1. Getting Started: What’s Out in the Literature and Is It Any Good?
Susan B. Fowler, PhD, RN, CNRN, FAHA

2. Literature

3. Research Critique Is not synonymous with “criticize”
Examines the strengths, weaknesses, meaning, and significance of the study (substantive and theoretical dimensions)
Be objective and realistic in identifying the study’s strengths and weaknesses

4. Important Points All studies have weaknesses or flaws
Research is critiqued to broaden understanding, improve practice, and provide background for conducting a study
The critique process involves comprehension, comparison, analysis, and evaluation

5. Cochrane Systematic Reviews
Cochrane Library www3.interscience.wiley.com/cgi-bin/mrwhome/ /HOME The Cochrane Collaboration. Oxford: Update Software; Updated quarterly.
Cochrane Database of Systematic Reviews (Cochrane Reviews)
'Gold Standard' for high-quality systematic reviews
Full-text included in Cochrane Library
Cochrane Reviews includes complete reviews and protocols (reviews that are still in progress)
Cochrane Reviews abstracts are in PubMed

6. More Reviews
Database of Abstracts of Reviews of Effects (Other Reviews - DARE)
prepared by the National Health Service Centre for Reviews and Dissemination, University of York, England
Complements the Cochrane Reviews by offering a selection of quality assessed reviews in those subjects where there is currently no Cochrane review
Brief critical appraisals of previously published reviews of the effects of health care
Structured abstracts, not full-text
DARE not indexed in PubMed, but original research articles may be
Also available at no charge on the web from University of York |

7. Other Systematic Reviews and Meta-analyses
PubMed MEDLINE - Systematic Reviews |
access: part of PubMed's Clinical Queries (linked on PubMed Home and Advanced Search pages)
Identifies systematic reviews and other similar types of studies found in biomedical journals included in PubMed database
No evaluation of comparative quality of different reviews on a topic
Abstracts supplied by authors/journals. No separate evaluation of quality of research
Identify systematic reviews in the biomedical area - gathers together much larger collection than other evidence-based practice resources

8. Evidence Guidelines/Summaries
BMJ Clinical Evidence |
Compendium of evidence on the effects of clinical interventions
Summarizes the current state of knowledge, including knowns and unknowns, based on thorough search
Categorizes interventions as beneficial, likely beneficial, no known benefit, harmful ...
DynaMed |
Best available evidence summaries for nearly 2000 topics
Clinical reference tool developed for use at the 'point-of-care'
Outline format to quickly identify key conclusions
Updated daily
Other Resources
USPSTF Guidelines |
AHRQ Evidence Reports |
FPIN Clinical Inquiries included in Journal of Family Practice | and American Family Physician |

9. RCTs, Case Cohorts, Control Studies
PubMed | (pubmed.gov )
note: Filtered by publication type, but not quality
Clinical Queries - Uses preconfigured search strategies to retrieve research-based citations on clinical topics in the areas of therapy, diagnosis, etiology, or diagnosis
Use Limits to search by specific publication type (e.g. meta-analysis, randomized controlled trial, review)
Cochrane Library | www3.interscience.wiley.com/cgi-bin/mrwhome/ /HOME The Cochrane Collaboration. Oxford: Update Software; Updated quarterly.
Cochrane Central Register of Controlled Trials (Clinical Trials)
Bibliography of controlled trials as part of an international effort to hand search the world's journals
Includes reports published in conference proceedings and in many other sources not in PubMed or other bibliographic databases

10. Content of Research Reports
The Abstract
The Introduction (review of the literature, theoretical framework, significance of and need for the study)
The Methods Section
The Results Section
The Discussion Section
The References

11. The Beginning The title The abstract
Could you tell what the article was about by reading the title?
The abstract
Includes a brief description of the problem
How the study was done (methodology)
The results
Conclusions

12. Next Steps The Problem Review of the Literature
Is it clear what the problem the authors are trying to solve?
Review of the Literature
Do the articles relate to the problem?
Is it organized, broad to specific?
Does it tell a story?
Comprehensive and current? What years are covered in the ROL?
Research Question/Aim/Purpose/Hypothesis
Do authors pose a research question or hypothesis?
Is it explicitly stated what the aim or purpose of the study is?
Design
Is the design stated?
Does the design flow from the research question or aim?
Did the authors explain why they choose this research design?

