They often include information produced for patients to understand their condition.
- For instance BMJ Best Practice provides a highly structured organisation of summary information related to a specific condition.
- Here is an example of UpToDate’s Guidelines page on Cleft Palates – similarly it summarises under key headings such as etiology, diagnosis and management. Most guideline summaries should have a references tab, where you can critically consider the sources used.
- Many of the specialist Clinical Practice guideline resources are organised around key topics or areas of medical practice but can aslo manage simple searches of a specific condition.
- Then you have resources such as Clinical Key that search across a broader spectrum of guideline sources and also pull in from a wider range of other sources resources… in this search for instance there are 9 guidelines and a 3 first consults found but also a large number of citations pulled in from Medline as well as bookchapters, images and other full text articles. Note that you can also filter by article type to hone in on these, you would certainly be interested in focussing in on systematic reviews for instance on your research topic. Go to live demonstration, show a number of the Systematic Reviews are coming from Cochrane.. and being indexed within Medline but that it is also bringing in systematic reviews from a wide range of other organisation.. Medline is one of the largest and databases collating medical information from a wide range of sources and indexing it with specialist medical terms which is why the second part of this workshop will focus on it. However back to our purpose.. To look at Guidelines and in this case First Consults (closely aligned to protocols). Clinical Key has identified 9 guidelines related to our topic in some way.. Of these you will notice they are coming from a range of specialist journals and professional organisations. First one looks very on topic and when you go into a guideline you will notice similarly to other guidelines the structuring and organisation of summary information about the condition. The First Consult in particular appears to be like a more traditional guideline.. Covering epidemiology, screening, prevention, diagnosis and treatment. Under resources you will find the summary of evidence used to inform this guideline. ??Follow lead from Cranofacial Journal, takes to Pubmed (associated with Medline) and out to journal site where payment option given.. What do you do if faced with this? Go back to OneSearch.
- An opportunity to explore one of the resources that provide access to evidence based summaries or guidelines to identify their
- Example: View Subject, Publication and Data tab to see if there is information on your topic OR try searching your terms within a website
- Example: View Subject, Publication and Data tab to see if there is information on your topic OR try searching your terms within a website
- SO how is your search strategy going, have by you been able to identify other similar terms that will help you identify all records about your topic. Coming up with other keywords/terms used to describe your topic and thinking about how you combine them. Other terms you could add: Nutrition Obesity For impact: Do you know of any medical terms that could help: Epidemiology – study of the distribution and determinants of health related states or events Aetiology Use OR to search for/identify bring all similar concepts together. Use AND to combine your core concepts together and make sure you only identify results that relate to your topic focus. Other terms you could add: Nutrition Obesity For impact: Do you know of any medical terms that could help: Epidemilogy – study of the distribution and determinants of health related states or events Aetiology It is worth putting some thought into what your concepts are and how you might
- Recap on Boolean: Here is a Venn diagram to clarify how the use of booleans, like AND, OR and NOT work in helping you to refine your search strategy. Note: the NOT excludes items containing both ‘indigenous’ and Canada – potentially relevant results? Use NOT with caution, generally for refining a search only or for multiple meanings of the same word, eg China (country) vs china (porcelain).
- Otherways you can refine your search include the use of the truncation symbol (usually an asterisk) to search for all derivatives of a word. Using quotation marks to search for a phrase. Two of the most common, but a variety of other search limiters you can use and found in many academic databases.
- Here is an expanded example of boolean and search limiters might be used to better refine and control your search strategy.
- Your next step would be to think about how you might express this search in a search engine like Google or in a sophisticated database like Medline. This is often expressed as a search string.. Generally at an earlier scoping phase of research you will use broad terms, however as you refine your research focus you would add terms and look for ways you can use the AND boolean in particular to increase specificity. Academic database often have many built in ways you can limit and filter search results. Highly constructed search strings won’t work in every situation, in particular won’t work so well when you are searching the grey literature – non published works ususally found on the web in government or specialist organisation websites. Not necessarily use all of the terms developed, you are starting a process of seeing which work best in the different resources we will search.
- As you develop your RCT focus for your assessment, you will want to further refine your question and the concepts that relate to it to fit into the PICO framework, clearly identifying the population or problem that is a of interest to you, the specific type of intervention you want to evaluate and analyse and the comparison group. This level of refinement to your search strategy is also of relevance when you are searching for and wanting to identify if there have been systematic reviews carried out in the RCT research focus you will be proposing. At the moment our sample search is focussed on a more qualitative search of Population or problem and outcome.
- Here is an expanded example of boolean and search limiters might be used to better refine and control a PICO based search strategy. As you search the literature you may find more related terms that will help you to refine your search so you hone in on specific studies of interest to your intervention.
- Example: View Subject, Publication and Data tab to see if there is information on your topic OR try searching your terms within a website
- The Cochrane library is an important site for viewing and accessing high level evidence. We mentioned it earlier and the availability of a Central register of trials (very broad inclusion) and of Cochrane specific systematic reviews.
- Example: View Subject, Publication and Data tab to see if there is information on your topic OR try searching your terms within a website
- Work in groups of three. Search these databases, look at the resources. Show going into guide, finding introduction to each of the resources.
- Example: View Subject, Publication and Data tab to see if there is information on your topic OR try searching your terms within a website If time available, look at one of these databases, see if you are able to construct a search in that one database, if it is of relevance to your topic area. Combination of search techniques between Grey sources and Ovid based databases such as Medline/etc. Some work better with simpler searching of keywords, some allow you to build your search using AND/OR and other search limits. Have a way of limiting searches.
- An important part of your role as clinicians will be to develop your skills at evaluating the evidence. I believe the Journal article assessment will help you to develop these skills. Your Unit Coordinator, Tom Briffa will be introducing you to the CASP – Critical Appraisal Skills Programme tools for you use as a checklist of what to look out for when you are evaluating the quality of the study you are reviewing. Another set of Critical appraisal tools you might consider using are those published by the Joanna Briggs Institute, link provided. If you are extra keen to delve into some critical analysis of different types of methodologies you may want to investigate the Cochrane Libraries Methodology Register. Only for the extra keen, may help to identify methodologies for your RCTs. Demonstrate limit to Methods Studies, within a Cochrane search.