Lecture5 Notes

Writing Literature Review
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  1 Writing a Literature Review Elements of a Literature Review AbstractIntroductionMethodologyResultsDiscussionConclusion Review of the literature Your interpretation of the evidenceBrief overviewBrief summary Abstract Similar to a research/journal articleKey components to summarize ãPurpose  –  Clinical question/relevance of the review ãMethodology  –  Process of acquiring articles ãResults  –  Results of the systematic search  –  Consistent findings and/or gaps ãConclusion  –  Final assessment of the overall evidence 1 Introduction Reasons (or need) for the review ãGive an overview of the problemãTarget the audience Clinical relevance of the problem ãEffect of this issue/problem on clinical practice or patientsãDescribe, as needed…  –  Anecdotal evidence  –  Current practice methods  –  Popular components/interventions Specific purpose of the review ãLast paragraph of the IntroductionãBe straightforward  –  “The purpose of this literature review is to...” 2 Methodology Searching for the literature ãTargeted search  –  Names and dates of databases searched ãSearch strategy  –  Keywords and phrases used Selecting the articles ãInclusion and exclusion criteria  –  Populations, interventions, or outcomes sought ãTopics of interest  –  Other criteria used to select final articles for review Evaluating the evidence ãStudy design classificationãQuality assessment 3 Results Literature collection and selection ãHow many collected?ãHow many reviewed?ãClassification/quality results Critical evaluation and synthesis ãExamine commonalities and/or trends  –  Describe consistent evidence in quality research ãFind contradictions and/or inconsistencies  –  Try to discern why (i.e., quality assessment)  –  Offer suggestions as to how studies may differ ãIdentify relationships ãLocate gaps 4  2 Discussion Examination of the evidence ãWhat does the evidence (in total) mean?  –  Interpret/explain the information found ãWhat are the limitations to the review?  –  Is the review comprehensive, complete? Clinical conclusions ãWas the clinical question answered?ãDo the results support/refute current clinical practice? ãDoes the information suggest a change? Future directions ãWhat other information is needed?ãWhat research needs to be conducted? Think about doing the review again ãWhat would you want to see in 5 years? 5 Conclusion Summarize findings ãRestate the purpose of the reviewãDescribe the overall evidence  –  Is it strong? Weak? ãWhat are the main conclusions?  –  Similarities/contradictions  –  Obvious gaps or needed work Clinical relevance ãWhat has been gained from the review?ãWhat is the “take-home message?” 6 Suggested distribution Given a 20 page review, one might: ãAbstract –1 pageãIntroduction –4 pagesãMethods –2 pagesãResults –8 pagesãDiscussion –4 pagesãConclusion –1 page Example paper – Scoliosis Abstract ãPurpose, methods, results, and clinical relevance all mentioned Introduction ãReasons for the review, clinical relevance, and purpose statedãMore detail regarding bracing options might have helped (figure?) Methodology ãSearch strategy detailed, particularly abstract analysisãThree databases, plus JPO searchedãKeywords, exclusion criteria, and classification discussed Results ãOverall observations mentioned, then individual articles reviewedãArticles critiqued and included only as necessary (some w/ tables) Discussion ãCommonalities and inconsistencies mentionedãFuture research ideas provided, clinical usefulness discussed Conclusion ãCautious, but fair summary of literature provided Example paper – Depression Abstract ãPurpose, methods, results, and conclusion noted brieflyãUse of “meta-analysis”incorrect Introduction ãGood definition of the problem of depressionãRationale for the review not justified enough (too short) Methodology ãSearch strategy detailed, great description of in/exclusion criteriaãThree databases searched, but only vague description of keywords Results ãBrief (too brief) discussion of search resultsãOverall observations mentioned 1 st , then individual articles reviewedãNicely divided into logical sub-sectionsãArticles not critiqued Discussion ãGeneral findings summarizedãLimitations to review notedãFuture directions, synthesis not discussed (too short) Conclusion ãShort summary, risk factors not noted (too short) Example paper – Tissue Management Abstract ãObjective, methods, brief results, and conclusions well and briefly describedãExcellent abstract Introduction ãGood general description and identification of