Exploring Evidence Based Practice And Practice Essay

Exploring Evidence Based Practice And Practice Essay
Title Page
Module Code 130OT
Module Title Exploring Evidence to Enhance Learning and Practice
Assignment details
Drawing on a range of evidence discuss how different types of research can be used to support
practice.
1500 words ± 10%
Word count 1647
Contents
Introduction 2
Quantitative Data 3
Qualitative Data 4
Systematic Reviews 5
Conclusion 7
References 8
Introduction
This piece of work will be exploring the different forms of research and their significance in the
evidence–based practice.
What is research?
Due to the evolving nature of occupational therapy, much of the work in this field is grounded in
evidence–based practice. It is imperative, for those seeking a career in Occupational Therapy and
those currently in the profession, to have a clear understanding of research methodology in order to
work ethically and effectively when carrying out their research. This will lead to the better quality
approach of care for the clients.
What is evidence Based Practice (EBP)?
EBP is "the conscientious, explicit and judicious use of current best evidence in making decisions

about the care of the individual patient. It means integrating individual clinical expertise with the
best available external clinical evidence from systematic research." (Sackett D, 1996) EBP is the
integration of clinical expertise, patient values, and the best research evidence into the decision–
making process for patient care. Clinical expertise refers to the
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Summary Of How To Read A Paper: The Basics Of...
The big idea of "How to Read a Paper: The Basics of Evidence–Based Medicine" is that it describes
the different types of clinical research reporting, and explains how to critically appraise the
publications. The book provides the tools to find and evaluate the literature, and implement the
findings in an evidence–based, patient–centered way. It is written for anyone in the health care
professions who has little or no knowledge of evidence–based medicine; it provides a clear
understanding of the concepts and how to put them into practice at the basic, clinical level.
The three things I have learned about this book are: 1) Assessing methodological quality. These
questions are needed to be answered in order to interpret your findings and be able ... Show more
content on Helpwriting.net ...
Was assessment 'blind'? In an attempt to achieve a comparable control group will not work out if the
people, who assess outcome, know which group the patient they are assessing was assigned to. Were
the preliminary statistical questions addressed? You will want to know the size of the sample, the
duration of the follow–up and the completeness of the follow–up. 2) When is a review systematic? A
systematic review is an overview of primary studies. They contain a statement of objectives,
sources, and methods and have been conducted in a way that is clear transparent and re–create. The
method for a systematic review is: state the objectives of the review of randomised controlled trials
and outline the eligibility criteriasearch for trials that seem to meet the eligibility criteriatabulate
characteristics of each trial identified and assesses its methodological qualityapply the eligibility
criteria and justify any exclusionsassemble the most complete datasheet feasible, with assistance
from investigators, if

An Insight Into Either Ultrasound ( Us ) Or Magnetic...
Introduction
The aim of this literature review is to gain an insight into either Ultrasound (US) or Magnetic
resonance imaging (MRI) is the more suitable imaging modality into diagnosing and assessing a tear
within the knee Menisci. Both within trauma and non–trauma adult patients.
This section of the review will explain the topic and reasoning into why it was done. The process of
its relevance into radiography in practise will also be outlined. This will provide background into
positive aspects it could bring.
The project targets and hypothesis will be demonstrated within this section.
Background into the Menisus of the knee
Within anatomy the Meniscus is a piece of cartilage located within the joints of the wrist,
acromioclavicular, ... Show more content on Helpwriting.net ...
Blood supply and age factors
"At the time of birth, nearly the whole meniscus is vascularised" (Institute of anatomy 1995, Vol. 66,
No. 4, Pages 308–312).
The menisci of the knee gains its blood supply from blood vessels entering from the joint capsule
accompanied by loose connective tissue.
Within the second year of life this is reduced to a avascular region located within the inner fringe of
the joint capsule. At the age of twelve the blood vessels are reduced again, being confined to the
lateral third. (Institute of anatomy 1995, Vol. 66, No. 4, Pages 308–312).
Finally after the age of fifty, only the lateral quarter of the meniscal base is vascularized (Institute of
anatomy 1995, Vol. 66, No. 4, Pages 308–312). This creates problems in older patients with
meniscus tear injuries, making it vital for having the best imaging modality in place to gain an early
diagnosis which would lead to a faster treatment.
Diagnostic Imaging role
The severity of a tear with the knee Menisci can easily be identified through the use of diagnostic
imaging.
Modalities used are commonly; conventional radiography, ultrasound (US), magnetic resonance
imaging (MRI), computed tomography (CT) and arthroscopy.
Ultrasound and MRI are the most appropriate imaging modalities for meniscus tears, this is due to
their high sensitivity or image quality and statistics.
Ultrasound
Ultrasound uses an oscillating sound pressure

Amyotrophic Lateral Sclerosis
Introduction
Evidence Based Medicine (EBM) is one of the most important skills for the heath profession in this
era. In this paper two occupational therapy on Amyotrophic Lateral Sclerosis (ALS) are critically
analyzed to test its validity for further evidence–based practice on the occupational therapy of ALS
patients. The two articles used for the critical appraisal of EBM are one, Interaction of physical
function, quality of life and depression in Amyotrophic lateral sclerosis: characterization of a large
patient cohort by Körner, Kollewe, Abdulla, Zapf, Dengler and Petri (Körner et al). Two, Systematic
review of the Effectiveness of Occupational Therapy–Related Interventions for People with
Amyotrophic Lateral Sclerosis by Arbesman and ... Show more content on Helpwriting.net ...
First, the method to collect which is one time followed retrospective survey question, is difficult to
conclude that is reliable. Retrospective question can be very subjective and can be vary depends on
many factors of the time at the question .Second, the study was compared to German population
only with the survey on ALS patients. Since QoL is very subjective to one life pattern or personality,
it is hard draw a conclusion with one time survey cohort study conducted and compare to one
nationality is valid. Hence, even though it is well structured study, it is hard to conclude that this
intervention can be useful to other group of people who are located in other countries with same
level of

Efficacy And Psychological Interventions For Psychosis And...
Reference Stafford, M. R., Mayo–Wilson, E., Loucas, C. E., James, A., Hollis, C., Birchwood, M.,
& Kendall, T. (2015). Efficacy and safety of pharmacological and psychological interventions for
the treatment of psychosis and schizophrenia in children, adolescents and young adults: A systematic
review and meta–analysis. PLoS One, 10(2) doi:http://dx.doi.org/10.1371/journal.pone.0117166
Purpose
The purpose of this study was to examine the effectiveness and safety issues surrounding
pharmacological and psychological interventions as treatments for psychosis and schizophrenia in
children, adolescents, and young adults. This study contrasted different medications and their
impacts on patient outcomes – both positive and negative. Furthermore, head–to–head comparisons
between medications were made; highlighting which medications had better significant impacts on
patients. Also, contrasting psychological interventions taking in to consideration the benefits of
family and individual cognitive behavioural therapy were examined in this study.
Design/Method
The design of this study was a systematic review and meta–analysis. The authors conducted research
of several different databases analyzing randomized controlled trials comparing: pharmacological,
psychological, or combined interventions for psychosis, and schizophrenia in children, adolescents
and young adults.
Sample/Setting
Twenty–seven randomized controlled trials including 3067 participants reported in 52 published

