Chapter 7 Literature Reviews: Finding and Reviewing Research Evidence

COMMENTS ON THE CRITICAL THINKING ACTIVITIES IN CHAPTER 7 Example 1:Complementary therapy and older rural women: Who uses it and who does not? 1. (#1) The thoroughness of the review is difficult to assess without undertaking a literature search ourselves. Shreffler-Grant and her colleagues, did however, cite numerous fairly recent studies relating to the use of complementary and alternative medicine (CAM), including several from 2004. Researchers should not be faulted for not including studies published within a couple of years of publication of their own report, because that is how long it may take for a submitted manuscript to get into print. In other words, these researchers may have written their report in 2005 or 2006 for a January 2007 publication date, and thus studies published after 2004 might not have been available for their review. Although you could not know this from the excerpted material in the textbook, the authors did cite a good mix of nursing and non-nursing sources. Several were from the fields of public health, medicine, and psychology. (#2) It does appear that all of the cited materials were primary source research reports. (#3). The literature review did offer a critique of studies that have focused on the use of CAM in rural areas, noting that discrepancies might be attributable to a number of methodological weaknesses, especially sampling limitations. The review specifically described gaps in the literature, and noted that the new study was designed to help fill that gap. (#4). The review does appear to be well-organized. It began by documenting the use of CAM in the United States, defined how the term was used, and then reviewed the literature on factors that have found to be associated with CAM use. Studies that have examined urban-rural differences were then reviewed, and gaps and problems in this literature were noted. The organization of the material helps to build a case for the new study. (#5). The review is written in the authors own words, with no quotes from original sources. The authors used appropriate language for describing the results of earlier studies (e.g., Studieshave had conflicting results: use has been found to be).

(#6) The review appears to support the need for the new study. The authors specifically noted that the study was designed to address these gaps in the literaturei.e., gaps that they identified in their review. Note, however, that the validity of the researchers conclusion about the need for a new study is dependent on the accuracy of their premise (i.e., that there are notable gaps), and this is impossible to ascertain without undertaking out own search. We must trust that these researchers, who appear wellversed in the current literature on this topic, have been thorough in their search for relevant research. 2. a. The review identified several independent variables that would be studied as possible predictors of CAM use in older rural women: education, age, rurality, marital status, spirituality, number of chronic illnesses, and health status. These variables had been studied in prior research, and the results were briefly summarized in the review. b. The dependent variable is use of CAM, and the review focused primarily on this variable. The review covered both background information on prevalence of use, dollars devoted to its use, and factors associated with its use. c. Examples of keywords that might have been used: complementary medicine, complementary therapy, alternative medicine, CAM. The term rural may also have been searched. Specific types of CAM could also be used to search in databases (e.g., herbal medicine, acupuncture, etc.). In this study, it is unlikely that the independent variables would have been used to search the literaturefor example, it would not have been productive to search for marital status or education. d. Here is but one study that might be relevant: Cartright, T. (2007). Getting on with life: The experiences of older people using complementary health care. Social Science and Medicine, 64, 16921703. This study was identified through PubMed by using a textword search for studies with either complementary medicine OR complementary therapy OR CAM AND old* published after 2006. (The Shreffler-Grant et al. study itself was also identified through this search strategy.)

Example 2: The experiences and challenges of pregnant women coping with thrombophilia 1. (#1) Again, as is generally true, it is difficult to evaluate the thoroughness of a review without actually doing a search. As for Example 1, however, we note that there were several citations to studies published within a couple of years of the publication date for this article (January 2007), so it does appear that the researchers used up-to-date information. It is also worth noting that the authors had 31 citations

from several fields, including nursing, medicine, psychiatry, social work, and sociology. (You would have known this only if you had looked up the original full article). (#2) The authors included primary source research reports in their review almost exclusively. (#3) As is true in many reviews that serve as context for a new study, this review did not critically appraise individual studies. The literature review primarily summarized what earlier researchers had found, without appraising the quality of the existing evidence. However, this may in part be due to the fact that no study had previously examined what it was like to experience thrombophilia during pregnancy. The study was undertaken not so much because of limitations in earlier research but because of the absence of earlier research on this specific topic. (#4) The literature review does appear to be well organized. The first paragraph described what thrombophilia is, indicated its potential severity and consequences, and noted its incidence. The review went on to discuss treatment for thrombophilia, and how the treatment itself could be stressful. Next the review presented information from studies on other pregnancy complications, and noted the significant gap in the literature pertaining specifically to the experience of of thrombophilia. This organization seems logical and well conceived. (#5).The review seems unbiased, used appropriately objective language, and provided supporting citations for assertions (e.g., Studies have identified). (#6) The review leads logically to the conclusion that research on the topic is needed. As was true in the preceding example, however, the extent to which the study fills a gap in the literature is partly a function of how thorough the review was. If there were important omissions, the argument might be less convincingalthough replication would be desirable in any event. 2. a. The central phenomenon of this study was pregnant womens experience with throbophilia. The review covered research relating to the context for this study (e.g., findings from studies on other difficult pregnancy situations, and information about thrombophilia itself). b. For this literature review, the primary keywords would by thrombophilia and pregnancy.

c. Here is but one article that might be relevant: Middeldorp, S. (2007). Pregnancy failure and heritable thrombophilia. Seminars in Hematology, 44, 93-97. This review article was identified through PubMed by using a search for the keywords thrombophilia AND pregnan* published after 2006. (The Martens and Emed study itself was also identified through this search strategy.)

