Answer To: HNN108UnderstandingResearchEvidence AssessmentTask1–EvidenceSynthesis 2000Wordsand50%weighting...
Soumi answered on Aug 24 2021
Final_43409_Template.docx
HNN108 Understanding Research Evidence
Assessment Task 1 – Evidence Synthesis
Search Strategy
Primary research articles have to be located for the research question “Which interventions are effective in preventing and reducing incidence of delirium in the acute hospital setting?” In order to do so it was necessary to search databases such as PubMed, EMBASE: Excerpta Medica Database, Google Scholar, Psych Info, SAGE and much more. However, in order to search relevant research articles for the study EBSCO was used as the database.
Description of concepts
After entering EBSCO, keyword selection was must to derive appropriate primary researches and not secondary researches. Therefore, ‘acute hospital settings’ and ‘prevention of delirium’ was used as the keywords. In order to narrow down the results, Boolean AND operation was used and both the keywords were joined. These provided 1542 hits further, filters were used in to narrow down the results. Results were refined using publishes year 2015-2019 as the filter, which narrowed down the results to 114.
Further, all full text (open access) and peer reviewed was used as the search limiter, which provided only 59 hits. Cohort study, observational study and randomised controlled trials were used as search limiter one by one and this narrowed the results to 6, 4 and 6 hits respectively. At last, the three articles to be used for this study were selected from these hits.
Similar search terms, using truncation (*), wild cards (?), alternate words and alternate spellings, etc
‘Acute hospital settings’ and ‘prevention of delirium’ was used as the keywords
Limits:
(Language, peer reviewed etc.)
· Language as English
· Peer Reviewed journals
· Cohort Study
· Observational Study
· Randomised Controlled Trials
Concept
Delirium can be considered as one of the most prominent as well as frequent mental health issue. Further, acute hospital environments provide the required triggers for the patients to undergo and suffer from delirium. As supported by the key finding from Stuck (2012), even though only 8% individuals were directly affected by the night-sleep disruptions in ICU, it is necessary to consider that around 40% of patients were not accounted for and therefore, the prevalence of delirium could have been high.
Further, elder patients who are above 65 years of age are more vulnerable to delirium in acute hospital settings such as ICU and LOS. This is evident from both RCT as well as cohort study. Cohort study presented by Schubert et al. (2018) also presented some analysis one-step ahead and delirium can increase the cost per patient, required nursing and other medical treatments. Moreover, cognitive dysfunction and physiologic derangement have been considered as one of the major factor behind delirium prevalence irrespective of patient’s age under acute hospital settings more commonly, ICD, ICU and LOS.
Both cohort and cross sectional study considered critical care from nurses and improving nursing process as one of the most effective intervention for reducing delirium prevalence. This was majorly because patient’s care is being supported by nursing and therefore, provisions suggested by Young et al. (2015) under Prevention of delirium (POD) system.
Databases searched:
· PubMed
· EMBASE: Excerpta Medica Database
· Google Scholar
· Psych Info
· SAGE
Article summaries
Reference to Article 1
Schubert, M., Schurch, R., Boettger, S., Nunez, D. G., Schwarz, U., Bettex, D., ... & Rudiger, A. (2018). A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients-a cohort study. BMC health services research, 18(1), 550.
Purpose / Aim of the study
Is the purpose relevant to my question?
Aim of this study was to identify relation between nigh-time sleep interruptions and delirium prevalence among patients in ICU undergoing cardiac surgery. Further, authors also aimed to study relation between delirium, falls and restraint use in cardiac surgery patients in ICU.
Who was included in the study?
Consider: Does the sample represent the target population in my question?
Author used an exclusion inclusion criterion, where patients above 18 years of age, receiving ICU care following valve surgery was used as inclusion criteria. Hospital A and B were used for this study with 40 and 32 ICU beds respectively and overall 76 patients were included in the sample size.
Design
Consider: Is the design relevant?
This study was a descriptive design.
Method
How was the research conducted?
Was there a potential for bias?
A cross-sectional study based upon the pre-collected data in order to identify relation between above mentioned variables and delirium. Prior published literature reviews were used assumptions in order to compare that collected data with prior published results.
Findings
What were the key findings?
Are the findings relevant for my question?
Only 8% patients were accounted for facing delirium due to sleep-time disturbances in ICU, while 47% did not. No falls were reported from the sample and no significant relation between delirium, falls and restraint use in cardiac surgery patients in ICU.
Level of Evidence
Is the research high-level evidence or just opinion?
The study does not present very well administered evidence and therefore may belong to level IV level of evidence.
Additional notes
- Was ethics review undertaken?
Yes
- Is it primary or secondary research?
Primary
Reference to Article 2
Young, J., Cheater, F., Collinson, M., Fletcher, M., Forster, A., Godfrey, M., ... & Inouye, S. K. (2015). Prevention of delirium (POD) for older people in hospital: study protocol for a randomised controlled feasibility trial. Trials, 16(1), 340
Purpose / Aim of the study
Is the purpose relevant to my question?
Authors aimed to assess delirium prevalence among acute care patients, which may or may not be at the risk of this disease. Further, authors aimed to compare to prior mentioned groups based upon defined indicators and at last to compare hospital mortality, nursing hours, cost per case, ICU and LOS for delirious and non-delirious patients.
Who was included in the study?
Consider: Does the sample represent the target population in my question?
39432 was a total sample size assessed for the eligibility of this study while only 29,278 patients were analysed. Out of these, only 10, 906 patients were screened with Delirium Observation Scale (DOS), which resulted into 7,837 and 3,069 as non-delirious and delirious patients respectively.
Design
Consider: Is the design relevant?
Authors selected ‘Delir-Path health service research program’, which was conducted in Swiss university hospital.
Method
How was the research conducted?
Was there a potential for bias?
Being a longitudinal cohort study data was collected from patients that were admitted between January and December 2014 after one year of delirium guidelines implementation. Patients below 18 years of age and those hospitalized for less than 1 day were excluded.
Findings
What were the key findings?
Are the findings relevant for my question?
Patients above 65 years of age were identified to be at higher risk for delirium along with higher mortality rate and longer stay at ICU and LOS. Further, they had more nursing hour requirement and...