This week you are selecting a research problem in a clinical area of healthcare that you will be addressing throughout the short papers and with your Final Project. You will want to place this research problem in the form of a question. For example, a research question could be “What is the impact of healthy lifestyles on decreasing childhood obesity in the Hispanic population?” After reviewing the Final Project Guidelines and Rubric document, submit your research question. Post any questions to the General Questions topic.
Overview
Healthcare administrators, managers, and executives are responsible for planning, directing, and coordinating health services at various levels for the
populations they serve. Interpreting research is integral to the role of a healthcare professional, especially when conducting a needs assessment for program
planning.
In this course, you will choose a clinical area of interest related to healthcare administration and create an annotated bibliography. For your final assessment,
you will compose an integrated review. In this review, you will discuss the criteria necessary for inclusion or exclusion in the research study, critique the quality
of each study, and present a synthesis of the results.
This integrated review will address the following course outcomes:
1. Critique ethical issues in healthcare research for their influence on compliance with rules and regulations
2. Evaluate basic research strategies applicable to healthcare settings for informing research proposals
3. Assess the appropriateness of utilizing secondary databases in healthcare research as an alternative to conducting original research
4. Justify the selection of specific data analysis methodology in published healthcare research for informing healthcare research methodology
5. Select healthcare administration issues to research in validating the need for program evaluation
Prompt
Using the six peer-reviewed literature articles from your annotated bibliography, compose an integrated review that focuses on a clinical issue of interest.
Ensure that the topic of this integrated review is viewed from the perspective of a healthcare professional who is looking to validate the need for program
evaluation at your hospital, even if your annotated bibliography was not this focused.
Specifically, your integrated review should focus on the following critical elements:
I. Abstract
Craft a well-drafted abstract. Be sure to adhere to the guidelines from the latest edition of the American Psychological Association’s style guide. Consider
the appropriate length for your audience.
II. Introduction
a) State the purpose, aims, or objectives of the integrated review. What do you wish to achieve through the drafting of this review? Be explicit in
your answer.
b) Introduce the topic of interest. Why is this topic the focus of the review?
c) What is the research question you are going to focus on? If you were to prepare a research proposal, what would your hypothesis be? Why?
d) What variables are of interest to you? How will these variables help you throughout this integrated review? Be sure to label the types of
variables each of these are.
e) Discuss the background and significance of the problem to healthcare administration.
III. Literature Search
a) What keywords and combinations were used in the initial search? Which were the most effective? Explain why these keywords and
combinations provided the most useful results.
b) Which databases were searched? Why were these the chosen databases? Assess the characteristics that make these databases the most
reliable.
c) Evaluate the inclusion and exclusion criteria for the sample. How did you decide to narrow the search and focus the review? How was the final
sample determined? Be sure to include your process.
IV. Methodology Analysis
a) What methodology was used in this research? Was it effective for the research question and hypothesis? Why or why not? Consider including
improvements for the methodology.
b) What statistical data analyses were employed in these articles? Were they appropriate for the research question and methodology? Why or
why not?
c) Evaluate the literature for any gaps that exist. Why do you think these gaps exist? Consider factors such as the location of the research, time the
research was conducted, and so on.
d) Evaluate the literature for inconsistencies that exist across the studies. Why do you think these inconsistencies exist? Consider factors such as
the location of the research, time the research was conducted, and so on.
V. Synthesis and Interpretation
a) Create an evidence table of your results. Be sure to include the following criteria for each study:
1. Report citation
2. Design
3. Method
4. Sample
5. Data collection
6. Data analysis
7. Validity and reliability
b) Compare and contrast the study findings. Be sure to include pertinent conclusions and statistical findings only.
c) Evaluate the research strategies used in the articles, as applicable to healthcare programs. Was the research design appropriate for the study
conducted? Was the statistical analysis employed the best choice for the research questions posed?
d) What ethical issues are pertinent specifically to healthcare research? How can these issues influence the research strategies chosen to
investigate clinical topics? Evaluate these research articles and consider how ethical concerns may have limited these clinical investigations.
e) What patterns and trends exist in the research? What generalizations can you draw from the research?
f) If secondary data was utilized, was the source biased or objective? Why? If original research was conducted, do you think the researchers were
biased or objective? Why? Be sure to support your answer.
g) Synthesize the main findings of the research articles. What were the hypotheses of the research studies? Did the research add any new scholarly
information to the existing body of knowledge?
h) Assess whether utilizing secondary data as an alternative to the researchers’ original research would have been a feasible option. If it had been
an option, what resource(s) would be the most appropriate to use? What would be some of the strengths and limitations of using secondary
data?
i) Assess the literature for any ethical concerns that may be present. Consider things such as conflicts of interest between the researcher and the
study sponsors, or the lack of an IRB approval for the study.
VI. Conclusion
a) What are the studies’ strengths? Are there patterns in the articles that you chose regarding their strengths?
b) What are the studies’ limitations? Are there patterns in the articles that you chose regarding their limitations?
c) Were the findings and conclusions reliable and valid? Why or why not? Logically support your answers.
d) What are the implications of this research? How will it influence your topic in the overall large picture of healthcare research?
Milestones
Annotated Bibliography
This milestone is due in Module Four. Submit a summary and analysis of six research articles relevant to the research problem that you have chosen. This
milestone is graded with the Annotated Bibliography Rubric.
