Appraising the Evidence in Healthcare and Medicine - Essay Example

Appraising the Evidence in Healthcare and medicine Appraising the Evidence Appraising the evidence is vital in any research practice in health sciences and medicine. It involves assessing the quality and level of evidence acquired from a particular research. A podiatrist is an important personnel in the medical and health sector dealing podiatric medicine. A podiatrist generally is involved in the diagnosis and treatment of foot disorders. Hence, appraising the evidence as a podiatrist involves a research or review of literature regarding foot disorders by evaluating its quality and the evidence level presented. The level of evidence measuring scale are numerous and the levels choice depends on the researcher. However, there is no clear distinction on which level of evidence scale is the best. This is attributed to the shortcomings of having a clear method of standardizing the various levels of evidence. There is need to critically evaluate the scale chosen for a certain study. Hence, I the process the podiatrist should consider the rationale of choosing a specific scale until the date when a standardized approach is developed. A lot of methods are available in assessing the quality of the evidence. Thus, conduct a review of the materials using different scales and criterion for grading. Notably, majority of the sources usually contain extra information regarding evidence-based practice (American Nurses Association, 2015). There is rapid technological advancements in the world, as well as new develop causes of certain diseases. The virus or microorganisms causing diseases are somehow evolving now and then tending to be resistant to certain medicines. Thus, research and treatment mechanisms in the medical field has to evolve too, to treat and prevent certain diseases. As podiatrists, one needs to keep up to date with certain developments in their field of specialization. Hence, conducting an appraisal of the evidence will help a podiatrist be well informed on which new development to be adopted for a certain situation (National Health Service, 2013). Podiatrists can be referred to as foot doctors. They are available to offer directions on best ways to maintain our feet well and the type of shoes suited for someone. Podiatrists can also are able to offer treatment and alleviate some of the common foot problems one experiences from time to time. Some of the foot problems include: problems associated with toenail such as ingrown toenails, fungal or thickened; calluses and corns; athlete’s foot; bunions; smelly feet; flat feet; verrucas; dry and cracked heels. Foot disorders are common problems among the populace and podiatrists are there to solve any problems associated with the feet. Podiatrists solve these problems by offering advice and treating the affected individuals on various foot problems. They also can give orthotics to the patients. Orthotics are paddings, arch supports, and insoles that are tailor-made meant to boot out pain on the heels. The orthotic device can be inserted into one’s shoes so as to give the foot a better alignment, or reduce pressure exerted on some of the foot’s vulnerable areas, or to ensure the shoes are more comfortable. The podiatrist as expertise also in removal of the feet’s hard skin, and clipping the toenails (Bureau of Labor Statistics, 2014). Hierarchy of Evidence Evidence-based practice achieves best results when the clinical judgments, values of patients, and recommendations accrued from the top evidence are integrated together. The best or top available evidence is usually preferred in most cases; this raises the issue of hierarchy of evidence. Categorizing the available evidence into a hierarchy helps draw better recommendations and conclusions for practice. To achieve this a clear understanding of the design of the study and its quality is vital. Generally, the evidence depending on its quality is ranked from highest quality to low quality (Petrisor, 2007). Literature on foot disorders can involve many aspects such as hard skin, ingrown toenails, athlete’s foot, orthotics, and many more. In each of the categories of foot disorders there exists a hierarchy of evidence. That is, there are studies which are more reliable than others due to the level of evidence presented. For instance, in the study of orthotics some studies may be well equipped to answer any issues in regard to orthotics. The quality and design of the study greatly influences the criterion of hierarchy of evidence (Petrisor, 2007). A randomized trial in research produces high quality evidence whereas quasi-randomized is of moderate quality. Evidence through observation is regarded as low quality whereas additional evidences is treated as very low quality. The best evidence of highest quality is much utilized than the lowest quality evidence (Petrisor, 2007). Podiatrists require various source of materials to determine which source is highest ranked of providing quality and valid information. The information would serve as basis for recommendation on the practice category. For example, in the category orthotics substantial information is needed if surgical procedures follow suite. Evidence Accessing To rank levels of evidence have to be sourced from somewhere. Evidence can be found in libraries or the online platform such as electronic databases. In the library on can