NURS 6052 Evidence-Based Project Part 1 Identifying Research Methodologies
NURS 6052 Evidence-Based Project Part 1 Identifying Research Methodologies
Please be mindful of plagiarism and APA format, I have included the rubric as directed and a Template. Please use my course resources as one of my references as instructed. Please use the template. Thank you.
Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies – Is there a difference between common practice and best practice?
When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a rookie, you likely kept the nature of your questions to those with answers that would best help you perform your new role.
Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.
Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?
In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
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To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.
Part 1: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
The full citation of each peer-reviewed article in APA format.
A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.
Include a title page, introduction, summary, and reference page.
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Matrix Worksheet Template
Use this document to complete Part 1 of the Module 2 Assessment, Evidence-Based Project, Part 1: Identifying Research Methodologies
| Full citation of selected article | Article #1 | Article #2 | Article #3 | Article #4 |
| Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) | ||||
| Brief description of the aims of the research of each peer-reviewed article | ||||
| Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. | ||||
| A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. | ||||
| General Notes/Comments |
Matrix Worksheet – Evidence-Based Project, Part 1: Identifying Research Methodologies Example Solution
Student’s name
Walden University
Course
Instruction
Month, Day, Year
Matrix Worksheet
Evidence-based practice (EBP) uses clinical inquiry to acquire evidence-based answers to improve practice. In this matrix worksheet, I will compare the various research articles that I selected from a literature search following a clinical inquiry. My clinical issue of interest was gastrointestinal upset after the use of antibiotics and other acute disorders. Antibiotics especially the broad-spectrum ones kill several types of bacteria in the gut and the system. This can lead to eradication or reduction in the normal flora of the gastrointestinal tract.
The reduction of this natural source of defense in the gut can lead to the proliferation and virulence of pathogenic bacteria. Probiotics are exogenous regimens either containing commensals or their substrates that maintain the normal flora in the body (Wang et al., 2020). This clinical inquiry aims at assessing the benefit of prophylactic administration of probiotic foods to prevent gastrointestinal effects of antibiotics used on the gut such as gastrointestinal upset.
My PICOT question stated: “Among patients with gastrointestinal retiled to microbial infections (P), does the use of probiotic foods (I) confer health benefits in improving their health (O) after 3 months (T)?” Several sources were searched and the following four articles were sued to provide evidence-based answers to the clinical questions.
| Full citation of the selected article | Article #1 | Article #2 | Article #3 | Article #4 |
| Skrzydło-Radomańska, B., Prozorow-Król, B., Cichoż-Lach, H., Majsiak, E., Bierła, J. B., Kanarek, E., Sowińska, A., & Cukrowska, B. (2021). The effectiveness and safety of multi-strain probiotic preparation in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled study. Nutrients, 13(3), 756. https://doi.org/10. 3390/nu13030756 | Hibberd, A. A., Yde, C. C., Ziegler, M. L., Honoré, A. H., Saarinen, M. T., Lahtinen, S., Stahl, B., Jensen, H. M., & Stenman, L. K. (2019). Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults. Beneficial Microbes, 10(2), 121–135. https://doi.org/10. 3920/BM2018.0028 | Rui, X., & Ma, S.-X. (2020). A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea. Medicine, 99(23), e20631. https://doi.org/10.1097/ MD.0000000000020631 | Arnold, L. E., Luna, R. A., Williams, K., Chan, J., Parker, R. A., Wu, Q., Hollway, J. A., Jeffs, A., Lu, F., Coury, D. L., Hayes, C., & Savidge, T. (2019). Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 29(9), 659–669. https://doi.org/10. 1089/cap.2018.0156 | |
| Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) | This article addresses the use of probiotics and their efficacies and effectiveness. It is addressed by PICOT intervention and outcomes at the same time. | This article meets my timeline criterion for article selection and addresses my intervention and outcomes. This article was more concerned with the mechanism that I would use to explain the clinical benefits of probiotic use. | This article addresses my population/problem, intervention, and outcomes. Therefore, I selected it because of its features and date of publications – less than 5 years old | This study was published in the last five years and was relevant to my clinical inquiry. The findings are therefore current and reliable. The uniqueness of the study population also made influenced the selection of this article |
