Reviews in Evidence-based Practice

Re mickles in Evidence- ground chargeIn an era of differentiate-based nurse, cargon providers need to base their clinical decisions on the preferences of patients, their clinical expertise, as healthful as the current trump out operable look separate applicable for practice (Beaven and McHugh, 2003 Mulh either, 1998 Sackett and Rosenberg, 1995).EBP, as a decision-making subprogram which integrates the best available enquiry, clinical expertise and patients characteristics (Sackett et al., 1997), is believed to be a rich practice which allow to progress in peoples *psychosocial experiences of illness and health cargon as well as in nursing professional development (Hamer, 2005). Muir-Gray (1996) highlights that it bridge over the gap surrounded by the ruley of knowledge and the time the knowledge is mathematical function in practice, and Thompson (1998) believes it is a tell for doing the right things right.On this basis, arrogant reviews has been gear up as the c ornerstone of EBP, stem from Cochranes acidulate on picture based medicine in the late 1970s. It has been considered the gold standard for measuring the military posture of an intervention (NHS Centre for Reviews and Dissemination, 2001). As a secondary enquiry method, it collates the best render about the clinical problem so that finiss can be drawn about issueive practices considering the potential bene pits and harm (Hamer, 2005). In fact, with SR being a crop for magisterialally identifying, scrutinising, tabulating and perhaps integrating all germane(predicate) studies, thus allowing for a to a greater extent documentary appraisal thatn superstar studies (Sackett et al., 1997), it has pass an indispensable aiding tool in improving practice and bore of care particularly for busy health professionals who do non yield enough time for keeping up to date with all the brand-newest re seek (Greenhalgh, 1997).Obviously, SRs are important in nursing in order to discover areas where reviews and research are needed and minimise unnecessary duplication of nursing research (Sackett et al., 1997). Thus, in that respect is a requirement to build up a solve to provide the results of research findings in a concise mode (Mulrow and Cook, 1997). SRs play a vital role in providing fast chafe to condensed up to date knowledge and offering a new hazard for EBP in nursing (Muri-Gray, 1996).Meanwhile, SRs in EBP has a primeval value as it offer the best approach to determining the highest quality show in order to answer clinical flows or solve any remote findings (Roberts and Yeager, 2004). And, by adhering closely to scientific procedures, which delimit these twinees, according to Schlosser (2006), then SR remains the best vehicle for practitioners to gain access to wide-ranging license to aid their practice.For health care professionals, the most important concern in the unlike debates surrounding EBP is what should give the indorse for clinical practice (Egger et al., 2001). Thus, in the proterozoic 1990s, the term review of effectiveness emerged and the hierarchy of evidence based on the quality of evidence rating was headed by randomised controlled trials (RCTs)(Cooke et al., 1992). RCT is a considered a quantitative area convention, which aims to sign on the bias of confvictimization issues, manipulate a definite intervention and inspect a possible ca social occasion-effect relationship between variables by contrasting different interventions between submit groups (Cook et al., 1992). Besides RCTs, at that place open been additional cohort studies, case series (either post-test or pre-test), well-designed pseudorandomised controlled trials and case-control studies (Cook et al., 1992).SRs of high-quality RCTs with ordered results are considered to be top of the hierarchy of evidence, the most trustworthy evidence for studying the effects of interventions, contrasting with single RCTs which whitethorn derive a fal se conclusion (Kunz et al., 1998).Thornley and Adams (1998) confirmed that a single study is sometimes inadequate to detect the certainty of an intervention, differentiate between the effects of one, or to recognise the causal relationship between variables of treatments beca design of the small sample coat of patients, which may inhibit the formation of true conclusions. This could be a checkup hazard if health care decision makers base policies on erroneous info from single trials (Jadad and Enkin, 2007).Based on the foregoing, SR can integrate more than than one study and facilitate the drawing of more real, objective, transparent conclusion to hold the evidence in making clinical decisions (Sackett and Wennberg, 1998).From this standpoint, the tendency was to bring down on SRs of RCTs and exclude other quantitative, qualitative or economic military rating study designs (Dixon-Woods et al., 2004). On the otherhand, it has been debated that RCTs are not suitable for all mo untain (Dixon-Woods et al., 2004). For instance, if we want to explore the lived experiences of listening to music as a postoperative injure management intervention, the appropriate method to study that is through a qualitative design (phenomenology) (Greenland, 1987). Clearly, the worth of other reviews cannot be neglected because, they postulate a great influence in discovering the essential features of findings, which can head early research design and clarify current levels of knowledge (Sackett and Wennberg, 1998).A closer look at the above will reveal that in that location are two main approaches of quantitative taxonomical reviews. The first is the SR of a single study design, which includes basal studies having the similar study design (eg. RCTs). The second type is the organized review, which states and combines the results from more than one study employ statistical proficiencys and can sum up the outcomes of similar, but independent studies, to piddle a single estimate of treatment effects (eg. Cohort studies) (Jadad and Enkin, 2007). This