Acupuncture for Chronic Headache in Primary Care

Acupuncture for Chronic Headache in Primary C ar query CritiqueIntroduction look involves the routine of dogmatic numbers to answer an interrogatory. It involves selective training collection, synthesis and analysis in the light of the question or inquiry and formulation of conclusions and recommendations, (Badke, 2004). General types of inquiry include observational studies which atomic number 18 utilise to test the effect of a sermon or intervention, (Peat, 2001, p. 16). clinical trails fall under the broad category of experimental trials. Clinical trials ar controlled experiments with patient roles, which range from studies to prevent, detect, diagnose, control and treat health problems to studies of the psychological impact of a health problem and ways to improve peoples health, comfort, functioning, and flavor of life, (Brooten, 2006, p.86). Generally, clinical trials keister be categorised into either randomise trials or non-randomised trials.This paper will try to measure out the scientific interrogation conducted by Vickers and colleagues (2004), entitled Acupuncture for chronic fear in radical c ar large, pragmatic, randomised trial, which was promulgated on 15 March 2004 at the British Medical Journal. This particular event was selected due to its relevance to this house of study. Numerous sagacitys from this field of study and valuable best go for information in quantitative question methods can be gained from undertaking this critiquing task. This reexamination will be carried out using the query frame model for critiquing health research formulated by Cald comfortably and co-workers (2005), which provides a comprehensive set of criteria against which the elements of the research phrase by Vickers and colleagues (2004) can be appropriately measured. This paper will first evaluate the oerview of the study, including the crimp, belles-lettres review and the methodology used. Next, it will critically analyse issues concern ing research ethics, selective information protection and research funding. Then, it will evaluate the reliability, validity of the research results, including the sampling methods apply. It will then identify the special strengths and weaknesses of the research article. Finally, the concluding judgement about the research article will be presented.Below are the definitions of selected important terms used in the research articleAcupuncture pertains to the technique of traditional Chinese medicine, in which a number of very fine metal inviteles are inserted into the scrape up at specially designated points, (Acupuncture, 2007).ANCOVA stands for analysis of covariance which is a statistical interposition that combines analysis of variance (ANOVA) and retroflection whereby the predictable component of the individual differences can be removed with regression analysis, (Anderson, 2001, p. 283).Chronic all impairments or deviations from normal that have one or more of the foll owing characteristics are permanent leave residual disability are caused by coloured pathological alteration require special training of the patient for replenishment or may be expected to require a pertinacious period of supervision, observation or care, (Sidell, 1997, p. 1)Negative binomial regression is one of a class of mixed Poisson models that mix a stand by source of variance with the Poisson variance to account for overdispersion, (Cohen, et al., 2003, p. 531).Outcome measures reflect patient health status at either the individual or the entireness (population) level, (Stommel Wills, 2004, p. 234).Randomised trial A randomised trial is a clinical trial that pertains to an experiment in which therapies under investigation are allocated by a chance mechanism, (Brooten, 2006, p.86).Sham Treatment is the experimental treatment that has no effect and which subjects cannot distinguish from the active treatment (Peat, 2001, p. 20). critical AnalysisIn March 15, 2004, the B MJ print Group Ltd, a all in all owned subsidiary of the British Medical Association, published the research article in its medical journal, the British Medical Journal (BMJ). Its print BMJ has been published continuously since 1840, and now appears in four weekly editions, varying totally in their advertising content. Together, their circulation totals about 122 000 copies, of which 10 000 are distributed outside Britain, (BMJ, undated). Its website provides the copious text of everything published in the print journal since 1994, as well as much material unique to the web, (BMJ, undated).These make the BMJ Publishing Group Ltd. an influential and authoritative source of medical articles.The authors are know medical practitioners with different fields of specialisations. Andrew Vickers is an assistant attending research methodologist at the Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center in stark naked York Rebecca Rees is a researc h officer at the Evidence for Policy and rehearse Information and Co-ordinating Centre (EPPI-Centre), Social Science interrogation Unit in London Catherine E Zollman is a general medical practitioner from capital of Vermont Health Centre in Bristol Rob McCarney is a research officer at the Department of Psychological Medicine, Imperial College in London Nadia Ellis is lecturer Department of Health and Social Sciences, Coventry University in Coventry and both Peter Fisher, who is the director of research and Robbert Van Haselen who works as the delegate director of research are from Royal London Homeopathic Hospital. Thus, base on their qualifications, the authors have the credibility, needed knowledge and expertise to engage in an extensive scientific study such as the article beingness evaluated.The article is appropriately titled as Acupuncture for chronic headache in pristine care large, pragmatic, randomised trial, since it essentially focussed on the authorization of t he use of stylostixis to relieve chronic headache. Moreover, the title expressly implies that the methodology utilizes a large experiment in the randomised trial. The abstract appears to be concise and complete. In a few paragraphs, the essential research components were summarised in the abstract, namely (1) the research objective (2) setting (3) participants (4) interventions (5) main case measures (6) results and (7) conclusions. The abstract provides the complete key information that the readers need to fully catch the article. The introduction explained the health costs related to headache, which is the main topic of the article, including the need to apply other approaches in its treatment, particularly, acupuncture. The introduction also provides the main find or rationale of the study, which was to estimate the effects of acupuncture in practice in general and to determine the effects of a policy of use acupuncture on headache, health status, days off sick, and use of re sources in patients with chronic headache compared with a policy of avoid acupuncture, in particular, (Vickers et al., 2004). However, the literature review was