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[PDF] How to critically appraise an article

   

Added on  2021-04-17

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Running head: CRITIQUECritiqueName of the student:Name of the University:Author’s note
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1CRITIQUECritical analysis of articles based on CASP tool questionnairesArticle 1: The article by Ahn et al. (2015) had a clear focused issue, as it aimed to evaluate theeffectiveness of intravenous lidocaine (intervention) in reducing postoperative pain (outcome)for laparascopic colectomy patient (population). The study was carried out by means of arandomized, double blind, placebo controlled study design. This indicates that participants wererandomized to treatment group and the allocation sequence was concealed from investigators andpatients. Few patients did not completed the trial, however data for all participant group wasanalyzed in the trial. Blinding is mostly done in randomized controlled trials (RCTs) to minimize likelihood ofdifferential treatment of outcome Karanicolas, Farrokhyar and Bhandari (2010) and Ahn et al.(2015) blinded investigator, anesthesiologist and patient to treatment. The similarity of the groupwas maintained by means of age range (20-65 years) and gender, however social class was notevaluated. The validity of the research is also understood from the fact that apart fromexperimental intervention, other protocols like administration of anesthesia and surgicaltechnique was kept same for the participants. The primary outcome that was measured includepain level and the secondary outcome measured included incidence of vomiting, frequency ofPCA device, amount of Fentanyl use and satisfaction score. On the basis of this outcomevariable, the study result showed no difference in pain at discharge between the two groups,however the amount of Fentanyl use was lower in patients receiving intravenous lidocaine. Otheroutcomes like nausea, satisfaction score and vomiting was also less frequent in the interventiongroup. Hence, the study outcome proved that pain is reduced significantly in patient receiving
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2CRITIQUEintravenous lidocaine intraoperatively. The preciseness of the treatment effect is understood fromthe fact that P value for Fentanyl in control and intervention group. The patient taken in the study were similar to the target population group, however itcannot be applied locally because it had major methodological limitation. Pain score was notmeasured preoperatively which was necessary to understand the effectiveness on lidocaine inpain management. Hence, this aspect can affect decision making regarding use of lidocaine fortarget patient group. Despite this limitation, the study result is useful as use of lidocaine can beconsidered for improving recovery in patient undergoing laparascopic colectomy as itstherapeutic effect is also proved by Li et al. (2018). Article 2:The review of the study by Tikuišis et al. (2014) revealed that it focused on examiningthe impact of IV lidocaine (intervention) on the quality of post operative pain (outcome) inpatients with hand assisted laparascopic colon surgery (HALS) (population). The data forresearch was obtained by randomizing patients to lidocaine infusion or a normal 0.9% salineinfusion. As per the requirement of a randomized controlled trial, allocation was concealed frompatients and those involved in gathering data for the study. The factors related to dropout ofparticipants were also considered as sample size was increased for this reason and there werefour participants group who were excluded and not analyzed till the end. Apart from this, theresearcher also eliminated treatment bias by measuring age, weight, BMI and duration of surgeryin both group of patient. The quality of the research evidenced is also understood by the researcher’s compliancewith RCT protocol. Apart from the experimental intervention, Tikuišis et al. (2014) maintained
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3CRITIQUEequal treatment of group by providing the same team of surgeons for performing HALS for allpatient. Post-operative pain was the primary outcome analyzed for both group and length ofhospital stay (LOS) and bowel function was secondary outcome measured for the study. Theyreview of the results of the study clearly showed that intensity of pain was significantly lower inlidocaine group compared to placebo group. In addition, the mean time for first bowel movementand hospital stay was lesser in intervention group compared to control group. The preciseness ofthe effect is also understood from the fact that confidence interval was significantly lower forlidocaine group. The strength of this evidence is that it has targeted the right clinical outcomes toevaluate the effectiveness in target patient and this can be applied locally too. The study hasuseful implicating in promoting restoration of bowel function and length of hospital stay as thiswould save cost and lead to reduction in the cost associated with surgery too (Tam et al. 2016). Article 3:Lee et al. (2017) focused on addressing the issue of peri-operative pain control byinvestigating about the effectiveness of intravenous lignocaine (intervention) in reducing post-operative pain and length of hospital stay (outcome) in laparoscopic surgery patient (population).It did not used randomization method for analysis of intervention and data was collected byreviewing cases of patient who underwent elective laparoscopic resection of colorectal cancerand received lignocaine after 24 hours of operation between 2012 and 2015. Hence, the study didnot used randomization method for recruitment of participant and it was a case series review. Allpatients who were selected for case review were analyzed and there was no need for blinding asthe effect of intervention was not compared with any control. Demographic data relate to age,sex and types of surgery was analyzed, however there was no need for considering the similarityof groups as it was a case review based study.
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