Integrated Review
The final project is due in Module Eight. Using the six peer-reviewed literature articles from your annotated bibliography, compose an integrated review that
focuses on a clinical issue of interest. Ensure that the topic of this integrated review is viewed from the perspective of a healthcare professional who is looking to
validate the need for program evaluation at your hospital. Remember to use APA format. This final project is graded with the Final Project Rubric.
Final Project Rubric
Guidelines for Submission: Submit the integrated review as one complete document, including the title page, abstract, written components, references, and any
necessary appendices. The written components of the review (excluding the title page, abstract, references, and appendices) should not exceed 12 pages,
double-spaced, with one-inch margins. Be sure to adhere to formatting guidelines from the latest edition of the American Psychological Association (APA)
reference manual.
Critical Elements Exemplary (100%) Proficient (85%) Needs Improvement (55%) Not Evident (0%) Value
Abstract Meets “Proficient” criteria, and
abstract is appropriate in length
for reader’s audience
Crafts well-drafted abstract,
adhering to guidelines from the
latest edition of the APA style
guide
Crafts abstract, but abstract is
not well drafted or does not
adhere to guidelines from the
latest edition of the APA style
guide
Does not craft abstract
2.5
Introduction:
Purpose
Meets “Proficient” criteria, and
purpose, aims, or objectives
demonstrate a keen
understanding of the integrated
review process
Explicitly states the purpose,
aims, or objectives of the
integrated review
States the purpose, aims, or
objectives of the integrated
review, but is not explicit in
doing so
Does not state the purpose,
aims, or objectives of the
integrated review
3.8
Introduction: Topic Meets “Proficient” criteria, and
explanation is explicitly clear
Explains why the topic is the
focus of the review
Explains why the topic is the
focus of the review, but
explanation is cursory or weak
Does not explain why the topic is
the focus of the review
3.8
Introduction:
Research Question
Meets “Proficient” criteria, and
research question demonstrates
depth of understanding of
chosen topic
Introduces the research question
and hypothesis, including
explanation behind hypothesis
Introduces the research question
and hypothesis, including
explanation behind hypothesis,
but explanation is illogical,
cursory, or weak
Does not introduce the research
question and hypothesis
3.8
Introduction:
Variables
Meets “Proficient” criteria, and
chosen variables of interest
reflect true understanding of
chosen topic of interest
Explains labeled variables of
interest, including how these
variables will be of help
throughout the integrated
review
Explains variables of interest, but
variables are not labeled and
explanation of how variables will
help throughout integrated
review is illogical or weak
Does not explain variables of
interest
3.8
Introduction:
Background
Meets “Proficient” criteria, and
discussion logically links research
question to healthcare
administration
Discusses the background of the
problem and significance of the
problem to healthcare
administration
Discusses the background of the
problem and discusses
significance of the problem, but
discussion is not thorough or
does not relate significance to
healthcare administration
Does not discuss the background
of the problem and significance
of the problem to healthcare
administration
3.8
Literature Search:
Keywords and
Combinations
Meets “Proficient” criteria, and
explanation for most useful
keywords and combinations
demonstrates a nuanced
understanding of research
databases
Evaluates which keywords and
combinations used in the initial
search provided the most useful
results, including an explanation
for why this is true
Evaluates which keywords and
combinations provided the most
useful results, including an
explanation for why this is true,
but evaluation is not limited to
initial search, or explanation for
why this is true is illogical, weak,
or cursory
Does not evaluate which
keywords and combinations used
in the initial search provided the
most useful results
3.8
Literature Search:
Databases
Meets “Proficient” criteria, and
assessment of characteristics
shows keen insight into reliability
of research databases
Assesses which databases were
chosen and what characteristics
make them the most reliable
Assesses which databases were
chosen and what characteristics
make them the most reliable,
but assessment is illogical, weak,
or not comprehensive
Does not assess which databases
were chosen and what
characteristics make them the
most reliable
3.8
Literature Search:
Inclusion and
Exclusion
Meets “Proficient” criteria, and
process of determining inclusion
or exclusion demonstrates ability
to logically evaluate research
Comprehensively evaluates the
inclusion and exclusion criteria
for the sample
Evaluates the inclusion and
exclusion criteria for the sample,
but evaluation is not
comprehensive
Does not evaluate the inclusion
and exclusion criteria for the
sample
3.8
Methodology
Analysis:
Methodology
Meets “Proficient” criteria and
includes improvements for
methodology
Logically evaluates the efficacy of
methodology used in the
research articles
Evaluates the efficacy of
methodology used in the
research, but evaluation is
illogical
Does not evaluate the efficacy of
methodology used in the
research
3.8
Methodology:
Statistical Data
Analyses
Meets “Proficient” criteria, and
explanations for appropriateness
of data analyses demonstrate a
nuanced understanding of
statistical techniques
Logically evaluates the
appropriateness of the statistical
data analyses used in the
research articles
Evaluates the appropriateness of
the statistical data analyses used
in the research articles but the
evaluation is not logically sound
Does not evaluate the
appropriateness of the statistical
data analyses used in the
research articles
3.8
Methodology: Gaps Meets “Proficient” criteria and
possible explanations for gaps in
literature take into consideration
factors such as location and time
Comprehensively evaluates the
literature for any gaps that exist,
including possible explanations
for those gaps
Evaluates the literature for any
gaps that exist, including possible
explanations for those gaps, but
evaluation is not comprehensive
or explanations are illogical or
weak
Does not evaluate the literature
for any gaps that exist
3.8
Methodology:
Inconsistencies
Meets “Proficient” criteria, and
possible explanations for
inconsistencies that exist across
the studies take into
consideration factors such as
location and time
Comprehensively evaluates the
literature for any inconsistencies
that exist across the studies,
including possible explanations
for those inconsistencies
Evaluates the literature for any
inconsistencies that exist across
the studies, including possible
explanations for those
inconsistencies, but evaluation is
not comprehensive or
