Evidence-Based Project Part 3: Critical Appraisal of Research Assignment Paper

Evidence-Based Project Part 3: Critical Appraisal of Research Assignment Paper

Evidence-Based Project Part 3: Critical Appraisal of Research Assignment Paper

Evaluation Table

 High blood pressure or hypertension is a serious public health issue as is the most critical risk factor for cardiovascular diseases and among the leading causes of death in the world. According to the Centers for Disease Control and Prevention (CDC) (2021), over half a million deaths in the U.S. in 2019 were attributed to hypertension as the main or contributing cause. Again, studies show that hypertension is more prevalent among African Americans compared to other racial groups and ethnicities in the country. Again, hypertension increases the risk for heart disease, stroke, congestive heart failure, and chronic kidney disease (Kalinowski et al., 2021). The implication is that developing evidence-based practice (EBP) interventions is essential in tackling the condition and ensuring that individuals get requisite care interventions, especially at home. The purpose of this paper is to make a critical appraisal of literature concerning home-based interventions to reduce adverse effects and events associated with hypertension, especially among African Americans.

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Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Buis, L. R., Dawood, K., Kadri, R., Dawood, R., Richardson, C. R., Djuric, Z., … & Levy, P. (2019). Improving blood pressure among African Americans with hypertension using a mobile health approach (the MI-BP app): protocol for a randomized controlled trial. JMIR research protocols, 8(1), e12601. Struggling to meet your deadline ? Get assistance on Evidence-Based Project Part 3: Critical Appraisal of Research Assignment Paper done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline DOI: 10.2196/12601	Karnjanapiboonwong, A., Anothaisintawee, T., Dejthevaporn, C., Attia, J., & Thakkinstian, A. (2020). Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis. BMC cardiovascular disorders, 20(1), 1-17. https://doi.org/10.1186/s12872-020-01736-2	Tran, K., Padwal, R., Khan, N., Wright, M. D., &Chan, W. S. (2021). Home blood pressure monitoring in the diagnosis and treatment of hypertension in pregnancy: a systematic review and meta-analysis. Canadian Medical Association Open Access Journal, 9(2), E642-E650. DOI:  https://doi.org/10.9778/cmajo.20200099	Tucker K. L., Sheppard JP, Stevens R, Bosworth H.B, Bove A, Bray EP, et al. (2017) Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Med 14(9): e1002389. https://doi.org/10.1371/journal.pmed.1002389
Evidence Level * (I, II, or III)	Level I-Randomized Control trails	Level I-Systematic review and meta-analysis.	Level I- systematic review and meta-analysis	Level I- Systematic Review and meta-analysis
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	Connectivity using smartphones and home blood pressure monitoring, as well as novel mobile health (mHealth) interventions can lead to behavioral changes and enhance long-term self-care for individuals with chronic conditions like hypertension. Through the use of mobile apps, the authors aim to reduce disparities affecting African Americans in accessing health for hypertension.	The conceptual framework in this study is that home blood pressure measurement (HBPM) may be a better and effective alternative than clinical blood pressure measurement (CBPM). However, CBPM performance and HBPM performance remain inconclusive based on existing evidence.	The conceptual framework in this study is that home blood pressure monitoring is more prevalent among pregnant persons but lacks guidelines. Therefore, the study assess the current practices in prescribing and using home blood pressure monitoring during pregnancy.	The conceptual framework in this study is that self-monitoring of blood pressure reduces hypertension risks and exacerbation. However, concerns arise about self-monitoring’s effectiveness and the groups that attain the most benefits.
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The authors used a randomized controlled trial for one year among people with uncontrolled hypertension. The inclusion criteria entailed being African American, aged between 25 years and 70 years, having a history of hypertension diagnosis, possess a smartphone with MI-BP app, and have uncontrolled BP at triage. Those expectant and those with existing medical conditions were excluded from the study.	The researchers applied a systematic review and meta-analysis of different databases, from Medline to Scopus and Cochrane Central Register of Controlled Trials and database by the World Health Organization.	The researchers conducted a systematic review and meta-analysis using observational studies as well as randomized controlled trials. The used Medline, Embase and Central databases for studies up to 2020. The researchers’ inclusion criteria entailed studies that compared office and home blood pressure monitoring in pregnant women.	The researchers used a systematic review and meta-analysis of randomized trials focusing on self-monitoring and no self-monitoring approaches among hypertensive patients or individuals. The eligibility for inclusion criteria entailed being randomized trials and 36 articles met the requirements.
