Sunday, November 10, 2019
Critique of the medical research Essay
Introduction (2) What is the purpose of the study?            The purpose of this study is to demonstrate the various factors for the prolonged pre-hospital delay in African-American with Acute myocardial infarction. Another purpose of the study is to demonstrate the manner in which perceived racism (experience of racial discrimination) affects the pre-hospital delay. Is the purpose of the study clearly presented?            The study has demonstrated to a certain extent that several related factors such as ethnic background, medical insurance, presence of a witness (relative or a family member during the attack), marital status, general health status, presence of any systemic disease and perceived racism, do play a very important role in prolonging the time period between the onset of the symptoms and hospitalization. However, further studies are required to provide more detailed information about these factors. Problem Statement (5) What problem was the study conducted to resolve?            The study was conducted to determine the factors associated with prolonged pre-hospital delay in African-Americans with acute myocardial infarction than Whites. It was found that death due to cardiovascular disease claims were significantly higher in African-Americans than any other group. Besides, the study was also conducted to demonstrate the extent to which perceived racism affects the pre-hospital delay in African-Americans with acute myocardial infarction. How is the problem important for nursing practice?            Acute myocardial infarction is one of the main causes of death in both, men and women, living in developed countries. Fatalities due to cardiovascular disease are significantly higher in African-Americans than any other racial group. The outcome following acute myocardial infarction varies depending on the rapidity at which with reperfusion therapy is provided. In this treatment intervention, the blood supply to the heart is restored back to normal. Agents that chemically dissolve thrombi (clots formed within the blood vessels) or expand blood vessels (vasodilators) are administered. Besides, surgical procedures such as angioplasty (reconstruction of the blocked artery), catheterization (insertion of an inflatable balloon-tipped tubular device) or coronary artery bypass (grafting a section of a vein), may also be performed to restore the blood supply to the cardiac tissues. Reperfusion therapy seems to be most valuable when provided within one hour following the development of symptoms and signs of myocardial infarction. Delay in providing treatment may play an important role in increasing the morbidity and mortality rates of acute myocardial infarction. As African-Americans take longer time in seeking treatment for the symptoms and signs of acute myocardial infarction than Whites, the outcome will definitely be less favorable in African-Americans. Hence, measures to lower delay times can be instituted in African-Americans with acute myocardial infarction. Is the problem statement clearly stated? Describe.            The delay in seeking treatment for the symptoms and signs of acute myocardial infarction are longer in African-Americans than Whites. As the period between the onset of the symptoms and signs of acute myocardial infarction and institution of treatment plays a very critical role on the outcome of the disorder, the specific factors associated with prolonged pre-hospital delay in African-Americans should be determined. The problem statement is clearly mentioned. Research Question(s) What is the research question? If not stated, what would you say the research question is?            A good research question would be â€Å"To study the causes or factors associated with prolonged pre-hospital delay in African-Americans with acute myocardial infarction†. Hypotheses What is the hypothesis? If not stated, what would you say the hypothesis is?            From the study, it is clearly evident that African-Americans take longer time to seek emergency medical help for acute myocardial infarction than whites. However, perceived racism (actual experience of racial discrimination) did not play an important role. Study Variables What are the independent and dependent variables? Or, if it is a descriptive or correlational design, what are the research variables?            In this study, a descriptive design is used.  To determine the factors associated with prolonged pre-hospital delays independent t tests and chi square tests were used. The independent variable includes ethnic group. The dependent variables include experience of racial discrimination, sex (males and females), presence of a witness, insurance, marital status, etc. Review of Literature In what way(s) does the literature review support the need for this study?            The literature obtained during the study only demonstrates the various factors that may prolong the pre-hospital delay in African-Americans. These factors are however not specific to the African-American group only. Further studies are needed to show how similar factors could play a role in prolonging the pre-hospital delay in other racial groups. Does the review of literature guide you to the study?            