Critical Appraisal of Research Methods and Findings

Introduction

Critical appraisal is referred to the process of systematically and carefully examining the scientific research outcomes for judgement of its value, trustworthiness and relevance in a certain context. The critical appraisal focuses on the way the research is executed and assessing the factors like generalizability, validity and relevance of the research findings. The critical analysis of articles for collecting evidence related to any topic is important as it ensures proper focus on research articles which are relevant to the research question and it is able to support or refute the claims made in reliable manner with high-quality evidence. In this study, the critical appraisal of an article named “Alpha-blockers for treatment of ureteric stones: systematic review and meta-analysis” developed by Hollingsworth et al. is to be executed to assess the value and relevance of the research outcomes and methods in the study.

Explaining system review and its comparison with other nature of reviews along with its role in evidence-based healthcare

There are mainly two types of literature review which are systematic review and narrative review. The systematic review is referred to the nature of literature review which uses systematic methods for summarising the findings of the carefully designed healthcare studies to provide gathering of high-quality evidence regarding the impact of healthcare interventions (Jahan et al. 2016). This nature of the review is generally complicated and mainly depends on examining the available clinical trials used in the study, the way the trials are executed to judge their quality and the way outcomes regarding healthcare are measured in the study. In systematic review, the researchers gather numeric data regarding the impact of the mentioned treatment in the study through the process of meta-analysis (Anderson et al. 2016). However, the Narrative review is referred to as the description and discussion of published articles and journals regarding certain topic from a contextual and theoretical viewpoint. This nature of reviews mainly consists of the critically examination and analysis of the literature which is published in books and paper-based or electronic journals (Nguyen et al. 2016).

The narrative reviews are mainly seen to describe and appraise published articles but the methods implemented in the articles are not effectively described in this form of review (Greenhalgh et al. 2018). However, in comparison, the system reviews are found to present well-defined review questions along with secondary questions and analysis. Moreover, the systematic review is found to present clearly defined criteria for selection of the articles along with the explicit methods used for data extraction and synthesis, present comprehensive research for identifying relevant articles regarding the study topic and allows the application of standards for critically appraising the quality of the study (Ferrari, 2015). The narrative reviews mention general debates along with appraisal of studies that are previously presented and present lack of information in them. The reviews also speculate the current intervention available and the rationale for the future study (Marra et al. 2019). In comparison, in systematic reviews, the researchers determine, examine and synthesise literature from the article based on a specific query. In addition, in systematic review comprehensive report is provided along with explicit processes for assumptions, rationale and methods to be opened to be examined by any external organisation. The reviews also gather what is already known and identify them on the basis of the knowledge (Ferrari, 2015).

The limitations faced with narrative review are that the assumptions as well as planning are not properly known at all times and biases in selection and evaluation within the study can be seen (Animasahun and Chapman, 2017). In comparison, in systematic reviews the scope of the study is found to be limited by search terms, queries and selection criteria as well as in this review the readers require to reformulate alternative questions which are not resolved or answered in the main questions of the study (Silva et al. 2017). The Evidence-based practice (EBP) in health and social care is the type of practice which mainly relies on the numeric and scientific evidence for framing stronger deductive or inductive arguments to develop guidance and decision-making for care to the service users (Middleton and Llewellyn, 2016). The study by Kelley and Chung (2018) mentions that healthcare practitioners are able to save considerable time as well as develop reliance on other’s expertise in providing care when they are offered pre-filtered evidence regarding healthcare. This pre-filtered evidence is gathered in EBP when someone with proper expertise in the area has presented and reviewed the strongest methodological data in the area of interest of health and social care (Kelley and Chung, 2018). The role of the system review is seen in this case where they provide opportunity to the practitioners to use it as a mode in gaining access to the required pre-filtered data (Samargandi et al. 2016).

In the study of Hollyer et al. (2019), it is mentioned that systematic reviews have the aim to gather findings from various original research and studies by use of strategies in limiting their biased presentation. This indicates that systematic reviews are effective to substantially lower time and use of expertise to identify, appraise and synthesise individual studies to gather evidence to be used in caring for service users in the health and social care. The effectiveness or efficacy of any rehabilitation intervention is seen rarely presented in a convincing manner in a single study. In fact, various studies are required to be analysed for developing sound evidence to finally reject or support any form of intervention in healthcare to be applied to patients (Thomas et al. 2018). The systematic review plays their role in this condition by employing meta-analysis to gather high ranked data from multiple studies delimiting biases regarding hierarchies of evidential treatment in medical filed (Thomas et al. 2018). All the systematic reviews may not include meta-analysis and few of them can provide descriptive information regarding patterns of treatment in terms of methodology. This nature of systematic review would rely on apprising evidence based on search terms and omit information regarding effective calculations (Nicoll et al. 2018). Thus, the systematic review allows unwanted duplication and error in care delivery by nurses and practitioners in the health and social care field as their knowledge would be enhanced through the pre-filtered evidence gathered from multiple resources in the process.

