Factors influencing treatment delay in acute myocardial infarction patients

¶ … Treatment Delay for Patients with Acute Myocardial Infarction

This article critique is intended to examine if the given research paper, "Factors influencing treatment delay for patients with acute myocardial infarction" by Lisa Lesneski serves its purpose and helps in determining the factors which are responsible for causing delay in treating AMI given its fatal nature. The thorough analysis enabled us to determine that where the statistical tools used for computation were suitable for such type of study, there were serious limitations which affected the suitability of the sample selected. Due to these limitations, the outcomes of the research could not be levied on the whole population i.e. patients of AMI. Furthermore, implied hypotheses, wrong sample selection, inefficient sample settings, and confusing criteria of selection of the subjects, made the research unable to provide empirical evidence.

Problem

The given article is concerned with factors which are acting as causative agents for delay in treatment of myocardial infarction. Where the author managed to give background of the disease in the form of comparison between different segments of population suffering from this heart condition, the author summed up the given problem by stating that the main causes of myocardial infarction is the blockage of coronary artery and the longer the artery remains blocked, the lesser the chances of patients' survival are. Time is the key factor for preservation of heart muscle. Although the problem statement manages to present the gist of the heart condition i.e. myocardial infarction, however the problem statement was not clear enough to state the purpose of the article which is identification of the factors causing delay in the treatment. However, the problem and its consequences were phrased and rephrased in the background of the concerned health condition.

Literature Review & Theoretical Framework

The given study was supported by earlier researches as well and was focused on identifying the impact of various variables such as the location of the patients, activities being performed when the symptoms appear, emotional, behavioral and cognitive responses and age / gender of the patient. The references of various studies were given concerning all these areas however the author mostly presented two contradicting opinions related to these factors; therefore no conclusive evidence could have been obtained. For example, the research itself offered a limited scope due to sample selection however when the given sample was examined in the context of location, the author mentioned two other researches conducted on the subject matter and they offered opposite opinions leading the readers to no conclusion and leaving room for further research. Also, other contexts like antecedes of the symptoms were not supported by external researches.

Research Design Elements

The research was designed in the form of comparative study where various contexts and variables were considered and evaluated with respect to their relation with delay in treating AMI. The hypothesis was rather implied instead of being stated and illustrated that the given variables were acting as the factors causing delay in the treatment of AMI. Most of these variables were independently analyzed during the data analysis. The given independent variables were context (patient location when symptoms began), antecedents (what patient was doing when symptoms occurred), affective or emotional response, behavioral response, cognitive response, response of others to patient symptoms, age, and gender.

Study Setting & Instruments

The research was conducted with the help of sample taken from the population which was enrolled in Northeastern Pennsylvania hospitals. The patients' records were acquired from hospital authorities and the responses of the patients were obtained in the form of forced survey which was supported by face-to-face interviews. Although the sample selected was strictly related to the population enrolled in the hospitals for the first time and they did not received any treatment from other hospitals or clinics however the study would have had a generalized impact if it would have represented a larger population instead of a limited physical setting. Secondly, exclusion elements were mentioned in the research paper but were not supported with an argument. The settings appeared to be insuffienct to ensure that this research can reflect the overall population of patients suffering from acute myocardial infarction. The research methodology was rather simple and concise however the questionnaires were more controlled than descriptive and various other factors were ignored which made the research rather opinion-based instead of being evidence-based.

Protection of Human Subjects

Necessary measures were taken for the protection of human subjects and they were rather sufficient for the purpose of this study. Prior consent was obtained from the patients and they were given liberty to withdraw from the research whenever they deem necessary. Since the sample only reflected the subjects who were over 18 and educated; therefore, it can be assumed that the patients were aware of their rights. Furthermore, confidentiality was also maintained by replacement of patients' names with numeric codes.

Sample

The sample selected constituted of patients who were admitted in three hospitals of Northwest Pennsylvania. Furthermore, the patients selected were over 18 years, belonged to Caucasian racial background and were educated. Where the sample had majority of men included in the sample and was highly influenced by racial restriction, it is doubtful if the findings of this research can by levied on overall population and other ethnic groups. Also, the selection of the subjects who could read and write English raised question marks on authenticity of the data selected.

Replication

The process used for data computation was replicable. For the analysis of the given data, descriptive statistical techniques were used. Also, in order to remove the abnormalities in the given sample in terms of time variables, traditional log formation was performed. Also, statistical tools like, ANOVA, multiple regression methods and use of SPSS, made the computation rather simple. These are the typical tools used for conducting statistical analysis on the given population, therefore replication was not complicated.

Descriptive Nature

If the nature of the subjects is examined, it is evident that they are suitable as per the criteria selected for this particular study. However, there is no concrete evidence if those criteria themselves, are rationally selected. Inclusion of sample containing subjects from a particular locality, involvement of subjects who can read / speak English and also their belonging to a particular race makes the outcomes of the study only applicable on a certain segment of a population. It is difficult to determine if they do describe the purpose of this research. The only indication that can be obtained from the given sample is that these subjects were easily accessible and there further relation / suitability in the context of this research is not clear.

Study Results

The results that were derived after statistical analysis only proved that the results were significant on in terms of patients' location and the time delay in seeking treatment. The p value found out after statistical analysis was 0.023 which was higher than the original value determined through regression analysis. In statistical hypothesis testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true.

Understanding

In the research paper, the given statistics are stated clearly and the percentages express the outcomes of the research rather well. In the field of medicine and psychology, the clinical significance means selection of outputs that by virtue of magnitude represent the practical relevance to the subject matter and more technically and restrictively, addresses whether an intervention or treatment may or may not fully correct the finding. If statistical significance and clinical significance are compared, one can argue that the statistical significance represents the results based on the concept of probability whereas the clinical significance refers to usage of judgment in relation to benefits offered by each treatment in terms of costs and viability factors.