Evidence-Based Project- Concept Of Health
Evidence-Based Project- Concept Of Health
Evidence-Based Project- Concept Of Health
Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change
The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.
In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.
To Prepare:
· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
The Assignment: (Evidence-Based Project) (This is the assignment, I just added other info you might need below. =My topic and PICOT is on UTI)
ORDER COMPREHESIVE SOLUTION PAPERS ON Evidence-Based Project- Concept Of Health
Part 5: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide PowerPoint presentation in which you do the following:
· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
·
· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
· Add a lessons learned section that includes the following:
· A summary of the critical appraisal of the peer-reviewed articles you previously submitted
· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides added).
End
Announcements For the PP
PICOT and PP
Posted on: Thursday, October 29, 2020 9:07:12 AM EDT
your slides this week, be sure to add your PICOT.
You can use more slides if needed. Try to stay under 15.
My PICOT in previous paper below:
PICOT
The use of PICOT in guiding and clarifying the essential element of question is an important initial step towards finding the right information to answer the question.
In women aged 18-65 years with uncomplicated UTI, how does nitrofurantoin compared to no interventions affect urinary tract within 30 days?
P- Adult women aged 18-65 years diagnosed with UTI in ABC clinic
I- Nitrofurantoin, 100mg orally twice daily for 7 days
C- No intervention
O- Complete UTI signs and symptoms resolution
T- One month
| RUBRIC: Use the Paper Rubric as a check list |
| CONTENT:
Excludes unnecessary information. Add your subject matter to your title slide. Do not to crowd the slides. Remember the 1X6X6 rules. One topic per slide, 6 lines or fewer per slide, 6 or fewer words per line. References pertinent and timely and properly cited (APA7) References (in-text citations, synthesis) within the PowerPoint No errors in grammar, capitalization, punctuation, and spelling.
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| DESIGN:
Font in each slide has to be 20 or larger. Each slide needs to have a title No use of animation No unnecessary graphics. Do not use Clip Art as it makes your file too large. Background of the slides and font should be uniform throughout the presentation and the text should be lighter than the background No unnecessary graphics For narrated PPs, use Kaltura to avoid submission difficulties. Student Support can help with this. |
Critical Appraisal in module 4 week 7
Urinary Tract Infection
Olayemi Olamide
Walden University
NURS 6052- Essentials of Evidence-Based Practice
October 18, 2020
Urinary Tract Infection
Urinary tract infection (UTI) happens when a bacteria infect the urethra, ureters, kidneys or bladder. It is a common infection among women due to their anatomy; shorter urethra and thus, shortening the distance bacteria travels to reach the bladder. Treating this infection with the best practice is critical to avoid further complications. Based on the critical appraisal of available research, nitrofurantoin is the best practice in UTI treatment.
Evidence shows that nitrofurantoin is the best practice in UTI treatment. Huttner et al. (2018) show that 5-day nitrofurantoin achieves significant clinical and microbiological resolution among females with uUTI at 28 days after therapy completion. Given the design of this study, a randomized controlled trial, the intervention is the only thing constituting a considerable difference between the participant groups, making the findings reliable and valid (Hariton & Locascio, 2018). The findings are further supported by other studies. Price et al. (2016) has established the effectiveness of nitrofurantoin in treating UTI.
Muller et al. (2017) has established efficacy of nitrofurantoin in preventing UTI and its superiority to placebo and other antibiotics such as methenamine hippurate. Huttner et al. (2015) point to nitrofurantoin’s efficacy in treating UTI. The study demonstrate that nitrofurantoin has statistically substantial clinical and microbiological effectiveness in lower UTI treatment when taken in the short-term, typically 5 to 7 days. Huttner et al. (2018) supports this finding, showing the achievement of considerable clinical and microbiological resolution of uncomplicated UTI when administered for five days. Given the quality and validity of the study designs in these studies, the findings can translate to practice (Melnyk & Fineout-Overholt, 2018). Thus, nitrofurantoin is the best practice.
