Does the author adequately explain how the data were handled? Describe

1.0 Introduction

a) Give the full reference of the article using APA format.

Lo, S. F., Chang, C. J., Hu, W. Y., Hayter, M. & Chang, Y.T.,(2008). The effectiveness of silver-releasing dressings in the management of non healing chronic wounds: a meta-analysis.Journal of clinical nursing, 18, 716-728. DOI 10.1111/j.1365-2702.2008.02534.x

b) Describe the qualification of the authors (e.g. research expertise, clinical expertise, educational preparation).

Shu fen Lo is an assistant professor at the department of nursing Tzu Chi College of Technology and a doctoral program student National Taiwan University. Chang on the other hand is a professor at Graduate institute of Basic Medical Science, in Chang Gung University Resource Center for Clinical Research as well in Chang Gung Memorial Hospital. On the other hand Hu is an associate professor, School of Nursing Science Taiwan University. Hayter is a senior lecturer in Nursing in Center for Health and Social Care Studies and Service Development at the University of Sheffield, UK. Lastly, Yu-Ting Chang, is a lecturer Department of Nursing Tzu chi College of Technology and a doctoral program student. All the authors have a high command in the area of research

c) Discuss the clarity and conciseness of the title. Did it clearly and accurately indicate the focus of the study?

The title is very accurate as regarding the purpose and the focus of the study. The title “The effectiveness of silver-releasing dressings in the management of non healing chronic wounds: a meta-analysis” has a direct relation to the entire research carried and the aim of study, which was to examine the efficacy of silver releasing dressing as pertaining the management of non healing chronic wounds. The heading has been well linked to the hypothesis of the paper and has been captured in all the headings used in the paper. The detail in which the heading has been treated makes the reader to easily connect the heading to the purpose of the study, which is a major requirement is such a research paper (Chumney & Simpson, 2006). The heading has therefore been well articulated and reflected in the discussions in each of the sections headings.

d) Discuss the quality of the abstract. Does it include all key components

Was the report well written and well-organized? If not, what was problematic?

The abstract in the research has been provided in a relatively different presentation where the researchers summarized each section from aims to conclusion unlike inmost cases where abstracts are presented in a paragraph. The abstract is however very detailed providing a comprehensive summary to each section in the research. The coverage provided in the abstract makes it easily to summarize the whole research including the results that were obtained from the research. The design of the study has however been briefly presented and does not offer much insight as concerning the research.

e) Was the report well written and well-organized? If not, what was problematic? Describe.

The research has well built on the current knowledge to design the research problem. The study builds on the previous studies carried out by Giullio & Barret (2005) who explained the contamination of wounds and the progression of infection in stages, leading to critical colonization. Giullio & Barret further explained that when the host response is relatively reduced after the above occurrences, an inflammatory response occurs leading to molecular and cellular abnormalities in the wound bed and this has been observed to cause non healing wounds. Through this basic knowledge, the research therefore builds to form the problem statement in the research. The report therefore has been well organized and presented. This is not correct APA format stlye

2.0 Research Problem

Is the meta-analysis focused on a clearly defined problem or question? Describe. (Comprehension and Comparison)
The research problem in the study is examining the efficacy of silver- releasing dressings in the management of non healing chronic wounds. This problem has been well defined and defended in the research with the justification that non-healing chronic wounds have a very negative effects on the patients and have a heavy financial burden on health care systems Chang et al (2008). The purpose of the research has been well explained as providing a relief the above conditions through stimulating an environment that wound enable the wounds to heal thereby relieving health care systems off such financial burdens. Several supporting research have well articulated a similar research problem such as Tomaselli (2006), supporting the significance and importance of the research in finding a lasting solution to the non-healing wounds problem. Considering the suffering of patients due to infections and lack of comfort due to non-healing wounds as well as the financial burden in healthcare facilities, the research is very important and significance in addressing this specific issue.

b) Is the scope reasonable? Describe. (Comprehension and Comparison)

