MSN 5300 Miami Regional University Nutritional Critical Appraisal Worksheet 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. 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 ...
Purchase answer to see full
attachment
