Review of three articles

Introduction

One of the most common conditions that require emergency treatment is acute appendicitis. Diagnosis comprises of history, investigations and clinical examinations. Usually, appendicitis may be mistaken with other ailments if proper diagnosis is not done. This paper is founded on three peer reviewed journal articles. The three journal articles comprise of a case study, a review article and an original article. The paper seeks to investigate appendicitis through the analysis of the three articles.

Selection criteria

Case Study

The article Apendicitis: a case study by Al Maqbali, MA (1) is a case study article as suggested by its title. It was on various grounds. First, it was selected because it provided information obtained through a case study of 21year old male who had been diagnosed with appendicitis. Second, the article was selected due to the fact that it was a case study article.  It therefore provided information that was based on a diagnosis and treatment of one unique case.

The found was found through the Curtis online library. Once on the Curtis University Website, I selected the library section. I then searched for articles that contained the key words appendicitis, abdominal pain, and emergency care in the case study section. It was selected on the basis of its relevance to the topic of study as well as on the basis of its being current.

Review

The article Review Article: Appendicitis in Groin Hernias by Meinke(2) was selected due to its relevance to the topic of research. It is a review article as is evidenced by the article title. The article also presents information obtained from an in-depth review of articles pertaining to surgery of appendicitis cases. Thirty four articles were reviewed and contained information of 45 patients. It mainly pursues the study of appendicitis in the groin hernias. Being specific to that section allows for more in depth study of the topic.

The article was obtained on the Ebscohost database. Upon login, the search word appendicitis was used to obtain a list of articles. It was obtained from its relevance to the topic of study (appendicitis and hernia apendicitis) which was filtered on the basis of time of publication and the reliability. In regard to reliability, academic journals were preferred.

Original article

The article Diagnostic Value of C-reactive Protein in Suspected Acute Appendicitis – A Prospective Case Control Study by Kumar, Kumar, Kumar and Ananthakrishnan(3) is an original; article. This is evidenced by the “Original Article” text on top of the document. The document also contains original information that was obtained by measurement by the researchers. The article is also based on an original study for which there was no previous study.  The article was selected due to its relevance to the topic of study. It pursues the topic of appendicitis at the level of diagnosis using the level of C-reactive protein.

The article was obtained after performing a search on Google scholar.  The search was performed by searching for appendicitis diagnosis. The article link led to the Indian Journal of Medical Sciences Website. At this website, the article was obtained in html view. To obtain a pdf file, registration was necessary.

Similarities of the Articles in the contribution to the topic of study

The first similarity is that the three articles agree that the diagnosis of appendicitis a difficult process. According to the study Maqbali (1), it is difficult to distinguish between the emergency cases of appendicitis with simpler functional abdominal cases like irritable abdominal bowel syndrome. The article poses the risk of misdiagnosis through its present case. The risk of making a misdiagnosis was big based on the lack of sufficient information to aid the diagnosis. A good example of missing information is the medical history of the patient. The review article (2) similarly presents the same fear. According to the article, almost all the cases were not recognized preoperatively. The article also argues that the cases of death were heightened by the risk of delay in identification of the condition. The third article, an original document (2), argues that there are many inflammatory and non-inflammatory conditions that resemble appendicitis. These conditions are most prevalent in females and at both extremes of age. It argues that the risk of misdiagnosis is high; so is the risk of late diagnosis. Late diagnosis helps the disease to progress. The article recommends surgery as soon as the condition is suspected.

The second similarity is the recommendation of using history as a basis for diagnosis. The case study article argues that the lack of sufficient medical history was the first challenge encountered by the surgery team in the diagnosis of the case in question. The factors to watch for are the location and radiation details, associated symptoms, and the duration and severity of pain (1). The original and review articles argue that decision to perform appendectomy were based on the history of the patient along with other factors like leucocytosis, clinical findings and ultrasound findings (2, 3).

Differences between the articles evaluated

The three articles focus on different aspects of appendicitis. First, the study by Maqbali (1) focuses on the diagnosis of the condition. Its main focus is on the various methods that are employed in the diagnosis of the condition. These include history taking, and physical examinations. Physical examinations include palpation, percussion, auscultation and digital rectal examination. The review article by Meinke (2) on the other hand is mainly focused on the spread of the disease amongst different groups. It focuses on age, gender, position, causal suppositions, stage at presentation, and clinical outcomes. The original article on the other hand focuses on the level of C-reactive proteins as a potential method of diagnosing appendicitis (3).

The second difference is in the findings. While the review article finds few cases of the condition for persons between the ages of 20 and 30, the case study article (probably coincidentally), uses a case of the same age group. The selection of the case of study is however not on the basis of age and so this could be a sign of inaccuracy of the results in the review study. The inaccuracy could be cause by the insufficiency of the sample size.