Adverse effects are a consideration when establishing the best practice. Studies have indicated the non-severity of adverse effects associated with nitrofurantoin (Muller et al., 2017; Huttner et al., 2015). These studies indicate that nitrofurantoin does not cause adverse effects. Non-severe adverse effects are gastrointestinal, including nausea, vomiting, and diarrhea. This is in line with Price et al. (2016), pointing to gastrointestinal adverse effects associated with nitrofurantoin.
In addition to this, education is a critical element in UTI prevention. Ahmadi et al. (2020) had established that an educational intervention program grounded on the Theory of Planned Behavior promotes UTI preventive actions and activities. This is supported by a systematic review by Jones et al. (2019), pointing to the effectiveness of education in reducing UTI.
In conclusion, based on a critical appraisal of research, nitrofurantoin is the best practice in treating UTI. Its administration in the short-term, usually 5 to 7 days, has shown clinical and microbiological efficacy. In addition, education would further encourage practices to prevent UTI.
References
Ahmadi, Z., Shamsi, M., Roozbahani, N., & Moradzadeh, R. (2020). The effect of educational intervention program on promoting preventive behaviors of urinary tract infection in girls: a randomized controlled trial. BMC pediatrics, 20(1), 1-10. https://doi.org/10.1186/s12887-020-1981-x
Hariton, E., & Locascio, J. J. (2018). Randomized controlled trials—The gold standard for effectiveness research. BJOG: an international journal of obstetrics and gynecology, 125(13), 1716. doi: 10.1111/1471-0528.15199.
Huttner, A., Kowalczyk, A., Turjeman, A., Babich, T., Brossier, C., Eliakim-Raz, N., … & Theuretzbacher, U. (2018). Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: a randomized clinical trial. Jama, 319(17), 1781-1789. doi:10.1001/jama.2018.3627
Huttner, A., Verhaegh, E. M., Harbarth, S., Muller, A. E., Theuretzbacher, U., & Mouton, J. W. (2015). Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials. Journal of Antimicrobial Chemotherapy, 70(9), 2456-2464. DOI: https://doi.org/10.1093/jac/dkv147
Jones, L. F., Meyrick, J., Bath, J., Dunham, O., & McNulty, C. A. M. (2019). Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review. Journal of Hospital Infection, 102(2), 200-218. https://doi.org/10.1016/j.jhin.2018.10.013
Melnyk, B. M., & Fineout-Overholt, E. (2018). Finding Relevant Evidence to Answer Clinical Questions. In Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Muller, A. E., Verhaegh, E. M., Harbarth, S., Mouton, J. W., & Huttner, A. (2017). Nitrofurantoin’s efficacy and safety as prophylaxis for urinary tract infections: a systematic review of the literature and meta-analysis of controlled trials. Clinical Microbiology and infection, 23(6), 355-362. DOI: https://doi.org/10.1016/j.cmi.2016.08.003
Price, J. R., Guran, L. A., Gregory, W. T., & McDonagh, M. S. (2016). Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis. American journal of obstetrics and gynecology, 215(5), 548-560. DOI: 10.1016/j.ajog.2016.07.040
Evaluation Table
Critical Appraisal Tool Worksheet Template
Evaluation Table
Critical Appraisal of Research
| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
| Ahmadi, Z., Shamsi, M., Roozbahani, N., & Moradzadeh, R. (2020). The effect of educational intervention program on promoting preventive behaviors of urinary tract infection in girls: a randomized controlled trial. BMC pediatrics, 20(1), 1-10. https://doi.org/10.1186/s12887-020-1981-x
|
Huttner, A., Kowalczyk, A., Turjeman, A., Babich, T., Brossier, C., Eliakim-Raz, N., … & Theuretzbacher, U. (2018). Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: a randomized clinical trial. Jama, 319(17), 1781-1789. doi:10.1001/jama.2018.3627 | Muller, A. E., Verhaegh, E. M., Harbarth, S., Mouton, J. W., & Huttner, A. (2017). Nitrofurantoin’s efficacy and safety as prophylaxis for urinary tract infections: a systematic review of the literature and meta-analysis of controlled trials. Clinical Microbiology and infection, 23(6), 355-362. DOI: https://doi.org/10.1016/j.cmi.2016.08.003
|
Huttner, A., Verhaegh, E. M., Harbarth, S., Muller, A. E., Theuretzbacher, U., & Mouton, J. W. (2015). Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials. Journal of Antimicrobial Chemotherapy, 70(9), 2456-2464. DOI: https://doi.org/10.1093/jac/dkv147
|
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| Evidence Level *
(I, II, or III)
|
I | I | I | I |
| Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here). **
|
Theory of planned behavior. This theory examines people’s attitudes and behavioral intentions. It was employed to examine the behavioral intention of mothers in engaging proper UTI preventing behaviors for their daughters. The theory informed the educational intervention in this study. According to Steinmetz et al. (2016), the theory of planned behavior is a principal theory in designing evidence-based interventions. |
Not mentioned |
Not mentioned |
Not mentioned |
| Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). |
This was a randomized controlled trial, whereby subjects who met the inclusion measures was randomized to treatment and control groups. Both groups received pre-test, and then training based on the theory was administered in the treatment group, and the routine care was administered to the control group.
