Appraisal And Evidence Synthesis Of Two Reviews

Appraisal And Evidence Synthesis Of Two ReviewsSelect two suss discloses of your choice. wholeness should be a opinionated Review and the otherwise a traditional Selective Review. Critic onlyy discuss the tone of your redirect examinations with respect to a banner assessment tool suitable for round offs.The aim of a brushup is to constitute an overview of the primary studies of a particular qualified and break up them in a charge, which is thorough, un crooked and reproducible, should it be repeated. ab go forth the gathering of the primary data that is exis ten-spotce reviewed. A authoritative review is a method of synthesising primary interrogation and studies. It is based on having a go throughly formulated question that social occasions dictatorial and unadorned methods to let break through, select and critically appraise relevant interrogation, and to collect and analyse data from the studies that ar intromitd in the review (Cochrane Collaboration Glo sasry, 2010). It as well uses an objective and transparent approach for inquiry synthesis, with the aim of minimizing bias. Statistical methods cognise as meta-analysis whitethorn or may non be use to analyse and summarise the results of the include studies (Wiesler McGauran, 2010).Systematic reviews differ from autobiography reviews. A story review differs in that the question organism answered is usually less(prenominal) specialised and has a wider focus of quest (Cook et al, 1997). A autobiography review may look more at the interaction of variables within a problem or the development and management of a problem, while a organized review go away usually focus on a specific and answerable question wherefore defend a clear defined outcome that it is gathering curtilage about. A narrative review summarizes different primary studies from which conclusions may be drawn in to holistic interpretation contributed by the reviewers witness bonk, existing theories and mo dels with results having a qualitative kinda than a quantitative meaning (Campbell Collaborative, 2001 Kirkevold, 1997).As with all types of research reviews both(prenominal)(prenominal) dustatic and narrative need to be appraised for their relevance and value to the subject it relates. A number of tools have been developed to help with the process of critically appraising of research. For the purpose of this assignment, the tool that will be utilize was produced by the Critical Appraisal Skills Programme (CASP), defining questions and prompts to assess the review, based on questions developed by Oxman et al (1994). This is an appraisal tool that assesses three main(prenominal) issues is the need valid? Whatthe results are and whether those results help locally. The aim of this tool has been knowing to answer these questions in a detailed and taxonomical manner. Furthermore, this tool has been selected as it has been specifically designed to support recite-based practice i n wellness and affectionate care (Public Health Resources Unit, 2006) and therefore it forces the reviewer to overly consider the sentiment of the patient and it is of relevance to the names that have been selected here.The systematic review to be used for this assignment is Gava et al (2009) Psychological handlings Versus Treatment as Usual for obsessional Compulsive Disorder. This review was chosen from The Cochrane Library, as the systematic reviews here have all been carried out using precise methodology, are updated in delimitate with new research and are specifically intended to help anyone k nonty in healthcare, including patients (The Cochrane Collaboration, 2010).The narrative review to be considered will be Abramowitz et al (2001) Cognitive Behavioural Therapy for obsessive Compulsive Disorder A review of the handling literature. This review was set in motion in a search on the CINAHL database. The CASP tool to be used is specific to systematic reviews (PHRU, 2006 ) then far it will be adapted here to in any case appraise the narrative review. The ten questions requireed in the CASP tool will now be considered.Did the review ask a clearly focused question?Liberati et al (2009) stated that authors should everlastingly identify their report as a systematic review or meta-analysis. Although sensitive search strategies have been developed to identify reviews, inclusion of the harm systematic review or meta-analysis in the title may repair indexing and identification (Montori et al, 2005). Furthermore, the title of a systematic review should be informative reservation key culture good accessible to the proofreader. This should include reflecting PICOS approach (participants, interventions, comparators, outcomes and study design) providing key information about the scope of the review (Liberati et al, 2009). The systematic review used for the purpose of this assignment wasPsychological Treatments versus Treatment as Usual for Obsessive C ompulsive Disorder (OCD) (Review). This title failed to domiciliate exposit of any participants or settings. The intervention and comparator are given as psychological treatments and treatment as usual, however, these had non been clearly specified and details of the outcome measure had not been provided either. Furthermore, the title simply stated review. such terms do not enlighten the reader whether the review was systematic or whether a meta-analysis was performed (Liberati et al, 2009). Therefore, it has to be noteworthy that the review failed to ask a clearly focused question.The narrative review of the Abramowitz et al (2001) study was Cognitive-Behavioural Therapy for Obsessive Compulsive Disorder A review of the treatment literature. As with the systematic review this theme also failed to use the PICOS