1 00:00:00,750 --> 00:00:04,130 Yeah, I know. Okay. 2 00:00:04,140 --> 00:00:07,320 Good evening. Thank you so much. Over attending. 3 00:00:08,280 --> 00:00:12,720 So with this this evening, we have and tribute to this. 4 00:00:12,750 --> 00:00:17,460 I am not going to be able to pretend to be able to introduce Andrew, but he's definitely introduced himself. 5 00:00:17,820 --> 00:00:22,500 And a great many of you are here. But it will be. And then the magic happens. 6 00:00:22,500 --> 00:00:25,950 Can really synthesis really be systematic? 7 00:00:26,520 --> 00:00:30,570 So, Andrew, the floor is yours. Thank you for attending. 8 00:00:30,840 --> 00:00:33,959 It's great to be here. And so particularly appreciation. 9 00:00:33,960 --> 00:00:39,030 You've had a heavy day and trying to not be too heavy, but I will try and be controversial. 10 00:00:39,690 --> 00:00:47,640 So we'll see how that goes. And obviously the controversy is present there in the of the title. 11 00:00:49,140 --> 00:00:59,190 What I would say is my background, just over 20 years ago, I joined the School of Health and related research for the University of Sheffield. 12 00:00:59,490 --> 00:01:04,650 We do a wide range of systematic reviews for all sorts of funders. 13 00:01:05,370 --> 00:01:10,559 Perhaps the one that I'm sort of most proud of at this particular moment was 14 00:01:10,560 --> 00:01:15,150 doing the review of for the Department of Health on alcohol minimum pricing, 15 00:01:15,840 --> 00:01:21,630 because although England resolutely refused to listen, partly because of how many votes they thought it would lose. 16 00:01:21,900 --> 00:01:29,850 But Scotland has just of course reacted to that thought it would make a lovely impact story and I was the first reviewer on that particular piece. 17 00:01:30,180 --> 00:01:38,010 But in later review life I saw the light and became a qualitative evidence synthesiser 18 00:01:38,970 --> 00:01:44,580 and that sort of led me in a roundabout really to familiarity with reality synthesis. 19 00:01:45,300 --> 00:01:51,510 I'm co-convenor, one of ten co-convenor of the Cochrane Qualitative and Implementation Methods Group. 20 00:01:51,840 --> 00:01:59,970 So I'm coming from the stance of being systematic review of an introduction, if you like, sympathetic to the qualitative tradition, 21 00:02:01,140 --> 00:02:09,030 very keen on the idea of the systematic review toolkit, in other words, that you need to be able to choose methods judiciously. 22 00:02:09,330 --> 00:02:16,170 And so that's where I'm going to be coming from today. So this is what I said that I would talk through. 23 00:02:16,170 --> 00:02:18,150 So I have to do this in some way. 24 00:02:18,470 --> 00:02:25,920 I'm just going to very briefly rehearse the role of really synthesis within health services, research and evaluation. 25 00:02:26,820 --> 00:02:35,850 Then looking at this sort of juxtaposition of another thing I should say is my my Ph.D. thesis, 26 00:02:35,850 --> 00:02:44,370 fairly recently I did five publications was on the conflicting traditions of qualitative synthesis I'm sorry, 27 00:02:44,370 --> 00:02:52,590 qualitative research, having systematic reviews as they came into conflict, if you like, about two tectonic plates rubbing together. 28 00:02:53,010 --> 00:02:58,559 I could see an element of that here with with systematic reviews of realist synthesis 29 00:02:58,560 --> 00:03:04,590 that they are like two tectonic plates struggling to to sort of occupy a role. 30 00:03:04,910 --> 00:03:07,229 I'm going to be a little bit provocative. 31 00:03:07,230 --> 00:03:16,290 This table is really synthesis, really a review method or is it so claiming time and resources away from from doing the real job? 32 00:03:17,400 --> 00:03:22,740 And then I'm going to look at some of the challenges and issues and I've sort of given a little 33 00:03:22,740 --> 00:03:31,290 bit of the story away at the end that won't be quite such an angry old man as I present myself. 34 00:03:32,340 --> 00:03:41,969 So where are we coming from? Really, synthesis is fitting within a new feature in an evaluation world, 35 00:03:41,970 --> 00:03:49,200 if you like research and evaluation world where we're increasingly interested in theory informed approaches. 36 00:03:49,470 --> 00:03:54,540 And so really synthesis offers a mechanism by which we can engage with that theory. 37 00:03:54,810 --> 00:04:01,020 Obviously we do that at two levels. We do it at the level of a programme theory, that's how it works type of theory. 38 00:04:01,230 --> 00:04:07,920 But then we try and relate it to something a bit more generalisable, a bit more transferable, hence the interest in mechanism. 39 00:04:08,190 --> 00:04:12,900 But it is only one route by which to pursue that sort of inquiry. 40 00:04:13,620 --> 00:04:23,010 Complex interventions, a recognition that to understand not just the intervention itself but the the health system within which it's operating, 41 00:04:23,440 --> 00:04:30,960 the population context, all of these other things, that that has become an increasing preoccupation. 42 00:04:31,200 --> 00:04:40,110 Obviously the MRC guidance on use of complex interventions and increasingly we're recognising that context is important. 43 00:04:40,410 --> 00:04:47,160 You can have the same intervention in different contexts, work or not, work or work with differential effectiveness. 44 00:04:48,180 --> 00:04:56,580 And of course really synthesis is appropriate to this mantra and I wish I had a pound for every time I saw this about a grant proposal or an article. 45 00:04:56,730 --> 00:04:59,900 What works for whom? Under what circumstances? The employer. 46 00:05:00,390 --> 00:05:10,090 Here is the it's not the only methodology explore and deliver against know one of the it happens to be a particularly sexy one at the moment. 47 00:05:10,090 --> 00:05:16,770 And by all means, let's take advantage of that. But let's not pretend it's the only one that looks at some variation. 48 00:05:16,810 --> 00:05:27,310 And so, as many of you are already aware, that the effectiveness review has its limitations, it was designed for a particular purpose. 49 00:05:28,090 --> 00:05:33,950 And when it gets beyond that purpose, it starts to feel deficient. 50 00:05:34,000 --> 00:05:39,010 So, for example, a systematic review, you strip out all the context. 51 00:05:39,370 --> 00:05:46,870 And then when you come to writing up your your discussion, you then try to reinsert the context with your recommendations. 52 00:05:47,350 --> 00:05:52,480 This seems a little bit perverse for throwing all the facts information away and then reconstituting it. 53 00:05:52,810 --> 00:06:01,450 It's a bit like a cartoon that I remember saying, which is someone who invented dehydrated water, and I'll just add water to get back to it again. 54 00:06:01,770 --> 00:06:10,180 And there's an element to that with a systematic review. There's a recognition that there's more diverse data that we can actually bring to bear. 55 00:06:10,900 --> 00:06:15,700 So we don't just think of the randomised controlled trial, we think of a company process evaluation. 