Rapid versus Standard Intravenous Rehydration in Paediatric Gastroenteritis by Freedman, Stephen B - Article Example

Name Instructor Course Date A Critique of Literature Review Article Reviewed: Freedman, Stephen B., Patricia C. Parkin, Andrew R. Willan, and Suzanne. "Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial." BMJ 343 (2011): d6976. Abstract of the study The study "Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial" seeks to establish if rapid instead of the norm intravenous rehydration leads to enhanced hydration and clinical results when given to children diagnosed with gastroenteritis (Freedman et al.1). The authors make use of a detailed abstract that clearly summarizes the content of the study. The article starts off by stating the objective of the research that is a brief explanation of what the study aims at achieving. The authors then describe the design of the survey that state how the researchers would attain the objectives. The abstract also contains a brief summary of the setting, participants, interventions, outcomes, results, and conclusion. Therefore, the abstract provides adequate information to regarding the phases of the research process. Throughout the text, can quickly note that the title is congruent with the text. However, the authors fail to note the keywords that serve the purpose of enveloping the main topics of the study (Creswell 44). Introduction and Background The study then proceeds to the introduction that gives a detailed background to the research to familiarize the reader with the issue at hand. Gastroenteritis is a morbidity that has remained a significant public health concern in many countries (Whyte, Al-Araji & McLoughlin 309). Most children get an administration of extended intravenous rehydration that adds to congestion in the emergency department (Freedman et al. 2). The authors refer to sources such as traditional teachings and the National Patient Safety Agency that support the mentioned rehydration techniques (Freedman et al. 3). Therefore, to reduce the costs and time spent at the hospital the researchers consider the use of rapid intravenous rehydration (Bruzzese, .Vecchio and Guarino 25) Citing various sources, the authors build a strong background to the study that clearly explains the root of the problem. There is a statement that describes the aim of the survey as well as a justification of the need to undertake the research. Hence, the authors adequately use evidence from relevant sources to orient the reader to the main issue in the study and state the need for the research to fill an unexplored gap in the literature regarding the efficacy of rapid intravenous rehydration in children (Koletzko 54). However, there is poor structuring of the study; the authors fail to make use of a subtitle that indicates the literature review thus mixing up the section with the introduction. Despite the poor structuring, the literature used in the research is current, relevant and comprehensive. Based on the year of publication of the study, the authors use recent references that reflect current developments in the medical field that are of interest to the topic. The article explains that the primary limitation of the reviewed literature is the lack of sufficient information on the efficacy of rapid intravenous rehydration. Therefore, the authors use enough evidence to build on the study and introduce the problem statement (Freedman et al. 2). Sample and Methodology The sample of the survey include participants selected in the period between December 2006 and April 2010. The article describes the sample and states that the size was 226 children. According to the study, the participants’ recruitment was in the paediatric emergency department at The Hospital for Sick Children, Toronto, Canada. The researchers deliberated eligibility to allow the participation of normal children that needed intravenous rehydration. Eligible participants were 90 days and above old, suffering from dehydration resulting from gastroenteritis and had shown no beneficial outcomes from oral rehydration and had a prescription for intravenous rehydration. To determine the sample size, the researchers excepted children weighing less than 5kg or 33kg, those with a supposed medical condition, history of an unyielding systemic disease, fluid restriction, and hyperglycaemia among other complications. The researchers further omitted participants whose parents posed a language barrier or were short of telephone follow-up (Freedman et al. 2). Therefore, the study comprised an efficient selection of the sample that would adequately contribute to attaining the study’s objectives (Bryman 62). In sampling, the researchers used randomization using a computer-generated technique. Randomization in the selection of study participants is essential to improve the reliability and validity of the research. Random sampling reduces the likelihood of bias by giving each member an equal opportunity to be a part of the study. In the study, the researchers allotted the patients in a 1:1 ratio. Despite the fact that random sampling purges systemic bias, improper techniques can cause more errors. The clinical trial also involved blinding of the physicians to the scores on the dehydration scale (Freedman et al. 2). Therefore, through