Research Critique: Esmond, Butler, and McCormack - Literature review Example

Research Critique: Esmond, Butler, and McCormack YOUR FULL OF YOUR SCHOOL OR Research Critique: Esmond, Butler, and McCormack In Comparison of hospital and home intravenous antibiotic therapy in adults with cystic fibrosis (Esmond, Butler, & McCormack, 2006), the authors set forth their findings obtained during a research project to compare intravenous (“i.v.”) antibiotic therapy for adults with cystic fibrosis in a hospital setting versus a home setting. The purpose of critiquing a research report is to examine its various components and opine upon the ethics, research methods, data quality, and other aspects of the information presented. I have chosen the nursing industry standard for critique as the method for presenting the information contained herein. Esmond et al., do a good job of comparing, evaluating, and presenting the relevant data as they establish the need for further research on the subject of whether it is more beneficial to allow adult cystic fibrosis patients to self-administer a regimen of i.v. antibiotics or to require them to obtain such treatment in a hospital. Ethics. Medical research ethics are of utmost importance, and it is “of particular interest to understand how such researchers go about the task of defining ethical research within their own sphere” (Daly, 1996, p. 51). The ethics of Esmond and her team are consistently in line with established practices, and obtaining approval from the Local Health Authority Research Ethics Committee prior to conducting the research (Esmond et al., 2006), p. 55), was compliant with the standard protocols, as “studies that involve testing or observation of people must be authorized by an institutional review board” (Orentlicher, 2005, p. 25). There was no coercion or influence exerted upon the study participants and, in fact, potential participants were volunteers who were pre-screened to ensure sufficient lung function and clinical suitability. Patients were provided with a framework to assist them in determining their suitability for self-management of acute respiratory infection, ensuring a good mix of those who preferred the hospital option with those who did not. Further, the participants were selected in consultation with the cystic fibrosis team which ensured that the i.v. antibiotic therapy was being used as a bona fide treatment modality rather than simply a symptom control for terminal patients. Finally, the privacy of the participants was controlled through the assignment of a number that was used throughout the process. In terms of professional ethics, it would be hard to imagine a more circumspect study than that considered here. Research Problem. The authors clearly identify the research objective in their “Aim of Study” section (p. 54). The study is designed to compare: home therapy with traditional hospital therapy for clinical outcome and quality of life in adult CF patients being treated with i.v. antibiotics for acute respiratory exacerbations, once the patient had chosen where they undertook treatment. (2006, p. 54) The study lacks a formal hypothesis, but offers a statement of intention regarding, in part, the purpose of informing the service department for the purposes of resource allocation planning. In this way, it impacts the nursing profession as the issue of staff planning will directly bear on the process of i.v. treatment of CF patients should a home-based regimen prove effective. It should be noted, however, that this program is for adult CF patients who prefer to self-administer the treatment at home and those who do not meet these or other criteria would remain hospitalized for the duration of the treatment, rendering little impact on staffing levels. Overall, the presentation of the problem is well-done. Research Literature Review. The literature review in this article, though more brief than some, seems appropriate. It notes that there have been several studies comparing home vs. hospital treatments and that the conclusions are not conclusive. This study differs from the primary studies listed in that the older research addresses retrospective experiences or historical controls (2006, p. 54) and the methodology used by Esmond et al. is more comparative of the patient experience. Writing literature reviews can be made more “pleasant for all readers” if a logical process is followed (Delamont, 2002, p. 72). In this article, the authors start with basic studies and then progressively move through similarities and differences inherent in the methodologies and conclusions, particularly in the quality of life measures. As discussed further herein, the authors’ use of a specific questionnaire that was not available to the previous studies is part of the design improvements for inquiries of this type. The literature review overall is constructed well, presented accurately and helps the reader to understand the basic issues while leading to the substantive aspects of the design, results, discussion, and conclusion portions. Conceptual Framework. The framework for this study is explicitly stated and is adequate for its purpose. For the patients, the matrix provided to assist them with determining their comfort level of participating in self-management is clear and useful. For the researchers and readers, the investigative framework is workable, consistent with the research paradigm, and described within the study in such a way as to help the reader understand exactly what the question is, how it is answered, and the continuity of the conclusions. The presented research problem is consistently treated and naturally flows from the stated objectives. Further, the authors tie their findings back to the framework throughout the discussion