Assignment Writing Help on Contribution of Evidence to my Area of Interest

CONTRIBUTION OF EVIDENCE TO MY AREA OF INTEREST

Introduction

Colorectal cancer (CRC) is my area of interest because it is a major health concern in Australia and in other parts of the world. My main concern with colorectal cancer is that while majority of the people continue to lose their lives from this disease, its early detection and successful removal of the tumor cells from the body through surgery can reduce its mortality rate (Rosman & Korsten 2010, p. 1212). This is in contrast to other types of cancer that early detection does not benefit cancer patients at all.  

Colorectal cancer originates and develops in the rectum or in the colon; thereby experts tend to separate this type of cancer into rectal cancer and colon cancer depending on where each of them starts. This notwithstanding, the two types of cancer have many common features (Oono et al. 2010, p. 803). In this respect, I will deal with the two types of cancer as one type of cancer by referring them to as colorectal cancer. From a general viewpoint, cancer is an abnormal cell growth that usually takes place at adulthood when most of the body cells cease to divide unless when repairing worn out tissues. For the colorectal cancer most of the abnormal cell growth starts at the innermost layer of the rectum or colon before it develops to some or all of the other layers. Consequently, the extent of colorectal cancer depends largely on the number of layers that have been attacked by abnormal cell growth (Chen et al. 2012, p. 2685). Colorectal cancer develops slowly, and in most cases, before it develops, tumors that usually begin as non-cancerous polyps develop on the inner part of the rectum or colon. Some polyps may not develop into cancer, but experts think that their existence in the body is a clear indication that cancer might develop later on. In line with the studies that indicate that screening exercises have the potential of reducing this type of cancer, seeking medical advice would minimize the risks of developing colorectal cancer at a later stage (Lee et al. 2013, p. 245). In fact, although not all polyps develop into cancer, removing polyps at an early stage may reduce the number of people that die from CRC.

All along, my main question has been whether combining colonoscopy with fecal occult blood test (FOBT) is beneficial in detecting colorectal cancer or not. FOBT refers to a screening method that detects the presence or absence of blood in the stool (Wu & Sung 2013, p. 4). On the other hand, colonoscopy refers to a medical test that uses a long flexible tube known as colonoscope to detect abnormal changes in the rectum and in the colon. This paper evaluates five articles on CRC with an aim of establishing how these reading materials can enhance my area of interest. The paper starts with a description of each article then proceeds to evaluating their levels of evidences before discussing their contributions to my area of interest.

Article 1

Whitlock, E. et al. 2008, Screening for Colorectal Cancer: An Updated Systematic Review, Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Oct. Report No.: 08-05-05124-EF-1.

Description

This article is a systematic review of colorectal cancer among average adults at risk of contracting CRC. Although the article covers five fundamental questions for updating recommendations relating to CRC its main focus is on FOBT, colonoscopy, sigmoidoscopy and double-contrast barium enema (DCBE). In terms of methodology, the researchers conducted a literature search for the studies that covered CRC. Upon conducting this search, they resolved their disagreements and identified 488 articles from 3948 articles they found. The researchers reviewed these studies against the criterion they had developed before conducting the study.    

Level of evidence

In relation to the hierarchy of evidences, this study is on the highest level of evidences because it is a systematic review. 

Discussion of applicability and contribution

Given that Whitlock’s study is one of the studies on the highest level of evidences in my area of interest, then I would apply its findings in my area of interest without wavering. In particular, I would consider combining FOBT tests with colonoscopy because adding fecal tests in CRC screening appears to be warranted from the study in question (Whitlock et al. 2008).  

In terms of how I would apply the findings from this study, I would first evaluate the accuracy of my two tests in detecting CRC and then decide whether to combine them or not based on the outcomes. This means that I would evaluate the accuracy of FOBT and then evaluate the accuracy of colonoscopy. If either of the two tests would not be accurate, then I would not combine them. In other words, if FOBT would not be accurate, then I would not combine it with colonoscopy, and vice versa. However, if the two tests would be accurate in detecting CRC, then I would consider combining the two tests because doing so would enhance the outcomes of my area of interest. Nonetheless, as I do all this, I would consider the negative outcomes the exercise would have on my area of interest (Kent & McCormack 2010, p. 147). This means that I would not implement the findings from Whitlock’s study without taking care of the limitations I would encounter on my area of interest. 

Article 2

Elmunzer, B. et al., 2015. Comparing the effectiveness of competing tests for reducing colorectal cancer mortality: a network meta-analysis, Gastrointestinal Endosc, 81(3):700-709.

