University Report: Critical Evaluation of Evidence in Healthcare

This report provides a critical evaluation of two research articles investigating the effects of psycho-stimulants on academic performance and executive functioning in university students. The first article, using a qualitative approach, explores the life context of pharmacological academic performance enhancement, examining the experiences of students using stimulants. The second article evaluates the relationship between non-medical use of prescription stimulants, executive functioning, and academic outcomes. The report analyzes the methodologies, findings, strengths, and weaknesses of each study, discussing barriers to the application of evidence-based practice. The analysis follows the PICO format, comparing the effectiveness of psycho-stimulants on academic performance. The conclusion suggests potential side effects of psycho-stimulants, while also emphasizing their impact on enhancing cognitive functions. The report highlights the importance of a multifaceted life context and improved cognition for achieving better academic results. It concludes by stating that the use of smart drugs alone will not be sufficient in improving academic performance.

Running head: CRITICAL EVALUATION
Title page (for all students except those in CANBERRA)
Student Name:
Unit: HLSC122 Semester 2, 2017
Assessment 3: Critical Evaluation of Evidence
Word count: 1771

CRITICAL EVALUATION 1
Introduction
Evidence based practice is essential because it involves a judicious and explicit
sue of current evidences that are best suited to make decisions related to individual
patient care. Attention deficit hyperactivity disorder is a neuro-developmental disorder,
characterized by impulsive behaviour and lack of concentration, generally treated with
the use of psycho-stimulants (Melegari et al., 2015). However, recently a large increase
is observed in the proportion of college students who are being involved in drug abuse
related to these psycho-stimulants, in spite of being not being diagnosed with ADHD.
Wasim, a student has observed that all his university friends are talking about using
smart drugs to improve their academic performance in examinations. Although he is
aware of the therapeutic role of these drugs in ADHD, he wants to investigate their
probable role in enhancing academic performance by analysing two articles. The first
article will use a qualitative approach to investigate the association between psycho-
stimulants and examination performance and the second article will evaluate the
association between these drugs and executive functioning. Thus, the articles will help
Wasim to judge the truthfulness of the claims made by his friends.
Body
PART A
Hildt, E., Lieb, K., & Franke, A. G. (2014). Life context of pharmacological academic
performance enhancement among university students - a qualitative approach.
BMC Medical Ethics, 15(1), 23-23. doi:10.1186/1472-6939-15-23
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CRITICAL EVALUATION 2
Authorship- Elisabeth Hildt is a neuroethic expert at the Department of
Philosophy; Andreas Günter Franke and Klaus Lieb are from the Department of
Psychiatry and Psychotherapy, at the University Medical Centre Mainz (Germany).
Klaus Lieb heads the department and Franke is a trainee under his guidance. Thus, all
the three authors were well educated and knowledgeable to conduct the research.
There were some contradictions in the academic results that had been achieved and in
the subjective experiences of the study participants.
Research Aims- In this study, the primary objective of the authors was to
evaluate effects of both prescribed and illicit psycho-stimulant usage on academic
performance enhancement. The authors examined the effects of methylphenidate and
amphetamine stimulants on the examination performance of university students. The
experiences of the participating students were measured with respect to administration
of the drugs. In addition, influence of several factors such as academic and peer
pressure, that are thought to increase personal life and academic excellence were also
assessed (Hildt, Lieb & Franke, 2014).
Design- Psycho-stimulant related placards were used to collect students from the
University of Mainz campus. Semi-structured, face-to-face interviews were conducted
on healthy students who did not report previous history of psychiatric disorders. The
interview questions were focused on prescribed or illicit intake of stimulants, their
individual perception on the probable effects of stimulants on academic improvement
and the observable negative effects (if any). The interview responses were transcribed
verbatim, and systematically analyzed with the help of a qualitative approach.
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CRITICAL EVALUATION 3
Findings- 18 results were analysed for final conclusions out of the 22 interviews
that had been carried out. Prescribed usage of stimulants was found among 4 students.
The rest 14 participants followed illicit usage of the stimulants. The findings suggested
that stimulants were mainly used prepare for a term paper and facilitate exam
preparation, in addition to gaining study time, and pursuing and achieving individual
projects, which were out of their academic domains. The intake was found to be
affected by performance and time pressure. Some of them also reported a motivation
increase, and sleep time reduction after the drug usage. The analysis also showed an
increase in energy for leisure activities on stimulant usage (Spencer, Devilbiss &
Berridge, 2015). Thus, it can be deduced that maximising time and boosting motivation
were the 2 most important effects.
