Growing Epidemic of Type 2 Diabetes

Running Head: CRITIQUING EVALUATION Critiquing Evaluation Criteria for Quantitative Research Article XXXXXXXXXXXX School name NURS-502 Instructor: Year 1 CRITIQUING EVALUATION 2 Critiquing Evaluation Criteria for Quantitative Research Article The title of the article selected is Association between sarcopenia and mortality in healthy older people, the authors are Daniel Bunout, Maria P de la Maza, Gladys Barrera, Laura Leiva, and Sandra Hirsch; and fortunately in references, found some articles written by some of them, and it has authors credentials to let us know more about them, and give us more credibility on the literature review. The title is clear including group of studies (older people) but not area where the research would be done. The purpose of this study is presented and discussed the importance of the problem; it is stated at the beginning of the report “to evaluate the association between loss of fat-free mass and mortality among older people.” Also shows the key points that sarcopenia is associated with functional decline in older people, and appendicular fat-free mass is a significant predictor of mortality in them. Researchers also provide an idea of what they are doing and why it can offer useful importance to evaluate the association between fat-free mass and mortality among older people. Growing Epidemic of Type 2 Diabetes

They stated that “the available prospective studies show an association between functional measures or frailty and mortality rather than muscle mass per se” and they wanted to evaluate the association between muscle mass (and fat-mass) with mortality in a cohort of healthy older people. The problem statement is clear because many factors have been evidenced to associate loss of muscle mass with loss of muscle strength and function, but not as a potential predictor of mortality, and it’s the aim to be evaluated on this work. During the study, the authors identify key research points and variables to be examined. The length of survival was tatted as dependent variable, and age, appendicular fat-free mass/height, and appendicular fat mass /height as independent variables, stratifying by sex; also CRITIQUING EVALUATION 3 were added life table analyses considering survival as a dichotomous variable, using the time of death or end of follow-up as the censoring variable, and sex-specific quartiles of appendicular fat-free mass. Sarcopenia, as stated by the researchers, “is defined as the inexorable loss of muscle mass that occurs with aging”. Available prospective studies only show the association between the functional measures or frailty and mortality rather than muscle mass per se, and the purpose of this study was to evaluate the ass ociation between muscle and fat mass, measured by DEXA and death in a cohort of healthy older people. Growing Epidemic of Type 2 Diabetes

The study has the potential to help solve this problem that is currently faced in clinical practice. The literature review follows a logical sequence that leads to a critical analysis of previous work support and conflict, since it refers to earlier studies of the case, making comparisons and drawing the same results valid for issuing proposals for improvement of the situation. But there is not a full literature review, because, after a little introduction where references are made, the authors begin immediately with the method of study. Then they added more literature review in the Discussion section, but not too much. The need for the present study, to the authors, is to complement and further deepen existing studies. The authors did not emphasize a rationale for the conceptual framework, which supports the basis of the study. At the Discussion section they stated “these results show that the loss of appendicular fat-free mass was significantly associated with mortality among people aged over 74 years of age”, so it liked to be their hypothesis, if so, then we could say that the hypothesis was posed precisely and in a form that permits it to be rested. Regarding the methodology used, the variables are relevant, and the concepts are clearly defined as the purpose of the study. Despite not having a clear question in the study proposal, CRITIQUING EVALUATION 4 and not being sure if what stated in my paragraph before was the hypothesis on it, I think that the design used is appropriate to find answers for this theme. The methods of data collection are sufficiently described; it was the information of healthy older people between 1995 and 2005, with body composition measured by DEXA. They had to leave independently in the community and be free of disabilities diseases (cancer, cardiac or renal failure). Life table analyses were performed considering survival. One thousand four hundred thirteen participants (1001 women and 412 men) were included in the report, but there was no information about how they were recruited. The study does not refer to identified or potential threats to internal or external validity, but they reported at the end of it that they did not measure functional parameters that were associated with mortality and that there was no record regarding chronic conditions that could modify the mortality results. The methods data collection is not sufficiently described (as explained before). It did not specify if all the researchers were data collectors or one of them only was. It’s no clear for me. Both sampling methods and subjects were described in the Methods section. They explained that it was a large population of participants (1413).All participants signed informed consent at the time of examination, authorizing the authors to use the data obtained for research purposes. The Institute of Nutrition and Food Technology Ethics Committee approved the studies. The instruments for data collection used are appropriate for this study. They used body composition obtained by DEXA, body mass index, and performed a Cox proportional hazards model with the variables listed above. Also, I think the reliability and validity of the measuring CRITIQUING EVALUATION 5 instruments of the study are adequate because were performed all statistical analysis using Intercooled Stat 9.1 for Windows, numerical values with a normal distribution were expressed as mean +/- standard deviation, and with non-normal distribution were expressed as median and range. Also survival differences between participants allocated in different quartiles of body composition were compared by X 2 analysis. The results for each were clearly and objectively presented in the study. They offer the characteristics of the study population on the results, and also tables that illuminate the presentation of results, with characteristics demographics, anthropometrics and the body compositions of participants by sex, and also they presented figures showing the twelve-year survival of older people between 74 and 78 years of age, and according to sex-specific fat-free mass/height.. This makes the presentation of the subject much easier to understand, besides supporting the theoretical framework raised and affirms the bibliography even more. The conclusion on this study are based on the results and related to the hypotheses that “the loss of appendicular fat-free mass was significantly associated with mortality among people aged aver 74 years of age, but fat mass was not predictive of mortality”. The researcher stated that in previous report they showed that there was a median loss of fat-free mass among women and men, but weight remained stable as there was a simultaneous increase in fat mass, and it would be associated with a significant reduction in walking capacity, disabilities, and even death, if there’s not preventive intervention on it. Figures illuminate the presentation for results, table show demographic, anthropometric and body composition parameters of the participants. They concluded that their study “showed having a low amount of appendicular fat-free mass is a significant predictor of mortality in older people and that efforts should be made to prevent age-associated Sarcopenia”, so it’s related to the hypothesis related above. They stated CRITIQUING EVALUATION 6 that the study has two weaknesses, one of them is that there was no record of chronic conditions which could modify the mortality results, and the other one is that they did not measure functional parameters that are associated with mortality in other studies. Growing Epidemic of Type 2 Diabetes

