My research topic is : “Antibiotics for upper respiratory infection’

My research topic is : “Antibiotics for upper respiratory infection’
Review the “Rapid Critical Appraisal Checklists” Appendix B in your course text. You should save this tool and use it throughout the development of the PICOT question, problem description, and literature review. Begin the development of your PICOT question using the following resource: Melnyk & Fineout-Overholt, Appendix A: Template for Asking Clinical Questions.

Formulate your PICOT question and post it to the Week 1 Discussion Board. Respond to at least two other statements, providing feedback on their clinical questions regarding relevance to primary care practice. Review the statements to see if the clinical issue is clearly defined and that all aspects are identified. Also, refer to the “PICOT: Components of an Answerable, Searchable Question” Table 2.2 in your text, p. 40. If one PICOT statement has at least three feedback posts, move to another statement. You will be using the feedback to make revisions to your PICOT question before using it in your Section B of Final Proposal: Problem Description assignment.

Required Texts
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer Health. ISBN: 978-1-4963-8453-9

Appendix A Question Templates for Asking PICOT Questions INTERVENTION

In ________________ (P), how does ________________ (I) compared to ________________ (C) affect ________________ (O) within ________________ (T)? ETIOLOGY Are ________________ (P) who have ________________ (I) compared with those without ________________ (C) at ________________ risk for/of ________________ (O) over ________________ (T)? DIAGNOSIS OR DIAGNOSTIC TEST In ________________ (P), are/is ________________ (I) compared to ________________ (C) more accurate in diagnosing ________________ (O)? PROGNOSIS/PREDICTION In (For) ________________ (P), how does ________________ (I) compared to ________________ (C) influence ________________ (O) during/over ________________ (T)? MEANING How do ________________ (P) with ________________ (I) perceive ________________ (O) during ________________ (T)? SHORT DEFINITIONS OF DIFFERENT TYPES OF QUESTIONS: Intervention: Questions addressing the treatment of an illness or disability. Etiology: Questions that address the causes or origin of disease, the factors that produce or predispose toward a certain disease or disorder. Diagnosis: Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation. Prognosis/Prediction: Questions addressing the prediction of the course of a disease. Meaning: Questions addressing how one experiences a phenomenon. SAMPLE QUESTIONS: Intervention: In elderly patients in acute care facilities (P), how do fall prevention programs with risk assessment (I) compared to fall prevention programs without risk assessment (C) affect fall rates (O) within one quarter after intervention (T)? Etiology: Are 50- to 60-year-old women (P) who have family history of obesity (I) compared with those without family history of obesity (C) at increased risk for increased body mass index (BMI) (O) during the first 3 years after hysterectomy or menopause (T)? Diagnosis: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead electrocardiograms (ECGs) (I) compared to one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)? Prognosis/Prediction: (1) For patients 65 years and older (P), how does receiving the influenza vaccine (I) compared with not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)? (2) In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared to being a nonsmoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)? Meaning: How do parents (P) of toddlers with a new diagnosis of a terminal disease (I) perceive their parenting role (O) during the first 3 months after diagnosis (T)? © Ellen Fineout-Overholt, 2006. If you use this form, please let Dr. EFO know by contacting her

