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Part 3:Advanced Levels of Clinical Inquiry and Systematic Reviews

Evidence-Based Practice and the Quadruple Aim

Tina Cherry

Walden University

NURS 6052: Essentials of Evidence-Based Practice

Dr. South

July 6, 2020

Chosen Clinical Issue

Mental health disorders impact the brain’s the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life.

Mental health patients are often given various medications to treat psychotic disorders.

Many of these medications are safe and effective treatment.

An understanding of the appropriate medication therapy improves patient outcomes.

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

The PICO(T) question identifies the target population (Davies, K. S. 2011). The best intervention to treat clients presenting with psychosis and schizophrenia.

The management strategy needed to be identified (Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. 2010). The safe and effective use of antipsychotic medications to treat mental disorders. The continuum performance of multitude interventions such as administering medication, arouse questions about the evidence supporting their use and effectiveness (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010).

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly.

LEVELS OF EVIDENCE OF THE PEER-REVIEWED ARTICLES

Chang, W. C., Chu, A., Kwong, V., Wong, C., Hui, C., Chan, S., Lee, E., & Chen, E. (2018). Patterns and predictors of trajectories for social and occupational functioning in patients presenting with first-episode non-affective psychosis: A three-year follow-up study. Schizophrenia research, 197, 131–137. https://doi-org.ezp.waldenulibrary.org/10.1016/j.schres.2018.01.021	Systematic review/meta-synthesis of qualitative studies	Level V: The level of evidence is from a systematic review of qualitative studies (meta-synthesis)
Endriyani, L., Chien, C., Huang, X., & Chieh, Y. L. (2019). The influence of adherence to antipsychotics medication on the quality of life among patients with schizophrenia in Indonesia. Perspectives in Psychiatric Care, 55(2), 147–152. https://doi-org.ezp.waldenulibrary.org/10.1111/ppc.12276	Systematic review/meta-analysis of randomized controlled trials (RCTs)	Level I: The level of evidence is from a systematic review or meta-analysis of all related RCTs
Potkin, S.G., Kane, J.M., Correll, C.U. et al. The neurobiology of treatment-resistant schizophrenia: paths to antipsychotic resistance and a roadmap for future research. npj Schizophr 6, 1 (2020). https://doi.org/10.1038/s41537-019-0090-z	Quasi-randomized trials	Level III: The level of evidence is from well-made controlled trials with randomization
Keenan, R., Chepulis, L., Ly, J., Carter, S., Lao, C., Asim, M., Bhat, A., Deo, S., Lim, K. P., Mohammed, R., Scarlet, S., & Lawrenson, R. (2020). Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication. Journal of Primary Health Care, 12(1), 29–34. https://doi-org.ezp.waldenulibrary.org/10.1071/HC19023	Cohort study	Level IV: The level of evidence is from well-formed cohort studies

The Four Research Databases Used

PUBMED – highest level on the Evidence Based Hierarchy – Systematic Review and Meta-analysis

Chang, W. C., Chu, A., Kwong, V., Wong, C., Hui, C., Chan, S., Lee, E., & Chen, E.

(2018). Patterns and predictors of trajectories for social and occupational functioning in patients presenting with first-episode non-affective psychosis: A three-year follow-up study. Schizophrenia research, 197, 131–137. https://doi-org.ezp.waldenulibrary.org/10.1016/j.schres.2018.01.021

MEDLINE - highest level on the Evidence Based Hierarchy – Systematic Review and Meta-analysis

Endriyani, L., Chien, C., Huang, X., & Chieh, Y. L. (2019). The influence of adherence to

antipsychotics medication on the quality of life among patients with schizophrenia in Indonesia. Perspectives in Psychiatric Care, 55(2), 147–152. https://doi-org.ezp.waldenulibrary.org/10.1111/ppc.12276

EMBASE - highest level on the Evidence Based Hierarchy – Meta-analysis

Potkin, S.G., Kane, J.M., Correll, C.U. et al. The neurobiology of treatment-resistant

schizophrenia: paths to antipsychotic resistance and a roadmap for future research. npj Schizophr 6, 1 (2020). https://doi.org/10.1038/s41537-019-0090-z

CINAHL - highest level on the Evidence Based Hierarchy – Systematic Review and Meta-analysis

Keenan, R., Chepulis, L., Ly, J., Carter, S., Lao, C., Asim, M., Bhat, A., Deo, S.,

Lim, K. P., Mohammed, R., Scarlet, S., & Lawrenson, R. (2020). Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication. Journal of Primary Health Care, 12(1), 29–34. https://doi-org.ezp.waldenulibrary.org/10.1071/HC19023

STRENGHTS OF USING SYSTEMATIC REVIEW IN THE RESEARCH

Systematic reviews often, but not always, use statistical techniques to combine results of the eligible studies, or at least use scoring of the levels of evidence depending on the methodology used. Using systematic review for clinical research has many strengths. The data is also well assessed and analyzed to produce excellent research results (Stillwell, Fineout-Overholt, Melynk, & Williamson, 2010). This gives significant advantage over other literature reviews. The research findings in systematic review articles are precise, accurate, and reliable (Walden University Library, n.d.).

Specific Sample

The influence of adherence to antipsychotics medication on the quality of life among patients with schizophrenia in Indonesia

The descriptive cross-sectional research design study conducts outpatient using purposive sampling technique in order to control the sample focusing on inclusion criteria. This was done with a small number of samples. Several inclusion criteria for subject selection were a diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (Endriyani at, el).

References

Chang, W. C., Chu, A., Kwong, V., Wong, C., Hui, C., Chan, S., Lee, E., & Chen, E. (2018). Patterns and predictors of trajectories for social and occupational functioning in patients presenting with first-episode non-affective psychosis: A three-year follow-up study. Schizophrenia research, 197, 131–137. https://doi-org.ezp.waldenulibrary.org/10.1016/j.schres.2018.01.021

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

Endriyani, L., Chien, C., Huang, X., & Chieh, Y. L. (2019). The influence of adherence to antipsychotics medication on the quality of life among patients with schizophrenia in Indonesia. Perspectives in Psychiatric Care, 55(2), 147–152. https://doi-org.ezp.waldenulibrary.org/10.1111/ppc.12276

Keenan, R., Chepulis, L., Ly, J., Carter, S., Lao, C., Asim, M., Bhat, A., Deo, S.,

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79. Retrieved from https://journals.lww.com/ajnonline/Fulltext/2010/03000/Evidence_Based_Practice,_Step_by_Step__Asking_the.28.aspx

Walden University Library. (n.d.-g). Quick answers: How do I find a systematic review articles related to health, medicine, or nursing. Retrieved from http://academucanswers.waldenu.edu/faq