Practice question how to address substance abuse disorders da

Practice Question: How to address substance abuse disorders
Date: 18th January, 2021.
Article Number
Author and Date
Evidence Type
Sample, Sample Size, Setting
Findings That Help Answer the EBP Question
Observable Measures
Limitations
Evidence Level, Quality
3
Sancho, M., De Gracia, M., Rodriguez, R. C., Mallorquí-Bagué,
N., Sánchez-González, J., Trujols, J., ... & Menchón, J. M.
(2018). Mindfulness-based interventions for the treatment of
substance and behavioral addictions: a systematic
review. Frontiers in psychiatry, 9, 95.
https://doi.org/10.3389/fpsyt.2018.00095
Permalink
https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00095/f
ull?report=reader
Database
Ebscohost.

Evidence: Systematic Review
Type: Narrative synthesis.
Purpose: The purpose of the review is to assess the efficiency of
Mindfulness-based interventions (MBI) in substance and
behavioral addictions.
Objective: The objective of this systematic review is to compare
MBI s with other interventions to inform future
Decisions.
Sample: 54 randomized controlled trials published in English
between 2009 and April 2017 were used in the study.
Search terms were used to get the articles from different
databases including PubMeb, Cochrane, and web of science.
Sample size: The total number of participants were 4, 916 from
the 54 studies.
Setting: Two independent reviewers conducted an online library
search at the comfort of their zones and later met for a review
of the studies upon which they eliminated some studies and
remained with relevant studies.
Generally, mindfulness-based evidence proved to be effective in
addressing substance abuse and behavioral addiction such as
gambling.
These interventions reduce dependence, cravings and other
addiction symptoms.
MBIs are more effective when combined with Treatment as
Usual (TAUs).
When compared with TAU, MBRP reduced alcohol dependence
and depressive mood more significantly than TAUs.
MBI patients recorded significantly the same satisfaction,
retention and frequency of substance use with Cognitive
Behavioral Therapy CBT patients.
MBRP was found to be more significant and directly related to
mindfulness while Relapse Prevention (RP) related inversely to
mindfulness.
Mindfulness-Based Relapse Prevention (MBRP) is also more
effective in reducing psychiatric severity such as anxiety and

depression.
MBI interventions such as Mindful Training for Smokers (MTS)
enhanced emotional regulation and
MBIs are more effective that lack of treatment.
Interventions such as yoga is more effective than physical
education.
MBIs are also effective in reducing the craving for smoking
among college students.
The first group received interventions that is tested.
The control group received alternative interventions.
The first limitation is that there was inconsistencies in number
of patients, comparators, MBIs, and outcome measures across
studies reviewed.
Another limitation is that only 54 trials were included in the
study hence could not integrate all the information needed.
Level: I
Quality: B
N/A

N/A
Attach a reference list with full citations of articles reviewed
for this Practice question.
Johns Hopkins Nursing Evidence-Based Practice
Appendix G: Individual Evidence SummaryTool
The Johns Hopkins Hospital/ The Johns Hopkins University
1
Directions for Use of the Individual Evidence Summary Tool
Purpose
This form is used to document the results of evidence appraisal
in preparation for evidence synthesis. The form provides the
EBP team with documentation of the sources of evidence used,
the year the evidence was published or otherwise
communicated, the information gathered from each evidence
source that helps the team answer the EBP question, and the
level and quality of each source of evidence.
Article Number
Assign a number to each reviewed source of evidence. This
organizes the individual evidence summary and provides an
easy way to reference articles.
Author and Date

Indicate the last name of the first author or the evidence source
and the publication/communication date. List both
author/evidence source and date.
Evidence Type
Indicate the type of evidence reviewed (for example: RCT,
meta-analysis, mixed methods, quaLitative, systematic review,
case study, narrative literature review).
Sample, Sample Size, and Setting
Provide a quick view of the population, number of participants,
and study location.
Although the reviewer may find many points of interest, list
only findings that directly apply to the EBP question.
Observable Measures
QuaNtitative measures or variables are used to answer a
research question, test a hypothesis, describe characteristics, or
determine the effect, impact, or influence. QuaLitative evidence
uses cases, context, opinions, experiences, and thoughts to
represent the phenomenon of study.
Limitations
Include information that may or may not be within the text of
the article regarding drawbacks of the piece of evidence. The
evidence may list limitations, or it may be evident to you, as
you review the evidence, that an important point is missed or
the sample does not apply to the population of interest.
Evidence Level and Quality
Using information from the individual appraisal tools, transfer
the evidence level and quality rating into this column.

