The Review Of Randomised Control Trials

The Review Of Randomised Control Trials The effectiveness of the methodological approach used in any study most certainly determines the accuracy and reliability of the research hence the need to select the most viable methodology. Subsequent studies indicate that the use of a poor methodology is not only misleading but it could also lead to detrimental consequences in the event that the results of the study are used as a basis for decision making or implementation of recommendations. Further, different methodologies are expected to be more effective in particular experiments only. The use of Randomised Control Trials Research is highly popular in nursing and medicine due to its effectiveness in obtaining outcomes that are relevant, mostly in testing the safety of treatments and drugs before they can be fully utilized in the health care system. RCT as Randomised Control Trials Research is often abbreviated is popular because unlike other methodologies, allocation bias is minimised and prognostic factors that are known or u nknown to the researcher are balanced, thus giving accurate results. This paper seeks to critique Randomised Control Trials Research with a view of establish its philosophical foundation and its application in research. In this regard, the paper also includes a critique of three experiments that were done using Randomised Control Trials Research. Methodological review The history of Randomised Control Trials can be traced back to about 600 B.C. It was first recorded by Daniel Judah, whose research is probably the earliest as far as clinical research is concerned. He sought to establish the effects of royal Babylonian diet and the vegetarian diet for a time period of 10 days (Stolberg, Norman Trop, 2004). While his research was devoid of contemporary medical standards such as ascertainment bias, allocation bias and confounding by divine intervention, the research has remained an influential record in the history of Randomised Control Trials. Major advancements were recorded in the 19th century. The credit for modern CRT is attributable to Sir Austin Bradford Hill. This was witnessed during the Medical Research Council trials which sought to test streptomycins effectiveness in treating pulmonary tuberculosis. The research is considered a landmark research in medicine and since Hills achievement, the use of randomised control trials has grown except ionally (Stolberg, Norman Trop, 2004). RCT are actually considered the basis for evidence-based medicine. Randomised Control Trials are used in modern day health care and medical trials in assessing the effectiveness of interventions such as drugs and medical procedures. Randomised Control Trials Research is a methodology that is highly popular in the medical and health services sector and which has been used in testing the efficacy of drugs, treatments and health care services such as nursing and medicine (Rosenberger Lachin, 1993; Jadad, 1998). Randomised Control Trials Research (RCT) is distinguished by the fact that once the eligible study subjects have been identified, they are put through one or other of the studys alternative treatments before the intervention to be studied begins. Once the study groups are randomized, they are followed up in exactly the same way and specific care standards are given to each study group depending on the research being performed (Edwards, Lilford Hewison, 1998). The use of Randomised Control Trials Research is considered highly effective because it minimises allocation bias to a significant level. Further it is possible to balance the known and unknown prognostic factors such that the treatments are more accu rate unbiased and reliable. A significant characteristic of Randomised Control Trials Research is that tests usually include a control experiment alongside the main treatment (Charlton, 1995). These are known as placebo-controlled studies and they are used in comparing changes recorded in the active treatment group in order to ascertain that the study group that was not included in the treatment does not react in a similar manner. This serves the purpose of proving whether the active treatment actually had an impact on the active study group. RCTs are occasionally known as randomised controlled clinical trials when they are used for clinical research (Charlton, 1995). Besides their use in medical research however, RCTs are also used in education, criminology, international development and social work. The use of RCT is mostly popular because of randomisation. This involves the selection of random samples and it has been identified as an effective approach because of various advantages as follows. Firstly, it eliminates bias because the researcher selects the participants from a random sample as opposed to convenience thus eliminating the possibility of researcher bias and confounding (Edwards, Lilford Hewison, 1998). Secondly, the use of RCT enhances blinding or masking of the treatments under study from the participants, investigators and assessors thus reducing the possibility of bias and irregularities (Charlton, 1995). The use of randomisation further permits the researchers to use probability theory in expressing that differences in outcome could have resulted from chance. Despite the efficacy of Randomised Control Trials Research, the method has raised various ethical issues that are said to limit the authenticity of the research methodology. To begin with, the Zelens design used in various RCTs is considered unethical because it randomizes the subject prior to obtaining their consent (Edwards, Lilford Hewison, 1998). This