| Brief description of the aims of the research of each peer-reviewed article | The study aimed at evaluating the effectiveness of multi-strain probiotics in patients with diarrhea-predominant irritable bowel syndrome | This study aims to establish whether the clinical benefits associated with probiotic use are associable with gut microbiota change | This study aimed to explore the safety and benefits of the probiotics among children who had antibiotic-induced diarrhea | The authors aimed at exploring the impact of probiotic mixture on the impact of quality of life of children with autism spectrum disorder (ASD). Gastrointestinal symptoms including diarrhea were some of the parameters for evaluation |
| Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. | This was a quantitative study that adopted a randomized control trial design. Placebo and double-blinding were also used. the intervention group received a multi-strain while the c0ntrol group received a placebo. At the study end, the symptom severity was assessed using a scale system. | This was a quantitative study with a randomized control trial design. The participants were randomly assigned into four groups receiving three different strains of probiotics and one placebo. Double blinding was done and outcomes in microbiota presence in blood and fecal samples were analyzed to infer gut barrier function | This was a quantitative study that adopted a retrospective case-control design. Thirty-six children of the 76 children who were enrolled in the study received additional probiotics to their treatment regiment while the other 40 did not. Duration of diarrhea among other outcomes was evaluated after seven days. | This is a quantitative study with a pilot control trial design. Thirteen children 92-13 years) were enrolled and assigned into the intervention and placebo groups. Symptom outcomes were recorded at baseline and after every 3 weekly washouts up to the 19th week. |
| A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. | This study is an RCT thus the high level of evidence (Melnyk & Fineout-Overholt, 2018). The authors are experts in microbiology and other related medical fields thus reliable findings. | This study is a high level of evidence study that used four groups to compare outcomes. The study was ethically approved and the methodology is reliable. | This study had a control group that improved the strength of comparison in this retrospective study. a universal tool such as the British Stool scale was used to improve the reliability of the findings. | The use of the control group gave this study more strength. It was also reliable because of the credibility of the authors and the database source |
| General Notes/Comments | The study was appropriate for addressing my clinical inquiry due to its relevance to the research question | Another high level of evidence study fit for understanding the intervention in my clinical inquiry. | This was a lower-level evidence study than the one analyzed before but meets most of the components of my clinical inquiry | A unique population would give my appraisal findings good generalizability and applicability across the human life span |
Conclusion
The use of probiotics is not a new concept. However, as health research advances new strains are introduced in the commercial probiotics. This begs the need to ascertain their benefits through evidence-based practice. This matrix comparison analyzed the methodologies of four articles obtained through a literature search using PICOT clinical inquiry. Two studies were randomized control trials, one was a retrospective case-control study, and the other was a pilot control trial study. All studies were quantitative.
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NURS 6052 Evidence-Based Project Part 1 Identifying Research Methodologies References
Arnold, L. E., Luna, R. A., Williams, K., Chan, J., Parker, R. A., Wu, Q., Hollway, J. A., Jeffs, A., Lu, F., Coury, D. L., Hayes, C., & Savidge, T. (2019). Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 29(9), 659–669. https://doi.org/10.1089/cap.2018.0156
Hibberd, A. A., Yde, C. C., Ziegler, M. L., Honoré, A. H., Saarinen, M. T., Lahtinen, S., Stahl, B., Jensen, H. M., & Stenman, L. K. (2019). Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults. Beneficial Microbes, 10(2), 121–135. https://doi.org/10.3920/BM2018.0028
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Lippincott Williams and Wilkins.
Rui, X., & Ma, S.-X. (2020). A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea. Medicine, 99(23), e20631. https://doi.org/10.1097/MD.0000000000020631
Skrzydło-Radomańska, B., Prozorow-Król, B., Cichoż-Lach, H., Majsiak, E., Bierła, J. B., Kanarek, E., Sowińska, A., & Cukrowska, B. (2021). The effectiveness and safety of multi-strain probiotic preparation in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled study. Nutrients, 13(3), 756. https://doi.org/10.3390/nu13030756
Wang, Y., Jiang, Y., Deng, Y., Yi, C., Wang, Y., Ding, M., Liu, J., Jin, X., Shen, L., He, Y., Wu, X., Chen, X., Sun, C., Zheng, M., Zhang, R., Ye, H., An, H., & Wong, A. (2020). Probiotic supplements: Hope or hype? Frontiers in Microbiology, 11, 160. https://doi.org/10.3389/fmicb.2020.00160
NURS 6052 Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Please be mindful of plagiarism and APA format, I have included the rubric as directed. Please use my course resources as one of my references as instructed. Please include Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer in the references. Thank you.
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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.
Include a title page, an introduction, and a summary.
