Draft literature synthesis

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Draft Literature Synthesis

Synthesize at least 10 no more than 5 years old (attached) primary research studies and/or systematic reviews; do not include summary articles. This synthesis should focus on the evidence-based peer-reviewed research articles that support your intervention. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Do not use secondary sources; read the entire article and make your own decision about the level of evidence, quality of the evidence, and applicability to your question. The evidence cited in this section must relate directly to your intervention. This is a synthesis where you address the similarities, differences, and controversies in the body of evidence to support your intervention.

 You will submit the Johns Hopkins Individual Evidence Summary Tool.

The evidence type (study design) is almost always identified in the article abstract or in other cases the methods section of the article. Read through the description of how the study was conducted in the methods section to determine the evidence type.

Level and Type of Evidence: *(For your synthesis Only use Level I, II, OR III Evidence).

I – Experimental (RCT, Systematic review of RCTs with or without meta-analysis)

II – Quasi-experimental (some cohort studies, time series, systematic review of a combination of RCTs and quasi-experimental, or quasi-experimental studies only with or without meta-analysis

III – Non-experimental (mostly: Correlation, cross-sectional, observational studies, case-control, case series, prospective cohort, psychometric instrument testing), systematic review of a combination of RCTs, quasi-experimental, and non-experimental, or non-experimental studies only with or without meta-analysis; Qualitative study or systematic review with or without a meta-synthesis; many higher level qualitative studies include the type of qualitative study that was conducted in the title of the article (phenomenology, ethnography, grounded theory, heuristic study, etc.).

IV- Expert opinion, nationally recognized expert committees/panels based on scientific evidence (clinical practice guidelines and consensus panels

V – Non-research based (experiential) (Literature reviews, Integrative reviews, quality improvement (program or financial evaluation), case reports, opinion of nationally recognized experts based on experiential evidence.

The evidence level:

The evidence level for Level I, II, and III can quickly be determined by asking a few key questions as illustrated on the following website: https://libguides.ohsu.edu/ebptoolkit/levelsofevidence.

Level IV and V are much easier to distinguish. Level IV articles are not very common with the search strategies you should be using.

Level IV involves publications about clinical practice guidelines or position statements from consensus panels.

For Level V evidence articles, the lower level qualitative studies often have the type of project in their title, including narrative model, case study model, case report, and historical model. Literature reviews and Integrative reviews (also Level V) are also easily identified.

Please review your literature appraisal contained in the Johns Hopkins Table for accuracy, and remember, there should be no clinical guidelines, sets of clinical recommendations, nor position statements, placed in your JH Table. Please let me know if you have any questions about how to appraise your evidence sources (articles).

Literature Synthesis Draft

This week a draft of the literature synthesis is due. Please follow the examples below when writing your draft. Please use the literature synthesis table to summarize the manuscripts used to support your evidence-based intervention. The table will be an appendix to your final paper. Consider organizing this section through use of themes inherent in the literature. For example, if you are focusing on falls prevention, organize this section as demonstrated below through use of level II headings such as:

Falls Prevention: Hourly Rounding Process

Falls Prevention: Team Huddles

Falls Prevention: Additional Strategies

The following are the requirements for the literature synthesis and Johns Hopkins Evidence Table as spelled out in the rubric:

Literature Synthesis Requirements:

1. Identifies search strategy utilized to identify sources to include appropriate databases such as CINAHL, Cochrane, and PubMed. Do not use Google Scholar or general search engine. Discusses key words utilized including combination of keywords, total articles found and inclusion/exclusion criteria to narrow search.

2. Synthesizes 10-12 research articles that are Evidence Level 1, 2 or 3 to support your evidence-based intervention. Describe how the intervention has been utilized to solve a similar problem by defining common themes found in the literature.

3. References are less than 5 years old (unless seminal) and professional. PermaLink of all articles is attached.

Literature synthesis table:

1. Completed with evidence level and quality (High, Good, Low or major flaws) identified for each article, including the appropriate appraisal of the level of evidence.

2. Identifies appropriate study design (levels I, II, OR III).

3. Accurately assesses how the article can inform the project. If the article does not inform the project, then it should not be used.

These are possible references to use (from the DNP proposal). No clinical guidelines or articles do not inform evidence that can’t be used. Feel free to use it or add anyone that you found pertinent.

