Acupuncture for Chronic Headache in Primary Care

Acupuncture for Chronic Headache in Primary Care Research Critique Introduction Research involves the use of systematic procedures to answer an inquiry. It involves data collection, synthesis and analysis in the light of the question or inquiry; and formulation of conclusions and recommendations, (Badke, 2004). General types of research include experimental studies which â€Å"are used to test the effect of a treatment or intervention†, (Peat, 2001, p. 16). Clinical trails fall under the broad category of experimental trials. Clinical trials are controlled experiments with patients, which range from â€Å"studies to prevent, detect, diagnose, control and treat health problems to studies of the psychological impact of a health problem and ways to improve people’s health, comfort, functioning, and quality of life†, (Brooten, 2006, p.86). Generally, clinical trials can be categorised into either randomised trials or non-randomised trials. This paper will try to evaluate the scientific research conducted by Vickers and colleagues (2004), entitled: Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial, which was published on 15 March 2004 at the British Medical Journal. This particular topic was selected due to its relevance to this field of study. Numerous insights from this field of study and valuable best practice information in quantitative research methods can be gained from undertaking this critiquing task. This critique will be carried out using the research framework for critiquing health research formulated by Caldwell and co-workers (2005), which provides a comprehensive set of criteria against which the elements of the research article by Vickers and colleagues (2004) can be appropriately measured. This paper will first evaluate the overview of the study, including the abstract, literature review and the methodology used. Next, it will critically analyse issues concerning resear ch ethics, data protection and research funding. Then, it will evaluate the reliability, validity of the research results, including the sampling methods employed. It will then identify the specific 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 article: Acupuncture – pertains to the â€Å"technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points†, (â€Å"Acupuncture†, 2007). ANCOVA – stands for ‘analysis of covariance’ which is a statistical treatment that combines analysis of variance (ANOVA) and regression; whereby â€Å"the predictable component of the individual differences can be removed with regression analysis†, (Anderson, 2001, p. 283). Chronic – â€Å"all impairments or deviations from normal that have one or more of the following characteristics: are permanent; leave residual disability; are caused by nonreversible pathological alteration; require special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care†, (Sidell, 1997, p. 1) Negative binomial regression – â€Å"is one of a class of mixed Poisson models that mix a second source of variance with the Poisson variance to account for overdispersion†, (Cohen, et al., 2003, p. 531). Outcome measures – â€Å"reflect patient health status at either the individual or the aggregate (population) level†, (Stommel Wills, 2004, p. 234). Randomised trial A randomised trial is a clinical trial that pertains to â€Å"an experiment in which therapies under investigation are allocated by a chance mechanism†, (Brooten, 2006, p.86). Sham Treatment – is the experimental treatment that â€Å"has no effect and which subjects cannot distinguish from the active treatment â€Å"(Peat, 2001, p. 20). Critical Analysis In March 15, 2004, the BMJ Publishing Group Ltd, a wholly owned subsidiary of the British Medical Association, published the research article in its medical journal, the British Medical Journal (BMJ). Its â€Å"print BMJ has been published continuously since 1840, and now appears in four weekly editions, varying only 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 â€Å"the full 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 recognized 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 New York; Rebecca Rees is a research officer at the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit in London; Catherine E Zollman is a general medical practitioner from Montpelier 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 deputy director of research are from Royal London Homeopathic Hospital. Thus, based on their qualifications, the authors have the credibility, needed knowledge and e xpertise to engage in an extensive scientific study such as the article being evaluated. The article is appropriately titled as Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial, since it essentially focussed on the effectiveness of the use of acupuncture to relieve chronic headache. Moreover, the title expressly implies that the methodology utilizes a large sample 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 outcome measures; (6) results; and (7) conclusions. The abstract provides the complete key information that the readers need to fully understand 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 aim or rationale of the study, whi ch was: â€Å"to estimate the effects of acupuncture in practice† in general; and â€Å"to determine the effects of a policy of ‘use acupuncture’ on headache, health status, days off sick, and use of resources 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 insufficient in terms of the extent of evaluating available 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 implicit 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, the procedures employed in the methodology were intricate and systematic. The participants were clearly identified and adequately described in the study. In the accrual of patients, several stages were established to facilitate the flow 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 prohibit the use of human subjects for medica l research, the researchers obtained written informed consent from the participants. The researchers implemented a system to ensure randomization of the study through a ‘password protected database’, thereby eliminating the potential for bias and subsequently improving the quality of the results. As Peat (2001, p. 28), explains: â€Å" in randomised controlled trials, the quality of the evidence is improved if measurement bias, such as observer or reporting bias, is reduced by using objective outcome measurements and if observers are blinded to the group 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 follow-up procedure was implemented to generate â€Å"a global estimate of current and baseline headache severity†, (Vickers, et al., 2004). This further enhanced the validity of the results. The large sample size helped ensure the reliability of the results. Additionally, t he use of measurable outcomes such as the Likert scale of headache severity helped eliminate bias by extending common measurement criteria for the respondents. The article correlated its results with the findings in â€Å"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 comprehensive. 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 easily 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 the absence of sham 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 o f available literature. Conclusion In the final analysis, the research article serves as an additional source of authoritative and credible information regarding the use of acupuncture for the 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 must evaluate a substantial body of literature to gain insight into the currently available information and subsequently identify knowledge gaps. Moreover, future randomised clinical studies in acupuncture should include a sham treatment to be able to consider potential placebo effects; and blinding of participants must be observed to eliminate bias. Bibliography Acupuncture. (2007). In The Columbia Encyclopedia (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. Research 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 Nursing Research (Second Edition). Joyce Fitzpatrick and Wallace, J.J., (Eds). New York: Springer Publishing Company. Caldwell, K., Henshaw, L., Taylor, G., 2005. Developing a framework 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 Regression / 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 Illness: 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 Wilkins Vickers, A.J., Rees, R., Zollman, C.E., McCarney, R., Smith, 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]. Appendix Figure 1Flow of Participants Through the Trial Source: Vickers, et al., 2004

