NURS 6052 Week 7 Assignment Evidence-Based Project, Part 3 Critical Appraisal of Research

NURS 6052 Week 7 Assignment Evidence-Based Project, Part 3 Critical Appraisal of Research

NURS 6052 Week 7 Assignment Evidence-Based Project, Part 3 Critical Appraisal of Research

Worksheet Template

Evaluation Table

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Howard, J., Huang, A., Li, Z., Tufekci, Z., & Zdimal, V. (2021). An evidence review of face masks against COVID-19. Proceedings Of The National Academy Of Sciences, 118(4), e2014564118. doi: 10.1073/pnas.2014564118	Dugdale, C., & Walensky, R. (2020). Filtration Efficiency, Effectiveness, and Availability of N95 Face Masks for COVID-19 Prevention. JAMA Internal Medicine, 180(12), 1612. doi: 10.1001/jamainternmed.2020.4218	Ueki, H., Furusawa, Y., Iwatsuki-Horimoto, K., Imai, M., Kabata, H., Nishimura, H., & Kawaoka, Y. (2020). Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2. Msphere, 5(5). doi: 10.1128/msphere.00637-20	Loeb, M., Dafoe, N., Mahony, J., John, M., & Sarabia, A. (2009). Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers. JAMA, 302(17), 1865. doi: 10.1001/jama.2009.1466
Evidence Level *(I, II, or III)	Level II	Level III	Level III	Level I
Conceptual FrameworkDescribe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The traditional RCT methodology is best suited to medical interventions in which therapy has a significant effect at the micro-scale. Furthermore, treatment procedures and their results are also independent across individuals in a sample group. The impact of face masks on an epidemic is a population-level result, in which personal-level measures have an aggregate influence on society as a system.	The clinical paradigm illustrated filtration effectiveness, availability, and efficiency of N95 respirators. Mask reprocessing and decontamination for reuse, which extends the usable life span of masks beyond the expiry dates and reduces manufacturing costs, are two non-standard choices being pursued by health facilities to maintain a steady supply of masks.	Simulation modeling.Here they created an airborne dissemination simulator of contagious SARS-CoV-2-containing aerosols produced by human coughs and respiration, and evaluated the infectious droplets’ transmissibility as well as the efficacy of several types of face masks to impede transmission.	A fit-test on the regular medical or an N95 masks while caring for patients with febrile respiratory disease. The purpose of this theory was to compare the N95 respirator to a regular surgical mask in terms of safeguarding healthcare providers against influenza.
Design/MethodDescribe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	This scholarly article addresses the public’s use of masks as COVID-19 source control. A systematic piece enables an integrated effort to research evidence, which can help interpret and clarify data. Widening the evidentiary basis is critical in the context of a rapidly expanding global pandemic. Using a search of typical preprint and indexes servers, the authors used a community-driven technique to find further publications, in which professionals identified similar papers, which were recorded using a freely released collaborative document. This clinical evidence was assessed, integrated, and evaluated by a diversified team of professionals. All of the information that underpins the findings were included in the publication, and no external data source was necessary for analysis. Improvements including more evidence were added to the working document, then submitted as a preprint to preprints.org.	The overall design utilized to present this research is defined by the concise and logical arrangement of shreds of evidence trying to establish an answer to the research topic through gathering, interpreting, analyzing, and discussing results in a professional approach.	A simulation model system was used to experiment with the effectiveness of face masks in controlling the spread of airborne dissemination of viral aerosols/droplets. The model was made up of a test chamber for transmission tests, built in a BSL3 facility, and two mannequin heads were placed facing each other. One of the heads was attached to a modified compressor nebulizer and exhaled a mist of viral suspension from its mouth, mimicking a virus spreader. In contrast, the other head was linked to an artificial ventilator with a virus collection unit. The artificial ventilator conducted a tidal breathing mechanism, set at a normal lung rate, a representative of breathing steady rate in adults. The mannequin heads were allocated face masks according to the manufacturer’s directions.	Four hundred and forty-six nurses in medical units, emergency sections, and pediatric units in eight tertiary care Ontario Health Centers contributed to a structured noninferiority randomized experiment