References

Arocha Rodulfo J. I. (2019). Sedentary lifestyle a disease from xxi century. Sedentarismo, la enfermedad del siglo XXI. Clínica e investigación en arteriosclerosis: publicación oficial de la Sociedad Española de Arteriosclerosis, 31(5), 233–240. https://doi.org/10.1016/j.arteri.2019.04.004

Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C. (2019). Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity. Journal of the American Association of Nurse Practitioners, 31(9), 505–510. https://doi.org/10.1097/JXX.0000000000000169

Bergum, H., Sandven, I., & Klemsdal, T. (2021). Long-term effects (>24 months) of multiple lifestyle interventions on major cardiovascular risk factors among high-risk subjects: A meta-analysis. BMC Cardiovascular Disorders, 21(1). https://doi.org/10.1186/s12872-021-01989-5

Bray, G. A., & Ryan, D. H. (2021). Evidence-based weight-loss interventions: Individualized treatment options to maximize patient outcomes. Diabetes, obesity & metabolism, 23 Suppl 1, 50–62. https://doi.org/10.1111/dom.14200

Brickwood, K. J., Watson, G., O’Brien, J., & Williams, A. D. (2019). Consumer-based wearable activity trackers increase physical activity participation: Systematic review and meta-analysis. JMIR mHealth and uHealth, 7(4), e11819. https://doi.org/10.2196/11819

Carbone, S., Lavie, C. J., Elagizi, A., Arena, R., & Ventura, H. O. (2020). The impact of obesity on heart failure. Heart Failure Clinics, 16(1), 71–80. https://doi.org/10.1016/j.hfc.2019.08.008

Følling, I. S., Oldervoll, L. M., Hilmarsen, C., & Ersfjord, E. (2021). A qualitative study explores the use of activity monitors for patients with obesity during weight-loss treatment. BMC sports science, medicine & rehabilitation, 13(1), 25. https://doi.org/10.1186/s13102-021-00253-9

Gal, R., May, A., van Overmeeren, E., Simons, M., & Monninkhof, E. (2018). The effect of physical activity interventions comprising wearables and smartphone applications on physical activity: A systematic review and meta-analysis. Sports Med Open, 4(1). https://doi.org/10.1186%2Fs40798-018-0157-9

Hall, K. D., & Kahan, S. (2018). Maintenance of Lost Weight and Long-Term Management of Obesity. The Medical clinics of North America102(1), 183–197. https://doi.org/10.1016/j.mcna.2017.08.012

Hu, L., Illiano, P., Pompeii, M. L., Popp, C. J., Kharmats, A. Y., Curran, M., Perdomo, K., Chen, S., Bergman, M., Segal, E., & Sevick, M. A. (2021). Challenges of conducting a remote behavioral weight loss study: Lessons learned and a practical guide. Contemporary Clinical Trials, 108, 106522. https://doi.org/10.1016/j.cct.2021.106522

Lavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T., & Blair, S. N. (2019). Sedentary behavior, exercise, and cardiovascular health. Circulation Research, 124(5), 799–815. https://doi.org/10.1161/CIRCRESAHA.118.312669

Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., Ross, H. M., McIlvenna, Y., Stefanetti, R., Trenell, M., … Taylor, R. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomized trial. Lancet (London, England), 391(10120), 541-551. https://doi.org/10.1016/S0140-6736(17)33102-1

Prabhakar, O., & Bhuvaneswari, M. (2021). Role of diet and lifestyle modification in managing nonalcoholic fatty liver disease and type 2 diabetes. Tzu Chi Medical Journal, 33(2), 135-145. https://www.tzuchi.com.tw/medjnl/files/2021/vol-33-2/2021-33-2-135-145.pdf

Swift, D., McGee, J., Earnest, C., Carlisle, E., Nygard, M., & Johannsen, N. (2018). The Effects of Exercise and Physical Activity on Weight Loss and Maintenance. Progress in Cardiovascular Diseases, 61(2), 206-213. https://doi.org/10.1016/j.pcad.2018.07.014 Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235–251. https://doi.org/10.1037/amp0000517

Vandelanotte C, Duncan M, Maher C, Schoeppe S, Rebar A, Power D, Short C, Doran C, Hayman M, Alley S. (2018). The effectiveness of a web-based computer-tailored physical activity intervention using Fitbit activity trackers: Randomized trial. Journal of Medical Internet Research. https://www.jmir.org/2018/12/e11321?rel=0

Example Template for Literature Synthesis Paper due Week 4:

Hi all,

I have had several good conversations with some of you regarding how to pull together your Lit. Synthesis. To make things easier, here is an additional template outline I can suggest which meets all criteria in the grading rubric. I would suggest working on your JH table first, so that you are immersed in all the results, and then writing your paper.

Very Important: Be sure that you have a core of at least 8 studies in your JH Table that are Level 1, 2 or 3 per the JH Appraisal definitions; then 2 additional studies may be qualitative studies, for a total of 10 core studies to support your work. In addition, of course, you will have any clinical guidelines you are following as additional references, and perhaps some CDC, HRSA, AHRQ, ADA, AAP, or other professional body type of references, but these should not be listed in your JH Table.

Here is an example:

                                        Title Page (comes first) – full page

Implementation of a Type 1 Diabetes Support Group in a High School Setting

                                                Student Name

                                      Course Number & Name

                                       Etc. Per APA title page

Top of next page:

                                           Literature Synthesis

  Implementation of a Type 1 Diabetes Support Group in a High School Setting 

Introduction (left-aligned)

          This is the problem statement similar to your Project Navigation form, a paragraph or two here is fine…………….Why do teens with T1DM need support groups? Why is your project important?

