Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Critical Appraisal Worksheet

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence Article #1 Article #2 Article #3 Article #4
Punab, M., Poolamets, O., Paju, P., Vihljajev, V., Pomm, K., Ladva, R., … & Laan, M. (2017). Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Human reproduction32(1), 18-31. Deshpande, P. S., & Gupta, A. S. (2019). Causes and prevalence of factors causing infertility in a public health facility. Journal of human reproductive sciences12(4), 287. Critical Appraisal, Evaluation/ Summary, and Synthesis of Evidence  Moramazi, F., Roohipoor, M., & Najafian, M. (2018). Association between internal cervical os stenosis and other female infertility risk factors. Middle East Fertility Society Journal23(4), 297-299.

ORDER YOUR CUSTOM PAPER HERE

He, Y., Tian, J., Oddy, W. H., Dwyer, T., & Venn, A. J. (2018). Association of childhood obesity with female infertility in adulthood: a 25-year follow-up study. Fertility and sterility110(4), 596-604 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence
Evidence Level *

(I, II, or III)

 

I I I I
Conceptual Framework

 

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

 

In this study, the authors wanted to analyze the reasons for reduced sperm count in males. The idea behind the study was to find out the primary causes of severe male infertility

 

 

In this study, the researchers wanted to find out the primary causes of infertility in men and women. The idea behind the study was to evaluate the individual factors that lead to infertility. This study was conducted to evaluate and understand the leading female infertility risk factors. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence In this study, the authors set to find out if there is a link between childhood-obesity and infertility in women. In this study, the interest of the authors was to find out if young girls between age 7 and 11 and have had obesity during their childhood are at a higher risk of becoming infertile.
Design/Method

 

Describe the design and how the study was carried out (In detail, including inclusion/ exclusion criteria). Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

In this study, the researchers conducted a prospective clinical-epidemiological study between 2005 and 2013, where male partners of couples failing to conceive a child for over ≥12 months were recruited. Out of the 8518 patients, 1737 (20.4%) turned positive for severe male factor infertility. A reference group of fertile controls was comprised of 325 partners of pregnant women.

 

 

This study was a cross-sectional, observational and descriptive study aimed at finding the causes of infertility based on the context of local populations. The authors conducted a analytical cross-sectional study is aimed at assessing the correlation between internal cervical os stenosis and other female infertility risk factors. This study is a Prospective longitudinal study where study participants are largely or entirely different on each sampling occasion; Prospective studies where the same participants are followed over a period of time. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence
Sample/Setting

 

The number and characteristics of

patients, attrition rate, etc.

The mean age of infertility patients and fertile controls was 33.2 ± 7.3 and 31.7 ± 6.3 years, respectively. All participants were examined using a standardized andrology workup, accompanied by a structured medical interview. Hormonal analysis included serum FSH, LH and testosterone. Semen quality was determined in accordance to the World Health Organization recommendations..

 

 

 

 

The study comprised 120 couples who came for infertility evaluation and treatment. Cause of infertility in the couple was assigned on the basis of history and examination findings. The prevalence of each cause was evaluated. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence This study was performed on 168 infertile women who were divided into two groups of infertile patients with cervical stenosis (n = 84) and the control group of infertile patients without cervical stenosis (n = 84). A total of 1,544 girls, aged 7-15 years in 1985, and who completed questionnaires at follow-up in 2004-2006 and/or 2009-2011.
Major Variables Studied

 

List and define dependent and independent variables

causal factors; contributing factors; cryptozoospermia; epidemiology; idiopathic infertility; male factor infertility; oligozoospermia. Causes of infertility in the couples were assigned on the basis of history and examination findings patients with cervical stenosis and the group of infertile patients without cervical stenosis Childhood; body composition; body mass index; infertility; waist-to-height ratio.
Measurement

 

Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

All participants were examined using a standardized andrology workup, accompanied by a structured medical interview. Hormonal analysis included serum FSH, LH and testosterone. Female factor accounted for 46.6% of the cases with polycystic ovarian syndrome (PCOS) being the leading cause (46%). Infertility was seen equally in lean and obese PCOS cases. Infectious causes such as pelvic inflammatory disease and tuberculosis were significantly associated with tubal factor infertility (P = 0.001). Two groups of patients with cervical stenosis and without cervical stenosis, showed a significant difference statistically in terms of duration of infertility (>3 years) (p < 0.05). Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence At ages from 7-11 years, girls at both the lower and upper end of the body mass index (BMI) z score had increased risk of infertility. Compared with normal weight girls, those with obesity at ages 7-11 years were more likely in adulthood to report infertility
Data Analysis Statistical or

Qualitative findings

 

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

Among 8518 patients, 1737 (20.4%) were diagnosed with severe male factor infertility. A reference group of fertile controls was comprised of 325 partners of pregnant women.. Results were tabulated, and the prevalence of individual factors was calculated. Intractable analysis was done using SPSS 16.0.. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence Parametric tests were used for statistical analysis. Demographic and clinical characteristics of all individuals are presented were presented in a table Girls with obesity at ages 7-11 years were more likely in adulthood to report infertility (adjusted relative risk [aRR] = 2.94, 95% confidence interval [CI] 1.48-5.84), difficulty conceiving (aRR = 3.89, 95% CI 1.95-7.77), or having seen a doctor because of trouble becoming pregnant (aRR = 3.65, 95% CI 1.90-7.02) after adjusting for childhood age, follow-up length, highest parental education, and marital status.
Findings and Recommendations

 

