Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews
DUE DATE:
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyse the evidence you have collected.
To Prepare:
• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
Instructor additional email.
Hi all! This week you should continue to work on your power point assignment. Please be sure to review the rubric and instructions carefully as you develop your power point. I have copied the assignment guidelines here with a brief explanation to help clarify the expectations.
Create a 6- to 7-slide Power Point presentation in which you do the following:
Identify and briefly describe your chosen clinical issue of interest. What is your topic? Why is it important to nursing practice?
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. What is the PICOT question? How was it developed? What information from the literature supports the need to answer the question? Why is this the best question to address the issue you’ve identified?
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. Summarize each article. Synthesize the information. What are common themes? What are some major differences in their findings?
Provide APA citations of the four peer-reviewed articles you selected. Be sure to use proper in text citations and cite correctly on the reference page.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. In your summaries, include this information. Where did the study fall in the hierarchy of evidence? What were the identified strengths and limitations of the study? What are the strengths of using systematic reviews?
Be specific and provide examples. This is important! Be sure to elaborate, add examples and details to support your assertions. Pretend the reader (me) is unfamiliar with your topic. The examples are what helps the reader understand what you are trying to say.
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
• Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)
• Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp
Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp
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Opioid Addiction and Management in United States
Opioids are a class of drugs that include both as a prescription pain medicine and also as an illegal drug such as heroin. Though opioid is described as a pain killer its continuous usage can lead to unprecedented outcomes such as dependency or even addiction. It is associated with increased mortality and a range of mental and general medical comorbid disorders. Moreover, it is one of the most abused drug in the united states, become a national crisis.
According to Gust and McCormally (2018), on average more than 90 Americans die every day due to opioid overdose and more than 2 million Americans abuse it. When proper medication is given, it improves outcomes, fosters recovery, and reduces addiction. As a clinician, conceptualizing the causes of off opioid addiction will not only allow me provide the patient with proper medication but also offer appropriate interventions that will sustain remission and even prevent relapse.
Peter a 21 year old boy was admitted to our facility of opioid addition. He was transferred from another hospital where he was receiving methadone maintenance therapy alone. Her mom was advised to bring Peter to our facility since we offer both MMT and psychosocial support as an intervention to opioid addiction to see whether her sons condition will become better faster.
P – Patient/problem: Young adult
I – Intervention: Methadone maintenance therapy (MMT) in conjunction with psychosocial support
C – Comparison: MMT only
O – diagnosing: Diagnosing opioid addiction
There are many literatures that have delved into finding MMT’s effectiveness when used in conjunction with psychosocial support; this makes the picot question above be an area of interest as it will be seen in the next slides.
The study participants were assigned standard MMT(n=31), and others used both standard MMT in conjunction with CBT(n=29) randomly. During the six-month study period, CBT participants attended a 50-minute session, 24 in number, and receiving standard MMT. This study showed no significant difference between the groups on the daily usage of heroin, psychological symptoms, psychological problem severity, MMT compliance and quality of life. However, CBT clients showed a significant improvement in their complimentary appraisal (p=0.2) in a six-month assessment and a lower emotional discharge within an assessment period of 12 months(p< 0.05) than MMT participants.
The study used concerned significant other (CSOs) and identified participants (IPs) to escalate care retention and recovery support. Further, opioid-dependent adults who took part in buprenorphine-detoxification, together with their CSO, were given CRAFT-Intervention (n-28 dyads). During this intervention, IP and CSO were led by a therapist for two joint sessions. After that, CSO joined the therapist for another ten-session individually. These study’s focus was to identify the number of days to IP, not finishing treatment. The secondary focus was on the number of days of IP opioids and other drug usages. This study showed that CRAFT participants who had parental family CSOs had higher treatment retention compared to nonparental family CSO. The IPs assigned to the CRAFT group showed a higher reduction in the usage of opioids and other similar drugs(both P’s < 0.0001).
MI is focused on reducing drug usage that is delivered in individual sessions, group sessions, and non –MI Nurse-led Hepatitis health promotion.
On each of the programs three sessions were provided to clients and for HBV-Seronegative participants they were given a series of hepatitis A and B vaccinations. The result of this study found that there were no significant difference in drug usage during and after the intervention. However, after six-month follow-up(p=0.003) MI that was delivered individually and also in group showed a decreased self-reported drug usage.
The participants were randomly assigned to three different sites to receive the usual medical intervention. The MMT participants received regular weekly urine testing for opioids, physical examination, and daily supervised methadone. For the CM participants, in addition to the usual care, they were asked to attend MMT on consecutive days and they were required to provide negative urine specimens for a prize. The prices were expected to increase the more the participant provided drug-negative urine and also an increased attendance. From this study, the CM patients had higher rates of MMT completion and treatment attendance compared to the MMT participants(P<0.05). Further, CM
participants submitted a more significant percentage of urine that were opioid free compared to MMT (p = 0.05).In addition to these, CM participants had a longer duration of continued abstinence.
It can be concluded that conducting a systematic review offers a critical way of identifying the most effective ways in which psychological treatment, in conjunction with MMT, can be used to enhance the health and well being of individuals suffering from opioid addiction.
References
Brigham, G. S., Slesnick, N., Winhusen, T. M., Lewis, D. F., Guo, X., & Somoza, E. (2014). A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification. Drug and Alcohol Dependence, 138, 240-243.
Gust, S. W., & McCormally, J. (2018). National Institute on Drug Abuse International Program: improving opioid use disorder treatment through international research training. Current opinion in psychiatry, 31(4), 287.
Hser, Y. I., Li, J., Jiang, H., Zhang, R., Du, J., Zhang, C., … & Peng, C. (2011). Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China. Addiction, 106(10), 1801-1809.
Kouimtsidis, C., Reynolds, M., Coulton, S., & Drummond, C. (2012). How does cognitive behaviour therapy work with opioid-dependent clients? Results of the UKCBTMM study. Drugs: education, prevention and policy, 19(3), 253-258.
Nyamathi, A. M., Nandy, K., Greengold, B., Marfisee, M., Khalilifard, F., Cohen, A., & Leake, B. (2010). Effectiveness of intervention on improvement of drug use among methadone maintained adults. Journal of Addictive Diseases, 30(1), 6-16.
