TO MICHEL

Introduction

A quantitative analysis of a research journal article was conducted on Warlow et al (2014), “gonad shielding in paediatric pelvic radiography: effectiveness and practice”. The main purpose of the research is to assess the accurate optimisation of gonad shielding between male and female paediatric patients, aged below 16 years. Accurate radiographic technique is important to ensure gonads are protected from radiation dose, using lead shields during pelvic radiography in paediatrics imaging (McCarthy et al, 2014).

A “Critical Appraisal Skills Programme (CASP)” tool will be using as a guide to critically review the information and to determine the relevance and usefulness of the evidence in the Warlow et al (2014) research article. The CASP tools are concisely and effectively cover for critical appraisal of evidence. The CASP tools compromise 12 categories of analysis study checklists, which are suitable for assessment of the aim, methodology, findings, ethical issue, and the validity of the research (CASP UK, 2013).

Critical appraisal section

The object of the quantitative research was to conclude whether gonad shielding use was practically accurate and frequent between male and female paediatric patients, aged below 16. The quantitative research has provided a clear goal of the study in the aims and objective section of the research because it seeks to find out the accuracy and efficiency use of the gonad shielding. The research also looked at two previous relative literatures regarding of ‘adherence of gonad protection practices’, both literatures finding was inadequate use of GS in paediatric patient. The researchers did not state clearly what the research question is but it can be easily obtained from the introduction part of the research article. The research question includes the entire requirement of PICO (Population, Intervention, Comparison, Outcomes) elements (Hastings & Fisher, 2014). In this case, “P” paediatric patients, under 16 age, “I” gonad protection, “C” between male and female, “O” female inadequately protected by GS comparing to males. So we can clearly understand that the study clearly focuses in the issue which is concerning of inadequate adherence of gonad protection.

In Warlow et al the research method is opted a “non-experimental” study and was controlled as a “retrospective survey analysis” pelvic radiography images that were collected anonymously from current DICOM, digital teaching library (DTL) from different NHS UK health care providers. Non-experimental research describes as an observation that focuses in previous prevalence rates (Thompson et al, 2007). Given to the nature of data collection in the research, quantitative cohort study design approach was used. Cohort study is an observational study where researchers observe the effect of an intervention in a group of people without trying to change it (Hood, 2009). In this term, cohort study is an appropriate design for the study because the researchers were identifying activities that have already occurred.

The target population being studied in the research is paediatric patients’ of pelvic radiography images aged below 16. The researchers has accessions to 259 radiography images that met inclusive criterion, of this a sample of 130 images are involved in the study, 70 from male and 60 from female patients. The sampling strategy was simply collected from the DTL data that met the inclusive criteria. The researchers were also excluding, rejected or repeated images. These shows the researchers were targeting the population by restricting their samples boundaries through inclusion/exclusion criteria, which could lead to success in minimising sampling bias. Tayler-Powell (2009) described sampling bias as the systemic error of over or under representing of population. Sampling was collected from several “UK NHS health providers” displays generalising (improves external validity) the wider population. External validity refers to the approximate truth of proportions (Trochim, 2006).

It is important the researchers mentioned that neither the participants nor the radiographers who takes the radiography images of pelvis known about the research, as the data was entirely anonymously collected from the pre-existing DTL. So we can understand another bias-reducing study strategy is used by the researchers because the participants and the health professionals were blinded. “Blinding embraces covering information from participants, data collectors, care givers, or data analysts to develop neutrality” (Politte & Beck, 2013).

With cohort design research randomisation is impossible. Random allocation helps to avoid bias. Bias influences the estimate result (Higgins et al, 2011). However, the researchers intended to avoid bias by specifying the age range of interested population sample which was stated paediatrics patient below 16 ages, the researchers also intent to explore existing problem from relevant systemic literatures that believed to be reliable sources and cannot be influenced or manipulated, since the majority of them were using database from Picture Archive and Communication System (PACS) (McDonough et al, 2013).

The researchers mentioned that nominal measurement was used to collect their data, allowing chi2 test to examine the hypothesis. Nominal measurements only provide information about categorical equivalence. In this case, presence of GS adequately protected and inadequately protected gonads in both genders are the nominal variables to be measured. The researchers could have made error when they estimate the coverage of pelvic basin; they mentioned that if 90% of the pelvic basin is protected, they were assuming as adequately covered. We do not know how this 90% were interpreted into adequacy. Chi-squared test aids to determine the connection between two categorical variables (Lemeshko, 2015). Since, the researchers clearly stated that their purpose was to investigate the adequacy and frequency use of GS in both paediatric genders, the measurement used was appropriate and can properly reflect the result.

