ISD5 Research Methods.docx

The Need for Evidence

The need for evidence

"In order to effectively carry out sound evidence-based decisions dental professionals must understand the principles of good research practice, at the level appropriate to their registrant category. The principles of an evidence-based approach and the underpinning scientific knowledge are fundamental to implementing

the outcomes. They should be applied as relevant to the registration category, and importantly, in relation to patient care. It is well recognised that producing registrants with good clinical and technical competence

is vital for safe practice. However, this cannot be the sole aim. It is just as important that all registrants are developed with a full range of skills to enable them to provide sound, evidence-based and well-delivered patient

care."

General Dental Council. Preparing for practice. 2015. https://www.gdc-uk.org/education-cpd/dental-education/quality-assurance (accessed 16/08/2024).

What is an Evidence-based Approach?

An approach to oral health care that involves the integration of:

• the systematic assessment of clinically relevant scientific evidence relating to the patient’s health and history with;
• the dental professional’s clinical or technical expertise and the patient’s treatment needs and choices

General Dental Council. Preparing for practice. 2015. https://www.gdc-uk.org/education-cpd/dental-education/quality-assurance (accessed 16/08/2024).

The 5 Step Approach (focussing on steps 1 and 2):

1. QUESTION: Information needs from practice are converted into focused, structured questions.

2. FIND: The focused questions are used as a basis for literature searching in order to identify relevant evidence from research.

3. APPRAISE

4. ACT

5. EVALUATE

Centre for Evidence Based Dentistry. Practising EBD. 2024. https://www.cebd.org/practising-ebd/ (accessed 16/08/2024).

What is the ‘Best Available Evidence’?

The levels of evidence pyramid provides a way to visualise both the quality of evidence and the amount of evidence available. For example, systematic reviews and meta-analysis are at the top of the pyramid, meaning they are both the highest level of evidence and the least common. As you go further down the pyramid, the amount of evidence will increase as the quality of the evidence decreases.

Where is the Research Evidence Published?

• Academic journals - The main body of the literature is published in peer-reviewed academic journals. This is what we will focus on.

There are different types of journal articles. Research articles are the ones you will probably encounter the most.

• Research articles: short, in-depth, papers that report on new research on specific topics
• Reports of trials (RCTs)
• Case reports
• Review articles (clinical reviews; systematic reviews)

How do articles get peer-reviewed? What role does peer review play in scholarly

research and publication?

• Write a draft article describing your research and findings for publication in a scholarly journal
• The journal’s editor reads over the article to decide whether it’s a good fit for the journal
• Copies of the research are sent off to a group of experts to evaluate the article’s quality for peer review
• Peers decide whether it is worthy of publication in the journal and recommend it to the editor
• It can then be published or adjustments made, in order to be added and read by journal subscribers

Scopus is the largest abstract and citation database of peer-reviewed literature.

Scopus metrics can be used to help you to identify influential journals in your subject

area.

How do you Find the Evidence?

For journal literature, this means using databases such as:

•Scopus - Interdisciplinary. The largest abstract and citation database of peer-reviewed literature

•Medline / Pubmed -Clinical medicine

•Web of Science - Interdisciplinary

•Dentistry and Oral Sciences Source – Core dental journals

You can apply your search across a range of databases and get access to a vast amount of abstracts for papers. The Library subscribes to many different databases, but they all work with the same concepts. Search by keyword to find articles on your topic.

The core literature is indexed by several databases, but each database will contain details of papers/articles that are not indexed by the others (unique content). The more you search, the more you will find.

As a rule, the databases contain abstracts but do not contain the full text of the article. However, some databases such as Scopus and MedLine link up with our subscriptions and provide an "Is it @ Liverpool" link for you to check.

Why Search More Than One Database?

The wider you search, the more you’ll find…whilst

each database has content that overlaps with coverage in other databases, the majority of indexed content will be unique to that individual database.

NB. Do not use Library Search when carrying out systematic literature searches

Library Search is great for finding books/eBooks and journal articles, however, it can only search in a limited way. For systematic literature searches, we recommend using the subject specialist databases provided by the Library. These databases have more advanced search interfaces which allow you to search wider and go more in-depth. Using the specialist databases you can be confident that you won't miss essential material in your research area and will save you time as your search results will be more targeted.

Developing Answerable Clinical Questions

Asking answerable questions

Make sure what you need to find out is presented as a clear, focused and precise

question.

Look at specific knowledge about managing specific patients with a specific disorder- make sure you are clear about what you want to search for.

It is important to do this before you start searching so you can ensure that when you apply your search to the database, you're going to maximise the relevancy of any results that come back.

