Evaluation of a multiprofessional community stroke team Essay Example for Free

Evaluation of a multiprofessional community stroke team Essay The study aims to conclusively evaluate how effective it is to employ a specialist community stroke team for the rehabilitation of stroke victims in a community based setting. This is clearly established at within the opening lines of the article. In the summary at the beginning of the article the author claims that the available evidence is inconclusive and his aim is to provide conclusive proof with regards to evidence based practise for the patient. A research article should state its’ aims clearly and should assume the audience has no previous background knowledge (Greenhalg, 2006). The literature reviewed in this article was from a variety of sources such as the Cochrane database and a selection of journal articles. On this basis the authors were able to deduce that previous research carried out provided contradicting reports. For example Roderick et al (2001) as cited by Lincoln et al (2004) found no significant difference in the effectiveness of rehabilitation which had taken place in the home to that which had occurred in a hospital setting. On the contrary Gladman et al (1993) as cited by Lincoln et al (2004) found a significant difference in a small group of younger patients. It was also suggested that there was a shift of focus from mainly hospital based rehabilitation to community based rehabilitation of stroke patients. According to Polger and Thomas (2008) a literature review should provide appropriate background information. That is, it should show the current knowledge level in that area of study. The author appears to have utilised much of his own previous work in the study and some are more than ten years old. This could possibly be an indication that indeed, there is a large gap in knowledge of this subject area. On the other hand it may indicate that the author has done a selective search of the literature. A quantitative approach was utilised in this study and the method used was a Randomised Controlled Trial (RCT). The articles’ methodology was well documented. According to Sim and Wright (2000) an analytic study attempts to quantify the relationship between two factors, that is, the effect of an intervention or exposure on an outcome. A term used to describe the design randomized controlled trial according to Greenhalgh (2006) is Parallel group comparison. This is when each group receives a different treatment and both are entered into the experiment at the same time. By comparing the groups an analysis is provided. In the Lincoln et al (2004) study Participants were divided into two groups, A and B with the former receiving routine care while the latter received the intervention – rehabilitation with the multi-professional community stroke team. The question posed by the authors could have been answered using a qualitative approach. The question could possible state; Evaluation of a multiprofessional community stroke team: a phenomenological study. SAMPLE Altman (1991) states that a study should have enough participants recruited in order to detect a significant effect if one exists. The sample group consisted of patients referred to the Nottingham Community Stroke Team who had suffered a stroke within the last two years, who were over sixteen years old and needed intervention from more than one multidisciplinary team member. Patients who lived outside the geographical area and/or had been treated by the community stroke team in the preceding two years were excluded. Four hundred and twenty eight patients were randomly selected at the start of the trial and randomly allocated to either Group A or Group B. An error resulted in seven people being recruited twice. This error was corrected by including only the outcome of their initial recruitment when the results were being analyzed. The target population of this study is relatively clearly defined (patients who have had a stroke within last two years, over the age of sixteen, etc ) and lends credence to the external validity of the study (Payton, 1994). According to Sim and Wright (2000) the accessible population is the portion of the target population that is available to the researcher and the sample is then taken from this accessible population. The groups are similar to each other with regards to gender and age distribution; this also increases the validity of the study as this similarity reduces the variables of the study. The overall population was a convenience sample which was then randomized to two groups. Six months after randomization all the patients were sent a letter asking them to consent to being in a study to evaluate the input of a community stroke team. According to Lincoln et al (2004) the consent forms and outcome questionnaires were sent this late so as to reduce bias. It was thought that group A which was receiving routine care would have lower expectations if confronted with the realization that the alternate group may receive superior care. Some would possibly insist on being referred to the specialist community stroke team The Local Research Ethics Committee granted ethical approval for this study to go ahead. This indicates that the value of the research undertaken outweighed any harm that this consenting method may have caused as patients in Group A were still receiving routine care. However, the department of health has issued guidelines which