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Systematic Review

Transcript: Is there evidence for an association between ADHD and SES? Does this exist across cultures? Does it vary by developmental stage? Records Identified through database searching n=1365 Systematic Review: Is there an association between coming from a disadvantaged socioeconomic background and risk of ADHD? Full text articles assessed for eligibility n=218 Characteristics of included studies Reporting of associations Subgroups- by SES measure and culture Meta-analyses of single parent, parental education and SES index studies Abby Higgins, PhD student Supervised by Dr G Russell, Prof T Ford and Prof J Mill Results 35 studies reported a significant association between a measure of socioeconomic disadvantage and ADHD- 7 did not. Extracting Data Records after duplicates removed n=838 Number of studies reporting significant associations, a trend or no association between SES and ADHD by SES measure The Question Additional records Identified through other sources n=4 Full text articles excluded n=176 Association not investigated n=28 No comparison group n=14 ADHD not reported separately n=17 Medication used as diagnosis n=7 Inadequate ADHD data n=14 Insufficient SES data n=41 Review/Conference abstract/Dissertation n=21 Data collected prior to 1994 n=4 Other n=6 Duplicate sample or majority of participants aged 4 or under n=24 Studies included in qualitative synthesis n=42 There is an association Did it vary by culture or age? How robust is it? What about study quality? Records excluded n=620 Is there an association between ADHD and SES? Conclusions Records screened n=838 Studies included in quantitative synthesis (meta-analysis) n=19 Characteristics of included studies- South America PRISMA flow chart of study selection Rationale Studies often cite link between ADHD and coming from a disadvantaged background There is little easily accessible conclusive evidence My PhD investigates the association But first, does it actually exist? Protocol First stage Framing the question by PICO Define inclusion and exclusion criteria Study design/settings/participants Searching for papers Search strategy Databases Flow chart

Systematic Review

Transcript: Results & Limitations Nurses in the emergency room are exposed to high incidents of violence because of dangerous patients, long wait times that cause people to get angry, lack of security, and lack of intervention training for the staff. The purpose of this study was to determine what emergency rooms were reporting about workplace violence (WPV) and provide research to guide and implement best practice policies that will protect healthcare workers. The review of literature in this study addressed the need for additional research on why more employees do not report WPV and research on ways to provide safer working conditions for staff. "The ED is a particularly vulnerable setting for workplace violence, and because of a lack of standardized measurement and reporting mechanisms for violence in healthcare settings, data are scarce" (Gacki-Smith, Juarez, Boyett, Homeyer, Robinson, & MacLean., 2009). Future Research & Clinical Practice Taylor, J. L., & Rew, L. (2010, December). A systematic review of literature: workplace violence in the emergency department.. Journal Of Clinical Nursing, 20(), 1072-1085. doi:10.1111/j.1365-2702.2010.03342.x Gacki-Smith, J., Juarez, A., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S., (2009, July/August). Violence against Nurses working in US Emergency Departments. The Journal of Nursing Administration, 39(7/8), 340-349. "A systematic review of the literature: workplace violence in the emergency department" (Taylor & Rew. 2010) The articles reviewed indicated multiple variations in definitions of WPV. Workplace violence was defined as verbal abuse, physical abuse, spitting, biting, sexual assault, stalking, and intimidation. The articles reviewed determined that WPV is prevalent among all staff members in ED's worldwide. This systematic review determined that most of the articles reviewed were descriptive methods. The researchers believed experimental design or predictive methods would have been a more accurate method. The authors of the article believed the inconsistencies of WPV definitions were a barrier to reporting accurate incidence rates and cross-comparing studies (Gacki-Smith, Juarez, Boyett, Homeyer, Robinson, & MacLean, 2009). Furthermore, incidence and occurrence were the major focus of the literature reviewed. The majority of the studies concluded that reporting of WPV is under-reported due to staff members believing that violence is part of the job. Additionally, staff associated substance abuse and mental illness as contributing factors to WPV. Some of the limitations to the literature review were the chosen time period. The authors believed if older data had been reviewed, additional valuable information could have been used in the analysis. Additionally, because the author was a nurse in the ED it was possible that the literature review was biased. Design & Measurements References Conclusion Kimberly Keene NUR518 November 30, 2012 Dr. Pat Shannon The study conducted in this article found multiple areas that could be further researched. This study concluded there are many instances of workplace violence not reported because of unknown reasons that indicated an area for further research. "In the future, ED staff should become more accountable for making their own environment safe, which also includes reporting incidents of WPV" (Gacki-Smith, Juarez, Boyett, Homeyer, Robinson, & MacLean., 2009). Additionally, studies that include interventions that decrease workplace violence that will provide guidelines for best practices. Research is also needed to develop evidence-based practices that will improve working conditions of healthcare workers. Instruments to measure the validity and reliability of studies regarding workplace violence need to be developed to provide a consistent method of obtaining data. Purpose & Problem The study reviewed literature that had used emergency rooms of different sizes and types that ranged from community hospitals, pediatric emergency rooms, to large trauma centers for their study setting. These studies were conducted mostly in the United States but some studies were conducted in Australia and Europe. The sampling size ranged from the entire staff in the ED to specific professional staff including physicians. The smallest sample size was eight with the largest sample size over 3500 staff members. The average response rate for the studies was a little over 60%. Convenient sampling was used for a majority of the studies but random sampling was used in only one of the studies. "The ED is a particularly vulnerable setting for workplace violence, and because of a lack of standardized measurement and reporting mechanisms for violence in healthcare settings, data are scarce" (Gacki-Smith, Juarez, Boyett, Homeyer, Robinson, & MacLean., 2009). This systematic review used 16 articles, eight studies from the USA, three from Europe, and five from Australia (Gacki-Smith, Juarez, Boyett, Homeyer, Robinson, & MacLean., 2009). The quantitative