Research Methodology And The Execution Of Slr
2. Research Method
This section provides an overview research method i.e. systematic literature review (SLR) used in
thesis research; it describes the research methodology, the design and the execution of SLR.
2.1 Overview of Systematic Literature Review
This section of chapter was to thoroughly define and go through systematic literature review
research method.
2.1.1 Definition
Kitchenham and Charters (2007) proposed that systematic literature review has been a widespread
research methodology since 1990s, but it was initiated by medical research where number of well
documented standards has evidently showed its use. While, since the year 2004, systematic reviews
are also performed by many software engineering researchers and number of important engineering
conferences also seek submissions in this research category. In addition to this many popular
journals and magazines have distinct section for papers, which are also based on this research
methodology. (Kitchenham & Charters, 2007)
According to Kitchenham,
"A systematic literature review (often referred to as a systematic review) is a means of identifying,
evaluating and interpreting all available research relevant to a particular research question, or topic
area, or phenomenon of interest" (p.8).
The fundamental study of the systematic literature review is known as primary studies, and the
systematic literature itself is known as a form of secondary study.
2.1.2 Adopting the Systematic Literature Review
There

Example Of Systematic Review
Method
Protocol
In order to find a protocol to systematically search and identify studies researching the effectiveness
of training programmes in ethics and its influence on ethical leadership and ethical behaviour,
previous systematic reviews on these topics were searched. However, no review protocols were
found.
Consequently, to ensure transparency with this systematic review, an evidence–based checklist was
used to guide this review's methodology. Specifically, this review followed the Preferred Reporting
Items for Systematic Reviews and Meta–Analysis Protocols (PRISMA–P) statement, designed by
PROSPERO in order to organise this research report (Moher et al., 2015). PROSPERO is an
international prospective register of systematic ... Show more content on Helpwriting.net ...
Specifically, some items exceeded the scope of this review or were not applicable such as funding
sources, and were consequently removed. Namely, items 2, 3a, 3b, 4, 5a, 5b, 5c, 11c, 12, 13, 14,
15a, 15b, 15c, 16 and 17 were omitted from the review. Subsequently, this adapted version of the
PRISMA–P 17–item checklist is presented in appendix table 1B. Lastly, it needs to be noted that this
adapted version of the PRISMA–P checklist is not quality assessment tool and was only used as a
mere guide for the researcher.
Eligibility criteria
Types of studies. The review considered literature focusing on the development of ethical leadership
in organisations (private and non–private) using interventions incorporating ethics training.
According to Kelly, Sadeghieh and Adeli (2014), peer reviewed literature can ensure credibility to
findings, because it allows scholarly work to be critically examined by other researchers in the same
field. As a result, full–text, empirical peer–reviewed journal articles and dissertations were
considered for inclusion in this review. Studies for inclusion reported the development of ethical
leaders where training programmes formed part of the intervention. Types of participants. Studies
considering participants that were actively working within a private or non–private organisation.
Studies involving students within higher education institutions such as

Information Based Medicine ( Ebm )
A Health intervention is an effort that promotes behaviour that optimizes mental and physical health,
or discourages or re frames behaviours considered to be potentially health–threatening. So, Evidence
based medicine(EBM) is not the only but the best approach to health interventions as it emphasizes
the use of evidence from well designed and conducted research in healthcare decision–making.
EBM is regarded as the gold standard of clinical practice. The term "evidence–based medicine", as it
is currently used, has two main tributaries. Chronologically, the first is the insistence on explicit
evaluation of evidence of effectiveness when issuing clinical practice guidelines and other
population–level policies. The second is the introduction of epidemiological methods into medical
education and individual patient–level decision–making.
Evidence–based medicine (EBM) is the process of systematically reviewing, appraising and using
clinical research findings to aid the delivery of optimum clinical care to patients.
EBM is the practice of solving the clinical problems in one 's practice by judicious and systematic
use of the medical literature. This includes framing questions rightly and searching the right kind of
literature. Thereafter, the available evidence needs to be evaluated for the validity, strength and
effect size. Finally, the results are examined for applicability to the current problem which requires a
detailed knowledge of the clinical setting, patient

Osteoarthritis Evidence-Based Practice (EBP)
In this essay, I will discuss Evidence–Based Guidelines provided by The National Institute of Health
and Care Excellence (NICE) which is an organisation that recommends the best available evidence
to guide clinical decisions in healthcare (NICE, 2017). The guideline evidence for Osteoarthritis will
be assessed and the validity and reliability of the guideline will be evaluated. Justification for the
chosen guideline will be included and how I will effectively apply the guideline in a healthcare
setting. Guidelines aid healthcare professions on how to care for patients with specific conditions.
Guidelines include information, advice and treatment recommendations on variety of conditions
(NICE, 2017). NICE guidelines help with care of pateints in specific clinical conditions and aid
health professionals ... Show more content on Helpwriting.net ...
Guidance on a treatment is important but more is required to achieve high quality care and
effectiveness, such as the patients physical, psychological and social assessment. A good thorough
patient assessment is crucial as it helps with finding the right treatment for the patient and increases
patient participation. Evidence–Based Practice (EBP) can be defined as the conscientious use of
current best evidence in making decisions about patient care (Sackett et al, 2000). Evidence–Based
Practice (EBP) is a practice which requires that decisions about health care are based on the best
available, current, valid and relevant evidence and the decisions should be made by those receiving
the care and those providing the care (Dawes M. et al, 2005). Professions such as Physiotherapists
use Evidence Based Practice as an aid when it comes to choosing the correct and

Introductory. Something That Humans All Have In Common,
Introductory Something that humans all have in common, is aging. Every single one of us ages and
as we age a lot of us get to have a friend along the way. That friend is aching pain. This aching pain
can stem from a certain disease, named osteoarthritis. Osteoarthritis is "the most common rheumatic
disease, primarily affecting the articular cartilage and the subchondral bone of a synovial joint,
eventually resulting in joint failure." (Fransen, 2015) Chances are that someone close to you has
osteoarthritis as it is a very prevalent chronic disease. Living with a chronic disease does not bring
much joy and preventative measures can be taken to avoid the pain or interventions can be used to
make the pain bearable. Some interventions that ... Show more content on Helpwriting.net ...
Exercise is something that can easily be taught to patients and nurses have the prime opportunity to
educate patients that are at risk or have osteoarthritis before they need a joint replacement surgery.
Mobility is a huge part of each individual's life and joints play a crucial role in one's mobility. When
a joint's function decreases a person's mobility, many other things are at risk to decrease as well such
as skin integrity and the cardiovascular system. As a nurse, it is important to treat patients
holistically and when one part is not functioning, such as the joint, it is our job to bring function
back to improve one's health overall.
Methods
Many of the studies reviewed followed similar methods to collecting data related to exercise and
knee osteoarthritis. There were many systematic reviews that supported this PICO question and
determined whether land–based therapeutic exercise is beneficial for people with knee osteoarthritis
in terms of reduced joint pain or improved physical function and quality of life. All of the studies
had searched various databases, which included, MEDLINE, EMBASE, The Cochrane Central
Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health
Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), Google scholar and
OpenGrey. Randomized control trials were put to use and

