“Why do we learn improvisation?”

the effective intervention for chronic pain and chronic stress on veterans Order Description   Search Strategy and Information Sources generate lists of citations from relevant resources. Some databases you can use to search include: • EMBASE (biomedical literature) • MEDLINE • Science Citation Index • PsycInfo (psychology literature) • CENTRAL (The Cochrane Central Register of Controlled Trials) • CINAHL (Cumulative Index to Nursing and Allied Health Literature) • NHS EED • MIDIRS (available to obstetricians, midwives and consumers) • Conference Papers Index • Research Registers • SIGLE   Systematic reviews are widely considered to be the best source of research evidence. Systematic reviews, unlike literature reviews allow for a more objective appraisal of evidence. They can also highlight the lack of evidence and therefore identify areas where further research may be needed. One definition of a systematic review is: 'A review of a clearly formulated question that uses systematic methods to identify, select and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.' STUDY TITLE: The title of the review should be as descriptive as is reasonable and reflect the systematic review type. If the review is examining clinical effectiveness this should be stated in the title. If specific interventions and/or patient outcomes are examined these should also be included in the title. Where possible the setting and target population should be stated.   RESEARCH QUESTION You need to think about the population (the types of people), the type of intervention or exposures and the types of outcomes that are of interest. Example From the review ‘Interventions for basal cell carcinoma of the skin'. Population: Adults of either gender who have one or more histologically proven, primary basal cell carcinoma (basal cell carcinoma is a type of skin cancer). It is important to include 'histologically proven' otherwise we may not know for sure if the lesions are basal cell carcinomas or something that could resembles basal cell carcinomas. The intervention would be any treatment for basal cell carcinoma compared to 'the gold standard' or other types of treatment. There should be one primary outcome which should reflect clinical practice and then a number of secondary outcomes. In general, reviews should include all reported outcomes that are likely to be meaningful to people making a decision about the healthcare problem the review addresses. OBJECTIVES AND SPECIFIC AIM(S): The review objectives must be stated in full. Conventionally a statement of the overall objective should be made and elements of the review then listed as review questions. This section should be as focused as possible and make explicit what the review intends to find out. Example: To conduct a systematic review to determine the best available evidence related to the post-harvest management of STSG donor sites. The specific review questions to be addressed are: What interventions/dressings used in the management of the STSG donor site is most effective: in reducing time to healing, in reducing rates of infection, and in reducing pain levels and promoting comfort? What interventions/dressings are most effective in managing delayed healing/infection in the split skin graft donor site? What interventions are most effective in managing the healed split skin donor site? BACKGROUND The background should describe the issue under review including the target population, interventions and outcomes that are documented in the literature. The background should be an overview of the main issues. It should provide sufficient detail to justify the conduct of the review and the choice of the various elements such as the interventions and outcomes. It is often as important to justify why elements are not included. In describing the background literature value statements about effect of interventions should be avoided. Example: “Use of acupuncture is effective in increasing smoking cessation rates in hospitalized patients”. This is what the review will determine. If this type of statement is made it should be clear that it is not the reviewer’s conclusion but that of a third party, such as “Smith indicates that acupuncture is effective in increasing smoking cessation rates in hospitalized patients”. RESEARCH METHODS Eligibility criteria: Criteria for Considering Studies for this Review Specify the study characteristics and report characteristics that will be used as criteria for eligibility. Types of studies This section should flow from the background. Many reviews will have a hierarchy of studies that have been considered. There should be a statement about the target study type and the range of studies that were used if the primary study type was not found. Also, years considered, language, publication status. Need to give rationale. Types of participants There should be details about the type of individuals targeted including characteristics (e.g. age range), condition/diagnosis or health care issue (e.g. administration of medication in rural areas and the setting(s) in which these individuals are managed. Again the decisions about the types of participants should have been justified in the background. Types of interventions There should be a list of all the interventions examined. In some cases it may be appropriate to list categories of interventions. For example: “pharmaceutical and non- pharmaceutical interventions for smoking cessation”. This section should be concise as the background section provides an opportunity to describe the main aspects of the interventions. Types of outcome measures There should be a list of the outcome measures considered. The clinical relevance of the outcomes must be considered. The background should provide enough information to justify the outcomes included. Search Strategy and Information Sources An overview of the search strategy should be provided. It is usual to undertake a staged approach including initial search, full search and search of reference lists and hand searching. The databases searched should be listed with the time frames included. The initial search terms should be appropriate for the review objectives. If reference lists, grey literature and selective hand searching are used this should be stated. A statement about assessment should be included. Example: “All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract, and descriptor/MeSH terms. A full report was retrieved for all studies that met the inclusion criteria (see appendix I). Studies identified from reference list searches were assessed for relevance based on the study title.” You need to generate lists of citations from relevant resources. Some databases you can use to search include: • EMBASE (biomedical literature) • MEDLINE • Science Citation Index • PsycInfo (psychology literature) • CENTRAL (The Cochrane Central Register of Controlled Trials) • CINAHL (Cumulative Index to Nursing and Allied Health Literature) • NHS EED • MIDIRS (available to obstetricians, midwives and consumers) • Conference Papers Index • Research Registers • SIGLE The citations identified need to be screened for relevance to the review question. Full manuscripts need to be obtained for potentially all relevant studies. Then, go through the papers to decide on whether to include these in the review or exclude them. This will be done based on the explicit study selection criteria. Methods of the Review (data collection process): Assessment of methodological quality A description of how methodological assessment was managed should include reference to the checklist developed by the review team. Assessing the quality of the included studies is an important step. Quality refers to the internal validity. The internal validity of a study refers to the degree which its results are likely to be free from bias. Bias: is any process at any stage of inference tending to produce results that differ systematically from the true values. There are four main sources of systematic bias in trials of the effects of healthcare: • Selection bias - Resulting from the way comparison groups are assembled. • Performance bias - Systematic differences in care given to the participants. • Detection bias - Systematic differences between the comparison groups in outcome assessment. • Attrition bias - Systematic differences between the comparison groups in the loss of participants in the study. Data extraction A description of how data extraction will be managed should include reference to the data extraction tool developed by the review team. In some cases revision of the data extraction tool will occur after the full search has been conducted. A statement should be made to that effect.   Data synthesis A description of how data synthesis will be managed should be included. Describe the methods of handling data and combining results of the studies. REVIEW RESULTS Description of the selected studies The type and number of papers identified and the number of papers that will be included and excluded should be stated. Reasons for exclusion at each stage should be presented using the flow diagram. For each study, present characteristics for which data were extracted [e.g., study size, study variables, follow-up period, .. ] and provide citations. Methodological quality This should be a summary of the overall quality of the literature identified. Present data on the risk of bias of each study. Results of individual studies: This section must be organized in a meaningful way based on the objectives of the review and the criteria for considering studies particularly considering types of interventions and outcomes. For all outcomes considered, present for each study, simple summary data for the intervention and comparison groups and the effect estimate. Present results of any assessment of risk of bias across studies. DISCUSSION The discussion should include an overview of the results and summary of the main findings including the strength of evidence for each main outcome taking into consideration their relevance to the groups [e.g., users, health care providers]. Limitations It should address issues arising from the conduct of the review including limitations [discuss limitations at study and outcome level and at review level] and issues arising from the results of the review. Conclusions Provide a general interpretation of the results in the context of other evidence.   Implications for practice Where possible implications for practice should be detailed, but must be based on the documented results, not author opinion. Where evidence is of a sufficient level, appropriate recommendations should be made. Recommendations must be clear, concise and unambiguous.