Evidence Based Data Used in Clinical Practice
Purpose:
This Assignment is helpful in developing the groundwork for understanding and integrating evidence-based practice in healthcare throughout the rest of the course. In this Assignment you will have the chance to see how the research you look for can be applied in the work you do in your practice.
Overview:
You will select a topic relevant to your practice area, post the topic to Discussion Board 2 for feedback, research the topic, and write a scholarly paper.
From the chapter readings and discussion, formulate a 3–5 page scholarly paper in APA format, providing an overview of the terms and function of EPB. An introduction, discussion and conclusion is expected in the overview on this topic
Directions:
- Formulate the question.
- Using the Cochrane database, research the question using the PICOT model and key words.
- Post your topic and a short summary of results for feedback from your instructor and peers by Day 5.
- Write a 3–5 page paper, reviewing evidence-based practice, as it relates to your practice question and integrate feedback from the instructor and/or peers.
- Include a minimum of three evidence-based references.
To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.
Assignment Requirements:
Before finalizing your work, you should:
- be sure to read the Assignment description carefully (as displayed above);
- consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
- utilize spelling and grammar check to minimize errors.
Your writing Assignment should:
- follow the conventions of Standard English (correct grammar, punctuation, etc.);
- be well ordered, logical, and unified, as well as original and insightful;
- display superior content, organization, style, and mechanics; and
- use APA 6th Edition format.
- Please see the Writing Center located in the Academic Success Center in the student portal for assistance with writing, APA, and online communication. https://campus2.purdueglobal.edu/page/writing-center
How
Concepts of evidence based practice
Rapid Critical Appraisal to Evaluate Evidence
Rapid critical appraisal is the opportunity to review evidence in a timely fashion. The ability to look at evidence and review it in a timely fashion will help your practice. You will learn how to look at the evidence that is
returned from your database search, and identify what level of evidence is available from your search. For example, being able to identify that a randomized control trial is a reliable source of evidence, rather than an
expert’s opinion.
Five Components of a PICOT
Recognizing the five components of PICOT questioning is the most pivotal aspect of evidence-based practice. Through PICOT, you can determine the patient population that you are working with, the intervention that you
propose (based on the research), a comparison intervention and then review the outcome and the time it takes to reach the outcome. For example, determining how long it takes for the evidence-based intervention to
improve the quality of life of a patient with terminal cancer.
P = patient, population, or problem
I = intervention, risk factor, assessment tool, or prognostic factor under scrutiny
C = comparison (alternative to intervention; at times this element may be absent)
O = outcome
T = time (Is there a certain period of time that must transpire for the intervention to produce an outcome? At times this element may also be absent.
How to Identify the Corresponding Research Design for the Foreground Question
As you develop a PICOT format, you decide what research design you will use that best meets the needs of your clinical question. For example, if the intervention is a medication, then a case control study would be ideal to
determine if the medication is effective compared to patients that do not receive the medication.
How to Identify the Corresponding Research Design for the Foreground Question
You will be able to identify the importance of evidence, recognizing that expert opinion and clinician opinion are the lowest level of evidence, with meta-analysis and randomized control trials at the top of the hierarchy.
Difference Between Foreground and Background
Foreground and background information must be distinguished for effective evidence-based PICOT development.
Foreground information can be answered based on scientific evidence about diagnosing, treating, or even assisting patients. This would be the actual clinical question being researched. So, for example, the question
of which analgesic works best to reduce a fever in a child would be foreground information
Background information is broader in scope as it helps develop the foreground question. For this example on analgesic questioning, the background information would be “how do analgesics work in children?”
After completing this unit, you should be able to:
Outline a rapid critical appraisal to evaluate evidence.
Recognize the five components of a PICOT (foreground) question.
Identify the corresponding research design that would best fit each foreground question.
Identify the hierarchy of evidence.
Interpret the difference between foreground and background information.
Course Outcome practiced in this unit:
MN504-1: Discover evidence based data used in clinical practice.
Running head: preventing urinary tract infections 1
preventing urinary tract infections 6
Cranberries for Preventing Urinary Tract Infections
Samantha Hunter
Purdue University Global
Cranberries for Preventing Urinary Tract Infections
The purpose of evidence-based practice is to provide the most effective, up-to-date patient care, resulting in the best patient outcomes. Nursing research involves the development of new knowledge, on a particular topic, which may then be translated into evidence-based practice. The purpose of this paper is to assess the effectiveness of cranberry derived products in the prevention of UTIs in women with recurrent UTIs. The writer developed the following PICOT question to conduct the research: In women who experience recurrent urinary tract infections (UTIs), how does the use of cranberry derived products effect the number of diagnosed urinary tract infections compared to those women who do not use cranberry derived products in a twelve month period?
Preventing Urinary Tract Infections
“Urinary tract infections (UTIs) refer to the presence of a certain threshold number of bacteria in the urine (usually > 105/mL)” (Occhipinti, Germano, & Maffei, 2016). UTIs are one of the most prevalent infections requiring outpatient treatment (Jepson, Williams, & Craig, 2012). “Complications resulting from persistent and repeated infections necessitate well over one million hospital admissions annually in the U.S.” (Jepson, Williams, & Craig, 2012). Certain sub-populations are at an increased risk of developing urinary tract infections including infants, pregnant women, elderly women, and individuals with urethral catheters (Jepson, Williams, & Craig, 2012). UTIs are 50% more common in women than men (Jepson, Williams, & Craig, 2012).
