PUBH6005 Assessment 3: Critical Appraisal of Two Study Designs

This document presents a critical appraisal of two study designs: a cross-sectional study and a case-control study. The analysis evaluates the methodological quality of each study, addressing questions related to inclusion criteria, subject description, measurement validity and reliability, confounding factors, and statistical analysis. The cross-sectional study examines the possibility of biasedness, while the case-control study focuses on evidence-based aromatherapy practices. The assessment highlights the strengths and weaknesses of each study design, providing justifications for the answers and comparing and contrasting the findings. The document also includes references and addresses the treatment effects, precision of estimates, and the overall impact of the studies. The document aims to inform synthesis and clinical decision-making in health care, emphasizing the importance of rigorous research and critical evaluation.

Table 1 Cross-sectional study: To analyse the methodological quality of a study and to
identify the overall extent this has been addressed towards the possibility of biasedness.
Critical appraisal questions Underline your answer
1.Were the criteria for inclusion in the
sample clearly defined?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The criteria for inclusion were not clearly defined as they need to be subjected in context
with rigorous appraisal with the help of two or more critical appraisers. At one stage it
was analysed that they should use their review in such a way that it gets subjected in
appraisal while at the same point of time it was defined that the inclusion was used to
inform synthesis and also in the interpretation of results.
Critical appraisal questions Underline your answer
2.Were the study subjects and the setting
described in detail?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
In terms of JBI institute all subjects were described in detail. As they took a specific view
on the basis of evidence and methods which are been used. In relation with this they also
implemented different theories, procedures and methodologies so that critical appraisal
can be done efficiently and also to aid in clinical decision making in whole health care.
Critical appraisal questions Underline your answer
3.Was the exposure measured in a valid and
reliable way?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The exposure was measured in reliable and valid way because institute guidance
conducted reviews in context with all types of research like qualitative, effectiveness and
so on. The exposure was also determined in reliable way as it measured all kind of risks
associated with health care, tests accuracy and different reviews. To ensure its validity it
was found on their website also.
Critical appraisal questions Underline your answer
4.Were objective, standard criteria used for
measurement of the condition?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
It was not clear that institute was using proper standard criteria to measure different
conditions of health care. Though they developed different appraisal tools and got
approved by extensive peer review but at the same point of time they could use another
criteria. In relation with this institute could also use their appraisal tools while creating
appraised topics in context with journal clubs and educational aspects also.
Critical appraisal questions Underline your answer
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5.Were confounding factors identified? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The main aim behind the case was to assess possibility of biasedness in its design, conduct
and overall analysis been done. So, institute identified it by implementing a proper
systematic review. All type of factors which were been identified can be further used to
inform about synthesis. It is very crucial for a health care institute to identify all
confounding factors so that proper analysis can be done. When the factor of biasedness
was determined it was used in journal clubs.
Critical appraisal questions Underline your answer
6.Were strategies to deal with confounding
factors stated?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Though all confounding factors were identified but institute didn’t state about the
strategies which they will be using to deal with those factors. They applied many
strategies like an analysis would be done in order to inform synthesis, different appraisal
tools were developed which can be used in clubs or as an educational tool. So, with
respect to this it was not clear as which kind of strategy institute would be using.
Critical appraisal questions Underline your answer
7.Were the outcomes measured in a valid
and reliable way?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, all outcomes were measured in valid and reliable way. It was valid because their
appraisal tools were developed by their own institute and certain collaborators. It was
considered as reliable because they got the approval from Joanna Briggs institute
scientific committee who used to follow a proper extensive peer review. The overall
outcomes were been used as an educational tool which is a very reliable thing.
Critical appraisal questions Underline your answer
8.Was appropriate statistical analysis used? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, an appropriate statistical analysis was been used. In context with the case study of
health care institute a proper systematic review was conducted. In context with this they
developed different theories and methodologies to do overall statistical analysis in
relation with the clinical decision making. They also applied the usage of critical appraisal
tools which were all on the basis of statistics. The institute also implemented different
reviews on the basis of various types of research.
Add additional pages if needed
Reference: (insert the reference here according to APA 6th edition)
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Kavanaugh, E. B. (2021). Information Literacy, Mental Health, and Lifelong Learning:
Librarians and Health Care Professionals in Academic, Clinical, and Hospital
Settings. Journal of Hospital Librarianship, 1-16.
Mohammadpour, M., and et.al, (2021). Main Factors Affecting the Readiness and
Responsiveness of Healthcare Systems during Epidemic Crises: A Scoping Review on Cases
of SARS, MERS, and COVID-19. Iranian Journal of Medical Sciences.
Kirubarajan, A., and et.al, (2021). Barriers to fertility care for racial/ethnic minority groups: a
qualitative systematic review. F&S Reviews.
Lam, W. L., & Ruettermann, M. (2021). Challenging surgical dogmas in hand surgery.
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Table 2 Case-control study: The case for an evidence based Aromatherapy practice
Critical appraisal questions Underline your answer
1.Did the study address a clearly focused issue? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, the study addressed a clear focused issue. The main problem which was described
was in relation with anecdotal evidence. It is evidence which is in the form of short stories
that people tell as what exactly happened to them. There are different kinds of
biasedness associated with it like in the form of evaluation bias, selection bias and so on.
There were certain risk factors been analyzed like with respect to the issue of cancer. The
main obstacle behind it was the lack of evidence and legitimacy of advice. Through this
case study various benefit factors were also determined as it was improving sleep, well-
being and reduction of nausea and vomiting in relation with the treatment been provided.
Critical appraisal questions Underline your answer
2. Did the authors use an appropriate method to answer their
question?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, author used appropriate way of answering the question. They operated different
variables which were useful in reducing the probability that acne has been decreased.
Authors also used the method of good clinical research in order to explore the effect of
treatment as well as intervention so that overall clinical effect can be measured. Apart
from the issue of cancer there were many other circumstances also like in relation with oil
and biasedness. So, they answered it effectively because they felt very confident about all
their well-designed studies.
Critical appraisal questions Underline your answer
3. Were the cases recruited in an acceptable way? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
In accordance with some cases efficiency was there but at the same point of time there
were many flaws also as research design didn’t supported all results. In context with the
risk of biasedness they were under powered because many issues were there with
respect to specific methodology. There were different cases been selected and all had
certain speciality. In context with the treatment of aromatherapy, it is very holistic in
nature and is very difficult to measure treatment across whole population. Though it is a
big challenge but it is also not impossible. The time frame of the study was also relevant
in context with all the cases as in future it would be providing many benefits.
Critical appraisal questions Underline your answer
4. Were the controls selected in an acceptable way? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
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As per the case study discussion has been done on the problem of cancer. If a person is
going through a treatment of cancer and suggests that smoking should be done, then it
must not be accepted because it clearly defines that lung cancer is caused by smoking. In
context with the treatment of acne it was clinical in nature, severe and so on but it can
get naturally solved. All controls were selected in an acceptable way because there were
many areas of concern which was highlighted as there were many participants who left
and also a published research was been done.
Critical appraisal questions Underline your answer
5. Was the exposure accurately measured to minimise bias? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The exposure was clearly identified and measured in relation with decrease biasedness.
As it was determined that bias is underpowered because there are not much participants
and many issues were getting arise with respect to specific methodology. To measure it
there was a catalogue which would help in decreasing the results of bias and implement a
strong clinical research. It was clearly defined that what challenges are associated with it
and to measure the effect of biasedness clients were been provided with some evidence
of how a treatment would work and will be justified.
Critical appraisal questions Underline your answer
6. Aside from the experimental intervention, were the groups
treated equally?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
There is no surety that all groups of the population were been treated equally. As per the
case study there are different aspects and on the basis of them the phase of genetic
should be applied by the author. For example, as per the case of using oil to treat people
who are suffering from cold. With respect to this it is in their genes that they may have
the problem of cold. So, it is not essential that by using that oil only they will not be
suffering from the disease. At certain times it gets naturally solved so with respect to this
it should be clearly defined that whether it has been cured with the treatment or
naturally.
Critical appraisal questions Underline your answer
7. Have the authors taken account of the potential confounding
factors in the design and/or in their analysis?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, author used different techniques to control different confounding factors. There are
various terms which are been used in the form of clinical research and helps to determine
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why anecdote is not considered as the most reliable form of evidence. So, the first
technique as per the case study is regression. In accordance with this everything will be
even out over time even with intervention and without it also. It was also analyzed that
there was restriction with respect to biasedness as introduction of bias in any kind of
research limits the level of trust which can be placed in the results.
Critical appraisal questions Underline your answer
8. How large was the treatment effect? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
As per the case study it is not clear that how large is the treatment effect. In context with
the good clinical research it is considered as a proper investigation in order to explore the
effect of treatment as various instruments are used. There are many challenges which are
in relation with the implementation of research but once it gets fully analyzed it will be
providing certain benefits also. The treatment effect would increase the professional
profile of both practitioner as well as the practice. It will also help in enhancing clinical
revenue.
