How effective are intranasal analgesics for paediatric pain management in pre-hospital settings?

Literature review checklist and timeline

Phase 1 Identifying your research question this should be completed from your level 5 proposal, but it is worth checking that this has been completed and relevant. You dont have to stick with the same topic.

• Perform a gap analysis There is no point in picking a topic that is either far too vague or one which has been done to death. If it is too vague/ hypothetical, then you are unlikely to find any literature to review. Likewise, if you pick a topic that has been done many times before, you will only find a lot of repeating literature and you wont be able to form any discussions. If this is a topic you are dead set on researching, try to find a slightly different angle to explore.


• Broadly pick a topic area you may want to brainstorm a few suggestions at this point, there is nothing wrong in being undecided now. You wont know if this is an appropriate topic with literature until you start to search, so having a backup is quite sensible at this point.


• Begin to refine the question if your question is on the effectiveness of something, what do you mean by this? Start to become more specific.


• Conduct a PICO on your topic/question this is essential to your review. Without this, you have no justifiable reason for picking the topic.

Phase 2 the search (January)

• Submit ethical approval checklist although there is a chance that your question may be modified. Your approach will remain the same, get this crossed off your list as early as possible. This is only submitted to the module leader and acts as a soft check on your topic for approval before you do too much work.


• Form a search strategy break down your question and highlight the key words pre-hospital, pain relief, paediatrics for example. These words will form your search strategy. You dont want to put your whole question in the search as you are reviewing all the informing literature.


• Inclusion/exclusion criteria are you only looking at UK source material? Material from the last 10 years? If so, why??? It's no good just to state that you are limiting your inclusion to the last 10 years if your topic is on CPR for example as the guidelines are reviewed every 5 years, so should your limit be 5 years in that case? You need to be able to justify your inclusion/exclusion criteria.


• Boolean operators don't forget to utilise your Boolean operators (AND, OR, NOT, ?) etc. This will allow you to find literature that is specific, but also include those that perhaps have a slightly different spelling. Pre-hospital and out of hospital mean the same things, but unless you are using Boolean operators effectively you may only end up searching one of these terms and omitting some key literature.


• Search on multiple databases Google doesnt have everything! Make sure that you are using not only Google Scholar but also looking in PubMed, COCHRANE, CINAHL etc. You may not find any new sources, but you need to evidence that you have at least searched!


• Alternative searching Its likely that you will at least want to specifically look at 1 or 2 journals within the field. Are you going to conduct a hand search of the Journal of Paramedic Practice? This doesnt mean physically going through each one by hand, but you should at least do an electronic search on their journal page just in case it didnt appear in your other searches.


• Pearl searching you may have found a piece that originally looked promising, but it isnt quite what you need, but what about the references in that piece? Was one of the informing pieces more what you need?


• Backward/forward engineering is the piece that you have found too old? OK, but does it still inform current data? If so, then it could still be appropriate. Remember there is evidence dating back to the 1970s that are still informing current JRCALC guidelines in some cases, this means that they are still relevant to the topic.


• Table creation collect all your findings together in an easy-to-read table, this will save you LOADS of time later, there is nothing worse than remembering that you found an article somewhere but cant now remember where it was. Keep a record of everything!!! It's not uncommon for you to have considered 100s of pieces (most of which are irrelevant) at this point. Remember a lot of this is going to inform your methodology statements.

Phase 3 Thematic analysis (February)

• Sieve and sort you may have anywhere up to 30 pieces of literature up to this point. Read the abstracts. They may have had a promising title, but the abstract tells a different story. If they are still promising, read on, and start to group pieces together. All the studies in one pile, all those looking at new developments in another for example. Dont be afraid to get brutal at this stage either.


• Analysis you need to discuss 3-4 topics in your literature review, and these topics should be seen within some/all of your remaining 5-10 pieces. All your pieces must contain at least one of the topics as well! So, if out of your 10 pieces 9 of them all talk about at least one of your chosen topics Communication, Education, and patient outcomes for example, then the remaining piece will offer little else to the discussion. You need to be able to compare and contrast multiple pieces, so having a single piece of literature offers only a very 1 sided interpretation and is not good for a literature review.


• Highlight pick a colour for each of your themes and start highlighting!!! Highlight the texts so that you can clearly see where in the text certain themes are discussed. This will allow you to start collecting the various pieces of your puzzle.


• CASP don't forget to start doing your CASP! You should have a nice table at the end that breaks down each of your pieces and outlines what they are, what they discuss, and why they are relevant.

Phase 4 Findings & Discussions (February)

• Data interpretation The longest part is now done! You have literally searched the entire internet for all the sources that are relevant to your topic, critiqued them for their rigour, relevance, and reach. And identified the 3-4 key themes that are evidenced across all the pieces. Now you need to interpret the data, findings, and discussions that are in each of those! There will be conflicting stances on the same topic. One article may have a positive finding, but the others are negative, why is this? What did they do differently?


• Statistics do you need to consider including statistics in your findings? Are there any trends that you have found within the literature? Will it make more sense to summarize using figures instead of words?


• Notetaking you dont necessarily need to have started writing your dissertation yet, its still appropriate to be making notes as you go along. 5000 words will quickly run out so get it right the first time rather than trying to go back and cut words or discussions to get under the count. Make some detailed notes on your findings and start to build an outline of your findings. This will lead you into thinking about what conclusions and discussions you are going to include in the final piece.

Phase 5 final write up (March)

• Lay out the jigsaw with 1 month to go you may be worried you dont have enough time to write up your dissertation, but if you have done your prep well, you should have all the pieces of the puzzle ready to go. Go back to the assessment guidance and look at what should be included in each area and then put your notes, highlights, tables etc. Into the corresponding piles/headings. All that detail about your methodology, put it under a heading of method, every highlighted extract for discussion theme 1 under that heading. Start to visualise your final product in front of you.


• Connect the dots make sure that you havent left anything behind. Is there an article that is still floating around that suddenly doesnt look like it fits? This is the last chance to get rid of it! Start looking at how you are going to Segway between different discussions? Are they equal? There is no point in spending 1000 words on the pharmacokinetics of ketamine if that only leaves you with 100 words to talk about training and education of administration for example. It all needs to be equal.


• Write! - with all the dots connected you should be able to write up your dissertation. Believe it or not, but you can easily write 5000 words in a day when everything is laid out in front of you! Do your references as you go along (it saves so much time, and once you get into the habit it starts to become second nature).


• Appendices and bibliography - dont forget to use an appendix if needed. Was there a table that wasnt appropriate for the main text, but you want to refer to? Put it in the appendix (after your reference list) and then this wont contribute to your overall word count. In some cases, I have seen appendices that are longer in word count than the main dissertation!! Did you read a piece of literature that has informed your dissertation, but it wasnt referenced? You can put this in a bibliography. This is different to a reference list as it only contains materials that are not referenced in the text. This might be a piece of grey literature or review that wasnt one of your main literature sources, or maybe one of the pieces of literature that was informative but didnt share one of your themes that you discussed? It is NOT all of the articles that you excluded from the start!!!


• Final check read it, re-read it, and re-read it again. This is a huge piece of work so dont be let down by a simple spelling mistake somewhere. Consider a nice front sheet and a contents page at the front of your work. Some students choose to include an acknowledgement as well, it is a nice touch as this represents not just the last couple of months of hard work, but a culmination of 3 years of study and those that have helped and supported you over those years.


• Submit get that submission in on time. Submissions are electronic, although being able to physically hand over a chunky dissertation is something of a rite of passage for some students and Ill gladly receive a well presented and bound dissertation (you will get it back at the end if you want)