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	The setting was 2 emergency departments (EDs) in Detroit city involving a sample size of 396 randomized subjects.	The authors compared these interventions in home setting as well as ambulatory and clinical areas.	The sampled articles meeting the inclusion criteria were 21 on 19 individual studies representing 2843 pregnant women.	The authors used 36 articles focusing on self-monitoring interventions on blood pressure
Major Variables Studied   List and define dependent and independent variables	The dependent variable in this study was the number of people whose hypertension (HTN) improved after changing their lifestyles to manage their HTN. The independent variable was the use of MI-BP among the patients to reduce disparities using multiple behavior self-monitoring.	The main variables studied in this research were diagnostic performances of the different approaches to blood pressure monitoring in detecting white coat hypertension (WCHT) and masked hypertension (MHT) and blood pressure levels. Therefore, body pressure level was the dependent variable while the different settings were independent variable.	The major variables included practice patterns on prescribing of home monitoring and the dependent variable entailed the levels of blood pressure incidents among the different participants	The main variables included effects of self-monitoring and those of no self-monitoring interventions among the participating articles.
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The authors used various measures during the study to determine the feasibility and efficacy of MI-BP. These included BP rates, physical activity, intake of sodium, and adherence to medication. The study monitored all these measurements for 1 year.	The authors used different measurements including diagnostic tests, sensitivity reporting, and specialty of both tests or proportion of the WCHT or MHT. The authors used bivariate mixed-effect regression model to measure diagnostic performance and random effect model to assess the prevalence of the two types or hypertension.	The researchers took measurements 3 to 36 times each week. Eight studies approved the use of home blood pressure devices. The authors focused on corresponding office and home blood pressure variations based on participants and methodology. The researchers measured systolic blood pressure and diastolic pressure at home which had lower values than those in the office	The measurements entailed using data based on primary outcomes and change in mean clinic or ambulatory settings as well as the proportion controlled below the targeted period. The implication is that measurements came from over 8,000 randomized participants in the study
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The main statistics deployed was randomized outcomes of those who participated in the study. The authors focused on the percentage of participants who had the highest rate of compliance to attain BP control at 30%. The authors used the chi-square test to compare the proportions at 5% significance level. They also considered 17.5% as higher rates of control for the intervention arm as meaningful to their study.	The analysis of data presented different aspects of the study that include pooled sensitivity, specificity and diagnostic odds ratio of the different monitoring models like the CBPM. Again, pooled prevalence of WCHT and MHT were considered at about 0.24 or 95%. The other aspects also pooled higher levels of sensitivity and specificity.	The analysis of data in this article focused on the outcomes of using home blood pressure monitoring in comparison to the office interventions. For instance, 42% of the studies showed better outcomes in home blood pressure monitoring interventions as effective.	The qualitative findings show that self-monitoring was effective among individuals that use limited antihypertensive medications. No differences were found based on sex and even comorbidities. The authors also measured ambulatory BP at 12 months from about 1478 patients.
Findings and Recommendations   General findings and recommendations of the research	The authors assert that incorporation of mobile apps and devices and use of mHealth interventions provide better controls for HTN patients. Further, using multiple health behaviors like diet and exercise, and self-monitoring can lower HTN associated disparities among African Americans who have uncontrolled BP. The authors recommend more studies since their research is the only one seeking to comprehend the efficacy of such interventions on the targeted population that has significant disparities.	The overall findings from the study is that diagnostic performance of home blood pressure monitoring (HBPM) offers better outcomes compared to clinical monitoring (CBPM). The authors also found increased prevalence of MHT in negative CBPM and some individuals with normal HBPM had higher BP based on the 24-h ABPM. As such, ambulatory monitoring (ABPM) is still essential in attaining a HTN diagnosis among patients. The authors recommend more work in the future research to attain support results or evidence.	The findings show that a host of issues surrounding use of home blood pressure monitoring in pregnancy require resolutions. These issues include technique, scheduling of the monitoring and target values. The research recommends prioritization in the use of validated home measuring devices and standardized measurement schedules to attain treatment targets.	The overall findings show that self-monitoring alone does not reduce BP or enhance control but requires other interventions that include systematic medication titration by physicians and patients, education, and change of lifestyles among patients. The authors recommend the need for more research to ascertain the efficacy of self-monitoring of BP alone.
