Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze 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 2: 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. CORE SKILL: reading the EVIDENCE HIERARCHY correctly — and understanding that the hierarchy ranks designs by ability to control BIAS, not by importance or truth.
THE HIERARCHY, from strongest to weakest for questions of INTERVENTION EFFECTIVENESS: systematic reviews and meta-analyses of RCTs → individual RCTs → controlled trials without randomization / quasi-experimental → cohort and case-control → systematic reviews of descriptive/qualitative studies → single descriptive or qualitative studies → expert opinion. (Melnyk & Fineout-Overholt’s seven levels is the version most nursing programs use; the JHNEBP and the Oxford CEBM hierarchies are alternatives.)
THE CRITICAL QUALIFICATION that separates a sophisticated paper from a rote one: THE HIERARCHY IS QUESTION-DEPENDENT. It ranks designs for CAUSAL questions about intervention effect. For a question about MEANING or EXPERIENCE (“what is it like to live with a colostomy?”), a phenomenological study is the HIGHEST level of evidence and an RCT is useless. For PROGNOSIS, cohort studies sit at the top. Applying the intervention hierarchy to a qualitative question is a category error. Saying this explicitly demonstrates that you understand the hierarchy rather than merely reciting it.
DISTINGUISH THE REVIEW TYPES — students conflate these constantly and rubrics punish it:
— SYSTEMATIC REVIEW: a PROTOCOL-DRIVEN, reproducible search with pre-specified inclusion/exclusion criteria, formal quality appraisal, and (usually) two independent reviewers. Follows PRISMA reporting. It is a research study in its own right, with the literature as its dataset.
— META-ANALYSIS: the STATISTICAL POOLING of results from multiple studies to produce a summary effect size. Not all systematic reviews contain a meta-analysis (pooling is inappropriate when studies are too heterogeneous — assessed with I²). Read the FOREST PLOT: each study’s effect and confidence interval, the diamond as the pooled estimate, and the line of no effect.
— LITERATURE / NARRATIVE REVIEW: no protocol, no systematic search, selection at the author’s discretion. Useful for background; HIGHLY SUSCEPTIBLE TO SELECTION BIAS and NOT a high level of evidence.
— SCOPING REVIEW: maps the extent and nature of a literature; used when the body of evidence is heterogeneous or emergent; does not typically appraise quality.
— INTEGRATIVE REVIEW: allows inclusion of both experimental and non-experimental studies; common in nursing.
KEY THREATS TO EVIDENCE QUALITY: PUBLICATION BIAS (positive results are more likely to be published — assess with a funnel plot); heterogeneity; small-study effects; conflicts of interest and industry funding; outcome switching; and underpowered studies.
GRADE is the modern framework for rating certainty of evidence (high/moderate/low/very low) and strength of recommendation — knowing that GRADE has largely superseded simple pyramids in guideline development is a mark of currency.
FOR THE ASSIGNMENT: identify a clinical issue, search systematically (name the databases — CINAHL, MEDLINE/PubMed, Cochrane, Joanna Briggs), document your search strategy and filters, and explain how you ASCENDED the hierarchy toward the strongest available evidence.
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