Critical Appraisal of Randomized Controlled Trial: Detailed Analysis

This report provides a critical appraisal of a randomized controlled trial (RCT) evaluating the effectiveness of emergency nurse practitioner (NP) services in achieving timely analgesia. The assessment addresses key aspects of the RCT, including randomization, patient accounting, group similarity, treatment equality, and the size of treatment effects. The analysis examines whether the results can be applied to a different context and if the benefits outweigh the harms and costs. The report evaluates the study's methodology, findings, and conclusions, highlighting the NP services' effectiveness in providing timely analgesia compared to standard care. The study found that NP services can administer analgesia within a shorter time frame and offer quality patient care. The report also addresses the limitations and ethical considerations of the study.

CRITICAL APPRAISAL OF
RANDOMISED CONTROLLED TRIAL

Table of Contents
INTRODUCTION...........................................................................................................................1
ASSESSMENT 2.............................................................................................................................1
2. Was the assignment of patients to treatment randomised?.....................................................1
3. Were all the patients who entered the trial properly accounted for at its conclusion?............1
5. Were the group similar at the start of the trial?.......................................................................2
6 Aside from the experiment intervention, were the groups treated equally?.............................2
7 How large was the treatment effects........................................................................................3
9 Can the results be applied in your context?.............................................................................4
11 Are the benefits worth the harms and costs?..........................................................................4
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Present study is based on critical appraisal of randomised controlled trial. In order to
address the randomised controlled trial report has taken support of evaluating emergency nurse
practitioners service effectiveness on achieving timely Analgesia article. Assignment has
answered several questions in order to evaluate the quality of RCT's.
ASSESSMENT 2
2. Was the assignment of patients to treatment randomised?
Yes
No
The entire study has been conducted by taking support of randomized controlled trial.
This has helped in making comparison between effectiveness of NP service and standard medical
care in emergency department in hospitals of Australia. Researcher has adopted pragmatic
randomized controlled trial design (Jennings and et.al, 2015). Patients were randomly assign to
get NP or standard care.
How was carried out
The entire study has been carried out as per the national statement on ethical conduct in
human research. Scholar has taken prior approval from the university and hospital human
research department (Carr, 2006). Individual has follows all ethical aspects and have taken
written consent from all the participants in order to minimize complications in the future.
Researcher has undertaken trial on 65000 patients. Aim, methods and protocols have been
reported to the department.
Was the allocation sequences concealed from researchers and patients?
No each person was well aware with the allocation of sequences and it was not
concealed from researchers and patients (Neuman, 2014). Allocation sequence was generated
through computerised manner and each patient and staff member was aware with this treatment
allocation. Each treating staff were able to get prior information before starting of trial.
3. Were all the patients who entered the trial properly accounted for at its conclusion?
Yes
Can's tell
No
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All the patients those who were entered for the trial were not properly accounted for at its
conclusion. It is essential in the research that individual involve all the participants in the study
in order to draw valid conclusion (Silverman, 2016). The trial was undertaken in one adult
tertiary ED. NPs were designed for providing quality care to the patients. But in this research in
treating staff and patients were ware with the trial outcome. Investigator has blinded all the
allocation groups with the results.
Was the trial stopped early?
No trial did not stop early, it has taken it full-time so that positive results can be
generated (Ledford and Gast, 2018).
Were patients analysed in the groups to which
they were randomised?
Yes patients analysed in the group to which they were randomised. Patients were
allocated to the control group and they were managed by medical officers.
5. Were the group similar at the start of the trial?
Yes
No
Yes selected group were similar at the start of the trial. From starting to the end
researcher has taken the same group members so that no complexity can get arisen in the study
(Jennings and et.al, 2015).
Other factors that may affect outcome
There are many elements that may impact on the outcome of entire study. These are age,
sex, social class etc (Carr, 20060. If the patient is old age then it may affect the results of the
treatment. Medical professionals have to give different treatment of different age group person.
Thus, results may get influenced if there is old age person. On other hand sex is another major
element (Nardi, 2018). Body mass of male and female is different from each others. In such
condition researcher can find difficulty in examining the outcome of the study on different sex
people. Social class is considered as another major element which impacts on overall outcome of
the research (Jennings and et.al, 2015).
6 Aside from the experiment intervention, were the groups treated equally?
Yes
Can't tell
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No
Yes there were two groups in the experiment and both these groups were treated equally.
Both these groups have got same attention and care from the NPs. There was no issue in related
