Critical Appraisal for Article power point

Critical Appraisal Worksheet for Group Project 2, Part b

Elements of Appraisal

Discussion

Study Design

Was the study a qualitative or quantitative design? Explain.

The study has a quantitative design because it examines the relationship between different variables, uses logistic regression analyses as its statistical method, and has a large number of subjects.

Practice Problem

State the practice problem/issue that is the focus of the study.

How does this practice problem/issue affect your nursing practice?

The practice problem of the study is the increasing and frequent Urinary tract infection (UTI) caused by some bacteria in pregnant women leading to significant complications for both fetus and mother.

This problems affects my nursing practice since I am interested in specializing in microbiology as I further my clinical nursing practice.

Study Purpose

State the purpose of the study.

Discuss whether this study was feasible to conduct in terms of money commitment; the researchers' expertise; availability of subjects, and ethical considerations.

The purpose of the study was to determine the prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland.

The study had a monetary commitment since there were different equipment that were needed for the many participants present like sterile containers, and labels. The participants were readily available since the study was conducted in antenatal care (ANC) in HGH, Hargeisa, and Somaliland. There was need for high ethical consideration during the study since the areas are Islam dominated.

Review of Literature

Was the literature review organized to show the progressive development of evidence from previous research?

Was a clear, concise summary presented of the current empirical and theoretical knowledge in the area of the study?

Did the literature review summary identify what was known and not known about the research problem? Did it logically direct the research purpose?

Yes. The literature review followed the chronology of evidence presentation from previous research, and how the information is relevant in the study’s evidence.

Yes. The study consisted of theoretical knowledge of previous researches on the topic of pregnant women with UTIs and the geographical areas under study then relating it with the research findings.

The summary of the literature review identified what was known about the research problem by citing other sources and using statistics to create a bacterial profile isolated from the urine culture of asymptomatic and symptomatic pregnant women with UTI but did not state what was unknown about the research problem. The details of the known facts gave a logical direction of the research purpose.

Theoretical Framework

Is a conceptual model or theoretical framework used? If so, is it presented with clarity? Does it adequately explain the phenomenon of concern?

Is the framework linked to the research purpose? If not, would another framework fit more logically with the study?

If a proposition or relationship from a theory is to be tested, is the proposition clearly identified and linked to the study hypothesis?

Logistic regression analyses were used as a conceptual model to explain the phenomenon in concern. Although not presented with clarity, they adequately explain the results.

Yes, the conceptual model used was linked to the purpose of study through analyzing the statistical significance.

Yes it is.

Research Question(s) and Hpothesis(es)

What is the research question? Is it clearly stated?

Does the research question match the purpose of the study?

What is the research hypothesis? Is it clearly stated?

Does the hypothesis match the purpose of the study?

Formulate a null hypothesis for this study.

Were the objectives, questions, or hypotheses logically linked to the concepts and relationships (propositions) in the framework? Explain.

The research question was: What is the prevalence, antimicrobial susceptibility pattern and rates of associated factors of urinary tract infection (UTI) among pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland? No, the research question was not clearly stated.

Yes, it does.

The research hypothesis is not clearly stated.

It is impossible to know if the hypothesis matches the purpose since it was not clearly stated.

The prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) does not affect pregnant women attending Hargeisa Group Hospital (HGH), Hargeisa, Somaliland.

The objectives, questions, and hypotheses of the study are not logically linked to the concepts and relationships proposed in the framework since they were not clearly stated.

Variables

List all research variables with corresponding levels of measurement on the NOIR scale.

Do variables represent the concepts identified in the framework?

How is each study variable defined (both conceptually and operationally)?

Are conceptual definitions of variables consistent with operational definitions?

· Prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI)

· Pregnant women

· Hargeisa Group Hospital (HGH), Hargeisa, Somaliland.

Yes.

· Prevalence, antimicrobial susceptibility pattern and associated factors of urinary tract infection (UTI) – dependent variable

· Pregnant women – mediating variable

· Hargeisa Group Hospital (HGH), Hargeisa, Somaliland – independent variable

Yes they are.

Study Design

What was the design was used in the study?

Was it the most appropriate design to answer the study question? Explain.

Was the design logically linked to the sampling method and statistical analyses?

Did the design provide a means to examine all objectives, questions, or hypotheses?

If there was an intervention (treatment) in the study:

· what was the intervention? was it clearly described?