General findings and recommendations of the research

The primary cause of infertility was defined for 695 of 1737 patients (~40%). The analyzed causal factors could be divided into absolute (secondary hypogonadism, genetic causes, and seminal tract obstruction. Primary infertility was more prevalent than secondary infertility. Female factor accounted for 46.6% of the cases with polycystic ovarian syndrome (PCOS) being the leading cause (46%). Infertility was seen equally in lean and obese PCOS cases. Two groups of patients with cervical stenosis and without cervical stenosis, showed a significant difference statistically in terms of duration of infertility (>3 years) (p < 0.05). At ages from 7-11 years, girls at both the lower and upper end of the body mass index (BMI) z score had increased risk of infertility. Compared with normal weight girls, those with obesity at ages 7-11 years were more likely in adulthood to report infertility (adjusted relative risk [aRR] = 2.94, 95% confidence interval [CI] 1.48-5.84), difficulty conceiving (aRR = 3.89, 95% CI 1.95-7.77), or having seen a doctor because of trouble becoming pregnant (aRR = 3.65, 95% CI 1.90-7.02) after adjusting for childhood age, follow-up length, highest parental education, and marital status.
Appraisal and Study Quality

 

 

Describe the general worth of this research to practice.

 

What are the strengths and limitations of study?

 

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

 

What is the feasibility of use in your practice?

Being a clinical-epidemiological study, this research gives first-hand account of the causes of male factor infertility.

 

The limitation of the study is it only included subjects with reduced total spermatozoa counts. Thus, these findings cannot be automatically applied to all male factor infertility cases

Being an observational study, the authors were only able to gather information regarding history and investigations done at the point of contact. No intervention in the form of investigations and treatment was possible. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence The authors did not find any significant correlation between cervical stenosis and endometriosis/ Endometrioma. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence Being a longitudinal study, there was no interventions-thus limiting the scope of the study.
 

 

Key findings

 

 

 

The primary cause of infertility was defined for 695 of 1737 patients (~40%). The analyzed causal factors could be divided into absolute (secondary hypogonadism, genetic causes, seminal tract obstruction) The incidence of primary infertility is more than secondary infertility. Increasing age of marriage influences the causes with unexplained infertility and male factor more commonly seen as the age of marriage increases. Female factor remains the main cause of infertility followed by unexplained causes. There wasn’t found any statistically significant correlation between cervical stenosis and endometriosis/ Endometrioma. At ages from 7-11 years, girls at both the lower and upper end of the body mass index (BMI) z score had increased risk of infertility. Compared with normal weight girls, those with obesity at ages 7-11 years were more likely in adulthood to report infertility
 

 

Outcomes

 

 

 

The prevalence of congenital anomalies in the uro-genital tract was not clearly correlated with the severity of impaired sperm production. The incidence of primary infertility is more than secondary infertility. Increasing age of marriage influences the causes with unexplained infertility and male factor more commonly seen as the age of marriage increases.. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence Findings of this study show a statistically significant correlation between internal cervical os stenosis and duration of infertility. Childhood obesity before 12 years of age appears to increase the risk of female infertility in later life.
General Notes/Comments .

 

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

 

  • Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

 

  • Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

 

  • Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

  • Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

  • Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

 

 

**Note on Conceptual Framework

 

 

  • Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

 

  • As stated by Grant and Osanloo (2014 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

 

  • Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

 

  • Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence References

Deshpande, P. S., & Gupta, A. S. (2019). Causes and prevalence of factors causing infertility in a public health facility. Journal of human reproductive sciences12(4), 287.

He, Y., Tian, J., Oddy, W. H., Dwyer, T., & Venn, A. J. (2018). Association of childhood obesity with female infertility in adulthood: a 25-year follow-up study. Fertility and sterility110(4), 596-604. https://doi.org/10.1016/j.fertnstert.2018.05.011

Moramazi, F., Roohipoor, M., & Najafian, M. (2018). Association between internal cervical os stenosis and other female infertility risk factors. Middle East Fertility Society Journal23(4), 297-299.

Punab, M., Poolamets, O., Paju, P., Vihljajev, V., Pomm, K., Ladva, R., … & Laan, M. (2017). Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Human reproduction32(1), 18-31.

EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence Assessment Instructions

Review the details of your assessment including the rubric. You will have the ability to submit the assessment once you earn a score of 80% or better on all of the related sub-competency quizzes and engage with your Faculty Subject Matter Expert (SME) in a substantive way about the competency.

Overview
For this Performance Task Assessment, you will critically appraise peer-reviewed articles related to a clinical question or interest and based on the critical appraisal of the articles, recommend a best practice that emerges from the research.

Professional Skills: Written Communication, Critical Thinking and Problem Solving, and Information Literacy are assessed in this competency.

Your response to this Assessment should:

Reflect the criteria provided in the rubric.
Adhere to the required assignment length.

This Assessment requires submission of two (2) documents, a completed Critical Appraisal Worksheet and an evidenced-based practice recommendation response. Save your files as EB004_appraisal_firstinitial_lastname (for example, EB004_appraisal_J_Smith) and EB004_EBP_firstinitial_lastname (for example, EB004_EBP_J_Smith). When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu.

Instructions

Access the following to complete this Assessment:

Critical Appraisal Worksheet

Before submitting your Assessment, carefully review the rubric. This is the same rubric the Assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively. Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence

Click each of the items below to complete this assessment.

Part 1: Critical Appraisal of Research

Identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICOT question to address this clinical issue of interest.
Using the keywords from the PICOT question, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles at the systematic-reviews level.
Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Critical Appraisal Worksheet.

Part 2: Evidence-Based Best Practices
Based on your appraisal, recommend a best practice that emerges from the research you reviewed. In a 1- to 2-page narrative, address the following:

Explain the best practice that emerged, justifying your proposal with APA citations for the evidenced-based research that you reviewed.  Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence