In inmates with hepatitis C (P), how does the use of AST platelet ratio index (APRI) score (I) compared to liver biopsy (C) influence health care cost and early detection of  liver fibrosis (O) during detention (T)?

Purpose: The purpose of this assignment is to document your performance of your search for evidence relevant to your defined PICOT question.

This is not a paper – you do not need a cover page, running head, etc. Just answer the questions!

  1. PICOT
    1. State your PICOT in question format, with identifiers (i.e., P, I, C, O, T).

In inmates with hepatitis C (P), how does the use of AST platelet ratio index (APRI) score (I) compared to liver biopsy (C) influence health care cost and early detection of  liver fibrosis (O) during detention (T)?

  1. Identify the type of PICOT you have (i.e., Intervention; Prognosis/Prediction; Diagnosis or Diagnostic Test; Etiology; Meaning). Prognosis
  2. Identify the types of research designs best suited to answer your type of PICOT (refer to your Melnyk & Fineout-Overholt text). Do not give the hierarchy of evidence ( i.e., all research designs) just ID those best suited to your type of PICOT. Single cohort study or case–control studies (Melnyk & Fineout-Overholt, 2015, p. 33).
  3. SOURCES
  4. Define and discuss strengths and limitations of the following evidence sources, addressing (a) convenience, (b) clinical relevance, and (c) validity.
  1. Primary research studies are the various pieces of research that provide first-hand information regarding a specific phenomenon and include experiments, surveys, historical and artistic works, and interviews (O’Donnell, 2017). The sources of evidence are highly convenient as they have no intermediates (Fain, 2017). Moreover, another key advantage of these sources is that they are highly relevant to clinical practice as they provide first-hand accounts of specific phenomena (O’Donnell, 2017). The key weakness of primary research studies is the difficulty of their validation due to insufficient predecessors making the confirmation of the studies difficult (O’Donnell, 2017; Tappen, 2015). Primary research helps the researcher to develop a hypothesis.

 

  1. Secondary sources are derived from the different primary sources as commentaries or interpretations and include the documentation from research that has been compiled, reports, and other studies that are mainly conducted by government agencies (O’Donnell, 2017). The principal advantage of secondary sources is their low cost, ease of access, and increased availability that makes their use convenient (Holloway & Galvin, 2016). Additionally, the validity of these sources can be assessed by evaluating primary sources (Croswell & Clark, 2017). Secondary sources are clinically relevant as they explore a specific phenomenon through different viewpoints unlike primary research studies that have limited clinical relevance (O’Donnell, 2017). Secondary sources lead to competent data as they enable comparisons between data sets from various research.

 

  1. Pre-appraised sources entail summaries provided by experts after a given set of studies (Croswell & Clark, 2017). The strengths of pre-appraised sources are their convenience since they are available in summarized versions and the ability to provide information that is relevant to a specific clinical issue (White, Raghavendra, & McAllister, 2017). However, the difficulty in validating the pre-appraised sources is their key weakness (Croswell & Clark, 2017).

 

  1. CPG databases/websites contain systematically developed statements that facilitate the work of professionals by assisting them to make appropriate decisions (Alonso-Coello et al., 2016). The strengths of the sources include increased convenience as demonstrated by their availability, and clinical relevance since they have been developed systematically (Alonso-Coello et al., 2016). However, the key weakness of CPG websites is the difficulty of evaluating and validating the effectiveness of the guidelines.
  2. List the multiple sources of evidence you will investigate (give examples of each type listed above).

III. SEARCH STRATEGY

  1. Identify a search strategy string / combinations of all the keywords/subject areas/title search you will use based on your PICOT.
    1. Identify MeSH / CINAHL language related to your PICOT. The search strategy string would be chronic hepatitis C AND inmates AND healthcare cost AND liver fibrosis AND early detection AST platelet ratio index OR liver biopsy.

 

  1. Show Boolean Logic. The Boolean used would be AND and OR. A prognosis type of PICOT indicates whether Or not a state exists And what to do if the condition exists. AST platelet ratio index OR liver biopsy AND liver fibrosis AND inmates

 

  1. Identify Limits that you will apply with rationale (e.g., English language, peer-reviewed literature, types of articles, etc.). Limits would be made based on language since the researcher only understands English, peer reviewed literature due to reliability and validity, and cohort studies that are suited for the prognosis or prediction research type. The time would also be limited to 18 years since most clinical guidelines have been developed over the past one and a half decade. Moreover, most articles pertaining to the use of APRI were published recently.

You must have a sound rationale for limiting your search to specific dates. i.e., that was when a change in guidelines occurred, that was when a systematic review was performed. Not just that you want to limit the number of studies to review!

Full-text availability should not be a limit to your search, as you can always send an Interlibrary Loan request electronically through UNF, and they will send you the article usually within a few days.

  1. Do a few test-drives in at least 3 separate databases using your search strategy and notate your “results/#hits” for each test drive. After the test drives, the search yielded 45,602 articles and one guideline [EMBASE (1), Mesh 126 articles and one guideline, PubMed (45475)].
  2. Refine your strategy until you end up with the most high-level studies.
  3. SCREEN study abstracts for PICOT matches. Keep notes on how many you exclude and why. EMBASE (0), MeSH 18, and PubMed (7) after the concept of inmates were introduced to the search.

 

  1. READ full-text of the articles to determine eligibility for inclusion. Keep notes on how many you exclude and why. After reading full texts, only seven (six from PubMed and one from MeSH) articles were found to be highly relevant to the to the PICOT question. The main criterion used in the exclusion was the presence of key words (AST platelet ratio index OR liver biopsy AND liver fibrosis AND inmates).

If you have a meta-analysis or systematic review as well as single studies, check the articles for duplicates and eliminate those single studies that are already included in the meta-analysis/systematic review and retain only the SR or MA and those published subsequent to the SR or MA.

 

  1. Write a narrative description of your search strategy and results

            Your description of your search methods and results should be explicit enough for someone to follow your steps and replicate your findings [it should only discuss your final search strategy]. The person reading the narrative will not have access to what you have presented in I, II, and III A-C above, so it needs to be written clearly and succinctly here.

  • Read systematic reviews, like Cochrane, for examples of how authors write up their search strategy.
  • Read the example provided in Melnyk & Fineout Overholt, page 70 (Step 2).

            A lot of studies that you find in your initial search will provide general (e.g., background, epidemiological) information surrounding your topic, but will not match your PICOT.  Hang onto these articles because you’ll need them to set the stage in the Introduction section of your DNP Project Proposal in order to discuss the factors surrounding the clinical issue. 

The PICOT question was used as a guide to a systematic literature search on renowned databases such as PubMed, Embase Ovid, and Medical Subject Heading databases. The keywords used for vocabulary search included AST platelet ratio index, liver biopsy, liver fibrosis, and inmates. The search successfully yielded 24 articles and 1 guideline and only 6 research articles and 1 guideline that perfectly answered the research question.