GCU HLT 362 Week 5 Article Analysis and Evaluation of Research Ethics

Article Citation and Permalink(APA format) Article 1 Yakkanti, R. R., Miller, A. J., Smith, L. S., Feher, A. W., Mont, M. A., & Malkani, A. L. (2019). Impact of early mobilization on length of stay after primary total knee arthroplasty. Annals of Translational Medicine, 7(4), 69. https://doi.org/10.21037/atm.2019.02.02
Point Description
Broad Topic Area/Title The impact of early mobilization on hospital length of stay (LOS) and discharge destination after primary total knee arthroplasty (TKA)
Problem Statement (What is the problem research is addressing?) The prolonged hospital stay after any kind of surgery is associated with higher complications as well as a costly burden on individuals and the healthcare system. The study addresses an intervention (early mobilization) that aims to minimize LOS and optimize discharge to home for patients who have had TKA.
Purpose Statement(What is the purpose of the study?) To determine if mobilization on the day of surgery (postoperative day 0 or POD 0) has an effect on the hospital LOS and discharge destination.
Research Questions(What questions does the research seek to answer?) Does mobilization on the POD 0 decrease hospital LOS compared to mobilization on a postoperative day 1 (POD 1)Is there a difference in discharge destination among patients undergoing primary TKA who are mobilized on POD 0 versus those mobilized on POD 1?
Define Hypothesis (Or state the correct hypothesis based upon variables used) Early mobilization leads to reduced hospital LOS and plays a role in discharge disposition more frequently to home versus a subacute facility.
Identify Dependent and Independent Variables and the Type of Data for the Variables Independent variables: Patient mobilization on the day of surgery (POD 0) versus the day following surgery (POD 1)Dependent variables: Hospital LOS and discharge destination (home versus sub-acute facility or rehabilitation center)
Population of Interest for Study Post-operative patients who have undergone primary TKA at a single institution by the same surgeon with the same implant design from July 1, 2015, to June 30, 2016
Sample 406 patients185 mobilized on POD 0221 mobilized on POD 1
Sampling Method Convenience sampling – Patients were mobilized on POD 0 or POD 1 based on the timing of the patient’s arrival on the orthopedic floor, and the availability of the physical therapy (PT) staff.Patients who arrived at the orthopedic floor before 5 P.M were mobilized on the same day, while those who came after 5 P.M were mobilized the following day due to the unavailability of the PT staff
Identify Data Collection Identify how data were collected Review of patient charts
Summarize Data Collection Approach Patent charts were examined for sociodemographic data, medical a surgical data, diagnosis (indication for surgery), side of procedure, ASA score, essential perioperative, laboratory results, PT metrics. Discharge data was also collected (LOS, discharge disposition)
Discuss Data Analysis Include what types of statistical tests were used for the variables. The two groups were compared for LOS using univariate analysis. A student’s t-test was performed comparing LOS between POD 0 and POD 1 groups.A chi-squared test was performed to compare the destination at discharge.

Age, gender, ASA score, and BMI-matched cases between the two groups were analyzed for the final statistical analysis.

The level of significance was set at a P value of <0.05
Summarize Results of the Study 406 TKA’s were reviewed, 185 patients in the POD 0 and 221 in the POD 1 group. After matching the cases based on gender, age, ASA score, and BMI, a total of 143 cases in each group (286 in total) was yielded·         The average age for all patients is 66.7 (range, 45-86)

·         The average LOS in POD 0 was 2.44, while in POD 1 was 2.80 (p, 0.002)

·         70.63% (n=101) were discharged home in POD 0 versus 58.74% (n=84) in POD 1 (p, 0.035)
Summary of Assumptions and Limitations Identify the assumptions and limitations from the article.Report other potential assumptions and limitations of your review not listed by the author. The use of a retrospective design is an inherent weakness of the study. Several factors were uncontrolled that could also play a role in patient mobilization, such as length of time spent in the PACU, availability of PT resources, level of postoperative pain control, duration of the motor nerve block, which limits the patient’s ability to mobilize the quadriceps muscle, and the inherent motivation level of thepatient

Potential limitations not listed by the author

Inadequate PT personnel or a lack of an efficient shift work arrangement to assure PT staff presence on the orthopedic floor beyond 5 p.m. Patients were not mobilized early on POD 0 due to the PT staff’s unavailability after 5 p.m.

Article Analysis and Evaluation of Research Ethics

Ethical Considerations

Evaluate the article and identify potential ethical considerations that may have occurred when sampling, collecting data, analyzing data, or publishing results. Summarize your findings below in 250-500 words. Provide rationale and support for your evaluation.

The purpose of this study is to determine whether early mobilization affects hospital LOS and the discharge destination of TKA patients. Yakkanti et al. (2019) achieve the study’s purpose by concluding unequivocally that early mobilization on the day of surgery (TKA) minimizes hospital LOS and optimizes release to home rather than sub-acute institutions. Like any other ethically authorized study, the author was obligated to preserve the rights of the study participants and follow the guidelines of the research ethics committee.