56 00:06:16,330 --> 00:06:19,390 Perhaps it comes from qualitative research we went through inside, 57 00:06:19,810 --> 00:06:25,540 helped in the design of the intervention that all offers information that can help us to understand what's going on. 58 00:06:26,350 --> 00:06:38,100 And importantly is there's a lot of the receptivity to either really state based approaches or the possible alternative logic model based approaches. 59 00:06:38,110 --> 00:06:44,349 Essentially, they both have a logic. The terminology is different, and for many people, 60 00:06:44,350 --> 00:06:50,860 the terminology of logic models is actually more accessible from another field of realist approaches. 61 00:06:51,370 --> 00:06:59,260 But but increasingly, all funders are saying, where is your logic in your proposal? 62 00:06:59,270 --> 00:07:09,940 You know, not just the outcome, but actually as part of the design, because this is a sort of cheap shot that I thought you'd find interesting. 63 00:07:10,120 --> 00:07:17,540 This is the growth of realist reviews and sympathy, just calculated from a fairly simple third of public off. 64 00:07:17,660 --> 00:07:21,660 Just earlier on in this week, we can see tremendous growth. 65 00:07:22,150 --> 00:07:26,270 And of course, it's not just within the medical field that we see where this incomplete. 66 00:07:26,290 --> 00:07:30,940 So this if be like is just just within the scope of my client. 67 00:07:33,250 --> 00:07:44,530 I've just selected some of the funded realist work that has been received just through one funding organisation, 68 00:07:44,530 --> 00:07:47,830 the nature of and the primary one in this country. 69 00:07:48,520 --> 00:07:56,770 And you can see that the program that's most interested in, in the realist approaches is the health services and delivery research program. 70 00:07:57,120 --> 00:08:00,730 That bears out my own experience as we come to the minute. 71 00:08:01,300 --> 00:08:07,990 But we do see them already there with with health technology assessments and other projects through in process. 72 00:08:08,590 --> 00:08:15,570 And the alternative here with this final one isn't a realist synthesis, but it's a logic model approach. 73 00:08:15,580 --> 00:08:21,580 So if you're interested in, you know, sort of counter pose, no counterpoint in the two different approaches together, 74 00:08:21,980 --> 00:08:26,050 that shows you another way of trying to explore the logic of what's going on. 75 00:08:27,160 --> 00:08:32,500 And this is my my own experience of really simple things that are mounting up a bit. 76 00:08:32,500 --> 00:08:38,110 So for the help that knows the assessment program, I'm looking at prevention of postnatal depression, 77 00:08:38,740 --> 00:08:42,550 particularly looking at the contribution of group processes. 78 00:08:42,760 --> 00:08:49,930 So groups have certain mechanisms that can be beneficial, so they can encourage you being part of a self-help group. 79 00:08:50,200 --> 00:08:55,359 But on the other hand, they can be demoralising. You think so-and-so's getting better? 80 00:08:55,360 --> 00:09:03,999 I'm not sure. Or I can sympathise with so-and-so, but she's been coming here for months and months and doesn't seem to be getting any better. 81 00:09:04,000 --> 00:09:07,100 So is it likely that I'm not going to be getting any better? So. 82 00:09:07,290 --> 00:09:09,940 So we do tend to think of groups as being a good thing, 83 00:09:10,270 --> 00:09:16,120 but of course we realise that there are adverse effects of group treatment and so that was the sort of thing we were able to 84 00:09:16,120 --> 00:09:25,940 explore in that particular really simple appointment to remind the system and looking at the logic behind people's attendance, 85 00:09:26,080 --> 00:09:30,400 whether there are particular types of appointments that people are more likely to attend. 86 00:09:30,760 --> 00:09:37,930 And one of the simple things we did was just look at the attendance rates across a variety of conditions, 87 00:09:37,930 --> 00:09:46,780 and we found that things that were about attendance for something in the general population that like a blood donation, 88 00:09:47,440 --> 00:09:59,880 had some very low participation, low attendance rates and things that were targeted at, for example, accompanying a sick child. 89 00:10:00,770 --> 00:10:04,940 Perhaps an inherited metabolic disease clinic have very high attendance. 90 00:10:04,940 --> 00:10:13,430 And so we could we can hypothesise things about people's feeling of the importance of the organs or indeed the symbolism of the appointment. 91 00:10:14,300 --> 00:10:20,240 There are other ones in public health and the community engagement group clinics. 92 00:10:20,810 --> 00:10:27,889 Some of you who are familiar with real surfaces might prefer that the idea of transferable or 93 00:10:27,890 --> 00:10:34,100 reusable platforms where you can take some of the arising from one area and use it in another. 94 00:10:34,670 --> 00:10:43,459 Well, course, because with the recurrence of groups in group clinics, I was able to use some of the thinking that had informed the group treatment, 95 00:10:43,460 --> 00:10:48,500 post-natal depression in terms of thinking about both positive and negative consequences. 96 00:10:49,940 --> 00:10:56,929 So work with a local research panel on dementia, dementia and how people, 97 00:10:56,930 --> 00:11:03,710 people involved in improvement of services when they have that diminished capacity 98 00:11:03,720 --> 00:11:09,740 and also that their life challenging while medically unexplained symptoms. 99 00:11:10,410 --> 00:11:18,920 And that was challenging because every aspect of the the question was would say and then we use really synthesis which 100 00:11:19,160 --> 00:11:27,740 is another layer of interpretation for the whole process and then one in a reorganisation context which is of care. 101 00:11:28,100 --> 00:11:34,130 But then I'll go through all of these, but just to show that there are other ones taking place. 102 00:11:34,520 --> 00:11:39,469 I will just highlight the avoidable admissions one that because this is part of 103 00:11:39,470 --> 00:11:43,970 the half a million pound contract that we have to do on demand rapid reviews. 104 00:11:44,360 --> 00:11:50,960 And we're actually doing a real synthesis to try and fix what happened with regard to avoidable admission. 105 00:11:52,130 --> 00:11:56,030 That's an interesting one because the problem we've actually said we want to know barriers and 106 00:11:56,030 --> 00:12:01,400 facilitators and we thought that's a very simplistic and probably not very helpful question to ask. 107 00:12:01,850 --> 00:12:07,330 And because it was the HSBC all programme said, well, would you mind if we explore the theory of synthesis? 108 00:12:07,370 --> 00:12:14,160 So, so we've up the expectations of behind that but we think would be more useful than just having a simple hope. 109 00:12:14,290 --> 00:12:19,170 And barriers and facilitators postcode problem. 110 00:12:20,300 --> 00:12:27,470 But I've already mentioned that some of the methods can contribute to all lines of inquiry. 111 00:12:27,800 --> 00:12:36,230 This is supposed to be me writing to horses because I'm also involved in some of the thinking around use of logic models and systematic reviews. 112 00:12:36,560 --> 00:12:40,490 And so it's just sort of fair to present factors. 