EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH ESSAY PAPER

EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH ESSAY PAPER

EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH ESSAY PAPER

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	(Davis et al., 2018) Struggling to meet your deadline ? Get assistance on EVIDENCE-BASED PROJECT, PART 3: CRITICAL APPRAISAL OF RESEARCH ESSAY PAPER done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline	(Tolia et al., 2018)	(Sutter et al., 2022)	(Gullickson et al., 2019)
Evidence Level * (I, II, or III)	I	III	I	III
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The novel weight and sign-based approach to control withdrawal method used in treating neonatal abstinence informed this study. It compared the effectiveness of the approach with the traditional treatment based on infant’s weight and severity of neonatal abstinence syndrome.	Not stated	Not stated	Not stated
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	This study was a randomized controlled trial. Inclusion criteria was infants born to mothers treated with methadone or buprenorphine for an opioid use disorder or for chronic pain and receiving prenatal care in third trimester. The exclusion criteria were infants born to mothers who consumed more than 3oz of alcohol per week during the pregnancy period, infants born at 37 weeks gestation or more, premature infants, and those with sepsis were also excluded.	The study was cohort research. The researchers obtained data for the research from the Pediatrix Clinical Data Warehouse (CDW). Data on all infants without congenital abnormalities discharged from participating NICUS between 2011 and 2015 with NAS were included.	The study was a single-site, open-label, randomized controlled pilot study. The research ran from October 1, 2016 to September 30, 2018. The inclusion criteria were if an infant had in-utero drug exposure to heroine, oral opioids, or methadone and born at or greater than 34 weeks of gestation. The exclusion included infants with serious medical comorbidities and primary in-utero exposure to buprenorphine.	The study was retrospective cohort study. The inclusion included all infants born to mothers residing in Nova Scotia since 1988 with coded Finnegan score or ICD-10 code of P96.1 and treated at the IWK Health Center.
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	116 infants with neonatal abstinence syndrome were used in this research.	The CDW data from participating NICUs in 33 states and Puerto Rico.	61 infants that met the above inclusion criteria	174 infants exposed to opioids between 2006 and 2015.
Major Variables Studied   List and define dependent and independent variables	They included length of hospital stay (LOS) and LOS attributable to neonatal abstinence syndrome and drug treatment.	Total hospital LOS, NICU LOS, use of medications for NAS, and NICU discharge disposition.	Length of hospital stay, length of treatment, need for a second treatment agent, need for assisted nutritional or feeding support, total morphine equivalents, adverse events, and breastfeeding.	Length of treatment, length of stay, need for breakthrough dose and peak morphine/clonidine dose.
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The statistics included Poisson distribution analysis, negative binomial regression, linear regression, and logistic regression.	Median and IQR values for continuous variables and counts and percentages. Univariate analyses, non-Gaussian distributions, multivariate Cox analysis, and Hazard ratios.	Means or medians, bivariate analyses, and parametric and non-parametric analyses.	Fisher’s exact test, and Maan-Whitney U-test.
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Methadone was associated with decreased number of days for LOS by14% relating to a difference of 2.9 days and 14% reduction in LOS due to neonatal abstinence syndrome. It also contributed to a difference of 2.7 days length of drug treatment. Methadone also reduced the median LOS (16 vs 20 days p=0.05), LOS due to neonatal abstinence syndrome (16 vs 19 days) and length of drug treatment (11.5 days vs 15 days).	There was shorter median hospital stay for infants treated with morphine (LOS 18 days vs 23 days and shorter median NICU LOS (17 days vs 21 days). The methadone group was less likely to need 2 medications (18% vs 26%; p<0.001) or 3 medications (6 vs 8%; P<0.001). multivariate analysis showed methadone treatment to be associated with shorter LOS (HR, 1.24; 95% CI, 1.11-1.37; P<0.01) compared to morphine treatment.	Length of stay was not statistically significant or different among the two treatment groups (methadone 15.1 vs morphine 17.9 days, p=0.50). Infants in the methadone group received more morphine equivalents of medications (33 vs. 9.68, p<0.05). More infants in the morphine group needed additional caloric support, but the difference was statistically insignificant (73% vs 46%, p<0.25). There were statistically insignificant differences in rooming in among the two groups also.	Infants in morphine + clonidine group had longer stay of treatment (19.7 vs 11.3 days). This group also had a higher peak dose (0.14 mg/kg q3h) as compared to morphine alone group (0.10 mg/kg q3h, p=0.04). There was statistically insignificant difference in the needed morphine breakthrough in both groups.
Findings and Recommendations   General findings and recommendations of the research	The use of weight and sign-based treatment for neonatal abstinence syndrome was associated with improved short-term outcomes in infants receiving methadone as compared to those receiving morphine.	Methadone treatment is associated with shorter LOS for infants born at or more than 26 weeks gestation as compared to morphine treatment. Future trials should aim at identifying comparative effectiveness of these treatments in infants with NAS.	There were no significant differences in LOT or LOS in the morphine vs methadone treatments. Infants treated with methadone were three times more likely to receive opioid equivalent treatments as compared to morphine group.	There was an increase in the incidence rate of NAS by fivefold from 1.48/1000 live births in 2007 to 7.50/1000 live births in 2015. The use of combined morphine plus clonidine was associated with higher peak morphine dose and longer length of treatment as compared to morphine alone.  Future studies should examine the impact of clinical characteristics such as antidepressant and methadone exposure on the outcomes.
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?	The study is worthy to nursing practice. The strengths include randomization of participants while its weaknesses include a small sample size. The risks associated with the implementation of the intervention include the lack of generalizability. The research is feasible for use in my practice.	The study is highly generalizable because of its larger sample size. Its findings impact practice. The strength of the study is its use of a large sample size while the lack of randomization is its weakness. The risk of selection bias threatens its application to practice. The intervention is feasible for use in practice.	The study is worthy for nursing practice. The strength of the study includes randomization and control of variables. The weakness is its use of a small sample size. The risks associated with the implementation of the intervention is the lack of data on its generalizability to larger populations. The intervention is feasible to my practice.	This research is worth for practice. It is associated with the strength of following participants for a long time. It has the disadvantage of a small sample size, which affect the use of the intervention in nursing practice. The intervention is not currently feasible for practice.
Key findings	Weight and sign-based treatment for neonatal abstinence syndrome have better short-term outcomes in infants receiving methadone as compared to morphine.	Methadone-treated infants born at or more than 26 weeks of gestation have more improved outcomes such as LOS as compared to morphine treated infants.	The key outcomes such as LOS and LOT are insignificant in morphine and methadone treatments for NAS.	The use of combined morphine and clonidine is associated with longer length of treatment and higher peak morphine dose.
Outcomes	There are improved NAS outcomes such as LOS and length of treatment in methadone than morphine.	There is the reduction of LOS with methadone treatment as compared to morphine.	They include insignificant differences in LOS and LOT. Methadone treated group required more of morphine equivalent treatments and transfers to the NICU because of oversedation.	Increased length of treatment and peak morphine dose.
General Notes/Comments	The research has significant implications to nursing practice.	The research reports findings that are generalizable to a larger population.	The study informs the need for a large study to determine the impact of the two treatments on NAS outcomes.	There is a need for another study to examine the impact of the intervention on a larger population sample.