ARTICLE
STRATEGY & COMPETITION
Can You Say What
Your Strategy Is?
It’s a dirty little secret: Most executives cannot articulate the
objective, scope, and advantage of their business in a simple
statement. If they can’t, neither can anyone else.
by David J. Collis and Michael G. Rukstad
REPRINT R0804E
PUBLISHED IN HBR
APRIL 2008
For the exclusive use of A. Gray, 2018.
This document is authorized for use only by Allan Gray in 2018.
http://hbr.org/search/R0804E
2 Harvard Business Review | April 2008 | hbr.org
CAN YOU SUMMARIZE YOUR COMPANY’S STRATEGY in
35 words or
less? If so, would your colleagues put it the same way?
It is our experience that very few executives can honestly an-
swer these simple questions in the affirmative. And the compa-
nies that those executives work for are often the most successful
in their industry. One is Edward Jones, a St. Louis–based bro-
kerage firm with which one of us has been involved for more
than 10 years. The fourth-largest brokerage in the United States,
Jones has quadrupled its market share during the past two de-
cades, has consistently outperformed its rivals in terms of ROI
through bull and bear markets, and has been a fixture on

Fortune’s
list of the top companies to work for. It’s a safe bet that just
by David J. Collis and Michael G. Rukstad
G
et
ty
Im
ag
es
a
nd
IP
N
st
oc
k
Can You Say
What
Your
Strategy Is?
COPYRIGHT © 2016 HARVARD BUSINESS SCHOOL
PUBLISHING CORPORATION. ALL RIGHTS RESERVED.

Can You Say
What
Your
Strategy Is?
It’s a dirty little secret:
Most executives
cannot articulate the
objective, scope, and
advantage of their
business in a simple
statement. If they
can’t, neither can
anyone else.
FOR ARTICLE REPRINTS CALL 800-988-0886 OR 617-783-
7500, OR VISIT HBR.ORG
http://hbr.org
about every one of its 37,000 employees could express the
company’s succinct strategy statement: Jones aims to “grow
to 17,000 financial advisers by 2012 [from about 10,000 to-
day] by offering trusted and convenient face-to-face finan-
cial advice to conservative individual investors who dele-
gate their financial decisions, through a national network of

one-financial-adviser offices.”
Conversely, companies that don’t have a simple and clear
statement of strategy are likely to fall into the sorry category
of those that have failed to execute their strategy or, worse,
those that never even had one. In an astonishing number of
organizations, executives, frontline employees, and all those
in between are frustrated because no clear strategy exists for
the company or its lines of business. The kinds of complaints
that abound in such firms include:
• “I try for months to get an initiative off the ground, and
then it is shut down because ‘it doesn’t fit the strategy.’
Why didn’t anyone tell me that at the beginning?”
• “I don’t know whether I should be pursuing this market
opportunity. I get mixed signals from the powers that be.”
• “Why are we bidding on this customer’s business again?
We lost it last year, and I thought we agreed then not to
waste our time chasing the contract!”
• “Should I cut the price for this customer? I don’t know if
we would be better off winning the deal at a lower price
or just losing the business.”
Leaders of firms are mystified when what they thought
was a beautifully crafted strategy is never implemented.
They assume that the initiatives described in the volumi-
nous documentation that emerges from an annual budget or
a strategic-planning process will ensure competitive success.
They fail to appreciate the necessity of having a simple, clear,
succinct strategy statement that everyone can internalize
and use as a guiding light for making difficult choices.
Think of a major business as a mound of 10,000 iron filings,

each one representing an employee. If you scoop up that
many filings and drop them onto a piece of paper, they’ll
be pointing in every direction. It will be a big mess: 10,000
smart people working hard and making what they think are
the right decisions for the company – but with the net result
of confusion. Engineers in the R&D department are creat-
ing a product with “must have” features for which (as the
marketing group could have told them) customers will not
pay; the sales force is selling customers on quick turnaround
times and customized offerings even though the manufac-
turing group has just invested in equipment designed for
long production runs; and so on.
If you pass a magnet over those filings, what happens?
They line up. Similarly, a well-understood statement of strat-
egy aligns behavior within the business. It allows everyone
in the organization to make individual choices that reinforce
one another, rendering those 10,000 employees exponen-
tially more effective.
What goes into a good statement of strategy? Michael
Porter’s seminal article “What Is Strategy?” (HBR November –
December 1996) lays out the characteristics of strategy in
a conceptual fashion, conveying the essence of strategic
choices and distinguishing them from the relentless but com-
petitively fruitless search for operational efficiency. However,
we have found in our work both with executives and with
students that Porter’s article does not answer the more basic
question of how to describe a particular firm’s strategy.
It is a dirty little secret that most executives don’t actually
know what all the elements of a strategy statement are, which
makes it impossible for them to develop one. With a clear
definition, though, two things happen: First, formulation be-
comes infinitely easier because executives know what they are

