Evidence Based Problem: Article Reviews
According to standards of evidence, the highest level of quality (Level 1) is that of a systematic review involving randomized controls to eliminate bias. On a lower level of quality (Level 3), that of systematic reviews of lower-quality studies, different types of methods may be used. In answer to my question regarding the Fowler’s positioning of mechanically-ventilated patients to reduce the risk of pneumonia on medical-surgical units, I first consulted a systematic review of the risks of pneumonia in general for patients. In a Level 4 systematic review conducted by Almirall (et al., 2017) of risk factors for community-acquired pneumonia (CAP), 29 observational studies including cross-sectional, case-control, and cohort studies were reviewed to assess risk factors for adult hospitalized patients for developing pneumonia. The studies all attempted to study different, albeit similar, risk factors.
In the Almirall (et al., 2017) review, the confirmed risk factors included advanced age; being a smoker; a history of environmental exposure to negative toxins; malnutrition; a history of previous CAP; and respiratory complaints like bronchitis, COPD, and asthma. Other exacerbating factors included poor dental health and having being treated with certain kinds of classes of pharmaceuticals, such steroids and gastric-acid or immunosuppressive...
References
Almirall, J., Serra-Prat, M., Bolíbar, I., Balasso, V. (2017). Risk factors for community-acquired pneumonia in adults: A systematic review of observational studies. Respiration, 94:299- 311
Kubota, S., Endo, Y., & Kubota, M. (2013). Effect of upper torso inclination in Fowler’s position on autonomic cardiovascular regulation. The Journal of Physiological Sciences, 63(5), 369–376. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751277/
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