The article “Post-Traumatic Stress Disorder (PTSD) Symptoms Predict Delay to Hospital in Patients with Acute Coronary Syndrome” by Newman J. et al. addresses the post-traumatic stress disorder symptoms, which are common in patients with the acute coronary syndrome. The rampant delays of visiting hospitals by patients suffering from acute coronary syndrome have led to poor outcomes related to the patients’ health. Many researchers have thoroughly described the role of demographic factors on the increased cases of delayed hospital visits. However, few analyses have been conducted on the impact of modifiable factors such as psychosocial disorders on pre-hospital delays.
In order to provide credible data on the relationship between post-traumatic stress disorder symptoms and pre-hospital delays, this paper discusses the researches of various authors. It is clear that the patients with symptoms of post-traumatic stress disorder avoid stressful circumstances and may be prone to the delayed requests of medical care once they experience cardiac symptoms (Newman, Muntner, Shimbo, Davidson, Shaffer, & Edmondson, 2011). The main agenda of the research is to establish whether post-traumatic stress disorder symptoms have a negative effect on the time the person comes to a hospital in patients with acute coronary syndrome.
The works of various authors were used in this research with each one playing a specific role in its success. Jonathan D. Newman, Karina W. Davidson, and Donald Edmondson participated in both the analysis of the research data and writing of the entire paper while Paul Muntner, Daichi Shimbo, and Jonathan A. Shaffer took part in writing the paper only. All the authors of this article have a good reputation and expertise in the field of medicine. All of them belong to the Department of Medicine at Columbia University Medical Center in New York (the United States of America) except for the author Paul Muntner, who works at the Department of Epidemiology at the University of Alabama at Birmingham.
The work presented in this article is not well-known, because very little data related to this topic of research have been available in the past. Despite the analysis of the demographic factors, there is very scare data on the role of modifiable factors, which is the subject of the research (Newman, Muntner, Shimbo, Davidson, Shaffer, & Edmondson, 2011). This creates the need to focus on the impact of psychosocial disorder factors on its relationship with the poor hospital outcomes arising from pre-hospital delay. The main target audience includes the people suffering from acute coronary syndrome as well as the medical caregivers offering critical services to treat post-traumatic stress disorder patients.
According to recent studies, it became clear that psychosocial factors have been ignored by patients with acute coronary syndrome despite their intense influence on the pre-hospital delay. This article explains the effects of pre-hospital delay on the poor outcomes among post-traumatic stress disorder patients (Hari, Shenoy, Doctorian, Choe, Desai, Sufficool, & Hilliard, 2014). The researchers have hypothesized that patients with post-traumatic stress disorder might have delays in presenting themselves for medical care when they experience cardiac symptoms for the first time. Therefore, the authors have embarked on examining the relationship between the prior post-traumatic stress syndrome and the pre-hospital delay in patients with acute coronary syndrome in presenting themselves for emergency medical care.
The article is well-developed helping the readers arrive at credible conclusions about the topic of the research. It has a well-established theoretical coherence based on the methods used to collect the data needed for the analysis. The researchers have assessed the relationship between post-traumatic stress disorder symptoms and pre-hospital delay in 241 adults experiencing the acute coronary syndrome. Such a huge research population proves the credibility of the data obtained, hence promoting the article’s theoretical coherence. The study involves prescription use, lifestyle, and stress evaluation of acute coronary syndrome patients (Newman, Muntner, Shimbo, Davidson, Shaffer, & Edmondson, 2011).
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The research population included 66 percent of male patients; 40 percent were Hispanic or Latino patients with a mean age of 61.9 years. The research established that pre-hospital delay periods were longer for patients with post-traumatic stress syndrome symptoms compared to those without these symptoms. After several adjustments of the ages, sex, ethnicity, and history of myocardial infarction, the mean pre-hospital delay was recorded in 173 percent of patients with the symptoms. According to this detailed analysis, it is clear that patients with acute coronary syndrome and post-traumatic stress disorder were associated with longer pre-hospital delays independently. However, there should be initiated further studies on the pre-hospital delay to examine the mechanisms of the relationship (Hari, Shenoy, Doctorian, Choe, Desai, Sufficool, & Hilliard, 2014).