113 00:12:40,850 --> 00:12:45,470 I'm not sure if it's the control or the intervention really synthesis, but as a comparator. 114 00:12:46,040 --> 00:12:53,329 And so I've been involved in producing guidance as part of an EU protocol on the use of logic models. 115 00:12:53,330 --> 00:12:57,440 And this is where the interesting similarities and differences come from. 116 00:12:59,670 --> 00:13:09,860 Erm there's no doubt that really synthesis can contribute something that is not present in most review methods. 117 00:13:10,460 --> 00:13:18,860 And this is a very nice article, it's part of the theory from just it's written a very good piece to this own complexity, this a series. 118 00:13:19,820 --> 00:13:24,979 But this is actually saying that that's one of the virtues of really synthesis 119 00:13:24,980 --> 00:13:28,850 is it's a method for integrating quantitative and qualitative data together. 120 00:13:30,080 --> 00:13:34,729 There are many methods to that. There are techniques for bringing together, 121 00:13:34,730 --> 00:13:41,090 like putting things in matrices or using a model or framework to bring quantitative and qualitative data together. 122 00:13:41,330 --> 00:13:47,990 But there are not very measured. So that to me could just we like to vote is the prediction. 123 00:13:48,620 --> 00:13:52,700 And so that's certainly worth bearing in mind when we're trying to evaluate the role of 124 00:13:53,300 --> 00:14:01,130 really thesis and the challenge of complexity is trying to unearth the sources of variation. 125 00:14:01,430 --> 00:14:08,700 Well, that's very close, very far, really synthesis. Although it's interesting that the authors of this paper also say that. 126 00:14:08,700 --> 00:14:18,260 So most of the models are a route by which to achieve that and we see a growing interest in review targets. 127 00:14:19,280 --> 00:14:27,500 And so if you like, what we're doing is we're opening an increasing toolbox of different review types for different purposes. 128 00:14:28,370 --> 00:14:31,790 And here are some examples. Rapid reviews. 129 00:14:32,390 --> 00:14:41,600 I know the course has already mentioned the theories of by three or four different papers on review types. 130 00:14:41,930 --> 00:14:49,970 So it's very appropriate to be thinking, well, what is the the role to be inhabited by realist reviews and really synthesis. 131 00:14:51,740 --> 00:14:59,810 But the danger is the we could adopt this sort of uncritically is yet another method and as I indicated in. 132 00:15:00,070 --> 00:15:06,950 I've been around a long time, and the first systematic reviews that we had to deal with were clinical effectiveness reviews. 133 00:15:06,970 --> 00:15:09,670 That was that was the model pioneered by Cochrane. 134 00:15:10,900 --> 00:15:18,910 Pretty early on, though, record of questions about clinical effectiveness in a health environment without asking the cost effectiveness question. 135 00:15:19,840 --> 00:15:28,080 I was then involved in one of the earliest NIH, HDI reports that included qualitative research. 136 00:15:28,090 --> 00:15:36,610 In a review. We were looking at a newborn screening, neonatal screening, and of course, 137 00:15:36,610 --> 00:15:41,260 one of the things you have to do is take a blood sample from the heel of the of the newborn. 138 00:15:41,470 --> 00:15:47,290 And we wanted to look at the qualitative evidence around that so that you have the question a bit larger. 139 00:15:47,290 --> 00:15:50,920 We've got clinical effectiveness, cost effectiveness, acceptability. 140 00:15:51,220 --> 00:16:00,640 And since then we had all of these parts of the decision in Portland, part of the decision question expanding the acceptability, feasibility, 141 00:16:00,640 --> 00:16:08,590 meaningfulness, and so that we've now seen what work for whom under the circumstances, so that it's just getting longer and longer. 142 00:16:08,830 --> 00:16:11,200 The patients are getting more and more expensive. 143 00:16:11,410 --> 00:16:20,530 It makes a lot of work for the research community, but it makes it even more important to know that the money is being spent in a useful way, 144 00:16:22,150 --> 00:16:31,150 just as a light hearted break here that there are so many review labels, we've estimated about 50 different review labels. 145 00:16:31,720 --> 00:16:39,340 But the other week I went and did a presentation in Huddersfield Go to Oxford, but still an interesting experience. 146 00:16:39,730 --> 00:16:49,270 I've developed a review label, Random Generator, and someone picked up on this on Twitter and said, Do you mind if I turn it into a tweet box? 147 00:16:49,270 --> 00:17:01,630 And so what we have now, every hour a new review is generated hypothetical review with a topic area, but then the actual review cycle. 148 00:17:01,870 --> 00:17:07,690 So there is a whole industry about review labels. So we've got a rapid make and narrative umbrella review. 149 00:17:07,960 --> 00:17:17,490 We've got findings from a rapid quantitative framework overview, a rapid quantitative realistic review, and a rapid qualitative hermeneutics. 150 00:17:17,500 --> 00:17:27,639 And so, yeah, I'm not sure you should follow the phone, but it's certainly if you want to get some really enthusiastic, 151 00:17:27,640 --> 00:17:31,480 if you find one of these topics in their area, they're going to think it's a real review fact. 152 00:17:31,900 --> 00:17:38,229 So you could be a bit mischievous and just read it and then it looks like we've done the same thing. 153 00:17:38,230 --> 00:17:42,760 But this is a real one and this was the interrupt project. 154 00:17:43,120 --> 00:17:51,580 And the reason for this is I want to show the complementarity of realist reviews within the whole, if you like, to a practice here. 155 00:17:51,880 --> 00:17:57,490 So look at what we're looking at intervention effectiveness, cost effectiveness, qualitative synthesis. 156 00:17:57,490 --> 00:18:03,100 That was a bit how I was involved and I'm going to rewrite since the first go round Crossing the load lead. 157 00:18:03,350 --> 00:18:07,270 But perhaps the most memorable thing, apart from the findings, of course, 158 00:18:07,270 --> 00:18:12,040 which were brilliant, but the most memorable thing was this scheme which actually, 159 00:18:13,030 --> 00:18:18,700 once you get your head around, it starts to make you think of the different role of the different types of review. 160 00:18:19,060 --> 00:18:24,310 So what we have found here are the different questions for decision making means to all of us. 161 00:18:24,760 --> 00:18:29,230 And then what you have here, you have the processes of evidence selection, if you like, 162 00:18:29,500 --> 00:18:36,220 and then you have different types of review that can help you answer these particular questions. 163 00:18:36,760 --> 00:18:46,210 And you can see here that the real synthesis is making an important contribution in terms of workers plan what work for whom and what context, 164 00:18:46,220 --> 00:18:53,500 what were the barriers. So it's important to think of really synthesis not as part of this industry, 165 00:18:53,740 --> 00:19:00,250 but in terms of complementarity with other parts of review for from different types of practice. 