state that participants must be consented and all pertinent information given prior to the start of any study. Data was collected via a questionnaire comprising of the Barthel Index, Extended ADL, General Health Questionnaire 12 (GHQ-12) and Euroquol. The participants were also asked to rate their knowledge of the expected extent of recovery from their stroke, and their overall satisfaction with the services they received from the community stroke team. The use of a questionnaire for data collection has both negative and positive aspects. Greenhalgh (2006) states that a questionnaire is an instrument used to measure human psychology, so whilst sending the questionnaire via post proves to be cost effective as the alternative would be to hold face to face interviews with the participants as focus groups or individually, it raises concerns about the reliability of the study. This is because the researcher is not present to interpret facial expressions and body language when the participants answer the questions. The alternative of conducting face to face interviews with such a large number of participants would prove to be costly and time consuming. However, according to Oppenheim (2003) long questionnaires are sometimes off putting and may generate low response rates, conducting these questionnaires via the postal service could possibly increase the likelihood of a low response rate. The results were shown as a table and diagram, the Mann-Whitney U-test which was used to compare the groups showed no significant differences on independence in personal or instrumental activities of daily living or on the patients’ mood. There was also no significant difference between the groups in their knowledge with regards to the resources available to assist them in adjusting to life after a stroke. There was also no difference between the two groups with overall satisfaction or in satisfaction with the practical helped received. However, patients in the Community Stroke Team were significantly more satisfied with the emotional care they received. (Lincoln et al, 2004) According to Wright et al (2009) the Mann-Whitney U-test is used when one group from the sample is larger than the other and when both samples are from the same population, as is the case with this study. There was no significant difference in carers’ mood between the two groups. However, the strain on carers of patients seen by the community stroke team was significantly less than that of carers of patients randomized to the routine care group. The carers of patients in the community stroke team group were significantly more satisfied with their knowledge of stroke and had higher overall satisfaction than the carers of those in the routine group. By utilizing the randomized controlled trial design the author lends credence to its validity as this design allows for the eradication of systematic bias. (Sim et al, 2000) This was done through the sampling process of selecting the participants from the target population and randomly allocating them to Group A which received routine care or Group B those in the care of the community stroke team. The collection of data by using a postal questionnaire helps to â€Å"blind† the researcher as he cannot influence the participants’ response. Although some participants did not respond to the questionnaire, others responded with incomplete forms, some died and a few were recruited twice, the author is cognizant of this and incorporates it into his findings. Crombie (2000) states that if the withdrawals and failures to respond can be seen as being consistent between both comparison groups then the results of the research will not be negatively impacted upon. This is because the results show that these failures are random among both groups and not specific to one. However one major fault is the fact that the services received by Group A were not collected due to impracticalities and unreliable recollections of the patients. Critical appraisal is not just an exercise in fault finding, it is the analysis of these faults and the assessment of their potential impact on the research which allows the reader to come to a decision regarding the strength or usefulness of the article being critiqued. In order for the research results to be utilized in clinical practice its’ reliability and validity are essential aspects which need to be covered. (Polger and Thomas, 2008) This article shows a research that was methodically sound and well designed. The sample was representative of the population being examined and attempts were made to minimize bias. The author was aware of the shortfalls of this research and attempted to incorporate this in his findings however, most of the issues identified did not affect the results of the study. The study if repeated would provide comparable results. However, the author states that the study provides evidence supporting the use of a community based stroke team to assist in the rehabilitation of stroke patients because of the increased emotional support for patients and greater satisfaction and reduced strain on carers. This statement would have been better justified on results from a qualitative study as this type of study aims to interpret people’s emotional and psychological response to the intervention or interventions being employed. The results from such a study would be closer to the patients’ and carers true feelings as the methodology behind that study would be different.