trying to create. Second, implementation becomes much sim-
pler because the strategy’s essence can be readily communi -
cated and easily internalized by everyone in the organization.
Elements of a Strategy Statement
The late Mike Rukstad, who contributed enormously to
this article, identified three critical components of a good
strategy statement – objective, scope, and advantage – and
rightly believed that executives should be forced to be crys -
tal clear about them. These elements are a simple yet suffi -
cient list for any strategy (whether business or military) that
addresses competitive interaction over unbounded terrain.
Any strategy statement must begin with a definition of
the ends that the strategy is designed to achieve. “If you
don’t know where you are going, any road will get you there”
is the appropriate maxim here. If a nation has an unclear
sense of what it seeks to achieve from a military campaign,
how can it have a hope of attaining its goal? The definition
of the objective should include not only an end point but
also a time frame for reaching it. A strategy to get U.S. troops
out of Iraq at some distant point in the future would be
very different from a strategy to bring them home within
two years.
Since most firms compete in a more or less unbounded
landscape, it is also crucial to define the scope, or domain,
of the business: the part of the landscape in which the firm
will operate. What are the boundaries beyond which it will
not venture? If you are planning to enter the restaurant
business, will you provide sit-down or quick service? A casual
or an upscale atmosphere? What type of food will you offer –
David J. Collis ([email protected]) is an adjunct professor in the
strategy unit of Harvard Business School in Boston and the

author of
several books on corporate strategy. He has studied and
consulted
to Edward Jones, the brokerage that is the main example in this
article, and has taught in the firm’s management-development
pro-
gram. Michael G. Rukstad was a senior research fellow at
Harvard
Business School, where he taught for many years until his
untimely
death in 2006.
Can You Say What Your Strategy Is?
hbr.org | April 2008 | Harvard Business Review 5
French or Mexican? What geographic
area will you serve – the Midwest or the
East Coast?
Alone, these two aspects of strat-
egy are insufficient. You could go into
business tomorrow with the goal of be-
coming the world’s largest hamburger

chain within 10 years. But will anyone
invest in your company if you have not
explained how you are going to reach
your objective? Your competitive ad-
vantage is the essence of your strategy:
What your business will do differently
from or better than others defines the
all-important means by which you will
achieve your stated objective. That
advantage has complementary exter-
nal and internal components: a value
proposition that explains why the tar-
geted customer should buy your prod-
uct above all the alternatives, and a
description of how internal activities
must be aligned so that only your firm
can deliver that value proposition.
Defining the objective, scope, and
advantage requires trade-offs, which
Porter identified as fundamental to
strategy. If a firm chooses to pursue
growth or size, it must accept that
profitability will take a back seat. If it
chooses to serve institutional clients,
it may ignore retail customers. If the
value proposition is lower prices, the
company will not be able to compete
on, for example, fashion or fit. Finally, if the advantage comes
from scale economies, the firm will not be able to accommo-
date idiosyncratic customer needs. Such trade-offs are what
distinguish individual companies strategically.
Defining the Objective
The first element of a strategy statement is the one that
most companies have in some form or other. Unfortunately,

the form is usually wrong. Companies tend to confuse their
statement of values or their mission with their strategic
objective. A strategic objective is not, for example, the plat-
itude of “maximizing shareholder
wealth by exceeding customer expec-
tations for _______ [insert product or
service here] and providing opportu-
nities for our employees to lead fulfill-
ing lives while respecting the environ-
ment and the communities in which
we operate.” Rather, it is the single
precise objective that will drive the
business over the next five years or so.
(See the exhibit “A Hierarchy of Com-
pany Statements.”) Many companies
do have – and all firms should have –
statements of their ultimate purpose
and the ethical values under which
they will operate, but neither of these
is the strategic objective.
The mission statement spells out
the underlying motivation for being
in business in the first place – the
contribution to society that the firm
aspires to make. (An
insurance company,
for example, might
define its mission as
providing financial
security to consum-
ers.) Such statements,
how ever, are not use-
ful as strategic goals

to drive today’s busi-
ness decisions. Sim-
ilarly, it is good and
proper that firms be
clear with employees about ethical values. But principles
such as respecting individual differences and sustaining the
environment are not strategic. They govern how employees
should behave (“doing things right”); they do not guide what
the firm should do (“the right thing to do”).
Firms in the same business often have the same mission.
(Don’t all insurance companies aspire to provide financial
security to their customers?) They may also have the same
values. They might even share a vision: an indeterminate
future goal such as being the “recognized leader in the insur -
ance field.” However, it is unlikely that even two companies
The trade-offs companies make
are what distinguish them strategically from other firms.
A Hierarchy of
Company Statements
Organizational direction comes in
several forms. The mission state-
ment is your loftiest guiding light –
and your least specific. As you work
your way down the hierarchy, the
statements become more concrete,
practical, and ultimately unique. No
other company will have the same
strategy statement, which defines
your competitive advantage, or
balanced scorecard, which tracks
how you implement your particular

strategy.
MISSION
Why we exist
VALUES
What we believe in
and how we will behave
VISION
What we want to be
STRATEGY
What our competitive
game plan will be
BALANCED
SCORECARD
How we will monitor
and implement that plan
The BASIC
ELEMENTS
of a Strategy
Statement
OBJECTIVE = Ends
SCOPE = Domain
ADVANTAGE = Means