Higher education in Canada Essay

Nowadays, most of the people in the world will have a chance to get educated. Many high school and colleges graduates would like to attend four-year University or higher education. They believed that education is a code to help them get success. But why people need to be educated, and what is the purpose of education? When we were young, we thought that we go to school is because of family expectation. After we grow up, we think that it is because of popular trend, people who get higher degree will get more success. But these are not the answer. Education is the key to explore our own life because its purpose is to train good members of society, to help people live better, and to explore our limit in order to upgrade our ability in our daily life. Education helps our society to train good members. According to John Henry Newman, the author of †The Idea of a University†, pointed out that †education neither confines its views to particular professions on the one hand, nor creates heroes or inspires genius on the other†. (53) University cannot promise to create a generation of heroes, presidents or genius, but it  can educate people knowledge, skills and experiences of social life, and let them learn to respect, to consult, to aid each other. Education also focuses on training students’ ability, †It teaches him to see things as they are, to go right to the point, to disentangle a skein of thought, to detect what is sophistical, and to discard what is irrelevant. †. (53) Education will give people a clear conscious view of everything around them, and let them distinguish what is right and what is wrong of their own opinions and judgments. Therefore, weare able to accommodate ourselves to others, influence to others, and come to an understanding with others. University education is the great means to †raising the intellectual tone of society, at cultivating the public mind, at purifying the national taste†. (54) Education helps people to live better. In the †Learning in the Key of Life†, Shorris, a novelist and journalist, said that †Do all rich people, or people who are in the middle, know the humanities? Not a chance. But some do. And it helps. It helps to live better and enjoy life more. Will the humanities make you rich? Absolutely. But not in terms of money. In terms of life†. (67) In other word, education can help us to become rich on both ways of money and life. Of course, between those we consider well educated and those who are poorly or inadequately schooled, people accept the higher education always have a better life. They can get more than the others who has lower income level, and make their life easier. People who received higher education have more power to dictate their life. For example, they can  plan our community, adjust our workweeks and even control the world financial markets. In the †Learning in the key of life†, Jon Spayde pointed †that kind of power has everything to do with attitude and access: an attitude of empowerment, even entitlement, and access to tools, people, and ideas that make living at any income level easier, and its crises easier to bear†. (67)Education is a light to illuminate our future, the more education we have, more bright future we will have. Education helps us to explore our limit in order to upgrade our ability in our daily life. According to David Orr, Oberlin College environment professor, he pointed out that university focus on teaching in high-tech training call †Slow Knowledge†, which is †resilience, harmony, and preservation of long-standing patterns that give our lives aesthetic, spiritual, and social meaning†. (68) For example, we cannot finish a 1,000-page novel in one second,because we need to watch the novel step by step and understand the story. We all are slow learners. Although we get academic education,we need to get experience from life in order to explore our limits. As Jon Spayde mention, †is it any wonder that many of us are beginning to feel that we didn’t get the whole story in school, that our educations didn’t prepare us for the world we’re living in today? †. (67) In addition to education, we also should learning from life and learning from experienceto enrich our life, and make our life easier. Education is a basis for our society. It also can train good members of society, to makeour life better, and enhance our ability in our daily life. Growth is a characteristic of life, so education is growing. It can help people be stronger and wiser. We should be awise old owland use our knowledge to make our life and society better. Word Cited Henry Newman, John. â€Å"The Idea of a University. † Lunsford, Andrea, and John Ruskiewicz, eds. THE PRESENCE OF OTHERS: VOICES AND IMAGES THAT CALL FOR RESPONSE. 5TH ED. BOSTON : Bedford/St. Martin’s. 2008. Print Spayde, John. â€Å"Learning in the Key of Life. †Lunsford, Andrea, and John Ruskiewicz, eds. THE PRESENCE OF OTHERS: VOICES AND IMAGES THAT CALL FOR RESPONSE. 5TH ED. BOSTON : Bedford/St. Martin’s. 2008.