Cranberry derived products (juices, syrups, tablets, capsules, etc.) have been commonly used for several years to prevent urinary tract infections. Historically, it was thought that the acid in the fruit created a bacteriostatic environment in the urine, not allowing bacteria to adhere to the bladder wall. However, recently, “a group of proanthocyanidins (PACs) with A-type linkages (PAC-A) was isolated from cranberries and shown to exhibit bacterial antiadhesion activity against both antibiotic-susceptible and -resistant strains of uropathogenic bacteria” (Occhipinti, Germano, & Maffei, 2016). “A randomized controlled trial (RCT) evaluating the dosage effect of cranberry found that to achieve a bacterial anti-adhesion effect in urine, 36 mg of cranberry PAC equivalents/d is effective, but 72 mg may offer better protection” (Jepson, Williams, & Craig, 2012). In order to keep the anti-adhesion activity high in the urinary tract, cranberry derived products should be taken both in the morning and in the evening.
Cochrane Library
When conducting research for the PICOT question, the Cochrane Library was used. The following key words were used in the search: urinary tract infection, UTI, cranberry, cranberries. The search was also limited by studies published between January 2014 to current. The search revealed 6 Cochrane reviews, of which 1 was applicable to the PICOT question of interest and 112 Cochrane trials, of which several were applicable to the PICOT question of interest.
The Cochrane review “Cranberries for preventing urinary tract infections” identified 24 studies, totaling 4473 participants, “to assess the effectiveness of cranberries in the prevention of UTIs” (Jepson, Williams, & Craig, 2012). According to the results of the review, consumption of cranberry juice does not decrease the number of symptomatic UTIs over a 12-month period (Schneeberger, Geerlings, Middleton, & Crowther, 2015). Unfortunately, these results may be due to lack of compliance with the cranberry juice regimen. “To maintain levels of cranberry PAC that are necessary to prevent anti-adhesion, people would have to continuously drink the juice twice a day in serving of 150 mL for an indefinite period of time” (Jepson, Williams, & Craig, 2012). However, cranberry derived products in the form of tablets and capsules may reduce the number of diagnosed UTIs in women who experience recurrent infections. Unfortunately, there are only 3 current studies that evaluate this regimen, none of which have enough data reported.
The double blind randomized controlled trial, “Standardized high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women,” is currently being performed to “describe the side effects of daily intake of cranberry extract containing 37 mg PACs compared to 2 mg PACs (placebo)” (Asma, et al., 2018).
A Systematic Review and Meta-Analysis titled, “Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women,” was conducted to “assess the effect of cranberry on the risk of UTI recurrence in otherwise healthy women” (Fu, Liska, Talan, & Chung, 2017). This study included 7 randomized control trials, totaling 1498 participants. The results of this study “showed that cranberry reduced the risk of UTI by 26%” (Fu, Liska, Talan, & Chung, 2017).
The purpose of the randomized placebo‑controlled clinical research study, “Effect of oral cranberry extract (standardized proanthocyanidin‑A) in patients with recurrent UTI by pathogenic E. coli” was to “evaluate the effect of cranberry extract (PAC-A, proanthocyanidin-A) on the in vitro bacterial properties of uropathogenic (E. coli) and its efficacy/tolerability in patients with subclinical or uncomplicated recurrent UTI (r-UTI)” (Singh, Gautam, & Kaur, 2016). The results of this study concluded that cranberry derived products containing PAC-A reduced bacterial adhesion in the urinary tract.
Conclusion
“A significant number of RCTs have been conducted to assess the effectiveness of cranberry products for preventing UTIs, particularly in its juice form” (Jepson, Williams, & Craig, 2012). The majority of these studies suggest that the benefit of cranberry juice to prevent recurrent urinary tract infections is small. However, more studies focused on cranberry products such as tablets and capsules need to be performed (Jepson, Williams, & Craig, 2012). “There is some evidence that cranberry products may reduce the incidence of UTIs compared to placebo, though the most effective amount and concentration of PACs that must be consumed and the duration for the intervention are unknown” (Asma, et al., 2018).
References
Asma, B., Vicky, L., Stephanie, D., Yves, D., Amy, H., & Sylvie, D. (2018). Standardised high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women [PACCANN]: A double blind randomised controlled trial protocol. BMC Urology, 18(1).
Fu, Z., Liska, D., Talan, D., & Chung, M. (2017). Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta- Analysis. The Journal of Nutrition, 147(12), 2282-2288.
Jepson, R. G., Williams, G., & Craig, J. C. (2012). Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews, (10), 1-80.
Occhipinti, A., Germano, A., & Maffei, M. E. (2016). Prevention of urinary tract infection with oximacro, a cranberry extract with a high content of a-type proanthocyanidins: A pre- clinical double-blind controlled study. Miscellaneous, 13(2), 2640-2649.
Schneeberger, C., Geerlings, S. E., Middleton, P., & Crowther, C. A. (2015). Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database of Systematic Reviews, (7), 1-31.
Singh, I., Gautam, L. K., & Kaur, I. R. (2016). Effect of oral cranberry extract (standardized proanthocyanidin-A) in patients with recurrent UTI by pathogenic E. coli: A randomized placebo-controlled clinical research study. International Urology and Nephrology, 48(9), 1379-1386.