Randomized Controlled Trials

The purpose of this paper is to present an analysis of a quantitative article using Melnyk & Fineout-Overholt’s (2015) rapid critical appraisal (RCA) for a randomized clinical trial. Topics included are the validity of the research, results of the research and how the information can be applied to the clinical care of my own patient population.

The author considers the simplest way of finding out best practice is by using guidelines. According to Field & Lohr (1992) guidelines are “systematic developed statements to assist practitioners and patients decisions for specific clinical circumstances.” Evidence is always current and a generous collection of many different systematic research reviews with multiple random control trials are available (AGREE, 2000). These types of trials are graded at the top level of hierarchy (Guyatt et al 2002).Nevertheless in contrast Devereaux and Yusuf (2005) argue that top level hierarchy is not a guaranteed deviation from the truth in randomized trials. The clinical guidance used is the National Institute of Clinical Guidance (NICE 2009) is based in the author’s homeland and is an independent organisation responsible for providing guidelines. The ethos behind NICE (2009) is to promote and prevent poor health nationally involving the public, health professionals and patients in the process (NICE 2009).

The National Guideline Clearinghouse provides information on clinical practice guidelines and the US Preventive Task Force provides recommendations for screenings and counseling based on the patient’s gender, age, race, etc. Both supply information for disease prevention and evidence based clinical practices that providers can use daily while caring for their patient. The recommendations and guidelines that are provided on the AHRQ website are ever evolving as new information becomes available thus allowing providers to keep up with current practice. The days of providing care based on “this is how it has always been done” are gone. The AHRQ guidelines and recommendations is the go-to website for medical providers looking to provide best care for their patients by following evidence based

Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned

Many organizations have developed practice guidelines for a myriad of clinical scenarios which include the use of specific drugs or classes of medications, typically in a step-wise pattern. These “Best Practice” guidelines are built on evidence based criteria and systematic reviews. It has been shown that these clinical guidelines, with their list of essential medications, improve the quality of care and lead to better outcomes, but have not been shown to reduce costs.4,5 The practice of medicine has moved dramatically towards the use of these guidelines in recent years. For example, best practices for diabetic care recommends that all patients be placed on an ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker) for prevention of diabetic nephropathy and a statin for prevention of coronary artery disease. However, each patient’s insurance may cover a different medication in this class

The process used to pool the data together was clinical trial decision making. The main factors influencing this process consist of patient, provider, and treatment. Two studies specifically explored decision making by the patient. Education requirements impacted decision making since understanding the risks and benefits of clinical trials was the most important factor taken into consideration by the patient. Educational interventions were noted to have increased patient enrollment. (Biedrzycki, 2010).

The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies.

The use of this systematic approach allows the reader to quickly discard papers which do not meet inclusion criteria.

In this article Munro, Watson, and McFadyen, (2006) conduct a controlled trial in which assesses the significance of the training personnel who work directly with people who possess mental health and substance e abuse problems receive. The sample was administered in a NHS mental health service and incorporated a sample size of 49 (27.8%) mental health nurses, either in adult generic mental health or addictions services, out of 176 nurses who were initially invited to take the survey. 24 of the nurses were assigned to the experimental group (receiving training) and the rest (25) of the nurses were sent to the control group (receiving no training). Data was retrieved at three different times using surveys. The first survey was taken before training , training would last for 4 days, and then the latter two surveys were allotted following right after and then again 6 months later.

The topic in this systematic review is clearly defined in the abstract & the introduction. Yes, the search for studies and other evidence was comprehensive and unbiased as it was able to be. Strict criteria were followed as described in Figure 1.

In a study done by Emadedin et al. in 2012, they injected MSC from each respective patients bone marrow, into six female volunteers with evidence of knee OA that was severe enough to require joint replacement surgery. The authors described a detailed, meticulous procedure in how they obtained the MSC from the patient’s bone marrow, and made it into the cells they needed for the procedure. They injected the patient’s affected knee joints with the stem cells and followed up with them in one year. At the one year mark, Emadedin et al. (2012) found that overall, the study was successful in decreasing pain and increasing the patients walking distance for the first 6 months. However, they discovered that 3 of the

In their research, Cohen, et al. (2001) and colleagues suggest that randomized controlled trials conducted in research settings, may not provide the whole picture about the most

Both clinicians who are enquiring clinical questions and researchers who are conducting in-depth searches for systematic reviews come across a few

Healthcare and the dispensing of targeted care under systematic assessment and diagnostic circumstances are becoming more streamlined with the advent of ICD-10, or International Classification of Diseases and Related Health Problems, code system (World Health Organization, 2015). Since 1979, clinicians, practitioners, and referring physicians have been

Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)