Description
I need the critique part of an essay rewritten (1100 words) See attached
Written Critique (55%)
Written critical discussion of the quality, methods, design, study results (incl. P values, CIs) of the given paper.
Prioritised and drawn from the framework template, the discussion is methodical, well-structured, and appropriately signposted. Synthesis and analysis are evident in a rounded set of unbiased arguments from different viewpoints/evidence sources (given paper plus wider evidence).
Discussion is contextualised to LCDs for adult T2D treatment throughout. Brief critical summary of quality of the research paper are presented.
What is the research question?
The null hypothesis is potentially “there is no significant difference between LCK and MCCR diets and their effect on T2D metabolic markers”. The paper does not state explicitly what the hypothesis is.
The scientific rationale for the research was that there is a general opinion that nutritional management is an important element in treating T2D, however the optimal level of carbohydrate intake is uncertain. There is a pre-defined hypothesis based on previous research that an ad-libitum LCK diet (ketogenic diet) may improve metabolic measures and reduce the need for diabetes related medications.
The study was conducted in San Francisco and the study population was persons aged over 18 with a BMI of over 25 and a HbAc1 level of over 6%. The two interventions that are compared comprise Low Carbohydrate Diet (LCK) with Mindfulness and Positive Affect Skills (Behavioural) and American Diabetes Association Diet (MCCR) with Mindfulness and Positive Affect Skills (Behavioural).
The outcomes considered encompass a primary outcome that measures Haemoglobin A1c (HbA1c) change from baseline to 3 months and then subsequently a secondary outcome that measures HbA1c changes from pre-intervention to 3 months. Other outcomes considered are body weight, LDL cholesterol, triglyceride to HDL cholesterol ratio and diabetes medications.
The key outcome measure will compare the two intervention groups and assess whether statistically significant changes occur within groups from pre-intervention to 3 months, 6 months and then 12 months.
Is the study ethical?
The study was approved by the Institutional Review and was registered with ClinicalTrials.gov (NCT01713764). Informed consent was obtained from all eligible participants. The sample size was based on the resources available to perform the trial rather than on sample size calculations 2014 paper. The ability to generalise this study to the general population was limited due to this relatively small sample size, thus affecting the sufficiency to reach a meaningful conclusion. Furthermore if a sample size is too small it has been claimed that the study will not be able to identify any clinical significance, therefore making the study pointless and therefore the use of the subjects unethical (Fayers and Machin, 1995; Altman 1980; Newell 1978).
Since this is a follow up trial of the 2014 pilot it should be powered, but it was stated that it is unpowered ref.
Funding was supported by various grants from the William K. Bowes, Jr. Foundation and the Mount Zion Health Fund, National Institutes of Health, National Center for Complementary and Integrative Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung and Blood Institute, National Institute of Mental Health. The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.
Study Design and Methods
This was a superiority trial with 2 arms whereby the study was designed to demonstrate the optimal level of carbohydrates to reduce HbA1c levels. The treatments being studied are LCK v MCCR. People included in the trial were aged over 18 with a BMI of over 25 and a HbAc1 level over 6%. It was a parallel-group randomised trial but participants and group leaders were unable to be blinded to the allocation of groups since at week 6 group leaders taught participants in both groups on sleep and exercise and a further leader taught them about behavioural strategies to support positive effect and mindful eating. This lack of blinding could have led to subjectivity in adherence to their respective intervention therefore leading to bias (Day, 2000; (Mansournia et al., 2017). Contamination bias was managed by allocating any related pairs of participants that were assigned to different interventions as one unit which was applied to two pairs (KRISHNA, SURAPANENI and MAITHREYI, 2010). All individuals in both arms were treated equally throughout the trial since all participants attended 19 classes over 12 months and both groups at week 6 were taught the importance of sleep and exercise for T2D and encouraged to increase them. Furthermore both groups were also taught about adherence and mindful eating.
Recruitment
Recruitment was not to all intents and purposes representative of target population as there was a monetary incentive and advertising was done through health organisations leading to potential volunteer bias since people may have been referred by their healthcare providers bringing about increased motivation leading to increased adherence to whichever intervention they were assigned KRISHNA, SURAPANENI and MAITHREYI, 2010). Individuals who volunteered are typically different to those who decline to volunteer (Susukida et al., 2017; (Gheorghe et al., 2013). Furthermore generalisability of the study is limited due to the relatively small sample size 2017 paper.
Did randomisation work?
The type of randomisation technique used was simple randomisation and randomisation was not stratified by sex. By chance the LCK group was 56% female compared to 89% of the MCCR group. This could have resulted in imbalances of covariates in a treatment group since the two groups were not similar at the beginning leading to the possibility of a Type 1 error (Suresh, 2011).
Supplementary data stated analysis was on an intention to treat basis. However MCCR was allocated n=18 and analysis was on n=14 and for LCK allocation was n=16 and analysis on n=15. Consequently since a certain number of participants were excluded, either due to not receiving the interventions or not participating in the support classes this would be defined as a modified intention to treat analysis (Gupta, 2011).
