Individual Critical essay

Instructions

1. You are asked by the Malaysian Pharmaceutical Society to give a talk on their annual conference about the common screening test that is run in your pharmacy as a pioneer health promotion project, focussing on the clinical effectiveness of the screening test, and its potential in being a nationwide screening test in all pharmacy outlets. Outline your talk.

In your answer:

Part A: Identify and critically appraise at least two peer-reviewed journal articles published since 2005 that address the issue identified. You should outline the strategy you used to locate the journal articles, and use the appropriate critical appraisal framework from the resource folder on LMS. Your appraisal should take no more than 2 A4 pages (600-800 words). You may use subheadings to help structure your answer.

Part B: In about one A4 page (300-400 words), outline your speech to the audience in the conference business people. Ensure your advice is appropriate for a public speech. (i.e. be careful about the technical complexity and language that you use to convey key health promotion messages).

Part C: Provide appropriate references using the Harvard referencing system. Be aware of the University’s policy on academic misconduct when writing your essay, particularly avoid plagiarizing other writer’s work.

Attachments:

LTU Guidelines for critiquing a quantitative paper.pdf

Part A: Critical Appraisal Essay

Overweight and obesity are defined as abnormal or excessive fat accumulation which may impair health. World Health Organization (WHO) states overweight and obesity as the fifth leading risk for global deaths. The fundamental causation is an energy imbalance between calories consumption and expenditure. Overweight and obesity are preventable in presence of supportive environments and communities, choosing healthier diets and regular physical activity. With slimming and fitness centres mushrooming in town, I choose this theme in vain to curb obesity in Malaysia, (i.e. Weight-management service in community pharmacy) ranking 6th in Asia (2010). These approaches up-live the role of pharmacist towards community health care, acknowledging the general view of acceptance. Search strategy used by accessing La Trobe’s Library W (A-Z) Databases in search for Wiley Online Library and then typed in my keywords using the advance search option. Keywords are community pharmacy; weight-lost; weight-management. A total of 251 results were obtained and is further filtered to 187 journals applicable. Sort for best match and date respectively, selection made in accordance of my study:-

1. Community pharmacy contribution to weight-management: identifying opportunities;2. The provision of current and future Healthy Weight Management (HWM) services from

community pharmacies: a survey of community pharmacists’ attitudes, practice and future possibilities.

The first study conducted to determine the view and preference of the general public towards weight-management services, along with participation of community pharmacies offering or would provide weight-management service; causative study. A pilot study is conducted in conclusion of the designed questionnaire construct ‘confidence’ in this context and understanding by respondents. The author do points the outcome of results obtained, such as lacking of public awareness and government initiatives. Method used (face-to-face questionnaires) is appropriate, enabling researchers to observe and evaluate participants during study such as usage of 5-point Likert-type scale. However, even if respondents were to give the same answer, their interpretation may vary accordingly. Hence, unstructured interview is superior in this respect in gaining complete information but intensify coding and analysis challenges. Face-to-face questionnaire enable rapid data collection and purposive targeting of respondents with demographic characteristics accordingly. Enhancement of a full-spectrum study of a population is in advantage comparatively with postal surveys. Appearance and demeanor of the interviewer may affect the responses of participant, presenting experimental bias and demand characteristic problem thus, trained and skilled interviewers to combat this problem. The study setting accounts for not to set-up nearby pharmacies, twice visits at different times of day would minimise pharmacy users respondents and maximise chances of a variety participants. However in field research, researchers have lesser control over study sample depending on whom is presenting then.

The purpose of second study was to derive baseline data of current weight-management services, attitude of pharmacists’ towards the provision of current and future HWM services; causative study. A cross-sectional postal survey was conducted, permits useful development data in a relatively short period of time. However, generation effect may be influential towards confounding threatening the internal validity (i.e. age of pharmacists). A pilot study was conducted on three

