HCS 504 Week 2 Locating, Evaluating and Citing Scholarly Sources Example

Does High-Flow Oxygen Keep Patients Off the Ventilator? Finding, Judging and Citing the Evidence a Department Manager Would Need

[Student Name]

University of Phoenix

HCS/504: Introduction to Graduate Study in Health Sciences/Nursing

Week 2 Assignment

[Instructor Name]

[Date]

The student, hospital and search are composites written for a model paper; the studies, guideline and evaluation tools come from the sources listed.

At a critical care committee meeting last month, a pulmonologist asked whether the hospital should buy six more high-flow nasal oxygen units, arguing that they keep patients off ventilators. The director of respiratory care, my mentor, asked me to find out what the evidence says. As a lead respiratory therapist starting a Master of Health Administration, I used the request to practice the graduate research skills this week covers. This paper describes how I framed the question, searched, evaluated what I found and cited it.

Framing the Question

A topic such as high-flow oxygen is too broad to search well. I turned it into a question with four parts: in adults with acute hypoxemic respiratory failure, does high-flow nasal oxygen, compared with standard oxygen therapy, reduce the need for intubation? The population, intervention, comparison and outcome became the building blocks of my search.

Choosing Where to Search

I searched two databases through the university library: one focused on medicine and one on nursing and allied health, where respiratory care research is often indexed. I avoided a general web search for the main evidence, because its results mix research with marketing and news.

Search Terms and Limits

I combined subject headings with keywords. For the intervention I used terms for high-flow nasal cannula and high-flow oxygen; for the condition, respiratory insufficiency and hypoxemic respiratory failure; and for the outcome, intubation. I joined synonyms with OR and concepts with AND. The first search returned 612 results. Limiting to adults, English language, the last ten years and study types of randomized trials, systematic reviews and guidelines reduced this to 48. Reading titles and abstracts left four candidates, including one web page a colleague had sent me.

A Method for Judging Sources

I evaluated each source with the CRAAP test, which asks about currency, relevance, authority, accuracy and purpose (Blakeslee, 2004). I also noted the type of evidence, because a single trial, a review that pools several trials and a guideline built on reviews carry different weight.

Source One: A Randomized Trial

The first source was a multicenter trial of 310 patients with acute hypoxemic respiratory failure, randomly assigned to high-flow oxygen, standard oxygen or noninvasive ventilation. Intubation rates were 38% with high-flow oxygen, 47% with standard oxygen and 50% with noninvasive ventilation, a difference that was not statistically significant, although high-flow patients had more ventilator-free days and lower 90-day mortality (Frat et al., 2015). It was published in a leading peer-reviewed journal by investigators at many hospitals and directly addressed my question. Its currency was the weakest point, since it is more than ten years old, and a single trial of 310 patients cannot settle the question alone.

Source Two: A Systematic Review and Meta-Analysis

The second source pooled 9 randomized trials with 2,093 patients. It found that high-flow oxygen reduced the risk of intubation compared with standard oxygen, with a relative risk of 0.85, but rated the certainty of that finding as low because of imprecision and risk of bias, and it found no difference in mortality (Rochwerg et al., 2019). This source scored highly for relevance and authority, since it was written by an international panel of critical care researchers and used a formal method to judge certainty. The review changed my answer from a single trial's maybe to a modest benefit backed by several trials, stated with honest uncertainty.

Source Three: A Clinical Practice Guideline

The third source was an international guideline developed with the same formal method for grading evidence. The panel made a strong recommendation for high-flow oxygen over standard oxygen in hypoxemic respiratory failure, based on moderate-certainty evidence (Rochwerg et al., 2020). The guideline's disclosure section listed industry relationships for some panel members, which I noted under purpose; the use of a structured method and a published review reduced my concern. For a committee, a guideline is often the most useful source because it turns evidence into a recommendation.

Source Four: A Device Maker's Web Page

The last candidate was a manufacturer's web page stating that its high-flow system reduces intubation by 50%. It gave no study, date or author. Its purpose was to sell a product, its claim did not match the trials I had read and its accuracy could not be checked. I set it aside. The contrast shows why scholarly sources matter: they say how their claims were tested.

