EVIDENCED BASED PRACTICE

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

· Identify and briefly describe your chosen clinical issue of interest.

· Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

· Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

· Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.

· Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

By Day 7 of Week 5

Submit Part 3 of your Evidence-Based Project.

Submission and Grading Information

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· Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click Open.

· If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

· Click on the Submit button to complete your submission.

NOTE : I started working on this topic already the attached bellow are the discussions and responses from instructors and colleagues.

Main Post ; PICO/T Question

Population : Adult

Diagnosis : Major Depression

Intervention ; Treatment 

Comparison : ECT or Tricyclic Anti-depressants

Outcome: Sedation , shock exposure , Therapeutic interchange level of tricyclic /behavior modification comparison 

Time frame of : Three weeks - four weeks (Laureate Education (Producer). (2018). 

Clinical Research question:

In adults with diagnosis of major depression with bipolar disorder should Psychiatrist use Tricyclic anti-depressant more often as treatment of choice or Electroconvulsive treatment (ECT)? (Davies, 2011).

Upon working in adult psych unit in acute care setting, it was observed that most patients are not happy with ECT but due to one reason or the other they found themselves signing the consent to go through the shock therapy. It was further noted that some other psychiatrists treat patient of the same diagnosis and almost of the same behavior with medications. Considering the risks, rigors, and cost of the shock wave therapy, and comparing with the outcome of using medications, it worth knowing which is more effective and which will help more patient population (Davies, 2011).

Navigating Database

Using the school database, I started my research by printing ECT and Major depression, using Nursing research database that links me with CINHAL with Med-Plus and it  connected with EBSCO host which generated 1200 results and I narrowed down by  clicking on peered reviewed, within 2-3years and ends up with 1001 results. 

Outcomes/Results

The outcomes finally reveals 998 peer reviewed journals and with different topics as well. Some scholars claimed that ECT might be fast and thought to be effective but no clinical evidence has yet proven that particular patient will respond well to the treatment (Feng, & Youssef, 2020).

Reference

Feng, T., & Youssef, N. A. (2020). Can epigenetic biomarkers lead us to precision medicine in predicting treatment response and remission for patients being considered for ECT? Psychiatry Research, 284, 112659. https://doi-org.ezp.waldenulibrary.org/10.1016/j.psychres.2019.112659

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N

Laureate Education (Producer). (2018). The Value of Clinical Inquiry [Video file]. Baltimore, MD: Author.

Instructor’s response; Hello, Babatunde.  Thank you for your discussion post.  I appreciate that you chose the subject of major depression.  People living with mental health issues have a special place in my heart.  Electroconvulsive therapy (ECT) has been an intriguing intervention for me since I witnessed it implemented to a patient when I was still a nursing student.  I agree that an alternative intervention or at least a comparative study with a more conservative method is worth investigating as ECT. 

Although the efficacy of ECT has been well documented, especially in the area of memory improvement and reduction in psychopathology (Kalisova, Kubinova, Michalec, Albrecht, Madlova, & Raboch, 2018), there are still some risks involved in performing the procedure like fractures and in rare cases, heart problems (Mayo Clinic, 2020).  Usually, Psychiatrists would weigh the benefits against the risks before ordering an ECT intervention. 

I support your clinical inquiry regarding using current data, but I would also recommend using current sources on researching discussion post foundations.  We can ask ourselves if the resource is current or, if not, if it is considered foundational (Walden University, 2020).  In your case, I think it is foundational in nature.  Keep it up.

Hi Babatunde, 

Thank you for that exciting post. According to Friedrich (2017), depression affects more than 300 million people and is the leading cause of disability worldwide (Luccarelli et al., 2020). Although relapse is common after discontinuation, Electroconvulsive therapy (ECT) is the most effective acute treatment for depression (Luccarelli et al., 2020). I worked in a psychiatric facility in the past, but ECT is not available for treatment in that facility. I am curious about what the outcome will be. 

If I may add how to improve your search to the database, limiting your search to a systematic review publication yielded 555 articles. According to Walden University (n.d.), a systematic review is on the top of the evidence pyramid, which provides a high level of evidence, but are also limited. Another technique that many forget is asking for help from the librarian. They can give tips about searching, where to search, and words that are important to use (Laureate Education, 2018).

References

Laureate Education (Producer). (2018a). Searching the Evidence [Video file]. Baltimore, MD: Author.

Luccarelli, J., McCoy, T. H., Jr., Seiner, S. J., & Henry, M. E. (2020). Maintenance ECT is associated with sustained improvement in depression symptoms without adverse cognitive effects in a retrospective cohort of 100 patients each receiving 50 or more ECT treatments. Journal of Affective Disorders, 271, 109–114. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2020.03.152

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? https://academicanswers.waldenu.edu/faq/7267