unethical aspect of this design however is mostly considered where screening and selected therapies are used as opposed to common therapeutic trials. The principle of clinical equipoise is common in defending the ethics of Randomised Control Trials. The principle which represents the genuine uncertainty about a preferred treatment within the expert medical community is used as a justification for the use of RCT (Gifford, 1995). On the other hand however, the clinical equipoise also raises ethical concerns, with suggestions being put forth that equipoise cannot generally justify RCT because it is likely to conflict with the unavaila bility of personal equipoise where a person believes that a particular intervention is effective (Gifford, 1995; Edwards, Lilford Hewison, 1998). Other limitations of RCT apart from ethical issues mostly concern external validity. They include differences in where RCT is performed such that one treatment works in a particular country and fails to work in another; characteristics of the patients such that there may be differences in their natural features; study procedures, for example where RCT patients are likely to receive more intensive treatment and care, which would certainly be impossible to achieve in the real world; and incomplete reports of adverse effects recorded during the interventions (Jadad, 1998). RCTs can also be highly expensive and are therefore considered inapplicable where financial resources are limited. Stolberg, Norman and Trop (2004) further notes that RCTs cannot be used in all types of trials. They note that there are a significant number of situations in which the use RCT is not appropriate, feasible or necessary in solving the said problems. Examples include cancer screening, ability to cease smoki ng and assessment of interventions that are likely to have rare outcomes or whose outcome takes long to develop. Critical discussion The use of randomised control trials research in nursing is undoubtedly relevant in that it aids in obtaining the desired results of the interventions used. It can be established that the use of random samples helps greatly in ensuring that authenticity of data is assured. As noted by Altman, Machin and Bagant (2000), data authenticity can only be assured if it can be established that there is no bias in the selection of the sample. Furthermore, unscrupulous researchers have been known to manipulate the research samples in order to ensure that the outcome of their studies favour the desired outcome. It is also clear that there is a limited possibility of coming up with false results because randomised control trials are mostly done hand in hand with control tests. This ensures that comparison of results yields the differences that exist between the two study groups. It is these differences that can determine for sure that the active group actually underwent a change as a result of a particular treatment. In Altman, Machin and Bagant (2000) definition of a control experiment, he notes that a control experiment serves as proof that the changes recorded in the active experiment is actually true and that the effect should not be recorded in the control experiment if the results are indeed true. Further, the status of the two study groups should have been the same at the beginning of the experiment. The use of randomised control trials in nursing promises the possibility of obtaining highly reliable results. This is because the research groups can be easily sought from medical records as opposed to where the researchers have to obtain samples from highly dispersed populations (Altman, Machin Bagant 2000). Furthermore, randomised control trials unlike other forms of research do not limit the researcher to a particular geographical region but only to persons with similar characteristics to be used for the study. This could however be disadvantageous in that the inability to locate the required sample population may result in inadequate results. Such an occurrence is likely to occur in cases where potential participants refuse to take part in the study for one reason or the other. An example is where the researcher seeks to experiment a certain medication with individuals suffering from HIV/AIDS and potential participants are unwilling to participate. According to Jadad (1998), ma ny individuals actually have the fear of being used as guinea pigs without the knowledge on whether the results will have positive or negative effects on them. Case studies Further critical analysis of the randomised control trials is done through the use of various case studies in the medical field as indicated below: In a study by Dulin, Hatcher, Sasser and Baringer (2006), they sought to prove that an over the counter supplement known as Policosanol used in the treatment of elevated cholesterol levels was ineffective. The study made use of Randomised Control Trials to examine the effectiveness of Policosanol derived from sugarcane; which had not been tested since its effectiveness was questioned. The objective of the study was to examine the efficacy of the sugar cane-derived policosanol in improving the health conditions of adults with mild hypercholesterolemia. The study would take eight weeks and it involved observing the percentage change in cholesterol level among the participants. The researchers studied the total cholesterol change, triacylglycerols and lipoprotein as well as the dietary habits, blood pressure and weight of the participants. A group of 40 healthy adults with mild hypercholesterolemia were included in the study and they were to receive 20mg of policosanol orally or placebo for the 8 weeks. The results