Nursing Matrices for PICOT Question

Matrix

APA Citation:

Pannucci, C. J., Dreszer, G., Wachtman, C. F., Bailey, S. H., Portschy, P. R., Hamill, J. B., ... & Pusic, A. L. (2011). Post-operative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plastic and reconstructive surgery, 128(5), 1093.

Variable and key concepts

· Acknowledges that VTE is a significant patient safety issue, hence the need for the Venous Thromboembolism Prevention Study looking specifically at post-operative treatment of plastic surgery patients as they are at times more vulnerable to VTE.

· List the important points of the article, variables, framework, and concepts mentioned.

· The hypothesis was implied.

· The research question was: does the enoxaparin have an impact in thwarting the symptoms and manifestation of VTE in patients after undergoing plastic surgery? It was clearly stated.

Sampling

· The participants were plastic surgery patients, post operation.

· There were 3334 patients included in the study: 1876 control and 1458 enoxaparin patients.

· The participants were all over 18 had been given general anesthesia and has post-operative stay in a hospital.

· No patients dropped out.

Design and Method

· The research was a quantitative study that focused on giving patients with a Caprini score of 3 or higher enoxaparin prophylaxis after surgery and for the remainder of the time they were in the hospital. The control group was a historic group of patients who had undergone operations between 2006-2008 but had not received any chemoprophylaxis for two months post-surgery.

· Quantitative study

· It was appropriate to answer the question, given what a concern VTE is to the medical community.

Instruments/Data Collection

· The data collected found that there was a marked minimization in risk with patients who had Caprini scores of 8 and between 7 and 8, when they were given the post-operative enoxaparin.

· The data was sufficient.

· Observation and data recording were the tools used.

· The instruments selected were valid.

Results

· The data found that enoxaparin is effective in preventing VTE, at least with patients who have undergone plastic surgery, so it does offer promise for hip replacement surgery patients.

· The study results are what I expected.

· The study results to make sense.

Strengths & Limitations

Strengths:

· The strengths of the study orbited around the large sample size.

· The study did show a statistical difference that was supported by data.

· Limitations: The study was just limited to plastic surgery patients.

Critique

The study was very specific, but still very worthwhile and can be used for my literature review. The researchers could have done much more explaining about their research in order to strengthen the study, but it was largely easy to understand and all elements of it made lucid sense.

APA Citation:

Pannucci, C. J., Wachtman, C. F., Dreszer, G., Bailey, S. H., Portschy, P. R., Hamill, J. B., ... & Pusic, A. L. (2012). The effect of post-operative enoxaparin on risk for re-operative hematoma. Plastic and reconstructive surgery, 129(1), 160.

Variable and key concepts

· While this study doesn’t look at VTE specifically, it does seek to determine the impact of enoxaparin in preventing post-operative uncontrolled bleeding.

· The hypothesis was implied.

· The research question was clearly stated and it was: whether receiving post-operative enoxaparin prophylaxis impacted the rates of 2-month re-operative hematoma.

Sampling

· The participants were plastic surgery patients.

· There were 3,681total participants: 2114 were in the control group and 1567 received the enoxaparin.

· The study did not discuss the sampling plan.

· There was no mention of patients dropping out.

Design and Method

· The research was designed as a quantitative study, gathering data through observation about the rate of hematomas in plastic surgery patients when compared to a historic control group.

· It was appropriate to answer the question because its important to know how effective or not effective enoxaparin is in reducing bleeding.

Instruments/Data Collection

· Complete data was available for 3,681 patients was available in the study and the data collected recorded the rates of re-operative hematomas in comparison to control groups, for example 3.38% vs. 2.65%.

· The data was reasonably sufficient.

· The instrument used was simply observation and recording the rates of hematomas in the participant group.

· The instrumentation was valid.

Results

· The results showed no compelling impact of the enoxaparin upon the rate of hematomas.

· This was not at all what I expected.

· The results don’t quite make sense.

Strengths & Limitations

Strengths:

· The strengths of the study were that it had a very large sample size to compare the control and experimental groups.

· Slight statistical variation was shown and supported by data.

Limitations:

The limitations of the study were that it only looked at plastic surgery patients and there was no designation about ages or general health.

Critique

The study is generally adequate. It could be used for a literature review, but is not ideal. The researchers explained their research adequately, but it could use improvement. The study was easy to understand, but the findings didn’t make necessary sense.

APA Citation:

Lassen, M. R., Raskob, G. E., Gallus, A., Pineo, G., Chen, D., & Hornick, P. (2010). Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomized double-blind trial. The Lancet, 375(9717), 807-815.

