Introduction an intervention . Successsful randomization also will reduce

Introduction   In cardiopulmonary resuscitation , chest compression is one of the most importantintervention a nurse can do immediately to a patient. It is critical to knowthe important aspect in chest compression like depth of compression, cycle ofcompression and interval in between manual deliver of oxygen through thereservoir bag. The purpose of this study is to compare the use of the CPR RADdevice with standard manual compression in the quality of chest compression ina manikin model. 1.    Yes.

There are true ramdomization done to the participants as it was chosen througheither  device or manual chestcompression  group. The subjects which isassigned randomly makes the basis in getting the cause to interpret and do anintervention . Successsful randomization also will reduce confounding variablesthat happen at the randomization time.  2.

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    Yes.The participants was assigned randomly by either the device or manual. It is agood allocation because if the people or group responsible in allocating theparticipants know on what treatment they will have or they have idea what willbe the next treatment then it will have discrepancy since it is not alreadyconcealed. If the patient allocation is unconcealed to the person that makesthe decision on who have the eligibility, they may wrongly or purposelyassigned either the treatment or control groups.   3.    Unclear.It does not clearly states the similarity of groups at the baseline. Therandomized controlled trial should guarantee that the groups are equal andcomparable in all known and unknown characteristics that could potentiallyinfluence outcomes.

The groups may differ only in their exposure to the treatmentinvestigated with this type of distribution. This helps to avoid bias.  4.

    Yes.During the randomized controlled trial, the participants were blinded. They areonly given consent before the start of the study. The person designated todeliver treatment should not try to place certain patients in the treatment orcomparison group in an effort to help them as this can affect the study. Theassignment should be random in order to have equal distribution of subjectcharacteristics that could affect the experiment to all group which in turncause bias.   5.    Yes.

The people designated to deliver treatment were blinded in the assignment ofthe treatment. They use randomization method, sealed envelopes, sequentiallynumbered opaque and six block randomization. The treatment allocation should beblinded from the person designed to give treatment as it will cause bias eitherit is intentional or not.  Theappropriate method to use is the production of computer generated sets ofrandom allocations  by a research supportunit who will not be performing data collection in advance of the start of thestudy 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 inthe assigned treatment.

In a randomized controlled trial, the study should bedouble blind, single bind, or open. For the double blind study, neitherparticipants or the assessor knows to which treatment the patient orparticipants has been allocated. It is most useful if the idea of the treatmentmight affect the course and results of the study. It is more important that theperson giving the treatment is blinded especially if the endpoints aresubjective. Blinding of patient or participants to the treatment is needed astheir attitude could affect their reliability in taking the test or even theeffect to them. Singe blind is the treatment were either participants or theassessor 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 thecontrolled group. Either the treatment group or the controlled group should betreated identically in all respects except for the intervention being tested andto this end participants. Investigator will ideally be blinded to which groupand individual is assigned.   8.    Unclear.As the study did not mention if the follow completed on the start and after thestudy was conducted.

As follow up is important since it will have a betterunderstanding on how the study was conducted. It will have a better picture forthe treatment and controlled groups. Another feature of randomized control isit can compare the treatment group to the control group. Randomized controlgroup can give a good evaluation of effectiveness that increase the consistencyof conclusions. Good control group also allows a more objective evaluation ofthe effect and further increase the clarity of the study design.  9.

    Yes.Analyzation was done before they are separated to different group. Both groupcomposed of mainly nurse, paramedic, doctors, medical student and hospitalstaff. It was clearly stated the different characteristics like age, sex, bodyweight, height, body mass index and occupation. Randomized control trial use ananalytical approach that help to data analysis and avoid methodical systematicbias. By using intention to treat analysis, it also considers that all patientsbelong to the groups to which they were initially randomly assigned, even ifthe subsequently withdraw or switch to another group. Patients or participantswho do not receive the assigned treatment should not be excluded from the plannedanalysis since they usually do not have the same prognostic features as theothers.

    10.  Unclear. As the study did not clearly say. Ifthere is high internal validity, it menas that the differences observed betweengroups are related to the intervention tested in the trial.

One example is thereduction in the mortality in the study population is really attributed to theintervention and not to the other factors such as age or sex. The internalvalidity of a clinical trial is directly related to the specific conductiondesign and study reporting.  11.  Unclear. As there is limitation on the studyconducted.

First is the result were recorder using a manikin, but maybe used aspreliminary data for further research regarding clinical use of the CPR RAD.Second, participants varied in terms of experience with most being medicalstudents. The result were not consistent with the standard recommendations.Some results were better in the manual group like for the shallow compressionsand correct position. Most of the time, the trial outcome report is not onlyincomplete but inconsistent with the protocol and also biased. Reviews andpublished article that incorporate them maybe be unreliable and over estimatethe benefits of an intervention. Registered planned trials and protocol shouldbe 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 groupsusing the device with descriptive statistics. The statistical analysis aim isto check whether an observed effect arises from the study intervention or hasoccured by chance.  13. Yes.The crossover trial study is the right design which the participants such asmedical personnel that includes nurses, physician, medical students, emergencymedicine technicians and hospital staff were asked to join. Those participantsthat fill the criteria was assigned randomly to either the manual or devicegroup.

For crossover trials, experimental intervention are given to participantsand then the placebo controlled intervention in consecutive periods and itserve as their own controls. It also use comparison of the same participantsresponses to the two interventions, thus minimizing variability caused byhaving different people in each intervention group. One of the major concernfor crossover trial is carry over that the effects of the first interventionaffect into the testing period of second intervention.  Conclusion   At the end ofthe study, it was concluded that the CPR RAD gained better results in terms ofquality of compression compared to standard manual compression. The use of thedevice helps to reduce fatigue which is beneficial to the rescuer and correctthe rate of compression.