Posted: December 2nd, 2014

“Which are the most Effective CT Protocols in the Diagnosis of Acute Appendicitis in Children?”

“Which are the most Effective CT Protocols in the Diagnosis of Acute Appendicitis in Children?”

Aim:
“To Review the Best CT Protocols For Accurate Diagnosis of Acute Appendicitis in Children”(Quotation mark not required. You also do not need to capitalise each word.
It is true to an extent that your task is to review however I’d say the aim of your review is to evaluate protocols or to determine the best protocol.
Objectives:
1.    To determine and appraise the most effective CT protocols in the detection of acute appendicitis in children; (It is difficult to find a distinction between these two objectives. They are effectively the same. Also, I’d usually present an overarching objective with smaller sub-aim.
2.    To establish the effectiveness of different CT protocols in the detection of acute appendicitis in children.
There are some grammatical errors in the title and aims. The wording of the overall aim is not quite right and needs to be alerted to something along the lines of to evaluate the effectiveness or to determine the most effective.

Literature Review Process
Having had the research study topic and research aims approved by the module advisers, a myriad of search approaches were employed to identify an appropriate database that would provide critical information relevant to the research area of interest. In pursuit of this, the researcher identified various key words that were critical in identifying pertinent articles, journals and books that would provide the needed information.( The language adopted here is very conversational in style and switches from the first to the third person. The language needs to be more formal, scientific, and concise in nature.
The study predominantly used journal articles because they are based on research studies and had to go through rigorous, in-depth analysis before publication in the peer reviewed journals. (This is ok but the language is a little too conversational. A better statement would have been ‘ Searches were limited to full text peer reviewed journal articles only). Journals that were especially invaluable in the course of the research study touched on roentgenology, medical diagnosis of appendicitis, paediatric ailments, and computed tomography scan, terms which formed the key search words.( Not sure I quite understand what you mean here. Usually your key search terms are closely linked to your……).These terms were slowly introduced (Not relevant) into the search engine to polish up (too conversational and not relevant)the search results until appropriate articles were identified that matched with the research topic and aims of the research study topic. Other key research terms that were further included in the course of the research were imaging/ radiology, acute appendicitis, diagnostic value, CT in children; Radiology, Ultrasonography, CT protocols. The inclusion of these search terms filtered the search results further.( Not sure I understand what you mean here. Entering search terms is not a means of setting filters/limits unless you are using specific combinations of key terms.
The GCU library was the significant database ( There are specific journal databases that are accessible through the GCU library but the GCU library is not a database in itself) that facilitated access to appropriate journals such as the Journal of Radiology, Journal of Paediatric Radiology, and the British Institute of Radiology. Other databases included the Radiological Society of North America Journals (RSNA) and the American Journal of Roentgenology.(While these journals might contain relevant articles –we normally have inclusion criteria for articles specifically and not whole journals) During the first search (I would normally like to see specifically what you entered into the search –this is a key aspect of making searches reproducible )on the GCU library 5675 results were obtained. Using the filter options provided by the database and introduction of additional search terms, as well as limitation of the searches to journal artcicles and books and official reports, the search yielded 2342 hits. Further limiting the search to peer reviewed journal articles that are written in English (limited to English only) the results yielded 347 relevant sources.
A quick perusal of the abstracts of the search results reflected the inclusion of some sources that were not very applicable to the research topic.( Based upon what criteria ? What would make an article relevant ? Where is your inclusion/exclusion criteria?However, they would be critical during the course of the research study in providing associated information on the research topic. Due to the fact that there has been very limited recent research in the field of CT Protocols in the Diagnosis of Acute Appendicitis in Children, the research study limits itself to journals articles, reports and book published within the past eight years.( why specifically 8 years)
The literature review process needs some improvements in order to be suitable for the Summative assignment. The language adopted is too conversational and needs to be more scientific and concise. It would be better to have each individual search strategy and the search yield results presented in a table so that the searches could be reproduced. There is no apparent use of Boolean operators and little justification for the search strategy adopted. Check the distinction between searches for journals and searches for relevant journal articles.

Critical Methodological Appraisal
One of the sources selected as a source for the research study is titled “US or CT for Diagnosis of Appendicitis in Children and Adults” authored by Doria, et al. (2006), published by the Radiological Society of North America. The validity of the article stems from the facts that it was published in a very credible peer reviewed journal( This is incorrect. Many poor studies and articles can be published in good journals and this does not mean they are good. We still need to be able to critically evaluate published articles and we cannot assume that just because they are published that they are valid too) the authors are associated with nationally recognised medical bodies that are highly regarded institutions ( For the purposes of critical appraisal this is not relevant) in the field of radiology; and the authors choice of sources and references reflected credible researches conducted in the field of radiology( not relevant. Good researchers can also do poor research at times)The study was a qualitative ( Are you sure? Quantitative research looks at numbers , qualitative research does not)research study that relied heavily on medical literature; it also included prospective and retrospective studies( This can’t be right . It would have been one or the other). The study aimed at analysing the effectiveness of CT as opposed to US in the diagnosis of appendicitis in children. This source is critical for the study as it provided important information on the use, applicability and accuracy of CT scan in children, which forms the core subject of the research study.
The second source that has been used to enrich the research topic ( You only had to appraise 1)is from the Journal of the American College of Surgeons (2009). The article is titled “Improving Diagnosis of Acute Appendicitis: Results of a Diagnostic Pathway with Standard Use of Ultrasonography Followed by Selective Use of CT.”  This study was included since it was a qualitative study (Are you sure)that aimed at assessing the accuracy of a diagnostic pathway in acute appendicitis using US and complementary Contrast-enhanced multi-detector CT, both of which are variables that are of interest in the research topic. With regards to the study design, one hundred and fifty-one participants with clinically suspected appendicitis followed the designed protocol. The results of US and CT experiments were correlated with surgical findings, histopathology and follow up( Sounds like a quantitative study to me). The validity and reliability of this source can be accredited to its use of a highly recommendable study design and research methodology in terms of study participants and approach of conducting the experiment.( This doesn’t make sense I’m afraid)

The critical appraisal conducted is not quite right. You should have used a critical appraisal tool to guide you through the process of critiquing a journal article. Also there are some wrong descriptions of the articles where they are described as qualitative when in fact they are quantitative in nature.

References
Doria, A. S., Moineddin, R., Kellenberger, C. J., Epelman, M., Beyene, J., Schuh, S., . . . Dick, P. T. (2006). US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiological Society of North America.
Poortman, P., Oostvogel, H. J., Bosma, E., Lohle, P. N., Cuesta, M. A., Lange-de Klerk, E. S., & Hamming, J. F. (2009). Improving Diagnosis of Acute Appendicitis: Results of a Diagnostic Pathway with Standard Use of Ultrasonography Followed by Selective Use of CT. Journal of the American College of Surgeons , 208(3

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