NURS6O30 Research and Evidence
ASSESSMENT 1: Research problem and systematic search strategy
Weight: 30%
This assessment aims to establish skills in developing a research question and performing a search for evidence to guide you in the clinical setting. Develop a clinical research question that requires a quantitative study to answer it. Describe the strategy you will use to search the existing literature to locate evidence to help you answer it.
You have a word limit of no more than 500 words for characteristics of study table and 500 words for the CASP tool – see instructions.
PART A: BACKGROUND SEARCH
1. PICO (quantitative analytic studies)
Key term
i.e. Child
i.e. Salbutamol
Alternatives
i.e. Paediatric, pediatric, infant
i.e. Albuterol, ventolin
How would you describe your Patient or Patient group?
Patient or population
What characteristics of your Patient/s or Population are important? Age, gender, condition, etc can all be significant.
What Intervention (quant) or Issue (qual) are you interested in?
Intervention/exposure
Define the Intervention (e.g., management plan) or exposure (e.g., passive smoking).
What alternative or different option do you want to Compare your intervention to?
Comparison
Describe the thing you would like to Compare the intervention with. It could be another intervention or no intervention.
What measurable Outcome/s are you interested in?
Outcome
Outcome is the final aspect of PICO. Some examples include: symptoms of asthma, a behaviour change, or mortality.
2. Reformatted (PICO) quantitative question
In ___________________________________ (P) how does ____________________________ (I) compared with __________________________ (C) affect _______________________ (O).
1. Search Strategy for literature to support proposal
Fill out the search strategy for your question – add or delete lines as necessary.
Database used:______________________________
P
Key terms and MESH terms:
1
2
3
4
5
(In this row, combine alternate terms for same topic)
6
7
8
9
10
11
(In this row, combine alternate terms for same topic)
12
13
14
15
16
(In this row, combine alternate terms for same topic)
17
18
19
20
21
(In this row, combine alternate terms for same topic)
22
(In this row, show combinations from above and relevant limiters to get your final set of papers)
O
C
I
3 Instructions and Template – NURS6030 Assignment 1
PART B: CHARACTERISTICS OF STUDIES TABLE
2. Key papers (500 words maximum)
Select five (5) individual study papers (not reviews) that are relevant to your overall clinical question. Document the characterises of the chosen papers using the below table. Use your own words to describe them.
Table 1: Characteristics of included studies
No
Article reference
Country
Participants (who?) and Setting (e.g. ED, hospital, community)
Study type and methods
Main results/findings (summarise in your own words)
Authors’ conclusions (summarise in your own words)
1
2
3
4
5
3.
PART C: APPRAISAL
4. Appraisal of a single paper completed using the appropriate CASP tool (500 words maximum for the answers entered into the tool)
· Choose a single quantitative study. Choose an RCT, cohort or case control study.
· Once you have chosen your paper, select the co
ect CASP assessment tool from the templates provided and paste the tool into this section. The templates are in Assignment 1 in Canvas.
· Appraise the paper using the questions and hints provided.
· Justify your answer to each question using the handy hints in the tool itself.
Article (provide full citation and doi)
________________________________________________________________________________________________________________________________________________
CASP tool (paste appropriate tool below and complete)
CASP Checklist: 11 questions to help you make sense of a Case Control Study
Section A: Are the results of the study valid?
1. Did the study address a clearly focused issue?
__Yes __No __Can’t tell
Comments:
Hint: Consider how an issue can be ‘focused’ in terms of:
· The population studied
· Whether the study tried to detect beneficial or harmful effect
· The risk factors studied
__________________________________________________________________________________________
2. Did the authors use an appropriate method to answer their question?
__Yes __No __Can’t tell
Comments:
Hint: Conside
· Is a case control study an appropriate way of answering the question under the circumstances?
· Did it address the study question?
Is it worth continuing?
3. Were the cases recruited in an acceptable way?
__Yes __No __Can’t tell
Comments:
Hint: We are looking for selection bias which might compromise the validity of the findings
· Are the cases defined properly?
· Were the cases representative of a defined population (geographically and/or temporally)?
· Was there an established reliable system for selecting all the cases?
· Are they incident or prevalent?
· Is there something special about the cases?
· Is the time frame of the study relevant to disease/exposure?
· Was there a sufficient number of cases selected?
· Was there a power calculation?
