Recommending an Evidence-Based Practice Change

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Running Head: CRITICAL APPRALSAL OF RESEARCH `1

CRITICAL APPRALSAL OF RESEARCH

Critical Appraisal of Research

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Part 4A

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Braun, K., Utech, A., Velez, M. E., & Walker, R. (2018). Parenteral nutrition electrolyte abnormalities and associated factors before and after nutrition support team initiation. Journal of Parenteral and Enteral Nutrition, 42(2), 387-392.	Fivez, T., Kerklaan, D., Mesotten, D., Verbruggen, S., Wouters, P. J., Vanhorebeek, I., ... & Garcia Guerra, G. (2016). Early versus late parenteral nutrition in critically ill children. New England Journal of Medicine, 374(12), 1111-1122.	Thomson, F. C., Naysmith, M., & Lindsay, A. (2019). Managing drug therapy in patients receiving enteral and parenteral nutrition. Hospital Pharmacist2002, 7(6).	Worthington, P., Balint, J., Bechtold, M., Bingham, A., Chan, L. N., Durfee, S., ... & Holcombe, B. (2017). When is parenteral nutrition appropriate?. Journal of Parenteral and Enteral Nutrition, 41(3), 324-377
Evidence Level * (I, II, or III)	Level I Quasi-experimental studies / cohort study	Level II systematic review of a combination of RCTs and quasi-experimental studies	Level II Quasi-experimental studies	Level I Quasi-experimental studies / cohort study
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The article focuses on the value of Nutrition support teams in the management of Parenteral Nutrition to reduce metabolic abnormalities.	The article focused on the significance of early parenteral nutrition in adults	The article have emphasized on effective strategies for the administration of drugs to the patients on enteral and parenteral nutrition without compromising therapeutic efficacy.	The article lacks effective theory to elaborate on the concept being presented.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The researchers adopted qualitative method where statistical, computational and mathematical tools were used to enhance the findings for the study.	The researcher adopted quantitative approach where the questionnaires were distributed to the sample population and their feedback enhanced the formulation of the research findings.	Qualitative research design was adopted for the study where descriptive statistics was adopted for analysis of the research data.	Quantitative approach was used for the study through the use of questionnaires to obtain relevant data for the formulation of the research findings.
Sample/Setting The number and characteristics of patients, attrition rate, etc.	The study entailed 735 participants that were mainly hospitalized adults who received Parenteral Nutrition	The study involved 1440 children that were critically ill and were exposed to early parenteral nutrition.	The survey was conducted in USA among the nurses to ascertain the techniques used in the administration of medication to the patients.	The research involved children who were exposed to parenteral nutrition
Major Variables Studied List and define dependent and independent variables	Management of Parenteral Nutrition is dependent variable while reduction of metabolic abnormalities is independent variable	The dependent variable for the study is early parenteral nutrition while independent variable is critically ill children.	The dependent variable is managing drug therapy while independent variable is patients receiving enteral and parenteral nutrition.	The dependent variable is the role of intravenous nutrition while independent variable is variety of patient populations.
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The researcher adopted logistic regressions in the examination of the relationship between the variables	Descriptive statistics was used by the researcher in the tabulation of the results to enhance the research findings.	The results from the questionnaires were used to address the clinical questions regarding parenteral nutrition.	The researcher used questions and answers to address the clinical questions regarding the research topic.
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	600 hospitalized patients responded to medication Implying that parenteral nutrition was effective.	1000 children responded positively to early parenteral nutrition signifying how effective it was.	250 nurses agreed with parenteral nutrition as an efficient strategy towards the treatment of the patients with deficiencies.	500 children responded positively to parenteral nutrition
Findings and Recommendations General findings and recommendations of the research	The research established that nutrition support team was associated with the decreased occurrence of EAs and mortality among the hospitalized adults receiving Parenteral Nutrition. The research recommends the utilization of Parenteral nutrition approach in the health sector.	The research ascertained that the rate of new infection among the children was lower upon receiving late parenteral nutrition compared to those who received early parenteral nutrition. The research recommended early parenteral nutrition for the effective treatment of the children.	The research has established that drugs should be administered through the similar access site such as TPN and the article further recommends the use of the separate lumen in a multi-lumen catheter to avoid the possibility of drug-parenteral feed incompatibilities.	The research established that parenteral nutrition is effective in the treatment of malnutrition and recommends the application of this medication approach to the children with malnutrition issues.
*Appraisal and Study Quality* Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	This study created awareness to the health practitioners regarding the significance of Parenteral nutrition approach in dealing with malnutrition The methodologies used for research were reliable and valid. The study was only limited to malnutrition problem among the patients. The implementation of the suggested practices and processes is somehow expensive hence effective strategies should be formulated for securing adequate funds.	This study created awareness to the health practitioners regarding the significance of Parenteral nutrition approach in dealing with malnutrition The methodologies used for research were reliable and valid. The study was only limited to malnutrition problem among the patients. The implementation of the suggested practices and processes is somehow expensive hence effective strategies should be formulated for securing adequate funds.	This study created awareness to the health practitioners regarding the significance of Parenteral nutrition approach in dealing with malnutrition The methodologies used for research were reliable and valid. The study was only limited to malnutrition problem among the patients. The implementation of the suggested practices and processes is somehow expensive hence effective strategies should be formulated for securing adequate funds.	This study created awareness to the health practitioners regarding the significance of Parenteral nutrition approach in dealing with malnutrition The methodologies used for research were reliable and valid. The study was only limited to malnutrition problem among the patients. The implementation of the suggested practices and processes is somehow expensive hence effective strategies should be formulated for securing adequate funds.
Key findings	Parenteral and enteral approaches are effective solutions to malnutrition problems for both the children and adults.	Parenteral and enteral approaches are effective solutions to malnutrition problems for both the children and adults	Parenteral and enteral approaches are effective solutions to malnutrition problems for both the children and adults	Parenteral and enteral approaches are effective solutions to malnutrition problems for both the children and adults
Outcomes	Improved health condition for the patients and reduced hospitalization Increased immunity for the patients	Improved health condition for the patients and reduced hospitalization Increased immunity for the patients	Improved health condition for the patients and reduced hospitalization Increased immunity for the patients	Improved health condition for the patients and reduced hospitalization Increased immunity for the patients
General Notes/Comments	Parenteral and enteral nutrition approach is the best in dealing with malnutrition challenge in the population	Parenteral and enteral nutrition approach is the best in dealing with malnutrition challenge in the population	Parenteral and enteral nutrition approach is the best in dealing with malnutrition challenge in the population	Parenteral and enteral nutrition approach is the best in dealing with malnutrition challenge in the population

