Assignment Week 5 Review

The purpose of the assignment is to compare and contrast integrative reviews and systematic reviews. After reviewing the chapters and PowerPoints for this week, please pick a topic and compare and contrast what the possible pros and cons are of an integrative review compared with a systematic review for that topic. You can dig deeper and find actual published work regarding your topic or use the review examples in Box 11.4

Please submit a summary of your findings (approximately 250 words). Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment. Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions.

Chapter 11

Systematic Reviews and Clinical Practice Guidelines

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  • Systematic review is the summation and assessment of research studies found in the literature based on a clearly focused question that uses systematic and explicit methods to identify, select, critically appraise, and analyze relevant data from the selected studies to summarize the findings in a focused area.

Systematic Review

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  • A review of studies using statistical methods
  • Statistically analyzes and integrates the results of many studies
  • Provides level I evidence, the highest level of evidence

Meta-Analysis

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  • Critically appraises the literature in an area, but without a statistical analysis
  • Broadest category of review

Integrative Review

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  • Summary of the quantitative research literature that used similar designs based on a focused clinical question
  • Brings together all the studies concerning a focused clinical question and, using rigorous inclusion and exclusion criteria, assesses the strength and quality of the evidence provided by the chosen studies in relation to:
  • Sampling issues
  • Internal validity (bias) threats
  • External validity
  • Data analysis

Systematic Review

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  • Systematic summary using statistical techniques to assess and combine studies of the same design to obtain a precise estimate of effect
  • Statistically analyzes the data from each of the studies

Meta-Analysis

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  • Phase I: The data are extracted (i.e., outcome data, sample sizes, and measures of variability from the identified studies).
  • Phase II: The decision is made as to whether or not it is appropriate to calculate what is known as a pooled average result (effect) of the studies reviewed.

Phases of Meta-Analysis

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  • Effect sizes are calculated using the difference in the averages scores between the intervention and control groups from each study.
  • Thus, the effect size is an estimate of how large of a difference there is between intervention and control groups in the summarized studies.

Effect Size

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  • Sometimes called a “blobbogram”
  • Graphically depicts the results of analyzing a number of studies

Forest Plot

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Forest Plot (Cont.)

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  • Largest repository of meta-analyses.
  • Cochrane Collaboration is an international organization that prepares and maintains a body of systematic reviews that focus on health care interventions.

Cochrane Collaboration

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  • Critical reviews of an area of research without a statistical analysis or a theory synthesis
  • Broadest category of review
  • Can include theoretical literature, research literature, or both
  • Can include both quantitative or qualitative research

Integrative Review

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  • PRISMA (Preferred Reporting for Systematic Reviews and Meta-analyses)
  • MOOSE (Meta-analysis of Observational Studies in Epidemiology

Reporting Guidelines: Systematic Reviews and Meta-Analysis

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  • The Center for Evidence Based Medicine (CEBM)
  • Questions
  • Does this study address a clearly focused question?
  • Did the study use valid methods to address the question
  • Are the valid results of the study important?
  • Are these valid, important results applicable to my patient or population?

 

Tools for Evaluating Individual Studies

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  • Systematically developed statements or recommendations that link research and practice and serve as a guide for practitioners.
  • Guidelines are developed by professional organizations, government agencies, institutions, or convened expert panels.
  • Guidelines provide clinicians with an algorithm for clinical management, or decision making for specific diseases.

Clinical Practice Guidelines

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  • Evidence-based practice guidelines are developed using a scientific process.
  • Expert-based guidelines: agreement of a group of nationally known experts in the field who meet and solely use opinions of experts along with whatever research evidence is developed to date.

Clinical Practice Guidelines (Cont.)

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  • National organizations develop clinical practice guidelines
  • Appraisal of Guidelines Research and Evaluation II (AGREE II)—one of the most widely used to evaluate the applicability of a guideline to practice

Evaluating Clinical Practice Guidelines

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  • AGREE II—Developed to assist in evaluating guideline quality, provide a methodological strategy for guideline development, and inform practitioners about what information should be reported in guidelines and how it should be reported.

Evaluating Clinical Practice Guidelines (Cont.)

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  • Does the PICO question used as the basis of the review match the studies included in the review?
  • Are the review methods clearly stated and comprehensive?
  • Are the dates of the review’s inclusion clear and relevant to the area reviewed?
  • Are the inclusion and exclusion criteria for studies in the review clear and comprehensive?
  • What criteria were used to assess each of the studies in the review for quality and scientific merit?
  • If studies were analyzed individually were the data clear?
  • Were the methods of study combination clear and appropriate?
  • If the studies were reviewed collectively, how large was the effect?
  • Are the clinical conclusions drawn from the studies relevant and supported by the review?

Critiquing Criteria—Systematic Reviews

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  • Is the date of publication or release current?
  • Are the authors of the guideline clear and appropriate to the guideline?
  • Is there a clinical problem and purpose clear in terms of what the guideline covers and patient groups for which it was designed?
  • What types of evidence (research, nonresearch) were used in formulating the guideline and were they appropriate to the topic?
  • Is there a description of the methods used to grade the evidence?
  • Were the search terms and retrieval methods used to acquire research and nonresearch evidence used in the guideline clear and relevant?
  • Is the guideline well referenced and comprehensive?
  • Are the recommendations in the guideline sourced according to the level of evidence for its basis?
  • Has the guideline been reviewed by experts in the area?
  • Who funded the guideline development?

Critiquing Guidelines—Systematic Reviews

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Human subjects

Pretest and posttest design

Statistical methods

Qualitative analysis

The only review type that can be labeled meta-analysis is one that reviewed studies using what?

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Answer: C

Rationale: The only review type that can be labeled a meta-analysis is one that reviewed studies using statistical methods.

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Level I

Level II

Level III

Level IV

Meta-analysis provides which level of evidence?

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Answer: A

Rationale: Meta-analysis provides Level I evidence, the highest level of evidence as it statistically analyzes and integrates the results of many studies.

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A systematic review:

is summary of the qualitative research literature

summarizes studies with different designs

provides an analysis of the studies

reports the most current and valid research on intervention effectiveness

Which statement about systematic review does the nurse identify as being true?

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Answer: D

Rationale: A systematic review is a summary of the quantitative research literature that used similar designs based on a focused clinical question. The goal is to bring together all of the studies concerning a focused clinical question and, using rigorous inclusion and exclusion criteria, assess the strength and quality of the evidence provided by the chosen studies.

The purpose is to report, in a consolidated fashion, the most current and valid research on intervention effectiveness and clinical knowledge, which will ultimately inform evidence-based decision making about the applicability of findings to clinical practice.

The components of a systematic review are the same as a meta-analysis except for the analysis of the studies.

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AGREE II Guideline

Cochrane Collaboration/Review

National Institutes of Health

Centers for Disease Control and Prevention

The largest repository of meta-analyses is what?

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Answer: B

Rationale: The largest repository of meta-analyses is the Cochrane Collaboration/Review.

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