Q.1 Goodacre et al’s article is an example of a secondary research while that of Ferrera et al’s research combines primary and secondary researching. The researchers draw conclusions based on the findings of previous researches in various journals about deep vein thrombosis from 1981 to 2005 and conducts sensitivity and specificity analyses. As well, the researchers followed a structured process of identifying cohort studies, searching databases and screening bibliographies and invited independent reviewers in order to avoid observation error. Statistical analysis of the screened studies was conducted. On the other hand, Ferrera et al conducts a survey of a patient and thematic content analysis of the reviewed literatures. Surveys are the most common form of research method for collection of primary data which purports on describing a particular issue. The first article ranks on the systematic reviews and meta-analyses while the second on case reports. Evidently, the fist article conducts the study based on definitive methodology with criterion as the basis and the researchers presented a concise documentation on the p-value analysis. Although the first article has cohort studies, we cannot consider it as a legitimate cohort study because cohorts recruited are limited with prevalent DVT. Thereby, the sample size is limited and the findings are subjected to personal bias where the conflict of interest is evident on the subjectivity of the researchers. Greenhalgh maintains that cohort studies begun on subjects who may or may not develop disease. The second has an inherent practical difficulty in recruiting subjects. The second article is tricky because it can be a case series as it features 90 cases of cervical pregnancy treated with local therapy and also a case report because it describes a particular event. As such, the article describes more than one case, though the researchers draw from a single case. Greenhalgh asserts that “case reports are often run together to form a case series, in which the medical histories of more than one patient with a particular condition are described to illustrate an aspect of the condition, the treatment, or, most commonly these days, adverse reaction to treatment.” Based on this assertion, we will classify Ferrera et al’s research as case report in the hierarchy of evidence. Further, instead of literature review, Ferrera et al should categorise the secondary research as meta-analysis because of the fact that they rendered a quantitative analysis. Meta-analysis refers to the method of synthesizing data of more than a single study for the purpose of producing summary statistic.
Q.2 The article about the diagnostic accuracy of ultrasonography for deep vein thrombosis has a higher clinical significance compared to that of consecutive cervical pregnancy with transvaginal local approach. Today, improving ways on how to image leg veins in order to reveal blood clot and the extent of the thrombosis is an important undertaking. Such situation only manifests that ultrasonography could still be developed in order to provide more accurate diagnosis for the purpose of distinguishing required therapy. The implication is that when there are no clear diagnoses of DVT, there will be no accurate therapies for the patient. DVT occurs in 1 per 1000 persons annually and about 1 to 5% of the total population affected by DVT will die because of complications. Medical ultrasonography is used to visualize muscles and internal organs as well as their size, structures and possible pathologies. The diagnostic and therapeutic importance of accurate ultrasonography could facilitate interventional procedures. What makes ultrasonography as an acceptable process in medicine lies on its useful delineation between solid and liquid spaces and there are no side effects in implementation. Nonetheless, the diagnostic accuracy is also dependent on the utilized technique: proximal versus optimal whereby it can produce inaccurate diagnosis. Considerably, ultrasonography would experience difficulty in penetrating bone structures and so it cannot provide for accurate probability and accurate configuration of the DVT. The limited depth of penetration will be a problem then. The implication on practice is when ultrasonography could not provide accurate diagnosis of DVT, then support diagnosis must be conducted. If possible, for ultrasonography to better perform in aspect of accuracy in diagnosis, the implication is on developing the machine and educating those who will be using it especially that ultrasonography is highly operator-dependent. The validity of the paper is on considering that results could vary between homogenous and heterogeneous population. The relevance on practice will be about the prognosis and causation wherein longitudinal cohort study and/or the effects of inaccurate DVT diagnosis must be given priority with emphasis on vigilance in interpreting results.
Reference
Ferrera, L, Gandhi, M, Jacobs, A and Rebarber, A 2007, Successful Management of a Consecutive Cervical Pregnancy by Sonographically Guided Transvaginal Local Injection, American Institute of Ultrasound in Medicine, vol. 26, pp. 959-965.
Goodacre, S, Sampson, F, Thomas, S, van Beek, E and Sutton, A 2005, Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis, BMC Medical Imaging, vol. 5, no. 6.
Greenhalgh, T 1997, How to read a paper: getting your bearings (deciding what the paper is about), BMJ, vol. 315, pp. 243-246.
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