The research problem is fairly narrow in scope in that it only addresses the problem of non healing wounds which is more specific. Though there are different types and causes of non healing wounds, the research broadens in the sense that it tries to solve the problem of infection to the wounds and providing the necessary conditions that would lead to healing. Since the causes of the problem have not been defined in the research, the research broadens in this sense and hence achieves a reasonable scope in coverage.

c) Are terms adequately defined? Describe. (Comprehension and Comparison)

The terms used in this research are relatively simple in that the research applies the general rather than technical language in nursing. There is therefore no need of defined terms because language used is simple to understand.

d) Is the problem relevant to nursing? Have prior studies been conducted on the problem area? Describe. (Comprehension and Comparison)

The research is based in nursing profession, which is the expertise field of the authors and has involved numerous previous works related to the same issue. The previous researches used have been very credible in offering important information since most of them involve infections of non healing wounds, which is the specific problem that the research addresses. Ovington (2004) and white & Cutting (2006) especially provided the best previous work related to the research problem in that, they studied the action of silver cations on bacterial cells therefore deactivating the bacteria. The critique on the weaknesses of the previous studies has also been well articulated in that the researches were weak on examining the issue of non healing wounds and as Leandro (2005) explains nurses have to provide an evidence based care and knowledge should accord to the practice thereby leading to the research problem.

3.0 Studies Included

a) Does the author provide clearly defined criteria for the inclusion and exclusion of studies? Describe. (Comprehension, Comparison and Analysis)

All published and non published studies were supposed to have been published between 1950- 2007. Other methods including contacting experts were also used. Other source that had the term managing wound dressing was all included in the inclusion criteria. The exclusion criteria involved excluding research that was non comparative that dealt with ulcers and that had the definition of the outcomes being unclear. The studies with no silver dressing, those witout any primary information from others, and those with only silver dressing controlled were eliminated in the exclusion criteria. This led to having very credible resource materials.

b) Does the author utilize appropriate databases and appropriate key search words in identifying potential studies? Describe. (Comprehension, Comparison and Analysis)

The authors utilized databases such as PubMed, CINAHL, Cochrane, MEDLINE, EBSCO and OCLC in the research in addition to other unpublished work and organization publications. Wound dressing management. And silver releasing dressings were the terms used in searching through published papers, websites and contacting wound dressing manufacturers. This was aimed at obtaining only the relevant studies, as an exclusion technique. This was done to limit the research to a narrow topic as Salkind (2005) this is not in the reference list explains as the requirements of a credible research criteria.

c) Are the studies from multiple authors and independent samples? Describe.(Comprehension, Comparison and Analysis)

The studies were obtained from multiple authors, organizations, manufactures and other experts in the field. In addition to the databases and websites, organizations such as European Wound Management Association were contacted, meaning that the studies were very independent. Jude eat al (2007) had a study on 134 patients from 18 centers and 4 countries, while Verdu et al (2004) had 124 patients from 10 centers. The studies were therefore very independent.

d) Are the studies contained in the meta-analysis randomized controlled studies? Or is there a mixture of experimental/quasi-experimental and correlation studies? Does the authorinclude both published and unpublished studies? Describe. (Comprehension, Comparison and Analysis)

Only randomized controlled trials were included in the study, and this resulted to the reduction of the required studies to only 8 studies. The randomization was necessary to offer a credible study base as would be required (Salkind, 2005). Munter et al (2006) had a study that involved 619 patients, 80 centers and 9 countries. Such randomization results to reliable results.

e) If original studies did not provide key information, did the author retrieve

that information from the original researchers? Describe. (Comprehension)

The researcher did not consider any research that did not have the key information or primary research. The abstracts and key words were first used to determine the relevancy of the study before downloading the full article.

f) Is the final number and type of studies sufficient for conducting the meta-Analysis? Describe. (Comprehension, Comparison, Analysis and Evaluation)

The final number of studies that were used were 8. These studies were enough to conduct the research in that they involved only randomized controlled trials of silver releasing dressing in wounds, which is the research problem in the study. A study such as Jude et al (2007), Verdu et al (2004) involved 134 and 125 patients from 18 centers and 10 centers respectively and dealt with wound characteristics. With such credible research work with large sample and control groups the study would offer very credible and reliable results.