166 00:19:04,810 --> 00:19:12,340 This is from a recent paper from the theories on complex interventions authored by Michael Eagle. 167 00:19:12,340 --> 00:19:17,140 Many of you know as a former public health director for Nice. 168 00:19:18,310 --> 00:19:25,720 But what I wanted to show was that when you look at the problem of systematic reviews, of complex interventions, 169 00:19:26,050 --> 00:19:34,270 when you try and invent the stages that you need to do in order to address that sort of review problem, 170 00:19:34,660 --> 00:19:43,150 you end up with something that looks very much like the ingredients, not the structure, but the ingredients of a real synthesis. 171 00:19:43,780 --> 00:19:51,099 Okay. And that leads me to this, which is, you know, I play all the right notes, but not necessarily in the right order. 172 00:19:51,100 --> 00:19:53,710 So so have one of these people, right? 173 00:19:53,950 --> 00:19:59,490 Is the systematic review, the complex interventions I just showed you, if that's the right way for you to really. 174 00:19:59,730 --> 00:20:04,050 Emphasised the right way. So how can you judge which of these is appropriate? 175 00:20:04,350 --> 00:20:09,930 Has one of them got all the right notes but not to my forward? So where do these two methods move? 176 00:20:11,230 --> 00:20:21,360 And so I indicated that there are different views that you can take of some of the role between systematic reviews and real syntheses. 177 00:20:22,110 --> 00:20:24,690 You can see them as as opposites, as enemies. 178 00:20:25,020 --> 00:20:36,630 But certainly, as Jeff has said previously, that was very often the starting point between these two worlds rubbing against each other. 179 00:20:36,660 --> 00:20:40,350 Perhaps we could see them one be additive to the other, 180 00:20:40,350 --> 00:20:47,490 which is implied by the time I showed you earlier, or perhaps more helpfully, we could see a synergism. 181 00:20:47,880 --> 00:20:54,630 The idea that these things become stronger than the sum of their parts by actually using them alongside each other. 182 00:20:56,890 --> 00:21:02,550 So. So let's look at when systematic reviews meet real estate reviews here. 183 00:21:04,920 --> 00:21:14,400 I think this was a very clever thing, a very cool thing to do, and this was to allow a real synthesis with systematic reviews. 184 00:21:14,940 --> 00:21:19,739 You must have realised that there was a lot of, a lot of mileage, 185 00:21:19,740 --> 00:21:28,710 a lot of funds in being a company with the idea of picking up the and and so this title is a need to put in place to do this reviews there. 186 00:21:29,010 --> 00:21:35,720 But a lot of the other work doesn't show that same respect. 187 00:21:35,730 --> 00:21:43,230 It's a bit like the kind of flight of convenience that many ships will have. 188 00:21:43,410 --> 00:21:51,180 You know, it's not because they want to be allied with Panama, but because that is a place, a convenient place to locate your ship under. 189 00:21:51,540 --> 00:21:57,720 And so I think this this was clever, very clever marketing that meant you could have your cake and eat it. 190 00:21:57,860 --> 00:22:02,760 It doesn't mean you have to sell out, but you can, if you like. 191 00:22:03,240 --> 00:22:06,450 The mixed analogy can ride the wave after wave. 192 00:22:06,480 --> 00:22:08,160 That was that was there. 193 00:22:09,210 --> 00:22:19,980 And when you see in that same paper something like this, when it clearly is at least imitating some of the systematic review process. 194 00:22:20,520 --> 00:22:32,129 And the interesting thing is that if you look at them, right, both in the books and they don't show the same sort of more recipe type approach, 195 00:22:32,130 --> 00:22:35,940 they're they're much more about this is the spirit of doing it. 196 00:22:36,120 --> 00:22:42,050 If anyone's tried to do a review based on, for example, chapter four of a phrasebook, 197 00:22:42,180 --> 00:22:48,390 you find it very challenging of a procedural manual for this particular audience the General Health Service, Research and Policy. 198 00:22:49,020 --> 00:22:52,290 Catching the eyes of funders is very good marketing. 199 00:22:52,350 --> 00:22:57,790 It's based on realist synthesis, how to really to be roughly under this sort of area. 200 00:22:59,340 --> 00:23:08,010 But I'll just put this up as one example. When you start to put the two side by side, you can you can see some of the similarities and differences. 201 00:23:08,500 --> 00:23:18,450 I think it's a little bit like the debate that we have with systematic review topics of record lumping versus splitting probably heard the fact. 202 00:23:18,840 --> 00:23:24,540 So we couldn't decide that we're going to look at the similarity to real review with systematic reviews. 203 00:23:24,840 --> 00:23:30,770 Or we could emphasise the difference depending on which suits suit psychological studies. 204 00:23:33,510 --> 00:23:37,980 And so, you know, is it is it a real review method or is it a rogue claimant? 205 00:23:38,700 --> 00:23:44,690 And this isn't just to publicise our book, which is still very well on Amazon value. 206 00:23:44,700 --> 00:23:58,799 It is really to introduce one of my sort of constant pieces, if you like, which is that rather than saying every review has to be a systematic review, 207 00:23:58,800 --> 00:24:03,150 which I have got colleagues in my own organisation who do believe that, 208 00:24:03,150 --> 00:24:08,330 and we've had interesting debates when you try to get all master students to all do a systematic review. 209 00:24:08,800 --> 00:24:11,610 So I'm sort of more and more in the middle. 210 00:24:11,940 --> 00:24:19,680 I think that any literature review can be systematic and that you can add certain parts to the systematic process. 211 00:24:20,280 --> 00:24:25,020 We came up with the acronym Southwest Search Appraisal, Synthesis and Analysis. 212 00:24:25,540 --> 00:24:28,890 And if you think of a graphic equaliser where you have all of these things, 213 00:24:29,130 --> 00:24:33,810 you can have a very systematic search, but not very much in the way of appraisal. 214 00:24:34,110 --> 00:24:40,200 But you could have a very systematic approach to synthesis, or you could have something that is perhaps more narrative and less structured. 215 00:24:40,470 --> 00:24:45,990 So all of these are negotiable points within so and so that's what the book's getting at. 216 00:24:47,910 --> 00:24:53,979 The the this is the second edition. So more than one person bought the first edition and they asked us to do it now. 217 00:24:53,980 --> 00:24:59,580 But I'm not quite sure about having a base there, I was told very early on. 218 00:24:59,960 --> 00:25:05,480 Actually, if you just focus on parts of it, it looks like I'm allied with the National. 219 00:25:06,500 --> 00:25:14,510 Her property that I was asking someone to admire the brand new book, just write for the post and they got it back. 220 00:25:14,510 --> 00:25:20,300 So some tips you teach you humble but the book the first edition with a lot of 221 00:25:20,870 --> 00:25:27,559 things like that which we told the publishers that wouldn't go down very well, 222 00:25:27,560 --> 00:25:30,380 particularly in America. So we got that challenge. 