Nursing Research And Evidence-Based Practice Discussion
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
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| Full APA formatted citation of selected article. | Article #1 | Article #2 | Article #3 | Article #4 |
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Inciardi, R. M., Lupi, L., Zaccone, G., Italia, L., Raffo, M., Tomasoni, D., … & Metra, M. (2020). Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA cardiology, 5(7), 819-824. . https://doi:10.1001/jamacardio.2020.1096
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Wark, T. W., Lang, W. R., Cahill, K. E., & Gardner, R. L. (2020). Management of Elevated Troponin I Levels in Adult Medical Inpatients. Journal of general internal medicine, 1-3.
DOI: 10.1007/s11606-020-06074-9 |
Krubiner, M., Shapira, U., Zeltser, D., Shapira, I., Berliner, S., Shenhar-Tsarfaty, S., … & Bar-Shai, A. (2019). Lung function deterioration predicts elevated troponin levels in apparently healthy individuals throughout a 5-year follow-up. Respiratory medicine, 154, 63-68. https://doi.org/10.1016/j.rmed.2019.05.021 | Shah, P., Doshi, R., Chenna, A., Owens, R., Cobb, A., Ivey, H., … & Mccarley, K. (2020). Prognostic value of elevated cardiac troponin i in hospitalized Covid-19 patients. The American journal of cardiology, 135, 150-153. https://doi.org/10.1016/j.amjcard.2020.08.041 | |
| Evidence Level *
(I, II, or III)
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Level IV | Level V | Level II | Level II |
| Conceptual Framework
Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here)Nursing Research And Evidence-Based Practice Discussion.**
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Cardiac involvements in amongst the patient who is having the Covid-19 contraction. Complication of SARS-CoV-2 is manifested here.
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Classification of type 2 myocardial infarction (T2MI). | Not being mentioned. | Clinical outcome framework is utilized. |
| Design/Method
Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). |
Assessment on 53-year-old woman for acute myopericarditis with systolic dysfunction is included. No exclusion criteria being found here. | Retrospective study in type 2 myocardial infarction (T2MI) patients who are admitted with increased cardiac troponin I (cTnI) levels. | Declination of lung function through 5-year follow up programme by increasing the troponin levels. | Inclusion involves the myocardial infarction patients. |
| Sample/Setting
The number and characteristics of patients, attrition rate, etc. |
53-year-old woman who is suffering with Covid 19 virus is admitted for presentation of acute myocardial infarction (MI).
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257 patients. | Lung function test and hs-cTnT was being performed in patients from Tel Aviv Medical Center Inflammatory Survey. | Hospitalized Covid 19 patients |
| Major Variables Studied
List and define dependent and independent variables |
Herat beats per minute, SpO2 levels, partial pressure of oxygen and carbon dioxide are being studied. |
Comparison of in-patient management between T1MI and T2MI patients. | Lung function was studied thoroughly. | Higher levels of Troponin I that is required for prognosis. |
| Measurement
Identify primary statistics used to answer clinical questions (You need to list the actual tests done)Nursing Research And Evidence-Based Practice Discussion. |
Electrocardiographic and Chest radiography are the major tests that are being performed on her. | Elevated troponin levels in amongst the T2MI patients. | Spirometer
Healthy population Pulmonary function test (PFT). |
Cardiac level injury is measured in Covid 19 patients. |
| Data Analysis Statistical or
Qualitative findings
(You need to enter the actual numbers determined by the statistical tests or qualitative data). |
Transthoracic echocardiography revealed normal left ventricular (LV). However, no evidences of heart valve diseases are being found. | Substantial variability are used in the patient caring regimens. | 90% of the test participants were being found with abnormal PFT. | Cardiac troponin I (cTnI) was found to be quite higher in the older patients. |
| Findings and Recommendations
General findings and recommendations of the research |
Laboratory testing should be performed well. | In patient education should be adjusted accordingly. | Positive correlation were found at increased levels of hs-cTnT (5.73?±?4.4?ng/L and 5.51?±?3.5 vs. 8.40?±?6.8, respectively. p?=?0.030). | Baseline comorbidities should have been considered. |
| 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? |
Strengths included the study of provisional factors related to MI.
