CAT

How do I examine and critically appraise the evidence?

- Analyze the articles most pertinent to your question - Evaluate the evidence -- Internal validity -- External validity - Apply hierarchy of evidence (LOS) - Treatment integrity - Social validity - Transportability (external validity), generalizability - Apply appraisal checklist, if available, for particular type of evidence (PEDRO, CONSORT)

How do I write the CAT?

- CAT is a 1-2 page summary of your findings - Keep it in an easy accessible location for other clinicians to use it if there is a similar clinical question - Disseminate and share CAT by submitting to a CAT bank or a professional journal

What is the educational value of CATs?

- Client-centered and based on "real-life" clinical scenarios - Focus on research evidence: promotes the acquisition and polishing of literature searching skills - Enhances critical appraisal and research evaluation skills - Fosters translation of research into clinical practice - Writing CATs can be part of pre-service training - Include in educational curriculum, teaching units - Journal clubs where results and articles are discussed and written up as a CAT

Why do we need CATs?

- Difficult to up with the expanding volume of literature - Research indicates that even "seasoned" clinicians encounter up to 5 "knowledge needs" for every inpatient and 2 "knowledge needs" for every 3 outpatients - CAT summaries of the best evidence for common clinical questions address these needs - Gold standard takes too much time and is not practical for busy clinicians

How can I formulate a well-built question?

- Identify gaps in knowledge (knowledge needs) from patient encounters - Determine the type of questions: intervention, diagnosis, prognosis, assessment, etc. - Translate the problem into an answerable question - Avoid vague unanswerable questions

What do "knowledge needs" do?

Raise the question about the best actions or treatment interventions

What are the key parts of a CAT?

1. Purpose 2. Reviewer 3. Date of completion 4. Proposed reevaluation 5. Well-built questions (PICO) 6. Search strategies and results 7. Evidence retrieved 8. Appraisal 9. Conclusions

What questions need to be asked to see if the CAT is valid?

1. Was the CAT focused by a well-built question? 2. What was the explicit and sensible process used to identify and select the evidence? 3. Is it unlikely that relevant studies were missed? 4. Was the evidence appraised the best available to answer the question? 5. Were the appropriate validity criteria applied to the evidence appraised? 6. Are the dates clearly stated? Date of search, date of publication, date of expiry 7. How strong is the message? 8. Is it expressed in terms likely to be helpful in clinical management? 9. Will the CAT's message help me in the care of my clients? 10. Can I apply the message in my clinical setting, to my clients? 11. Were all clinically important outcomes, beliefs, harms, and costs discussed? 12. Is the academic or training level of the authors or commentators clearly stated? 13. Have the authors, site developers, and sponsors disclosed all competing interests? 14. Is there a mechanism to contact the authors?

What do good quality CATs specify/update?

Expiration dates after which they should be considered obsolete

What are some limitations of the CAT?

- Individual CATs can be wrong or inaccurate - CATs appear first as drafts w/o peer review - First drafts may contain inferior evidence, or errors of fact, calculations, or interpretation - Can be turned into educational benefit: revise CATs in group discussions w/ clinicians or in other educational events - Individual "one-article" CATs contain only a single element of the relevant research literature - These CATs are not comprehensive explorations for all useful articles - Non-representative of the entire body of evidence - Individual CATs may have a short shelf life - Become obsolete as soon as newer, better evidence becomes available - Without constant updating for newer, better evidence, their clinical bottom line becomes out of date - Time pressure and heavy caseload of clinicians, can be overwhelming for busy clinicians - Development of the necessary skills for formulating well-built, searchable question - Resources for instant access to the evidence where and when it is needed is lacking in most clinical/educational settings

How can I search for the best evidence?

- Locate the best evidence - Locate most recent evidence - Seek out reviews before individual studies - Database reviews of effects (DARE) - Cochrane data base of systematic reviews - General purpose databases

What is a critically appraised topic (CAT)?

- Preferred categorization format for quick studies in EBP - Defined as a brief summary of a search and appraisal of the literature related to a focused clinical question (PICO)

How can we integrate CATs into EBP?

- Systems to share CATs via CAT banks - Make info needed by therapists more widely available and accessible - CAT checked by second person/expert - Meta-search engine: "Cat Crawler" can search all 8 major CAT banks at one time

What is the purpose of a CAT?

- To be used to enhance clinical reasoning and to make clinical decisions - Describes the best, most recent evidence - Evaluates the findings and summarizes the results in 1-2 pages

What do the different CAT formats do?

1. Answer explicit clinical questions from real clinical situations 2. Appraise a recently published article that is important - Summarize an article used to provide evidence as part of a guideline - Gold standard CATs - Includes commentary from clinician in the field on practicalities and context of related research - Medical fields and allied health professions have devoted journals to publish these CATs

How are CATs a part of the EBP process?

1. Develop a well structured question (PICO) 2. Select the best evidence sources 3. Execute the search strategy using free-text Boolean searching or MESH 4. Examine and synthesize the evidence 5. Write CAT 6. Apply the evidence 7. Evaluate the application of the evidence 8. Revise CAT 9. Disseminate the findings (i.e., share CAT)

How do I make a CAT?

1. Formulate a well-built question 2. Search for the best evidence 3. Examine and critically appraise the evidence 4. Write the CAT