The review of the literature does guide to the study. The review demonstrates the current incidence and mortality scenario of acute myocardial infarction in the African-American race. It also demonstrates the need for immediate reperfusion treatment. The study also shows how individuals of the African-American race are at a greater risk of developing acute myocardial infarction than Whites. However, more details need to be provided. Are there existing gaps in the literature identified by the author(s)?            No, the gaps in the literature are not identified by the author. The author could have also tried to study other factors that could play an important role in prolonging pre-hospital delays such as educational levels, socio-economic status, urban/rural divide, etc. Theoretical/Conceptual Framework Does the study have a conceptual or theoretical framework? If so, briefly describe the model or framework?            The study is based on a conceptual framework. The framework describes several factors associated with prolonged pre-hospital delay such as ethnic group, sex, general health status, insurance status, marital status, etc. These variables cannot be clearly defined, and only the possible role they play, can be described. Is a rationale stated for the conceptual/theoretical framework? Explain            The various factors associated with prolonged pre-hospital delay include sex, ethnic group, general health status, insurance position, etc. As these cannot be clearly defined and only their possible roles are defined, a conceptual framework is suggested. Ethodological aspects Research design What study design is used?            A descriptive design is being used. In what way(s) is the design used an appropriate one?            The author is justifying a phenomenon. Certain variables are being studied which can be determined earlier and later in time. Were pilot study findings used to design the major study? No, pilot studies were not being used. However, references were being made to previous studies. Name and describe at least two threats to the internal validity of the study design.            The two threats to the internal validity of the study design include history threat (in which some historic event has occurred which makes the individual aware) and testing threat (in which some form of pretest may make the individual aware of any similar tests in future). Name and describe at least two threats to the external validity of the study design.            Three threats to the external validity of the study design include different people (results of the study may be due to unusual people), different places (were perhaps the educational background was different) or different time (at which the incidence of acute myocardial infarction were higher than normal). What are the extraneous variables in this study? How are they being controlled for in this study?            The extraneous variables in this study are the time period between the onset of symptoms of acute myocardial infarction and provision of reperfusion therapy. African-Americans take significantly longer than whites in seeking treatment for the symptoms of acute myocardial infarction (3.2 hours to 2 hours). Target Population, Sample, and Setting Who is the target population for the study?            The target population of the study is African-Americans who had acute myocardial infarction. What sampling method was used?            Quota sampling is being used in this study. The stratums of the population that have the criteria are selected. From this stratum, convenience or judgment is used to select the 64 subjects for the study. What are the sample inclusion and exclusion criteria? If not stated, what would you say they are? Inclusion criteria – African-Americans, who had acute myocardial infarction, 18 years and older, who could understand and speak English, conscious and properly oriented, living as in their communities independently, had a steady circulatory system. Exclusion (not mentioned) – Whites, individual below 18 years of age, non-English speaking, those who were not properly oriented. In what way(s) is the sample large enough?            The study was reasonably large enough as it was conducted in 5 hospitals, in 2 areas of a state. In what way(s) is the sample representative of the population?            The sample represents an important portion of the population. This group is one that acute myocardial infarction can occur. African-Americans are a major group of USA. Adults are being used in the study. Besides, English-speaking portion of the population is being studied. Is the setting appropriate for this study? Explain your answer.            Yes, the settings are appropriate for this study. The study s being conducted within a month after the individual had myocardial infarction. This ensures full recovery from the attack and also fresh memories of the event. Data Collection Describe data collection instrument/measurement tools.            Data was being collected by personal interview a month after the acute myocardial infarction. In what way is the support for instrument validity and reliability adequate for use in this study?            The study was being conducted on individuals who were alert, properly oriented, above 18 years of age and who could speak and understand English. The chance of the results being not reliable was less. However, some individuals may not exactly remember the pre-hospital delay. In what way(s) are the instruments used appropriate for this study?            The instruments used were appropriate for the study, as most of the question being asked were based on general facts (such as marital status, insurance, general health status, etc). Describe procedures used for data collection.            