They added that training is the only way to revert the functional effects of sarcopenia. This would help us to be more cautious when assessing these patients, since early detection of frailty or sarcopenia, would be the key to preventing aging disabilities, even death. Thus further prospective studies are needed to confirm the results obtained in other populations because there is no information about chronic conditions together with sarcopenia and its influences on mortality results. In conclusion they added that “having a low amount of appendicular fat-free mass is a significant predictor of mortality in older people, and efforts should be made to prevent age-associated sarcopenia. No doubt, after the above, we can say that the study is relevant to the practice in the health field, either to prevent the development of disease or to mitigate its consequences. Despite having addressed to a conclusion that has implications on health practice and to recommend further studies on other populations, this study is not of sufficient quality to meet the criterion of scientific merit. There is not hypothesis or questions stated clearly, no theoretical or conceptual framework explained, the literature review was not enough, especially considering it is matter of concern to health workers, and the researchers belong to Institute of Nutrition and Food Technology (University of Chile).This study did not show risk to the participants. CRITIQUING EVALUATION 7 References Bunout, D., De la Maza, M. P., Barrera, G., Leiva, L., & Hirsch, S. (2011). Association between Sarcopenia and Mortality in Healthy Older People. Australasian Journal of Ageing, 30 (2), 89-92. Growing Epidemic of Type 2 Diabetes

CRITIQUING EVALUATION 8 Running Head: CRITIQUING EVALUATION Critiquing Evaluation Criteria for Qualitative Research Article XXXXXXXXXX School NURS-502 Instructor: Year 1 CRITIQUING EVALUATION 2 Critiquing Evaluation Criteria for Qualitative Research Article The title of the article selected is The Challenge of Appropriate Identification and Treatment of Starvation, Sarcopenia, and Cachexia: A Survey of Australian Dietitians, the authors, is Alison Yaxley and Michelle D. Miller; and fortunately, it has author’s credentials to let us know more about them, and give us more credibility on the literature review. The title is clear, including area of study (Australia) and group studied (dietitians). The purpose of this study is evidently presented and discussed the importance of the problem, and as they stated that the aim was to determine if Australian dietitians understand and use the terms starvation, sarcopenia and cachexia, and provide targeted treatment strategies accordingly. They added “there is a need for increased awareness of the existence of starvation, sarcopenia, and cachexia among Australian dietitians and researches into appropriate methods of identification and treatment for each condition” at the end of the abstract. Researchers also provide an idea of what they are doing and why it can give useful importance to evaluate the appropriate diagnosis in the elderly. There is no philosophical underpinning of the research described, but they remitted to Guidelines used in practice, including the DAA, that take a necessary tactic to malnutrition when focusing on starvation or malnutrition alone, without mention cachexia or sarcopenia. The purpose of conducting research is made explicit at the beginning of the abstract, describing the project significance in the health field, especially in the dietitians in this study. The methods used to collect data were through an anonymous cross-sectional survey of members of the DAA, to gain information on their practices regarding the diagnosis and treatment of different malnutrition in the elderly. All the members were required to be graduated from a tertiary program level, and they were invited to participate via email and to access to a CRITIQUING EVALUATION 3 webpage where there was a questionnaire to be answered. Growing Epidemic of Type 2 Diabetes

