course materials

1. Discussion: Literature Searches
Discussion: Literature SearchesDiscussion: Literature SearchesAn important step in the EBP
process is reviewing the current body of literature to better understand the subject or topic
in which you are interested. By conducting a review of the literature, you are building
foundational knowledge about the topic; later, you can use this background to build new
insights. Developing a strong grasp of a topic can only be garnered by taking the time to
thoroughly search for relevant information and resources.CLICK HERE TO ORDER YOUR
ASSIGNMENTFor this Discussion, you will practice searching the literature to find evidence
on a specific topic.To prepare:Choose a simple search term(s) relating to a topic of your
PICOT question.Review the information on the evidence hierarchy discussed in Chapter 2 of
the course text, in the article, “Facilitating Access to Pre-Processed Research Evidence in
Public Health,” and in the multimedia presentation “Hierarchy of Evidence Pyramid,” found
in this week’s Learning Resources.Review the information on the Walden Library’s website,
“Levels of evidence.” Take a few minutes to explore the different types of databases
available for each level of evidence and focus on the meaning of filtered and non-filtered
resources.Conduct a literature search in the Walden Library on your selected topic using the
databases that you reviewed. Use at least one database for each of the three levels of filtered
information and at least one unfiltered database. Record the number of hits that you find at
each level of the hierarchy of evidence.Select one article from the results at each level of the
hierarchy. Compare the articles based on the quality and depth of information. What would
be the value of each resource if you were determining an evidence-based practice?By Day
3Post a summary of your search. Describe what topic you selected, the search term(s) that
you used, and the number of results found at each level of the hierarchy. Compare the types
of information found in the articles from different levels and the value of the information
from each level. Highlight a useful tip that you could share with your colleagues about
conducting an effective literature search. Discussion: Literature SearchesRead a selection of
your colleagues’ responses.By Day 6Respond to at least two of your colleagues on two
different days using one or more of the following approaches:Share an insight from having
read your colleagues’ postings, synthesizing the information to provide new
perspectives.Validate an idea with your own experience and additional sources.Make a
suggestion based on additional evidence drawn from readings, or after synthesizing
multiple postings.Click on the Reply button below to reveal the textbox for entering your
message. Then click on the Submit button to post your message.Bottom of FormMy PICOT
QuestionIn cardiac patients who have thoracic surgery, what are the effects of antibacterial

2. soap baths and bacitracin prophylactic nasal swabs on preventing or decreasing Deep
Sternal Wound Infections (DSWI)?Classmate Post #1Tabitha LAs a nurse conducting
efficient research to improve practice is highly essential. Nurses must keep up with current
evidence-based practice to be aware of changing guidelines and recommendations. In this
discussion, the literature search based on the PICOT question, of ‘for patients receiving
antibiotics, does the use of probiotics reduce the occurrence of Clostridium difficile when
compared to patients receiving antibiotics without probiotics?’. Discussion: Literature
SearchesTo begin my search, I simply entered ” Clostridium difficile” “probiotics”
“prevention’” into the Walden Library. To aid in the process of narrowing search results, I
altered the timeline to only present results from 2013-2018 to ensure no outdated results
would appear. Setting a distinct time frame is essential to avoid using data that may no
longer be relevant because of newer results. This search gave me a total of 229 results. Next,
I filtered through results using the ‘peer-reviewed scholarly journals’. This filtering of
results will help articles that have been written by experts and reviewed by experts
unbiasedly. Adding peer-reviewed scholarly journals did narrow the results down to 163
results. However, the filter did leave lower level hierarchy evidence unfiltered evidence
such as randomized trials that is the highest level of unfiltered infection according to
“Hierarchy of Evidence Pyramid”. In this randomized controlled trial it was concluded, “Due
to the low incidence of antibioticassociated diarrhoea in both groups, no conclusion can be
made on the efficacy of L. reuteri DSM 17938 on AAD in hospitalized Bulgarian children,”
(Georgieva, Pancheva, Rasheva, Usheva, Ivanova,& Krassimiram, 2015). This result makes
answering the original question quite difficult to answer.To further my search, I attempted
to locate filtered information. From my previous results I was able to find a systematic
review, which is the top of the evidence pyramid. This research leads me to more definite
answers. “Four different types of probiotics were found to be effective for primary
prevention of CDI (S. boulardii, L. casei DN114001, the mixture of L. acidophilus and Bifido.
bifidumand the mixture of L. acidophilus, L. casei and L. rhamnosus),” (MacFarland, 2015).