Inclusion criteria included literate mothers and whose daughters were healthy. The exclusion criteria included the unavailability of mothers in educational intervention and to continue to take part in the study. For three months, the mothers were followed, and a post-test was given and effect of the intervention evaluated. |
This was a randomized clinical trial carried at 3 sites, including Geneva in Switzerland, Petah-Tiqva in Israel, and Lodz in Poland, from 2013 October to 2017 May.
The exclusion criteria included pregnancy and lactation, use of antibiotics or UTI indications in the previous 4 weeks, suspected upper UTI, complicated UTI, renal insufficiency, and immunosuppression.
Randomization was computer-created. The participants of the study were randomly allocated to 5-day oral nitrofurantoin 100 mg 3 times each day or one fosfomycin 3 g dose.
Urine sample collected for clinical evaluation and a follow-up made twice at fourteenth and the twenty-eighth day after antibiotic medication completion. |
This was a systematic review and meta-analysis of randomized clinical trials. Medline, Cochrane Library, and Embase databases were searched studies using “nitrofurantoin” descriptor.
The inclusion criteria included controlled clinical trials, human patients of both genders in all settings, oral nitrofurantoin, placebo, no treatment, and nitrofurantoin at various doses. The exclusion criteria included uncontrolled trials, in vitro studies, animal studies, nitrofurantoin with other antibacterials targeting uropathogens and non-systematic administration. |
This was a systematic review and meta-analysis of controlled trials. Cochrane Library, Medline and Embase were searched for randomized controlled trials using “nitrofurantoin” descriptor.
The inclusion criteria included controlled clinical trials, human patients of both genders and ages in all settings, oral nitrofurantoin, placebo, no treatment, and nitrofurantoin at various dose. The exclusion criteria included uncontrolled trials, animal studies, in vitro studies, nitrofurantoin with other antibacterials targeting uropathogens. |
| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
Convenience sampling was employed to select participants and a total of 280 moms having girls below the age of two were selected, but only 100 met the inclusion measures. They were randomly allocated to the control and treatment groups, each consisting 50 participants. | In this study, 996 patients were screened, but a sample of 513 patients met the inclusion criteria. 225 patients were randomized to nitrofurantoin and 258 to fosfomycin.
The sample included adult women above the age of 18 presenting lower UTI symptoms and who tested positive for either leukocyte esterase or nitrates in the urine dipstick test.
|
In this study, 3785 articles were established. Of these articles, 209 were human clinical trials. However, 26 articles met the inclusion trials and thus, used in this systematic review and meta-analysis. Timeframe for the articles were from 1946 to 2015.
|
In a time frame of between 1946-2014, 3586 articles were identified. A majority of these articles were UTI prophylaxis studies and nitrofurantoin use in non-UTI uses. Eventually, 27 studies met the inclusion criteria for this systematic review and meta-analysis. |
| Major Variables Studied
List and define dependent and independent variables |
Dependent variables UTI preventive behaviors.
