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During the last few decades however, limited epidemiologic evidence and clinical
reports suggests that type 2 diabetes in youth is increasing in frequency (CDC
SEARCH; Fagot-Campagna et al, 2001; Neufeld et al, 1998; Rosenbloom et al, 1999).
Type 2 diabetes is rare among children less than 10 years of age. Among youth
aged 10 to 19, type 2 diabetes is still rare, however higher rates are seen in many
minority populations. From 2002 to 2005, 15,600 youth were newly diagnosed with
type 1 diabetes annually and 3,600 new cases of type 2 diabetes in youth were
diagnosed annually. Type 1 diabetes incidence was greater than the incidence of
type 2 diabetes in white youth aged 10-19. Newly diagnosed cases of type 2
diabetes outnumbered new cases of type 1 diabetes in Asian/ Pacific Islander and
Native American youth aged 10-19. In Black and Hispanic youth, aged 10-19,
incidence rates of type 1 and 2 diabetes were similar. Data from 2010 estimated
that 215,000 people younger than 20 in the US had type 1 or 2 diabetes. (CDC
Diabetes Fact Sheet, 2011). Complications of Diabetes Diabetes increases risk of
cardiovascular disease, stroke, blindness, kidney disease, neuropathy, and lower
limb amputations. If a person with diabetes can effectively manage their blood
glucose by keeping their hemoglobin A1c to near normal levels and manage their
blood pressure, many diabetes-related complications can be prevented of delayed.
Unfortunately though, diabetes was still the seventh leading cause of death based
on U.S. death certificates in 2007. Adults with diabetes have death rates due to
cardiovascular disease that are 2 to 4 times higher than adults without diabetes.
Diabetes is the leading cause of new cases of blindness among adults less than 75
years of age. Diabetes is also the leading cause of kidney failure among US adults
(CDC Diabetes Fact Sheet, 2011). Type 2 diabetes diagnosed in childhood or
and to participate in 150 minutes or more of moderate physical activity per week.
Subjects in this group received a 16-lesson curriculum covering a healthful diet and
physical activity to help them achieve these goals. Fifty percent of the lifestyle
group were able to obtain a 7% reduction in body weight, 38% were able to
maintain that weight loss. The goal of 150 min of weekly physical activity was
obtained by 74% of the lifestyle group, 58% of the group was able to maintain this
level of activity throughout the study period. At the end of the study the lifestylemodification intervention reduced the incidence of type 2 diabetes by 58%, and the
metformin intervention decreased the incidence by 31% relative to the placebo
group (DPP, 2002). What are the behavioral and environmental factors contributing
to the increasing rates of obesity and type 2 diabetes in the US? More specifically,
what are the behavioral and environmental factors that are contributing to the high
rates of obesity and increasing cases of type 2 diabetes in youth? Increasing portion
sizes, the availability and intake of energy-dense foods and sugary drinks, the easy
access and convenience of fast-food restaurants, limited access to healthy
affordable foods in some communities, and advertising of less healthy foods
targeted at youth have all been identified as contributors to increasing energy
intake. Lack of safe places to play and exercise in some communities, decreased
levels of active forms of transportation, lack of daily physical activity in all schools,
and increasing use of television and media have been identified as factors
contributing to decreases in energy expenditure among youth (CDC Childhood
Obesity; Dehghan, Akhtar-Danesh, and Merchant, 2005).
CHAPTER 3- METHODOLGY
This chapter presents the research methodology which has been preformed to carry out
this study. The research design that has been used for conducting this study is presented followed
by demonstration of the rationalization for choosing this specific design. A discussion is also
presented for conducting a qualitative study and using the method of secondary data collection.
The inclusion and exclusion criteria have also been presented in this section along with the
method of data analysis that has resulted in the emergence of various themes.
Research Design
The research design that has been selected for performing this study is a secondary
qualitative research design. The rationale for the selection of this research design is based on its
relevance with the aims and objectives of this study. The secondary qualitative research has been
performed through a systematic review of the studies which have been performed previously by
several researchers on the topics that are related to this study. This methodology is appropriate
for the search strategy of this study as the aim of the researcher is to evaluate the effects of
prophylactic antibiotics on the rate of survival of the dental implants. The appropriateness of this
method resides in its ability to allow the collection of the outcomes of numerous studies. It also
provides a way to the researcher through which interpretation of the outcomes of these studies
could be performed to develop a more succinct outline of the topic (Barbour, 2010, p. 156). This
research design also enables to perform a an analysis of the present literature as it enabled the
researcher to gather important information on the topic of study (Jolley, 2010, p. 78). This has
enabled the generation of numerous themes of the topic under study which included the
associated information essential for conducting the systematic review. The secondary research
design has included a systematic review of the studies that have been done for the evaluation of
the effects of prophylactic antibiotics on the rate of survival of the dental implants.
restrictions of language had also been considered while conducting the search of studies so that it
becomes possible to eliminate the studies that are in languages other than English language.