http://hbr.org
in the same business will have the same strategic objective.
Indeed, if your firm’s strategy can be applied to any other
firm, you don’t have a very good one.
It is always easy to claim that maximizing shareholder
value is the company’s objective. In some sense all strategies
are designed to do this. However, the question to ask when
creating an actionable strategic statement is, Which objec-
tive is most likely to maximize shareholder value over the
next several years? (Growth? Achieving a certain market
share? Becoming the market leader?) The strategic objective
should be specific, measurable, and time bound. It should
also be a single goal. It is not sufficient to say, “We seek to
grow profitably.” Which matters more – growth or profitabil-
ity? A salesperson needs to know the answer when she’s
deciding how aggressive to be on price. There could well
be a host of subordinate goals that follow from the strate-
gic objective, and these might serve as metrics on a bal -
anced scorecard that monitors progress for which individu-
als will be held accountable. Yet the ultimate objective that
will drive the operation of the business over the next several
years should always be clear.
The choice of objective has a profound impact on a firm.
When Boeing shifted its primary goal from being the largest
player in the aircraft industry to being the most profitable,

it had to restructure the entire organization, from sales to
manufacturing. For example, the company dropped its pol -
icy of competing with Airbus to the last cent on every deal
and abandoned its commitment to maintain a manufactur-
ing capacity that could deliver more than half a peak year’s
demand for planes.
Another company, after years of seeking to maximize prof-
its at the expense of growth, issued a corporate mandate to
generate at least 10% organic growth per year. The change
in strategy forced the firm to switch its focus from shrinking
to serve only its profitable core customers and competing on
the basis of cost or efficiency to differentiating its products,
which led to a host of new product features and services that
appealed to a wider set of customers.
At Edward Jones, discussion among the partners about
the firm’s objective ignited a passionate exchange. One
said, “Our ultimate objective has to be maximizing profit
per partner.” Another responded, “Not all financial advisers
are partners – so if we maximize revenue per partner, we are
ignoring the other 30,000-plus people who make the busi-
ness work!” Another added, “Our ultimate customer is the
client. We cannot just worry about partner profits. In fact, we
should start by maximizing value for the customer and let
the profits flow to us from there!” And so on. This intense de-
bate not only drove alignment with the objective of healthy
growth in the number of financial advisers but also ensured
that every implication of that choice was fully explored. Set-
ting an ambitious growth target at each point in its 85-year
history, Edward Jones has continually increased its scale
and market presence. Striving to achieve such growth has
increased long-term profit per adviser and led the firm to its
unique configuration: Its only profit center is the individual
financial adviser. Other activities, even investment banking,

serve as support functions and are not held accountable for
generating profit.
Defining the Scope
A firm’s scope encompasses three dimensions: customer
or offering, geographic location, and vertical integration.
Clearly defined boundaries in those areas should make it ob-
vious to managers which activities they should concentrate
on and, more important, which they should not do.
The three dimensions may vary in relevance. For Edward
Jones, the most important is the customer. The firm is config-
ured to meet the needs of one very specific type of client. Un-
like just about every other brokerage in the business, Jones
does not define its archetypal customer by net worth or in-
come. Nor does it use demographics, profession, or spending
habits. Rather, the definition is psychographic: The compa-
ny’s customers are long-term investors who have a conserva-
tive investment philosophy and are uncomfortable making
serious financial decisions without the support of a trusted
adviser. In the terminology of the business, Jones targets the
“delegator,” not the “validator” or the “do-it-yourselfer.”
The scope of an enterprise does not prescribe exactly what
should be done within the specified bounds. In fact, it encour -
ages experimentation and initiative. But to ensure that the
borders are clear to all employees, the scope should specify
where the firm or business will not go. That will prevent man-
agers from spending long hours on projects that get turned
down by higher-ups because they do not fit the strategy.
For example, clarity about who the customer is and who
it is not has kept Edward Jones from pursuing day traders.
Even at the height of the internet bubble, the company
chose not to introduce online trading (it is still not available

to Jones customers). Unlike the many brokerages that com-
mitted hundreds of millions of dollars and endless executive
hours to debates over whether to introduce online trading
(and if so, how to price and position it in a way that did
not cannibalize or conflict with traditional offerings), Jones
wasted no money or time on that decision because it had set
clear boundaries.
Similarly, Jones is not vertically integrated into propri-
etary mutual funds, so as not to violate the independence of
its financial advisers and undermine clients’ trust. Nor will
the company offer penny stocks, shares from IPOs, commod-
ities, or options – investment products that it believes are
too risky for the conservative clients it chooses to serve. And
it does not have metropolitan offices in business districts,
because they would not allow for the convenient, face-to-
face interactions in casual settings that the firm seeks to
provide. Knowing not to extend its scope in these directions
has allowed the firm to focus on doing what it does well and
reap the benefits of simplicity, standardization, and deep
experience.
Defining the Advantage
Given that a sustainable competitive advantage is the es-
sence of strategy, it should be no surprise that advantage
is the most critical aspect of a strategy stateme nt. Clarity
about what makes the firm distinctive is what most helps
employees understand how they can contribute to successful
execution of its strategy.

