NUR6900 Module 5: Systematic Literature Review Critical Appraisal

This report presents a critical appraisal of a systematic literature review by Milinis et al. (2018), focusing on the effectiveness of graduated compression stockings (GCS) combined with pharmacologic thromboprophylaxis in preventing venous thromboembolism (VTE) among surgical patients. The assessment meticulously evaluates the review's methodology, including the clarity of the research question, the appropriateness of inclusion criteria, the search strategy employed across databases like MEDLINE and Embase, and the adequacy of sources and resources. The critical appraisal also examines the methods used to minimize bias, such as the application of the Cochrane Risk of Bias Tool and the involvement of two independent reviewers. Furthermore, the report scrutinizes the methods for combining studies, the assessment of publication bias, and the connection between the review's findings and clinical practices. The author identifies the scope for future research and highlights the strengths and limitations of the original review, providing a comprehensive analysis of its quality and impact.

Running head: NUR6900 ASSESSMENT 3
SYSTEMATIC LITERATURE REVIEW CRITICAL APPRAISAL
Name of the student
Name of the university
Author note

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Systematic review is a specific type of literature review, in which depending on a
specific research question, a set of research articles and collected and then critically appraises
all the research studies so that effective result could be achieved (Moher et al., 2015). This
paper would also appraise one such systematic review paper and it is aspect, the Joanna-
Briggs systematic review critical appraisal tool would be used so that accurate critique could
be included in the paper,
Chosen paper: (Milinis et al., 2018)
Presence of review question in the paper
As per Milinis et al. (2018), the primary aim of the paper was to identify the benefits
of Graduation Compression Stockings (GCS) in combination with pharmacologic
thromboprophylaxis in reducing the risk of venous thromboembolism among the surgical
patients. This was selected as a research question or the primary aim of the study as Milinis et
al. (2018) mentions that due to the lack of research about this concept, the strategy using
which it prevents healthcare complications among the surgical patients. Further, it was
mentioned that 21% of the surgical patients were suffering from venous thromboembolism
and 43% cases of post-operative cases were found. Hence, the research question and aim of
the paper was explicitly stated.
Appropriate ness of the inclusion criteria
In the inclusion criteria of the paper, patients with minimum 21 days of
thromboprophylaxis, presence of drugs such as oral anticoagulants, documented use of GCS
and confirmed VTE through the application of medical imagining technique. Besides this, the
patients that were included in the study were above the age of 18. Finally, the patients that
were involved in the research were abdominal or orthopaedic surgery. Hence, the inclusion
criteria for the systematic review was associated with the review question. Further, it was

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seen that the papers that were found after application of the inclusion and exclusion criteria,
were appropriate for answering the research question.
Search strategy
The search strategy for this research paper was conducted in the research articles such
as MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases and in these
databases, application of keywords, with permutation and combination using Boolean
operators. The paper mentioned in a clear PRISMA diagram the way the exclusion and
exclusion criteria helped the researches to refine the search and sieve through 19 research
articles for this systematic review. Further, it was also included that full text articles and the
Randomized control trail was given priority due to its high level of evidence mentioned by
Milinis et al. (2018). Therefore, the search strategy was appropriate for the study.
Adequacy of the source and resources
The sources and resources included in the search strategy were appropriate for the
study as all the 19 articles were full text and randomized control trails due to which the
evidence of level increased and hence reliability of the paper enhanced. Further, the articles
with abstract, presence of short pharmacological thromboprophylaxis or improper description
and data analysis were eliminated from the process. Hence, through the application of the
search strategy, the paper included relevant sources to answer the research questions.
Appropriateness of the critical appraisal of the papers
The appropriateness of the cortical appraisal of the papers could be understood from
the fact that the paper included meta-analysis guidelines that has been published in the
PROSPERO databases and hence, the critical appraisal of each of the paper included in the
systematic review was conducted. Further, it is mentioned in the paper that to remove the bias
present in the research articles, the researchers implemented the e Cochrane Risk of Bias

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Tool so that a bias free and accurate result could be obtained. Hence, this critical appraisal
conducted was appropriate for the research process.
Application of two or more reviewers independently
The paper included a bias tool, Cochrane Risk of Bias Tool for the removal of bias
present in the 19 research article mentioned in the process. Further, it was mentioned that two
reviewers were included in the review process and in the critical appraisal and those
reviewers were working differently so that no bias or influence could affected their critical
appraisal of the papers. Hence, the decisions and comments they made for the completion of
the research process were unbiased and hence, the authenticity of the systematic review was
maintained.
Methods to decrease the data extraction related errors
In this paper, it was mentioned that the two researchers included the data from 19
research articles independently and then details of the articles related to first author, sample
size, operation type, detail of pharmacological expression and the duration of the treatment
with effective drug dose was included. As the data collection was collected from both the
reviewers separately and they utilised the Cochrane Risk of Bias Tool for the assessment, the
bias of the review process related to the 19 research articles that could affect the data
collection and extraction, were eliminated.
The methods used to combine studies appropriate
The 19 papers that were included in the study was appropriate and it could be said
because all the articles were amalgamated to find the research answer so that the
effectiveness of the technique in VTE treatment could be understood. All the studies were
heterogeneous studies and hence inclusion of these in the study provided a detailed narration
so that from the results of the multiple studies, an effective result or finding could be

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obtained. Further, the reviewers were able to provide a detailed description of the studies and
hence, inclusion of these multiple and variable research articles helped the researchers to
understand the effectiveness of the paper and the intervention in answering the research
question.
Publication bias were assessed
This review paper, does not provide a description of any publication bias and the
strategies the reviewers applied for the removal of the publication bias. Further, in this paper
description of only methodological bias could be observed and hence, the application of
Cochrane Risk of Bias Tool was done by the reviewers so that the risk of this bias could be
decreased. Hence, the assessment of publication bias was conducted or not, is not clearly
mentioned in this paper.
Support of report data from policy and practices
The research article mentioned about application of clinical practice guidelines and
policies for the elimination of risk related to VTE among the surgical patients were involved
in the process and hence, the clear linkage between the results and the review were mentioned
in the research article. However, the conclusion of the review paper did not include any of
such guidelines or policies that could be applied to the healthcare facilities and could be used
for the reduction of the risk mentioned in the paper. Hence, the clear indication of the
mentioned policies and practices is missing in the paper.
Scope for future research
Reviewers of this paper mentioned that no clear indication of the application of GCS
for the reduction or prevention of VTE among the surgical patients were observed from the
conducted systematic review and hence, the paper identified the scope for future research and
in the course mentioned the future clinical trials so that investigation of costs, benefit and

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possible adverse conditions could be understood in the process. Hence, the future scope of
research was clearly mentioned in this research process.

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References
Milinis, K., Shalhoub, J., Coupland, A. P., Salciccioli, J. D., Thapar, A., & Davies, A. H.
(2018). The effectiveness of graduated compression stockings for prevention of
venous thromboembolism in orthopedic and abdominal surgery patients requiring
extended pharmacologic thromboprophylaxis. Journal of Vascular Surgery: Venous
and Lymphatic Disorders. DOI: https://doi.org/10.1016/j.jvsv.2018.05.020
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... & Stewart, L.
A. (2015). Preferred reporting items for systematic review and meta-analysis
protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1. DOI:
https://doi.org/10.1186/2046-4053-4-1