· was the treatment appropriate for examining the study purpose and hypotheses?

· did the study framework explain the links between the treatment (independent variable) and the proposed outcomes (dependent variables)?

· were subjects randomly assigned to the treatment group, or were the treatment and comparison groups dependent?

· were the treatment and comparison group assignments appropriate for the purpose of the study?

· was a protocol developed to promote consistent implementation of the treatment to ensure intervention fidelity?

· did the researcher monitor implementation of the treatment to ensure consistency? How might this impact findings?

A cross-sectional study design was used in the study.

It was the most appropriate design to use on the question study because it allowed the researchers to compare the different variables simultaneously.

Yes.

The design provided a means to examine the hypothesis, questions, and objectives by examining the variation of the variables across different studies and research.

Yes.

The researchers suggested the intervention of culture and antibiotic susceptibility testing was recommended before giving treatment to prevent antimicrobial resistance which was clearly stated in the conclusion.

Yes.

Yes, the study framework explained that when patients were introduced into the culture and antibiotic susceptibility testing before giving treatment to prevent antimicrobial resistance, the treatment system for UTI in pregnant women will help avoid self-medication.

The urine samples were randomly collected from participants.

Yes, they were.

Yes, the uni-variable and multivariable logistic regression analyses were utilized to identify the independent risk factors for UTI.

The researchers monitored implementation of the treatment to ensure consistency by conducti ng cultured and antimicrobial susceptibility pattern on the samples. This showed the impact of the suggested treatment method on UTI patients.

Study Sample

Were any subjects excluded from the study because of age, socioeconomic status, or ethnicity? If so, explain. Was sound rationale provided?

Did the sample include an understudied or vulnerable population, such as young, elderly, pregnant, or minority subjects?

What sampling criteria (inclusion and exclusion) were used? Was sampling criteria appropriate for the type of study conducted? Explain.

Were the rights of human subjects protected? Explain.

Was the refusal rate for the study provided? If so:

· was it greater than 20%?

· how might this have affected the representativeness of the sample?

· did the researchers provide rationale for the refusals?

Was the attrition rate for the study provided? If so:

- what was it?

- did the researchers provide a rationale for the attrition of study participants?

- how did attrition influence the final sample as well as study results and findings?

How large is the sample?

How was sample size determined?

Yes. Cultured and antimicrobial susceptibility pattern was determined for the isolates. This was based on the logistic regression analyses were utilized to identify the independent risk factors for UTI that affected different patients.

The subjects were all pregnant women.

Systematic random sampling technique was used to select the participants, which were all supposed to be pregnant women.

Although the study was conducted under the most considerable conditions, we are not told how the researchers tried to protect the human rights.

No, the refusal rate was not provided.

The attrition rate was not provided.

The sample was very large.

The determined sample size was 422 participants.

Research Instruments

Did the measurement methods selected for the study adequately measure the study variables?

What instruments or tools were used to collect data?

How did you determine if the instruments are valid? reliable?

Respond to the following questions that are relevant to the measurement approaches used in the study:

1. Scales and questionnaires

(a) Were the instruments clearly described?

(b) Were techniques for completion and scoring of the instruments provided?

(c) Were validity and reliability of the instruments described?

(d) Did the researcher reexamine the validity and reliability of instruments for the present sample?

(e) If an instrument was developed for the study, was the instrument development process described?

2. Observation

(a) Were phenomenon that were to be observed clearly identified and defined?

(b) Was interrater reliability described?

(c) Were techniques for recording observations described?

3. Interviews

(a) Did interview questions address concerns expressed in the research problem?

(b) Were interview questions relevant for the research purpose and objectives, questions, or hypotheses?

(c) Did the design of the questions tend to bias subjects' responses?

(d) Did the sequence of questions tend to bias subjects' responses?

4. Physiological measures

(a) Were physiological measures clearly described? If appropriate, are brand names (ex., Hewlett-Packard) of instruments identified?

(b) Were accuracy, precision, and error of physiological instruments discussed?

(c) Were physiological measures appropriate for the research purpose and objectives, questions, or hypotheses?

(d) Were methods for recording data from physiological measures clearly described? Was recording of data consistent?

Systematic random sampling technique was use to adequately measure the study variables.

Structure questionnaires was used by trained nurses for the collection of Clinical and Socio-demographic data.