and conclusion. Accordingly, the concept of evaluating CF patients for the purposes of determining the benefits of self-treatment is appropriately carried throughout the piece. Research Design. Given the nature of the question, the authors have designed an appropriate research scheme. The clinical objective is to compare home therapy of i.v. antibiotic treatment with its hospitalized counterpart. The first element of the design, a patient determination matrix, is well done. By recruiting only those patients who had chosen the location of their treatment prior to selection for the study, the researchers were able to prevent bias within the sampling population. No patient was induced to attempt one treatment methodology over another for the purposes of participating in the study, eliminating any potential prejudice. The data collection was straightforward, a combination of objective clinical performance and subjective answers to a questionnaire. This design was clearly identified as quasi-experimental, and given the research objectives, was appropriate. This design structure allowed patients to be studied in their natural clinical setting, with minimal disruption (2006, p.54). The points of comparison used by the researchers seem reasonable as they were a mixture of physiological and quality of life measures. The clinical measures were entirely appropriate for gathering the stated objective information; expiratory volume, forced vital capacity, oxygen saturations, and body mass index. The quality of life measure was solely a function of the Cystic Fibrosis Quality of Life questionnaire, which is specifically designed to measure nine domains of various aspects of patient quality of life (Gee, Abbott, Conway, Etherington, & Webb, 2000). The treatment itself was tailored to the sample group, based upon the latest standardized measures (Cystic Fibrosis Trust Antibiotic Group, 2001). This design presents a good combination of quantifiable data sets for both physiological and psychological analysis. The comparison was rightly set as a function of individual data compared between the two environments, and the results are externally valid. The only design limitation I observed was the sample size. The use of only 15 individuals in each group yields a sample size that is insufficient upon which to draw broad conclusions. This limitation is also noted in the report, which calls for additional research. While the statistical evaluation does not directly account for this problem, the establishment of a threshold for statistical significance, combined with the population sample limitation notes, provides the reader with sufficient material to form an opinion on the results, being able to understand and rely upon the caveat. Overall, the research design is well-constructed and serviceable. Sampling Design. When analyzing both the quantitative and qualitative samplings in this study, it is clear to see that the researchers and their article excel in the approach to sampling. The target population is immediately and clearly restricted to adults that have cystic fibrosis, and the setting that is to be used similarly demonstrated and appropriate. Selection procedures are also obviously identified and sensible, particularly the choice to reserve inclusion in the group until after the participant has chosen the location of treatment. At every level, bias is attenuated throughout the sampling procedures either by the timing of selection or through the research data obtained. The clinical data is drawn objectively and under controlled procedures. The questionnaire is administrated in a straightforward manner, and the answers tabulated and quantified using appropriate methodology. In terms of the sampling design, as previously noted, the size of the population is too small to draw any sweeping conclusions. Researchers are able to identify statistically significant events, but are not able to extrapolate these conclusions with any meaningful expectations. The aim of the study is achieved, in part, through this design due to the comparison of good data. The utility of the demonstrated outcomes, however, will have to be verified by additional research for there to be any significant service development. This limitation is duly noted by the authors, citing the fact that this is a pilot study, not a power calculation. Data Quality. The quality of the data is good. In terms of the clinical data, the data classifications were determined using standard protocols from the Cystic Fibrosis Trust. The actual data collection was done under controlled clinical standards by trained professionals, and the comparisons are a function of tabulation and standardized calculation. The reader can rely upon the validity of the clinical data. The psychological or quality of life data was obtained using a questionnaire designed specifically for the target population by an objective and independent source. While the article does not mention any proctoring of the questionnaire, there is no reason to suspect that the subjects would misrepresent their opinions in order to skew the results; this population had been selected after they chose the location of their treatment. The report itself represents the validity of the measures, offers no reason to question the veracity of the data, and adequately describes the related procedures. Accordingly, there is a strong congruence between the variables as designed and the operational modality described. Based upon this, I can conclude that the data is reliable and therefore the inferences drawn are valid. Data Analysis. The analysis of the data, as presented in the report, is exceptional. The descriptive statistics sufficiently present the major characteristics of the data set, and the statistically