This may introduce some bias since if an intervention is truly effective an intention-to-treat analysis will provide an unbiased estimate of the efficacy of the intervention at the level of adherence in the study (McCoy, 2017). KEEP SENTENCE?
Results
The primary endpoint for this trial was a change in HbA1c levels after 12 months. HbA1c measurement is a reliable biomarker and indicator of insulin resistance for testing individuals for diabetes and prediabetes Sherwani et al., 2016; (Borai et al., 2011). Some secondary measurements taken into consideration were changes in lipids, insulin resistance and weight.
Estimating Treatment Effect
Treatment effect was that there was an overall reduction of HbA1c levels from both LCK and MCCR groups but overall a larger reduction for the LCK group. Other effects were an increase in LDL cholesterol in the LCK group compared to the MCCR group. This may raise some concerns about the long-term effects of such a
diet on cardiovascular disease. Furthermore the ratio of triglycerides to HDL,
decreased in the LCK group compared to the MCCR group, suggesting that the very
low-carbohydrate ketogenic diet may have certain benefits on lipid profiles.
Statistical Outcomes
Since the sample size is small the confidence interval is likely to be less precise (Biau, Kernéis and Porcher, 2008).
The results show that statistically HbA1c reduced more in the LCK group at both 6 and 12 months, though it increased a bit at 12 months. The p value for this was 0.01 meaning that there is a 1% chance of observing a difference in HbA1c levels with the LCK intervention, which is statistically significant 2017 paper.
The supplementary data shows that at 12 months a value of p 0.03 HbA1c levels began at above 6.5% and finished below 6.5%, which is not statistically significant.
A secondary outcome was weight loss demonstrating a value of p <0.001 at 6 and 12 months for both interventions, but the LCK group lost an average of 8.3% body weight compared to MCCR 3.8%.
Analysis and Conclusions
Numerous studies have been done previously that examine the relationship between dietary habits and T2D. The length of these studies varied between less than 3 months to up to 9 months (Di Onofrio et al., 2018; Forouhi et al., 2018; Hamid et al., 2017; (Sleiman, Al-Badri and Azar, 2015).
Other studies have looked at either very low or moderate carbohydrate intake with a duration of 14 days to 1 year. (Wheeler et al., 2012). Saslows study differs as it is a twelve-month randomized parallel trial of a moderate-carbohydrate versus very low-carbohydrate diet. The primary outcome measure was a change in HbA1c and secondary outcomes were changes in lipids, insulin resistance and weight, although they were not statistically significant 2017 paper.
One of the reasons noted for fair adherence was due to the supportive psychological strategies around positive behaviour and mindful eating. Other studies suggest that adherence to low carbohydrate diets is equal to that of other diets containing the same number of calories and positive results are usually attributed to the effect of carbohydrate restriction on satiety and appetite suppression due to behavioural effects or hormones (Feinman et al., 2015; (Gunnars, 2020).
NTDC5418 Disordered Physiology Nutritional Therapy Diploma Course DipION (Professional practice) Institute for Optimum Nutrition Ambassador House | Paradise Road, Richmond, TW9 1SQ 0208 614 7800 |courseadmin@ion.ac.uk| www.ion.ac.uk
NTDC5418 Disordered Physiology 2
Contents
SUMMATIVE ASSESSMENT …………………………………………………………………………………………….. 3
SUBMISSION DEADLINE ……………………………………………………………………………………………………… 3
WHY THIS ASSIGNMENT? …………………………………………………………………………………………………… 3
LEARNING OUTCOMES ……………………………………………………………………………………………………….. 4
BRIEF SUMMARY OF THE TWO PARTS OF THE ASSIGNMENT ………………………………………………………………. 4
ASSIGNMENT GUIDANCE …………………………………………………………………………………………………….. 4
HOW IS PART 1 STRUCTURED? ……………………………………………………………………………………………… 5
GUIDELINES FOR APPENDIX: CRITICAL APPRAISAL FRAMEWORK TEMPLATE (PROCESS) …………… 10
AIM ………………………………………………………………………………………………………………………….. 10
HOW TO CRITICALLY READ A PAPER ………………………………………………………………………………………. 10
PRESENTATION ……………………………………………………………………………………………………………… 11
WORD COUNT ………………………………………………………………………………………………………………. 11
REFERENCING ……………………………………………………………………………………………………………….. 11
OPTIONAL FORMATIVE BRIEF: CRITICAL APPRAISAL OF THE GIVEN PAPER USING THE FRAMEWORK TEMPLATE ………………………………………………………………………………………………………………… 13
SUBMISSION DATE: 20T H APRIL 2020, 12PM VIA TURNITIN – NOT MARKED …………………………………………. 13
CONTEXT…………………………………………………………………………………………………………………….. 13
THE FRAMEWORK TEMPLATE ……………………………………………………………………………………………… 13
NTDC5418 Disordered Physiology 3
Summative Assessment
NTDC5418 Disordered Physiology Summative Assignment Written Evaluation Evaluation of the efficacy of very low carbohydrate diets in the modulation of type 2 diabetes, for use in nutritional therapy practice. Weighting 100% Part 1: 99% Part 2: 1% Pass and Progression Both parts of the assessment must be present, in order to pass. Part 1: The written evaluation pass mark is 40%. Part 2: The appended critical appraisal framework pass/fail. Threshold assignment mark is 35%-39%, although not a pass, will allow progression to the next module while resubmitting to achieve a pass. Submission Deadline Monday 22th June 2020 via Turnitin
Why This Assignment?