Animals Of All Kinds Have Been Known For Their Positive...
Animals of all kinds have been known for their positive impact on humans. Animal–assisted
Therapy (AAT) was first incorporated into the mental health institutions in the late eighteenth
century to help increase socializations among the patients. As of today, a number of AAT programs
have mainly targeted populations of patients with PTSD or those who have experienced trauma.
PTSD (post–traumatic stress disorder) is classified as an anxiety disorder characterized by the
common symptoms avoidance, intrusion, alterations in mood and cognition, and alterations in
arousal and reactivity (O'Haire, M.E,. Guerin, N.A., & Kirkham, A.C., 2015). The presence of an
animal is thought to encourage a safe and open environment, elicit positive emotion and warmth,
increase socializations, and increase the release of oxytocin, which aids in the relaxation process.
Perhaps that's why PTSD or trauma patients respond so well when AAT is included in treatment.
AAT is not a therapy used alone, but rather coupled with other treatment to enhance the therapy
process. (Dietz, T. J., Davis., & Pennings, J. 2012).
PICO Statement My PICO statement is in patients with PTSD or traumatic experiences, what is the
effect of animal–assisted therapy compared to no animal assisted therapy on decreasing traumatic
symptoms? Therapy is the type of PICO question. Based on my PICO statement the best type of
evidence to use for this particular question would be randomized or non–randomized controlled
trials.

Evidence Based Practice
Evidence Based
Sachin J. Koshiya
Utica College
Evidence Based Practice (EBP) is "the process of lifelong, self directed learning in which caring our
own clinical patient create the need for clinically important information about diagnosis, prognosis
and interventions" (Crist, McVay and Marocco, 2016), also mentions that time and experience may
work against us sometimes if we do not pursue current evidence. EBP also describe, as practice
which based on best evidence with clinical judgment, additionally, best evidence mentioned as
timely, well design study, which significant to the question a physical therapist (PTs) about patient
management (Jewell, 2005) . Evidence may assist the PTs practice in various decision making areas
... Show more content on Helpwriting.net ...
Effectiveness of resistance training on muscle strength and physical function in people with
Parkinson's disease: a systematic review and meta– analysis . Clinical Rehabilitation 30(1), pp:11–
23.doi: 10.1177/0269215515570381
Ehab, G., Barsnley, S., & Chellappa, R. (2012). Effect of physical exercise–movement strategies
programme on mobility, falls, and quality of life in Parkinson's disease. International Journal Of
Therapy & Rehabilitation, 19(2), 88–96.
Goodwin, V., Richards, S., Henley, W., Ewings, P., Taylor, A., Campbell, J., & ... Campbell, J. L.
(2011). An exercise intervention to prevent falls in people with Parkinson's disease: a pragmatic
randomized controlled trial. Journal Of Neurology, Neurosurgery & Psychiatry, 82(11), 1232–1238.
doi:10.1136/jnnp–2011–300919
Jewell, D. (2015). Guide to evidence–based physical therapist practice (3rd ed.). Burlington, MA:
Jones and Bartlett Learning.
Schlenstedt, C., Paschen, S., Kruse, A., Raethjen, J., Weisser, B., & Deuschl, G. (2015). Resistance
versus Balance Training to Improve Postural Control in Parkinson's Disease: A Randomized Rater
Blinded Controlled Study. PLoS ONE, 10(10), e0140584.

The Evidence Hierarchy: A Change In Practice
The evidence hierarchy is a ranking that distinguish the types of research evidence based on the
strength of the evidence itself (Polit & Beck, 2012). It is mostly applicable to the research questions
regarding the effects of clinical interventions. The evidence that are ranked based on the evidence
that uses appropriate research methods, rigorously reviewed with minimized biases and has great
clinical implications. The strongest evidence based on the evidence hierarchy is systematic reviews,
which draws conclusions from many randomized controlled trails (Polit & Beck, 2012). A
comprehensive database research was conducted through online library to research for evidence in
relation to the PICOT question. According to a level VII study, beta ... Show more content on
Helpwriting.net ...
Especially for those who have underwent percutaneous intervention unless otherwise
contraindicated due to other conditions to reduce all–cause mortality. The advanced practice nurses
play critical roles in ensuring best evidence practice are being utilized, and the guidelines are being
followed. The advanced practice nurses should also prescribe beta blocker therapy based on
individuality of each unique patients. The advanced practice nurses are the advocate for the patients'
overall health, not only prescribing medical therapies but also educate patients on those evidences to
incorporate health promotion model into the

Catheter Associated Urinary Tract Infection
Catheter Associated Urinary Tract Infection (CAUTI) is defined as the occurrence of a urinary tract
infection (UTI) in patients with a urinary catheter in the past 48 hours. Published guidelines by the
Infectious Diseases Society of America (IDSA) further defines CAUTI by the presence of
significant bacteriuria of ≥ 103 CFU/ml found in the urinalysis and signs and symptoms of a UTI
without the presence of another cause for these findings. Signs and symptoms of CAUTI could
include: altered mental status, fever, chills, flank pain, costovertebral angle tenderness, and
hematuria. If the catheter has been removed in the past 48 hours the symptoms could also include
urgency and frequency (Fakih et al., 2016).
A2. Significance of the problem
The most common health care associated infection (HAI) is CAUTI. Forty percent of all hospital–
acquired infections are UTIs and 80% of these are directly linked to having an indwelling urinary
catheter in place (Underwood, 2015). Urinary catheters are required in up to 25% of hospitalized
patients and bacteriuria results in about 25% of patients with a catheter for greater than 5 days and
this number increases by 1 to 5% for each day the catheter is in place after that. The harmful
consequences of CAUTI include increased length of stay, higher health care cost, and increased
mortality. CAUTI is known to cost health care in the U.S. $400–$500 million annually (Leuck et al.,
2015).
A3. Current Practice
The growing concerns over

Systematic Review Paper
Abstract
Traditionally, systematic reviews (SR) are descriptive secondary research, which may or may not be
accompanied by statistical methods (metaanalysis) of pooling the results of primary, quantitative
studies to answer a clinical question or test a hypothesis (Chalmers 1996). Similarly, qualitative
primary studies can be pooled and synthesised in order to develop new theories to aid decision
making, re–shape policies, and influence professional practices. Over the past 20 years, patient and
public involvement (PPI) in research have become increasingly crucial, which has fuelled the
increasing popularity of qualitative research as better ways of incorporating public and patient views
into health, social and economic policies. There is however a confusing array of methods available
for conducting secondary qualitative research. In this paper epistemological concepts guiding a
number of methods are discussed. The consensus on enhancing transparency in reporting the
synthesis of qualitative research (ENTREQ) is also reviewed
Introduction
Synthesis of qualitative data has never been as popular as meta–analysis. It is however becoming an
increasingly useful secondary research tool in a diverse area of problem solutions, ranging from
leadership and management problems (Walsh 2005; Galuska 2012), sociology (Wilder 2014) to
clinical research questions (Beck 2002; Kennedy et al. 2003 and Orri 2014). Secondary research
could be part of a course work, dissertation or thesis,