Appendix B

 appendix B Rapid Critical Appraisal Checklists These rapid critical appraisal (RCA) checklists have been developed over several years and are designed to help you strive for mastery of the RCA phase of critical appraisal of evidence. The questions in the first section of the checklists are about what makes good research—and, therefore, contribute to determining the validity of a study. The second section of the checklists asks about information that helps establish study reliability within clinical practice. The third section of the RCA checklists contains questions about applicability of the study findings to patients. Becoming proficient at understanding the different aspects within the RCA checklists and consistently using them when appraising evidence will improve clinicians’ understanding of various types of research methods, designs, statistical analyses, and translation of evidence into practice. Caveat: Though these resources have been developed over several years, they don’t get old. Thinking that requires everything to have the latest year on it is flawed thinking. These resources have been updated as the science of rigorous research methodology grows; however, their essence has not changed from the original intent of helping clinicians find the pearls within a study that demonstrate the validity, reliability, and applicability of research. Note: These RCA checklists are also available in MS Word format on for ease of use. GENERAL APPRAISAL OVERVIEW FOR ALL STUDIES Date: Reviewer: Article Citation (APA): PICOT Question: Overview/General Description of Study • Purpose of Study: • Study Design: • General Description of Study: Research Question(s) or Hypotheses: Study Aims: Sampling Technique, Sample Size, and Characteristics: Major Variables Studies: • Independent Variable(s): • Dependent (outcome) Variable(s): Variable Analysis Used (include whether appropriate to answer research questions/hypothesis or discover themes): © Fineout-Overholt, 2010. This form was designed to help learners engage research as a fundamental tool in evidence-based decision-making. If you use this form for another use, please contact the author at [email protected]. RAPID CRITICAL APPRAISAL QUESTIONS FOR SYSTEMATIC REVIEWS AND META-ANALYSES OF CLINICAL INTERVENTIONS QUESTION VALIDITY 1. Are the results of the review valid? a. Are the studies contained in the review randomized controlled trials (RCTs)? Yes No Unknown b. If not, were all relevant studies included in the review? Yes No Unknown c. Does the review include a detailed description of the search strategy to find all relevant studies? Yes No Unknown d. Does the review describe how validity of the individual studies was assessed (e.g., methodological quality, including the use of random assignment to study groups and complete follow-up of the participants)? Yes No Unknown e. Were the results consistent across studies? Yes No Unknown f. Were individual patient data or aggregate data used in the analysis? Individual Aggregate g. Does the review include a description of how studies were compared using statistical analysis? Yes No Unknown RELIABILITY 2. What were the results? a. How large is the intervention or treatment effect (OR, RR, effect size)? b. How precise is the intervention or treatment (CI)? APPLICABILITY 3. Will the results assist me in caring for my patients? a. Are my patients similar to the ones included in the review? Yes No Unknown b. Is it feasible to implement the findings in my practice setting? Yes No Unknown c. Do the pooled or combined results of the studies support the hospital’s values and goals of service delivery? (i.e., Is it feasible to implement the findings in my practice setting?) Yes No Unknown d. Were all clinically important outcomes considered, including risks and benefits of the treatment? Yes No Unknown e. What is my clinical assessment of the patient and are there any contraindications or circumstances that would inhibit me from implementing the treatment? Yes No Unknown f. What are my patient’s and his or her family’s preferences and values about the treatment that is under consideration? Yes No Unknown Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt & Melnyk, 2005. This form may be used for educational, practice change, and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR RANDOMIZED CLINICAL TRIALS (RCTS) VALIDITY 1. Are the results of the study valid? a. Were the participants randomly assigned to the experimental and control groups? Yes No Unknown b. Was random assignment concealed from the individuals who were first enrolling participants into the study? Yes No Unknown c. Were the participants and providers blind to the study group? Yes No Unknown d. Were reasons given to explain why participants did not complete the study? Yes No Unknown e. Were the follow-up assessments conducted long enough to fully study the effects of the intervention? Yes No Unknown f. Were the participants analyzed in the group to which they were randomly assigned? Yes No Unknown g. Was the control group appropriate? Yes No Unknown h. Were the instruments used to measure the outcomes valid and reliable? Yes No Unknown i. Were the participants in each of the groups similar on demographic and baseline clinical variables? Yes No Unknown RELIABILITY 2. What are the results? a. How large is the intervention or treatment effect (NNT, NNH, effect size? ____________________ b. How precise is the intervention or treatment (CI)? ____________________ APPLICABILITY 3. Will the results help me in caring for my patients? a. Were all clinically important outcomes measured? Yes No Unknown b. What are the risks and benefits of the treatment? ____________________ c. Is the treatment feasible in my clinical setting? Yes No Unknown d. What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself? ____________________ Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt & Melnyk, 2005. This form may be used for educational, practice change, and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR QUASI-EXPERIMENTAL STUDIES Explain your answers and recommendation for use of this study in the body of evidence to answer your PICOT question. VALIDITY 1. Are the results of the study valid? Yes No Unknown Rationale/Comment • Study participants in intervention and comparison groups are similar. 1 2 3 • The intervention is clearly identified. 1 2 3 • There is a control group. 1 2 3 • Participants in the comparison group(s) received a reasonable treatment/care to the exposure or intervention of interest given to the intervention group. 1 2 3 • Follow-up between groups is adequately described and analyzed. 1 2 3 • Appropriate statistical analysis was used for the data gathered. 1 2 3 • Measurement of the outcome was obtained pre- and postintervention. 1 2 3 • The outcomes are the same across all groups and were measured with the same instrument. 1 2 3 • Outcomes were measured with valid and reliable instruments. 1 2 3 RELIABILITY 2. What are the results? • What were the magnitude of the results? • What was the precision of the results? APPLICABILITY 3. Will the results help me in caring for my patients? • Were the study patients similar to my own? 1 2 3 • Will the results lead directly to selecting or avoiding therapy? 1 2 3 • Are the results useful for reassuring or counseling patients? 