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1.Would you recommend the findings of this study be implemented in clinical practice? Why/why not?
The study focuses on patients with medically unexplained symptoms (MUS). The research paper analysis MUS from the patients view. The study analysis the feelings of patients with MUS in primary health care settings.
The healthcare needs of patients with MUS have been ineffective partly due to theories which are obsolete and partly due to the lack of understanding of the problems faced by the patients. The present study proposes to comprehend the feelings of MUS from their prospective, and clarify how they adjust with the changed conditions.
The aim of the research was to explain and thereby deduce what it means to be living with MUS from a patient’s viewpoint.
The research design used in the present study is phenomenological-hermeneutic type. Here the study was to understand the feelings and experiences of patients with MUS by interpreting the interviews.
The research attempted to study the experience of patients with MUS, their learning curves and process of learning. Hence, the research design was an appropriate process.
The participants of the study were patients with MUS at the two primary healthcare centres in Sweden.
The patients recruited for the study were from two primary healthcare centres at Sweden. They were within the age group of 18 to 64 years and the patient should have had minimum of eight visits during the last 12 months. Moreover, 50% of the symptoms of the patients should have been due to unexplained reasons. The criteria used for the inclusion of the patients were a modified version of Smith (2004).
Patients who did not meet the above criteria were excluded from the study. In addition to the above patients with mainly psychiatric and medical reasons were excluded from the study. Furthermore, in cases where the nurses called first for the recruitment purpose were also excluded. In addition patients from whom no oral or written consent were received and all those patients who did not provide any reply were also excluded from the study.
The inclusion and exclusion criteria for selection of the patients were such that it met the requirements of the ethics committee. The criteria enabled that suitable patients are selected while maintain the safety and security of the patient. The selection process ensured that accurate results for the research are derived.
For the purpose of the research non-probability quota sampling technique was used. In this technique only patients with MUS were selected and the others were rejected.
For the purpose of the study the sampling technique was an ideal technique. Quota sampling helps to select the appropriate sample population. It provides for a better representation of the required sample. The disadvantage of quota sampling is that it is difficult to detect a sampling error.
The sampling process seems to be a fairly sufficient process since only patients with MUS were easily identified and recruited for the study.
The sample size was determined by the process of inclusion and exclusion criteria. All patients who met the inclusion criterion and exclusion criterion were selected for the study. Initially a total of 20 participants met the criterion. The final 10 patients were recruited during the period of September to November, 2011.
The study concerned only patients with MUS. In addition the selection criterion was a modified version of Smith et al., (2004). Moreover the selection process was done by persons who had no relation with either the patients or the study. Thus the sampling technique can be said to be appropriate for the study.
The data for the research was collected during the time period of September to November 2011. Interview method was chosen to collect the data. All interviews during the entire study period were digitally recorded. The interview process was as per the convenience of the patient. Five of the participants of the study were willing to be interviewed at their homes, three at the university, one at the health care centre and one at a public library.
The aim of the present study was to learn about the learning curves of patients with MUS from the patients themselves. Hence, the data collection process seems to be an appropriate method for the present study, since to learn about the experiences of patients with MUS from the patients themselves interview method is the most suitable process.
The concept of rigor as taken in qualitative study can be defined from four perspectives.
To maintain a degree of rigor two measures undertaken are:
In the sampling process in situations where the nurse called first those patients were not considered, even though the patients were eligible to be included in the study. Thus a position of neutrality was undertaken.
To maintain consistency of research methods only those patients were included from whom both oral and written consent was received.
The data for the study was analysed using three methods : naive reading, structural analysis as well as comprehensive understanding.
To analyse the study topic the method of data analysis was an appropriate one.
The findings of the study suggest that patients with MUS constantly face new challenges in life. The patients have high learning ability and have devised methods to face the challenges.
The study has to be undertaken under changed circumstances to implement the findings of the study.
The present study is only a one time study concerning two suburban primary health care centres. To conclusively prove the premise of the study one needs to undertake more such studies. Such studies should be longitudinal as well as held at other places. Only when the conclusion of the present study is repeatable and reproducible can it be implemented.
The present article is written in a very lucid language which is easy to understandable. The paragraphs are just of the required length signifying the essence of the article under study.
The article is written in an error free style (spelling mistakes). It uses correct grammatical styles with use of punctuation marks wherever required.
To analyse the present literature we have compared the literature with three other articles. The articles are Hilderink, Collard, Rosmalen, & Voshaar (2013); Hinton & Kirk (2016) and Moulin, Akre, Rodondi, Ambresin & Suris (2015).
All the three articles the referencing pattern used is APA 6th. References earlier than 2012 can be found in all the three articles.
We find that all the references in Moulin, Akre, Rodondi, Ambresin & Suris (2015) are supported by DOI, in the article by Hinton & Kirk (2016) DOI’s are missing.
Hence it can be said that to explain the subject of MUS references prior to 2012 should be used.
All the three articles as well as the present article are written in very fluid language, easily understandable. The title of the articles are quite relevant and are able to express the views of the writers.
The oldest reference in the present literature is - Bruner, J. S. (1986). Actual minds, possible worlds. Cambridge, MA: Harvard University Press.
The latest reference in the literature is by - Bergh, A. L., Friberg, F., Persson, E., & Dahlborg-Lyckhage, E.(2014). Perpetuating ‘New Public Management’ at the expense of nurses’ patient education: A discourse analysis. Nursing Inquiry. doi: 10.1111/nin.12085
Thus not all the references used in the literatures are recent academic literatures. There are about 36 references used which are before 2012.
Even though most of the references used are not recent academic literatures, but then the referencing pattern refers to APA 6th Edition referencing style. The names of all authors upto 5 have been in texted. Page number and DOI numbers have been provided wherever possible. The references are ordered in alphabetical order by the author’s first name.
Hilderink, P. H., Collard, R., Rosmalen, J. G. M., & Voshaar, R. O. (2013). Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: a systematic review. Ageing research reviews, 12(1), 151-156
Hinton, D., & Kirk, S. (2016). Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. Health & social care in the community, 24(1), 12-26.
Moulin, V., Akre, C., Rodondi, P. Y., Ambresin, A. E., & Suris, J. C. (2015). A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived?. Journal of adolescence, 45, 317-326.
Smith, R. C., Korban, E., Kanj, M., Haddad, R., Lyles, J. S., Lein, C., et al. (2004). A method for rating charts to identify and classify patients with medically unexplained symptoms. Psychother Psychosom, 73(1), 3642.
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