NR 500 Week 6 Clinical Significance

NR 500 Week 6 Clinical Significance

NR 500 Week 6 Clinical Significance

NR 500 Week 6 Discussion: Clinical Significance (graded)

Explore these issues on the Internet and through other resources. Share what you find out on these topics:

Confidence Intervals: Why are they useful in helping to determine clinical significance?

There are many controversies surrounding the issue of clinical significance vs. statistical significance. Identify one of them and summarize it. Finish with your opinion about the controversy.

Confidence Intervals Example Student Paper

According to McNeely and Warren (2006), confidence intervals provide a means of assessing both statistical and clinical significance. Confidence intervals (CI) allow for a more flexible approach to analyze research data. Confidence intervals are appropriate for reporting the results of clinical trials because they focus on confidence of an outcome occurring, rather than accepting or rejecting a hypothesis (Page, 2014, p. 730 NR 500 Week 6 Clinical Significance ).

CIs are useful in the interpretation of studies with small sample sizes, allowing researchers and consumers of scientific literature to draw more meaningful conclusions about the clinical significance of these studies. Confidence intervals are constructed at a confidence level (i.e. 95 %) (Page, p. 731). This means that if the same population is sampled on several instances and interval estimates are made on each occasion, the resulting intervals would support the true population parameter in approximately 95 % of the cases.

Increased use of CIs by researchers and improved understanding of CIs with clinicians will help avoid misinterpretation of clinical research as we move toward evidence- based practice (McNeely & Warren, 2006; Page, 2014). In addition, CI’s are of practical, clinical value because they provide good estimates of the likely results that will be realized when applying the study’s interventions in everyday practice (Page, 2014 NR 500 Week 6 Clinical Significance ). Confidence intervals are one way for researchers to help decide if a statistical result, whether significant or not, may be of relevance in practice.

Statistical Significance vs Clinical Significance

The purposes of statistics are to describe and summarize information, identify associations, relationships, or differences, and facilitate predictions or generalizations. It appears that researchers talk about statistical significance, and clinicians talk about clinical significance (Page, 2014, p. 728). Both terms are often utilized in research reports, and important for us, as nurses, to understand how these terms are similar and different. Although these terms sound alike, they are not interchangeable concepts.

According to this week’s lesson, clinical significance is a matter of judgment and not a mathematical tool like statistical significance (Chamberlain College of Nursing, 2017). Clinical significance demonstrates the amount of change that takes place because of a study intervention. Clinical significance has more to do with the study results having a meaningful impact regarding an intervention or treatment to a population (Page, p. 729). When the intervention creates a noticeable impact on the participants of the study, the intervention is considered to be clinically significant.

Statistical significance addresses a hypothesis which is represented by P (probability). Statistical significance of a study is the result from a selected sample of a population with the goal of applying the findings to another population and is determined by the probability or p factor (Page, p.728). According to Page (2014), statistical significance is heavily dependent on the study’s sample size. With large sample sizes, small treatment effects, which are clinically inconsequential, can appear statistically significant. The p factor is based on that there is only a 5 percent (p < 0.05) coincidence that a difference will occur in a study (Page, p. 728 NR 500 Week 6 Clinical Significance ).

When using statistics to estimate a value, it’s important to remember that no matter how well your study is designed, your estimate is subject to an error or underestimation of effect. A controversy surrounding clinical verses statistical significance results can be related to effect size or a real clinical effect has taken place (Page, p. 729). While a P value can inform the reader whether an effect exists, the P value will not reveal the size of the effect (Kühberger et al., 2015). Outcomes with small P values are often misunderstood as having strong effect sizes (Page, p.

730). Whereas clinical significance shows that there was a response to treatment and how much effect occurred but the sample size may not represent accurate significance.

One of the first practical steps in designing a study is choosing the sample size needed to answer the research question. An important idea to grasp, is that in a study, result may be statistically significant but may not prove clinical significance because the sample size was too large. Equally, the result may not be statistically significant because the study was so small that the difference proved to be large and would seem potentially important from a clinical point of view. Statistical significance does not provide information about the effect size or the clinical relevance (Engineering Statistics Handbook, 2013). Because of that, researchers may misinterpret statistically significance as a clinical one. In this situation, it may be wise to conduct additional studies in order to have a more accurate conclusion.

