Evidence Selection and Critical Appraisal - Assignment Example

Evidence selection and critical appraisal using CASP Objective Name Professor Course Date Part 1 Formulating answerable question Before one start critically appraising a research, it is important to formulate an answerable question. Formulating clear answerable question will guide the reviewer on how to collect studies, conduct the analysis and check whether studies are eligible(Egger, and Smith, 2008). To the reader a properly formulated question will guide their initial assessment on the relevance of the study. In addition as Stewart, and Parmar, (2006) suggest post hoc question are more susceptible to bias than those question determined prior. However, it is important to note that changes to the review question may be required. The reason for changes in the review question should be clearly sated in the completed review. Most importantly, to formulate answerable question PICO should be followed. In this case, we would like to know whether Vasopressin Release is heterogonous to all Adipsic Diabetes Insipidus patients. However, this question is too broad to answer efficiently, thus it is appropriate to break it down into specific factors using PICO approach. Factors that are more specific have to be determined before the nurse can develop a focused answerable practice-based question. By framing the question using PICO approach; Population: the patients, Intervention: An intravenous infusion of trimetaphan Comparison: The responses of ADI patient are compared to control group responses. Outcome: secretion Baroregulation AVP in response to the infusion Therefore, a more focused question can be written as: is the pattern of AVP release heterogeneous to all ADI patients? This question will be used during qualitative research study to increase the understanding of the constrain. PART 2 A critical analysis of a quantitative research using CASP framework By critical appraisals a research, a reader is able to understand a scientific research publication. CASP can be used to appraise both quantitative and qualitative research. The CASP guideline has about ten questions for both qualitative and quantitative research, which evaluate validity, relevance, and value of a research. In this section the following quantitative research is appraised: subject Baroregulation of Vasopressin Release in Adipsic Diabetes Insipidus 1. Did the study ask a clearly focused questions? The answer is yes. PCOT is the framework is used to answer this question. The study population composed of nine patients with ADI, six of which were male and nine control volunteers again six of which were male. The intervention of the study was hypertension saline infusion in nine patient and nine normal group. The purpose of the study was to confirm the whether the release of Baroregulation of Vasopressin follows a heterogeneous pattern among all ADI patients. The comparison of the study was use of ADI patient and the control group to compare the response of the hypertension saline infusion. The outcome of the study was vasopressin (AVP) response to hypotension in nine patient , hypertonic saline infusion produced absent thirst and AVP response in ADI group. The study concludes that AVP responses to hypertension in ADI group are heterogeneous and reflect site of lesion causing the diabetes insipidus 2. Was this randomized control trial and was it appropriately so? Yes. Randomized control trial involves Radom allocation of different trials to the subjects. This method is normally used to investigate effectiveness of a health issue. The research aim was to investigate the effect of intervention on ADI patients and normal people. This mean that, the subject received similar interventions and researchers aim was to test the response of the intervention on ADI patients and compare them to response of normal people. The researcher used stratified randomization to eliminate confounding effect which is apropreite for this kind of study. 3. Were the participant appropriately allocated to intervention and control group? The answer to this question is yes. the researcher clearly describes the clinical characteristics of ADI patients. Patients were considered to have ADI on basis of subnormal thirst and AVP responses to hypotonic saline infusion in presence of hypotonic polyuria. In addition all patient were tested for anterior pituitary hyponification; ACTH and GH reverse were tested by either insulin hypoglycemia or glucagon testing, TSH deficiency by TRH test , and gonadotrophin deficiency by GnRH test. In fact the researcher found that the patient were on pituitary replacement therapy. The rest of the participants were not on any medication. 4. Were the participant, staff and study personnel blind to participants study group ? No. The researcher and the participant were not blinded. They understood the detail of the research. It is stated in the report that the control group volunteered to participate in the research meaning that they were briefed of what research entailed. Blinding helps to reduce bias in a study. Where the subject or those collecting data are not blind, this introduce bias. However blinding is impossible especially to treatment where the active participation of the participants is required. In this case the researcher used open trial rather than blind trial 5. Were all the participant who participated in the trial accounted for at its conclusion? Yes. It is important to account for the entire participant who entered in the trial. In this case, all the eighteen participants were accounted for at the conclusion. The researcher analyzed the result of all the nine patient and compared them to the control group. 6. Were the participants in all groups followed up and data collected in the same way? The answer is yes. The data was collected in the same way from all the participants. The researcher state, all the participants underwent intravenous hypertonic saline infusion to diagnosis ADI and normal. In addition, after an overnight all the subject admitted to the investigating units. All the subject were requested to abstain for caffeine nicotine and alcohol for 12 hr before the study. Blood pressure was measured at the same interval, blood sample was withdrawn at 30 min interval and thirst was measured at blood sampling time, for all the participant and However it is important to not the researchers do not mention on whether the participant were followed and for how long . 7. Did the study have enough participants to minimize the play of chance? Yes. In this study the subject were enough to reduce the play of chance. The sample size can be determined by inputting the population size the confidence level margin of error and response distribution. Power calculation enable the researcher determine the size of sample that is required to make precise statistical conclusion. In this case, the statistical significance is the evidence that proves that play of chance was minimized. 8. How are the result presented and what are is the main result? The researchers present the result in clear manner, often comparing between the control and ADI group. For instance the study found out that baseline osmolality was higher in ADI groups than in control, the infusion of saline led to rise in plasma osmalality in both ADI and control group. In addition in order to assist the leader the researcher provides more explanations. For instance, rather than just reporting that there was rise in plasma osmalality, the researcher further reports that the rise in plasma osmolality was caused by a rise in plasma sodium concentration. 