Strengths and weaknesses- The study had several limitations. One of them was
inclusion of extremely small number of interviews. Although the there were around
36,000 registered students in the university, the placards were able to gain the
willingness of only 22 students. The low participation rate can be attributed to stigma
related to drug abuse. Secondly a selection bias was formed due to exclusion of willing
participants with reported psychiatric disorders or under the action of prescribed
psychoactive medications, and the type of students who wanted to participate.
Moreover, time frame, social desirability and behavioural aspects could have influenced
the spontaneous answers given by the participants. However, the strength can be
attributed to the fact that study acted as a starting point for conducting qualitative and
quantitative studies in future, which would investigate observable effects of stimulants
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CRITICAL EVALUATION 4
on academic performance, and the motivation behind pharmacological neuro-
enhancement.
Munro, B. A., Weyandt, L. L., Marraccini, M. E., & Oster, D. R. (2017). The relationship
between nonmedical use of prescription stimulants, executive functioning and
academic outcomes. Addictive Behaviors, 65, 250-257.
doi:http://dx.doi.org/10.1016/j.addbeh.2016.08.023
Authorship- Marisa E. Marraccini is an Assistant Professor at the Alpert Medical
School of Brown University. Lisa L. Weyandt works as a professor at the Department of
Psychology, University of Rhode Island. Danielle R. Oster and Bailey A. Munro are
Doctoral Research Assistants in the same university. Thus, they have adequate
qualifications and resources to conduct the study. There were few discrepancies in the
study related to its generalization and inclusion of voluntary participants.
Research Aims- Executive functioning is the key factor that involves cognitive
flexibility and self regulation and is thought to underlie academic performance. Based on
preliminary research that revealed presence of educational difficulties among college
students, with EF deficits, this study aimed to understand the association between
executive functioning and non-prescribed use of psycho stimulants in a sample
population of college students (Munro et al., 2017).
Design- The study considered six different schools and public universities from
different regions and contacted with the staff and faculty via e-mail to seek their
permission for providing eligible participants for the study. Informed consent was taken
from the willing participants and they were made to complete two sets of questionnaire.
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CRITICAL EVALUATION 5
The demographic questionnaire contained questions on the age, gender, ethnicity, and
name of the university, and on being members of any fraternity or sonority. The SSQ
questionnaire measured non-medical use of prescribed psycho stimulants by the
students. The dimensions of the adult executive functioning were measured by the
Barkley Deficits in Executive Functioning Scale. A total EF summary score was
generated for the population. Statistical methods (t-test) were used for result analysis.
Findings- This study identified the relationship between non-medical use of
psycho-stimulants and executive functioning of the brain for the first time. It is evident
from the results that students with self reported EF deficits had a higher SSQ score.
This indicated that such students had an increased likelihood of being associated with
non medical use of psycho-stimulants (Gerlach et al., 2014). Furthermore, those
students also reported a lower grade point average than participants with moderate EF.
Strengths and weaknesses- The strength lies in the fact that the study was able
to successfully determine the relation between psycho-stimulants and executive
functioning of the brain. This was due to the presence of positive results in the survey
completed by the college students. It also helped in establishing academics as the
primary reason for drug abuse. Therefore, it had great implications in identifying
students at a risk for usage of these drugs and in creating intervention or prevention
policies related to their usage. One limitation was the presence of a convenient sample
that led to generalization of the study. Additionally the disproportionate number of
Whites and females caused a selection bias. Presence of only 3 participants having <2
GPA score increased the difficulty to assess psycho-stimulant effectiveness on the
brain. Furthermore, the study contained voluntary participants, which might not be the
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CRITICAL EVALUATION 6
suitable representatives of the entire population. Further research was needed to
evaluate the relationship between NMUPS, academic outcomes and EF.
PART B
Barriers for the application of evidence in practice- Evidence-based practice
(EBP) is therefore defined as an approach that focuses on solving problems with the
aim of improving health outcomes among several patients. This is achieved by
integration of best research evidences from well designed studies. Time management,
inadequate knowledge, limited IT access and skills, lack of motivation and patient
factors are some of the most common existing barriers in EBP implementation (Laska,
Gurman & Wampold, 2014). While applying evidence based research finding in a
practical environment, adequate knowledge is often unavailable. A sound knowledge on
psycho-stimulants is required before understanding its effectiveness in improving
academic skills. Lack of time and insufficient English proficiency also act as major
barriers while using evidences from research findings. Although, it is generally known
that psycho-stimulant drugs are used for the treatment of children with ADHD, their
probable effects on improvement of academic performance or cognitive skills of college
or university students had not been evaluated properly. Further, it is of extreme
importance to properly recognise the criteria, which will reflect a high quality research.
