This assignment will provide a critical analysis of O’Keeffe et al (2011) study ‘’Role of ambulance response times in the survival of patients with out of hospital cardiac arrest’’. The author has used Caldwell et al (2011) framework for critiquing health research in order to provide a thorough, systematic approach to analysis. This tool was chosen because it provides a structured holistic approach to the analysis, unlike xxxxx framework because it xxxxxxx.The title is important in order to gain initial interest from readers; this is done using key words pertinent to the study in order to quickly enable the reader to decipher if this study is likely to be useful to them (Wisker, 2007). The title tells the reader the nature of the study, in this case it is likely to gather attention of those such as the author who have attended many out of hospital cardiac arrests and may want to know if ambulance response times has an impact on their outcome.Author credibility can be used as a method of determining to what extent the source is reliable (Rieh and Danielson, 2007). The authors of this paper are credible as they are highly regarded within the pre hospital environment, having significant qualifications and experience between them (Smart, 2005). Gale et als (2013) suggests that simply because the authors have experience and high level qualifications does not mean that the article is valid or reliable. However Oh (2016) suggests that the researchers credibility is vital in assessing the credibility of a study such as this, where 3 of the 4 researchers are part of a Medical Care Research Unit and the fourth author has emergency department experience and this therefore increases the credibility of the reasarch.The purpose of an abstract is to give the reader information on which they can make the decision if reading the rest of the study would be of interest or benefit to them (Disman et al, 2017). The abstract of this paper summarises all the key componants, the methods used, results achieved and gives a brief conclusion. Nardi (2018) says these are all the necessary components, and by being structured and clearly presented it gives the reader confidence the rest of the article is also well put together. The rationale for undertaking this study was to determine if there was a relationship between ambulance response times and their survival to discharge of the same group of patients reaching hospital discharge following their out of hospital cardiac arrest. The outcome of the study was intended to be used in further planning and resource management in the NHS ambulance service in the United Kingdom; to provide the best levels of patient care. The article also explains that it was intended to form part of an ongoing review into the implications of making changes to the policies regarding ambulance response times and the effect this would have on patient outcomes. This study has no mention of a previous literature review undertaken by the researchers, but Patten and Newhart (2017) state this is not necessarily a weakness as it can confuse and intimidate readers with limited experience in reading research papers. The introduction clearly states the aim of the research as being to clarify if there is a relationship between the response time of the ambulance and the survival rates in out of hospital cardiac arrest patients in order to make improvements and lead to better standards of care. Health care research often evaluates the correlation between factors such as these in order to bring changes without having a detrimental effect on the patient care (Sheikh et al, 2015). This research was funded by the Department of Health which oversees the medical care in the United Kingdom and has the general control of the budgets and strategic policy regarding the ambulance service and wider NHS (Cylus et al, 2018).One ethical consideration identified by the author is that there was significant personal information collected from on scene details, the ambulance patient report form and the hospital’s emergency department and inpatient to discharge notes. In the study the researchers make no reference to how they dealt with this compilation of personal information or the consent or confidentiality of participants involved in this study. It can be assumed that all ethical considerations were taken into account my the 24 ethics committees that approved this research prior to the commencement of the study. The role of these ethics committteess is to ensure studies abide by ethical rules such as confidentiality, repsect, right to withdraw information and privacy (Pozgar, 2019). The first principle of the Nuremburg code is to ensure that patients have voluntarily consented (Merz, 2018), and by having gained ethical approval from the 24 commiittees this suggests this has been dealt with and hence there are no ethical concerns identified by the author in this this study.The study is quantitative in nature, meaning it aimed to collect numerical and statistical data about the chosen subject and therefore a quantitative approach was required in order to statistically analyse the findings and make reccomendations for further research or changes in policy (Pope and Stanistreet, 2017). The methodology chosen was a non-experimental design used appropriately to analyse the past events.The sample used in this study was explained by the researchers as being a retrospective 5 year review of the effect ambulance response times had on survival in out of hospital cardiac arrests. The study used data from across 4 ambulance services, which were selected as these ambulance services categorise incidents and therefore researchers could just access the required information for category A calls as required for the study. The population is identified as being xxxxx.It is not possible to determine if the sample is reflective of the population as the study does not explain if the sample groups were from rural or urban areas or if there were other confounding factors that would have impacted on the results of this study. Confounding factors in this study may include patient’s age, lifestyle and ethnicity as these all have an effect on patients that may have impacted in the findings (Nagao et al, 2016). The readers cannot understand if the sampling group is reflective of the wider population as there are again few details given (Morse, 1991). If the researchers were to collect data and use a representative sample from across the entire UK then this would prove too time consuming and expensive as collecting from a larger number of sources with different methods of data storage (Safdar et al, 2016). It is important the representative sample represents the target sample as closely as possible as this helps to ensure the generalisability of results (Manolio and Collins, 2010). The researchers aimed to do this in two ways, by using a set of guidelines in order to ensure the uniform reporting of cardiac arrests identified in the articles as the utstein style, and excluded patients whereby the outcome was not known. The study did not identify the ambulances services used, this could be a weakness as it may not cover a range of environments or patient demographics however the research states a range of typical environment were used which therefore supports their strength of the validity and reliability of the research.The researchers identify they used a logistic regressive model to analyse the data which measures the variables based on values between 0 and 1 (Peng et al, 2002). The author considers this suitable as the aim was to compare response with outcome. The results are given in descriptivly and are supported by tables and bar charts which were useful for the author who suggests the descriptive form alone would have been confusing when analysing statistical data.The longest part of any quantitative research is the discussion (Morgan, 2013). This discussion is longer still as it also contains the conclusion. O’Keefe shows that the reduction in response times has been achieved after previous research was carried out. By doing this O’Keeffe has shown a comparison with previous data results of a study that has been carried out. The discussion contains lots of detail that was a little difficult to clearly understand, but it did identify that shorter response times are linked to an increase in survival following out of hospital cardiac arrests but only if other predictive factors were present. It has been proven in this study that the reduction in response times would lead to better outcomes following ohca, but due to funding constraints and costs to the NHS to implement this it would not be practical to imply that this shows that further research would be required.The study did not say if the data collected was gathered in urban or rural areas suggesting that it may not be generalizable. However overall it was generated in the study is similar to the outcome of previous research carried out in different areas suggesting it is generalizable.Completing a critical analysis the author acknowledges that the role of response time in survival of patients with OHCA studied by O’Keeffe has both weaknesses and strengths. The aim of this study was achieved however some of the information provided was brief and hard to understand. By using Caudwell to critically analyse this piece of research it made the analysis process understandable and clarified that reading research requires a different way of thinking, essential to deliver evidence based practice.REFERENCESCaldwell, K., Henshaw, L. and Taylor, G., 2011. Developing a framework for critiquing health research: an early evaluation. Nurse education today, 31(8), pp.e1-e7.Cylus, J., Roland, D., Nolte, E., Corbett, J., Jones, K., Forder, J. and Sussex, J., 2018. 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