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Medicalc - Medical Application Critical Appraisal

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Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness,and its value and relevance in a particular context

It is an important element of evidence-based medicine.

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Grounded theory is used to develop theories that can be used in practice, suggesting this is a desired method for this research. The article is well set out, permitting the research design to be effortlessly recognisable and easily read. Although the researcher states that grounded theory was used, one may say that it was used incorrectly. Grounded theory is used to create theories that can be applied in real life situations and although this study does create a theory, (effective and ineffective handovers) it is building on an already established theory (MIST Mechanism-Injuries-Signs-treatment). The use of grounded theory is very ambiguous in this research; it could be argued that is has been applied correctly, due to using current research to guide the study. Whether it was applied accurately or not, the researcher has not explained how they used grounded theory or integrated the theories into the research. The researcher does not disclose how they determined the exact method used. This would be beneficial as the research question, method of data collection and data analysis all depend on each other, and therefore these paramount decisions need to be made continually throughout the research process.

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The clinical question researched in the I-ELCAP study (The International Early Lung Cancer Action Program Investigators.) of CT screening for lung cancer is only partly defined. Although the outcomes of interest—early detection of lung carcinomas and lung cancer mortality—are obvious and the intervention is clearly described, the article is less clear with regard to the population of interest and the standard of care. The study population was not recruited through a standardized protocol. Rather, it included anyone deemed by physicians at the participating sites to be at above-average risk for lung cancer. Nearly 12% of the sample were individuals who had never smoked nor been exposed to lung carcinogens in the workplace; these persons were included on the basis of an unspecified level of secondhand smoke exposure

It is impossible to know whether they were subjected to enough secondhand smoke to give them a lung cancer risk profile similar to that of a smoker. It is also not obvious what was considered the standard of care in the I-ELCAP study.

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Briefly, sometimes science/health stories found in the news are genuinely based on valid studies, but jump to wrong conclusions by failing to consider some important aspects, such as the study design and the level of evidence of the original research

Finding and using research results to support your professional decisions must be a systematic process, based on the principles of evidence-based medicine and healthcare.

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Unger M. A pause, progress, and reassessment in lung cancer screening. N Engl J Med. 2006 Oct 26;355(17):1822–4.

The International Early Lung Cancer Action Program Investigators. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006 Oct 26;355(17):1763–71.

Campbell DT, Stanley JC. Experimental and quasi-experimental designs for research. Chicago: Rand McNally; 1963.

Holland P. Statistics and causal inference. J Am Stat Assoc. 1986;81:945–60.

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