Keywords
A significant role is played by the keywords during the retrieval of relevant studies. This
formed the basis for utilisation of several keywords for performing the search of literature. The
selection of keyword had been based on their relevance with the study topic. This had allowed
retrieving the relevant studies that demonstrates the impact of the prophylactic antibiotics on the
rate of survival of the dental implants. The keywords that were used for search of the relevant
studies included Antibiotic, Dental Implant, Prophylactic, Prevent, Postoperative,
Therapy, Surgery, Infection, Disease, Antimicrobial and Agents. The studies retrieved
from the initial search had been than further analysed for inclusion or exclusion from the study
based on the inclusion and exclusion criteria set for selection of the relevant studies.
Boolean Operators
Boolean operators are used for performing a logical search of the terms which are
relevant to the study and enable the researcher to exclude several items that are irrelevant to the
search. Boolean operators are used for joining, exclusion, or expansion of the keywords when
conducting a search. This method involves a combination of different key words along with the
utilisation of capitalised AND for restricting the search and OR for expanding the search
upon combination. Subject heading with map terms were used to identify terms from the
database thesaurus, in order to refine the search. Boolean operators were used in the search that
allowed the researcher to perform the search in accordance with the study topic and narrowing
the search. It also saved the time so that search of the useful research materials could be
performed and enabled to exclude the irrelevant items.
antibiotics in dental implants were included. This has resulted in the inclusion of only six studies
which were included in the systematic literature review.
Critical Analysis
The critical analysis is a crucial procedure of any research study. It entails significant
thoughts which apply rational and logical thought procedure while dissecting the textual
information and data (Green & Thorogood, 2013). As it is complex in nature, it prompts an
intellectual action which entails analysis and evaluation on the material accumulated. Browne
and Keeley (2001) explained the critical thinking as a form of knowledge that interconnects with
the research questionnaire which is supposed to be seriously analyzed.
It gives an ability to reply and raise the critical question at the correct time and needs to
make use of the critical questions effectively ((Bryman & Bell, 2011). With no methodology,
critical evaluation and systemic literature, any study cannot be put into to a practice or in any
way put in the consumption of knowledge (Hart, 2005). Critical evaluation of the information
also proposes a structure for the assessment of the inferences on varied researches and their
purpose
CHAPTER 3- METHODOLOGY
The process of conducting a review of literature is presented including its various aspects.
Search of the literature, critical appraisal, thematic analysis and synthesis of the literature to
provide answer to research question. Research paradigm which can be appropriate for achieving
the aforementioned purpose has also been presented. Aptness of literature review for this study
and the significance of being methodical during search of literature are discussed. Importance of
adequate inclusion/exclusion criteria, selection of relevant search terms, and databases is argued.
Various methods of critiquing and analysing the literature are presented. Ethical implications of
the literature review are also considered.
time for the collection of data. Ignorance of the human element is also an important aspect of this
design.
According to Aveyard (2013), a literature review is a thorough analysis and interpretation
of existing literature on a particular research topic. Meanwhile, Machi and MacEvoy (2009)
define literature review as a written document that puts forth a logically argued case based on a
thorough understanding of the existing state of current knowledge about a particular topic. A
convincing thesis is established by this case that answers the question being sought by the
research study to be answered. Conducting a literature review is a systematic process started with
the identification of a research interest or issues by the researcher that he or she would like to
explore further. The issue or area of interest is generally read by the researcher to ascertain what
is known or unknown about that topic. Based on this phenomenon, development of research
question takes place. As the researcher proceeds, it is imperative to narrow down and clarify the
research question and come up with a research topic to help frame the literature review. The
outcome of the comprehensive literature review is the formulation of an argument which tends to
answer the research question initially posed by the researcher. Machi and MacEvoy (2009) have
presented a six step guide to conduct a literature review according to which the first step is
selection of a specific topic. It is followed by a search of literature that involves previewing,
selecting, and organising data for the study. The next step is development of an argument through
organisation of the relevant literature into a body of evidence explaining pre-existing knowledge
about the topic. A survey of the literature including assembling of the key findings, their
synthesis, and analyses in order to form the argument about information related to the area being
consider for the study is next step in this process. Later, critique of the literature and analyses is
performed by the researcher regarding the parameters that answered by the research question.
Finally, a review is written by the researcher where he or she composes and refines the work to
ensure its understanding by the target audience.
The current literature has not delivered adequate information pertaining to the topic being
considered for research which is in accord by majority of the researchers (Sharp & Hamilton,
2001). However, it has been researched in great depth by various authors at different points of
time each of them presenting different findings. Therefore, considering the gaps in the literature
about this topic, there is a need for an additional study to comprehensively reassess the
knowledge and provide its synopsis to develop a better and clearer understanding of the issue.
Thus, for the purpose of this study, a literature review was adopted as research methodology
because it was felt by the researcher that there was a need to synthesise the different findings,
and reanalyse the results to come up with new inferences. It also aimed at impending novel ideas
that could contribute towards better understanding of the different factors leading to patient nonattendance, and subsequently minimise the adverse effects of those factors on the hospital
management. The fact that there is no dearth of literature on this research topic encouraged the
researcher to use literature review as a research methodology, instead of conducting primary
research. Moreover, the fact that there was a difference of opinion among the different authors
encouraged the researcher to synthesise and reanalyse the findings of the different authors to
come up with new and unique inferences. The author would have instead opted for a primary
research method if there had been a scarcity of literature on this topic or a consensus of opinion.
