NURS 6052 WK5 Assign Part 2 Advanced Level Of Clinical Inquiry And Systemic Review

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 synopsis).
  • 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 2: 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.

Borderline Personality Disorder

I had to frame a composite question that would be the basis of my clinical inquiry, namely, that in patients who have a borderline personality disorder (P), does the use of (CBT) (I), compared to pharmacologic treatment (C), result in effect socio-occupational functioning (O), over six months (T).

Learning Resources

Note: To access this module’s required library resources, please click on the link to the

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

Advanced Level Of Clinical Inquiry And Systematic Review Sample Paper

Offloading As A Treatment For Diabetic Foot Ulcers (DFU) In Adults

Diabetic foot ulcers (DFU) account for roughly 60% of limb loss in diabetic patients (Gwilliam, Critz & Gustavson, 2017). Without performing all the non-weight bearing loads, plantar foot DFU is difficult to cure. To continue to have the best quality of life, diabetic neuropathy patients generally do not know that DFU begins until the wound is completely covered. Neuropathy is one of the main causes of DFU, which can threaten the extremities.

Traditional debridement dressings are traditional treatment methods. Effective pressure reduction (offloading) is now the best standard treatment (Tickner et al., 2018). Other offloading devices include orthopedic shoes, braces, walking aids like walkers and foam inserts.

Describe How You Developed A PICOT Question On The Chosen Clinical Issue Of Interest

PICOT stands for Population, Intervention, Comparison, Results, and Time. PICO(T) problems can be expressed as a prognosis, intervention, diagnosis, and etiology. The development of the PICO(T) questions should focus on the main questions to find the correct answers and evidence for the clinical questions and eliminate the uncertainty. The development of my PICO(T) began with the process of searching for diabetic foot ulcers. 

Different treatments have been suggested in the research, and I decided to study diabetic foot ulcers of offloading. I have found that using a total contact cast (tcc) for discharge is the gold standard for plantar ulcers as it can reduce pressure on the wound and lead to wound healing. (Tickner et al., 2018). Hence, my PICOT question is: In an adult with a diabetic foot ulcer, does offloading promote ulcer healing?

Identify Four Research Databases Use To Conduct The Search For Peer-Reviewed Articles

The Walden University Library was utilized to search for systematic reviews on diabetic foot ulcers and the use of offloading for healing. I used the four databases below. However, my search’s best results were from Cinahl Plus with Full Text and Proquest

  • Nursing and Allied Health Database.
  • Cochrane
  • Cinahl Plus with Full Text
  • Embase
  • Proquest Nursing and Allied Health Database

APA Citation Of The Peer-Reviewed Articles

The articles listed here in APA format were read to determine the level of evidence in each on the PICO(T): In an adult with a diabetic foot ulcer, does offloading promote the ulcer’s healing?

  • Cavanagh, P. R., Lipsky, B. A., Bradbury, A. W., & Botek, (2005). Treatment for diabetic foot ulcers. The Lancet, 366(9498), 1725-1735.
  • Elraiyah , Tsapas, A., Prutsky, G., Domecq, J. P., Hasan, R., Firwana, B., … & Steinkraus, L. W. (2016). A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of vascular surgery, 63(2), 46S-58S.
  • Tickner, A., Klinghard, C., Arnold, J. F., & Marmolejo, (2018). Total Contact Cast Use in Patients With Peripheral Arterial Disease: A Case Series and Systematic Review. Wounds: a compendium of clinical research and practice, 30(2), 49-56.
  • Sahu , Prusty, A., & Tudu, B. (2018). Total contact casting versus traditional dressing in diabetic foot ulcers. Journal of Orthopaedic Surgery, 26(3), 2309499018802486

Systematic Reviews: Strength in research

The systematic review solves a clinical problem and is carried out by searching for diverse information. Systematic reviews are time-consuming and conducted by multiple investigators. A comprehensive review of the system will reduce a large amount of information into a single document to provide evidence to answer clinical questions. The system review follows specific guidelines and a scientific design, which can reduce deviations and errors.

A systematic review can also determine the lack of evidence. When a large amount of statistical data is collected in a systematic review, a meta-analysis can be performed from the evidence, which is a statistical analysis of the results, usually combining the results in a table or graph (Gopalakrishnan and Ganeshkumar, 2013)

References

  • Cavanagh, P. R., Lipsky, B. A., Bradbury, A. W., & Botek, G. (2005). Treatment for diabetic foot ulcers. The Lancet, 366(9498), 1725-1735.
  • Elraiyah, T., Tsapas, A., Prutsky, G., Domecq, J. P., Hasan, R., Firwana, B., … & Steinkraus, L. (2016). A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of vascular surgery, 63(2), 46S-58S.
  • Gwilliam, A., Critz, D., & Gustavson, R. G. (2017). Best Practice Guidelines And Algorithm Established For Treatment And Referral Of Patients With Diabetic Foot Ulcers. In Journal Of Wound Ostomy And Continence Nursing (Vol. 44, No. 3, Pp. S49-S49). 
  • Two Commerce Square, 2001 Market St, Philadelphia, Pa 19103 Usa: Lippincott Williams & Wilkins.
  • Gopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. Journal of family medicine and primary care, 2(1), 9.
  • Sahu, B., Prusty, A., & Tudu, B. (2018). Total contact casting versus traditional dressing in diabetic foot ulcers. Journal of Orthopaedic Surgery, 26(3), 2309499018802486. Hopkins Medicine (n.d.). Retrieved from https://www.hopkinsmedicine.org/evidence-basedpractice/_docs/appendix_c_evidence_level_quality_guide.pdf