approach, nevertheless, as a narrative review summaries the research more generally, these details may not flat be attach (Cook et al, 1997). In this review the inte rvention was specified as Cognitive-Behavioural Therapy (CBT) and it had been clearly indicated that this was a traditional review. Even though the question was not clearly focused, the author does provide the reader with an insight as to what the article contains.Did the review include the right type of study?The studies discussed in the systematic review included looking at any psychological treatment compared to any treatment as usual for adults with OCD, which shape uped to be appropriate for answer the research question. All of the included studies were randomised obligeled trials (RCTs) which appeared to be an appropriate study design with the focus being on the effectiveness of interventions (Hill Spittlehouse, 2003). However, by including RCTs however if and excluding other forms of research, this may result on moderate the conclusions drawn in the review. This appears of particular relevance to healthcare where qualitative forms of data, such as patients experience o f an intervention, should be considered of great importance (Petticrew, 2001).The studies discussed in the narrative review also count to address the question as research carried out on CBT for OCD was drawn upon. It also stated that the review focused particularly on movie and solution prevention treatment. This decision appeared to reflect the authors have got interest rather than a thorough search of the available literature, which may lead-in to more or less form of bias being introduced. The review draws largely upon RCTs and meta-analyses, which may be appropriate as the focus of interest was effectiveness (Hill Spittlehouse, 2003). However, limiting to the inclusion of only this research design and in a narrative review, it would seem that a range of research could have been incorporated easily as this review appeared limited from not having done so. As explicit details of all(prenominal) study used were not provided, other methodology could have been included but not clearly pick upd.Did the reviewers try to identify all relevant studies?To help identify all potentially appropriate research, a thorough literature search must be conducted in order to carry out a systematic review. This involves not only searching electronic databases, but also checking the reference lists of any selected articles in order to identify upgrade research (Greenhalgh, 1997b), searching for non- English language research and unpublished research ( Centre for Reviews Disseminations, 2008). This helps to reduce any bias in research that is published in non-English languages, as research showing funda psychological results tend to be published in English journals. Furthermore, by having English publications only may have a greater concussion on the results than there actually was.By searching a number of mingled electronic journal databases, reference lists, unpublished and ongoing research and also research in non-English language indicated that Gava et al (2009) a ttempted to conduct a thorough literature research.There were no details or information provided to indicate how the studies were obtained or how the search was conducted for the narrative review. Even though researches from other countries have been referenced, no indication has been given whether this was taken from non-English language publications. tenseness has been placed on research into exposure andresponse prevention therapy and the authors own work has also been cited. This however places some aspect of bias on the review as the reviewer has a clear interest in the topic currently being reviewed.Did the reviewers assess the grapheme of the included studies?The Gava et al (2009) systematic review describes rigorous fibre assessment. A pre-determined scoring system was used which should help to reduce bias by making gauge criteria objective and unrelated to the outcomes of the research (Greenhalgh, 1997b). To help reduce the chances of any bias emerging, property assess ments were carried out by two authors independently. However, it must be noted that all articles were included regardless of their quality pattern. Furthermore, it has been suggested that not all the authors do the method of randomisation used explicit and they were not always guile to the allocation.Abramowitz et als (2001) review does not mention any formal quality assessment. It must be noted that some informal judgements have been made. Furthermore, it has been noted that some of the research discussed in the review failed to be conducted to a mettlesome standard as reference was made to the use of control groups where likeness treatments used was known to be of no bene turn back to sufferers of OCD. This is unethical as participants allocated to the control groups would have received ineffective treatment which would have had an impact on the results as participants in these groups would have experienced higher dread levels and frustration making gains in the experimental group appear some(prenominal) higher. As narrative reviews do not normally employ pre-defined quality assessment tools, research included is probably to be of inconsistent quality and is more at risk of bias (Cook et al, 1997).If the results of the studies have been coincide, was it reasonable to do so?Results of distributively study used mass be combined in a systematic review to increase the sensitivity to earthshaking results (Crombie, 1996). However, this should only be done when the studiesand their results are confusable enough to postulate the combination of findings meaningful (Crombie, 1996).The Gava et al (2009) review did combine the results of all the studies