The Fate of the True Woman in The Blithedale Romance Essay -- Blitheda

The Fate of the "True Woman" in The Blithedale Romance The female characters in Nathaniel Hawthorne's The Blithedale Romance, Zenobia and Priscilla, differ in their representations of womanhood. Zenobia begins as an independent character, whom later surrenders to Hollingsworth's control, whereas Priscilla is ever submissive to his desires. This determines how the male characters, Coverdale and Hollingsworth, view both women. Coverdale and Hollingsworth are first enamored by Zenobia's charm, but both fall for Priscilla's docility. Zenobia represents female independence and Priscilla embodies feminine subservience; the triumph of Priscilla casts the male vote in this novel unanimously for obedient women. Hollingsworth describes the True Woman: "She is the most admirable handiwork of God, in her true place and character. Her place is at man's side . . . All the separate action of woman is, and ever has been, and always shall be, false, foolish, vain, destructive of her own best and holiest qualities, void of every good effect, and productive of intolerable mischiefs [sic]! . . . The heart of true womanhood knows where its own sphere is, and never seeks to stray beyond it!" (Hawthorne 122-3). Zenobia falls short of Hollingsworth's definition of the True Woman. In the beginning of the novel, she is noted for being an intellectual, a writer. Such "separate action" as thinking and writing surely offends the True Womanhood. This betrayal reaches its pinnacle at Eliot's Pulpit, where she vows to speak "in behalf of woman's wider liberty" (Hawthorne 120). It is here that Hollingsworth describes the True Woman whom Zenobia is so very unlike. Priscilla, however, is the epito... ...sible ever to redeem them? (Hawthorne 124). However, by falling for Priscilla, a True Woman, he perpetuates the degradation of woman through the ideal of True Womanhood. Zenobia's failure to submit fully to the ideal of True Woman condemns her to unhappiness. "Everything had failed her-prosperity, in the world's sense, for her opulence was gone-the heart's prosperity, in love" (Hawthorne 239). According to Coverdale, herself, and much of society, there was nothing left for her to do but die. Priscilla, although a True Woman, is also doomed to such a fate. Zenobia laments Priscilla's fate, "...you have a melancholy lot before you, sitting all alone in that wide, cheerless heart, where . . . the fire which you have kindled may soon go out" (Hawthorne 220). Therefore, it appears that a woman of this time, True or otherwise, was condemned to a life of misery.

Opposing Viewpoints: Jefferson and the Lousiana Purchase

Jefferson Goes Against His Own Philosophy: Louisiana Purchase The Louisiana Purchase was the acquisition by the United States of America in 1803 of 828,000 square miles of France's claim to the territory of Louisiana. The Louisiana territory encompassed all or part of 15 current U. S. states and two Canadian provinces. At the time, the purchase faced domestic opposition because it was thought to be unconstitutional. Although Thomas Jefferson agreed that the U. S.Constitution did not contain provisions for acquiring territory, he decided to go right ahead with the purchase anyway in order to remove France's presence in the region and to protect both U. S. trade access to the port of New Orleans and free passage on the Mississippi River. Thomas Jefferson was strongly anti-federalist. While he might have written the Declaration of Independence, he definitely did not author the Constitution. Instead, that document was mainly written by James Madison. Jefferson spoke against a strong fede ral government and instead advocated states' rights.He feared tyranny of any kind and only recognized the need for a strong, central government in terms of foreign affairs. He felt that all powers given to the National Government were enumerated. If they were not expressly mentioned in the Constitution then they were reserved to the states. By completing this purchase, Jefferson had to put aside his principles because the allowance for this type of transaction was not expressly listed in the Constitution. Jefferson's philosophical consistency was in question because of his strict interpretation of the Constitution.Many people believed Jefferson were being hypocritical by doing something they surely would have argued against with Alexander Hamilton. There were several effects of Jefferson's decision to go against his own philosophy. It can be argued that his taking liberties with the Constitution in the name of need would lead to future Presidents feeling justified with a continual i ncrease in the elasticity of the Constitution. Jefferson should rightly be remembered for the great deed of purchasing this enormous tract of land, but one wonders if he might regret the means in which he earned this fameNecessary and Beneficial Westward Expansion: Louisiana Purchase The Louisiana Purchase was one of the largest land deals in history. In 1803, the United States paid approximately $15 million dollars for over 800,000 square miles of land. The purchase spurred along the beginning of America's fascination with exploring the west. With the purchase of this new territory, the land area of America nearly doubled. This land deal was arguably the greatest achievement of Thomas Jefferson's presidency, but also posed a major philosophical problem for Jefferson.As a strong Republican, Jefferson did not believe in straying from the exact words of the Constitution. With the Louisiana Purchase, Jefferson had clearly not followed his own strict interpretation of the Constitution. Federalist critics howled that the Constitution nowhere permitted the federal government to purchase new land. Jefferson was troubled by the inconsistency, but in the end decided that the Constitution's treaty-making provisions allowed him room to act. As a president, he wisely allowed for his own views to bend in order to better the nation as a whole.Although Jefferson’s view of strict-interpretation did not allow for the purchase, Jefferson’s actions were justified. Waiting for a Constitutional amendment might cause the deal to fall through. In 1801, Spain and France signed a secret treaty ceding Louisiana to France. France suddenly posed a potential threat to America. There was a fear that if America did not purchase New Orleans from France, it could lead to war. The change of ownership of this key port resulted in its closing to Americans. Therefore, Jefferson sent envoys to France to try and secure its purchase.With increased pressure, Jefferson decided to go thro ugh with the purchase. Luckily, the people of the United States basically agreed that this was an excellent move. The Louisiana Purchase demonstrates Jefferson's ability to make pragmatic political decisions. Although contrary to some of his central principles, guaranteeing western expansion was so important to Jefferson's overall vision that he took bold action. Increased resources, westward expansion, and a growing sense of national pride all resulted from the purchase. The gains were dramatic, as the territory acquired would in time add 13 new states to the union.