The more accurate and concise you can be, the better search results you're going to get. A benefit of careful and thoughtful question-forming is that it makes a search for evidence easier. A well-formed question makes it relatively straightforward to find out and combine the appropriate terms needed to represent your need for information in the database that you're searching.

Break Your Question into Separate Concepts

Use a Concept Table to help you develop your search strategy. Identify the separate concepts within the question, and then list all of the relevant terms that might be used to describe each of those concepts. The number of columns needed will depend on how many concepts, or parts, there are in your question.

Boolean Operators: Combining Keywords

Once you have worked through your Concept Table and have identified what keywords you're going to use, you need to look at how you can combine them together to answer your question..

This is where Boolean operators (“, *, ]) come in.

• “ for specific phrase
• * for words that may be pluralised or varied
• ( for directing search in one direction first

Boolean operators

• To retrieve relevant information you need to be able to link concepts/keywords together
• Databases use Boolean operators to do this
• There are three main operators:

OR (broadens search) OR is mORe results - finds articles where either term is present

AND (focuses search) combines concepts to find articles where both concepts are present

NOT (excludes a concept) use with CAUTION - only when getting a lot of irrelevant results

We can add Boolean operators to the Concept Table to combine the different concepts of our search strategy. We would use OR to combine each term within the same Concept column. We would use AND to combine all of the columns together into a complete search strategy.

Be aware of how you can expand or limit your search by using the appropriate Boolean operator to combine keywords.

Variation in Terminology

When deciding what key concepts or keywords to use, bear in mind that there is a good deal of variation in terminology, so you need to think about synonyms - different ways of expressing the same term. If you don't include all of the variations, then key papers containing those terms might not appear in your results. e.g.

• The outbreak of Novel Coronavirus disease (COVID-19) caused a worrying delay in the diagnosis of oral cancer in north-west Italy: The Turin Metropolitan Area experience
• Mouth cancer − Risk factors and potentially malignant disorders
• Ameloblastic Fibroodontoma of Mandible Causing Tumour Induced Osteomalacia: A Case Report with Review of 88 Phosphaturic Oral Neoplasms

Another example would be the variation in terminology used for A&E: A&E / Accident & Emergency / Casualty / ER / Emergency Room / Trauma Room

Truncation, Wildcards and Phrase Searching

Truncation

Keywords may be singular, plural or adjectives.

Think about alternative spellings, particularly UK/US variants e.g. tumour/tumor

In order not to miss any references most databases support the use of truncation. Truncation is where you use the first part of a word, followed by an asterisk *, and the database will search for all the possible endings without you having to search for each one individually e.g. dent* would search for dental, dentist, dentistry, dentition

Take care where you truncate. Think about the word you are truncating, an example being:

gen* finds genome, genomics, gene, genotype, genetic, genetics

BUT also finds general, gender, genre, gentleman

Wildcards

A wildcard is a symbol (usually an asterisk *) that you place at the point in the word where there is an alternative spelling e.g. an*esthetic OR apic*ectomy

Phrase searching

Another thing to be aware of is that if you use "inverted commas" around a phrase (i.e. anything that is more than one word) it will enable the database to search for exactly that phrase, rather than each word individually e.g. "root canal"

By inserting inverted commas, the database will search for the phrase "root canal" rather than the individual words root and canal, which may not appear together in an article in your results, so the search would bring

back articles that weren't relevant to you.

Limiting Your Search

Limits

• • Applying limits will focus your search

Consider limits like the publication date, and how far back you want to go.

Language...databases are international, so they include content from other countries, published in other languages. If you only want to return results published in English, then this is an important limit to consider.

Publication types...are you looking for an article, or do you need a systematic review or peer-reviewed articles? You need to consider the limits when you are planning your search.

Remember limits are database dependant so do check each database out to see how to apply the limits to their interface

Revised Search Strategy

Bearing all of the above in mind, let's look back at our Concept Table and revise our search strategy.

The revised search strategy includes phrase searching (to reduce the number of results and increase relevancy), and the asterisk truncation symbol to ensure all variant word endings are captured. We also have a

wildcard for alternative spelling in the first column.

Applying the Search Strategy to Scopus

This is how we can apply the search strategy to Scopus. You can see from the screenshot (and go back to the lecture recording) that each concept column has been applied to a separate line, so there are three search lines for three different concepts. By splitting out the different concepts like this, it allows the database to easily read what it is you are looking for and bring back the most relevant set of results.

You can also search each line at a time and then use the Search History function to combine.

Snowballing

Something that you can do in Scopus, once you have found some relevant articles, is 'snowballing'. You find an article that you are interested in, click on the title, and then there are different options for further information available to you.

In the 'Cited by' box, you can see in which other articles this one has been cited, and it gives you a link to the index record for that article. It is a really good place to check because the articles in this list may not have

appeared in your search results.