PICOT  (restate PICOT here)       

          In school aged students grades 9-12 with Type 1 Diabetes, what is the impact of a peer support group for Type 1 Diabetic Students on improving their self-management of diabetes as measured by the Type 1 Diabetes Self-Management Questionnaire (DSMQ) compared with those without a school support system over a 10-week period?

Search Methodology

            Description of your search method, criteria, search terms and results go here (refined from DB #2).

 

Review of the Literature (this is the main section)

 

Type 1 Diabetes and It’s Impact on High School Students (Subheading 1) (Make this first subheading a logical pick that you will build upon with the next subheadings; i.e., if several research teams found common issues that drive the current problem in particular, start with that subheading topic; be sure for each section and for each sentence, that you cite multiple ref.s appropriately in parentheses at the end; using this style improves flow rather than trying to begin all your sentences with authors’ names).

           

          Start with a very broad, “juicy” topic sentence based on similar results or commonalities from multiple studies; An example topic sentence for the first paragraph is from my talk with Ashley, here is the brainstorm: “Based on a review of the literature, several studies revealed that teens with type 1 diabetes (TID) often feel bullied or excluded from activities at school.” Then go on to discuss and summarize all the similar results and outcomes from these studies in successive sentences, and then also any unique results from perhaps just 1 or 2 studies. [This is what you would call a “Problem” subheading]

 

Potential Benefits of Support Groups (Subheading 2) (Introduce the next logical subtopic here): 

           Start with another very broad, “juicy” topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: “There are many benefits to the implementation of support groups that have been reported for teens with TID and other illnesses to help them adjust well and feel more included at school.” Then go on to discuss and summarize all the similar results from this group of studies with similar results in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution subheading]

 

Parents of T1D Students Need Support Too (Subheading 3) (Introduce the next logical subtopic here): 

            Start with another very broad, “juicy” topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: “In addition to the need to support teens who have been diagnosed with TID and who are feeling excluded and unsure about self-management of their diabetes, several studies have revealed that parents of children with TID also need to be heard and supported in regard to learning how to support their teen in self-managing their TID at school.” Then go on to discuss and summarize all the similar results from this group of studies in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution subheading]

Anywhere from 2 – 4 subheadings is likely to suffice for your paper, depending on the evidence you have found 🙂

Then — 

Conclusions

          Wrap up your findings in broad strokes and finish with mentioning the intervention you will implement to address these evidence-based issues and concerns.

Note that this will then flow beautifully into your next paper, which is your Week 5 Assignment:

               Evidence-Based Intervention

 Ok, to be continued for your next paper — I hope this outline is helpful!

Literature Synthesis (Previous work).

Student

University

NR

July 12, 2022

 

 

 

 

 

 

 

 

 

Literature Synthesis

Introduction

Obesity is a chronic condition linked to multiple public health concerns causing higher mortality and morbidity rates (WHO, 2021). Evidence-based studies by several experts have recently revealed that diet, lifestyle changes, and physical activity are practical body weight management approaches that can significantly impact patients’ health outcomes (Bray & Ryan, 2020; Brickwood et al., 2019; Følling et al., 2021).

PICOT question:

In overweight adult patients in a primary care clinic, what is the impact of implementing the American Heart Association Diet and Lifestyle recommendations, compared to standard care, on body weight in 8-10 weeks?

Research Methodology

           The literature search focused on key concepts related to obesity complications, diet, lifestyle changes, physical activity intervention using Fitbit activity trackers, and physical activity benefice for patients. These major topic areas were obesity self-management, obesity management and care in primary care, and the standards of care for obesity.

Keywords and Search Terms

Simple Terms:

Obesity care

Obesity complications

Lifestyle recommendations

Obesity management

Physical activity intervention using Fitbit activity trackers

 

Boolean Terms:

Obesity AND Diet and Lifestyle recommendations

Obesity care management AND Obesity complications

Body weight reduction AND Diet and Lifestyle recommendations

Physical activity intervention using Fitbit activity trackers AND obesity self-management

Diet and Lifestyle recommendations AND primary care

Methodology of Search

Research studies done during the previous 5-6 years were included in the search criteria. Chamberlain Library, PubMed, Google Scholar, and CINHAL were among the databases searched. Initial searches yielded over 25000 articles, of which 47 were chosen and examined because they fit the project’s theme and supplied data to support the practice problem. The first 47 papers were filtered down to a group of 12 studies that were the most relevant to the specific PICOT query. These 12 papers were studied in further detail and then appraised using the Johns Hopkins Evidence Appraisal table.

Resources Discovered

Twelve papers were chosen for their relation to the areas listed by the PICOT question. All articles selected were highly scored based on the search keywords and Boolean keyword searches. Multiple database searches were conducted using similar, if not identical, search phrases, and the final list was amalgamated.