systematic review

Transcript: (Polit & Beck, 2012) Limitations Restrictions that may decrease credibility Qualitative Problem Information from various quantitative studies is combined to formulate the effect size, the existence of a relationship and the magnitude. •Search and Retrieval Process (Polit & Beck, 2012) • Appraisal of Primary Studies • Respected Quality Appraisal Scale • Results Review and Rating • Use of Appraisal Information Questions for meta-analysis are narrow, focusing on a specific topic. If the question becomes more broad it makes the study ineffective. (Polit & Beck, 2012) •Extraction of Sample Characteristics (Burns & Grove, 2011) (Burns & Grove, 2011) Donabedian's Model of Structure. (2007, October). Retrieved from .x/abstract Sample (Polit & Beck, 2012) The sample should contain the primary studies that have answered the hypothesis. Implications and Further Research Data Analysis Scoping reviews allow a process for refining the question. Data Extraction and Synthesis Questions Burns, N., & Grove, S.K. (2011). Understanding nursing research: Building an evidence based practice(5th ed.). Maryland Heights, MO: Elsevier Saunders. Polit, D. F., & Beck, C. T. (2012). Nursing research; Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. Meta-analysis Manojlovich, M., & Luschinger, H. K. (2008). Application of the nursing work life model to the ICU setting. Retrieved from abstract/MED/19007714/reload=0;jsessionid=YggF1VZ2DakuQXVm1lch.0 (Donabedian's Model of Structure, 2007) (Polit & Beck, 2012, p. 655) "Systematic review begins with a problem statement and a research question or hypothesis." Methodologic approaches to developing new knowledge based on the analysis of existing qualitative research findings. General (Polit & Beck, 2012) Quality Appraisal Metasynthesis (Polit & Beck, 2012) Data Analysis Bae, S. (2011). Assessing the relationships between nurse working conditions and patient outcomes: Systematic literature review. Journal of Nursing Management, 19(6), 700-713. doi:10.1111/j.1365-2834.2011.01291.x The problem-solving process is the identification of a clinical problem that needs further study to approach answers, a gap in nursing knowledge. Search Strategy (Pilot & Beck, 2012, p. 656) References "Sampling criteria typically cover substantive, methodical, and practical elements." (Polit and Beck, 2012) •Integrity of the Dataset Quantitative (Burns & Grove, 2011) Systematic Review Kris Altman, Susan Odden, & Mary Sue Dumas NUR/518 December 3, 2012 Dr. Pat Shannon "Key constructs should be defined, and the definitions should indicate the boundaries of the inquiry." (Polit & Beck, 2012, p. 656) Structural Contingency Theory of Adaptation. (2008). Retrieved from Contingency%20Theory%20of%20Organizational%20Adaptation.pdf Conclusions are a synthesis of the findings. Logical reasoning creating a meaningful whole from the pieces of information gathered Assessing the relationship between nurse working conditions and patient outcomes: Systematic literature review (Structural Contingency Theory of Adaptation, 2008) (Manojlovich & Luschinger, 2008) Guidelines for determining a research purpose are the requirements for a clear, concise statement of the focus of the study; it can capture the essence of the study in a sentence. •Method of Data Pooling and Integration •Credibility and Thoroughness of Data •Summary of Findings (Bae, 2011) Conclusion

