Evidence based plan- EBP Plan assignment. due 11/23
fdsa123
QuantitativeResearchArticleCritiqueweek11.docx1
Quantitative Research Article Critique
Study Research Design
Prajwal Dhakal and his colleagues conducted a retrospective cohort study to determine “Effectiveness of sequential comprehension devices in prevention of venous thromboembolism in medically ill hospitalized patients. The researchers used this type of research design because they already knew about the disease. They could explore the past to determine causes of the condition and how to prevent it. By using a cohort study, the researchers could prospectively follow one or more samples and conduct subsequent evaluations with respect to an outcome or a disease in order to determine the risk factors associated with the disease. In addition, retrospective studies are less expensive to conduct and can be carried out immediately. However, there is poor control over covariates and exposure factors.
Purpose of the Study
The researchers sought to examine the effectiveness of sequential compression devices for venous thromboembolism prevention in hospitalized patients. Dhakal et al indicate that the disease, which consists of deep vein thrombosis and pulmonary embolism, affects at least 1 million people in the United States per annum. Hospitalization is one of the primary risk factors for this serious health problem, with a significant increase in risk compared to non hospitalized persons. As a result, physicians commonly use anticoagulants to prevent it in hospitalized patients. They also recommend sequential compression devices in combination with anticoagulants or in cases of contraindicated anticoagulants. In routine practice, they use sequential compression devices despite limited evidence in hospitalized patients.
Type of Tested Hypothesis
While the researchers did not specify the type of hypothesis being tested, it is clear that they hypothesized that sequential comprehensive devices are not effective for prevention of venous thromboembolism prevention in medically ill patients. This reasoning is based on the fact that the researchers had limited evidence as a beginning point to further investigate the effectiveness of these devices in preventing the condition. So it was important that they examined effectiveness of sequential compression devices in preventing this condition in medically ill patients. Most importantly, the researchers could use the hypothesis test to arrive at an assumption about a population parameter.
Hypothesis Testing Approach
For hypothesis testing, the researchers analyzed a patient’s risk for venous thromboembolism, length of hospital stay, as well as other comorbidities among propensity score-matched persons on sequential comprehension devices and those without thromboprophylaxis. They used t-tests, Wilcoxon rank-sum tests for continuous variables, and chi-square tests for categorical variables to compare differences between sequential comprehension devices groups and patients without thromboprophylaxis. For each patient, the researchers used a multivariate logistic regression model to estimate the probability of receiving sequential comprehension devices. T-tests could help determine any significant difference in venous thromboembolism incidence between the sequential compression group and those without the disease. The decision to use the Wilcoxon test would help in ranking sum of observations of combined samples. The Chi-Square test would help in determining whether research variables are closely related or independent.
Independent Variable(s) in the Study
The independent variable in this study was the use of sequential compression devices in patients with the disease and those without the disease. This position is based on the fact that the researchers could not manipulate the use of sequential compression devices in the study. In addition, it was a standalone variable and could not be changed by other variables being measured. The effectiveness these devices in disease prevention could not be changed by the variable being measured, which was venous thromboembolism. Other factors such as length of stay and age of a patient could not affect effectiveness of sequential compression devices.
Dependent Variable(s) in the Study
The dependent variable in this study was the prevention of venous thromboembolism in medically ill patients. The decision is based on the fact that prevention of this condition depends on other factors. For instance, use of anticoagulants can help in preventing this health problem. Thus, the researchers focused on factors that could influence the prevention of this health problem. They tried to investigate if the use of sequential compression devices could help in preventing the condition.
Target Population
Dhakal et al included all patients admitted to inpatient service at Sparrow hospital between April 2015 and March 2016 for the study. Patients less than 18 years or diagnosed with deep vein thrombosis and pulmonary thrombosis upon hospital admission were not included in the study. Patients on anticoagulants and sequential compression devices at the Sparrow hospital were also excluded from the study. Moreover, the researchers excluded patients using anticoagulants either at home or in hospital. Overall, the study included 30,824 participants from a total of 39,268 patients. The decision to exclude these prospective participants was to eliminate impacts of anticoagulant use in the study.
Organization of Literature Review
The researchers explored various materials on deep vein thrombosis and pulmonary thrombosis to determine the prevalence, risk factors, and prevention of the disease in the United States. An analysis of works of literature indicates that the condition affects at least 1 million people in the United States per year. Various studies associate hospitalization with the high rate of this disease in the country. In addition to exploring literary materials on this medical condition, the researchers explored articles about anticoagulants and determined that they are commonly used to prevent the disease in medically ill patients in hospitals. Most importantly, they explored articles on sequential compression devices and determined that most of the current guidelines are consensus-based.
Data Collection Method
The researchers used primary data collection methods for this study. In particular, trained investigators were used to abstract data including the length of stay, venous thromboembolism vents, comorbidities, and demographic features. They also collected other data such as diagnostic methods for disease prevention. Eligible participants were categorized into sequential compression devices group only during hospital stay and no thromboprophylaxis during hospital stay. By using primary data, the researchers could collect relevant information suitable for the purpose of their study. In addition, the use of primary data could help the researchers develop a deeper understanding of the relationship between sequential compression devices and venous thromboembolism.