Description

This article is a meta-analysis of the studies that evaluate the death rate resulting from CRC-related medical tests. The article focuses much of its attention on the death rate that relate to FOBT, colonoscopy and flexible sigmoidoscopy. In terms of methodology, through an intensive research, the researchers identified studies that covered FOBT, colonoscopy and flexible sigmoidoscopy after which they conducted both network and traditional meta-analyses on the outcome of the studies they found.

Level of evidence

In relation to the hierarchy of evidences, this study is either at the top most level or at the second top most level because it is a meta-analysis study.   

Discussion of applicability and contribution

Once again, this study is among the high-ranking studies because it is a meta-analysis study. In addition, it is among the studies that have highlighted their limitations. Consequently, in spite of the fact that Elmunzer and his colleagues evaluated both observational studies and randomized trials in their study the same way, I would consider this study as credible evidence because the researchers have clearly outlined this limitation in their study. Apart from outlining this limitation, the researchers have gone ahead to combine the traditional meta-analysis method with network meta-analysis method (Elmunzer et al. 2015, p. 708). This practice enhances the outcomes of their study. In this regard, I consider the findings from this study to be credible because they are in line with other studies in my area of interest. Therefore, the quality of this study is good enough such that it can influence the manner in which I would handle my area of interest. Indeed, in my setting the findings from this study means that more needs to be done to enhance the accuracy of colonoscopy and FOBT in detecting CRC given that their accuracies vary from each other.            

Article 3

Rosman A & Korsten M., 2010. Effect of verification bias on the sensitivity of fecal occult blood testing: a Meta-Analysis, J Gen Intern Med, 25(11): 1211–1221.

Description

This article is a meta-analysis of the studies that evaluate the specificity and sensitivity of chemical-based FOBT together with the studies that try to correct verification bias through colonoscopy or through longitudinal follow-up. In particular, the study compares and contrasts the specificity and sensitivity among other diagnostic characteristics of the particular studies that correct verification bias with the ones that do not correct verification bias. The researchers conducting this study searched for published materials that covered the subjected in question and compared them.     

Level of evidence

In relation to the hierarchy of evidences, this study is either at the top most level or at the second top most level because it is a meta-analysis study. This being the case, the study contains credible evidence that I can rely on in my area of interest.    

Discussion of applicability and contribution

In relation to the hierarchy of evidences, this study is among the high-ranking studies (Kent & McCormack 2010, p. 147). In addition, the study critically evaluates the sensitivity of FOBT test and establishes that its sensitivity to measure CRC has been overestimated by published materials. In relation to this fact, I would use this study in my area of interest because it is credible evidence. In particular, I would try to estimate the accuracy of FOBT in CRC based on the outcomes it would give in comparison to the outcomes I would obtain from colonoscopy. If the outcomes of FOBT would be less accurate than those of colonoscopy, I would consider conducting a study to evaluate the accuracy of FOBT in relation to colonoscopy. If need be, I would consider using a different significance level other than using the 0.05 significance level that previous studies used. I would do this because the quality of this study is good enough to make me use its results, and make the necessary adjustments in my area of interest (Imperiale et al. 2014, p. 1290). For me, the results of this study indicate that more need to be done to establish the sensitivity of FOBT in detecting CRC. For this reason, it would be necessary to evaluate whether a combination of colonoscopy and FOBT would be accurate in detecting CRC.

Article 4

Amiot A. et al. 2014, The detection of the methylated Wif-1 gene is more accurate than a fecal occult blood test for colorectal cancer screening, PLoS One, 15;9(7).

Description

The article is a cross-sectional study that focuses its attention on FOBT and methylated wif-1 with an aim of establishing the most accurate method in screening CRC. The researchers included 247 outpatients in their study. All of these patients had significantly high risk of CRC based on their medical histories. In this respect, the researchers collected the research participants’ data relating to urine, stool, medication, and diet among other things that were of interest in the study and tested them for a period of four years.

Level of evidence

In relation to the hierarchy of evidences, this study is not among the high-ranking evidences because it is a cross-sectional study. Nonetheless, it is among the credible evidences because it is experimental. In addition, it is a well-designed study.      

