Draft Literature Synthesis Synthesize at least 10 no more than 5 years old (attached) primary research studies and/or systematic reviews; do not include summary

The evidence type (study design) is almost always identified in the article abstract or in other cases the methods section of the article. Read through the description of how the study was conducted in the methods section to determine the evidence type.

Level and Type of Evidence: *(For your synthesis Only use Level I, II, OR III Evidence).

I – Experimental (RCT, Systematic review of RCTs with or without meta-analysis)

II – Quasi-experimental (some cohort studies, time series, systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only with or without meta-analysis

III – Non-experimental (mostly: Correlation, cross-sectional, observational studies, case-control, case series, prospective cohort, psychometric instrument testing), systematic review of a combination of RCTs, quasi-experimental, and non-experimental, or non-experimental studies only with or without meta-analysis; Qualitative study or systematic review with or without a meta-synthesis; many higher level qualitative studies include the type of qualitative study that was conducted in the title of the article (phenomenology, ethnography, grounded theory, heuristic study, etc.).

IV- Expert opinion, nationally recognized expert committees/panels based on scientific evidence (clinical practice guidelines and consensus panels

V – Non-research based (experiential) (Literature reviews, Integrative reviews, quality improvement (program or financial evaluation), case reports, opinion of nationally recognized experts based on experiential evidence.

The evidence level:

The evidence level for Level I, II, and III can quickly be determined by asking a few key questions as illustrated on the following website: https://libguides.ohsu.edu/ebptoolkit/levelsofevidence.

Level IV and V are much easier to distinguish. Level IV articles are not very common with the search strategies you should be using.

Level IV involves publications about clinical practice guidelines or position statements from consensus panels.

For Level V evidence articles, the lower level qualitative studies often have the type of project in their title, including narrative model, case study model, case report, and historical model. Literature reviews and Integrative reviews (also Level V) are also easily identified.

Please review your literature appraisal contained in the Johns Hopkins Table for accuracy, and remember, there should be no clinical guidelines, sets of clinical recommendations, nor position statements, placed in your JH Table. Please let me know if you have any questions about how to appraise your evidence sources (articles).

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Literature Synthesis Draft

This week a draft of the literature synthesis is due. Please follow the examples below when writing your draft. Please use the literature synthesis table to summarize the manuscripts used to support your evidence-based intervention. The table will be an appendix to your final paper. Consider organizing this section through use of themes inherent in the literature. For example, if you are focusing on falls prevention, organize this section as demonstrated below through use of level II headings such as:

Falls Prevention: Hourly Rounding Process

Falls Prevention: Team Huddles

Falls Prevention: Additional Strategies

The following are the requirements for the literature synthesis and Johns Hopkins Evidence Table as spelled out in the rubric:

Literature Synthesis Requirements: 

1. Identifies search strategy utilized to identify sources to include appropriate databases such as CINAHL, Cochrane, and PubMed. Do not use Google Scholar or general search engine. Discusses key words utilized including combination of keywords, total articles found and inclusion/exclusion criteria to narrow search.

2. Synthesizes 10-12 research articles that are Evidence Level 1, 2 or 3 to support your evidence-based intervention. Describe how the intervention has been utilized to solve a similar problem by defining common themes found in the literature.

3. References are less than 5 years old (unless seminal) and professional. PermaLink of all articles is attached.

Literature synthesis table:

1. Completed with evidence level and quality (High, Good, Low or major flaws) identified for each article, including the appropriate appraisal of the level of evidence.

2. Identifies appropriate study design (levels I, II, OR III).

3. Accurately assesses how the article can inform the project. If the article does not inform the project, then it should not be used.

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These are possible references to use (from the DNP proposal). No clinical guidelines or articles do not inform evidence that can’t be used. Feel free to use it or add anyone that you found pertinent.

