Systematic Research Review Critique

The systematic review under critique in this paper is Rats, cities, people, and pathogens: A systematic review and narrative synthesis of literature regarding the ecology of rat-associated zoonoses in urban centers. This report seeks to investigate the relationship between pathogenic infections that people develop in cities and how these diseases relate to the high population of rats in such areas. Rats are known to contain certain pathogens such as bacteria, viruses, and parasites. This systematic review analyzes the evidence of infections caused by bacteria such as Yersinia pestis, Streptobacillus moniliformis Bartonella spp., Leptospira interrogans, and Rickettsia typhi, among the urban population due to the high number of rats that exist in these regions. The following paper seeks to critique and appraise this systematic review especially in terms of its applicability to nursing practice.

Practicing nursing involves a proper diagnosis of diseases, appropriate treatment, and a good care. Rat infestation in urban areas contributes significantly to human mortality and morbidity. The fundamental aim of practicing nursing is to preserve lives and protect the sanctity of life. Prior awareness of disease prevalence allows quick and precise diagnosis. This systematic review applies directly to nursing practice because the result it presents informs the nurses that there is a high possibility of diagnosing rat infestation in urban areas, reducing the aspect of underdiagnosis or misdiagnosis (Himsworth, Jardine, Patrick & Parsons, 2013).

This review also relates to nursing practice as nursing entails creating awareness about various conditions and how to prevent them. Nurses spend most of the time advising patients or clients about their conditions and how to manage them. Nurses also advice on what needs to be done to prevent infection. Gaining knowledge about the various rat infestations that the urban population is predisposed to enable nurses to create awareness on how to prevent these infections or reduce rat population in their residences. The pharmaceutical part of nursing also depends on fundamental knowledge of various diseases, their prevalence and the respective treatment. Correct diagnosis leads to the right prescription. When nurses get to understand the dynamics of these rat infections, they can offer the right treatment to counter them. The right medication is vital in the fight against a particular disease. The subject matter in this systematic review, therefore, is entirely relevant to nursing practice.

There are seven levels of evidence in the field of nursing research. These levels of evidence depend on the study designs used (Ebling Library, 2016). Different study designs validate the weight of the evidence presented. The study design used in the systematic review under critique is the analytic study design. It is based on published reports that were descriptive and qualitative. The analytic study design also focuses on looking through various published reports to select the ones that are relevant and will lead to the precision of the review (Ebling Library, 2016). The systematic review under discussion clearly states that its results came from the analysis of 161 research papers that were published before. The authors used relevant papers by leaving out any research paper that was published before 1990. They also focused on documents that were specific to studies on the impact of Norway and black rats in urban centers. It was good to use a variety of research papers that were consistent. Even though the authors did not use any observational or experimental design, they were able to obtain results similar to the ones they would have had if they engaged into observational or experimental study designs. The review was also done through a rigorous process that ensured no irrelevance or biases. This type of study design causes evidence to fall under level V as it is a systematic review that has obtained evidence from qualitative and descriptive studies (Ebling Library, 2016). The standard of evidence, therefore, is a little lower than evidence from actual observational and experimental studies.

The initial step for presenting the studies in this systematic review involved a three-month search for relevant documents that could be put into consideration. A lot of research has been done over rat infestations that lead to zoonoses over years. The method of choosing prior documents for review is ambiguous and unprecise. It is worth noting that an individual would wonder on how the authors managed to come up with 704 papers for initial consideration. However, not all relevant materials were presented for the original review since it would have taken years to get down to a viable number. The method of presentation of the studies used after the initial consideration is, however, clear and significant (Himsworth, Jardine, Patrick, & Parsons, 2013). The precision with which the final 161 papers were obtained from the 704 articles is worth commending. The review states that research papers published before 1990 were eliminated because of relevance. They then focused on the documents that had viable research on Norway and black rats. The use of the 161 different research papers provided an excellent study basis for this review. Bringing together the various observational and experimental results based research papers validated the presented studies. The documents selection process is agreeable since they ignored papers with small samples and the decisions were made by consensus. Reaching the study selection by consensus reduced the chances of biases and irrelevance. Consensus decision also facilitated the precise nature of the studies presented for this study review (Himsworth, Jardine, Patrick, & Parsons, 2013).

