Identify what is not known as a result of the evidence synthesis. Inconsistencies in study populations, interventions, comparison, and outcomes were discussed as gaps in the evidence.

PICOT 2 Table Guidelines 1. Grading the Evidence – Assign a “Quality Rating” for each individual study (Dearholt and Dang, 2012, A, B, or C). Quality Rating using the scheme below (Newhouse) or the one from Dearholt and Dang (2012) a. Quality Rating Scheme from Newhouse, R.P. (2006). Examining the support for evidence-based nursing practice. Journal of Nursing Administration, 36(7-8), 337-40. A: High – consistent results with sufficient sample, adequate control, and definitive conclusions; consistent recommendations based on extensive literature review that includes thoughtful reference to scientific literature B: Good – reasonably consistent results; sufficient sample, some control, with fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence C: Low/major flaw – Little evidence with inconsistent results; insufficient sample size; conclusions cannot be drawn. 2. Create a Strengths and Weaknesses Table for each study in your review. Using the table, discuss the strengths and weaknesses of the evidence. Include threats to internal and external validity for each article. To critique/identify strengths and weaknesses of each article, you may use the Rapid Critical Appraisal Forms (Melnyk & Fineout-Overholt, 2014), or the Quantitative Article Critique Tool, although you will not include these forms tools in your paper. Strengths and Weaknesses Table

Evidence Based Practice Question (PICO(T)):
Source (Authors, year)	Strengths	Weaknesses	Level of Quality Rating
1)
2)

3. Overall Evidence Synthesis: Using the Evidence Review table from PICOT 1, discuss the similarities and differences between the studies. Discuss agreement about the results among studies. Discuss strengths and weaknesses of the studies in the table and how these compare to one another. Summative Evidence Rating Table:

Evidence Based Practice Question (PICO):
Level of Evidence	Number of Studies	Summary of Findings	Overall Quality

4. Gaps – Identify what is not known as a result of the evidence synthesis. Inconsistencies in study populations, interventions, comparison, and outcomes were discussed as gaps in the evidence. Make recommendations for future research to address identified gaps. Were studies difficult to compare because the intervention and/or outcomes of differed from one study to another? 5. Recommendation for practice a. Discuss considerations when deciding to apply or not apply the evidence to practice (practice context, patient preferences, strength of the evidence). b. Identify potential barriers to implementation of the evidence (feasibility, ethical concerns, resources, risk/benefit to patient/organization). c. Make a recommendation for practice for a specific population/setting based on the evidence, with USPSTF Grade Rating. i. This recommendation is based on weighing the rating you gave to each studies evidence, similarities and differences between studies, major validity threats, feasibility of the decision, resources needed, ethical issues, potential risks and benefits at the patient, nursing, and organizational levels, and patients’ or health care professionals’ differences that may limit the full implementation of the evidence.

Recommendation based on the methodology used by the U.S. Preventative Services Task Force (USPSTF):
Grade	Definition	Suggestions for Practice
A	The USPSTF recommends the service. There is high certainty that the net benefit is substantial.	Offer/provide this service.
B	The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.	Offer/provide this service.
C	Note: The following statement is undergoing revision. Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.	Offer/provide only if other considerations support the offering or providing of the service in an individual patient.
D	The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.	Disourage the use of this service.
I	The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement.	If offered, patients should understand the uncertainty about the balance of benefits and harms.
Source: U.S. Preventive Services Task Force Ratings. U.S. Preventive Services Task Force. December 2013. http://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-ratings

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