References

Arocha Rodulfo J. I. (2019). Sedentary lifestyle a disease from xxi century. Sedentarismo, la enfermedad del siglo XXI. Clínica e investigación en arteriosclerosis: publicación oficial de la Sociedad Española de Arteriosclerosis, 31(5), 233–240. https://doi.org/10.1016/j.arteri.2019.04.004

Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C. (2019). Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity. Journal of the American Association of Nurse Practitioners, 31(9), 505–510. https://doi.org/10.1097/JXX.0000000000000169

Bergum, H., Sandven, I., & Klemsdal, T. (2021). Long-term effects (>24 months) of multiple lifestyle interventions on major cardiovascular risk factors among high-risk subjects: A meta-analysis. BMC Cardiovascular Disorders, 21(1). https://doi.org/10.1186/s12872-021-01989-5

Bray, G. A., & Ryan, D. H. (2021). Evidence-based weight-loss interventions: Individualized treatment options to maximize patient outcomes. Diabetes, obesity & metabolism, 23 Suppl 1, 50–62. https://doi.org/10.1111/dom.14200

Brickwood, K. J., Watson, G., O'Brien, J., & Williams, A. D. (2019). Consumer-based wearable activity trackers increase physical activity participation: Systematic review and meta-analysis. JMIR mHealth and uHealth, 7(4), e11819. https://doi.org/10.2196/11819

Carbone, S., Lavie, C. J., Elagizi, A., Arena, R., & Ventura, H. O. (2020). The impact of obesity on heart failure. Heart Failure Clinics, 16(1), 71–80. https://doi.org/10.1016/j.hfc.2019.08.008

Følling, I. S., Oldervoll, L. M., Hilmarsen, C., & Ersfjord, E. (2021). A qualitative study explores the use of activity monitors for patients with obesity during weight-loss treatment. BMC sports science, medicine & rehabilitation, 13(1), 25. https://doi.org/10.1186/s13102-021-00253-9

Gal, R., May, A., van Overmeeren, E., Simons, M., & Monninkhof, E. (2018). The effect of physical activity interventions comprising wearables and smartphone applications on physical activity: A systematic review and meta-analysis. Sports Med Open, 4(1). https://doi.org/10.1186%2Fs40798-018-0157-9

Hall, K. D., & Kahan, S. (2018). Maintenance of Lost Weight and Long-Term Management of Obesity. The Medical clinics of North America, 102(1), 183–197. https://doi.org/10.1016/j.mcna.2017.08.012

Hu, L., Illiano, P., Pompeii, M. L., Popp, C. J., Kharmats, A. Y., Curran, M., Perdomo, K., Chen, S., Bergman, M., Segal, E., & Sevick, M. A. (2021). Challenges of conducting a remote behavioral weight loss study: Lessons learned and a practical guide. Contemporary Clinical Trials, 108, 106522. https://doi.org/10.1016/j.cct.2021.106522

Lavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T., & Blair, S. N. (2019). Sedentary behavior, exercise, and cardiovascular health. Circulation Research, 124(5), 799–815. https://doi.org/10.1161/CIRCRESAHA.118.312669

Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., Ross, H. M., McIlvenna, Y., Stefanetti, R., Trenell, M., … Taylor, R. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomized trial. Lancet (London, England), 391(10120), 541-551. https://doi.org/10.1016/S0140-6736(17)33102-1

Prabhakar, O., & Bhuvaneswari, M. (2021). Role of diet and lifestyle modification in managing nonalcoholic fatty liver disease and type 2 diabetes. Tzu Chi Medical Journal, 33(2), 135-145. https://www.tzuchi.com.tw/medjnl/files/2021/vol-33-2/2021-33-2-135-145.pdf

Swift, D., McGee, J., Earnest, C., Carlisle, E., Nygard, M., & Johannsen, N. (2018). The Effects of Exercise and Physical Activity on Weight Loss and Maintenance. Progress in Cardiovascular Diseases, 61(2), 206-213. https://doi.org/10.1016/j.pcad.2018.07.014 Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235–251. https://doi.org/10.1037/amp0000517

Vandelanotte C, Duncan M, Maher C, Schoeppe S, Rebar A, Power D, Short C, Doran C, Hayman M, Alley S. (2018). The effectiveness of a web-based computer-tailored physical activity intervention using Fitbit activity trackers: Randomized trial. Journal of Medical Internet Research. https://www.jmir.org/2018/12/e11321?rel=0

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Example Template for Literature Synthesis Paper due Week 4:

Hi all,

I have had several good conversations with some of you regarding how to pull together your Lit. Synthesis. To make things easier, here is an additional template outline I can suggest which meets all criteria in the grading rubric. I would suggest working on your JH table first, so that you are immersed in all the results, and then writing your paper.

Very Important: Be sure that you have a core of at least 8 studies in your JH Table that are Level 1, 2 or 3 per the JH Appraisal definitions; then 2 additional studies may be qualitative studies, for a total of 10 core studies to support your work. In addition, of course, you will have any clinical guidelines you are following as additional references, and perhaps some CDC, HRSA, AHRQ, ADA, AAP, or other professional body type of references, but these should not be listed in your JH Table.