explanations are illogical or weak
Does not evaluate the literature
for any inconsistencies that exist
across the studies
3.8
Synthesis and
Interpretation:
Evidence Table
Meets “Proficient” criteria, and
evidence table of results is
organized and visually appealing
Creates a comprehensive
evidence table of results
Creates an evidence table of
results, but does not include all
required components
Does not create an evidence
table of results
3.8
Synthesis and
Interpretation:
Compare and
Contrast
Meets “Proficient” criteria, and
comparisons and contrasts of
study findings include only
significant conclusions and
statistically significant findings
Compares and contrasts the
study findings, including
pertinent conclusions and
statistical findings only
Compares and contrasts the
study findings, but includes
superfluous information
Does not compare and contrast
the study findings
3.8
Synthesis and
Interpretation:
Research Strategies
Meets “Proficient” criteria, and
evaluation is focused on the
appropriateness of the research
strategies within healthcare
programs
Comprehensively evaluates
research strategies used in the
articles as applicable to a
healthcare program
Evaluates research strategies
used in the articles, but research
strategies do not apply to
healthcare programs or
evaluation is not comprehensive
Does not evaluate research
strategies used in the articles
3.8
Synthesis and
Interpretation:
Ethical Issues
Meets “Proficient” criteria, and
evaluation considers how ethical
concerns may have limited
clinical investigations specifically
in the chosen clinical topic
Evaluates research articles for
how possible ethical concerns
may have limited clinical
investigations
Evaluates research articles for
how possible ethical concerns
may have limited clinical
investigations, but evaluation is
limited, illogical, or weak
Does not evaluate research
articles for how possible ethical
concerns may have limited
clinical investigations
3.8
Synthesis and
Interpretation:
Patterns and Trends
Meets “Proficient” criteria, and
analysis demonstrates nuanced
ability to interpret research
findings
Analyzes patterns and trends in
the research, drawing
generalizations from these
patterns and trends
Analyzes patterns and trends in
the research and draws
generalizations from these
patterns and trends, but analysis
is cursory or generalizations are
illogical
Does not analyze patterns and
trends in the research
3.8
Synthesis and
Interpretation:
Secondary Data
Meets “Proficient” criteria, and
support for evaluation includes
specific examples
Evaluates if sources or
researchers were biased or
objective, with support for
answer
Evaluates if sources or
researchers were biased or
objective and supports answer,
but evaluation is not complete or
support is illogical or weak
Does not evaluate if sources or
researchers were biased or
objective
3.8
Synthesis and
Interpretation:
Synthesize
Meets “Proficient” criteria, and
synthesis of articles
demonstrates nuanced ability to
blend multiple articles to support
research question
Comprehensively synthesizes the
main findings of the research
articles
Synthesizes the main findings of
the research articles, but
synthesis is not comprehensive
Does not synthesize the main
findings of the research articles
3.8
Synthesis and
Interpretation:
Utilizing
Meets “Proficient” criteria, and
identification of strengths and
limitations to using secondary
data considers clinical topics in
healthcare administration
Assesses whether utilizing
secondary data is a feasible
alternative to the researchers’
original research, including what
resources would be most
appropriate to use and the
strengths and limitations to using
secondary data
Assesses whether utilizing
secondary data is a feasible
alternative to the researchers’
original research, but assessment
is not comprehensive
Does not assess whether utilizing
secondary data is a feasible
alternative to the researchers’
original research
3.8
Synthesis and
Interpretation:
Ethical Concerns
Meets “Proficient” criteria, and
assessment includes scenarios
such as conflicts of interest
between the researcher and
study sponsor or the lack of an
IRB approval for the study
Comprehensively assesses the
literature for ethical concerns
Assesses the literature for ethical
concerns, but assessment is not
comprehensive
Does not assess the literature for
ethical concerns
3.8
Conclusion: Strengths Meets “Proficient” criteria, and
evaluation of studies’ strengths
demonstrates keen ability to
read beyond superficial results of
research articles
Thoroughly evaluates the studies
for patterns in strengths
Evaluates the studies for
patterns in strengths, but
evaluation is not thorough
Does not evaluate the studies for
patterns in strengths
3.8
Conclusion:
Limitations
Meets “Proficient” criteria, and
evaluation of studies’ limitations
demonstrates keen ability to
read beyond superficial results of
research articles
Thoroughly evaluates the studies
for patterns in limitations
Evaluates the studies for
patterns in limitations, but
evaluation is not thorough
Does not evaluate the studies for
patterns in limitations
3.8
Conclusion: Findings Meets “Proficient” criteria, and
assessment demonstrates
nuanced understanding of
statistical principles
Assesses the findings and
conclusions for reliability and
validity, logically supporting
answers
Assesses the findings and
conclusions for reliability and
validity and supports answers,
but assessment is illogical or
support is weak or illogical
Does not assess the findings and
conclusions for reliability and
validity
3.8
Conclusion:
Implications
Meets “Proficient” criteria, and
analysis of implications
demonstrates a keen
understanding of research topic
overall
Thoroughly analyzes the
implications of the research,
including how the research will
influence the clinical topic in the
overall picture of healthcare
research
Analyzes the implications of the
research topic, including how the
research topic will influence the
clinic topic, but analysis is
cursory or weak or does not
consider how research fits into
the overall picture of healthcare
research
Does not analyze the
implications of the research topic
3.8
Articulation of
Response
Submission is free of errors
related to citations, grammar,
spelling, syntax, and organization
and is presented in a
professional and easy-to-read
format
Submission has no major errors
related to citations, grammar,
spelling, syntax, or organization
Submission has major errors
related to citations, grammar,
spelling, syntax, or organization
that negatively impact
readability and articulation of
main ideas
Submission has critical errors
related to citations, grammar,
spelling, syntax, or organization
that prevent understanding of
ideas
2.5
Earned Total 100%
- HCM 440 Final Project Guidelines and Rubric
Overview
Prompt
Milestones
Annotated Bibliography
Integrated Review
Final Project Rubric
Full Title of the Integrative Review Student Name
HCM 440 – Healthcare Research & Evaluation
Southern New Hampshire University
XXXX, XX, 2021
Abstract
Aim.
