Case Management: Blood Pressure and Lipid Level Control

Article Citation

McAlister, F., Majumdar, S., Padwal, R., Fradette, M., Thompson, A., Buck, B.,…

Shuaib, A. (2014). Case management for blood pressure and lipid level control after minor stroke: Prevention randomized controlled trial. Canadian Medical Association Journal, 186(8), 577-584.

Guidelines for Critiquing the Ethical Aspects of a Study

1. The Institutional Review Board (IRB) of the University of Alberta called the Health Research Ethics Board approved the study.
2. All the subjects offered written informed consent before taking part in the study.
3. The study does not present information about provisions for anonymity or confidentiality.
4. The study did not use vulnerable subjects because it used adult patients with ischemic stroke.
5. It does not appear that subjects might have been coerced into acting as subjects because all of them were adults 18 years and above and had given written informed consent before taking part in the study as subjects.
6. It is evident that the benefits of participation in the study outweighed the risks because the benefits involved the intervention of pharmacist-led case management aimed at improving the management of ischemic stroke or transient ischemic attack among patients while the risk involved the intervention of standard nurse-led management of ischemic stroke.
7. The study neither provided the opportunity for subjects to ask questions about the study nor informed them on how to contact the researcher if other questions arose because assessment of patients only took place once a month for six months.
8. The subjects were told how researchers could obtain the results of the study as they had to report to their respective clinics where monthly evaluations by nurses took place.

Guidelines for Critiquing Problem Statements, Purpose Statements, and Research Questions Based on the problem statement, purpose statement, or research question

1. The background information of the study presents the research problem area.
2. The study has a succinct problem statement and succinct purpose statement.
3. The study variables and the population are presented.
4. The determination can be easily made as to whether the study was quantitative or qualitative.
5. Analysis of the problem statements and purpose statements supports the decision that empirical data were gathered on the topic of interest in nursing.
6. It appears that the study was ethical because the subjects gave written informed consent and Institutional Review Board approved it.
7. The feasibility of the study is evident because the requirements are sophisticated, and the methodology is simple.
8. The significance of the study to nursing is apparent because it entails the determination of the comparative effectiveness of pharmacist-led management and nurse-led management of ischemic stroke.

Guidelines for Critiquing the Literature Review

1. The literature review of the study is not comprehensive.
2. The literature review of the study is very concise.
3. The review flows logically from the purpose of the study, which forms the basis of research.
4. All sources used are relevant to the study topic of management of ischemic stroke.
5. Sources are not critically appraised because the literature review is very concise.
6. The study includes current sources as their publication dates range from 1999 to 2013.
7. The study used paraphrases in all of its in-text citations.
8. The study does not present both supporting and opposing theories and research findings.
9. Critical examination of the sources used can allow the determination of whether they are primary or secondary sources.
10. All sources that are cited in the article are on the reference list.
11. The references appear to be free of citation errors because there is a consistency of the citation style.

Guidelines for Critiquing the Study Framework

1. The framework is not presented in the study.
2. The basis of the framework is not presented in the study.
3. Appropriateness of framework cannot be determined because the framework is not presented in the study.
4. The concepts in the study are not clearly defined.
5. The relationships among the concepts are presented.
6. The study identifies propositional statements that will guide the research question and hypothesis.
7. There are no operational definitions provided for the theoretical concepts that will be tested.
8. The article does not present how the researcher relates the study findings to the study framework.
9. It is not presented that the findings support the framework.

Guidelines for Critiquing Hypotheses and Research Questions

1. The study contains a hypothesis.
2. The hypothesis is not worded and concise because the background information insinuates that pharmacist-led management is more effective than nurse-led management of ischemic stroke among patients.
3. The hypothesis is not written in a declarative sentence because the study does not single out the hypothesis.
4. The hypothesis of the study is directly tied to the study problem.
5. There is not an identified study framework and thus the hypothesis is not derived from a framework.
6. The hypothesis does not contain the population and any variables of the study.
7. The hypothesis is stated as a directional research hypothesis because it holds that pharmacist-led management of ischemic stroke is more effective than nurse-led management.
8. The hypothesis of the study can be empirically tested using a chi-square test and a two-sample independent t-test.
9. The hypothesis does not contain only one prediction because the study has many independent variables, which give diverse outcomes.

Guidelines for Critiquing Quantitative Research Designs

1. The design is identified and described in the research report as a prospective study of six months with a randomized controlled trial and the blinded assessment of outcomes.
2. The design is appropriate to test the study hypothesis and the research question it experimentally determines the level of blood pressure and cholesterol.
3. The study used an experimental design, which was the most appropriate because it was a prospective, randomized, and controlled trial.
4. To control for threats to internal validity, the blind assessment was used to avoid the experimenter’s bias while randomization of subjects was used to prevent selection biases. To control for external threats to validity, eligibility criteria and matched experimental conditions were used to ensure that the selected subjects effectively represented the population,
5. The experiment clearly described the assignment of subjects to the experimental and control groups.
6. The research design allows the researcher to draw a cause-and-effect relationship between the treatments, which are nurse-led management and pharmacist-led management.
7. As the study used the experimental design, the use of a non-experimental design would not be appropriate because the outcomes are dependent on the treatments employed.
8. In the experimental design, inclusion and exclusion criteria were means used to control for extraneous variables, such as subject characteristics.

Guidelines for Critiquing Qualitative Designs

1. The study of ischemic stroke management does not lend itself to study by qualitative methods, and thus, the quantitative approach is more appropriate than the qualitative approach.
2. The study does not focus on the subjective nature of human experience.
3. Qualitative approach is not presented.
4. The study findings have significance for nursing because they demonstrate that pharmacist-led management of ischemic stroke is effective.
5. The researchers clearly describe how participants were selected using eligibility criteria, which provided the inclusion and exclusion criteria.
6. The sample size of 280 subjects was determined based on expected outcomes pharmacist-led case management of 10% over and above other interventions.
7. The study fully presented the data collection and recording process, which entailed the monthly assessment of the blood pressure and lipid profile of subjects.
8. It is clear how researchers avoided bias in data collection because they employed predefined eligibility criteria and randomization.
9. The data analysis method is consistent with the purpose and approach of the study because chi-square was used to ascertain the association between blood pressure and lipid control and binary outcomes. Moreover, the two-sample independent t-test was used to establish the difference of binary outcomes between groups, and multiple logistic regression was used to adjust the effects of extraneous variables.
10. The study presented the findings using tables and statistics. Moreover, the study acknowledged the existence of five limitations, namely, the short period of study, underpowered measurements, high attrition, unblinded study, and low external validity.
11. The study does not make any suggestions for further research based on the study findings.