223 00:25:30,890 --> 00:25:40,760 But the point I'm making is that systematic reviews, systematic approaches to those sites are possible within a range of reviews. 224 00:25:40,760 --> 00:25:47,450 So let's look at how a systematic review really review sort of, Maria, if you like, 225 00:25:48,350 --> 00:25:53,990 using a systematic review with some sort of yardstick or benchmark in this context. 226 00:25:54,530 --> 00:25:58,819 So you can have a structured question or a real synthesis. 227 00:25:58,820 --> 00:26:06,070 You can construct this trend field and tenure in the field of management came up with this formulation called CMO, 228 00:26:06,380 --> 00:26:09,380 which has intervention and mechanism, outcome and context. 229 00:26:09,380 --> 00:26:14,570 So it's very close to the CMO. There are differences in the search strategy. 230 00:26:14,660 --> 00:26:21,830 If you've ever tried mapping out the course of doing a a realist review in terms of the searching process. 231 00:26:23,250 --> 00:26:25,100 Sorry, I get excited. 232 00:26:25,490 --> 00:26:36,550 And then then you can see that it really challenges being documented in a formal XML sort of way and sampling in the matrimonial analytic context, 233 00:26:36,560 --> 00:26:40,520 employing every appropriate or every included study. 234 00:26:40,970 --> 00:26:47,450 And that's certainly not something we are encouraged to do in a realistic review of the role of quality assessment. 235 00:26:47,450 --> 00:26:55,580 Well, the formula that that right articulates is that you're trying to trade off relevance and rigour. 236 00:26:55,850 --> 00:27:02,810 And so as a consequence, the quality assessment process isn't privileged as much as it is within the systematic review process. 237 00:27:03,680 --> 00:27:12,350 And unless the famous quote that you've got the encounter about finding nuggets, which means that even in a relatively poor quality paper, 238 00:27:12,350 --> 00:27:20,600 you can find something that actually contributes an important part of your of your picture and synthesis. 239 00:27:20,600 --> 00:27:28,940 It's not a problem. We propose mechanism for organising in some lovely presentations of synthesis of graphical and tabular form. 240 00:27:30,050 --> 00:27:35,720 The analysis is obviously more interpretive rather than the process of systematic review. 241 00:27:37,790 --> 00:27:48,619 In your classic systematic review. Use of theory is relatively uncommon, although in fairness in Cochrane reviews now they have a standard paragraph, 242 00:27:48,620 --> 00:27:51,739 which is how this intervention is thought to work. 243 00:27:51,740 --> 00:27:55,550 So there's some theorising going on there and that's been a major breakthrough. 244 00:27:55,970 --> 00:28:04,820 And then reporting standards over to Jeff and colleagues that are well behind box initiative giving it is giving 245 00:28:04,820 --> 00:28:14,180 it support and contributing a long way to getting the legitimacy of the review within the review community. 246 00:28:15,140 --> 00:28:25,100 But actually we're on a lot stronger, if you like, if we don't use the quantitative systematic reviews, our benchmark. 247 00:28:25,430 --> 00:28:31,700 But if we look to the field of qualitative synthesis, the areas that I'm concentrating on myself, 248 00:28:32,150 --> 00:28:39,440 because essentially we see that that such things of purpose and theoretical sampling are regarded as being legitimate. 249 00:28:39,440 --> 00:28:45,499 Within that context, we can see that in being interpretive such metrics is matter. 250 00:28:45,500 --> 00:28:48,770 Ethnography is a legitimate thing to do with it. 251 00:28:48,770 --> 00:28:57,470 It's not just about. I'm using that to reason that we can see a role for theory very prominently in qualitative research. 252 00:28:57,710 --> 00:29:07,480 So we can see similarities in terms of the role of the reporting standards as a as a sort of more a guide rather than than a scaffold, if you like. 253 00:29:08,300 --> 00:29:17,780 In fact, you know, if we look at it in that context, the only the only real differences is the the unique realist review of trading of relevance 254 00:29:17,780 --> 00:29:27,760 and rigour where where quality assessments have an easy stance within quality of evidence. 255 00:29:29,120 --> 00:29:33,560 But I think generally people accept that is something that you do need to do. 256 00:29:34,520 --> 00:29:43,440 So we can see that things are much closer to each other than the sort of stereotype this antagonism brings. 257 00:29:46,280 --> 00:29:55,640 So somewhat surprisingly, given my title, I do see realist review as occupying a place not just as another of these 50 labels, 258 00:29:55,970 --> 00:29:58,610 but as a legitimate part of the toolkit. 259 00:29:59,000 --> 00:30:05,780 And so when I produce guidance for the European project, looking at different methods of using qualitative evidence. 260 00:30:06,190 --> 00:30:14,589 Really synthesis of here that together with an assessment of the different functions of the the different qualitative 261 00:30:14,590 --> 00:30:23,050 methods of accepting that the synthesis is purely quality by the food and also looking at some of the roles. 262 00:30:23,380 --> 00:30:35,740 So for example, in generating exploring the difference between the Trinity that that Goff and Thomas generating, exploring and testing. 263 00:30:36,310 --> 00:30:45,240 And so if think really synthesis does all of those in the same package whereas other formats with methods the methods applied. 264 00:30:49,600 --> 00:30:55,420 We already have allusion in the course downstairs to this particular diagram. 265 00:30:56,020 --> 00:31:01,270 This was the inspiration for my title. If I can find inspiration for something like that. 266 00:31:02,140 --> 00:31:09,580 But you know that you have all of the the sort of the new tie of mapping out these wonderful things. 267 00:31:10,060 --> 00:31:14,560 And then a reporter enters the room and says, oh, what's going on here is this. 268 00:31:15,070 --> 00:31:18,520 And magic happens. And you have a review for now. 269 00:31:18,520 --> 00:31:24,160 And the next generation perhaps is not like nothing at all on the charts in this way. 270 00:31:25,480 --> 00:31:31,780 But when we're measuring this against the standards for systematic reviews, we want to know, 271 00:31:31,780 --> 00:31:38,320 well, what's going on there, what gets us from this side of the miracle to the other side. 272 00:31:39,700 --> 00:31:47,859 And and so there is some of the areas that I personally think need more detailed report detailing 273 00:31:47,860 --> 00:31:53,790 how you actually identify program theories that would take away some of the magic that's going on. 274 00:31:54,430 --> 00:31:57,669 We need more detail on how people prioritise programs. 275 00:31:57,670 --> 00:32:06,240 There is very clear, although not apparent to everyone, is that you can't support every program theory that you can generate the literature. 276 00:32:06,250 --> 00:32:12,280 You have to have some method, method or mechanism for prioritising another one. 277 00:32:12,640 --> 00:32:18,700 How do you select the evidence to support the program and how to then link the program? 278 00:32:18,700 --> 00:32:22,240 Query and your explanation of what's going on to make range building? 279 00:32:23,110 --> 00:32:32,650 Do you just have to resort and resort to having some right person who's multi-disciplinary, who's for all these theories going around in their head, 280 00:32:32,950 --> 00:32:42,190 and who can suddenly make the link between program and mid-range and not component, and how do we make that link? 281 00:32:42,760 --> 00:32:48,459 So there's lots of challenges there. That's the expression black box use before cuts work. 282 00:32:48,460 --> 00:32:50,830 I think more detail is required. 283 00:32:53,510 --> 00:33:03,640 I'm there's a couple of reasons for expressing these reservations that first, we've already said the realist review method is complexity. 284 00:33:04,300 --> 00:33:12,010 And here we have from a forthcoming book, we have the sort of model of the conventional systematic review, 285 00:33:12,370 --> 00:33:17,449 and then we have the model of the search for a realist review. 286 00:33:17,450 --> 00:33:21,550 And you can see how how complex that process actually is. 287 00:33:21,940 --> 00:33:28,270 And that provides a challenge every stage in terms of people having confidence in what you've done and how you report it. 288 00:33:28,900 --> 00:33:31,900 And then we have challenges in terms of the interpretation. 289 00:33:31,900 --> 00:33:35,500 So we have statements here. I have reference this. 290 00:33:35,500 --> 00:33:39,280 We could probably track down who it is by putting it into phrase, 291 00:33:39,940 --> 00:33:44,799 but essentially this is the magic trick I'm a little bit suspicious of that they suddenly 292 00:33:44,800 --> 00:33:50,440 came up with these these four common mechanisms and they decided what they are. 293 00:33:50,740 --> 00:33:57,250 And then in terms of how they selected them and decided they were important, they were in at least two of the three case examples. 294 00:33:57,250 --> 00:34:01,600 So if they decide to exclude all of these things going on here. 295 00:34:04,330 --> 00:34:09,219 And so the question that I had to grapple with very early on in the process is, 296 00:34:09,220 --> 00:34:15,700 is it possible to search for theories, systematically compiled pilot program theory and reframe? 297 00:34:17,710 --> 00:34:22,390 And this is where some of the conflict comes in. Ramsay is very friendly, can be real. 298 00:34:22,390 --> 00:34:28,360 And so we're not talking about conflict. I don't mean that, like I've been emotionally scarred by the debate that we've had here. 299 00:34:28,360 --> 00:34:32,050 But but certainly this was very interesting for me in the juxtaposition here. 300 00:34:32,410 --> 00:34:39,040 So I posted on the round of these lists, but that I saw the Achilles heel of realist review being that. 301 00:34:39,040 --> 00:34:43,280 So, you know, it really depends on the theoretical resources that you're helping to dispose of. 302 00:34:43,750 --> 00:34:46,890 So, you know, how are you going to get back there if you've got an expert? 303 00:34:46,900 --> 00:34:54,850 And that's great. I'm not an expert in the topic area, but an expert in all the theories that we can use to explain and ask the question, 304 00:34:54,850 --> 00:35:00,309 is there any way to can make that more systematic? And as I said, we're just in danger of magic. 305 00:35:00,310 --> 00:35:03,820 People clearly pulling flowers out of the box. 306 00:35:04,660 --> 00:35:12,040 And then, of course, I left the person in fresh green have said, you're always asking for a technical way of eliciting program theories. 307 00:35:12,280 --> 00:35:22,089 I say it can't be done. And of course, she's right in the sense that if can take it up to the server, that that's not the only way you can do it. 308 00:35:22,090 --> 00:35:30,520 But certainly trying to be systematic can have a place in the process as I'm going to demonstrate and then reinforce. 309 00:35:30,520 --> 00:35:36,730 And I mean, that's the brilliant thing about Rameses is that you had the very people who were thinking about these things all the time. 310 00:35:37,120 --> 00:35:44,230 And so he says that the the mystery of theory generation is a little bit old and not that, again, coming in that first sentence. 311 00:35:44,860 --> 00:35:48,150 But he says he likes a bit of magic can come. Bring them up. 312 00:35:48,420 --> 00:35:53,670 But he suspects that we can't include hocus pocus in the Ramsay's declarations. 313 00:35:54,060 --> 00:36:00,060 So he's realising that, in fact, you know, the fact of being able to sort of try to put into effect, 314 00:36:00,070 --> 00:36:05,880 you know, so no hocus pocus in Ramsey's declarations, the two traditions they're contending with. 315 00:36:07,050 --> 00:36:17,380 And he makes the point of the need to move between the programs through what he calls the stakeholder theories that and the abstract mid-range theory. 316 00:36:17,400 --> 00:36:20,790 So he's appreciating it's an important process. 317 00:36:22,970 --> 00:36:26,570 And then I tried to ask, what if he never did with that particular audience? 318 00:36:26,570 --> 00:36:32,809 But I tried to have the last word I said. But, you know, even the analogy of magic is of an unfortunate one, 319 00:36:32,810 --> 00:36:44,420 because if you look at people like the David Blaine or of the other magicians, they spend hours perfecting so that it all looks like magic. 320 00:36:44,420 --> 00:36:47,000 But actually there's a lot of work going on beneath that. 321 00:36:47,450 --> 00:36:55,489 I suspect there's an element of fact about really synthesis, but actually that the argumentation is very well constructed. 322 00:36:55,490 --> 00:37:02,160 It has a very strong logic, but that still doesn't take away the need to explain how how the trick was done. 323 00:37:04,340 --> 00:37:11,810 And then I just said, but the problem is that if we start to call, you turn out to be rather magic. 324 00:37:12,530 --> 00:37:16,339 Then, although paused, Paulson said, We can think the nuggets. 325 00:37:16,340 --> 00:37:20,870 Then we sort of really can't turn our thoughts into two nuggets. 326 00:37:22,770 --> 00:37:33,870 So can we search for them? Well, this is a suggestion that we can actually search for particular types of theories using particular search methods. 327 00:37:34,320 --> 00:37:40,290 There are a series of terms that we know are explicitly associated with program theory, 328 00:37:40,620 --> 00:37:52,260 and these are primarily extracted from a very good article by James Thomas and colleagues, which is on and is on program logic from program theory. 329 00:37:53,460 --> 00:37:57,930 Can we find bit range theory? Well, I'll show you. We can find mid range theory. 330 00:37:58,710 --> 00:38:06,390 Obviously, the best part of the mid range theory in terms of its utility on the theory is why the contribution would be where the 331 00:38:06,390 --> 00:38:12,660 people who have been grappling with the problem in the primary studies can make a connection to the mid range theory. 332 00:38:12,660 --> 00:38:20,850 So there would be some of the spectrum for us. But it's not untypical to find that some literatures inhabit different worlds. 