a). Did the reviewer determine the methodological comparability of the studies in the review? Describe. (Comprehension and Comparison)

The reviewer determined the methodological comparability of the studies in a set of 15 elements that were indentified to determine quality of score. Each study was evaluated through these criteria with the highest study quality score being 30. This enabled papers with a score of more than 18 to be included in the analysis. For example studies with only silver dressing controlled trail were eliminated through this process. This was inline with the research rules which according to Salkind (2005) explain that inclusion criteria should be guided by methodological issues.

b) Did the reviewer use appropriate procedures for appraising the quality of the individual studies? Were formal criteria utilized for appraisal and were those criteria explicit? Did two or more reviewers do the appraisals and was interpreter reliability reported?

Reviewing was carried out by S.-FL and Y-TC Chang. The criteria used in assessing the quality were very formal and were the CONSORT statement and Melynk & Overholt (2005) checklist. The criterion was appropriate in that it analyzed 15 aspects per each study with a total score of 30. The inter rata agreement was also calculated using Cohen’s kappa statistics. The formal appraising methods result into quality studies being included in the inclusion criteria as explained before (Chumney & Simpson, 2006). Each aspect per study had a possible score of 0-2 and papers that scored more than 60% were included in the analysis. Sensitivity analyses and quality were then calculated in screening using the interpreter reliability test.

5. Data Analysis and Findings

a) Does the author adequately explain how the data were handled? Describe. (Comprehension and Comparison)

The author does adequately describe the data was handled mostly during data extraction. As Chumney & Simpson (2006) explains in meta- analysis the procedure should be do use inclusion and exclusion criteria to sort out the data. Ratios such as ratio rate ratio (RR), mean differences, weighted mean differences and other statistical analysis was then carried out at 95% confidence level. Homogeneity and Q tests were then carried out on the data among other tests. In absence of heterogeneity p> 0.10 and with heterogeneity p< 0.10 and random effect models were used.

b) Were appropriate subgroup analysis (for moderator variables) undertaken? Describe. (Comprehension, Comparison and Analysis)

The appropriate sub group analysis was not undertaken. The author explained the methods through which the intervention groups would be compared to the experiential group in ratios such as (RR), absolute risk reduction (ARR) and other measures for comparing. The writer further indicates that the tests were two sided since analyses were conducted using Comprehensive Metaphysics analysis, version 2.

c) Do the reviewers adequately explain their method of pooling and integrating their data? Describe. (Comprehension, Comparison, Analysis)

The reviewers have well explained the methods used in integrating their data. In order to review the efficacy and safety of silver related dressings about six studies were retrieved and heterogeneity tests carried out for the studies. The tests were aimed at indicating any significance difference that might have been evident between the studies. The methods of pooling were therefore adequately indicated.

. d. Are the effect sizes clearly displayed and explained? Describe (Comprehension, Comparison, Analysis)

The effect sizes have been clearly indicated using the analysis tests carried out on the data. The meta- analysis showed a significant effect of group 1 in wound area reduction as compared to group C, which was an effect size of 0.28. This meant that p<0.01; t-test, and random pact model was therefore used. The effects have been well indicated compared to the intervention group in all the studies. The effect size showed the significance of the silver cations compared to the intervention group (White & Cutting, 2005)

e. Do the authors adequately address clinical vs. statistical significance in their discussion of the findings? Describe. (Comprehension, Comparison, Analysis)

Both the clinical and statistical significance have been well addressed in the research. For wound exudates level reduction the result showed an effect size 0.31 in 3 trials compared to the intervention group which represented a p<0.001 (t-test) this meant there was no statistical heterogeneity and the wound exudates was not uniform in all groups. The level of comparison between the two factors is very adequate. This indicated the success of the study in addressing the research question, since the silver cations were expected to have positive effects on the wounds (Ovington, 2004)

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