Study Findings and Ethical Procedures
Out of the 30,824 patients, 0.22 percent developed venous thromboembolism during their stay in hospital, with deep vein thrombosis in 55 patients, and pulmonary thrombosis in 12 cases. The disease was determined in 47 cases out of 20,018 cases on sequential compression devices, with 47 patients developing deep vein thromboembolism and 6 patients developing pulmonary embolism. Risk-adjusted analysis indicated no significant decline in disease incidence in the sequential compression devices group compared to those without thromboprophylaxis. While it is important to obtain informed consent when conducting any research, the researchers did not obtain informed consent. In addition, the research was carried out without any approval from ethics committee. In this case, the researchers may have had good reasons for not seeking such informed consent, especially if the study involved incompetent patients.
Intervention for Control Group
The control group in this study included patients without thromboprophylaxis because they did not receive the sequential compression devices. While in some studies the control groups may receive conventional treatment, this group did not receive did not receive any intervention in this study. In essence, the control group was used as a benchmark to examine how those provided with sequential compression devices responded to the disease. It helped in establishing a cause and effect relationship between sequential compression devices and prevention of venous thromboembolism by isolating the impact of the former. By having the independent variable on the experiment group and not having it on the control group, the researchers could compare the outcomes of the two groups.
Primary Source of Evidence
An analysis of the article’s reference list shows that the researchers used numerous primary sources of evidence such as peer-reviewed journals and case studies. For instance, “Effectiveness of Intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical patients: A systematic review” by Pavon et al is a peer-reviewed article. Primary sources of evidence are first-hand accounts of a given topic from individuals who had direct experience with it. Hence, primary sources of evidence contain the author’s own account and experience on a specific topic that he or she participated in. Common examples of primary sources of evidence include original articles such as speeches, letters, manuscripts, autobiographies, and eyewitness accounts. Other examples include empirical scholarly materials such as research articles and case studies. Creative works such as photography, video, and music are also examples of primary sources of evidence.
Secondary Source of Evidence
In addition to primary sources of evidence, the researchers used secondary sources of evidence to describe, summarize, and discuss relevant information for the study. The book, Propensity score analysis: Statistical methods and analysis, by Guo and Fraser is one secondary source of evidence used by the researchers in this study. Secondary sources of evidence imply that the author did not take part in the event. Secondary sources are produced for a broad audience and may include definitions of terms, significant theories, and summaries of major studies related to a topic. Other examples of secondary sources include publications such as magazine articles, encyclopedias, and textbooks.
Research Hypothesis
Although the researchers did not indicate the type of hypothesis being tested, it is clear that that they hypothesized that sequential compression devices are ineffective in the prevention of venous thromboembolism in medically sick hospitalized patients. This was the null hypothesis for the study. It is by testing a null hypothesis that the researchers could determine whether to reject or accept the null hypothesis. So the researchers would reject the null hypothesis if they determined that sequential compression devices were effective in the prevention of this health problem in hospitalized patients. In essence, it is only by testing a null hypothesis that the researchers could determine whether a statistical relationship in a given sample reflected a relationship in population or was due to chance.
Data Reliability and Validity
Data collection method shows evidence of reliability and validity. With respect to data reliability, the researchers included more than 30,000 participants, which was complete and necessary to meet the intended purpose of the study. The fact that the researchers could not alter the research subjects also demonstrates data reliability. The exclusion of patients diagnosed with deep vein thrombosis and pulmonary embolism as well as those using anticoagulants is clear evidence of data validity. By doing so, the research findings would truly represent the phenomenon the researchers intended to measure.
Cronbach’s Alpha Coefficient
While the researchers used different instruments for data collection, they did not mention their Cronbach’s alpha coefficient. The reason for not using Chronbach’s alpha coefficient could be due to the fact it is affected by dimensionality as well as exam timeline. Reliability also increases with an increase in duration. Chronbach’s alpha coefficient measures how closely a set of items are related as a group. In essence, it is a measure of internal consistency and is considered as a measure of scale reliability. Generally, a high alpha value does not mean that a measure is unidimensional. Typically, Cronbach’s alpha is a coefficient of reliability or consistency rather than a statistical test.
Supporting of Hypothesis
The researchers found no relationship between sequential compression devices and reduction in venous thromboembolism incidence during hospital stay, which supported the null hypothesis. The participants demonstrated a similar incidence of the condition with sequential compression devices compared to those without thromboprophylaxis. In comparison to those without this health problem, sequentially compression devices patients showed significant differences in risk factors for the disease, including higher prevalence for cancer, longer length of stays, and higher Charlson Comorbidity Index.
Personal Perspective about Sample Size
The research sample of more than 30,000 was representative of the chosen population under study. The use of a representative sample from a larger population adequately replicated the larger population based on the characteristics under study. The use of a larger sample also reduced probability of sampling errors and increased the probability that sample size reflected the target population.
Study’s Contribution to Nursing
While the risk of venous thromboembolism in hospitalized patients may persist for sometime after hospitalization, the study’s findings help in understanding this condition during hospital stay which may result in decreased disease incidences. Studies indicate that the number of symptomatic venous thromboembolism cases during hospital stay in sick patients is the same as the number of venous thromboembolism cases after discharge. However, the researchers indicate that the number of patients with this condition after discharge is lower than those reported in other literary materials.
Reference
Dhakal, P., Wang, L., Gardiner, J., Shrotriya, S., Sharma, M., & Rayamajhi, S. (2019). Effectiveness of sequential compression devices in prevention of venous thromboembolism in medically ill hospitalized patients: A retrospective cohort study. Turkish Journal of Hematology. doi.org/10.4274/tjh.galenos.2019.2018.0413 . https://pubmed.ncbi.nlm.nih.gov/31042860/