Background.
Design and data sources.
Review method.
Results.
Conclusion.
Keywords: XXX
The abstract is the summary of the integrative including the statement of the problem with the aim statement, PICO, procedure for the integrative review, method of evaluation of results, research findings, and conclusions on one page. Do not use pronouns such as “I, my, we” are in this review. Do not include personal information. Write objectively in a scientific manner with a ‘neutral narrative voice’, refer to the Writing Tips for Healthcare Professional. Pages 2-4 for guidance. Do not use constructive words, example given” isn’t”.
Introduction
Background. The problem being addressed in this integrated review is
Introduce the topic of interest with supportive evidence and in-text citations. Discuss the significance of the problem. State the guiding question, which is the PICO in the correct format, In XXX (P), how does XXX interventions (IV) compared to XXX intervention (CV) affect XXX (O)? and identify and define the independent variable (IV) and dependent variable (DV). The IV is the intervention (I) and DV (O) is the outcome and why this is the focus of the review.
Aim. The aim of this integrative review is to conduct a review of the literature using a systematic approach for current research and synthesize six high level of evidence (LOE) research studies on XXX intervention compared to no XXX intervention or another intervention for adults with or children or adolescent with XXX to validate XXX program for XXX.
Literature Review
Design and Data Sources. Systematic literature searches from XX databases of these years XX for previously published peer-reviewed studies. Inclusions were XX. Exclusions were XX.
Which evidence-based databases were searched (these are the healthcare evidence-based databases – Medline, PubMed, PubMed Central, Cochrane Systematic Reviews, and CINAHL)? Why were these databases chosen for the PICO searches? Assess the characteristics that make the chosen healthcare evidence-based databases the most reliable for integrative review. Give an overall of each database characteristics that was chosen. Reminder — google, google scholar or the general library is NOT healthcare evidence-based databases and EBSCO is the host, not the database. State keywords and combinations used in the initial search and following searches. State MeSH terms used in the searches. Which were the most effective? Explain objectively why these keywords and combinations provided the most useful results.
Integrative Review Methodology
Review method. A five-stage integrative review method was used for this clinical intervention for a healthcare program. This method consisted of (a) problem formulation was developed using a guiding question PICO format, XXXX state PICO (b) searches of these evidence-based databases XXX state those databases by using the key words XXX and MeSH terms XXX , (c) evaluation of data, (d) data analysis and interpretation, and (e) presentation of results in Appendix A – Table 1 Evidence Table by the identification and evaluation of was used to review and synthesize current knowledge. (Adapted from Whittemore & Knafl 2005).
Include the search and focus the review (such less than 5 years, systematic reviews, meta- analysis, no books, blogs etc.)? How will these variables (IV and DV) help throughout this integrated review? How were the final six research articles determined? Be sure to include the process.
The evidence table is critical to receive methodology points in the rubric. The Table will address:
· What was each research study objective or purpose statement? If primary research (LOE II-IV), was the researchers bias or objective? If secondary research (e.g., systematic reviews and meta-analysis), was the analysis biased? What would the strengths of using secondary data evaluated in a systematic review with meta-analysis, LOE 1 or a narrative systematic review (LOE IV)? Evaluate by identifying the research design and methods in the journal articles, title, abstract and method sections and score the level of evidence (LOE) for validity on the hierarchy of evidence table.
Running head – SHORTEN TITLE
SHORTEN TITLE 1
· What methodology and sampling were used in each research article and furthermore, the statistical data analyses employed in each research article?
Analysis and Synthesis
Results. Using evidence-based medicine’s systematic process for conducting an integrative review, six peer reviewed research studies published in refereed journals were analyzed and synthesized on a proposed clinical intervention and furthermore, to use for the validation of healthcare program.
Research Method
s.
Explains types of research methods used and discusses the appropriateness of methods.
Data Collection
and Analysis.
Identifies data collection methods used and analyzes the types of statistical tests.
