Research Critiques and PICOT Statement Final Draft

Research Critiques and PICOT Statement Final Draft

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to \”Research Critiques and PICOT Guidelines – Final Draft.\” Questions under each heading should be addressed as a narrative in the structure of a formal paper. Research Critiques and PICOT Statement Final Draft.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Research Critique Guidelines

Qualitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Research Critiques and PICOT Statement Final Draft.
Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
Were the purpose and research questions related to the problem?

Method of Study:

Were qualitative methods appropriate to answer the research questions?
Did the author identify a specific perspective from which the study was developed? If so, what was it?
Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?
Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.
Did the author evaluate or indicate the weaknesses of the available studies?
Did the literature review include adequate information to build a logical argument?
When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Research Critiques and PICOT Statement Final Draft.

Results of Study

What were the study findings?
What are the implications to nursing?
Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

Was the study approved by an Institutional Review Board?
Was patient privacy protected? Research Critiques and PICOT Statement Final Draft.
Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.
Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
Integrate a summary of the knowledge learned.

Quantitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. Research Critiques and PICOT Statement Final Draft.
How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
Were the purpose and research questions related to the problem?

Methods of Study

Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?
Was informed consent obtained from the subjects or participants?
Did it seem that the subjects participated voluntarily in the study?
Was institutional review board approval obtained from the agency in which the study was conducted?
Are the major variables (independent and dependent variables) identified and defined? What were these variables?
How were data collected in this study?
What rationale did the author provide for using this data collection method?
Identify the time period for data collection of the study. Research Critiques and PICOT Statement Final Draft.
Describe the sequence of data collection events for a participant.
Describe the data management and analysis methods used in the study.
Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?
What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

What is the researcher’s interpretation of findings?
Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? Research Critiques and PICOT Statement Final Draft.
What limitations of the study were identified by researchers?
Was there a coherent logic to the presentation of findings?
What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?
What suggestions are made for further studies?

Ethical Considerations

Was the study approved by an Institutional Review Board?
Was patient privacy protected?
Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.
Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. Research Critiques and PICOT Statement Final Draft.
Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier.

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833” Research Critiques and PICOT Statement Final Draft.

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. Research Critiques and PICOT Statement Final Draft. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Research Critiques and PICOT Statement Final Draft. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges Research Critiques and PICOT Statement Final Draft.

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Research Critiques and PICOT Statement Final Draft. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology, 11, 429-441. doi: 10.2147/clep.s204322”

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. Research Critiques and PICOT Statement Final Draft. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019) Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019).

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Research Critiques and PICOT Statement Final Draft. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014).

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology, 11, 429-441. doi: 10.2147/clep.s204322 Research Critiques and PICOT Statement Final Draft

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice. Journal of Clinical & Diagnostic Research, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806

PICOT statement and research critiques

PICOT statement

The PICOT question is presented as: “In patients with normal renal function who have had recent surgery (P), does the use of NSAIDs (I) increase the future risk of adverse renal effects (O) compared with non-use of NSAIDs (C) during recuperation (T)?”

The PICOT question has five elements as discussed:

P: patient population – describes the unique demographic qualities that identify the study population. In this case, the study population is restricted to patient who recently underwent surgery and require pain medication for which NSAIDs are an option. Research Critiques and PICOT Statement Final Draft.
I: indicator/intervention – describes the variable of interest in the study as a prognostic factor. In the present case, the prognostic factor is the use of NSAIDs that is suspected of significantly increasing adverse renal events among the patient population.
C: control/comparison – describes the absence of the prognostic factor thereby facilitating effective comparison efforts. In the present case, the prognostic factor is the non-use of NSAIDs.
O: outcome – describes the risk or rate of the adverse outcome occurred that is determined as adverse renal effects for the present study.
T: time – identifies how long it takes to observe the study participants. In the present case, the time describes the recuperations time when the patient is an invalid and recuperating following the surgery. Research Critiques and PICOT Statement Final Draft.

Qualitative study critique

Background of study

The study sought to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. It notes that NSAIDs use has become increasingly prevalent among patients visiting personnel. It further notes that the use of these medication is accompanied by an inherent risk linked to patient demographics that include concomitant medication, age and coexisting medical conditions. Despite the inherent risks and warnings from medical personnel on these risks, it is not uncommon for patients to continue using NSAIDs even when the risk of adverse effects is heightened. The study seeks to address this information gap by identifying the proportion of patients who are at high risk of reporting adverse reactions from using NSAIDs (Bloom et al., 2019). As such, the study seeks to provide qualitative evidence on the extent and distribution of NSAIDs among patients at high risk of reporting adverse reactions. Research Critiques and PICOT Statement Final Draft.

