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MSN 5300 Miami Regional University Nutritional Critical Appraisal Worksheet

MSN 5300

Miami Regional University

MSN

Question Description

I’m trying to learn for my Nursing class and I’m stuck. Can you help?

I;m taking Advanced Nursing Inquiry and Evidence Base Practice, I have my PICO paper about a research article Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia. My question to you guys is you can help me with this Critical Appraisal. I attachhed all my paperwork,just let me know , this work is for Saturday March 28.

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Group Name: RIVERO Date: 01/23/2020 PICO Worksheet Original Revised Define your Question using PICO P I Patients (≥ 65 years) suffering femoral neck fracture and undergoing hip replacement with Hypoalbuminemia. Administration of postoperative oral nutritional supplementation and intravenous infusion of human albumin. Research Method: M e t h o d o l o g y - Quantitative Research design: C Administration of intravenous infusion of human albumin only. O Decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty. - Retrospective cohort study State your Question resulting from PICO: In older patients (≥ 65 years) whose suffering femoral neck fracture and undergoing hip replacement with Hypoalbuminemia, is administration of postoperative oral nutritional supplementation and intravenous infusion of human albumin more effective for decrease the rate of surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty than administration of intravenous infusion of human albumin only? List thesaurus or subject heading terms from your PICO question. Try to find a subject heading for each main concept. List keywords from your PICO question that can be used for your search. - Surgical site infection - Hip fracture An increase in the frequency of surgical site infections in elderly patients with hypoalbuminemia undergoing hip arthroplasty. We want to investigate if oral nutritional supplementation after the procedure is more effective in reducing surgical site infections than administration of intravenous infusion of human albumin only. List other criteria used to limit your search. - Older adults or elderly - English - Publication: 2016 – 2020 - Abstract - Full Text - Academic Journals List the databases you plan to search: - CINAHL - MEDLINE August 2019 MSN5300 KmR MSN5300 Evidence Table A literature review is the foundation for every research project. The matrix reflects the structure of empirical research articles. Summarize each study across the row. Adding pg #s will help keep track of where specific information is located. Try to summarize in your own words - add quotes where you don't. Citation (APA format) Research question/ Purpose/Hypothesis Theory/ Framework Research Design Research Sample Research variables/ measures Intervention/ Treatment 1. 2. 3. 4. 5. KmR MSN5300 Rev. 1.2020 MSN 5300 Evidence Table (…con't…) Purposefully look for similarities and differences between studies, identify themes that emerge and think about how each study might relate to others reviewed. Major findings, contributions KmR Study limitations, gaps that remain Study implications for research, practice, policy Make note of how this research is linked to other studies reviewed MSN5300 What are the implications of your analysis? What is missing? Where are the gaps in the body of literature? What would you suggest for future research? For practice? What new questions should be asked? Miscellaneous Rev. 1.2020 MSN5300 Group Project #1, Part b Critical Appraisal Presentation Scoring Rubric Group Name: CATEGORY Content (x5) Organization Critical Analysis Comprehension Preparedness Timing Group Member Participation 4 3 2 1 Demonstrates good understanding of the critique process. Provides explanations of majority of critique elements; partially supports conclusions/ideas with evidence from the study. Provides some negative critique mixed with positive narrative. Demonstrates limited understanding of the critique process. Provides explanations of some of critique elements; limited support of conclusions/ideas with evidence from the study. Provides mostly positive narrative. Demonstrates little to no understanding of the critique process. Does not provide explanations of critique elements; does not support conclusions/ideas with evidence from the study. Provides only positive narrative. Information is well-organized. Presentation flows nicely. Information is organized. Presentation flows fairly well. Information is fairly organized. Presentation does not flow well. Analyses and conclusions are accurate, detailed, insightful, valid, and consistent with data. Able to accurately answer almost all questions posed by colleagues about the topic. Completely prepared and has obviously rehearsed. Presentation is 18-20 