Fluent Essays

Instructions for Evidence-Based Poster: 1-2 slide PowerPoint with the following components: · PICO Question ( SEE ATTACHED PICO QUESTION)   background information in this case the use of epidural injection for back pain in the elderly. or  in elderly patients experiencing acute and chronic low back pain, what are the effects of using alternative pain medication therapies such as NSAIDS in improving mobility compared to using epidural steroid injections?  · PICO Question ( SEE ATTACHED PICO QUESTION)  · Recommendations from evidence based on the literature reviewed- must give recommendation summarized from a minimum of 10 articles, why it is relevant in practice, and one example of how it can be used in clinical practice. · Completed Appendix G with reference page (which I have and is attached for you to use)Date: 25 January, 2021. EBP Question:  The Use of Steroids Injections for Chronic or Acute Pain Article Number Author and Date Evidence Type Sample, Sample Size, Setting Findings That Help Answer the EBP Question Observable Measures Limitations Evidence Level, Quality 1. Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S. M., ... & Park, B. J. (2013). Systematic review of RCTs, with meta- analysis 29 articles of randomized control trials of database searches · Epidural steroid injection did not provide improvement of back pain disability more other methods. · Epidural steroid injection failed to decrease the number of patients that attended subsequent surgery. · Weight mean difference. · Number of months. · Percent confidence interval. The article did not provide evidence-based recommendations for the results. Level I High Quality 2. El Abd, O., Amadera, J., Pimentel, D. C., & Gomba, L. (2015). Explanatory mixed method design that includes only a level I quantitative study 150 consecutive patients receiving TFSI. Setting is a spine center associated with a rehabilitation hospital. · Transforaminal Epidural Steroid Injections with dexamethasone offers minor self-limited transient adverse effects which can be managed easily. · Adverse effects in a period if two weeks. · Intensity and duration of side effects. The sample size enrolled was too small to provide proper evidence of the results. Level I Good quality 3. Brose, S. W., Montfort, J., Gustafson, K. J., Mittebrun, I., Gauriloff, S., Mosher, M., & Bourbeau, D. J. (2017). Opinion of respected authorities 1 Patient 70-year-old man with paraplegia suffering from multifocal degenerative wrist pain. · Corticosteroid injection of the pisotriquetral joint under ultrasound guidance is effective in the management of wrist pain stemming from that joint.  · Bleeding and bruising after injections. · Pain resolution after the injections The sample size is way too low to draw any evidence-based conclusions. Level IV Good Quality. 4. Kennedy, D. J., Plastaras, C., Casey, E., Visco, C. J., Rittenberg, J. D., Conrad, B., ... & Dreyfuss, P. (2014). Randomized Control Test 78 subjects suffereing from acute uni-level disc herniation leading to unilateral radicular pain. · Transforaminal epidural corticosteroid injections are an effective treatment for acute radicular pain due to disc herniation · only require 1 or 2 injections for symptomatic relief · Dexamethasone displays possession of rationally parallel effectiveness in comparison with triamcinolone. · Surgical rates · Injections received · Categorical scores of pains · Mean Oswestry Disability Index. No recommendations were provided after the results. Level I Good Quality. 5. Cohen, S. P., Hanling, S., Bicket, M. C., White, R. L., Veizi, E., Kurihara, C., ... & Pasquina, P. F. (2015). Randomized Control Trial · Military, VeteranRunning head: EVIDENCE-BASED PRACTICE 1 EVIDENCE-BASED PRACTICE 2 Evidence-Based Practice: Level and Quality of Research Article Evidence-Based Practice: Level and Quality of Research Article The article selected was Epidural Steroid Injection Therapy for Low Back Pain: a meta-analysis by Choi, Hahn, Kim, Jang, Park, Lee, Chung, and Park (2013). The article aimed at systematically assessing the long-term advantages of injections of epidural steroid for low-back pain patients. The article is a Level I article because it is an experimental study with randomized control trials. The article also embodies explanatory mixed method designs that contain only Level I quantitative study. The article includes systematic reviews of Randomized Controlled Trials with meta-analysis, which is characteristic of Level I articles. The article is a high quality article. This is because it conveys its formation in a greatly structured manner. It’s title succinctly reflects the content of the study and it provides five important keywords used in the study. The article also gives a clear background of information about the study as well as the aims of the study. The gap in literature is well conveyed which justifies the need for the study. The article is consistent and the materials and methods used in the study are clearly defined. The information provided is specified and it clearly demonstrates how the study is planning on achieving its aims. This is one of the most important characteristics of a high quality article according to Guyatt et al. (2018). Additionally, the article is high quality because it uses sufficient sample size for the study design and provides generalizable results (John Hopkins Nursing Evidence-Based Practice, 2017). The results are well-analyzed and presented in a manner that any average reader would comprehend. The discussion provided in the article shows insights into the meaning and importance of the research findings. The article offers definitive conclusions which are clearly stated and can be validated by the study. The article also uses comprehensive literature review to provide its recommendations which makes them consistent. All these characteristics justify the article as high quality. References Choi, H. J., Hahn, S., Kim, C. H., Jang, B. H., Park, S., Lee, S. M., ... & Park, B. J. (2013). Epidural steroid injection therapy for low back pain: a meta-analysis. International journal of technology assessment in health care, 29(3), 244-253. Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2018). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj, 336(7650), 924-926. John Hopkins Nursing Evidence-Based Practice. (2017). Appendix D: Evidence Level and Quality Guide. John Hopkins University School of Nursing.1. What is the problem? Many elderly patients often complain of back ache and are put on steroid epidural injections. Clinicians have the number of these epidural injections limited. The main problem that led to this study is the increased immobility among the patients who are put on long term epidural steroids. 2. Why is the problem important and relevant? What would happen if it were not addressed? It is important to focus on the wholeness of the patient. Considering the possible outcomes of the therapy. If left unaddressed, some patients are left immobile many of which are the bread winners and this leaves the family in great loss and the burden of taking care of their patient. 3. What is the current practice? Currently, clinicians prescribe limited doses for patients with back pain. This temporarily reduces the pain and inflammation and promotes patient’s comfort. In some instances, patients may be placed on long term use of these steroids. 4. How was the problem identified? (Check all that apply) (x)Safety and risk-management concerns (x)Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness) (x)Unsatisfactory patient, staff, or organizational outcomes · Variations in practice within the setting (x)Variations in practice compared to community standard · Current practice that has not been validated · Financial concerns 5. What are the PICO components? P – (Patient, population, or problem). The problem is common in patients who are elderly and have back pain. These patients have history of manual work during their lifetime that have to led to the chronic back pain. I – (Intervention) administration of alternative drugs for the management of back pain, for instance NSAIDS. C – (Comparison with other interventions, if foreground question). The use of NSAID is far much safer to patient compared to the epidural steroids for back pain since it does not have serious complications like the steroids. O – (Outcomes are qualitative or quantitative measures to determine the success of change). Increasing mobility in patient who have back pain and prevent further damage of the spine bones. 6. Initial EBP question ❑Background ❑Foreground The continuous use of epidural steroids. JohnsHopkinsNursingEvidence-BasedPractice AppendixB:QuestionDevelopmentTool JohnsHopkinsNursingEvidence-BasedPractice Appendix B Question Development Tool © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 7. List possible search terms, databases to search, and search strategies. Epidural steroids Steroids for back pain 8. What evidence must be gathered? (Check all that apply) ( x) Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase) (x)Standards (regulatory, professional, community) Guidelines · (x)Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences) · Position statements 9. Revised EEvidence Based Practice Poster Presenter: ______________________ Date: ___________ PICO Question: _________________________ Total Points: ___ Category 4 3 2 1 Significance/Backgrou nd to the Problem PICO Question Identification In-depth coverage of topic, topic is relevant to nursing practice research-based information, outstanding clarity, PICO question complete Good coverage of topic, topic is appropriate to nursing practice basis in sound, research-based information, PICO question complete Minimal coverage of topic, topic is appropriate to nursing practice, PICO question complete Minimal to no coverage of topic, topic is not relevant to nursing practice, not based on research-based information, PICO incomplete/ or not included Literature Appraisal (Appendix G) Minimum of 10 peer-reviewed full text articles written in last 5 years or less. All articles are relevant to EBP problem and provides clear evidenced based recommendation s. Minimum of 10 peer-reviewed full texted articles written in 5 years or less. 8-9 articles relevant to EBP problem and provides clear evidenced based recommendation s. Minimum of 10 peer-reviewed articles, full texted articles, articles written in more than 5 years. 7-8 articles relevant to EBP problem and provides clear evidenced based recommendation s. Less than 10 peer reviewed full texted articles written in 5 years or less. Less than 7 articles relevant to EBP problem and provides clear evidenced based recommendation s. Project Recommendations Clear and concise summary of evidenced based recommendation from appraisal of articles. Two recommendation s to answer PICO question. Clear and concise summary of evidenced based recommendation from appraisal of articles. One recommendation to answer PICO question. Recommendatio ns lacks concision or may be irrelevant to PICO question. One recommendation to answer PICO question. Recommendatio n lacks relevance to PICO question, or none given. References (Submitted with Appendix G) Reference page in Word document typed in 12 font, APA format for each article. Reference page in Word document typed in 12 font, APA format for each article. Missing references. Reference page in Word document, typed in 12 font, APA format incorrect. Missing references. Reference page not included. Slide (Poster) Appearance Attractive, easy to interpret, pleasing colors with high contrast, slide presentation well-organized, excellent use of bullets, and graphics which enhance the presentation of the content Attractive, easy to interpret, pleasing colors with good contras