Group G Table of Evidence (TOE) Toni Banks, ObeFangbemi, Yessenia Miranda, Claudia Rodriguez

(Write citation using APA format, just as you would in a reference list. Put articles in alphabetical order by the first author’s last name)

(If the study doesn’t list one, write what the implied RQ or Hypothesis is and label as “implied.”)

(State independent and dependent variables using bullet points. Note: Participants are not variables)

(Include study design (i.e. meta-analysis, RCT), level of evidence (See the Evidence Hierarchy in Polit & Beck (2014)), other key design features such as use of placebo, blinding, etc.

(Do not put the actual data here. That belongs in the Findings column.)

(Include quantitative data. What are the researchers’ final conclusions based on the outcomes?)

To examine the likelihood of enhancing early recovery after gum chewing after Laparoscopic Colectomy from postoperative ileus.

Sample:

19 patients suffering from colorectal cancer took part in the study after undergoing elective laparoscopic colectomy.

Setting:

Incheon St. Mary’s Hospital, The Catholic University of Korea School of Medicine

Chewing gum can be used to enhance the recovery period after cancer surgery from postoperative ileus.

Chewing gum is the independent variable because it was controlled as 10 patients randomly selected were given gum while 9 were in a controlled group

Operational definition:

Patients randomly chosen to chew gum were given sugarless gum thrice a day after first postoperative AM up to the initiation of oral intake.

Conceptual definition:

Chewing gum is a repetitive action of biting or working gum with teeth in the mouth over a period of time.

Dependent variable(s):

Postoperative ileus is the dependent variable because the effects resulting from patients chewing and not chewing gum was noted, recorded and observed to be directly related in terms of first flatus, occurrence of first bowel movement and hospital stay duration.

Two-group controlled trial that was randomized

Level of evidence:

Level 1 – meta-analysis of randomized trials

Key design features:

Placebo controlled

Interest was in first flatus passage time, first defecation time and hospital stays after operation were recorded.

First flatus passage was observed on day 2.1 after the surgery in the group chewing gum, while the control group was observed to be day 3.2 (P < 0.01). In the group that chewed gum, first defecation occurred 2.7 days earlier that is on postoperative day 3.1 as compared to 5.8 days for the control group (P < 0.01). For the gum-chewing group, postoperative hospital stays was 13.5+/-3.0 days while for the control group was 14.5+/-6.1 days.

Conclusions:

Chewing gum promotes postoperative ileus early recovery and can be used as a physiologic and inexpensive way to stimulate bowel motility.

To examine the gum-chewing effects on ileus duration following cesarean section and the effects differences when sugar-substituted and sugar-free gum is used.

Sample:

76 women were studied after elective cesarean section, with no history of cesarean or abdominal surgery.

Setting:

ZonguldakKaraelmas University School of Medicine, in Turkey

Chewing gum is the independent variable because it was controlled as 28 women randomly selected were given sugar-free gum, 25 were given sugar-substituted gum, and 23 patients were in a controlled group

Dependent variable(s):

First bowel sounds and first flatus are the dependent variables as results of these were recorded when patients were given sugar-substituted gum, sugar-free gum and no gum at all after cesarean section.

Randomized controlled trial (RCT)

Level of evidence:

Level 1 – RCT

Key design features:

Placebo-controlled study

Interest was infirst bowel sound and first flatus or defecation after surgery.
 

For the group given sugar-substituted gum, first bowel sounds time decreased significantly at 6.3+/-2.0 h comparing to the group given sugar-free gum that was at 8.8+/-1.9 h (P<0.05). First bowel sounds for the sugar-substituted group recorded an equally lower time at 11.2+/-1.0 h (P<0.05) than the control group. First defecation or flatus did not record any major difference.

Conclusions:

First defecation or flatus had no difference for patients in the gum-chewing study bearing in mind that the women had no previous history of abdominal operation. This patient went through cesarean surgery after being injected with general anesthesia. It was shown to reduce postoperative ileus and improve gastrointestinal motility recovery following cesarean section.

