University of Saint Augustine for Health Sciences

NUR7050: Evidence-Based Practice for Healthcare Professionals

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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.

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
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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.

APATemplateforEvidenceSynthesisandPracticeRecommendationPaper.docx

References