Example 3: Anxiety, Anger, and Blood Pressure in Children 1. (#1) We dont know how thorough the authors review was without doing our own search. The authors included citations to some recent and several older studies, which suggests thoroughness. The most recent study they cited was by Meinginger et al. (2004)a study that the researchers appeared to rely on heavily, as it was cited several times. Their reference list was quite long (44 citations), again suggesting thoroughness, and the citations were from diverse fields, especially medicine, psychology, and nursing. (#2) There are some secondary sources (e.g., the Wyllie article), but overwhelmingly the citations are for original research reports. (#3) As is true in many reviews that serve as context for a new study, this review did not critically appraise individual studies. The literature review primarily summarized what earlier researchers had found, without appraising the quality of the existing evidence. The study was undertaken to address a gap in what researchers have studiedblood pressure in children in relation to anger and anxietyand not because of study limitations of previous research on this topic. (#4) The review in this article was very well-organized, and the use of subheadings made it easy for readers to follow the organizational structure. The article began with an introduction that described the importance of studying hypertension in children. The section labeled Literature review began with a paragraph summarizing factors associated with high blood pressure in adults and adolescents, and then subsequent subsections summarized research on each of these factors individually. A summary at the end of this section might, however, have helped to pull all of the information together and might have made a better transition to the next section on the study purpose. (#5) The review seems unbiased, did not use subjective language, and documented assertions with appropriate citations from the research literature (e.g., Trait angerand trait anxietyare psychological

factors that have been associated with). Findings were succinctly summarized, and there was no reliance on quotes from other writings. (#6) Yes, assuming that the review was thorough, it offered support for a new study on factors associated with high blood pressure in children. 2. a. review. b. The dependent variable was blood pressure, and, as noted above, research on its association with the independent variables was succinctly summarized. c. Here are several sets of keywords which, when we used them in a PubMed search, did retrieve the Howell et al study, as well as other possibly relevant studies: (a) blood pressure AND anxiety; (b) blood pressure AND anger; (c) blood pressure AND child*; (d) hypertension AND anxiety; (e) hypertension AND anger; and (f) hypertension AND child*. The independent variables in this study were trait anger, anger expression, trait anxiety, gender,

height, and weight. All these variables, in relation to blood pressure, were covered in the literature

Example 4: Anniversary of Birth Trauma 1. (#1) The literature review does seem extremely thorough. It includes the major studies on the topic of birth trauma and PTSD after childbirth. It included recent research, including Becks own studies on PTSD and birth trauma, published in 2004. This is a field in which Beck is an expert, and represents a continuation of her program of research on psychological effects relating to pregnancy. The references included citations from the nursing, medical, psychiatric, and psychological literature. (#2). The review does rely mainly on primary source research studies, although one recent review article (Olde et al., 2006) was cited. The review article was not used as a substitute for an analysis of primary studies, but rather as a support for the need for more attention to be focused on birth trauma and PTSD as a serous mental health problem. (#3) The review identified an important gap in the literature. Only a limited number of studies on birth trauma were found in the literature. These were primarily quantitative studies that examined predictors of PTSD resulting from birth trauma. The research that had been undertaken to describe the

meaning of the experience of a traumatic birth for women had previously been done by Beck. There was no research relating to the experience of reliving the trauma on the anniversary of giving birth. (#4) The literature review was well organized. The article began with an introduction that described research on the prevalence of PTSD secondary to childbirth. Then the argument for the new research was further developed by describing research on the potential long-term effects of such PTSD on women and their families. The literature review section did a good job of defining PTSD, describing studies on triggering events for PTSD, summarizing risk factors for PTSD, describing intervention research for at-risk pregnant women, and finally describing the only three qualitative studies that have focused on traumatic births. The ideas supporting the new study were well developed. (#5). The literature review was objective and used appropriate language. Beck paraphrased throughout the review. No quotes from original sources were relied upon to describe the relevant studies. (#6). Becks literature review supported the need for her qualitative study. No phenomenological studies (and no studies of any kind) had been conducted specifically on the topic of the anniversary of a birth trauma. 2. a. The central phenomenon that Beck focused on in this study was the experience of traumatic births, and the anniversary of those births. Existing literature relating to the key phenomena was adequately covered in her review. b. Beck discussed prior research in two sections of the report: the literature review section (part of the Introduction) and also in the discussion section. c. In performing her literature review, Beck might have used the following keywords for her computerized search: birth trauma, childbirth, and PTSD.