minutes long. Analyses and conclusions are consistent with data. Analyses and conclusions are mostly correct. Information appears to be disorganized. Presentation is difficult to understand. Analyses and conclusions are unclear or inaccurate. Able to accurately answer most questions posed by colleagues about the topic. Able to accurately answer a few questions posed by colleagues about the topic. Well- prepared and rehearsed. Presentation is 1517 minutes long. Somewhat prepared but it is clear that rehearsal was lacking. Presentation is 1214 minutes long. Consistently participated in development of the project Frequently participated in development of the project Sometimes participated in development of the project Demonstrates full knowledge of the critique process. Provides clear explanations of all critique elements; supports conclusions/ideas with evidence from the study. Provides both positive and negative critique. Points Unable to accurately answer questions posed by colleagues about the topic. Does not seem at all prepared to present. Presentation is less than 12 minutes or greater than 20 minutes. Never participated in development of the project Adapted from: Oral Presentation Rubric - ReadWriteThink. (n.d.). Homepage - ReadWriteThink. Retrieved June 11, 2018 from http://www.readwritethink.org/classroomresources/printouts/oral-presentation-rubric-30700.html KmR MSN5300 Rev. 1.2020 CRITICAL APPRAISAL CHECKLIST: QUANTITATIVE RESEARCH How do you rate this paper? 1 2 3 4 5 6 7 8 9 10 OBJECTIVES, HYPOTHESIS, STUDY PURPOSE Are the objectives (or aims) of the study clearly stated? Is the study question clearly stated? Is the hypothesis clearly stated? Is the study purpose an important clinical issue? LITERATURE REVIEW Did the researchers base their work on a thorough literature review? DESIGN, SAMPLE Is the study design suitable for the objectives? Are inclusion/exclusion criteria described? Was this the right sample to answer the objectives? Was a power analysis conducted to determine sample size? If subjects left the study, were reasons provided? Has ethical approval been obtained? MEASUREMENT Is the method of data collection consistent consistent with the study design? Is reference made to assumptions in the data? Is it clear what variables were measured? Is it clear how variables were measured? Is it clear how instruments were scored? Are instruments valid? Are instruments reliable? Are the measurements reproducible? STATISTICAL ANALYSIS, PRESENTATION OF RESULTS Are data adequately described? Are statistical analysis methods appropriate to the data? Are results logically presented in table, charts/graphs? Are all statistics correctly interpreted? Do results fit with previous research on the topic? DISCUSSION Are the results discussed in relation to existing knowledge on the subject and study objectives? Is the discussion biased? INTERPRETATION Is the study question answered? Are the authors’ conclusions justified by the data? Does this paper help you answer your clinical problem? How do you rate this paper now? 1 2 3 4 5 6 7 8 9 10 YES NO References Coughian, M., Cronin, P. & Ryan, F. (2007). Step-by-step guide to critiquing research part 1: Quantitative research. British Journal of Nursing, 16(II), 658-663. Fineout-Overholt, E. (2019). A guide to critical appraisal of evidence. Nursing 2019 Critical Care, 14(3), 24-30. 9.2019 MSN5300 KmR CCAP Critical Appraisal Tool Quantitative Research Checklist PICO Question: Criteria Title of the Article: Does the title accurately describe the study? Problem/Purpose Statement: Is the research question clear? Is the purpose clearly stated? Is there a statement predicting the relationship between variables? Are there operational definitions for the variables? Literature Review: Are appropriate references cited supporting the quantitative work? Are supporting/opposing studies cited? Does the review use current literature? (published within the last 5 years; unless a seminal article) Method: Are the independent and dependent variables clearly identified? Is the quantitative methodology clearly stated in the article? Does the study state the overall plan for addressing the hypothesis? Participants: Population clearly described? Selection procedures stated in the article? Is human protections discussed? Is there mention of the Institutional Review Board (IRB)? Was consent obtained? Yes 2 points a No 1 point Total Criteria Yes 2 points No 1 point Data Collection: Does it state data collection procedures?