Discuss about the Critical Analysis of a Research Article for Healthcare World.
Research is a fundamental factor in almost all professions, particularly in the health sector. It plays a vital part in the basis and growth of the healthcare world (Parkes et al., 2001). This essay essentially focuses on the critical appraisal of a research article based on the CASP (Singh, 2006, p.76). Critical appraisal is the systematic analysis of a research paper to determine its strengths and weaknesses (Young, 2008, p.82). This paper reviews an article about Natural ways of averting heart complications (Seely et al., 2013, pp.409-416). Many research articles are evaluated due to an utter level of information available on the healthcare settings. Critical appraising of an article enables one to differentiate low-quality articles from the standard ones, while at the same time filtering out misleading information to the public (Taylor et al., 2004, p.30).
The purpose of this article is to establish the fact that integrating naturopathic care with usual care can significantly lower the risk of cardiovascular complications in high risk population. The population studied consisted of randomly selected individuals who are at high risk of suffering from cardiovascular malady. The intervention given are those that are focused on the naturopathic care compared with usual care. The naturopathic care included specific diets, lifestyle recommendations as well as selected natural healthcare product. Additionally, the primary outcomes are the variations in the incidence of metabolic disorder and changes in Framingham ten-year cardiovascular peril score (Taylor et al., 2000, pp.120-125).
The title of the article establishes what the research is all about, without being too extensive, using irrelevant words or giving a glimpse about the results. The reader can easily determine the aim of the research without straining (Linzer et al., 1988, pp. 2537-2541). The title summarizes the natural interventions that can be used to prevent cardiovascular disease. Based on the CASP, population, intervention, and outcomes are undoubtedly evident in the research paper. Therefore, we can clearly establish that the question pointed out the purpose of the research (Savigny et al., 2009).
To properly understand the influence of interventions, it is essential to compare intervention group (study group) with another group who are not under interference (control group). The research is a randomized control trial which deems appropriate for this type of research, as the researchers are trying to establish the impact of naturopathic based on the study group and control group (Horsley et al., 2011). The authors chose random control trial in which, the participants were randomly allocated to the study. In the research, randomization was done centrally in blocks of 8 stratified by sex before the intervention was assigned. To ensure legibility of the results, only participants, clinician and those responsible for collecting the outcomes were informed of the group assignments, but not statisticians. The participants came from multiple work sites from Canada. The authors articulate conducting unrestricted free screening without any form of discrimination. 120-140 willing individuals at the highest risk of endocardial disease at each site were requested to participate in the studies.
In the article, 1125 individuals went through screening, but only 246 participated in the research. The participants were selected randomly based on the level of the risk of the screened individuals. The research does not explain why the participants decided to participate in the study, nor why others chose not to participate in the research (Kuper et al., 2008, p 1035). This is vital information that for those people who like to volunteer to take part in research studies, hence, the research may not be only relevant to post-employees. The research is also unclear how the participants became aware of the screening and consequently the research and the information they were told before the whole process began (Hannes et al., 2010, pp. 1736-1743).
Certified doctors took the measurement of body weight, lipid profile, blood pressure and waist circumference of all the participants before the study commenced. The study group had a negligible elevated frequency of larger waistline, hip circumference, metabolic syndrome and greater weight. Also, the naturopathic category consisted of participants who reported higher weekly minutes of exercises. Based on the randomization schedule, 124 participants were allocated to the study group while 122 remained under usual care. The control group continued to visit their respective physicians as usual, while the study group complemented the usual care with naturopathic care.
Based on the CASP analysis of a research article, we can state that the allocation of the participants to both intervention and control group was relatively random. The authors explained why each of the participants was grouped into either of groups based on the randomization schedule (Seely et al., 2013, pp.409-416). Also, it is evident that the two groups are balanced as required by CASP. However, the process of selecting the participants from the whole group who participated in the screening process and creation of the awareness about the research is not very well explained.
In the research, the statisticians were blinded from group allocation to avoid bias in results. All the partakers, clinical doctors, and those adjudicating or gathering outcome information knew of the group allocation except the statisticians. However, because members, clinical doctors and those gathering information knew of the group allocation, the whole process of group assignment cannot be said to be absolutely blind. Participants and clinicians should not know the allocation process (Ulin et al., 2005). Group assignment is biased as a participant’s decision to give approval or the recruiters’ decision to enroll a particular participant might be influenced by the knowledge of which group the participants will be assigned to if they participate in the screening process.