limited to only one source of published work the Cochrane review of 26 randomised trials. This would be very scrimpy in terms of the extent of evaluating getable sources of information related to the topic of the study. Moreover, it does not provide a comprehensive evaluation of scholarly work from which the rationale of the study could be based.The study is a quantitative research, since the data obtained are represented in the form of numbers and statistical treatment was employed to interpret the data gathered (Grinnell Unrau, 2005, p. 62). Despite the lack of connotative statement of the hypothesis, the audience or reader can obtain a general notion or idea of what is being tested (the effectiveness of acupuncture in the treatment of chronic headache). However, the variables were not clearly defined. Nevertheless, t he procedures employed in the methodology were intricate and systematic. The participants were clearly identified and adequately describe in the study. In the accrual of patients, several stages were established to facilitate the commingle and recruitment of participants. Figure 1 in the appendix illustrates the flow of participants in the study. Moreover, ethical principles were upheld during the conduct of participant recruitment. Since most legal instruments expressly abrogate the use of human subjects for medical research, the researchers obtained written informed consent from the participants.The researchers employ a system to ensure randomization of the study through a password protected database, thereby eliminating the potential for submit and subsequently ameliorate the quality of the results. As Peat (2001, p. 28), explains in randomised controlled trials, the quality of the evidence is alter if measurement bias, such as observer or reporting bias, is reduce by us ing objective outcome measurements and if observers are blinded to the convention status of the subjects. The method of data collection proves to be valid and reliable, as evidenced by the relatively high number of treatments (12 treatments) employed over a sufficient length of time (3 months). Moreover, a complete procedure was implemented to generate a global estimate of current and service line headache severity, (Vickers, et al., 2004). This further enhanced the validity of the results. The large essay size helped ensure the reliability of the results. Additionally, the use of measurable outcomes such as the Likert scale of headache severity helped eliminate bias by extending greens measurement criteria for the respondents. The article correlated its results with the findings in prior literature on acupuncture, (Vickers, et al., 2004), suggesting a high degree of validity of results generated.The presentation of results was systematic and at the same time, clear and comprehe nsive. The results portion explained the process of participant recruitment including the flow of participants through the trial, patient compliance and dropout rate and their characteristics. It also provided a clear explanation of data that were obtained with accompanying tables and graphs. Thus, the audience can comfortably comprehend the results obtained. In the discussion, the results generated were translated into the main findings of the study which were stated in a clear, yet simple manner. Moreover, the strengths and the limitations were identified and discussed clearly.The strengths of the research article are anchored on its methodology, such as in the recruitment of participants with a large sample size, the implementation of a system to conceal the randomization and the meticulous follow-up procedure one year after the experiment. Such procedures helped ensure that the research findings are reliable and valid. On the other hand, one of the limitations of the study is t he absence seizure of pharisaism acupuncture for the participants, thereby failing to consider the potential placebo effects. Additionally, the participants were not blinded in the study thereby raising the possibility of bias in terms of the participants assessments of their headache scores. In terms of the literature review, the article failed to provide an objective evaluation of a sufficient body of literature related to the topic of the research. Thus, it failed to address the gaps in knowledge related to acupuncture and chronic headache due to the lack of an extensive evaluation of available literature.ConclusionIn the final analysis, the research article serves as an supererogatory source of authoritative and credible information regarding the use of acupuncture for the sculptural relief of chronic headache. The findings of the study strongly support available scientific evidence. The weaknesses of the research article discussed above can serve as important considerations for researchers who are planning to engage in a similar undertaking they essential evaluate a substantial body of literature to gain insight into the currently available information and subsequently identify knowledge gaps. Moreover, upcoming randomised clinical studies in acupuncture should include a sham treatment to be able to consider potential placebo effects and conspicuous of participants must be observed to eliminate bias.BibliographyAcupuncture. (2007). In The Columbia cyclopedia (6th ed.). New York Columbia University Press.Anderson, N.H., 2001. Empirical Direction in Design and Analysis. Mahwah, NJ Lawrence Erlbaum Associates.Badke, W.B., 2004. investigate strategies Finding your way through the information fog. (Second Edition). New York iUniverse, Inc.British Medical Journal. Undated. Available from http//resources.bmj.com/bmj/about-bmj. Accessed 18 April, 2008.Brooten, D., 2006. Clinical Trails. In Encyclopedia of treat Research (Second Edition). Joyce Fitzpatric k and Wallace, J.J., (Eds). New York Springer Publishing Company.Caldwell, K., Henshaw, L., Taylor, G., 2005. Developing a material for critiquing health research. Journal of Health, Social and Environmental Issues, 6(1), 45-54.Cohen, J., Cohen, P., West, S.G. and Aiken, L.S., 2003. Applied Multiple turnaround / Correlation Analysis for the Behavioral Sciences. Hillsdale, NJ Erlbaum.Grinnell, R. M., Unrau, Y. A., (Eds.), 2005. Social Work Research and Evaluation Quantitative and Qualitative Approaches (7th ed.). New York Oxford University Press.Peat, J. K. (Ed.), 2001. Health Science Research A Handbook of Quantitative Methods. Crows Nest, N.S.W. Allen Unwin.Sidell, N. L. , 1997. Adult Adjustment to Chronic infirmity A Review of the Literature. Health and Social Work, 22(1), 5+.Stommels, M., Wills, C.E., 2004. Clinical Research Concepts and Principles for Advanced Practice Nurses. Philadelphia Lippincott Williams and WilkinsVickers, A.J., Rees, R., Zollman, C.E., McCarney, R., S mith, C.M., Ellis, N., Fisher, P., 2004. Acupuncture for chronic headache in primary care large, pragmatic, randomised trial. Available from http//www.bmj.com/cgi/content/full/328/7442/744. Accessed 15 April 2008. accompanimentFigure 1Flow of Participants Through the TrialSource Vickers, et al., 2004