Appraisal And Evidence Synthesis Of Two Reviews

Appraisal And Evidence Synthesis Of Two Reviews Select two reviews of your choice. One should be a Systematic Review and the other a Traditional Selective Review. Critically discuss the quality of your reviews with respect to a standard assessment tool suitable for reviews. The aim of a review is to give an overview of the primary studies of a particular subject and analyse them in a way, which is thorough, unbiased and reproducible, should it be repeated. about the gathering of the primary data that is being reviewed. A systematic review is a method of synthesising primary research and studies. It is based on having a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review (Cochrane Collaboration Glosasry, 2010). It also uses an objective and transparent approach for research synthesis, with the aim of minimizing bias. Statistical methods known as meta-analysis may or may not be used to analyse and summarise the results of the included studies (Wiesler McGauran, 2010). Systematic reviews differ from narrative reviews. A narrative review differs in that the question being answered is usually less specific and has a wider focus of interest (Cook et al, 1997). A narrative review may look more at the interaction of variables within a problem or the development and management of a problem, while a systematic review will usually focus on a specific and answerable question; therefore have a clear defined outcome that it is gathering evidence about. A narrative review summarizes different primary studies from which conclusions may be drawn in to holistic interpretation contributed by the reviewers own experience, existing theories and models with results having a qualitative rather than a quantitative meaning (Campbell Collaborative, 2001; Kirkevold, 1997). As with all types of research reviews both systematic and narrative need to be appraised for their relevance and value to the subject it relates. A number of tools have been developed to help with the process of critically appraising of research. For the purpose of this assignment, the tool that will be used was produced by the Critical Appraisal Skills Programme (CASP), defining questions and prompts to assess the review, based on questions developed by Oxman et al (1994). This is an appraisal tool that assesses three main issues; is the study valid? What the results are and whether those results help locally. The aim of this tool has been designed to answer these questions in a detailed and systematic manner. Furthermore, this tool has been selected as it has been specifically designed to support evidence-based practice in health and social care (Public Health Resources Unit, 2006) and therefore it forces the reviewer to also consider the perspective of the patient and it is of relevance to the articles that have been selected here. The systematic review to be used for this assignment is Gava et al (2009) Psychological Treatments Versus Treatment as Usual for Obsessive Compulsive Disorder. This review was chosen from The Cochrane Library, as the systematic reviews here have all been carried out using precise methodology, are updated in line with new research and are specifically intended to help anyone involved in healthcare, including patients (The Cochrane Collaboration, 2010). The narrative review to be considered will be Abramowitz et al (2001) Cognitive Behavioural Therapy for Obsessive Compulsive Disorder: A review of the treatment literature. This review was found in a search on the CINAHL database. The CASP tool to be used is specific to systematic reviews (PHRU, 2006); however it will be adapted here to also appraise the narrative review. The ten questions asked in the CASP tool will now be considered. Did the review ask a clearly focused question? Liberati et al (2009) stated that authors should always identify their report as a systematic review or meta-analysis. Although sensitive search strategies have been developed to identify reviews, inclusion of the terms systematic review or meta-analysis in the title may improve indexing and identification (Montori et al, 2005). Furthermore, the title of a systematic review should be informative making key information easily accessible to the reader. This should include reflecting PICOS approach (participants, interventions, comparators, outcomes and study design) providing key information about the scope of the review (Liberati et al, 2009). The systematic review used for the purpose of this assignment was Psychological Treatments versus Treatment as Usual for Obsessive Compulsive Disorder (OCD) (Review). This title failed to provide details of any participants or settings. The intervention and comparator are given as psychological treatments and treatment as usual, however, these had not been clearly specified and details of the outcome measure had not been provided either. Furthermore, the title simply stated review. Such terms do not enlighten the reader whether the review was systematic or whether a meta-analysis was performed (Liberati et al, 2009). Therefore, it has to be noted that the review failed to ask a clearly focused question. The narrative review of the Abramowitz et al (2001) study was Cognitive-Behavioural Therapy for Obsessive Compulsive Disorder: A review of the treatment literature. As with the systematic review this paper also failed to use the PICOS approach, nevertheless, as a narrative review summaries the research more generally, these details may not even be appropriate (Cook et al, 1997). In this review the intervention was specified as Cognitive-Behavioural Therapy (CBT) and it had been clearly indicated that this was a traditional review. Even though