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ASSESSMENT 2

Part 1: General Content Questions
1. Why is it important to use short and specific search terms in database search instead of long descriptive sentences? 
With the use of short and specific search terms in databases search can provide with the concise and the exact data which is being searched. However with use of long descriptive sentences the database is likely to provide data in relation to the diverse precise terms present in that sentence or rather give information about the search term that has more information 
2. Describe the relationship between the two frameworks that underpin this subject: Tanner’s Model of Clinical Judgement and Evidence Based Practice? 
Both the frameworks Tanner’s Model of Clinical Judgement and Evidence Based Practice tend to illustrate on the process by which nurses think about a clinical aspect and then they render their clinical service and judgment. While implementing both the clinical frameworks on the use of tele monitoring based service by the primary care clinicians like nurses it could be been that both of the frameworks tend to determine how the nurses perceive the situation of hypertension by the use of tele monitoring and supervision. In this aspect there lies a direct relationship between both the frameworks as the focus subject of the both the medical framework is same. While the Tanner’s Model of Clinical Judgement depicts that the primary care clinicians undertake the process of clinical judgment by including noticing, interpreting, responding and reflecting. While in Evidence based judgment the primary care clinicians tend to render the judgment which is based on the evidences in relation to the case situation (McKinstry et al. 2013)
3. Describe the purpose of a systematic review compared to a single randomised controlled trial? 
The systematic review involves evaluating a number of previous research papers or rather they are recognised to the diverse types of literature reviews that are collected and crucially evaluated. While the single randomised controlled trial are recognised to be the planned experiments that determine the treatment or a study’s effect on real patients 
Part 2: Research Methodology and results
4. What is the advantage of using randomized control trail study design in this particular study? 
By the use of randomized control trail study design there is great reduction in the biasness in the experimental study and even helps in preventing the introduction and continued use of useless and dangerous treatments. While the major disadvantage associated to randomized control trail study design is that the study involves a tradeoff between the internal and external validity 
5. What were the primary and secondary outcome/outcomes in this study? 
The primary outcome of the specified study was the mean daytime ambulatory systolic blood pressure at six months post randomization. While the secondary outcome of the study was the mean daytime ambulatory systolic and diastolic blood pressure. Both the outcomes of the study determine the overall main outcome of the study 
6. How did the authors assess blood pressures in this study?  
The authors of the study tried to evaluate the blood pressure by introducing an intervention consisting of tele monitoring and supervision by primary care clinicians. In this way they determined daytime systolic and diastolic ambulatory blood pressure in patients with uncontrolled blood pressure.

7. Has the study used an adequate sample size? Justify your answer 
Yes, the clinical study has used a specified sample size. About 401peopleaged between 29-95 years who were diagnosed with uncontrolled blood pressures that is they had a mean daytime ambulatory measurement between near about greater than or equal to 135/85 mm of Hg to less than or equal to 210/135mm of Hg

8. The authors claim that the mean difference in daytime systolic ambulatory blood pressure fell between telemonitoring group and usual care group at 6 months was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). What does this tell you? 
From the above statement of the author it could be stated that the mean daytime systolic ambulatory blood pressure fell in both groups. From the study it could be observed that the arm in which that tele monitoring was intervened had a fall from 146.0mm of Hg to 140.0 mm of Hg while for the arm with the usual care there was fall from 146.5 mm of Hg to 144.3 mm of Hg. On calculating the difference between the two arms at six month the value that has been obtained was 4.3 mm of Hg that was adjusted being between the baseline and minimization factors. Therefore the intervention had been proved to be more effective in reducing the blood pressure  