technique is called meta-analysis, which can provide a quantitative price reduction of the research.One of the purposes of meta-analysis is to reduce the dubiety or controversy, and to reduce the bias and increase precision of the conclusions of a review (Sackett and Wennberg, 1998). However, the use of meta-analysis method is not necessary in each single systematic review. For instance, if the characteristics of the included studies are non-homogeneous or perplexityable, it may be inappropriate or even misleading to statistically family results to give a meaningless summary in this case, a account summary should be presented (Jadad and Enkin, 2007).A systematic review is considered to be a process to locate all studies for a specific purposeful question (drawn from research and other resources), critically appraise the methods of the studies, summarise the outcomes, present key findings, identif y reasons for varied outcomes across the studies, and identify limitations of existing knowledge (Khan et al., 2003). In other words, it is a tool to collect and assess all relevant research evidence giving swearative, experimental answers to scientific research questions (Evans, 2001). systematic reviews are different from traditional literature/ news report/ critical reviews (Khan et al., 2003). disrespect often being very helpful as background reading, they have a number of disadvantages. They differ from the systematic reviews in that they are depicted objective, and not guided by a peer-reviewed protocol, and as such cannot be replicated moreover, those studies that erect the authors point of view are more likely to be selected (*Ravnskov, 1992). In addition, traditional narrative reviews may make different reviewers reach dissimilar conclusions from the same research bases (Teagarden, 1989). Thus, they appear lacking in rigorous scientific design to minimise the risk of bi ases or ensure reliability (Khan et al., 2003).The systematic review overcomes the problems which traditional narrative reviews have, through making the review process obvious. In this way, it is possible for the reader to replicate the process of the review and establish the generality and transparency of scientific findings (Egger et al., 2001). Moreover, it also provides objectivity for training by summarising the results of otherwise unmanageable quantities of research (*Ravnnskov, 1992).The rationale for undertaking a systematic review in the field of healthcare has been well established, according to Torgerson (1998) and is heavily embedded in the scientific paradigm. As the importance of EBP continues to be promoted, the compose and acceptability of systematic reviews prosper, and a constantly expanding volume of information necessarily to be considered by practitioners and researchers. However, it is impossible to read, critically evaluate and synthesise the read of k nowledge, let alone update this regularly (Egger et al., 2001). Thus, the systematic review has become an essential tool for keeping up to date with the new evidence accumulating in a field of study.While reducing the ever-increasing torrent of published and unpublished research into manageable portions, Clarkson et al. (2003) explains that the systematic review also reduces twain systematic errors (biases) and random errors (those occurring by chance). It provides a more objective, comprehensive view of the literature, which is of high quality and relevant to specific clinical practice. Yet clearly, this rationale does not exclusively apply to healthcare research. positive reviews can also provide raw material for establishing clinical guidelines and help plan new research by identifying existing gaps (Pearson et al., 2005).Clarkson et al. (2003) add that it can be utilise to formulate policy and develop guidelines on healthcare organisation and delivery. They are of particular benefit in areas of clinical uncertainty or where there is a wide variation in practice. Thus, healthcare providers, researchers and policy-makers can use systematic reviews to efficiently integrate existing information, providing data for rational decision-making.Systematic reviews not only inform clinical decision-making, but also inform the research agenda. The comprehensive searching, appraising and synthesising of research literature does not guarantee a definitive answer to a scientific research question (Clarkson and Ismail, 2003). By identifying questions for which, at present, there is insufficient good quality evidence upon which to base clinical decisions, systematic reviews highlight areas requiring further research.Conversely, the authors also point out that the results of systematic review may provide strong evidence regarding the benefits or harms of a particular intervention, and may actually preclude a new study from being conducted.Based on the foregoing Cochranes execution on evidence-based medicine (NHS Centre for Reviews and Dissemination, 2001), conducting a systematic review is a gold-standard procedure for assessing the effectiveness of music as a postoperative pain management intervention.A systematic review is a piece of work / research that identifies relevant articles and synthesises the results obtained from the studies , critiquing them for their quality using a framework, possibly using a meta-analysis to help summarise the findings (Khan et al., 2003 Egger et al., 2001).They are vital tools for the healthcare practitioner/ worker/ clinician because research accumulates quickly and systematic reviews summarise giving amounts of research, helping to make the information more accessible and easier to understand and use (Egger et al., Parahoo, 1997). Systematic reviews provide a reliable summary of the available evidence and this helps make clinical decisions (Lancaster et al., 1997).Reviews are a way of informing readers of patt erns, strengths and limitations of the methodology used and this helps to make recommendations for future research (Parahoo, 1997).All available evidence