While this research seems to provide more definite answers, it does also state, “More
clinical experience with these four probiotics might be recommended to confirm if they are
effective in larger populations of patients,” (MacFarland, 2015).While the systematic review
by MacFarland was able to provide more definite research data than the controlled trial
there was still a plethora of search results to go through. By selecting the “title” option for
my keywords, it narrowed my results down to a total of eight along with the previous filters.
This search brought me to a literature search writing, which concluded, “The probiotic
formulation containing these three lacto-bacilli strains (L. acidophilus CL1285, L. casei
LBC80R, L. rhamnosus CLR2, Bio-K+) is a promising example of how a probiotic was used to
prevent serious healthcare-associated infections such as CDI. This probiotic is well
characterized, has an excellent safety profile, and, when applied in hospitals, showed
reductions in CDI rates, sometimes sustained over years. More research is recommended
for probiotics in the prevention of CDI,” (Macfarland, Ship, Auclair, & Millette, 2018).
Discussion: Literature SearchesAfter reading several different results such as those
discussed. I was able to conclude that a common answer to my question, ‘for patients
receiving antibiotics, does the use of probiotics reduce the occurrence of Clostridium

3. difficile when compared to patients receiving antibiotics without probiotics?’ was while
probiotics seem to have a beneficial effect on preventing C-diff infection more research
needs to be conducted.In conclusion, it is essential that nurses know how to conduct
literature searches. Understanding how to narrow searches by using filtering tools and
keywords is crucial along with selecting a specific time frame. Understanding the different
hierarchies of evidence is also important in understanding how to interpret
information.ReferencesLaureate Education (Producer). (2012). Hierarchy of evidence
pyramid. Baltimore, MD: Author.MacFarland, L. (2015). Probiotics for the Primary and
Secondary Prevention of C. difficileInfections: A Meta-analysis and Systematic Review.
Antibiotics, Vol 4, Iss 2, Pp 160-178(2015), (2), 160.
doi:10.3390/antibiotics4020160McFarland, L., Ship, N., Auclair, J., & Millette, M. (2018).
Review: Primary prevention ofClostridium difficile infections with a specific probiotic
combining Lactobacillusacidophilus, L. casei, and L. rhamnosus strains: assessing the
evidence. Journal OfHospital Infection, 99443-452.
doi:10.1016/j.jhin.2018.04.017Georgieva, M., Pancheva,R., Rasheva, N., Usheva,N., Ivanova,
L., & Krassimira, K. (2015). Useof the probiotic Lactobacillus reuteri DSM 17938 in the
prevention of antibiotic-associated infection in hospitalized Bulgarian children: a
randomized, controlled trial.Journal Of IMAB,21(4), 895-
900. doi:10.5272/jimab.2015214.895Classmate Post #2Samantha AInitial
PostCOLLAPSEInitial Post –My PICOT question was: In traumatic brain injured patients
requiring an external ventricular drain (EVD), does the utilization of chlorhexidine (CHG)
dressing versus a standard occlusive, sterile dressing help decrease the risk of all EVD
infections for the duration of the patient’s required time of EVD therapy. In choosing a
simple search term I initially started complicated and progressively simplified my search
criteria. In each level of evidence and the corresponding database, my search terms initiated
with, chlorhexidine dressings preventing external ventricular drain infections. Utilizing this
search criteria was too specific and too new of a concept to result in any articles within the
systematic review databases, the critically-appraised topics, critically-appraised individual
articles, and in the unfiltered databases. I thus, simplified my search criteria to external
ventricular drain infections, where I found 36 articles in the critically-appraised topics
through the Annual Review database, 3 articles in the Evidence Based Nursing database,
none in the systematic review databases, and 11 in the CINAHL Plus unfiltered database.