Third, while the scope of study is diverse. First, the case study only relies on the data offered by one case. This makes it the least expanse. It also only tends to be interested with the nature of different diagnostic methods that are employed (1). The article by Meinke (2) on the other hand is the most deeply covered in regard to the coverage of the nature of the spread of the disease. It offers information from a bigger sample and offers a contribution from more researchers since it is a review article. The original document is also different in regard to the scope of study. The article covers the results from more than a hundred patients. It therefore offers a more reliable result compared to the other two in regard to the sample of study.

Finally, the analytical methods employed are different. The case study is mostly intent on the qualitative aspects of the condition. It explores the various methods that are employed or may be employed to assist the case in question. The review article lifts data from the various articles that are reviewed and puts them to use. It uses statistical methods to analyze the prevalence of appendicitis among the different groups of patients. Mostly, the statistical data obtained is presented raw in the form of tables and graphs. The original article on the other is more developmental on the data. The data obtained is not only presented in the form of graphs but also further analyzed to determine if there exists a correlation between the amount of the C-reactive protein and appendicitis (3, 4).

Experience obtained from the search and analysis

The search and analysis of the three articles contributed to my knowledge in the field in various ways. First, the search exposed me to various articles that would have contributed to the article albeit slightly. The process of selecting the article involved a lot of decision making skills. It also involved analysis of the articles to determine the one best suited for this paper. The articles were therefore contributive in the overall growth of the skills in analysis and decision making. The process also provided a basis for understanding appendicitis. The analysis exposed me to various aspects of the disease from the diagnosis and treatment to the prevalence of the challenge. The article therefore laid the foundation for similar articles to be written with more ease.

Contribution of the articles to the research project

First, the articles contributed to the topic of study in the research paper. Though the articles contributed at different levels and in different ways, their contribution was important. The case study article and the original article provided insight into the methods employed in the diagnosis of the condition. One of the methods identified is the use of medical imaging in the diagnosis of the condition. Imaging is used in the form of tomography, ultrasonography, diagnostic laparoscopy and magnetic resonance imaging (2, 3). The research paper will be intent to identify how such methods can be used in the diagnosis and follow up of cases of appendicitis. All the three articles will contribute to the research paper by providing a foundation for the different levels of growth of the disease. Since the level of development of appendicitis was varied for the different patients assessed in the three studies, the information provided will be of use in determining the changes the patient undergoes during the different stages of appendicitis development.

The review of the three articles will also contribute to the overall development of the paper. The information provided by the study will help to provide insight in regard to the fields that have been least researched so that the research paper produced will offer improvement to the topic of research. This will help in the development of the research paper as well as to the improvement of medical methods.

The different conclusions made by the different articles will also form a foundation for the exploration of the topic. Al-Maqbali (1) argues that appendicitis could be possibly misdiagnosed for a host of other conditions that cause similar abdominal pains. The physician should therefore be armed with a series of examinations to make sure that a prompt diagnosis is conclusive and accurate. On the other hand, while he acknowledges the findings made by Al-Maqbali, (1) Meinke (2) argues that the hernial appendicitis is more common among patients at both extremes of age. He also points out that most appendicitis patients are male. With this information, it would be easier to provide preventive measures for the groups whose risk is higher. Kumar et al (3) on the other hand provide insight into the level of C-reactive proteins with respect to appendicitis. While this method is simple and prompt, it may be used to identify cases of appendicitis faster hence preventing misdiagnosis.

Conclusion

In conclusion, the risk of misdiagnosing appendicitis is big (5). This is due to the number of conditions that have similar symptoms. Several methods have been identified to lower the risk of misdiagnosis. Improved tools have been identified which include imaging as well as physical examination. While most methods are able to help lower the risk, in the case of acute appendicitis, prompt action is required. For this reason, any suspecting should warrant immediate surgery (1, 6). This is especially the case for patients at both extremes of age as well for men. The risk of misdiagnosis is higher among women and persons of extreme age.

References

1. Al-Maqbali M. Appendicitis: a case study. Nursing Standard. 2013;27(42):35-41.

2. Meinke A. Review Article: Appendicitis In Groin Hernias. J Gastrointest Surg [Internet]. 2007 [25 August 2014];11(10):1368-1372. Available from: http://dx.doi.org/10.1007/s11605-007-0160-9

3. Kumar R, Kumar R, Pradeep Kumar N, Ananthakrishnan N. Diagnostic value of C-reactive protein in suspected acute appendicitis – A prospective case control study. Indian J Med Sci [Internet]. 2011 [25 August 2014];65(9):399. Available from: http://dx.doi.org/10.4103/0019-5359.108956

4. Gil P, Morales G, Bernal M, Llorca D, Marton B, Naranjo G. [Complicated acute apendicitis. Open versus laparoscopic surgery]. Cirugia espanola. 2008;83(6):309–312.

5. Albayrak Y, Albayrak A, Albayrak F, Yildirim R, Aylu B, Uyanik A et al. Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis. Clinical and Applied Thrombosis/Hemostasis. 2010;.

6. Althoubaity F. Suspected acute appendicitis in female patients. Trends in diagnosis in emergency department in a University Hospital in Western region of Saudi Arabia. Saudi medical journal. 2006;27(11):1667–1673.

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