Critical appraisal questions Underline your answer
9. How precise was the estimate of the treatment effect? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
As per the case study the treatment effect was very precise in nature because author
considered all important variables. In context with the clinical research there are different
terms which are used so with respect to this author also talked about the aspect of oil,
regression and cancer. The discussion was also done in context with the effect of
biasedness. It was estimated that once all the methods would be known various benefits
would be provided. In context with the clinical knowledge it was precise that it will be
either confirmed or challenged which would lead to a change in practice. It was
considered by the author that evidence based practice will enhance clinical revenue and
will also support full clinical potential.
Critical appraisal questions Underline your answer
10. Do you believe the results? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
As per the case study, the results can’t be believed because in some cases research design
was not supporting all results and due to the effect of biasedness, it caused limit to all
results. It was been analyzed that there was an misinterpretation that evidence has no
kind of effect because around half of the people who were dealing with cancer decided to
not use CAM whilst treatment and the main barrier was lack of evidence. The results was
not getting accepted as in terms of aromatherapy it its totally patient centered so it is
very difficult to measure one treatment in context with the whole population.
Critical appraisal questions Underline your answer
11. Can the results be applied to the local population? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
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It is a unclear condition that whether the results would be applied to local population or
not. It is considered difficult to measure treatment across whole population and is also a
challenge but at the same point of time it is also not impossible to do that. The results
can be applied to local population if people would not think that the framework does not
accommodate all oil interventions. It can also be applied to local population because
clients of the business are there via word of mouth so with respect to this full clinical
potential get supported.
Critical appraisal questions Underline your answer
12. Do the results of this study fit with other available evidence? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes the results of this case study fit with other available evidences because as per their
analysis also the possibility of biasedness has been assessed. With respect to this different
tools were been developed and as per the case study also many new tools were getting
developed in order to decrease the bias and deal with all kind of challenges.
Add additional pages if needed
Reference: (insert the reference here according to APA 6th edition)
Salandra, R., Criscuolo, P., & Salter, A. (2021). Directing scientists away from potentially
biased publications: the role of systematic reviews in health care. Research Policy, 50(1),
104130.
Russo, G., and et.al, (2021). The impact of economic recessions on health workers: a
systematic review and best-fit framework synthesis of the evidence from the last 50
years. Health Policy and Planning.
Korkmaz, N., and et.al (2021). Influenza vaccination rates, knowledge, attitudes and
behaviours of healthcare workers in Turkey: A multicentre study. International Journal of
Clinical Practice, 75(1), e13659.
Love, D. J., and et.al (2021). Simulation of “North Carolina Protocol for Allocating Scarce
Inpatient Critical Care Resources in a Pandemic” in a Multi-hospital Health Care
System. North Carolina medical journal, 82(1), 21-28.
ONLINE
Agnew, 2020, the case for evidence based aromatherapy practice
[Online] Available Through:
https://tisserandinstitute.org/the-case-for-an-evidence-based-aromatherapy-practice/
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Table 3 Cohort study: Implicit bias and racial disparities in health care
Critical appraisal questions Underline your answer
1.Did the study address a clearly focused
issue?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, the case study focused on a clear issue. The main objective of the case was that why
black people are not receiving the same quality of health care than other racial groups.
With respect to the institute of medicine they determined that black people are sicker
and have short life in comparison with other while people. Even on the basis of age,
insurance status they receive less health care. The case also described that racial
disparities in health can be clearly determined just by looking at the individuals.
Critical appraisal questions Underline your answer
2.Was the cohort recruited in an acceptable
way?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
It was unclear that cohurt was recruited in acceptable way. There were many people who
were involved like in relation with some scholars they determined that racial disparities in
health can be explained by just looking at the individuals whereas in context with
physicians harbor racial biases they can be both consciously as well as unconsciously held.
Critical appraisal questions Underline your answer
3.Was the exposure accurately measured to
minimise bias?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
In order to minimise biasedness the exposure was not clearly measured as it was
identified that unconscious biases are held by health care providers in terms of
determining certain racial disparities in health. In context with the physicians they explicit
racial biases as they cannot account for racial disparities in health.
Critical appraisal questions Underline your answer
4.Was the outcome accurately measured to
minimise bias?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
It was unclear that the outcome was accurately measured. As many experiments were
been done but each one showed different perspective. In accordance with one
perspective it was seen that physicians whose IAT tests revealed to harbor pro-white
biases represented more pain medications than in context with black. In other cases it
was seen that physicians whom IAT tests revealed anti-black implicit biases was not
representing thrombolysis to all black patients.