My clinical issue of interest was gastrointestinal upset after the use of antibiotics and other acute disorders.
PICOT Question: Why does the use of antibiotics to treat acute disorders lead to gastrointestinal upset among adult patients than when using other medications?
I need 7 slides of PowerPoint presentation.
Please follow the instructions and answer all the required questions.
NURS 6052 Evidence-Based Project, Part 3: Critical Appraisal of Research
Please be mindful of plagiarism and APA format, I have included the rubric as directed and a template. Please use my course-required readings materials for the references.
Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research
Realtors rely on detailed property appraisals conducted using appraisal tools to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.
Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.
In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.
To Prepare:
Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)
Part 3A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.
Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.
Part 3B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
Include a title page, an introduction and a summary.
NOTE:
I HAVE ATTACHED THE ARTICLE USED FOR MODULE 2 AND 3. PLEASE USE THE REQUIRED READING FOR THE REFERENCES.
LET ME KNOW IF YOU NEED ACCESS TO WALDEN LIBRARY.
Module 2 Articles
| Article #1 | Article #2 |
| Skrzydło-Radomańska, B., Prozorow-Król, B., Cichoż-Lach, H., Majsiak, E., Bierła, J. B., Kanarek, E., Sowińska, A., & Cukrowska, B. (2021). The effectiveness and safety of multi-strain probiotic preparation in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled study. Nutrients, 13(3), 756. https://doi.org/10.3390/nu13030756 | Hibberd, A. A., Yde, C. C., Ziegler, M. L., Honoré, A. H., Saarinen, M. T., Lahtinen, S., Stahl, B., Jensen, H. M., & Stenman, L. K. (2019). Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults. Beneficial Microbes, 10(2), 121–135. https://doi.org/10.3920/BM2018.0028 |
| Article #3 | Article #4 |
| Rui, X., & Ma, S.-X. (2020). A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea. Medicine, 99(23), e20631. https://doi.org/10.1097/MD.0000000000020631 | Arnold, L. E., Luna, R. A., Williams, K., Chan, J., Parker, R. A., Wu, Q., Hollway, J. A., Jeffs, A., Lu, F., Coury, D. L., Hayes, C., & Savidge, T. (2019). Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 29(9), 659–669. https://doi.org/10.1089/cap.2018.0156 |
Module 3:
Four articles were selected from the systematic search. The first article, by Nasiri et al. (2018) was a systematic review and metanalyses of randomized control trials thus level I evidence. The second article by Agamennone et al. (2018) is also a systematic review and metanalysis of various clinical studies thus level I evidence. The third article displayed is by Goodman et al. (2021) provides level I evidence because it is from a systematic review and metanalysis study. The fourth article, by Cai et al. (2018) was also a systematic review with network metanalysis thus level I evidence.
Critical Appraisal Tool Worksheet Template
Evaluation Table
| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
| Evidence Level * (I, II, or III) | ||||
| Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).** | ||||
| Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). | ||||
| Sample/Setting The number and characteristics of patients, attrition rate, etc. | ||||
| Major Variables Studied List and define dependent and independent variables | ||||
| Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). | ||||
| Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). | ||||
| Findings and Recommendations General findings and recommendations of the research | ||||
| 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? | ||||
| Key findings | ||||
| Outcomes | ||||
| General Notes/Comments |
- Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
- Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
- Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
- Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
- Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
**Note on Conceptual Framework
- The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework
- Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
- As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”
- Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.
- Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
References
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.
Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. https://academicguides.waldenu.edu/library/conceptualframework
Critical Appraisal Tool Worksheet Example Solution
Critical Appraisal
Critical appraisal is the fourth of the six steps of evidence-based practice to appraise the selected evidence. This critical appraisal serves two main purposes: to assess the evidence for its closeness to the truth or the actual occurrence in the population and to assess the evidence for usefulness in application to practice. My clinical issue of interest was the use of probiotics in the treatment of gastrointestinal symptoms associated with antibiotics use. Eight journal articles from peer-reviewed journals were selected for early steps of critical appraisal. In this critical appraisal, four of the eight articles with varying methodologies and levels of evidence are appraised and evaluated.
