Introduction an intervention . Successsful randomization also will reduce


   In cardio
pulmonary resuscitation , chest compression is one of the most important
intervention a nurse can do immediately to a patient. It is critical to know
the important aspect in chest compression like depth of compression, cycle of
compression and interval in between manual deliver of oxygen through the
reservoir bag. The purpose of this study is to compare the use of the CPR RAD
device with standard manual compression in the quality of chest compression in
a manikin model.

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1.    Yes.
There are true ramdomization done to the participants as it was chosen through
either  device or manual chest
compression  group. The subjects which is
assigned randomly makes the basis in getting the cause to interpret and do an
intervention . Successsful randomization also will reduce confounding variables
that happen at the randomization time.


2.    Yes.
The participants was assigned randomly by either the device or manual. It is a
good allocation because if the people or group responsible in allocating the
participants know on what treatment they will have or they have idea what will
be the next treatment then it will have discrepancy since it is not already
concealed. If the patient allocation is unconcealed to the person that makes
the decision on who have the eligibility, they may wrongly or purposely
assigned either the treatment or control groups.



3.    Unclear.
It does not clearly states the similarity of groups at the baseline. The
randomized controlled trial should guarantee that the groups are equal and
comparable in all known and unknown characteristics that could potentially
influence outcomes. The groups may differ only in their exposure to the treatment
investigated with this type of distribution. This helps to avoid bias.


4.    Yes.
During the randomized controlled trial, the participants were blinded. They are
only given consent before the start of the study. The person designated to
deliver treatment should not try to place certain patients in the treatment or
comparison group in an effort to help them as this can affect the study. The
assignment should be random in order to have equal distribution of subject
characteristics that could affect the experiment to all group which in turn
cause bias.



5.    Yes.
The people designated to deliver treatment were blinded in the assignment of
the treatment. They use randomization method, sealed envelopes, sequentially
numbered opaque and six block randomization. The treatment allocation should be
blinded from the person designed to give treatment as it will cause bias either
it is intentional or not.  The
appropriate method to use is the production of computer generated sets of
random allocations  by a research support
unit who will not be performing data collection in advance of the start of the
study which are then sealed in consecutively numbered opaque envelopes.


6.    Unclear.
In the study, it does not show in detail if the outcome assessor is blind in
the assigned treatment. In a randomized controlled trial, the study should be
double blind, single bind, or open. For the double blind study, neither
participants or the assessor knows to which treatment the patient or
participants has been allocated. It is most useful if the idea of the treatment
might affect the course and results of the study. It is more important that the
person giving the treatment is blinded especially if the endpoints are
subjective. Blinding of patient or participants to the treatment is needed as
their attitude could affect their reliability in taking the test or even the
effect to them. Singe blind is the treatment were either participants or the
assessor is blind. Open is study where no one is blind in the treatment.


7.    Unclear.
During the study, there are only two groups, the treatment group and the
controlled group. Either the treatment group or the controlled group should be
treated identically in all respects except for the intervention being tested and
to this end participants. Investigator will ideally be blinded to which group
and individual is assigned.



8.    Unclear.
As the study did not mention if the follow completed on the start and after the
study was conducted. As follow up is important since it will have a better
understanding on how the study was conducted. It will have a better picture for
the treatment and controlled groups. Another feature of randomized control is
it can compare the treatment group to the control group. Randomized control
group can give a good evaluation of effectiveness that increase the consistency
of conclusions. Good control group also allows a more objective evaluation of
the effect and further increase the clarity of the study design.


9.    Yes.
Analyzation was done before they are separated to different group. Both group
composed of mainly nurse, paramedic, doctors, medical student and hospital
staff. It was clearly stated the different characteristics like age, sex, body
weight, height, body mass index and occupation. Randomized control trial use an
analytical approach that help to data analysis and avoid methodical systematic
bias. By using intention to treat analysis, it also considers that all patients
belong to the groups to which they were initially randomly assigned, even if
the subsequently withdraw or switch to another group. Patients or participants
who do not receive the assigned treatment should not be excluded from the planned
analysis since they usually do not have the same prognostic features as the



10.  Unclear. As the study did not clearly say. If
there is high internal validity, it menas that the differences observed between
groups are related to the intervention tested in the trial. One example is the
reduction in the mortality in the study population is really attributed to the
intervention and not to the other factors such as age or sex. The internal
validity of a clinical trial is directly related to the specific conduction
design and study reporting.


11.  Unclear. As there is limitation on the study
conducted. First is the result were recorder using a manikin, but maybe used as
preliminary data for further research regarding clinical use of the CPR RAD.
Second, participants varied in terms of experience with most being medical
students. The result were not consistent with the standard recommendations.
Some results were better in the manual group like for the shallow compressions
and correct position. Most of the time, the trial outcome report is not only
incomplete but inconsistent with the protocol and also biased. Reviews and
published article that incorporate them maybe be unreliable and over estimate
the benefits of an intervention. Registered planned trials and protocol should
be available in public before completion of trial.



12. Yes.
During the study, all of the participants characteristics in each group was  compared between manual groups and groups
using the device with descriptive statistics. The statistical analysis aim is
to check whether an observed effect arises from the study intervention or has
occured by chance.


13. Yes.
The crossover trial study is the right design which the participants such as
medical personnel that includes nurses, physician, medical students, emergency
medicine technicians and hospital staff were asked to join. Those participants
that fill the criteria was assigned randomly to either the manual or device
group. For crossover trials, experimental intervention are given to participants
and then the placebo controlled intervention in consecutive periods and it
serve as their own controls. It also use comparison of the same participants
responses to the two interventions, thus minimizing variability caused by
having different people in each intervention group. One of the major concern
for crossover trial is carry over that the effects of the first intervention
affect into the testing period of second intervention.



   At the end of
the study, it was concluded that the CPR RAD gained better results in terms of
quality of compression compared to standard manual compression. The use of the
device helps to reduce fatigue which is beneficial to the rescuer and correct
the rate of compression.