333 00:38:20,850 --> 00:38:28,559 So there's one body of literature and perhaps one of retreat in the literature search and the example of the empirical stuff, 334 00:38:28,560 --> 00:38:38,140 maybe another body of literature. So part of what I'm suggesting here is sort of joining those two literatures back home to help me find the range. 335 00:38:40,980 --> 00:38:48,240 So if one was to combine a string of terms using Google Scholar, 336 00:38:48,960 --> 00:38:55,710 not because it's superior to bibliographic databases, but because it has a full text facility. 337 00:38:55,710 --> 00:38:58,900 So you're getting into the content of the article, not just the title. 338 00:38:58,920 --> 00:39:04,860 That's right. But if we use a string of terms like logic model or theory of change or theory of action, etc., 339 00:39:04,860 --> 00:39:10,590 etc., and combine it with the topic that we're exploring, in my case, post-natal depression. 340 00:39:11,130 --> 00:39:15,840 Then you find studies which articulate there is case. 341 00:39:16,890 --> 00:39:21,240 They might not be the one that you choose to use, but they are candidate theory. 342 00:39:21,900 --> 00:39:25,410 They might not be the ones that push greenhouse which used to generate, 343 00:39:25,710 --> 00:39:32,280 but there are another pool that you can put alongside your expert generation, alongside the input from your study. 344 00:39:33,240 --> 00:39:39,000 So she was right. You can't just do this. It's a single process, but it has some complementarity. 345 00:39:40,380 --> 00:39:48,150 And by doing it systematically, you can report it and you can communicate the science of what you've done. 346 00:39:51,330 --> 00:39:59,819 Of course, we do have some problems. Jeffress alluded to the fact that not the formal course of the program of change, the policy or theory of change. 347 00:39:59,820 --> 00:40:04,440 So you will only get 12 if you like, the tip of the iceberg of theorising. 348 00:40:04,770 --> 00:40:09,899 But it's a good way in which they may not relate to your specific focus. 349 00:40:09,900 --> 00:40:15,150 And so just because it happens to be on the topic might not be the part of the clinical part, 350 00:40:15,150 --> 00:40:22,530 but has to be part of the chain of the theory of change may be in a separate document. 351 00:40:22,530 --> 00:40:25,230 And what I've come up with is a method called cluster theory, 352 00:40:25,830 --> 00:40:33,630 which is where you try and track down from a source article or other related reports to that particular study. 353 00:40:33,960 --> 00:40:39,810 And so the theory of change might might be identified with one of those other accounts. 354 00:40:40,170 --> 00:40:48,270 So essentially, you're using the the study you have found as the gatekeepers of the study, you have found the problem because again, 355 00:40:48,600 --> 00:41:01,650 reportable and systematic and come up with a procedure for handling theory recorded became an acronym and give you the reference. 356 00:41:01,980 --> 00:41:05,400 So the this is one quote for my kids. 357 00:41:05,400 --> 00:41:10,710 These two are looking at realist theory for how local government uses nice guidance, 358 00:41:11,520 --> 00:41:17,150 but so the behaviour is actually to provide guidance to the health context, 359 00:41:17,160 --> 00:41:23,549 the public health and local government, the the exclusions, the sorts of models or theories. 360 00:41:23,550 --> 00:41:31,570 We're not interested in a thing called economic models, statistical models, and then we have the terms associated with multiple multiplicity. 361 00:41:33,600 --> 00:41:42,540 And I'm not going to go into the details of the procedure, but just to say that this is starting to make look more systematic but reproducible. 362 00:41:42,810 --> 00:41:56,430 It's transparent, it's explicit. And we mustn't pretend that that's when it comes to mid range theory, but it's completely open season. 363 00:41:56,790 --> 00:42:05,880 There were a number of pro of mid-range theories which are very common in phenomena in literature, and that's how they become mid-range theories. 364 00:42:06,420 --> 00:42:10,860 So there are certain ones we could actually be looking at in our literature. 365 00:42:11,220 --> 00:42:14,730 So if you've got a reference management database you could be searching. 366 00:42:14,730 --> 00:42:19,290 I wonder if any of the abstracts have any of these laboratories in American what's made the. 367 00:42:19,660 --> 00:42:23,800 But again it's not the. Speaker to lead you all the way that you can be a star. 368 00:42:25,570 --> 00:42:30,700 And in fact, there's an even better list of competitive competition because you can see behaviour 369 00:42:30,700 --> 00:42:35,490 change changes where you actually almost like choosing a pipe for your bedroom, 370 00:42:35,540 --> 00:42:41,050 you can go through and decide which of these might well be ones that help to explain what's going on. 371 00:42:44,590 --> 00:42:52,140 So here's just a couple of strategies here. So two strategies, diffusion of innovation for now is guidance. 372 00:42:52,150 --> 00:42:59,710 Okay. So I picked something that I think is a potential theory and I've done a search to see has anyone 373 00:43:00,580 --> 00:43:06,909 cross reference or used in the same document the diffusion of innovation theory and nice guidance. 374 00:43:06,910 --> 00:43:12,140 And sure enough, at the top here we have someone making that particular point. 375 00:43:12,610 --> 00:43:15,670 So again, it's being systematic in its relation. 376 00:43:16,130 --> 00:43:27,410 Well, what I'm trying to do is get more if you think of your detective programs on telly, you have the power of something. 377 00:43:28,450 --> 00:43:34,810 That's sort of the magic connected to that. But you also have folks who go through the grass looking for the murder weapon. 378 00:43:35,590 --> 00:43:42,909 And so I'm a plus. This is this is pretty well a systematic way, not for the whole process. 379 00:43:42,910 --> 00:43:46,900 We determine the plot rows, but actually giving you some of the evidence. 380 00:43:47,380 --> 00:43:51,640 And then this is the other approach once you have a citation for a theory. 381 00:43:51,640 --> 00:43:58,300 So this is the citation of diffusion of innovations you can use in Google Scholar search within citing articles. 382 00:43:58,600 --> 00:44:06,290 And so there anyone who cited the diffusion of innovation theories have they reference national of the nice guidance. 383 00:44:06,820 --> 00:44:15,150 So to approach is to systematically start making connections between midbrain theory and public with all the others. 384 00:44:15,190 --> 00:44:20,680 But there are some problems with biases here. 385 00:44:21,550 --> 00:44:24,250 Certain disciplines that cooler theories. Theories. 386 00:44:24,700 --> 00:44:32,939 There's a lot of theories in the sociology and causal theory, the things that we work in like public health like most and they used to. 387 00:44:32,940 --> 00:44:43,030 There is another issue is actually you might find some theory that explains some parts of the pathway, but not the pathway you're interested in. 388 00:44:43,330 --> 00:44:49,299 And we've had problems with that before in selected models and theories of the right phenomenon. 