Medical and surgical patients

Assessment three–critique of the literature 60%

Assessment three builds on your work in the themed discussion boards (Assessment 2). For this assessment, you will be evaluating four recent journal articles related to your clinical question. You will do this by summarising and evaluating the articles in an annotated bibliography. An example of an annotated bibliography and a conclusion has been provided. Assessment three is divided into three sections to guide your critique of the literature.

General instructions

  • Due date – Due Sunday Week 12, 31/05/2020@1300 (CST)
  • The word count for the assessment is 1500 words +/- 10%
  • Assignments submitted after midnight will be subject to a 5% late penalty for eachday not submitted as per the Higher Education Assessment Procedures.
  • Markers will stop reading at the maximum allowable word count
  1. Introduction/Background(100 words)
    Summarise the clinical problem you identified in the discussion board post and explain why this is an important healthcare issue
  2. Annotated bibliography(4 x 300 words)

Write an annotated bibliography for each of the four articles. In your annotated bibliography, you

will need to address the following elements:

  • APA 7threference
  • Was the article qualitative or quantitative?
  • What was the aim of the research?
  • What was the main argument of the study?
  • What methodology has been used (how was the study conducted)
  • What were the results of the study and do they answer the study question/aim?
  • What are the strengths and limitations of the study?
  • Overall statement on applicability of research to clinical practice

3.Conclusion(200 words)

Conclude the assignment by bringing together (or Synthesizing) your evaluations and observations of the individual research articles in order to give the reader an overview of how the four articles address your clinical question. To conclude your assignment, decide whether the articles answer your question.

Annotated bibliography example

Smith, Z., & Hawthorn. (2018). Below knee TED stockings compared to thigh high stocking in preventing DVT.Hospital,6(32), 99-34. Doi: 1564ert9g34u59g3

Smith and Hawthorn used a quantitative study design to compare the effectiveness of below-knee ted stockings to thigh high stocking in preventing deep vein thrombosis (DVT) in hospitalised patients. The authors argued that there was very little evidence supporting the use of thigh high stockings and that their use was associated with more complications such as pressure injuries. In this study, the authors used a randomised controlled trial design and patients were randomly allocated to receive either the below-knee or thigh-high TED stockings. All patients admitted to a surgical ward were approached to participate in the study. A total of 2034 patients were recruited into this study out of 3000 patients approached to participate.

The study protocol involved patients wearing the stockings during the day and night and were only to be removed during showering. Patients were monitored for DVTs during their hospitalisation, and the frequency of DVTs was compared between the two groups. The results from this study showed no significant difference between rates of DVT in patients who were allocated below-knee stocking and thigh high stockings. Smith and Hawthorn also report that 48 patients who were allocated thigh high stockings developed complications, ranging from mild irritation to more serious pressure injuries. No such complications were reported in the below-knee stocking group.

The study by Smith and Hawthorn has several strengths. Firstly, it’s one of the few studies tocompare below-knee stockings to thigh high stockings, which helps to add to the evidence base supporting their use. Secondly, this study used a large study population which helps to build confidence in the study outcomes. Unfortunately, there are several limitations to this study that need to be acknowledged. Firstly, it is unclear whether true randomisation of study participants occurred as this is not described in the research article. When randomisation does not occur, this can introduce bias into the results. Secondly, only surgical patients were used in this study, which means the results could not be easily generalised to other populations such as medical or paediatric patients. Lastly, there is no description of how the researchers ensured patients adhered to the study protocol, which means it is possible some patients did not wear their stockings all the time. Overall this article adds to the growing body of research supporting the use of below-knee TED stockings, but due to the limitations mentioned, stronger evidence is needed to support a practice change.

Conclusion example

The four articles evaluated for this assessment examined whether below-knee TED stockings were as effective as thigh-high TED stockings in preventing DVTs in hospitalised patients.

Smith and Hawthorn (2018) and King and Phillips (2017) reported no difference between DVT rates when comparing stocking length in surgical patients. The generalizability of these results is limited, as both studies used surgical adult patients, and most of the participants were young, between 30 and 60 years of age. Moreover, despite reporting a randomised controlled trial study design only, the study by King and Phillips (2017) made clear their randomisation and blinding process.

In comparison, Henley and Nadeem (2020) and Parveen and Hue (2016) reported increased DVT rates in both medical and surgical patients allocated to wearing below-knee stockings. It is important to note that these two studies used a weaker study design, using a retrospective cohort design.
Both studies reviewed the notes of medical and surgical patients who were diagnosed with a DVT in hospital, to determine what stockings they were allocated. This study design meant it was not possible to know how long the stockings were worn or whether participants wore more than one pair of stockings throughout their hospitalisation.

Overall the evidence supporting the routine use of below-knee stockings is inconclusive. Only two of the four reviewed articles reported no difference between DVT rates between the two stocking types and significant methodological differences between the four studies exist.

My question in Assessment 2 isIs self-management practise more successful than overuse of prescription medications to reduce cardiovascular risk for patients with Diabetes Mellitus? So the 4 articles should be related to that question.

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