Independent variables TPB-based education: attitudes, intention, perceived control behavior and subjective norm.
|
Dependent variables Uncomplicated UTI resolution
Independent variables 5-day oral nitrofurantoin 100mg 3 times daily Single oral fosfomycin 3 g |
Dependent variables UTI prophylaxis
Independent variables Nitrofurantoin |
Dependent variables Lower UTI treatment
Independent variables Nitrofurantoin |
| Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). |
Descriptive and inferential statistics.
Paired t-test, Independent t-test, and Chi-square. Significance level (0.05) Kolmogorov-Smirnov test was employed. |
χ2 test was employed to compare clinical and bacteriologic resolution between the intervention groups.
Fisher exact test was used to compare adverse effect incidences and outcomes. |
Review Manager version 5.3 was utilized in carrying out the meta-analysis. I2 inconsistency measure was used to assess heterogeneity in trial results. Confidence interval of 95 percent was considered for the trials. | Review Manager version 5.3 was used in carrying out the meta-analysis. I2 inconsistency measure was used to assess heterogeneity in trial results. |
| Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the statistical tests or qualitative data). |
Paired t-test indicated considerable variance between the variables’ mean score in the treatment group prior to and afterward the intervention. On the other hand, the control group did not show any significant mean score of variables.
Independent T-test did not indicate significant relation between TPB constructs and UTI preventive behavior in both groups, but the difference was statistically significant after the three months. Significance level was 0.001. |
After therapy completion at 28 days, 70 percent of the patients who received nitrofurantoin achieved clinical resolution as compared to 58 percent of those who received fosfomycin.
At 14 days, 75 percent of the patients who received nitrofurantoin achieved clinical resolution as compared to 58 percent of those who received fosfomycin.
8 percent of those who received nitrofurantoin and 6 percent of those who received fosfomycin experiences gastrointestinal adverse effects. |
Nitrofurantoin showed effectiveness (95% CI 0.30-0.48) in UTI prevention when compared to no prophylaxis. The prophylactic efficacy of nitrofurantoin is comparable to other antibacterials, but superior to methenamine hippurate. Compared to other antibacterials, nitrofurantoin has higher risk of 2.24 for non-severed adverse effects (95% 1.77-2.83). | Nitrofurantoin has a clinical and microbiological efficacy of between 79 and 92 percent for UTI treatment when administered 5 to 7 days. Its efficacy diminished (61 to 70 percent) if administered for 3 days. Toxicity is rare (5 to 16 percent) and predominantly gastrointestinal. |
| Findings and Recommendations
General findings and recommendations of the research |
TPB-based educational intervention promotes UTI preventive behaviors among mothers with young girls. Educating mothers on UTP preventive behaviors improves their knowledge, which drives positive attitude, intention, subjective norm, and perceived behavioral control, all of which encourages mothers to engage in preventive behaviors.
The authors recommended educational intervention (training) grounded in TPB to change mother behaviors to engage in UTI preventive behaviors for their daughters. |
5-day nitrofurantoin achieves significant clinical and microbiological resolution likelihood among women with uncomplicated UTI at 28 days after completing the therapy.
The study recommended 5-day nitrofurantoin for women with uncomplicated UTI. |
The efficacy of nitrofurantoin as UTI prophylaxis is equivalent to other antibiotics and superior to placebo and methenamine hippurate. Adverse effects are non-severe.
|
Nitrofurantoin’s efficacy is equivalent to trimethoprim and ciprofloxacin. However, its microbiological cure is more favorable than comparators.
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| Appraisal and Study Quality
Describe the general worth of this research to practice.
What are the strengths and limitations of study?
What are the risks associated with implementation of the suggested practices or processes detailed in the research?
What is the feasibility of use in your practice? |
This research would inform practice by informing training based on TPB in healthcare settings to promote protective behaviors to prevent UTI among children. As a randomized controlled trial, randomization minimizes bias and the risk of confusing factors affecting the results, and ensuring delivery of high-level evidence with regard to TPB-based education in promoting UTI preventive behaviors (Hariton & Locascio, 2018).
A key strength of this study is the educational intervention design for UTI prevention based on a need assessment. However, there are limitations, including information collection using self-report and 3-month follow-up as a longer follow-up would have led to more accurate outcomes.