Review of the Literature

 Based on a review of the literature, diet, lifestyle changes, physical activities, and activity trackers impact weight loss outcomes (Bray & Ryan, 2020; Brickwood et al., 2019; Følling et al., 2021). Researchers note that physical activities have short-term impacts; they emphasize the need for individualized programs tailored to individual needs for better outcomes and state that wearable trackers can enhance the effects of physical activities and help sustain the change, making it more effective (Brickwood et al., 2019; Følling et al., 2021).

The quantity of weight lost varies significantly across all weight loss methods, including drugs and surgery. According to research by Bray and Ryan, 2020, around 5% of weight reduction may be linked to lifestyle changes, and sustainable lifestyle modifications are more successful than unsustainable ones. Research reveals that lifestyle changes contribute significantly to weight loss, and it is more effective when accompanied by other weight-reduction programs like activity monitors/trackers that determine the effectiveness of the change by either strengthening or undermining the ability of the patient to change (Bray & Ryan, 2020; Følling et al., 2021). Weight-reduction programs for patients with obesity are more effective when combined healthy diet, lifestyle changes, and physical activities.

References

Bray, G. A., & Ryan, D. H. (2021). Evidence-based weight-loss interventions: Individualized treatment options to maximize patient outcomes. Diabetes, obesity & metabolism23 Suppl 1, 50–62. 
https://doi.org/10.1111/dom.14200Links to an external site.

Brickwood, K. J., Watson, G., O’Brien, J., & Williams, A. D. (2019). Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis. JMIR mHealth and uHealth, 7(4), e11819. 
https://doi.org/10.2196/11819Links to an external site.

Følling, I. S., Oldervoll, L. M., Hilmarsen, C., & Ersfjord, E. (2021). A qualitative study explores the use of activity monitors for patients with obesity during weight-loss treatment. BMC sports science, medicine & rehabilitation13(1), 25. 
https://doi.org/10.1186/s13102-021-00253-9Links to an external site.

Obesity. (2021, June 9). WHO | World Health Organization. 
https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesityLinks to an external site.

 Comment from the professor

Hi student,

This is a very good Intro and Search Methodology! For your Review of the Literature section, do you have a few more studies to synthesize so that there are at least 2 themes for you to discuss in 2 different paragraphs?

For example, are you able to initially focus simply on weight loss and lifestyle modifications in general and these types of study outcomes in your first paragraph? Then, for your second paragraph, you could describe how another group of studies where trackers were used revealed even more favorable results for weight loss, and what those results were in % weight loss, e.g.? How were these tracker studies’ results better than more basic weight loss studies?

I would suggest teasing these differences out a bit more so that you have 2 well-developed paragraphs based on these 2 different themes. You may need to delve into your studies further, and/or find a few studies that evaluated weight loss in general through healthy lifestyle modifications.

Also, you make a statement about the following study: “According to research by Bray and Ryan, 2020, around 5% of weight reduction may be linked to lifestyle changes…”. If this is the case, what do they attribute the other 95% of their participants’ weight loss to for their study? Were they on medication, or was this one of the “tracker” studies? Or something else? It will be fascinating to learn more about your topic, as weight loss is such a huge challenge for many folks across the U.S. and globally!

Keep working on this and reflecting on your studies, and perhaps locate a few more general weight loss studies if you need to, to be able to compare to the “tracker” studies and their results 🙂

Hope this is helpful!

Use of American Heart Association Diet and Lifestyle Recommendations to Promote Healthy Behaviors

Student Name

Course Number & Name

Etc. Per APA title page

                                           Literature Synthesis

 

Use of American Heart Association Diet and Lifestyle Recommendations to Promote Healthy Behaviors

          Obesity represents a common but preventable cause of morbidity and severe medical complications. Despite efforts to curb the issue, globally, the annual cases of obesity continue to rise. Obesity has reached epidemic proportions worldwide, negatively affecting people’s health status (Carbone et al., 2022). Internal clinical reports at the practicum site reveal a significant increase in obese patients. Physical activity is advised to minimize the risk of chronic diseases such as diabetes, cardiovascular disease, and cancer. According to the literature, it is common to find patients with a sedentary lifestyle and physical inactivity. Still, wearables and smartphone apps provide new ways to improve physical activity habits (Gal et al., 2018). The easy availability of sophisticated activity trackers such as Fitbit offers a unique opportunity to enhance the efficacy of computer-tailored interventions. These advanced activity trackers can monitor steps, heart rate, energy expenditure, sleep, sedentary behavior, and physical activity intensity (Vandelanotte et al., 2018). The evidence-based intervention for the current project is the American Heart Association Diet and Lifestyle Recommendations (Bray et al., 2019). These evidence-based recommendations focus on knowing how many calories an individual should be eating and drinking to reduce body weight and aiming for at least 150 minutes of moderate physical activity, or 75 minutes of vigorous physical exercise, or an equivalent combination of both, each week (Arnett et al., 2019).

PICOT       

          In overweight adult patients in a primary care clinic, what is the impact of implementing the American Heart Association Diet and Lifestyle recommendations, compared to current practice, on body weight in 8-10 weeks?

Search Methodology

            The literature search focused on key concepts related to obesity complications, diet, lifestyle changes, physical activity intervention using Fitbit activity trackers, and physical activity benefice for patients. These major topic areas were obesity self-management, obesity management and care in primary care, and the standards of care for obesity.

Keywords and Search Terms

Simple Terms:

Obesity care

Obesity complications

Lifestyle recommendations

Obesity management

Physical activity intervention using Fitbit activity trackers

Boolean Terms:

Obesity AND Diet and Lifestyle recommendations

Obesity care management AND Obesity complications

Body weight reduction AND Diet and Lifestyle recommendations

Physical activity intervention using Fitbit activity trackers AND obesity self-management

Diet and Lifestyle recommendations AND primary care

Methodology of Search

Research studies done during the previous 5-6 years were included in the search criteria. Chamberlain Library, PubMed, Google Scholar, and CINHAL were among the databases searched. Initial searches yielded over 25000 articles, of which 47 were chosen and examined because they fit the project’s theme and supplied data to support the practice problem. The first 47 papers were filtered down to a group of 12 studies that were the most relevant to the specific PICOT query. These 12 papers were studied in further detail and then appraised using the Johns Hopkins Evidence Appraisal table.

Resources Discovered

Twelve papers were chosen for their relation to the areas listed by the PICOT question. All articles selected were highly scored based on the search keywords and Boolean keyword searches. Multiple database searches were conducted using similar, if not identical, search phrases, and the final list was amalgamated.

Review of the Literature (this is the main section)

 

Obesity and Its Impact on patient health (Subheading 1) (Make this first subheading a logical pick that you will build upon with the next subheadings; i.e., if several research teams found common issues that drive the current problem in particular, start with that subheading topic; be sure for each section and for each sentence, that you cite multiple ref.s appropriately in parentheses at the end; using this style improves flow rather than trying to begin all your sentences with authors’ names).    

          Based on a review of the literature, several studies revealed that obesity is a prevalent yet avoidable contributor to morbidity and serious chronic diseases.” Then go on to discuss and summarize all the similar results and outcomes from these studies in successive sentences, and then also any unique results from perhaps just 1 or 2 studies. [This is what you would call a “Problem” subheading]

Potential Benefits of Healthy Diet and Lifestyle Modifications (Subheading 2) (Introduce the next logical subtopic here): 

           Start with another very broad, “juicy” topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: Healthy diet and lifestyle modifications promote healthy behaviors and contribute to reducing obesity, and patients who loosed weight have been reported to feel more healthy.” Then go on to discuss and summarize all the similar results from this group of studies with similar results in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution *(to the problem obesity) subheading]

 

Parents of T1D Students Need Support Too (Subheading 3) (Introduce the next logical subtopic here): 

            Start with another very broad, “juicy” topic sentence based on similar results or commonalities from multiple studies; Next example brainstorm: “In addition to the need to support teens who have been diagnosed with TID and who are feeling excluded and unsure about self-management of their diabetes, several studies have revealed that parents of children with TID also need to be heard and supported in regard to learning how to support their teen in self-managing their TID at school.” Then go on to discuss and summarize all the similar results from this group of studies in successive sentences, and then also any unique results from perhaps just 1-2 studies. [Solution subheading]

Anywhere from 2 – 4 subheadings is likely to suffice for your paper, depending on the evidence you have found 🙂

Then — 

Conclusions

          Wrap up your findings in broad strokes and finish with mentioning the intervention you will implement to address these evidence-based issues and concerns.

Note that this will then flow beautifully into your next paper, which is your Week 5 Assignment:

               Evidence-Based Intervention

 Ok, to be continued for your next paper — I hope this outline is helpful!

References

Bray, G. A., & Ryan, D. H. (2021). Evidence-based weight-loss interventions: Individualized treatment options to maximize patient outcomes. Diabetes, obesity & metabolism, 23 Suppl 1, 50–62. https://doi.org/10.1111/dom.14200Links to an external site.

Brickwood, K. J., Watson, G., O’Brien, J., & Williams, A. D. (2019). Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis. JMIR mHealth and uHealth, 7(4), e11819. https://doi.org/10.2196/11819Links to an external site.

Følling, I. S., Oldervoll, L. M., Hilmarsen, C., & Ersfjord, E. (2021). A qualitative study explores the use of activity monitors for patients with obesity during weight-loss treatment. BMC sports science, medicine & rehabilitation, 13(1), 25. https://doi.org/10.1186/s13102-021-00253-9Links to an external site.

Obesity. (2021, June 9). WHO | World Health Organization. https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesityLinks to an external site.

Draft Literature Synthesis

Purpose

The purpose of this assignment is to synthesize the literature that supports the evidence-based intervention for the quality improvement project.

Preparing the Assignment

Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.

Synthesize at least 10 (no more than 5 years old) primary research studies and/or systematic reviews; do not include summary articles. This synthesis should focus on the evidence-based peer-reviewed research articles that support your intervention. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Do not use secondary sources; read the entire article and make your own decision about the level of evidence, quality of the evidence, and applicability to your question. The evidence cited in this section must relate directly to your intervention. This is a synthesis where you address the similarities, differences, and controversies in the body of evidence to support your intervention.

The Johns Hopkins Individual Evidence Summary Tool and the Johns Hopkins Research Evidence Appraisal Tool are located in the Student Resource Center.  You will be submitting the Johns Hopkins Individual Evidence Summary Tool with this assignment.

Consider organizing this section through use of themes inherent in the literature. For example, if you are focusing on falls prevention, organize this section as demonstrated below through use of level II headings.

Falls Prevention: Hourly Rounding Process

Falls Prevention: Team Huddles

Falls Prevention: Additional Strategies

The following are the requirements for the literature synthesis and Johns Hopkins Evidence Table as spelled out in the rubric:

Literature Synthesis Requirements:

1. Identifies search strategy utilized to identify sources to include appropriate databases such as CINAHL, Cochrane, and PubMed. Do not use Google Scholar or general search engine. Discusses key words utilized including combination of keywords, total articles found and inclusion/exclusion criteria to narrow search.

2. Synthesizes 10-12 research articles that are Evidence Level 1, 2 or 3 (unless faculty approved) to support evidence-based intervention. Describe how the intervention has been utilized to solve a similar problem by defining common themes found in the literature.

3. References are less than 5 years old (unless seminal) and professional. PermaLink of all articles is attached.

Literature synthesis table:

1. Completed with evidence level and quality (High, Good, Low or major flaws) identified for each article, including appropriate appraisal of the level of evidence.

2. Identifies appropriate study design.

3. Accurately assesses how the article can inform the project. If article does not inform the project, then it should not be used.

Clarity of Writing

1. Use of standard English grammar and sentence structure.

2. No spelling errors or typographical errors.

3. Organized around the required components using appropriate headers.

APA Formatting/References

All information taken from another source, even if summarized, must be appropriately cited in the manuscript and listed in the references using APA (current edition of the APA manual) format.

1. Document setup

2. Title and reference pages

3. Citations in the text and references

Practice Question:

Date:

Article Number

Author and Date

Evidence Type

Sample, Sample Size, Setting

Findings That Help Answer the EBP Question

Observable Measures

Limitations

Evidence Level, Quality

· N/A

· N/A

· N/A

· N/A

· N/A

· N/A

· N/A

Attach a reference list with full citations of articles reviewed for this Practice question.

Johns Hopkins Nursing Evidence-Based Practice

Appendix G: Individual Evidence Summary Tool

The Johns Hopkins Hospital/ The Johns Hopkins University

1

Directions for Use of the Individual Evidence Summary Tool

Purpose

This form is used to document the results of evidence appraisal in preparation for evidence synthesis. The form provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence.

Article Number

Assign a number to each reviewed source of evidence. This organizes the individual evidence summary and provides an easy way to reference articles.

Author and Date

Indicate the last name of the first author or the evidence source and the publication/communication date. List both author/evidence source and date.

Evidence Type

Indicate the type of evidence reviewed (for example: RCT, meta-analysis, mixed methods, quaLitative, systematic review, case study, narrative literature review).

Sample, Sample Size, and Setting

Provide a quick view of the population, number of participants, and study location.

Findings That Help Answer the EBP Question

Although the reviewer may find many points of interest, list only findings that directly apply to the EBP question.

Observable Measures

QuaNtitative measures or variables are used to answer a research question, test a hypothesis, describe characteristics, or determine the effect, impact, or influence. QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to represent the phenomenon of study.

Limitations

Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you, as you review the evidence, that an important point is missed or the sample does not apply to the population of interest.

Evidence Level and Quality

Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column.

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Evidence level and quality rating:

Article title: Number:

Author(s): Publication date:

Journal:

Setting: Sample (composition and size):

Does this evidence address my EBP question?

Yes

No-Do not proceed with appraisal of this evidence

Is this study:

QuaNtitative (collection, analysis, and reporting of numerical data)

Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in

research, and generalize results from a larger sample population; provides observed effects of a

program, problem, or condition, measured precisely, rather than through researcher interpretation of

data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of

records or documents. Statistical tests are used in data analysis.

Go to Section I: QuaNtitative

QuaLitative (collection, analysis, and reporting of narrative data)

Rich narrative documents are used for uncovering themes; describes a problem or condition from the

point of view of those experiencing it. Common methods are focus groups, individual interviews

(unstructured or semi structured), and participation/observations. Sample sizes are small and are

determined when data saturation is achieved. Data saturation is reached when the researcher identifies

that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a

starting point for studies when little research exists; may use results to design empirical studies. The

researcher describes, analyzes, and interprets reports, descriptions, and observations from participants.

Go to Section II: QuaLitative

Mixed methods (results reported both numerically and narratively)

Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in

combination, provides a better understanding of research problems than using either approach alone.