on a specific topic is collected, analysed and synthesised (Parahoo, 1997) and by combining the information and assessing them together it is hoped that a clear conclusion can be organise (Davies and Crombie, 2003 Lancaster et al., 1997).Meta-analysis is often employed to collate primary research data from discordant critiqued articles and this can give an overall summary statistic or pooled estimate effect (Chalmers and Altman, 1995). Combining data from several primary studies increases the power of the result and accordingly allows readers to be more aware of the efficacy of the intervention (Chalmers and Altman, 1995 Lancaster et al., 1997).Systematic reviews give up a more objective view/ appraisal of the research than narrative reviews and this helps to sort out disputes between different articles (Egger et al., 2001).Na rrative reviews are state to have lower quality than systematic reviews and several reasons are addicted for this by Egger et al., 2001.Classical reviews are subjective so are susceptible to bias and error.Systematic reviews have strict protocols whereas classical reviews do not necessarily have formal rules/ structure which may lead to error. Once studies have been identified, the author may only include studies that support their view rather than systematically looking at the evidence and the characteristicis of the study to help form a conclusion. This explains why reviewers using the classical (traditional) methods may obtain different answers and miss small but potentially operative differences. This in turn may lead to conclusions from a reviewer being associated more with the qualification and specialty of the author/ researcher/ reviewer than the presented data particularly in controversial areas.Systematic reviews are therefore more objective because all potentially relev ant studies are gathered using a specific protocol, the results cna be tabulated and analysed, possibly using meta-analysis leading to a more objective appraisal which can help resolve uncertainties when study conclusions differ.Systematic reviews can highlight any conflicts or inconsistencies in the research and this can be studied (Chalmers and Altman, 1995), hence, systematic reviews have been described as being at the top of the hierarchy of evidence (Davies and Crombie, 2003).Implications from the ever expanding volumes of healthcare literature (Beaven and McHugh, 2003) means that, it is impossible for a clinician to access, let alone understand, the primary evidence that informs practice (Glasziou, Irwig and Colditz, 2001 Handoll et al., 2008). As a result of this, useful research studies and valuable findings are concealed and abandoned as a consentient (Beaven and McHugh, 2003). Systematic reviews of primary studies are therefore an essential aspect of evidence-based health care for practitioners who want to keep up to date with evidence in making informed clinical decisions (Lipp, 2005 Glasziou et al., 2001 Handoll et al., 2008 Schlosser/ FOCUS, 2010).Commencing with a well-defined research question, such reviews utilise explicit methods to systematically identify, select, critically appraise, extract, analyse and synthesise data from relevant studies on a particular topic (Handoll et al., 2008 Petticrew and Roberts, 2006 Wright et al., 2007 Sackett et al., 2000). This process helps to minimise bias (Cook, Mulrow and Haynes, 1997), eliminate poorly conducted studies, confers power to the results that may not be wedded to individual studies (Lipp, 2005) and thus provide practitioners with reliable, valid and condensed evidence (Glasziou et al., 2001) in a considerably shorter period of time (Mulrow, Langhorne, and Grimshaw, 1997). Systematic reviews may involve the use of statistical methods (meta-analysis) (Handoll et al., 2008) in estimating the pre cision of treatment effects (Egger, Smith and ORourke, 2001). inappropriate traditional narrative reviews, systematic reviews allow for a more objective appraisal of the evidence and may thus contribute to resolving uncertainty when original research, and reviews disagree (Egger et al., 2001). By using an efficient scientific technique, systematic reviews also can counteract the need for further research studies and get under ones skin the timelier implementation of findings into practice (Lipp, 2005). They can also inform the research agenda by identifying gaps in the evidence and generating research questions that will shape future research (Eagly and Wood, 1994 Handoll et al., 2008 Lipp, 2005).In spite of the numerous benefits of systematic reviews, they are not without challenges. Apart from being laborious (Petticrew Roberts, 2006), they require expertise in the subject matter as well as the review process (Manchikanti, 2008). despite it being a rigorous, transparent methodol ogy of search, appraisal, data line, retrieval, data synthesis and interpretation of the evidence from primary studies, there are limitations of early forms of SR methodology (associated with the hierarchy of evidence approach and advocated by the Cochrane movement) that are progressively well recognised (Cooke et al., 1992). One of these limitations is that SR is a time-consuming process and it needs appropriate understanding of the research designs and methods together with knowledge of techniques for analysis, including statistical test (Gerrish and Lacey, 2006). Although the intention is to be systematic in the identification of studies and extraction of data, the systematic review process inherently has biases of included studies, from poor search as well as publication related (Evans, 2001). In the same vein, language bias which exclude studies in languages other than English in the appraisal, in some way weaken the review as well (Evans, 2001).It is important to identify th e most appropriate research design to fit the question. A systematic review was chosen since the research aim is to summarise lots of data collected in primary studies, which requires a systematic approach.