Critical Appraisal of Research
Tina Cherry
Walden University
NURS 6052: Essentials of Evidence-Based Practice
Dr. South
July 18, 2020
Part 4A: Critical Appraisal of Research
| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
| Phahladira, L., Luckhoff, H. K., Asmal, L., Kilian, S., Scheffler, F., du Plessis, S., … & Emsley, R. (2020). Early recovery in the first 24 months of treatment in first-episode schizophrenia-spectrum disorders. npj Schizophrenia, 6(1), 1-8. | Endriyani, L., Chien, C. H., Huang, X. Y., & Chieh‐Yu, 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. | Potkin, S. G., Kane, J. M., Correll, C. U., Lindenmayer, J. P., Agid, O., Marder, S. R., … & Howes, O. D. (2020). The neurobiology of treatment-resistant schizophrenia: paths to antipsychotic resistance and a roadmap for future research. npj Schizophrenia, 6(1), 1-10. | Keenan, R., Chepulis, L., Ly, J., Carter, S., Lao, C., Asim, M., … & Scarlet, S. (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. | |
| Evidence Level *
(I, II, or III) |
II | I | II | II |
| Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here). ** |
There was no conceptual framework used. | There was no conceptual framework used. | Clinical path to confirmation of treatment-resistant schizophrenia (TRS) was used in place of the conceptual framework. | There was no conceptual framework used. |
| Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). |
Cohort analysis | Descriptive cross-sectional design. | Neuroimaging study | Data collection used the RANZCP model for practice. Guidelines relevant for
managing schizophrenia. |
| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
There were 234 patients for eligibility for the study.
The study considered 98 patients with first-episode schizophrenia spectrum disorders. All the patients were given treatment on a long-acting antipsychotic medication. |
Purposive
sampling technique. 139 respondents met the inclusion criteria. |
The study took no defined or quantifiable population, and the study took no sample for study analysis. | 120 patients with a diagnosis of
schizophrenia or schizoaffective disorder. 3 patients were then excluded. The analysis included 117 patients. |
| Major Variables Studied
List and define dependent and independent variables |
Response trajectories
Patient-rated quality of life. Rates and predictors of recovery. Clinician-rated social occupational functioning. |
Independent variable was antipsychotic.
Antipsychotic was the state of the patients. The dependent variable was schizophrenic patient’s quality of life This was the desired outcome on administering the test element. |
levels of glutamate as
well as glutamate plus glutamine (Glx). |
The study applied the following BMI, WC, BP, HBA1c, lipid profile, PRL, CBC and ECG. |
| Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done). |
The tests focused on measuring the rates of symptom remission.
The tests also focused on measuring functional remission and good quality of life. |
The study aimed to measure the aspects of Socio-demographics data and history of illness and medication of the patients.
The research also measured antipsychotics treatment assessed by using Glasgow Antipsychotics side-effect scale (GASS). The test also measured drug attitude inventory (DAI-10). |
The study focused on determining the impacts and roles of AP antipsychotic, ECT electroconvulsive therapy on the development of TRS.
A variable condition is analyzed in cases where the trial of clozapine was not previously completed. |
Two thirds
of patients were evaluated for HbA1c, lipids, BP, CBC and weight in the research. Also, 10% of patients had PRL, WC or ECG measurements recorded. |
| Data Analysis Statistical or
Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). |
Analysis of core psychopathology tests show significant improvements
(effect size d = 3.36) and functionality (d = 1.78). The study found out that most of such improvements happened within the first 6 months after the first treatment. There was a less realizable improvement in subjective quality (d = 0.37) which was characteristically slower after 12 months of treatment. |
The test analysis that was deployed was the use of chi-square and Fischer’s exact test.
The research measured the responses to the treatment condition based on the residential area subdimension. The results for this case included B = 0.668, OR = 1.949, p = .065. it also measured medication adherence. The result included B = 2.041, OR = 7.699, p = .064). |
There was no data collected, analyzed, and reported for the study.
The study based its outcome on the publication modeling of the previous research elements related to treatment-resistant schizophrenia. |
Patients were more likely to have an
HbA1c measurement if they were non-Māori (78% vs. 60% of Māori; P, 0.05). Patients were more likely to have an HbA1c measurement if they were enrolled in a rural practice (88% vs. 65% of patients in urban practices; P, 0.05). |
| Findings and Recommendations
General findings and recommendations of the research |
Over 70% of patients met the threshold for Symptom remission
over 50% met the criteria for functional remission and good quality of life. There were 29% of respondents met the full criteria for recovery. |
The results indicated that they did not add enough understanding of the quality of life among patients with schizophrenia. | Abnormalities in glutamate regulation
may specifically play a role in TRS. |
The measured HbA1c levels differed
by age, ethnicity, and practice location but not by gender or funding model. |
| 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? |
The study was useful in analyzing the trajectories patients may take towards understanding how to treat first-episode schizophrenia-spectrum disorders.