Evidence based practice is the incorporation of individual clinical expertise with best research
evidence and patient values and expectations. Health care decision of individual patients should be
based on best available research evidence. A health decision made from a sound research evidence
has the potential to ensure best practice and reduce variations in health care delivery. In health
science, an ever increasing plethora of studies being published and is challenging for clinicians to
keep up with the literature. Integrating research into practice is time consuming and need methods
for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on
the latest research evidence. Systematic reviews and meta–analyses summarize the research
evidence, which is generally the best form of evidence, thereby making the available evidence more
accessible to decision makers and are positioned ... Show more content on Helpwriting.net ...
It synthesizes the results of various primary studies by using strategies that reduces biases and
random errors. These reviews follow a strict scientific design and provide consistent estimates about
the effects of interventions, therefore, conclusions are defensible. Systematic reviews shows where
knowledge is lacking and can be used to guide future research. These reviews are usually carried out
in the areas of clinical tests such as diagnostic, screening and prognostic; public health
interventions; economic evaluations; adverse effects and how and why interventions work.
Cochrane reviews are systematic reviews undertaken by Cochrane Collaboration members, aims to
help people to make well–informed decisions about healthcare by preparing, maintaining, and
promoting the accessibility of systematic reviews of the effects of healthcare

A Research Study On Ivf
Before this systematic review published, only two reviews were available of outcomes for singletons
after IVF techniques. In comparison with natural conception, it has been proposed that the obstetric
results of pregnancies are poorer with IVF/ICSI. Today, it is reported that the number of women that
undergo IVF/ICSI process is increasing around the world. With this, I am curious about the risks for
women having IVF/ICSI and how perilous it is to them since the process is not natural. I would also
like to know what causes the risks and specifically the factors that increase them. As a nurse who
had IVF education and practice and worked with such renowned IVF specialists such as Dr. Buckett,
Dr. Holzer and Dr.Tan, I decided to conduct a synthesized evidence search on the systematic review
so that I can help these patients to have more attentive care to prevent or minimize the possible risks
of In Vitro Fertilization techniques that may potentially endanger them.
In this synthesized, evidenced search, I wanted to learn whether IVF pregnancies are bound to
greater precarious risks and whether there is the way to minimize possible risks by providing more
antenatal care to the clients. I find this important since most of the patients having IVF/ICSI are very
delicate, so they would require more systematic care based on recent studies.
I used the key search terms. I entered "Systematic review", "IVF", and "ICSI". Out of more than 40
systematic reviews on the Health Reproduction

Evaluation Of A Research On Management Education
Thank you for your submission to Journal of Management Education, "Criticality in Management
Education: What It Is and What It Is Not" (JME–16–0084–ETR). I have completed the evaluation of
your paper by soliciting reviews from three experts, who assessed the potential contribution to
management education research. Based on their assessment and mine, I would like to offer a high
risk revise and resubmit for this manuscript.
As I understand it from my reading and the reviewers' comments, the aim of this manuscript is to
provide a systematic review of criticality in the management education domain. Like most
instructors who aspire to foster students' criticality/critical thinking skills, I read this manuscript
with great interest for new insights into the literature and for ideas I could use in the classroom. As it
currently stands the document's strength is its aspiration summarized by Reviewer 3 (R3): "Your
manuscript has an interesting premise that we use the term critical loosely and management
education can benefit from a critical discussion, more precision, and focus. You present a
complicated and important concept, and attempt to delineate terms and meaning." However, this is
more work to be done to actualize this intent. The manuscript's weaknesses are in four main areas:
1) argumentation, 2) systematic review methods 3) scope, and 4) implications for practice. Each
point is elaborated below and with suggestions for you to consider during your revision.
1.

Search And Appraisal Strategies For Hypertension And...
Search and Appraisal Strategies CINAHL, PubMed, Google scholar and Cochrane library were
searched for the following terms: hypertension, diet, exercise, lifestyle, pharmacotherapy, yoga,
DASH diet. The key words "hypertension and lifestyle interventions" were searched at the title and
abstract level in PubMed, CINAHL, Cochrane and Google Scholar. Inclusion criteria consisted of
peer–reviewed meta–analysis, systematic reviews, randomized control trials (RCT) or quasi
experimental studies focused on life style modifications in the reduction of systolic blood pressure,
published between 2010 and 2015. The exclusion criteria included studies published prior to 2010
and also pediatric and perinatal studies. The search yielded a ... Show more content on
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The appraisal of all these 10 articles led to identification of the three primary themes: a) positive
findings, b) mixed findings, and c) barriers associated with implementing life style modifications in
the treatment of hypertension.
Positive Findings The literature published since 2010 indicates that the lifestyle modification can be
used as an alternative to pharmacotherapy in the treatment of hypertension. Authors of the nine
articles of ten articles utilized for this study has concluded that lifestyle changes, which mainly
includes physical activity and dietary changes is very effective in the management of hypertension.
Randomized Control Trials This study utilized 6 RCT's selected from various databases. The study
conducted by (Hinderliter et al., 2013) concluded that changes in dietary habits, weight and blood
pressure persist for 8 months after completion of the 16th week ENCORE program with some
attenuation of the benefits. The ENCORE study was done with 144 overweight individuals with
hypertension, randomized to 16 weeks intervention, which includes behavioral weight management
and DASH diet and DASH diet alone. Follow up assessments were done after 8 months of the end
of the treatment and the systolic blood pressure at the end of 16 weeks was found to be reduced by
16.1 (95% confidence interval CI = 13.0–19.2) mmhg with DASH–WM group, 11.2 (95% CI = 8.1–
14.3) mmhg in the DASH–A group and 3.4 (95% CI = 0.4–6.4) mmhg in the

The Impact Of Telemedicine On Health, A Systematic...
Introduction
To evaluate and study the impact of telemedicine in health, a systematic literature review was
conducted. An electronic research through the University of Maryland library was done the articles
selected dated from 2000 to 2014. A total of 12 articles was reviewed that dealt with clinical
outcomes, efficacy, patient and provider satisfaction. Telemedicine as an emerging field can greatly
improve the outcomes of healthcare thus resulting in decrease the delivery cost of healthcare. While
the results of the studies are inconclusive on some of the areas, there are some strong supports for
patient satisfaction. The literature reviews cost effectiveness, provider satisfaction, patient
satisfaction and clinical outcomes. ... Show more content on Helpwriting.net ...
Several managed care organizations were represented. All of the organizations interviewed indicated
that there is a market demand for complementary and alternative medicine such as Telemedicine.
The study showed that while cost and clinical efficacy were important, both of these were less
important than market demand. This unexpected result show that consumer demands are actually
more important in shaping the demand for telemedicine and should be used to pursue development
of telemedicine among healthcare providers that will essentially lead to better reimbursement from
health insurance companies (Whitten and Kuwahara, 2003). Whitten and Kuwara states that payers
must answer both patients need and suppliers concerns of telemedicine cost Methods and
Organization of the Report. Qualitative reports on 12 peer reviewed articles were researched through
the University of Maryland to get information on the cost effectiveness, clinical efficacy, individual
and provider satisfaction. The 12 articles printed dates ranged from 200 and 2014. The articles
represented articles that have been published on the topic of telemedicine subject in various areas.
The review articles began with searching the database looking for articles on telemedicine and found
a possible 100 articles on the topic and were narrowed down to just a few dozen that fit the
standards the matter was searching for.
Review of the