9. How precise are the results As mentioned above, comparison between the responses of patient group and the control group is clearly presented. The main finding was that AVP responses to hypertension in ADI are heterogeneous and reflects the site of the lesion causing the diabetes inspidius. Therefore, the results are precise. 10. Were all-important outcomes considered so the results can be applied? The researcher provides that the study show the pattern of baroregulated AVP release is heterogeneous in ADI patients. The patient with isolated osmoreceptor defects are able to secrete AVP in response to hypotension, but the lesions in craniopharyngiama patients is more extensive, such that baroregulated AVP release is impaired. Moreover the study was carried out under the permission of local ethical committee thus the result are reliable. The research provides valuable information .Therefore, the result can be applied, since the researcher has considered all-important outcome. The ten questions have been answered and since the answers were yes to most of the question, the research is thus valuable and will provide valuable information. Part 3 a. Evidence based practice (EBP) Evidence based practice is now a major focus for health care policy makers, practitioners and researchers. The practice has gained momentum in nursing professional and is now considered crucial for promoting excellence patient care. EBP is an important aspect of maintain high quality health care. Data from recent studies indicates that the practice can improve the patient outcome by 28%. In addition, implementation of MBP has been found to increase the patient satisfaction and eliminate unnecessary practice as well as improving efficiency. Egger, and Smith, (2008) reported that in the past two decades there has been a progress in implementing EBP in the healthcare. However, Schulz, and Grimes (2006) found the implementation of MBP among the nurses is inconsistent in most of the health care facilities. The available scientific studies have identified and described a number of barriers to implementation of evidence-based practice. First Sharma, (2010), suggest while most of nurses realized the importance of EBP, there was a general lack of knowledge regarding research information. Egger, and Smith, (2008) revealed that lack of time and knowledge and complexity of statistics as the main barriers to implementing EBP in Australia. Other study reported workplace culture, the role of institution as the main Barrie. In addition, Schulz, and Grimes (2006) reported that lack of role model to support staff in research as the min barrier. Some of the barriers of implementing evidence based practice in my work place include, lack of knowledge of availability of published scientific research and how to critique research, lack of support of change from colleague, lack of authority to change the practice. Some of the organizational barriers include lack of access to research, lack of time to implement new idea, and lack of awareness of the available educational tools related to research. b. the summary of the clinical question Adispic diabetes inspidus is a rare but complex condition; therefore, there exist little information about it. In most cases, the condition is characterized by impaired thirst and defective AVP secretion. The diagnosis of ADI present a management dilemma to many care givers. the management of the condition normally requires regular desmopressin, and frequent fixed fluid intakes that may vary with climatic condition. It is also necessary to conduct regular review of plasma sodium. Liu, and Liehr, (2009) reports, thirst mechanism prevent dehydration in DI patients. The need to continually take more fluids is not comfortable to most patients. DDAVP is a more convenient treatment option. DDAVP can be administered as intra spinal spray, as well as orally in two or three daily intakes. After treatment of the condition some patient are thought to regain their thirst response. Determining whether to reduce tight fluid intake schedules, is a challenge to many caregivers. My proposed research is to confirm objectively whether the patient has regained their thirst mechanism in order to relax their strict fluid intakes schedule. As mentioned earlier having to take fluid on strict schedule is uncomfortable to some patient thus knowing when to relax the schedule would be very important for both to the caregivers and the patient. The objective of my research would be to objectively determine whether ADI patient under treatment have regained their thirst mechanism. Conclusion The guideline used above can help the health educator, practitioner or student obtained a deeper meaning of quality of any the published research. No study is 100% accurate however it is important for health practitioners to peruse whether the research are accurate before using the findings. If the answer to most of the CASP question is no, then the quality of research is questionable. Furthermore, it is important for health practitioners to develop a culture of critically appraising research material to embrace evidenced based practice. At first, one may find it difficult and time consuming but after repeatedly applying the guideline, you will be more confidence and will be interested in reading research publications. Critical appraisal is crucial element of evidence-based medicine. The five steps of evidence-based medicine are asking answerable questions, searching for evidence, then carry out critical appraisal, and finally evaluation of the new practice. Critical appraisal is important to identify papers that are clinically relevant, combat information overload as well for professional development. There are numerous benefit associated with evidence based practice. Such benefits include increased patient satisfaction and elimination of unnecessary practice and improved efficiency. Some of the barriers of implementing evidence-based practice include lack of knowledge of availability of published scientific research and how to critique research, lack of support of change from colleague, lack of authority to change the practice. Some of the organizational barriers include lack of access to research, lack of time to implement new idea, and lack of awareness of the available educational tools related to research. References Egger, M. & Smith, G. D. 2008, Bias in location and selection of studies, BMJ, vol. 316, no. 7124, pp. 61-66. Liu, H. & Liehr, P. (2009). Instructive messages from Chinese nurses' stories of caring for SARS patients. Journal of Clinical Nursing, 18, 2880-2887. Schulz, K. F. & Grimes, D. A. 2006, Generation of allocation sequences in randomized trials: chance, not choice, Evidence-Based Medicine, vol. 359, no. 9305, pp. 515-519. Sharma, S. 2010, Levels of evidence, Evidence-Based Ophthalmology, Evidence-Based Medicine vol. 11, no. 2, pp. 73-74. Stewart, L. A. & Parmar, M. K. 2006, Bias in the analysis and reporting of randomized controlled trials,International Journal of Technology Assessment in Health Care, vol. 12, no. 2, pp. 264-275. Read More