of the study indicated that no significant changes were witnessed in cholesterol levels between the 20 adults under policosanol treatment and the 20 adults under placebo. The same applied to triaclyglycerol and other components tested for. In conclusion therefore, policosanol was ineffective in altering the serum lipid profile of individuals and therefore not effective in reducing cholesterol levels. Richardson and Montgomery (2005) sought to experiment the effectiveness of a dietary supplement for use by children who suffered from developmental coordination disorder. This is a form of disorder affecting approximately 5 percent of school going children and results in learning and behaviour difficulties as well as psychosocial adjustments that are likely to be evident even in adulthood. The researchers sought to experiment whether the use of a supplement to replace the polyunsaturated fatty acids whose absence are said to cause the disorder could help in treating the disorder. The basis for this experiment was that there was insufficient evidence-based treatment for the disorder; such that experimenting with the fatty acid supplements would provide useful information for use in treating developmental coordination disorder and treating motor skills. Richardson and Montgomery (2005) used a randomised controlled trial of the dietary supplementation which consisted of -3 and -6 fatty acids. The test was compared with Placebo and included 117 children with the developmental coordination disorder, aged between 5 and 12 years. This augurs well with Jadad (1998) who explains that a Randomised Control Trials Research should include the population under study as well as a control group to be used for comparing the outcome of the research. The research which took three months included a parallel observation of the two groups in order to establish any changes in the population. This was followed by a 1-way crossover in which the placebo group was changed to active treatment for another three months. The results of the study indicated that while there was no effect on motor skills treatment, students who received active treatment showed a significant improvement in spelling, reading and behaviour. The same was observed when the placebo group was put under active treatment; while the children continuing with active treatment continued to improve or maintain improvement. I t was thus concluded that the fatty acid supplements could be used in take care of educational and behavioural challenges for children who suffer from developmental coordination disorder. In the third example of the use of CRT in medical practice, the study by Blinkhorn, Gratix, Holloway, Wainwrit-Stringer and Worthington (2003) sought to determine the importance of health educators in enhancing general dental care. The question was on whether dental health educators should be placed to educate parents of at-risk children in order to advance dental care. The study involved 269 mothers who received tooth-brushing advice, sugar control and the use of fluoride toothpaste for 2 years at intervals of 4 months each. 334 pre-school students were included in the study. 138 families and 172 children were included in the test group and 131 families and 162 children were used as a control. Mothers in the test group were required to visit a dental health educator while the rest were used as a control group. After 2 years, 271 children and 248 mothers were remaining in the study. The end result indicated that there was increased general knowledge, tooth-brushing skills and attitud es among parents who had visited a dental educator. Children in the test group however showed little difference in terms of caries experience in relation to the control group. Accordingly, primary care trusts are expected to consider the cost of sending dental health educators in relation to the outcome. According to the study, Â £40 was used in every 2 hour session for counselling 10 parents. Critique of the articles It can be established that the use of randomized control trial research is effective in testing the outcome of various treatments and interventions, mostly through the use of a placebo study group. Similarly, the use of random study groups represents the authenticity of the researches identified above as far as the randomised control trials are concerned. The use of randomised control trials main characteristic is the use of a random sample in testing the efficacy of a certain subject or practice. This is well exhibited in all the three studies where the researchers note that they selected the samples randomly. This most definitely played an imperative role in ensuring that there was no bias in the study and that the results obtained could effectively be used in representing the entire population (Altman, Machin Bagant, 1998). As noted by Jadad (1998), the nature of randomised control trial research ensures that the subjects of the study are not in any way related to the researcher and that results are not manipulated to suit the researchers purpose. The research by Dulin, Hatcher, Sasser and Baringer (2006) represents a well researched paper which is characterised by a well designed methodology. It represents a true picture of how randomized control trial research should be done in order to achieve the most desirable results. Notably, Richardson and Montgomery (2005) make use of an active group study and a placebo group. According to Altman, Machin and Bagant (1998), the use of a control group in RCT is highly imperative as it helps in establishing the authenticity of the research and in comparing the eventual results. The same is witnessed in the