pharmacists of different pharmacies indentified substantial questionnaire ‘confident’. There is a high response rate should increase the generalisability of the results (i.e. 39/47 completed the questionnaires). Mail survey is a rather convenient methodology addressing to respondents, enables answering at their leisure which yield experimental bias and demand conflicts (face-to-face survey). Besides, this is a relatively cheaper, fast and covers larger samples; researcher could control and choose his/her own focus group. Despite the boon, serious problem called nonresponse bias occurs when large proportions of participants fail to complete and return questionnaire. Well planned, researcher developed a strategy in increasing response rate simply by making multiple contacts with respondents (two reminders at fortnightly intervals). Closed and open questions and free text option may provide more complete and accurate information than restricted item. However, participants may not understand exactly researcher’s intention of asking, failing to provide the needed information. Summarizing of data may be difficult in interpreting participant’s responses, running a risk of misclassifying answers. In this study, lesser respondents’ response to lack of public awareness as HWM barrier compared with earlier study by Award et al. but instead, lack of client demand. I strongly agree with inclusion of provision training on weight-management services as part of pharmacy undergraduate academic, combating the rise of global obesity alarm. With confidents in hand, pharmacist consultation may automatically be in preference of general public as sough for from doctors and dieticians. The author states a clear refine suggestion for future studies on the effect of pharmacy-base weight management services using large-scale study in preventing and treating overweight and obesity, concurrently with the need to note what services are currently available, how and whom to be delivered to. Notation on barriers are made clear and significant – workload and reimbursement towards provision of HWM services, require adequate addressing and training as initiatives, increases PCT capacity for management of obesity. Although both studies’ a quantitative study designed, qualitative analysis data could enhance the ‘confidence’ of data obtained by observing the analyzed behaviour of respondents. Data collected in both cross-sectional studies ‘on spot’ at a time may differ in time as provision and intervention of weight-management gain acceptance generally by public, healthcare professionals, and government.

In conclusion, a systematic review found a lack of effectiveness and cost-effectiveness of community pharmacy-based weight management services, a review conducted revealing no affirmative conclusions. This does not say that pharmacy-base weight management show no future in reducing the risk of the global obesity problem leading to a number of chronic illnesses. Community pharmacists provide people the access to a health professional without appointment over extended hours and in convenient locations. ‘Sugar Isn’t So Sweet’ hence, “Don’t dig your grave with your own knife and fork”. One should eat to live, not live to eat; let’s do the little tummy a favour.

Part B: Advisory Speech

Dear Ladies and Gentlemen: members of Malaysian Pharmaceutical Society, dedicated lecturer, Mr. Ganesh, and my fellow friends. It is a great pleasure for me, Caren to be here, speaking for this annual conference on screening test of weight-management services conducted in my pharmacy as a health promotion project.

Addressing to all of present on the floor, I’m sure that everyone is aware about television programmes such as The Biggest Loser, You Are What You Eat. The shows gather a group of severely overweight or obese participants, sending them off without food and say “this is how much food you consume in a week”.

Prevalence of overweight and obesity is increasing worldwide at an alarming rate. Malaysia, a multi-racial and multi-cultural country is famous for variety of food, now ranked sixth in Asian countries with high adult obesity rate, according to the World Health Organization (WHO). About 1.7 million Malaysians aged >18 estimated obese in a study conducted by the Health Ministry. Not a good endorsement for our nation which promotes so much sporting prowess.

Obesity is a major risk factor non-insulin-dependent diabetes mellitus, heart attack, hypertension, kidney disease, high cholesterol, stroke, cancer and various psychosocial associated consequences, which in turn affect the country’s productivity. Increasing awareness among decision-makers, health professionals and the general public on prevention and reducing the rate of obesity, the main obesogenic environment factor contributors are imbalance energy level and sedentary lifestyle. Hence, plan/implement inventions in favour of creating environments for healthier diets and lifestyles - National Nutrition Action Plan, BMI of students to be recorded and ban food containing excess sugar and salt in school.

The saturation marketing of unhealthy food and drink has become so pervasive in trying to reduce obesity seemingly like trying to treat an alcoholic in a town full of bars! Government and healthcare professionals should work hand-in-hand, implementing weight-lost management services and screening of advertisements on television promoting unhealthy food, and by reviewing fast food taxation. Don’t dig your grave with your own fork and spoon.

During the dark ages, we can see how technology helped us in many ways, but failed us in a physical sense. Sport/exercise would be a contributing factor in helping eliminate obesity. Not only a fun way of meeting friends, it’s also a great way for character building. In case of busy working life, Malaysians are encouraged to walk using the stairways to office instead of hanging yourself up with elevators. It comes down to a simple question: what do you want out of life, and what are you willing to do to get it?