The main strength of this research is the ability to obtain data on modifiable factors, which has been very scarce in the field of post-traumatic stress disorder. Since many researchers have concentrated on non-modifiable factors that account for little on pre-hospital delays avoiding the modifiable factors, the commitment of the authors of this article to research on the modifiable factors makes it outstanding. The authors show their expertise in the field by analyzing the relationship between post-traumatic stress disorder and pre-hospital delays in patients with the acute coronary syndrome (Tulloch, Greenman, & Tass 2014). They also established poor outcomes of myocardial infarction for these patients.
The strength of the article is in the ethics approval of the study by the Institutional Review Board of Columbia University Medical Center. The study keenly observed the medical research guidelines by acquiring the written consent from the study population and well recorded the results in the university health information systems. This shows that the information provided by the patients during the research is highly credible since the participants gave consent approving their willingness to provide personal, medical, and other information (Tulloch, Greenman, & Tass 2014). However, the recruitment of the patients to participate in the research weakens the study as they were chosen from the clinical departments at Columbia University making the study constrained only to one center.
Some patients who were transferred from the nearby hospitals to the Columbia University Medical Center lacked the complete data on their symptoms of post-traumatic stress disorder. Incomplete medical records of the patients who were part of the study population posed a huge problem to the data analysts as they could not make credible conclusions because of incomplete data. This necessitated the exclusion of these patients from the study, thus reducing the number of participants to 241 patients (American College of Sports Medicine, 2013). This negatively influenced the results of the study as fewer patients than expected participated in it.
As a way of improving the quality of the arguments, various recommendations need to be considered. The researchers should decrease the period upon which screening of the patients begins from 7 to 3 days. This is because the level of the traumatic experiences of the patients may drastically change within a short time depending on the duration of their exposure to the trained mental health care professionals performing the patient screening (Tummala & Farshid, 2015). The screening process should not be constrained to the screening questions presented in the structured clinical interview. Instead, the professionals performing the screening should be allowed to include other critical questions that they perceive to be important in developing the quality results of the research study.
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The analysis of the influence of suggested depression and social support on the pre-hospital delay included the psychosocial factors as covariates. The professionals collecting the patients’ data used the Beck Depression Inventory to determine the depressive symptoms in patients (Newman, Muntner, Shimbo, Davidson, Shaffer, & Edmondson, 2011).
The set score of above 10 for measuring significant clinical depression is agreeable since it sets a very low range in order to capture a reasonable number of patients for a complete analysis. Although the data collection process is perceived to have been conducted in the best manner possible, the differences in hospital delay time across different ages, sexes, and ethnicities were not statistically significant and required detailed statistical manipulations.
According to a systematic review of the literature from 1960 to 2008, many studies have concluded that among the patients hospitalized with acute myocardial infarction, women and older persons are more likely to get to the hospital later than men and younger persons. Therefore, women and the elderly in the society exhibit longer pre-hospital delays in seeking medical care thus proving the arguments made by the authors of the discussed article (Tummala & Farshid, 2015). Women tend to be more vulnerable to post-traumatic stress disorder because many researchers have found the link between childbirth and the disorder symptoms. Prior studies have indicated that anxiety may have a close link with the increased pre-hospital delays. Such delays have caused adverse clinical complications leading to the increased mortality rate in the society.
In conclusion, the influence of post-traumatic stress disorder symptoms on the pre-hospital delay for patients with acute coronary syndrome has been covered well by the authors of the article. Despite the critique of the population study selection and various data collection techniques, the overall outcome of the research can be considered highly credible. The application of modern techniques such as the use of beck depression inventory has enabled the trained mental health care professionals performing the patient screening to arrive at outstanding data. The decision to focus on the modifiable factors in the analysis of the influence of the disorder symptoms on pre-hospital delay presentation has made the study very unique compared to other research works in the same field.