APATemplateforEvidenceSynthesisandPracticeRecommendationPaper.docx

    University of Saint Augustine for Health Sciences

    NUR7050: Evidence-Based Practice for Healthcare Professionals

    NOTE: An abstract is not required

    NOTE: This is a template and guide. Delete all highlighted materials.

    1

    1

    Synthesis of the Literature

    Synthesize your final primary quantitative research studies and/or systematic reviews; do not include summary articles such as a review of the literature, a clinical article, or a clinical practice guidelines. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Refer the reader to your evidence table(s). See Table 1 and 2. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. The studies that you cite in this section must relate directly to your PICOT question. This is a synthesis (Table 3) rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

    Practice Recommendations

    So. . . using available best evidence, what is the answer to your question? This section is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a synthesis statement, and, based on your conclusions drawn from your review of the body of evidence related to your clinical question, give a recommendation for practice change. This would logically be the intervention of your PICOT question. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice, and you recommend reinforcement and education regarding this best practice. Using Johns Hopkins, identify whether this recommendation be graded A, B, or C based on the strength of the evidence.

    References

    Remember that this is a reference list rather than a bibliography. A bibliography is everything you read to prepare the paper but a reference list is only what you cited. If there is not a citation for a reference, it should not be here. PLEASE make sure that your references and your citations throughout the paper are in APA format. You can go from an A paper to a B paper on APA errors alone. Take the time to make sure that they are correct. We have already formatted the paper for you with this template.

    12

    Table 1

    Primary Quantitative Research Evidence (this table may be single space and 10-point font; ONLY primary quantitative research articles should be in this table) Example provided.

    Source

    Study design

    JH Level of Evidence

    Population/

    Sample

    AgeRace/ Ethnicity

    Setting/Location

    % dropout

    Intervention (IV)

    Details

    Action

    DurationFidelity

    Comparison/ Control (IV)

    Details

    Action

    Duration

    Fidelity

    Outcome (DV) &Time

    Intervention vs comparison

    (statistical test, value, p value)

    Grading of evidence

    JH Quality Rating

    Author’s conclusions

    ———–

    Other outcomes of interest

    Your Conclusions

    Limitations

    Fit/Useful

    Abel, 2020

    RCT

    Level I

    196 inter-city

    Age 36.4 (8.9) [Range 24 – 49]

    55% Male,

    40% Black,

    62% Latino

    73% Medicaid, annual income <$25,000

    Setting: Outpatient

    Location: Boston, MA

    Baseline pain score 6.4 avg on both groups

    Dropout: 15/200, 7.5%

    Weekly chiropractic adjustment

    Assessed & tx

    10 weeks

    100% of visits over 10weeks

    Average total 180 mins

    Massage

    Medical massage

    50 min/wk

    100% for 10 weeks

    At 10 weeks,

    avg pain score

    Tx = 3.6

    Control = 5.2

    (X2 = 7.3; p<.05):

    Latino males

    Tx = 2.8

    Control = 5.7

    (X2 = 8.3; p<.001):

    Latino women

    Tx =6.0

    C = 2.8

    (X2 = 9.2; p<.001):

    Quality A

    Pain scores

    30% lower w/ wkly chiro compared to 50 mins/wk medical massage

    Tx more effective in Latino males

    C more effective in Latino women

    ———

    Massage would cost 30% more out of pocket

    Tx. Better than control

    Chiropractic adjustments effective in general and in Latino males but not in Latino women

    Limitations =

    -not equal time in tx

    -not include high income

    Yes/Yes but only if cost covered by Medicaid in my state

    Legend: (all abbreviations and acronyms used in the table should be listed here such as: )

    Table 2

    Evidence Summaries (this table may be single space and 10 point font; ONLY systematic reviews should be in this table) (Example provided)

    Source

    Study design

    JH Level of Evidence

    Population/

    Sample

    Search strategy

    Inclusion

    Exclusion

    N articles addressing your PICOT

    Other descriptions

    Intervention (IV)

    Details

    Action

    DurationFidelity

    Comparison/ Control (IV)

    Details

    Action

    Duration

    Fidelity

    Outcome (DV)

    & Time

    Mean differences

    Intervention vs comparison

    Effect size

    Heterogeneity

    (statistical test, value, p value)

    Grading of evidence

    JH Quality Rating

    Author’s conclusions

    ——

    Other outcomes of interest

    Your Conclusions

    Limitations

    Fit/Useful

    Brown, 2018

    Meta-analysis

    Level I

    Medline

    OVID

    CINAHL

    2000-2017

    RCTs, conducted in the US, high-quality (>21/25 points on CONSORT), comparing regular chiropractic adjustment vs regular medical massage for chronic pain measured using a 0-10 scale

    10 RCTs of low back pain

    Exclusions

    Studies of phantom pain

    Total participants N=867

    Avg age 59 (6)

    Avg baseline pain scores 3.2 (3.4)

    Avg Dropout:

    8% (4) Only completers included in this analysis

    Chiropractic adjustment in office

    Most weekly

    (2/10 allowed 2x wk)

    Fidelity

    All > 80%

    Massage

    45-60 mins

    Most weekly

    (2/10 allowed 2x wk)

    Fidelity

    All >86%

    At 8 weeks

    N=4

    Tx = 3.6

    Control = 5.2

    (RR for 2 point pain reduction= 1.6 (1.1-2.3); p=.04):

    I2= 10%

    At 12 weeks

    N=6

    Tx = 3.2

    Control = 4.8

    (RR for 2 point pain reduction= 1.7 (1.4-2.4); p=.04):

    I2= 13%

    Quality B due to no ITT

    wkly chiropractic adjustment was more effective than weekly massage for reducing chronic pain based on the data from these studies

    —none

    Tx. Better than control

    High dropout rate and not analyzed with ITT

    Partially- my population is much younger on average

    Partially- my population has a variety of pain sources

    Useful- yes

    Add more

    Legend: (all abbreviations and acronyms used in the table should be listed here)

    Table 3.

    Synthesis Matrix (identify the trends; this table may be single space and 10 point font; ONLY primary quantitative research articles or systematic reviews should be in this table; use only the highest level and quality of evidence; if the evidence is of mixed level or mixed quality, sort the trends using the Johns Hopkins Appendix H; trends must be related to the outcome) (example provided regarding effective pain management which may or may not be within your scope of practice- make sure your PICOT is within your scope of practice.)

    Main ideas

    Albright (2020)

    Reference 2

    Reference 3

    Reference 4

    Reference 5

    Add columns as necessary

    Weekly chiropractic adjustment equally effective as weekly massage

    Biweekly chiropractic adjustment associated with 30% lower pain scores compared to weekly massage in those with back pain

    In those with a mean age under 50, weekly massage associated with 20% lower pain scores compare to chiropractic adjustments

    Add more as needed

    Figure 1

    Results of Search for Research

    Use to generate a diagram describing the results of your search. Paste it here.

                                                                                                                                      Order Now