the question was not clearly focused, the author does provide the reader with an insight as to what the article contains. Did the review include the right type of study? The studies discussed in the systematic review included looking at any psychological treatment compared to any treatment as usual for adults with OCD, which appeared to be appropriate for answering the research question. All of the included studies were randomised controlled trials (RCTs) which appeared to be an appropriate study design with the focus being on the effectiveness of interventions (Hill Spittlehouse, 2003). However, by including RCTs only and excluding other forms of research, this may result on limiting the conclusions drawn in the review. This appears of particular relevance to healthcare where qualitative forms of data, such as patients experience of an intervention, should be considered of great importance (Petticrew, 2001). The studies discussed in the narrative review also seem to address the question as research carried out on CBT for OCD was drawn upon. It also stated that the review focused particularly on exposure and response prevention treatment. This decision appeared to reflect the authors own interest rather than a thorough search of the available literature, which may lead to some form of bias being introduced. The review draws largely upon RCTs and meta-analyses, which may be appropriate as the focus of interest was effectiveness (Hill Spittlehouse, 2003). However, limiting to the inclusion of only this research design and in a narrative review, it would seem that a range of research could have been incorporated easily as this review appeared limited from not having done so. As explicit details of each study used were not provided, other methodology could have been included but not clearly described. Did the reviewers try to identify all relevant studies? To help identify all potentially appropriate research, a thorough literature search must be conducted in order to carry out a systematic review. This involves not only searching electronic databases, but also checking the reference lists of any selected articles in order to identify further research (Greenhalgh, 1997b), searching for non-English language research and unpublished research ( Centre for Reviews Disseminations, 2008). This helps to reduce any bias in research that is published in non-English languages, as research showing significant results tend to be published in English journals. Furthermore, by having English publications only may have a greater impact on the results than there actually was. By searching a number of various electronic journal databases, reference lists, unpublished and ongoing research and also research in non-English language indicated that Gava et al (2009) attempted to conduct a thorough literature research. There were no details or information provided to indicate how the studies were obtained or how the search was conducted for the narrative review. Even though researches from other countries have been referenced, no indication has been given whether this was taken from non-English language publications. Emphasis has been placed on research into exposure and response prevention therapy and the authors own work has also been cited. This however places some aspect of bias on the review as the reviewer has a clear interest in the topic currently being reviewed. Did the reviewers assess the quality of the included studies? The Gava et al (2009) systematic review describes rigorous quality assessment. A pre-determined scoring system was used which should help to reduce bias by making quality criteria objective and unrelated to the outcomes of the research (Greenhalgh, 1997b). To help reduce the chances of any bias emerging, quality assessments were carried out by two authors independently. However, it must be noted that all articles were included regardless of their quality standard. Furthermore, it has been suggested that not all the authors made the method of randomisation used explicit and they were not always blind to the allocation. Abramowitz et als (2001) review does not mention any formal quality assessment. It must be noted that some informal judgements have been made. Furthermore, it has been noted that some of the research discussed in the review failed to be conducted to a high standard as reference was made to the use of control groups where comparison treatments used was known to be of no benefit to sufferers of OCD. This is unethical as participants allocated to the control groups would have received ineffective treatment which would have had an impact on the results as participants in these groups would have experienced higher anxiety levels and frustration making gains in the experimental group appear much higher. As narrative reviews do not normally employ pre-defined quality assessment tools, research included is likely to be of inconsistent quality and is more at risk of bias (Cook et al, 1997). If the results of the studies have been combined, was it reasonable to do so? Results of each study used can be combined in a systematic review to increase the sensitivity to significant results (Crombie, 1996). However, this should only be done when the studies and their results are similar enough to make the combination of findings meaningful (Crombie, 1996). The Gava et al (2009) review did combine the results of all the studies reviewed. The results of each study were presented in a forest plot showing the mean, standard deviation and confidence interval for each. Heterogeneity was also considered both by eyeballing the data and also by statistical analysis, which found no significant differences in the main analyses, but did find significant