As mentioned above, the complete definition of a firm’s
competitive advantage consists of two parts. The first is a
statement of the customer value proposition. Any strat-
egy statement that cannot explain why customers should
buy your product or service is doomed to failure. A simple
graphic that maps your value proposition against those of
rivals can be an extremely easy and useful way of identifying
what makes yours distinctive. (See the exhibit “Wal-Mart’s
Value Proposition.”)
The second part of the statement of advantage captures
the unique activities or the complex combination of activi -
ties allowing that firm alone to deliver the customer value
proposition. This is where the strategy statement draws
from Porter’s definition of strategy as making consistent
choices about the configuration of the firm’s activities. It is
also where the activity-system map that Porter describes in
“What Is Strategy?” comes into play.
As the exhibit “Edward Jones’s Activity-System Map” shows,
the brokerage’s value proposition is to provide convenient,
trusted, personal service and advice. What is most distinctive
about Jones is that it has only one financial adviser in an office,
which allows it to have more offices (10,000 nationally) than
competitors do. Merrill Lynch has about 15,000 brokers but
only 1,000 offices. To make it easy for its targeted customers
to visit at their convenience – and to provide a relaxed, per-
sonable, nonthreatening environment – Jones puts its offices
in strip malls and the retail districts of rural areas and sub-
urbs rather than high-rise buildings in the central business
districts of big cities. These choices alone require Jones to
differ radically from other brokerages in the configuration of
its activities. With no branch-office management providing
direction or support, each financial adviser must be an en-

trepreneur who delights in running his or her own operation.
Since such people are an exception in the industry, Jones has
to bring all its own financial advisers in from other indus-
tries or backgrounds and train them, at great expense. Until
2007, when it switched to an internet-based service, the firm
had to have its own satellite network to provide its widely
dispersed offices with real-time quotes and allow them to
execute trades. Because the company has 10,000 separate
offices, its real estate and communication costs are about
50% higher than the industry average. However, all those
offices allow the financial advisers who run them to deliver
convenient, trusted, personal service and advice.
Other successful players in this industry also have distinc-
tive value propositions and unique configurations of activi -
ties to support them.
Merrill Lynch. During the five-year tenure of former CEO
Stan O’Neal, who retired in October 2007, Merrill Lynch
Wal-Mart’s Value Proposition
Wal-Mart’s value proposition can be summed up as
“everyday low prices for a broad range of goods that are
always in stock in convenient geographic locations.” It
is those aspects of the customer experience that the
company overdelivers relative to competitors. Under-
performance on other dimensions, such as ambience
and sales help, is a strategic choice that generates cost
savings, which fuel the company’s price advantage.
If the local mom-and-pop hardware store has
survived, it also has a value proposition: convenience,
proprietors who have known you for years, free coffee
and doughnuts on Saturday mornings, and so on.

Sears falls in the middle on many criteria. As a result,
customers lack a lot of compelling reasons to shop
there, which goes a long way toward explaining why the
company is struggling to remain profitable.
Low prices
Selection across
categories
Rural convenience
Reliable prices
In-stock
merchandise
Merchandise quality
Suburban
convenience
Selection within
categories
Sales help
Ambience
Wal-MartSearsMom & pop
stores
Customer
purchase criteria*

poor excellent
Delivery on criteria
Source: Jan Rivkin, Harvard Business School
* in approximate order of
importance to Wal-Mart’s
target customer group
http://hbr.org
developed an effective strategy that it called “Total Merrill.”
The company’s value proposition: to provide for all the fi -
nancial needs of its high-net-worth customers – those with
liquid financial assets of more than $250,000 – through retire-
ment. While a lot of brokerages cater to people with a high
net worth, they focus on asset accumulation before retire-
ment. Merrill’s view is that as baby boomers age and move
from the relatively simple phase of accumulating assets to
the much more complex, higher-risk phase of drawing cash
from their retirement accounts, their needs change. During
this stage, they will want to consolidate their financial as-
sets with a single trusted partner that can help them figure

out how to optimize income over their remaining years by
making the best decisions on everything from annuities
to payout ratios to long-term-care insurance. Merrill offers
coherent financial plans for such customers and provides
access to a very wide range of sophisticated products based
on a Monte Carlo simulation of the probabilities of running
out of money according to different annual rates of return
on different categories of assets.
How does Merrill intend to deliver this value to its chosen
customers in a way that’s unique among large firms? First,
it is pushing brokers – especially new ones – to become cer-
tified financial planners and has raised internal training re-
PRICE
one-time
commission
TARGET
CUSTOMER
individual
conservative
delegates
decisions
BRANCH
SUPPORT
branch-office
assistant
PRODUCT
blue chips

mutual funds
ONE FINANCIAL
ADVISER PER OFFICE
advisers run their own
offices
MARKETING
local mailings
knocking on doors
INVESTMENT
PHILOSOPHY
long-term
buy and hold
BROKER TYPE
entrepreneur
member of
community
HIRE & TRAIN
hire from
outside industry
internally train all
financial advisers
VALUES &
CULTURE
volunteerism
mentoring