Well, Malaysians seek for pharmacists attention in favour of drug/medicine consultations, why not weight-management then? We, pharmacists are ever-ready to listen and together we would work out a solution to curb overweight and obesity. If you didn’t need a pill to get fat, why would you need one to not get fat?

Thank you.

Reference(s)

1. Janet Krska et al. (2010). Community Pharmacy Contribution to Weight Management: Identifying Opportunities. International Journal of Pharmacy Practice. Royal Pharmaceutical Society of Great Britain. Volume 18, Issue 1, pp 7-12.

2. Rumana S. et al. (2011). Management (HWM) Services from Community Pharmacies: a Survey of Community Pharmacists’ Attitudes, Practice and Future Possibilities. International Journal of Pharmacy Practice. Royal Pharmaceutical Society of Great Britain. Volume 19, Issue 2, pp 106-114.

3. Flodgren G. et al. (2010). Interventions to Change the Behaviour of Health Professionals and the Organisation of Care to Promote Weight Reduction in Overweight and Obese Adults (Review). The Cochrane Library. Issue 12.

4. J. Gordon et al. (Sep. 2010). A systemic review of weight management interventions in the community pharmacy setting. Nutrition and health: cell to community. International Journal of Pharmacy Practice. Volume 18, Supplement 2, pp. 6-7. [online]: http://0proquest.umi.com.alpha2.latrobe.edu.au/pqdweb?index=4&did=2196398111&SrchMode=2&sid=8&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1302147281&clientId=20828&cfc=1

5. Daniel Clark et al. (May 2010). Screening, Referral, and Participation in a Weight Management Program Implemented in Five CHCs. Journal of Health care for the poor and underserved. Vol. 21, Issue 2, pp 617-628.

6. Kimberly Braxton Lloyd, PharmD. (February 2007). Implementation of a Weight Management Pharmaceutical Care Service. Obesity. The Annals of Pharmacotherapy. Vol 41, No 2, pp185-192.

7. Irene S.I. Um et al. (12 August 2010). Managing Obesity in pharmacy: the Australian experience. Pharmacy World & Science International Journal of Clinical Pharmacy and Pharmaceutical Care. Volume 32, Number 6, pp. 711-729.

8. Li-Hsiu Chem et al. (March 2007). Pharmacists’ experiences in the Provision of Screening and Monitoring Services. Australian Pharmacist. Pharmaceutical Society of Australia. Volume 26, Issue 3, pp 250-256.

9. WHO Western Pacific Region [online]: http://www.wpro.who.int/health_topics/obesity/

10. Malaysia Gains Sixth Rank in Asia in Obesity Rates [online]: http://topnews.us/content/230086-malaysia-gains-sixth-rank-asia-obesity-rates

11. Point of Care Testing 2004. FIP Statement of Policy. International Pharmaceutical Federation.

12. Implementing the Clinical Guidelines for Weight-management in New Zealand 2010/11.

Appendix:

Guidelines for Critiquing a Quantitative PaperAuthor: Janet Krska, Claire Lovelady, Deborah Connolly, Shaun Parmar and Michael J. DaviesTitle: Community pharmacy contribution to weight management: identifying opportunities

Reference: IJPP 2010, 18: 7-12

Guidelines for Critiquing a Quantitative PaperAuthor: Rumana S. Newlands, Margaret C. Watson and Amanda J. LeeTitle: The provision of current and future Healthy Weight Management (HWM) services from community

pharmacies: a survey of community pharmcists’ attitudes, practice and future possibilitiesReference: Royal Pharmaceutical Society 2011 International Journal of Pharmacy Practice, 19, pp. 106-114

Guidelines for Critiquing a Quantitative PaperAuthor: Janet Krska, Claire Lovelady, Deborah Connolly, Shaun Parmar and Michael J. DaviesTitle: Community pharmacy contribution to weight management: identifying opportunitiesReference: IJPP 2010, 18: 7-12

Aim (or Research Question)What was the aim of this study? (What were the researchers trying to find out?)

To determine the public’s views on weight-management services, including pharmacies as a potential venue, and the extend of current pharmacy involvement in weight management. Causative study.

RationaleWas an adequate rationale for this study provided? (Were there good reasons for the study being conducted?)