Variable and key concepts

· The major goals and concepts of this study are to determine the major effectiveness of apixaban versus enoxaparin after major joint replacement.

· The hypothesis, which seems to favor apixaban, is implied.

· The research question was clearly stated and sought to determine which substance apixaban in comparison to enoxaparin, was more successful in controlling bleeding in patients after major joint surgery.

Sampling

· The participants were patients who were going through elective unilateral or bilateral knee replacement surgery.

· There were a total of 3057 participants: 1528 who received apixaban, versus 1529 who received enoxaparin.

· The participants were gathered by volunteering.

· There was no mention of any patients dropping out.

Design and Method

· The research study was quantitative: patients were randomly chosen to receive apixaban versus enoxaparin via an interactive central telephone system.

· It was appropriate to answer this question because it needs to be seen which substance is more effective in these situations.

Instruments/Data Collection

· The data collected found that the main outcome manifested in 147 (15%) of the patients who received apixaban and 243 (24%) of the patients receiving enoxaparin.

· The data was sufficient.

· The instrument used was observation along with the recording of data.

· This form of instrument was valid.

Results

· The results were in favor of apixaban (2.5mg twice daily) as opposed to 40mg of enoxaparin as a means of controlling the bleeding for patients with major knee replacements.

· This is what I expected, given the implied hypothesis of the research.

· This finding makes reasonable sense.

Strengths &

Limitations

Strengths:

The strengths of the study were the large participant size and the comparative structure. The statistical difference was showed and supported.

Limitations: The study should have examined a control group sample that received no medication.

Limitations:

Critique

The study is very strong. The researchers explained their intentions, methods and findings very well, and I can definitely use this for my research study.

APA Citation:

Li, X. M., Sun, S. G., & Zhang, W. D. (2012). Apixaban versus enoxaparin for thromboprophylaxis after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials.

Variable and key concepts

· The article sought to determine both the safety and success of apixaban in comparisons to enoxaparin when treating patients for hip or knee surgeries.

· The hypothesis was implied and it appeared the authors thought apixaban might be more effective.

· The research question was clearly stated and it sought to get a comparison of data of the overall effectiveness of these two drugs for patients who’ve had hip or knee surgical work.

Sampling

· The participants were four randomized and controlled studies.

· The participants numbered 14,065.

· The participants and select studies were gathered via a meta-analysis of significant randomized-controlled trials through the following databases: PubMed, Cochrane Library, Embase China Biological Medical Literature collection, Countries Journal full-text database, as well as WanFang database.

· There were no dropouts given the type of study it was.

Design and Method

· The study was a quantitative research design that compared the data selected from four previously conducted studies on this exact issue.

· It was extremely important to answer this question as controlling bleeding post-surgery is crucial and finding the best drugs to accomplish that is vital.

Instruments/Data Collection

· The data collected was a large pool and found notably, that when the two substances were compared, the patients treated with apixaban had fewer VTE and all-around mortality.

· Was the data sufficient? The data was significant and the instrument used was data comparison using all the surveys selected. This was a valid means of assessing the data.

Results

· The results of the study found that apixaban is a superior drug to use to minimize the occurrence of VTE in patients undergoing knee and hip surgery.

· These results are precisely what I expected given the background of the drug and make complete sense.

Strengths & Limitations

Strengths:

· The strengths of the study were that they looked at such a massive body of data and used it to make the most compelling conclusions. They showed relevant and repeated statistical differences and supported those differences with the study.

· Limitations:

The limitations of the study were that they didn’t actually conduct any research, but just assessed and compared previously executed studies.

Critique

Overall, my opinion is that this study is excellent and should be included in my literature review, as the data is comprehensive and analyzed well. The research was easy to understand and all the findings made sense.

APA Citation:

Goldhaber, S. Z., Leizorovicz, A., Kakkar, A. K., Haas, S. K., Merli, G., Knabb, R. M., & Weitz, J. I. (2011). Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. New England Journal of Medicine, 365(23), 2167-2177.

Variable and key concepts

· The authors of the study wanted to determine the success of using apixaban versus enoxaparin in medically ill patients after they are discharged from the hospital with the intent of preventing VTE.

· The hypothesis is mostly stated, as the researchers think apixaban will be more effective.

· The research question is clearly stated and seeks to examine the effectiveness of using apixaban as a means of prolonging prophylaxis after hospital discharge rather than enoxaparin.

Sampling

· The participants were patients who suffered from serious conditions like congestive heart failure or comparable conditions that might provoke VTE.