OWNERSHIP
partnership,
not public
COMPENSATION
each financial adviser
is a profit center
TECHNOLOGY
satellite (historically)
HEADQUARTERS
St. Louis home office
for all activities
REGIONAL
STRUCTURE
no regional
management
LOCATION
rural
suburban
strip mall
CUSTOMER
RELATIONSHIP
face-to-face
convenient

trusted financial
adviser
Edward Jones’s Activity-System Map
This map illustrates how activities at the brokerage Edward
Jones
connect to deliver competitive advantage. The firm’s customer
value
proposition appears near the center of the map – in the
“customer
relationship” bubble – and the supporting activities hang off it.
Only
the major connections are shown.
CUSTOMERS’
needs
COMPETITORS’
offerings
COMPANY’S
capabilities
CONTEXT
(technology, industry

demographics, regulation, and so on)
SWEET
SPOT
quirements to put them on that road.
The certified financial planner license
is more difficult for brokers to obtain
than the standard Series 7 license, be-
cause it requires candidates to have a
college degree and to master nearly
100 integrated financial-planning top-
ics. Second, Merrill offers all forms
of insurance, annuities, covered calls,
hedge funds, banking services, and so
on (unlike Edward Jones, which offers
a much more limited menu of invest-
ment products). Since several of these
products are technically complex,
Merrill needs product specialists to
support the client-facing broker. This
“Team Merrill” organization poses
very different HR and compensation
issues from those posed by Edward
Jones’s single-adviser offices. Merrill’s
compensation system has to share in-
come among the team members and
reward referrals.
Wells Fargo. This San Francisco
bank competes in the brokerage busi-
ness as part of its tactic to cross-sell
services to its retail banking custom-
ers in order to boost profit per customer. (It aims to sell each

customer at least eight different products.) Wells Fargo’s
objective for its brokerage arm, clearly stated in a recent an-
nual report, is to triple its share of customers’ financial assets.
The brokerage’s means for achieving this goal is the parent
company’s database of 23 million customers, many of them
brought into the firm through one particular aspect of the
banking relationship: the mortgage. Wells Fargo differs from
Edward Jones and Merrill Lynch in its aim to offer personal -
ized, rather than personal, service. For example, the firm’s
IT system allows a bank clerk to know a limited amount of …
Practice Question:
Date:
Article Number
Author and Date
Evidence Type
Observable Measures
Limitations
DOI 10.1186/s13722-017-0090-0
Cook, R. L., Zhou, Z., Kelso-Chichetto, N. E., Janelle, J.,

Morano, J. P., Somboonwit, C., ... & Bryant, K. (2017). Alcohol
consumption patterns and HIV viral suppression among persons
receiving HIV care in Florida: an observational
study. Addiction science & clinical practice, 12(1),
22.Retrieved from
https://ascpjournal.biomedcentral.com/track/pdf/10.1186/s13722
-017-0090-0.pdf
Quantitative
Evidence.
The participants of the study were recruited from community
setting clinics across Florida and others from a collaborative
network of health departments across the state.
There were 619 participants, 63 % of whom were male and 37 %
were female. In terms of race, 22% were non-Hispanic whites,
56 % were non0hisanic blacks, 16 % were Hispanic, and 4 %
represented others. The researchers also analyzed the
participants in terms of the level of education in four
categories: less than high school (33%), high school or
equivalent (31%), and above high school (36%). 84 % of the
participants experienced homelessness, while 16 % did not
(Cook et al., 2017).
The research revealed that heavy and binge drinking was
common among participants with less than high school
education, smokers and illicit drugs users, homeless people, and
participants with anxiety and depression.
The rate of adherence reduces with an increase in the rate of
alcohol consumption. Optimal adherence was reported by 80%
of non-drinkers, 68 % of low-level drinkers, 58 % of binge
drinkers, and 51% of heavy drinkers. When compared to
abstinence, heavy drinking
There is a direct effect between heavy drinking and suboptimal
ART suppression, and an indirect, smaller, but a significant
effect that is mediated via poor ART adherence.

Generally, the findings suggest that the relationship between
heavy drinking and suboptimal HIV viral suppression could be
due to other factors such as the effects of alcohol on the
immune system, behavior, such as persistence on therapy and
engagement in care.
Like other studies, this study revealed that the rate and not
patterns of alcohol drinking leads to poor HIV viral
suppression. An increase in the consumption of alcohol leads to
poor viral suppression and vice versa.
Therefore, researchers recommend the implementation of
alcohol consumption strategies in HIV clinical and public health
routine. The findings also reinforce the benefits of screening
and brief intervention for alcohol-related problems in HIV care
settings (Cook et al., 2017). A further proposal is to identify
drinkers who are in dire need of intervention and come up with
the most effective strategies.
Through the anonymous self-reported questionnaire, the
participants answered questions that measured four observable
characteristics: Alcohol consumption,
Covariates, Antiretroviral adherence, and viral suppression.
Self-reported adherence may over-estimate adherence,
especially from dishonest participants. Although it was
anonymous, it is normal for a participant to overestimate
adherence.
Another limitation is that the sampling was based on
convenience and may not represent the entire population of
people living with HIV/AIDS in Florida (Cook et al., 2017).
The researchers based on people who were under care for the
previous one year only.
The sample was lower compared to other studies involving
people living with HIV/AIDS, and since the number of
questions was limited, there is a likelihood of an
underestimation of the actual consumption. However, the
researcher tried to address these limitations by obtaining
information on HIV viral suppression from the state HIV

surveillance. The representation of diverse demographic groups
could also address the sample limitations.
Level-III
Quality-Good.
N/A
N/A
N/A

Attach a reference list with full citations of articles reviewed
for this Practice question.
11
Purpose
Article Number
Author and Date
Evidence Type
and study location.