From the articles found utilizing the search criteria of the external ventricular drain
infections, mostly unrelated articles to my very specific PICOT question was found. For the
purpose of this discussion board I further simplified my search criteria to chlorhexidine
dressings. Discussion: Literature SearchesUpon simplifying my search criteria to
chlorhexidine dressings, I was able to produce at least one article per level of evidence and
the corresponding databases. In the Cochrane Database of systematic Reviews, one article
populated from my CHG dressing search. Systematic reviews are completed by a impressive,
comprehensive literature review, in which a specific clinical question is asked (Walden
University, 2012). The poorly executed studies are eliminated and practice suggestion is
made based on the remaining well done studies (Walden University, 2012). The article
explained the data collection, analysis, bias, quality of evidence, included and excluded

4. studies, and summary of findings with primary and secondary outcomes (Lai, 2017).
Furthermore, this article had two review authors independently assess the controlled trials
eligibility and the risk associated bias within each randomized controlled trila (Lai, 2017).
In reference to the critically-appraised topics, which consist of multiple research studies on
a particular topic I found one article utilizing the search term CHG dressing (Walden
University, 2012). The article came from the Annual Review and focused on national
statistics reviewing a decision-analysis model and The Dressing Study (Chandra & Chong,
2014). Next, I used the CHG dressing search criteria in the Evidenced-Based Nursing
database of critically-appraised individual articles resulting in seven articles. These articles
evaluate and provide a synopsis of specific research studies (Walden University, 2012). The
article I reviewed was a meta-analysis which included randomized controlled trials of CHG
dressing versus site care and the results evaluating prevention of bacteria colonization on
the catheter and prevention of catheter associated blood stream infection (Lorente, 2014).
Finally, I searched the CINAHL Plus unfiltered database and found 75 articles about CHG
dressings. In unfiltered databases, the individual owns the responsibility to review the
articles for validity and reliability (Walden University, 2012). In the CINAHL Plus database
the article I reviewed was a case study at University College London Hospital focusing on
two patients in one cardiac intensive care unit (Jeanes & Bitmead, 2015).After beginning my
search term as specific I found a lack of articles in the higher levels of evidence databases,
once I simplified my terms to an intervention that has been around for greater than two
years I was able to find at least one article per level of evidence. As the level of evidence
decreased there are more articles to be found, which raises the question of validation and
reliability, especially when searching the unfiltered databases. A useful tip to share when
conduction an effective literature search is to analyze the specific nature of your research
question in relationship to the level of evidence that will be present. The more specific the
question the less availability at the higher levels of evidence, the more recent the practice
change you are researching, as well, will result in less related articles at the higher levels of
evidence. This raises great caution to the researcher, the more specific and more recent the
search criteria is the more the research must rely upon lower levels of evidence in
unfiltered databases. This requires the researcher to analyze each article and verify the
reliability and the bias within each article. Discussion: Literature
SearchesReferencesChandra, S. & Chong, D. (2014). New cost-effective treatment strategies
for acute emergent situations. Annual Review of Medicine, (65) pgs 459-469Jeanes, A., &
Bitmead, J. (2015). Reducing bloodstream infection with a chlorhexidine gel IV
dressing. British Journal Of Nursing, 24S14-S19. doi:10.12968/bjon.2015.24.Sup19.S14Lai,
N. M. (2017). Antimicrobial dressings for the prevention of catheter-related infections in
newborn infants with central venous catheters. Cochrane Database Of Systematic Reviews,
(1), doi:10.1002/14651858.CD011082.pub2Lorenet, L. (2014). Review: chlorhexidine-
impregnated dressings reduce risk of colonisation of central venous catheters and risk of
catheter-related bloodstream infection. BMJ Journals 18(3). doi:10.1136/eb-2014-
101959Walden University. (2012). Levels of evidence. Retrieved
from http://academicguides.waldenu.edu/c.php?g=80240&p=…