a problemãExcellent rationale for the review Methodology ãSearch strategy briefly detailed, little description of in/exclusion criteriaãFour databases searched, good description of keywords Results ãNice discussion of search results (great flowchart)ãNicely divided into logical sub-sectionsãIndividual articles reviewed in good detail Discussion ãGoals restated, general findings summarizedãExcellent effort to synthesize the literatureãFuture directions only vaguely discussed Conclusion ãVery comprehensive, well-written conclusion  3 OrganizationOrganization is Important Organization ãSeparate sections  –  Bold, italics, and/or underline to separate sections ãStart broad, and focus to detailsMaintain a flow of information ãEach section of the review should be consistentãAlways remember the purpose of the review Line up key review parameters ãTry to match up study similarities  –  i.e. apples-to-apples , oranges-to-oranges ãLook for common themes or gaps However, do notjust make a list ãYou are the interpreter  ãConsider both scientific evidence and clinical experienceãAssess the information and draw conclusions Comparing Research Potential comparisons among studies ãOverall questions askedãAssumptions madeãHypotheses/theories put forwardãStudy designs usedãPopulations studiedãOutcome measures (variables) selectedãDevices/interventions assessedãResults obtainedãResearchers’interpretationsãProposed future work Ultimately, up to the reviewer…you Linking Words & Phrases For trends and similarities ã also ã additionally ã likewise ã similarly For contradictions ã however  ã conversely ã on the other hand ã in contrast to Tables & FiguresTables & Figures Tables and figures ãCan be used to show cross-study comparisonsãSometimes, more effective than text Correctly label ãTables –above the tableãFigures –below the figure Number and reference ãNumber tables & figuresãAlways reference in text Properly cite and note significance ãClearly cite studies being comparedãNote significant findings, such as an asterisk (*) ExperimentalTrials (22%)ObservationalStudies(43%)ExpertOpinion(35%) Figure 1 –Distribution of reviewed papers   Table 2 –Summary of reviewed literature  4 Tables Percent of subjects reporting a change when using an ESAR foot compared to CF 1 Menard (1989) 2 Murray (1988) * p <0.05 5535Seattle FootSkin problems 2 3945Seattle FootResidual limb pain 2 61 N/ASeattle FootBalance and endurance 2 8713Seattle FootOverall gait performance and awareness of keel action 2 5539Seattle FootHip and knee shock and stress 2 7416Seattle FootAnkle motion 2 2861Flex-Foot Skin problems caused by prosthesis 1 4045Flex-FootPain 1 7030Flex-FootRecreational activity level 1 6827Flex-FootGait 1 Percent of subjects reporting improvementsPercent of subjects reporting no changeESAR footFunctional area **** Figures  Ankle ROM During Walking Gait 051015202530Wagner (1987) n=3Torburn(1990) n=5Lehmann (1993 #2) n=9Powers (1994) n=10Snyder (1995) n=7 Study, Year, Number of Subjects    T  o   t  a   l   A  n   k   l  e   R  a  n  g  e  -  o   f  -   M  o   t   i  o  n   (   d  e  g  r  e  e  s   ) SACHQuantumFlexFoot 4  3 . 9  % I  n c r  e a s  e Ov  er  S A  C H4  0 . 0  % I  n c r  e a s  e Ov  er  S A  C H 9  3 . 3  % I  n c r  e a s  e Ov  er  S A  C H 6  0 . 0  % I  n c r  e a s  e Ov  er  S A  C H 5  3 . 3  % I  n c r  e a s  e Ov  er  S A  C H1  6 .1  % I  n c r . Ov  er  S A  C H 8 1 . 6  % I  n c r  e a s  e Ov  er  S A  C H7  3 . 3  % I  n c r  e a s  e Ov  er  S A  C H ***** Writing Style & FormatTechnical Writing The goals of technical writing ãConvey your informationãBe understandableãBe accurate Paragraph structure ãOne topic per paragraphãFirst sentence defines paragraphãFirst-last sentences “linked” Sentence structure ãAvoid run-on sentencesãKeep sentences to-the-point Technical Writing First person vs. third person voice ãFirst person (i.e. “we”or “I”)  –  Better for narratives ãThird person (i.e. “it,”“them,”or “they”)  –  Better for technical writing Active vs. Passive voice ãActive = “Our results show…”ãPassive = “Results showed…”ãPassive voice vs. active voice  –  Passive accepted in scientific writing  –  Removes pronouns  –  Sounds objective Technical Writing Verb tense ãMay change between sections  –  Methodology = past tense  –  Discussion = present tense ãShould be consistent within sections Use of superlatives ãRarely descriptive in scientific writing  –  Very, quite, fairly, rather, somewhat, relatively ãMost can be eliminated  –  Avoid using vague words (some, few, enough, etc.)
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