The research problem that the study attempts to investigate is the frequent and long-term feeding difficulties that children with CHARGE experience (Dobbelsteyn, Peacocke, Blake, Crist, Rashid, 2007). This problem is easily identified in the first sentence of the abstract. It is clearly stated and described in more detail in the introduction. The problem statement and purpose of this study are clear, but it may be difficult for a reader to identify its significance. The authors note that this is the first study of its kind to explore risk factors for feeding difficulties and skills in children with CHARGE syndrome, which gives it significance in laying a foundation for new research paths. In terms of nursing, the researchers state that professionals can use the information to provide a more accurate prognosis and guidelines for managing the condition.
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Review of Literature
The study does not have a dedicated literature review section. This is partially due to it being the first study on the topic, which offers little research for comparison. A short review of literature is present in the introduction to describe basic characteristics and symptoms of CHARGE and to develop a basis for the study, which would justify the research being done. This article was published in 2007, but a majority of the references used were from the 1990s. Very few sources were within the five-year range of the date of publication for this study. Despite the topic being niche and having no previous research, the majority of the literature simply outlined the symptoms and medical characteristics of CHARGE syndrome in children.
The references were articles in respected and credible medical journals and magazines. It is unclear which of the sources are primary research or secondary analysis, but the journals of publication indicate that they were written and peer-reviewed by experts in the medical field. Overall, the literature that the study does present creates a foundation that is useful for the discussion of the conducted research and is entirely relevant to the topic.
There is no clear conceptual or theoretical framework outlined by the researchers in this study. However, one can be inferred. The authors are suggesting that specific characteristics of CHARGE syndrome such as structural defects in the palate, nasal cavity, and pharynx, cardiovascular impairments, and neurological dysfunction can all cause developmental issues and physiological responses, which lead to feeding difficulties. These key concepts in terms of various characteristics are defined clearly and extensively. The researchers could have been clearer in outlining the conceptual map to their research.
Research Question and Hypothesis
The basic research question posed by the study is: “which CHARGE syndrome characteristics have the greatest impact on early feeding development and predict feeding behaviors in the long term?” The research question is directly stated. However, there does not seem to be a clear hypothesis stated or implied by the authors other than highlighting which potential structural defects and neurological dysfunction may lead to issues. This is placed within the context of a conceptual framework discussed earlier. Key variables are clearly stated in the variables section. The independent variable included various CHARGE characteristics include clinical features, medical interventions, and feeding behaviors or interventions. Meanwhile, the dependent variable consisted of the score on a Pediatric Assessment Scale for Severe Feeding Problems (PASSFP). In a manner, the study examined the reliability and validity of the PASSFP scale as a clinically viable tool to measure feeding difficulties.
The rights of the participants were protected by outlining the study’s methods and purpose beforehand. Researchers sought to obtain informed consent from the parents before participation. Ethical approval was received from the University of the researchers as well as CHARGE-oriented organizations that helped to find participants for the study. Overall, the study posed an insignificant risk to participants or their children as it simply sought to gather information. The only risk is the privacy and confidentiality of data since it was stated that personal information was gathered. This was not anyhow addressed by the researchers.
The research design consisted of offering the participants a questionnaire developed specifically for the study. This type of design fit the research purpose of determining which characteristics had an effect on feeding difficulties. It is not the best possible design as it based the data on parent judgment and observations. It attempted to convert qualitative observations into quantifiable measurements, which leaves the potential for error. However, the researchers did use a significant number of data points to determine relationships. The design was not adequately described and explored, which threatens the validity of the study. It was not clear how researchers chose to convert feeding behaviors into quantifiable data. There was an overwhelming reliance on the PASSFP scale, which was neither demonstrated nor described in detail. This can create instances of bias since researchers select a tool without informing the audience that can be potentially supportive of the original hypothesis.
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The population sample consisted of parents of 39 children that were previously confirmed with a diagnosis of CHARGE syndrome. The criteria were based on the characteristics determined by the Canadian Pediatric Society. Although the sample was clearly identified and described, very little detail was provided. Basic details such as the range and the average age of the children, as well as the number of parents participating, would have been helpful. The sampling design was adequate. The researchers sought out participants through official medical organizations focusing on pediatric health and CHARGE syndrome. Participants were provided information on the study and the criteria for eligibility. Therefore, there was a rigorous and multi-step process that narrowed the eligible sample size to reduce any potential flaws or biases. There was no power analysis conducted. The sample size was not large, but considering that CHARGE syndrome is not common, it may be appropriate. The sample size seems adequate to conduct the research necessary to address the research question.
Data Collection and Measurement
The operational and conceptual definitions are congruent. The key variables were operationalized using the PASSFP scale, which provided a numerical score that reflected the feeding development of each child. This is a reliable and valid tool as researchers note that it has been helpful in determining the level of difficulty an individual child may have during feeding and dependence on tube feeding. Furthermore, the measure could provide differentiation amongst groups of children who required various methods of feeding: regular, tube fed, and mild feeding difficulties. Overall, the data in the experiment was collected through the use of a specially developed questionnaire. It helped to ascertain the independent variables of clinical characteristics and medical history. Furthermore, it helped to determine the child’s feeding skills and challenges during various periods of time, which were established as reference points.
Data were analyzed using a computer software program called Statistical Package for Social Sciences (SPSS). The software was used to determine frequencies, means, and standard deviations. Furthermore, a Fisher’s exact test was used to determine the relationship between clinical characteristics and feeding issues. Correlation between PASSFP scores and age was determined by Spearman’s rank-order correlation test. Meanwhile, the relationship between clinical characteristics and PASSFP was determined through the Mann-Whitney U test. The researchers provided a thorough description of the data analysis methods used. The outlined statistical methods and tests are appropriate for the level of measurement to determine relationships and comparisons for analysis.
Presentation of Findings and Implications
The findings are summarized in extraordinary detail and specificity, presenting numeric and statistical data. The researchers used tables and graphs to demonstrate the collected and analyzed data, referring to these throughout the results section of the article. The findings are demonstrated in a manner facilitating a meta-analysis as various independent variables of the study are compared in relationships to the dependent variable. There is not enough information to be used for evidence-based practice. However, this is not the aim that the authors sought to achieve. The presented findings can serve as guidelines and just general awareness for medical professionals to be aware of how congenital disabilities relate to feeding difficulties. Since during the time of the study’s publication, no research was done to explore such relationships, this information was medically significant. These recommendations for clinical practice and further research are reasonable and well-developed. The researchers note that there are a variety of factors and issues that should be considered in the diagnosis and management of CHARGE syndrome in relation to feeding difficulties. The authors did not present limitations or challenges to the study.
Dobbelsteyn, C., Peacocke, S. D., Blake, K., Crist, W., & Rashid, M. (2007). Feeding difficulties in children with CHARGE syndrome: Prevalence, risk factors, and prognosis. Dysphagia, 23(2), 127-135. Web.