Sample/Setting  The number and characteristics of patients, attrition rate, etc.	There are over 100 nations with mask requirements, and several localities, such as the United States, use their mask requirements. It was possible to evaluate the influence of protective gear at a systemic level by examining the timeline of pandemic transmission and mask use and variables such as geographic and demographic characteristics and the duration of other policy initiatives.	In this research article, the researchers recognized the current phenomenon of the COVID-19 pandemic, which influences the understanding of the cultural behavior of the target population, and, therefore, the core setting of the context	The entire simulation was carried out under ideal conditions. The system, together with all its attributes, mimicked the real-world situation during the guidelines given by WHO and CDC recommending face masks to control the spread of COVID-19	Nurses were recruited from pediatric units, medical units, and emergency sectors from eight tertiary care institutions in Ontario, out of which six were located in the Larger Toronto zone. Two out of eight centers were community-based institutions with bed range between (256 and 400), while the other six were university-allied teaching hospitals (with bed numbers ranging from 309 to 399). A sum of 22 departments was involved in the research, including six pediatric units, seven emergency units, and nine acute medical sectors.
Major Variables Studied  List and define dependent and independent variables	Independent variable: geographic and demographic statistics.Dependent variable: Duration of the pandemic transmission.	Dependent variables: types of masks.Independent variables: filtration efficiency.	Dependent variable: masks effectiveness.Independent variable: concentration of virus aerosols.	Dependent variables: specific outcome from a participant.Independent variables: total outcome from all participants.
Measurement  Identify primary statistics used to answer clinical questions (You need to list the actual tests done) NURS 6052 Week 7 Assignment Evidence-Based Project, Part 3 Critical Appraisal of Research.	Population impact: analyzing the duration of mask use and pandemic transmission, alongside with co-founders including geographic and population statistics, and judgments of other policy interference.Transmission Characteristics: Presymptomatic incubation phase oscillating between 2days to 15days, with 5.1days as the median length. The dimensions of oral fluid particles were another statistic of concern. Source control: (1) indirectly and directly calculating the quantity of particles with varying sizes, (2) calculating the number of infectious particles.	Out of the essential four scales of measurement, i.e., ratio, ordinal, nominal, and interval, which provide a varying type of data, the researchers employed the ration scale that’s (odds ratio, 0.97; 95% Confidence Interval, 0.86-1.1) vs. (odds ratio, 0.85, 95% Confidence Interval, 0.23-3.32) to demonstrate the insignificant benefits of N95 respirators over regular medical masks in preventing severe respiratory infections	To check the correctness of N95 and medical masks and evaluate the performance of the proposed protection and filtration capacity, simulation experiments was used.	The principle of noninferiority would be realized if the lower limit of a 95% CI (Confidence Interval) computed for the reduction in rate (N95 group less surgical group) was greater than 9%. The mask’s noninferiority determined the surgical mask’s efficacy to the N95 respirator. A key result was a four-fold increase in hemagglutinin titers or lab-confirmed influenza as determined by polymerase chain reaction.