the sampling method as well as shadowing to ensure a sufficient randomized clinical trial, the researchers were able to minimize the likelihood of errors in the study (Neuman 55). In the intervention, all the possibly eligible children received oral rehydration. Over time, the researchers increased the rate of volume given to the eligible participants. The bedside nurses played the role of selecting samples at night who received intravenous rehydration. Some of the children received the standard intravenous rehydration while others got the rapid type. The nurses observed and recorded any outcomes. Thus, the researchers clearly explain the methodology that they implement to attain the study’s aims. The nurses, during observations after every thirty minutes, would note the oral rehydration score, vital signs, and adverse effects. Using a standardized telephone text, the researchers collected follow-up information (Freedman et al. 2-3). They made efforts to ensure that they to collect adequate data to meet the aim of the study. The nurses used precisely eligible measurement tools that would enhance the reliability of the survey. However, they failed to mention any ethical issues that came up in the data collection phase (DeCoux 83). The article also describes the outcome measurements that help develop reliability and validity of the study. The primary outcome was rehydration that the researchers explain as a score of less than or equal to 1 on the dehydration scale. According to the authors, to ensure research validity, the scale chosen relates with a stretch of stay and the utilization of intravenous rehydration and thus gives the impression that it draws a parallel with clinical decision making. The secondary outcomes comprise extended treatment, score on the scale, sufficient oral intake, discharge, and repeat emergency room call within 72hours (Freedman et al. 3). Hence, by describing the outcome measurements, the researchers provide a clear explanation of how they were able to meet the study’s objectives. The approach not only adds validity and reliability but also enables the replication of the research for further research and improvements in the field (Fink 50). Data Analysis In the analysis, the article reports the use of statistical techniques. The researchers used SAS software to evaluate the data with two-sided significance tests at 5% stage for the primary outcome measurement and 1% for the secondary outcomes measures. The researchers also developed a sensitivity analysis excepting patients with variations from the study conventions. They utilized the Fisher’s exact test to evaluate the variance in the primary outcome between groups and for the secondary outcomes. The researchers paralleled the clinical dehydration scores between two factions using mixed model repeated calculates. They also utilized the median test and Cochrane’s test for the assessment of median baseline score and physician’s contentment with discharge respectively (Freedman et al.3). Therefore, the statistics were primarily correlational. The choice of analysis techniques that are well established and reliable adds to the validity of the study. The authors describe the statistics for each primary variable that clearly organizes the work for the easier understanding of the reader (Motulsky 2128). Findings The authors document findings that are statistically analysed and put in such a way that the average audience of the article can understand. In the introduction to the study, it was clear that the researchers expected rapid intravenous rehydration to be more efficient that the standard procedure regarding saving costs and time among other benefits. Nevertheless, the findings demonstrate that there is no variance in clinical efficiency between rapid and standard intravenous rehydration. The study shows that two hours following the administration of rapid intravenous rehydration, the dehydration attained was the same to that seen in the norm rehydration technique. Hence, no outcome indicated a beneficial trend towards the utilization of rapid intravenous rehydration; instead, they showed the tendency for worse outcomes casting doubt on the use of the technique (Freedman et al. 4). The researchers present adequate information to verify their results and also state their findings in a clear and complete manner. The information produced in the results is coherent with the data collected. However, they fail to use graphs and tables that would help enhance clarity of the text (Ott and Longnecker 38). The researchers display insight into the meaning and importance of the results of their study. According to the article, the findings of the research are significant as the literature encompasses a scarcity of high-quality research that indicates the efficacy of rapid intravenous rehydration. As a result, the study paves the way for further research in the area by providing more literature to guide other studies. The researchers explicitly compare their study to others while discussing how they met the objectives of their research. They use previous research work as a setting in which one can understand a new survey (Freedman et al. 4-5). They, however, fail to utilize theoretical concepts that would further guide the interpretation of the study