differences on some of the secondary analyses. General reasons for heterogeneity were discussed at the start of the paper, but the specific heterogeneity found was not discussed in great lengths. Furthermore, a weighting system was used to combine the results. This means that in the analyses stages studies displaying lower level quality were then given a lower weight making this an effective method for including such studies. The Abramowitz et al (2001) review did not combine the results of all the studies reviewed. In general terms the CRD (2008) state that the intentions of a narrative review is generally to provide a summary of relevant research rather than to synthesis or re-analyse. Furthermore, they also state that this could lead to further biased conclusions based on the reviewers own opinions rather than on stringent analyses that could be recreated by other researchers. How the results presented and what are the main result? In the systematic review, the results have been presented in the body of the text and also as in forest plots. CRD (2008) state that results should be expressed in formats that are easily understood. The most commonly used graphic is the forest plot as it provides a simple representation of the precision of individual and overall results and of the variation between study results (CRD, 2008). The results indicated that psychological treatments led to more improvements in OCB symptoms than did treatments as usual. Improvements in dropout rates, quality of life, anxiety and depression levels in both psychological and treatment were also taken into consideration. Psychological therapy was broken down further to look at the variables being expressed, the mean differences being calculated for continuous variables, but it also took into consideration and reported on the individual effects of CBT, Cognitive Therapy and Behaviour Therapy. Abramowitz et al (2001) review also discussed results for each study reviewed. This indicated that exposure and response prevention were both effective therapies for OCD. However, since no statistics had been used then it was not possible to assess how large and significant the results were without referring to the original research. The research presented tends to be interpreted in favour of exposure and response prevention therapy, even with the results appear to suggest little difference (JÃ ¼ni et al, 2001). The conclusions drawn here are based on the authors own opinions and could have been subjected to biased interpretation of results or detection bias (JÃ ¼ni et al, 2001). How precise are the results? The use of confidence intervals in systematic reviews gives the reader an idea of how precise the results can be considered to be (Hopkins, 2001). Confidence intervals describe the range within which a result for the whole population would occur for a specified proportion of times a survey or test was repeated among a sample of the population. Confidence intervals are a standard way of expressing the statistical accuracy of a survey-based estimate (Young Bolton, 2009). The confidence interval expresses the uncertainty around the point estimate, describing a range of values within which it is reasonably certain that the true effect lies; wider confidence interval reflects greater uncertainty (CRD, 2008). Where a 95% confidence interval is reported then we can be reasonably confidence that the range included the true value for the population as a whole. Formally we would expect it to contain the true value 95% of the time (Young Bolton, 2009). Although intervals can be reported for a ny level of confidence, in most systematic reviews of health interventions, the 95% confidence interval is used (CRD, 2008). Eight studies (11 study comparisons) were identified, all of which compared cognitive and/or behavioural treatments versus treatment as usual control groups. Seven studies (ten comparisons) had usable data for meta-analyses. These studies demonstrated that patients receiving any variant of cognitive behavioural treatment exhibited significantly fewer symptoms post-treatment than those receiving treatment as usual (SMD -1.24, 95%, CI -1.61 to -0.87, 1Â ² test for heterogeneity was not significant at 33.4%) (Gava et al, 2009). Different types of cognitive and / or behavioural treatments showed similar differences in effect when compared with treatment as usual. Results obtained for CBT on OCD symptoms exhibited that the overall mean difference (fixed effects) was in favour of psychological treatments (WMD -7.73, 95%, CI -9.92, -5.55). The 1Â ² test of heterogeneity was not significant at 33.4%. Results obtained for cognitive therapy on OCD symptoms exhibited that the overall standardised mean difference (random effects) were slightly in favour of psychological treatments (SMD -1.20, 95%, CI -2.66, 0.25). The 1Â ² test of heterogeneity was not significant at 74.2%. The overall treatment effect appeared to be influenced by differences in baselin e severity (Gava et al, 2009). Within the Abramowitz et al (2001) paper, there does not seem to be any confidence intervals apparent within, thus leaving us unable to analyse how precise the results, which are described within the paper truly are. In comparison to the systematic review, this approach appears to be highly less open; the author is able to narrate the results in however way they please for example they could suggest that they are highly significant or interpret them as equal to their own theoretical standing but without the need of referral to the original case, however there is no way a certain conclusion as to whether this has occurred or not be drawn up. Can the results be applied to the local population? Within