Epe literature review training november 28 2011 (1)

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Epe literature review training november 28 2011 (1)

  1. 1. REVIEWING THELITERATUREAshley Juhl, M.S.P.HIndira B. Gujral, M.S., Ph.D.Epidemiology, Planning, and EvaluationBranch
  2. 2. AgendaWhat is Evidence-Based Public Health? (Indira Gujral) Brief overview of why it mattersConducting the Search (Ashley Juhl) Identifying the search question Searching the databases Utilizing the CDPHE Digital LibraryCritiquing the Literature (Indira Gujral) Abstract pertinent information from each document Organize documents for review Summarize the scientific literature review Rating evidence
  3. 3. ObjectiveWhat will I learn from this training? How to search for and obtain articles using the CDPHE Digital Library How to critique and summarize articles How to use tools to apply these new skills  Critique Literature  Literature Library  Levels of Evidence to Rate Strategy
  4. 4. Using Scientific Literature Step 1 Step 7 Step 2Step 6 Step 3 Step 5 Step 4 Materials Located: I:E P EPortfolio Project
  5. 5. WHAT IS EVIDENCE-BASED PUBLIC HEALTH?
  6. 6. What is “Evidence?” Objective  Systematic reviews (Meta-analysis)  Literature from one or more journal articles  Public health surveillance data  Program evaluations  Qualitative data  Community members  Other stakeholders  Media/marketing data  Word of mouth  Personal experienceSlide modified from presentation by Ross Brownson, PhD (2011) Subjective
  7. 7. What is “Evidence-based Public Health”?  Institute of Medicine (1988) – public health is driven by ―crises, hot issues, and concerns of organized interest groups‖  Barriers: lack of political will, deficits in research, resources, leadership, competencies, and deficits in relevant and timely research  Goal – to improve population health through widespread adoption of evidence-based strategies
  8. 8. Why use Evidence-Based Strategies? Higher likelihood of a successful program Reduces costs Impacts the population Contribute to the body of knowledge
  9. 9. Types of Public Health Research Studies Characteristic Descriptive Research Intervention Research Contextual Conditions Typical Data/ Size and strength of Relative effectiveness of Information on the adaptation and Relationship preventable risk—disease public health intervention translation of an effective relationship (measures of intervention burden, etiologic research) Common setting Clinic or controlled community Socially intact groups or Socially intact groups or setting community-wide community-wide Example Smoking causes lung cancer Price increases with a Understanding the political targeted media campaign challenges of price increases reduce smoking rates Quantity More (study = 78.5%) Less (study = 14.9%) Even Less Action Something should be done. This particular intervention How an intervention should be should be implemented implementedSlide modified from presentation by Ross Brownson, PhD (2011)
  10. 10. CONDUCTING THE SEARCH
  11. 11. Objectives Learn how to formulate an answerable question for the literature review (PICO) Identify search databases Gain knowledge of resources for grey literature Learn about the Digital Library project and how to access full-text journal articles
  12. 12. SEARCH QUESTION
  13. 13. PICO The acronym PICO can be used to describe this ―answerable‖ question, so that  ―P‖= patient problem or population  ―I‖ = intervention  ―C‖ = comparison intervention  ―O‖ = outcome
  14. 14. PICO ExamplesProblem/ Intervention Comparison OutcomePopulationUnintended School-based sex Abstinence Avoidance ofpregnancy among education education unintendedteens pregnancy Education in family Consistent planning clinic contraceptive use Education in school- Delayed initiation based health clinics of sexual intercourse Community-based All three outcomes programs
  15. 15. Sample Search Questions For teenagers, will school-based sex education programs as compared to school-based abstinence programs decrease unintended pregnancy rates? Among teenagers, will education in family planning clinics increase consistent contraceptive use? Among teenagers, will education in school-based health clinics delay the initiation of sexual intercourse? Among teenagers, will education in community-based health clinics decrease unintended pregnancy rates, increase consistent contraceptive use, and delay the initiation of sexual intercourse?