The research has a clearly drawn consort diagram that accounts for all the people who participated in the research (Seely et al., 2013, pp.409-416). According to the article, 1125 individuals took part in the screening process and out of them, 246 were either willing or qualified for the research program. The 879 people who failed to participate in the research were unwilling to participate, did not contact the researcher or had below standard cardiovascular activities. Out of the 246 participants, 124 were randomly categorized under the intervention group while the remaining 122 grouped under the control category. Since the participants were being assigned to the two groups randomly, there is a possibility of a potential intervention participant placed in the control group. Based on the diagram, the participants were not allowed to cross over from their assigned groups once the research commenced.
Of the 246 participants who started the program, 39 participants were lost to follow-up. To be noted is that drop-out was equally distributed between the intervention and study group. The 39 participants were each followed up to about 3 times to find out the reason for drop-out, and 17 people responded. Most of the cases were related to medical complications, while some lost interest. The percentage of participants lost to follow-up represented 15.9% of the initial population. All the contestants’ results were analyzed by the respective categories they were assigned.
The aim to account for the analysis of the intervention group was 85.4% while that of the control group was 82.8% of the original population (Seely et al., 2013, pp.409-416). The paper also takes into account the safety and adverse events that occurred during the research period. One patient died before the study commenced while 5 participants contracted life terminal illnesses such as cancer. The adverse events occurred uniformly between the two groups. All these evidently shows that all the participants in the research were justified for at the end of the study.
All the 246 partakers in both groups were monitored from the beginning to the end of the research process. The data of all the participants were collected and analyzed using means of standard deviation at baseline, 26th and 52nd week. Therefore, it can be deduced that there was no bias during collection of the data and that all participants were taken into account and treated equally (Taylor et al., 2004, p.30). For instance, the intervention participants were received naturopathic care at a frequency of 7 preset times over a period of one year, which is somewhat similar to the frequency of visit to the routine naturopathic care in the community. Also, the follow-up schedule and parameters accessed were the same for both groups.
To design a practical clinical trial, the primary consideration is given to the number of participants required to be added to the sample to end up with the desired results (Parkes et al., 2001). Research with few participants will give misleading results, while on the hand, large sample size tends to be difficult to work with during collection and interpretation of results. Sample size estimation helps a researcher to estimate the appropriate sample size for a given study design (Young, 2009, p.82). The study consisted of 246 participants, which is not too small or too large, but the ideal sample size. This increases the possibility of the result obtained to determine the impact of naturopathic care in preventing cardiovascular disease. However, the paper does not demonstrate power calculations or explained why they used 246 participants to carry out their research. Power calculations are essential in minimizing the play of chance (Rychetnik et al., 2002, pp.119-127).
Two hundred and forty six people were selected out of the 1125 individuals who participated in the screening. The study took 52 weeks, in which intervention class had better performance than the control category (risk reduction to 16.9%, 95% confidential confidence (CI), P=0.002%). The analyses exhibited a significant reduction risk in the cardiovascular complication after counseling concerning the nutritional and physical activity. The reduction risk of 16.9% implies that the 1 in every six people who underwent naturopathic care was advantaged compared to the participants who did not experience the counseling by not suffering from metabolic syndrome (Seely et al., 2013, pp.409-416). The study also shows that 3 out of 100 people who receive naturopathic care but having the intermediate cardiovascular disorder are less likely to experience fatal symptoms such as stroke or heart attack as compared to the patients under the usual care. The research also found that thorough lifestyle involvement can greatly reduce risk factors associated with cardiovascular complications.
To be certain about the range of values within which the research can be proven with assurance to have covered general population, confidential intervals are used (Horsley et al., 2011). The smaller the difference recorded in the interval, the more precise the approximation of the outcome is, making it likely to get a more realistic and dependable result of the whole treatment process (Akobeng, 2005, pp.837-840). In this research paper, studies were examined within 9 categories of interventions; weight 0.22 (-2.78 to 3.22), 95% CI, lightweight lipoprotein, mmol/L –0.01 (–0.28 to 0.25), 95% CI, heavy-weight lipoprotein mmol/L 0.14 (0.04 to 0.24), 95% CI, Triglyceride, mmol/L -0.03 (–0.56 to 0.5), 95% CI, cholesterol to high density lipoprotein –0.79 (–1.24 to –0.35), 95% CI, Glycated hemoglobin, % –0.14 (–0.29 to 0) 95% CI, fasting blood glucose mmol/L 0.48 (–2.50 to 3.45), 95% CI, Systolic blood pressure –6.55 (–9.70 to –3.42), 95% CI, Diastolic blood pressure –3.33 (–5.92 to –0.75), 95% CI. General cardiovascular risk decline was -0.37% (95% CI –4.35 to –1.78%; p < 0.001), while that of metabolic risk reduction was –16.90% (95% CI –29.55% to –4.25%); p =0.002 (Seely et al., 2013, pp.409-416). Based on the results, the intervention proven that there was a substantial decline in cardiovascular disease after counseling about nutritional and physical exercise.
