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This is a structured literature review that adopts a quantitative methodological perspective that seeks to find out if the flu vaccine is effective in HIV-positive individuals that are immunocompromised. The research focus on analysing available literature based on same or similar research questions. This quantitative perspective has been adopted as the research question aims to find how effective an intervention is, which in this case the flu vaccine (Bell, 2005).

Search strategy

Search strategy is a systematic process of collecting and accumulating evidence based on the key terms of the chosen topic for analysation of findings and coming up with ample summary. A carefully considered literature search is crucial in performing a robust search and consists of a systematic and well-organised search from the already published data to identify a breadth of good quality references on a specific topic (Rau, 2004). There are a number of reasons for conducting a literature search that include: drawing information for making evidence-based guidelines, a step in the research method and as part of academic assessment. However, the main purpose of a thorough literature search is to formulate a research question by evaluating the available literature with an eye on gaps still amenable to further research (Cronin, Ryan & Coughlan, 2008). The literature research was done electronically using various search engines as well as databases. The first step conducted in the literature search was to identify any reviews that had been previously carried out in this topic area. This was to gain an idea of where there were gaps in literature as well as informing the researcher if the review actually needed to be carried out as a recent review would suggest there is no need of further research on the topic since all studies have been exhausted in that field. (Cooper et al., 2017). This search was performed in The Cochrane Database of Systematic reviews as well as in The Centre of Reviews and Dissemination. Once this search had been performed it returned results that suggested the most recent review undertaken was in 2018 but only collected data up


till 2015 so was not the most up to date in its data collection. The use of those databases was to ensure fast and efficient detailed collection of data as they are quick compared to manual literature research on books and articles in the library. The second search was then performed to identify potential research studies that would be used in collecting and analysing data for use in this review. The PICO framework was used to guide the search strategy (Cochrane, 2017b). It gave a specific procedure of conducting the research as per its guidelines. Databases searched in a systematic manner included MEDLINE, ProQuest and Science Direct (2014-2018). English language articles were selected and in order to reduce the return of results that could have popped in different languages. Delimiters and medical subject headings (MeSH terms) were used such as “HIV”, “Flu” and “vaccine”, and truncated keywords were used: “flu vaccin”, “immunocompromised”. The use particular databases ensure the collection of relevant information because they are medical databases.

Formulating research question

When developing research question based on the systematic review, PICO research strategy too was applied. The tool is commonly used in the healthcare research as it helps in isolating the key terms or concept in the research topic. It also helps in developing search terms that determine the inclusion as well as exclusion criteria. There are specific key terms applied when researching using PICO. Such particular terms enable fast search of the research question. The key words used in this research were “Flu vaccination” and “HIV”. The PICO helped in identifying the major subject of the research that in this case are the adults that are HIV positive. It observes the intervention being evaluated and its outcome as expected. The intervention in this research is the Flu vaccination which is observed how effective it works on the people whose immune have been compromised. The expected outcome is that the vaccine be effective on the HIV positive patients as it is in those who are HIV negative. The specific search strategy is presented in appendix 1. Table 1: PICO framework on search strategy

 framework on search strategy

Filters were also applied such as publication date was limited to the last five years, only scholar journals were selected and age range was adults (25-65). The use of the scholarly journals in the research was to ensure accuracy of the data gathered. Liabo and Gray (2008) state that it is essential that a comprehensive list of key terms (“MeSH” terms) related to each component of PICO has been identified in order to retrieve all relevant trials in the chosen area. Grasping the importance of optimal search strategy requires the need to balance sensitivity where there is a high proportion of relevant studies as well as with specificity where there is a low proportion of irrelevant studies being retrieved (Uman, 2011).

The databases listed have been selected due to being the most appropriate for this subject area and in identifying effectiveness of vaccinations/medical interventions. The population of interest is people with HIV. A scoping search has also been undertaken to get an idea of the literature that is already out there and where there are gaps that could be filled. This included looking in the following sources: Medline, Cochrane Library of Systematic Reviews. Databases for research protocols will also be explored such as PROSPERO, Cochrane and the Joanna Briggs institute. These were used in order to identify previous reviews carried out on flu effectives in the HIV population and any limitations noted by researchers in the evidence base. Secondly, a grey literature search would be performed manually by searching known flu journals such as Vaccine (Schardt et al, 2007). The manual data collection helped in gathering information that were not yet available electronically in the databases.