  16. 16. SEARCHING THE DATABASES
  17. 17. What is “Evidence?” Objective  Systematic reviews (Meta-analysis)  Literature from one or more journal articles  Public health surveillance data  Program evaluations  Qualitative data  Community members  Other stakeholders  Media/marketing data  Word of mouth  Personal experience SubjectiveSlide modified from presentation by Ross Brownson, PhD (2011)
  18. 18. Systematic Reviews PubMed  http://www.ncbi.nlm.nih.gov/pubmed?holding=codphlib  searches for systematic reviews in biomedical literature The Cochrane Library  http://www.thecochranelibrary.com/view/0/index.ht  systematic reviews of primary research in human health care and health policy  free full text from CDPHE computer (through 4/2012) The Campbell Library  http://www.campbellcollaboration.org/library.php  prepare, maintain and disseminate systematic reviews in education, crime and justice, and social welfare  free full text
  19. 19. What is “Evidence?” Objective  Systematic reviews (Meta-analysis)  Literature from one or more journal articles  Public health surveillance data  Program evaluations  Qualitative data  Community members  Other stakeholders  Media/marketing data  Word of mouth  Personal experience SubjectiveSlide modified from presentation by Ross Brownson, PhD (2011)
  20. 20. PubMed Search citations for biomedical literature from MEDLINE, life science journals, and online books Clinical Queries will locate clinical studies, systematic reviews, and medical genetics citations MeSH Database will help pinpoint concepts ClinicalTrials.gov will locate clinical trial information and results http://www.ncbi.nlm.nih.gov/pubmed?holding=codphlib
  21. 21. My NCBI Save searches and records Automatic email alerts Filter search results by subject Free http://www.ncbi.nlm.nih.gov/sites/myncbi/
  22. 22. PubMed Search For teenagers, will school-based sex education programs as compared to school-based abstinence programs decrease unintended pregnancy rates?  teenagers  school-based sex education  school-based abstinence education  unintended pregnancy
  23. 23. What is “Evidence?” Objective  Systematic reviews (Meta-analysis)  Literature from one or more journal articles  Public health surveillance data  Program evaluations  Qualitative data  Community members  Other stakeholders  Media/marketing data  Word of mouth  Personal experience SubjectiveSlide modified from presentation by Ross Brownson, PhD (2011)
  24. 24. Types of Grey Literature conference papers/posters/abstracts official documents and white papers reports and proceedings theses and dissertations official documents informal communications research in progress reports registered clinical trials
  25. 25. Grey Literature NOT controlled by commercial publishers Often includes information vital to research – especially public health NOT indexed in major databases, including PubMed More current than published material
  26. 26. Grey Literature Sources Specialized search engines  New York Academy of Medicine Grey Literature Report  Science.gov  Scirus  Google Scholar  Promising Practices Institutional repositories, scientists websites
  27. 27. CDPHE DIGITAL LIBRARY
  28. 28. Problem State and local public health lack sufficient access to databases, full-text journal articles, and books  Individual/program subscriptions  University access through students/faculty Impedes ability to find best available evidence to improve health
  29. 29. Digital Library Project Purpose: To better understand the usefulness of providing public health departments with access to selected licensed e-resources (databases, books, journal articles) Funder: National Network of Libraries of Medicine, New England Region  CDPHE Lead: Dr. Lisa Miller (Director, DCEED) Funding through April 2012  CDPHE Digital Library launched in January 2011
  30. 30. Project Objectives Promote selected e-journals and two databases that contain evidence-based public health resources (in addition to PubMed):  Stat!Ref– compilation of full-text E-books  Global Health—contains public health information back to 1912 License EndNote for multiple users Provide subsidized Interlibrary Loan to those who work in the selected public health departments
  31. 31. Where is the Digital Library?
