Library News

UPDATED: November 17, 2025. Original Post: July 20, 2020

Integrating the best available health evidence into decision-making processes is an important part of evidence-based practice. However, before applying clinical research findings to patient care, health care providers must determine whether the research findings are valid.

It is important to remember that published studies are not necessarily trustworthy. Healthcare research must be evaluated before being used to guide clinical decisions. Critical appraisal provides a framework for this evaluation.

What is critical appraisal?

Critical appraisal is “the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.” (CASP)

To critically appraise clinical research is to look at its methodological quality, trustworthiness, and applicability to a patient’s specific situation. Critical appraisal helps us ask two essential questions about a particular research study (Sala Serra & Domingo Torrell, 2022):

• Are the results believable and free of bias or errors? (internal validity)
• Do the results apply to populations other than the sample participants, specifically to my patient’s situation? (external validity)

When should critical appraisal be conducted?

Research should always be critically appraised, no matter its intended use. Such uses may include:

• Patient care in a clinical setting
• Organizational policies or guidelines
• Care directives
• Educational projects

For example, if a recently published study in your discipline suggests a therapy is effective and safe for patients, critically appraising the study ensures the findings are valid and unbiased, and the therapy is appropriate for the specific needs of your patient.

Beyond clinical scenarios, critical appraisal is also a key part of evidence synthesis. As part of the systematic review process, for example, articles included in the review are critically appraised for validity. This ensures that the integrity of the overall review is not impacted by the quality of the individual studies included.

Using critical appraisal checklists

Any type of clinical study can be critically appraised, and each study type has its own checklist. Critical appraisal checklists provide a step-by-step guide through the appraisal process. There are many critical appraisal tools available from organizations that are experts in evidence-based research evaluation, including:

• JBI (formerly Joanna Briggs Institute): Critical Appraisal Tools
• Centre for Evidence-Based Medicine (CEBM): Critical Appraisal Tools
• Critical Appraisal Skills Programme (CASP): Critical Appraisal Checklists
• Scottish Intercollegiate Guidelines Network (SIGN): Critical Appraisal Notes and Checklists
• Critically Appraising for Antiracism Tool (Naicker, R. 2023)

For example, CASP’s Randomised Controlled Trial Checklist includes questions about study methodology such as:

• Was the assignment of participants to interventions randomised?
• Were the investigators ‘blind’ to the intervention they were giving to participants?
• Do the benefits of the experimental intervention outweigh the harms and costs?
• Would the experimental intervention provide greater value to the people in your care than any of the existing interventions?

Critical appraisal for antiracism is rarely addressed in standard tools. To avoid overlooking underrepresented patient populations, consider supplementing your chosen tool with Naicker’s Critically Appraising for Antiracism Tool.

Critical appraisal can be conducted without the use of a formal checklist, but using an established set of appraisal criteria may be helpful if you want to ensure that you are consistent in how you appraise clinical research.

For more info on critical appraisal in your daily work or a larger project, email AskLibrary@nshealth.ca or book a one-on-one consultation with a librarian.

Additional Support

In-depth Resources in Library Services' Searching subject guide.

References

1. CASP - Critical Appraisal Skills Programme. (2025, October 15). What is critical appraisal?. https://casp-uk.net/what-is-critical-appraisal/

2. Naicker, R. (2022). Critically appraising for antiracism. Education for Information, 38(4), 291–308. https://doi.org/10.3233/EFI-220052

3. Sala Serra, M., & Domingo Torrell, L. (2022). Validity of a study: Internal and external validity. Cirugia espanola, 100(10), 649–651. https://doi.org/10.1016/j.cireng.2021.12.007

Selena MacDonald

Librarian Educator
Nova Scotia Hospital, Central Zone

Every year, the Patient Education Team identifies patient pamphlets that have not been reviewed or updated within 5 years of the last review date. We then contact content creators to confirm whether these pamphlets need to be updated or removed from circulation.

Routine archiving of out-of-date pamphlets is done in accordance with policy AD-LIB-001 Patient Education Materials: Development and Maintenance, which helps ensure Nova Scotia Health patients, families and essential care partners receive up-to-date patient education materials.

As you know, changes to drug names, clinic or department contact information, and clinical practice are common. Patient pamphlets must be reviewed by the teams that created them, and/or the teams that use them, to ensure that such changes are reflected in the materials we provide to patients. This helps ensure misinformation and outdated directives are removed to help keep patients and care partners safe.

Library Services' Patient Education Team is available to support Nova Scotia Health staff in updating any existing pamphlets. Pamphlets published in 2020 or before that have not been reviewed and updated by January 31, 2026 will be archived and removed from the patient education resources collection.

What do you need to do?

• Check the list of titles that are due for review.
• Complete the Archiving Project form to let us know you intend to update a pamphlet or to recommend it be archived.
• Complete the Archiving Project form to recommend a pamphlet for archiving.
• Share this information with your colleagues who are involved in patient education pamphlets in your area, department, unit, or clinic.

