Evidence-Based Project, Part 3: Critical Appraisal of Research
Evidence-Based
Clinical Inquiry & Systematic Reviews
1
Clinical Issue
The identified area of concern is: Hypertension
Hypertension is currently among the most prevalent medical conditions; the disease progression may be treated to help in reducing the incidence as well as completely eradicate its occurrence.
Widespread research have been performed on this topic/ hypertension considering the fact that it has become more prevalent particularly in the United States. Hypertension is currently considered one of the leading risk factor resulting in heart diseases as far as its mortality rate is considered (Jarl, Tolentino, James, Clark, and Ryan, 2014)
Hypertension can take place at any age group, however, the condition is most prevalent in African Americans as indicated byt statistics. Generally, Lewis, Dirksen, Heitkemper, Bucher, and Harding (2014) in their article claimed that, “Hypertension is diagnosed with a systolic blood pressure of 140 mm Hg or more and a diastolic blood pressure of 90 mm Hg or more” (p. 712).
Generally, hypertension diagnosis is done using a reading of greater than 140/90 mm Hg through the measurement of blood pressure in the extremities on 2 different circumstances. The Symptoms have been identified to be unknown , however, once the diagnosis has been done of the increased blood pressure in a healthcare setting.
2
PICO(T) question
3
According to Grove, Gray, and Burns (2015), there is a model for developing an evidenced based practice research question through the utilization of the population or participants, intervention used for practice, comparison of the intervention, as well as the outcome required for practice within two months, PICO(T).
In this model a clinical question is used to guide the research study. The PICO(T) question guiding this paper is “In the adult population in the United States, how does the DASH diet compared to a non-restricted diet affect hypertension within two months?”
In this evidenced based project, the patient is the adult population in the United States; the management is by DASH diet; the comparison is a non-restricted diet; and the outcome is blood pressure range, or more specifically whether the individual is considered hypertensive using the above classification.
The utilization of the DASH diet with regard to blood pressure range is becoming more essential in today’s clinical setting considering the fact that the healthcare providers are continually diagnosing individuals with hypertension.
4 research databases
Google scholar
ISI Web of Science
Scopus
PubMed
Reviews
| APA citations of the four peer-reviewed articles | Level of evidence | Description of the level of evidence | Strengths of using systematic reviews for clinical research | Specific and relevant examples that fully support the research |
| Epstein, D. E., Sherwood, A., Smith, P. J., Craighead, L., Caccia, C., Lin, P., . . . Blumenthal, J. A. (2012). Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: Results from the ENCORE trial. Journal of the Academy of Nutrition and Dietetics, 112(11), 1763-1773. | Level 1 | This incorporates Meta-analysis ,numerous controlled studies having the results which reliably support the particular action, intervention as well as treatment | One of the strength of the study include the utilization of the systematic review . This is because it typically provides a an effective avenue of determining the appropriate evidence that will provide answers to the question. The inadequate motivation provided to the participants was basically the limitation of the study. | For instance, a group of patient, with the DASH diet in addition to the weight management were able to lose a mean weight of about nineteen pounds which remained constant in the individuals who utilized only the DASH diet and the normal diet. Therefore, utilization of the DASH diet enhanced a reduction in clinic systolic as well as diastolic blood pressure. |
5
Reviews
| APA citations of the four peer-reviewed articles | Level of evidence | Description of the level of evidence | Strengths of using systematic reviews for clinical research | Specific and relevant examples that fully support the research |
