NRS 433 Topic 4: Measurement, Statistics, and Appraisal Tasks

Topic 4: Measurement, Statistics, and Appraisal Tasks

When making decisions concerning a patient’s care, evidence-based clinical practice is a methodical, problem-solving process that takes into account patient values and preferences, the best available data from well-designed research, and the clinician’s experience. Evidence-based practice in healthcare comprises gathering evidence and using it to guide therapeutic decisions. To address clinical inquiries, the highest degree of proof should normally be obtained in healthcare research.

Trials are included in Controlled Randomization Level A evidence, the highest level. At random, subjects are chosen and assigned to groups. They are subjected to experimental procedures or therapies that are closely monitored. A systematic review or meta-analysis was performed on all relevant RCTs. A systematic review is a critical examination of existing research that focuses on a specific clinical question, includes a thorough literature review, ranks study quality, and presents findings methodically. A meta-analysis is a study design that integrates and analyzes data from multiple RCTs using statistical methods.

A+ grade Well-designed control trials without randomization are used to gather evidence. This study does not use random assignment to divide participants into experimental and control groups. Because the subjects in the study cannot be considered equal in terms of the study’s primary demographic and clinical characteristics at the start of the trial, this type of research has a lower level of internal validity. This study is vulnerable to intentional or unintentional bias in sample enrollment, non-blinding, imprecise participant selection criteria, and inaccurate or inefficient instruments. A clinical cohort study looks into groups of people who have similar characteristics or exposures in order to compare the outcomes of those who were and were not exposed (e.g., development of heart disease after exposure or nonexposure to 10 years of secondhand smoke).

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A case-controlled study compares participants known to have an ailment or outcome to those known not to have that disease or outcome using an observational technique. With the exception of the condition or outcome, subjects are matched based on features to bring them as close as possible. Case-control studies are commonly used to determine the likelihood that a condition or disease will manifest itself (via an odds ratio), as well as whether there is a link between the ailment/disease and risk factors. There is no control over the interventions or participant selection in uncontrolled studies (for instance, a convenience sample, such as patients on a certain unit, may be studied because they are the only group that is ostensibly accessible). In epidemiological research, long-term observations of individuals are used to determine the risk or likelihood that they will contract a disease. Population-following prospective studies and retrospective database searches are examples of this research. Qualitative and quantitative research that employs language to describe phenomena such as symptoms, behaviors, culture, and group dynamics. Statistical techniques are used in quantitative research to establish causal or linked numerical connections.

Also Read:

Topic 4 DQ 1

. Describe two ways that researchers attempt to control extraneous variables. Support your answer with peer-reviewed articles.

Re: Topic 4 DQ 1

Variables are the key features for method of inquiry during a science experiment. Experimental methods objectively investigate a hypothesis or research question in order to avoid any bias. The which is manipulated in an attempt to have a direct effect on the dependent variable. The dependent variable is the part of the experiment which is being tested and measured and is ‘dependent’ on the independent variable. (McLeod, 2019)

Extraneous , which is of no particular interest to the researcher, and may influence the outcome of an experiment. Confounding variables are a type of extraneous variable which directly affects how the independent variable acts on the dependent variable. It can lead the researcher to think there is a cause and effect where there is not. Controlling extraneous variables can be done with random sampling. Although random sampling does not completely exclude any extraneous variables, it does help with equality within all groups. (Statistics How To, 2019) Randomized control groups allow chance to select the groups so any confounding variable can be cancelled out, as long as there is a large enough sample group. (Shuttleworth, 2009) Another way the researcher can attempt to control extraneous variables is matching during selection of the study sample. Matching equates participants on the variables being controlled such as age or gender. It involves balancing subjects from a set of background variables before assigning them to the experiment. (Extraneous variables and control techniques, n.d.)

References

Extraneous variables and control techniques. (n.d.). Extraneous variables and control techniques. Retrieved from http://resourcecentre.foodrisc.org/medialibrary/2013/05/10/c504834b/Extraneous%20variables%20and%20control%20techniques.pdf. Topic 4: Measurement, Statistics, and Appraisal Tasks

McLeod, S. (2019, August 1). What are independent and dependent variables? Retrieved from Simply Psychology: https://www.simplypsychology.org/variables.html

Shuttleworth, M. (2009, March 12). Randomized controlled trials. Retrieved from Explorable.com: https://explorable.com/randomized-controlled-trials

Re: Topic 4 DQ 1
The independent are the interventions and are plotted on the X axis, while the dependent variables are the outcome of the intervention and are plotted on the Y axis (Grand Canyon, 2018). When plotting the data, the straighter the line, the stronger the relationship between the intervention and the outcome; this also indicated the research’s validity (Grand Canyon, 2018). Extraneous variables are any variables other than the independent variable that could influence the research study’s outcome. As a result, these factors should be controlled to the greatest extent possible in order to aid in providing alternative explanations for the effect (Mcleod, 2019). Extraneous variables are classified as investigator effects, situational variables, and personal variables. Randomization of group assignments and using double blinde methods where neither the researcher nor the participant knows if they are receiving the intervention are two methods for mitigating the effects of extraneous variables (Grand Canyon, 2018). These methods of controlling extraneous variables help to maintain validity; however, because there is no way to account for every extraneous variable, we use positive and negative correlation. If there is a positive correlation, the intervention has a cause and effect relationship. Measurement, statistics, and appraisal tasks are covered in Topic 4.
Grand Canyon University (Ed). (2018). Nursing research: Understanding methods for best practice.