As such, the study proposal was reviewed by the University of Louisville Institutional Review Board (IRB), which authorized it and issued a green light to the researchers. The IRB committee is dedicated to protecting human subjects and serving as an oversight body to guarantee that human subjects’ rights are not abused as a result of their involvement in research (Walden University, 2020).

Furthermore, all patient data were de-identified in accordance with HIPAA de-identification guidelines, a body that safeguards the privacy of patients’ health information. De-identification refers to the elimination of identifying data from a dataset (Chevrier et al., 2019). To ensure the anonymity of study participants, patient identifiers such as name, phone number, date of birth, and social security number must be removed.

The University of Louisville Institutional Review Board not only approved the research but also granted a complete waiver of consent. As a result, no formal informed consent was acquired or necessary to perform the study. There is no requirement for consent in retrospective research if the patients have been anonymized; nonetheless, permission from the IRB is required.

GCU HLT 362 Week 5 Article Analysis and Evaluation of Research Ethics References

HLT 362 WEEK 5(1) STATISTIC Article Analysis and Evaluation of Research Ethics

Search the GCU Library and find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the topic Resources or textbook.

Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template. See Chapter 5 of your textbook as needed, for assistance.

HLT-362V-RS5-National Cancer Institute Data

American Indian /Alaska Native(includes Hispanic) Asian / PacificIslander (includesHispanic) Black (includes Hispanic)
Year of Diagnosis Rate per 100,000 Rate per 100,000 Rate per 100,000
2000 45.7 41.8 77.8
2001 47.9 41 79
2002 44.6 40.4 75.8
2003 50 40.9 77.3
2004 51.7 40.5 75.1
2005 48.7 40.2 73.7
2006 46.4 39.8 73.4
2007 43.1 38.8 71.2
2008 45 38.5 70.8
2009 40.1 39 71.6
2010 42.4 37 67.8
2011 39.6 36.6 64.1
2012 36.6 36.7 64.3
2013 39.9 36.6 60.5
2014 32 34 61.3
2015 38.7 34.4 57.4
Hispanic (any race) White (includes Hispanic)
Rate per 100,000 Rate per 100,000
34.2 68.8
34.1 68.7
34.1 68
34.5 67.1
35 65.8
33.8 65.9
32 65.8
32.7 65.2
32.2 63.9
31.8 63.1
30.3 60.4
29.4 58.5
28.2 57.5
28.8 56.3
26.8 55.4
26 53.2

National Cancer Institute (2018) Lung and bronchus cancer. Retrieved https://seer.cancer.gov/explorer/application.php?site=47&data_type=1&graph_type=2&compareBy= chk_race_3=3&chk_race_6=6&chk_race_2=2&chk_age_range_1=1&chk_data_type_1=1&advopt_pand_age_range_1_and_data_type_1