access various books under area of interest. Most library have their own catalogue systems which fastens the rate of which the target book is reached. The first thing to do is to formulate a question that covers the research topic. The questions can involve either of the following components namely aetiology, prognosis, diagnosis, treatment, experiences and concerns of clients and patients (CQUniversity Library, 2015). The question formulated can be summarized as Patient or population, intervention, outcome and type of study. The resources for evidence appraisal are easily found online in some of the electronic databases. For podiatric medicine practice there are various databases one can outsource information such as medical websites. They are as follows PubMed, CINAHL, Cochrane Library, PEDro to name a few. The search procedure involves entering full text of words, search key words, and filter the research criterion (CQUniversity Library, 2015). There are a couple of problems associated with the search for relevant evidence which are as follows; too much content found. In case of the library system there can be a lot of books to choose from and hence make your work tedious. Also, one may be restricted to access some documents from the electronic databases. Some important documents also require payments before being downloaded which raises the cost of the appraisal initiative. Use of Checklists Case Control Study In a case control study one starts evaluating whether the study identifies or addresses a specific problem or issue, as well as the appropriateness of the method used. Also, evaluation for biasness in the choice of the cases and control is done. Evaluate also instances of prejudice in the measurement method of the exposure and factors influencing the results. Also, account for any restrictions that the authors might have neglected in the design and technique used. Evaluate whether the results are presented in a clear manner and your personal opinion on the validity of the results. Finally, an assessment of the applicability of the results in immediate population, as well as its relation to previous researches is done (Song, 2010). Example: Honglei et al., 2003 conducted a research to determine if the use of non-aspirin NSAIDs and aspirin is associated with decreased PD risk. The method used for the study ‘case control’ was appropriate as it exhaustively answered the research question. There was no bias in the selection of the cases as both genders were appropriately represented. The controls were selected in an acceptable way as much of the cases over 90% were directly received from the qualified health practitioners. The exposure was measured without bias, however, there was few cases where the authors had to review the cases blindly, though this was 3.1% of all the cases. The authors accounted for various risks such as early symptoms of PD, age, smoking status, alcohol consumption and caffeine intake in relevance to aspirin use. The authors basically exhausted the major confounding factors in their research design and analysis. Cohort Study In a cohort study one analyzes the following elements: an assessment is done to determine if the study focused on a clear issue and whether an appropriate method was used in solving the problem identified. Also, consider the justification of using the cohort, as well as measurement methods of the exposure and outcomes that would not prejudice the findings. Also, consider if the study exhausted the contributing factors, subjects follow up and duration it took. A clear presentation of the results and if you personally agree with the results. Also, reflect on the applicability of the results to certain population and whether it is consistent with other research (Song, 2010). Example: Rist et al., 2012 study sought to find out if there is an association between migraine and cognitive decline among women. They used a cohort study in their research design which was appropriate in this scenario. The cohort was justified to use women since migraine affects women more than men. The authors exposure measurements were objective and up to the acceptable standards. Though the authors at some point were blinded by the participant’s migraine status this did not lead to subjectivity in the measurement of outcomes. The study accounted for all confounding factors both in their analysis and design. The follow ups were within a period of two years and the response was worth forthcoming. The results show that migraine was not associated with faster rates of cognitive decline. The results are consistent with past researches. Randomized Control Trials, RCT The use of randomized control trial as an appraisal tool broadly focuses on the validity of the trial, the results obtained and their significance to target group. An assessment of the study involves the following elements: analyze if there is a specific question to be answered, and whether the researcher was justified to use the RCT method in the study. Also, does the study define the participants it used and if all the participants selected accounted for in the final results? The methods of data collection used, and whether the study included an appropriate number of participants to represent an actual correlation. Finally, were the results presented in a systematic order and were they accurate. Also, is the evidence from the results and whole study enough