What does this review ask?
It should be pointed out that the review under analysis, namely Usefulness of Clinical Prediction Rules for the Diagnosis of Venous Thromboembolism: A systematic Review aims to provide an analysis of the role predicting rules are playing for the process of diagnosis. The study is focused on physical assessment and diagnosis of venous thromboembolism. The fundamental problem is that symptoms cannot be considered as specific to diagnosis. Physical peculiarities and symptoms have limited value and do not contribute to prediction rules development.
What are the elements of this review? Are the results valid? What are the final results? Can this be applied to nursing practice?
As a matter of fact, the study opens with an introduction part where the researchers state aim and objective of their review and outline the problem. The introduction is followed by the methods part, and it is centered on the description of the methods that were used in order to reach stated objectives. The researchers state how many articles have been chosen for the study and the reason for choosing them (Tamariz et al., 2004).
In addition, the experts make an accent on the results section where they are involved in a further investigation. This section deals with the quality of the study, description of the peculiarities of the Wells prediction rules for the deep vein thrombosis, pulmonary embolism, and D-dimer results to clinical prediction rules. After consideration of results, the researchers go on and discuss the findings in the discussion section. This section is devoted to limitations and strength of the research. There are the following elements in review, namely:
- Introduction
- Method
- Results
- Discussion
- References
The review under analysis contains tables that illustrate the findings. These tables contribute to better understanding of information. It should be pointed out that the results of the review can be considered as valid. The researchers took into consideration 72 articles that were considered to be relevant to the study, and the experts came to the conclusion that they should be taken into consideration. However, after closer examination, 49 articles were excluded from the study because they contained not appropriate information:
- 31 articles were not centered on prediction rules as it was stated before;
- 7 articles were described as retrospective research;
- 2 articles did not have original findings;
- 8 articles were not corresponding to the research question;
- 1 article was centered on discussion of preventive mechanisms of thrombosis (Tamariz et al., 2004).
Moreover, 30 patients were involved in the study in order to investigate the relationship between the prediction rules and the process of diagnosis.
According to the results of the study, Wells rule was considered as the most commonly tested mechanism for diagnosing the disease and for evaluation of probability. The researchers concluded that Wells prediction rules could be considered as relevant and effective for the process of treatment of clients with risk factors. However, in spite of obtained results, the expert notes that the sphere needs to be further investigated as clinical prediction rules might have potential barriers in usage.
Clinical prediction rules can positively influence the practice of advanced practice nurse and registered nurse, however, there is a number of potential issues that can be associated with clinical prediction rules, and thus, they should be taken into consideration. The study proved that the Wells prediction rule is beneficial for implementation as it contributes to predicting the outcomes. With the consideration of the above stated information, it is worth noting that nurses should get a better understanding of clinical predicting rules and their effect.
Who funded the review?
This study was possible to conduct due to the Johns Hopkins Evidence-Based Practice Center and the Agency for Healthcare Research and Quality.
Strengths and limitations of the review
The review under analysis deals with the investigation of a usefulness of prediction rules in relation to the diagnosis of venous thromboembolism. As for the strength and weaknesses of the review, the following information should be taken into consideration. First and foremost, it is worth noting that the researchers used only relevant articles that underwent the process of analysis. Moreover, 30 patients were analyzed carefully, and the information obtained contributed to the results of the study. The researchers concluded that clinical prediction rules have certain benefits for the health care system. As a matter of fact, clinical prediction rules provide standardized approaches that can be used in any medical establishment in order to estimate potential risks.
In spite of the fact that there are certain advantages of clinical prediction rules, it is of paramount importance to note that there are some limitations that should be taken into account. As for the limitations of the study, it is worth highlighting that this work has certain weak points. First and foremost, it should be stressed that the results that were obtained after analyzing articles and conducting research “cannot be extrapolated to patients with suspected deep vein thrombosis who have a known malignancy, family history of thrombosis, previous episode of venous thromboembolism, or concomitant pulmonary embolism, as these patients were generally excluded from the studies” (Tamariz et al., 2004).
In addition, it should be stressed that additional effects and biases were impossible to exclude from the research. Thus, with the consideration of the above stated information, the conclusion can be drawn that further investigations are essential. Concluding the research, the experts note that Wells prediction rules can be considered as useful while diagnosing patients with risk factors. Nevertheless, taking into account that the review has a number of crucial limitations, it should be stressed that the issue should be further investigated.
Was the objective accomplished?
The fundamental objective that was chosen be researchers was related to providing a summary of the evidence regarding the value and usefulness of clinical prediction rules with the consideration of the diagnosis of venous thromboembolism. It should be pointed out that the experts aimed to review the accuracy of clinical prediction rules. This objective was accomplished, and the researchers outlined their findings in the results and discussion sentence.
Critical thoughts
I do not profess to be an expert regarding the subject, but I am strongly convinced that the sphere of medicine should experience constant research and improvement. Clinical prediction rules are considered to be a field that should be further researched and investigated.
The results obtained while the research are essential for taking into consideration. Nurses play a significant role in the process of treatment, and thus, they should implement all appropriate knowledge, skills, and capabilities to improve a patient’s outcome. Clinical prediction rules consider as a controversial issue, however, according to the experts that conducted this study they can be used beneficially in the process of treatment. Nurses should implement the principles of clinical prediction rules into their practice in case it does not contradict traditional system of health care.
Reference
Tamariz, L., Eng, J., Segal, J., Krishnan, J., Bolger, D., Streiff, M.,… Bass, E. (2004). Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: A systematic review. The American Journal of Medicine, 117(9), 676-684.