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Compare And Contrast The Methods Used In Both Articles, With An Eye To A Assessing The Quality ...

Question: Compare and contrast the methods used in both articles, with an eye to a assessing the quality an...

Compare and contrast the methods used in both articles, with an eye to a assessing the quality and limitations of the findings and informing future research. a) explain why the authors of each article selected the methods they did. How appropriate were the methods to the overall purpose of the paper. Back response with examples. b) Analyze a difference and similarity in the mthods chosen with respect to the health question being addressed in the selected articles. Explain your answer using evidence from the two articles and the information. c) Assess a strength and limitation of the different approaches used in the articles . Explain answer using evidence from the articles.

Two articles to be reveiwed:
https://pdfs.semanticscholar.org/2f04/b98d77b4ec298dddcd4b20e623fa0589ce1c.pdf and the full text RESEARCH IN BRIEF
The effect of ambulation after cardiac catheterization on patient
outcomes
Sek Ying Chair MBA, PhD, RN
Assistant Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
David R Thompson PhD, MBA, RN, FRCN, FESC Director and Professor of Clinical Nursing, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China, Shu Kin Li MBBS, FRCPChief of Service, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. Submitted for publication: 24 August 2005 Accepted for publication: 26 January 2006.
Introduction
Cardiac catheterization remains the most definitive procedure for diagnosis and evaluation of coronary artery disease
(Woods et al. 2005). Currently, cardiac catheterization has become a routine diagnostic procedure performed in many
hospitals in Hong Kong. Although it can be performed through brachial, radial, or femoral arteries (Woods et al.
2005), the transfemoral puncture is the most common approach (Noto et al. 1991, Chair et al. 2003). However,
because vascular complications occur in 43–58% of transfemoral cardiac catheterization patients (Noto et al.
1991, Lehmann et al. 1997, Chair et al. 2003), strict bed rest and immobilization of the catheterized leg have been considered
essential to reduce the risk of their development (Grossman 1980, Woods et al. 2005). The recommended bed rest duration after transfemoral cardiac catheterization varies from two to 24 hours (Baum & Gantt 1996, Chair et al. 2003). Many patients find it difficult to use the bedpan or urinal in the recumbent position during bed rest, moreover, studies reported that back pain severity increased with longer duration of bed rest after cardiac catheterization (Barkman & Lunse 1994, Baum & Gantt 1996, Chair et al.
2003). Therefore, to obtain optimal patient outcomes, the length of bed rest duration after cardiac catheterization should be minimized.
Aims
The aims of this study were to compare patient outcomes of vascular complications, back pain, and urinary discomfort between patients ambulated at four and 12–24 hours (usual care) post-transfemoral cardiac catheterization.
Methods
Patients admitted for elective cardiac catheterization at a general hospital in Hong Kong Island were recruited to the
study. Inclusion criteria were that patients should be ethnic Chinese, aged over 18 years, had no bleeding disorders, were not receiving anti-coagulant therapy within the previous 24 hours before the procedure, had no back pain, blood
pressure <180/110 mmHg before the procedure and no complications developed during cardiac catheterization. Patients were randomly assigned to either a control or experimental group according to a computer-generated random table of number. Patients in the experimental group were ambulated after four hours bed rest postcardiac catheterization, whereas patients in the control group were ambulated the morning after the procedure, 12–24 hours. Correspondence: Sek Ying Chair, The Nethersole School of Nursing,
The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. Tel: (852) 2609 6225, E-mail: sychair@cuhk.
edu.hk 2007 Blackwell Publishing Ltd 212 doi:10.1111/j.1365-2702.2006.01599.x after bed rest depending on the time the patient had the procedure completed during the day (usual care). The puncture site was assessed for vascular complications hourly for the first six hours then the next morning at 08:00 hours using the guidelines (Christenson et al. 1976). Significant bleeding was defined as blood loss estimated at >100 ml, haematoma>5 cm in width or bleeding that led to further attempts to reestablish haemostasis by manual pressure,sandbag, or reinforcement of pressure dressing. For all patients, back pain was assessed at four hours, eight hours and the next morning at 08:00 hours after cardiac catheterization by using a visual analogue scale consisting of a 100-mm long line with the left anchor representing ‘no pain’, and the right anchor representing ‘the worst possible pain’. Urinary discomfort

was assessed at six hours after the procedure by use of a five-point Likert scale self-developed measurement consisting
of four questions, a higher value referring to more urinary discomfort. The test–retest reliability of the urinary discomfort
measurement on 18 subjects was significantly correlated (r =0.95, P < 0.001), and the Cronbach’s alpha was 0.876.
Findings
A total of 86 (male, n = 41; female, n = 45) subjects completed the study, 43 in each group with a mean age of
63 years (SD = 9.6, range 34–75). Fifty-six (65%) subjects had either received no formal education or were educated at
elementary level, and eight (9.3%) had received a college education. Most (65.1%) subjects had a monthly family income <HK$8000 (approximately US$1000). Seventy-one patients (82.6%) were either retired or housewives. Table 1 shows that the two groups were not significantly different in age, gender, education level, and monthly household income. Occupation status was significantly different between the two groups (chi-square, P = 0.009) with more retired subjects in the control groups but more housewives in the experimental group.

There was no difference between the two groups on vascular complications. One subject in the control and none in the
experimental group developed bleeding at the puncture site that required manual pressure to re-establish haemostasis (Fisher’s exact test, P = 1). Repeated measures analysis of variance was used to evaluate the back pain experienced across time and between groups. There was a significant difference between the two groups at the three time intervals on backpain intensity (F2,83 = 9.80, P < 0.001) with the control group reporting more pain at each time interval. Moreover, the two groups also differed significantly on urinary discomfort (t65.6 ¼ 3Æ24, P = 0.006) with the control group experiencing higher levels of urinary discomfort (Table 1).