Critical Appraisal of Research

The analysis of the above studies shows that treatment of neonatal abstinence syndrome (NAS) is a challenge in nursing end medical practice. However, the reviewed studies demonstrate some potentials in the use of methadone in treating NAS. For example, the research by Davis et al., (2018) the use of methadone for infants born with NAS was associated with a reduction in the length of hospital stay and median length of hospital stay. It also the length of treatment because of NAS. A reduction in hospital stay has additional benefits that include cost reduction in healthcare and improved outcomes among the affected populations. Similar findings on the effectiveness of methadone have been replicated in the study by Tolia et al., (2018) where it led to shorter length of hospital stay as compared to morphine treatment alone. Despite this, evidence provided by Sutter et al., (2022) contradicts those reported by the above authors. Accordingly, their study showed that there were no significant differences in the length of treatment or hospital stay in the morphine vs methadone treatments. Infants treated with methadone were three times more likely to receive opioid equivalent treatments as compared to morphine group (Sutter et al., 2022). Therefore, future studies should utilize large sample sizes to determine the potential impact of the intervention in improving outcomes among patients suffering from NAS.

References

Davis, J. M., Shenberger, J., Terrin, N., Breeze, J. L., Hudak, M., Wachman, E. M., Marro, P., Oliveira, E. L., Harvey-Wilkes, K., Czynski, A., Engelhardt, B., D’Apolito, K., Bogen, D., & Lester, B. (2018). Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Clinical Trial. JAMA Pediatrics, 172(8), 741–748. https://doi.org/10.1001/jamapediatrics.2018.1307

Gullickson, C., Kuhle, S., & Campbell-Yeo, M. (2019). Comparison of outcomes between morphine and concomitant morphine and clonidine treatments for neonatal abstinence syndrome. Acta Paediatrica, 108(2), 271–274. https://doi.org/10.1111/apa.14491