Systematic Review

Transcript: Meta analysis Heterogeneity Publication bias The Sample "Bacterial resistance to antibiotics and wounds that fail to heal with standard therapy have resulted in a renewed interest in the use of honey for medicinal purposes (Shumacher, 2004). Search Strategy (Bardy et al., 2008) References The articles were scrutinized and scored by two reviewers The JADAD system was used to assign points 43 studies were scored (Fawcett & Garity, 2009) A Systematic Review (Fawcett & Garity, 2009) Data was pooled into five categories The scores and randomization Two tables were used to summarize the studies Table 1 the findings Table 2 the quality of the studies Inclusion and exclusion criteria Search strategy -two reviewers independently screened ref; total of 43 were included in review No attempt to contact original researchers Rationale for exclusion Quality Appraisal Problem (Polit & Beck, 2012) (Polit &Beck, 2012) (Polit & Beck, 2012) Data Analysis-Quantitative Bardy, J., Slevin, N., Mais, K., & Molassiotis, A. (2008). A systematic review of honey uses and its potential value within oncology care. Journal of Clinical Nursing, 17(), 2604-2623. doi: 10.1111/j.1365-2702.2008.02304.x Fawcett, J., & Garity, J. (2009). Evaluating research for evidence-based nursing practice. Philadelphia, PA: F. A. Davis. Polit, D., & Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing pratice (9th ed.). Philadelphia, PA: J. B. Lippincott. Schumacher, H. H. (2004). Use of medical honey in patients with chronic venous leg ulcers after split-skin grafting. Journal of Wound Care, 13, 451-452. A systematic review of honey uses and its potential value within oncology care By Richard Fleeger and Kimberly Valentine Clearly stated Objectives of the review used integrative approach: -to integrate the evidence to assess whether honey has a role in health care -identify if evidence applies to cancer care -make recommendations for the practice Relevant-there are many therapeutic uses of honey Concepts, variables adequately defined Data Analysis Positive outcomes with honey Limitation Implication for nursing Further research (Bardy et al., 2008) Criteria for selecting primary studies Biographical database Key words Supplementary efforts -used "honey studies" in COCHRANE and PUBMED -searched "honey and systematic reviews" in all above databases Conclusions Journal of Clinical Nursing Bardy, J., Slevin, N. J., Mais, K. L., & Molassiotis, A. (2008). Data Extraction Appraised quality of primary studies Criteria defined Two reviewers doing appraisals Inter-rater agreement reported Appraisal information (Bardy et al., 2008)

Systematic Review

Transcript: Disagreement of studies and researchers Literature Review Eligibility Criteria for Inclusion and Exclusion Too much bias not reproducible Small effect size It may prevent unethical repeating of clinical trials Allocation One author or more recruitment Heterogeneity can be cause by one of the two factors: Chance (can be measured) Different PICOs (should be fixed) Opportunities ! Invent a question GROUP A Literature Search They are all good balls But which should we use? Systematic Review Combine Effect Sizes GROUP B Specific I squared: The percentage of variation across studies that is due to HETEROGENEITY and NOT due to CHANCE 0-100% Some may think about conducting new unbiased research! Systematic Reviews & Critical Appraisal We have problems Subjective Assessing Risk of Bias CRITICAL THINKING Should We Continue? COURSE LIAISON: What about merging them? Priori Hypothesis Observational Answer a focused clinical question Critical appraisal of a Cochrane systematic review Where are small, big, important and unimportant studies? Steps of Systematic Review Describe and Discuss the Results Measurement and Outcome Reproducible When we review research we should take the same steps to avoid bias and random errors as when we conduct a new research Vs May be biased Cumulative Meta-Analysis To improve precision evaluate the body of evidence Improve applicability Usually by a librarian Multiple synonyms Many Databases (50%) Sensitive not Specific Grey literature Trial registries FDA Hand-searching by references Ask experts Thank you! Examples about Meta-Analysis Broad Provide summary or overview of a topic These tend to loose when we accumulate studies Imagine the difference between a tree and a forest! Prognosis/Harm Were both groups treated equally through out the study? RCTs Systematic reviewa How can they fit together? Imagine how this is important for guidelines developers! INTRODUCTION TO THE PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (IPPCR) R: Recruitment A: Allocation M: Measurement M: Maintenance B: Blinding O: Outcome Blinding Cochrane Risk of Bias Tool (double assessed) Screen Abstracts and full texts for Inclusion No protocol with no search strategy - Can i generalize the results on a larger population? - Can those results be applied in everyday medical practice? - any problem in applying them on my own patients? Strict rules of studies Quasi Random Science is cumulative and scientists should cumulate science scientifically References: Cannot be biased The most important bias here is: Publication Bias Funnel Plot (Christmas Tree) Watch out for surprises in board exams !!! Explain Heterogeneity Ibrahem Hanafi & Tarek Turk 5th year medical students at the Faculty of Medicine of Damascus University 13/12/2015 Sensitivity Test for suspicious studies is to discuss results with and without it and measure the difference. Objective Diagnostic Studies Become a peer reviewer for a journal !! Good in your CV ;-) External Validity Extract Data χ2 Test: H0= all studies are evaluating the same effect H1= there is at least difference between two studies So high P-value suggests homogeneity Before you apply any study's results on your patients, make a judgement !!! The power of a review paper is equal to the power of the studies upon which it is based. Faculty of Medicine of Damascus University was confirmed as a Remote-Site for the NIH IPPCR Course. We have a small community taking the course of 200-300 students. The course began two months ago but registration is still OPEN and same is the community! SO you are WELCOMED on board!! You can register BY the end of the year and start learning AT your convenience. Protocol with comprehensive search strategy Too many papers Maintenance However, before conducting a research we should find out what the already existing research shows! Medical Literature has problems Three authors or more Pooling studies can reduce the P-value to the significance range Rate Confidence Internal Validity