Critical appraisal of methods of selection, extract and appraisal used by Hollingsworth et al. in the study along with summarising the findings

The study by Hollinghsworth et al. (2016) informs that they considered the use of studies of any language which are randomised controlled trials and considered alpha-blockers in comparison to control or placebo for treating ureteric stones. The randomised controlled trial studies are the effective selection by the researchers to be included in executing the systematic review. This is because randomised controlled trials (RCT) allows the researchers to properly compare one treatment with another to determine which is superior to manage the illness among patients, Moreover, RCT studies allow high-quality empirical evidence regarding the efficacy of any treatment to be gathered (Lilienfeld et al. 2018). Thus, the use of RCT as inclusion criteria for studies would allow the researchers to present effective comparative results. The RCT studies have the advantage of having minimum bias due to randomised allocation of participants (Cassese et al. 2016). This aspect acts in favour of the researchers to present minimum biased findings from previous studies in the review. The key aim of the study is to examine the efficacy and safety of the alpha-blockers to treat patients who have ureteric stones (Hollinghsworth et al. 2016). Thus, considering the inclusion of studies that focussed on alpha-blockers and avoided inclusion of trials where alpha-blockers were used as adjacent to surgery was an effective step by researchers as it allowed them to involve related data that are similar to the aim of the study.

The study mentioned that reference manager software EndNote was used for removing duplicated records from the study (Hollinghsworth et al. 2016). The EndNote is referred to as the quality reference management software that are used various researchers to arrange advanced reference and bibliography (Kali and Srirangaraj, 2016). The duplicated records are essential to be removed from the study as it leads to wastage of time and money along with lowers the enriched inclusion of data in the study (Tam et al. 2017). Therefore, the use of reference manager EndNote was an effective step towards enriched execution of the study. The Covidence is referred to as the online software product which improves the synthesis of evidence regarding healthcare by enhancing the experience and efficiency of creating and managing standard reviews. This support main steps in the review process in the Cochrane regarding citation and creating risk of bias examination and acts to enhance link with RevMan to make the review writing process more effective (Crilly et al. 2019). Thus, the use of covidence is effective step by the researcher as it allows quality systematic reviews to be organised.

The risk of bias examination is required for establishing transparency in the results and findings of the systematic review (Zhang et al. 2017). In this study, the Cochrane Collboration tool is used for assessing risk of bias in the study which is an effective approach as it provides narrative information regarding the methodological features which contributes to increase risk of bias in the trials (Hollinghsworth et al. 2016). Thus, the use of this tool helps the researcher to determine in details regarding the aspects they are to control in the study to minimise the risk of bias. The Hartung-Knapp-Sidik-Jonkman method is used for determining random-effects meta-analysis. The use of this method is appropriate for the study as it led to better analysis of data for studies that have smaller study samples (van Aert and Jackson, 2019). The study is seen to execute sensitivity analysis for the statistical data gathered (Hollinghsworth et al. 2016). This is an effective approach taken by the researcher for the study as it allowed proper analysis of the robustness of the findings ensuring greater validity for the study.

The findings mentioned in the study informed that total of 55 randomised controlled trials was involved. The analysis of the studies revealed that there is moderate quality of evidence present which indicates alpha-blockers as effective intervention for facilitating passage of ureteric stones. On the basis of previous subgroup analysis, it was found that alpha-blockers did not provide any positive treatment impact for patients who have small ureteric stones. However, 57%b increased stone passage risk was identified in patients with larger ureteric stones compared to the patients under control. The impact of the alpha-blockers for the removal of ureteric stones was found to be independent of its location (Hollinghsworth et al. 2016). The implication of these findings in the clinical field from the Hollingsworth et al. review is that it proved alpha-blockers to be used for patients suffering from ureteric colic to reframe the treatment process for them as well as avoid medical expulsion therapy. This is because in this were patients can be avoided from stone surgery and its related risk ensures better health management through the use of alpha-blockers.