Part 3 A: Evaluation Table
| Full APA formatted citation of the selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
| Skrzydto-Radomańska, B., Prozorow-Król, B., Cichoż-Lach, H., Majsiak, E., Bierła, J. B., Kanarek, E., Sowińska, A., &Cukrowska, B. (2021). The effectiveness and safety of multi-strain probiotic preparation in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled study. Nutrients, 13(3), 756. https://doi.org/10. 3390/nu13030756 | Hibberd, A. A., Yde, C. C., Ziegler, M. L., Honoré, A. H., Saarinen, M. T., Lahtinen, S., Stahl, B., Jensen, H. M., &Stenman, L. K. (2019). Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults. Beneficial Microbes, 10(2), 121–135. https://doi.org/10. 3920/BM2018.0028 | Rui, X., & Ma, S.-X. (2020). A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea. Medicine, 99(23), e20631. https://doi.org/10.1097/ MD.0000000000020631 | Arnold, L. E., Luna, R. A., Williams, K., Chan, J., Parker, R. A., Wu, Q., Hollway, J. A., Jeffs, A., Lu, F., Coury, D. L., Hayes, C., &Savidge, T. (2019). Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 29(9), 659–669. https://doi.org/10.1089/ cap.2018.0156 | |
| Evidence Level * (I, II, or III) | This is an evidence level I study (Randomized Controlled Study). | The study is evidence Level I (Randomized Controlled Trial). | Evidence Level III (Observational/non-experimental study). | Evidence Level I (A Placebo-Controlled Randomized Pilot Trial). |
| Conceptual Framework Describe the theoretical basis for the study (If there is no one mentioned in the article, say that here).** | The study aimed at determining whether the use of a multi-strain probiotic in adults with irritable bowel syndrome that predominantly presents with diarrhea was effective and safe. | The research purposed to determine if changes in the gut microbiota attributed to probiotic or symbiotic use were associated with the earlier observed clinical benefits of controlling energy metabolism and body fat mass in overweight adult individuals. | The objective of this study was to determine the safety and benefits of probiotics, particularly live combined Bacillus subtilis and Enterococcus faecium granules with multivitamins, when used in the management of children with diarrhea attributed to antibiotics. | The conceptual framework of the research was to analyze gastrointestinal (GI) symptoms in regards to targeted probiotic use with expected effect on the quality of life in autistic spectrum disorders. |
| Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). | The study adopted a randomized controlled study which is a type of experimental study. Adult patients with the aforementioned condition were randomly selected into two groups. One group was set to receive a multi-strain probiotic for eight weeks whereas the second group was a control group receiving a placebo for a similar duration. The two groups were observed for anticipated outcomes such as changes in the severity of symptoms and clinical improvement based on the IBS severity scoring system and Global improvement score. | A randomized controlled trial of protocol compliant participants was randomly assigned one of the four groups of interventions including a group receiving a placebo and observed for 6 months. Plasma and fecal samples were collected from these individuals at baseline, 2 months, 4 months, 6 months, and one-month post-intervention. These samples were then examined for fecal microbiota composition and metabolites and the correlation with obesity-related clinical outcomes was established. | This retrospective observational study analyzed children with antibiotic-associated diarrhea. These were randomly allocated into two groups; one intervention group receiving standard treatment with probiotics and the other group being the control group thus receiving only the routine care. The treatment for both groups lasted for 7 days. The duration of diarrhea, the number of days required dressing, the severity of abdominal pain, the consistency of stool, and any noted adverse occurrence were all measures used to assess the safety and effectiveness of the treatment. | A controlled randomized pilot trial was conducted on children of age between 3 to 12 years with preexisting autism spectrum disorders, anxiety, and gastrointestinal symptoms were randomly allocated into two groups of probiotic crossovers for eight weeks with and in-between three-week washout. One group received a placebo/probiotic sequence whereas the other had a probiotic/placebo sequence. A mixed analysis was then employed to assess the primary and secondary outcomes. |
| Sample/Setting The number and characteristics of patients, attrition rate, etc. | The study sample consisted of 51 patients with diarrhea-predominant inflammatory bowel disease who were randomly selected from 76 patients meeting the inclusion criteria of greater than 175 points based on the IBS-SSS score. | The study population was from a larger clinical study of healthy adults who were either overweight or obese of whom a total of 134 protocol compliant individuals were selected for the study. | The study was conducted in Jiamusi University First Affiliated Hospital whereby participants were 72 children between the age of five to eleven years diagnosed with AAD with no other preexisting gastrointestinal illness. | The study involved 13 children aged between 3 and 12 years who had ASD, gastrointestinal symptoms, and anxiety. |
