Critical Evaluation Of Evidence: Analysis Of Two Articles

Body: Critical Appraisal of the first article of Hildt et al

Discuss about the Critical Evaluation of Evidence.

While more and more health research findings were published to contribute to the social life, there has been increasing concern about the quality and reliability of this information (Rai et al., 2016). Inaccurate findings may lead to imprecise applications. To prevent the misinformation, it is vital to critically appraise the existing scientific evidence for better understanding on which information can be considered as appropriate. According to Hill et al., (2001) he defined critical appraisal as a systematic process of examining evidence of the research to prove its validity, relevance, and results before using it to make the decision. This was an essential skill to informed decision-making in health care practice (Mhaskar et al., 2009). 

This part will critically appraise an article of “Life context of pharmacological academic performance enhancement among university students – a qualitative approach” from Hildt et al (2014). The first thing to do when analyzing a research paper is to look at the authors and their expertise, qualifications, and role in the study (Borbasi & Jackson., 2016). This research was implemented by three authors named Elisabeth Hildt, Klaus Lieb and Andreas Günter Franke. These researchers were all Professor with a lot of experiences on the research topic. Especially, the first author is an expert in neurotics as stated in the article. Through Google scholar, it is found that they had worked together on several related topics on illicit stimulants used for mental development. They also worked at the University of Mainz where the study was conducted.

The research aim and questions were stated clearly in the abstract and introduction part. The sensation of pharmacological of enhancing academic performance using illicit and prescription stimulant like the Methylphenidate among the students in the university. The research question included: Why there is the use of stimulant by the student and other people in academic content? What are some of the effect experienced by users and the consideration of value? Do the leaners gain any academic advantage if they use a stimulant? What are the side effects experienced from the use of stimulant? And finally, what are some of the impacts on student’s life? The aim and questions of this study were specific and appropriate with authors’ research intention. 

From the literature review, it was evident that the author realized that there was lack of scientific pieces of evidence on the research topic that could be used to upkeep the pro/cognitive things in individuals who were healthy in line with the effect of “smart drug”. And the extent in which academic concert can be judged from getting high, parting, and other devotions are not well indicated. Besides, it was found that the widespread use of the potential cognitive drug on campuses and high school is about the very less pro-cognitive effect and side effects mentioned in the literature and given the probability of not taking drugs as prescribed and illegal drugs. It was also realized that there was no qualitative research on the topic. The explanation for the dominant sensation of academic enactment cannot be explained by the existing epidemiological studies. And can only be speculated concerning motivational factors and deeper reasons. Therefore the author may decide to eliminate some of the lack of empirical scientific data concerning real-world effects and contextual factors of academic performance enhancement.

Critical Appraisal of the second article of Munro et al

Regarding the research methodology; this was a qualitative research utilizing an extensive self-developed semi-structured interview guideline in a face-to-face setting. With the abovementioned type of research questions, a qualitative research was the most suitable method to answer them. Regarding sampling method, participants were accessed by public invitation through placards posting on public bulletin boards in the University of Mainz campus inquiring about student who had attempted to use illicit or prescription (psycho) stimulants for cognitive enhancement devotions to contact the research team secretly via email. The exclusion criteria of participant selection were shown in the method section. The study only accommodated healthy students who had no psychiatric disorder, and current doctors’ instructions of medication were accommodated in the findings. Due to this limitations, only a few students participated in an interview. Only 18 students have reported the non-medical use of illicit stimulants and a prescription for academic performance. And the article did not show any statement related to the saturation criteria of this population. The data analysis was conducted to ensure the objectivity with anonymous transcriptions and two independent raters. But the interviewer bias and recall bias had not discussed yet. In specific, it could be presented when the researchers asked about their experience on negative side effects or increase in mental performance or when the participant could exchange information and interview questions in advance. Hence the selection bias was pointed out and minimized by recruiting a trained psychologist and three trained interviewers. Besides, the research time and interview places were not mentioned in the article.