Observable Measures
determine the effect, impact, or influence. QuaLitative evidence
Limitations
Practice Question: What is the cause of frequently
hospitalization for addict patients?
Date:01/06/2021
Article Number
Author and Date
Evidence Type

Observable Measures
Limitations
DOI: 10.1007/s11606-016-3919-4 ©
Velez, C. M., Nicolaidis, C., Korthuis, P. T., & Englander, H.
(2017). “It’s been an experience, a life learning experience”: a
qualitative study of hospitalized patients with substance use
disorders. Journal of general internal medicine, 32(3), 296-303.
doi: 10.1007/s11606-016-3919-4
J Gen Intern Med. 2017 Mar; 32(3): 296–303.
Published online 2016 Dec 12.
Qualitative evidence for building knowledge
There were 32 participants who reported high to moderate use
of alcohol (39%), amphetamine (46%), and opioids (65%).
The study was conducted in an urban medical Center.
N/A
Addiction is a common issue in society and hospitalization of
addicts is a wake up for call. Hospitalization provides an
opportunity to initiate coordinated care for addicts (Velez et al.,
2017). Most of the victims attribute their addiction to
homelessness, pain, trauma, and other social chaos. The
participants revealed that they prefer healthcare providers who
understood SUD and initiate the best treatment options that
support change and enhance patient outcomes. From the

interviews, effective strategies include involving peers in the
treatment process, coordinated care after patient discharge, and
access to medical-assisted intervention strategies (Velez et al.,
2017).
The themes that emerged from the analysis are categorized into
three factors: patient level factors, provider level factors and
health-system factors.
Patient-Level Factors
The first finding is that hospitalization of addicts is a wake-up
call because some of them regret putting themselves in situation
that makes them end up in hospitals. As most patients narrated,
they wish they would never end up in the same situation again.
Another revelation is that hospitalization is also an opportunity
to stop taking drugs. The patients also reveals that pain
complicates care and influences them to take drugs more to
manage the pain.
Provider-level factors
The patients identified factors that may affect providers’
approach to care for the addicts. The first one is that care is
more effective if the patient has a choice and takes part in
decision-making. Patients also revealed that having health
providers who are not judgmental encourages them to stay in
hospital. For example, care givers who are ex addicts are more
understanding, flexible and are likely to influence change. The
participants openly mentioned that withdrawal is not easy and
effective withdrawal management strategies would be helpful in
the process. Treated withdrawal is necessary to prevent
suffering and a feeling that the care was inadequate.
Health-system factors
The patients identified the health system as a great influence in
care and management of addicts. They identified that hospitals
do not offer basic needs such as jackets which makes the lives
of addicts more miserable. They also mentioned that health
systems fail to address the issues of trauma and stressors, since
most of the people around them are hostile. They also
emphasized the need of having peers with first-hand experience

to take them through the journey. Lastly, they were interested in
medication-assisted therapy which they believed was effective.
In my opinion, the patient-factors are the most relevant and
plays a greater role in addressing the problem. The system and
provider factors are secondary elements can only be
incorporated when the patient factors are implemented. For
example, providers can only be effective if the patients have
identified the need to change. Similarly, effective withdrawal
strategies can be impactful if addicts are willing and ready to
withdraw.
Interview questions that targeted observations, thoughts
experiences, and opinions were used to collect data from the
participants.
The first limitation is that the study may lack generalizability
because the interview was conducted in a single site and all the
patients/participants were insured.
Since the interviews were conducted in a hospital for real -time
information, the interviews may have been limited in a way.
Real time interviewing may not allow deeper conversations
hence limiting respondents from revealing useful information.
The study assesses patient perspectives only, leaving out the
perspectives of significant stakeholders such as health care
providers and health administrators. This implies that useful
inputs that may be incorporated will be left out.
There is influence of personal biases from respondents.
Since interviews are less anonymous, they may be a concern for
respondents who may conceal useful information.
Good quality evidence.
Level II.1

N/A
N/A
N/A
Reference
Velez, C. M., Nicolaidis, C., Korthuis, P. T., & Englander, H.
(2017). “It’s been an experience, a life learning experience”: a
qualitative study of hospitalized patients with substance use
disorders. Journal of general internal medicine, 32(3), 296-303.
doi: 10.1007/s11606-016-3919-4