Critical appraisal skills are a mandatory requirement set by the professional body (BANT). They
are essential to evidence based nutritional therapy practice and there are many instances where
you will draw upon these skills in professional life. For this reason, teaching of critical appraisal
skills are developed throughout the course, including the year 2 modules Disordered Physiology
and Functional Biochemical Imbalances and Nutritional Therapeutics in year 3.
The assessment builds on basic researching and academic literacy skills developed in Level 4.
The critical appraisal framework, (submitted as an appendix to the written evaluation), is a tool
used to extract data, works as an aide memoir, and repository for critical comment helping you to
deep dive into a specific area of study in preparation for the evaluation.
The evaluation encourages you to theme findings and demonstrate understanding of the
modulation of systems dysfunction by a nutritional intervention. In translating findings to practice
you will need to draw on a diverse evidence base demonstrating an evidenced based / informed
approach and critical thinking about the utility of the evidence evaluated. Academic integrity is
monitored in the uploading of the assignment to Turnitin.
Engaging with this learning is a step on the path to ensuring that on graduating you will be both a
scholar and practitioner, proficient in applying evidence informed nutritional therapy
In this assignment you critique 1 given paper in depth using a provided critical appraisal
framework template to help you develop a systematic approach to critical appraisal skills (this is
mandatory and will be submitted as an appendix).
Extracting data and critical comment from the framework template enables you to develop
written critical appraisal skills, including prioritising key strengths and limitations of the research
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in order to deliver a convincing critical argument and conclusion about the strength of the paper /
evidence.
Learning outcomes
1. Critically appraise a given research paper using an appropriate framework.
2. Evaluate potential effects of a nutrition intervention on the pathophysiology of a chronic
condition/dysfunction.
3. Translate research findings to nutritional therapy clinical practice justifying conclusions
using an evidence based/informed approach.
Brief summary of the two parts of the assignment
Part 1 Written Evaluation 99%
Aim: To evaluate a given intervention for use in clinical practice drawing on information presented
in your critical appraisal framework template and a wider engagement with the current evidence
base, drawing conclusions and identifying gaps in the research.
Part 1 Word count: 2000 (+/- 10%) words
Part 2 Appendix: Critical appraisal framework template (compulsory) Pass/Fail 1%
Aim: To engage you with the ‘processes’ underpinning critical writing using a given paper –
researching the topics to become knowledgeable of issues/controversies, to identify potential
bias, understanding the appropriateness of the research methodology, and if the results are
presented accurately and the discussion and conclusions made are congruent with the title and
aim. This process will help you to begin to identify any issues in applying the intervention to practice.
Part 2 Word count: n/a
To write Part 1 the evaluation (product) you will first need to complete Part 2 the critical appraisal framework first (process).
Assignment Guidance
Part 1 Guidelines for Written Evaluation 99% (Product)
Aims
Write an evaluation, constructing convincing critical arguments and conclusions about the strength of the evidence to support the use of low carbohydrate diets to modulate type 2 diabetes, drawing on information presented in the critical appraisal framework template (submitted in the appendix).
Title
“Evaluation of the efficacy of very low carbohydrate diets in the modulation of type 2 diabetes, for
use in nutritional therapy practice.”
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Paper to critique
The free full-access research study that you are required to critique is:
Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD, Ploutz-Snyder
R, Goldman V, Cox RM, Mason AE, Moran P, Hecht FM (2017) Twelve-month outcomes
of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in
overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes. 7:(12):304.
Doi: 10.1038/s41387-017-0006-9
How is Part 1 structured?
Structure is written essay-style assessment and must include the following components
(headings):
• Introduction 15%
• Critique 55%
• Evaluation (application to practice)15%
• Summary 9%
Marks are also given for
• Presentation and referencing 5%
Introduction 15%
This is in two sections – The aim of the evaluation (whole assignment – see assignment title), and
overview of the research paper to be critically appraised:
Aim: This needs to be a concise overview of what you are going to be presenting. It is best to
rough this out but then come back to it and refine it once you have finished the critique,
evaluation, and summary.
Overview of the research paper to be critically appraised: Write a concise description of the
Research paper provided – Imagine the person reading your assignment has never read the paper
before and what key points they need to know to understand it – Your description of the paper
should include the purpose of the study, its design (type of study, who took part), methods
(interventions observed, main measurements made), time-frame, results and the authors’
conclusion. Keep the overview concise, descriptive and uncritical.
Critical appraisal 55%
Now critique the study design, methods and results.
Use the completed critical appraisal framework template to structure and provide content. You
may wish to organise your critical appraisal of the paper to support your ‘aim’ by using subheadings
that follow the order of questions in the critical framework template (selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis & conclusions).
This is a useful ‘signposting’ a technique to help guide the reader and will also help ensure your writing is methodical and well structured.