Gaps and Inconsistencies.
Identifies both the gaps and inconsistencies noted in the body of evidence (six research studies)
Synthesis of the findings. According to the analyzed and synthesis of these research studies, XXXX.
Review these videos an Integrative Literature Review.
On synthesis, review this video: Synthesis: Definition & Examples — you must synthesize four findings of the six research studies.
Compare and contrast using a “bird’s eye view” of the study findings and patterns and trends using the MEAD synthesis method.
Review this video:
Be sure to include ONLY pertinent conclusions and statistical findings with in-text citations. DO NOT use long quotes. You might want to use the synthesize worksheet to identify those items ONLY, do not include that worksheet in this integrative review. Evaluate the six research journal articles for gaps and inconsistencies that exist and again, share an overview “bird’s eye look”. This is about three to four pages of the integrative review.
This need to be covered in the synthesis in the narrative:
· Compare and contrast the study findings with pertinent conclusions and statistical findings only.
· What patterns and trends exist in the research?
· What generalizations can be drawn from the research?
This is the place to add your materials from your module six paper along with synthesis.
Ethics
Comprehensively evaluate these research studies and consider how ethical concerns may have limited these clinical investigations. Assess each research study article for ethical concerns that may be present. Consider conflicts of interest between the researcher and the study sponsors, or the lack of an IRB approval for the study.
Conclusions
Strengths. What are the research studies’ strengths? Are there patterns in regard the strengths for the intervention evaluation?
Limitations. What are the studies’ limitations? Are these patterns of limitations such as research design, methods, and sampling?
Validity and reliabilities. Were the findings and conclusions reliable and valid, such as low LOE scores? Why or why not? Logically support the argument.
Implications. What are the clinical implications of this research on the intervention into the healthcare programming for a hospital or health center? How will it affect the implementation of the intervention in relation to the outcome?
References
Must be alphabetic order by the first author, do not number references. Use APA style,
consider using journal option of
Citefast located at:
https://www.citefast.com/?s=APA
Also, PubMed and PubMed Central databases have citations capabilities on each journal article (click on ‘cite’ and locate APA style) to locate the journal article DOI. DO NOT use proxy SNHU DOIs. Refer to DOI announcement.
Appendix A
Table 1 – Title.
This MUST be changed to the APA style format. It usually takes up a couple pages and put this in landscape view. Instructions on converting to landscape view is on the internet.
|
Author/ Date/Journal |
Research Design/ Purpose Statement |
Research Method |
Sample |
Data Collection |
Data Analysis |
Validity/ Reliability |
Convert to an APA style evidence table of your six research articles into Table 1. Use these seven columns to entry information. The research articles must be in alphabetic order of first author.
This video explores the “whys” of an evidence table:
This is how to format your evidence table using word in APA style.
The validity score is the located on the LOE hierarchy table, e.g., systematic reviews with mega-analysis are LOE I and randomized controlled trials are LOE II. Make sure you use the correct score.
Running
head: FLUID RESUSCITATION
1
Fluid Resuscitation for Sepsis: Integrated Review
Autumn Teal
HCM 440 – Healthcare Research & Evaluation
Southern New Hampshire University
April 26, 2020
Running head: FLUID RESUSCITATION
2
Abstract
Aim: The aim of this integrative review is to conduct a review of the literature using a
systematic approach for current research and synthesize these research studies of albumin
resuscitation compared to saline resuscitation in critical care patients with sepsis to validate a
program Critical Care Center for Patient Innovation at Tennessee Memorial Hospital.
Background: Fluid resuscitation is the primary treatment for patients with septic shock and
sepsis. However, only few studies have described the current initial fluid resuscitation practice.
Design and Data Sources: Systemic literature searches from healthcare evidence-based
databases, CINAHL, MEDLINE, and Cochrane Database of Systemic Review for previously
published peer-reviewed studies throughout the years 2011-2019. The inclusion of healthcare
evidence-based databases was integrated. Articles published beyond 2011 were excluded from
database searches.
Review Method: A five-stage integrative review method was used to review and synthesize
current knowledge. This method consisted of developing a problem formulation using a PICO
format, “In critical care patients, how does albumin resuscitation compared to saline resuscitation
affect sepsis?”
Results: Six papers were included in this research dated between 2011 to 2019. According to the
synthesis, the use of albumin containing products versus saline fluid resuscitation did not show a
reduction in mortality among patients.
Conclusion: The use of albumin-containing fluids compared to normal saline for resuscitation in
patients diagnosed with sepsis of any severity did not demonstrate significant advantage. Due to
the cost-effectiveness of albumin, crystalloids should be the first choice for fluid resuscitation in
septic patients.
Running head: FLUID RESUSCITATION
3
Keywords: fluid resuscitation, saline, albumin, sepsis, crystalloids, colloids
Introduction
Background. The problem being addressed in this integrated review is the significance of
mortality rates based on albumin or saline fluid resuscitation in patients diagnosed with sepsis.
The primary treatment and management of patients diagnosed with sepsis is the resuscitation of
fluids. The ideal volume and composition of the resuscitation fluids are currently unknown
(Carlsen & Perner, 2011). The estimated number of patients per year diagnosed with severe
sepsis tops 750,000 in the United States and reaches up to 19 million worldwide. Sepsis presents
with a short-term mortality rate of 20%-30% and exceeds up to 50% when shock is present in the
body. Sepsis death rates continue to rise in the United States and is the leading cause of death
among hospitalized patients in non-coronary intensive care units (Jiang, et al., 2014). However,
early administration of fluid resuscitation interventions is key in the management of sepsis.
