Peer-Reviewed Article Analysis: Feeding, Pneumonia, and Dysphagia

This report presents a critical analysis of a peer-reviewed journal article by Li et al. (2015) focusing on the effect of feeding management on aspiration pneumonia in elderly patients with dysphagia. The analysis employs the framework developed by Caldwell, Henshaw, and Taylor (2005) to evaluate various aspects of the study, including the credibility of the authors, the rationale behind the research, the methodology used, and ethical considerations. The study by Li et al. (2015) investigated the impact of dietary interventions and feeding safety instructions on elderly dysphagia patients, dividing them into control and intervention groups. The analysis highlights the strengths of the article, such as its detailed methodology and relevant rationale, while also pointing out weaknesses, including the lack of a clearly stated aim, the absence of ethical considerations, and the absence of a hypothesis. The report concludes by emphasizing the importance of feeding management in reducing aspiration pneumonia incidence and improving the quality of life for elderly patients with dysphagia.

Running head: CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
Name of the Student
Name of the University
Author’s Note:

1CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
Li, M., Wang, Z., Han, W.J., Lu, S.Y. and Fang, Y.Z., 2015. Effect of feeding management
on aspiration pneumonia in elderly patients with dysphagia. Chinese Nursing Research, 2(2-
3), pp.40-44.
Introduction
Aspiration pneumonia is one of the foremost causes for mortality and morbidity in
elderly patients (Marik and Kaplan 2003). Almost 5 to 15 per cent patients hospitalised with
this disease die within first thirty days of admission (Chalmers et al. 2017). Nurses play a
major role in caring for these elderly patients who are suffering from dysphagia. To reduce
the mortality rate novel therapy is required in this field as well as careful actions are required
from the nurses. Hence, the above mentioned article was selected. The aim of this article is to
critically analysis the paper published by Li et al. (2015) using the framework provided by
Caldwell, Henshaw and Talor (2005). The objective of the study published by Li et al. (2015)
is to examine the effects of dietary interventions and feeding safety instructions on the
dysphagia patients suffering from aspiration pneumonia. To investigate this goal, forty
elderly dysphagia patients were selected who were hospitalized in long term duration and
were in need of oral intake. Forty selected patients were divided equally in two groups for
control group and intervention group. A multi- disciplinary team were created which includes
rehabilitation therapist, clinical nurses, and nutritionist. The feeding procedure was managed
by all of them collaboratively. The patients in the control group of this study design were
provided with dense liquid, semi- solid food, and partial mushy nourishment according to
their preference, choices and taste whereas patients in the intervention group were provided
with only mushy diet. Patients have their food with assistance or by themselves. The
experiment was performed for three months. At the end of the intervention, it has been
reported that the incidence of the aspiration pneumonia has been reduced amongst both
groups. The difference of the findings was also statistically significant with a p value of less

2CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
than 0.005. One case in the control group was died because of aggravated dysphagia. Seven
participants in control group and four participants in intervention group had aspiration
pneumonia. During this study, no participants were quitted. From their investigation, the
authors have concluded that assistance and motivation is required for patients with dysphagia
to eat mushy diet. However, nurses should be there to provide guidance and safety
instructions. The authors of this study have concluded that mushy diet and oral intake can
decrease the aspiration pneumonia incidence as well as enhance the quality of life (Li et al.
2015).
Presently, many frameworks are available for critical review of a peer reviewed
journal. Few examples of these of frameworks are framework developed by Caldwell,
Henshaw and Talor (2005) and CASP checklist (Brice 2019). To critically evaluate the article
published by Li et al. (2015), framework developed by Caldwell, Henshaw and Talor (2005)
will be used. This framework was designed to use both as assessment aid and teaching tool.
One of most interesting features of this framework is that it will help students who are
critically review a research paper and do not have the clear understanding of quantitative and
qualitative research. The aim of this framework is to help student in their research paper
assessment and the students can use independently (Caldwell, Henshaw and Talor 2005).
Therefore, the framework developed by Caldwell, Henshaw and Talor (2005) will be used as
an assessment tool. The assessment of the article published by Li et al. (2015) is critically
evaluated and discussed in the next section. This article by Li et al. (2015) is a quantitative
study; hence Caldwell’s quantitative framework will be used in this scenario.
Discussion
There are many research available in the area of aspiration pneumonia (Guillon et al. 2011;
Kuyama, Sun and Yamamoto 2010), few research is available where aspiration pneumonia is

3CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
studied among the patient with dysphagia (Sue Eisenstadt 2010) and almost none is available
where authors have studied the effect of food management (Huang, Chiou and Liu 2017).
Therefore, each component of the Caldwell, Henshaw and Taylor (2005) quantitative
framework analysis is discussed for this article in the below sections.
Content reflectivity of the title: The title of this article is “Effect of feeding management on
aspiration pneumonia in elderly patients with dysphagia” and it is aptly reflect on the content
of this article as the main objective of this study is to examine the feeding safety and dietary
intervention in the elderly dysphagia patient suffering from aspiration pneumonia.
Credibility of the authors: The authors of this article are very much credible. The first
author, Min Li, of this article has more than 50 published articles in good peer reviewed
journal. The papers written by Min Li have more than 8000 citations in his published article.
Amongst them, 250 citations are h-index and i10-index citations (scholar.google.co.in 2019).
Therefore, it can be said that the authors of this article are credible.
Key components in the abstract: The abstract provided by the authors is concise and
managed to summarise the content of the paper in a very neat manner. The abstract had all
the key components in it like objective, methods, results and conclusion. Thus, a reader is
more likely to be interested to read the whole article as he or she will get concise and detailed
information about the article.
Rationale behind the research: The authors have researched thoroughly before conducting
the research. They showed that occurrence rates for dysphagia were 35.6 per cent, 43.7 per
cent, and 50 per cent amongst the age groups of 80 to 89 years old, 90 to 99 years old, and
100 years old respectively (Han, Sun and Yi 2012). They have also reported that the more
than 60 per cent people over 85 years old are suffering from dysphagia and this number is
likely to increase as predicted Chinese population over 80 years old will increase to 24

4CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
million (Jin, Zhang and Dou 2011). Hence, it can be concurred that the rationale behind their
research is clearly defined.
Up- to- date literature review: this article does not have any literature review section in
general. Only a brief introduction is provided in this article. However, references provided in
the introduction section are dated in the period of 2011 to 2013. This article was published in
the year 2015. Accordingly, it can be seen that the references are within the last five years at
the time of the publication of this article, thus the literature review section is up to date for
this article (Pontis et al. 2017). Therefore, the rationale behind this investigation is significant
and the objective of this study was derived from relevant data.
Aim of the research: No clear aim of this study is mentioned by the author. The author have
mentioned the objective of the study in the introduction section which is to investigate and
examining feeding management of the elderly dysphagia patients who are suffering from
aspiration pneumonia. According to the author this will be performed by forming a
multidisciplinary team consisting of rehabilitation therapist, clinical nurses, and nutritionist.
Therefore, no clear aim of the research is mentioned in this article. This particular aspect can
be depicted as a drawback for this investigative study.
Hierarchy of evidence: The aim of this article is find out whether their intervention therapy
works on the dysphagia patients suffering from aspiration pneumonia. Hence, according to
the Aveyard and Sharp (2013), this research article fall under the traditional ‘Hierarchy of
evidence’. The author of this study works with two group: one was control group and another
was intervention group. Therefore, this study falls under the case controlled studies. Hence,
this article have ‘third highest hierarchy of evidence’ (Aveyard and Sharp 2013).
Evaluation of ethical issues regarding this investigation: No mention of ethical
consideration is present in this article. There is few scenarios where it ethical implications

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can be considered. But the authors have not provided any information regarding this matter.
The authors have not mentioned whether they take any consent from the patients before they
were included in the survey. Also, in the introduction, authors have mentioned that they have
taken a survey of 931 senior citizens. They have not provided any details about the
questionnaire techniques and whether the surveys were taken anonymously to maintain the
privacy of the participant (Mort et al. 2015). Hence, this is a disadvantage for this study as no
ethical implications were considered.
Justification and identification of methodology: The methodology section of this article is
just and appropriate for this type of investigation. The authors have provided very detailed
information about participants whom took part in this investigation. The article is revolved
around the feeding habits and diet of the participants. Hence, the authors have successfully
included the diet safety instruction, so no mishaps happen during the investigation. Along
with that, the authors have also provided detailed information regarding eating status, eating
posture, tableware selection, time and effort required for each swallow, feeding time, oral
hygiene, and observation of breathing. To prevent any aggravation of aspiration and choking,
treatment method was considered. As mentioned above, this a quantitative study and the
authors have rightly used statistical tool to examine the significance of their study. The
authors have used the software SPSS 20.0 to process and analyse the collected data. Thus, it
can be inferred that the methods and material section is an advantage for this study.
Rationale behind the study design: As mentioned in the above section, the material and
methods section is very detailed and apt. Each procedure is explained clearly and the
rationale behind the methods is provided in the section. For example, the diet should be taken
into consideration as the objective of this study examine the effects of dietary interventions
and feeding safety instructions on the dysphagia patients suffering from aspiration
pneumonia. Among them, conditions of few patients are serious and all of them are old.

