Thursday, December 12, 2019
Effectiveness of Preoperative Immunonutrition-Samples for Students
Questions: 1.Did the trial address a clearly focused Issues? 2.Aside from the experimental intervention, were the groups treated equally? Answers: 1.The validity of the randomized controlled trial (RCT) by Barker et al. (2013) is understood by its clear research purpose and focus. The review of the article showed that the main purpose of the study was evaluating the effectiveness of preoperative immunonutrition supplementation (intervention) on post operation outcomes (outcomes) between well nourished (population studied) and malnourished gastrointestinal patients (comparator). Hence, from this statement, the intervention provides and population studied is clearly understood. The significance of this research is that it points out to the issue of adverse post operative outcome in patient undergoing major gastrointestinal surgery due to malnutrition and stress. Some of the adverse post operative outcome includes high treatment cost, increased mortality, impaired wound healing, high infection rate and depressed immune system. Depressed immunes system is one of the major challenges that contribute to other negative issues in patie nt post surgery. Research has showed that immunonutrition has the potential to minimize early inflammation in surgery and improve post operative outcomes (Zheng et al. 2007). However, there is lack of evidence regarding the function of immunoutrition according to nutritional status. Hence, the use of RCT to evaluate effect of immunutrition supplementation on post operative outcome is an important research area that will have many positive implications in the future. 2.One of the unique elements of RCT studies is that it studies the effect of any intervention by randomization of patients to treatment and control group. Hence, apart from the treatment, all other things and conditions must remain same in treatment and control group. Barker et al. (2013) also treated the groups equally by maintaining a balanced group. A balanced group can be assessed by the method of enrolment, randomization, allocation concealment, blinding and follow up procedure used in the study (Farrokhyar et al. 2010). In the study by Barker et al. (2013), participants were randomized into treatment or control group in 1:1 ratio. Furthermore after admission, all surgical and hospital staffs were blinded to patients treatment allocation and only researchers were blinded to participants treatment group. This helps to minimize any potential bias during the research (Clark, Fairhurst and Torgerson 2016). There was no lost to follow up case post the allocation too. In addition, adh erence to trial protocols also strengthens the validity and credibility of the group and equal treatment of the group. Patients were also analyzed in the group to which they were randomly assigned. References Barker, L.A., Gray, C., Wilson, L., Thomson, B.N.J., Shedda, S. and Crowe, T.C., 2013. Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial.European journal of clinical nutrition,67(8), pp.802-807. Clark, L., Fairhurst, C. and Torgerson, D.J., 2016. Allocation concealment in randomised controlled trials: are we getting better?.BMJ: British Medical Journal (Online),355. Farrokhyar, F., Bajammal, S., Kahnamoui, K. and Bhandari, M., 2010. Ensuring balanced groups in surgical trials.Canadian Journal of Surgery,53(6), p.418. Zheng, Y.M., Li, F., Qi, B.J., Luo, B., Sun, H.C., Liu, S. and Wu, X.T., 2007. Application of perioperative immunonutrition for gastrointestinal surgery: a meta-analysis of randomized controlled trials.Asia Pacific journal of clinical nutrition,16(S1), pp.253-257.