How can the Patient Education Team help?

We can send you the latest version of the pamphlet as a Word document, so you can edit it easily. We facilitate the review and update process for you, including:

• Integrating your team’s edits and feedback
• Reviewing for plain language and readability
• Coordinating adaptation and reprint copyright permission requests
• Ensuring improved accessibility and consistent messaging in line with other Nova Scotia Health materials
• Updating layout and branding

Get started on your pamphlet review project by completing the Archiving Project form to connect with the Patient Education Team.

For guidance and resources on how to update or archive a pamphlet, refer to the Patient Pamphlets section of the Library’s Content Creator Toolkit.

Questions? Reach out to the Patient Education Team at Pamphlets@nshealth.ca.

Kallen Rutledge

Librarian Educator, Patient Education Pamphlets Lead
Nova Scotia Hospital, Central Zone

Has your team ever been asked for permission to reproduce or adapt your content? Do you want to ensure proper credit is given when your work is shared?

Creative Commons (CC) licensing could be the solution.

Creative Commons is a global, nonprofit system that offers open licences for creative works. There are six types of CC licences, each allowing different levels of sharing, copying, and adaptation. All licences require attribution to the original creator.

Nova Scotia Health teams now have the option to assign Creative Commons licences to their work!

This change follows the example set by the Nova Scotia Health Policy Office, which publishes new policies under a CC licence, and is inspired by Alberta Health Services which has successfully used CC licensing for several years.

To retain control over how your content is used, we recommend choosing one of the two most restrictive CC licences:

• CC BY-NC-SA (Attribution-NonCommercial-ShareAlike)
  Allows others to reuse or adapt your work for noncommercial purposes providing they credit you and share any changes under the same license.
• CC BY-NC-ND (Attribution-NonCommercial-NoDerivatives)
  Allows others to share your work for noncommercial purposes with proper credit, but no changes or adaptations are allowed.

Want to learn more?

Visit the Creative Commons subject guide for information on:

• Why choose Creative Commons? Learn how it can increase collaboration and extend the impact of Nova Scotia Health’s work locally, nationally, and globally.
• Considerations before assigning CC licences, including the need for leadership approval.
• How to select the right CC licence for your content.
• Licensing Statements/Disclaimers, approved by Nova Scotia Health Legal Services.
• Support Tools, including a customizable licence tracking spreadsheet, infographics, templates for Word and PowerPoint, and a helpful FAQ section.

Ready to get started or have questions?

• Email us at copyright@nshealth.ca
• Book a one-on-one consultation
• Request a Custom Education Session for your team

Roxanne MacMillan

Librarian Educator
Halifax Infirmary, Central Zone

We keep in mind health care workers' busy schedules, offering sessions on a variety of dates and times. There is sure to be a session suitable for you. Register for one or several classes below, offered from September through December:

• Accessing Full Text
  It can be challenging enough to find the journal articles that you need, but then accessing the full text of the article can also be difficult. Library Services pays for several subscriptions to give you access to many articles. This session will help you access them. The session will also help you get the full text of articles to which Library Services doesn't provide access.
• Developing Patient Education Pamphlets
  This session highlights how easy-to-read and up-to-date patient education materials can support patient care and safety. Learn how to get started, what is involved in developing and updating pamphlets, and how to find, use and share pamphlets effectively.
• Find it Fast
  This session focuses on navigating core library tools and resources, including the catalogue, ejournals and ebooks, and databases. Learn how to access library resources and services through this virtual tour.
• Finding Free-to-use Images: Public domain, open licenses, and more!
  In this hands-on session, you’ll work with a sample search to find free-of-charge or open-licensed photographs, illustrations, and more in Google Images, Microsoft products, as well as reputable online sources. You’ll learn to interpret how images are licensed and how to cite them appropriately.
• Introduction to Covidence
  Covidence is now available through Nova Scotia Health’s institutional license. Covidence is an online software that allows research teams to collaborate through each stage of a knowledge synthesis project (e.g. systematic reviews).
• Introduction to Knowledge Synthesis
  Library Services has a new, free service to support researchers in their knowledge synthesis projects (e.g. systematic reviews, scoping reviews, etc.). This session will outline how the service works, who can access it, and what the librarians can do for your team.
• Managing Citations with Zotero NEW
  Tired of manually formatting references or losing track of your sources? In this session, we’ll cover how to install Zotero, collect references from websites, databases, and PDFs, organize your library with folders, and generate in-text citations and bibliographies in multiple styles.
• Using Generative A.I. NEW
  Generative A.I. (also called Gen A.I.) is a term for any A.I. that creates text, images, video, and audio to meet and/or respond to your prompts. Gen A.I. is growing increasingly popular, with some of the most well-known Gen A.I. tools being ChatGPT, Microsoft CoPilot, and DALL-E. This session will give a general overview of generative A.I., including what to consider before, during, and after you use a Gen A.I. tool.