  32. 32. Digital Library Contents Colorado specific PubMed link Access to Cochrane Library, STAT!Ref and Global Health Links to 55 e-journals with free full-text Free journal article delivery service  Poudre Valley Health System Medical Library Other databases, academic, and government websites
  33. 33. Access to Journal Article Delivery Service Access to LoansomeDoc will be provided by Poudre Valley Health System  Library of first resort Registration to LoansomeDoc to monitor usage https://docline.gov/loansome/login.cfm  Free service, easy to use Utilize University of Massachusetts Lamar Soutter Library  Library of last resort
  34. 34. Requesting Journal Articles for Delivery PubMed  Select send to – order - order articles  Sign in to LoansomeDoc  Request article even if not in holdings (ignore cost box) Other sources  Email Jerry Carlson directly gmc@pvhs.org  Include all article information Articles will be e-mailed to requestor directly at no charge
  35. 35. Requesting Journal Articles for Delivery Continued Before submitting request, make sure the journal is not listed in the ―E-Journals‖ section of the Digital Library page  Immediate retrieval of article (access to free full-text from a CDPHE computer)
  36. 36. Digital Library Questions Please Contact:  Karen Dahlen (external project coordinator)  kdahlen@comcast.net  Ashley Juhl (internal CDPHE contact)  ashley.juhl@state.co.us Happy Searching!
  37. 37. QUESTIONS?Stretching session
  38. 38. HOW TO CRITIQUE ANARTICLE
  39. 39. Abstracting Information Critique an Article Critique: ―an act of criticizing‖ Merriam Webster Key Elements:  Balanced  Includes strengths and weaknesses  Constructive  Providing suggestions for how the study might be improved
  40. 40. What will I be Critiquing? Objective  Systematic reviews (Meta-analysis)  Literature from one or more journal articles  Public health surveillance data  Program evaluations  Qualitative data  Community members  Other stakeholders  Media/marketing data  Word of mouth  Personal experience SubjectiveSlide modified from presentation by Ross Brownson, PhD (2011)
  41. 41. How to Critique an Article (Handout)1. Source* Is the report from a peer reviewed publication?* Is the research current?2. Research Problem* Is the problem identified clearly?* Is it significant--does the researcher provide a good argument for significance?
  42. 42. How to Critique an Article3. Literature Review* Is it convincing that the author reviewed a sufficient amount of literature? (More than one source?)* Is it balanced, presenting literature that supports and that differs from the researchers position?* Is the review written critically (giving strengths and weaknesses of previous work)?* Are references current, or a combination of current and classic?
  43. 43. How to Critique an Article4. Theoretical Framework* Is a theoretical framework specified?* Does the framework "fit" the problem? Include all relevant variables?* Are results interpreted in reference to the theoretical framework?--Note: qualitative research, descriptive studies, and physiologic studies typically will not have a theoretical framework.
  44. 44. How to Critique an Article5. Variables* Are the variables in the study appropriate to the problem?* Are the means to measure the variables appropriate?6. Hypotheses* Are hypotheses stated? If not, does the researcher provide sufficient information to determine what the hypotheses were?* If stated, are the hypotheses clear? Specific? Testable?--Note: qualitative research and many types of descriptive studies do not involve hypotheses. In a qualitative study the researcher may suggest hypotheses as a result of the research.
  45. 45. How to Critique an Article7. Design (overall)* Is the design specified correctly?* What design was used?* Is the design appropriate to answer the research question?* Did the researcher attempt to control for threats to internal and external validity?
  46. 46. How to Critique an Article8. Sample* Is the sample size adequate?* Is the sample likely to be similar to members of the appropriate population overall?* Are the criteria for including and/or excluding people or items from the sample clear and appropriate?
  47. 47. How to Critique an Article9. Data Collection* Are the instruments or other means for data collection described sufficiently?* Are reliability and validity of instruments addressed? Are these adequate?* Are data collection methods described clearly?* Are the data collection methods appropriate?* Could the researcher have affected the results of the study in some way related to the collection of data?
  48. 48. How to Critique an Article10. Data Analysis* Is the process used to analyze data clear?* Were the processes for data analysis appropriate to answer the research question?* Do the results provide an answer to the research question?* If tables are provided, are these clear and understandable?For qualitative studies, some additional items for critique include:* Does the researcher provide sufficient examples of the data (for example, passages or quotations from interviews) to support the identified results?* Does the researcher describe processes that were used to avoid biasing or influencing the data obtained and the analysis procedures used? (Ex. Peer review, logs, memos, "member check―)
  49. 49. How to Critique an Article11. Discussion and Interpretation of Findings* Does the discussion "fit" with the data? Is it logical based on the data and results presented?* Does the researcher discuss the findings in regard to previous research?* Does the researcher discuss the findings in regard to the theoretical framework?* Does the researcher identify limitations of the study? How do these affect the quality of the study?* Does the researcher discuss implications for practice? Are these appropriate?
