Conduct a critical appraisal of a systematic review article.
Complete a critical appraisal using the article, Kleinpell, R.M., Ely, E.W., & Grabenkort, R. (2008). Nurse practitioners and physician assistants in the intensive care unit: An evidence-based review. Critical Care Medicine, 36(10), 2888-2897, and the Systematic Review Appraisal Sheet (attached). It is recommended you review the checklist of components to be included in a systematic review article (also attached) to assist you with this assignment.

Text S1 – Checklist of items to include when reporting a systematic review or meta-analysis

Section/topic    #    Checklist item    Reported on page #

1    Identify the report as a systematic review, meta-analysis, or both.
2    Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.

3    Describe the rationale for the review in the context of what is already known.
4    Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).

5    Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.
6    Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.
7    Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.
8    Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.
9    State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).
10    Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.
11    List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.
12    Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.
13    State the principal summary measures (e.g., risk ratio, difference in means).
14    Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.
15    Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).
16    Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.

17    Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.
Study characteristics    18    For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.
Risk of bias within studies    19    Present data on risk of bias of each study and, if available, any outcome-level assessment (see Item 12).
Results of individual studies    20    For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group and (b) effect estimates and confidence intervals, ideally with a forest plot.
Synthesis of results     21    Present results of each meta-analysis done, including confidence intervals and measures of consistency.
Risk of bias across studies    22    Present results of any assessment of risk of bias across studies  (see Item 15).
Additional analysis    23    Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression) (see Item 16).
Summary of evidence    24    Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., health care providers, users, and policy makers).
Limitations    25    Discuss limitations at study and outcome level (e.g., risk of bias), and at review level (e.g., incomplete retrieval of identified research, reporting bias).
Conclusions    26    Provide a general interpretation of the results in the context of other evidence, and implications for future research.
Funding     27    Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.

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