Before conducting the study, approval had been sought from the appropriate institutional review board and all other participating groups. Then the patients who met the criteria were being selected, from 5 hospitals in 2 areas of the State. They were being studied from April, 2003 to June, 2004. The subjects were appropriately diagnosed for acute myocardial infarction based on the history, laboratory tests, ECG and a surgical intervention. They were interviewed within a month after the attack, to ensure that they had recovered fully, as well as not forgotten details of the event. Data Analysis Are the statistical tests used identified and the values reported?            Yes, statistical tests are being used in this study, namely: – independent t tests and chi square tests. Values were also being provided from the 2 groups being compared (namely: – males V. females, insured V. non-insured, single V. married, etc). Are the statistics appropriate for the level of measurement of each variable, sample size, sampling method, and research questions/hypotheses?            Yes the statistics are appropriate for each variable, sample size, sampling method and research hypothesis. What is the level of statistical significance used in interpreting the study results? Was this stated or implied?            The results have been interpreted to the 0.01 level, thus showing that they are reliable. This was implied. Ethical aspects Ethical issues What way(s) have the rights of human subjects been adequately protected during this study? The human subjects were being adequately protected during the study. No identity of any subject has been given. 3 out of the 64 chosen from the study were being allowed to opt out. The subjects were being adequate amount of time to fully recover from the acute myocardial infarction. Besides, only individuals above the age of 18 and those who were conscious, alert and well-oriented were chosen. 2. was the research approved and monitored by an Institutional Review Board or similar ethics review committee?            Yes, only after seeking prior approval from the appropriate institutional review board and all the participative groups, was the study being conducted. Interpretive Aspects Discussion What are two major strengths of the scientific rigor of the study?            The two major strengths of the scientific rigor of this study includes:- The sampling method used was a quota sampling method, in which the stratums of the population that have the criteria are selected. From this stratum convenience or judgment is used to select the 64 subjects for the study. Independent t tests and chi square tests were being employed to study the several factors associated with prolonged pre-hospital delay.            These were most appropriate in this case.       Do the figures and tables illuminate the presentation of results?            The figures give us an exact idea of the role each and every factor was playing on the pre-hospital delay. The figures suggest that the findings are more reliable.  Are study limitations identified? If so, what are the two major limitations of the scientific rigor of the study?            The two major limitations of the scientific rigor of this study:- The chances of errors in this study are high as the data collecting methods are not appropriate (subject may not remember the period of the pre-hospital delay). The factors associated with prolonged pre-hospital delays may not be specific to the African-American group. The study did not concentrate on several other associated factors such as socio-economic status, rural-urban divide, educational levels, etc. In what way(s) are the implications of the study findings appropriate?            The study shows that the pre-hospital delay was longer than one hour. This meant that the individual was not going to benefit much from reperfusion therapy. The study also showed that perceived racism did not affect the pre-hospital delay much. What recommendations for nursing practice and future research have been made?            Some of the recommendations that have been made include: – Educating the patients and their families. Lowering the pre-hospital time. Further research in studying the role of other associated factors. Summary and Conclusions In what way(s) are the conclusions of the study appropriate?            The study goes on to show the present state of affairs in African-Americans. As the pre-hospital delay was significantly longer than one hour, they are not going to benefit much from reperfusion therapy (the benefits of such therapy is best when administered within an hour after the onset of symptoms and signs of acute myocardial infarction). Besides, the study has also suggested that only through adequate education and counseling of the patients and their families, could the outcome be improved (to enable shorter pre-hospital delays). The study has not only shown, the various factors that play an important role in prolonging the pre-hospital delay, but has also suggested that such delays should be decreased in order to improve the benefits, prognosis and survival rates. Do the benefits of the study outweigh the risks?            