Medicine Paper

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This assignment requires you to compare and critically appraise two academic texts.

Type of texts: One of these texts can be the same text you summarized for Assignment 1. The texts can be on-line articles, journal articles, reports of different studies, written versions of conference papers or chapters from books. You should choose texts that present different arguments or offer different solutions to a particular ‘problem’ or issue that is important in your field.

You should discuss your choice of texts with your lecturer before working on this assignment.

Structure:

The structure you choose to follow for Assignment 2 depends to some extent on the texts you have chosen. The following sets out possible structures:

Introduction:
Information about the topic/area of research.
Identify the 2 articles and their main purpose
Initial evaluation of Text 1
Summary of Text 1
Summary of Text 1
Brief summary of Text 1
Critical evaluation of Text 1
Summary of Text 2
Initial evaluation of Text 2
Summary of Text 2
Critical evaluation of the two texts/comparison – based on certain criteria
Brief summary of Text 2
Critical evaluation of Text 2
Conclusion
Critical evaluation of the two texts
Conclusion

Answer

Title: A Critical Review of Two Texts

 

Contents

Introduction. 2

Summary of Dorresteijn et al. (2012) 2

Brief Summary of Dorresteijn et al. (2012) 2

Initial Evaluation of Dorresteijn et al. (2012) 2

Critical evaluation of Dorresteijn et al. (2012) 2

Summary of Ortegon, Redekop & Niessen (2004) 3

Brief summary Ortegon, Redekop & Niessen (2004) 3

Initial evaluation Ortegon, Redekop & Niessen (2004) 3

Critical evaluation of Ortegon, Redekop & Niessen (2004) 3

Critical evaluation of the two texts/comparison. 3

Conclusion. 4

References. 5

 

Introduction

            The area of research that this critical review focuses on is prevention of diabetic foot ulceration. The two articles to be used in the review are Dorresteijn et al. (2012) and Ortegon, Redekop & Niessen (2004).

Summary of Dorresteijn et al. (2012)

This study assesses the impact of patient education in the ongoing efforts to prevent the occurrence of foot ulcers among individuals with diabetes mellitus. In terms of method, the study reviews prospective randomized controlled trials (RCTs) that provide an evaluation of educational programs aimed at preventing foot ulcers among individuals with diabetes mellitus. In terms of choice of participants, the review targets studies that focus on patients with diabetes mellitus, aged 18 years and above, in any type of healthcare setting.

Brief Summary of Dorresteijn et al. (2012)

            This study reviewed 12 high-level studies, and it found that educating diabetes patients about the importance of looking after their feet promotes foot-care behavior change as well as promotes the patients’ foot care knowledge, albeit in the short term. Moreover, the paper did not find sufficient evidence that educating people alone, without putting in place additional preventive efforts, will reduce the prevalence of ulcers and subsequent amputations.

Initial Evaluation of Dorresteijn et al. (2012)

Based on the analysis of findings, indications are that education seems to have short-term influence on self-reported behavior among patients as well as foot care knowledge. Moreover, it seems that patient education alone cannot be relied on in efforts to bring about meaningful reductions in incidences of ulceration and amputation.

Critical evaluation of Dorresteijn et al. (2012)

The findings of this review seem to contradict those provided in many earlier reviews on the topic. In those reviews, sufficient evident seemed to have been tabled to demonstrate that public education can significantly contribute to the prevention of diabetic foot ulcers. However, the present review seems to provide more credible outcomes because of the way it targets well-considered and complete overview of critical evidence. For instance, of the 12 RCTs the study reviewed, only five exhibited a high risk of bias.

The importance of the study may be assessed based on its primary and secondary outcome measures as well as process outcomes. The primary outcome measures include foot ulceration and recurrence of ulcer that leads to amputation. On the other hand, the secondary outcome measures include the development of callus and its resolution, fungal infection, and hospital admissions. In terms of process outcomes, the focus of the study seems to shift towards scores on foot care knowledge and scores on the assessment of patients’ behavior. Nevertheless, it may be necessary to subject the study findings to further scrutiny with a view to remove some of biases that potentially exert an adverse effect on their validity.

