Systematic Review Critique The influence of comorbid chronic physical conditions on depression recognition in primary care A systematic review Charles drew university of medical science Nursing research (NUR 635) 3 Nov 2015 Table of Contents Introduction. 3 The Problem.. 3 Search Strategy. 4 The Sample. 5 Quality Appraisal 5 Data Extraction. 6 Data Analysis. 6 Quantitative Analysis. 7 Qualitative Analysis. 7 Conclusion. 8 References. 10 The project deals in reviewing the given article, The influence of comorbid chronic physical conditions on depression recognition in primary care: A systematic review (by Mathhew Menear, Isabelle Dore, Anne-Marie-Cloutier, Laure Perrier, Pasquale Roberge, Arnauld Duhoux, Janie Horde, and Louise Fournier), is related to the monitoring, assessing, and examining the effects of chronic medical diseases and depression in the patients. The project requires in reviewing the article on the basis of the relevant problems, search strategies involved, quality appraisal methods, data extraction and analysis of the samples as implemented by the respective reviewers of the article. The project also deals in assessing the research study followed by the reviewers and their different approaches in determining the chronic medical comorbidity and repression diseases in the respective patients. The main objective of this study is the people who are suffering from depression often found in comorbidity chronic physical condition and such circumstances are broadly alleged to obstruct with primary care providers capability to identify their despair (Radner & Aletaha, 2010). In community-based primary care settings it was intended to observe the facts correlated to the control of chronic physical comorbidity burden on depression. The comparison between the lower burdens of chronic physical comorbidity and the higher burdens of chronic physical comorbidity recognized at primary care. From the inception to July 2013, CINAHL, Medline, PsycINFO, Embase and Cochrane central register of controlled trials were searched. Reverse citation and reference list investigation were also executed (Hughes & Guthrie, 2013). Between studies a methodological and a clinical heterogeneity was conducted by a narrative synthesis. On the basis of the relationship between depression recognition in primary care and chronic physical comorbidity burden the research was conducted. 13 studies reporting data were identified and 5817 unique citations after searching. From the given study it can be understood that chronic physical comorbidity burden exaggerated the principal care contributors negatively. However, the researcher also identified that depression recognition doe not negatively affect by the chronic physical comorbidity burden. Some conflicting results arise from the research study regarding the different approaches to determining the chronic medical comorbidity and recognition. Depression is a familiar and devastating condition. In primary care a body of evidence subsists about improving depression outcomes by using collaborative care models (Bower & Sibbald, 2011). Within general practice setting such approaches have not been routinely adopted. Now a day its a common disorder that affects most of the population. It is a type of disorder that can be handled with primary care. However, it can be resulted significant distress and disability. Sometimes common health problems have huge financial connotations. Several guidelines have to be followed while handling the depression management. At the early stage if this can be identified and handled with utmost care then it can be preventable. In the primary care the patient needs to be monitored thoroughly by the physician. The nurses should be proactively following up the patient periodically and need to take required action when the treatment is unsuccessful and should give the patient psychological support. In the research study, it was found that 80% of the people who are suffering from depression were treated in the primary care (Payne & Mercer, 2013). The patients who are in the severe stage cannot be deal in primary care. The process of the care needs to be improved so that it can be helpful for the patients. In order to manage the patients with depression it is the responsibility of the nurse and the physician to take good care of the patients. In this research study, some points are augmented. Some people said that in primary care the patient should be treated by the trained mental health nurses rather than treated by general nurse. Trained nurses have the specialized skills which are necessary to take good care of the patients who are at the primary stage. A proper clinical supervision can be made by the specialized nurses (Chen & Wang, 2010). The reviewers conducted a systematic review by performing reference and reverse citation searches in order to compare the chronic comorbidity among the patients using a piloted screening tool. Out of the 13 studies, being identified form 5817 citations; most of them (seven studies) were unable to provide the evidences of recognizing the chronic depression among the comorbidity patients (Menear & Fournier, 2015). Six studies were successful in providing some evidences wherein two of them recognized higher rates of recognition of the disease in the concerned patients. The reviewers identified 130 chronic conditions representing cancer, digestive, blood, digestive, circulatory, neurological, musculoskeletal, respiratory, sensory, urinary, nutritional, and other related conditions for implementing a systematic review by selecting the relevant databases (World Health Organization, 2015). The reviewers included the studies relevant with the chronic patients that contrast with the higher and lower chronic comorbidity conditions and leaving out the irrelevant studies. They implemented strict definition of the chronic comorbidity in order to determine the influence of the disease in the respective patients. They also implemented PRSIMA flow chart to narrate their search and screening strategies in order to conduct a systematic review in examining the depression recognition and chronic comorbidity burden in patients. The reviewers implemented a strict definition of the chronic comorbidity to include the relevant studies in their database. They excluded the studies that did not relate to the chronic disease definition (Wesseling & Fournier, 2015). Out of the 13 studies screened by these reviewers, most of them were unable to provide the evidences of recognizing the chronic depression among the comorbidity patients. The studies were also limited to small sample sizes and thus, lacked quality information in respective of the chronic diseases and depression recognition in patients. These studies, however, provides a better understanding about the causes of the chronic diseases in patients. Though the studies lacked some quality information and incorporated poor quality methods, the reviewers are of the opinion that the inclusion of these factors would not have changed their findings anyways. There is still no evidence as provided in the given article, that the reviewers actually contacted with the original researchers in this regard. The