Critical Evaluation of Evidence: HLSC122, Semester 2, 2017 Report

This report critically evaluates two research articles. The first article, by Hildt et al. (2014), explores the life context of pharmacological academic performance enhancement among university students using a qualitative approach. The report assesses the methodology, including the semi-structured interviews and participant selection, and discusses the strengths and weaknesses of the study, such as potential biases and the lack of saturation criteria. The second article, by Munro et al. (2017), investigates the relationship between nonmedical use of prescription stimulants, executive functioning, and academic outcomes through a quantitative study. The report evaluates the research methods, including the use of questionnaires and sampling techniques, and highlights the ethical considerations and presentation of findings. Both studies are analyzed for their relevance to health practice, considering barriers to applying the evidence in practice, such as the target audience's understanding of stimulants and the cost of accessing research papers. The report concludes with a discussion on the implications of the research for students, researchers, and the broader field of health and medicine.

Title page
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Unit: HLSC122 Semester 2, 2017
Assessment 3: Critical Evaluation of Evidence
Word count:
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Introduction:
While more and more health research findings were published to contribute to
the social life, there has been increasing concern about the quality and reliability of this
information (Rai et al., 2016). Inaccurate findings may lead to imprecise applications. To
prevent the misinformation, it is vital to critically appraise the existing scientific evidence
for better understanding on which information can be considered as appropriate.
According to Hill et al., (2001) he defined critical appraisal as a systematic process of
examining evidence of the research to prove its validity, relevance, and results before
using it to make the decision. This was an essential skill to informed decision-making in
health care practice (Mhaskar et al., 2009).
Body:
PART A
A1. Critical Appraisal of the first article of Hildt et al
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
This part will critically appraise an article of “Life context of pharmacological
academic performance enhancement among university students - a qualitative
approach” from Hildt et al (2014). The first thing to do when analyzing a research paper
is to look at the authors and their expertise, qualifications, and role in the study (Borbasi
& Jackson., 2016). This research was implemented by three authors named Elisabeth
Hildt, Klaus Lieb and Andreas Günter Franke. These researchers were all Professor
with a lot of experiences on the research topic. Especially, the first author is an expert in
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neurotics as stated in the article. Through Google scholar, it is found that they had
worked together on several related topics on illicit stimulants used for mental
development. They also worked at the University of Mainz where the study was
conducted.
The research aim and questions were stated clearly in the abstract and
introduction part. The sensation of pharmacological of enhancing academic
performance using illicit and prescription stimulant like the Methylphenidate among the
students in the university. The research question included: Why there is the use of
stimulant by the student and other people in academic content? What are some of the
effect experienced by users and the consideration of value? Do the leaners gain any
academic advantage if they use a stimulant? What are the side effects experienced
from the use of stimulant? And finally, what are some of the impacts on student’s life?
The aim and questions of this study were specific and appropriate with authors’
research intention.
From the literature review, it was evident that the author realized that there was
lack of scientific pieces of evidence on the research topic that could be used to upkeep
the pro/cognitive things in individuals who were healthy in line with the effect of “smart
drug”. And the extent in which academic concert can be judged from getting high,
parting, and other devotions are not well indicated. Besides, it was found that the
widespread use of the potential cognitive drug on campuses and high school is about
the very less pro-cognitive effect and side effects mentioned in the literature and given
the probability of not taking drugs as prescribed and illegal drugs. It was also realized
that there was no qualitative research on the topic. The explanation for the dominant
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sensation of academic enactment cannot be explained by the existing epidemiological
studies. And can only be speculated concerning motivational factors and deeper
reasons. Therefore the author may decide to eliminate some of the lack of empirical
scientific data concerning real-world effects and contextual factors of academic
performance enhancement.
Regarding the research methodology; this was a qualitative research utilizing an
extensive self-developed semi-structured interview guideline in a face-to-face setting.