PART 4B

Best Practice emerging from the articles

All the articles have focused on Parenteral Nutrition as the most efficient strategy in modern medicine in dealing with malnutrition challenge among the children and adults in the society (Braun, Utech, Velez & Walker, 2018). It serves as the effective therapeutic modality for both the children and the adults for the achievement of the best health status. It aims to solve the issue of over malnutrition or under malnutrition among the children and adults for the desired body composition to deal with malnutrition pediatric. The articles have also outlined that this medication can be administered to the patients in various ways without compromising therapeutic efficacy (Thomson, Naysmith & Lindsay, 2019). Nutritional support to the patients can be administered either parenterally or enterally at the health care setting and for patient with certain health conditions require special parenteral nutrition. For instance, those with Crohn’s disease may require long term parenteral nutrition treatment.

The articles outline that Parenteral Nutrition can be used to bring the best outcome for the hospitalized adults and children with malnutrition issues(Worthington, Balint et al 2017). The articles depict that early parenteral nutrition is significant to the children who are in critical condition as far as the malnutrition aspect is concerned (Fivez, Kerklaan et al., 2016). For the children in ICU, parenteral nutrition has to be withdrawn for effective medication and this brought about positive outcome. Generally, all these articles suggest the application of parenteral and enteral nutrition approach for the solution of malnutrition problems for the achievement of the desired outcome. These approaches can be used to solve obesity among other challenges experienced by children and adults in the society today.

References

Braun, K., Utech, A., Velez, M. E., & Walker, R. (2018). Parenteral nutrition electrolyte abnormalities and associated factors before and after nutrition support team initiation. Journal of Parenteral and Enteral Nutrition, 42(2), 387-392.

Fivez, T., Kerklaan, D., Mesotten, D., Verbruggen, S., Wouters, P. J., Vanhorebeek, I., ... & Garcia Guerra, G. (2016). Early versus late parenteral nutrition in critically ill children. New England Journal of Medicine, 374(12), 1111-1122

Thomson, F. C., Naysmith, M., & Lindsay, A. (2019). Managing drug therapy in patients receiving enteral and parenteral nutrition. Hospital Pharmacist2002, 7(6).

Worthington, P., Balint, J., Bechtold, M., Bingham, A., Chan, L. N., Durfee, S., ... & Holcombe, B. (2017). When is parenteral nutrition appropriate?. Journal of Parenteral and Enteral Nutrition, 41(3), 324-377

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