Conclusion

To sum up, my impression is that both significances (statistical and clinical) may not be mutually exclusive, but complementary in reporting results of clinical research. The reader needs to understand the difference between the two to logically make an interpretation on the data that is presented. In nursing, clinical significance measures should be utilized rather than statistical significance because it measures the effect size, clinically meaningful difference, confidence interval and magnitude rather than believing on chance or hypothesis (Page, 2014).

NR 500 Week 6 Clinical Significance References

Chamberlain College of Nursing. (2017). NR-500 Week 6 Basic research overview [Online lesson]. Downers Grove, IL: DeVry Education Group.

Engineering Statistics Handbook. (2013). What are confidence intervals? Retrieved from http://www.itl.nist.gov/div898/handbook

Kühberger, A., Fritz, A., Lermer, E., & Scherndl, T. (2015). The significance fallacy in inferential statistics. BMC Research Notes, 8(1), 1-9. doi:10.1186/s13104-015-1020-4

McNeely, M., & Warren, S. (2006). Value of confidence intervals in determining clinical significance. Physiotherapy Canada, 58(3), 205-211.

Page, P. (2014). Beyond statistical significance: clinical interpretation of rehabilitation research literature. International Journal of Sports Physical Therapy, 9(5), 726-736.

Response to peer:

In clinical research, it’s not only important to assess the significance of the differences between the evaluated groups but also it is recommended, if possible, to measure how meaningful the outcome is. For instance, to evaluate the effectiveness and efficacy of an intervention. Statistical significance does not provide information about the effect size or the clinical relevance. Because of that, researchers often misinterpret statistically significance as clinical one. On one hand, a large sample size study may have a statistically significant result but a small effect size. Outcomes with small p-values are often misunderstood as having strong effect sizes.

On the other hand, another misinterpretation is present when non-statistical significant difference could lead to a large effect size but a small sample may not have enough power to reveal that effect. Clinical relevance is commonly assessed because of an intervention. Nevertheless, it can be also extended to any other non-experimental study design types, for instance, for cross-sectional studies. Both statistical and clinical significances are not mutually exclusive, but complementary in reporting results of clinical research.

Response to instructor: What are your thoughts about utilizing Google for your research?

(I used my post from week 2 peer response).

Students and scholars should understand that Google Scholar is a web-based academic search engine for academic and scholarly information (Haddway et al., 2015, p. 2). Google Scholar has several limitations that should be recognized before using it as a sole source for researching scholarly data. Google Scholar has limitation of the number of search results displayed; there is incomplete Boolean operation of the advanced search capability; and the non-disclosure of the algorithm by which search results are ordered mean that Google Scholar is not a transparent search resource (Haddway et al., 2015, p. 14 NR 500 Week 6 Clinical Significance).

Google Scholar is helpful when used in combination with library databases since it offers a quick way to locate academic sources using links to the full text of many journal articles and other sources, but it shouldn’t replace the traditional academic databases due to its limitations (Haddway et al., 2015, p. 14). Students still need to judge the quality of the information by using criteria, such as currency, reliability, authority, and purpose (Hebda & Czar, 2012, p. 93).

Haddaway, N. R., Collins, A. M., Coughlin, D., & Kirk, S. (2015). The role of Google Scholar in evidence reviews and its applicability to grey literature searching. Plos ONE, 10(9), 1-17. doi:10.1371/journal.pone.0138237

Hebda, T. L., & Czar, P. (2012). Handbook of Informatics for Nurses & Healthcare Professionals, 5th Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781269431095/

NR 500 Week 7 Creating a Professional Presentation

Think about good and not-so-good professional presentations that you have attended in the past. Give an example of what made an effective presentation. Give another example of what detracted from their ability to deliver a message to the audience.

NR 500 Week 8 Discussion What Did You Learn (graded)

Reflecting on this course, consider and answer the following questions: How do you envision using the AACN essentials learned in this course in your future graduate course work? How do you envision using the concepts learned in this course in your future nursing practice?