The rationale of this study is to address a global issue of obesity by improving diet and increasing physical exercise, priorities for the NHS in England and included in the Government White Paper Choosing Health Through Pharmacy

Study DesignWhat was the study design (cross-sectional, case-control, cohort (longitudinal), quasi-experimental, randomised control trial)? Was this an appropriate design for the research question? If not, what would have been a better study design?

Cross-sectional Study Design with two questionnaires devised: one for the general public and the other for community pharmacies. These were assessed using randomised control trial which is an appropriate design for the research question.

Was Blinding Necessary for the Proper Conduct of this Study?If you think this was the case: say why and how it was done.

No, blinding is not necessary for the Proper Conduct of this Study.

Outcome MeasuresWhat were the outcomes (or study end-points?) How were they measured? Do you think the way of collecting outcome data was appropriate (i.e., a valid way of measuring the outcome)? Were the outcome data measured reliably (i.e., accurately)? Were the data collected the same way, every time?

The outcomes are not surprising to which general public did not consider pharmacy as a preferred point of contact for advice or wanting on weight management services from pharmacies. Locations in gyms and leisure centres or GP surgeries and the involvement of a dietician rather than a nurse or pharmacist have an upper hand due to limited awareness of locals or national NHS weight management services or initiatives. Questionnaires (face-to-face) may be a valid way of measuring the outcome but may not account for reliability (retrospective estimates of dispensing prescription frequency or OTC products supply). Hence, subject to recall bias. This is a valid way of measuring using primacy sampling. Data may vary as more interventions are being made in future.

Exposure (or Study) MeasuresWhat were the exposure (or study) measures? (For example: this may be a new treatment in a trial or a particular exposure in a cohort (longitudinal) study). Were they carefully defined? How were these data collected?

This is a recent uncontrolled trial of weight-management services provided by community pharmacies in question for the benefits of pharmacy weight-management programmes. Pharmacists are encouraged to increase public awareness of local and national schemes, lacking in definition strategy. Data were collected based on surveys conducted at streets at shopping centres.

Sampling ProcessFrom what (theoretic) population did the study subjects come? How were the subjects selected? Were there any selection criteria and exclusion criteria? If so, were these criteria reasonable? What type of sampling was used for this study – probability or non-probability)? If non-probability(non-random) methods were used, could this have introduced a bias (in that the people selected may not have been representative of the study population)?

Face-to-face consumer surveys (avoid pharmacy users) often considered the best method of collecting attitudinal information from consumers liberating the inclusion of hard-to-reach individuals among the benefits presented. This is a non-probability sampling for questionnaires are conducted at shopping centres. Attitudinal information from consumers were collected may result to bias for the unrepresentative samples (employed, males and the elderly)

Study SampleHow many people were involved in the study? Did the researchers say why they chose that number? What was the response rate? Might this have affected the representativeness (generalisability) of the findings?

Subjects are of 177 members of the public, 75% of whom tried to lose weight and of OTC weight-loss product / prescribed medicines consumer; 49 community pharmacists for this study to identify opportunity of weight management services in pharmacies. Generally low response rate, but high response rate from those who considered actively involved. This may affect the generalisability of the findings.

Control GroupIf the study included a control group, how was this group defined? Was it appropriate to use random allocation? If so, was it used? Apart from the main study exposure, were the “control” and “test” groups comparable, in terms of other characteristics which might confound (confuse) the studyoutcomes?

The control study group may be defined to weight management services not at community pharmacies by using random allocation such as questionnaires which had also being used indirectly in this study. The “control” and “test” groups are comparable which identify weight management as the focussing objective.

ResultsWhat were the results? How did the reported results match up with the research question? Was the analysis appropriate?

The result showed that the general public did not consider pharmacy as a preferred venue for weigh-management and seems not apprehensive. Overall community response rate of 75% obtained. Majority pharmacists agree to weight-management services. Lack of awareness of local or national NHS weight-management services or initiatives in relation to weight-management has still room for improvement to identify opportunities in community pharmacies. Analysis did not account for pharmacists’ capabilities and workloads.

Completeness of Data – ComplianceIf there was an intervention, how many subjects actually received the intervention as intended? Were there any drop-outs in this study? If so, was there a difference in drop-out between groups? Were there any missing data, and to what extent did this occur? Would these drop-outs and/or loss of data have introduced biases?

