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-analyses 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.

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Solution

1 ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS

2 PATRICIA OMOROGBE MASTER OF SCIENCE IN NURSING, WALDEN UNIVERSITY

NURS 6052: 2 ESSENT OF EVIDENCE-BASED PRACT

Dr. Constance Cooper

Jan 3rd, 2021

Introduction

3 SELECTED CLINICAL ISSUE OF INTEREST DEVELOPING A PICOT QUESTION

PICOT question

Research databases Level of evidence of each article

4 STRENGTHS OF SYSTEMATIC REVIEWS IN CLINICAL RESEARCH

5 THIS PRESENTATION WILL DISCUSS MY SELECTED CLINICAL ISSUE OF INTEREST AND DESCRIBE HOW I DEVELOPED A PICOT QUESTION FOCUSED ON THE CLINICAL ISSUE OF INTEREST. 6 I WILL INCLUDE THE FOUR RESEARCH DATABASES USED TO CONDUCT THE SEARCH FOR THE PEER-REVIEWED ARTICLES AND THE CITATIONS FOR THE ARTICLES. 7 BESIDES, I WILL DESCRIBE THE LEVEL OF EVIDENCE OF EACH PEER-REVIEWED ARTICLE. 4 LASTLY, I WILL DISCUSS THE STRENGTHS OF USING SYSTEMATIC REVIEWS FOR CLINICAL RESEARCH.

2 CLINICAL ISSUE OF INTEREST COGNITIVE DECLINE IN MILD-MODERATE AD

8 AD-PROGRESSIVE DECLINE IN COGNITIVE FUNCTION

Deficits in memory, language, judgment, & reasoning

Drugs slow/ reverse AD progression Proposed therapies have been unsuccessful

Need for non-pharmacological approaches to improve cognitive function

2 THE CLINICAL ISSUE OF INTEREST IS COGNITIVE DECLINE IN MILD-MODERATE ALZHEIMER’S DISEASE (AD). AD IS A NEUROCOGNITIVE DISORDER CHARACTERIZED BY PROGRESSIVE DETERIORATION OF COGNITIVE FUNCTION (BERG-WEGER & STEWART, 2017). THE DECLINE IN COGNITIVE FUNCTION RESULTS IN COGNITIVE DEFICITS, EVIDENCED BY SHORT-TERM MEMORY, LANGUAGE DYSFUNCTION, POOR JUDGMENT, IMPAIRED REASONING, DIFFICULTY MANAGING COMPLEX TASKS, AND VISUOSPATIAL DYSFUNCTION (BERG-WEGER & STEWART, 2017). Pharmacological therapies available for AD helps only to slow or reverse the progression of AD but do not reverse the effects of cognitive decline. Besides, therapies previously proposed for AD have produced mostly disappointing outcomes (Berg-Weger & Stewart, 2017). Therefore, there is a major need to identify non-pharmacological approaches to improve cognitive function in the early stages of the disease before the symptoms progress.

9 DEVELOPING A PICOT QUESTION

I developed a PICOT question centered on cognitive function in AD by first identifying a population of interest. In this case, the population of interest was patients with mild to moderate AD.

The second step was to identify an intervention that would help address the issue of cognitive decline in AD. The identified intervention was cognitive training combined with drug therapy. The intervention will be compared to drug therapy alone. The next step entailed identifying a measurable outcome that will be used to determine the effectiveness of the proposed intervention. The desired outcome after cognitive training is improved cognitive function. Lastly, I set up a time frame that will be used to evaluate the intervention. The time frame for this case is six months.

10 THE PICOT QUESTION FOR THE CLINICAL ISSUE IS:

In patients with mild to moderate AD (P), does cognitive training combined with drug therapy (I) compared to drug therapy alone (C) improve cognitive function (O) in six months (T)?

Population of interest- patients with mild to moderate AD

Intervention- cognitive training +drug therapy

Comparison- Drug therapy alone

Outcome- Improved cognitive function

Time- Six months

PICOT Question

In patients with mild to moderate AD (P), does cognitive training combined with drug therapy (I) compared to drug therapy alone (C) improve cognitive function (O) in six months (T)?

10 THE PICOT QUESTION FOR THE CLINICAL ISSUE IS:

In patients with mild to moderate AD (P), does cognitive training combined with drug therapy (I) compared to drug therapy alone (C) improve cognitive function (O) in six months (T)?

Research Databases

APA PsycInfo

BioMedCentral

CINAHL Plus

11 COCHRANE DATABASE OF SYSTEMATIC REVIEWS.

The research databases used to search peer-reviewed articles on non-pharmacological interventions that can improve cognitive functioning in patients with mild-moderate AD include APA PsycInfo, BioMedCentral, CINAHL Plus, and Cochrane Database of Systematic Reviews.