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Hence, a safety net is required in this scenario and the authors have considered that aspect.
Another example is that the authors have clearly mentioned why a multi- disciplinary team is
required and the function of the each of the members’ roles and responsibilities. For that
reason, it can be said that the rationale behind the study design is clearly evident.
Experimental hypothesis: No hypothesis was adopted by the authors for this investigational
study. The authors have identified a research gap which needs to be addressed and they have
designed their experimental design accordingly. The objective of their study was to
investigate the effect of the feeding management of the elderly dysphagia patients who are
suffering from aspiration pneumonia and the authors did not adapt or assumed any hypothesis
for this experimental design (Moore et al. 2015). This particular aspect might be considered
as a drawback to this article.
Key variables: The goal of this article was to study the effect of feeding management and
comparison between the control and intervention groups about the presence of aspiration
pneumonia. To achieve that objective, key variables needed for the examination are clearly
defined in the methods and material section. However, in the result section the effect of this
key variables were not portrayed and only the presence of the aspiration pneumonia is
mentioned.
Identification of population: In this study the identification of the population is very clearly
defined. The data related to the population was clearly mentioned in this article. Not only that
the selected participants were gone through inclusion criteria. Authors have both inclusion
and exclusion criteria are in place for participant selection. Both the inclusion and exclusion
criteria have two parameters. A total of 95 cases were analysed for this study and only 40
cases were included in the final investigation. Apart from that clinical data of the each patient
were also collected. These data was also tested for significance difference and no significance

7CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
difference was found between the groups with a p value greater than 0.05. This implies that
the all the sample collection was similar before the intervention and there was no significance
difference between the groups. Standardized Swallowing Assessment was used for the
diagnosis of the dysphagia (Jiang et al. 2016).
Reflectivity of the sample against population: yes, the samples used in this article are
reflective of the general population of the society. The patients were admitted in the geriatric
ward in Huadong Hospital and were suffering from aspiration pneumonia. The authors have
investigated and applied their intervention method in the patients who are reflective of the
population in the society. Hence, it can be said that the intervention method applied in this
method are reflective of the population in the society.
Validity and reliability of the data collection method: the data by the authors for their
intervention is valid and reliable. Significance test have been performed before the start of the
intervention and after the intervention between the groups. The difference between the groups
before the intervention was not significant (p value more than 0.05) and difference between
the groups were significant after the intervention (p value less than 0.005). This implies that
the difference occurred between the groups was due to the intervention and thus can be
concluded that the data collection method is valid and reliable (Kooiman et al. 2015).
Validity and reliability of the data analysis method: the authors have performed
independent t-test for inter group comparison and chi square test was used for the comparison
between groups. The analysis was performed on the software SPSS 20.0. Studies have
reported that the chi square test and independent t-test is good measurement tool to analyze
validity and reliability of the data (Mertler and Reinhart 2016). Hence, it can be concur that
the data analysis methods are valid and reliable.

8CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
Presentation of result: The result presented by the authors leaves a lot to be desired. They
have provided the end result of their findings. They have not provided how the different
parameters have effect on their study and findings. They have mentioned that their
intervention is effective as there is reduction of aspiration pneumonia after the intervention.
While this data is correct and statistically significant, the authors have not delve dipper in to
the investigation like whether threshold duration of the intervention (Ebihara et al. 2016).
Comprehensibility of discussion: The discussion provided by the authors in this article is
comprehensible and discussed in detailed and flowing manner. Additionally the discussion
section was divided in the sub section for better understanding of this study’s findings.
Additionally, the findings of this study can be generalized and applied to the population.
Thus, in can be inferred that the discussion section of this article is comprehensive and to the
point.
Comprehensibility of conclusion: The authors have provided a very concise and to the point
conclusion. They have provided their findings in brief and concise manner which helps them
to establish the fact that their investigation has managed to achieve the objective established
at the start of the investigation. Therefore, it can be said that the conclusion section of this
article is comprehensive and concise.
Conclusion
Therefore, from the above discussion, it can be said that the authors have managed to achieve
their objective established at the start of the investigation. This article is one of the few article
which studied the effect of feeding management for aspiration pneumonia among elderly
patients with dysphagia. Overall study designing, data collection method, data analysis and
population identity are strong in this article. Their invention method has managed to reduce
aspiration pneumonia and the findings is very much significant (p value less than 0.005).

9CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
However, this study has its flaws and drawbacks. The authors have considered the ethical
implication of their study and presentation of their result leaves a lot to be desired.
Nevertheless, the strong aspects of this article are far outweighs the limitation of this article.
Additionally, the findings from this article can be generalised and transferred to the general
population of the society. Thus, to conclude, it can be said that this investigation is a quality
research and have applicability to the society even though it has few limitations.

10CRITICAL ANALYSIS OF A PEER REVIEWED JOURNAL ARTICLE
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