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 article and its research findings are vital or critical to the need to develop self-monitoring models to reduce prevalence of HTN among the targeted population. The research allows practitioners to know these interventions and their efficacy to reduce ED visits for individuals with uncontrolled hypertension. The strengths of the article include its research methodology, in-depth and multiple interventions and duration of their research. However, its sample is limited and only focuses on urban African Americans in one city.   The risks associated with the implementation may include need for effective monitoring and ensuring that the mobile apps function well without and failures. The feasibility of using this article in the practice is high because it is based on evidence.	The findings from the article are worth to practice as they detail different ways of monitoring hypertension and associated efficacy. The study’s strengths include its use of systematic review and meta-analysis that offer the highest levels of evidence in EBP. The risks associated with the implementation of the interventions include increased complexity and need for close monitoring to attain set goals. The feasibility of using this article in my practice is average as it compares different settings which may not align with the practice.	The findings from this study are vital and can be implemented as EBP interventions at home to improve patient outcomes and reduce adverse events. The study’s strengths include its focus on home control of BP and use of systematic review by analyzing many articles. However, its limitation is the need for more studies to validate the efficacy of the proposed approaches to monitoring of BP. No risks exist in using the practices suggested in the research apart from increased awareness about their efficacy. The feasibility of using this study in my practice is average as it requires more studies to validate the approaches suggested.	The findings from the study are important to practice as they show that self-monitoring of BP is essential for patients as compared to no self-monitoring. Therefore, the study is effective in the practice as it shows the need to integrate the measures. The strength of the study is its use of systematic review and meta-analysis as it offers highest level of evidence. However, its limitation is the setting where it only focuses on limited areas of self-monitoring of BP. There are no risks associated with implementing the practices detailed in my setting as they are based on evidence. The feasibility of using this research in my practice is high because of its benefits and approaches.
Key findings	The main findings from the article include need to address disparities in HTN prevention and increased monitoring among the most at risk populations.	The main findings from the article is that HTN monitoring is essential in getting a diagnosis and secondly, using multiple approaches is effective to understand the prevalence of the condition among targeted population.	The main findings of the article show the need for increased self-monitoring of BP at home to reduce adverse events.	The main findings show that self-monitoring is better but requires additional measures to improve outcomes.
Outcomes	The outcomes of the study are categorical that mHealth interventions can reduce health disparities among African Americans with HTN.	The outcomes show that blood pressure monitoring is critical in controlling hypertension in all settings, especially at home.	The outcomes from the study show the need to have specific approaches for various patients with hypertension problem to reduce prevalence and adverse effects on the population.	The outcomes from the study shows that having other interventions enhance self-efficacy of the self-monitoring approaches in blood pressure management.
General Notes/Comments	The research is essential in developing EBP interventions at home like self-monitoring to reduce the prevalence of hypertension.	The article is vital as it shows different ways to monitor BP in diverse settings for effective interventions.	The article is necessary in the study as it shows the use of different approaches to attain better management of hypertension through blood control mechanisms for those at elevated risk of the condition.	The article is important to developing interventions aimed at tackling blood pressure and hypertension among at most risk populations.