Systematic Review Presentation

Transcript: By: Emily Amayreh, Megan Matthews, Lily Watson What are health professionals feelings and attitudes towards working with the Alzheimer’s population? Sample Relevant Literature Sullivan and Muscat (2005) Used Alzheimer's Disease Knowledge test Found that carers of persons with AD know twice as much about AD than non-carers. The authors concluded that there is a need for public education on AD. Padilla (2011) Outlines four main principles about the ethical care of service professionals Recognizing and being attentive to others Taking responsibility for action Performing caring work competently Being responsive to care receivers’ position or considering care from their perspective Alzheimer’s Disease is predicted to double every 20 years. Friends and family care for approximately 70% of people with AD in their home. Care of people with AD is extremely resource demanding and has a great impact on formal and informal caregivers. Hogan, Lisy, Savannah, Henry, Kuo, & Fisher (2003) Found 6 themes from their data: 1. "I feel guilty leaving her" 2. "Our roles have been reversed" 3. " what you are going through" 4. I have to cook, I have to clean...I am always busy" 5. "Some people shy away" 6. "My health care comes after his" Themes: 1. Rewarding 2. Hardest part is seeing the client suffer 3. Elicits emotions of anger and frustration 4. Unpredictable Our sample included: 1. An occupational therapist who has been working with this population for 7 years 2. A nurse who has been caring for her mother with Alzheimer's for 2 years 3. Blog describing the impact of caring for a family member with Alzheimer's: Title: Caregiving, Mothering Mother, and More: A blog about the guilt, frustrations, humor, and sweet times that come with caregiving with a focus on Parkinson's and Alzheimer's Author: Carol D. O'Dell Limitations and Recommendations Methodology Findings Systematic Review Presentation Relevant Literature References Padilla, R. (2011). Effectiveness of Occupational Therapy Services for People with Alzheimer’s Disease and Related Dementias. American Journal of Occupational Therapy. 65(5). Sullivan, K. & Muscat,T. (2005). Attitudes towards the diagnosis of Alzheimer's disease among carers and non-carers. International Journal of Therapy and Rehabilitation, 12(9), 379-386. C. O'Dell. (2013, January 4). Caregiving firsts, starting a new day or a new year [Web log comment]. Retrieved from C. O'Dell. (2012, October 29). How to be a friend to someone who has dementia/alzheimer's. Retrieved from C. O'Dell. (2012, August 29). "I need You-I don't need you:" The push-pull of caregiving. Retrieved from C. O'Dell. (2012, April 23). Laughter and sleep, a caregiver's best defense against depression and stress. Retrieved from C. O'Dell. (2012, May 11). Need a safe place to vent, ask questions, and let it all out? Caregivers need to talk to other caregivers. Retrieved from Hogan, V.M., Lisy, E.D., Savannah, R.L., Henry, L., Kuo, F., & Fisher, G.S. (2003). Role change experienced by family caregivers of adults with alzheimer's disease: Implications for occupational therapy. Physical & Occupational Therapy in Geriatrics, 22(1), 21-43. doi: 10.1300/J148v22n01_02 Participants were selected based on their experience working with the Alzheimer's population Blog was found by searching the internet Interviews were distributed via e-mail Once the participants had responded, we analyzed the data and found common themes Data is reliable because we asked the same questions to each participant Descriptive validity Interpretive validity Internal validity Research Question Larger sample size to compare When working with this population (Alzheimer’s) the clients may have other pertaining health issues that affect the perceptions of the caregivers. Two of the three interviews were family members this could have caused a bias Not all health professions represented No information regarding feelings toward working with the different stages of Alzheimer’s Blog vs personal interview Conclusions & Implications 1. Use this information to help prepare health professionals who may be working with this population. a. Offer training on the stages of Alzheimer’s/Allen’s cognitive levels and what they may expect b. Use this information to prepare them for unpredictability and help them find ways to cope with it c. Knowing that they will experience anger and frustration, helping them to use this knowledge to be more prepared when they do d. By helping professionals know what to expect (emotions and functionally in their patients), this will help them to more effectively treat their clients when these instances arise (thereby improving outcomes).

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