What the Evidence Says

Together, the three scholarly sources suggest that high-flow oxygen modestly reduces the need for intubation in adults with hypoxemic respiratory failure and is recommended over standard oxygen for these patients, though the size of the benefit is uncertain. That answer is more cautious than the pulmonologist's claim but supports the purchase if our current units are frequently unavailable, which is a question for our own data.

Where Each Source Sits Among Levels of Evidence

Health sciences programs often rank evidence in levels. Systematic reviews of randomized trials sit near the top, single randomized trials below them and expert opinion and unsupported claims at the bottom. Guidelines are built on the top levels but add a panel's judgment about benefits, harms, cost and patient values. Placing my sources this way explained why I gave the review and the guideline more weight than the trial, even though the trial was the most widely cited. It also explained why a claim with no study behind it, however confident, sits below all of them.

Turning Evidence Into a Local Question

Evidence answers whether an intervention works; it does not tell a hospital how many devices to buy. For that, the committee needs local data: how often all current units are in use, how often patients wait for one and how many patients with hypoxemic respiratory failure the hospital treats each year. I proposed a four-week count of unit availability at each shift change, which the director approved. Separating the research question from the operational one is a habit I expect to use often as a manager.

Citing the Sources

I followed the seventh edition of the APA manual (American Psychological Association, 2020). Two decisions came up. First, the review and guideline have many authors; APA lists up to 20 in a reference and uses the first author with et al. in the text. Second, because two sources share a first author, the years distinguish them in citations. Each journal reference includes its DOI as a link.

Next Time

On a second pass I would ask a librarian to review my search terms, since I may have missed studies indexed under different headings, and I would set up an alert for new trials, as research on high-flow oxygen continues.

Conclusion

A precise question, a documented search in library databases, a named evaluation method and careful citation turned a committee member's claim into an evidence-based answer. The trial, the meta-analysis and the guideline each passed the test for different reasons, and the web page failed it. The same process will serve every paper in this program and many decisions as a manager.

References

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000

Blakeslee, S. (2004). The CRAAP test [Article in LOEX Quarterly, vol. 31, no. 3]. LOEX Clearinghouse for Library Instruction, Eastern Michigan University. https://commons.emich.edu/loexquarterly/vol31/iss3/4

Frat, J.-P., Thille, A. W., Mercat, A., Girault, C., Ragot, S., Perbet, S., Prat, G., Boulain, T., Morawiec, E., Cottereau, A., Devaquet, J., Nseir, S., Razazi, K., Mira, J.-P., Argaud, L., Chakarian, J.-C., Ricard, J.-D., Wittebole, X., Chevalier, S., . . . Robert, R. (2015). High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. New England Journal of Medicine, 372(23), 2185-2196. https://doi.org/10.1056/NEJMoa1503326

Rochwerg, B., Einav, S., Chaudhuri, D., Mancebo, J., Mauri, T., Helviz, Y., Goligher, E. C., Jaber, S., Ricard, J.-D., Rittayamai, N., Roca, O., Antonelli, M., Maggiore, S. M., Demoule, A., Hodgson, C. L., Mercat, A., Wilcox, M. E., Granton, D., Wang, D., . . . Burns, K. E. A. (2020). The role for high flow nasal cannula as a respiratory support strategy in adults: A clinical practice guideline. Intensive Care Medicine, 46(12), 2226-2237. https://doi.org/10.1007/s00134-020-06312-y

Rochwerg, B., Granton, D., Wang, D. X., Helviz, Y., Einav, S., Frat, J. P., Mekontso-Dessap, A., Schreiber, A., Azoulay, E., Mercat, A., Demoule, A., Lemiale, V., Pesenti, A., Riviello, E. D., Mauri, T., Mancebo, J., Brochard, L., & Burns, K. (2019). High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: A systematic review and meta-analysis. Intensive Care Medicine, 45(5), 563-572. https://doi.org/10.1007/s00134-019-05590-5