Data Analysis Statistical orQualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Here, they looked at estimated outcomes (the actual reproduction number R0 was appraised to be between the range of 2.4 and 3.9) based on models, and a study-based approach (Ecological Studies), as part of a broad range impact on population analysis.	Computing statistical confidence intervals to verify proof from observable evidence that N95 respirators have no significant qualification over medical masks in controlling the transmission of severe respiratory syndromes, for example, (odds ratio, 0.86; 95% Confidence Interval, 0.22-3.33).Percentage computation: this technique was used to calculate filtration efficiency (filtration efficiency ranging from 53% to 85%)	Simulation and modeling.Descriptive statistics: specific independent outcomes were recorded and presented in graphical charts.	Fisher exact test was employed to determine the statistical significance in contingency tables with anticipated cell frequencies, not more than 5.Hypothesis testing. This article hypothesized N95 respirator, which is expensive and considerably unaffordable than surgical masks, provides similar protection to regular surgical masks among health care professionals at the highest exposure risk to influenza. Qualitative fit testing using the Bittrex or saccharin protocol.
Findings and Recommendations  General findings and recommendations of the research	The distinction between medical masks and N95 masks might be the key driver of disparities in SAR-CoV-2 outcomes in different locations. These findings correspond to the model that depicts significant population-level effects from widespread use of surgical masks compared to type N95.N95 and regular surgical masks have different capacities to filter particles depending on the particle trajectory and size. N95 with valves as a consideration, do not filter respiratory pathogens compared to masks without valves, dodging filtration procedure and offering limited source control.	N95 respirators with less fit still had filtration inefficacy of more than 90%.N95 equivalents, of which large volumes have been bought or donated to United States health facilities, performed less well, with their filtration effectiveness ranging between 53 percent to 85 percent. Regular medical masks with ear loops or ties portrayed substantially lesser filtration efficacy, with a range between 37 percent and 69 percent, as one would anticipate given their comfortability, looser fitness, and thinner filtration.	Surgical masks, cotton masks, and N95 respirators have a protective efficiency and are higher if worn by the virus source. However, none of the masks completely blocked the dissemination of virus aerosols even when sealed.The information derived from the simulation will help medical staff comprehend the performance and proper use of masks and determine if additional equipment is necessary to safeguard themselves from infected patients.	There was no significant variation between N95 receptors and surgical mask sets in respiratory metapneumovirus, syncytial virus type B, rhinovirus-enterovirus, coronaviruses, or parainfluenza 3.When contrasted to the N95 respirator sample, the surgical mask group had a considerably higher frequency of nurses reporting fever.
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?	Worth: The article offers considerable evidence in favor of the widespread use of N95 masks compared to regular surgical masks as source control to minimize public transmission.Strength: The addresses concerns for healthcare workers to wear quality masks (type N95) which is a shred of evidence behind the control of respiratory infections. Limitation: No basic indication for the efficacy of control, only alarms about how they can be used. Risks associated: The radical change from the initial days when a respiratory pandemic emerges and masks are infrequently used or recommended.   Feasibility: Observational and RCT studies provide helpful information, but they aren’t enough to make a case. Concrete evidence of mask efficacy is encouraging yet uncertain. The article should investigate more information because there are no RCTs, only one epidemiological trial, and conflicting information from different respiratory disorders.	Worth: Although non-NIOSH accepted medical masks and N95 respirators appear to have poor filtration effectiveness according to laboratory tests, there is a reason the researchers needed to be optimistic about their real-life performance.Strength: Despite the actual infectious dosage of the virus is determined to lead to clinical infections is unknown, filtering most if not all particles by masks that have small submicron particle filtration efficacy might be adequate to control transmission in most cases. Limitation: Despite the proof that regular medical masks have a lesser filtration efficacy than their counterparts, observable research reveals that N95 respirators have no substantial advantage over traditional surgical masks in preventing respiratory infections. Risks: although it was not considered high risk for health staff caring for patients confirmed to be COVID-19 positive if they were both wearing regular medical masks, the particle of SARS-Cov-2 were identified to last for several hours after an aerosolizing event.	