__________________________________________________________________________________________
4. Were the controls selected in an acceptable way?
__Yes __No __Can’t tell
Comments:
Hint: We are looking for selection bias which might compromise the generalisability of the findings
· Were the controls representative of the defined population (geographically and/or temporally)?
· Was there something special about the controls?
· Was the non-response high, could non-respondents be different in any way?
· Are they matched, population based, or randomly selected?
· Was there a sufficient number of controls selected?
_____________________________________________________________________________________________________
5 Was the exposure accurately measured to minimise bias?
__Yes __No __Can’t tell
Comments:
Hint: We are looking for measurement, recall, or classification bias
· Was the exposure clearly defined and accurately measured?
· Did the authors use subjective or objective measurements?
· Do the measures truly reflect what they are supposed to measure (have they been validated)?
· Were the measurement methods similar in the cases and controls?
· Did the study incorporate blinding where feasible?
· Is the temporal relation co
ect (does the exposure of interest precede the outcome)?
_____________________________________________________________________________________________________
6. (a) Aside from the experimental intervention, were the groups treated equally?
__Yes __No __Can’t tell
List:
Hint: List the ones you think might be important, that the author may have missed
· Genetic
· Environmental
· Socio-economic
_____________________________________________________________________________________________________
6. (b) Have the authors taken account of the potential confounding factors in the design and/or in their analysis?
__Yes __No __Can’t tell
Comments:
Hint: Look fo
· Restriction in design, and techniques e.g. modelling, stratified-, regression-, or sensitivity analysis to co
ect, control or adjust for confounding factors
Section B: What are the results?
7. How large was the treatment effect?
Comments:
Hint: Conside
· What are the bottom line results?
· Is the analysis appropriate to the design?
· How strong is the association between exposure and outcome (look at the odds ratio)?
· Are the results adjusted for confounding, and might confounding still explain the association?
· Has adjustment made a big difference to the OR?
_____________________________________________________________________________________________________
8. How precise was the estimate of the treatment effect?
Comments:
Hint: Conside
· Size of the p-value
· Size of the confidence intervals
· Have the authors considered all the important variables?
· How was the effect of subjects refusing to participate evaluated?
_____________________________________________________________________________________________________
9. Do you believe the results?
__ Yes __No
Comments:
Hint: Conside
· Big effect is hard to ignore!
· Can it be due to chance, bias, or confounding?
· Are the design and methods of this study sufficiently flawed to make the results unreliable?
· Consider Bradford-Hills criteria (e.g. time sequence, dose-response gradient, strength, biological plausibility)
Section C: Will the results help locally?
10. Can the results be applied to the local population?
__Yes __No __Can’t tell
Comments:
Hint: Consider whethe
· The subjects covered in the study could be sufficiently different from your population to cause concern
· Your local setting is likely to differ much from that of the study
· Can you quantify the local benefits and harms?
11. Do the results of this study fit with other available evidence?
__Yes __No __Can’t tell
Comments:
Hint: Conside
· All the available evidence from RCTs, Systematic Reviews, Cohort Studies, and Case Control Studies as well, for consistency
Remember: One observational study rarely provides sufficiently robust evidence to recommend changes to clinical practice or within health policy decision making. However, for certain questions observational studies provide the only real evidence. Recommendations from observational studies are always stronger when supported by other evidence.
CASP Checklist: 11 questions to help you make sense of a Randomised Controlled Trial
Section A: Are the results of the study valid?
Screening Questions
1. Did the trial address a clearly focused issue?
__Yes __No __Can’t tell
Justify your answer:
HINT: An issue can be ‘focused’ In terms of
· The population studied
· The intervention given
· The comparator given
· The outcomes considered
2. Was the assignment of patients to treatments randomised?
__Yes __No __Can’t tell
Justify your answer:
HINT: Consider
· How was this ca
ied out?
· Was the allocation sequence concealed from
3. Were all of the patients who entered the trial properly accounted for at its conclusion?
__Yes __No __Can’t tell
Justify your answer:
HINT: Consider
· Was the trial stopped early?
· Were patients analysed in the groups to which they were randomised?
Is it worth continuing?
Detailed questions
4. Were patients, health workers and study personnel ‘blind’ to treatment?
__Yes __No __Can’t tell
Justify your answer:
HINT: Think about
· Patients?
· Health workers?
· Study personnel?
5. Were the groups similar at the start of the trial?
__Yes __No __Can’t tell
Justify your answer:
HINT: Look at
· Other factors that might affect the outcome such as age,
· sex, social class