Enrolled in an MSN….and wondering what to do for an evidence-based clinical project?
Recently a former student contacted me about that very question. Part of my response to her is below:
“One good place to start if you are flexible on your topic is to look through Cochrane Reviews, Joanna Briggs Institute, AHRQ Clinical Practice Guidelines, or similar for very strong evidence on a particular topic and then work to move that into practice in some way. (e.g., right now I’m involved in a project on using evidence of a Cochrane review on the benefits of music listening–not therapy–in improving patient outcomes like pain, mood, & opioid use).
Once you narrow the topic it will get easier. Also, you can apply only the best evidence you have, so if there isn’t much research or other evidence about the topic you might have to tackle the problem from a different angle” or pick an area where there IS enough evidence to apply.
Are we talking cigarettes? water? coffee? other? Yes, other. In this case about what is sometimes called “filtered” or “unfiltered” literature in the evidence-based medicine pyramid of research evidence. (I have more than one issue with this particular pyramid as a representation of all evidence, but for right now let’s look at filtered information & unfiltered information. Pyramid source: Wikimedia Commons
Filtered is considered stronger–meaning that we can be more confident that literature from this category better supports cause and effect. I agree.
Unfiltered evidence (usually single studies etc) is considered weaker–meaning that we must be more cautious about its accuracy in representing reality. I agree.
But, “Is unfiltered information really unfiltered?” No filtering at all? My qualified answer is, “No.” Argue with me if you like.
My opinion: If the “unfiltered” article is a primary source, research study that has strong design and is published in a peer-review journal then it has been filtered by multiple, expert peer reviewers just to make it to publication.
Thus, when discussing filtered vs. unfiltered one should be very clear on what those terms mean and do not mean.
Critical Thinking: When filtered literature (systematic reviews & critically appraised topics & articles) has been filtered by one individual, is that superior to unfiltered literature in terms of introducing bias? What if the “filtered” evidence is 7 years old and a primary, “unfiltered” source(s) from this year has different findings? What is the relationship between “filtered” and “unfiltered”–after all the “unfiltered” is the pyramid base so what does that mean?
For more Info: For peer review, the lower level filtering of single studies, consider its 1) advantages (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975196/) and 2) its potential flaws (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420798/)
Self-report by participants is one of the most common ways that researchers collect data, yet it is fraught with problems. Some worries for researchers are: “Will participants be honest or will they say what they think I want to hear?” “Will they understand the questions correctly?” “Will those who respond (as opposed to those who don’t respond) have unique ways of thinking so that my respondents do not represent everyone well?” and a BIG worry “Will they even fill out and return the questionnaire?”
One way to solve at least the latter 2 problems is to increase the response rate, and Edwards et al (2009 July 8) reviewed randomized trials to learn how to do just that!!
If you want to improve your questionnaire response rates, check it out! Here is Edwards et al.’s plain language summary as published in Cochrane Database of Systematic Reviews, where you can read the entire report.
Methods to increase response to postal and electronic questionnaires
Postal and electronic questionnaires are a relatively inexpensive way to collect information from people for research purposes. If people do not reply (so called ‘non-responders’), the research results will tend to be less accurate. This systematic review found several ways to increase response. People can be contacted before they are sent a postal questionnaire. Postal questionnaires can be sent by first class post or recorded delivery, and a stamped-return envelope can be provided. Questionnaires, letters and e-mails can be made more personal, and preferably kept short. Incentives can be offered, for example, a small amount of money with a postal questionnaire. One or more reminders can be sent with a copy of the questionnaire to people who do not reply.
Critical/reflective thinking: Imagine that you were asked to participate in a survey. Which of these strategies do you think would motivate or remind you to respond and why?
For more info read the full report: Methods to increase response to postal and electronic questionnaires