Sample sizes vary based on methods used. Data collection involves collecting and analyzing both

quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and

can influence stages in the research process.

Go to Section III: Mixed Methods

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Section I: QuaNtitative

Level of Evidence (Study Design)

Is this a report of a single research study?  Yes  No

Go to B

1. Was there manipulation of an independent variable?
 Yes  No

2. Was there a control group?
 Yes  No

3. Were study participants randomly assigned to the intervention
and control groups?  Yes  No

If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or
experimental study.

LEVEL I

If Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and
No to questions 2 and 3, this is quasi-experimental.
(Some degree of investigator control, some manipulation of an independent variable,
lacks random assignment to groups, and may have a control group).

LEVEL II

If No to questions 1, 2, and 3, this is nonexperimental.
(No manipulation of independent variable; can be descriptive, comparative, or
correlational; often uses secondary data).

LEVEL III

Study Findings That Help Answer the EBP Question

Skip to the Appraisal of QuaNtitative Research Studies section

A

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Section I: QuaNtitative (continued)

Is this a summary of multiple sources of research

evidence?
 Yes

Continue

 No

Use Appendix F

1. Does it employ a comprehensive search strategy and rigorous
appraisal method?

If this study includes research, nonresearch, and experiential
evidence, it is an integrative review (see Appendix F).

 Yes

Continue

 No

Use Appendix F

2. For systematic reviews and systematic reviews with meta-analysis

(see descriptions below):

a. Are all studies included RCTs? LEVEL I

b. Are the studies a combination of RCTs and quasi-experimental,

or quasi-experimental only?
LEVEL II

c. Are the studies a combination of RCTs, quasi-experimental, and

nonexperimental, or non- experimental only?
LEVEL III

A systematic review employs a search strategy and a rigorous appraisal method, but does not

generate an effect size.

A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from

studies to generate a new statistic: the effect size.

Study Findings That Help Answer the EBP Question

Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section

B

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Appraisal of QuaNtitative Research Studies

Does the researcher identify what is known and not known
about the problem and how the study will address any gaps in
knowledge?

 Yes  No

Was the purpose of the study clearly presented?
 Yes  No

Was the literature review current (most sources within the past
five years or a seminal study)?  Yes  No

Was sample size sufficient based on study design and rationale?
 Yes  No

If there is a control group:

 Were the characteristics and/or demographics similar in
both the control and intervention groups?

 Yes  No

N/A

 If multiple settings were used, were the settings
similar?  Yes  No

N/A

 Were all groups equally treated except for the
intervention group(s)?  Yes  No

N/A

Are data collection methods described clearly?
 Yes  No

Were the instruments reliable (Cronbach’s [alpha] > 0.70)?
 Yes  No N/A

Was instrument validity discussed?
 Yes  No N/A

If surveys or questionnaires were used, was the response
rate > 25%?  Yes  No

N/A

Were the results presented clearly?
 Yes  No

If tables were presented, was the narrative consistent with the
table content?  Yes  No

N/A

Were study limitations identified and addressed?
 Yes  No

Were conclusions based on results?
 Yes  No

Complete the Quality Rating for QuaNtitative Studies section

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Appraisal of Systematic Review (With or Without Meta-Analysis)

Were the variables of interest clearly identified?
 Yes  No

Was the search comprehensive and reproducible?

 Key search terms stated  Yes  No

 Multiple databases searched and identified
 Yes  No

 Inclusion and exclusion criteria stated
 Yes  No

Was there a flow diagram that included the number of studies eliminated
at each level of review?  Yes  No

Were details of included studies presented (design, sample, methods,
results, outcomes, strengths, and limitations)?  Yes  No

Were methods for appraising the strength of evidence (level and quality)
described?  Yes  No

Were conclusions based on results?
 Yes  No

 Results were interpreted
 Yes  No

 Conclusions flowed logically from the interpretation and systematic
review question  Yes  No

Did the systematic review include a section addressing limitations and
how they were addressed?  Yes  No

Complete the Quality Rating for QuaNtitative Studies section (below)

Quality Rating for QuaNtitative Studies

Circle the appropriate quality rating below:

A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate
control; definitive conclusions; consistent recommendations based on comprehensive literature review
that includes thorough reference to scientific evidence.

B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control,
and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive
literature review that includes some reference to scientific evidence.

C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the
study design; conclusions cannot be drawn.

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Section II: QuaLitative

Level of Evidence (Study Design)

Is this a report of a single research study?

 Yes
this is
Level III

 No
go to II B

Study Findings That Help Answer the EBP Question

Complete the Appraisal of Single QuaLitative Research Study section (below)

Appraisal of a Single QuaLitative Research Study

Was there a clearly identifiable and articulated:

 Purpose?
❑ Yes ❑ No

 Research question? ❑ Yes ❑ No

 Justification for method(s) used? ❑ Yes ❑ No

 Phenomenon that is the focus of the research? ❑ Yes ❑ No

Were study sample participants representative? ❑ Yes ❑ No

Did they have knowledge of or experience with the research area? ❑ Yes ❑ No

Were participant characteristics described? ❑ Yes ❑ No

Was sampling adequate, as evidenced by achieving saturation of data? ❑ Yes ❑ No

Data analysis:

 Was a verification process used in every step by checking and confirming
with participants the trustworthiness of analysis and interpretation?

