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Sackett (1998) defines evidence based practice
(EBP) as being the conscientious, explicit and judicious use of current best
evidence in the management of patients. EBP provides a means of integrating
individual clinical expertise with the best available external clinical evidence
from systematic research (Sackett, 1998) Evidence based practice
should be used amongst healthcare professionals to optimise the experience and
quality of care each and every individual patient receives. Gibbs (2007) states
that by focusing on the patient’s needs, healthcare staff that partake in evidence based
practice are undergoing a lifelong learning process which involves learning
about issues of direct clinical importance with the intention of helping the
patient. Understanding and evaluating research articles as a healthcare
professional allows these professionals to make more educated decisions and can
lead to incites that include dramatic improvements to the healthcare that
patients receive (Fain, 2017). Research highlights the challenges involved in
closing the evidence-practice gap, and may add to the growing body of knowledge
on which basic actions can be taken to ensure the best care and treatment
available reaches the patient. However, it is important that healthcare
professionals approach published research with a critical perspective in order
to allow them to make an objective decision on the quality of published
research. Critical appraisal tools may be used to provide an objective measure
of such published research. Checklists are designed to
be followed when analysing healthcare research articles, journals and reports.
These checklists help ask questions about the research to aid the analysis
(, 2017). Using a framework when taking part in evidence based
practice allows all the relevant information to be withdrawn from the articles,
in this critical analysis the Ingham- Broomfield framework will be used to
analyse each article. Amaratunga (2002) suggests that the use of
appraisal tools allow the research to be broken down in to its constituent
sections e.g. literature search, methodology etc. and for each section to be
objectively analysed

The aim of this assignment is to use the
Ingham-Broomfield critical appraisal tool (***) in order to critically appraise
two radiography specific articles.

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1, is an article based on quantitative (quasi-experimental) research article
titled “Computed radiography versus indirect digital
radiography for the detection of glass soft-tissue foreign bodies” (Sheridan and McNulty,
2016). This article uses both projection imaging techniques. Using the quantitative
research method suggests how the authors set up the research with very little independent
variables including the same soft tissue, the same glass fragments and the same
radiographers reporting on the images.

Article 2, is a qualitative and
quantitative study on radiographer’s knowledge and attitude towards patients
with HIV/AIDS in Ghana. The author of this study constructed two short
questionnaires to analyse specific attitudes and to identify the extent of
knowledge that radiographers have of HIV/AIDS sufferers.


Article 1-

Author and Date

This article differentiates between computed radiography and
digital radiography in their detection of glass foreign bodies in soft tissue. The
title of this article appears to be succinct and clearly identifies the nature
of the research, with a clear and self-explanatory vocabulary. Both Authors of the research paper studied diagnostic
medical imaging at university level and also N. Sheridan operated in a radiology
department in Ireland which suggests both authors are of clinical experience in
their field of research. The article was accepted for publication in
2016 and thus reflects up-to-date research with current clinical relevance. This
article is published in a peer-reviewed journal which establishes this article’s
reliability and validity. Research must be either scientifically or
societally beneficial in order to qualify as relevant (Shaw and Elger, 2013).



abstract has been used to identify a clear aim in which the authors aimed to
compare CR and DR in the detection of radio-opaque glass foreign bodies. The
method is stated as a quantitative experiment using a variety of sizes of glass
which were placed in soft tissue and then imaged by each radiographic
technique. The aim of this research was to identify which type of radiography
was more efficient in detecting the foreign body. The
abstract allows the reader to determine this is a quantitative approach to
research, which is defined by Burns and Grove (2005) as quantitative
research is a formal, objective, systematic process in which numerical data are
used to obtain information about the world.


Identifying the problem

authors identify, using appropriate literature that the detection and removal
of embedded foreign bodies, especially glass, is challenging and that many
foreign bodies are missed and not removed. The authors indicate the implication
of unremoved glass foreign bodies in terms of wound infection and risk of legal
action for the resulting long-term implications of non-removal 

The authors establish a
clear rationale for the study in attempting to identify the most sensitive
projection imaging (CR or DR) in the detection of glass foreign bodies. The
authors determine an aim, which is to directly compare CR and DR for the
visibility of radio-opaque glass FB’s. However, they do not use the aim to
reference the use of chicken as a human tissue equivalent or the varying sizes
of glass foreign bodies. Further the authors outline an objective, being to
consider the size of the foreign bodies and changing exposure factors on
visibility, this may have been identified as two separate objectives to provide
greater clarity.