to getting care (Neuman, 2014). Researcher was well aware with the ethical aspects thus,
individual has focused on the equal treatment so that desired results can be obtained.
7 How large was the treatment effects
Outcome measured
There were 265 patients in the investigation and out of 265 there were 260 those who
were randomly assigned. It has been found that 128 people are receiving standard ED medical
led care and 130 receiving NP care (Silverman, 2016). Treatment groups were balances and on
the bases of demographic characteristics of individual treatment have been provided to all
patients (Cook and Reed, 2015). Researcher has taken care of age, sex any other demographic
aspects. The outcome has been found that patients with pain are able to get treatment within 30
minutes. NPs are managing the people well as compare to standard care group. It has been
identified that nurse practitioners are providing treatment to the patients at minimum period of
time as compare to standard care treatment process (Jennings and et.al, 2015).
Is the primary outcome clearly specified?
Primary outcome was clearly specified to some extent. There were 28 patients those who
have refused analgesia during ED episodes of care. People those who have received analgesia
within 30 minutes from being seen were 49.2% in NP group but 29.7% received standard care.
The difference between both these care was 19.5% (Ledford and Gast, 2018).
What results were found for each outcome?
In the primary outcome it was found that There was different time to analgesia for the
patients. First pain score is recorded 71.1% for the standard care and for NP care its was 63.%. A
subsequent pain score was documented 9.3% for standard care patients and 13.1% for the NP
care patients (Jennings and et.al, 2015). Thus, there is no major difference in median change
between both standard and NP care. On other hand from the secondary results it was found that
time to analgesia in both standard and NP are difference from each others. In the secondary
outcome it was analysed that NP care method is more effective as compare to standard care. NP
services are able to quickly respond or administered the services within 30 minutes following ED
arrivals (Green and Thorogood, 2018). From the secondary results it has been found that
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Wilcoxon Breslow test reflect that there is difference in median time (Neuman, 2014). Previous
studies have reflected that documentation of pain score is less than 37% but current study has
found 67% documentation in first pain score. The study has shown that NO services are giving
effective results and they have interrelation with quality of patient care (Ledford and Gast, 2018).
Thus, current results have shown scope of NP service models and there effectiveness in order to
deliver analgesia within national benchmarks (Padgett, 2016).
9 Can the results be applied in your context?
Yes
Can't tell
No
From the study it can not be determined that results can be applied to the local population
or not because demographic character of each person is different,. Changes in age, sex, social
class may impact on overall results (Jennings and et.al, 2015). Thus, it is difficult to measure that
where same results will be generated or not. Thus, it can not be said that results can be applied in
context or not.
In the present research, scholar has selected the patients on the bases of their specific
criteria. Researcher has looked upon their demographics characteristic. But it can not be
measured that local population will have the same criteria (Neuman, 2014). Thus, patients
covered by the trial are not similar enough to the patients to whom experiment will apply this.
They all have different body mass, different beliefs. In such condition it is difficult to examine
the test on then and get the same results.
11 Are the benefits worth the harms and costs?
Yes
Can's tell
No
No benefits are not worth the harm and cost. All the efforts that have been made in the
study have given desired results to the scholar.
There was some things which were not addressed. The study was required to concentrate
more on ED service limitation (Ledford and Gast, 2018). This is very important to analyses
effective pain management system and finding issues in delay accessed to ED care. Researcher
have not included overcrowding, lack of bed, inconsistent practices among clinicians. All the
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patients those who have participated in this study must have opportunity to manage their pain
through best management practices.
CONCLUSION
From the above study it can be concluded that emergency nurse practitioners services
take less time as compare to standard care services. NP's are able to apply best practices for
managing pain of the patients. It is essential for the practitioners that to take support of these
services by this way they will be able to meet with the medical needs of patients and can be able
to provide them quality care services.
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REFERENCES
Carr, W., (2006). Philosophy, methodology and action research.Journal of philosophy of
education. 40(4). pp.421-435.
Cook, D. A. & Reed, D. A., (2015). Appraising the quality of medical education research
methods: the medical education research study quality instrument and the Newcastle–
Ottawa scale-education. Academic Medicine. 90(8). pp.1067-1076.
Green, J. &Thorogood, N., (2018). Qualitative methods for health research. Sage.
Jennings, N. and et.al., 2015. Evaluating emergency nurse practitioner service effectiveness on
achieving timely analgesia: a pragmatic randomized controlled trial. Academic Emergency
Medicine. 22(6). pp.676-684.
Ledford, J. R. & Gast, D. L., (2018). Single case research methodology: Applications in special
education and behavioral sciences. Routledge.
Nardi, P. M., (2018). Doing survey research: A guide to quantitative methods. Routledge.
Neuman, L.W., (2014. Social research methods. Pearson Education Limited.
Padgett, D. K., 2016). Qualitative methods in social work research (Vol. 36). Sage Publications.
Silverman, D., (2016). Qualitative research. Sage.
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