The result was presented in pie chart in percentage distribution of three portions which are shielding protecting pelvic basin/testes, shields with in adequate protection and no shields. The result was compared between males and females using chi2 test in adherence of GS in fig 2. & 3 of the pie chart, the p value was 0.588, therefore no significant difference were found in frequency application of GS in both genders, but the adequacy use of GS found to be higher in males comparing to females, p< 0.0001. Generally, the statistics of the result provided clear information about the evidence the study produced. Appropriate amount of statistics was used such as, tables, pie chart and Venn diagram was used to present the findings.

The researchers were explaining how their findings fit in contrast to previous findings of “Fawcett and Barter and Kenny and Hill” research in their discussion section. The researchers concluded that the variable position of the pelvic basin of female’s paediatric patients was the main cause of the inadequacy protection of the ovary. The researchers understanding were that, even though the GS correctly placed; it is not likely effective to protect female patients and they declared GS to be abandoned in females.

The researchers careful considered about ethical issue by removing patient and staff or hospital identifiable information. Ethical authorisation was guaranteed according to UK data protection. Appropriate collection of data protects participants and respects vulnerable populations (Creswell, 2009).

The study contributes a meaningful indication by concluding that female gonad protection is not a practical tool for optimisation, so should be abandoned but also radiographers should reduce radiation dos to females by adhering tighter collimation. For, males the use of GS justifies significant of dose reduction, and the researchers declared the greater reduction of dose in males can be achieved through employing good radiography practice.

Conclusion

The main findings of the result correlated to the null hypothesis in terms of frequency use of DS which was not significant difference in the application of GS between females and males. But in terms of accuracy, there was significant difference between male and female. This observational study can implicate the current practice of gonad shielding in UK but unlikely to recommend changes use of GS in females.

References

CASP UK, 2013. CASP checklists. CASP UK [online]. [viewed16 April 2016]. Available from: http://www.casp-uk.net/#!casp-tools-checklists/c18f8

Hastings, C. & Fisher, C.A., 2014. Searching for proof: Creating and using an actionable PICO question. Nursing Management (Springhouse) [online]. 45(8), pp. 9-12. [viewed 16 April 2016]. Available from:

http://ovidsp.tx.ovid.com.gcu.idm.oclc.org/sp-

Creswell, J.W., 2009. Research design: qualitative, quantitative and mixed method approaches, 3rd ed. London: Sage Publications.

Higgins, J.P.T., Altman, D.G., Gøtzsche, P.C., Jüni, P., Moher, D., Oxman, A.D., Savović, J., Schulz, K.F., Weeks, L. & Sterne, J.A.C., 2011. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ: British Medical Journal [online]. 343(7829) pp. 889-893. [viewed 18 April 2016]. Available from:

http://www.jstor.org.gcu.idm.oclc.org/stable/pdf/23052222.pdf?_=1461068694011

Hood, M.N., 2009. A Review of Cohort Study Design for Cardiovascular Nursing Research. The Journal of Cardiovascular Nursing [ONLINE]. 24(6), pp. E1-E9. [Viewed April 18 2016]. Available from: http://ovidsp.tx.ovid.com.gcu.idm.oclc.org/sp-

Lemeshko, B.Y., 2015. Chi-Square-Type Tests for Verification of Normality. Measurement Techniques [online]. 58(6), pp. 581-591. [viewed 22 April 2016]. Available from: http://link.springer.com.gcu.idm.oclc.org/article/10.1007%2Fs11018-015-0759-2

McDonagh, M., Peterson, K., Parminder, R., Chang, S., & Shekelle, P., 2013. Avoiding bias in selecting studies [online]. NCBI. [viewed 17 April 2016]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK126701/

McCarty, M., Waugh, R., McCallum, H., Montgomery, R.J. & Aszkenasy, O.M., 2001. Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit. Pediatric Radiology [online]. 31(9), pp. 646-649. [viewed 16 April 2016]. Available from:

http://download.springer.com.gcu.idm.oclc.org/static/pdf/892/art%253A10.1007%

Polit, D.F. & Beck, C.T., 2013. Essentials of nursing research: appraising

evidence for nursing practice, 8th ed, Philadelphia: Williams & Wilkins Health.

Thompson, C.B. & Panacek, E.A., 2007. Research study designs: Non-experimental. Air Medical Journal [online]. 26(1), pp. 18-22. [viewed 16 April 2016]. Available from: http://ac.els-cdn.com.gcu.idm.oclc.org/S1067991X06003099/1-s2.0-

TROCHIM, W., 2006. Research methods knowledge base: External validity [online]. [viewed 19 April 2016]. Available from:

http://www.socialresearchmethods.net/kb/index.php

Tyler-Powel, E., 2009. What is sampling bias [online]. University of Wisconsin-Extension. [viewed 18 April 2016]. Available from:

http://www.uwex.edu/ces/4h/evaluation/documents/Whatissamplingbias.pdf

WALL, B.F., HAYLOCK, R., JANSEN, J., HILLIAR, M., HART, D. & SHRIMPTON, P., 2011. Radiation risks from medical x-ray examinations as a function of the age and the sex of the patient [online]. Health protection agency. [viewed 19 April 2016]. Available from: https://www.researchgate.net/publication/265259419_HPA-CRCE-028_-_Radiation_Risks_from_Medical_X