Essay On In Vitro Studies
Discussion:
In–vitro studies are considered as a preclinical research and of important significance, as before
carrying out clinical trials, the safety and effectiveness of new drugs are examined In–vitro first.
However, unlike clinical studies on humans, preclinical studies are far enough, by 2002, the lancet
outlined a scientific rational for conducting SRs on animal studies, after that, manny SR and meta–
analysis of in–vitro studies were published(1) Including studies discussing the modeling of
cerebrovascular disease(2)
So like SR and Meta–analysis on humans, the quality assessment and risk of bias in SR and meta–
analysis of in–vitro studies needs to be tested and examined. (1)
Empirical evidence reports that too many ... Show more content on Helpwriting.net ...
we will invite the 65 corresponding authors of our systematic review, some international researchers
who are experts in QA, have an interest in experimental studies, and journal editors who are
interested in publishing SR of in–vitro studies.
By using email survey or Survey website, we will conduct a two to four rounds of sending,
receiving, modify and resend again.
The objective of the first round is that the panelists will show their opinion about the items included
in the initial checklist, rank the importance of each criterion included and suggest new items if
needed.
In the second round, we will receive their feedback on the results of the first round, re–rank the
importance of the criteria which did not reach a 70% consensus of inclusion or exclusion, and
indicate the importance of the proposed criteria during the first round.
The third round, to further refine the checklist, whether excluding any less important criterion or re–
including any of the excluded criteria in the checklist.
The fourth round, to review the final checklist and recommend for further improvement(4).And
third, a pilot test of the new tool, using a random sample as a pilot from the included studies of our
systematic review (5) sending emails with the new tool as a survey to the collected authors of
experience of in vitro studies, know their comments and

In this essay, I am going to consider how evidence–based practice can be used to support, justify,
legitimate and/or improve clinical practice. I am also going to explore and discuss primary and
secondary research evidences about how nursing interventions can potentially improve the quality of
life of patients in the community suffering from heart failure. I will gather these evidences using a
literature search which I will include an account of. Using a critiquing framework for support, I will
appraise both primary and secondary evidences that I have chosen. I will also look at potential non–
evidential factors that can influence evidence utilisation in practice. Finally, a conclusion will be
drawn. Evidence–based Practice (EBP) is ... Show more content on Helpwriting.net ...
I did not choose PsychInfo or Social Care Online and several specialist databases as I did not want
to get any articles that focus on other perspective other than nursing. I asked the search engine to
look for heart failure in the title section of articles and also lifestyle as secondary to it. I also used
quotation marks to specifically search for heart failure rather than search each word individually. To
further refine my search, I went onto the chronic heart failure filter. Using these search criteria, I
was able to pick the primary evidence that fits best to my aims. I used the Cochraine Library to
search for my secondary evidence as it is best to look for systematic reviews which is a form of
secondary evidences. I used the advance search feature of the database. I performed the search using
heart failure with quotation marks in the title section of articles. I also used quality of life and
exercise in the abstract of possible articles as keywords. As well as this, I used the search engine's
function to only show results restricted to systematic reviews. Using these search criteria, I
successfully chosen my secondary evidence. The primary evidence that I have chosen is a study
conducted by Brodie et al (2008) about how a physical activity 'lifestyle' intervention based on
motivational interviewing, compared to standard care, can improve quality of life for people with
chronic heart failure. The authors of this article included an account of its

Postoperative Pain And Anxiety Essay
Analyzing the Effect of Music on Postoperative Pain and Anxiety
The effect of music on postoperative pain and anxiety was studied on an orthopedic unit in a central
Florida hospital (Allred, Byers, & Sole, 2010). The authors clearly identified the problem many total
knee arthroplasty patients experience after surgery is moderate to severe postoperative pain and
increased anxiety. Throughout the introduction of the study, it was stressed the importance and need
for this research to be conducted. The authors discussed the effects of inadequately treated pain and
how health care professionals, including nursing, should make it a priority in a patient's treatment
plan (Allred et al., 2010). Several references were provided supporting the issue ... Show more
content on Helpwriting.net ...
The researchers included both a hypothesis and research questions. They stated a hypothesis,
however it is a research hypothesis versus a null hypothesis. A research hypothesis explains there is
correlation between two or more variables. A null hypothesis is a classification of hypotheses that
states there is no connection between the independent and dependent variables. Statistical testing is
performed to determine whether the statement is acceptable or not. Whereas the research question is
an analysis statement detailing the variables and population of the specified research study (Adams,
2015). The hypothesis, the authors were hoping to prove, was whether the use of music would
reduce pain and anxiety in postoperative pain in a particular patient population during a defined time
frame (Allred et al., 2010). An example of a null hypothesis for this study would state music would
have no effect on postoperative pain in a particular patient population during a defined time frame.
There were four research questions the researchers attempted to answer. Three of the four
questioned the effect of music on the patient's pain, anxiety, and physiologic parameters. However
the fourth question pertained to the impact of music on the amount of opioids taken from the
beginning of the intervention until six hours later (Allred et al., 2010). The clinicians had not
mentioned this component of the study before

Evidence Based Management Essay
This essay is going to analyze the article titled 'What's the Evidence on Evidence–Based
Management?' by Trish Reay, Whitney Berta, and Melanie Kazman Kohn that was written in 2009.
The article was a systematic review of the available literature in response to increasing advocacy for
the application of evidence–based management (EBMgt). The authors were driven by three
overarching research objectives: (I) to find out whether there was adequate literature about the
concept of EBMgt, (II) to evaluate the quality of existing evidence (literature) concerning EBMgt,
and (III) to find out whether there is a correlation between employing EBMgt and improved
organizational performance.
The Author's Ability to Explain Why the Study According to the authors of the article, their
systematic review was necessitated by the increased call for EBMgt. They note that there are a
number of eloquent and outspoken proponents of evidence–based management, especially Denise
Rousseau who has strongly pointed out that there is inadequate management practice and decision–
making founded on EBMgt. They note that the medical and healthcare professionals have already ...
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Firstly, the authors do not adequately explain why the study. They decided to conduct the review in
order to contribute to the debate by other researchers about evidence–based management. In my
opinion, it would have been better to predicate their research on the end–user needs: that is, to find
out to what extent EBMgt is being practiced in organisations; the relevance of EBMgt; and its
impact on organisational performance. These ought to be the ultimate research objectives of future
studies about the same subject as well as future managerial practice. That means that their research
questions should have been geared toward the usage, relevance and importance of EBMgt to end–
users, the organisational

Patient Satisfaction Literature Review
Conceptualization of patient satisfaction. Part 1. Theoretical issues: A systematic literature review
Introduction
Patient satisfaction has been a popular term in health care service in the last few decades owing to
its appropriateness to better quality of health service (WHO, 2000; Andaleeb, 2001; D'Souza &
Sequeira, 2012). Evaluating patient satisfaction with health care service allows some positive
changes in health care delivery and its quality (DuPree, Anderson & Nash, 2011) by identifying
problems and obstacles. A reflection of patients' view in the functioning of health service improves
health management and health professionals' behaviors as determining proper policies, management
procedures; prioritizing training needs and resource allocations ... Show more content on
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There is a need for satisfaction studies put more effort into exploring patient satisfaction concept
itself rather than testing correlations between variables (Staniszewska & Ahmed, 1999).
This article is a first part of research with an overall purpose to review a literature of the patient
satisfaction conceptual framework. The current article aimed to review a theoretical framework that
can be a basis for the next article to review a patient satisfaction of aspects which will be used for
designing a patient satisfaction measurement system.
This article presents a review of patient satisfaction theories and describes terms and concepts are
used to define patient satisfaction and their relationships. It helps to our further step to review
determinants, predictors, and factors of patient satisfaction. The research with a series of two articles
will shed light on the concept of patient satisfaction including the latest findings to bring it on a
further conceptualization