Take This Internship and Shove It by Anya Kamenetz

â€Å"Take This Internship and Shove It† by Anya Kamenetz is about the declining state of jobs for new college graduates or current college students. Anya Kamenetz is attempting to prove that internships, particularly unpaid internships, are part of the problem of new graduates finding employment in their field of study. Kamenetz is also trying to prove internships are harmful to the job market in general. Kamenetz describes internships as â€Å"fake jobs† and states internships cause low wages and decline in young workers being part of a union. When an employer can hire someone for free he or she is more likely to do so instead of spending company money on a paid employee. Employers get away with these practices because with an already†¦show more content†¦Kamenetz uses an example of working as a waitress where someone will learn responsibility and how it feels to â€Å"contribute value to a larger enterprise† (Kamenetz). The main warrant of this a rticle is that unpaid internships are destroying career opportunities for the current generation. Kamenetz thinks these two issues are connected and she uses plenty of facts to back up the speculated connection. Although, the warrant seems truthful based on the facts given, where were these facts found and are they are correct? The sources aren’t given except a website name, Vault, generic terms like newspapers and business magazines, Britain’s National Union of Journalists, and various uses of surveys. It is difficult to take these facts as absolute truth without support for them. Anya Kamenetz is currently a staff writer employed by Fast Company magazine in Brooklyn, New York and writes for Tribune Media. At the time â€Å"Take This Internship and Shove It† was written, she was employed as a column writer for Village Voice (DIYU). There is definitely a bias in this article which was discovered through research and inference. Previous articles and books written by Kamenetz show a bias on the behalf of disagreeing with how the future has been molded financially for young adults. Without even reading her book â€Å"Generation Debt: How Our Future Was Sold Out for Student Loans, Credit Cards, Bad Jobs, No Benefits, and Tax Cuts for Rich Geezers†, one can infer, by the wordShow MoreRelatedInternships Do More Harm Than Good965 Words   |  4 PagesInternships do more harm than good What is an internship? An internship is a work-related learning experience for individuals who wish to develop hands on work experience in a certain occupational field. Most internships are temporary assignments that last approximately three months or up to a year. After reading the essayâ€Å" Take This Internship and Shove it â€Å" by Kamenetz Anya who graduated from Yale University, I agree with her that internships do more harm than good because of the opportunity costRead MoreBenefits And Benefits Of Soliciting Internships973 Words   |  4 PagesApproving Internships Internships give people a good opportunity for getting a job in the future. Internship students are not getting paid from the company who has hired them. Even though, people do not like internships they will get the experience from that job. Having this internship is helping people understand how the real life job is. People are even building a reputation with others. For example, people are getting noticed from others companies. Internships helps students to take the next step