| Major Variables Studied List and define dependent and independent variables | The independent variable was the multi-strain probiotic treatment for the intervention group and the placebo for the control group. The dependent variables under observation in both groups included improvement or changes in the severity of IBS symptoms with specific attention to the pain intensity, quality of life, and presence of adverse events in the study participants. | The independent variable in this study was probiotic Bifidobacterium animalis subspecies lactis 420 and the placebo used which were Litesse ultra polydextrose and microcrystalline cellulose. The dependent variables were the fecal microbiota or gut flora composition and metabolites and correlation with waist-hip ratio. | The independent variables in this particular study were the probiotics used which included live combined Bacillus subtilis and Enterococcus faecium granules when added or not added to standard treatment of AAD in children. The dependent variables were the diarrhea duration in days, daily dressing number needed, the severity of abdominal pain, consistency of stool whether normal, liquid or constipated, and any experienced adverse outcome all of which were used to determine the safety and effectiveness of the probiotic. | The independent variable was VISBIOME which is a probiotic formulation with eight species majorly Lactobacillus and a placebo administered to study subjects. The dependent variables were health benefits with Pediatric quality of life inventory GI module as the primary outcome and parent-rated anxiety scale for autism spectrum disorder, analysis of microbiota, and parent-chosen target symptoms as the secondary outcomes. |
| Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). | The inflammatory bowel syndrome severity scoring system (IBS-SSS) and IBS Global Improvement scale were used to assess improvement in the severity of symptoms in diarrhea-predominant IBS. | Fecal and blood samples were obtained from participants from which outcomes of fecal microbiota components and metabolites were assessed. Change in the ratio of waist-to-hip in addition to the waist area fat mass was also observed for change. | The outcome measurements after interventions were either primary or secondary and included the diarrhea duration in days, daily dressing number needed, severity of abdominal pain based on visual analog pain score, consistency of stool based on the Bristol stool scale, and any experienced adverse outcome. | PedsQL, PRAS-ASD, and parent-selected target symptoms were measures used to assess the outcome of the probiotic/placebo treatment. |
| Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). | After eight weeks of intervention, it was noted that the probiotic led to a statistically significant improvement from baseline in the IBS symptom severity (165.8 +/- 78.9 IBS-SSS score), pain severity, and quality of life in comparison to placebo (105+/-60.2 IBS-SSS). In regards to the IBS-GIS, the group that received the probiotic also reported improved symptoms in contrast to the group receiving the placebo both at the fourth (p=0.04) and twelfth (p=0.003) week of intervention. However, there was no difference in the occurrence of adverse events between the two study groups. | Probiotic use when compared with placebo resulted in altered gut microbiota by causing increasing some such as Lactobacillus, and Akkermansia and reducing some such as Paraprevotella. Metabolites such as glycoursodeoxycholic acid were also reduced by probiotic use. This caused a negative correlation between waist-hip ratio and waist fat mass thus improving clinical obesity-related outcomes. | Probiotic treatment reduced the diarrhea duration (p<.01), the number of daily dressings (p<.01), the degree of pain in the abdomen (p<.01), and the consistency of stool (p<.01). Furthermore, no adverse events were reported. | From the 77% retention rate of participants, there were no statistically significant outcomes in PedsQL and PRAS-ASD despite probiotic use showing greater Lactobacillus retention and better improvement as compared to placebo. |
| Findings and Recommendations General findings and recommendations of the research | The multi-strain probiotic was found to significantly improve IBS symptoms and thus is beneficial to the patient in addition to its safety and good tolerance. | The altered gut microorganism contributing to the protective gut barrier and metabolites caused a negative correlation with waist-hip ratio and waist fat mass thus improving clinical obesity-related outcomes. | Probiotic treatment greatly reduces the severity of AAD and thus should be considered in individuals with this condition. | The retaining of Lactobacillus with probiotic use leads to improvement and is thus beneficial. |
| Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of the study? What are the risks associated with the implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? | Findings were statistically significant and thus can be feasible in clinical practice due to the demonstrated benefits with support from other similar studies. | The study demonstrates the role of gut microbiota in improving weight management in overweight management and hence can be considered as one of the weight reduction strategies. | Statistically significant findings from this study may justify the use of probiotic AAD. More studies may be required especially in the other age groups for wider coverage. | Since the findings from this study were generally statistically insignificant, there is a need to do a repeat study using a larger study group to present more accurate findings. |