(how, where, and when were data collected, and what period of time). Were data collection instruments used in the study? Were the instruments reliable (consistent) and valid (accurate)? Results: Were the hypothesis answered? Are limitations described clearly? Are recommendations made to replicate and/or revise the study? Are findings generalizable? Are tables and figures clear and relevant? Application to Nursing: Are the implications for nursing clear? Are the results applicable to my patients? Total Score valuationCriteria: Excellent= 47-52 Good= 41-46 Fair= 35-40 Poor/Questionable= 25 and below The following two questions can be answered on a separate paper. Is the study purpose an important clinical issue? Why or why not? Name: Approval Date: What does this research mean for clinical practice on your unit? Nurse Scientist Signature: Total He et al. Journal of Orthopaedic Surgery and Research https://doi.org/10.1186/s13018-019-1343-2 (2019) 14:292 RESEARCH ARTICLE Open Access Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia Yaoquan He1, Jun Xiao1, Zhanjun Shi1, Jinwen He2 and Tao Li1* Abstract Background: Nearly half of elderly patients with hip fracture were malnourished, indicated with a serum marker of hypoalbuminemia. Malnutrition was a risk factor for poor outcomes in geriatrics after hip replacement. The purpose of this study was to investigate if oral nutritional supplementation after the procedure in geriatrics with hypoalbuminemia was beneficial for outcomes. Methods: A retrospective cohort study of older (≥ 65 years old) patients suffering femoral neck fracture and undergoing hip replacement with hypoalbuminemia was conducted. Outcomes were compared between patients with and without postoperative nutritional supplementation. Results: There were 306 geriatric patients met the criteria. Following adjustment for baseline characteristics, patients with nutritional supplementation showed a lower grade of wound effusion with adjusted OR 0.57 (95% confidence interval (CI), 0.36 to 0.91, P < 0.05). And also a lower rate of surgical site infection (5.5% compared with 13.0% [adjusted OR 0.40, 95% CI, 0.17 to 0.91, P < 0.05]), periprosthetic joint infection (2.8% compared with 9.9% [adjusted OR 0.26, 95% CI, 0.08 to 0.79, P < 0.05]), and 30 days readmission (2.1% compared with 8.7% [adjusted OR 0.22, 95% CI, 0.06 to 0.79, P < 0.05]). The average total hospital stay was longer in patients without nutritional supplementation (10.7 ± 2.0 compared with 9.2 ± 1.8 days, P < 0.05). Conclusions: The data suggest that postoperative nutritional supplementation is a protective factor for surgical site infection, periprosthetic joint infection, and 30-days readmission in geriatric with hypoalbuminemia undergoing a hip replacement. Postoperative nutritional supplementation for these patients should be recommended. Keywords: Hip arthroplasty, Hypoalbuminemia, Nutritional supplementation, Surgical site infection, Periprosthetic joint infection * Correspondence: litchn@163.com 1 Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. He et al. Journal of Orthopaedic Surgery and Research (2019) 14:292 Background Hip arthroplasty (HA), including total hip arthroplasty and semi-hip arthroplasty, is one of the most common surgical procedures performed in geriatric femoral neck fracture. Although HA is a safe, effective procedure, a small percentage of HA procedures do result in major complications, including pneumonia, surgical site infection (SSI), wound dehiscence, prosthetic joint infection (PJI), heart failure, and death [1–4]. Prior studies have identified respiratory disease, older age, diabetes mellitus, and prior infection as risk factors for postoperative complications [1, 5–8]. Malnutrition has been identified as another potential risk factor for poor outcomes. It has been shown to increase the risk of SSI, wound dehiscence, and PJI [4, 9, 10]. Unfortunately, it has been shown that more than half of in-hospital geriatric patients present with malnutrition [11]. Hypoalbuminemia (serum albumin concentration < 3.5 g/dL) is most commonly used serum marker of malnutrition [12]. It has shown that the percentage of hypoalbuminemia in elderly patients with hip fracture is nearly 50% [13, 14]. Although hypoalbuminemia is potentially modifiable before the operation, it is difficult to achieve for a limited time for the purpose of reducing complications (such as pneumonia, deep vine thrombosis) due to prolonged bed rest in geriatric femoral neck fracture patients. Current nutrition guidelines state that oral nutritional supplements are recommended in geriatric patients after hip fracture and orthopedic surgery to reduce complications [14–16]. However, contradictory results have found. Several studies, including RCT (randomized placebo-controlled test) [17], indicated beneficial effects of nutritional status, hospital stay, clinical outcome, and mortality [17–20]. Other studies failed to demonstrate these [19, 21]. A recent meta-analysis included 41 trials and 3881 participants, the results showed low-quality evidence of nutritional supplementation on complications and mortality [22]. The heterogeneity of included patients and surgical procedures may be a significant