Heart & Lung Questions
1. Under what circumstances would a published systematic review not be accompanied by a quantitative meta-analysis? Select all that apply.
Only qualitative research could be found in the area of the search.
The author was unable to contact all of the authors of the individual studies in order to obtain raw data.
The research located in the search was of poor quality and incompletely described.
The author did not have time to conduct a meta-analysis.
E. The search yielded only a few studies with small sample sizes and differing designs.
2. The abstract for a systematic review and meta-analysis should include specifics about the report that follows. What elements of a typical abstract were present for this report? Select all that apply.
Purpose
Total number of subjects in all of the articles analyzed
Number of studies in the meta-analysis
Results
Recommendations for future study
3. What were the characteristics for the pooled sample of all selected studies? Select all that apply.
Mean age: 63 years
Males 69%
All post-cardiac surgery
More than 85% white
Mostly college graduates
4. The clinical question that drove the review was not explicated. What was the implied question?
A. Do patients accept and tolerate therapeutic massage in the immediate postoperative period of hospitalization?
B. By what magnitude, on average, does therapeutic massage reduce postoperative thoracic surgery pain?
C. Does the total evidence of available literature support massage as a pain-control intervention after thoracic surgery?
D. Is massage by therapists any more effective than massage by others in reducing pain for hospitalized postoperative thoracic surgery patients?
5. The combined review and analysis by Boitor et al. addressed acute pain in critically and acutely ill adults after thoracic surgery. What intervention was the focus of the project?
A. Attention control
B. Pharmacological analgesia
C. Massage
D. Routine postoperative care
6. What points did the authors make about the significance of this problem? Select all that apply.
Opioid overdose is a frequent occurrence in postoperative patients.
Unrelieved postoperative pain predicts both persistence and severity of long-term pain.
Unrelieved pain can interfere with both mobility and respiratory function.
The pain following thoracic surgery can be severe.
Of all surgeries performed, thoracic surgery is the most frequent.
7. Which were the search criteria for studies included in this review? Select all that apply.
RCTs only
Any publication year prior to 2015
Adult, not pediatric, subjects
Focusing on cardiac surgery only
Assessment of the effect of massage on acute postoperative pain
Massage could not have been administered instead of opioid medication
Pain recorded only by visual analog scale
8. The intent of a meta-analysis is to produce a large pooled sample. A large pooled sample has which advantage?
A. If results vary, two differing pathways are statistically analyzed.
B. It is more convincing to the reader.
C. A larger sample permits generalization to diverse groups.
D. As the sample size increases, power of the statistical test increases, as well.
9. A formal search of several information sources was conducted by a research librarian. In addition, what other strategies were used to discover additional research on the topic? Select all that apply.
Authors of studies identified were contacted personally for information about any other unpublished trials.
National Institutes of Health were contacted relative to any applications for funding currently in progress.
Several databases likely to contain information on clinical trials were searched.
Published reviews of the literature were searched.
Reference lists of included articles were scanned.
10. How were the studies selected for inclusion? Select all that apply.
First, titles and abstracts were screened independently by two investigators, identifying several eligible texts.
If the investigators disagreed as to whether a report was eligible, a third author was consulted.
The third author then made a unilateral preliminary decision as to inclusion or non-inclusion.
The principal author reviewed all disputed reports and made the final decision.
Studies conducted outside the United Kingdom, Canada, Australia, the United States, and Iran were excluded because of language clarity problems.
11.How many article abstracts were read by the authors, in their literature search?
A. 25
B. 140
C. 165
D. 194
12. How many full-text articles were read by the authors, in their literature search?
A. 25
B. 140
C.165
D. 194
13. Were the authors of selected studies contacted by the Boitor et al. team and, if so, when did the contact occur?
A. In the discussion phase, selected authors were contacted, to determine their opinions of topics for subsequent research.
B. No study authors were contacted.
C. All studies’ authors were contacted by Boitor et al. during the search phase.
D. During the analysis phase, all study authors were contacted to confirm pain scores recorded within 24 hours of massage.
14. What was the purpose of including Figs. 2 and 3?
A. They provide foci of visual interest, drawing the reader to the illustrations of bias risk, so that the reader will review mean scores and differences.