| Key findings | Improved IBS symptoms from probiotic use. | Probiotic use alters the gut microbiota together with its metabolism which contributes to weight reduction and improvement in gastrointestinal barrier function. | There was an improvement in symptoms and shortened duration of illness with probiotic use in AAD. | Probiotics when used in ASD with gastro-intestinal symptoms led to abundant Lactobacillus which may contribute to symptom and quality of life improvement. |
| Outcomes | The probiotic is safe and beneficial in its use for the management of IBS-D. | Probiotic consumption can successfully lead to clinical benefits of controlling energy metabolism and body fat mass in overweight adult individuals. | Probiotics safely and effectively treated antibiotic-associated diarrhea. | The findings were not statistically significant. Thus, conclusions on the safety and effectiveness of probiotics in ASD cannot be sufficiently drawn. |
| General Notes/Comments | This study has remarkable data with clear evidence of the correlation between probiotic use and improvement in IBS-D symptoms. | There are a few lapses in this study that should be considered in future studies. | An experimental study can be considered in the future to further support the findings. | This study still has gaps due to the small sample size. A larger study population can be considered in the future to represent a true picture of the findings. |
Part 3B: Critical Appraisal of Research
The above evaluation table summarized the findings of individual evidence-based sources that addressed various sections of my clinical inquiry that was in the form of a PICOT question. Two sources were high-level evidence sources that included systematic reviews while the other sources ranked lower in the hierarchy. Systematic reviews have the findings more validity because systematic reviews consolidate the findings from various relevant and valid sources and organize their findings by following a systematic process (Melnyk & Fineout-Overholt, 2018). From the above evaluation, I can conclude that probiotic use improves systems of irritable bowel symptoms. They enhance weight reduction by alteration in microbiota and their metabolism. Probiotics use among patients with antibiotics associated diarrhea also alleviates these symptoms. Gastrointestinal symptoms also improve among children with gastrointestinal symptoms in atrial septal defects. No study evaluated the contraindications for use of these agents among impatient with gastrointestinal symptoms
The best practice, therefore, would include the prescription of antibiotics among patients with gastrointestinal symptoms especially diarrhea that would be associated with disturbance in the balance between microbiota and pathogenic bacteria in the gut. The decision to prescribe these agents or not is solely made based on clinical reasoning and decision making based on appropriate evaluations. Best practice may consider probiotic use among patients with antibiotic-associated diarrhea, irritable bowel symptoms,
Conclusion
The above best practice statement is backed up by evaluated data for reliable and scholarly sources that are recent and thus credible. Further studies should evaluate when not to use these agents in the indicated patients. Otherwise, they can be considered safe and effective. Data on their efficacies were not evaluated.
References
Arnold, L. E., Luna, R. A., Williams, K., Chan, J., Parker, R. A., Wu, Q., Hollway, J. A., Jeffs, A., Lu, F., Coury, D. L., Hayes, C., &Savidge, T. (2019). Probiotics for gastrointestinal symptoms and quality of life in autism: A placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 29(9), 659–669. https://doi.org/10.1089/cap.2018.0156
Hibberd, A. A., Yde, C. C., Ziegler, M. L., Honoré, A. H., Saarinen, M. T., Lahtinen, S., Stahl, B., Jensen, H. M., &Stenman, L. K. (2019). Probiotic or synbiotic alters the gut microbiota and metabolism in a randomized controlled trial of weight management in overweight adults. Beneficial Microbes, 10(2), 121–135. https://doi.org/10.3920/BM2018.0028
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Lippincott Williams and Wilkins.
Skrzydto-Radomańska, B., Prozorow-Król, B., Cichoż-Lach, H., Majsiak, E., Bierła, J. B., Kanarek, E., Sowińska, A., &Cukrowska, B. (2021). The effectiveness and safety of multi-strain probiotic preparation in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled study. Nutrients, 13(3), 756. https://doi.org/10.3390/nu13030756
Rui, X., & Ma, S.-X. (2020). A retrospective study of probiotics for the treatment of children with antibiotic-associated diarrhea. Medicine, 99(23), e20631. https://doi.org/10.1097/MD.0000000000020631
NURS 6052 Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change
Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer in the references. Thank you.
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 7, Patient Concerns, Choices and Clinical Judgement in Evidence-Based Practice (pp. 219–232)
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396
Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
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.
Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: 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.
Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
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)
Please use my required reading for the references.
Include a title page and an introduction.
I have attached the articles used for module 4, PICOT, and my clinical interest.
I want 8-9 slides and please answer all the questions.
Also Read: NURS 6512 Discussion: Building a Health History Instructions