Yes, the benefits of the study definitely outweigh the risks. Many studies conducted in the past have shown that African-Americans take longer time than Whites to seek medical help for the symptoms of acute myocardial infarction. However, it is the first study that has demonstrated the various factors associated with prolonged pre-hospital delay in African-Americans. Presentation and Stylistic Aspects Title Does the title of the article accurately describe the study? In what way does it or does it not?            The title describes the study. It demonstrates the various factors responsible for the prolonging the pre-hospital delay in African-American with the symptoms of acute myocardial infarction. However, such factors may not be specific only to the African-American Community. They could even exist in other communities. Further studies are required to assess the role of similar factors on other communities and the role of other factors on the African-American community. Is the language used in the title understandable and informative?            Yes, the language used in the title is simple, understandable and informative. Complicated words are seldom being used. Is the title clear and concise?            Yes, the title is clear and concise. It gives us an idea briefly of the problems and the factors the study is going to assess. Researcher Qualifications Are researcher(s) qualifications presented?            Yes, the researches full qualifications are presented in the Abstract. Angela D. Banks is a Registered Nurse and has completed her PhD. Kathleen Dracup is also a Registered Nurse and has done her DNSc (Doctor of Nursing Science). Are researcher(s) qualified to conduct the research? Justify your answer.            Yes, both researchers are qualified to conduct research in this field. Emergency management of acute myocardial infarction requires appropriate Nursing Services. Evidence-Based Nursing Management will help solve problems encountered by the nurses through:- Identifying the problem using current and appropriate nursing information and practices. Searching relevant research data for a suitable option Studying the option for evidence using criteria established. Choosing the most appropriate intervention. This study is conducted using scientific methods and current nursing knowledge. The conclusion suggested is also based on current medical evidence. Abstract Does the abstract contain enough information about the study so the reader understands essence of article?            Yes, the abstract contains enough information so as to give the reader an idea of the article. Does the abstract state the purpose of the study, problems investigated, research question or hypothesis, study design and methods used, sample, instruments used, results or findings?            Yes the abstract brieflTitle of Articley states the purpose of the study, problems investigated, research question, hypothesis, study design and methods used, sample, instruments used, results. It eve suggests ways the problem can be solved. Is the abstract 100 to 200 words in length?            The abstract is about 225 words in length and is roughly within its limits. Presentation Does the format of the article follow the research process?            Yes, the format follows the research process.  Is the article organized and sufficiently concise?            No, the article is not well-organized. The article is concise.  Is the article written using correct grammar and sentence structure?            Yes, the grammar is reasonably correct and the sentence structure is normal.  Do cited references appear in reference list?            Yes, the references do appear in the list.  Are cited references current?            Some of the references are not current. References Allende, J.E. (2004), â€Å"Rigor – The essence of scientific work†, Electron. J. Biotechnol, vol. 7, no. 1. http://www.scielo.cl/scielo.php?pid=S0717-34582004000100001&script=sci_arttext&tlng=en Banks, A.D. and Dracup, K. (2006), â€Å"Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction.†, Am J Crit Care, vol. 15, no. 2, March. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16501134&dopt=Abstract http://goliath.ecnext.com/coms2/gi_0199-5363827/Factors-associated-with-prolonged-prehospital.html Emden, C. and Hancock, H. (1996), Oral presentation: Scientific rigor and qualitative research, [Online], Available: http://www.cochrane.org/colloquia/abstracts/adelaide/ADELO218.htm, [Accessed: 2006, October 31]. Gurtwiz, J.H. et al (1997), â€Å"Delayed Hospital Presentation in Patients Who Have Had Acute Myocardial Infarction†, Annals of Int Med, vol. 126, no. 8, 15th April, pp. 593-599. http://www.annals.org/cgi/content/abstract/126/8/593?ck=nck Indiana University (2001), Unit 4: Descriptive Designs, [Online], Available: http://www.indiana.edu/~educy520/topic_intro/520topic_4.html#designs, [Accessed: 2006, October 31]. JJEC (1998), Glossary, [Online], Available: http://www.jrsa.org/jjec/resources/definitions.html, [Accessed: 2006, October 31]. Stat Pac (1997), Survey Sampling Methods, [Online], Available: http://www.statpac.com/surveys/sampling.htm, [Accessed: 2006, October 31]. Trochim, WM.K. (2006), External Validity, [Online], Available: http://www.socialresearchmethods.net/kb/external.htm, [Accessed: 2006, October 31]. Trochim, WM.K. (2006), Single Group Threats, [Online], Available: http://www.socialresearchmethods.net/kb/intsing.htm, [Accessed: 2006, October 31]. University of Minnesota (2001), Evidence Based Nursing, [Online], Available: http://evidence.ahc.umn.edu/ebn.htm , [Accessed: 2006, October 31].
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