B. They present a visual representation of values obtained in the various studies and the report, the weighting of each by sample size, and outcomes.
C. They are the means by which the authors calculated mean difference of the independent variable.
D. They contrast the results obtained for sham/attention control versus those obtained for standard care.
15. In Fig. 3, the study by Albert (2009) seems to have shown no significant difference between the experimental and control conditions. In Fig. 2, the study by Boitor (2015) displays a confidence interval that includes both negative and positive values. What are the implications of these points, in terms of generalizability?
A. They imply that massage was enacted inappropriately in Albert and Boitor. The intervention was found to be statistically significant in pain control in the meta-analysis, so it must be effective.
B. They imply that the results were even more impressive in the studies by Albert and Boitor, giving even more support for wide generalizability.
C. They imply that even though the results of the meta-analysis showed significant results, the intervention did not achieve statistical significance in some individual studies, indicating that massage may not be effective across all sites.
D.They have no implications for generalizability.
16. What information can be derived from the results portion of the discussion section? Select all that apply.
Results from the largest RCT study were similar to those obtained from the meta-analysis.
Because pain decrease was greater in comparison with standard care than in comparison with attention control, patients may have benefitted somewhat from attention control interventions.
Reported pain decrease differed by country, with the largest differences reported by the studies conducted in Iran.
For the 12 studies analyzed together, massage reduced pain intensity in post-thoracic surgery patients, in comparison with sham massage or attention control, and also compared with standard care alone.
On a 0- to 10-point visual analog scale, a 0.8 difference in pain score was statistically significant. Therefore, a decrease in pain from 6.9 to 6.1 must be interpreted as clinically significant.
17. What did the authors identify as implications for practice? Select all that apply.
There are no contraindications to at-bedside massage.
Massage is easily delivered and can be easily implemented by bedside nurses, following a short training.
Massage can complement pharmacological analgesia.
Massage can decrease heart rate in anxious patients, improving circulatory function.
Massage may have the potential to concomitantly improve other symptoms such as pain distress and anxiety.
18. What did the authors suggest as possible areas of investigation, in terms of subsequent research studies? Select all that apply.
Massage and decreasing the use of opioids during hospitalization
Massage and shortened recovery time
Massage and panic attacks
Massage as a complement to pharmacological analgesia.
Massage and pain interference
Massage and pain distress
Massage and decrease in number of days in the ICU
19. What limitations did the authors identify? Select all that apply.
Massage was not the same across all studies.
Methods used to assess pain intensity differed across sites.
Not all the data were collected by researchers: some data were reported by bedside nurses.
Participants may not have been blind to their group assignment: experimental group versus control.
Statistical choices may have overestimated the effects of massage on pain.
Massage may be perceived negatively by some individuals, especially if they are anxious.
The search might have missed other RCTs on the topic.
20. What conclusions did the authors draw about this meta-analysis?
Massage therapy is a no-cost intervention and should be considered, for that reason.
Nurses have ample time to include massage therapy in patient care.
More RCTs are needed on this topic.
Massage therapy should be instituted as standard care in ICUs.
21. According to Fig. 1.3 in Understanding Nursing Research, in an evidence-based practice climate, what is the ranking of a systematic review and quantitative meta-synthesis, relative to other types of research? Select all that apply.
It is ranked higher than experimental quantitative research.
It is ranked lower than cohort studies.
It is ranked higher than qualitative research.
It is ranked lower than expert opinion.
It is ranked equally with mixed-methods systematic reviews.
22. Which statement best represents one of the main contributions of this report to the discipline of nursing, in terms of knowledge?
A. The report displayed other studies’ results in Figs. 2 and 3, summarizing quality research on this topic.
B. The report critiqued 12 randomized controlled trials on massage therapy, ranking them in order of excellence.
C. The report identified potential areas for study, related to the value of massage therapy.
D. The report provided evidence that, in general, massage therapy is effective in producing a small change in pain intensity.
23. What was the framework/philosophical orientation for this report?
A. Maslow’s theory of human motivation
B. Lazarus’s coping paradigm
C. Melzack and Wall’s gate control theory of pain
D. None was stated