Literature review

In this
article, the authors do not approach the literature with a critical review,
however relevant articles of previous experiments are referenced to justify the
experiment. In this article, the authors use the literature of previous
research to show the clinical significance of the study, using the specific
studies helps back up the results of this research study as reliable. All
previous studies as well as the study taking place in this research article all
comment on the size of the foreign body having a significant impact on the
detection and diagnosis of a foreign body. Therefore, despite the main
objective being the comparison of CR and DR the authors have taken in to
account the size of the foreign body using evidence from the previous research.
This suggests that the authors of this article have used good literature to perform
an authentic study as well as support their research (Grewal, Kataria and
Dhawan, 2016). Further literature that could have been used is an article by
Levine et al, (2008) which is a more recent study and comments in detail the
difficulty of identifying and removing foreign bodies on first examination as
well as the risk of missing foreign bodies. However, this article also refers
to glass only accounting for 13% of all foreign bodies. Of
the limited literature used there is no reference to the comparison of CR and
DR in detection of FB’s and this lack of cited literature is used as
justification for the current study



The authors of article
1 used a quasi-experimental study to compare CR and DR in their detection of
glass foreign bodies with a further objective to determine if size of the glass
changed the detection rate. A quasi-experimental method is ideal for this study
to maximise the articles validity due to the fact that it removes systematic
error (Ross and Morrison, 2005). Validity in qualitative research assesses
“appropriateness” of the tools, processes and data as well as whether the
research question is valid for the desired outcome (Leung, 2015).

The quasi-experimental
method means there is no change in the variable factors of the experiment. The x-ray
tube, the film focal distance, the soft tissue used, the foreign body were all
the same across all experiments, as well as the same projections were taken of
each soft tissue. Having good control variables further increases validity.

A sample of chicken
thigh was used to replace human soft tissue. Although the tissue type is
similar, the size of the tissue is not relative to that of a human which
questions the internal validity of the experiment.

In this experiment,
the use of chicken thigh soft tissue was used to reduce any ethical issues and
comply with any international guidelines and regulations. Original publications that need to be taken in to
consideration and abided by include, The Declaration of Helsinki, Belmont
Report, Council for International Organisations of Medical Sciences/World
Health Organisation International Guidelines for Biomedical Research Involving
Human Subjects, World Association of Medical Editors Recommendations on
Publication Ethics Policies, International Committee of Medical Journal
Editors, CoSE White Paper, International Conference on Harmonisation of
Technical Requirements for Registration of Pharmaceuticals for Human Use-Good
Clinical Practice. These articles and guidelines form the literature that are
relevant to the ethical and legal aspects of conducting research that
researchers should abide by when conducting translational and clinical research
(Sng, Yip and Han, 2016). Using Chicken thigh complied with all the rules and regulations
while confidentiality, anonymity, dignity and patient freedom of harm, were all

Due to the large numbers of variables that were
controlled there was little room for any bias in this experiment, Pannucci and
Wilkins (2010), state how reviewers
of literature must consider the degree to which bias was prevented by proper
study design and implementation. As some degree of bias is nearly always
present in a published study, readers must also consider how bias might
influence a study’s conclusions. As the authors created a strong experiment and
reduced the chance of systematic error, the experiment is designed to prevent
bias to the optimum level.

Visual Grading Analysis was used
in the experiment to enhance the quality of each set of images. This recreates
the image to the best quality possible and is justified to use by Bath and Mansson


Pilot study

Pilot studies represent a fundamental phase of the
research process. The purpose of conducting a pilot study is to examine the
feasibility of an approach that is intended to be used in a larger scale study
(Leon et al, 2011). The
pilot study for this experiment allowed for the same proposed environment as
the actual study. The largest foreign body was used and was imaged using both
radiographic techniques, where the exposure factors were varied to produce
maximum contrast over each modality. The authors chose an appropriate sample
experiment to mimic the acquisition of the actual study.


Main study

author state that they have collated data which is not normally distributed,
this was discovered by using the Kolmogorov-Smirnov
test, and
thus have chosen statistical tests which may be applied on non-parametric data
which is not normally distributed. Non-parametric data refers to data that is
not expected to follow specific distribution. The authors used the Mann-Whitney U and the Kruskal-Wallis non-parametric tests to
interpret the data. Both of these tests are useful for non-parametric data and
therefore the results given are significant.

All the results are then
displayed across graphs, graphs are a common
method to visually illustrate relationships in data. The purpose of a graph is
to present data that are too numerous or complicated to be described adequately
in the text (Slutsky, 2014). From the graphs and the statistical tests that
took place, there is an obvious statistical difference between CR and DR in the
detection of glass foreign bodies.

In the discussion section
of this article the authors discuss the positives and negatives of other
modalities in foreign body detection and then comments on the important role
plain film play in FB detection. The authors identify that the use of low
exposure factors in this experiment could have led to the success of CR, however
the authors also state that when increased exposure factors are used DR became
more superior. The authors identified some limitations to this experiment
including; the use of non-human tissue, only one type of glass used and not
being able to window the images. Also, the authors suggested that the
radiographers used for the experiment were qualified to report on images,
perhaps if the experiment were to take place again reporting radiographers or a
radiologist could be used to report on the images.