reviewed. The results of each study were presented in a forest spell showing the mean, standard deviation and potency interval for each. Heterogeneity was also considered both by eyeballing the data and also by statistical analysis, which found no monumental residuals in the main analyses, but did find strong struggles on some of the secondary analyses. General reasons for heterogeneity were discussed at the start of the paper, but the specific heterogeneity found was not discussed in great lengths. Furthermore, a weight unit system was used to combine the results. This means that in the analyses stages studies displaying lower level quality were then given a lower weight making this an effective method for including such studies.The Abramowitz et al (2001) review did not combine the results of all the studies reviewed. In general terms the CRD (2008) state that the intentions of a narrative review is generally to provide a summary of relevant research rather than to synthesis or re-analyse. Furthermore, they also state that this could lead to further biased conclusions based on the reviewers own opinions rather than on tight analyses that could be re prepared by other researchers.How the results presented and what are the main result?In the systematic review, the results hav e been presented in the body of the text and also as in forest plots. CRD (2008) state that results should be expressed in formats that are easily understood. The most commonly used graphic is the forest plot as it provides a simple representation of the precision of mortal and overall results and of the variation between study results (CRD, 2008). The results indicated that psychological treatments led to more improvements in OCB symptoms than did treatments as usual. Improvements in dropout rates, quality of life, anxiety and depression levels in both psychological and treatment were also taken into consideration. Psychological therapy was broken start further to look at the variables being expressed, the mean differences being compute for continuous variables, butit also took into consideration and inform on the individual effects of CBT, Cognitive Therapy and Behaviour Therapy.Abramowitz et al (2001) review also discussed results for each study reviewed. This indicated th at exposure and response prevention were both effective therapies for OCD. However, since no statistics had been used then it was not come-at-able to assess how large and substantive the results were without referring to the original research. The research presented tends to be interpreted in favour of exposure and response prevention therapy, even with the results appear to suggest little difference (Jni et al, 2001). The conclusions drawn here are based on the authors own opinions and could have been subjected to biased interpretation of results or detection bias (Jni et al, 2001).How precise are the results?The use of confidence intervals in systematic reviews gives the reader an idea of how precise the results can be considered to be (Hopkins, 2001). Confidence intervals describe the range within which a result for the whole population would move on for a specified proportion of times a survey or running play was repeated among a sample of the population. Confidence interval s are a standard way of expressing the statistical accuracy of a survey-based estimate (Young Bolton, 2009). The confidence interval expresses the uncertainty around the point estimate, describing a range of value within which it is reasonably certain that the true effect lies wider confidence interval reflects greater uncertainty (CRD, 2008). Where a 95% confidence interval is reported then we can be reasonably confidence that the range included the true value for the population as a whole. Formally we would rest it to contain the true value 95% of the time (Young Bolton, 2009). Although intervals can be reported for any level of confidence, in most systematic reviews of health interventions, the 95% confidence interval is used (CRD, 2008).Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies dem onstrated that patientsreceiving any variant of cognitive behavioural treatment exhibited solidly fewer symptoms post-treatment than those receiving treatment as usual (SMD -1.24, 95%, CI -1.61 to -0.87, 1 test for heterogeneity was not substantial at 33.4%) (Gava et al, 2009). Different types of cognitive and / or behavioural treatments showed similar differences in effect when compared with treatment as usual. Results obtained for CBT on OCD symptoms exhibited that the overall mean difference (fixed effects) was in favour of psychological treatments (WMD -7.73, 95%, CI -9.92, -5.55). The 1 test of heterogeneity was not momentous at 33.4%. Results obtained for cognitive therapy on OCD symptoms exhibited that the overall standardised mean difference (random effects) were slightly in favour of psychological treatments (SMD -1.20, 95%, CI -2.66, 0.25). The 1 test of heterogeneity was not significant at 74.2%. The overall treatment effect appeared to be influenced by differences in b aseline severity (Gava et al, 2009). deep down the Abramowitz et al (2001) paper, there does not seem to be any confidence intervals apparent within, thus leaving us unable to analyse how precise the results, which are expound within the paper truly are. In comparison to the systematic review, this approach appears to be exceedingly less open the author is able to narrate the results in however way they please for example they could suggest that they are highly significant or interpret them as equal to their own theoretical stand but without the need of referral to the original case, however there is no way a certain conclusion as to whether this has occurred or not be drawn up.Can the results be