Retrieved from ,ch.4Mcleod, S. (2019, July 30). Extraneous Variable. Retrieved from

Topic 4 DQ 2

Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

Re: Topic 4 DQ 2

Evidence-based medicine (EBM) is a field in which evidence is sought and used to make clinical decisions. The levels of evidence were first depicted in the periodic health examination report in 1979. Randomized clinical trials were described as having the highest level of evidence because they are unbiased and are less likely to cause systemic error. This is due to the randomization of confounding factors, which biases the results. According to this report, case series and expert opinion are the lowest levels because they are highly likely to be biased based on author experience and lack control over confounding factors. This level, however, is constantly being modified based on various settings. According to the Centre for Evidence-Based Medicine, randomized clinical trials are not required when determining a disease’s prognosis; thus, cohort studies and systemic reviews of cohort studies are considered the highest levels of evidence. The levels of evidence are shown in the table of levels of evidence for therapeutic studies below.

Level 1A – Systemic review of randomized clinical trials (RCT).

Level 1B -Individual RCT.

Level 1C- All or none studies.

Level 2A – Systemic review of cohort studies.

Level 2B – Individual cohort studies.

Level 2C – Research and ecological studies outcomes.

Level 3A – Case-control study systemic review.

Level 3B – Individual study of case-control.

Level 4 – Case series.

Level 5 – Expert opinion.

These levels of evidence has impacted a lot on nursing practice resulting to a lot of practice change. These levels assist the nurses in decision making when considering the best medical intervention to give to the patients. For example, level 4 level of evidence for care report that finger injection with epinephrine results to finger ischemia, this evidence has resulted to nurses avoiding giving finger injections of epinephrine. For the high levels of evidence, health care providers should follow a strong recommendation unless an alternative compelling rationale is available. For the lower levels as the nurses follow the recommendations, they should be alert for new information and respect the preference by the patient.

References.

Centre for Evidence-Based Medicine, http://www.cebm.net

Plast Reconstr Surg. 2011 Jul; 128(1): 305-310. doi 10.10997/PRS.0b013e318219c171.

McCarthy CM, Collins ED, Pusil AL. Where do we find the best evidence? Plast Reconstr Surg. 2008; 122:1942-1947. (PubMed).

Re: Topic 4 DQ 2

LEVEL C: Evidence obtained from consensus viewpoint and expert opinion: a study that obtains agreement about specific practices from all clinical experts on a review panel. Expert opinion involves obtaining agreement from a majority of clinical experts on a review panel. Note: This level of evidence is used when there are no quantitative or qualitative studies in a particular area. Meta-synthesis: a systematic review that synthesizes findings from qualitative studies using an interpretive technique to bring small study findings, such as case studies, to clinical application. And finally LEVEL ML (multilevel): clinical practice guidelines, recommendations based on evidence obtained from: More than one level of evidence.

Level I – Experimental study, randomized controlled trial (RCT), Systematic review of RCTs, with or without meta-analysis

Level II – Quasi-experimental Study, Systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only, with or without meta-analysis.

Level III – Non-experimental study. Systematic review of a combination of RCTs, quasi-experimental and non-experimental, or non-experimental studies only, with or without meta-analysis. Qualitative study or systematic review, with or without meta-analysis

Level IV – Opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence.
Includes: – Clinical practice guidelines, Consensus panels

Level V is Based on experiential and non-research evidence. Includes: Literature reviews, Quality improvement, program or financial evaluation, Case reports, and Opinion of nationally recognized expert(s) based on experiential evidence.

The levels of evidence are an important component of EBM. Understanding the levels and why they are assigned to publications and abstracts helps the reader to prioritize information. This is not to say that all level 4 evidence should be ignored and all level 1 evidence accepted as fact. The levels of evidence provide a guide and the reader needs to be cautious when interpreting these results.

Reference

Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305–310. doi:10.1097/PRS.0b013e318219c171

Nurse.com (n.d.) Evidence Based Practice Retrieved from

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

  • Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
  • Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
  • One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
  • I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

  • Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
  • In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
  • Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
  • Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

  • Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
  • Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
  • I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

  • I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
  • As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
  • It is best to paraphrase content and cite your source.

 

LopesWrite Policy

  • For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
  • Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
  • Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
  • Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

  • The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
  • Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
  • If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
  • I do not accept assignments that are two or more weeks late unless we have worked out an extension.
  • As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

  • Communication is so very important. There are multiple ways to communicate with me: 
    • Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
    • Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

 

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