Amanda Andrews

Librarian Educator, Education & Training Lead
Eastern Zone - Cape Breton, Guysborough, Antigonish

Both Zotero and Covidence can store, manage, and deduplicate citations. However, they differ significantly in their application and scope.

What is Zotero?

Zotero is a free citation management software that includes a desktop application and a browser extension.

What you can do with Zotero:

• Save bibliographic information from any page on the internet.
• Import citations through various file types (e.g. BibTeX, RIS, Zotero RDF).
• Sort your citations into folders and sub-folders.
• Create a single citation or an entire reference bibliography in any citation style.

Learn more about accessing and using Zotero:

• Visit our Citation Management subject guide for more information about accessing and using Zotero.
• Visit the Zotero website for tutorials and information on how to make the most out of Zotero.
• Visit the Zotero blog and forums to troubleshoot very specific issues that you may encounter.

TIP: You can use Google to search within the Zotero blog and forum by adding site: forums.zotero.org/discussions or site: zotero.org/blog/ after your Google search query. This limits your search to only those sites. For example, to learn how to add full-text PDFs to your saved citations, search full text pdf site:zotero.org/blog/.

What is Covidence?

Covidence is a web-based software that lets members of a research team collaborate through the various stages of a knowledge synthesis project (such as a systematic review). Nova Scotia Health has an institutional license to Covidence, which means Covidence is now free to use for Nova Scotia Health staff!

What you can do with Covidence:

• Upload citations
• Screen titles and abstracts
• Screen full-text articles and resources
• Complete data extraction

Learn more about accessing and using Covidence:

• To create an account or join your existing account to our license, follow the steps outlined on our Institutional Subscriber page or our Knowledge Synthesis and Covidence subject guide.
• For articles, books, and training webinars, visit Covidence Academy
• For troubleshooting and detailed walkthroughs, visit Covidence Knowledge Base
• For both shorter and longer video content (including recorded webinars) that are accessible to the public, visit Covidence’s YouTube Channel

What’s the difference?

Zotero is great for organizing literature sources, creating reference lists, and assisting with in-text citation. You will likely find Zotero more useful for everyday research needs.

Covidence is best for conducting knowledge synthesis projects with a team that will lead to a published review article. Outside of scholarly publications, Covidence could also be used by a team to screen through a large amount of potentially relevant literature to find those that are most relevant to your specific needs.

Both tools have distinct features that make them suitable for different purposes. The table below lists the different strengths of each tool, depending on your project needs:

Interested in learning more about knowledge synthesis? Check out our Knowledge Synthesis and Covidence subject guide!

Reach out to LitSearch@nshealth.ca with your questions.

Kendell Fitzgerald

Librarian Educator
Halifax Infirmary, Central Zone

Vinson Li

Librarian Educator
Yarmouth Regional Hospital, Western Zone

UPDATED: July 28, 2025.   Original Post: November 8, 2017

Developing a clear question is an important first step when researching information to guide your work and/or decision-making, and when preparing for a potential research project. In health care, practitioners and researchers are faced with complex questions which make starting the research process a daunting task. A well-built question is clear, focused, and summarizes the issue to be investigated. Determining the type of question will help you select the best resource to consult for your answer.

Background vs. Foreground Questions

Background questions are used to gather general information, typically asking the 5Ws: Who? What? When? Where? Why? To answer these questions, start with general resources, such as overview textbooks, summaries, medical directories, etc.

Example: Looking for general information on diabetes care? Search for resources using Library Services' Discover search. Use the filters on the left-hand side of the page to retrieve results for books to find general information on the disease and its presentation.

Other helpful resources for answering background questions include Library Services’ Subject Guides, which contain best bets on library resources for specific topics in healthcare research. Need resources that inform patient care? Our collection of Clinical Practice Supports highlights information and tools for clinical staff.

Building Foreground Questions

Foreground questions are specific and complex. They often consider multiple factors to guide decision making and/or inform further research.

Example: In women with migraine and aura, how does use of combination birth control pills affect risk of stroke compared to progestin-only birth control?

Clearly articulating a foreground question and identifying key components can be challenging. Using the PICO(T) model can help you identify your key concepts and build your question before examining the literature.

PICO Example:

This Evidence Based Practice module from Dalhousie University's Kellogg Library takes you through the steps of creating an answerable clinical question using PICO.

Structuring your Search

Using PICO to develop your question will help you identify key search concepts. Tools like a search planning grid can help you plan and organize your PICO criteria into search terms. Once identified, additional terms can be derived from synonyms and related concepts to expand your search results.

Once you have determined the key terms for your search, you will be able to search databases and search engines by combining your terms using Boolean operators (AND, OR, NOT).

Still have Questions?

Visit Library Services’ Searching guide for more tips and assistance. Book a one-on-one consultation with a Librarian Educator to discuss building effective research questions or request a custom education session on the topic. Want to get started on searching? Try out your question-building skills by submitting a literature search request. We bet your results will be more relevant!

Happy searching!

Selena MacDonald

Librarian Educator
Nova Scotia Hospital, Central Zone