Facilitating the work of a meta-analyst

Utilization of Postnatal Healthcare Services Delivered through Home Visitation and Health Facilities for Mothers and Newborns: An Integrative Review from Developing Countries

Despite evidence about the value of high quality postnatal services for the survival, health and wellbeing of the mother and neonate, sub-optimal use of the available services delivered through public sector remains a persistent challenge in India and most low-middle income countries. An extensive search till Dec 31, 2017 in databases including PubMed, Scopus and Science Direct was conducted and selected studies were organized, categorized and summarized for integrated review. Of the 3463 studies screened, 47 relevant studies were identified through integrated systematic process. The 'nexus' framework consisting of four domains namely: social-cultural, educational, organizational and economic-physical were used to determine the promoters and inhibitors of postnatal care-utilization. The important inhibitory factors at household and community context were myths-cultural practices, gaps in the awareness of mother and families regarding danger signs and postnatal complications and hesitancy to contact health workers due to trust deficit. There were lack of clarity about job responsibilities, poor quality of training, skills building and supervision of front line workers. Quality of home visits, and irregular incentives to health workers were other factors. The facilitating factors were mother's autonomy, young mothers, access to media and repeated and timely contact with the health worker, antenatal care (ANC) attendance and institutional deliveries, conditional cash transfer and availability of health insurance. Several factors like social mobilization, skill building and training cut across the domains of the nexus framework. The review suggested a multi-dimensional focus on implementing integrated continuum of care models covering prenatal-postnatal and infancy period.

Foundation of evidence-based decision making for health care managers-part II: meta-analysis and applying the evidence

This article is a continuation of a 2-part series that seeks to build the skills of health care managers and supervisors in critically reading and interpreting systematic reviews and meta-analyses. The first article, part I, defined the types of systematic reviews and outlined the process of conducting them. This article, part II, focuses on meta-analysis, a type of systematic review. This article explains the additional procedures associated with meta-analyses and describes the potential shortcomings of both systematic reviews and meta-analyses. Finally, this article provides a way for health care managers and supervisors to appraise systematic reviews and meta-analyses and to determine whether the evidence applies to their problems and settings.

ALLIANCE SCOPE AND FIRM PERFORMANCE IN THE BIOTECHNOLOGY INDUSTRY

We test the relationship between alliance scope and firm performance in the context of the biotechnology industry by means of a meta-analysis. Meta-analysis is a statistical technique that allows a systematic review of the existing research that is more rigorously systematic compared to conventional narrative reviews as it uses statistics to capture the strength of relationships. The analysis confirms that a relationship between alliance scope and firm performance does exist. Furthermore, results suggest that there is a statistically significant difference in firm performance between exploitation alliances and exploration alliances, confirming recent studies in the innovation and R&D management literature. Managerial implications and future research suggestions are provided.

The needs of informal caregivers of elderly people living at home: an integrative review

BACKGROUND

Over the past years, researchers have developed studies about informal caregivers who care for the elderly living at home. Meeting these needs can help these professionals to provide more appropriate care.

AIM

To explore and define the current status of published literature related to the needs of informal caregivers who care for the elderly living at home.

METHOD

This study follows an integrative literature review using Whittemore and Knafl's method. Given the lack of higher-level evidence on this area of study, this method was considered to be the most appropriate to explore and define the current status of the available literature, which comes from a variety of scientific sources, and diverse methodologies. The literature research was performed using eleven electronic databases. The search was developed during the months of December 2010 and February 2011 and updated from March to April 2011. Studies written in English, Portuguese and Spanish were included. A total of 14 articles met the criteria in this review. Data were extracted from primary studies using quantitative, qualitative and mixed methods.

RESULTS

The literature review showed a shortcoming of studies about the needs of caregivers of the elderly at home. It also identified a lack of high-quality scientific evidence in this area. From the literature available, four core themes were generated to reflect the literature: information and training, professional support, effective communication and legal and financial support.

CONCLUSION

This integrative review offers important insight into the needs of informal caregivers, specifically for the elderly. The inclusive nature of integrative review method enabled us to provide a good understanding of underlying issues on the needs of informal caregivers. Challenges for the future are to broaden and enhance the scope of research in this area to provide effective support to intervention projects, services and care to informal caregivers.

The integrative review: updated methodology

AIM

The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.

BACKGROUND

Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.

DISCUSSION

A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.

