Literature Synthesis - 2 pages

University of Saint Augustine for Health Sciences

NUR7050: Evidence-Based Practice for Healthcare Professionals

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Synthesis of the Literature

Synthesize your final primary quantitative research studies and/or systematic reviews; do not include summary articles such as a review of the literature, a clinical article, or a clinical practice guidelines. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Refer the reader to your evidence table(s). See Table 1 and 2. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. The studies that you cite in this section must relate directly to your PICOT question. This is a synthesis (Table 3) rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

Practice Recommendations

So. . . using available best evidence, what is the answer to your question? This section is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a synthesis statement, and, based on your conclusions drawn from your review of the body of evidence related to your clinical question, give a recommendation for practice change. This would logically be the intervention of your PICOT question. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice, and you recommend reinforcement and education regarding this best practice. Using Johns Hopkins, identify whether this recommendation be graded A, B, or C based on the strength of the evidence.

References

Remember that this is a reference list rather than a bibliography. A bibliography is everything you read to prepare the paper but a reference list is only what you cited. If there is not a citation for a reference, it should not be here. PLEASE make sure that your references and your citations throughout the paper are in APA format. You can go from an A paper to a B paper on APA errors alone. Take the time to make sure that they are correct. We have already formatted the paper for you with this template.

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Table 1

Primary Quantitative Research Evidence (this table may be single space and 10-point font; ONLY primary quantitative research articles should be in this table) Example provided.

Source	Study design JH Level of Evidence	Population/ Sample Age Race/ Ethnicity Setting/ Location % dropout	Intervention (IV) Details Action Duration Fidelity	Comparison/ Control (IV) Details Action Duration Fidelity	Outcome (DV) &Time Intervention vs comparison (statistical test, value, p value)	Grading of evidence JH Quality Rating	Author’s conclusions ----------- Other outcomes of interest	Your Conclusions Limitations	Fit/Useful
Abel, 2020	RCT Level I	196 inter-city Age 36.4 (8.9) [Range 24 – 49] 55% Male, 40% Black, 62% Latino 73% Medicaid, annual income <$25,000 Setting: Outpatient Location: Boston, MA Baseline pain score 6.4 avg on both groups Dropout: 15/200, 7.5%	Weekly chiropractic adjustment Assessed & tx 10 weeks 100% of visits over 10weeks Average total 180 mins	Massage Medical massage 50 min/wk 100% for 10 weeks	At 10 weeks, avg pain score Tx = 3.6 Control = 5.2 (X2 = 7.3; p<.05): Latino males Tx = 2.8 Control = 5.7 (X2 = 8.3; p<.001): Latino women Tx =6.0 C = 2.8 (X2 = 9.2; p<.001):	Quality A	Pain scores 30% lower w/ wkly chiro compared to 50 mins/wk medical massage Tx more effective in Latino males C more effective in Latino women --------- Massage would cost 30% more out of pocket	Tx. Better than control Chiropractic adjustments effective in general and in Latino males but not in Latino women Limitations = -not equal time in tx -not include high income	Yes/Yes but only if cost covered by Medicaid in my state

Legend: (all abbreviations and acronyms used in the table should be listed here such as: )

Table 2

Evidence Summaries (this table may be single space and 10 point font; ONLY systematic reviews should be in this table) (Example provided)

Source	Study design JH Level of Evidence	Population/ Sample Search strategy Inclusion Exclusion N articles addressing your PICOT Other descriptions	Intervention (IV) Details Action Duration Fidelity	Comparison/ Control (IV) Details Action Duration Fidelity	Outcome (DV) & Time Mean differences Intervention vs comparison Effect size Heterogeneity (statistical test, value, p value)	Grading of evidence JH Quality Rating	Author’s conclusions ------ Other outcomes of interest	Your Conclusions Limitations	Fit/Useful
Brown, 2018	Meta-analysis Level I	Medline OVID CINAHL 2000-2017 RCTs, conducted in the US, high-quality (>21/25 points on CONSORT), comparing regular chiropractic adjustment vs regular medical massage for chronic pain measured using a 0-10 scale 10 RCTs of low back pain Exclusions Studies of phantom pain Total participants N=867 Avg age 59 (6) Avg baseline pain scores 3.2 (3.4) Avg Dropout: 8% (4) Only completers included in this analysis	Chiropractic adjustment in office Most weekly (2/10 allowed 2x wk) Fidelity All > 80%	Massage 45-60 mins Most weekly (2/10 allowed 2x wk) Fidelity All >86%	At 8 weeks N=4 Tx = 3.6 Control = 5.2 (RR for 2 point pain reduction= 1.6 (1.1-2.3); p=.04): I2= 10% At 12 weeks N=6 Tx = 3.2 Control = 4.8 (RR for 2 point pain reduction= 1.7 (1.4-2.4); p=.04): I2= 13%	Quality B due to no ITT	wkly chiropractic adjustment was more effective than weekly massage for reducing chronic pain based on the data from these studies ---none	Tx. Better than control High dropout rate and not analyzed with ITT	Partially- my population is much younger on average Partially- my population has a variety of pain sources Useful- yes
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Legend: (all abbreviations and acronyms used in the table should be listed here)

Table 3.

Synthesis Matrix (identify the trends; this table may be single space and 10 point font; ONLY primary quantitative research articles or systematic reviews should be in this table; use only the highest level and quality of evidence; if the evidence is of mixed level or mixed quality, sort the trends using the Johns Hopkins Appendix H; trends must be related to the outcome) (example provided regarding effective pain management which may or may not be within your scope of practice- make sure your PICOT is within your scope of practice.)

Main ideas	Albright (2020)	Reference 2	Reference 3	Reference 4	Reference 5	Add columns as necessary
Weekly chiropractic adjustment equally effective as weekly massage
Biweekly chiropractic adjustment associated with 30% lower pain scores compared to weekly massage in those with back pain
In those with a mean age under 50, weekly massage associated with 20% lower pain scores compare to chiropractic adjustments
Add more as needed

Figure 1

Results of Search for Research

Use http://prisma.thetacollaborative.ca/ to generate a diagram describing the results of your search. Paste it here.