Nevertheless, the appropriate use of fluid therapy remains controversial. Therefore, the question
arises, in critical care patients, how does albumin resuscitation compared to saline resuscitation
affect sepsis? The independent variable (IV) in the study is the use of albumin-containing fluids
and the dependent variable (DV) would be how this affects patients diagnosed with sepsis. The
aim of this integrative review is to conduct a review of the literature using a systematic approach
for current research and synthesize these research studies of albumin resuscitation compared to
saline resuscitation in critical care patients with sepsis to validate a Critical Care Center for
Patient Innovation program at Tennessee Memorial Hospital.
Highlight
Running head: FLUID RESUSCITATION
4
Literature Review
Design and Data Sources. Systemic literature searches were performed from CINAHL,
MEDLINE, and Cochrane Database of Systemic Review databases from 2011 to 2019 for
previously published peer-reviewed studies. These databases were chosen for the searching of
evidence-based scholarly-reviewed articles to validate credible and reliable studies. CINAHL
database provides the top nursing and allied health literature available including nursing journals
and publications from the National League for Nursing and the American Nurses Association.
Literature covers a wide variety of topics from biomedicine to allied health disciplines.
MEDLINE is a bibliographic database of life sciences and biomedical information. It includes
academic journals covering medicine, nursing, pharmacy, dentistry, veterinary medicine, and
healthcare. Cochrane Database of Systemic Review is a library consisting of collections of
databases in medicine and other healthcare specialties. Initial key word searches included fluid
resuscitation, sepsis, saline, albumin-containing solutions, and crystalloids. Further restriction of
key words and MeSH terms included meta-analysis, systematic-review, sepsis, albumin, and
resuscitation yielded considerable results with reliable and expedient information. Utilizing
MeSH terms such as albumin and resuscitation and sepsis produced relevant research articles to
include those specific key words in correlation with the PICO being addressed. Inclusion criteria
for this integrated review were journals and articles that were peer reviewed with information on
fluid resuscitation for sepsis patients and published between 2011 and 2019. Exclusions
consisted of any articles beyond the year 2011 in order to narrow the search. Journal and articles
that did not contain information on sepsis patients or did not have supportive data were also
excluded. All articles were evaluated for highest level of evidence (LOE).
Running head: FLUID RESUSCITATION
5
Methodology Analysis
Review method. A five-stage integrative review method was used. This method consisted of (a)
problem formulation was developed using a PICO format, in critical care patients, how does
albumin resuscitation compared to saline resuscitation affect sepsis, (b) searches of these
evidence-based databases, CINAHL, MEDLINE, and Cochrane Library by using the key words
fluid resuscitation, sepsis, saline, albumin-containing solutions, and crystalloids and MeSH terms
included meta-analysis, systematic-review, sepsis, albumin, and resuscitation (c) evaluation of
data, (d) data analysis and interpretation, and (e) presentation of results in an evidence table by
the identification and evaluation of what was used to review and synthesize current knowledge.
Focus of this review on fluid resuscitation in sepsis was narrowed towards articles less than eight
years old with a focus on systematic reviews and meta-analysis for highest level of evidence
(LOE). Any and all articles from blogs, books, and Google or Google Scholar were excluded due
to lack of credibility and reliability. The dependent and independent variable search terms lead to
the majority of articles and journals chosen being systematic reviews and meta-analysis. These
findings indicate that the articles contain high level of evidence (LOE) and reliability.
Synthesis and Interpretation
Results. Using standard process for conducting an integrative review, six peer-reviewed research
studies published in refereed journals were analyzed and synthesized. According to the synthesis
of these studies, the use of albumin-containing products versus normal saline resuscitation
therapy demonstrated no significant advantage in patients with any severity of
sepsis.
The research strategies used to gather information consisted of predominantly randomized
controlled trials (RCTs) with secondary data such as systematic reviews and meta-analysis in
Running head: FLUID RESUSCITATION
6
quantitative research methods. These studies followed a logical manner with a clear and evident
link beginning with the purpose of the study following through. These sources were objective
with no bias noted in the research studies reviewed, with the exception of Annals of Internal
Medicine and The American Journal of Emergency Medicine. The risk of bias for individual
studies and quality of evidence were assessed and was found within the limitations. These trials
were heterogenous in case mix, fluids evaluated, and duration of fluid exposure. Imprecise
estimates for several comparisons in this network meta-analysis contribute to low confidence in
most estimates of effect (Rochwerg, et al., 2014).
