Critical Appraisal



Introduction
The sedative medication has become a necessity in clinical practice to reduce the pain and anxiety among patients. In particular, the paediatrics experience substantial fear, anxiety before dental treatment and express noncompliance behaviour. The current study provides a critical appraisal of a meta-analysis to investigate the effect of midazolam medication to reduce the anxiety and pain among children.
What type of qualitative research design was utilized to conduct the study?
The meta-analysis was carried out to assess the effect of midazolam in paediatrics before dental treatment. 
Are the results valid/trustworthy and credible?
The results were found to be trustworthy as the recognised journals were approached to explore the answer such as Embase, SIGGLE, the WorldWideWeb, Medline, Community of Science Database. Thirty-eight studies were chosen from the latest researches published in the recognised journals of Embase, SIGGLE, the WorldWideWeb, Medline, Community of Science Database. The accuracy of completeness of the data was assured through the data extraction process. The articles that were found to be highly relevant and fluffing the criteria were included in the study. The irrelevant articles with unambiguous results were excluded from the study. The results were found to be valid according to the literature that has been included in the study. According to other studies, the results were found to be consistent with the literature.   Are implications of the research stated?
The implications of the research have not been stated, but it increased the insight regarding the dire needs of the sensitive situation before dental treatment. Also, it has increased the understanding of how to much medication dose should be given to the patients before dental treatment to avoid pain and anxiety.
What is the effect on the reader?
The results of the study were plausible, as the substantial data supported the fact that oral midazolam decreases the pain, agitation, and anxiety before surgery among children (Kim et al., 2016: Linares et al., 2014). A large body of research suggested that sedative medication such as midazolam is effective for pediatric to reduced the anxiousness ad pain (Fazi, Kurth, Jantzen, Watcha & Rose, 2001).
What are the results of the study?
The results of the study indicated that the literature has weak evidence regarding the effectivity of midazolam use before dental treatment among children. The research approach was not much accurate for the study due to a lack of recent data, and the least number of articles were included in the study.
How does the researcher identify the study approach?
The researcher identified the study approach through literature, and the data collection approach was not accurate. The data extraction has not been made for several reasons.
The data collection approach was accurate as the researcher approached high ranked journals, but he did not primarily focus on the recent data; rather, he included studies from 1966 to onward. The researcher should include lasts five or above years of articles to provide the updated information to enhance the implication and validity of the research.
Is the significance/importance of the study explicit?
The significance of the study was mentioned, as the current study provided substantial information regarding the effectiveness of the midazolam does not reduce pain and anxiety among patients. The findings of the current study contradict with the literature as according to the literature, midazolam reduces anxiety and pain among children undergoing surgical treatment. The potential contribution of the study was to provide contradictory and unique results.
Is the sampling clear and guided by study needs?
The sampling of participants and articles were clear and according to the need of the study but the selection of sample found to be least effective. The sample size and composition were reflecting the needs of the study. As far as the phenomenon of human experience is concerned, the constructs were identified in terms of experimental and plausible effects. The sources of data collection and verifying data were clear, and the role of the researcher and activities were explained thoroughly. Almost 28 oral and nitrous oxide has been used in the current study to investigate the effects.
Are data analysis procedures described?
The data analysis procedures were well described and provided the direction of guidance. The thirty articles were reported to be at the high risk of bias and six were found to be at the low risk of bias. The standardised mean difference was carried out to assess the average outcome with the 95%CL 1.58, P< 0.001 and I2 found to be equal 91%. The weak evidence from five trails found to be at high risk of bias, which indicates the weak relationship between midazolam and cooperative behaviour for treatment or reduction of anxiety or pain.
How are specific findings presented?
The data finding has been presented in the qualitative and descriptive form. The writing of the articles effectively promoted comprehension regarding the concerned phenomenon. The detailed description has been given for each step, but unfortunately, no conclusion can be drawn from the study which sedative provide the high results to control the behaviour, anxiety and pain.
Will the results help me care for my patients?
The results were found to be the least valid and reliable in terms of clinical practice. Still, the finding would help me in providing the best care to my patients understanding the needs and desire of the patient. The result could vary in the situation as a few patients might get an advantage after taking midazolam pill, while some other might get no effect. The results were moderately relevant to patient values and circumstances. However, the results may be applied to clinical practice in terms of individual difference. Each case and child is unique and reacts differently to the medication. The low mg of midazolam can work effectively for some patient; in contrast, the high dosage might be effectless. The study provided an understanding of how the literature provides a substantial difference in the effect of midazolam.
Conclusion
The metanalysis provided a detailed description of the effectivity of midazolam for dental treatment. The study was found to have a few gaps that would be covered in further studies to assess the implication and significance of the current study. Further studies should also be overviewed to assess the validity of the current study.