Interviews of 177 members (69.5% - females) experienced difficulties in recording accurately the total number of people approached due to many whom refused being interviewed with 1/8 people approached actively considered participating. Desired quota sample proved difficult to attain since fewer older people and males agreed to be interview. Hence, people aged 65 or over are under-represented.

Discussion - Conclusions In general public did not consider pharmacy

What did the authors conclude? If a program failed, did they say why it might have failed? If it was a success, do they say why it worked?

as a preferred venue for weigh-management and seems lacking awareness and initiate less interest to weight consultant in pharmacies. However with standard guidelines and professional guidance enforced may prove success for this study as suggested and supported by Government. Here, the author did not consider community pharmacists’ capabilities albeit majority gave in their green-signals.

Discussion – Limitations of StudyIf the study had limitations, did the researchers properly consider/discuss the limitations of their study, and the implications of these limitations on the results?

Study sample was not truly representative in case of age or general health but included those who has the intention in loosing weight. Data collection selected during day may create bias towards employed, males and the elderly. Independent pharmacies and those in low deprivation area were under-represented may have different servies provided. The frequency of dispensing prescriptions or supplying OTC products was based on retrospective estimates subject to recall bias. Self-reported data should be viewed with caution. Non-generalized sample may account for limitation of weight management services, requiring further study to be conducted. This would develop and evaluate community pharmacy weight-management services and for effective marketing.

Discussion – Comparison with Other StudiesHad the researchers compared their findings to previously conducted studies? If they found differences, did they give reasons why this was so?

The Author(s) declare(s) no conflicts of interest to disclose

Was this Study Useful/Relevant to Furthering Community (or Peoples’) Health?Give your reasons.

Yes, this study is useful/relevant to furthering community health in addressing obesity, a worldwide issue among the risk factor to a number of chronic diseases.

Guidelines for Critiquing a Quantitative PaperAuthor: Rumana S. Newlands, Margaret C. Watson and Amanda J. LeeTitle: The provision of current and future Healthy Weight Management (HWM) services from community

pharmacies: a survey of community pharmcists’ attitudes, practice and future possibilitiesReference: Royal Pharmaceutical Society 2011 International Journal of Pharmacy Practice, 19, pp. 106-114

Aim (or Research Question)What was the aim of this study? (What were the researchers trying to find out?)

To derive an accurate account of community pharmacists’ activities and attitudes towards the provision of current and future Healthy Weight Management (HWM) services.

RationaleWas an adequate rationale for this study provided? (Were there good reasons for the study being conducted?)

Global obesity epidemic management schemes addressing services which will be influenced by health professionals’ attitudes and willingness to provide future weight management services.

Study DesignWhat was the study design (cross-sectional, case-control, cohort (longitudinal), quasi-experimental, randomised control trial)? Was this an appropriate design for the research question? If not, what would have been a better study design?

Cross-sectional study design, quasi-experimental control trial targeting on all community pharmacist in charge in Grampian. Appropriate design conducted to attain the attitude of pharmacists’ towards weight-management provisions at point of time.

Was Blinding Necessary for the Proper Conduct of this Study?If you think this was the case: say why and how it was done.

No, blinding is not necessary for the Proper Conduct of this Study

Outcome MeasuresWhat were the outcomes (or study end-points?) How were they measured? Do you think the way of collecting outcome data was appropriate (i.e., a valid way of measuring the outcome)? Were the outcome data measured reliably (i.e., accurately)? Were the data collected the same way, every time?

Most pharmacists reported being confident or very confident to provide HWM services which required more training to boast confidence. Survey was conducted using postal questionnaire to pharmacists with two reminders sent to all non-responders at fortnightly intervals, with a copy of the questionnaire being included with the second reminder. This reduce confounding results and increase validity using primary sampling. Reliability of the questionnaire was assessed using test/retest process with the Kappa statistic ranged fair to very good agreement showing no statistically significant difference between the test and retest responses. The 10% accuracy test of data entry identified no errors. There is at least two sections of the questionnaire were reliable. Data collected the same way, every time.

Exposure (or Study) MeasuresWhat were the exposure (or study) measures? (For example: this may be a new treatment in a trial or a particular exposure in a cohort (longitudinal) study). Were they carefully defined? How were these data collected?

