PUB015-6 Critical appraisal of a published article Assignment Sample 2024
Introduction
Congenital Heart Disease (CHD) is a common defect occurring during birth, which if left untreated might lead to morbidity as well as mortality. The main aim of the study is to provide a critical appraisal of the research paper by application of a relevant appraisal tool well suited for the study that is being appraised. As the article makes use of cohort study, the application of cohort study checklist is chosen as an appraisal tool in the “Critical Analysis Skills Programme”. In this study, the impact of paediatric cardiology clinical programs on outcomes of heart disease in Guyana is the main focus of the study.
Appraisal
Article Citation: “Isaac, D., Nagesh, V., Bell, A., Soto, R., Seepersaud, M., Myers, K. and Zahir, S., (2017). Impact of a pediatric cardiology clinical program on congenital heart disease outcomes in Guyana. Global pediatric health, 4, p.2333794X17731667.”
Validity
The CASP Cohort tool determines validity based on a valid design. The cohort basically focuses on meeting the objectives for assessment of the impact that echocardiography education projects have on “Guyana Paediatric Cardiology Clinical Committee (GPCSC)” clinics and the outcomes of Guyanese children with CHD. It also aims to present an appreciative of the features of CHD in a emerging nation by extracting data on paediatric patients with CHD denoted to as GPHC. The patients in the cohort were identified with initial inclusion and exclusion criteria (Isaac et al. 2017). The inclusion criteria involved those who were younger than those who were 18 years at an initial surgery for completing information available. The cohort had included only those who were sent for surgery from the year 2005 and 2014. Patients in the “post GPCSC” were diagnosed and followed for GPCSC. The time period selected for the convenience sample included those denoted to as GPCSC during the initial period of 2 years. The exclusion criteria were for those who were above the age of 18 years. Also, 21 patients who had no recorded birth date were excluded from comparative analysis.
The second part is of the evaluation of the assignment of the participants to intervention. In this study, a cohort data was used to collect data on post-operative follow-up. In the “post-GPCSC cohort” and “pre-GPCSC”, data has been gathered by means of anonymized fashion from electronic medical records as well as databases of the students. The comparison was made on a qualitative basis for a descriptive statistics of 2 cohorts (Ba-Saddik, 2019). All the 88 patients were identified for the study and sent abroad for surgery in between the years 2005 and 2014. Based on meeting the aforesaid objectives, and to gain an understanding of the impact, the study design is valid for cohort study.
Methodology
This part of the CASP cohort study included an appraisal focusing on the methods of analysing the participants in the paediatric clinic. A reconsidering cohort study was commenced for comparing the physiognomies as well as results of the children with CHD in Guyana prior to and subsequently after the application of the GPCSC. The program was initially targeted for provision of an adult echocardiography, with a crucial necessity to make provision for diagnosis to the paediatric patients acquiring cardiac disease. In a time-period of 1 year, out of 70% of the echocardiograms conducted at GPHC, there was revelation of noteworthy aberrations by emphasizing the augmented load of underdiagnosed CHD. For both the cohorts, data poised was made on demographics and a follow-up made on a postoperative basis. On being available, note was completed of mortality for supplementary interference in surgery.
Data has been applied primarily towards obtaining records from charitable foundations as well as security. A considerable range of patients from pre-cohort had missing information; counting age, DOB and concluding diagnosis (Islam et al. 2018). In the case of post-GPCSC cohorts as well as pre-GPCSC patients had been shadowed through a GPCSC, with data being extracted within an anonymized fashion from the electric medicinal record and databank. Out of the 88 patients, only 67 patients acquired a planned intervention. As availability of instructive indicators had varies for time of diagnosis and interference, development of local cardiac expertise initiated more responses from that of being property treated with. The young patients diagnosed with GPCSC were nearly 1 year old, in comparison to the 2 month age in pre-GPCSC cohort. The obtainability of diagnostic tools and expertise creates a triage for prioritization and allowing ways for appropriate administration of the difficult patients.
Results
The study implied a comparison made between two cohorts both prior to and subsequently the application of GPCSC. In the cohort of pre-GPCSC, 88 patients had been identified to be sent abroad for study in between the years of 2005 and 2014. The exclusion criteria were patients who did not have any record of their date birth. The data was obtainable for 16 patients with incomplete data applicable for 51 patients. In the cohort prior to GPCSC, 9% were declared to be dead, 43% to be alive and 48% to be unknown. On the other hand, the pre-cohort situation had 25% to have a diagnosis based on a pre-operative basis. 19% were sent abroad to not have undergone any surgery whereas 4 were inoperable for unknown reasons. A total of 114 have been identified to have required surgical procedures with 74 prioritised for receiving early intervention through Baby Heart within the study period.