Warlow, T., Walker-Birch, P. & Cosson, P., 2014. Gonad shielding in paediatric pelvic radiography: Effectiveness and practice. Radiography [online]. 20(3), pp. 178. [viewed 02 April 2016]. Available from:

http://su3pq4eq3l.search.serialssolutions.com/?ctx_ver=Z39.88-2004

Introduction

Qualitative research is a type of research that does not use statistical method, seeks to understand people’s viewpoints and motivations and focuses in words and meanings (Denscombe, 2014). A qualitative research article was conducted in Howard (2013), “An exploratory study of radiographer’s perceptions of radiographer commenting on musculo-skeletal trauma images in rural community based hospitals”. The aim of the author is to explore radiographers practice towards commenting in musculoskeletal trauma patients, especially in smaller hospitals with minor injury unit (MIU).

The paper will look at the strength and weakness of the Howard (2013) research article, using “Critical Appraisal Skills Programme (CASP)” tool. The qualitative research CASP tool consist 10 evaluate list questions that will help us to appraise the broad knowledge and issues of the research and it will also allow us to sense the existing evidence in the Howard literature study.

Critical appraisal section

The research aim is visibly stated at the end paragraph of the introduction part of the study article, which was to investigate radiographer’s perception of drivers and barriers of practice on commenting musculoskeletal trauma images and to identify their view on training needs community hospital based in rural Aberdeen shire. We can understand that the author was looking for phenomenological knowledge of perception and view of the radiographers. Phenomenology approach study is about describing common experiences of individuals (in these case radiographers) and meaning of their experience of concept (Wilson, 2015).

The author indicated at the first and second paragraph of the method section that she wants to identify the participants (radiographers) experience and perception regarding to commenting at the current time, and she decided to achieve this by focus group and individually one to one interviewing the radiographers. The research reported in the current article uses Interpretative Phenomenological Analysis (IPA; Smith, 1996) to consider the key themes and meanings that emerge from interviews with people who are discussing their experiences of eating difficulties with a researcher. IPA appears well appropriate to this particular research question, in that it concerns itself with understanding the participants’ ‘lived experience’ from an idiographic level, rather than JOURNAL OF HEALTH PSYCHOLOGY 16(1) 118 that abstracted through the notion of a generalized theory (Reid, Flowers, & Larkin, 2005). Qualitative approach is an appropriate method for the research because the author collected data through interviewing from the radiographers and she was addressing the meaning of their interviewing. “Qualitative researches, study things in their natural setting, interpret phenomena in terms of the meaning people bring to them; interviewing participants to collect data is one of the methods used in qualitative research” (Brinkmann & Kvale, 2015).

The author has justified the research design by stating that the focus group and individual semi-structured interviews is constructive means of qualitative research when collectively used. Chadwick et al (2008) support the authors’ idea by stating that interviews and focus group are the most common method used in health care research. However, one-on-one interview has some drawbacks which is participant may hesitate to provide information. Nevertheless, the author may be avoided this disadvantage by combining both the focus group and one-on-one interviews (Rubin & Rubin, 2005).

The author explained that a purposive sampling was used to recruit participants and justified her employment strategy by stating that the method enabling her to choose with relevant knowledge and characteristics of participants. We can see the author has chosen a purposive homogenous sampling method because homogenous sampling is a sample whose units share the same characteristics and traits (Miles et al, 2014). Phenomenological study has challenges in finding participants who have common experience in the phenomenon (Levasseur, 2003). In this case we can see the researcher overcomes the challenge by carefully choosing participants whom shared common professional experience. Additionally the author explained the reason for her choice for the 5 community hospitals with minor injury unit because these hospitals have no radiological support on site. Furthermore the author clarifies her justification by taking consideration from previous research suggestions which is “patients can benefit from the practice of radiographers providing an initial comment” in hospitals with minor injury units. Purposive sampling has some disadvantage that is the high probability of researcher bias (Emmel, 2013). The researcher mentioned her concern shared characteristics of sample (age and gender).

In a qualitative research approach a researcher must decide how data will be collected, stored and where will be collected. The researcher provides clear details in the last paragraph of in the “population and sample” section, the researcher was clear that the data was collected in one of the lager community sites for focus group and for individuals in their workplace site. The researcher said that the data will collect through semi-structured interview technique and further indicated open-ended questions applied for both groups the focus and the individuals. It also mentioned that in the data analysis section, the interviews were audio recorded and transcribed verbatim. Warren et al (2003) described audio record as the most used form of focus group semi-structured interviews.