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You do not need to include every question from the framework template in the written critique. Prioritise main points for discussion – Think about what strengths and flaws you feel are most important to assessing the quality of evidence?
Avoid demonstrating bias. Demonstrate you can construct a referenced rounded set of arguments from different viewpoints. Drawing on the wider evidence is key to avoiding bias. When writing critically remember to move beyond simply description the study in order to demonstrate your knowledge of the strengths and flaws and why these are significant and critically reference your writing by citing Greenhalgh or other critical resource. Your critique may look something like this: “X and y issues related to recruitment may introduce selection bias and lack of generalisability of the results”.
Contextualise your critique to adult dietary interventions in the management of weight and type 2 diabetes throughout. Discussion of animal research, and other diseases are not relevant.
When critiquing the study results, specifically comment on whether the main outcome measures are statistically significant and reliable (refer to P values and confidence intervals (CIs).
Complete this section with a briefly summary of your findings.
• Are the authors’ conclusions congruent with their findings?
• What is your assessment of the values and validity of the article as a contribution to the
topic area?
You are encouraged to be bold in your view, but your summary must be substantiated.
Evaluation of application to practice 15%
How will your findings inform your practice?
Before you write this section, you need to be clear this is not the place to summarise the paper you have critiqued that happens in the critique section. In this section you are drawing on your findings in the critique and from your wider reading and beginning to think about how this approach may be applied in practice.
The question you must attempt to answer in this section, based on the evidence you have presented, is:
Can the dietary intervention, very low carbohydrate diets, be used effectively to modulate type 2
diabetes in nutritional therapy clinical practice?
At the beginning of this section you will need to inform the reader what your definition of as a very
low carbohydrate diet is. This could be one figure or a range. Why have you chosen this definition?
The structure of this section is based on themes relating to clinical practice. One of the ways to
start identifying potential themes is to define the ‘scope of practice’ e.g. Children? Adults? Male?
Female? Ethnic group? With or without medication? Long term use? Adherence/compliance? Etc.
The population group in the article critiqued are adults so you are not expected to speak to the
use of this dietary approach in children. However, it is likely clients in your practice will be on
medication so is this approach suitable to the types of medication they are likely to be taking? So,
what else must guide your practice? Codes of Ethics? Safety? These are themes too.
You must decide how you will turn these themes into subheadings. You do not have much word
count, so the marker is looking for how you prioritise. The mistake here would be to discuss each
theme separately – think how can you put several themes together to save word count?
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You will need to demonstrate you are reading widely and using an ‘evidence-based approach’.
This means not only drawing on research but also expert opinion and client experience of the
approach.
As you are not yet in clinical practice your markers will be expecting a generalized application to
clinical practice. In level 6 Nutritional Therapeutics you will return to this application to practice in
much more detail. This is why the weighting of this section is low as we want you to focus on
developing your critical appraisal skills.
This section must be referenced.
Summary 9%
A conclusion has two distinct parts
1. the summation of your findings
2. what needs to happen next statement
1. End your evaluation by drawing conclusions about whether, based on your critical appraisal of
the study quality, design, methods and results contextualised within a wider understanding of the
subject, that the use of very low carbohydrate diets in the modulation of type 2 diabetes has the
weight of evidence of efficacy/success. You might sum up in terms such as: ‘Very low
carbohydrate diets (w1) were/were not statistically significant (P = 0.001) and/or reliable (CI…)
indicating that (x2). Strengths/limitation in study quality, design & methods (y) mean results may
be interpreted with (confidence/caution).
You may also like to consider whether the author’s conclusions fairly represent their findings and
whether the abstract clearly presents the finding i.e. does the research ‘hang together’. You might
sum up in terms such as: ‘Although the author concluded (X1) this conclusion may be skewed due
to (Y2), therefore a more appropriate conclusion might state (Z’).
Your summation must be congruent with the arguments made in the critical appraisal and the
Introduction ‘aim’. This is also call ‘internal consistency’.
As this is a summation no new evidence should be presented.
2. What happens next: Think of the reader as the ‘research community’. You will need to
demonstrate you have identified any ‘gaps’ in the research. From these identified gaps you will
need to propose a concise recommendation for further research. By identifying gaps and
proposing new directions for research you further demonstrate your understanding the subject,
the wider context in which it sits, and research methodology. Look at the conclusions of papers
you are reading for your background research and the given paper to see how these may be
presented.
Presentation and referencing 5%
Write in academic English (3rd person /avoid use of 1st person).
Arial 12, Double spaced, Standard 2.5cm margins.
Referencing ION House style – Vancouver
Word count is 2000 (+/- 10%) words.
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Overall Descriptor Part 1 Written Evaluation 99% 0 – 29 30 – 39 40 – 49 (3rd) 50 – 59 (2ii) 60 – 69 (2i) 70 and above (1st)
Introduction (15%)
Briefly outline aim of the evaluation. Concise, detailed outline of the given paper (incl. type of study, purpose, design, methods, time-frame, results, & authors’ conclusion) is provided.
No/little attempt to introduce the aim. Outline of the paper is missing/contains major omissions &/or inaccuracies.
Partial introduction to the aim the evaluation. Outline of the paper is provided although contains significant omissions &/or inaccuracies &/or minimal of attention to concise writing.
