Rapid Critical Appraisal Essay.

Rapid Critical Appraisal (RCA)

After a GAO is completed and the keeper study is deemed relevant to the PICOT question, a Rapid Critical Appraisal (RCA) is completed next.  The RCA helps extract all pertinent information regarding the quantity and quality of the evidence the study provides.  Unlike the GAO (which is the same no matter what type of study you are evaluating), RCA forms vary depending on the type of study.  (There are a limited variety of RCA forms, so if one does not exist for the type of study you are examining, use the form that most closely addresses the attributes of the study.)Rapid Critical Appraisal Essay.

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Two articles were previously selected and provided for you to use as the keeper studies for this project:  “Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?” (Davies, et al.) and “A Cluster Randomised Trial of Cloth Masks Compared with Medical Masks in Healthcare Workers” (MacIntyre, et al.).  You should have two completed GAO’s–one for each article–in addition to downloading, saving, and closely reading both articles.  The RCA is an even more detailed examination of the article, so you must be quite familiar with the article to find and analyze the correct information.Rapid Critical Appraisal Essay.

The RCA for Randomized Controlled Trials (RCT) is best suited for the MacIntyre study.  Download the blank RCA for RCTs provided below and complete it for the MacIntyre study. You will submit the answers on the next page.

An RCA has been completed for you for the Davies article and also is provided below.  Download, save, and review the completed Davies RCA to become familiar with the form, the study, and finding the information.  You will need the RCA information for both articles as we move through the class.Rapid Critical Appraisal Essay.

PICOT:  For hospital healthcare workers (HCWs) (P), how does use of cloth masks (I) compare to use of medical masks (C) for droplet transmission prevention (O) while wearingon every shift for 4 consecutive weeks?

Are the results of the study valid?

1. Were subjects randomly assigned to the experimental and control groups?

In this study, hospital wards would be randomized to cloth masks, medical masks or a control group. The control group would engage in usual practice which would include mask wearing. The participants of the study would use their designated masks for every shift over a four week period.Rapid Critical Appraisal Essay.

1. Was random assignment concealed from the individuals who were first enrolling subjects into the study?Unknown
2. Were the subjects and providers blind to the study group?

The laboratory results in the study would be blinded. Laboratory testing was also done in a blinded manner. However, because the use of face masks is a visible intervention, the clinical end points could not be blinded.Rapid Critical Appraisal Essay.

1. Were reasons given to explain why subjects did not complete the study?

The inclusion criteria for the study were the minimum age limit of 18 years. Reasons for exclusion included, doctors and nurses that were unable to or refused to participate, long facial hair and current respiratory illness. The study does not state if explanations were given as to why doctors and nurses refused to participate.Rapid Critical Appraisal Essay.

1. Were the follow-up assessments conducted long enough to fully study the effects of the intervention?

The participants of the study would be followed through the same calendar time for four weeks of using face masks. They were also followed for an additional week to check for the appearance of symptoms of infection.Rapid Critical Appraisal Essay.

1. Were subjects analyzed in the group to which they were randomly assigned?

Subjects were tested based on the group they were randomized. This was to ensure that data could be compared between infection rates of infection between participants with medical masks and those with cloth masks.

1. Was the control group appropriate?The control group was appropriate as they were asked to proceed with normal practice. This may or may not have included the use of masks. This allowed for the determination of a baseline for infection levels at the institution.
2. Were the instruments used to measure the outcomes valid and reliable?

The instruments used were reliable and valid. Descriptive statistics would be compared among the control and intervention arms.

1. Were the subjects in each of the groups similar on demographic and baseline clinical variables?The participants in the groups were similar in the above variables. The participants were randomly chosen within wards. Those with different variables such as facial hair and exciting infections were excluded.Rapid Critical Appraisal Essay.

What are the results?

1. How large are the interventions or treatment effect (NNT, NNH, effect size, level of significance)?

In the analysis influenza like illness was significantly higher among healthcare workers with cloth masks (RR=13.25 and 95% CI 1.74 to 100.97). This is in contrast to the medical mask group. The rate of influenza like illness was also slightly higher in the group with cloth masks compared to the control group (RR=3.49 and 95% CI 1.00 to 12.17).Rapid Critical Appraisal Essay.

1. How precise is the intervention or treatment (CI)?

This is not applicable as there is no confidence interval with this true experiment.

Will the results help me in caring for my patients?

1. Were all clinically important outcomes measured?

The influenza like illness rates were measures for all three groups. This allowed for the determination of the most effective prevention mechanism.

1. What are the risks and benefits of the treatment?

The use of medical masks is safe and therefore bears little to no risk. This study has shown that the use of face masks is more effective in preventing infections in clinical settings.Rapid Critical Appraisal Essay.

1. Is the treatment feasible in my clinical setting?

The use of medical masks is not only feasible but it would prove be3neficial if set as th3e standard for health care workers.