| Jarl, J., Tolentino, J. C., James, K., Clark, M. J., & Ryan, M. (2014). Supporting cardiovascular risk reduction in overweight and obese hypertensive patients through DASH diet and lifestyle education by primary care nurse practitioners: Supporting cardiovascular risk reduction. Journal of the American Association of Nurse Practitioners, 26(9), 498-503. | Level 11 | Utilization of the quasi-experimental. Moreover, the utilization of the pretest-posttest design was also done such that there was consideration of the average score of the participants of the REAP as well as PHI questionnaire before and after implementation of the DASH diet. | The utilization of the REAP as well as PHI measurement scores was one of the strength of the study, as it resulted in accuracy as well as reliability (Grove et al. 2015). Limited/inadequate size of the sample was the major weakness of the study. A strong representative sample of the target population increases with sample size greater than thirty participants (Grove et al. 2015). | The results indicated that the mean REAP score included the post-test score which in this case was 64.5 while the pre-test score gave a value of 57.5 on the other hand, the mean PIH scores was determined to be 79.2 as well as 72.7This indicated the mean weight loss of about 3.6 pounds through the time period of two months. This shows a reduction in sodium intake hence reduction in blood pressure |
Reviews
| APA citations of the four peer-reviewed articles | Level of evidence | Description of the level of evidence | Strengths of using systematic reviews for clinical research | Specific and relevant examples that fully support the research |
| Kim, H., & Andrade, F. C. D. (2016). Diagnostic status of hypertension on the adherence to the dietary approaches to stop hypertension (DASH) diet. Preventive Medicine Reports, 4, 525-531. | Level 11 | A general quantitative research that incorporated the descriptive, basically the cross-sectional design. Nine nutrients were used to provide scores. This also included the DASH diet. | The utilization of the larger sample size (5,848) constituted the strength of the research (Grove et al. 2015). | The result showed that the diagnosed hypertensive patients had higher sodium intake, had saturated fat as compared to individuals with undiagnosed hypertension , had high probability of having the DASH accordance scores. |
7
Reviews
| APA citations of the four peer-reviewed articles | Level of evidence | Description of the level of evidence | Strengths of using systematic reviews for clinical research | Specific and relevant examples that fully support the research. |
| Saneei, P., Salehi-Abargouei, A., Esmaillzadeh, A., & Azadbakht, L. (2014). Influence of dietary approaches to stop hypertension (DASH) diet on blood pressure: A systematic review and meta-analysis on randomized controlled trials. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 24(12), 1253-1261. | Level 1 | The data was collected by a systematic review and meta-analysis of all seventeen randomized controlled trials. The duration of each study lasted from two to twenty-six weeks. | The utilization of the systematic review as well as meta-analysis constituted the strength of the study. Randomized clinical trial reduces bias (Grove et al. 2015). The variation of the DASH diet was considered the weakness of the study. | Decrease in the systolic blood pressure incorporated the reduction of about 1.67 to 12.7 mmHg reduces the diastolic measurements to 10.2 mmHg. The general average result indicated that DASH diet decreases the blood pressure. |
8
References
Epstein, D. E., Sherwood, A., Smith, P. J., Craighead, L., Caccia, C., Lin, P., Blumenthal, J. (2012).
Determinants and consequences of adherence to the dietary approaches to stop hypertension
Diet in African-American and white adults with high blood pressure: Results from the ENCORE trial. Journal of the Academy of Nutrition and Dietetics, 112(11), 1763-1773.
Grove, S. K., Gray, J., & Burns, N. (2015). Understanding nursing research: Building an evidence- Based practice (6th ed.). St. Louis, MO: Elsevier, 212, 241, 258, 287, 421.
Jarl, J., Tolentino, J. C., James, K., Clark, M. J., & Ryan, M. (2014). Supporting cardiovascular risk Reduction in overweight and obese Hypertensive patients through DASH diet and lifestyle Education by primary care nurse practitioners: Supporting cardiovascular risk reduction. Journal of the American Association of Nurse Practitioners, 26(9), 498-503.
Kim, H., & Andrade, F. C. D. (2016). Diagnostic status of hypertension on the adherence to the dietary Approaches to stop Hypertension (DASH) diet. Preventive Medicine Reports, 4, 525-531.
Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (2014). Medical-surgical Nursing: Assessment and Management of clinical problems (9th ed.). St. Louis, MO, MO: Elsevier/Mosby, 712-713.
Saneei, P., Salehi-Abargouei, A., Esmaillzadeh, A., & Azadbakht, L. (2014). Influence of dietary Approaches to stop hypertension (DASH) diet on blood pressure: A systematic review and Meta-analysis on randomized controlled trials. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 24(12), 1253-1261.