quality appraisal in the review was conducted by two reviewers. One of the reviewers helped in the extraction of the data by utlising the piloted electronic tests while the other reviewer helped with the verification of the accuracy of the acquired data. Implementing the Quality Assessment Tool, these two researchers conducted the research by representing the study sample in respective of the participation rate, confounders assessment, chronic diagnosis approach and establishment, data collection methods and thus, providing appropriate analysis of the patients depression status (Katon & McCulloch, 2010). The reviewers outlined the acquired information in a tabular form for the better understanding of the resulting outcomes. The table is shown to be included four basic dimensions which include the study sample demographic characteristics, their commodity characteristics, depression characteristics and study characteristics of the population. In order to extract accurate information, the two reviewers followed the criteria which included the administrative aspect of the research like the study authors, study design and settings (including countries and care sectors), year of publication and data collection, data sources and patients characteristics including age, sex and ethnicity (Diederichs & Bartels, 2011). These reviewers were also able to extract some important quality information while conducting the research, which included the methodological aspect of the research like the diagnosis methods, comorbidity index system and groupings, chronic recognition indicators, results and sources on indicators as well As evident from the table being provided by the reviewers: the demographic characteristics covered the age , ethnicity and sexes of the study sample the comorbidity characteristics demonstrated the measures and data sources for assessing the chronic diseases the depression characteristics covered the diagnosis and data sources of the diseases the study characteristics included the study design and settings, indicating the report results Though the reviewers did not explain their methods of integrating and pooling of the required data, they had mentioned about implementation of the methods involving the reverse citation and reference list investigation methods in order to extract accurate information relating to the chronic comorbidity and depression patients (Walker & Bernstein, 2011). They mentioned about the implementation of strict definition of the chronic comorbidity as a guideline and followed PRSIMA flow chart in order to conduct a systematic review in examining the depression recognition The reviewers concluded the acquired information in a tabular form for the better understanding of the resulting outcomes. The table is shown to be included four basic dimensions which includes the study sample demographic characteristics, their commodity characteristics, depression characteristics and study characteristics (Murphy & Cunnane, 2011). The table covers the demographic, comorbidity, depression and the study characteristics of the sample population. As the meta-analysis of the research outcomes had not been performed, the reviewers were compelled to conduct narrative synthesis method to provide methodological and clinical analysis of the relevant studies. This analysis method of the reviewers incorporated several factors including the influences of the chronic comorbidity and depression on the assessment, defining, measurement and evaluation technique being implemented by the reviewers. These reviewers estimated the outcome by measuring and assessing the influences of the different relevant studies. The reviewers had considered adequate heterogeneity effects between the studies. This approach had enabled them to measure and report chronic comorbidity to perform narrative results. They also calculated odd ratios between comorbidity groups in order to explicitly report the difference in the outcomes as depicted in the study (Ani & Baker, 2009). This heterogeneity approach of the researchers was reflected through the table which was able to depict the major dimensions of the research including the demographic, comorbidity, depression and the study characteristics of the sample population. For the publication issues, they managed to remove the repetitive and irrelevant studies form their reviewing criteria. The two reviewers implemented the Quality Assessment Tool in order to implement the research. These reviewers followed the criteria which included the administrative aspect of the research like the study authors, study design and settings (including countries and care sectors), year of publication and data collection, data sources and patients characteristics including age, sex and ethnicity. These reviewers were also able to extract some important quality information while conducting the research, which included the methodological aspect of the research like the diagnosis methods, comorbidity index system and groupings, chronic recognition indicators, results and sources on indicators as well (Wesseling & Bijlsma, 2013). The results of the 13 studies selected by the reviewers are clearly demonstrated through the table being provided by them. The table helps in determining the demographic characteristics the study sample, the comorbidity aspects, the depression characteristics and the study characteristics of the sample population in brief. The reviewers were able to draw conclusions on how the chronic recognition research examination was defined and determined on the basis of the respective potential influences. But, the review has certain limitations, which the reviewers had clearly listed in the same. For example, they admitted of examining the strategies published in French or English and leaving out the publications in other languages. They also included the studies, inscripting the contrasting evidences relating with the higher and lower chronic comorbidity conditions and leaving out the irrelevant studies. The studies also lacked some quality information and incorporated poor quality methods in examining the chronic diseases and depression in the patients. In this research study, some points are augmented which are related with the nursing practices to be implemented. As for example, the patients should be treated by the trained mental health nurses rather than by general nurses. Trained nurses must have the specialized skills which are necessary to take good care of the patients who are at the primary stage. A proper clinical supervision can be made by the specialized nurses in order to properly treat the chronic patients. The proper reviewing of the provided article shows that there has been uncertainty whether the chronic comorbidity impacts on the recognition of the depression in patients and whether it varies over the time as well. In respective of future aspect, studies with a broader range of depression recognition and influence factors should be considered in order to get accurate results. In addition, accurate measures and tools should be implemented to properly examine the influence of the chronic comorbidity in patients. 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