Summary of Ortegon, Redekop & Niessen (2004)

The aim of this study is to examine the impact of optimal preventive and treatment-related measures targeted at diabetic foot ulceration in terms of economic and lifetime health outcomes. Findings of the study indicate that when diabetic foot is managed using guidance-based care, diabetic foot complications are reduced, cost-effectiveness is achieved, and the rate of survival is improved.

Brief summary Ortegon, Redekop & Niessen (2004)

In this study, diabetic foot ulceration is identified as one of the most common health problems affecting people with diabetes, and this leads to poor quality of life, low life expectancy, and a huge economic burden. Against the backdrop of these challenges, the study not only examines two factors: optimal foot care (OFC) and Intensive glycemic control (IGC).

Initial evaluation Ortegon, Redekop & Niessen (2004)

The argument presented in this study, it seems, is anchored on the need to address both the preventive measures and cost-effectiveness. Thus, there is a point beyond which preventive measures may need to give way to alternative disease management measures in an efforts to keep costs low.

Critical evaluation of Ortegon, Redekop & Niessen (2004)

Four factors may be used to provide a critical evaluation of the study by Ortegon, Redekop & Niessen (2004): cost effectiveness, nature of preventive measures, quality of life, life expectancy, and interaction between preventive and disease management measures. More detailed evidence may be needed to ascertain the veracity of the relationship among these factors. For example, the authors assume that costs automatically increase with a reduction in preventive measures without providing adequate supporting evidence.

In terms of preventive measures, the use of sensitivity analysis in the study was appropriate. It was also acceptable for the authors to adapt the values of utility weights determined through results from previous studies to ensure that they meet the study’s ulcer categorization. Meanwhile, further research on the dynamics of OFC and IGC in terms of their contribution to enhanced quality of life and life expectancy may need to be undertaken. Moreover, the line between preventive and disease management strategies seems blurred, and this somewhat takes attention away from the primacy of preventive strategies in the fight against diabetic foot ulceration.

Critical evaluation of the two texts/comparison

The two essays address the issue of preventing diabetic foot ulceration from different perspectives. Dorresteijn et al. (2012) examine it from the point of view of patient education while Ortegon, Redekop & Niessen (2004) evaluate it in terms of cost-effectiveness of two approaches: optimal foot care (OFC) and Intensive glycemic control (IGC). Each of the two approaches has its weaknesses. For example, the use of scores on foot care knowledge and scores on the assessment of patients’ behavior by Dorresteijn et al. (2012) fail to address aspects of cost-effectiveness. On the other hand, the two factors highlighted by Ortegon, Redekop & Niessen (2004) (OFC IGC) do not give an indication on the role of public education in the overall preventive strategy.

Nevertheless, one may argue that Ortegon, Redekop & Niessen (2004) provide a more optimistic appraisal of preventive measures for diabetic foot ulceration. More importantly, the study assesses preventive strategies as a percentage of overall disease management efforts of diabetes. In contrast, the pessimism portrayed in Dorresteijn et al. (2012) may have arisen because the studies that were reviewed recruited too few study participants and also failed to follow up on them for a long period of time to allow the detection of clinically important variations in primary outcomes.

Conclusion

In conclusion, Ortegon, Redekop & Niessen (2004) seem to provide more information regarding diabetic foot ulcers than Dorresteijn et al. (2012) because they focus on both prevention and treatment. Nevertheless, the study by Dorresteijn et al. (2012) also has its strong points, for example the comprehensiveness with which it addresses aspects of bias as well as the agreements and disagreements presented in previous studies.

 

References

Dorresteijn, J., Kriegsman, D., Assendelft, W. & Valk, G. (2012). Patient education for preventing diabetic foot ulceration. The Cochrane Collaboration, 10, 1-51.

Ortegon, M., Redekop, W. & Niessen, L. (2004). Cost-Effectiveness of Prevention and Treatment of the Diabetic Foot: A Markov analysis. Diabetes Care, 27(4), 901-907.

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