1 2 3 Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt, 2018. This form may be used for educational, practice change, and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR COHORT STUDIES VALIDITY 1. Are the results of the study valid? a. Was there a representative and well-defined sample of patients at a similar point in the course of the disease? Yes No Unknown b. Was follow-up sufficiently long and complete? Yes No Unknown c. Were objective and unbiased outcome criteria used? Yes No Unknown d. Did the analysis adjust for important prognostic risk factors and confounding variables? Yes No Unknown Comments RELIABILITY 2. What are the results? a. What is the magnitude of the relationship between predictors (i.e., prognostic indicators) and targeted outcome? ____________________ b. How likely is the outcome event(s) in a specified period of time? ____________________ c. How precise are the study estimates? ____________________ APPLICABILITY 3. Will the results help me in caring for my patients? a. Were the study patients similar to my own? Yes No Unknown b. Will the results lead directly to selecting or avoiding therapy? Yes No Unknown c. Are the results useful for reassuring or counseling patients? Yes No Unknown Comments Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt & Melnyk, 2009. This form may be used for educational, practice change, and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR DESCRIPTIVE STUDIES VALIDITY 1. Are the results of the study valid? • Were study/survey methods appropriate for the question? Yes No Unknown • Was sampling methods appropriate for the research question? Yes No Unknown • Were sample size implications on study results discussed? Yes No Unknown • Were variables studied appropriate for the question? Yes No Unknown • Dependent variables are: • Independent (outcome) variables are: • Were outcomes appropriate for the question? Yes No Unknown • Were valid and reliable instruments used to measure outcomes? Yes No Unknown • Were the chosen measures appropriate for study outcomes? Yes No Unknown • Were outcomes clearly described? Yes No Unknown • Did investigators and/or funding agencies declare freedom from conflict of interest? Yes No Unknown RELIABILITY 2. What are the results? • What were the main results of the study? • Was there statistical significance? Explain. • Was there clinical significance? Explain. • Were safety concerns, including adverse events and risk/benefit described? Yes No Unknown APPLICABILITY 3. Will the results help me in caring for my patients? • Are the results applicable to my patient population? Yes No Unknown • Will my patients’ and families’ values and beliefs be supported by the knowledge gained from the study? Yes No Unknown Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt & Gallagher-Ford, 2012. This form may be used for educational, practice change and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR QUALITATIVE EVIDENCE VALIDITY 1. Are the results of the study valid (i.e., trustworthy and credible)? a. How were study participants chosen? b. How were accuracy and completeness of data assured? c. How plausible/believable are the results? i. Are implications of the research stated? Yes No Unknown 1. May new insights increase sensitivity to others’ needs? Yes No Unknown 2. May understandings enhance situational competence? Yes No Unknown d. What is the effect on the reader? 1. Are results plausible and believable? Yes No Unknown 2. Is the reader imaginatively drawn into the experience? Yes No Unknown RELIABILITY 2. What were the results? a. Does the research approach fit the purpose of the study? Yes No Unknown i. How does the researcher identify the study approach? Yes No Unknown 1. Are language and concepts consistent with the approach? Yes No Unknown 2. Are data collection and analysis techniques appropriate? Yes No Unknown ii. Is the significance/importance of the study explicit? Yes No Unknown 1. Does review of the literature support a need for the study? Yes No Unknown 2. What is the study’s potential contribution? iii. Is the sampling strategy clear and guided by study needs? Yes No Unknown 1. Does the researcher control selection of the sample? Yes No Unknown 2. Do sample composition and size reflect study needs? Yes No Unknown b. Is the phenomenon (human experience) clearly identified? i. Are data collection procedures clear? Yes No Unknown 1. Are sources and means of verifying data explicit? Yes No Unknown 2. Are researcher roles and activities explained? Yes No Unknown ii. Are data analysis procedures described? Yes No Unknown 1. Does analysis guide direction of sampling and when it ends? Yes No Unknown 2. Are data management processes described? Yes No Unknown c. What are the reported results (description or interpretation)? i. How are specific findings presented? 1. Is presentation logical, consistent, and easy to follow? Yes No Unknown 2. Do quotes fit the findings they are intended to illustrate? Yes No Unknown ii. How are overall results presented? 1. Are meanings derived from data described in context? Yes No Unknown 2. Does the writing effectively promote understanding? Yes No Unknown APPLICABILITY 3. Will the results help me in caring for my patients? a. Are the results relevant to persons in similar situations? Yes No Unknown b. Are the results relevant to patient values and/or circumstances? Yes No Unknown c. How may the results be applied in clinical practice? Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt & Melnyk, 2005. This form may be used for educational, practice change, and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR EVIDENCE-BASED PRACTICE (EBP) IMPLEMENTATION OR QUALITY IMPROVEMENT (QI) PROJECTS Indicate the extent to which the item is met in the published report of the EBP or QI project. Validity of Evidence Synthesis (i.e., good methodology) 1 No 2 A Little 3 Somewhat 4 Quite a Bit 5 Very Much 1. The title of the publication identifies the report/project as an EBP implementation or QI project. 2. The project report provides a structured summary that includes, as applicable, data to establish the existent and background of the clinical issue; inclusion and exclusion criteria and source(s) of evidence; evidence synthesis, objective(s), and setting of the EBP or QI project; project limitations; results/outcomes; and recommendation and implications for policy. 3. Report includes existing internal evidence to adequately describe the clinical issue. 4. Provides an explicit statement of the question being addressed with reference to participants or population/intervention/comparison/outcome (PICO). 5. Explicitly describes the search method (i.e., was it systematic), inclusion and exclusion criteria, and rationale for search strategy limits. 6. Describes multiple information sources (e.g., databases, contact with study authors to identify additional studies, or any other additional search strategies) included in the search strategy, and date. 7. States the process for title, abstract, and article screening for selecting studies. 8. Describes the method of data extraction (e.g., independently or process for validating data from multiple reviewers). 9. Includes conceptual and operational definitions for all variables for which data were abstracted (e.g., define blood pressure as systolic blood pressure, diastolic blood pressure, ambulatory blood pressure, automatic cuff blood pressure, or arterial blood pressure). 10. Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level). 11. States the principal summary measures (e.g., risk ratio, difference in means). 12.