limitation to delineate accurate conclusion [22]. The purpose of this study was to retrospectively investigate the effect of oral supplementation of enteral nutritional powder on the complications of geriatric femoral neck fracture with hypoalbuminemia. We analyzed the effect of nutritional supplementation on a particular cohort to decrease heterogeneity. Page 2 of 8 treatment of choice. Patients with moderate to severe malnutrition (weight loss of > 5% in the previous month or > 10% in the previous 6 months and/or serum albumin concentration < 2.7 g/dL) were excluded. Other exclusion criteria were severe heart failure (New York Heart Association class III or IV), respiratory failure, acute and/or chronic renal failure, hepatic insufficiency or cirrhosis (Child B or C), and any of gastrointestinal or cognitive condition that may preclude the patient from adequate oral nutrition intake. This study was approved by the Regional Ethics Committee of our hospital. The cohort was divided into two groups by the treatment of oral nutrition supplementation, Enteral Nutritional Powder (TP, ENSURE®), which started around February 2014. Data elements Interventions The cohort received a surgical procedure of HA at days 1–3 after admission and a 12-h overnight fast. The surgeries were conducted by four different surgeons in the same procedure, which was under spinal anesthesia with supine position and lateral approach. Anticoagulation, analgesic and rehydration therapy was routinely conducted postoperatively. For hypoalbuminemia (serum albumin concentration < 3.5 g/dL), all the patients were treated with one of the solutions after surgery. The control group was treated with intravenous infusion of human albumin only. And the nutritional supplementation group was treated with Enteral Nutritional Powder (TP, ENSURE®). At POD3 (post operation day 3), blood test was carried out to check whether hypoalbuminemia was corrected (serum albumin ≥ 3.5 g/dl). If yes, the treatments stopped. If no, Enteral Nutritional Powder (TP, ENSURE®) plus intravenous infusion of human albumin was the new solution for the nutritional supplementation group. For both groups, treatment stopped only when hypoalbuminemia was corrected (serum albumin ≥ 3.5 g/dl) or wound effusion disappeared. Enteral Nutritional Powder (TP, ENSURE®) was given at a dose of 250 ml (200 ml cold water added with 55.8 g ENSURE® powder, providing 251.1 kcal and 8.87 g protein. The energy distribution was 14.2% protein, 54% carbohydrate and 31.8% fat) by 3 times a day. A detailed formula of Enteral Nutritional Powder (TP, ENSURE®) was shown in Additional file 1: Table S1. The cohort received the same rehabilitations postoperative. Methods Inclusion and exclusion Data collection We conducted a retrospective cohort of older patients (≥ 65 years of age) with hypoalbuminemia (serum albumin concentration < 3.5 g/dL) who were admitted to our hospital between February 2007 and February 2017 because of femoral neck fracture and HA was the Patient variables included demographics (age and gender), body mass index (BMI), and preoperative comorbidities (hypertension requiring medication, diabetes mellitus, congestive heart failure, chronic obstructive pulmonary disease, chronic renal failure, hepatitis). He et al. Journal of Orthopaedic Surgery and Research (2019) 14:292 Laboratory indicators included serum albumin, total lymphocyte count (TLC), hemoglobin, and blood urea nitrogen (BUN) preoperative, and postoperative. We also documented the combined medication such as glucose, amino acids, fat emulsion, human serum albumin, and blood transfusion. Outcomes The primary outcomes included rates of major and minor postoperative complications, such as SSI, wound effusion, wound complications (including wound dehiscence, delayed healing, edema, and hematoma), and PJI. Secondary outcomes included 30-day readmission and reoperation rates, total hospital length of stay, and total amount of human albumin intravenously infused. When considering wound effusion, we counted the number of infiltrated sterile gauze, which was routinely covering the wound after operation. We usually use four pieces of sterile gauze to cover the wound. Any infiltration over four pieces was documented as “large amount of wound effusion” and were defined as “5” in the analysis. For convenience for analyses, we defined 0 and 1 as “little” effusion, 2 and 3 as “moderate” effusion, and 4 and 5 as “large” effusion. We also evaluated functional outcome using the Harris hip scores at 1 month followup. Statistical analyses Statistical analyses were conducted in SPSS Statistics 22. The level of significance was set at α = 0.05 (P < 0.05) and all the tests were two-tailed. Results of continuous variables were expressed as means±SD, and frequency and ratio were ...
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Final Answer