study by Richardson and Montgomery (2005) and Blinkhorn, Gratix, Holloway, Wainwrit-Stringer and Worthington (2003) who made use of control groups to establish whether the results obtained in their studies were actually a true representation of the real picture. Richardson and Montgomery (2005) and Dulin, Hatcher, Sasser and Baringer (2006) and Blinkhorn, Gratix, Holloway, Wainwrit-Str inger and Worthington (2003) however fail in that they make use of different sample sizes for the active participants and placebo groups. Richardson and Montgomery (2005) use 117 children indicating that the number was uneven between the control group and the placebo group. The same applies for Dulin, Hatcher, Sasser and Baringer (2006) and Blinkhorn, Gratix, Holloway, Wainwrit-Stringer and Worthington (2003) who used 138 families and 172 children in the test group and 131 families and 162 children as a control. According to Charlton (1995), such differences in the study sample are likely to cause biased outcomes because the population sample in each case does not equal the other, thus defeating the rationality of comparison. The study by Dulin, Hatcher, Sasser and Baringer (2006) consistently defines the variables and shows how the population sample was obtained. This is one of the requirements for ensuring consistency and authenticity as defined by Altman, Machin and Bagant (1998). This is because with the ability to define the population sample and how it was obtained determines the overall outcome of the study. Richardson and Montgomery (2005) also define their population samples thus giving authenticity to the study. It is notable however that in Blinkhorn, Gratix, Holloway, Wainwrit-Stringer and Worthington (2003), only the sample size is given and there is limited information on how the 269 mothers and 334 pre-school children were obtained. Conclusion Randomised control trials research proves to be an effective methodology in enhancing nursing research. This can be evidenced by the use of randomised control trials in various medical and clinical researches, aimed at determining the efficacy of certain interventions in treating various complications. It can be established that through the use of random samples and a control group, the use of randomised control trials is expected to produce highly authentic results which can be used as a basis to introduce the intervention to the rest of the population. Notably however, there are disadvantages associated with randomised control trials research methodology as well as ethical issues related to the methodology. Common limitations include external validity in the research and the justification of the use of randomised control trials in complicated cases. In conclusion however, there is no study methodology without its own limitations and randomised control trials are no exception. This means that the benefits associated with the research methodology should be given more attention as opposed to the cons in conducting effective studies in nursing research.

My Philosophy of Education Essay -- Educating Educational Teaching Ess

My Philosophy of Education Generally when you compare twins you find that they are different in many ways. Even if they are identical and they look exactly alike they usually have different personalities. Normally they are extreme opposites; one takes up the more dominant outgoing personality while the other is shy and more of a follower. Ever since my sister and I were little I have taken on the more dominant role. From the time of playing school when I was little I have always loved being in control. Of course, I was always the teacher and got to boss everyone around. Even into my high school years I took pride in being captain of my basketball team and my teammates looking to me as the leader. I have never shied away from people; I love interacting and talking to people. From playing school and being the teacher until the present I have had many chances to interact with people of all ethnic groups and backgrounds. I love helping people and knowing that I have touched someone’s l ife, touches my heart. That is how I always knew I wanted to be a teacher since my childhood years playing with my friends. I took great pride in being the teacher and now I take even greater pride knowing my dream will soon come true. I will no longer have to pretend because my students will be real and they will be looking for me to lead them to success. When I was little I was the All-American tomboy. I have always adored sports of all kinds. I was one of the kids my mom would shout for me to come in for dinner and call me back in for bedtime. I was one of the neighborhood guys playing everything from football to basketball. At age five when my dad told me that he played sports everyday at work I decid... ...y class and some not so athletic kids in my class. If I want all my students to reach their potential I will have to use positive reinforcement to make all my students feel equally talented. By using behaviorism they will all have fun, feel good about themselves, and be learning at the same time. My dominance has helped me shape my future and hopefully I can shape the future of my students. By incorporating the different teaching methods and philosophies I can hopefully keep my students interested and they will develop into their own with a unique personality. I will feel that I have successfully done my job as a teacher if my kids walk out of my classroom knowing more than when they walked in. If I can teach them one new thing daily that is one more thing they can put into their suitcase of knowledge for their travels into the future.

