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Matrix Synthesis

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If there are studies with differing results/outcomes, are there any notable differences between the studies (e.g., hierarchical rating, recency of the study, sample size)? Describe noted differences.  Your observations.
Two studies were selected for comparison due to their difference in research designs, titles, limiters used, and outcomes. The studies chosen were Brouwer (2005) and Ozgur (2006). Brouwer (2005) was a double-blind, randomized controlled trial with a sample size of 383 children. This was a Level Two studies that showed no benefit from the vaccine. This finding was different as compared to the selected studies from Fletcher (2007). Fletcher’s (2007) review was a Level One study which found the vaccination Prevanar to be beneficial for prevention of otitis media. The review by Brouwer (2005) was published two years earlier than the review by Fletcher (2007). Prevanar was in the process of testing for pneumonia prevention during this two year lapse in reviews and may explain why the results are different.
The study by Ozgur (2006) was a prospective, single-blind study. One-hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined from a day care center. Ozgur (2006) shows a benefit from the pneumonia vaccination in the prevention of otitis media in children six months to five years of age. This review tested the vaccine at the height of flu season. The P value for influenza during testing was less than 0.05 at the height of flu season compared to 0.01 during the non-influenza season. I found these results intriguing, because there was a decrease in cases of otitis media at a daycare center where most viruses are easily spread. This study’s findings were different from the findings of abstracts one and three that Group A selected as best-evidence. The study was recent and had a smaller sample size. This was an observational study that did not control confounding variables. The decrease of otitis media cases is still promising despite the study’s weaknesses.
Evaluative Criteria: Recognizes incongruences between the findings of the selected studies and offers explanations.
Thinking about all of your selected studies (e.g., quantity, hierarchical ratings) and the consistency/inconsistency of their findings, evaluate the sufficiency of your selected collective (not individual) evidence to address your EBP clinical problem/situation and as a sufficient basis on which to develop an intervention decision and plan for implementation/evaluation of an intervention. Include in your evaluation of the sufficiency of collective evidence, your perception of the need (or lack of need) for further research. Support your evaluation with evidence.  Your evaluation:
Group A’s decision to choose these reviews as the best evidence shows promise for otitis media prevention through pneumonia vaccination. These selections also show a need for further research. The selections show that half of the reviews conclude positive results while the other half shows little or no benefit from pneumonia vaccination. The selected reviews consist of three random controlled trials and one systematic review of random controlled trials. These studies are ranked as Level One and Level Two evidence on the hierarchy chart. These rankings give the studies an increased amount of credibility to the findings. The systematic review by Fletcher (2007) shows that Prevanar would cover approximately 60 – 80% of serotypes that cause pneumococcal otitis media. Juhani’s (2001) study shows a decrease in otitis media by 6% after immunization. There is a sufficient amount of evidence to show that, although not 100% effective, pneumococcal immunization does decrease otitis media cases related to these bacteria. These results warrant consideration for implementation.
Evaluative Criteria: Evaluates the sufficiency of selected studies, collectively, to address EBP question and use as a basis for an intervention decision.
Provide an overview of the current state of evidence on your topic. Draw conclusions from the collective results of the examined evidence through the use of synthesis. The following example illustrates conclusions drawn from the synthesis of collective results.
Two meta analyses and a population based case control study compared large samples of cases with brain tumors of any variety with large control groups. The study did not find a greater risk of brain tumor development in individuals, who had used cell phones for 5-10+ years (Kan, Simonsen, Lyon & Kestle, 2008; Lahkola et al. 2007; Lahkola, Tokola & Auvinen, 2006). In contrast, Hardell, Carlberg, and Hansson (2006) in a pooled analysis of 2 case control studies with a smaller sample size found a greater risk for the development of malignant brain tumors among cell phone users. A greater risk for the development of malignant brain tumors was noted with long term ipsilateral use of cell phones (Hardell, Carlberg, & Hansson, 2006; Lahkola et al., 2007). Your overview.
One randomized double-blind control trial and one randomized control trial, which  studied the effects of pneumococcal vaccination for prevention of otitis media, found no benefit in decreasing cases among children from one to eight years of age (Le, 2007; Van Heerbeek, 2006). In contrast, a meta-analysis by (Fletcher, 2007) and a randomized double-blind trial by (Juhani, 2001) show a benefit from pneumococcal vaccination in infants two years of age and younger.  Greater benefit from pneumococcal vaccination for prevention of otitis media was shown in children less than two years of age.
Evaluative Criteria: Accurately represents the current state of evidence regarding EBP topic, based on selected studies, collectively.
Discuss the implications for practice which can be drawn from the results of your EBP inquiry. What specific “evidence-based” practice intervention(s) are supported (not supported) by your findings? Are there specific parameters that should be followed in the implementation of supported intervention(s)? Once implemented, what types of follow-up or evaluation are supported/suggested by your research findings? Your discussion.
The implications for practice conclude that pneumococcal vaccination is beneficial in preventing otitis media. Otitis media cases have been shown to decrease in frequency as published by Fletcher and Juhani (Fletcher, 2007; Juhani, 2001). These are Level One and Level Two reviews which allow the practitioner a sense of trust to their findings. Parameters that should be followed include vaccinating children up to two years of age (Fletcher, 2007;Juhani, 2001). The findings have concluded that there is no benefit in vaccinating children over two years of age (Le, 2007; Van Heerbeek, 2006). It is suggested that the pneumococcal vaccine should be given before the onset of cold and flu season. Follow up should be included at seven, fourteen, twenty, and twenty-six months (Le, 2006).

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