Some introduction to the aim of the evaluation. Outline of the given paper is basic &/or lacking in key essential detail &/or contains several omissions. Evidence of concise writing is adequate.
A good introduction to aim. A good outline of the given paper. Some errors &/or omissions &/or loss of attention to concise writing in places.
Very good introduction to aim. A very good, mostly concise and detailed outline of the given paper. Minor errors &/or omissions.
The aim is clearly & fully introduced. An excellent concise yet detailed outline of the given paper. No omissions &/or inaccuracies.
Written Critique (55%)
Written critical discussion of the quality, methods, design, study results (incl. P values, CIs) of the given paper.
Prioritised and drawn from the framework template, the discussion is methodical, well-structured, and appropriately signposted. Synthesis and analysis are evident in a rounded set of unbiased arguments from different viewpoints/evidence sources (given paper plus wider evidence).
Discussion is contextualised to LCDs for adult T2D treatment throughout. Brief critical summary of quality of the research paper are presented.
(Are the authors’ conclusions congruent with their findings? What is your assessment of the values and validity of the article as a contribution to the topic area?
No/limited critical discussion of quality, design & methods and results (P values, CIs) of the paper. Discussion is descriptive rather than critical &/or inaccurate &/or missing. Discussion is unsupported by different critical viewpoints (given paper plus wider evidence) & biased. No/little attempt to structure discussion (applying the framework) &/or prioritise points for discussion &/or signposting &/or contextualisation to LCDs for treatment of T2D in adults.
No/Incomplete &/or inaccurate summary, significant errors in the conclusions. Lacking internal consistency to the critique/wider evidence.
Reader cannot gain a sense of what is being claimed. Strong bias is evident.
A partial critical discussion of quality, design & methods and results (P values, CIs) of the paper. For the most part discussion is descriptive rather than critical &/or inaccurate &/or contains significant omissions. Discussion is mostly un-support by different critical viewpoints (given paper plus wider evidence) & largely biased. Little evidence of structure (applying the framework) &/or prioritisation points for discussion &/or signposting &/or contextualisation to the intervention – LCDs for treatment of T2D in adults
Mostly descriptive summary requiring marker to interpret what is being concluded. Lacks clarity, &/or succinctness, Limited internal consistency with the critical discussion/wider evidence. Several errors/ inconstancies. Limitations of existing evidence base is neglected. Largely descriptive rather than critical. Unjustified conclusions/opinions. Limitations of existing evidence base is neglected.
Adequate critical discussion of quality, design & methods and results (P values, CIs) of paper. Several misunderstandings &/or omissions although adequate analysis & synthesis is demonstrated. Discussion is supported by a minimal range of critical views/evidence (given paper plus wider evidence) although some tendency to bias. Structure (following the appraisal framework) &/or prioritisation of points for discussion &/or signposting is adequate. Some loss of contextualisation of discussion to the intervention in places.
Satisfactory summary with some criticality, some issues with logical presentation of conclusions, clarity &/or succinctness due to omission of some key/essential detail/in some places and rationale for conclusions are not easily apparent making it hard for reader to always ascertain what is being claimed. Some repetition. Inconsistent internal consistency with the critical discussion/wider evidence in places. Bias is repeated.
A good critical discussion of quality, design & methods and results (P values, CIs) of the paper. Some misunderstanding &/or omissions although good analysis & synthesis is demonstrated. Discussion is mostly supported by a rounded set different critical viewpoints/evidence sources (given paper plus wider evidence) & bias is mostly avoided. Structure (following the appraisal framework) &/or prioritisation of points for discussion &/or signposting is good. Discussion is contextualised to LCDs for treatment of T2D in adults for the most part.
Good summary, logical conclusions predominately linked to the evidence presented but is not always explicit, &/or thoroughly presented, they may have to make some interpretation as to what is being claimed. Some minor bias may be evident/or evident by omission. Personal opinion is inconstantly substantiated.
A very good critical discussion of quality, design & methods and results (P values, CIs) of the paper. Minor misunderstandings&/or omissions though analysis & synthesis is very good overall. Discussion is supported by a rounded range of different critical viewpoints/evidence sources (given paper plus wider evidence) & bias is avoided. Structure (following the appraisal framework) &/or prioritisation of points for discussion &/or signposting is very good. Discussion is contextualised to LCDs for treatment of T2D in adults, with minor digression.
Very good, concise, succinct, logical summary on the quality of the given research paper. (High internal consistency). Mostly/not equally contextualized within wider knowledge of the condition and intervention. Personal opinion is mostly substantiated.
An excellent critical discussion of quality, design & methods and results (P values, CIs) of the paper. No misunderstandings &/or omissions and analysis & synthesis is insightful. Discussion is supported by a rounded & wide range of different critical viewpoints/evidence sources (given paper plus wider evidence) with no bias. Structure (following the appraisal framework) &/or prioritisation of points for discussion &/or signposting is excellent. Discussion is consistently contextualised LCDs for treatment of T2D in adults.
Excellent, concise, succinct, logical, consistent, non-biased summary on the quality of the given research paper contextualized within wider knowledge of the condition and intervention.