Local Ethics of the Medical Association Rheinland approved this study, and each participant was given a free tape-recording for the entire session as well as a written informed consent of participating in the interview. So the authors followed the process of a study as shown in the book of Dickens (Dickens, 2010).

Two rates were used to form independent categories. Further analysis was made using categories with congruent content which were formed by both rates. However, there was a consideration on the blinding for participants when they could inform each other about the interview questions. Six categories were identified by the author, and those categories were involving to the life setting of stimulant used to boost academic performance. In the result part entailing context of stimulant applied exceeding boosting of academic performance timing of use, subjective experience of enhancement, pressure performance, results of enhancement, pressure of performance, and objective academic results. These categories were presented by using narrative and verbatim quotes. Under each category, the authors gave the participant’s detailed views on the use of stimulants and CE to answer the respective research questions.

In summary, it can be concluded that this article showed the appropriate research methods and matched findings with the research questions. Nevertheless, it still had some weaknesses such as some bias have not yet mentioned and discussed; no saturation criteria was stated; minor incorrect calculation: 38.9% ? 44.4% (n=8) prescription stimulants or the allowance shouldn’t be informed in advance the selection process and interview

This part will critically appraise an article of “The relationship between nonmedical use of prescription stimulants, academic outcomes and executive functioning” from Munro et al (2017). The first author is doing her PhD program, and this research was a part of her doctoral dissertation accessible at the University of Rhode Island. The other three authors were PhD and had experiences on the research topic. They all were qualified to conduct this research.

The main aim of the study is to distinguish the connection between executive function (EF) and nonmedical usage of prescription stimulants (NMUUPS) in a large sample of 5 regions in the US by the college students. Specifically, it was hypnotized that:

1. There were high chances for the student who has reported EF as measured by BEFS to report the nonmedical use of prescribed stimulants than an average report of EF skills by another student.
2. The performance of academic performance and EF would be moderated by NMUPS; Specifically, NMUPS was estimated to brace the relationship amid EF and academic brilliance.

These hypotheses were appropriate with the literature presented in the introduction part. The author also found that there was difficulty in education for the students who were experiencing EF deficit and these students were being involved in risky behaviors. From the literature, it can be stated that the NMUPS are used by the students who have EF deficit to help them overcome this deficit so that they can excel in academic. However, up to now, no researcher has researched to determine the relationship between EF and NMUPS among the population of college students. So, they hope those study findings would be valuable in deceitful inhibition and intervention programs.

Regarding research methods, this was a quantitative study using measures of The Stimulant Survey Questionnaire (SSQ), BDEFS and grade point average (GPA). Faculty and staff assisted in doing sampling. They forwarded emails containing a link to the survey to the students who were willing to participate and were eligible. The same data was also posted on the official Facebook web page of the public university to attract participants. The interested students who provided consent were interviewed. A total of 308 undergraduate students recruited from six public US universities. This sampling method also ensured the blinding enrolled for the study. However, it also revealed some selection and information bias that had been discussed in the limitation of the research. Instruments and its reliability and validity are the important criteria to evaluate the quality of research (Ingham-Broomfield, 2008) (Polit & Hungler, 2013). The SSQ and BDEFS that respectively measure the nonmedical use of instruction stimulant medication in universities in the error of their time in school and to evaluate the measurement of EF of adults in daily life were necessary questionnaires to attend to the research question. Good reliability was demonstrated as a proof of high internal consistency. IRB proved this study at six public universities located in southern, northern, southwest, south-east, northwest, and central-Midwest of US but not from Ethical Committee. Additionally, no statement was declared for informed consent. Hence, it was not followed the standard of an ethical issue, and the participant might be not free from harm (Dickens, 2010).