Literature search provides not only an opportunity to learn more about a given topic but provides insight on how the topic was studied by previous analysts. It helps to interpret ideas, detect shortcomings and recognise opportunities. A researcher can identify the areas that still require further studies and exploration to better the medical care giving of HIV positive persons. In short, systematic and well-organised research may help in designing a novel research (Grewal, Kataria & Dhawan, 2014).

Inclusion/Exclusion Criteria of Study Papers

The PICO framework was used to identify the inclusion criteria of papers and anything out with this framework was excluded. The inclusion on the research included, search in English language, and the patients had to be HIV positive, the age between 25 years to 65years. The types of publication used were to be journals that do not go past five years. As most current information are of great value to the research. The use of the language specification was to create better understanding and interpretation of data collected. The use of up to date information is also vital in a medical research as there are numerous discoveries and improvement in done on regular basis to improve the healthcare services (Aveyard, 2014). Studies excluded were those written in other languages with patient focus below the age of 25 years and above 65 years. Results on other unrelated topics were also excluded to avoid biased and inaccurate in the findings of the research. (see table below)

 framework on search strategy  framework on search strategy

Data Extraction

Data was extracted based on methodological quality and included only Randomised Controlled Trials (RCT’s) and was appraised using the Cochrane’s Risk of Bias tool.

Quality Appraisal

Once studies are selected, the quality of the research or evidence requires evaluation. The analysis of the collected information is significant as it helps determine the accuracy of data and brings understanding of the research topic. The CASP tool application in research is used in determining the weakness and strength of the literature .Using a quality appraisal tool, such as the Critical Appraisal Skills Programme (CASP) tool results in a structured approach to assessing the rigour of studies being reviewed (CASP, 2017). The tool has a specification list that is made of ten questions that are additional divided in three sections. The first section questions the validity of the results, the second sections ask for the results while the third section as whether the findings and the results of the research question will help locally (Singh, 2013). The healthcare professionals use Critical Appraisal Skills Programme to help them understand the available literature which will improve evidence-based practice.

Risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk bias in randomized trials. The Cochrane Collaborating tool discourses particular areas that are assessed as high risk of bias, low risk on bias and unclear (Eldrige et al, 2016). The addressed areas in the tool include:

  • Bias that arise from randomization process,
  • Bias resulting from deviation from the proposed intervention
  • Bias resulting from some missing outcome data
  • Biasness in measurements of the outcome
  • Bias in some parts of the reported results

Quality Assessment

The quality assessment done on the Retrieved RCTs examination of a perfect explanation of the method and cover-up of allocation of randomization, how deep the participating patients and the evaluators were blinded to the flu vaccine as an intervention. Another examination was whether or not everyone that was randomised originally was all included in the final main analysis.

Data synthesis

In possible occasions, qualitative systematic reviews were conducted using the similar Random Controlled Trials conducted using thematic analysis. The thematic analysis was used to identify meanings in particular pattern across a dataset to provide information on the research question. The method identity’s the patterns through rigorous process of familiarization with the data, data coding as well as theme development. The method has its advantage since it is not held on to with a specific epistemology or theoretical perspective which makes it a flexible method to use (Maguire & Delahunt, 2017). The quality of the research conducted was evaluated using the thematic analysis method.


The methodology used in the literature review was systematic and provided the basis of the research as anticipate. The various databases that were used for the research proved to be quite resourceful and provided information needed for the research. The application of the PICO tool in the research helped in narrowing done the research through the data sources providing only the required information on the topic. Cochrane Collaboration’s tool was used in analysing any available biasness that could have occurred during the research to ensure accuracy of the data collected. Quality is critical when conducting any medical research and various frameworks and methods were applied to ensure they were both attained.

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  • Aveyard, H., 2014. Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK).
  • Eldridge, S., Campbell, M., Campbell, M., Dahota, A., Giraudeau, B., Higgins, J., Reeves, B. and Siegfried, N., 2016. Revised Cochrane risk of bias tool for randomized trials (RoB 2.0): additional considerations for cluster-randomized trials.
  • Maguire, M. and Delahunt, B., 2017. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. AISHE-J: The All Ireland Journal of Teaching and Learning in Higher Education, 9(3).
  • Singh, J., 2013. Critical appraisal skills programme. Journal of Pharmacology and Pharmacotherapeutics, 4(1), p.76.

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