Read and respond to Josephine Akarue and Mamadou Bhoye Diallo and provide further suggestions on how their database search might be improved.

Read and respond to Josephine Akarue and Mamadou Bhoye Diallo and provide further suggestions on how their database search might be improved.

Josephine Akarue:

Clinical Issue of Interest

For my clinical research, I’m looking at the treatment of hypertension, which is an extremely common and expensive disorder that occurs in millions of people around the world. If uncontrolled, hypertension can cause heart disease, stroke, kidney failure, and death. Although, hypertension can be managed successfully through lifestyle changes, medication, and observation. As the condition has become more common and has chronic health consequences, the best and most effective treatments are important. I want to know if home blood pressure and patient education are effective in controlling hypertension.

Evolution of the PICO(T) Question.

For this question, to get a clear answer, I came up with the following PICO(T) question: For adults with hypertension (P), does blood pressure monitoring at home and patient education (I) compared with regular clinic visits (C) lower blood pressure (O) for 6 months (T)? This is a comparison of how effective home monitoring and patient education are compared with traditional treatment of hypertension in a daily clinic visit. The one outcome I am most interested in is better blood pressure control as this is the single best indicator of success with hypertension.

Search Process and Results

I started my research at the Walden University Library. I searched multiple resources such as PubMed and CINAHL. One of the first searches I did was in PubMed. I would type in phrases such as “hypertension,” “home blood pressure monitor” and “patient education” and return 120 papers. So, I combined phrases such as “hypertension AND home blood pressure monitoring AND patient education” in Boolean operators to narrow down the search results to 65. To ensure that these papers were up-to-date, I reselected the results only with studies from the past 5 years (down to 30). And I made sure to type in the same keywords in CINAHL and that search came up with 45 articles. I then applied the Boolean operators and searched studies from the past five years which gave me 18 articles containing both cohort studies and RCTs. Such studies were more directly related to my PICO(T) question, and they also had good support for using home monitoring instead of going to the doctor’s office for hypertension management.

Tips To Make the Search More Secure and More Effective.

As my database search gets further honed and optimized, I will add some more techniques. I will start with synonyms for the key words like “blood pressure monitoring” or “hypertension management” to get a broader view of the studies. I will also apply more specific filters like restricting findings to RCTs or observational studies, as these have stronger support for intervention studies. I’ll also query a number of databases to broaden the range of results and make sure that I cover the subject in full. And last, I’ll look through the reference lists of articles that match and check for any additional studies that were not found in the first look.

Resources

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61.

Walden University. (n.d.). Evidence-based practice research: CINAHL search help. Retrieved from

Mamadou Bhoye Diallo:

According so Hashmi, et al. (2024) telehealth is a fresh approach to improving access to healthcare using remote technology. The implementation of telemedicine can be scary to some people, due to the lack of knowledge. My original clinical issue of interest is the implementation of telemedical and effectiveness or lack thereof, if any. In this discussion I will develop a PICOT question, and refine my search using Boolean operators and making my main point more focused on one population.

PICOT:

POPULATION: Psychiatric Patients

INTERVENTION: Follow up appointments and primary visitation done by telemedicine implementation

COMPARISON: Psychiatric patients who only do in person appointments

OUTCOME: Improved patient outcomes and prescriptions filled in a timely manner

TIME: 3 months

The question that would be formed for this is, “In psychiatric patients, how does implementing telemedicine for follow-up appointments and primary visitation, compared to in-person appointments only, affect patient outcomes and timely prescription filling over a 3-month period?”

While utilizing the Walden Library database, I began my search in EBSCO where I simply typed “telemedicine” and a total of 41,000 articles were available for me to pick from. That is far too broad. I changed the search to “telemedicine and psychiatry” and received 2,993 articles to choose from. Then I changed the search to “telemedicine in psychiatry and outcomes” and received 4 articles to choose from, I will attach some below.

In ProQuest I started by writing “telemedicine effectiveness” and received 21,272 results. I refined the search by writing “telemedicine in psychiatry and outcomes” and received 209 results. Using Boolean operators like AND, OR, and NOT makes a significant difference when it comes to refining your search. Another way to increase the rigor and effectiveness of a database search is to add parentheses to group terms, for example (telemedicine and psychiatric patients) and outcomes). Also, quotations can be used to search for an exact phrase like “psychiatric telemedicine outcomes”. The use of Boolean operators will make refining searches easier, and finding topic specific articles will be more feasible to obtain.

References:

Hashmi ZG, Rokayak O, Boggs KM, et al. Teletrauma Use in US Emergency Departments. JAMA Surg. 2024;159(12):1383–1391. doi:10.1001/jamasurg.2024.3758

Shaker, A. A., Austin, S. F., Storebø, O. J., Schaug, J. P., Ayad, A., Sørensen, J. A., Tarp, K., Bechmann, H., & Simonsen, E. (2023). Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Mental Health, 10, e44790.

Norman, S. (2006). The use of telemedicine in psychiatry. Journal of Psychiatric and Mental Health Nursing, 13(6), 771–777. to an external site.

Ali, A. S., Austin, S. F., Ole Jakob Storebø, Julie, P. S., Ayad, A., John Aasted Sørensen, Tarp, K., Bechmann, H., & Simonsen, E. (2023). Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Mental Health, 10

Telemedicine as a Referral Bridge: A Nurse Practitioner–Led Intervention to Increase Initial Psychiatric Appointment Attendance. (2024). The Journal for Nurse Practitioners, 20(7)

 

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