1. What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself?

The use of medical masks will reduce infection levels for both medical workers, patients and visiting friends and family thereby resulting in better health outcomes for all parties in the ward.

PICOT:  For nurses working with populations at risk for Covid-19 infection (P), how does use of cloth masks (I) compare to use of medical masks (C) for droplet transmission prevention (O) while wearing during a 12-hour shift (T)?Rapid Critical Appraisal Essay.

Are the results of the study valid?

1. Were subjects randomly assigned to the experimental and control groups?N/A, there were no subjects examined.The comparison (control)group was predetermined to be medical masks.
2. Was random assignment concealed from the individuals who were first enrolling subjects into the study?N/A, the experiment compared efficacy of cloth masks versus medical masks for aerosol filtration; random assignment does not apply.
3. Were the subjects and providers blind to the study group?There were no subjects and it is assumed that the providers administering aerosol particulate could see which mask was being tested at the time.Rapid Critical Appraisal Essay.
4. Were reasons given to explain why subjects did not complete the study?N/A, all masks studied were tested to completion.
5. Were the follow-up assessments conducted long enough to fully study the effects of the intervention?Unknown, while testing was performed immediately after exposure to determine permeability of each mask, testing was performed on a new mask each time, which does not take into account repeated exposure to droplet pathogens over hours of time.
6. Were subjects analyzed in the group to which they were randomly assigned?Yes, data was collected and compared per assigned group.
7. Was the control group appropriate?Yes, medical masks are an appropriate comparison.
8. Were the instruments used to measure the outcomes valid and reliable?Yes, the manufactured cough box placed in the high-frequency particulate air-filtered room is an appropriate test environment. The Andersen Bioaerosol Sampler and the Casella Slit-Samplerare reliable, gold-standard tools for evaluating aerosol particulate.
9. Were the subjects in each of the groups similar on demographic and baseline clinical variables?N/A.Rapid Critical Appraisal Essay.

What are the results?

1. How large is the interventions or treatment effect (NNT, NNH, effect size, level of significance)? When coughing, both medical and cloth masks reduced transmission of microorganisms; the cloth mask reduced transmission by 50% (p = 0.004) and the medical mask eliminated transmission (p < 0.001). The medical mask had the lowest permeation (n=3) of colony-forming units for the smallest particles evaluated (comparable to SARS-CoV-2) while the cloth mask had the fewest colony-forming units (n=3) for the largest particles (>7 mm) tested.
2. How precise is the intervention or treatment (CI)?N/A, no confidence intervals with this true experiment.Rapid Critical Appraisal Essay.

Will the results help me in caring for my patients?

1. Were all clinically important outcomes measured?Yes, the test bacteria Bacillus atrophaeus is comparable in size to influenza virus (60-100 nm) and SARS-CoV-2 is approximately 100 nm (0.1 mm), so the permeability comparison is clinically appropriate for my population.
2. What are the risks and benefits of the treatment?Risk for both droplet transmission and breathing difficulty are minimized with use of medical masks, as they provide superior filtration and lower pressure drop across fabric. However, if medical masks are unavailable, cloth masks do provide some protection against particle transmission (more than no mask).Rapid Critical Appraisal Essay.
3. Is the treatment feasible in my clinical setting?Yes, medical masks are available in my clinical setting, although many clinics have had shortages.
4. What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself?Nurses—the population of interest—value evidence, safety, and accessibility. In the quest to prevent droplet transmission, the expectation is proven methodology and availability of materials, so they may execute their job while minimizing risk to themselves and their patients.  Patients value and expect that healthcare facilities will keep them safe and avoid nosocomial infection, which involves health and safety of the nursing staff.Rapid Critical Appraisal Essay.

Are the results of the study valid?

1. Were subjects randomly assigned to the experimental and control groups?Yes No Unknown
2. Was random assignment concealed from the individuals who were first enrolling subjects into the study?Yes No Unknown
3. Were the subjects and providers blind to the study group?Yes No Unknown
4. Were reasons given to explain why subjects did not complete the study?Yes No Unknown
5. Were the follow-up assessments conducted long enough to fully study the effects of the intervention?Yes No Unknown
6. Were subjects analyzed in the group to which they were randomly assigned?Yes No Unknown
7. Was the control group appropriate?Yes No Unknown
8. Were the instruments used to measure the outcomes valid and reliable?Yes No Unknown
9. Were the subjects in each of the groups similar on demographic and baseline clinical variables?Yes No Unknown

What are the results?

1. How large is the interventions or treatment effect (NNT, NNH, effect size, level of significance)?
2. How precise is the intervention or treatment (CI)?

Will the results help me in caring for my patients?

1. Were all clinically important outcomes measured?Yes No Unknown
2. What are the risks and benefits of the treatment?
3. Is the treatment feasible in my clinical setting?Yes No Unknown
4. What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself?

Rapid Critical Appraisal Essay.