Sutter, M. B., Watson, H., Yonke, N., Weitzen, S., & Leeman, L. (2022). Morphine versus methadone for neonatal opioid withdrawal syndrome: A randomized controlled pilot study. BMC Pediatrics, 22(1), 345. https://doi.org/10.1186/s12887-022-03401-3

Tolia, V. N., Murthy, K., Bennett, M. M., Greenberg, R. G., Benjamin, D. K., Smith, P. B., & Clark, R. H. (2018). Morphine vs Methadone Treatment for Infants with Neonatal Abstinence Syndrome. The Journal of Pediatrics, 203, 185–189. https://doi.org/10.1016/j.jpeds.2018.07.061

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To Prepare:

• Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
• Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
• Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

# Part 1 chart linked below and modules 2 and 3.

and rubric linked below.

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Criteria	Ratings					Pts
Part 3A: Critical Appraisal of ResearchCritical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: · An Evaluation Table	45 to >40.0 pts Excellent The critical appraisal accurately and clearly provides a detailed evaluation table. …The responses provide a detailed, specific, and accurate evaluation of each of the peer- reviewed articles selected.	40 to >35.0 pts Good The critical appraisal accurately provides an evaluation table. …The responses provide an accurate evaluation of each of the peer- reviewed articles selected with some specificity.	35 to >31.0 pts Fair The critical appraisal provides an evaluation table that is inaccurate or vague……….. The responses provide an inaccurate or vague evaluation of each of the peer-reviewed articles selected.		31 to >0 pts Poor The critical appraisal provides an evaluation table that is inaccurate and vague or is missing.	45 pts
Part 3B: Evidence-Based Best PracticesEvidence- Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with the selected resources.	35 to >31.0 pts Excellent The responses accurately and clearly suggest a detailed best practice that is fully aligned to the research reviewed…… The responses accurately and clearly explain in detail the best practice, with sufficient justification of why this represents a best practice in the field….. The responses provide a complete, detailed, and specific synthesis of the four peer reviewed articles.	31 to >27.0 pts Good The responses accurately suggest a best practice that is adequately aligned to the research reviewed…… The responses accurately explain the best practice, with adequately justification of why this represents a best practice in the field….. The responses provide an accurate synthesis of at least one outside resource reviewed on the best practice explained.	27 to >24.0 pts Fair The responses inaccurately or vaguely suggest a best practice that may be aligned to the research reviewed………………….. The responses inaccurately or vaguely explain the best practice, with inaccurate or vague justification for why this represents a best practice in the field…………. The responses provide a vague or inaccurate synthesis of outside resources reviewed on the best practice explained.	24 to >0 pts Poor The responses inaccurately and vaguely suggest a best practice that may be aligned to the research reviewed or are missing. …The responses inaccurately and vaguely explain the best practice, with inaccurate and vague justification for why this represents a best practice in the field or are missing. …A vague and inaccurate synthesis of no outside resources reviewed on the best practice explained is		35 pts

Criteria	Ratings									Pts
									provided or is missing.
Resource Synthesis	5 to >4.0 pts Excellent			4 to >3.0 pts Good			3 to >2.0 pts Fair		2 to >0 pts Poor
	The response fully integrates at least two outside resources and two or three course- specific resources that fully support the responses provided.			The response integrates at least one outside resource and two or three course- specific resources that may support the responses provided.			The response minimally integrates resources that may support the responses provided.		The response fails to integrate any resources to support the responses provided.	5 pts
Written Expression and Formatting—Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.	5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity….. A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.			4 to >3.0 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. …Purpose, introduction, and conclusion of the assignment are stated but are brief and not descriptive.		3 to >2.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60– 79% of the time. …Purpose, introduction, and conclusion of the assignment is vague or off topic.			2 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time….. No purpose statement, introduction, or conclusion is provided.	5 pts
Written Expression and Formatting—English	5 to >4.0 pts	4 to >3.0 pts			3 to >2.0 pts			2 to >0 pts		5 pts

 

Criteria	Ratings						Pts
Writing Standards: Correct grammar, mechanics, and proper punctuation.	Excellent Uses correct grammar, spelling, and punctuation with no errors.	Good Contains a few (one or two) grammar, spelling, and punctuation errors.	Fair Contains several (three or four) grammar, spelling, and punctuation errors.		Poor Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting:The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.	5 to >4.0 pts Excellent Uses correct APA format with no errors.	4 to >3.0 pts Good Contains a few (one or two) APA format errors.		3 to >2.0 pts Fair Contains several (three or four) APA format errors.		2 to >0 pts Poor Contains many (five or more) APA format errors.	5 pts
Total Points: 100