Spf and Sunscreen

What do the SPF Numbers on Sunscreen mean? What is the SPF number on the sun screens? The higher the number, the better, right? Before you head out in the sun this summer, you should know a few things about SPF. What is it, exactly? What do the numbers mean, and how high can they go? We use sunscreen to block ultraviolet light from damaging the skin. There are two categories of UV light. The UVA- has more long-term damaging effects on the skin, like premature aging. UVB –causes sunburns.SPF or sun protection factor, numbers were introduced in 1962 to measure a sunscreen's effect against UVB rays. To determine a sunscreen's SPF, testers round up 20 sun-sensitive people and measure the amount of UV rays it takes them to burn without sunscreen. Then they redo the test with sunscreen. The â€Å"with sunscreen† number is divided by the â€Å"without sunscreen† number, and the result is rounded down to the nearest five. This is the SPF. SPF numbers start at 2 and have just recently reached 70.To figure out how long you can stay in the sun with a given SPF, use this equation: Minutes to burn without sunscreen x SPF number = maximum sun exposure time For example, if you burn after 10 minutes of sun exposure, an SPF of 15 will allow you to be in the sun for up to 150 minutes without burning. You should know that this equation is not always accurate. People usually use far less sunscreen than the amount used in testing. In the real world, the average sun worshipper uses half the amount of sunscreen used in the laboratory, which could result in a sunburn in half the time. My mom and her family grew up around a swimming pool.They spend all day by the pool when we go out of town. My grandparents have to get cancer removed every year. It is true, a higher SPF number means more sun-exposure time. It also indicates the level of UVB absorption, but this number doesn't increase exponentially, which can be confusing. For example, an SPF of 15 absorbs 93. 3 pe rcent of UVB rays, but an SPF of 30 absorbs 96. 7 percent. The SPF number has doubled, but the absorption rate has increased by only 3. 4 percent. Because of the confusion about UVB absorption, the FDA proposed a cap on SPF numbers. Any sunscreen higher than 30 SPF would be a â€Å"30-plus. Thirty was the decided cap because above that, the percentage of UVB absorbed and overall protection of the skin increases only slightly, but people may misinterpret these higher SPF numbers as a much higher level of protection or even a guarantee of all-day protection. SPF| % UV absorbed | 2| 50 | 4 | 70 | 8 | 87. 5 | 15 | 93. 3 | 30 | 96. 7 | 50 | 98 | As helpful as the FDA was trying to be, the cap is clearly not in practice: Neutrogena and Hawaiian Tropic recently released sunscreens boasting an SPF of 70. We have sunscreens ranging from 15 SPF to 70 SPF in our cupboard at home.There are several factors that allow all of us to get a sunburn even if we have sunscreen on. First, we don’ t use enough. Second, despite waterproof or sweatproof labels, all sunscreens decrease in effectiveness when exposed to water or sweat. If you don't apply the correct amount and then reapply after exposure to water, a 12-hour bake in the sun could give you a serious sunburn. The bottom line is that a sunscreen with a higher SPF does offer higher protection against UVB rays, but once you get past SPF 30, protection doesn't increase very much, and the higher number may give you a false sense of protection.Instead of letting SPF be your only guide to sun protection, avoid a burn by following a few simple sunscreen rules. 1. Know yourself: If you are whiter than a sheet of paper, if your Aunt Linda has skin cancer, or if you are sensitive to the sun because of a medication or a medical condition, take extra measures. Stay out of the sun as much as possible, wear a hat when you are out, use a broad-spectrum sunscreen with a high SPF and reapply that sunscreen often. Don’t put a lo t of sun screen on and lay out by the pool. 2.Look for â€Å"Broad-spectrum† label: The SPF number indicates protection only against UVB rays — many sunscreens, even those with a high SPF, allow UVA rays to be absorbed by the skin. UVA protection is usually indicated by a â€Å"broad-spectrum† label. Look for this label to ensure the most well-rounded sun coverage. Broad-spectrum sunscreen ensures protection from both UVA and UVB rays. The latest sunscreens boast new chemicals, like Mexoryl, which has proven to be one of the most effective UVA-blockers out there. 