The Literature Review

1. The Literature Review • Primary Sources • Secondary Sources • Theoretical literature • Empirical literature • Integrative reviews • www.best4health.com/ • www.cochrane.org/ • www.guideline.gov • www.stti.iupui.edu/library/ojksn/ • www.ahcpr.gov/clinic/

2. Definition of a Literature Review • A systematic and explicit approach to the identification, retrieval, and bibliographical management of independent studies … locating information … synthesizing … developing guidelines …

3. Purposes of the Lit. Review • Facilitate development of the Conceptual Framework by summarizing knowledge • Clarify the research topic • Clarify the research problem • Verify the significance of the research problem • Specify the purpose of the study • Describe relevant studies or theories • Develop definitions of major variables • Select a research design, data measurement, data collection & analysis, & interpret findings

4. Ethics and Research • Starts with the study purpose, design, methods of measurement, and subjects • Guidelines for all of these • It is still a concern today • More recent ethical issues are: • Fabrication of a study • Falsification or forging of data • Dishonest manipulation of the design or methods • Plagiarism • 50% of the top 50 research institutions in US have been investigated for research fraud

5. Ethical Problems in Historyhttp://helix.nih.gov:8001/ohsr/mpa/45cfr46.php3 • Nazi medical experiments (1933-1945) • Tuskegee syphilis study by the USPHS (1932-1972) • Willowbrook study (1950-1970) Hepatitis study • Jewish Chronic Disease Hospital study with live CA cells in 1960s

6. Ethical Problems in History • University –Atomic Energy Government Exp. • 18 men and women injected with plutonium to determine body distribution (at the time said to be terminal) 1945-47 • 20 subjects ages 63-83 given doses of radioactive radium and thorium inj. or oral. 1961-65 • 64 male inmates at Washington St. Prison had testicular radiation to determine the smallest does to makes someone sterile. 1963-70 • 125 retarded residents were fed radioactive ir9n and calcium to see if a diet rich in cereal would block the digestion of those two minerals. 1946-56

7. Nuremberg Code-1949 • Voluntary consent • Must yield fruitful results for society • Anticipated results justify the type of experiment • Avoids all unnecessary physical-mental injury • Cannot do studies that have a known injury or death unless the exp. Physician is a subject • Risk does not out weight humanitarian benefit • Proper precautions to prevent injury, dis., death • Conducted by qualified persons • Subjects can always stop the study • Researcher must always be ready to stop the study (risk)

8. Declaration of Helsinki-1964-84 • Differentiated therapeutic vs. non-therapeutic research • Clinical vs. Basic • Greater care to protect subjects in non-therapeutic research • There must be a strong, independent justification for exposing a healthy vol. to substantial risk • The investigator is to protect the health and life of research subjects

9. The Belmont ReportThree Ethical Principles • Principle of respect for persons • Right to self determination and freedom to participate or not • Principle of Beneficence • Do no harm to others • Principle of Justice • Treat everyone fairly without discrimination • Led to USDHHS Code on Ethics • Title 45, Part 46 (45 CFR 46) • Office of Human Subjects Research (OHSR) within NIH • http://helix.nih.gov:8001/ohsr

10. Generally Called Subject Rights • Right to self-determination (can stop the research) • Right to privacy-anonymity-confidentiality • Right to fair treatment • Right to protection from discomfort and harm

11. Institutional Review Board • IRB review process 4-6 weeks • Consent forms (voluntary subjects) • Disclosure forms • Confidentiality • Compensation disclosure • Ethics documented in the research • Accountability to rules, regulations, and legal entities

12. Research Problem • The research problem dictates the method of inquiry (research method, or research design)

13. Problem Clarification>Method • What are the mother’s ages, education level, and marital status for those who have a child with a birth defect from low folic acid intake in Denver County? • There is a significant difference between mothers ages 15-19 having babies with birth defects when placed on supplemental folic acid versus those without the supplements.

14. Problem Clarification>Method • What is the relationship between mothers ages 15-19 who have effective dietary habits and folic supplement use versus those that do not in relation to the number of birth defects in Denver county. • There is no statistical difference between women ages 15-19 having babies with birth defects from low folic acid intake when randomly comparing Denver to Jefferson Counties

15. Problem Clarification>Method • How did M. Jones (a 15 y.o.) mother have good nutrition with Folic Acid supplements, still have a baby with neural-spinal tube closure defect? • What is the experience of Jefferson County teen mothers (ages 15-19) caring for babies with spinal cord defect associated with poor nutrition?

16. Problem Clarification>Method • What keeps teen mothers (ages 15-19) from being nutritionally prepared for pregnancy when they know being sexually active is logically and directly related to becoming pregnant?

17. Problems • Hypotheses: • Predicts a relationship between variables • More precise than a problem statement • Must be written before collecting the data • Testing the hypothesis is the heart of empirical research • They are never proven, they are accepted or rejected

18. Problems • Hypotheses • Identify the population, specify the variables, indicate the type of research, indicate variable measurement techniques, suggest an appropriate sampling method, and guide the interpretation of results • Help link theory to reality and back to theory • Encourage logical thinking to reduce misinterpretation

19. Types of Hypotheses • Simple: predicts a relationship between 1 independent and 1 dependent variable • Null: (or statistical) predicts no relationship • Complex: predicts a relationship with 2 or more independent and dependent variables • Directional: predicts the relationship between the variables (simple or complex) • Nondirectional: no relationship predicted • Research: most commonly used for clarity, is directional and in relational form.

20. Research Question • Used when knowledge is insufficient or in qualitative studies (exploratory, descriptive) • Written as interrogative sentences-present tense • Identifies the problem • Contains one of more variables • Reflects the problem statement • May or may not be empirical • Focuses on variables and their possible relationships