The strengths of the research are based on the variable informing factors isolation. |
The general study design, analysis, and outcome were meeting scientific standards. It was important in addressing the cases of adherence to antipsychotics medication.
The strengths were in the use of the research design. The weakness was the lack of the conceptual and theoretical frameworks. The study is feasible in adding up more knowledge in research. |
The study was useful in exploring the options for Clinical research priorities for TRS.
It was therefore important in providing useful information towards understanding TRS treatment-resistant schizophrenia. The cross-dimensional analysis of the relevant literature was a useful way to address the key elements of the study. Lack of data quantification of the study outcome, analysis and references makes the study less empirical and cannot be replicated with certainty. The study is useful in the review of the variable factors and their impacts towards understanding TRS. |
The study was important in explaining the variables involved in the application of HbA1c to patients with schizophrenic conditions and related conditions.
The strength was in the classification of people in the specific categories for descriptive analysis. The weakness is the lack of empirical analysis and variables to inform the study. The use is important in defining variables in the study of Schizophrenia and related conditions. |
| Key findings
|
The study found that Symptom remission is not a prerequisite for functional remission
and a good quality of life. |
No significant difference among all
subdimensions of socio-demographic factors in medication adherence. The research also found out that there was a correlation between medication adherence and quality of life. |
Researchers should focus on understanding the pathophysiology of TRS when designing an appropriate response model.
Effective management should involve categorizing patients into groups Features of such groupings should be the stage of illness when TRS emerges or based on the clinical Phenomenology. Experimental research should also focus on response to biomarkers, the possibilities of response to dopamine antagonists and clozapine |
Patients with measured HbA1c levels differed
by age, ethnicity, and practice location. However, this did not differ by gender or funding model |
| Outcomes
|
The study found out that from the tested patients with first-episode schizophrenia-spectrum disorders, few non-remitters achieve other recovery criteria. | Side-effect factor (p < .05) could influence medication adherence. | Significant knowledge gaps are frustrating the understanding of the
pathophysiology and pathways |
It is possible to improve the monitoring of patients receiving antipsychotic
medication in primary care of those with schizophrenia and related conditions. |
| General Notes/Comments | The research is a good addition in understanding the response rates among the patients with first-episode schizophrenia-spectrum disorders under different conditions. | The research was a useful tool for improved research concepts. | The research is a useful addition relevant to providing the right framework for managing TRS. | The paper is a useful addition to model the area of descriptive study. |
Part 4B: Critical Appraisal of Research
Evidence-based practice depends on internal and external evidence. Diagnosing and responding to treatments to schizophrenia may be challenging to the medical practitioners and care providers (Grant & Osanloo, 2014). Therefore, a multifaceted approach that would rope in variable factors that informs such positions would be appropriate in the study of the elementary factors contributing to faster patient recovery (The Johns Hopkins Hospital, 2019). As such, it is important that when developing the treatment model for the patients, developing the right modeling of the treatment process is core. This can be applied using best practice that emerges from the development of the research design and operations. According to Melnyk, and Fineout-Overholt, (2018), there is a need for the development of evidence-based nursing process undertaking through cross-dimensional cohort analysis. Moreover, crafting of the evidenced-based practice in the analysis of the patient condition need the inclusion pf all the intervening and independent factors for a more accurate result (Fineout-Overholt, Melnyk, Stillwell, & Williamson, 2010a).
From the analysis, it has also been established that in the design of the research studies, the respondents need to be dividends into categories that recognize the differences in the unique elements, factors or variables that might inform the nature and the type of study (Fineout-Overholt, Melnyk, Stillwell, & Williamson, 2010b). This means that when developing the experimental research, it is important to develop control experimental data and the pre and post-test data collected for the development of reporting elements (Williamson, 2009). The research result can be developed and achieved using cohort analysis among the patients with schizophrenia, and the conditions related to schizophrenia. When reporting the experimental data outcomes, it is useful to pay attention to the key variables used in the definition of the study. This should also inform the development of data analysis as well. In the end, they are vital for creating a better updating of the research study validity especially when explaining and reporting elements of schizophrenia.
References
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi: 10.1097/01.NAJ.0000383935.22721.9c
Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi: 10.1097/01.NAJ.0000388264.49427.f9
Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer
Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733
Assignment – Week 7
DUE: JUL 20, 2020
Assignment
Jul 26, 2020 9:26 PMGRADED
79.00/100
Table of Contents
Week 7 Assignment
(Section 2.11, p. 39) The title of the paper should be repeated on the first line of the second page, centered, in bold, and in uppercase and lowercase letters. The heading “Introduction” should not be used, but the introduction is placed directly below the title. Remember that all assignments require an introduction, purpose statement, and conclusion.
What practice is supported by all of the studies? You read and analyzed 4 studies on a topic. Did they all agree about an appropriate practice? That element is not clear. The reference list is mostly correct, just a few things noted. There are more than a few grammar errors or spelling errors noted.
I appreciate your efforts for the paper… I suggest the writing center as a resource. They are very easy to work with.
Critical Appraisal Tool Worksheet and Critical Appraisal of Research
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