to justify possible conclusions? Example: Wen et al. 2012 did a study to evaluate the effectiveness of a home based early intervention of children’s body mass index (BMI) at age 2. A RCT was an appropriate research design considering the research question or problem. There were 667 participants who were first time mothers. The intervention grouping of the participants was done in a random manner by a computer program. The staff that were collecting and entering data were blinded to treatment allocation, however, the mothers were not. The intervention group had 337 while the control group had 330 participants. During the follow-ups a total of 170 participants from both groups were lost. Also, participants from both groups received same treatment a mother gets inclusive of follow-up intervals. Though I cannot tell the sample size of participants were appropriate enough to make general conclusions, their results are significantly helpful. The intervention group had a lower BMI than the control group with a difference of 0.29. Hence it is appropriate to conclude that using trained community nurses to carry an early home based intervention program is an effective way of reducing mean BMI of children at the age of 2. Qualitative In qualitative research study one considers the following key terms; the rigor, main research methods, credibility and relevance of the study. An analysis is done to determine if the research clearly presents its goals, and was it important and necessary to conduct the study. Also consideration of the appropriateness of using the qualitative method. This involves a look into the research design, recruitment strategy, data collection, participant-researcher relationship, and ethical issues. Furthermore, is the evidence thoroughly analyzed, with a clear statement of findings? Finally, an assessment of the value of the research is done (McLeod, 2008). Example: Grace et al. 2008 study investigated how the lay beliefs of communities, religious teaching and perspectives from professionals influenced diabetes prevention in the Bangladeshi community. It was appropriate to use qualitative research design since the research tries to illuminate on the actions and subjective ideas of the target group. The method used was exhaustively justified from the selection of the setting and participants involved all serve to address the research topic. The strategy of recruitment was appropriate and it included all relevant individuals in the study as follows lay people, Islamic scholars, religious leaders and health professionals. The data collection strategy ensured all relevant data was collected as 17 focus groups were created in three phases, and the setting was appropriate. There were no research biases as the research was carried by qualified professionals and all ethical considerations were followed. The authors also carried out a deep analysis of the data collected evaluating various beliefs of lay people, religious leaders, and health professionals regarding healthy lifestyles. A knowledge base of diabetes was also analyzed. From the results it was noted that lack of enough knowledge was not the cause of poor healthy lifestyle choices as previously believed. There need to be better adaptation methods of interventions meant for white people; to be meaningful to Bangladeshi people. Also, religious leaders and health professionals should work together to promote healthy lifestyles. Also, the gap in cultural understanding in health professionals need to be addressed. References American Nurses Association, A., 2015. Appraising the Evidence. [Online] Available at: http://www.nursingworld.org/Research-Toolkit/Appraising-the-Evidence [Accessed 6 April 2015]. Bureau of Labor Statistics, U., 2014. Department of Labor, Occupational Outlook Handbook, 2014-15 Editio, Podiatrists. [Online] Available at: http://www.bls.gov/ooh/healthcare/podiatrists.htm [Accessed 6 April 2015]. CQUniversity Library, A., 2015. EBP for Allied Health - Finding and Evaluating Evidence. [Online] Available at: http://libguides.library.cqu.edu.au/content.php?pid=398453&sid=3538510 [Accessed 6 April 2015]. Grace, C. B. R. S. S. K. P. &. G. T., 2008. Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives.. BMJ, 337(a1931). Honglei, C. S. M. M. A. e. a., 2003. Nonsteroidal Anti-inflammatory Drugs and the Risk of Parkinson Disease. Arch Neurol. , 60(8), pp. 1059-1064. James, A. S. A. &. W. R., 2005. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, Issue 4. McLeod, S., 2008. Research Data: Qualitative and Quantitative. [Online] Available at: http://www.simplypsychology.org/qualitative-quantitative.html [Accessed 6 April 2015]. National Health Service, N., 2013. Foot Problems and the podiatrist. [Online] Available at: http://www.nhs.uk/livewell/foothealth/pages/foot-problems-podiatrist.aspx [Accessed 6 April 2015]. Petrisor, B. &. B. M., 2007. The Hierachy of Evidence: Levels and grades of recommendations. Indian J Orthop., 41(1), pp. 11-15. Rist, P. K. J. B. J. G. M. G. F. &. K. T., 2012. Migraine and cognitive decline among women: prospective cohort study. BMJ, 345(e5027). Song, J. &. C. K., 2010. Observational Studies: Cohort and Case-Control Studies. Plast Reconstr Surg, 126(6), pp. 2234-2242. Wen, L. B. L. S. J. R. C. W. K. &. F. V., 2012. Effectiveness of home based early intervention on childrens BMI at age 2: randomized control trial. BMJ, 344(e3732). Read More