To determine if gum chewing improves postoperative ileus following open appendectomy

Sample:

66 randomized patients took part in the study after undergoing open colectomy

Setting:

Brigham and Women’s Hospital, Harvard Medical School, Boston.

Is chewing gum able to reduce post colectomy ileus?

Hypothesis: Implied

Chewing gum is suggested to minimize post colectomy ileus duration.

Chewing gum is the independent variable in this case because it was controlled as 66 patients would randomly receive on postoperative day 1, 1 of 3 postoperative regimens.

Dependent variable(s):

Postoperative ileus is the dependent

Meta-analysis of randomized trials

Level of evidence:

Level 1 – meta-analysis of randomized trials

Key design features:

placebo-controlled study

Interest was in first postoperative flatus passage and postoperative complications

First postoperative flatus passage median times recorded were: 60 hours for gum and sips, 67 hours for sips, and 72 hours for bracelet and sips (p=0.384). Differences in first bowel movement passage time, actual discharge time, and patient discharge time were insignificant. 30-day and inpatient follow up indicated no distribution or frequency difference of postoperative complications.

Conclusions:

Contrary to preliminary study findings, clinical trial results demonstrated that even though chewing of gum was safe, it does not minimize post colectomy ileus duration.

To examine the possibility of gum chewing in reduction of postoperative ileus whenever open appendectomy is conducted on a patient.

Sample:

46 randomized patients that underwent open appendectomy as a result of appendicular generalized peritonitis, appendicular abscess and acute catarrhal appendicitiswere studied.

Setting:

University teaching hospital in Cameroon

What effect does chewing gum provide after open appendectomy on postoperative ileus?

Hypothesis:

Chewing gum will speed up recovery after open appendectomy. This is based upon successful recovery acceleration in postoperative intestinal transit.

Chewing gum is the independent variable because it was controlled as half the number of patients was asked to chew gum after surgery while half was not given gum.

Operational definition:

Patients randomly chosen to chew gum were given sugarless gum every evening, morning and afternoon for 30 minutes.

Conceptual definition:

Chewing gum is a repetitive action of biting or working gum with teeth in the mouth over a period of time.

Dependent variable(s):

-First bowel movement
-First flatus
-Complications resulting from appendectomy
-Hospital duration
Postoperative ileus represented by the measurable outcomes noted above is the dependent variable because the effects resulting from patients chewing and not chewing gum was noted, recorded and observed to be directly related. Patients that were given gum to chew showed improvement in recovery after surgery.
For example, hospital duration mean time for the group that chewed gum was 4.9 days, while for the controlled group it was 6.7 days. Also, the first bowel movement for the group that chewed gum was at postoperative day 2.3, while for the controlled group it was at postoperative day 3.3.

Operational definition:
Postoperative ileus is the oral intake intolerance and obstipation affecting gastrointestinal tract activity after open appendectomy.
Conceptual definition:
Postoperative ileus is the oral intake intolerance and obstipation resulting from non-mechanical factors that result in a disruption of the gastrointestinal tract motor activity after surgery either abdominal or non-abdominal.

Two-group controlled trial that was randomized

Level of evidence:

Level 1 – meta-analysis of randomized trials

Key design features:

Placebo controlled

Interest was in hospital duration, first bowel movement occurrence, first flatus occurrence and arising complications

First flatus passage happened on day 2.2 postoperative for the group that chewed sugarless gum and on day 3.0 for the group that was controlled (P < 0.0001). 4.9 days was the hospital stay period for the group that chewed gum and 6.7 days for the group controlled (p < 0.00001).

Conclusions:

The research was conducted on 46 patients in Yaoundé, Cameroon where half of the patients were in a control group and the other half in a chewing gum group. It was concluded that the group that chewed gum after open appendectomy had a reduction in postoperative ileus. This treatment was recommended for use in other African nations due to its cheapness and effectiveness.