 Part 3B: Critical Appraisal of Research

The need to find effective interventions to help manage hypertension is essential and forms the basis for the application of evidence-based practice (EBP) interventions in different areas of care, especially at home. The four reviewed articles are emphatic that effective blood pressure control is important for any individual with hypertension or those with elevated risks of adverse effects and events (De Melo et al., 2021). One best practice that emerges from the reviewed articles is the need for self-monitoring of blood pressure among different patient populations, not just those at risk and with high prevalence rates. The studies observe that self-monitoring can occur at home, in ambulatory settings, or in clinical practice. However, the emphasis of monitoring should be at home since patients are not close to their care providers compared to clinical settings or in ambulatory situations.

The authors of all the articles demonstrate that existing evidence does not show increased adherence, better outcomes or effectiveness of the self-control interventions as key to addressing hypertension situations. However, they are categorical that it is a core aspect of blood pressure control to mitigate adverse effects of hypertension among those individuals at the most risk of the condition. The article by Trans et al. (2020) shows that pregnant women suffering from hypertension need blood pressure monitoring at individual level. However, what is lacking are the standard approaches, models and interventions that these individuals should use. Therefore, the articles recommend more research on the use of self-monitoring programs at home. These studies demonstrate that home-based programs on hypertension can lead to better outcomes in managing the condition among those at the highest risk of getting adverse events like emergency care needs (Forde et al., 2020). These articles show the need to have multiple interventions to help patients control blood pressure as opposed to monitoring that may not amount to effective management of the condition.

Conclusion

The critical appraisal of literature on hypertension, especially among African-Americans, illustrate the need to adopt best practices by providers and organizations as ways to improve outcomes and manage hypertension. African American populations need such interventions to reduce the prevalence of hypertension and ensure that they can effectively manage the condition through an array of primary and secondary interventions for better outcomes. The appraisal shows best practices like self-monitoring should be integrated with others to attain better outcomes and not alone.

References

Centers for Disease Control and Prevention (CDC) (2021 September 27). Facts About Hypertension.

            https://www.cdc.gov/bloodpressure/facts.htm

De Melo, K. C., Nascimento, L. G., Vieira, P. H., Jaques, L. A. D. B., Do

            Nascimento, E. B., De Figueirêdo, A. G. M., … & Silva, J. S. N. (2021).

             Home Blood Pressure Monitoring (Hbpm) In Clinical Practice: A Systematic

            Review and Experience Report of Online Toll for Results Report in Brazil.

            Journal of Hypertension, 39, e146. doi: 10.1097/01.hjh.0000745976. 64977.c3

Forde, A. T., Sims, M., Muntner, P., Lewis, T., Onwuka, A., Moore, K., & Diez Roux, A. V.

            (2020). Discrimination and hypertension risk among African Americans in the

            Jackson Heart Study. Hypertension, 76(3), 715-723.

            https://doi.org/10.1161/HYPERTENSIONAHA.119.14492

https://doi.org/10.1161/HYPERTENSIONAHA.119.14492

Kalinowski, J., Kaur, K., Newsome-Garcia, V., Langford, A., Kalejaiye, A., Vieira, D., … & Spruill, T.

             (2021). Stress interventions and hypertension in Black women. Women’s Health, 17,

17455065211009752. https://doi.org/10.1177/17455065211009751
                   

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                   Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research
                   Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

                   Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

                   In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

                   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.

                   By Day 7 of Week 7
                   Submit Part 3A and 3B of your Evidence-Based Project.

                   Submission and Grading Information
                   To submit your completed Assignment for review and grading, do the following:

                   Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name. Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
                   Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
                   Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+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.

                   Grading Criteria