Personal opinion is substantiated.
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Evaluation of application to NT practice (15%)
How will findings inform practice? Appropriate evaluation of whether, (based on evidence in critical discussion and wider reading), very low carbohydrate diets (LCDs) can modulate type 2 diabetes (T2D).
Random discussion. Lacks coherent grasp of possibility of application of findings to practice. Assumptions presented rather than evaluation of findings based on evidence. No/poor use of literature. Unethical/unsafe practice.
Discussion misses some possible key applications to practice or application to practice proposed are not possible. Lead by literature rather than by findings. Minimal evaluation of application to practice. Potential unethical practice.
Discussion linked to aim and objectives. Misses an obvious possible application to practice. Application/s proposed not fully evidenced. Reader needing to interpret &/or read between the lines. Logical evaluation but rather limited in scope. Summary appears in this section.
Discussions of significant findings are sometimes implied rather than explicit. Evaluation generally clear with systematic account of significant findings emerging from the critique. Integration within the larger context of practice beginning to emerge are explored.
Evaluation is organised, prioritised into emerging themes and evidenced. Discussion & debate reveals clear and critical awareness of issues relating to practice.
Critical awareness of practice issues that are grounded in a diversity of literature/ evidence. Claims for findings are measured and appropriate to the context. Discussion is innovative yet ethical and professional.
Summing up (9%)
Brings together the findings of the critique and issues regarding application to practice with recommendations for future research that benefits practice.
Demonstrates your understanding of research design. Identification of research ‘gaps’ and recommendations for further research.
Unsupported summary of recommendations for practice / further research not made, unclear, and/or inappropriate. Major omissions.
Clear distortion/bias of existing knowledge &/or evidence. Unethical/unsafe practice
Conclusions are possible but there are several errors, inconsistencies &/or omissions in the summation &/or identification of research gaps &/or further research recommendations. Minimal recommendations.
Very limited grounding in critique/literature/ evidence (poor internal consistency). Failure to justify conclusions drawn
Satisfactory summation and identification of obvious research ‘gaps’ & recommendations for further research, although lacking in key/essential detail &/or logic is not immediately apparent in places.
Conclusions and recommendations are not immediately apparent /some internal consistency.
Logical summary and Identification of research ‘gaps’, & recommendations for further research predominantly linked to evidence although rationale for recommendations are not fully justified in places &/or lacks some detail &/or would not advance the subject/intervention.
Thoroughly and systematically presented. Identification of research ‘gaps’, & recommendations for further research driven/justified by information gathered (high internal consistence). Ideas fully justified, with the possibility these may advance the subject/intervention. Minor omissions &/or inaccuracies /or misunderstandings exist in an otherwise insightful interpretation.
Identification of research ‘gaps’, & recommendations for further research fully justified and likely to advance the subject/intervention. No omissions &/or inaccuracies. The summation is positioned within a clinical practice framework.
80+ Conclusions lead to creative recommendations. Uses limitations of existing knowledge to suggest new possibilities and further work. Clear evidence of critical competence.
Writing and Referencing (5%)
Academic English (3rd person), grammar, sentence construction, accurate citations (Vancouver) and reference list.
Poor academic English &/or attention to grammar &/or spelling &/or signposting. No/little attempt to follow referencing guides.
Major errors in academic English &/or grammar &/or spelling &/or signposting. Significant errors in the in-text citation and reference list although use of Vancouver guidelines may be apparent.
Satisfactory academic English &/or grammar, spelling & signposting. Some in-text citation &/or reference list errors &/or omissions.
Good academic English, grammar, spelling & signposting. Occasional in-text citation &/or reference list errors &/or omissions.
Very good academic English, grammar, spelling & signposting. Minor referencing errors (in-text citations, reference list) or omissions.
Sophisticated use of academic English & signposting. No errors in. grammar / spelling. No referencing errors (in-text citations, reference list) or omissions. Overall Descriptor Part 2 Critical Framework (1%) Pass/Fail Fail – 0.0 Fail – 0.0 Pass – 1.0
Systematic utilization/completion of the given critical appraisal framework template
Evidence and critical notes are concise & use academic English.
Accurate citations (Vancouver).
Not submitted/Significant areas within the template not completed.
Submitted but incomplete not allowing the marker to view the underpinning information need to support opinion, arguments and conclusions.
Submitted and complete. Marker can see engagement with the critical appraisal process. Marker can see how the student may have constructed arguments, supported opinions and reached conclusions.
NA
NA
NA
NTDC5418 Disordered Physiology 10
Guidelines for Appendix: Critical Appraisal Framework Template (process)
(1% – pass/fail)
Aim
To engage with the ‘processes’ that underpin and facilitate writing a critical appraisal – researching the topic/subject, and research methodologies, and completing a critical appraisal framework template for a given research paper on the efficacy of low carbohydrate diets in the modulation of type 2 diabetes.
Demonstrate evidence of topic/subject knowledge, research methodology and concise critical
note taking.
How to Critically Read a Paper
Revise your lecture/workshop notes and read the relevant chapters in:
Greenhalgh T (2019) How to read a paper. The basics of evidence-based medicine and healthcare 6th edn., Wiley-Blackwell (see module reading list).