Describes the method of combining results of studies, including quality, quantity, and consistency of evidence. 13. Specifies assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies). 14. Describes appraisal procedure and conflict resolution. 15. Provides number of studies screened, assessed for eligibility, and included in the review, with reasons for exclusion at each stage, ideally with a flow diagram. 16. For each study, presents characteristics for which data were extracted (e.g., study size, design, method, follow-up period) and provides citations. 17. Presents data on risk of bias of each study and, if available, any outcome-level assessment. 18. For all outcomes considered (benefit or harms), includes a table with summary data for each intervention group, effect estimates, and confidence intervals, ideally with a forest plot. 19. Summarizes the main findings, including the strength of evidence for each main outcome; considering their relevance to key groups (i.e., healthcare providers, users, and policy makers). 20.

Discusses limitations at study and outcome levels (e.g., risk of bias) and at review level (e.g., incomplete retrieval of identified research, reporting bias). 21. Provides a general interpretation of the results in the context of other evidence, and implications for further research, practice, or policy changes. Validity of Implementation (i.e., well-done project) 1. Purpose of project flows from evidence synthesis 2. Stakeholders (active and passive) are identified and communication with them is described 3. Implementation protocol is congruent with evidence synthesis (fidelity of the intervention) 4. Implementation protocol is sufficiently detailed to provide for replication among project participants 5. Education of project participants and other stakeholders is clearly described 6. Outcomes are measured with measures supported in the evidence synthesis Reliability of Implementation Project (i.e., I can learn from or implement project results) 1. Data are collected with sufficient rigor to be reliable for like groups to those participants of the project 2. Results are evidence implementation and are clinically meaningful (statistics are interpreted as such) Application of Implementation (i.e., this project is useful for my patients) 1. How feasible is the project protocol? 2. Have the project managers considered/included all outcomes that are important to my work? 3. Is implementing the project safe (i.e., low risk of harm)? Summary Score Recommendations with consideration of this type of level IV intervention evidence: • 32–64: consider evidence with extreme caution • 65–128: consider evidence with caution • 128–160: consider evidence with confidence © Fineout-Overholt, 2011. This form may be used for educational, practice change and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR CASE STUDIES VALIDITY 1.