13. Design Analysis of numerical data
Quantitative
Qualitative
Analysis of numerical data
Experimental
Quasi-experimental
Comparative
Longitudinal
Correlational
Analysis of data such as words (e.g., from interviews), pictures (e.g., video), or objects (e.g., an artifact)
Grounded theory - social processes
Phenomonology – lived experience
Ethnography – culture
Historical

14. The Journey Continues Sample Tool Is the population described?
Is the sample method, or how the sample was chosen described?
Is the sample size right for the analysis? Was a power analysis done to determine sample size?
Were standards for protection of human subjects discussed?
Tool
Was the tool created by the authors or already established?
Is a copy of the tool included in the article?
Is reliability discussed?
Is validity discussed?

15. Tool, Instruments, Questionnaires, and More
Validity
Reliability
Extent to which the tool measures what it was intended to
Content
Criterion related
construct
Results are repeatable and consistent
Internal consistency
Test-retest
Inter-rater

16. Power
The probability that a statistical test will detect a significant difference that exists - the risk of a Type I error can be calculated using power analysis.
Level of significance
Sample size
Power - acceptable level is .80
Effect size - the degree to which the null hypothesis is false

17. Effect Size
An estimate of how large the treatment effect is, that is how well the intervention worked in the experimental group compared to the control group (intervention studies)
The larger the effect size, the stronger are the experimental intervention’s effects.
Effect size for intervention studies:
.2 = small effect
.5 = medium effect
.8 = large effect

18. Getting Closer to the End
Methodology
Are methods of data collection sufficiently described?
Is the time frame when the study occurred described?
Data Analysis
Is information presented sufficient to answer the research question(s)?
Were statistical tests used to analyze the data?
Were values obtained from the analysis?
Was statistical significance reported?
Are the results explained?
Are tables and figures easy to understand and informative?

19. Confidence Intervals
Probability that a value will fall within a range of variables
The larger the CI the less precise the measurement of that variable
A very wide interval may indicates that more data should be collected before anything very definite can be said about the parameter
95% CI most common

20. The End Discussion Conclusions Is a discussion section presented?
If yes, are the results compared with the literature review?
Conclusions
Are conclusions clearly stated?
Are conclusions directly related to the results?
Do the findings add to the present nursing knowledge?
Are study limitations identified?
Did authors make recommendations for further research?
Carlson, J. (1999). J Emerg Nurs, 25,

21. References
Relevance (extent to which the reference bears on the research question)
Primary sources (descriptions of studies written by the researchers)
Secondary sources (descriptions of studies written by someone other than the original researcher)
Opinion and anecdotal

22. Level of Significance
The researcher does not know when an error in statistical decision making has occurred. The researcher can control the risk of making a Type I Error by setting the level of significance.
Level of Significance (alpha level) is the probability of making a Type I Error or the probability of rejecting a true null hypothesis.

23. Level of Significance
Usual level set at .05 (willing to accept the fact that if the study were carried out 100 times, the decision to reject the null hypothesis would be wrong 5 times)
If researcher wants to have smaller risk of falsely rejecting null hypothesis, set at .01.
Decreasing risk of making Type I Error increases risk of Type II Error.
Findings are significant or not significant.

24. Clinical Significance
Related to practical importance of the findings
No common agreement in nursing about how to judge clinical significance
Effect size?
Difference sufficiently important to warrant changing patient care?

25. Clinical Significance
Who should judge clinical significance?
The patients and their families?
The clinician or researcher?
Society at large?
Clinical significance is ultimately a value judgment

26. Research Journals
Examples of peer reviewed / refereed journals: Nursing Research, Advances in Nursing Science, Applied Nursing Research, Clinical Nursing Research, Western Journal of Nursing Research
Example of Peer Reviewed online resource: Medscape
Peer Review – Look for statement in first few pages of journal that it is peer reviewed. Content is “reviewed” by experts in field before publication

27. Let’s Get to Work – Critique in Action!!