With the abovementioned type of research questions, a qualitative research was the
most suitable method to answer them. Regarding sampling method, participants were
accessed by public invitation through placards posting on public bulletin boards in the
University of Mainz campus inquiring about student who had attempted to use illicit or
prescription (psycho) stimulants for cognitive enhancement devotions to contact the
research team secretly via email. The exclusion criteria of participant selection were
shown in the method section. The study only accommodated healthy students who had
no psychiatric disorder, and current doctors’ instructions of medication were
accommodated in the findings. Due to this limitations, only a few students participated in
an interview. Only 18 students have reported the non-medical use of illicit stimulants
and a prescription for academic performance. And the article did not show any
statement related to the saturation criteria of this population. The data analysis was
conducted to ensure the objectivity with anonymous transcriptions and two independent
raters. But the interviewer bias and recall bias had not discussed yet. In specific, it could
be presented when the researchers asked about their experience on negative side
effects or increase in mental performance or when the participant could exchange
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information and interview questions in advance. Hence the selection bias was pointed
out and minimized by recruiting a trained psychologist and three trained interviewers.
Besides, the research time and interview places were not mentioned in the article.
Local Ethics of the Medical Association Rheinland approved this study, and each
participant was given a free tape-recording for the entire session as well as a written
informed consent of participating in the interview. So the authors followed the process of
a study as shown in the book of Dickens (Dickens, 2010).
Two rates were used to form independent categories. Further analysis was made
using categories with congruent content which were formed by both rates. However,
there was a consideration on the blinding for participants when they could inform each
other about the interview questions. Six categories were identified by the author, and
those categories were involving to the life setting of stimulant used to boost academic
performance. In the result part entailing context of stimulant applied exceeding boosting
of academic performance timing of use, subjective experience of enhancement,
pressure performance, results of enhancement, pressure of performance, and objective
academic results. These categories were presented by using narrative and verbatim
quotes. Under each category, the authors gave the participant’s detailed views on the
use of stimulants and CE to answer the respective research questions.
In summary, it can be concluded that this article showed the appropriate
research methods and matched findings with the research questions. Nevertheless, it
still had some weaknesses such as some bias have not yet mentioned and discussed;
no saturation criteria was stated; minor incorrect calculation: 38.9%  44.4% (n=8)
prescription stimulants or the allowance shouldn’t be informed in advance the selection
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process and interview
A2. Critical Appraisal of the second article of Munro et al
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
This part will critically appraise an article of “The relationship between
nonmedical use of prescription stimulants, academic outcomes and executive
functioning” from Munro et al (2017). The first author is doing her PhD program, and this
research was a part of her doctoral dissertation accessible at the University of Rhode
Island. The other three authors were PhD and had experiences on the research topic.
They all were qualified to conduct this research.
The main aim of the study is to distinguish the connection between executive
function (EF) and nonmedical usage of prescription stimulants (NMUUPS) in a large
sample of 5 regions in the US by the college students. Specifically, it was hypnotized
that:
1. There were high chances for the student who has reported EF as measured
by BEFS to report the nonmedical use of prescribed stimulants than an
average report of EF skills by another student.
2. The performance of academic performance and EF would be moderated by
NMUPS; Specifically, NMUPS was estimated to brace the relationship amid
EF and academic brilliance.
These hypotheses were appropriate with the literature presented in the
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introduction part. The author also found that there was difficulty in education for the
students who were experiencing EF deficit and these students were being involved in
risky behaviors. From the literature, it can be stated that the NMUPS are used by the
students who have EF deficit to help them overcome this deficit so that they can excel in
academic. However, up to now, no researcher has researched to determine the
relationship between EF and NMUPS among the population of college students. So,
they hope those study findings would be valuable in deceitful inhibition and intervention
programs.
Regarding research methods, this was a quantitative study using measures of
The Stimulant Survey Questionnaire (SSQ), BDEFS and grade point average (GPA).
Faculty and staff assisted in doing sampling. They forwarded emails containing a link to
the survey to the students who were willing to participate and were eligible. The same
data was also posted on the official Facebook web page of the public university to
attract participants. The interested students who provided consent were interviewed. A
total of 308 undergraduate students recruited from six public US universities. This
sampling method also ensured the blinding enrolled for the study. However, it also
revealed some selection and information bias that had been discussed in the limitation
of the research. Instruments and its reliability and validity are the important criteria to
evaluate the quality of research (Ingham-Broomfield, 2008) (Polit & Hungler, 2013). The
SSQ and BDEFS that respectively measure the nonmedical use of instruction stimulant
medication in universities in the error of their time in school and to evaluate the
measurement of EF of adults in daily life were necessary questionnaires to attend to the
research question. Good reliability was demonstrated as a proof of high internal
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consistency. IRB proved this study at six public universities located in southern,
northern, southwest, south-east, northwest, and central-Midwest of US but not from
Ethical Committee. Additionally, no statement was declared for informed consent.