The methods for identifying the latent relevant studies include search of several
bibliographic databases and scanning the reference list of the eligible studies and reviews that
already exist. Scanning the conference proceedings and hand-searching the major journals and
important databases at the internet is also a significant step in the process of searching. The third
step is the evaluation of collected data. In this step, the studies that have been studied are
subjected to quality assessment through critical appraisal guidelines and quality checklists that
are based on designs. The next step is summarisation of the evidence that include development of
the review in a systematic manner (Hagen-Zanker & Mallett, 2013). The final step is the
interpretation of findings that involves a comprehensive description of the findings of the review
along with a conclusion and recommendations for further research on the topic being studied
(Uman, 2011).
another. The studies that are in languages other than English language were excluded because it
might be difficult for the researcher to read and comprehend other languages.
3.3 Choosing Search Terms
According to Fink (2014), it is important for the researcher to select the search terms
carefully while searching in library catalogues or databases. Search engines and library databases
are not intelligent like humans and their response to search queries is generated by merely
matching up words that are entered in the search box. They do not consider the meanings of
different words. Therefore, during the utilisation of the search option in the library catalogues or
databases, it is imperative that careful selection of the key words or phrases describing the topic
as clearly and specifically as possible is considered (Fink, 2014). Selection of good keywords
make literature search very easy for the researcher. However, often the word describing the topic
of a research might have multiple meanings which make identification of appropriate key words
a difficult task. Hence, the researcher needs to be very careful about the selection of key words.
Despite the best efforts of the researcher there exist a possibility of missing some of the
journal articles or books as different key words might have been used by the authors of those
journal articles or books to describe their work (Ridley, 2008). Therefore, utilisation of a variety
of keywords that can be employed to describe the research topic is always helpful. Hence, as
Ridley (2008) suggests, the researcher can commence by using specific terms describing the
research topic, then move on to using similar and related terms, and later check whether any of
the words already used can be spelled differently. Majority of the words have different UK and
US spelling (e.g. organisation vs. organization). Some of the library catalogues or databases
cannot automatically call up journal articles or books that use US spelling if the researcher
entered the UK spelling during search. Therefore, both the UK and the US spellings should be
used by the researcher when entering the search terms to assure that any important journal
articles or books are not missed while searching for the pertinent literature. Additionally, the use
of both singular and plural forms of the key words should be tried by the researcher as the title of
the journal article or book may contain either of the two. There is a possibility that library
catalogue or database search engine might not retrieve the plural form in the search result if the
researcher entered the singular form, or vice versa. The search terms used for this research study
are discussed in the next chapter to provide a brief overview of the considerations by the
researcher during the search process of this dissertation.
Search strategy is an essential criterion of a systematic review that involves search of the
relevant databases. The first step in searching the databases is defining the question of research
and breaking into individual concepts. Use of synonyms of key terms for searching the relevant
information is crucial to the process of review. Filters and limits are also used for searching the
material that allows the retrieval of information pertaining to the topic being studied. The second
step of a systematic review is the collection of data. The criteria for the selection of studies have
to be specified prior to the commencement of review. It should present the criteria for
inclusion/exclusion. The process of search should be extensive that should involve search of
multiple databases.
Name of
Database
Description
CINAHL
CINAHL is the world's most inclusive database of nursing & allied health
research, offering full text for approximately more than 770 indexing and
journals from the fields of nursing and allied health. It possesses coverage of
publications from the National League for Nursing and the American Nurse
Association.
PubMed
central
MEDLINE
Provides the citations and abstracts for journals that are related to biomedical
literature from around the world. It contains 21 million references to articles
published in approximately 5,600 current biomedical journals.
Science
Direct
database
Science Direct database contains around more than 25% of the worlds
technology, science, and medicine bibliographic and full text information.
Google
Scholar
Google Scholar finds results from academic or scholarly sources. This can
assist in focusing on the search or can be helpful if peer-reviewed material is
being searched for a course work or dissertation. Results may include journal
articles, books, papers, abstracts, and theses etc.
the work of others is properly cited, and their research findings are not portrayed as own. Hence,
the researcher has to adhere to the principles of academic honesty and integrity, and give credit
to the researcher by whom the primary research was actually conducted. Secondly, the researcher
needs to ensure that the information collected by another researcher was gathered in an ethical
manner, and the researcher who conducted the primary research observed the ethical principles
of research. The researcher has prevented the presentation of any counterfeit information. It is
essential to avoid use of information without acknowledging the researchers. Any such activity is
considered as plagiarism due to which researcher has provided appropriate citation and
referencing of every article that has been utilised in the research. Misinterpretation of the results
of the literature has also been prevented by the researcher in the entire process of research to
eliminate the possibility of violation of ethics (Wager and Wiffen, 2011). The ethical
considerations of this research have been discussed in greater detail in the subsequent chapter.