Finally, the
experiment and the article composed by the authors were put together to a high
standard where all the aims and objectives proposed in the paper were answered
and backed up by well-defined previous research.


Article 2-


Title, Author and Date

This article is a
qualitative study on radiographer’s knowledge and attitude towards HIV/AIDS
sufferers in Ghana. The authors of this article decorate the first page with a
large title in bright colours which captures the eye of the reader. All of the
authors have a healthcare background specifying in radiography, however, each
of the authors are on a student level. The article was published in 2016 which suggests
research is up to date, despite this in the introductory paragraph statistics
used are over 10 years old. Also, this article has not been published in a peer
reviewed journal and therefore validity and reliability is questionable. Gannon
(2001) states that without an external seal of approval from a peer reviewed
journal, they would consider any results presented as preliminary and
potentially flawed.



In this article, the authors did not create a
specific abstract section, instead the abstract was broken in to subsections,
Aim and Objectives of the study. The authors do not include any insights in to
the methodology or overall results of the experiment which is unlike what
Andrade (2011) suggests where usually
sections defined in a structured abstract are the Background, Methods, Results,
and Conclusions. Therefore, the abstracts composed by these authors lacks sufficient
detail and justification for the experiment.


Identifying the problem

In this article, the
authors use a similar article on attitudes and behaviours in managing HIV/AIDS
patients, whereby they identify a lapse in improving the quality of life of the
sufferers. The authors establish a clear rationale after they stated to the
best of their knowledge there has been no previous research into radiographers’
knowledge and attitudes toward HIV/AIDS patients specifically in Ghana. The
main aim of this article is an assessment of the radiographers’ knowledge and
attitude towards HIV/AIDS, but also to highlight the factors that affect
attitude towards HIV/AIDS, and finally to comment on the compliance of the
radiographers with the care of HIV/AIDS sufferers.


Literature review

In article 2 there is
not a specific literature review section to the article. However, previous
literature has been used and referenced to help justify and support their
research. The authors have referenced many previous research articles relating
to the attitudes of healthcare professionals towards HIV/AIDS patients, however
the articles used are not particularly relevant to the study taking place. A
lot of the articles that relate to HIV and AIDS are based outside of Africa,
when 69% of the worlds AIDS sufferers are from sub-Saharan Africa. Therefore,
the research used by the authors is unreliable and irrelevant in this study. Other
literature that could have been used includes the study on ‘Attitudes and Behaviours
of Health Workers and the Use of HIV/AIDS Health Care Services’ (Dapaah, 2016)
which related directly to sub-Saharan Africa and particularly Ghana. Likewise,
another article that could have been referenced is a similar study based in Nigeria
composed by Umeh et al., (2008).



The authors state that they used a cross-sectional survey was used
to conduct this experiment, however, there was no justification used to support
this decision and there were also no references of previous studies to explain
how and why this study method was used. The authors state how they used a pre-validated
questionnaire which they modified to suit their sample group, this shows how
the authors have tried to justify the validity and accuracy of their experiment.
The advantage of using a survey tool is allowing a
large population to be assessed with relative ease (Jones et al., 2013). Despite
being appropriate for a large size due to pre-set answers it is difficult to
analyse specific feelings of the participants, especially in this area of
research. The sample group used was constructed of majority 25-29-year-old
radiographers of whom were predominantly male. This sample would be good if
this is an accurate representation of radiographers in Ghana, however, the
authors have not referenced any previous literature to support this. A
sample is expected to mirror the population from which it comes and therefore, sampling
error can make a sample unrepresentative of its population (Bineham, 2006). Also,
question 6 of the survey seems to be poorly written and therefore may be miss
interpreted by the participants. This indicates that there could be lapse in the
reliability of the experiment and also forms a type of bias in the paper. Where
Bias is defined as deviation of results
or inferences from the truth, or processes leading to such a deviation.
Questionnaire bias is a result of unanticipated communication barriers between
the investigator and respondents that yield inaccurate results (Choi and Pak,

The authors suggest that they
took all of the ethical precautions when panning this experiment, they state
that confidentiality, anonymity and dignity was upheld while seeking approval
from the ethics committee. The authors show good understanding of the nature of conflicts arising
from moral imperatives and how they may deal with them if they were to arise
(Avasthi et al., 2013).

Despite the authors
using a cross-sectional survey that allows many participants to take
part, the authors only used 44 radiographers which is a relatively small sample
group. Nayak (2010) states how a smaller sample size
will give a result which may not be sufficiently powered to detect a difference
between the groups and the study may turn out to be falsely negative.


Pilot study

The authors of article
2 do not state that a pilot study took place.




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