the Gava et al (2009) paper, population details and setting for each study do not seem to be clearly apparent. Although a high percentage are noted as outpatient, a number of settings were not highlighted as to their location or setting. Due to this lack of knowledge, and that some of the studies could have been carried out in a inpatient setting, it would not be possible to ascertain a generalised result to the local population with information found in the inpatient studies. It was stated that the statistical data, or demographics, of the participants were of a similar and consistent nature however there was no in depth analysis or description of them. Due to this small fact, therefore it would not have been possible to state that these were similar to the local population. The duration of treatments described when provided locally was usually shorter thus it can assume some of the methods could not be provided within the local settings. Therefore, the generalisation of the results requires some degree of accuracy and precision for there are often vast and clearly significant differences between the sample and the settings used, here and the local population. Once again, within the Abramowitz et al (2001) review, there was no description of the population meaning that it was not possible to ascertain a generalised collaboration of results. Furthermore, as one of the studies had been carried out in an inpatient setting, then it would not have been possible to generalise these results within such settings. The duration of these studies are described as being of 60-90 minutes on a daily basis which frankly could not have been possible locally. Therefore it is vital that care is taken when attempting to create a generalised result from this review as things that appear to be insignificant, as such small details can be inevitably crucial elements. Were all the important outcomes considered? The Gava et al (2009) review discussed various outcomes as well as improvements in OCD symptoms. Also considered were the outcomes for anxiety symptoms, depressive symptoms, dropout rates and quality of life. These elements were not only likely to be of a high degree of importance to the service providers but also to the service users themselves. Service leads, mental health commissioners and policy makers / government officials may also be interested in dropout rates and reasons for dropout i.e. at initial assessment or at follow up appointment. Details of each therapy session missed, cancelled, failed to attend would be important as well. The narrative review also discussed various improvements in OCD symptoms with each intervention. Consideration was given to the distress linked with exposure therapy, as it would be an important factor for all parties concerned i.e. patient and their families, and also taking into account the supporting role of the carer while patient receives therapy. Abramowitz et al (2001) review state that a relatively large number of clients refuse participation in exposure therapy because of anxiety evoking elements of treatment (i.e. confronting feared stimuli). This places emphasis on the importance of understanding the rationale for exposure therapy, demonstrating mastery of case conceptualization, and providing the client with a convincing explanation of why confronting feared situations will result in long-term abatement of obsessions and compulsions. Should policy or practice change as a result of the evidence contained in the review? The current use of CBT for OCD is supported by the Gava et al (2009) review. Despite this, any RCT or other psychological therapy was unidentifiable by the author whilst other types of therapy did not fit the required format needed in order to carry out a RCT to the same quality that a CBT does thus meaning it has more controlled research in comparison to other forms of therapy. One criticism of systematic reviews is their bias towards certain methodologies for important research may not be included thus leading to biased conclusions. Further research is therefore needed to make comparisons between CBT and other types of therapy; it may be that a mixed methods review would have been carried out in order to do this effectively (Dixon-Woods et al, 2004) A biased review is also present in Abramowtiz et al (2001). In this case it is towards studies in support of exposure and response prevention therapy. No decision can be reached from this review for a thorough search to identify all research in the area -quality assessment and the clear display of results was not completed. Conclusions are more likely to be biased and not be representative of all the evidence in the field within narrative views for they do not follow a predefined and set methodology thus, narrative reviews are less likely to influence policy and practise. Conclusion It is evident that both methodologies consist of advantages and disadvantages. Systematic reviews use pre-defined methodologies with the intention of reducing bias making the results to appear more robust. Nevertheless a critique appears to be the evident over emphasis of RCT which is argued to find less generalisable results. On the other hand, narrative review results appear to be more generalisable and tend to be more flexible in the incorporation of other methodologies. However within these reviews, the scientific, pre-defined strategies are not employed, thus considering them to have a higher risk of leading to bias. To conclude, it appears that both of these reviews can be of significant help and are easily justifiable for use, depending on the question that the researcher is trying to answer and the point at which the evidence base is at in its development.