significant results are addressed sufficiently. The issue of using a new questionnaire to obtain the quality of life issues is incorporated into the analysis of those issues seamlessly. In terms of the presentation of the quantitative analysis itself, the judicious use of tables and figures was complimentary without undue repetition. The observations made and the conclusions drawn are supported by the data provided, and both statistically significant and insignificant comparisons are discussed. The authors have achieved clarity and brevity, with no anomalous analytical methodologies presenting. Conclusion. Upon review of this article, I conclude that the authors have done a good job of constructing and presenting a pilot project that clearly demonstrates the need for further research. The study is a strong presentation of the issue of home-based antibiotic treatment administration, and provides good conclusions based on the data presented. The overall presentation of the material is good. There are some issues from the study that that met my expectations, and others I found to be surprising. Upon reading the title of the article, I knew that there would be a focus on the location of a clinical treatment. The constants in this research were that all participants would be adults who had cystic fibrosis, all would have an infection that needed a regimen of antibiotic treatment, and that all would be asked to comment on a number of quality of life issues. I presumed that those participants who chose to receive their care in a hospital would achieve a better clinical result, as that expectation is both intuitive and a finding in previous research (Donati, Guenette, & Auerbach, 1987). In this regard, I was correct. The authors note that one of the statistically significant data analysis results was in the area of lung function, with the self-treated patients experiencing fewer efficacies than those treated in the hospital. Various reasons for this are offered in the article. Contrastingly, I expected that those patients who chose home treatment would report a higher quality of life, as they have been known to do (Bramwell, Halpin, Duncan-Skingle, Hodson, & Geddes, (1995). This, too, is not surprising since most people would rather spend two weeks at home rather than at a medical institution. The report bore this expectation out as well, noting that there was an overall improvement of scores on the part of the self-administered, home-based patients for the most part. Surprisingly, this did not stand true at all levels. The patients treated in hospitals had higher negative scores for quality of life in areas such as social functioning, physical functioning, and emotions (Esmond, 2006, p. 57). The patients treated in homes actually demonstrated higher negative scores in the areas of future concerns, interpersonal relationships, and body image. Possible reasons for this, too, are discussed in depth within the article. Another surprise was the revelation that the body mass index improvements in both groups were the same. Since there is a known higher incidence of lower nutrition in hospital patients (Lennard-Jones, 1992), and since it is easy to believe that anyone eating at home is going to eat more and of a higher quality, I expected the self-treated, home-based patients to show a significantly increased result in body mass. This didn’t happen, and various reasons are posited by the authors. Overall, for the reasons cited herein, my critique of this article is positive. The authors engaged in a thorough, ethical study. They set forth the research question clearly, and conducted a satisfactory and well-presented literature review. The conceptual framework and research design were both logical and properly carried out. Their conduct of the sampling design, data collection and analysis was within acceptable measures, with the exception of sample size, which was addressed satisfactorily within the study itself. The lucid discussion presented the elements well, and the conclusion was a logical derivative of the data. While some of the findings were unexpected, the majority of the information was within the realm of expectations and, given the clear presentation of the material, I believe this to be a good example of a quality research article. References Bramwell, E.C., Halpin, D.M.G., Duncan-Skingle, F., Hodson, M.E., & Geddes, D.M. (1995). Home treatment of patients with cystic fibrosis using the ‘Intermate’: the first year’s experience. Journal of Advanced Nursing, 22, 1063-1067. Cystic Fibrosis Trust Antibiotic Group (2001). Report of the Cystic Fibrosis Trust Antibiotic Group. Cystic Fibrosis Trust, Bromley. Daly, J. (1996). Ethical Intersections: Health Research, Methods, and Researcher Responsibility. Boulder, CO: Westview Press. Delamont, S. (2002). Fieldwork in Educational Settings: Methods, Pitfalls and Perspectives. London: Routledge. Donati, M.A., Guenette, G., & Auerbach, H. (1987). Prospective controlled study of home and hospital therapy of cystic fibrosis pulmonary disease. Journal of Pediatrics, 111, 301-305. Esmond, G., Butler, M., & McCormack, A. M. Comparison of hospital and home intravenous antibiotic therapy in adults with cystic fibrosis. Journal of Clinical Nursing, 15, 52-60. Gee, L., Abbott, J., Conway, S. P., Etherington, C., & Webb, A. K. (2000). Development of a disease specific health related quality of life measure for adults and adolescents with cystic fibrosis. Thorax 55, 946-954. Lennard-Jones, F. (1992). A Positive Approach to Nutrition as Treatment. London: Kings Fund. Orentlicher, D. (2005). Making Research a Requirement of Treatment: Why We Should Sometimes Let Doctors Pressure Patients to Participate in Research. The Hastings Center Report, 35(5), 20-43. Read More