11
Purpose
Article Number
Author and Date
Evidence Type
and study location.

Observable Measures
determine the effect, impact, or influenc e. QuaLitative evidence
Limitations
Recommendation from professor wk 1
I enjoyed reading your selected research study which addresses
hospitalized patients with substance abuse disorders. You have
offered some pertinent points in your discussion (good job!),
but a few areas are still incomplete and will need to be better
addressed for this week’s assignment. Allow me to offer some
helpful guidance. For example, it is important to provide more
specifics about the actual study, such as what type of qualitative
study was conducted or at a minimum, how the data collection
process occurred. There also appears to be an omission of the
actual data findings which need to be added. You do accurately
note that a data analysis occurred, but the details of this are
missing. As you likely know, in qualitative studies, the findings
are confirmed with the pertinent themes and/or patterns which
emerged from the completed data analysis. In your selected
article, three major themes were identified and discussed. Of

these, which one do you believe was the most relevant and why?
Your thoughts are important and will fully answer how the
research design answered the scientific question(s).
Additionally, more details of the limitations of the study should
be discussed. Please refer to your Polit & Beck textbook for
guidance. Another helpful suggestion…When you are discussing
details of the study, please be sure to reference the
authors’/researchers’ names as in-text citations for the sake of
clarity in the sentences which will also meet APA requirements.
JH Evidence Summary Tool
You are off to a nice start, but a few of the columns are still
incomplete. One helpful recommendation is that in the second
column, be sure to add the doi locator number and the name of
the database where you retrieved the article after it. Second, be
sure your font and font size are consistent throughout the tool.
Please be sure to watch the Course Orientation presentation by
Dr. Olson that has been posted in the Announcements area this
week. That information shows some excellent examples of what
this tool should look like for a successful grade in this course.
Please add the required information and repost this tool as soon
as possible and let me know if you have questions.
APA Formatting
Your APA formatting is good with a few minor errors noted.
Continue to use the APA resources located under the Resource
tile on the course homepage to assist you with discussions and
the important week 6 paper.
Wk 2 comments from professor
Thank you for a nicely written analysis of the Week 2
discussion assignment. You correctly identified a quantitative
study that investigates alcohol consumption pattern and HIV
suppression among individuals who are receiving care in
Florida. This particular study generally relates to your chosen
national topic from Week 1. Overall, this is a very good study
and the breakdown of the demographics of the study
participants using several tables is excellent. The sample was
very large.

There are a few concerns about this article. As I have noted
with other student submissions this week, the theoretical model
is not properly identified. Second, the pertinent reliability
information of the survey instruments is missing. The other
concern is about the wide-ranging confidence intervals (CI) in
the data…it is a little too wide. So, I went back to look at the
results a little more closely and I noted a MAJOR red flag when
the researchers discussed that approximately 9% of participants
did not report or partially reported the use of illegal drugs in the
past year. Instead of deleting those surveys from their study
(which is what is expected), they note that to address the
potential for biased estimates, multiple imputations were
performed using fully conditional specification (FSC) method to
generate 20 completed datasets. In other words, they filled in
the missing responses themselves using other data. Wow! Can
you appreciate that there could be an ethical concern with the
actual findings? Remember that a survey must be completed by
the participant in its entirety. That means they must answer
every question themselves. If they leave questions blank and
choose not the fully answer the survey, then that means that we
(as the researchers) must completely discard that survey. We
cannot use it. Yes, it is frustrating because our sample will be
smaller. But we have an ethical obligation to discard an
incomplete survey so that our results will be as accurate as
possible.
Your Johns Hopkins Evidence Summary tool is off to good
start, but there are multiple issues with spacing, font size, etc.
Additionally, the doi locator has been placed in the wrong
column. Please refer to the samples provided by Dr. Olson and
make the needed corrections to this tool as soon as possible.
This will be very important as you prepare for your upcoming
Week 6 paper.
APA Formatting
The APA formatting (both in-text and reference list) is mostly
acceptable. Be sure capitalize the names of journal titles in the

References list. Please continue to use your APA resources for
all weekly discussions.
Wk 3 comments from professor
You have provided a wonderful, analytical analysis of a
systematic review which collectively studies factors associated
with mindfulness-based interventions in substance abuse
disorders (SUDs) and behavioral addictions (BAs). This was a
very interesting study to read.
One of the key concerns that the authors identify early is the
clear criteria for inclusion and exclusion criteria for the
selected studies. I cannot stress enough how important this
aspect is when conducting research. If inclusion and exclusion
criteria are not clearly specified, then serious problems with
extraneous variables which were not accounted for in the
methodological plan, can almost corrupt the final study results
of a systematic review. The author undertook the task of
assessing findings from numerous pilot studies involving trials
(54 studies reported) which is a major challenge for any
researcher. However, the final insights offered by the authors
are significant. Overall, great work!
Your summary tool is robust and commendable. You are doing
great work populating the columns with needed information.
The Times New Roman font and size are consistent througho ut
the document. As you continue to build your final summary
tool, it will serve as an excellent resource of collated
information for this class and in your future work.
APA Formatting
The use of in-text citations and reference list look good overall.
You are doing very well with this requirement but remember (as
a helpful hint) to capitalize the first word that follows a colon
in a journal title. Please refer to your APA Manual for guidance
as needed.

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