Only one patient is studied which is the biggest limitation here. No such risks are being found. |
T2MI patients are included and others are excluded. Helped in studying the research question. | Declination of the clinical condition is found to be clinically significant.
Prospective cohort studies are to be considered here which isn’t being done properly. |
Decision of treating the patients should be prioritized on the basis of patient conditions. The respiratory symptoms are being considered well down here. |
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Key findings
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With concern to acute myocardial infarction, this can be stated that the most common symptoms that are observed here are dry cough, fatigue and shortness of breath | Medical interventions can be given off as ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor. | Measurements of troponin I is being studied here which states the one-time parameters should be utilized be carefully. | Hypertension was observed in patients suffering with elevated cTnI. |
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Outcomes
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The symptoms and the clinical manifestations helped in proposing mechanisms of how the disease can be dealt with. | Enhanced levels of troponin modification is needed. | Prognostic accuracies are comprehended using both hs-cTnI and hs-cTnT. | Myocardial infarction can happen in Covid-19 affected patients where the higher values are associated with some of the bad outcomes. |
| General Notes/Comments |
Studied is well comprehensive to understand the outcomes.
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Management should be improvised. | Important differences must be considered accordingly. | Higher clinically associated values are being proclaimed down with the worse outcomes. |
From the research, the best practices emerged from the study conducted by Wark et al., (2020). There are several reasons to choose this study. However, the main reason is its high number of participants, 257 patients, which provide more validity to the result. A total of 33% of the people in the study had started or increased their cardioprotective medicine. A total of 41% of the people in the study had their hearts tested. A high troponin level was documented in two-thirds of discharge reports (64%) whereas 19% of discharge instructions indicated additional outpatient examination.
The practise habits of hospital doctors taking care of patients with troponin increases were found to be very variable. While the best therapy techniques for T2MI as well as acute myocardial infarction individuals are unknown, it is clear that all these individuals have an unsatisfactory short- and long-term prognosis and they may gain from therapies to avoid future cardiovascular illness. In addition to research investigating the influence of high troponin readings on unfavourable outcomes throughout this patient group, best practice recommendations for inpatient drug titration as well as risk stratification are needed immediately. Furthermore, having thorough and correct discharge information may help with post-hospital treatment.
Hence, from this study, it can be stated that a more improved management system is required to improve the myocardial infarction among the patient. As a result, from this quality improvement study, it can be stated that medicinal interventions could be given off as ARNI (angiotensin receptor-neprilysin inhibitor), ARB (angiotensin II receptor blocker), and ACEI (angiotensin-converting enzyme inhibitor) Nursing Research And Evidence-Based Practice Discussion.
These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
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The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework
Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”
Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.
Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
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.
Inciardi, R. M., Lupi, L., Zaccone, G., Italia, L., Raffo, M., Tomasoni, D., … & Metra, M. (2020). Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA cardiology, 5(7), 819-824. . https://doi:10.1001/jamacardio.2020.1096
Krubiner, M., Shapira, U., Zeltser, D., Shapira, I., Berliner, S., Shenhar-Tsarfaty, S., … & Bar-Shai, A. (2019). Lung function deterioration predicts elevated troponin levels in apparently healthy individuals throughout a 5-year follow-up. Respiratory medicine, 154, 63-68.
https://doi.org/10.1016/j.rmed.2019.05.021
Shah, P., Doshi, R., Chenna, A., Owens, R., Cobb, A., Ivey, H., … & Mccarley, K. (2020). Prognostic value of elevated cardiac troponin i in hospitalized Covid-19 patients. The American journal of cardiology, 135, 150-153.
https://doi.org/10.1016/j.amjcard.2020.08.041
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide.
https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview.
https://academicguides.waldenu.edu/library/conceptualframework
Wark, T. W., Lang, W. R., Cahill, K. E., & Gardner, R. L. (2020). Management of Elevated Troponin I Levels in Adult Medical Inpatients. Journal of general internal medicine, 1-3. https://doi: 10.1007/s11606-020-06074-9 Nursing Research And Evidence-Based Practice Discussion