Worth: The model offers considerable evidence in favor of the widespread use of N95 masks compared to regular surgical masks as source control to minimize public transmission.  Strength: assist medical personnel with understanding the proper usage and performance of masks, as well as determining whether they require further protection from contaminated patients. Limitation: Errors might be made in the rules or set up strategies of the simulation Risk: In case of any leakage or unrecognizable error in any phase, the results would be biased	Worth: Given the potential that N95 face masks are unavailable and in low supply in many countries during a pandemic, understanding the efficiency of the regular medical mask is essential for the general public healthStrength: Audits were conducted from 11th Mar to 3rd Apr 2009, during what we expected to be peak influenza season, to examine participants’ cooperation with the provided N95 respirator or mask. Limitation: There is a likelihood that N95 respirators will be inadequate during a pandemic and hence not available to a large population. Risks: The researchers did not anticipate severe results such as mortality rate.   Feasibility: Nurses were required to show proof of current fit-test certifications. Nurses who failed a fit test were not allowed to participate in the trial.
Key findings	There is available evidence that suggests universal adoption of N95 masks among nurses when attending patients with respiratory infections in conjunction with corresponding public health measures could significantly reduce the rate of respiratory diseases.	Medical masks secured with either ear loops or ties had less filtration efficacy between 37 and 69 percent.There were instances of concern for the likelihood of SARS-CoV-2 transmission, infectiousness, and viability. The general effectiveness of any mask depends heavily on its real-life application, not necessarily from its viability in lab efficiency tests. The researchers used random sampling to choose a sample from a vast population, showing that the resultant data was biased contributed by the intentional bias from the sampling process.	Surgical masks, cotton masks, and N95 respirators have a higher level of protection when worn by the viral source. Even when sealed, none of the masks completely stopped the spread of virus aerosols.	A substantial ambiguity prevails regarding the effectiveness of PRE (personal respiratory equipment) against influenza for health practitioners.There is limited comparative proof of PPE, and information comparing N95 and regular medical masks among healthcare professionals are lacking. The researchers used random sampling to choose a sample from a vast population, showing that the resultant data was biased contributed by the intentional bias from the sampling process.
Outcomes	Masks effectively reduce the spread of respiratory viruses in periods and places where their usage is mandatory.	Under lab conditions, N95 respirators reprocessed through sterilization using ethylene oxide, and the ones that are nearly 11 years past their expiration date maintain a high filtration capacity.	Even when completely secured under the circumstances studied, medical masks (N95 masks and even surgical masks) were unable to entirely block the transfer of virus aerosol.	(478) nurses were examined for eligibility between 23rd Sept and 8th Dec in 2008, and (446) nurses were randomly enrolled and assigned to intervention; 221 were allocated N95 masks, and 225 received surgical masks. Influenza infection was seen in 22.9%, i.e., 48 nurses in the N95 respirator set, and 23.6% (50 nurses) in the standard medical mask set (an absolute risk variance, from -8.8% to 7.3%, -0.73%; 95% confidence interval; P=0.86), with the lower CI limit falling within noninferiority limit of minus nine percent.
General Notes/Comments	As a result, choosing primary and secondary goals for respiratory protection studies is an important design stage that could ultimately determine the study’s genuine worth.	Surgical masks and N95 substitutes will keep health-care  and clinicians professionals safe in the future.	The longevity of the viruses in the air varies based on the constituents of viral droplets, such as proteins, inorganics, and surfactants, implying that the constituents of viral aerosols also affect the penetration efficacy of masks.	Compared to regular surgical masks, whose efficacy anticipates a range from 2percent to 92 percent for particles below 20 μm in diameter, dissemination by small droplet dispersion would be comparable with higher protection with the N95 respirators.