Advertising and Marketing Research

Market research is any organized effort to gather information about markets or customers. It is a very important component of business strategy. [1] The term is commonly interchanged with marketing research; however, expert practitioners may wish to draw a distinction, in that marketing research is concerned specifically about marketing processes, while market research is concerned specifically with markets. [2] Market Research is the key factor to get advantage over competitors. Market research provides important information to identify and analyze the market need, market size and competition. Market research,as defined by the ICC/ESOMAR International Code on Market and Social Research, includes social and opinion research, [and] is the systematic gathering and interpretation of information about individuals or organizations using statistical and analytical methods and techniques of the applied social sciences to gain insight or support decision making. [3] Market Research is a systematic, objective collection and analysis of data about a particular target market, competition, and/or environment. It always incorporates some form of data collection whether it be secondary research (often referred to as desk research) or primary research which is collected direct from a respondent. The purpose of any market research project is to achieve an increased understanding of the subject matter. With markets throughout the world becoming increasingly more competitive, market research is now on the agenda of many organisations, whether they be large or small. The Market Research Process To conduct market research, organisations may decide to undertake the project themselves (some through a marketing research department) or they might choose to commission it via a market research agency or consultancy. Whichever, before undertaking any research project, it is crucial to define the research objectives i. e. what are you trying to achieve from the research? and what do you need to know? After considering the objectives, Market Researchers can utilise many types of research techniques and methodologies to capture the data that they require. All of the available methodologies either collect quantitative or qualitative information. The use of each very much depends on the research objectives but many believe that results are most useful when the two methods are combined. Quantitative Research Quantitative research is numerically oriented, requires significant attention to the measurement of market phenomena and often involves statistical analysis. For example, a bank might ask its customers to rate its overall service as either excellent, good, poor or very poor. This will provide quantitative information that can be analysed statistically. The main rule with quantitative research is that every respondent is asked the same series of questions. The approach is very structured and normally involves large numbers of interviews/questionnaires. Perhaps the most common quantitative technique is the ‘market research survey’. These are basically projects that involve the collection of data from multiple cases – such as consumers or a set of products. Quantitative surveys can be conducted by using post (self-completion), face-to-face (in-street or in-home), telephone, email or web techniques. The questionnaire is one of the more common tools for collecting data from a survey, but it is only one of a wide ranging set of data collection aids. Qualitative Research Qualitative research provides an understanding of how or why things are as they are. For example, a Market Researcher may stop a consumer who has purchased a particular type of bread and ask him or her why that type of bread was chosen. Unlike quantitative research there are no fixed set of questions but, instead, a topic guide (or discussion guide) is used to explore various issues in-depth. The discussion between the interviewer (or moderator) and the respondent is largely determined by the respondents' own thoughts and feelings. As with quantitative techniques, there are also various types of qualitative methodologies. Research of this sort is mostly done face-to-face. One of the best-known techniques is market research group discussions (or focus groups). These are usually made up of 6 to 8 targeted respondents, a research moderator whose role is to ask the required questions, draw out answers, and encourage discussion, and an observation area usually behind one way mirrors, and video and/or audio taping facilities. In addition, qualitative research can also be conducted on a ‘one on one’ basis i. e. an in-depth interview with a trained executive interviewer and one respondent, a paired depth (two respondents), a triad (three respondents) and a mini group discussion (4-5 respondents).

Microeconomic Analysis Questionnaire - 2929 Words

BEO2264 MICROECONOMIC ANALYSIS TUTORIAL QUESTIONS TOPIC 1 Question 1 (a) Discuss how microeconomic theory can help to explain the effects of lowering the minimum wage for teenage employees in the retail industry (b) How is the usefulness of a theory evaluated (c) â€Å"Observation without theory and theory without observation are equally useless in explaining the complexities of the real world†. Discuss. Question 2 (a) Distinguish between positive analysis and normative analysis. (b) The following statements were overheard in a conversation between two students. Student A: â€Å"Making unemployed people work for social security benefits is a poor social policy because it is exploitative†. Student B: â€Å"Making unemployed†¦show more content†¦There are four people (A, B, C and D) living on the island. Their preferences are as follows: A has a strong preference for pineapples; B has a strong preference for coconuts; C doesn’t care for any pineapples; and D doesn’t care for any coconuts. (a) For each of the four people, draw a representative indifference curve in a diagram (measure pineapples along the vertical axis). (b) Define the MRS of coconuts to pineapples (MRSC,P). (c) Discuss the shape of each indifference curve you have drawn for part (a) and relate them to the MRSC,P. Question 4 The utility function that Jane receives by consuming food and clothing is given by U= F*C. (a) In a diagram, draw the indifference curves associated with utility levels of 12 and 24 (measure clothing along the horizontal axis). (b) Suppose that the price of food is $1 per unit and the price of clothing is $3 per unit, and Jane has $12 to spend. Graph the budget line that Jane faces in the diagram you have drawn for part (a). (c) From your diagram, find Jane’s utility-maximising choice of food and clothing. (d) What is the MRSC,F at the point of utility maximisation? 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