Method of study

To study applied a retrospective database review approach. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. Research Critiques and PICOT Statement Final Draft. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency (Bloom et al., 2019). The methodology is appropriate since it focused on collecting the required information from the population of interest.

Results of study

The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change (Bloom et al., 2019). Using this information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities. Research Critiques and PICOT Statement Final Draft.

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions Research Critiques and PICOT Statement Final Draft. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges.

Ethical considerations

Although the study does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Conclusion

The research applied a qualitative approach that used a retrospective methodology. It notes that NSAIDs use is common among patients. In addition, it notes that although NSAIDs use is typically accompanied by warnings on use, these warnings are typically ignored. It further adds that patients and medical personnel often overlook the labels for NSAIDs listing these side effects and complications. The result is that NSAIDs use remains high among patients at high risk of adverse reactions. Given these results, the study recommends greater awareness of NSAIDs side effects and complications with a focus on identifying patients at high risk of adverse reactions and ensuring that their use of NSAIDs is controlled. Research Critiques and PICOT Statement Final Draft.

Quantitative study critique

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. Journal of Clinical and Experimental Hepatology. doi: 10.1016/j.jceh.2019.04.050

Background of study

Gawande et al. (2019) presents research results from a study on etiologies, course, and outcome in patients with acute-on-chronic liver failure (ACLF) was determined. In fact, it presents the results of a study that investigated the prevalence of ACLF as a health issue, the underlying etiology, precipitating factors for the health issue, and the associated mortality. It notes that ACLF is a medical condition that requires greater understanding in order to implement the appropriate interventions. In line with this awareness, the study objective was to collect information that informs ACLF. The underlying intention was to identify an appropriate risk factor and prevention strategy (Gawande et al., 2019). Research Critiques and PICOT Statement Final Draft.

Methods of study

The research applied a quantitative methodology. In this case, the study recruited 208 participants who included 182 males and 26 females. The participants were recruited between October 2015 and December 2017, all from the gastroenterology department of SMS Medical College and Hospital in Jaipur (Gawande et al., 2019). The research methodology is appropriate since it recruited a large sample that improved the results generalizability. Still, the methodology has a shortcoming with regards to not mentioning whether a third party verified the statistical analysis and study results, and the software used to conduct data analysis. These shortcomings allow for researcher bias.

Results of study

The study reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Research Critiques and PICOT Statement Final Draft. Mortality for inpatients was reported at 37.5% (p<0.05). The study determined that the identified factors (alcohol, viral hepatitis, cryptogenic cirrhosis, autoimmunity, nonalcoholic steatohepatitis, and Wilson disease) are precipitating factors linked with etiology for ACLF, and they should be noted as factors that increase mortality. It concludes that the identified precipitating factors should be noted in liver health management since they are predictors of mortality (Gawande et al., 2019).

The study results are useful for improving care outcomes for persons diagnosed with ACLF or at risk of developing liver disease. The findings offer statistical evidence to link the identified predictive factors ACLF occurrence and mortality. Using the study results nursing practice can present liver management protocols that offer the high risk factors to be noted to improve care outcomes. Of particular concern would be alcohol that is noted to significantly increase the risk of mortality for persons with ACLF (Gawande et al., 2019) Research Critiques and PICOT Statement Final Draft.

Ethical considerations

Gawande et al. (2019) mentions that the study was approved by an institutional review board (IRB) to imply that the study did not pose a threat to the participants with appropriate measures applied to adequately protect them. In addition, informed consent was sought from the participants. The measures applied in the study address concerns about beneficence (do no harm) and informed consent (Gawande et al., 2019). Babbie (2016) adds to the discussion by mentioning that in addition to beneficence and informed consent, the study should address confidentiality, respect for anonymity, and respect for privacy. It mentions that even as medical research focuses on advocacy, protecting dignity, preventing harm and caring, it should not forget to defend the rights of the research participants as an incongruent aspect of ethics. As such, there study should detail how it addressed ethical concerns about respect for privacy, confidentiality and anonymity. Still, IRB approval is an indication that these ethical concerns were addressed, although not mentioned in the literature (Babbie, 2016) Research Critiques and PICOT Statement Final Draft.

Conclusion

The research assesses the etiologies, course, and outcome in patients with ACLF. Towards this end, that study applied a quantitative methodology that recruited 208 participants with ACLF. Ethical approval was sought from an IRB to ensure that the participants’ rights were protected. The study results reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Mortality for inpatients was reported at 37.5% (p<0.05). Based on these results, it is possible to improve ACLF care outcomes by reducing the risk factors.

References

Babbie, E. (2016). The basics of social research (7^th ed.). Boston, MA: Cengage Learning.

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice. Journal of Clinical & Diagnostic Research, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806 Research Critiques and PICOT Statement Final Draft

Research Critiques and PICOT Statement Final Draft

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