Does radiation dose of CT imaging increase the risk of cancer (brain tumours – leukaemia) in children?

Assessment Component 1 – Conducting a critical review

The main aim of this task is to allow you to demonstrate not only your critical skills in analysing research based and theoretical material, but also your ability to present a logical and coherent account of it.

In conducting your literature review you will be expected to include the following:

• reading in your immediate area of interest but also in related theoretical areas which strengthens relevance and importance of topic
• insight into the search and review method
• a critical analysis of the research related to your topic using your knowledge of the research process and research methodology and methods.
• a discussion of any relevant theoretical aspects of your topic with identification of the ways these have been derived from, or supported in, the literature.
• an identification of the strengths, weaknesses and omissions in the literature
• a discussion of the implications of the literature for current and future practice of your discipline.

8.1 Structure and format of the critical review
You should adhere to the structure and format in the guidelines detailed below. Failure to do so will be reflected in the mark awarded.

1) Review title:
The title should encapsulate what it is that you have done. The title should be concise and informative; a poorly worded title often indicates a poorly thought through project. The title will be dependent on your review topic and the review question you choose to study within that topic. See box 1 for examples titles derived from the review topic.
Example 1
Topic: Vulnerable children
Final Title: “Building resilience in vulnerable children: a critical review of practice”.

A word about your review topic:
In principle the process of allocating topics will involve the offer of a selection of a fairly broad area of investigation; some supervisors may in fact leave the topic completely open and allow you a free choice (but this must be within an area of competence of the supervisor). It will then be your job to turn that topic into a manageable subject from which you can devise a review question. Projects should be practice rather than policy focused, though you will need to demonstrate an awareness of relevant policy.
Remember: critical (and systematic) reviews don’t restrict themselves to evidence of effectiveness (see Example 3 above). The Joanna Briggs Institute (JBI) approach to systematic evidence review helpfully provides a typology of evidence identified by the acronym FAME (see Box 2).

Reviews can also focus on pre-registration education and continuing professional development issues relevant to a topic (for example levels of knowledge, attitudes and beliefs, or effectiveness of education in preparing for/changing practice).

By now it should be evident that the process for a critical review has much in common with a systematic review particularly in respect of the formulation of a clear question.

A critical review differs from a systematic review in the following main respects:
• A systematic review should be undertaken by at least two people
• The information retrieved for a critical review is not assessed for suitability for meta-analysis.
• The search protocol and inclusion and exclusion criteria for the selection of literature to be considered for a critical review are not as rigid as is typically the case with systematic reviews.

2) Abstract: 280 words
The abstract should clearly and concisely describe your project, outline the main findings and be easily understood by people outside of the project (i.e. no jargon or abbreviations). This should between 250-300 words and not include references: it does not count as part of the overall word allowance.
3) Introduction: 850 words
The introduction provides the rationale and justification for the review and must be clearly stated. It is important to justify the need for the review and subsequent proposal as, “Research which duplicates other work unnecessarily or which is not of sufficient quality to contribute something useful to existing knowledge is in itself unethical” (Department of Health: Research Governance Framework, 2001). A key word here is ‘unnecessarily’. Therefore, you should provide a short introduction to the topic area and set the scene for the proposed review (that is, provide the background information). Issues covered are likely to include relevant policy and guidance on the topic; epidemiology (the scale of the problem); relevance to your profession; any key issues that might influence your search strategy and review (controversies, debates, clarification of terms used).
4) Methods: 500 words
This section should start by giving a clear indication of the question the review seeks to answer. Note: the question requires an even greater level of precision than your project title. You should use one of the following mnemonics to ensure your question contains the essential components for a question that will inform practice (see Box 3).

This should provide an explanation of the approach taken to the literature search:
• time frame;
• databases searched;
• journals searched by hand should be included with date/periods searched;
• key terms used;
• the inclusion and exclusion criteria used to identify key papers (types of participants, types of intervention/activity, types of outcomes);
• the criteria used to judge the papers and key information extracted from each paper (various guidelines and check lists are available: SIGN, SCIE, CASP, PEDro). If appropriate, the scheme used to grade the evidence reviewed and recommendations made should be detailed.

An excellent project will justify these decisions rather than simply describe them (for example why a particular time frame was chosen or particular research design was excluded).

Remember in designing your search strategy you are seeking to include only the most relevant literature to address your review question.

Your initial search may uncover too much or too little information and you will have to adjust your strategy accordingly. The finding that there is not much literature is in itself an important one and you should make the most of this.

You are recommended to use a flow diagram to guide your selection process and depict the logical flow of information and your decision making through the different phases of your search and review. A template for a PRISMA flow diagram can be accessed from http://www.prisma-statement.org The Prisma flow diagram may be reported in either the methods section or the findings section as it is relevant to both. Use your own judgement to decide where it is most appropriately located for your individual project.

5) Findings: 2,000 words

This section covers the presentation of the main evidence from your review and a summary of its quality. It is the most difficult to structure and there will be a number of possibilities open to you in terms of how you deal with this task. The weakest approach will be to simply list each piece of literature reviewed in turn. A stronger approach that gives better evidence of ability to synthesise material is to use a thematic approach to the structure: for example by intervention, or outcome, or research design, to name but a few possibilities.

The group approach to supervision is particularly helpful here and your peers will be able to give you feedback on whether the particular approach you have taken to presenting your findings makes sense.

Firstly you should report the results of your literature search. As outlined in the methods section above you are recommended to use a flow diagram to depict the logical flow of information and your decision making through the different phases of your search and review. A template for a PRISMA flow diagram can be accessed from http://www.prisma-statement.org The Prisma flow diagram may be reported in either the methods section or the findings section as it is relevant to both. Use your own judgement to decide where it is most appropriately located for your individual project.

Secondly you should report on your critique of the papers you have included. The critique should be a balanced discussion and evaluation of the strengths, weakness and notable features of the text. Remember to base your discussion on specific criteria. Good reviews also include other sources to support your evaluation (remember to reference).

6) Discussion: 500 words
This should: outline the implications of the review both for your profession and within a multiprofessional context (ie you should identify the impact your research has on other professional groups (these need not be limited to the groups within the School of Health and Life Sciences e.g police; speech and language therapist, educational psychologists; highlight the methodological limitations of the review (are there any papers you could not get hold of because of difficulty accessing the journal or are they in another language); identify any gaps in the literature and make recommendations for practice and further research.

7) Conclusion: 200 words
This should provide two or three statements summarising your key findings. There should be a statement of what the review has added (how it contributes to practice).

This format is now common in many journals so you should not have too much difficulty in finding a model to follow.

8) References:
Link to library website & RefWorks Please note that users of RefWorks should choose the Harvard British Standard 2010 output style; this is consistent with the library’s guide.

9) Appendices:
This section should not be used for figures and tables that you have generated to present your review and referred to in the text – these should be included at an appropriate point within the main body of the text. However, you may want to include additional evidence that is salient to your review or provides a context e.g. client/patient information guidance; an illustration of a theoretical model; equipment specifications etc.

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