CONCLUSION

An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

African American, Chinese, and Latino family caregivers' impressions of the onset and diagnosis of dementia: cross-cultural similarities and differences

PURPOSE

We explored cross-cultural similarities and differences in minority family caregivers' perceptions of the onset and diagnosis of Alzheimer's disease in their relatives, with specific attention to clinical encounters.

DESIGN AND METHODS

We performed a meta-synthesis of three qualitative studies conducted in Massachusetts with 22 African American, Latino, and Chinese caregivers.

RESULTS

All participants conveyed striking similarities of thought about normalization of cognitive symptoms until one critical event, usually relocation, precipitated family awareness that an elder's behavior was not the result of "normal aging." A lack of knowledge about Alzheimer's disease, rather than culturally influenced beliefs, was the major deterrent to having an elder's memory assessed. Community physicians' failure to recognize Alzheimer's disease or refer to specialists was more problematic than language or ethnic differences. Physicians' disrespect for caregivers' concerns about memory loss was particularly noted by African Americans, stigmatization of persons with Alzheimer's disease was noted by Chinese, and fears that acculturation would end family home care was noted by Latinos.

IMPLICATIONS

Amid ethnocultural differences, there are many similarities in needs that offer providers the possibility to unify quality improvements in Alzheimer's disease outreach, education, and physicians' services. Suggestions include providing the public with more confidential access to Alzheimer's disease information, increasing dementia awareness among community physicians, motivating clinicians to adopt culturally sensitive communication patterns, and providing community education to reduce normalization by families and stigmatization of persons with Alzheimer's disease.

Combining Evidence in Nursing Research

BACKGROUND

The knowledge explosion in health care coupled with recent evidence-based practice initiatives has increased both the need for and the production of reviews of past research. The proliferation of such reviews has contributed to inconsistency in methods and terminology. Differing methods for integrative reviews, systematic reviews, meta-analyses, and qualitative reviews have been proposed, yet are not clearly differentiated in published reports. Although there are common features to these methods, each method has a distinct purpose, sampling frame, definition, and type of analysis.

APPROACH

The literature on research review methods was analyzed and synthesized. Specific attention was directed toward the issues specific to combining primary nursing research studies.

RESULTS

The defining characteristics of different research review methods, the common stages of all research reviews, and criteria for evaluating quality are described.

DISCUSSION

Greater clarity regarding research review methods has the potential to enhance methodological rigor and subsequently the applicability of findings of all review methods to practice and policy.

Research methods: managing primary study quality in meta-analyses

Meta-analyses synthesize multiple primary studies and identify patterns of relationships. Differences in primary study methodological quality must be addressed for meta-analysis to produce meaningful results. No single standard exists for addressing these quality variations. Quality measurement scales are fraught with development and application problems. Several strategies have been proposed to address quality. Researchers can set minimum levels for inclusion or require that certain quality attributes be present. An inclusive method is to weight effect sizes by quality scores. This allows the inclusion of diverse studies but relies on questionable quality measures. By considering quality an empirical question, meta-analysts can examine associations between quality and effect sizes and thus preserve the purpose of meta-analysis to systematically examine data. Researchers increasingly are combining strategies to overcome the limitations of using a single approach. Future work to develop valid measures of primary study quality dimensions will improve the ability of meta-analysis to inform research and nursing practice.

Meta-analysis and decision analysis bridge research and practice

Research synthesis methods provide meaningful quantitative data through systematic review of the research literature and translation of these findings into practice implications. Meta-analysis has been the gold standard for translation of research findings into practice. Decision analysis has emerged as an alternative to and extension of meta-analysis. Examples, contrasting the application of meta-analysis and decision analysis, are presented and discussed in relation to its relevance in providing clinical direction. The methods are points along the continuum of translating research findings into practice. Meta-analytic studies provide an essential foundation for estimating and assigning the probabilities used in decision analysis, whereas the outcomes of decision analysis provide data for estimating the cost effectiveness of different interventions or treatment options. Decision analysis can assist in bridging the research-practice gap. Nurse researchers are urged to collaborate with other disciplines that have used these methods to refine translation and use of research findings in practice.

Meta-analysis: a tool for evidence-based practice

Evidence-based practice rests on the knowledge generated from sound empirical research combined with clinical expertise. However, many clinicians lack the time to evaluate multiple studies. Meta-analysis is a statistical procedure for combining the results of multiple studies investigating a common problem or issue to produce a pooled effect size, and to evaluate the efficacy of interventions across studies. Meta-analysis can thus be used to synthesize and integrate empirical research to provide important evidence for best-practice decisions. This article examines the meta-analysis process and its links to evidence-based practice.