Hence, it was not followed the standard of an ethical issue, and the participant might be
not free from harm (Dickens, 2010).
Regarding the results, it would be consistent with two above hypotheses and
concisely presented by tables and interpretation that was more visual for the readers
(Burns & Grove., 2009) (Richardson-Tench et al., 2016). However, the information in
the tables and the interpretation was not quite relevant. For instance, the population of
the endorsed participant with an idea of students nonmedical use stimulant that is
prescribed while reading, in the final week more than 71% use stimulant that is not
prescribed. 70.5% are used during exams while “during tests” (62.7%) were shown in
table 2 as wrote in the article. P value also was not marked in the tables. It was hard for
readers to follow the research findings.
To sum up, this study had some strengths involving in good instruments and data
analysis, but the weakest points were ethical issue and presentation as well as
interpretation of findings.
PART B
The application of evidence in practice should not be ignored because of
individual barriers of the study population (Greenhalgh et al., 2016). The targeted group
was the students who normally lack understanding on using stimulants. As indicated in
both studies, stimulants were used not only for academic performance enhancement
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but other purposes. They also have limited skills to refuse of using this kind of smart
drugs. Besides, they lack research skill to understand thoroughly on the risk of using
drugs whereas Munro’s study also has not proved the relationship between stimulant
use and EF deficits. It is clear that there were limited readers in this research topic. The
topic related to psychology and neuroscience is quite difficult that not everyone can
understand it. Concerning organizational barriers, it was costly access these research
papers. In other hands, the universities would not interfere too much with student’s life.
Therefore, the support for the student will be lacking. Also, there was still a long way for
researchers to have shreds of evidence on the risk of using smart drugs for academic
enhancement. More resources and budget will be needed.
In Munro et al’s article, the PICO elements were provided clearly while in Hildt et
al’s study, there was no comparable group due to the type and design of this qualitative
research. The population of two studies was also the university scholars who were
popularly using the nonmedical use of prescription drugs
Conclusion
To sum up, the answer to the clinical question is unclear. It can’t be concluded
whether stimulants increase academic performance in university students or not. It
depends much on the way to implement a study to produce research findings on that
topic. Further studies should be conducted on this problem, and some meta-analysis
based on applied research findings will be able to give the most reliable answer for that
question.
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References
Borbasi, S., & Jackson, D. (Eds.). (2016). Navigating the maze of research: Enhancing
nursing and midwifery practice. (4th ed.). Chatswood, Australia: Elsevier
Dickens, B. M. (2010). Ethical issues in health. MEDICAL AND HEALTH SCIENCES-
Volume VII, 92.
Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., & Warland, J. (2016). Understanding
Research Methods for Evidence-Based Practice in Health 1e.
Grove, S. K., Burns, N., & Gray, J. (2013). The practice of nursing research: Appraisal,
synthesis and generation of evidence (7th ed.). St. Louis, MO: Elsevier/Saunders
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
Hill, A., & Spittlehouse, C. (2001). What is critical appraisal? (Vol. 3). Hayward Medical
Communications.
Ingham-Broomfield, R. (2008). A nurses' guide to the critical reading of research. Australian
Journal of Advanced Nursing, The, 26(1), 102.
Mhaskar, R., Emmanuel, P., Mishra, S., Patel, S., Naik, E., & Kumar, A. (2009). Critical
appraisal skills are essential to informed decision-making. Indian Journal of Sexually
Transmitted Diseases, 30(2), 112–119. http://doi.org/10.4103/0253-7184.62770
Munro, B. A., Weyandt, L. L., Marraccini, M. E., & Oster, D. R. (2017). The relationship
between nonmedical use of prescription stimulants, executive functioning and
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academic outcomes. Addictive Behaviors, 65, 250-257.
doi:http://dx.doi.org/10.1016/j.addbeh.2016.08.023
Polit, F. D., & Beck, C. T. (2013). Essentials Nursing Research Methods, Appraisal, and
Utilization. Lippincott, Willams Wilkins.
Raj, S., Sharma, V. L., Singh, A. J., & Goel, S. (2016). Evaluation of Quality and readability of
health information websites identified through india’s major search engines. Advances
in preventive medicine, 2016.
Richardson-Tench, M., Taylor, B., Kermode, S., & Roberts, K. (2016). Inquiry in health care
(5th [ACU] ed.). South Melbourne, Australia: Cengage Learning.
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