Discussion of applicability and contribution

With regard to the above fact, I would also include this study in my area of interest because though its level of evidence is not as high as that of other studies evaluated in this study; the method used in the study is credible. This is in relation to the fact that qualified technicians read hemoccult readings blindly (Amiot et al. 2014, p. 2). In addition, all the research participants went through colonoscopy tests under anesthesia. This means that both technicians and research participants did not influence the outcomes of the study in any way. Apart from this fact, the study was conducted for a period between 2003 and 2007. For a study of this magnitude, this was a good time to evaluate the outcomes of the study. Based on this understanding, the quality of this study is good enough to influence my area of interest. For this reason, I would apply the results of this study in my area of interest because I consider the study to be credible.

Article 5

Vatandoost N. et al. 2015. Early detection of colorectal cancer: from conventional methods to novel biomarkers, J Cancer Res Clin Oncol, PMID: 25687380.

Description

This article review provides an overview of the current screening methods namely FOBT, colonoscopy, and sigmoidoscopy with an aim of establishing their efficacy in detecting CRC. The study establishes that there is increasing evidence to support that the combination of the three screening methods is effective in detecting CRC. In terms of contribution, the study establishes that the combination of the said screening methods could minimize limitations associated with the current screening methods (Vatandoost et al. 2015, p. 1).

Level of evidence

In relation to the hierarchy of evidences, this study is not among the high-ranking evidences because it is an article review. Nonetheless, it is among the credible evidences because it has been written by experienced medical practitioners.     

Discussion of applicability and contribution

Finally, concerning this study, I would also include it in my area of interest because it contributes significantly to this area. This study particularly demonstrates that combining the three screening methods namely FOBT, colonoscopy, and sigmoidoscopy enhances early detection of CRC thereby minimize the number of death rates resulting from CRC. For me, this would be a significant contribution in the sense that it would a strong foundation for my area of interest. Although this study has not specified the methodology used in the study, I would include this study because it has relied heavily on previous studies. This means that the results of this article are in line with previous studies; thus, I would include the study in question in my area of interest (Hamer & Collinson 2005, p. 21). 

Conclusion

In conclusion, I would rely heavily on the hierarchy of evidence in considering the studies that I would include in my area of interest. In this respect, the first thing to consider when including studies in my area of interest would be the type of study, the methodology used in the study and its level of evidence based on hierarchy of evidence. In relation to the hierarchy of evidences, systematic reviews would be the first studies to include in my area of interest followed by meta-analysis with the article reviews coming last. In spite of this fact, I do acknowledge the fact that it has been somewhat difficult to classify some studies according to their types as well as identify the methodology used in some studies. For example, I have not been able to identify the methodology used in the study by Vatandoost and his colleagues. This notwithstanding, through critical review, I have been able to identify at least five articles that I would include in my area of interest.  

References

Amiot, A. et al., 2014. The detection of the methylated Wif-1 gene is more accurate than a fecal occult blood test for colorectal cancer screening, PLoS One, 9(7).

Chen, J. et al., 2012. Colorectal cancer screening: Comparison of transferring and immuno fecal occult blood test, World J Gastroenterol, 18(21): pp. 2682–2688.

Elmunzer, B. et al., 2015. Comparing the effectiveness of competing tests for reducing colorectal cancer mortality: a network meta-analysis, Gastrointest Endosc, 81(3):700-709.

Hamer, S. & Collinson, G., 2005. Achieving evidence-based practice: a handbook for practitioners. Edinburgh, Churchill Livingstone.

Imperiale, T. et al. 2014, Multi-target Stool DNA Testing for Colorectal-Cancer Screening. N Engl J Med, 370: 1287-1297.

Kent, B. & McCormack, B., 2010. Clinical context for evidence-based nursing practice. Chichester, West Sussex, U.K., Sigma Theta Tau International Honor Society of Nursing.

Lee, Y. et al., 2013. Accuracy of fecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions, BMJ Open, 3(10).

Oono, Y. et al., 2010. A retrospective study of immunochemical fecal occult blood testing for colorectal cancer detection, Clin Chim Acta, 3;411(11-12):802-805.

Rosman, A. & Korsten, M., 2010. Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis, J Gen Intern Med, 25(11): pp. 1211–1221.

Vatandoost, N. et al., 2015. Early detection of colorectal cancer: from conventional methods to novel biomarkers, J Cancer Res Clin Oncol, PMID: 25687380.

Whitlock, E. et al. 2008. Screening for Colorectal Cancer: An Updated Systematic Review, Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Oct. Report No.: 08-05-05124-EF-1.

Wu, C. & Sung J., 2012. Colorectal cancer screening: are stool and blood based tests good enough? Chinese Clinical Oncology, 2(1): pp. 1-7.