Critical appraisal questions Underline your answer
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5(a)Have the authors identified all important
confounding factors?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
No, authors were not able to identify all crucial confounding factors as their certain
structural factors which makes people of color sicker in comparison with white ones is
long. If all providers represent implicit racial biases in order to excess mortality across
people of color, then it should be represented that individuals who have biases
compromise the health of color.
Critical appraisal questions Underline your answer
5(b)Have they taken account of the
confounding factors in the design and/or
analysis?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes, they have taken into account of all confounding factors with respect to their design in
their whole analysis. It was analyzed that in terms of racial and ethnic minorities receive
low quality health care than those white people even in relation with insurance status,
severity of conditions, income and age.
Critical appraisal questions Underline your answer
6(a)Was the follow up of subjects complete
enough?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
It was unclear that whether overall follow up was complete or not. With respect to NAM
findings it was determined that the providers are less likely to deliver efficient treatments
to people of color in comparison with white counterparts even after controlling class,
access to health insurance and so on.
Critical appraisal questions Underline your answer
6(b)Was the follow up of subjects long
enough?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Yes. The follow up was long enough because the rates at which black patients have their
limbs was higher than those of white patients. Black patients were suffering from bipolar
disorders had long term negative effects and was not efficient.
Critical appraisal questions Underline your answer
7.What are the results of this study? Yes/No/Unclear
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Evidence: justification, compare and contrasting or/and providing solution
Yes the result was ultimately that all implicit biases were responsible for racial disparities
in health was dangerous as both structural and individual factors can never operate
simultaneously. The residential neighbourhoods remain segregated.
Critical appraisal questions Underline your answer
8.How precise are the results? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The results were precise as all structural factors that make people of color sicker than
other white counterparts.
Critical appraisal questions Underline your answer
9.Do you believe the results? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
It is a unclear situation with respect to all results as all experiments which were been
done showed different perspectives.
Critical appraisal questions Underline your answer
10.Can the results be applied to the local
population?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
As the situation was not clear so in relation with this it cannot be applied to local
population.
Critical appraisal questions Underline your answer
11.Do the results of this study fit with other
available evidence?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
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Critical appraisal questions Underline your answer
12.What are the implications of this study for
practice?
Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Add additional pages if needed
Reference: (insert the reference here according to APA 6th edition)
Ayers, S., & De Visser, R. (2021). Psychology for medicine and healthcare. Sage.
Biddle, M. S., Gibson, A., & Evans, D. (2021). Attitudes and approaches to patient and
public involvement across Europe: a systematic review. Health & social care in the
community, 29(1), 18-27.
Yieh, L., & Dukhovny, D. (2021, January). Perils and pitfalls for evaluating economic studies
in neonatology. In Seminars in Perinatology (p. 151389). WB Saunders.
Odonkor, C. A., and et.al, (2021). Disparities in health care for black patients in physical
medicine and rehabilitation in the United States: a narrative review. PM&R, 13(2), 180-203.
ONLINE
Bridges, 2020, Implicit Bias and racial disparities in health care
[Online] Available Through:
https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-
of-healthcare-in-the-united-states/racial-disparities-in-health-care/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383175/
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Add additional pages if needed
Table 3 Randomised controlled trial: (Patients Suffer during COVID situation in Health
care.)
Critical appraisal questions Underline your answer
1. Did the trial address a clearly focused
issue?
Yes/No/Unclear
Evidence:
Yes, the issues is been determined towards Covid situation where patients are not much
aware about COVID precautions. During in this catastrophe medical or health care
institution are trying to provide proper facilities but due to shortage of oxygen and
plasma, they are not getting proper health care facilities.
Critical appraisal questions Underline your answer
2. Was the assignment of patients to
treatments randomised?
Yes/No/Unclear
Evidence:
Yes, Because the treat meant was considered to those who are majorly facing COVID
situation towards their health care and not getting proper medical facilities. Some off
patient which target at the age group of 25-40.
Critical appraisal questions Underline your answer
3. Were all of the patients who entered the
trial properly accounted for at its conclusion?
Yes/No/Unclear
Evidence:
No, many of the patients were dies du to heavy disease of having COVID symptoms as
well as those who have less immunity consumption they were not getting proper medical
facilities in proper manner.
Critical appraisal questions Underline your answer
4.Were patients, health workers and study
personnel ‘blind’ to treatment?
Yes/No/Unclear
Evidence:
Yes, Doctor were trying their best to overcome from these disease where people who are
disabled like deaf and blind they are also come in range of COVID situation. Due to that
Government is provide Mask, Vaccine and other medical food concept development.
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