APA Citations

Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A.,. & Kane, R. L. (2018). 8 DOES COGNITIVE TRAINING PREVENT COGNITIVE DECLINE? 12 A SYSTEMATIC REVIEW. Annals of internal medicine, 168(1), 63-68. 8 HTTPS://DOI.ORG/10.7326/M17-1531

13 CRUZ GONZALEZ, P., FONG, K. N., CHUNG, R. C., TING, K. H., LAW, L. L., & BROWN, T. (2018). 14 CAN TRANSCRANIAL DIRECT-CURRENT STIMULATION ALONE OR COMBINED WITH COGNITIVE TRAINING BE USED AS A CLINICAL INTERVENTION TO IMPROVE COGNITIVE FUNCTIONING IN PERSONS WITH MILD COGNITIVE IMPAIRMENT AND DEMENTIA? 15 A SYSTEMATIC REVIEW AND META-ANALYSIS. FRONTIERS IN HUMAN NEUROSCIENCE, 12, 416. 14 HTTPS://DOI.ORG/10.3389/FNHUM.2018.00416

APA Citations

Hill, N. 16 T., MOWSZOWSKI, L., NAISMITH, S. L., CHADWICK, V. L., VALENZUELA, M., & LAMPIT, A. (2017). 17 COMPUTERIZED COGNITIVE TRAINING IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT OR DEMENTIA: 15 A SYSTEMATIC REVIEW AND META-ANALYSIS. 16 AMERICAN JOURNAL OF PSYCHIATRY, 174(4), 329-340. 18 HTTPS://DOI.ORG/10.1176/APPI.AJP.2016.16030360

Kallio, E. L., Öhman, H., Kautiainen, H., Hietanen, M., & Pitkälä, K. (2017). 12 COGNITIVE TRAINING INTERVENTIONS FOR PATIENTS WITH ALZHEIMER’S DISEASE: A SYSTEMATIC REVIEW. Journal of Alzheimer’s Disease, 56(4), 1349-1372. https://doi.org/10.3233/JAD-160810

Levels of Evidence Article Level of Evidence Butler et al. (2018) Level I Cruz Gonzalez et al. (2018) Level I

19 HILL ET AL. (2017) Level I

19 KALLIO ET AL. (2017) Level I

19 BUTLER ET AL. (2018): Level I. 12 THIS WAS A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS OF COGNITIVE TRAINING INTERVENTIONS.

Cruz Gonzalez et al. (2018): Level I. 20 THE STUDY CONDUCTED A SYSTEMATIC REVIEW OF RANDOMIZED CONTROL TRIALS (RCTS) WITH META-ANALYSIS.

19 HILL ET AL. (2017): Level I. 18 THE RESEARCHERS CONDUCTED A SYSTEMATIC REVIEW AND META-ANALYSES OF RCTS OF CCT IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT OR DEMENTIA.

19 KALLIO ET AL. (2017): Level I. Researchers systematically reviewed the current evidence from RCTs.

4 STRENGTHS OF USING SYSTEMATIC REVIEWS FOR CLINICAL RESEARCH

Addresses a question by analyzing clinical research Only the best & relevant evidence is provided

Minimal bias- dependable & accurate conclusions

Sums up findings from various studies

Precise estimates on the impact of interventions

Reveal gaps in knowledge

A systematic review refers to a type of publication that addresses a question by analyzing research that matches a particular explicitly-specified criterion.

21 THE STRENGTHS OF USING SYSTEMATIC REVIEWS FOR CLINICAL RESEARCH INCLUDE:

The researchers systematically search, appraise, and summarize all available literature for a particular topic. Consequently, only the best and relevant evidence is provided.

The approach used to search and select the research articles minimizes bias resulting in reliable and accurate conclusions.

A systematic review sums up findings from various studies, and thus the information is easier to read and understand.

Systematic reviews provide precise estimates of interventions that benefit clinical research. For instance, a systematic review can provide accurate results on the outcomes of cognitive training in AD patients.

When used in clinical research, they reveal gaps in knowledge, which informs future research studies.

References

2 BERG-WEGER, M., & STEWART, D. B. (2017). 2 NON-PHARMACOLOGIC INTERVENTIONS FOR PERSONS WITH DEMENTIA. MISSOURI MEDICINE, 114(2), 116–119.

Tawfik, G. 22 M., DILA, K. A. 22 S., MOHAMED, M. Y. 22 F., TAM, D. N. 23 H., KIEN, N. 22 D., AHMED, A. M., & HUY, N. T. (2019). 22 A STEP-BY-STEP GUIDE FOR CONDUCTING A SYSTEMATIC REVIEW AND META-ANALYSIS WITH SIMULATION DATA. 23 TROPICAL MEDICINE AND HEALTH, 47(1), 1-9. 24 HTTPS://DOI.ORG/10.1186/S41182-019-0165-6

Citations (24/24)

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2Another student’s paper
3Another student’s paper
4Another student’s paper
5Another student’s paper
6Another student’s paper
7Another student’s paper
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11https://en.wikipedia.org/wiki?curid=10013
12https://www.cmaj.ca/content/179/10/1019
13Another student’s paper
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15https://eurekamag.com/research/065/310/065310750.php
16Another student’s paper
17https://www.mcmasteroptimalaging.org/blog/detail/blog/2017/07/24/computer-brain-games-for-treating-cognitive-impairment
18Another student’s paper
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20https://en.wikipedia.org/wiki?curid=5750
21Another student’s paper
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23Another user’s paper
24Another student’s paper

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