Transcript How to conduct a literature review

How to conduct a literature review
Aoife Lawton
Systems Librarian HSE Regional
Library & Information Service, Dr.
Steevens Hospital, Dublin 8.
Health & Social Care Professionals
Inaugural Research Conference,
22/02/2013
Learning Outcomes:
By the end of this session you will:
 Have
a good understanding of what a literature
review comprises
 Understand the workflow involved in doing a
literature review
 Have a good knowledge of resources available to
you from the Regional Library
 Learn search strategies
 Feel confident to write a lit review in the future!
Definitions
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Literature review "review". Oxford Dictionaries. April 2010.
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noun 1a formal assessment of something with the intention of
instituting change if necessary
2a critical appraisal of a book, play, film, etc. published in a
newspaper or magazine
Systematic review "systematic". Oxford Dictionaries. April
2010.
– adjective done or acting according to a fixed plan or system;
methodical
Literature review
“Appraisal of previous research or literature on a subject” University of
Bristol
“The use of ideas in the literature to justify the particular approach to the
topic, the selection of methods, and demonstration that this research
contributes something new” (Hart, 1998)
“Creates a firm foundation for advancing knowledge. It facilitates theory
development, closes areas where a plethora of research exists, and
uncovers areas where research is needed” (Webster and Watson, 2002)
The function of a lit. review “should be informative, evaluative and
integrative” (Thomas 2000)
Systematic review
“Review of the literature based on a scientific
design” University of Bristol
“A systematic review identifies an intervention
for a specific disease or other problem in
health care, and determines whether or not
this intervention works” Cochrane Library
“ A systematic review is based on data from
original research studies that have been
selected in an objective and rigorous manner
using a defined methodology” (“How to write
a paper”, George Hall 1998)
“one undertaken according to an explicit,
rigorous and reproducible
methodology” (“Diffusion of innovations in
Health Service Organisations: a Systematic
literature review” / Trisha Greenhalgh [et al]
2005).
“An understanding of systematic
reviews and how to implement them
in practice is becoming mandatory
for all professionals involved in the
delivery of health care. Systematic
reviews are crucial to evidence
based medicine. Besides health
interventions, systematic reviews
may concern clinical tests, public
health interventions, social
interventions, adverse effects, and
economic evaluations”
(Centre for Evidence Based Medicine,
Oxford, Centre for Reviews &
Dissemination, University of York)
5 Steps of EBP
Ask a
Focused
Question
Evaluate
Effectiveness
Integrate the
Evidence into
Clinical
Practice
5 Steps of
EBP
Locate the
Evidence
Appraise the
Evidence
What it is and what it is not
It is
 Guided by your
research question
 A critical review of
available literature on a
given topic
 A piece of discursive
prose
It is not
 A set of summaries
 A descriptive list of
available material
 A description of ideas of
prominent authors in a
given field
Source: University of Toronto “The Literature review: a few tips on conducting it” Accessed 01/02/2013
A literature review should:
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be organized around and related directly to the
thesis or research question you are developing
synthesize results into a summary of what is and is
not known
identify areas of controversy in the literature
formulate questions that need further research
A literature review should:
Content
Description and discussion of previous
researcher, theoretical background,
definitions of key terms and some
material which concerns the wider
research context in which the study is
located.
Structure
Clear structure in the order in which
topics are covered. Sequencing and
grouping of sections – numbering
Sources
almost everything in a literature review
needs to be referenced including
theoretical ideas, terminological
definitions, results other people got,
methods other people used..
Which are appropriate sources –
Relevant to the topic, key figures who
have contributed to the field, up-todate (last 5 years –) and state scope
Presenting information from sources
where the source got the information from-it
needs to be clear whether what a quoted
source says is:
a) based on theory or
b) giving evidence from someone’s
experience/opinion, or
c) a report of empirical research. These
different origins give the information
different weight in an argument.
Coherence and Logic
one point should follow on from another,
there should not be contradictions,
unacknowledged sources and repetition
Relevance
show connection with your own study.
Examples of literature reviews
Reports….
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Section (i) the impact of prenatal
exposure to parental substance
misuse.
Section (ii) consequences that drug
misuse has on the type of
parenting;
Section (iii) summarises what is
known about how parental
substance misuse affects the
development and life chances of
the children involved
Section (iv) interventions used in
connection with parental substance
misuse
Each of these sections is used to
draw conclusions about gaps in
practice and research in Ireland
Researching Parents Experiences of the ASD Diagnostic Process in
County Mayo.
S.L.T Research Group 2007
Theses….