The researchers suggest that the efficacy of interventions studied in the research paper increase the generalizability of the application of the result practically. The authors discussed how the study could be a basis for further development naturopathic care in control and prevention of cardiovascular disease. The researchers also propose further research to improve the regression to the mean to maximize the reliability of the results. The authors noted that they did not put into consideration sufficient cardiovascular events to allow for comparison between the groups. There is no mention of transferability of this study being used in other situations (Dawes et al., 2005, p.1), other than being used in the prevention of cardiovascular disease. The researchers suggest that since they do not access for the contamination of the participants, there is a possibility of the result being biased. Additionally, the duration between the writing of the article and publishing it, is short, hence qualifying the article to be relevant and up to date (Milne & Oliver, 1996, pp.439-445).
In conclusion, the research is properly designed with relevant and useful results. The objectives and background of the research are evident, enabling the researchers to conduct the study within specific guidelines. The results section consist of flow charts and tables that clearly displays the aftermath of the study. Also, the results are accompanied by discussion and analysis to help readers understand the outcome of the research better. The major downfall of the research paper is lack of blind that might have led to the expectation and measurement predispositions. Also, the study did not clearly demonstrate the value of the normal lifestyle in comparison with the natural remedies to reduce risk in the naturopathic category. Since the researchers have suggested the need for further research, the readers may not contemplate on changing their current practice founded in this paper alone. However, the article can be tremendously useful in other research areas.
References
Akobeng, A.K., 2005. Principles of evidence based medicine. Archives of disease in childhood, 90(8), pp.837-840.
Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K., Porzsolt, F., Burls, A. and Osborne, J., 2005. Sicily statement on evidence-based practice. BMC medical education, 5(1), p.1.
Hannes, K., Lockwood, C. and Pearson, A., 2010. A comparative analysis of three online appraisal instruments’ ability to assess validity in qualitative research. Qualitative health research, 20(12), pp.1736-1743.
Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R. and Stewart, R., 2011. Teaching critical appraisal skills in healthcare settings. The Cochrane Library.
Kuper, A., Lingard, L. and Levinson, W., 2008. Critically appraising qualitative research. Bmj, 337(aug07_3), pp.a1035-a1035.
Linzer, M., Brown, J.T., Frazier, L.M., DeLong, E.R. and Siegel, W.C., 1988. Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills: a randomized control trial. JAMA, 260(17), pp.2537-2541.
Milne, R. and Oliver, S., 1996. Evidence-based consumer health information: developing teaching in critical appraisal skills. International Journal for Quality in Health Care, 8(5), pp.439-445.
Parkes, J., Hyde, C., Deeks, J.J., Milne, R., Pujol-Ribera, E. and Foz, G., 2001. Teaching critical appraisal skills in health care settings. Cochrane Database Syst Rev, 3(3).
Rychetnik, L., Frommer, M., Hawe, P. and Shiell, A., 2002. Criteria for evaluating evidence on public health interventions. Journal of Epidemiology & Community Health, 56(2), pp.119-127.
Savigny, P., Kuntze, S., Watson, P., Underwood, M., Ritchie, G., Cotterell, M., Hill, D., Browne, N., Buchanan, E., Coffey, P. and Dixon, P., 2009. Low back pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners, 14.
Seely, D., Szczurko, O., Cooley, K., Fritz, H., Aberdour, S., Herrington, C., Herman, P., Rouchotas, P., Lescheid, D., Bradley, R. and Gignac, T., 2013. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. Canadian Medical Association Journal, 185(9), pp.E409-E416.
Singh, J., 2013. Critical appraisal skills programme. Journal of Pharmacology and Pharmacotherapeutics, 4(1), p.76.
Taylor, R., Reeves, B., Ewings, P., Binns, S., Keast, J. and Mears, R., 2000. A systematic review of the effectiveness of critical appraisal skills training for clinicians. Medical education, 34(2), pp.120-125.
Taylor, R.S., Reeves, B.C., Ewings, P.E. and Taylor, R.J., 2004. Critical appraisal skills training for health care professionals: a randomized controlled trial [ISRCTN46272378]. BMC Medical Education, 4(1), p.30.
Ulin, P.R., Robinson, E.T. and Tolley, E.E., 2005. Qualitative methods in public health. San Francisco, CA: JosseyBass.-
Young, J.M. and Solomon, M.J., 2009. How to critically appraise an article. Nature Reviews. Gastroenterology & Hepatology, 6(2), p.82.
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