The method used was adequate to address the phenomenon of interest because they resorted to database of Dietitians Association of Australia. The particular approach used to guide the inquiry was the method used, every participant was invited to participate via weekly email from DAA in August 2010; it notified them about a link to answer a questionnaire and provided information on the survey. The participants were asked to answer the survey by selecting the appropriate answers from randomordered lists provided and giving further comments where was necessary. The researchers described the selection of participants, and the informants in this study were participants themselves. The data collection was focused on dietitians’ experience on the theme. The researchers described very well strategies for data collection; it was a survey through a questionnaire, with a maximum of 42 questions, dependent on responses that were given, from a link in a website.The Social and Behavioral Research Ethics Committee of Flinders University approved the protocol on this research, and Informed consent was implied upon completion of the survey. Researchers were blinded to respondent’s identities. Saturation of the data was not described, but it was implied due to two hundred and twenty-one DAA members including three students, were the participants. The procedures of collecting data were made explicit. The strategies and procedures to analyze data were described. Survey data responses, as the researchers stated, were analyzed using Survey Monkey and IBM SPSS Statistics, version 19.0.0. The reporter of descriptive statistics was done as frequencies and percentages. The Chisquared test was used to compare case study responses for selected subgroups of study participants. Statistical significance was set at P 0.05. The procedures used to analyze data can be understood without problems. CRITIQUING EVALUATION 4 Credibility, auditability, and fittingness are addressed in this study. There is credibility in this study; the participants recognized the experience as their own. Growing Epidemic of Type 2 Diabetes

But “the diagnosis criteria used in the questionnaires were based on consensus definitions which have not yet been validated however they were developed by leading experts in the field and therefore likely to be proved to be valid and reliable in future work”. The readers can follow the thinking of the researcher and can increase it with the view of the tables to help better understand the report. The research process is documented in Materials, Methods and Result sections. The results of this study are meaningful to individuals not involved in the research. The findings are applicable outside the study situation because sarcopenia does not have a consensus yet about its definitions; the same problem stated in this study happens in nursing’ and doctor’s fields, despite it was explicit in the survey. Often it is a diagnosis that goes unnoticed with other characteristics, but by itself is capable of producing disabilities to death. The readers can be able to apprehend the essence of the experience from the report of the findings. The researcher’s conceptualizations are accurate to the data, but we must mention that the majority of the participant’s responders in the study were young and had been practicing for a short time and worked only in metropolitan public hospitals, and it could be a limitation in the data interpretation. It would have been more interesting than the sample used was more heterogeneous, working in different places (public and privates), different ages and participating for a long time. The researchers stated that “more work is warranted to explore how dietitians might expand existing or collaborate to develop new screening and/or assessment tools to assist in differentiating sarcopenia, cachexia, and starvation, contribute to the evidence base for CRITIQUING EVALUATION 5 appropriate treatment strategies, and determine the cost-effectiveness of this change in practice”. There is no conclusion paragraph on this study, only a discussion one, and on it was reflected the conclusions about the findings and the further investigations topics related to it. Growing Epidemic of Type 2 Diabetes

The significance of the study to nursing was not explicit, but it is applicable because sarcopenia does not have a consensus yet about its definitions; the same problem stated in this study happens in nursing’ and doctor’s fields, despite it was explicit in the survey. The researchers used the APA format in this study. A complete list of references was included using APA style format. CRITIQUING EVALUATION 6 References Yaxley, A., & Miller, M. (2011). The Challenge of Appropriate Identification and Treatment of Starvation, Sarcopenia, and Cachexia: A Survey of Australian Dietitians. Journal of Nutrition and Metabolism, 2011, 1-6. . Growing Epidemic of Type 2 Diabetes