Here is an example:

                                        Title Page (comes first) – full page

Implementation of a Type 1 Diabetes Support Group in a High School Setting

                                                Student Name

                                      Course Number & Name

                                       Etc. Per APA title page

Top of next page:

                                           Literature Synthesis

  Implementation of a Type 1 Diabetes Support Group in a High School Setting 

Introduction (left-aligned)

          This is the problem statement similar to your Project Navigation form, a paragraph or two here is fine…………….Why do teens with T1DM need support groups? Why is your project important?

PICOT  (restate PICOT here)       

          In school aged students grades 9-12 with Type 1 Diabetes, what is the impact of a peer support group for Type 1 Diabetic Students on improving their self-management of diabetes as measured by the Type 1 Diabetes Self-Management Questionnaire (DSMQ) compared with those without a school support system over a 10-week period?

Search Methodology

            Description of your search method, criteria, search terms and results go here (refined from DB #2).

 

Review of the Literature (this is the main section)

 

Type 1 Diabetes and It's Impact on High School Students (Subheading 1) (Make this first subheading a logical pick that you will build upon with the next subheadings; i.e., if several research teams found common issues that drive the current problem in particular, start with that subheading topic; be sure for each section and for each sentence, that you cite multiple ref.s appropriately in parentheses at the end; using this style improves flow rather than trying to begin all your sentences with authors' names).

           

          Start with a very broad, "juicy" topic sentence based on similar results or commonalities from multiple studies; An example topic sentence for the first paragraph is from my talk with Ashley, here is the brainstorm: "Based on a review of the literature, several studies revealed that teens with type 1 diabetes (TID) often feel bullied or excluded from activities at school." Then go on to discuss and summarize all the similar results and outcomes from these studies in successive sentences, and then also any unique results from perhaps just 1 or 2 studies. [This is what you would call a "Problem" subheading]

 

Potential Benefits of Support Groups (Subheading 2) (Introduce the next logical subtopic here): 

           Start with another very broad, "juicy" topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: "There are many benefits to the implementation of support groups that have been reported for teens with TID and other illnesses to help them adjust well and feel more included at school." Then go on to discuss and summarize all the similar results from this group of studies with similar results in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution subheading]

 

Parents of T1D Students Need Support Too (Subheading 3) (Introduce the next logical subtopic here): 

            Start with another very broad, "juicy" topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: "In addition to the need to support teens who have been diagnosed with TID and who are feeling excluded and unsure about self-management of their diabetes, several studies have revealed that parents of children with TID also need to be heard and supported in regard to learning how to support their teen in self-managing their TID at school." Then go on to discuss and summarize all the similar results from this group of studies in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution subheading]

Anywhere from 2 – 4 subheadings is likely to suffice for your paper, depending on the evidence you have found 🙂

Then – 

Conclusions

          Wrap up your findings in broad strokes and finish with mentioning the intervention you will implement to address these evidence-based issues and concerns.

Note that this will then flow beautifully into your next paper, which is your Week 5 Assignment:

               Evidence-Based Intervention

 Ok, to be continued for your next paper — I hope this outline is helpful!

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Literature Synthesis (Previous work).

Student

University

NR

July 12, 2022

 

 

 

 

 

 

 

 

 

Literature Synthesis

Introduction

Obesity is a chronic condition linked to multiple public health concerns causing higher mortality and morbidity rates (WHO, 2021). Evidence-based studies by several experts have recently revealed that diet, lifestyle changes, and physical activity are practical body weight management approaches that can significantly impact patients' health outcomes (Bray & Ryan, 2020; Brickwood et al., 2019; Følling et al., 2021).

PICOT question:

In overweight adult patients in a primary care clinic, what is the impact of implementing the American Heart Association Diet and Lifestyle recommendations, compared to standard care, on body weight in 8-10 weeks?

Research Methodology

           The literature search focused on key concepts related to obesity complications, diet, lifestyle changes, physical activity intervention using Fitbit activity trackers, and physical activity benefice for patients. These major topic areas were obesity self-management, obesity management and care in primary care, and the standards of care for obesity.