and add to its validity and reliability (Galvan72). The researchers acknowledge other literature relevant to the topic and use them to explain their findings for easier understanding further. Strengths and Limitations The study also includes an explanation of the strengths and limitations. According to the article, the advantages comprise the utilization of accurate measures to ensure blinding and reduce the likelihood of bias. The research also provides generalizability and external validity by using participants typical of those who require intravenous rehydration in developed nations. Nevertheless, there are also weaknesses to the study. For instance, they did not include children who have cardiovascular complications for ethical and logistical rationales. They, however, fail to explain the ethical and logistical issues arising in the study. They also neglected to blind the attending physicians to the replication electrolyte results that would have swayed the findings. Moreover, the research lacked the use of theoretical concepts that would build validity and reliability. Despite the presence of strengths and limitations, the study adequately fills in the gap in the literature concerning the efficacy of rapid intravenous rehydration (Freedman et al. 5). Conclusion and Recommendation In conclusion, the authors summarise the study and state the policy implications. According to the article, the research of haemodynamically steady children with gastroenteritis who needed rehydration found no beneficial effects on the utilization of rapid intravenous rehydration. With regards to policy implications, the researchers caution that it is essential to consider the probable risks of the procedure in its use in children. However, the study does not expound on the implications of their findings in healthcare (Freedman et al. 5). The omission creates a gap whereby the average reader may not understand how the results would benefit the medical field other than caution against the use of rapid intravenous rehydration in children (Mertens 85). Despite acknowledging the weaknesses of the study, the researchers do not make any suggestions for further research. Considering there are limitations to the research and a scarcity of literature on the topic, there is an explicit requirement for further studies in the area (Aveyard 69). Therefore, it is clear that the survey adequately provided literature that could be used in further research to look into the issue of the routine utilization of rapid intravenous rehydration in children. Moreover, the researchers use accurate measures to ensure validity and reliability of the study. However, some omissions weaken the research (Lampard and Pole 70). For instance, the lack of utilization of theoretical concepts to build on the study and promote the interpretation of findings (Parahoo 93). There is also a brief section of literature review in the introduction part that does not adequately explain the background of the topic. There is also an absence of graphs or tables that would help clarify the text in the findings (Machi & McEvoy 79). Despite the weaknesses, the study provides sufficient information that would allow for replication. Works Cited Aveyard, Helen. Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK), 2014. Bruzzese, Eugenia, Andrea Lo Vecchio, and Alfredo Guarino. "Hospital management of children with acute gastroenteritis." Current opinion in gastroenterology 29.1 (2013): 23-30. Bryman, Alan. Social research methods. Oxford UniversityPress, 2015. Creswell, John W. Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications, 2013. DeCoux, Valerie M. "Kolb's learning style inventory: A review of its applications in nursing research." Journal of Nursing Education 29.5 (2016): 202-207. Fink, Arlene. Conducting research literature reviews: From the Internet to Paper. Sage Publications, 2013. Freedman, Stephen B., Patricia C. Parkin, Andrew R. Willan, and Suzanne. "Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial." BMJ 343 (2011): d6976. Galvan, Jose L. Writing literature reviews: A guide for students of the social and behavioural sciences. Routledge, 2016. Koletzko, Sibylle. "Management of acute infectious diarrhea in infants and young children." new horizons, fresh ideas (2014): 54. Lampard, Richard, and Christopher Pole. Practical social investigation: Qualitative and quantitative methods in social research. Routledge, 2015. Machi, Lawrence A., and Brenda T. McEvoy. The literature review: Six steps to success. Corwin Press, 2016. Mertens, Donna M. Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative, and mixed methods. Sage Publications, 2014. Motulsky, Harvey J. "Common misconceptions about data analysis and statistics." British journal of pharmacology 172.8 (2015): 2126-2132. Neuman, W. Lawrence. Understanding research. Pearson, 2016. Ott, R. Lyman, and Micheal T. Longnecker. An introduction to statistical methods and data analysis. Nelson Education, 2015. Parahoo, Kader. Nursing research: principles, process and issues. Palgrave Macmillan, 2014. Whyte, L. A., R. A. Al-Araji, and L. M. McLoughlin. "Guidelines for the management of acute gastroenteritis in children in Europe." Archives of disease in childhood-Education &PracticeEdition 100.6 (2015): 308-312. Read More