Article Analysis and Evaluation of Research Ethics Example Two

Article Citation and Permalink(APA format) Article 1Fritz, B. A., King, C. R., Mehta, D., Somerville, E., Kronzer, A., Ben Abdallah, A., Wildes, T., Avidan, M. S., Lenze, E. J., Stark, S., & ENGAGES Research Group. (2022). Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA Network Open, 5(3), e221938. https://doi.org/10.1001/jamanetworkopen.2022.1938
Point Description
Broad Topic Area/Title Falls Among Hospitalized Patients
Problem Statement(What is the problem research is addressing?) Up to 4 percent of patients during their inpatient stay, the experience falls after elective inpatient surgical procedures. Upon discharge, this percentage rises threefold among these patients in their first year after elective inpatient surgical procedures (Fritz et al., 2022). These falls have a significant impact on the patient’s life quality, finances, and safety and thus need to be addressed.
Purpose Statement(What is the purpose of the study?) The authors of this study used a multicomponent intervention that included patient education, a home medication review by a specialist, and an assessment of home safety. This study aimed at assessing whether this multicomponent intervention was associated with patient fall incidence reduction in patients who had undergone elective inpatient surgical procedures
Research Questions(What questions does the research seek to answer?) This study’s research questions sought to find answers to whether an intervention that incorporates patient education, specialist’s medication review at home, and identification of hazards in the patient’s home environment could be associated with reductions in patient falls during the first year after an elective inpatient surgical procedure.
Define Hypothesis (Or state the correct hypothesis based upon variables used) Effects of falls among hospitalized patients are multifactorial, multifaceted and have physical, emotional, financial, and functional consequences on the quality of life of the affected patients. Elective inpatient surgical procedures add to these risks in the postoperative period. The preoperative and postoperative periods is an opportunity to offer multicomponent strategies to prevent fall and minimize fall risks.
Identify Dependent and Independent Variables and the Type of Data for the Variables The dependent variable in this study was the incidence of patient falls in the first year after elective surgery reported by the patient. This study also had secondary dependent variables such as quality of life scores by the Veterans RAND tool. The application of the multicomponent fall prevention intervention was the independent variable.
The population of Interest for Study The study population was a group of adult patients who had undergone general anesthesia before an elective inpatient surgical procedure and had at least 2-day hospital stays.
Sample The study sampled a total of 1396 patients from two different studies assigned into intervention and control groups. The 698 patients were from the ENGAGES indicates Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes clinical trial study, while the other 698 patients in the control groups were from the d SATISFY-SOS, Systematic Assessment and Targeted Improvement of Services Following Yearly Surgical Outcomes Surveys cohort study and had met the inclusion criteria same as those in the intervention group.
Sampling Method A non-random sampling, quota sampling, the method was used to select eligible participants from the intervention and control patient pools.
Identify Data Collection Identify how data were collected Data on the primary outcome variable was collected through patient surveys that were administered for baseline assessment during the first postoperative month and also after the first postoperative year in both groups. These surveys were sent through email, and those who did not respond were followed by phone. The secondary variable, quality of life, was assessed using the Veterans RAND 12-item health survey tool. This tool had both mental and physical assessment items.
Summarize Data Collection Approach The data collection approach was biphasic, with baseline data for primary outcomes assessed for compression purposes at the study end. The quality of life assessment was done a month before the procedure and one year after the surgical procedure. This data collection approach transformed quality types of data into objective quantitative data for analysis
Discuss Data Analysis Include what types of statistical tests were used for the variables. Logistical regression analysis was used to analyze the propensity scores that were used to match the intervention and control group participant data. Pearson χ2 or Wilcoxon rank sum tests were used as appropriate to examine whether the matched cohorts had confounders. Comparative analyses were indicted for outcome variables for both cohorts. Null hypothesis significance testing (NHST) was used for these comparisons.
Summarize Results of the Study Fall incidence in the intervention groups after one year was 32.7% (228 of 698) and the incidence in the control groups was 32.2% (225 of 698). Cooperative analysis and significance testing. These differences were statistically insignificant at a 95% confidence interval. However, quality of life scores in the intervention groups was higher than that in the control groups.
Summary of Assumptions and Limitations Identify the assumptions and limitations of the article.Report other potential assumptions and limitations of your review not listed by the author. This study had a multidisciplinary approach in the implementation of the intervention that increased the likelihood of success of each intervention. The study sued a large sample size that increased the accuracy of results, reduced the margin of error, and enabled the identification of outlier values. Despite these strengths, this study had limitations because it was a single-center study, thus limiting the generalizability of the findings. Selection and recall bias are potential limitations due to the sampling method and periodical data collection methods applied in this study.

Ethical Considerations

Evaluate the article and identify potential ethical considerations that may have occurred when sampling, collecting data, analyzing data, or publishing results. Summarize your findings below in 250-500 words. Provide rationale and support for your evaluation.

This study used an approach that did not involve true experiments making it ethically appropriate for vulnerable patients. The lack of intervention used in the control groups showed lower benefits in their life quality during the study period. A potential ethical consideration arises because withholding this intervention (that would be reasoned as clinically beneficial) for the control groups on a nonrandom basis was biased and unethical (Handley et al., 2018).

Therefore, the causal association is limited by the nonrandom assignment of patients, undermining the principle of fairness because the participants did not get an equal chance of selection. Another ethical consideration in this method was the potential harm from the intentional withholding of an intervention that was viewed as beneficial to the patient’s quality of life.

Other general considerations in this study would be patient data confidentiality, privacy, and security owing to the study approach used. Sharing of patient data from the two studies to this study would jeopardize confidentiality. Even if protected health information were encrypted, the authors of this study would require to follow them up. This would have required personal patient data, thus the need to disclose them to a third party. The patients thus would lack autonomy in the use of their data.

The study was limited in external validity partially due to being a single-center study. The presence of confounders such as exercise that would have improved the quality of life of the patients in the intervention groups would have led to inferential bias that limits the external validity of this study (Lewis, 2020). Nevertheless, the quality of evidence and the level of evidence in the hierarchy are higher making. Despite the aforementioned limitations, this study still has many methodological strengths

GCU HLT 362 Week 5 Article Analysis and Evaluation of Research Ethics References

  • Fritz, B. A., King, C. R., Mehta, D., Somerville, E., Kronzer, A., Ben Abdallah, A., Wildes, T., Avidan, M. S., Lenze, E. J., Stark, S., & ENGAGES Research Group. (2022). Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA Network Open, 5(3), e221938. https://doi.org/10.1001/jamanetworkopen.2022.1938
  • Handley, M. A., Lyles, C. R., McCulloch, C., & Cattamanchi, A. (2018). Selecting and improving quasi-experimental designs in effectiveness and implementation research. Annual Review of Public Health, 39(1), 5–25. https://doi.org/10.1146/annurev-publhealth-040617-014128
  • Lewis, J. (2020). Experimental design: Ethics, integrity, and the scientific method. In Handbook of Research Ethics and Scientific Integrity (pp. 459–474). Springer International Publishing. https://doi.org/10.1007/978-3-030-16759-2_19

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