Some of the risks associated with implementing the suggested practices include risk of stigmatization and low efficacy and effectiveness (Gopichandran et al., 2016)
The suggested practice in this study is a feasible means of promoting children’s health, with the potential of engaging mothers in promoting their children’s health. |
This study has a potential of informing practice, especially offering care to women with uncomplicated UTI. By eliminating the element of choice, this randomized controlled trial eliminated selection bias and risk of confusing factors. Consequently, the interventions, nitrofurantoin and fosfomycin, were the only things comprising a considerable difference between the participant groups (Hariton & Locascio, 2018). This enhances the reliability of the finding to inform practice.
A major strength of this study is high validity and reliability given that it is a randomized controlled trial (Hariton & Locascio, 2018). However, it has various limitations, including open design, which introduced some measurement bias level. Also, heterogeneity in microbiologic methods was introduced due to non-centralization of laboratory analyses.
The major risk with implementing the suggested practice (5-day nitrofurantoin to treat uncomplicated UTI in women) is severe adverse effects.
Based on the established 5-day nitrofurantoin efficacy, this practice can be implemented for clinical resolution of UTI among women. |
The study is vital in informing practice about UTI prevention. Based on this study, nitrofurantoin should be implemented in UTI prevention as it has shown efficacy and safety.
A major strength of this study is that it is a comprehensive synthesis of evidence (Melnyk & Fineout-Overholt, 2018). However, assessment of the quality of the studies included is limited and operational definition for individual quality items not explicitly offered.
Risks associated with nitrofurantoin use in practice include severe toxicity, including pulmonary and hepatic hypersensitivity and antibacterial resistance.
High feasibility use of nitrofurantoin in practice since this is a clinically feasible drug. |
The findings of this study would inform practice in treating lower UTI. The findings of this study, strong clinical and microbiological efficacy of nitrofurantoin in lower UTI treatment, is supported by other studies (Ingalsbe et al., 2015; Montelin et al., 2019). Thus, nitrofurantoin would be implemented as the first-line of treatment for lower UTI.
Reduced bias, together with objective summaries, improves the reliability and accuracy of conclusions (Melnyk & Fineout-Overholt, 2018). Limitations include large variations and debatable quality of study designs.
Various risks are associated with implementing nitrofurantoin in treating lower UTI, including antibacterial resistance, high toxicity, and high hypersensitivity reactions.
Nitrofurantoin is a clinically feasible drug. |
|
Key findings
|
Educational intervention program grounded on the Theory of Planned Behavior promotes UTI preventive actions and activities among mothers having young daughters to promote their health. | 5-day nitrofurantoin is a better alternative for uncomplicated UTI treatment among women when compared to single-dose fosfomycin. | Nitrofurantoin is effective in UTI prevention. It does not cause severe adverse effects. Severe harmful effects happen rarely, but the risk increases with nitrofurantoin prophylaxis duration. | Nitrofurantoin has statistically significant clinical and microbiological efficacy in treating lower UTI when administered in short-term, usually 5 to 7 days and its toxicity is mild. This finding is supported by Mitrani-Gold et al. (2020), showing the efficacy of nitrofurantoin in uncomplicated UTI treatment.
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Outcomes
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TPB-based education is effective in promoting UTI preventive behaviors. | Clinical response after therapy completion at 218 days and statistically significant bacteriologic response and adverse effect incidences. | Efficacy and safety of nitrofurantoin in UTI prevention.
Limited incidence of adverse events.
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Efficacy of nitrofurantoin in UTI treatment and mild toxicity. |
| General Notes/Comments | Training based on TPB should be carried out in healthcare centers to maintain children health.
|
References
Gopichandran, V., Luyckx, V. A., Biller-Andorno, N., Fairchild, A., Singh, J., Tran, N., … & Vahedi, M. (2016). Developing the ethics of implementation research in health. Implementation Science, 11(1), 161. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0527-y
Hariton, E., & Locascio, J. J. (2018). Randomized controlled trials—The gold standard for effectiveness research. BJOG: an international journal of obstetrics and gynecology, 125(13), 1716. doi: 10.1111/1471-0528.15199.
Ingalsbe, M. L., Wojciechowski, A. L., Smith, K. A., & Mergenhagen, K.
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