Keywords and Search Terms

Simple Terms:

Obesity care

Obesity complications

Lifestyle recommendations

Obesity management

Physical activity intervention using Fitbit activity trackers

 

Boolean Terms:

Obesity AND Diet and Lifestyle recommendations

Obesity care management AND Obesity complications

Body weight reduction AND Diet and Lifestyle recommendations

Physical activity intervention using Fitbit activity trackers AND obesity self-management

Diet and Lifestyle recommendations AND primary care

Methodology of Search

Research studies done during the previous 5-6 years were included in the search criteria. Chamberlain Library, PubMed, Google Scholar, and CINHAL were among the databases searched. Initial searches yielded over 25000 articles, of which 47 were chosen and examined because they fit the project's theme and supplied data to support the practice problem. The first 47 papers were filtered down to a group of 12 studies that were the most relevant to the specific PICOT query. These 12 papers were studied in further detail and then appraised using the Johns Hopkins Evidence Appraisal table.

Resources Discovered

Twelve papers were chosen for their relation to the areas listed by the PICOT question. All articles selected were highly scored based on the search keywords and Boolean keyword searches. Multiple database searches were conducted using similar, if not identical, search phrases, and the final list was amalgamated.

Review of the Literature

 Based on a review of the literature, diet, lifestyle changes, physical activities, and activity trackers impact weight loss outcomes (Bray & Ryan, 2020; Brickwood et al., 2019; Følling et al., 2021). Researchers note that physical activities have short-term impacts; they emphasize the need for individualized programs tailored to individual needs for better outcomes and state that wearable trackers can enhance the effects of physical activities and help sustain the change, making it more effective (Brickwood et al., 2019; Følling et al., 2021).

The quantity of weight lost varies significantly across all weight loss methods, including drugs and surgery. According to research by Bray and Ryan, 2020, around 5% of weight reduction may be linked to lifestyle changes, and sustainable lifestyle modifications are more successful than unsustainable ones. Research reveals that lifestyle changes contribute significantly to weight loss, and it is more effective when accompanied by other weight-reduction programs like activity monitors/trackers that determine the effectiveness of the change by either strengthening or undermining the ability of the patient to change (Bray & Ryan, 2020; Følling et al., 2021). Weight-reduction programs for patients with obesity are more effective when combined healthy diet, lifestyle changes, and physical activities.

References

Bray, G. A., & Ryan, D. H. (2021). Evidence-based weight-loss interventions: Individualized treatment options to maximize patient outcomes. Diabetes, obesity & metabolism, 23 Suppl 1, 50–62.  https://doi.org/10.1111/dom.14200Links to an external site.

Brickwood, K. J., Watson, G., O'Brien, J., & Williams, A. D. (2019). Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis. JMIR mHealth and uHealth, 7(4), e11819.  https://doi.org/10.2196/11819Links to an external site.

Følling, I. S., Oldervoll, L. M., Hilmarsen, C., & Ersfjord, E. (2021). A qualitative study explores the use of activity monitors for patients with obesity during weight-loss treatment. BMC sports science, medicine & rehabilitation, 13(1), 25.  https://doi.org/10.1186/s13102-021-00253-9Links to an external site.

Obesity. (2021, June 9). WHO | World Health Organization.  https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesityLinks to an external site.

 Comment from the professor

Hi student,

This is a very good Intro and Search Methodology! For your Review of the Literature section, do you have a few more studies to synthesize so that there are at least 2 themes for you to discuss in 2 different paragraphs?

For example, are you able to initially focus simply on weight loss and lifestyle modifications in general and these types of study outcomes in your first paragraph? Then, for your second paragraph, you could describe how another group of studies where trackers were used revealed even more favorable results for weight loss, and what those results were in % weight loss, e.g.? How were these tracker studies' results better than more basic weight loss studies?

I would suggest teasing these differences out a bit more so that you have 2 well-developed paragraphs based on these 2 different themes. You may need to delve into your studies further, and/or find a few studies that evaluated weight loss in general through healthy lifestyle modifications.

Also, you make a statement about the following study: "According to research by Bray and Ryan, 2020, around 5% of weight reduction may be linked to lifestyle changes…". If this is the case, what do they attribute the other 95% of their participants' weight loss to for their study? Were they on medication, or was this one of the "tracker" studies? Or something else? It will be fascinating to learn more about your topic, as weight loss is such a huge challenge for many folks across the U.S. and globally!

Keep working on this and reflecting on your studies, and perhaps locate a few more general weight loss studies if you need to, to be able to compare to the "tracker" studies and their results 🙂

Hope this is helpful!