 

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Critical appraisal

There is a great need to evaluate whether the performance of an appraisal practice implemented is effective or not. A thoughtful, prepared critical appraisal must meet distinct characteristics, including; (1) clear and specific objectives, a quality that an efficacious critical appraisal possesses to match the researcher’s topic description, (2) provide reliable, consistent, and valid information to help in decision strategic decision making, (3) matches the real essence of the research because it’s tailored logically to pull together every single shred of evidence to support the research question. Throughout my research journey to reviewing various healthcare articles under distinct settings, I have ensured I am fully committed to the whole ideologies of the research article and monitored the schemes effectively to see to it that concerns are justified.

In fact, out of four reviewed articles, two of them, i.e., (filtration effectiveness, efficiency, and availability of N95 respirators for respiratory infection prevention) portray a lack of experimental studies comparing the efficacy of regular medical masks to N95 under real-life paradigms. In the medical sector, it is important to distinguish between lab testing and real-life experiences regarding PPE in controlling severe respiratory infections. This dispossession of any evidence to generate the fact that there is a correlation between a lab experiment and real-world experience dismisses the worth of the articles. However, according to (Loeb, Dafoe, Mahony, John & Sarabia, 2009), an original randomized trial research contribution on how N95 Vs. medical mask prevents Influenza among healthcare workers demonstrates a real-life paradigm to test the effectiveness of the two types of masks.

NURS 6052 Week 7 Assignment Evidence-Based Project, Part 3 Critical Appraisal of Research

Its abstract captures the theory behind its randomized experiment. Its primary purpose was to compare the N95 respirator to a regular surgical mask to safeguarding healthcare providers against Influenza (Loeb, Dafoe, Mahony, John & Sarabia, 2009). In this case, a fit-test on the typical medical or N95 masks while caring for patients with the febrile respiratory disease was carried before commencing the experiment to justify the results. In addition, this experiment used the sampling method as a data collection technique which ensured that the sample group was a true representative of the target population, eliminating errors. I recommend this investigation because it helped determine the fundamental nature of the effectiveness between the two types of masks and evaluate the rate of infection, which would be difficult when using scholarly sources for evidence due to their scarcity.

To recap, there is a pressing requirement to determine whether an appraisal practice’s performance is effective or not. A well-prepared critical evaluation must possess certain features, such as providing dependable, consistent, and valid data to aid in strategic decision-making. In any medical field, it’s essential to distinguish between lab testing and real-world experiences when it comes to PPE to treat serious respiratory infections. The experiment aided in discovering the true nature of the effectiveness of the two types of masks and determining the rate of infection, which would have been difficult to do with scholarly sources due to their rarity.

References

 

Bessesen, M., Savor-Price, C., Simberkoff, M., Reich, N., Pavia, A., & Radonovich, L. (2013). N95 Respirators or Surgical Masks to Protect Healthcare Workers against Respiratory Infections: Are We There Yet?. American Journal Of Respiratory And Critical Care Medicine, 187(9), 904-905. doi: 10.1164/rccm.201303-0581ed

Dugdale, C., & Walensky, R. (2020). Filtration Efficiency, Effectiveness, and Availability of N95 Face Masks for COVID-19 Prevention. JAMA Internal Medicine, 180(12), 1612. doi: 10.1001/jamainternmed.2020.4218

Howard, J., Huang, A., Li, Z., Tufekci, Z., & Zdimal, V. (2021). An evidence review of face masks against COVID-19. Proceedings Of The National Academy Of Sciences, 118(4), e2014564118. doi: 10.1073/pnas.2014564118

Loeb, M., Dafoe, N., Mahony, J., John, M., & Sarabia, A. (2009). Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers. JAMA, 302(17), 1865. doi: 10.1001/jama.2009.1466

Ueki, H., Furusawa, Y., Iwatsuki-Horimoto, K., Imai, M., Kabata, H., Nishimura, H., & Kawaoka, Y. (2020). Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2. Msphere, 5(5). doi: 10.1128/msphere.00637-20

Critical Appraisal Tool Worksheet Template

Critical Appraisal of Research

Mental health disorders have far-reaching consequences on patients, health care practitioners, and families. As a result, evidence-based care interventions that engage patients in care and promote self-management are recommended. Telehealth provides a tech-based platform for health care and health education (Zhao et al., 2021). If applied effectively and its risks controlled, telehealth can optimize care effectiveness and reduce mental health burdens in many populations. The purpose of this worksheet is to critically appraise research on the role and effectiveness of telehealth interventions in improving treatment outc