Organizational Factors Associated With Collaboration...
The purpose of this submission is to recommend, with supporting rationale, an appropriate
methodology to address the research question (RQ): What does the research evidence suggest are
the organizational factors associated with collaboration within Fortune 500 firms? The reader will
first find the Background that discusses items that should be considered when determining the
appropriate systematic review methodology, then there will be an analysis of the current question
using those considerations. The paper will end with a brief conclusion describing the findings.
Background
The systematic review approach chosen by those conducting a study is based on several dimensions.
These include the researcher's epistemology (Rousseau, Manning, & Denyer, 2008, pp. 485–487),
research study purpose (Gough, Oliver, & Thomas, 2012, p. 58), primary research question (Gough
et al., 2012, p. 58; Harden & Thomas, 2005, p. 266), purpose of the study (Gough et al., 2012, p. 76)
and the type of data available (Gough et al., 2012, p. 55). There is also the consideration of the
stakeholders and anticipated consumer of the report since culture and politics can influence the use
of the evidence that results from systematic reviews.
There are numerous specific systematic review methods described in the literature with each method
having a specific fit for purpose, appropriately considering the purpose of the reviews, the types of
questions to be answered, and evidence available for inclusion in

Advantages Of Star Model Of Evidence Based Practice
Introduction:
A model is a representation of concepts which are used to help people know, understand or simulate
a subject matter. Moreover, a model is used to create the various hypothesis which can be tested in
the laboratory or utilized for explaining a case study. The goal of this assignment is to explore three
models of evidence–based practice (EBP) that interest the authors and give a summary. Although
several models used in research, this paper will highlight three specific models and provide a
summary, strengths, weaknesses and a model that can be implemented in a particular practice.
ACE Star Model of Evidence–Based Practice:
The ACE Start Model of evidence–based practice developed at the University of Texas Health
Science ... Show more content on Helpwriting.net ...
The John Hopkins Nursing Evidence–Based Practice Model is a powerful problem–solving
approach to clinical decision making and is used in research. The model is designed to meet the
needs of the practicing bedside nurses and used a three step process called a PET, facilitating nurses
in translating evidence to clinical, administrative and education based on evidence. According to
Melnyk and Overholt (2015), there are three steps to the JHNEBP model. The first phrase is practice
questions: Identification of an EBP question and defines its scope. The second phrase is evidence of
internal and external evidence team determine if its feasibility to implement. The final phase is a
translation which includes recommended practice for changes and dissemination of findings.
ARCC Model of Evidence–Based Practice:
Compared and Contrast the three Models Strengths and Weaknesses:
Models are the conceptual framework that helps people to understand specific concepts. In
examining the three types of models, each presents a unique concept of understanding evidence–
based practice. The John Hopkins model integrates cultural values into evidence–based practice.
Furthermore, the main strength of this model is it provides a simple framework for nurses at the
bedside and incorporates internal and external factors that may affect research. On the other hand,

Rationale For Considering Values And Preferences
How the guideline panels use the information: rationale for considering values and preferences
Values and preferences impact the strength of recommendations, together with other factors. If the
variability exists for patient values, the strength of recommendation is weak, indicating
recommendations may not apply to specific patient subgroup. Guideline readers and clinical
practitioners need to pay special attention to weak recommendations and accompanying values and
preferences under these scenarios.2
The systematic review on utilities suggested major bleeding equivalent to nonfatal pulmonary
embolism; while intracranial bleed overall was 2 to 3 times worse than major bleed or pulmonary
embolism. This relative importance helps guideline panels to weigh the balance of benefits and risks
and make the decision accordingly. 16
Considered as significant factors in producing recommendations, the extent to which the values and
preferences vary and the extent to which the panellists are confident about the estimates and their
variation can influence the strength of the recommendation. If the patient values and preferences are
uncertain, or vary across different patient subgroups, the strength of recommendation should be
weak. Was there any recommendations influenced by local values and preferences
The local values and preferences contributed to the formulating of recommendations. Since "there is
an important variability about how much people value its (sublingual immunotherapy)

Critical Review of Meta Analysis
A Critical Review of Meta–Analysis
Abstract
Meta–analysis has been much debated and criticized since its creation, and it has been argued that
systematic reviews are superior. The present study examined the reverse idea – that meta–analysis is
the superior method. A literature search was conducted of meta–analysis studies for psychotherapy
within the PsycINFO database. The resulting studies were further examined and classified as either
primary articles or secondary articles. Primary articles were further examined for secondary articles
associated with them. It was found that there was some criticism within the literature. The results
were compared to a study of systematic review literature conducted at the same time. The ... Show
more content on Helpwriting.net ...
As with any other process, meta–analysis has several disadvantages or weaknesses. It's been argued,
for example, that one of the weaknesses of meta–analysis is associated with the fact that it requires a
great amount of effort and expertise, and that currently there is a major drawback in the research
community of those who conduct them (Berkeljon & Baldwin, 2009). Lipsey & Wilson (2001) also
argued that meta–analysis often 'loses' a lot of valuable qualitative data (for example, the social
context of the study) because it aggregates only quantitative data. It is further argued that the
exclusion of such data may sometimes interfere with the process of arriving at the right conclusion
(Lipsey & Wilson, 2001). Other authors also argue that meta–analysis includes a mix of different
studies in a single review which could be very problematic (Berkeljon & Baldwin, 2009). For
example, Glass, McGraw & Smith (1981) referred to this as the "apples and oranges" problem,
arguing that different treatments and measures are given the same weight, when, in fact, they are not
always the same. This, Glass, McGraw, and Smith claimed, can result in a misrepresentation of the
measures used in each study, as well as their level of contribution to the review, which would skew
the results. Lastly, the weaknesses of meta–analysis have been noted by others to stem from the fact
that if poor quality studies or

The Effects Of Sucrose On Pain
decreases pain is unknown. However, theory supported in animal studies shows the analgesic effects
of sucrose can be reversed by using naltrexone. Further studies show that infants who were born to
mothers being treated with methadone did not demonstrate the same analgesic effects from sucrose.
These findings are essential in demonstrating that the decrease in pain is not similar to the response
elicited by non–nutritive (NNS) sucking and decrease pain through activation of a different
neurological pathway. The main point is the effect of sucrose on pain relief is linked to the
sweetness of the solution, as seen with other sweetening solutions such as glucose (McCall,
DeCristofaro, & Elliott, 2013).
The intended handlers for this intervention ... Show more content on Helpwriting.net ...
Inclusion criteria were children less than 1 year of age. The initial search returned 12 results. The
search was furthered by including randomized control trials that returned seven results including a
randomized control trail by Hatfield, 2008. This randomized control trial is considered Level II
evidence in the hierarchy of evidence for intervention and treatment questions (Melnyl & Fineout–
Overholt, 2015). This specific RCT was chosen from the seven because it discussed immunizations,
sucrose as the intervention and the focused population (1–12 month infants) where the others did
not. The database was searched for main terms for information on the related topic included oral
sucrose, infants, and immunizations. Alternative terms included oral sweeteners, neonates, needles,
and analgesia. MeSH terms included Needles*, Sucrose/*administration & dosage, Pain/*prevention
& control, Punctures/*adverse effects, Sweetening Agents/*administration & dosage, Humans;
Infant; Randomized Controlled Trials as Topic. Inclusion criteria included infants < 1 year of age,
publication dates: 2005–2016, randomized control trial, systematic review, USA, glucose/sucrose,