389 00:44:49,300 --> 00:44:59,250 But the right path which is. To be aware of the temple and try to be customers and serve as well as the behemoth thing. 390 00:44:59,250 --> 00:45:04,320 If that wasn't enough, then we listened to clusters, which essentially were looking for two types of evidence. 391 00:45:04,710 --> 00:45:06,270 We're looking for sibling studies. 392 00:45:06,270 --> 00:45:15,830 These are studies that actually issued from the same study, sibling papers from the same study, or kinship papers, papers that are linked in some way. 393 00:45:15,840 --> 00:45:18,809 So there might be antecedent projects to your project. 394 00:45:18,810 --> 00:45:26,879 So that's cited in your paper and that's where some of the initial theorising and I'm aware of time, 395 00:45:26,880 --> 00:45:36,900 so I would just preference to add quickly here, I'm not going to spend much time on this. 396 00:45:36,900 --> 00:45:40,800 The purpose of really synthesis is making a link with ground theory. 397 00:45:41,100 --> 00:45:44,820 What we want, some practical, we want to stick with mid range theory. 398 00:45:45,210 --> 00:45:49,190 But just to say that some of these things are not typically people because they're 399 00:45:50,040 --> 00:45:56,670 typically labelled to solve with social inequality to try and place to pick them up. 400 00:45:58,230 --> 00:46:11,490 So this is just very briefly a worked example of and we use the existing logic model and tested against collective model. 401 00:46:13,470 --> 00:46:21,540 We tried to make a link between various initiatives of postnatal depression and the theory. 402 00:46:22,110 --> 00:46:31,440 So this is where we start to move from the the program theory behind each of these and make a link to a wider field. 403 00:46:31,830 --> 00:46:39,100 So this relies on the if the originators of the initiative action identifying that there is a new branch behind it. 404 00:46:42,210 --> 00:46:45,660 And so this is where we link our program series. 405 00:46:45,900 --> 00:46:51,720 We give them labels. Some people won't like that, but it's just a sort of shorthand for referring to them later. 406 00:46:52,080 --> 00:46:56,040 So we have a program theory, developing trust program theory. 407 00:46:56,160 --> 00:47:01,050 Post-natal depression will be prevented if women develop meaningful relationships with other women's in the group, 408 00:47:01,830 --> 00:47:09,720 women in the group and with health care providers. Some references there, a link to mid-range theory and then some sort of component. 409 00:47:12,780 --> 00:47:20,300 So after starting off in a fairly antagonistic view, I'm coming towards the end to suggesting some sort of rapprochement. 410 00:47:20,310 --> 00:47:25,380 We can see similarities between qualitative synthesis and really synthesis. 411 00:47:25,650 --> 00:47:32,280 We can recognise that the world is big enough for horses, for courses, approach to going deep into the toolkit, 412 00:47:32,610 --> 00:47:44,220 either for a particular review method for a particular problem, or to place them alongside each other in order to yield some sort of complementary. 413 00:47:46,530 --> 00:47:54,210 So from the searching that I've hopefully demonstrated, it is possible to be more systematic than we are at the moment with realists. 414 00:47:54,240 --> 00:48:00,840 And I think we do that, that with more knowledge as a genuine, bona fide method of doing review. 415 00:48:01,260 --> 00:48:10,169 But at the moment, this is not I hope we've demonstrated through examples and they weren't manufactured examples, 416 00:48:10,170 --> 00:48:20,200 those of standard search strings using the very crude search strategies, as you can see for much of their compression with the right results with the. 417 00:48:22,280 --> 00:48:28,450 And so there is a role for another sort of type of search assistance specifically looking for. 418 00:48:30,140 --> 00:48:33,250 But what we don't want to do is move to search whether we fly. 419 00:48:33,800 --> 00:48:36,410 And this is where we come back to screen analysis point. 420 00:48:36,950 --> 00:48:43,400 If we only draw on the theories that people have already identified, we're losing some of the value. 421 00:48:44,450 --> 00:48:50,950 And so we really need to make sure that this is just a line of inquiry, a line of exploration. 422 00:48:50,960 --> 00:48:54,440 It's not the answer. It's part of the journey, part of the plane. 423 00:48:55,520 --> 00:49:04,310 I'm not trying to turn us all into let's try to churn out ideas by just having a to search term. 424 00:49:07,070 --> 00:49:13,040 So the reconciliation and reconciliation is possible and these are two of the possible routes. 425 00:49:14,270 --> 00:49:19,549 We can certainly demonstrate that realist review. 426 00:49:19,550 --> 00:49:23,980 Really, synthesis is more systematic than it currently does. 427 00:49:23,990 --> 00:49:27,500 Just on the other side, 428 00:49:27,530 --> 00:49:38,480 we can actually look at the contribution of some of the things that really synthesis brings to the mix and how that impacts on other review methods. 429 00:49:38,810 --> 00:49:45,830 So we have, if you like, we're benefiting both parts by strengthening both parts by the synergy between them. 430 00:49:46,670 --> 00:49:55,580 And so in the forthcoming book, it's overtaken by the two back in leads and just contribute to the to contribute the chapter. 431 00:49:55,970 --> 00:49:59,780 We've tried to put the real research into a more systematic basis. 432 00:50:01,380 --> 00:50:07,910 Sorry about that. I'm happy to say that some of these things like around afterwards. 433 00:50:09,050 --> 00:50:13,010 But the other thing that will increase the acknowledgement, the acceptance, 434 00:50:13,010 --> 00:50:18,740 the greater synthesis is recognition of the importance of the theory to our understanding of interventions. 435 00:50:19,190 --> 00:50:25,760 And this is where where real synthesis can benefit from the work we're doing in qualitative synthesis. 436 00:50:26,150 --> 00:50:29,750 This is a seminal initiative, not the paper, 437 00:50:29,870 --> 00:50:36,500 but the initiative for a really important Cochrane funded qualitative methods group to actually demonstrate, 438 00:50:36,590 --> 00:50:43,190 along with members of the quantitative community, the importance of all social theories for that systematic review. 439 00:50:44,010 --> 00:50:49,520 And so we start to move into other types of quality assessments. 440 00:50:50,240 --> 00:50:53,180 How we judge papers for purposes of theories. 441 00:50:53,960 --> 00:51:01,220 Are we moving away from judging fitness of research designs, which is the systematic reviews to fit lots of theories? 442 00:51:01,220 --> 00:51:11,510 Do we start evaluating theories? So we want to move away from the current sexiness of really synthesis as the answer to everything. 443 00:51:11,960 --> 00:51:16,190 If we were to leave certain funding programmes, that's the idea. 444 00:51:16,220 --> 00:51:21,800 To the man with a hammer, everything is a nail to open up this really rich new toolbox, 445 00:51:22,070 --> 00:51:26,150 selecting appropriate methods for each of the problems that we face. 446 00:51:26,720 --> 00:51:30,800 And on that note of the wide field.