Attached.

CCAP Critical Appraisal Tool
Quantitative Research Checklist
PICO Question: In older patients (≥ 65 years) whose suffering femoral neck fracture and
undergoing hip replacement with Hypoalbuminemia, is administration of postoperative oral
nutritional supplementation and intravenous infusion of human albumin more effective for
decrease the rate of surgical site infection, prosthetic joint infection, and readmission after hip
arthroplasty than administration of intravenous infusion of human albumin only?
Criteria
Title of the Article:
Does the title accurately
describe the study?
Problem/Purpose
Statement:
Is the research question
clear?
Is the purpose clearly
stated?
Is there a statement
predicting the relationship
between variables?
Are there operational
definitions for the variables?
Literature Review:
Are appropriate references
cited supporting the
quantitative work?
Are supporting/opposing
studies cited?
Does the review use current
literature? (published within
the last 5
years; unless a seminal
article)
Method:
Are the independent and
dependent variables clearly
identified?
Is the quantitative
methodology clearly stated
in the article?
Does the study state the
overall plan for addressing
the hypothesis?
Participants:
Population clearly
described?

Yes (2 points)

No ( 1 point)

2

2
2
2

1

2

2
1

2

2

2

2

Selection procedures stated
in the article?
Is human protections
discussed?
Is there mention of the
Institutional Review Board
(IRB)?
Was consent obtained?

2
2
1

2


MSN5300 Evidence Table
A literature review is the foundation for every research project. The matrix reflects the structure of empirical research articles. Summarize each
study across the row. Adding pg #s will help keep track of where specific information is located. Try to summarize in your own words - add quotes
where you don't.

Citation (APA format)
1.
He, Y., Xiao, J., Shi, Z., He, J., &
Li, T. (2019). Supplementation of
enteral nutritional powder decreases
surgical site infection, prosthetic
joint infection, and readmission
after hip arthroplasty in geriatric
femoral neck fracture with
hypoalbuminemia. Journal of
Orthopaedic Surgery and
Research, 14(1), 292.

Research question/
Purpose/Hypothesis
To investigate if oral
supplementation
resulted in positive
outcomes in geriatric
individuals with
hyperalbuminemia

Theory/
Framework
No
theoretical
framework
was identified

Research
Design
A
retrospective
cohort
composed of
individuals
diagnosed with
hyperalbumine
mia

Research
Sample
Sample was
composed of
individuals
over the 65
years. 306
patients were
selected to be
part of the
study. 145
placed in
nutritional
supplementati
on and 161
placed in
control group

Research variables/
measures
Nutritional
supplementation

Intervention/
Treatment
Oral
supplementation

Outcome measures
included lower
grade of wound, 30
days readmission in
clinical settings,
average hospital
stay, and
periprosthetic joint
infection

2.

3.

KmR

MSN5300

Rev. 1.2020

4.

5.

MSN 5300 Evidence Table (…con't…)
Purposefully look for
similarities and differences
between studies, identify
themes that emerge and think
about how each study might
relate to others reviewed.

Major findings,
contributions
Oral supplementation
resulted reduced
lower grade of
wound, 30 days
readmission in
clinical settings,
average hospital stay,
and periprosthetic
joint infection as
compared to the
control group results

KmR

Study limitations,
gaps that remain
Patient observation
was limited to the
discharge period

Study implications
for research,
practice, policy
Oral supplementation
could be provided to
patients diagnosed
with different geriatric
condition for the sole
purpose of reducing
incidences of lower
grade of wound, 30
days readmission in
clinical settings,
average hospital stay,
and periprosthetic
joint infection

Make note of how this research
is linked to other studies
reviewed
Oral supplementation has been
shown to be effective in reducing
an individual’s risks to various
diseases especially in conditions
that lack use of specific elements
and ions

MSN5300

What are the implications of your analysis...

henryprofessor (72994)
UC Berkeley

Anonymous
Return customer, been using sp for a good two years now.

Anonymous
Thanks as always for the good work!

Anonymous
Excellent job

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