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Miriane Nguele
Walden University
September 29, 2019

Evidence-Based Project

Advanced Levels of Clinical Inquiry and Systematic Reviews

Introduction

Clinical inquiry, accompanied by systemic review help obtain efficient information and data necessary for making patient-centered decisions (Holly, Salmond & Saimbert, 2017).
Such information are necessary for structuring medical services at the benefit of the patients.
Also, it is a competence-based approach as far as the practice of clinicians and nurses are concerned
The bottom line of the inquiry is to establish the basic necessities enhancing the delivery of advanced medical services, and this satisfies both patients and the nurses.

Identification and description of chosen clinical issue of interest

Post-traumatic stress disorder ( PTSD) has changed and gained new understanding over time. Once thought to only affect war veterans as “shell chock”, then later added to the DSM-V as PTSD and understood to affect many other populations. According to diagnostic and statistical manual of mental disorders ( DSM-V), a traumatic event is defined as the exposure to actual or threatened death, serious injury or sexual violation and leading to re-experiencing, avoidance, negative cognitions, mood and arousal.
Post-traumatic stress disorder (PTSD) is seen in children, adolescents and adults. It can occur alone or with other disorders. Currently it is recommended that cognitive behavioral therapy (CBT)and eye movement desensitization and reprocessing ( EMDR) be used for the treatment of PTSD.

Description of how I developed a PICO(T) question based on the clinical issue

Because of PTSDs prevalence I’m interested to compare the efficacy of CBT and EMDR in relieving PTSD symptoms, as well as anxiety and depression, in patients diagnosed with PTSD.
(P) – In PTSD diagnosed patients (is)
(I) – Eye-movement desensitization and processing ( EMDR) therapy
(C) – ( verses) Cognitive behavioral therapy (CBT)
(O) – More effective treatment for PTSD
( T) – Over a 1 year

The 4 research Databases used
(next page)

key words were: Post – traumatic stress disorder, “ PTSD”, eye movement desensitization and reprocessing, “EMDR”, Cognitive Behavioral Therapy, “CBT”. The Boolean connector AND was used to form different combinations of the keyword.

Key terms (4 Databases)	Number of articles in PubMed	Number of articles in MEDLINE	Number of articles in EMBASE	Number of articles in CINAHL
Post-traumatic stress disorder and EMDR and reprocessing AND CBT	49	35	29	2
PTSD AND EMDR AND CBT	59	36	46	8
PTSD AND eye movement desensitization and reprocessing AND CBT	48	35	20	3
PTSD AND eye movement desenitiuration and reprocessing AND Cognitive Behavioral Therapy	110	110	7	4
Post- traumatic stress disorder AND eye movement desenitiuration and reporcessing AND Cognitive Behavioral Therapy	98	106	6	3
Post- traumatic stress disorder AND eye movement desenitiuration and reprocessing AND CBT	41	34	20	2

Explanationof the strengths of using Systematic reviews for clinical research

Using systematic review for clinical research has many strengths. Systematic reviews combine quantitative data with the purpose to understand the effects of treatments or interventions, while trying to reach a specific outcome or desired result. The first step of a systematic review is to form question or hypothesis. The initial question will help to determine what is unknown and what data needs to be gathered for further analysis. It is very important to have a clear plan of interest. After the clinical issue is decided on, it is then important to have a protocol for gathering the data. The data gathered needs to be unbiased and abstracted accurately so that the outcomes can be analyzed subjectively. In meta-analysis, multiple similar studies and their results are collected and compared with the end with the end goal being to precisely pinpoint desired outcomes of treatments and interventions.

Mata-analysis can also recommended further research in specific areas if needed. Essentially a meta-analysis is the gathering of multiple systematic reviews.

Specific example

In the article,” Cognitive Behavior Therapy versus Eye Movement Desensitization and Reprocessing in the patients with post-traumatic Stress Disorder: Systematic Review and Meta- analysis of Randomized Clinical Trials” they systematically searched EMBASE,MEDLINE and COCHRANE for randomized clinical trials that compare CBT and EMDR in PTSD patients. Fourteen studies out of 714 were eligible after the inclusion criteria was established. Meta-analysis of 11 studies showed that EMDR is better than CBT in reducing post-traumatic symptoms. However, meta-analysis of four studies at three-month follow-up revealed no statistically significant difference. The EMDR was no difference between CBT and EMDR in reducing depression. Large population randomized trials with longer follow-up are recommended to build more quantitative data.

CONCLUSION

Clinical inquiries, at advanced levels, reveal detains necessary for enhancing patient care.
PICO (T), when effectively tailored to the matter at hand, is necessary for solving such issues.
Its development involves determination of the matter at hand, seeking ways of intervening, comparing the options, and lastly, measuring the outcomes of the interventions.

References

Khan, A. M., Dar, S., Ashmed, R., Bachu, R., Adnan, M. &
Kotapati, V P. (2018). Cognitive Behavioral Therapy Versus Eye Movement Desensitization and Reprocessing in Patients in Post-traumatic Stress Disorder: Systematic Review and Meta-analysis of Randomized Clinical Trials. Cureus. Doi:10.7759/cureus, 3250

Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017). Psychosocial interventions for children and adeloscents after man-made and natural disasters: a meta-analysis and systematic review. Psychosocial Medicine, 47(11), 1893-1905. https://dol-org.ezp.waldennulibrary.org/10.1017/s0033291717000496

Lewey, J. H., Smith, C. L., Burcham, B. et al, (2018) Comparing the effectiveness of EMDR and TF-CBT for Children and Adolescents: A Meta-Analysis. Journal of Child and Adolescent Trauma, 11(4), 457-472. https://doiorg.ezp.waldenulibrary.org/10.1007/s40653-018-0212-1

Chen, L., Zhang, G., Hu, M. & Liang, X. (2015) Eye Movement Desensitization and Reprocessing Versus Cognitive Behavior Therapy for Adult Post-Trauma Stress Disorder: Systematic Review and Meta-Analysis. The Journal of Nervous and Mental Disease, 203(6), 443-451. https://doiorg.ezp.waldenulibrary.org/10.1097