The results are classified into the three pathogenic categories which are bacteria, viruses and parasites. The Leptospira interrogans is the most predominant bacterial infections through zoonoses and is majorly harbored in rats in urban areas. This bacterium affects kidney and can lead to the renal system failure, febrile diseases, weils syndrome and pulmonary hemorrhage syndrome that has a mortality rate of up to 50 %. This bacterium is transferred by the direct contact with rat urine or through water and food (Himsworth, Jardine, Patrick, & Parsons, 2013). Yersinia pestis bacteria are mostly hosted by Norway and black rats in cities. This bacterium is passed to humans from rats via fleas. Xenopsylla cheopis is also passed to people from rats through fleas. When fleas feed on dead rats, they ingest this bacterium which then stops their digestive system and proper flow of blood. To survive, these fleas have to bite these bacteria into others passing the bacteria to humans. The bacteria then concentrate at the lymph nodes causing their swelling leading to bubonic plague that has a mortality rate of 20% (Himsworth, Jardine, Patrick, & Parsons, 2013).

Rickettsia typhi is an intracellular bacterium of the white blood cells that is transmitted among rats and also from rats to people through fleas; fleas feed on an infected rat then excrete this bacterium through the feces that can be on food ingested by humans. This bacterium causes Murine typhus a self-limiting disease in humans. The above-described bacteria are reserved in rats and passed to humans, resulting in the same bacteria causing illnesses in humans. Other bacteria include Bartonella, Streptobacillus moniliformis, Escherichia coli and Salmonella spp. Viral zoonoses were also proven to lead to Seoul Hantavirus virus and Hepatitis E virus. Parasitic Zoonoses are caused by Hymenolepis spp. and Rodentolepis spp parasites that can lead to various heart infections. Climatic and geographical aspects also proved to affect various zoonoses (Himsworth, Jardine, Patrick, & Parsons, 2013).

The systematic review concludes the obvious fact that rat zoonoses are common, and that rat infestation poses a health risk to the population. In the conclusion, it is clear that the review meets its objective of proving that the high number of rats in urban areas poses a risk to the health situation in this area. The paper also meets its theme of finding specific pathogenic organisms that cause rat zoonoses. The conclusion also brings out the fact that the review has considered viable statistics of the various countries that have experienced detectable level of rat zoonoses. It is, therefore, agreeable as the conclusion states that the review has proved the potential health risk caused by rat infestation.

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The other aspect of the conclusion that draws attention is that the amount of health risk posed by rat infestations in the urban areas has yet to be figuratively given. The systematic review opens up a window for more research. The end reveals that little concrete research has been conducted concerning this matter (Himsworth, Jardine, Patrick, & Parsons, 2013). Only the basic fact that rat infestation causes health risk has been proven. Questions about the numerical rate of infestation and the reality of the individually stated disease still linger (Institute of Laboratory Animal Resources, 2013). I plan to serve as a nurse in an urban or semi-urban area; this information is, therefore, fundamental to me as it will strengthen my diagnosis and prescription skills. Currently, I have some knowledge to enhance the awareness we are creating to help people prevent certain major infections that can be regulated through behavioral practices. I will include advice on reducing rat infestations because of the tangibility they carry.

The above discussed systematic review was qualitatively done. The authors invested their time and knowledge to bring out their objective. This review is fundamental to the nursing profession as stated above. All nurses especially those serving in urban and semi-urban areas should be aware of these risks. It will facilitate correct diagnosis of these diseases. More research needs to be done however to seal the gaps that exist in the review. Gaps like the proper effective treatments and how to create awareness to other stakeholders apart from medical practitioners.