The review also informed that the patients who were provided alpha-blockers showed significantly less time for the passage of stones (Hollinghsworth et al. 2016). Thus, this informs that use of the alpha-blockers is able to provide speedy recovery to the patients with ureteric stones. The findings of the review mentioned that the use of alpha-blockers helped in created less episodes of pain among patients as well as acted to reduce hospital admission (Hollinghsworth et al. 2016). Thus, the review is to be implemented in the clinical field to replace surgical intervention for ureteric stones as the alpha-blockers are found to be more effective than the previous intervention to provide quality health condition to the patients. The findings of the review mention that alpha-blockers may not be used to assist all but it is to be implemented for the removal of stones among patients who have stones that are ≥5 mm in size (Hollinghsworth et al. 2016).

Explaining meta-analysis and the way it is done

The Meta-Analysis is referred to the formal, quantitative and epidemiological design of the study which is used for systematically examine the results and findings presented in previous studies for deriving conclusion regarding the study (Cheng et al. 2019). As asserted by Ribassin-Majed et al. (2017), decision regarding the use of any intervention or ensuring validity of any hypothesis is unable to be executed on the basis of results collected from a single study. This is because results are found to vary from one study to another. The meta-analysis in this condition uses objective formulas to gather and analyse data from multiple studies to reach a definitive conclusion. The meta-analysis is also done to overcome the issues created by small sample size in single studies to properly identify the impact of interest along with analyse the points that need larger sample sizes for collecting high-quality data regarding the study topic (Rey-Mermet and Gade, 2018). The meta-analysis is used to determine if new studies are required for further investigation and are used for generating new hypothesis for future researches (Moldovan et al. 2017).

The critical issues required to be considered in meta-analysis includes detection and selection of studies, heterogenesity of findings, data analysis and available information. The outcome in meta-analysis is dependent on the studies which are included in the process. There are two phases considered to include studies in meta-analysis out of which the first phase is detection of literature search for identifying potential and valid studies and the second phase is considering criteria used for listing the studies to be included. In this aspect of meta-analysis, there are three problems often faced that is biasness in search and publication in the detection phase and biases of selection in the second phase that is selection phase (Cooper et al. 2019). The publication biases which creates issues in detection of articles for meta-analysis is that positive studies are often printed whereas the negative studies remain unpublished making researchers unable to determine the true impact of the facts they are using. Therefore, to avoid this error the researchers required to consider the unpublished studies as well to detect the articles from where data is to be gathered (Nikolakopoulou et al. 2018). The search bias may be raised as a result of the use of faulty search terms leading the meta-analysis to miss some effective articles that could able to enhance the study. The selection bias may be faced when the studies are not included in the meta-analysis by following all the criteria mentioned for the study topic (Veroniki et al. 2016).

The heterogenosity in meta-analysis is referred to the extent of dissimilarities in the findings present in individual studies. In certain cases, the dissimilar results are able to be traced back to condition that is present in individual studies or some cases the dissimilarities are unable to be determined. In any of the condition, the heterogenosity level rises to such an extent that the justification for the integrated results is difficult to be explained in the meta-analysis (Borenstein et al. 2017). In most of the individual studies, the summary of results such as odds ratios, standard deviations, mean and others except the possibility to error in mentioning the data. This lack of information is able to severely impact the analysis and conclusions to be reached in the meta-analysis (Fusar-Poli et al. 2016). The analysis of data in meta-analysis is usually done by using fixed-effect model or random-effect model and each of them has pros and cons. When the heterogeneity in the studies is high, the findings in the meta-analysis are found to be mostly dependent on the models used but when the heterogeneity is low the meta-analysis tends to use both the models to develop balanced effect. Therefore, sensitivity analyses with the meta-analytic studies are to be included to ensure robustness in the results is properly maintained (Pladevall et al. 2016).

The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) is referred to the transparent framework to develop and present summaries of evidence and deliver systematic approach for recommendations regarding clinical practice (Moberg et al. 2018). The biases in identification and selection of studies usually occur when the findings of the study do not disclose the inherent limitations. The GRADE in seen to be used for rating body of evidence at the outcome level compared to study level. Therefore, the researchers by using GRADE to be able to judge whether the bias risk in particular studies are effectively large or their confidence in the impact of estimated treatment is lower. This is because considerations of risk bias and the way to resolve them are mentioned in detail within the GRADE guidelines in series 4 (Parmelli et al. 2017). Therefore, GRADE allows informing the researcher regarding the risk of bias in the studies and helps to resolve the biasness issue faced for meta-analysis. In GRADE, it is seen that there is detailed discussion regarding the publication bias faced regarding any study topic (Dahm et al. 2017). Therefore, the issue to be faced as a result publication bias during detection of studies is resolved through its help making the meta-analysis to be performed in enriched manner.