Lack of access to a large library, and inadequate computer resources are other barriers
in implementation of EBP (Rousseau & Gunia, 2016). In addition, time commitment also
creates difficulties in finding best evidence to questions on clinical practice. EBP
implementation is time consuming in clinical practice. It has replaced traditional
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CRITICAL EVALUATION 7
treatment plans. However, the discovery of new evidences often creates difficulty for the
researchers.
Alignment with PICO elements- The PICO format was completely followed by the
two research studies that were investigated by Wasim. They were built on a well
formulated format or framework in order to improve scientific rigour (Brignardello-
Petersen et al., 2015).
PICO format (Munro et al., 2017):
P (Population) - 6 public university students; I (Intervention) - NMUPS;
Nonmedical use of prescribed stimulants; C (Comparison) - Students with
NMUPS and EF deficits compared to those deficits; O (Outcome) - Measuring
effects of psycho-stimulant on executive brain functioning.
PICO format (Hildt, Lieb & Franke, 2014):
P (Population) - Psycho-stimulant using university students; I (Intervention) -
Psycho-stimulant effects on academic performance; C (Comparison) -
Respondents with stimulant use compared placebo controlled group; O
(Outcome) - Interview analysis of psycho-stimulant effects.
Conclusion
Thus, it can be concluded from the analysis of the two articles that there are
some potential side effects of every psycho-stimulant in addition to enhancing cognitive
functions. Although, the effects of prescribed and non-prescribed psycho-stimulants on
academic excellence of students belonging to different universities were assessed by
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CRITICAL EVALUATION 8
both the articles, one article established a better association between the two factors.
The first research was more successful in providing evidence. It is considered to
superior to the second study owing to the fact that the former study revealed that
enhancement of academic performance through the use of psycho-stimulants is not any
isolated phenomenon. The study stated that in addition to the administration of these
drugs, there lies a multifaceted life context that involves staying awake and alertness,
which are of crucial relevance in enhancing cognition. This improved cognition helps in
achieving better academic results. Furthermore, the findings also suggested that
administration of these drugs increase the motivation for leisure activities among the
students. Thus, the use of smart drugs by university classmates will alone not be
sufficient in improving their academic performance.
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CRITICAL EVALUATION 9
References
Brignardello-Petersen, R., Carrasco-Labra, A., Glick, M., Guyatt, G. H., & Azarpazhooh,
A. (2015). A practical approach to evidence-based dentistry: III: how to appraise
and use an article about therapy. The Journal of the American Dental
Association, 146(1), 42-49.
Gerlach, K. K., Dasgupta, N., Schnoll, S. H., & Henningfield, J. E. (2014). Epidemiology
of stimulant misuse and abuse: implications for future epidemiologic and
neuropharmacologic research. Neuropharmacology, 87, 91-96.
Hildt, E., Lieb, K., & Franke, A. G. (2014). Life context of pharmacological academic
performance enhancement among university students–a qualitative
approach. BMC medical ethics, 15(1), 23.
Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-
based practice in psychotherapy: a common factors
perspective. Psychotherapy, 51(4), 467.
Melegari, M. G., Nanni, V., Lucidi, F., Russo, P. M., Donfrancesco, R., & Cloninger, C.
R. (2015). Temperamental and character profiles of preschool children with ODD,
ADHD, and anxiety disorders. Comprehensive psychiatry, 58, 94-101.
Munro, B. A., Weyandt, L. L., Marraccini, M. E., & Oster, D. R. (2017). The relationship
between nonmedical use of prescription stimulants, executive functioning and
academic outcomes. Addictive behaviors, 65, 250-257.
Rousseau, D. M., & Gunia, B. C. (2016). Evidence-based practice: the psychology of
EBP implementation. Annual review of psychology, 67, 667-692.
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CRITICAL EVALUATION 10
Spencer, R. C., Devilbiss, D. M., & Berridge, C. W. (2015). The cognition-enhancing
effects of psychostimulants involve direct action in the prefrontal
cortex. Biological psychiatry, 77(11), 940-950.
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