THE EFFECTIVENESS OF SEAT- BELT LEGISLATION IN' THE REPUBLIC OF
IRELAND, Dr. M. Murphy Degree of Master of Public Health 1986)
Occupational Therapist Managers’ perceptions of the impact of Continued
Professional Development activities on their staff’s Clinical Competence
F.Shortall (MSc Health Services Management 2008)
A case study analysis of Person-Centred-Planning for people with
intellectual disability following their transfer from institutional care. D.
Fitzsimons, RNID, BA (hons), MBA, Ph.D. 2012
“WHAT ARE THE VIEWS OF IRISH BIRTH PARENTS AND FOSTER CARERS
ON POST ADOPTION CONTACT” B. Donovan (MSC. Health Services Management
2008)
An analysis of the culture in Ireland on open disclosure following
adverse events in healthcare. A. Duffy (MSc in Healthcare 2012)
29 PAGES out of 127
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2.0 Literature Review 32
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2.1 Origins of Open Disclosure 32
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2.2 Principles of Open Disclosure 35
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2.3 Ethical Considerations 39
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2.4 Specific Disclosure Considerations 42
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2.4.1 Near Miss Events 44
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2.5 Patient Expectations following an Adverse Event 44
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2.5.1 Apology v Disclosure 47
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2.6 Open Disclosure and the Perceived Impact on Litigation 50
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2.6.1 Apology Laws and Disclosure Legislation 50
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2.6.2 The University of Michigan Health System 53
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2.6.3 COPIC – 3Rs Program 54
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2.6.4 Veterans Affairs Medical Centre Lexington Kentucky 55
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2.7 Clinicians’ Experiences and Perceptions of Open Disclosure 56
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2.7.1 The Impact of Adverse Events on Healthcare Staff 59
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2.7.2 The Process of Disclosure 61
CONTINUING PROFESSIONAL DEVELOPMENT: QUANTIFIYING THE VIEWS
OF OCCUPATIONAL THERAPIST MANAGERS IN AN IRISH CONTEXT L. Penny
(MA Healthcare Management 2005)
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Competency
Healthcare Outcomes
Motivation
Support personnel for Occupational Therapy in Ireland
Relevance of CPD within the Irish Healthcare Sector
Management development and CPD in Ireland
Staffing Recruitment, Retention and Shortages in Ireland
CPD and State Registration in Ireland (new)
“I keep six honest serving men
(they taught me all I knew):
Their names are What and
Why and When And How
and Where and Who”
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Rudyard Kipling, 1865-1936,
Just So Stories
Literature review workflow
Asking a Focused Question (Step 1)
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A focused, answerable question contains at
least three parts
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P
I
C
O
(Patient/Population/Problem)
(Intervention)
(Comparison)
(Outcome)
PICO
Example 1: PICO
In adult patients younger than 50 years old with acute low back pain (<6 weeks),
does bed rest reduce the risk of recurrence of pain within one year compared
with physiotherapy?
The PICO format for this question might be:
P
I
C
O
Adult patients <50yr with acute LBP
Physiotherapy
Bed rest
Recurrence of pain within one year
Step 2:How would you search for these
terms?
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Compile a list of keywords and synonyms
Keep limits & filters in mind
low back pain, low back ache, low backache, "Low Back Pain" [Mesh]
treatment, management, therapy,
bed rest, rest, in hospital patient, acute,
physiotherapy, physical therapy
recurrence, pain, pain management
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FILTERS AGE (<50 years)
Search strategy - Boolean
DRIVING
DRIVING
MOBILE
PHONE
CYCLING
DRIVING
MOBILE
PHONE
Truncation replaces stem of word e.g.
comput* returns compute, computer,
computers etc.
Phrase Searching e.g. “quality of life”
Population/Pat
ient
Intervention/E
xposure
Comparison
Your
Question
Search
Terms
in adult patients
<50yrs old with acute
LBP (<6wks)
low back pain OR low OR
LOW BACK PAIN OR
back ache OR low
PAIN MANAGEMENT
backache
Physiotherapy
bedrest
Physiotherapy OR
physical therapy
(Treatment OR
management OR
therapy)
bedrest or rest
MeSH
PHYSICAL
THERAPY
MODALITIES
AND
OR
BED REST
AND
OR
Outcome
Recurrence of pain
within 1 year
Recurr*
AND
Search History
S1
low back pain OR low back ache OR low backache, OR
"Low Back Pain" [Mesh]
S2
(Physiotherapy OR physical therapy) OR (Treatment OR
management OR therapy) OR
“physical therapy modalities”
S3
(Bedrest OR rest) OR (“Bedrest” [Mesh])
S4
Recur*
S5
S1 AND S2 AND S3 AND S4
Asking a Focused Question (Step 1)
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E (Expectations) (about improvement or innovation or
information)
C (Client Group) (at whom is the service aimed? e.g.
persons above 65)
L (Location) (where is the service sited? e.g. primary care,
hospital)
I (Impact) (what is the change in the service which is being
looked for?)