In the cohort prior to GPCSC, 16 of all patients were found to have obligated extra intervention subsequent the post-surgery. Among them 2 of the patients has a progression in the disease rendering them to be inoperable at the time in which they were produced with. On the contrary, 6 were said to have received intervention on the basis of GPCSC. The extra 8 teenagers were either on the waitlist for the process of involvement or tailed upon at a suitable time for supplementary level of intervention (Sharma et al. 2020). In the post-GPCSC cohort, 7 children necessitated a repeat in intercession and 3 of them received intervention. On the other hand 4 of them were trailed up for a proper scheduling in surgery during the last phase of the study period. Before the application of the GPCSC, children who were directed for surgery abroad were unsuccessful to obtain follow-up experiencing better levels of survival on a post-operative basis. As sample sizes on pre-GPCSC and post GPCSC cohorts were similar to one another, the complete data can result in an inoperable state. Correction on a complex cyanotic pathology implied an increase in level of risk that often requires additional levels of intervention (Wang and Wang, 2020). The application of diagnostic tools and a triage for an appropriate prioritization implies allowing correct management of the difficult patients.
The average age at intervention has been similar to pre as well as “post GPCSC cohort”. The patients were triaged to obtain surgery after older patients were presented with advanced pathology suppressing or postponing the surgery at an impracticable condition. As such the factors that contributed to similarity in age imply wide age varies at the time of analysis as well as involvement (Hemphill et al. 2020). The eldest patient to have received intercession in the cohort was 3.4 months as associated to 5.8 months pre-cohort. The issue had been a study with systematic lack of data, in Guyana to be diagnosed prior to and after GPCSC. The results also implied that a lack of effective health data fallouts in insufficient answerability to the healthcare system bringing breaks in distribution as well as preparation. As a result, a deprived eminence of information is consistent upon receiving lower levels of know-how and lack of consistent registers for health care delivery in Guyana.
Application
For the purpose of fulfilling the requirements of the assessment, the study indicated a program at “Guyana Paediatric Cardiology Clinical Committee (GPCSC)” for establishment of a program at an echo-cardiology lab. The program indicated a functioning lab at GPHC for training native surgeons to achieve as well as understand echocardiograms. To address the need for under-diagnosed CHD, the patients requiring surgery were undergoing timely intervention. It was undertaken for publicizing the service availability for municipal and country areas, in order to ease conveyance to distant rural patients for valuation as well as management.
Under the new-fangled package, all the paediatric patients were receiving cardiac pathology to be seen as GPHC clinics as reviewed by Baby Heart and Libin Cardiovascular facilities. The decisions in regard to management and timing are made through intervention carried out by the multidisciplinary team (Zühlke et al. 2019). All patients had been followed up by the cardiology clinic under a direct and remote supervision of the cardiovascular facility. Due to this reason, the supervision and cardiology clinic has been associated with localized services through a paediatric approach.
Conclusion
Youngsters with “congenital heart disease (CHD)” have remained left untreated due to prevention of mortality and allowing normal development. In this study, a critical appraisal of the Cohort Study Checklist as a tool has been made for carrying out the intervention. The limitations of the study are that it included a systematic lack of data, diagnosed before the creation of GPCSC. Despite the limitations observed, some high effects were involved resulting in a reduction of paediatric cardiology levels. This study has emphasized on the validity of the findings along with the methods, results and application of the effectiveness of the Guyana paediatric in cardiology.
References
Ba-Saddik, I.A., (2019). Clinical Pattern of Congenital Heart Disease among Children Admitted to Al-Sadaka Teaching Hospital, Aden. Yemen (Jan-Dec 2016). EC Paediatrics, 8, pp.1117-1122.
Hemphill, N.M., Kuan, M.T. and Harris, K.C., (2020). Reduced physical activity during COVID-19 pandemic in children with congenital heart disease. Canadian Journal of Cardiology, 36(7), pp.1130-1134.
Isaac, D., Nagesh, V., Bell, A., Soto, R., Seepersaud, M., Myers, K. and Zahir, S., (2017). Impact of a pediatric cardiology clinical program on congenital heart disease outcomes in Guyana. Global pediatric health, 4, p.2333794X17731667.
Islam, S., Kaul, P., Tran, D.T. and Mackie, A.S., (2018). Health care resource utilization among children with congenital heart disease: a population-based study. Canadian Journal of Cardiology, 34(10), pp.1289-1297.
Sharma, A., Nallasamy, K., Jain, A., Williams, V. and Jayashree, M., (2020). Blood component utilization before and after implementation of good transfusion practice measures in a pediatric emergency department. Transfusion and Apheresis Science, 59(2), p.102719.
Wang, Y. and Wang, J., (2020). Modelling and prediction of global non-communicable diseases. BMC Public Health, 20, pp.1-13.
Zühlke, L., Lawrenson, J., Comitis, G., De Decker, R., Brooks, A., Fourie, B., Swanson, L. and Hugo-Hamman, C., (2019). Congenital heart disease in low-and lower-middle–income countries: current status and new opportunities. Current cardiology reports, 21(12), pp.1-13.
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