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Synthesis of the Literature

Synthesis of the Literature

Synthesis of the Literature

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Synthesize your final primary quantitative research studies and/or systematic reviews; do not include summary articles such as a review of the literature, a clinical article, or a clinical practice guidelines. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Refer the reader to your evidence table(s).  See Table 1 and 2. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. The studies that you cite in this section must relate directly to your PICOT question. This is a synthesis(Table 3) rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

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Practice Recommendations

So. . . using available best evidence, what is the answer to your question? This section is for you to summarize the strength of the body of evidence (quality, quantity, and consistency), make a synthesis statement, and, based on your conclusions drawn from your review of the body of evidence related to your clinical question, give a recommendation for practice change. This would logically be the intervention of your PICOT question. You might want to design an algorithm and include it in as a figure. Perhaps you found substantiation for usual practice, and you recommend reinforcement and education regarding this best practice.Using Johns Hopkins, identify whether this recommendation be graded A, B, or C based on the strength of the evidence. Synthesis of the Literature

 

References

Remember that this is a reference list rather than a bibliography. A bibliography is everything you read to prepare the paper but a reference list is only what you cited. If there is not a citation for a reference, it should not be here. PLEASE make sure that your references and your citations throughout the paper are in APA format. You can go from an A paper to a B paper on APA errors alone. Take the time to make sure that they are correct. We have already formatted the paper for you with this template. Synthesis of the Literature

 

Table 1

Primary Quantitative Research Evidence (this table may be single space and 10-point font; ONLY primary quantitative research articles should be in this table)Example provided. Synthesis of the Literature

Source Study design

 

JH Level of Evidence

Population/

Sample

 

Age
Race/ Ethnicity

Setting/
Location

% dropout

Intervention (IV)

 

Details

Action

Duration
Fidelity

Comparison/ Control (IV)

Details

Action

Duration

Fidelity

Outcome (DV) &Time

Intervention vs comparison

(statistical test, value, p value)

 

 

Grading of evidence

JH Quality Rating

Author’s conclusions

———–

Other outcomes of interest

Your Conclusions

Limitations

Fit/Useful
Abel, 2020 RCT

 

Level I

 

196  inter-city

Age 36.4 (8.9) [Range 24 – 49]

55% Male,

40% Black,

62% Latino

 

73% Medicaid, annual income <$25,000

Setting: Outpatient

Location: Boston, MA

Baseline pain score 6.4 avg on both groups

Dropout: 15/200, 7.5%

Weekly chiropractic adjustment

Assessed &tx

10 weeks

100% of visits over 10weeks

Average total 180 mins

 

Massage

Medical massage

50 min/wk

100% for 10 weeks

 

 

At 10 weeks,

avg pain score

 

Tx = 3.6

Control = 5.2

(X2 = 7.3; p<.05):

 

 

Latino males

Tx = 2.8

Control = 5.7

(X2 = 8.3; p<.001):

 

 

Latino women

Tx =6.0

C = 2.8

(X2 = 9.2; p<.001):

 

 

 

 

 Quality A

 

 

Pain scores

30% lower w/ wkly chiro compared to 50 mins/wk medical massage

 

Tx more effective in Latino males

 

C more effective in Latino women

———

Massage would cost 30% more out of pocket

Tx. Better than control

 

Chiropractic adjustments effective in general and in Latino males but not in Latino women

 

Limitations =

-not equal time in tx

-not include high income

 

Yes/Yes but only if cost covered by Medicaid in my state
                   
                   
                   
                   

 

Legend:(all abbreviations and acronyms used in the table should be listed here such as: )

 

Table 2

Evidence Summaries (this table may be single space and 10 point font; ONLY systematic reviews should be in this table)(Example provided)

 

Source Study design

 

JH Level of Evidence

Population/

Sample

 

Search strategy

Inclusion

Exclusion

 

N articles addressing your PICOT

 

Other descriptions

 

Intervention (IV)

 

Details

Action

Duration
Fidelity

Comparison/  Control (IV)

Details

Action

Duration

Fidelity

Outcome (DV)

& Time

 

Mean differences

Intervention vs comparison

Effect size

Heterogeneity

 

(statistical test, value, p value)

 

 

Grading of evidence

JH Quality Rating

Author’s conclusions

 

 

——

Other outcomes of interest

Your Conclusions

Limitations

Fit/Useful
Brown, 2018 Meta-analysis

 

Level I

 

Medline

OVID

CINAHL

2000-2017

 

RCTs, conducted in the US, high-quality (>21/25 points on CONSORT), comparing regular chiropractic adjustment vs regular medical massage for chronic pain measured using a 0-10 scale

10 RCTs of low back pain

Exclusions

Studies of phantom pain

 

Total participants N=867

Avg age 59 (6)

Avg baseline pain scores 3.2 (3.4)

Avg Dropout:

8% (4)  Only completers included in this analysis

Chiropractic adjustment in office

 

Most weekly

(2/10 allowed 2x wk)

 

Fidelity

All  > 80%

 

 

Massage

45-60 mins

 

 

Most weekly

(2/10 allowed 2x wk)

 

Fidelity

All >86%

 

 

At 8 weeks

N=4

 

Tx = 3.6

Control = 5.2

(RR for 2 point pain reduction= 1.6 (1.1-2.3); p=.04):

 

I2= 10%

 

At 12 weeks

N=6

 

 Tx = 3.2

Control = 4.8

(RR for 2 point pain reduction= 1.7 (1.4-2.4); p=.04):

 

I2= 13%

 

 

 

Quality B due to no ITT

 

 

wkly chiropractic adjustment was more effective than weekly massage for reducing chronic pain based on the data from these studies

—none

 

Tx. Better than control

 

High dropout rate and not analyzed with ITT

Partially- my population is much younger on average

Partially- my population has a variety of pain sources

Useful- yes

Add more                  
                   
                   
 

 

 

 

                 

 

Legend:(all abbreviations and acronyms used in the table should be listed here)

 

 

Table 3.

Synthesis Matrix(identify the trends; this table may be single space and 10 point font; ONLY primary quantitative research articles or systematic reviews should be in this table; use only the highest level and quality of evidence; if the evidence is of mixed level or mixed quality, sort the trends using the Johns Hopkins Appendix H; trends must be related to the outcome) (example provided regarding effective pain management which may or may not be within your scope of practice- make sure your PICOT is within your scope of practice.)

 

Main ideas Albright (2020) Reference 2 Reference 3 Reference 4 Reference 5 Add columns as necessary
Weekly chiropractic adjustment equally effective as weekly massage            
Biweekly chiropractic adjustment associated with 30% lower pain scores compared to weekly massage in those with back pain            
In those with a mean age under 50, weekly massage associated with 20% lower pain scores compare to chiropractic adjustments            
Add more as needed            

 

Figure 1

Results of Search for Research

Use http://prisma.thetacollaborative.ca/ to generate a diagram describing the results of your search. Paste it here.

 

 

 

 

 

 

 

 

 

 

 

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