9. The researchers compared the mean differences in daytime systolic ambulatory blood pressure between telemonitoring group and usual care group at 6 months and reported p=0.0002. What does this tell you? 
The P value as determined by the researchers claimed the key outcome of the inferential statistical test performed for the study. It is actually the probability of obtaining the result as in this case is the determination of difference in blood pressure change or rather reduction between two group determined as randomized group and usual care group. With a low value of p as reported for the study is 0.0002 demonstrates that the there is strong evidence in concern to towards the advantages of using tele monitoring
10. What did the authors find about the effect of telemonitoring on the mean daytime diastolic ambulatory blood pressure? 
The authors in relation to the effect of tele monitoring on the mean daytime diastolic ambulatory blood pressure depicted that the baseline blood pressures of the monitored population was about 84.4 mm of Hg while that of the usual care was 85.7 mm of Hg. After six months of intervention with the tele monitoring it was found that the diastolic blood pressure of the monitored was about 83.4 mm of Hg while that of the usual care was about 84.3 mm of Hg (Stoddart et al. 2013). On calculation of the adjusted difference between the treatment groups and usual care groups for baseline blood pressures and minimization factors it was found to be 2.3 and there statistical evaluated p value was determined to be 0.001. This value was obtained for 95%of Cl while the value for adjusted only for baseline difference was marked to be 2.17 with p value to be 0.0022
11. Would you consider using telemonorting for management of uncontrolled hypertension for your patients?
 Based upon the results obtained from the concerned research study on managing the clinical condition of hyper tension by the use of telemonitoring it could be stated that interventions has proved to be clinical successful process in reducing the blood pressure rates. The statistical results signify a major difference between the reduced blood pressure from baseline to after a six months intervention, whose mean value has been determined to be 4.3 mm of Hg. Therefore this clearly determined that the treatment group had undergone a considerable amount of reduction in their systolic and diastolic blood pressure values. The clinical significance could be formulated from the effectiveness it has shown in reducing the blood pressures in patients with uncontrolled hypertension in primacy care settings. However, from the aspect of the cost effectiveness of the telemonitoring method it could be seen that there was elevation in the overall cost value. On critical evaluation of all the aspect considering telemonitoring as an effectiveness option for the patients is not a disadvantageous factor (Ngandu et al. 2015).
12. Calculate Relative Risk of Healing (RR), Absolute Risk Difference (ARD), and Numbers Needed to Treat (NNT). 
RR= 85/65= 1.30
ARD= 65-85= (-20)
NNT =1/ARD= 1/(-20)= (-0.05)
13. How would you interpret your findings for RR, ARD, and NNT above
From the findings of RR is 1.30 which is greater than 1 and the Cl does not include 1, therefore there is a relationship between alternative compression bandages for treating venous leg ulcers. While the ARD determine the difference between the absolute risk of events in the control group and the absolute risk of events in the treatment group while the NNT determines the number needed to be treated (Neuman, 2016)
14. Is it worth using bandage B over Bandage A?  
From the implications stated above it could be stated that it is worth using bandage B over bandage A since 85% of the patients had been healed from the venous leg ulcer in the same time period of 12 weeks. This could be determined from the time period of treating the ulcer and the Use of the bandage or rather the intervention. 
Part 3: Implementation of EBP
15. What are some of the barriers to implementing new research findings into clinical practice? 
The barriers of implementing new research findings into clinical practice are as follows:
Lack of education
Lack of human resources
Lack of time to read literature
Lack of experience  

16. Reflecting on your learning experience in this subject, how the subject help prepare you your role as a junior clinician? 
Evidence based practice is important for the progressive improvement of clinician practice is one of the most important aspect that I have learned from this subject. For a clinician it is important that before giving any clinical judgment all the vital evidences in relation to the clinical conditions have been crucially evaluate. From this aspect I could understand the significance evidence based practices have upon the clinician treatment that is rendered to the patent. Along with this I understood the use of analytical in the clinical practices. For a junior clinicians like me it is essential the diverse methods by which a clinicians thinks about a medical issues before determining the kind of treatment practices that would be rendered to the patients. Evidence based practices leads to thinking about the condition in a more processed and systematic manner and gives more importance to the evidences. Therefore I would try to render my interventions based on the evidence implications 
 
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