applied to the local population?Within the Gava et al (2009) paper, population details and setting for each study do not seem to be clearly apparent. Although a high dower are noted as outpatient, a number of settings were not highlighted as to their location or setting. Due to this lac k of knowledge, and that some of the studies could have been carried out in a inpatient setting, it would not be possible to disclose a extrapolated result to the local population with information found in the inpatient studies. It was stated that the statistical data, or demographics, of the participantswere of a similar and consistent nature however there was no in enlightenment analysis or description of them. Due to this small fact, therefore it would not have been possible to state that these were similar to the local population. The duration of treatments described when provided locally was usually shorter thus it can assume some of the methods could not be provided within the local settings. Therefore, the generalisation of the results requires some distributor point of accuracy and precision for there are often vast and clearly significant differences between the sample and the settings used, here and the local population.Once again, within the Abramowitz et al (2001) rev iew, there was no description of the population meaning that it was not possible to ascertain a generalised collaboration of results. Furthermore, as one of the studies had been carried out in an inpatient setting, then it would not have been possible to generalise these results within such settings. The duration of these studies are described as being of 60-90 minutes on a daily basis which frankly could not have been possible locally. Therefore it is vital that care is taken when attempting to create a generalised result from this review as things that appear to be insignificant, as such small details can be inevitably crucial elements.Were all the important outcomes considered?The Gava et al (2009) review discussed various outcomes as well as improvements in OCD symptoms. Also considered were the outcomes for anxiety symptoms, depressive symptoms, dropout rates and quality of life. These elements were not only liable(predicate) to be of a high degree of importance to the servic e providers but also to the service users themselves. Service leads, mental health commissioners and policy makers / government officials may also be raise in dropout rates and reasons for dropout i.e. at initial assessment or at take up appointment. Details of each therapy session missed, cancelled, failed to attend would be important as well.The narrative review also discussed various improvements in OCD symptoms with each intervention. Consideration was given to the distress linked with exposure therapy, as it would be an important factor for all parties concerned i.e. patient and their families, and also taking into account the supporting role of the carer while patient receives therapy.Abramowitz et al (2001) review state that a relatively large number of customers abandon participation in exposure therapy because of anxiety evoking elements of treatment (i.e. confronting feared stimuli). This places ferocity on the importance of understanding the rationale for exposure th erapy, demonstrating mastery of case conceptualization, and providing the client with a convincing explanation of why confronting feared situations will result in long-term abatement of obsessions and compulsions.Should policy or practice change as a result of the evidence contained in the review?The current use of CBT for OCD is supported by the Gava et al (2009) review. Despite this, any RCT or other psychological therapy was unidentifiable by the author whilst other types of therapy did not fit the required format needed in order to carry out a RCT to the same quality that a CBT does thus meaning it has more controlled research in comparison to other forms of therapy. One criticism of systematic reviews is their bias towards certain methodologies for important research may not be included thus leading to biased conclusions. Further research is therefore needed to make comparisons between CBT and other types of therapy it may be that a mixed methods review would have been carried out in order to do this effectively (Dixon-Woods et al, 2004)A biased review is also present in Abramowtiz et al (2001). In this case it is towards studies in support of exposure and response prevention therapy. No decision can be reached from this review for a thorough search to identify all research in the world -quality assessment and the clear display of results was not completed. Conclusions are more likely to be biased and not be representative of all the evidence in the field within narrative views for they do not follow a predefined and set methodology thus, narrative reviews are less likely to influence policy and practise.ConclusionIt is evident that both methodologies consist of advantages and disadvantages. Systematic reviews use pre-defined methodologies with the intention of reducing bias making the results to appear more robust. Nevertheless a critique appears to be the evident over emphasis of RCT which is argued to find less generalisable results. On the other han d, narrative review results appear to be more generalisable and tend to be more flexible in the incorporation of other methodologies. However within these reviews, the scientific, pre-defined strategies are not employed, thus considering them to have a higher risk of leading to bias. To conclude, it appears that both of these reviews can be of significant help and are easily justifiable for use, depending on the question that the researcher is trying to answer and the point at which the evidence base is at in its development.