❑ Yes

❑ No

 Was there a description of how data were analyzed (i.e., method), by
computer or manually?

❑ Yes ❑ No

Do findings support the narrative data (quotes)? ❑ Yes ❑ No

Do findings flow from research question to data collected to analysis undertaken? ❑ Yes ❑ No

Are conclusions clearly explained? ❑ Yes ❑ No

A

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Skip to the Quality Rating for QuaLitative Studies section

For summaries of multiple quaLitative research studies

(meta-synthesis), was a comprehensive search strategy and

rigorous appraisal method used?

 Yes
Level III

 No
go to Appendix F

Study Findings That Help Answer the EBP Question

Complete the Appraisal of Meta-Synthesis Studies section (below)

Appraisal of Meta-Synthesis Studies

Were the search strategy and criteria for selecting primary studies clearly defined? ❑ Yes ❑ No

Were findings appropriate and convincing? ❑ Yes ❑ No

Was a description of methods used to:
 Compare findings from each study?

❑ Yes ❑ No

 Interpret data? ❑ Yes ❑ No

Did synthesis reflect: ❑ Yes ❑ No

 New insights? ❑ Yes ❑ No

 Discovery of essential features of phenomena? ❑ Yes ❑ No

 A fuller understanding of the phenomena? ❑ Yes ❑ No

Was sufficient data presented to support the interpretations? ❑ Yes ❑ No

Complete the Quality Rating for QuaLititative Studies section (below)

B

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALIT ATIVE_RESEARCH.htm
2 Adapted from Polit & Beck (2017).

Quality Rating for QuaLitative Studies

Circle the appropriate quality rating below:

No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective

process based on the extent to which study data contributes to synthesis and how much information is

known about the researchers’ efforts to meet the appraisal criteria.

For meta-synthesis, there is preliminary agreement that quality assessments should be made before
synthesis to screen out poor-quality studies1.

A/B High/Good quality is used for single studies and meta-syntheses2.

The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in

sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry.

Evidence of some or all of the following is found in the report:

 Transparency: Describes how information was documented to justify decisions, how data were
reviewed by others, and how themes and categories were formulated.

 Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple
sources to corroborate evidence.

 Verification: The process of checking, confirming, and ensuring methodologic coherence.

 Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences,
background, or prejudices might shape and bias analysis and interpretations.

 Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and
interpretation give voice to those who participated.

 Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature.

C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the

features listed for High/Good quality.

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

Section III: Mixed Methods

Level of Evidence (Study Design)

You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before
appraising the study in its entirety.

1. Evaluate the quaNitative part of the study using Section I. Level Quality

Insert here the level of evidence and overall quality for this part:

2. Evaluate the quaLitative part of the study using Section II. Level Quality

Insert here the level of evidence and overall quality for this part:

3. To determine the level of evidence, circle the appropriate study design:

 Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their
purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the
level of the quaNtitative part.

 Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their
purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on
the level of the quaLitative part, and it is always Level III.

 Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of
providing a more complete understanding of a phenomenon by merging both datasets. These designs are
Level III.

 Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each
phase informing the next phase. These designs are Level III.

Study Findings That Help Answer the EBP Question

Complete the Appraisal of Mixed Methods Studies section (below)

Johns Hopkins Nursing Evidence-Based Practice

Appendix E
Research Evidence Appraisal Tool

©2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studie s included in Mixed Studies Reviews: The MMAT.
Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/ resources/search/232

Appraisal of Mixed Methods Studies3

Was the mixed-methods research design relevant to address the quaNtitative

and quaLitative research questions (or objectives)?
❑ Yes ❑ No ❑ N/A

Was the research design relevant to address the quaNtitative and quaLitative

aspects of the mixed-methods question (or objective)?
❑ Yes ❑ No ❑ N/A

For convergent parallel designs, was the integration of quaNtitative and

quaLitative data (or results) relevant to address the research question or

objective?

❑ Yes ❑ No ❑ N/A

For convergent parallel designs, were the limitations associated with the

integration (for example, the divergence of quaLitative and quaNtitative data or

results) sufficiently addressed?

❑ Yes ❑ No ❑ N/A

Complete the Quality Rating for Mixed-Method Studies section (below)

Quality Rating for Mixed-Methods Studies

Circle the appropriate quality rating below

A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant
study design; relevant integration of data or results; and careful consideration of the limitations of the
chosen approach.

B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study
design; moderately relevant integration of data or results; and some discussion of limitations of
integration.

C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components;
study design not relevant to research questions or objectives; poorly integrated data or results; and no
consideration of limits of integration.

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