The researchers to determine whether or not certainty is to be rated lower for inconsistency in the study then the researchers are required to examine the point of similarity that determines and overlap intervals of confidence along with statistical criteria for hetergenosity. In GRADE guidelines, detailed discussions regarding the inconsistency in studies are mentioned (Mercuri and Gafni, 2018). Therefore, the use of GRADE would help to resolve the issues faced in meta-analysis regarding heterogensity and inconsistency problems. The GRADE approach for rating imprecision provides 95% confidence interval to ensure quality studies are included in evidence (Siegfried et al. 2017). Therefore, this aspect of GRADE facilitates data for meta-analysis to be collected in an accurate manner.

Critically examining the qualitative evidence synthesis and their role to provide information in healthcare practice and research

Qualitative evidence synthesis (QES) is referred to the approach used in systematic reviews for gathering qualitative evidence for the research. The QES has been found to be recognised in increasing manner to have key role in addressing the research questions regarding intervention or system complexity along with the development of guidelines. This is because of the unique role played by the QES in establishing relative importance of acceptability, outcomes, fidelity and reaching interventions (Flemming et al. 2019). The role of the qualitative evidence synthesis (QES) in health and social care is to look deeper in analysing the information available and the attitudes, behaviour and feelings of the stakeholders (Houghton et al. 2017). This is effective approach of QES to ensure understanding of the needs and quality of care as well as effects of treatment and medical intervention based on the underlying principles for the stakeholders in relation to real-life context. The role of QES in health and social care is that it provides greater openness and freedom to the researchers in reporting information that may lead to expand new topics that are not previously considered valid (Munthe-Kaas et al. 2018). This is because in collecting qualitative data in this process the views and information presented by participants in the previous studies are analysed and examined by researcher in new way to develop better information to be presented in the systematic review.

The Qualitative evidence synthesis (QES) has the role to provide detailed picture of the ways in which certain people or participants feel and show actions (Benoot et al. 2016). This is because during collection of qualitative data from the previous studies the researchers are able to determine factors which stimulate the experiences expressed by the individuals by examining the interview transcripts mentioned and data shared. The role of QES when used along with quantitative evidence synthesis in health and social expresses attempts to neglect pre-judgements of any response or information (Benoot et al. 2016). Thus, the QES acts to bring together qualitative findings for establishing better understanding of research problems which are sensitive and subtle in nature. This ensures QES has the ability to provide better interpretations regarding the effect of any condition, medical intervention or policy on the real-life experience as well as feelings of people involved with the condition. However, limitations are faced with the use of qualitative evidence synthesis for the studies.

The hindrance with using QES is that it often allowed issues with generalising outcomes. This is because the qualitative data are found to be specific to age of participants, place, preference of researcher and others that make it specific and hard to be generalised to be implemented for the general population (Houghton et al. 2016). In addition, the use of QES in collecting informing in health and social care makes the researchers to face difficulty in systematic comparisons. This is because often in individual studies it is seen that various people have provided wide differentiating responses which are often found to highly subjective nature (Reilly and Houghton, 2019). The another hindrance of using qualitative evidence synthesis to inform data in health and social care is that the interpretation is dependent on the skill of the researcher that may lead to create biasness on the representation of findings (Ames et al. 2019). This is because the thoughts and skills of the researchers at times may not be adequate to properly analysing the data from different studies to be presented in systematic manner during review.

Conclusion

The above discussion informs that the study to be reviewed used systematic review process. The systematic reviews which are generally complicated involve systematic techniques to be used for summarising results of the studies to gather quality information. The studies which included information regarding alpha-blockers to treat ureteric stones were included in the study which was an effective step as it helps the researcher to gather the information that is related to the study aim. The Meta-analysis is executed to analyse the results and present the findings and the issues to be faced with meta-analysis include detection and selection of studies, heterogenesity of findings, data analysis and available information. The qualitative evidence synthesis (QES) has the role in health and social care to provide in-depth information regarding treatment intervention.

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