Systemic Review
Appraisal of Systemic Review
Healthcare workers, especially nurses, have for ultimate goal to provide the best care possible for
patients. Caring for patients does not only include making sure that they are safe and well–taking
care of but it also requires for nurses to act as patients' advocate and ensure that the best methods are
used to provide care. Nurses contribute to ensuring that the patients are as comfortable as possible
and help prevent or reduce pain as much as they can (Dearholt.& Dang, 2012, p. 12P). People have
a different reaction to pain. For some patients being pain–free might be one their ultimate goal while
they are in the hospital and if a nurse can help achieve that goal that will significantly contribute in
making the ... Show more content on Helpwriting.net ...
This rating scale is used to determine whether or not research is worth putting into practice. During
the appraisal of research, there is a different level of evidence that is taking into consideration. There
is three quality rating with five different categories. The quality rating is graded from high, good,
and low or major flaw level of evidence. A high–quality research requires the study to be well
structured and organized with all the necessary elements and definite conclusion. Research is
considered good when the result is within normal limits and the conclusion although not conclusive
can lead to more research. Lastly, a low–quality rating did not provide much information and stayed
inconclusive (Dearholt.& Dang, 2012, p. 12P). There is five level of evidence in which research can
fall under. The level is from I to V. the level I includes all systematic review researches that are
experimental with a randomized controlled trial. These researches might be randomized with or
without meta–analysis.
Level II includes all the systematic review that are quasi–experimental studies. These researches
might be with or without

Freedom Therapy : A Psychological Intervention For People...
Chapter 1– Introduction
Dignity therapy was developed by Dr. Harvey Max Chochinov in Canada and it is a psychological
intervention for people facing serious illness; focuses on dignity conservation tasks and address their
emotional and existential need for the end of life patients (Fitchett et al, 2015). In dignity therapy
patients completed systematic life review that captured the loveliest and most important moment,
the lesson they have to learn in life and any dreams and hopes they haves for their loved one in the
future. And the life systematic review is recorded, transcribed and edited to create an official legacy
document, and it is can be given to patients as a gift and it can be bequeathed to patient's families as
a remembrance. ... Show more content on Helpwriting.net ...
Both physical and psychological lose that leads patient losing dignity. Chochinov et al (2002)
describe a model of dignity that is related concerns (symptoms, psychological distress, uncertainty,
death anxiety, and independent). How to address the psychological problem of patients with end of
life and protect and respect patient's dignity are required in professional nursing care, this is related
to NMC (2015) code that all registered nurses should respect patient as an individual and promote
and protect the dignity of patients. Also improving the care of the dying is one of the most important
priorities in NHS (DH, 2008).
RCN (2008) highlights dignity is concerned with how people fee, think and behave in relation to the
value of themselves and others. To treat the patient dignity the way that is respectful of them as
valued individuals in a non–judgemental environment. People received palliative care are one group
who may have particularly sensitive needs in term of their condition, symptom, psychological
problem and life expectancy (Gustafsson et al, 2014). As the health

The Process Of Carrying Out A Search Strategy
In the process of carrying out a search strategy, a number of measures usually taken into
consideration. First and foremost, identification of the question is crucial as it enables one to
translate natural language terms to subject descriptors and MeSH terms. In the process of
conducting the search, it is important to begin the search with the letters P and I, bearing in mind
that the search results should be initially kept abroad. In the database search, there should be
inclusion of cross infection (and other searches related to hospital acquired infection and the use of
antibiotics). The search strategy should also include sites such as CINAHL and Medline/PubMed as
initial article databases used in scoping search for various health ... Show more content on
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Depending on the research question, the aim of the study can be achieved through adoption of
different population sample, new conceptual frameworks, various techniques, or trying to link
different studies where the outcomes did not provide solutions to the problem. The goal of the
literature review is to determine the kind of search that has been carried out in line with the present
research. In recognition of this approach, the study of various articles to provide evidence of the
health challenge. There are four categories of literature reviews employed in the study. They
include: those that analyze health systems written for the perspective of comprehensive resources;
synopses which mainly allow for the extraction of high–quality information mainly in the form of
abstracts; syntheses which involve systematic reviews and; studies on the actual research question.
Some of the two research evidence sources that were considered for the study include: Bettany–
Saltikov, J. (2012) How to do a systematic literature review in nursing: a step–by–step Guide.
Maidenhead: McGraw–Hill/Open University Press. This article was used in understanding some of
the various categories of literature reviews that can be used expound on the present research
question. The other article is: Rice, H. E., Englum, B. R., Gulack, B. C., Adibe, O. O., Tracy, E. T.,
Kreissman, S. G., & Routh, J. C. (2015). Use

Example Of Decision Analytic Models
Decision analytic models are used to examine cost effectiveness of healthcare interventions. These
models summarise available evidence succinctly for analysis. When there is a lack of observed
evidence, expert opinions on the mean or median values (occasionally the minimum and maximum
range) for the parameter of interest are commonly used. This does not provide sufficient information
to examine whether the distribution of uncertainty surrounding the parameter of interest is
representative of the expert's opinion. As this is a key component in Probabilistic Sensitivity
Analysis (PSA) commonly used in decision analytic models, as recommended by NICE(1), there is
need to ensure the appropriate distribution of parameter uncertainty to ... Show more content on
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This systematic review by Grigore et al(2) highlighted the need for guidelines to critically appraise
elicitation exercises and suggested for more research to define these measurement criteria. The
authors proposed that until a definitive checklist is developed, the validity and reliability of the
elicitation exercise should always be reported explicitly.
Following this 2013 systematic review, the same authors published an article in 2016, on a study
that compared the results for two commonly used elicitation methods, the histogram and hybrid
methods(3). This study had the following 3 objectives
1) Examine how these two methods appealed to the experts,
2) Determine if there were any differences in the elicited distributions and;
3) Compare the impact of the elicited distributions on an actual decision model
The study results showed that
1) Generally, the experts found the histogram method easier to use compared to the hybrid method
although the two elicitation methods were closely ranked by the experts in terms of ease of use and
face validity
2) The distributions from the histogram method were slightly narrower than the distributions from
the hybrid method, suggesting greater certainty when aggregated.