The researcher expresses her concern as she was known to the participants and she was worried this may introduced unintended bias. This may affect participants may affect answering the question correctly. Pope et al (2006) states that qualitative researchers need to consider how they are observed by the interviewees. Participants may wish to please the researcher by giving answers he/she thinks the researcher wants, so possible dispute of bias or influence could happen. However the researcher was taken reflexive approach to minimise her influence. The researcher shows her reflexive by practicing interview technique aiming to maintain neutral character, keeping reflective diary to enable clarity and limit bias and also examined her own interview technique by critical appraising her records.

The researcher does give evidence of ethical approval that gained to access the participants and the community radiography departments as the setting from Robert Gordon University and regional NHS community. But the researcher does not give evidence of participants consent. “Informed consent includes gaining the voluntary participation of the individuals, with her/his right to withdraw from study at any time”, a gap regarding ethics in the study (Denscombe, 2010).

The researcher explained the analysis process that the interview audio recorded and transcribed verbatim (word by word). The researcher provided how the themes were developed by giving example “key themes also noted during the interviews and further reading of the transcription/notes and listening to records also has taken”. The research decided to restructure the data in “framework analysis” where framework analysis involves listening to tapes and re-reading fieldnotes or transcripts, second step is thematic analysis to develop coding scheme, then applying codes to whole data set, finally re-arranging the data according to thematic content (Green & Thorogood, 2009). We can see the researcher provided the detailed systematic steps of framework analysis and reflective diary was examined to ensure her bias was not introduced. It can be concluded that the data analysis has been rigorous in this project.

The findings are presented clearly in detail in the discussion section in key themes that represent the participants feeling on radiographer commenting impact upon: patient care pathway, diagnostic radiography profession and Continued Professional Development (CPD) radiographers. The researcher provided a clear account related to the research question and presented the findings in a way fitting to qualitative research.

Conclusion

The researcher discussed that the study revealed the practice radiographer commenting in the community setting facilitate patient pathway and also enhances diagnostic outcomes. The study also emphasis the need for more training for radiographers undertaking image commenting, this can be enhanced through CPD and e-learning. The study concluded by declaring the benefit of the research that

“It is vital that the role extension into radiographer commenting is underpinned by a sound evidence base therefore further research relating to this valuable practice is essential.

References

Brinkmann, S. & Kvale, S., 2015. Interviews: learning the craft of qualitative research interviewing, 3rd ed. California: Sage Publications.

Chadwick, B., Gill, P., Stewart, K. & Treasure, E., 2008. Methods of data collection in qualitative research: interviews and focus groups. BDJ [online]. 204(6), pp. 291-295. [viewed 21 April 2016]. Available from:

http://media.proquest.com.gcu.idm.oclc.org/media/pq/classic/doc/1449332851/fmt/pi/

Denscombe, M., 2014. The good research guide: for small-scale social research projects, 5th ed, Maidenhead: Open University Press.

Denscombe, M., 2010. The good research guide: for small-scale social research projects. 4th ed. Maidenhead: Open University Press.

Emmel, N., 2013. Sampling and choosing cases in qualitative research: a realist approach. London: SAGE.

Green, J., & Thorogood, N., 2009. Qualitative methods for health research, 2nd ed. Thousand Oaks: Sage Publications.

Krueger, R.A. & Casey, M.A., 2015. Focus groups: a practical guide for applied research, 5th ed. California: Sage Publications.

LeVasseur, J.J., 2003. The Problem of Bracketing in Phenomenology. Qualitative Health Research [online]. 13(3), pp. 408-420. [viewd 20 April 2016]. Available from: http://qhr.sagepub.com.gcu.idm.oclc.org/content/13/3/408.full.pdf

Rubin, H.J. & Rubin, I.S., 2005. Qualitative interviewing: the art of hearing data, 2nd ed, Thousand Oaks: Sage Publications.

Miles, M.B., Huberman, A.M. & Saldana, J., 2014. Qualitative data analysis: a methods sourcebook. 3rd ed. Beverly Hills: Sage Publications.

Warren, C.A., B., Barnes-brus, T., Burgess, H., Wiebold-lippisch, L., Hackney, J., Harkness, G., Kennedy, V., Dingwall, R., Rosenblatt, P.C., Ryen, A. & Shuy, R., 2003. After the Interview. Qualitative Sociology [online]. 26(1), pp. 93-110. [viewed 20 April 2016]. Available from: http://media.proquest.com.gcu.idm.oclc.org/media/pq/classic/doc/2164482061/fmt/

Wilson, A., 2015. A guide to phenomenological research. Nursing standard (Royal College of Nursing [online]. 29(34), pp. 38. [viewed 21 April 2016]. Available from: http://journals.rcni.com.gcu.idm.oclc.org/doi/pdfplus/10.7748/ns.29.34.38.e8821

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