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Introduction
A systematic review is a very important aspect of evidence-based nursing practice. It entails gathering, evaluating, and synthesis of a clinical problem so that appropriate conclusions can be drawn on the most effective practice to adopt. The contents of this paper have been prepared about a systematic review of a study on antibiotics for syphilis diagnosed during pregnancy.
Discussion
The report has not clearly stated the research problem. This is because, as given by Polit & Beck, a research problem or question is a mysterious situation that needs to be addressed through a disciplined inquiry. The research question or research problem should be narrow, focusing on a certain kind of intervention and associated outcomes. This report assumes a retrospective approach that is not easily manageable because a specific kind of intervention has not been proposed for investigation. The scope of the project is not appropriate in that penicillin is not the most preventative measure to prevent the occurrence of congenital syphilis. The report gives a big picture of the various causes associated with syphilis thus using penicillin as the solution does not seem to solve the problem.
The topic of integration is not important for nursing because it does not give an account of the effects of penicillin on patients. A topic of integration as earlier mentioned should have an intervention and associated outcomes which, apparently are lacking. Randomized controlled trials were used in identifying the appropriate treatment regimen associated with penicillin in the treatment of syphilis. This approach is approaching because the study is retrospective. The report does not define the concepts and variables appropriately. This is because the project is not specific about the king of variables it seeks to examine. In addition, this can be attributed to the fact that the integrated approach has not been adequately described (Polit & Beck 2008).
The report has described the criteria used for selecting some of the primary studies. On the other hand, it is quite evident that most of the primary studies are not associated with a reasonable criterion for selection. Most of the time, the reviewers have just stated the use of studies in obtaining findings but the criteria used for selecting the studies is not known. There is only one instance when an indication of the selection criterion has been given as, “strict evidence from randomized controlled trials did not provide recommendations for optimal dosage and duration of administering the drug” (Walker 2010).
The report has used publications that date back to 1945. I find this as lacking credibility because it is more than fifty years old and information usually becomes outdated with time. A lot has happened between then and now. However, reports from organizations like the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) as well as publications made in the last ten years (1990-2009) and which are valid and more credible have been used. Keywords have been exhaustively identified and defined. For instance, a clear definition of syphilis about primary and secondary has been given. There is no evidence of supplemental efforts being used to identify relevant studies. Secondary sources are the main criteria used to identify relevant studies used in the review (Walker 2010).
Attempts to give treatment for syphilis to pregnant mothers were considered to be the inclusion criteria. This is defensible in that it will target the pregnant women infected with any kind of syphilis based on randomization. The search strategy used in coming up with the report has yielded a strong and broad sample of studies. There were electronic searches from where the Cochrane Pregnancy and Childbirth Group’s Trials Register was obtained. These trials are broad in that they entail trials from Cochrane Central Register of Controlled Trials, MEDLINE, journals, and reports from very important conferences. There were no restrictions on the language used. However, randomized controls could not be traced. The review does not give a detailed description of the sample used for the study. Therefore, the advantages and disadvantages of the sample could not be identified. As earlier said, there was a lack of supplemental efforts hence; reviewers did not attempt to contact original researchers for more information.
The reviewers have given an appraisal about the quality of primary studies done by identifying the key gaps in these studies. They have used a well-defined criterion to address this issue of the quality of the primary studies. For instance, they give an account of what the studies have covered and what has not been dealt with. Unfortunately, there is no clarity on the number of people that did the appraisals. All that has been given are the various ideas and conclusions that can be derived from the primary studies. However, there was no integrated agreement among the reviewers doing the appraisal. There are no questions on how the appraisal information has been used to select studies and analyze results.
Adequate information on methodological aspects of the study was not extracted about the methodologic and administrative aspects of the study. There is no information on the research design and sampling techniques of the population to be studied. As a result, there was inadequate information extracted about the characteristics of the sample population. In addition, the report does not say the person who will be in charge of carrying the research. Ethical considerations that have to be put in place have also not been identified. Since these are the aspects making for an adequate extraction of information on the methodologic and administrative issues, it is, therefore, apparent that information lacks on this (DiCenso, Guyatt, & Ciliska (2005).
An explanation has been given on how data would be pooled and integrated. This was done by scrutiny of papers that met the inclusion criteria from where data was extracted. Analysis of data is not thorough and credible because it does not include thorough and detailed information on the treatment regimen, which is the main reason for the study. No figures or tables have been used to summarize findings. Secondary text is how findings have been summarized through comparison but still, the comparison is not justifiable enough.
There is no justification for a narrative integration method because the research question or problem is aimed at investigating the appropriate quantities to be used for the treatment of syphilis during pregnancy. The use of a meta-analysis is justifiable as it will look at the appropriate quantities to be used for treatment when compared with other studies. However, appropriate procedures to compute effect sizes for the associated outcomes have not been followed. Contrary to the use of an array of findings to confirm findings, one or two previous studies have been used to affirm a particular finding. Therefore, appropriate procedures have not been followed about meta-analysis in computing effect size for relevant outcomes. It is because of this that the meta-analysis performed cannot be regarded as that which is justified. There is evidence of heterogeneity but it is not exhaustive. The report entails looking at different concepts or variables to investigate the problem but then leaves the most crucial aspect of it which is prevention. The report assumes a more curative approach to dealing with syphilis during pregnancy. A random-effects model was used. This is appropriate because it reduces the chances of biases in the study.
The report does not give an appropriate subgroup analysis of the study population used. This is not justified because valid research will give an explicit description of the findings of the subgroup. An adequate analysis of the subgroup used in the study is very important in testing the hypothesis and achieving the objectives of the study. As a result, one can therefore conclude that the objectives of this study were not adequately achieved and the hypotheses were not appropriately tested. The report has not adequately addressed the issue of publication bias about penicillin G. It just points out one instance where CDC acknowledges penicillin as the only therapy that has got documented efficacy about syphilis during pregnancy without pointing out the biases involved.
The reviewers have not described the techniques used in comparing the findings. In addition, there is no explanation of the method used for interpreting data. The abstracted findings do not seem adequate and convincing enough if a meta-summary was to be performed. This is because, in a meta-summary, there need to be findings from several studies, not just one or two. This enhances the validity and reliability of data. There are no clear explanations as to the procedures used to compute effect sizes. In addition, how information has been presented is not professional and up to standards as it lacks adequate evidence to support it. However, the report has brought a better understanding of dosage quantities for both primary and secondary syphilis (Polit & Beck 2008).
Conclusion
Accountability of the conclusion drawn by the reviewers in terms of quality, consistency, and quantity of evidence is questionable. Limitations of the review are noted in that randomized trials could not be identified to give a lead on whether the recommended treatment schedules for pregnant women with syphilis ought to be changed. While there are no clear implications of the study on the nursing practice, implications for further research have not been articulately and explicitly stated.
References
DiCenso, A., Guyatt, G., and Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis, MO: Elsevier Mosby.
Polit, D.F., & Beck, C.T. (2008). Nursing research: Generating and assessing evidence for nursing practice (8th ed.). Philadelphia: Lippincott.
Walker, G.J.A. (2010). Antibiotics for Syphilis Diagnosed during Pregnancy (Review). Liverpool: John Wiley & Sons, Ltd.
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