Regarding the results, it would be consistent with two above hypotheses and concisely presented by tables and interpretation that was more visual for the readers (Burns & Grove., 2009) (Richardson-Tench et al., 2016). However, the information in the tables and the interpretation was not quite relevant. For instance, the population of the endorsed participant with an idea of students nonmedical use stimulant that is prescribed while reading, in the final week more than 71% use stimulant that is not prescribed. 70.5% are used during exams while “during tests” (62.7%) were shown in table 2 as wrote in the article. P value also was not marked in the tables. It was hard for readers to follow the research findings.

To sum up, this study had some strengths involving in good instruments and data analysis, but the weakest points were ethical issue and presentation as well as interpretation of findings.

The application of evidence in practice should not be ignored because of individual barriers of the study population (Greenhalgh et al., 2016). The targeted group was the students who normally lack understanding on using stimulants. As indicated in both studies, stimulants were used not only for academic performance enhancement but other purposes. They also have limited skills to refuse of using this kind of smart drugs. Besides, they lack research skill to understand thoroughly on the risk of using drugs whereas Munro’s study also has not proved the relationship between stimulant use and EF deficits. It is clear that there were limited readers in this research topic. The topic related to psychology and neuroscience is quite difficult that not everyone can understand it. Concerning organizational barriers, it was costly access these research papers. In other hands, the universities would not interfere too much with student’s life. Therefore, the support for the student will be lacking. Also, there was still a long way for researchers to have shreds of evidence on the risk of using smart drugs for academic enhancement. More resources and budget will be needed.

In Munro et al’s article, the PICO elements were provided clearly while in Hildt et al’s study, there was no comparable group due to the type and design of this qualitative research. The population of two studies was also the university scholars who were popularly using the nonmedical use of prescription drugs

Conclusion

To sum up, the answer to the clinical question is unclear. It can’t be concluded whether stimulants increase academic performance in university students or not. It depends much on the way to implement a study to produce research findings on that topic. Further studies should be conducted on this problem, and some meta-analysis based on applied research findings will be able to give the most reliable answer for that question.

References

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Dickens, B. M. (2010). Ethical issues in health. MEDICAL AND HEALTH SCIENCES-Volume VII, 92.

Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., & Warland, J. (2016). Understanding Research Methods for Evidence-Based Practice in Health 1e.

Grove, S. K., Burns, N., & Gray, J. (2013). The practice of nursing research: Appraisal, synthesis and generation of evidence (7th ed.). St. Louis, MO: Elsevier/Saunders

Hildt, E., Lieb, K., & Franke, A. G. (2014). Life context of pharmacological academic performance enhancement among university students – a qualitative approach. BMC Medical Ethics, 15(1), 23-23. doi:10.1186/1472-6939-15-23

Hill, A., & Spittlehouse, C. (2001). What is critical appraisal? (Vol. 3). Hayward Medical Communications.

Ingham-Broomfield, R. (2008). A nurses’ guide to the critical reading of research. Australian Journal of Advanced Nursing, The, 26(1), 102.

Mhaskar, R., Emmanuel, P., Mishra, S., Patel, S., Naik, E., & Kumar, A. (2009). Critical appraisal skills are essential to informed decision-making. Indian Journal of Sexually Transmitted Diseases, 30(2), 112–119. https://doi.org/10.4103/0253-7184.62770

Munro, B. A., Weyandt, L. L., Marraccini, M. E., & Oster, D. R. (2017). The relationship between nonmedical use of prescription stimulants, executive functioning and academic outcomes. Addictive Behaviors, 65, 250-257.  doi:https://dx.doi.org/10.1016/j.addbeh.2016.08.023

Polit, F. D., & Beck, C. T. (2013). Essentials Nursing Research Methods, Appraisal, and Utilization. Lippincott, Willams Wilkins.

Raj, S., Sharma, V. L., Singh, A. J., & Goel, S. (2016). Evaluation of Quality and readability of health information websites identified through india’s major search engines. Advances in preventive medicine, 2016.

Richardson-Tench, M., Taylor, B., Kermode, S., & Roberts, K. (2016). Inquiry in health care (5th [ACU] ed.). South Melbourne, Australia: Cengage Learning.