What would constitute success? How is this being
measured? – similar to outcomes in the PICO-format)
P (Professionals Involved)
SE (SErvice (e.g. outpatient services)
ECLIPSE
Example 2: ECLIPSE
What is the impact of an increase in the level of cost-sharing on
access to health services for the chronically ill in European countries?
The ECLIPSE format for this question might be:
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Expectation: increased/improved access to
health services
Client group: Chronically ill
Location: (a selection of) European countries
Impact: increased cost-sharing
Professionals involved: Health service managers
Service: access to health services
Asking a Focused Question (Step 1)
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P (Population) the demography/problem of the
population
E (Exposure): who delivered the exposure
(intervention/treatment) how, where, why, what
C (Comparator): comparison interventions
O (Outcome): reason for doing the intervention
T (Time period): short/long term/specified e.g. 6
months
PECOT
Example 3: PECOT
What is the efficacy of hand therapy for decreasing pain and
improving function in carpal tunnel syndrome?
The PECOT format for this question might be:
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P (Population) carpal tunnel syndrome
E (Exposure): hand therapy
C (Comparator): other therapy; no therapy
O (Outcome): decreased pain; increased
function
T (Time period): short/long term/specified e.g.
6 months
Population/Patient
Your Question
Search Terms
MeSH/CINAHL
Patients with carpal tunnel
syndrome
carpal tunnel syndrome* OR
CTS
carpal tunnel syndrome
[MeSH]
carpal tunnel syndrome
[CINAHL]
OR
Exposure
Hand therapy
Occupational therapy
(Treatment OR management
OR therapy)
Comparison
Outcome
Open release surgery
decreased pain; increased
function
occupational
AND
therapy/methods [MeSH]
hand therapy [CINAHL]
Surgical Procedures,
Operative [MeSH]
ORSurgery, operative [CINAHL]
AND
Pain OR pain management
AND function
Pain [MeSH] OR Pain
measurement [MeSH]
OR Pain [CINAHL]
OR
Time period
6 months
AND
Step 3: Identify resources
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For the search you have chosen, identify
which resources you are going to search &
which ones you will exclude.
Pyramid of Evidence
e.g.
Pubmed
Qualitative
e.g. ACP
Journal Club
Cochrane Systematic
Reviews
Other Systematic
Reviews & Meta-Analyses
e.g. Uptodate
Evidence-Based
Guidelines &
Summaries
Evaluated
Information
Critically-Appraised
Individual Articles
Randomized Controlled Trials
(RCTs)
Cohort Studies
Case-Control Studies
Case Reports, Case Series, Practice Guidelines etc.
Anecdotal Evidence, Clinical Reference Textbooks, Expert
Opinion
Unevaluated
Information
Set up an Athens account
Step 4: Inclusion/Exclusion criteria
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Consider limits – date/time period, age,
country, publication type, EBM
Appropriateness of intervention (Bowling
2009)
Applicability
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don’t have to include all articles that cite a theory
how applicable is the article to your research question?
Step 5: Read & Evaluate Results
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Evaluate & review your results
Modify search terms/concepts as necessary
Different databases use different keywords
Search each concept separately
Explode/Focus
Combine as appropriate
Are you using the appropriate resources – if
not broaden search to include others.
Critical Appraisal Links
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AGREE (Appraisal of Guidelines for
Research & Evaluation) Appraisal tool
designed to assess the quality of clinical
guidelines. http://www.agreetrust.org
Centre for Evidence-Based Medicine
Critical Appraisal Guides
http://www.cebm.net/index.aspx?o=1157
CASP Checklists
www.phru.nhs.uk/pages/phd/resources.htm
Step 6: Synthesize results
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Analyze (separate, connect, compare,
explain)
Synthesize (combine, integrate, design,
rearrange, compose, generalise)
Evaluate (assess, decide, recommend,
select, support, conclude)
Step 7: Write review
Plan of action:
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Pre-write lit. review structure (outline) the outline should contain
at least 3 sections:
1.
Introduction define the topic, together with your reason for selecting the
topic. You could also point out overall trends, gaps, particular themes that
emerge, etc. Cooper, H.M (1988) The structure of knowledge synthesis
2.
3.
Body of text discuss sources, organize
chronologically/thematically/methodologically
Conclusion summarize the major contributions, evaluating the current
position, and pointing out flaws in methodology, gaps in the research,
contradictions, and areas for further study.
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OR use IMRAD (Introduction, Method, Results And Discussion)
(Glasziou Director CEBM Oxford)
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Allocate evidence for each section
Develop first draft
Abide by academic conventions
Allocate time to revise draft
Write the final draft
Over to you!
Group work
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