The Princess Bride Movie Review

Savannah Sheets 9th English 24 May 2012 The Princess Bride Movie Review â€Å"Hello. My name is Inigo Montoya. You killed my father. Prepare to die. † This is one of the many humorous lines in the movie, The Princess Bride. The Princess Bride is a romantic, action-comedy film and was directed by Rob Reiner in 1987. The plot of this movie is a fairytale narrated by a grandfather to his grandson full of action in attempt of getting a kidnapped princess back to her childhood love the day before her planned marriage with the prince.The main characters, Buttercup the princess (Robin Wright) and Westley (Cary Elwes) fall in love when they are just two young teenagers shown at the beginning of the story. Fate separates them for 5 years and soon brings them back together before she gets married to Prince Humperdinck. Westley, her childhood sweetheart, wears a disguise and follows 3 men who have kidnapped Princess Buttercup to get her back. His wits help him team up with the kidnappers and overcome Prince Humperdinck and his ‘army’.Westley is caught but soon escapes with the help of Fezzik the Giant and Inigo Montoya. They all jump out of the window and ride away on horses. Westley and Buttercup marry and live happily ever after. The Princess Bride is often compared to the movies Ella Enchanted, Spy Kids, and Stardust, all of which have different aspects of themes that were similarly incorporated in the movie. It took place in the fictional countries of Florin and Guilder, sometime between the establishment of Europe and after the manufacturing of blue jeans.The story reaches out mostly to the young adult audience, but would easily be satisfactory to people of other audiences as well. The events in the story are highly unlikely, but are well-structured and amusing to the viewers which help it to be easier to understand. The dialogue is meant to sound like the story was based from the medieval times, with a twist of comedy. Finally, the themes portray ed in this movie were that true love conquers all. Westley, even after all of the time spent apart, found his true love and in the end it all worked out with a happily ever after.Good versus evil is also a theme in this movie because Prince Humperdinck tries to marry Princess Buttercup knowing that she is still in love with Westley. Even though it was an arranged marriage, Prince Humperdinck tried to convince her that it would take time for them to fall in love, but they would eventually get used to it. Princess Buttercup has a nightmare which opens her eyes. She dreams about the marriage which is interrupted by who is known as â€Å"The Ancient Boo-er†. She tells Buttercup that she is a disgrace because she has power but isn’t using it to her advantage and is letting down the people of her country.

Economic Growth and Financial Development

There are three views about the relation between economic growth and financial development. First, financial development has impact on economic growth (i. e. Bagehot, 1873; Schumpeter, 1912; McKinnon, 1973; Shaw, 1973; Patrick, 1966; Goldsmith, 1969; Fry, 1973). Second, economic growth leads to financial development and that where there is economic growth financial development follows (i. e. Robinson, 1952). The third view, however, contends that both financial development and economic growth Granger cause one another.In the essay, our group focus on the first view which financial development will has passive influence on economic growth. During the year from 1955 to 1993, many scholars has study the relationship between financial development and economic growth. Along with the time goes, the theory that financial development will real promote economic growth has been more and more prefect. In the years between 1950s and 1960s, economists such as Gurley and Shaw began to stress the c redit markets and the importance of financial intermediaries, which they believed play an important role in economy. 5] They argued that tradition monetary transmission mechanism ignores the factor of financial structure and financial flow and only pays attention to the total amount of money and the connection of the output. In 1955, Gurley and Shaw bring up the development of financial institution is both a determined and determining variable in the growth process. (Gurley and Shaw, 1995, p. 532). Gurley and Shaw stressed that financial intermediaries exert influence on credit supply rather than money supply.In this way, financial intermediaries improve the efficiency of savings turning into investments and then affect the whole economic activities. They are the earliest scholars to study in-depth the relationship between financial and economic development in developing countries. Gurley and Shaw pointed out that the main access road of monetary policy transmission probably have di verted from money quantity, which is traditionally thought as the medium of exchange.Whereas, the â€Å"financial capability† of economy would has a closer relationship with the gross expenditure. They put forward financial development enhances the intermediation of loanable funds and therefore growth will be stimulated and they have a debt-intermediation view. The Debt-intermediation view establishes relations between finance and growth. First, economic growth would be associated with financial development, as external indirect finance provides surplus units with the capacity to spend beyond their earnings.Second, growth would stimulate and be stimulated by the â€Å"institutionalisation of saving and investment†; income grows, richer wealth-holders will increase their desire to diversify their asset portfolio. If financial innovation is such to accommodate this â€Å"diversification demand†, financial institutions can enhance their lending capacity and thus bo ost growth; the process becomes a cycle. Gurley and Shaw has earlier pointed that the growing importance of NBFI (non-bank financial intermediaries) when they discussed their activities about potentially serious problems for monetary management and monetary policy. 