Are the results of the study valid? • Is the study question/issue clearly articulated? Yes No Unknown • Is the researcher’s perspective clearly described and taken into account? Yes No Unknown • Are the methods for collecting data clearly described? Yes No Unknown • Are the methods for analyzing the data likely to be valid and reliable? Yes No Unknown • Are quality control measures used? Yes No Unknown Comments RELIABILITY 2. What are the results? • Are the results credible, and if so, are they relevant for practice? Yes No Unknown Comments APPLICABILITY 3. Will the results help me in caring for my patients? • Are the conclusions drawn justified by the results? Yes No Unknown •

Are the findings of the study transferable to other settings? Yes No Unknown Comments Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt 2017.

This form may be used for educational, practice change and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR LITERATURE REVIEW (LEVEL VII) VALIDITY 1. Are the results of the review valid? A. Are the designs of the articles in the review identified? Yes No Unknown B. Does the review include a detailed description of the search strategy to find all relevant studies and was it systematic? Yes Yes Unknown C. Do the reviewers use standard criteria to describe the validity of the individual studies (e.g., criteria about methodological quality)? Yes No Unknown D. Were the results consistent across studies? Yes No Unknown RELIABILITY 2. What were the results? A. Were the results described across the studies or were the findings described study by study? (Hint: Were there synthesis tables?) Yes No Unknown B.

What are sources of bias within the report that make the literature review unreliable? (See validity questions above.) C. Does the bias within the literature review methodology make the results as described unusable? (if so, stop here.) Yes No Unknown APPLICABILITY 3. Will the results assist me in caring for my patients? A. Are my patients similar to the ones included in the review? Yes No Unknown B. Is it feasible to implement the findings in my practice setting? Yes No Unknown C. Were all clinically important outcomes considered, including risks and benefits of the treatment? Yes No Unknown D. What is my clinical assessment of the patient and are there any contraindications or circumstances that would inhibit me from implementing the treatment? Yes No

Unknown E. What are my patient’s and his or her family’s preferences and values about the treatment that is under consideration? Would you use the study results in your practice to make a difference in patient outcomes? • If yes, how? • If yes, why? • If no, why not? Additional Comments/Reflections: Recommendation for article use within a body of evidence: © Fineout-Overholt, 2015. This form may be used for educational, practice change, and research purposes without permission. RAPID CRITICAL APPRAISAL QUESTIONS FOR EVIDENCE-BASED GUIDELINES CREDIBILITY 1. Who were the guideline developers?

2. Were the developers representative of key stakeholders in this specialty (interdisciplinary)? Yes No Unknown 3. Who funded the guideline development?

4. Were any of the guidelines developers funded researchers of the reviewed studies? Yes No Unknown 5. Did the team have a valid development strategy? Yes No Unknown 6. Was an explicit (how decisions were made), sensible, and impartial process used to identify, select, and combine evidence? Yes No Unknown 7. Did the developers carry out a comprehensive, reproducible literature review within the past 12 months of its publication/revision? Yes No Unknown 8. Were all important options and outcomes considered? Yes No Unknown 9. Is each recommendation in the guideline tagged by the level/strength of evidence upon which it is based and linked with the scientific evidence? Yes No

Unknown 10. Do the guidelines make explicit recommendations (reflecting value judgments about outcomes)? Yes No Unknown 11. Has the guideline been subjected to peer review and testing? Yes No Unknown APPLICABILITY/GENERALIZABILITY 12. Is the intent of use provided (e.g., national, regional, local)? Yes No Unknown 13. Are the recommendations clinically relevant? Yes No Unknown 14. Will the recommendations help me in caring for my patients? Yes No Unknown 15. Are the recommendations practical/feasible (e.g., resources—people and equipment—available)? Yes No Unknown 16. Are the recommendations a major variation from current practice? Yes No Unknown 17. Can the outcomes be measured through standard care? Yes No Unknown Modified from Slutsky, J. (2005). Using evidence-based guidelines: Tools for improving practice. In B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare. A guide to best practice (pp. 221–236). Philadelphia, PA: Lippincott, Williams & Wilkins. This form may be used for educational, practice change, and research purposes without permission.

Order your Copy Today