University of Saint Augustine for Health Sciences
NUR7050: Evidence-Based Practice for Healthcare Professionals
NOTE: An abstract is not required
NOTE: This is a template and guide. Delete all highlighted materials.
Synthesis of the Literature
Synthesize your final primary quantitative research studies and/or systematic reviews; do not include summary articles such as a review of the literature, a clinical article, or a clinical practice guidelines. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Refer the reader to your evidence table(s). See Table 1 and 2. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. The studies that you cite in this section must relate directly to your PICOT question. This is a synthesis (Table 3) rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
Practice Recommendations
So. . . using available best evidence, what is the answer to your question? This section is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a synthesis statement, and, based on your conclusions drawn from your review of the body of evidence related to your clinical question, give a recommendation for practice change. This would logically be the intervention of your PICOT question. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice, and you recommend reinforcement and education regarding this best practice. Using Johns Hopkins, identify whether this recommendation be graded A, B, or C based on the strength of the evidence.
References
Remember that this is a reference list rather than a bibliography. A bibliography is everything you read to prepare the paper but a reference list is only what you cited. If there is not a citation for a reference, it should not be here. PLEASE make sure that your references and your citations throughout the paper are in APA format. You can go from an A paper to a B paper on APA errors alone. Take the time to make sure that they are correct. We have already formatted the paper for you with this template.
Table 1
Primary Quantitative Research Evidence (this table may be single space and 10-point font; ONLY primary quantitative research articles should be in this table) Example provided.
| Source | Study design JH Level of Evidence |
Population/ Sample Age Race/ Ethnicity Setting/ Location % dropout |
Intervention (IV) Details Action Duration Fidelity |
Comparison/ Control (IV) Details Action Duration Fidelity |
Outcome (DV) &Time Intervention vs comparison (statistical test, value, p value) |
Grading of evidence JH Quality Rating |
Author’s conclusions ———– Other outcomes of interest |
Your Conclusions Limitations |
Fit/Useful |
| Abel, 2020 | RCT Level I |
196 inter-city Age 36.4 (8.9) [Range 24 – 49] 55% Male, 40% Black, 62% Latino 73% Medicaid, annual income <$25,000 Setting: Outpatient Location: Boston, MA Baseline pain score 6.4 avg on both groups Dropout: 15/200, 7.5% |
Weekly chiropractic adjustment Assessed & tx 10 weeks 100% of visits over 10weeks Average total 180 mins |
Massage Medical massage 50 min/wk 100% for 10 weeks |
At 10 weeks, avg pain score Tx = 3.6 Control = 5.2 (X2 = 7.3; p<.05): Latino males Tx = 2.8 Control = 5.7 (X2 = 8.3; p<.001): Latino women Tx =6.0 C = 2.8 (X2 = 9.2; p<.001): |
Quality A |
Pain scores 30% lower w/ wkly chiro compared to 50 mins/wk medical massage Tx more effective in Latino males C more effective in Latino women ——— Massage would cost 30% more out of pocket |
Tx. Better than control Chiropractic adjustments effective in general and in Latino males but not in Latino women Limitations = -not equal time in tx -not include high income |
Yes/Yes but only if cost covered by Medicaid in my state |
Legend: (all abbreviations and acronyms used in the table should be listed here such as: )
Table 2
Evidence Summaries (this table may be single space and 10 point font; ONLY systematic reviews should be in this table) (Example provided)
| Source | Study design JH Level of Evidence |
Population/ Sample Search strategy Inclusion Exclusion N articles addressing your PICOT Other descriptions |
Intervention (IV) Details Action Duration Fidelity |
Comparison/ Control (IV) Details Action Duration Fidelity |
Outcome (DV) & Time Mean differences Intervention vs comparison Effect size Heterogeneity (statistical test, value, p value) |
Grading of evidence JH Quality Rating |
Author’s conclusions —— Other outcomes of interest |
Your Conclusions Limitations |
Fit/Useful |
| Brown, 2018 | Meta-analysis Level I |
Medline OVID CINAHL 2000-2017 RCTs, conducted in the US, high-quality (>21/25 points on CONSORT), comparing regular chiropractic adjustment vs regular medical massage for chronic pain measured using a 0-10 scale 10 RCTs of low back pain Exclusions Studies of phantom pain Total participants N=867 Avg age 59 (6) Avg baseline pain scores 3.2 (3.4) Avg Dropout: 8% (4) Only completers included in this analysis |
Chiropractic adjustment in office Most weekly (2/10 allowed 2x wk) Fidelity All > 80% |
Massage 45-60 mins Most weekly (2/10 allowed 2x wk) Fidelity All >86% |
At 8 weeks N=4 Tx = 3.6 Control = 5.2 (RR for 2 point pain reduction= 1.6 (1.1-2.3); p=.04): I2= 10% At 12 weeks N=6 Tx = 3.2 Control = 4.8 (RR for 2 point pain reduction= 1.7 (1.4-2.4); p=.04): I2= 13% |
Quality B due to no ITT |
wkly chiropractic adjustment was more effective than weekly massage for reducing chronic pain based on the data from these studies —none |
Tx. Better than control High dropout rate and not analyzed with ITT |
Partially- my population is much younger on average Partially- my population has a variety of pain sources Useful- yes |
| Add more | |||||||||
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Legend: (all abbreviations and acronyms used in the table should be listed here)
Table 3.
Synthesis Matrix (identify the trends; this table may be single space and 10 point font; ONLY primary quantitative research articles or systematic reviews should be in this table; use only the highest level and quality of evidence; if the evidence is of mixed level or mixed quality, sort the trends using the Johns Hopkins Appendix H; trends must be related to the outcome) (example provided regarding effective pain management which may or may not be within your scope of practice- make sure your PICOT is within your scope of practice.)
| Main ideas | Albright (2020) | Reference 2 | Reference 3 | Reference 4 | Reference 5 | Add columns as necessary |
| Weekly chiropractic adjustment equally effective as weekly massage | ||||||
| Biweekly chiropractic adjustment associated with 30% lower pain scores compared to weekly massage in those with back pain | ||||||
| In those with a mean age under 50, weekly massage associated with 20% lower pain scores compare to chiropractic adjustments | ||||||
| Add more as needed |
Figure 1
Results of Search for Research
Use http://prisma.thetacollaborative.ca/ to generate a diagram describing the results of your search. Paste it here.