Because all filled questionnaires for this study were checked visually, coded and entered into excel and then exported to SPSS version25 software (SPSS Inc., Chicago, IL, USA) for analysis.

Yes.

No.

Yes.

No.

No.

Yes.

No.

Yes.

Yes.

Yes.

No.

No.

No.

No.

They were not clearly described.

Yes, through questionnaires.

Recording of data was consistent.

Data Collection

State the data collection procedures.

How often were data collected and for how long?

Was the data collection process conducted in a consistent manner?

Did any adverse events occur during data collection? If adverse events did occur, how were they managed?

Data was collected through structured questionnaires that were offered by trained nurses to the participants for the collection of Clinical and Socio-demographic data.

Data was collected and taken to the lab after every hour for the three weeks of research.

Yes.

No.

Data Analysis

Were data analysis procedures clearly described?

What statistical tests were used to analyze data?

Were statistical tests suitable to the types of data collected/levels of measurement? Explain.

What assumptions in the data must be met for the type of statistical tests used? How do you know if these assumptions were met?

Were data analysis procedures clearly described? Did the researcher address any problems with missing data and if so, how was this problem managed?

Were data analysis techniques consistent with the study purpose research objectives, questions, and/or hypotheses? Explain.

Were data logically organized/presented in tables, graphs and/or charts? Describe.

What was the alpha for each statistical test?

Describe how statistical significance was demonstrated (or not) for each variable.

Yes.

Uni-variable and multivariable logistic regression analyses.

Yes. This is because statistical knowledge helps utilize proper data collection methods, employ correct analyses, and present results effectively.

Some assumptions of the logistic regression model include the independence of errors and that all the continuous variables are linear. These assumptions were met because there were more than 10 cases for each independent variable with least frequent outcomes.

Although the data analysis procedures were clear, the researchers did not address the problems of the missing data.

It is unclear if the data analysis techniques consistent with the study purpose research objectives, questions, and/or hypotheses since they were not clearly stated.

The data collected in the study were laid out in a graph.

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Associations between dependent and independent variables were assessed and its strength was described using odds ratios at 95% confidence intervals. A statistically significant association considered as  P-value < 0.05.

Study Results and Interpretation

Were study results statistically significant? How did you determine statistical significance?

What is your statistical interpretation of study results?

Were findings discussed in relation to each objective, question, or hypothesis? In other words, was the research question/hypothesis answered? Describe.

Were study findings clinically significant? If so:

· discuss implications of the study for nursing practice.

· what changes could you make in your practice based on the results of this study?

What were the study conclusions? Did conclusions fit the results from the data analyses? Were the conclusions based on statistically significant and clinically important results? Explain.

Were study limitations described? Discuss. Do you think the study had weaknesses not identified by the researcher? If so, explain.

Did the researcher generalize the findings appropriately? Who will benefit from results of the study? Discuss.

Were there any unexpected findings? Discuss.

Yes they were. Statistical significance was determined by creating a P-value that was compared to the results.

Majority of the isolates were resistant to the commonly prescribed antibiotics, therefore, culture and antibiotic susceptibility testing was preferable and more effective.

It is unclear since the research question/hypothesis were not well stated.

Yes.

Clinicians were communicated the findings of culture and sensitivity tests that they would apply in their researches.

I would find procedures that will make the culture and antibiotic treatment methods recommended more effective.

The conclusion was that the culture and antibiotic susceptibility testing was recommended before giving treatment to prevent antimicrobial resistance at least at Referral Hospital Setup and health information dissemination to the patients recommended to avoid self-medication practice

The study limitations were not described. Due to the efficient use of statistics, the study had very minimal weaknesses.

Yes. Future researchers on the topic and clinicians will benefit the most from the results of the study.

No. All the findings were in line with the concepts investigated in the study.

Recommendations for Future Research

Discuss study recommendations.

Is need for further research identified?

Culture and antibiotic susceptibility testing was recommended before giving treatment to prevent antimicrobial resistance. Also, the patients were recommended to avoid self-medication practice.

There is need for more research to find other treatment methods for UTI in pregnant women.

Study Rigor

Discuss elements of rigor based on study design. In your opinion, did the researchers address these aspects adequately in the published report? Why or why not?

How does rigor impact study results?

No elements of rigor were discussed in the study.

Rigor provides an accurate representation of the population studied and allows the researcher to establish consistency in the methods used over time.