You can also click to view all of the references that are contained within the journal article. If this article is relevant to your research, there is a good chance that some of the references will be too, and you can follow up on the papers that have been cited to read them in full.

The 'Related documents' section will show you articles based on what appears in the reference list.

Happy with your Search?

If you are happy, then save your search.

You can set up an alert on each database.

Consider exporting your results to a referencing package like EndNote Desktop.

If you are not getting the results you expect, common problems to look out for are:

• Spalling mistakes
• Typing errors
• Searching with the wrong keywords
• Incorrect symbols for Boolean, truncation, and wildcards
• Searching on the wrong database

It is worth checking all of these aspects of your search before you go any further.

Critical Appraisal

Once you have assembled a relevant list of journal articles that you want to look at, you need to systematically evaluate the research and think about how to read each paper. It is a good idea to think about the following

questions as you work your way through each paper:

What is the paper about?

• Why was the study done, and what clinical question were the authors addressing?
• What type of study was done?
• Was this design appropriate to the research?

You can find out more information on this from a variety of sources, but I would recommend an article written by Trisha Greenhalgh - "How to read a paper: getting your bearings (deciding what the paper is about)" that is available via the BMJ. You can get full-text access to this through the Library.

To read further on this topic, I would recommend a book written by the same author: "How to read a paper: the basics of evidence-based medicine". You can access this in in print or as an eBook via the Library.

Also, see "Evidence-based dentistry in practice" for information on using Critical Appraisal Skills Programme (CASP) questions to help you appraise the evidence.

Manchester University has created a freely- accessible Academic Phrasebank as a general resource for academic writers, which "aims to provide you with examples of some of the phraseological ‘nuts and bolts’ of writing organised according to the main sections of a research paper or dissertation".

• https://www.phrasebank.manchester.ac.uk/

What is Academic Integrity? What is Plagiarism?

Academic integrity is an ethical code of practice in the academic community – based on honesty and respect for the work and ideas of others

As part of this code of practice, when submitting work you must clearly acknowledge any material that has been included from other sources. You must acknowledge the ideas and information you have retrieved from others through referencing.

Section 8.1 of the University's Code of Practice on Assessment provides the following definition of plagiarism: "Plagiarism occurs when a student misrepresents, as his/her own work, the work, written or otherwise, of any other person (including another student) or of any institution".

For example:

• Using words more or less as they have been used originally
• Using ideas/theories without saying whose ideas they were
• Paraphrasing without stating where it has come from

Plagiarism can occur both intentionally and unintentionally. Good referencing practice will help you to avoid the possibility of plagiarism.

What is Referencing?

Referencing, also called citing, means that whenever you use another author’s work/thoughts/ideas/images/graphs in your own work, you should acknowledge that you have done so.

Why do we reference?

• To show which sources you have used and where you found them
• To allow your readers to identify your sources and verify your data
• To demonstrate a good level of scholarship, showing the extent of your research and how you have incorporated and synthesised this in your work
• To strengthen your academic argument, recognising and building on the work of others
• To avoid plagiarism

When Should you Reference?

References must be provided whenever you use someone else's opinions, theories or data to avoid committing plagiarism. A reference is required if you:

• paraphrase (use someone else's ideas in your own words)
• summarise (use a brief account of someone else's ideas)
• quote (use someone else's exact words)
• copy (use someone else's figures, tables, diagrams, graphs or structure)

The only time you do not need to reference is when something is common knowledge.

What Referencing Style Should I Use?

There are many different ways to present references, and preferred styles will vary according to subject area, or individual journal requirements.

For ISD5 it is recommended that you use the Harvard referencing style. Harvard is an author-date referencing style used in many dental journals, and there are multiple versions of this style, which can vary slightly. Author-date styles usually cite the author and the year of publication whenever someone's else's work is quoted/paraphrased/referred to etc. e.g. (Blake, 2019). So that you can be sure you are being correct and consistent in your referencing, the University has adopted the Cite Them Right Harvard version of this style (available in EndNote Desktop). Cite Them Right is available online and print copies are available in the Library. Cite Them Right Online can help you easily construct your

references.

Using EndNote Desktop to Manage Your References

You can find support with referencing on the Referencing Library Guide.

It is important to apply your referencing style consistently and acknowledge the sources you have used in your work - we have reference management software that can assist you in doing this. The preferred software offered by the University is EndNote Desktop. It is free to download your own copy and enables you to build up a library of references. You can insert references into your work using the Cite While You Write plugin in Word and automatically create bibliographies from your EndNote Desktop library. For more information see our

KnowHow tutorials on the EndNote Desktop support page.