In particular chapters:
3) The Science of Trashing Papers
4) Assessing Methodological Quality
5) Statistics for the Non-Statistician
This essential text can also be purchased as a textbook via Vitalsource (see RelION). If you Google ‘Trisha Greenhalgh how to read a paper’ you can access chapters from this book free via the BMJ website, though not necessarily from the most recent publication.
Each section of the template must be completed (see marking grid).
Framework questions are summarised below:
Step 0: What the paper is about – getting your bearings.
1. What is context of this research? Why was the study done?
2. What is the question and hypothesis?
3. What type of study was performed? Is the study design appropriate?
4. How was the study funded and did the study meet expected standards of ethics and governance?
Step 1: Selection and sampling / external validity and generalisability
1. Describe the recruitment process. What are the potential issues?
2. Describe the inclusion/exclusion criteria. How many recruited patients were excluded?
3. How generalizable are the results (external validity)?
Step 2: Comparability of the groups being studied
1. For RCTs – How was randomised assignment to study groups performed and concealed?
2. If a non-randomised comparative study, were the controls appropriate?
3. How do the baseline characteristics of study groups compare?
Step 3 – Intervention integrity – the 5 C’s
1. Contamination – Did both study groups receive the correct intervention assigned to them?
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2. Crossover – risk of participants and researchers knowing group assignment and affecting behaviour?
3. Compliance – what was the degree of compliance by the study groups to their assigned intervention?
4. Co-intervention – were any co-interventions applied to the groups which could affect results?
5. Count – what was the drop-out rate at follow up?
Step 4: Study outcomes
1. Was the study large enough and continued for long enough?
2. What main outcomes were measured and how? What are the limitations of these?
3. Comment on the quality of assessment ‘blinding’. If compromised did this affect assessment of outcome measures?
Step 5: Analysis and Conclusions
1. Comment on the parametric test(s) applied to the data
2. Have withdrawals been accounted for? Was ‘Intention To Treat’ (ITT) analysis followed?
3. How do results compare?
4. Are the results statistically significant?
5. Are the results clinically significant?
6. Do the authors conclusions fairly represent their findings?
7. Does the abstract present the findings?
There is a formative critique template self-assessment grid on page 14 this provides more detail so that you can assess your level of engagement with the critique processes and your skill level.
Presentation
Instructions on presenting the template:
• Title “Part 2: Critical appraisal framework template”.
• Succinct evidence drawn from the paper to support your critical appraisal should be written in “Arial 12, black regular font”. Evidence can be direct quote or paraphrased as necessary but avoid paraphrasing to the extent that essential detail is lost.
• Critical appraisal notes should be written in “Arial 12, black bold font”. Keep your writing succinct.
• You may use single-spaced lines for this section only.
• Write in academic English (3rd person /avoid use of 1st person).
Word count
There is no set word count for the template; however, it shouldn’t need to be more than 2000 (+/-
10%) words.
Referencing
Use Vancouver for all text citations in the assignment (in-template, in-text) and list references at
the end of the assignment in numerical order (not alphabetical order).
You must use the ION Guide to Citing and Referencing in which the Vancouver style is used and formatting the references within the numbered list is explained. Using Cite This for Me and setting up a project within it may speed up collation of information and reference formatting.
Please be sure your presentation is consistent, it is when the style varies that marks are lost.
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Optional Formative Exercise
To help you complete this template there is an optional formative exercise (unmarked) supported by the module leader (see pages 12 – 15).
Students who submit to the optional formative deadline tell us that engaging with this task improves their understanding and skills of critical appraisal and aids their time management.
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Optional Formative Brief: Critical appraisal of the given paper using the framework template
Submission Date: 20t h April 2020, 12pm via Turnitin – not marked
Context
The critical appraisal framework is your working (process/thought) document.
This optional formative task and any work you add to it subsequently is eventually submitted
(compulsory) in Part 2 the Appendix of module assignment. It will be used by your marker to
gain insight into the arguments and observations you are putting forward in the assignment.
As this is a ‘process tool’ there is no word count and it is only marked pass/fail (see assignment
marking grid Part 2).
This optional formative task is designed to help you get started early on the background research you will need in the introduction of your assignment.
Through systematically critiquing the given paper using this framework template alongside input from the module leader throughout the module you will develop further your skills of critical appraisal needed for the critique section of the assignment.
While critiquing the given paper you will engage with the wider evidence base and start to identify if this intervention is useful in clinical practice.
You will also start to notice gaps in the evidence base, these observations are placed in the assignment summary.
Students who submit to the formative deadline tell us that engaging with this task improves their understanding and skills of critical appraisal and aids their time management. (See Evaluation Assignment Brief).
The Framework Template
A critical appraisal framework is a ‘process tool’ that allows you logically and efficiently collate your research findings/notes from which you can then populate the sections of the assignment.
In year 3 you will be using this tool/technique frequently to determine if you will or will not use an approach/intervention in nutritional therapy practice.
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Optional Formative: Use this formative guide when completing the critical appraisal template Overall Descriptor Part 2 Critical Framework (1%) Pass/Fail 0-29 30-39 40-49 50-59 60–69 70 and above
Completion of Framework
Systematic
utilization/completion of the given critical appraisal framework template.
