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Systematic reviews: some initial thoughts

Systematic reviews: some initial thoughts. COST meeting Sept 2010 With thanks to all those who feature in the photographs, and especially to the women and staff in Blackburn. Defining the question .

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Systematic reviews: some initial thoughts

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  1. Systematic reviews: some initial thoughts • COST meeting Sept 2010 • With thanks to all those who feature in the photographs, and especially to the women and staff in Blackburn

  2. Defining the question • ‘To summarize qualitative findings is to destroy the integrity of the individual projects on which such summaries are based, to thin out the desired thickness of particulars…and ultimately to lose the vitality, viscerality and vicarism of the human experiences represented in the original studies’ • (Sandelowski et al 1997 p366).

  3. Cochrane.. • Population • Intervention • Outcome

  4. Example.. Population Pregnant and labouring women Intervention Place of birth Outcome Mode of birth

  5. Question What is the impact of place of birth on mode of birth for pregnant and labouring women?

  6. Question definition for qualitative studies expertise (1) • ‘what is the nature of midwifery expertise in the context of physiological birth?’

  7. Expertise question after a number of iterations • ‘What accounts of intrapartum midwifery skills, practices, beliefs and philosophies are given by practitioners working in the field of midwifery who are practising‘beyond the ordinary’ in the intrapartum setting? • Downe et al 2007

  8. Topic definition: broad or narrow?(Finfgeld 2003)

  9. Where and how to search

  10. Inclusion/exclusion criteria • Language? • Discipline? • Population group? • Setting (eg birth centre review) • Type of study • Location of data: how close to the original? • Date range - what is the rationale? • Study quality: what about opinion?

  11. Example from expertise study • Our exclusion criteria were as follows: • studies not published in English • papers which only presented opinion; • research that only resulted in quantitative data • majority of the participants not maternity care practitioners • participants not selected as ‘beyond the ordinary’ • papers focused a priori on specific aspects (such as intuition) or narrow areas of practice (such as using the ventouse, or undertaking episiotomy) • studies with inadequate information to establish the quality of the research.

  12. How many studies are enough/too many? • Noblit and Hare: few is sufficient • Russell et al (1997): 3 studies included • Paterson et al (2001): 292 studies included

  13. Which data to include?

  14. Which data, example • Freestanding midwife led units: • 2 PhD theses • 3 published papers • (total 4 studies)

  15. Should quality criteria be used? • Some argue that…the very idea of criteria is incompatible with…(the… anti realist assumptions…(of qualitative research)….We suggest that this position is unnecessarily constraining …if the findings of research cannot be taken to represent even an approximation of the truth…why should commissioners…fund… such research’ (Murphy et al 1998 p10).

  16. Should quality criteria be used?(Walsh and Downe 2005) • ‘meta-synthesis of methodologically flawed studies may result in flawed meta-synthesis’ • Others would argue that quality lies in trustworthiness and ‘ringing true’ • But…who decides what is good quality? • 8 existing checklists and summary frameworks, different aspects included; Spencer and colleagues located 29 different checklists in their search.

  17. Our list • Scope and purpose defined • Design appropriate • Sampling strategy clear and appropriate • Analysis • Interpretation • Reflexivity • Ethical dimensions • Relevance and transferability • (Walsh and Downe 2005)

  18. Quality summary score • Key to quality rating • A No or few flaws. The study credibility, transferability, dependability, and confirmability33 is high • B – Some flaws, unlikely to affect the credibility, transferability, dependability, and/or confirmability of the study • C – Some flaws which may affect the credibility, transferability, dependability, and/or confirmability of the study • D – Significant flaws which are very likely to affect the credibility, transferability, dependability, and/or confirmability of the study • Downe et al 2007 (adapted from Jackson, unpublished)

  19. Our technique currently • Critical Appraisal Skills Programme (qualitative) • Then: Walsh and Downe (2005) • Then: Downe et al (2007) as summary quality score

  20. Mapping study characteristics • (EPPI-centre at the Social Science Research Unit SSRU: http://eppi.ioe.ac.uk/cms/) • See web examples

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