Data was collected in numerous ways however randomized trials was leading. Carlsen & Perner
(2011) consisted of a prospective cohort study of all patients with sepsis or septic shock admitted
in six intensive care units during a three-month period. Patients were divided into two groups
according to the overall median volume of resuscitation fluid administered during the first
twenty-four hours after the diagnosis. Jiang, et al., (2014) consisted of fifteen eligible
randomized controlled trials for analysis. Several predefined subgroup analyses were performed
according to patient age (adult or pediatric), type of resuscitation fluid (crystalloids or gelofusine
or starch), concentration of albumin (4% to 5% solution or 20% to 25% solution), follow-up
interval (intensive care unit mortality, hospital mortality, 28/30 day mortality and ninety day
mortality), disease severity (sepsis, sever sepsis, septic shock), and definition of sepsis. Despite
the subgrouping of this particular study, there was no significant effect of albumin-containing
fluids on mortality in patients with sepsis of any severity. While the difference in mortality
between groups did not reach statistical significance, these findings indicate that 4% to 5%
albumin may be safer than 20% to 25% albumin for fluid resuscitation in patients diagnosed with
Running head: FLUID RESUSCITATION
7
sepsis of any severity. Conclusive to this, further studies are implausible to change the existing
conclusion.
Despite best efforts of research and data collection methods, gaps and inconsistences were
present throughout this review process with indications of observable limitations. Rochwerg, et
al., (2014) trials consisted of heterogenous trials, fluids assessed, extent of exposure, and risk of
bias. These factors have the potential to alter conclusions. Liu, et al., (2019) meta-analysis
comprised of potential limitations. Subgroup and sensitivity analyses were of difficulty to
perform due to lack of data. Patients that were included in this meta-analysis presented with
varying levels of secondary trauma such as acute pancreatitis which resulted in heterogeneity.
There was potential for partial recovery of identified research studies, introducing bias. Carlsen
& Perner (2011) impedes strong conclusions regarding the effects of fluid resuscitation for septic
patients. Gaps for this study includes the lack of timing and rate of fluid infusion assessment by
clinicians. The majority of patients in this research method were given broad-spectrum
antibiotics before the absolute diagnosis, but those who had not received them did not present
with an inferior outcome. Despite the limitations and gaps present, this study was solely
observational in design. Delaney, et al., (2011) consisted of a meta-analysis that presented with
non-optimal methodological quality. The results of this analysis differ from those of previous
meta-analyses of albumin in patients with sepsis or severe sepsis. This method focused on a
specific population rather than heterogenous populations such as others. Jiang, et al., (2014)
meta-analysis presented with heterogeneity between different studies and the methodological
quality of all studies included in this research was adaptable.
Running head: FLUID RESUSCITATION
8
Ethical Concerns
Ethical concerns. There were no present concerns of ethics in the creation and implementation in
any of these reviewed studies. The ethics committee of Copenhagen and the Danish Data
Protection Agency approved the study of Carlsen & Perner, (2011). All other studies were
deemed ethical and declared no conflict of interest.
Conclusion
Strengths. The strength of these reviews is included in a precise clinical question that is limited
to patients with sepsis rather than critically ill patients as a whole. The strength lies in the focus
of resuscitation rather than the maintenance of fluid therapy. Studies consisted of inclusions of
patients in intensive care units and comprised of follow-up with the National Patient Registry
using national patient identification numbers.
Limitations. The patterns of limitations varied between studies reviewed based on population,
study size, demographics and control or subgroups being most prevalent. Despite the present
gaps and inconsistencies in each study, they were efficient in concluding the result of albumin-
containing products versus saline in fluid resuscitation not demonstrating an increase in mortality
rates in patients with sepsis.
Validity and Reliability. The results of all studies reviewed deemed reliable and valid as
indication of highest level of evidence (LOE). All studies presented with strong level I of
evidence excluding Carlsen & Perner, (2011), which consists of LOE II. Studies revealed reliable
as confirmation of strong sources, authors, and year published. Studies supported each other with
aligning evidence and outcomes in relation to albumin versus saline resuscitation in patients with
sepsis.
Running head: FLUID RESUSCITATION
9
Implications. The implications of this research reveal that there is no advantage to administering
albumin versus saline in the reduction of mortality in sepsis patients. Based off of these
conclusions, a sepsis patient can be treated with either available intervention. Factors such as
population, demographic, or available access have no determination in which product is
administered. However, if economic burden is present, the use of crystalloids should be of first
choice due to the cost of albumin-containing products.
Running head: FLUID RESUSCITATION
10
References:
Carlsen, S., & Perner, A. (2011). Initial Fluid Resuscitation of Patients with Septic Shock in the
Intensive Care Unit. ACTA Anaesthesiologica Scandinavica, 394–400. doi:
10.1111/j.1399-6576.2011.02399.x
Delaney, A. P., Dan, A. P., McCaffrey, J. P., & Finfer, S. P. (2011). The Role of Albumin as a
Resuscitation Fluid for Patients with Sepsis: A Systematic Review and Meta-Analysis.