1] Subsequent analysis of the problems had to two results. [2] First, if the monetary authorities exerted control over the financial system through the operating of the financial markets, monetary management would not be undermined. [3] Second, which placed specific restrictions on banks, at that time the dominant financial entities, the growing role of NBFI was stimulated in part by the opportunities for intermediation created by monetary policy measures.These contributions stressed the relevance for financial â€Å"deepening† (mean financial development) of rising wealth and income, then attempts to control the activities of financial intermediaries. Wealth and income incent the demand for financial services. Res trictions and Controls on financial intermediaries create the stimulation for further financial intermediation by generatingâ€Å"quasi-rents† that risk among participants in financial and capital markets and reflect differences in information. 4] However, Gurley and Shaw do not address the issue of causality between financial development and economic growth. In 1966, Patrick make the causality issue is addressed, he posed theâ€Å"stage of development† hypothesis, where the direction of causality between financial development and economic growth changes over the course of development. [6] Two hypotheses are developed, one is Demand-following hypothesis: a causal relationship from real to finance and the other is Supply-leading hypothesis: a causal relationship from finance to growth.The supply-leading hypothesis supposes a causal relationship from financial development to economic growth, which means mature creation of financial institutions and markets increases the supply of financial services, and thus leads to real economic growth. Patrick suggests that initial development is spurred by supply-leading process, which gives way to demand-following process. He posed financial institutions and services emerge as demand for those services unfolds. The idea is that finance is passive in the growth process, but lack of financial institutions may prevent growth to occur.Financial institutions and their services precede the emergence of demand; government support is needed to finance and nascent modern sector, such as subsidized loans, information to small business and long loan durations. He points out the importance of finance in economic growth. The difficulty of establishing the link between financial development and economic growth was first identified by Patrick (1966), he argued that a higher rate of financial growth is positively correlated with successful real growth. [7] In his theory, commercial banks may issue banknotes and accept â€Å" easy† collaterals. Easy loan† can induce economic growth, for it can finance innovation-type investment, however, in fact it can also induce irresponsible borrowing. Since the important work of Patrick, that first postulated a bi-directional relationship between financial development and economic growth. A large empirical literature has emerged testing this hypothesis as the Patrick's (1966) problem remains unresolved: What is the cause and what is the effect? Is finance a leading sector in economic development, or does it simply follow growth in real output which is generated elsewhere. References: [1] de Oliviera Campos, R. 1964) â€Å"Economic Development and Inflation with Special Reference to Latin America† in Development Plans and Programmes Paris: Organisation for Cooperation and Development [2] Duesenberry, J. S. and M. F. McPherson (1991) â€Å"Monetary Management in Sub-Saharan Africa† HIID Development Discussion Papers no. 369, January [3] Friedm an, M. (1973) Money and Economic Development The Horowitz Lectures of 1972 New York: Praeger Publishers [4] Malcolm F. McPherson and Tzvetana Rakovski (1999) â€Å"Financial Deepening and Investment in Africa: Evidence from Botswana and Mauritius†, Copyright 1999 Malcolm F.McPherson, Tzvetana Rakovski, and President and Fellows of Harvard College [5] Liu Pan Xie Tao (2006) The Monetary Policy Transmission in China-â€Å"Credit Channel† And Its Limitations, Working Papers of the Business Institute Berlin at the Berlin School of Economics (FHW-Berlin) [6] Anthony P. Wood and Roland C. Craigwell Financial Development and Economic Growth: Testing Patrick’s Hypothesis for Three Caribbean Economies [7] Philip Arestis (2005) FINANCIAL LIBERALISATION AND THE RELATIONSHIP BETWEEN FINANCE AND GROWTH, University of Cambridge

The Cost Of Having A Baby - 2224 Words

The Cost of Having a Baby Tiffany Jones November 16, 2014 HCM 615 Health Care Finance Dr. Donald S. Brady There are many things in life are great gifts, and being a parent is one. Getting the news that you are expecting a child is a speechless moment. It is a very joyful occasion and everyone is happy about what to expect over the next nine months. Baby names start flowing and in every magazine you are looking at outfits and furniture and things of that nature. But has anyone stop to think about what is cost to have this baby? What medical expenses that will be incurred during this forty weeks process. The answer is no. No one probably really cares but the hospital and the insurance company. Now it’s time to take a look at some of the cost behind the blessing of labor and delivery. The amount that a mother will incur to have her bundle of joy will depend on many different factors. One may take into consideration where you live, whether there are any complications and whether mommy has a vaginal birth or a C-section. But just to take a glimpse inside this world, here are a few figu res that may surprise you. For prenatal care and delivery, the cost in some areas can range from about $9,000 to over $250,000 (Alfieri, 2012), which is quite a wide range, if not more. This is without the privilege of having insurance to cover. Even with the privilege of having health insurance, the majority of these expenses could be covered, but that’s not always the case. ItShow MoreRelatedMedical Ethics : Medical Ethical Dilemma Essay878 Words   |  4 Pagesme because it dealt with a baby in the neonatal intensive care unit (NICU) born at twenty-four weeks’ gestation, weighing nine ounces. I want to be a NICU nurse so I am sure I will be faced with an issue similar to this at some point in my career. 2. What are your feelings about this dilemma? Are you for or against? 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