Study measures as follows: current provision of HWM services, weight-lost products or services available, confidence of provider, perceived need for HWM services, previous HWM training and perceived need for further training, barriers to provide HWM services, respondent and pharmacy characteristics, carefully defined through piloted study questionnaire.

Sampling ProcessFrom what (theoretic) population did the study subjects come? How were the subjects selected? Were there any selection criteria and exclusion criteria? If so, were these criteria reasonable? What type of sampling was used for this study – probability or non-probability)? If non-probability(non-random) methods were used, could this have introduced a bias (in that the people selected may not have been representative of the study population)?

Focus on pharmacists in charge in pharmacies to identify provision services of HWM. Non-probability sampling type were used which enable generalisability due to high response rate. However, there was an over-representation of female pharmacists and employee pharmacists, missing data about previous weight management training for it was a relatively small, local study. A larger, national survey would be required for this study.

Study SampleHow many people were involved in the study? Did the researchers say why they chose that number? What was the response rate? Might this have affected the representativeness (generalisability) of the findings?

128 participating pharmacists of Grampian, north-east Scotland were sent with questionnaires. Overall response rate was 64.8% (83/128) may represent generalisability.

Control GroupIf the study included a control group, how was this group defined? Was it appropriate to use random allocation? If so, was it used? Apart from the main study exposure, were the “control” and “test” groups comparable, in terms of other characteristics which might confound (confuse) the studyoutcomes?

Recent systematic review conducted found that there is no clear evidence/lacking of success rate for weight-management service to be conducted at community pharmacies in terms of effectiveness and cost-effectiveness. Thus, a large-scale definitive studies need not focus only of the effect of pharmacy-based weight management services for the prevention and treatment of overweight and obesity but account for how and what services are currently being delivered and to whom received such services.

ResultsWhat were the results? How did the reported results match up with the research question? Was the analysis appropriate?

Response rate was 83/128 (64.8%) in cumulative after the first mailing, first reminder and second reminder. Survey is revolving around community pharmacies to identify pharmacists’ willingness, attitudes, practice and future possibilities of HWM services, is appropriate towards study question.

Completeness of Data – ComplianceIf there was an intervention, how many subjects actually received the intervention as intended? Were there any drop-outs in this study? If so, was there a difference in drop-out between groups? Were there any missing data, and to what extent did this occur? Would these drop-outs and/or loss of data have introduced biases?

There is no intervention of samples intended to be received for this study. There are one or two missing data enlisted but provide no significant biases to the obtained results. A survey conducted in 2007 to identified ‘community-pharmacy-based services’ apparently mismatch with the current service provision and pharmacy use, which needs further exploration to ensure the efficiency and comprehensive provision of HWM services by the public.

Discussion – ConclusionsWhat did the authors conclude? If a program failed, did they say why it might have failed? If it was a success, do they say why it worked?

Author concluded that Grampian community pharmacists had provided a range of HWM services. Results will be used to inform future service development for community pharmacists and weigh management initiatives. Perceived barriers could be addressed and training needs met, community pharmacies could increase capacity in primary care treatment for obesity management.

Discussion – Limitations of StudyIf the study had limitations, did the researchers properly consider/discuss the limitations of their study, and the implications of these limitations on the results?

The lack current provision could be due to lack of demand by clients or lacking in pharmacists confidence towards HWM services. More experienced pharmacists did not want to provide one-to-one HWM consultations, subsequence of uncomfortable level for more training in providing this service. Workload was the most frequently reported barrier in the current study, but reimbursement was cited as a barrier to the future provision of HWM services.

Discussion – Comparison with Other StudiesHad the researchers compared their findings to previously conducted studies? If they found differences, did they give reasons why this was so?

Yes, the researchers compared their findings to previously conducted studies. They found that respondents to the current survey reported higher levels for all services of HWM indicates willingness to provide such services in the future. Pharmacists’ confidence in providing counselling reported directly associated to positive outcome of a weight management programme.

Was this Study Useful/Relevant to Furthering Community (or Peoples’) Health?Give your reasons.

The study is relevant to furthering community health to reduce the risk factor of obesity in accordance to curb increasing number of chronic disease patients.