Evidence and critical notes are concise & use academic English.
Accurate citations
(Vancouver).
No/little attempt to
utilize/ complete the
critical appraisal
framework template.
Evidence &or critical
notes are missing.
No/little attempt to
use academic English
&/or follow Vancouver
referencing guides.
Partial utilization/completion
of the critical appraisal
framework template &/or
the template contains major inaccuracies.
Evidence &/or critical notes are partial &/or
are not concise. Major errors in academic English. Major
errors &/or omissions in the in-text citation although use of Vancouver guidelines may be apparent.
Utilization/completion of the critical appraisal framework template
is apparent/adequate.
Evidence &or critical notes are adequately concise. Significant errors in academic English. Significant citation errors
&/or omissions
(Vancouver).
Some errors &/or omissions
in an otherwise systematic
utilization/ completion of the
critical appraisal framework
template.
Concise
notes and evidence are
apparent in places but
lacking elsewhere. Some
errors in academic English.
Some citation errors &/or
omissions (Vancouver).
Minor errors &/or omissions
in an otherwise systematic
utilization/ completion of
the given critical appraisal
framework template
Concise notes &
evidence for the given word
count. Minor errors in
academic English. No
citation errors &/or
omissions (Vancouver).
Systematic
utilization/completion of the given critical appraisal
framework template
with no inaccuracies
or omissions. Very concise
notes & evidence for the
given word count. Excellent
academic English. No
citation errors &/or
omissions (Vancouver).
Critical Appraisal
Critical appraisal (in the
template) of the given paper in terms of selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions.
Critical views are consistently referenced (e.g. Greenhalgh) and supported by
appropriate evidence drawn from the paper. Critical notes are contextualised to LCDs for treatment of T2D in adults
throughout.
No/little evaluation of
selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions. No/little attempt to
contextualise
discussion to LCDs
for treatment of T2D
in adults. Critical
views are not
referenced &/or
supported by
appropriate evidence
drawn from the
paper.
Minimal evaluation of selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions. demonstrating only
partial understanding of
critical appraisal. Writing
does not move beyond the descriptive. Significant
omissions &/or inaccuracies in the critical appraisal.
Minimal contextualisation of
the discussion to LCDs for treatment of T2D in adults. Critical views are minimally referenced &/or supported by evidence drawn from the
given paper
Apparent evaluation of
selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions.
demonstrating adequate
understanding of critical
appraisal. Writing may be descriptive rather than critical in places &/or contain some omissions &/or inaccuracies in the
critical appraisal. Adequate contextualisation of the
discussion to LCDs for
treatment of T2D in adults. Critical views are
adequately referenced &/or supported by evidence drawn from the given paper.
Some errors &/or omissions
in an otherwise good
evaluation selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions. demonstrating good
understanding of critical
appraisal. Good
contextualisation to LCDs for
treatment of T2D in adults.
Critical views are supported
with appropriate references &
evidence drawn from the
paper with some omissions.
Minor errors &/or omissions in an otherwise very good
evaluation of selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions. demonstrating very good internal understanding of
critical appraisal. Very
good contextualisation to
LCDs for treatment of T2D in adults, minor digression only. Critical views are supported with appropriate references & evidence drawn from the paper with minor omission/s.
Insightful evaluation of
selection and sampling, comparability of groups, intervention integrity, study outcomes and analysis and conclusions.
demonstrating complex
internal understanding of
critical appraisal with no
omissions &/or
inaccuracies. Excellent
contextualisation to LCDs for treatment of T2D in adults throughout. Critical
views are consistently
supported with appropriate
references & evidence
drawn from the paper.
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Engagement with Wider Evidence
Engage with wider research on the topic to LCDs for
treatment of T2D in adults in order to contextualize the paper within broader evidence
base, with consideration of quality & appropriateness (e.g.
purpose &/or type &/or
currency of study &/or
consideration of major
limitations) of wider evidence.
No/little evidence of
engagement with
wider evidence &/or
contextualization
within the broader
evidence base for
LCDs for
management of T2D
in adults &/or wider
evidence is
inappropriate &/or
poor quality.
Partial evidence of
engagement with wider
evidence &/or
contextualization within the broader evidence base for LCDs in management of T2D
in adults &/or a significant number of papers are
inappropriate &/or poor
quality.
Partial evidence of
engagement with wider
evidence &/or
contextualization within the broader evidence base for LCDs for management of
T2D in adults &/or some of papers are inappropriate
&/or not the highest
available quality.
Good engagement with /
utilization of mostly high
quality appropriate available
research to demonstrate a good understanding of how the paper fits within the wider evidence base for LCDs for
management of T2D in
adults.
Very good engagement
with / utilization of high-quality appropriate
research to demonstrate
very good understanding of how the paper fits within the wider evidence base for
LCDs for management of T2D in adults.
Excellent utilization of the highest quality available
appropriate research to
demonstrating insightful
understanding of how the paper fits within the wider evidence base for LCDs for
management of T2D in
adult
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