Assignment : Evidence Based Practice, Research, And...
Intensive Alternate Assignment: Evidence–Based Practice, Research, and Quality Improvement This
paper will address content covered in the Intensive session that occurred in Austin on September 12,
2014. It is an alternate assignment designed to replace classroom instruction and forum exercises of
that day. Evidence–Based Health Care Evidence–based health care is the "conscientious use of
current best evidence in making decisions about the care of individual patients or the delivery of
health services" (Cochrane, 2014). Best evidence is based on current information from relevant,
peer–reviewed research that can include such topics as the effects of health care, the potential for
harm, the accuracy of diagnostic tests, and the reliability of prognostic factors (Cochrane, 2014).
Several different scales exist to quantify and assess this evidence, such as the one used by the U.S.
Preventive Task Force (USPSTF, 2012). For purposes of the DNP program, the scale utilized by the
Joanna Briggs Institute is more applicable (JBI, 2013, pdf). The JBI Grades of Recommendation
consist of an "A" grade and a "B" grade. An "A" grade signifies a strong recommendation based
desirable effect, adequate supporting data, beneficial of low impact to resource utilization, and that
values, patient experience, and preferences have been considered. A "B" grade signifies a weak
recommendation where it is unclear if desired effect outweighs undesired effect, the supporting
evidence is not of high

Systematic Review Essay examples
Systematic Review
NUR/518
University of Phoenix
Systematic Review The purpose of a systematic review is to attempt to find, evaluate and synthesize
high quality research relevant to the research question. A systematic review uses carefully developed
data collection and sampling procedures that are put in place in advance as a protocol. (Polit, 2012).
A systematic review must contain the following: a clear inclusion and exclusion criteria, an explicit
search strategy, systematic coding and analysis of included studies, and a meta–analysis if possible.
(Hemingway & Brereton, 2009). Systematic reviews are conducted by nurse researchers to avoid
reaching incorrect or misleading conclusions that ... Show more content on Helpwriting.net ...
(Bae, 2011).
Seven studies used the Practice Environment Scale of the Nursing Work Index to measure nurse
working conditions, one used the Work Environment Survey, and the remaining three used a variety
of instruments from prior studies.
In examining the association between working conditions and patient outcomes, the eleven studies
contained a total of fourteen different patient outcome variables. The association between autonomy
and patient outcomes were examined in two studies. Six studies measure the philosophy
emphasizing the quality of clinical care and the association with patient outcomes.
Nurse participation was examined in regards to the relationship between nurse participator and the
patient outcomes, as well as the association between supportive managers and patient outcomes.
Other areas that were examined were collaborative relationships with physicians, supportive
relationships with peers, staffing and decentralization, patient–centered climate and busyness.
The findings of this systematic review suggest that evidence supporting a positive relationship
between better nurse working conditions and improved patient outcomes is

CRITICALAPPRAISAL OF A SYSTEMATIC REVIEW AND
NARRATIVE...
CRITICAL APPRAISAL OF A SYSTEMATIC REVIEW AND NARRATIVE REVIEW RELATED
TO COMPUTERISED PHYSICIAN ORDER ENTRY SYSTEM
The author of this paper is a nurse educator working in an Intensive Care Unit (ICU) within the
north–west region of England. For the purpose of this paper, the author has chosen a systematic
review (SR) and a narrative review (NR) and aims to critically analyse these reviews using the
Critical Appraisal Skills Programme (CASP) tool. The CASP tool has been developed by the
Solutions for Public Health (SPH) (formerly known as Public Health Resources Unit), which is
controlled by the National Health Service (NHS) (SPH, 2006). The tool is based on the guidelines
formed by a group of clinicians at McMaster University, Canada ... Show more content on
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The author feels that using two different tools would increase the rigour of the appraisal and its
relevance to practice. In the forthcoming sections of this essay, the author will attempt critically
analyse the two papers using the CASP tool for SRs.
Formulation of the research question
Formulation of the research question guides the type of data collection for the study and states what
the study will 'hypothesise' (Polit and Beck, 2010). The CASP tool acknowledges that clearly–
focused research question will describe the population studied, the intervention given and the
outcomes considered (SPH, 2006). The research question in the SR is clearly formulated. The
population of patients studied were general and critically ill hospital patients, the intervention was a
SR and outcome to be assessed was about the safety of the CPOE and clinical decision support
systems or CDSS (CDSS is a computerised medication prescription system) based on hierarchy of
outcome measures (kindly refer to table 2 of SR) within ICU settings. Likewise, in the NR, the
population of patients studied were general and critically ill patients, the analysis was done via a NR
and the purpose of the study was to assess the results of CPOE on clinical and surrogate outcomes in
hospitalised patients in both general and critical care settings.
Based on this, the author acknowledges that the SR has adopted a narrow and more specific research
question as

The Effects Of Deep Breathing Exercises On The Prevention...
PICO question: How does the use of incentive spirometers compare to the use of deep breathing
exercises in the prevention of pulmonary complications in post–operative, hospitalized patients?
Background and Rationale: Currently, postoperative pulmonary complications "account for about
25% of deaths occurring within 6 days of surgery," (Yoder, M 2015). Post–operative pulmonary
complications (PPCs) are of major concern due to the increased length of hospital stays and high
rates of occurrence and death as a result. Those at greater risk of developing a pulmonary
complication include preexisting lung disease, medical comorbidities, poor nutritional status, overall
poor health, and in those who smoke. (Yoder, M, 2015.) The type of surgery the patient is having
also affects the risk. Complications include, but are not limited to, pneumonia, bronchospasm,
respiratory failure and prolonged mechanical ventilation. The development of such complications
negatively affects the expected outcomes for patients. "The basic mechanism of PPCs is a lack of
lung inflation that occurs because of a change in breathing to a shallow, monotonous breathing
pattern without periodic sighs, prolonged recumbent positioning and temporary diaphragmatic
dysfunction. Mucociliary clearance along with the decreased cough effectiveness, increases risks
associated with retained pulmonary secretions, " (Overend, T., Anderson, C., Lucy, S., Bhatia, C.,
Jonsson, B., & Timmermans, C., 2001). Currently,

Advantages And Disadvantages Of Systematic Review
Introduction and Statement of the problem
The most important criterion that distinguishes and characterizes systemic reviews from other
narrative reviews is "being comprehensive ". That's why developing an explicit and comprehensive
search strategy is considered a must and an indispensable step of systematic reviews, failure to attain
such step through searching all available channels of information is a potential threat to the validity
of the systematic review.
The information sources for systematic review comprise three main fold:
Academic bibliographic databases
Hand searching for printable journals, conferences and databases.
Informal channels for further data searching.
Limitations of quick searches:
Searching only one academic database suffers major shortcomings. First, that won't ensure retrieval
of all relevant literature, according to previous study only 30–80 % of the available studies will be
retrieved during searching a single database. Second, most databases tend to publish studies which
shows effectiveness of interventions, not adverse effects. And finally databases like Medline for
example English articles represent most of the indexed studies. To sum up searching a sole data
bases will ends up with a systematic review that suffers selection bias, language bias and publication
bias.(Suarez–Almazor, Belseck, Homik, Dorgan, & ... Show more content on Helpwriting.net ...
Considering it's ease of use, simplicity and capability of obtaining a great number of relevant studies
in a minimum time. It's worth noting that electronic searching should be pertained mainly to
academic databases like PubMed and Cochrane central. The use of search engines like Google
scholar, Intute and TRIP or publisher's website as springer link and science direct should limited.
Making a systematic review from articles obtained from such sources will surely suffer publication
and selection bias.(Higgins & Green,

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