  50. 50. How to Critique an Article12. Ethical Considerations* Does the researcher indicate that approval was obtained from appropriate review boards?* Were the rights of human subjects protected (confidentiality)?13. Application to Public Health* How similar are the conditions of the study (setting, sample, interventions, etc.) to our setting?* How feasible would it be to make a change in practice based on this research?
  51. 51. HOW TO ORGANIZE MYARTICLES
  52. 52. Organizing Documents for Review TIPS FOR KEEPING YOURSELF SANE….AND ORGANIZED! Organize by publication type (review articles, government/agency guidelines, original research) Enter information into reference management database (EndNote, Reference Manager, ProCite) Store articles in a file drawer in alphabetical order by author’s name Keep your literature summaries organized electronically (Xcel, Access, Word)
  53. 53. Literature LibraryLiterature Library• Xcel Sheet with all of the pertinent information• More information than an abstract• Critical for sustaining work over time (i.e.childhood obesity)• Materials Located: I:E P EPortfolio Project
  54. 54. Literature Library Title: Managed Care and School-Based Health Centers Authors: Kaplan, DW Archives of Pediatric Medicine 1998 Study Design: Retrospective cohort Study Population: Adolescent members of Kaiser Permanente 342 adequate Records Review Chi-Squares presented Results: Adolescents with access to SBHCs were more than 10 times more likely to make a mental health or substance abuse visit (98% of these visits were made at the SBHC) (P,.001). Adolescents with SBHC access had an after-hours (emergent or urgent) care visit rate of 0.33 to 0.52 visits per year less (38%-55% fewer visits) than adolescents without SBHC access, and, overall, made almost 1 additional medical visit per year. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least 1 comprehensive health supervision visit compared with 68.8% of adolescents without access (P=.04). In addition, the adolescents with access were screened for high-risk behaviors at a higher rate. School-based health centers seem to have a synergistic effect for adolescents enrolled in managed care in providing comprehensive health supervision and primary health and mental health care and in reducing after-hours (emergent or urgent) visits. Conclusion: School-based health centers are particularly successful in improving access to and treatment for mental health problems and substance abuse. Notes: old article but everyone cites this Managed Care and School-Based Health Centers
  55. 55. HOW TO RATE THELITERATURE (HANDOUT)
  56. 56. SUMMARY OF EVIDENCE
  57. 57. Public Health Evidence Rating (Handout) How Established Considerations for Level of Scientific Data Source Examples EvidenceProven Peer review via systematic or Based on study design and execution Community Guide narrative review External validity Cochrane reviews Potential side benefits or harms Narrative reviews based on published Costs and cost-effectiveness literatureLikely Effective Peer Review Based on study design and execution Articles in the scientific literature External validity Research-tested intervention programs Potential side benefits or harms Technical reports with peer review Costs and cost-effectivenessPromising Written program evaluation Summative evidence of effectiveness State or federal government reports without formal peer review Formative evaluation data (without peer review) Theory-consistent, plausible, potentially Conference presentations high-reach, low-cost, replicableEmerging Ongoing work, practice-based Formative evaluation data Evaluability assessments* summaries, or evaluation works in Theory-consistent, plausible, potentially Pilot studies progress high-reaching, low-cost, replicable National Institute of Health (NIH) Face validity research (RePORT database) Projects funded by health foundationsNot Recommended Varies. Evidence of effectiveness is conflicting Varies. and/or of poor quality. Weak theoretical foundation Balance of benefit and harm cannot be established or evidence demonstrates that harm outweighs the benefits. * A pre-evaluation activity that involves an assessment to establish whether or program or policy can be evaluated, what the barriers to its evaluation might be. Source: Adapted from Healthy People 2020 and Brownson RC, Fielding JE, Maylahn CM. Evidence-based Public Health: A Fundamental Concept for Public Health Practices . Annual Review of Public Health. Vol. 30: 175-201
  58. 58. FEASIBILITY OFIMPLEMENTING THESTRATEGY

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