Table 1 Demographic and outcomes comparisons between groups

______________________________________________________________________________________________________________
   Control (n = 43)    Experimental (n =43)    P-value Statistical test used
Age [years: mean (SD)]    63.2 (±9.7) 62.7 (±9.7) 0.816    t-Test
Gender, n (%)

Male 19 (44.2)    22 (51.2) 0.517 Chi-square

Female 24 (55.8)    21 (48.8)
Educational level, n (%)
No formal education    11 (25.6)    12 (17.9)    0.729 Mann–Whitney U-test
Primary school    16 (37.2) 17 (39.6)
Secondary school    13 (30.2)    9 (20.9)
University    3 (7)    5 (11.6)
Monthly household income, n (%)
<=HK$8000 22 (51.2)    34 (79)    0.052    Mann–Whitney U-test
<=HK$8001–$18 000 14 (32.6) 6 (14)
>HK$18 001 7 (16.2)    3 (7)
Occupation, n (%)
Retired 30 (69.8)    21 (48.8) 0.009 Chi-square
Housewife 4 (9.3) 16 (37.2)
Presently working    9 (20.9)    6 (14)
Vascular complications, n (%) 1 (2.3)    0 (0)    1.00 Fisher’s exact test
Back pain
Four hours 1.55 0 .97 <0.001 Repeated measure of ANOVA
Eight hours    4.41 1.34
The next morning    4.01 1.77
Urinary discomfort 2.57 1.09 0.006 t-Test

__________________________________________________________________________________________________________
Prolonged bed rest in the supine position is difficult for many patients who have undergone cardiac catheterization. Some
patients complain of back pain and have the desire to move from side to side. Others complain of difficulty to urinate in a
supine position. In this study, patients allowed to ambulate at four hours postcardiac catheterization experienced significantly
less back pain and less urinary discomfort, but did not experience any increase in vascular complications at
puncture site.
The average age, high unemployment rate, low education standard and low-income level of patients in this study was
reflective of the study site which is less affluent than the general Hong Kong population Implications for practice The results suggests that early ambulation may play a substantial role in reducing back pain and urinary discomfort in post-transfemoral cardiac catheterization. Allowing patients to get out of bed after four hours of bed rest following cardiac catheterization could be introduced into routine practice in Hong Kong, as it was found to be safe and might aid in promoting patient comfort without increasing the
incidence of vascular complications. In addition, the shorter bed rest duration may reduce the nursing time needed for
administering analgesics or back rubs to relieve back pain. Early ambulation after cardiac catheterization may also reduce the nursing time needed for assisting patients to use urinal and bedpan during bed rest period after the procedure.
References
Barkman A & Lunse C (1994) The effect of early ambulation on patient comfort and delayed bleeding after cardiac angiogram: a
pilot study. Heart & Lung 23, 112–117.
Baum RA & Gantt DS (1996) Safety of decreasing bedrest after coronary angiography. Catheterization and Cardiovascular Diagnosis
39, 230–233.
Chair SY, Taylor-Piliae RE, Lam G & Chan S (2003) Effect of positioning
on back pain after coronary angiography. Journal of
Advanced Nursing 42, 470–478.
Christenson R, Staab E, Burko H & Foster J (1976) Pressure dressings and postarteriographic care of the femoral puncture site.
Radiology 119, 97–99.
Grossman W (1980) Cardiac Catheterization and Angiography. Lea
& Febiger, Philadelphia, PA.
Lehmann KG, Feris ST & Heath-Lange SJ (1997) Maintenance of hemostasis after invasive cardiac procedures: implications for
outpatient catheterization. Journal of American College of Cardiology 30, 444–451.
Noto T, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR & Vetrovec GW (1991) Cardiac catheterization 1990: a report of
the registry of the society for cardiac angiography and interventions (SCA&I). Catheterization and Cardiovascular Diagnosis 24,
75–83.
Woods SL, Froelicher ESS, Motzer SU & Bridges EJ (2005) Cardiac Nursing, 5th edn. Lippincott, Philadelphia, PA.

Answer 1

A,Compare;

Subject:

Post_transfemoral cardiac catheterization

Aims: Ambulating the patient after 4hours and Ambulating the patient after 12-24hours..Author were selected this article for the purpose of people with post_transfemoral cardiac catheterization to find out their complications and improve if they Ambulating by 4and 12-24 hours..in this they want to find out the patient outcome of each age group and gender..they have selected the patient admitted for elective cardiac catheterization at a general hospital in Hong Hong island..They selected for this article from ethinc Chinese aged over 18years,with no bleeding disorders,not receiving anti_coagulant thereputic with in the previous 24hours before the procedure..Bec Because if they use Anti coagulant thereputic there will be more bleeding complications after the procedure..they must be without pain,normal vitals especially BP <180/110mm/hg..

B,They used the two groups experimental and control groups.

Experimental group were ambulatory after four hours bed rest post cardiac catheterization.. Because they want to see the difference what will happen when they ambulate with different duration..

Control groups we ambuated after 12-24 hours..as usual care for all the procedure here the puncture site was assessed after first six hours.. there was blood loss more than 100 ml.heamatoma >5cm..to stop bleeding from they used manual pressure,sand bag, reinforcement pressure dressing..

Back pain assessment left anchor representing no pain right anchor representing the worst possible pain..urinary discomfort six hours interval more urinary discomfort..post operative bedrest can prevent a number of complications like bleeding and heamotoma,back pain and urinary discomfort..the length of bed rest is a research here for preventing complications..