Critical Care Medicine, 39(2), 386–391. doi: 10.1097/CCM.0b013e3181ffe217
Jiang, L., Jiang, S., Zhang, M., Zheng, Z., & Ma, Y. (2014). Albumin Versus Other Fluids for
Fluid Resuscitation in Patients with Sepsis: A Meta-Analysis. PloS One, 1–21. doi:
0.1371/journal.pone.0114666
Liu, C., Lu, G., Wang, D., Lei, Y., Mao, Z., Hu, P., … Zhou, F. (2019). Balanced Crystalloids
Versus Normal Saline for Fluid Resuscitation in Critically Ill Patients: A Systematic
Review and Meta-Analysis with Trial Sequential Analysis. The American Journal of
Emergency Medicine, 37(11), 2072–2078. doi: 10.1016/j.ajem.2019.02.045
Rochwerg, B. H., Alhazzani, W. J., Sindi, A. undefined, Heels-Ansdell , D. undefined, Thabane,
L. undefined, Fox-Robichaud, A. undefined, … Annane, D. undefined. (2014). Fluid
Resuscitation in Sepsis: A Systematic Review and Meta-Analysis. Annals of Internal
Medicine, 1–11. doi: 10.7326/M14-0178
Seccombe, A., McCluskey, L., Moorey, H., Lasserson, D., & Sapey, E. (2019). Assessing Fluid
Resuscitation in Adults with Sepsis Who Are Not Mechanically Ventilated: A Systematic
Review of Diagnostic Test Accuracy Studies. Journal of General Internal Medicine,
1874–1883. doi: 10.1007/s11606-019-05073-9
Running head: FLUID RESUSCITATION
11
Appendix A
Table 1. Summary Evidence Table
Report Citation Design Method Sample Data Collection Data Analysis Validity and
Reliability
Carlsen & Perner
(2011)
To evaluate the
current initial fluid
resuscitation
practice in patients
with septic shock in
the intensive care
unit (ICU) and
patient
characteristics and
outcome associated
with fluid volume.
Prospective
cohort and
observational
study.
Patients with
septic shock
admitted in six
ICUs during a 3-
month period.
One-page case
report form by
the clinician of
the patient in the
specific ICU and
entered into an
Excel data sheet
by a single
research nurse.
Although more
severely shocked
patients received
higher volumes
of crystalloids,
colloids, and
blood products,
mortality did not
differ between
groups.
Level II LOE.
Strong size of
patient groups.
Delaney, et al.
(2011)
To assess whether
resuscitation with
albumin-containing
solutions, compared
to other fluids, is
associated with
lower mortality in
patients with sepsis.
Prospective
randomized
clinical trials
with
quantitative
data synthesis.
Eight studies
including
patients with
sepsis and nine
studies of
patients with
sepsis as a
subgroup.
Two reviewers
independently
extracted data
onto data forms
designed
specifically for
the study; data
was checked for
accuracy by a
third reviewer.
Evidence
suggests
albumin reduces
mortality when
used as a
resuscitation
fluid for patients
with sepsis.
Level I LOE.
Systematic
review and
meta-analysis
with strong
reliability.
Jiang, et al.
(2014)
To evaluate
whether the use of
albumin-containing
fluids for
resuscitation in
Fifteen
randomized
controlled
trials.
Patients with
sepsis of any
severity.
Extraction of all
relevant data
was conducted
by two authors
independently.
The present
meta-analysis
did not
demonstrate
significant
Level I LOE. A
meta-analysis
with strong
reliability.
Running head: FLUID RESUSCITATION
12
patients with sepsis
was associated with
a decreased
mortality rate.
Methodological
quality.
advantage of
using albumin-
containing fluids
for resuscitation
in patients with
sepsis of any
severity.
Liu, et al.
(2019).
To compare the
efficacy and safety
of balanced
crystalloids with
normal saline.
Nine
randomized
controlled trials
were identified.
Methodological
quality of
included trials
was assessed
by two
reviewers
according to
the Cochrane
Risk of Bias
Tool.
Critically ill
patients over the
age of 18
requiring fluid
resuscitation.
Two
independent
reviewers
performed the
data extraction
using a
standardized
form.
Among critically
ill patients
receiving
crystalloid fluid
therapy, the use
of a balanced
crystalloid
compared with
normal saline
did not reduce
the risk of
mortality.
Level I LOE. A
systematic
review and
meta-analysis.
Low risk of
publication bias.
Limited sample
size, >18 years.
Rochwerg, et al.
(2014).
To examine the
effect of different
resuscitative fluids
on mortality in
patients with sepsis.
14 studies
(18,916
patients) with
15 direct
comparisons.
Adult patients
with sepsis or
septic shock.
Two reviewers
extracted data on
study
characteristics,
methods, and
outcomes. Risk
of bias and
quality of
evidence were
assessed.
Among patients
with sepsis,
resuscitation
with balanced
crystalloids or
albumin
compared with
other fluids
seems to be
associated with
Level I LOE. A
systematic
review and
network meta-
analysis.
Risk of bias.
Imprecise
estimates.
Running head: FLUID RESUSCITATION
13
reduced
mortality.
Seccombe, et al.
(2019)
To assess studies of
diagnostic tests that
identify the need
for fluid
resuscitation in
adults with sepsis,
as defined by the
presence of fluid
responsiveness.
594 patients
within 14
studies.
Reported using
PRISMA
guidelines.
Adults with
sepsis without
intensive care
organ support,
who would be
appropriate for
admission to an
acute medical
unit.
Data was
extracted using a
piloted,
standardized
form, following
translation of
non-English
language articles
if required.
Evidence to
support fluid
assessment in
awake adults is
lacking.
Level I LOE. A
systematic
review with high
reliability.
Median sample
size and
primarily single-
centre.
|
You indicated your guiding research question is Can a telemonitoring system lead to decreased hospitalization in elderly patients within a year? You need to write this in a PICO. Please review the list of PICOs on the announcement and submit a problem statement and aim related to it. Write it objective without any “I” statements. To envision it looks at the example integrative review conducted by a former student (Yellow highlighted areas is applicable to assignment 1.2) and the template. |
|
Feedback Date |
|
Mar 5, 2022 2:18 PM |
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
