Additional Critique of Evidence

Unit 5 Assignment – Additional Critique of Evidence 4/7/22 1000w

This is part 3 of your evidence-based practice project.

In this assignment, you will refer back to assignment you completed in week 4/ the previous week, as this assignment will build upon it.

For this assignment, you will re-review your three articles selected from your week 2 and 4 assignment. Then, you’ll write a paper on the following (be sure to include the content from your previous papers in weeks 2 and 4.

For each of the three articles, please discuss the following in your paper: Additional Critique of Evidence

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1. Research design of the study
2. Threats to external/internal validity
3. Potential legal/ethical issues within the article
4. Data analysis (be sure to elaborate on this more from your paper in week 4, providing specifics about the results)
5. Implications for evidence-based practice and how this article could be used to make an evidence-based change
6. Conclusion/summary of the evidence

Remember to support your ideas with the articles you found. These articles should be less than five (5) years old. They should not be from the Web, but from the library databases, and be sure to use a narrative format.

In addition, you must follow APA guidelines, providing a title page, reference page, appendix, and in-text citations, as well as use level headings to match the assignment criteria listed above. Additional Critique of Evidence

Please use, at minimum three scholarly references, and your paper should be 800-1000 words, excluding title and reference pages.

 

 

 

 

 

 

Topic and PICOT Question

“The effects of proning treatment in COVID-19 patients” is the evidence-based practice topic chosen. Respiratory distress is the outstanding and pervasive COVID-19 symptom, thus, the prone position is a typical treatment for such problems. It necessitates practitioners to keep an eye on patients lying on their stomachs for effective proning. The prone posture entails lying on the frontal abdomen to relieve respiratory discomfort. The prone posture contrasts with the supine position, in which people lie horizontally on their backs. In a respiratory crisis, however, the prone position is preferable to the supine position because the supine posture compresses the lungs and inhibits air exchange, resulting in low oxygen levels.

Acute respiratory distress syndrome (ARDS) caused by deteriorating symptoms is of primary importance to the evidence-based issue. Although additional problems such as multi-organ failure andpulmonary edema might occur, ARDS is the most common in severely ill patients, involving around 17% of COVID-19 patients. The chosen evidence-based subject aims to investigate the efficacy of prone treatment in treating COVID-19 individuals experiencing deteriorating symptoms. In addition, it also assesses whether it reduces mortality for COVID-19 patients without access to mechanical ventilators (White & Lo, 2020).

A PICOT question is also created to address the evidence-based topic.Because of its specificity, the PICOT question is a foreground question since the important information required is for making therapeutic judgments. Because it examines whether proning treatment leads to better results for COVID-19 patients, the PICOT question can be categorized as targeting an intervention. The complete PICOT question is; “For COVID-19 positive patients, has the use of proning therapy been effective in reducing mortality and intubation rates?”The separate elements of the PICOT question include:

P: Covid- 19 positive patients in the ICU.

I:Proning therapy

C: supine position

O: Reduced intubation and mortality of COVID-19 patients

T: during hospital admittance.

First Article

The first article is by Ghelichkhani & Esmaeili, 2020 which is a commentary on using the prone position in managing COVID-19. The article’s concept is that prone positioning is the most effective intervention when dealing with acute respiratory distress syndrome (ARDS). Since ARDS is prevalent among COVID-19 patients by about 17%, prone positioning can be used to improve ventilation. However, the article’s authors assert that the efficiency of the prone position is influenced by commencement of therapy, duration of intervention, and patient selection

As a result, it’s critical to pick particular patients for the therapy and keep track of their time in the posture. The authors conclude thatproning be done for a minimum of 12 hours each day to be successful and started early in ARDS patients to reduce mortality.

The study is qualitative and does not collect numerical data. Instead, the authors depend on the available information in already published research articles to arrive at conclusions. The authors depend on historical studies and select primary sources that contain relevant information about COVID-19 and proning. For instance, the article references a meta-analysis that identified mortality rates dropping by about 17% after implementing the prone position for 12 hours a day.

The primary subjects of the article are COVID-19 patients suffering from ARDS. The article does not specify the specific tools that were deployed to select and identify relevant articles, the selection criteria, or database sources. The article is reliable because it is located in a health-related database, PubMed Central, and is created by authors with expertise on the subject. The weakness of the article is its commentary nature. The authors do not specify how they selected their sources of information.