,

Use of American Heart Association Diet and Lifestyle Recommendations to Promote Healthy Behaviors

Student Name

Course Number & Name

Etc. Per APA title page

                                           Literature Synthesis

 

Use of American Heart Association Diet and Lifestyle Recommendations to Promote Healthy Behaviors

          Obesity represents a common but preventable cause of morbidity and severe medical complications. Despite efforts to curb the issue, globally, the annual cases of obesity continue to rise. Obesity has reached epidemic proportions worldwide, negatively affecting people's health status (Carbone et al., 2022). Internal clinical reports at the practicum site reveal a significant increase in obese patients. Physical activity is advised to minimize the risk of chronic diseases such as diabetes, cardiovascular disease, and cancer. According to the literature, it is common to find patients with a sedentary lifestyle and physical inactivity. Still, wearables and smartphone apps provide new ways to improve physical activity habits (Gal et al., 2018). The easy availability of sophisticated activity trackers such as Fitbit offers a unique opportunity to enhance the efficacy of computer-tailored interventions. These advanced activity trackers can monitor steps, heart rate, energy expenditure, sleep, sedentary behavior, and physical activity intensity (Vandelanotte et al., 2018). The evidence-based intervention for the current project is the American Heart Association Diet and Lifestyle Recommendations (Bray et al., 2019). These evidence-based recommendations focus on knowing how many calories an individual should be eating and drinking to reduce body weight and aiming for at least 150 minutes of moderate physical activity, or 75 minutes of vigorous physical exercise, or an equivalent combination of both, each week (Arnett et al., 2019).

PICOT       

          In overweight adult patients in a primary care clinic, what is the impact of implementing the American Heart Association Diet and Lifestyle recommendations, compared to current practice, on body weight in 8-10 weeks?

Search Methodology

            The literature search focused on key concepts related to obesity complications, diet, lifestyle changes, physical activity intervention using Fitbit activity trackers, and physical activity benefice for patients. These major topic areas were obesity self-management, obesity management and care in primary care, and the standards of care for obesity.

Keywords and Search Terms

Simple Terms:

Obesity care

Obesity complications

Lifestyle recommendations

Obesity management

Physical activity intervention using Fitbit activity trackers

Boolean Terms:

Obesity AND Diet and Lifestyle recommendations

Obesity care management AND Obesity complications

Body weight reduction AND Diet and Lifestyle recommendations

Physical activity intervention using Fitbit activity trackers AND obesity self-management

Diet and Lifestyle recommendations AND primary care

Methodology of Search

Research studies done during the previous 5-6 years were included in the search criteria. Chamberlain Library, PubMed, Google Scholar, and CINHAL were among the databases searched. Initial searches yielded over 25000 articles, of which 47 were chosen and examined because they fit the project's theme and supplied data to support the practice problem. The first 47 papers were filtered down to a group of 12 studies that were the most relevant to the specific PICOT query. These 12 papers were studied in further detail and then appraised using the Johns Hopkins Evidence Appraisal table.

Resources Discovered

Twelve papers were chosen for their relation to the areas listed by the PICOT question. All articles selected were highly scored based on the search keywords and Boolean keyword searches. Multiple database searches were conducted using similar, if not identical, search phrases, and the final list was amalgamated.

Review of the Literature (this is the main section)

 

Obesity and Its Impact on patient health (Subheading 1) (Make this first subheading a logical pick that you will build upon with the next subheadings; i.e., if several research teams found common issues that drive the current problem in particular, start with that subheading topic; be sure for each section and for each sentence, that you cite multiple ref.s appropriately in parentheses at the end; using this style improves flow rather than trying to begin all your sentences with authors' names).    

          Based on a review of the literature, several studies revealed that obesity is a prevalent yet avoidable contributor to morbidity and serious chronic diseases." Then go on to discuss and summarize all the similar results and outcomes from these studies in successive sentences, and then also any unique results from perhaps just 1 or 2 studies. [This is what you would call a "Problem" subheading]

Potential Benefits of Healthy Diet and Lifestyle Modifications (Subheading 2) (Introduce the next logical subtopic here): 

           Start with another very broad, "juicy" topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: Healthy diet and lifestyle modifications promote healthy behaviors and contribute to reducing obesity, and patients who loosed weight have been reported to feel more healthy." Then go on to discuss and summarize all the similar results from this group of studies with similar results in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution *(to the problem obesity) subheading]

 

Parents of T1D Students Need Support Too (Subheading 3) (Introduce the next logical subtopic here): 

            Start with another very broad, "juicy" topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: "In addition to the need to support teens who h

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