Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Note: You will access this article from the Walden Library databases.

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79
Note: You will access this article from the Walden Library databases.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Note: You will access this article from the Walden Library databases.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

Required Media

Laureate Education (Producer). (2018). Searching the Evidence [Video file]. Baltimore, MD: Author. 

THIS IS THE MODULE 2 TO COMPLETE THIS ASSIGNMENT

The PICOT format is used to formulate questions in evidence-based practice. It is a beneficial method as it enables a researcher to identify the most effective and useful resources used in evidence-based practice and healthcare research. P stands for the population or the patient’s problem. In this threshold, one explains who is the patient, their health status, and demographic data. I stand for the interventions that should be performed on the patient. For instance, they may be tests, therapies, or medications. C stands for Comparison. It indicates other alternative plans that the healthcare practitioner may conduct on the patient. O stands for the outcomes that the health practitioner seeks. T stands for the time frame that should be used (Lira & Rocha, 2019). 

One of the clinical issues that are faced in the US is an opioid overdose. The problem has increased with more reported cases of people dying from opioid overdose daily. It is estimated that more than 130 people die daily from opioid misuse. Therefore, the opioid crisis can be used to formulate a good PICOT question. Over time, self-administered drugs such as naloxone, also known as Narcan, have been developed to curb opioid misuse (Narcan, n.d). 

In this case, the PICOT question that will be suitable and effective is “Can opioid users who have access to naloxone be compared to those without access to naloxone at the risk of having a fatal opioid overdose?”

In searching for peer-reviewed articles and research papers about the topic, some keywords should be used to ease the search. Some of the keywords used in this search include opioid overdose, the use of naloxone to curb opioid effects, the risk of overdosing among opioid users, overdose, emergency department, prevention, and death and opioid misuse. The databases that is used in this search include Ebsco, PubMed, and ProQuest. 

When I searched how opioid users with access to naloxone and those without access to naloxone compared to the risk of suffering from an opioid overdose, there were 504 results. I narrowed down the research by limiting it only to academic journals, and the results were reduced to 120. I narrowed the research further by only limiting it to the peer-reviewed articles written within the last five years, and the results were reduced to 85. 

When I searched how naloxone prevents opioid misuse, there were ten results. When the search was narrowed down to only peer-reviewed articles written in the last five years, the results were reduced to 2. When I replaced the word naloxone with Narcan, the results increased to 161, which included peer-reviewed articles written in the last five years. When I searched the term opioid overdose, the results increased further to 8432. However, when I searched for opioid overdose prevention, the search results decreased to 4483.

There are some strategies that can be used to increase the rigor and the effectiveness of the database search. According to Melnyk and Fineout-Overholt (2018), one of the factors that contribute to effectiveness in a database search is using the right databases. Some databases have been equipped with peer-reviewed articles in one field. Therefore, it is wise to search in the relevant database. For instance, when searching about healthcare issues, one should search in healthcare databases for better results.

Additionally, to come up with effective and rigorous searches, one should search in numerous databases. That gives access to the most relevant searches as different databases may contain different articles. Also, one should use the appropriate vocabulary. That will ensure that the search results are relevant to the topic of interest. Finally, one should combine terms and concepts suing the Boolean operators to ensure that the search results are effective and relevant to the topic of interest.

References

Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos brasileiros de oftalmologia, 82(2), 1-1.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Narcan. (n.d). Retrieved June 19, 2019, from https://www.narcan.com/