Second Article

The second article is by Rahmani et al.(2020) and is qualitative in design. The article focuses on the outcome of using the prone position in the treatment of COVID-19. The prone position is commonly used to improve oxygenation in patients with ARDS who cannot breath without assistance. According to Rahmani et al. (2020), the prone posture promotes uniform ventilation and lowers patient mortality. Proning as a medical intervention is non-invasive ventilation; however, it is not entirely perfect and contains weaknesses. Of key interest is that it is usuallyeffective and successful when controlled by a healthcare team. COVID-19 patients under respiratory distress need supervision and constant monitoring when applying proning to improve oxygenation.

The method used in the study is a literary analysis of previous works to establish facts. It is qualitative, and thus the authors attempt to assess the effects of proning on COVID-19 patients based on available research. The authors reference multiple studies adapting statistics and other factual information. In addition, the authors also reference present theories on the prone position that illustrate proning results in homogenous ventilation. The article’s primary focus is COVID-19 patients admitted to the Intensive Care Unit (ICU) suffering from respiratory distress.

The article’s authors do not specify the tools used to select the studies referenced in the literature. However, one can infer that the studies selected to align with the main topic and are relevant in helping the authors identify relevant information. The information in the article is credible first because it is located in a recognized medical journal. Second, the article’s authors have competency in the relevant topic and expertise in presenting similar information. The last rationale for the article’s credibility is because it has been cited by other authors and used as a reference point in creating other published peer-reviewed articles.

 

Third Article

The third article is a study by Hallifax et al. (2020) to determine if successful awake proning of COVID-19 patients in need of respiratory assistance is linked to better medical outcomes. The study’s problem of focus is that awake proning promotes oxygenation in COVID-19, despite the lack of data on clinical effects. Its goal is to investigate how effective awake proning is in COVID-19 patients who need breathing assistance. A total of 565 COVID-19 patients were studied in a High Dependency Unit (HDU). According to the authors, awake proning may be beneficial for COVID-19 patients.

The researchers’ methods used for data analysis included logistic regression analysis and multivariate logistic regression. The authors specified criteria for patient admission to the HDU. Patients for the study were transferred to the HDU when their oxygen requirement increased. However, patients with increasingly deteriorating conditions were not enrolled in the study. Respiratory specialists monitored the patients in the HDU and encouraged them to line in the prone position for at least 2 hours daily.

Regarding the study’s validity,it expands on previously unsolved issues; for example, it provides evidence that awake proning improves medical outcomes in patients with respiratory distress. The study’s outcomes are consistent with earlier research, and they add that awake proning is a viable intervention in COVID-19 that needs more research. The study’s findings are consistent with past studies on the issue, and the authors remain cautious in their assertions, instead urging more evaluation and investigation. Nurses may utilize awake proning in COVID-19 patients in the HDU to enhance outcomes, and the findings are immediately applicable in nursing practice.

Conclusion

In conclusion, the prone position has been historically used to address respiratory distress problems, specifically ARDS. Since ARDS is the most common condition in COVID-19 patients with worsening symptoms, it is vital to assess the effectiveness of applying proning to alleviate their respiratory distress. There are specific aspects that should be addressed before using the prone position. For instance, the efficiency of the prone position is influenced by patient selection, commencement, and length of placement in the prone position. Practitioners need to select specific patients capable of benefiting from the intervention. It is also essential for health care practitioners applying the intervention to monitor the patients and ensures they receive a minimum of two hours of proning daily.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/

Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678

Rahmani, F., Salmasi, S., &Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580

White, D. B., & Lo, B. (2020). A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. https://doi.org/10.1001/jama.2020.5046

 

 

 

 

 

 

 

 

Appendix

Matrix Table

Article/Reference (in APA format)	Purpose of the Article/Study Question	Variables (i.e.; Independent vs. Dependent)	Study Design	Sampling	Methods	Instrument	Findings/Results
Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/	Assessing the management of COVID-19 patients through prone position	There are no variables	Narrative inquiry	Purposeful sampling of COVID-19 patients	Selecting previous relevant  articles	Document or article analysis	The prevalence of ARDS in COVID-19 is 17% and prone position can be used to improve ventilation in this population.
Rahmani, F., Salmasi, S., &Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580	The effects of prone position in COVID-19 patients	There are no variables	Narrative inquiry	Purposeful sampling of COVID-19 patients	Selecting previous relevant  articles	Literature analysis	the prone position leads to homogenous ventilation and reduces patients’ mortality rate
Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678	Determine if successful awake proning of COVID-19 patients who require respiratory support is linked to better outcomes.	Respiratory support. Ventilation	Retrospective study.	COVID-19 patients requiring respiratory assistance in the HDU	Selecting patients who require oxygen support for the HDU and performing awake proning at least twice a day for 2 hours.	Logistic regression analysis, Multivariate logistic regression, and Firth bias-reduced logistic regression	High mortality rate for COVID-19 patients who require respiratory support although awake proning can address this issue.