21 Mar Respond?to at least?two?of your colleagues?on two different days and provide further suggestions on how their database search might be improved.SEARCHINGDATABASESPEERRESPON

Heather Rypien

Peer 1

Module 3 Initial Discussion Post

The clinical issue of interest is using non-surgical facial aesthetic procedures among individuals. For instance, the safety and effectiveness of neurotoxin injections in managing dynamic facial wrinkles compared to other non-surgical options is a clinical issue of interest that forms the basis of evidence-based practice for exploration and more research (Carro et al., 2023). This issue is significant as many people seek non-surgical facial aesthetic procedures to improve their skin and mitigate aging.  The use of non-surgical procedures remains an effective way to attain such goals. However, patients should understand the different procedures and their effects on their skin.

The search entailed using associated terms like "non-surgical facial procedures," "aesthetic procedures," "facial aesthetics," and "facial wrinkles" in two different databases, PubMed and Medline. The initial search generated 100 articles. To narrow down the search and results, I focused on "non-surgical facial aesthetic procedures" and used the Boolean operator "AND," reducing the number of articles to about 25 (Melnyk et al., 2023). Further refining the search using terms like “effectiveness” led to only ten articles and eventually four due to comparison with other procedures.

Increasing the rigor and effectiveness of the search is essential to get the best outcomes. Therefore, to increase the rigor and effectiveness of a database search based on the PICOT question, one can apply certain strategies like using specific and relevant key terms, use the Boolean operators, and applying filters (Hoffmann et al., 2023). For instance, most databases provide filters that narrow down the search results. Filters limit the search to a specific period, allowing one to get current articles, review articles and even those published in highly regarded journals (Connor et al., 2023). Using specific and relevant key terms or words also allows one to get better search results as they narrow down to articles containing the keywords.

My proposed PICOT question-

Among patients receiving non-surgical facial aesthetic procedures (P) are neurotoxin injections such as Botox effective and safe (I) compared to other non-surgical options (C) in managing dynamic facial wrinkles (O) within two months (T)?

References

Carro, M. A., & Tokgöz, E. (2023). Nonsurgical Facial Aesthetic Procedures. In Cosmetic and reconstructive facial plastic surgery: A review of medical and biomedical engineering and science concepts (pp. 1-59). Cham: Springer

Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P. F., … &Gallagher‐Ford, L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: findings from a scoping review. Worldviews on Evidence‐Based Nursing, 20(1), 6-15. DOI: 10.1111/wvn.12621.

Hoffmann, T., Bennett, S., & Del Mar, C. (2023). Evidence-based practice across the health​professions. Elsevier Health Sciences.

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &​healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Danielle Latrice Joiner- Lucky ( She/Her)

Peer 2

Week 3 Discussion Main Post

Original PICOT question: In home health patients aged 65 and above (Population), does implementing a structured medication adherence program (Intervention), compared to standard care (Comparison), reduce the rate of rehospitalization (Outcome) within a 60-day recertification period (Timeframe)?

Description of clinical interest

     My clinical issue of interest revolves around addressing rehospitalization rates among home health patients, focusing on improving medication adherence within a 60-day recertification period. This issue is significant because rehospitalization can increase healthcare costs, patient discomfort, and potential complications. Improving medication adherence is crucial in preventing rehospitalization, as non-adherence can worsen medical conditions and the need for additional medical intervention. By implementing strategies to enhance medication adherence within the context of home health care, healthcare providers can reduce rehospitalization rates and improve patient outcomes.

Search Results

     Initially, when searching for original research articles in the CINAHL database without using Boolean operators, such as the keywords "home health," "rehospitalization," and "medication adherence," only 1 article resulted. I broadened my search to “home health” and "rehospitalization," which resulted in 120 articles. As Boolean operators were added to refine the search, the number of articles returned decreased, but the relevance and specificity of the results increased.

Strategies to Increase Rigor and Effectiveness of Database Search

     According to Melynk (2023), “An example of subject headings is Medical Subject Headings (MeSH), which is the set of terms used by the NLM to describe the content of articles indexed in MEDLINE. If the MeSH term acquired immunodeficiency syndrome was searched, all these articles would contain information about it regardless of what terms the author(s) chose to use when writing, including HIV, HIV-positive, acquired immune deficiency syndrome, STI, STD, sexually transmitted disease, and sexually transmitted infection.” Incorporating standardized MeSH terms related to the components of the PICOT question can enhance search precision. For example, using terms like "Home Care Services," "Patient Readmission," and "Medication Adherence" as MeSH terms can refine the search results.

     Clearly defining inclusion and exclusion criteria based on the PICOT elements ensures that the search results align with the research question. For example, specifying the age range of home health patients, the timeframe for recertification, and the type of interventions considered can refine search results to include only relevant studies. Stillwell (2010) states that the inclusion and exclusion criteria "combine the searches to yield articles that are manageable in number and relate specifically to the PICOT question."

     Conducting searches across multiple databases (e.g., PubMed, CINAHL, PsycINFO) ensures comprehensive coverage of the literature. Each database may index different journals or publications, and searching various databases reduces the risk of missing relevant studies. According to Walden (n.d.), “CINAHL stands for Cumulative Index to Nursing & Allied Health Literature and includes peer-reviewed articles, reports of evidence-based practice, case studies, systematic reviews, and more; PubMed includes the MEDLINE database, plus in process-citations, "Ahead of Print" items, NIH-funded research projects, books from the NCBI Bookshelf, and selected items from PubMed Central.” When using the CINAHL database using the keywords “home health”, AND, “rehospitalization the search yield 120 results. When using PubMed using the keywords “home health" AND "rehospitalization," the search yielded 3436 results. When adding the keyword "medication adherence" in PubMed, the results decreased to 130. When finally adding the keyword “within 60 recertification days” in PubMed, the results decreased to 12 results. The commonality observed from the resulting research articles ranged in patients with diagnoses of heart failure, schizophrenia, and chronic illness, which dealt with difficulty managing medication routines at home due to their medical status or debilitating conditions.

     By employing these strategies, researchers can conduct a rigorous and comprehensive database search to identify relevant original research articles that address the clinical issue of interest, informing evidence-based practice and decision-making.

References

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer. Chapter 2, “Asking Compelling Clinical Questions” (pp. 37–60)

OpenAI. (2024). ChaptGPT (Jan 4 version). [Large language model]. https://chat.openai.com/

Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence. American Journal of Nursing, 110(5), 41-47.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981