3. Be prepared- be proactive in planning: To be effective, sunscreen eeds to be fully absorbed into the skin, so apply it 15 to 30 minutes before you even step into the sun. Make sure your whole family has taken the time to put sunscreen on. Then get ready for your time outdoors. 4. Reapply yourself: Whether you're lying by the pool or mowing the lawn, you'll probably be exposed to sweat or water, the n atural enemies of sunscreen. To be safe, reapply after you swim or sweat. If you are going to a friends home or to the park, take a bottle with you. My mom keeps a bottle in each of our golf bags.It takes almost 3 hours to play 9 holes in the junior league and it is extremely hot. 5. Full exposure: No matter how high the SPF, sunscreen can protect only the skin it covers. The most commonly missed spots are the temples, ears, back of the neck and top of the feet. If you are sometimes guilty of losing your focus while applying your lotion, try one of the sunscreens that contains disappearing colorants, so you can identify unlotioned areas before they burn to a crisp. Our generation needs to learn from our parents and grandparents.My grandma and grandpa Cox are always having skin cancer frozen or burned. My grandma has had a small part of her nose removed from malignant skin cancer. My mom grew up with a pool in her backyard her whole life. She spent so many years laying out in the sun with no sunscreen on. She also spent a year at BYU Hawaii so she could be in the sun. Our family is good about putting sunscreen on but we can all be better. I have learned so much about protecting my skin. This summer I am going to make a goal to wear sunscreen at the beginning of the day and have a bottle with me.

Organizational Analysis of Hospital Z Essay - 1008 Words

Successful medical organizations have as their guiding principles a professionally stated purpose which encompasses and details their mission statement, vision statement, values statement, and broad strategic goals. The organizational structure is established on these statements, and the function of each department and the duties of each employee are based upon fulfilling the purpose of these statements. Additionally, these statements must encompass the various aspects of the organization and its stakeholders. As Moore, Ellsworth, and Haufman (2011) purport, â€Å" Any organization planning as though it exists in a vacuum is ignoring factors critical for its survival† (p. 16). Without these guiding principles to serve as a direction for the†¦show more content†¦512-513). Quite succinctly, none of these are being exercised. Apparent at first appraisal of Hospital Z is what appears to be the issue of organizational (in)justice, which, according to Coutier, Denis, and Bilodeau, â€Å"refers to the perception of being treated fairly in the workplace†¦It is critical to the employer-employee relationship, exerting a wide influence on employees’ attitudes and behavior in the workplace† (p. 398). These authors further contend that research categorizes â€Å"...four types of justice perceptions: procedural, distributive, relational (interpersonal) and informational justice† (p. 398). These perceptions exist at the workplace and contribute to the problems. Additionally, the unwillingness of the business office employees to accept onsite help from the hospital financial analyst team. They appear to be content with the status quo, which has resulted in their current financially precarious situation. They do not have the foundation needed, which should be as described by Weiss, Hassell, and Parks (2013) â€Å"†¦fertile enough to accept the seeds of change and to nurture them to grow† (p. 492). Another issue that is at the center of the problems of Hospital Z is that of motivation, or the lack thereof. As Patrick, Smy, Tombs, and Shelton (2012) point out, motivation begins with training, because trainee characteristics and attitudes influence motivation to learn and subsequent training success. HavingShow MoreRelatedOrganizational Strategy And Hr Activities At The King Company896 Words   |  4 PagesLet’s get started by discussing how the King’s Company relations amongst its staff sections. Current Relationship among Staff Elements and Human Resources During this portion of the case study I will try to define the current connection between organizational strategy and HR activities at The King Company. 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