Posted: August 31st, 2022

Western Sydney College

Faculty of Medication

Introduction to Scientific Epidemiology (401173)

FINAL ASSIGNMENT

Autumn, 2019

Due date: 11.59pm , Might 31 2019

This project ( help with nursing paper writing from experts with MSN & DNP degrees) relies on the educational goals and ideas as described within the Unit Studying Information. There are 9 questions price a complete of 64 marks and this project ( help with nursing paper writing from experts with MSN & DNP degrees) will contribute 64% in direction of the full Assessment for this topic (sample nursing essay examples by the best nursing assignment writing service).

Your project ( help with nursing paper writing from experts with MSN & DNP degrees) ought to be typed, with ample area left between questions. Assignments ought to be submitted through vUWS. Be as concise as attainable in your solutions, and use the variety of marks allotted to every Question Assignment as a information for a way a lot to jot down.

Please observe that is a person train.

Late assignments won’t be accepted with out prior approval.

You’re required to reply ALL questions (1-9)

Web page 1 of seven

Reply questions 1-2 based mostly on the next situations:

Q1: Fred, a 65-year-old overweight man with a historical past of sort 2 diabetes mellitus and hypertension presents to the GP observe for a follow-up appointment. Throughout the session, he asks whether or not there’s a higher remedy to glicazide and metformin, his oral hypoglycemic medicines, which he has been taking to regulate his blood sugar. His good friend has just lately been placed on a more recent oral hypoglycemic remedy (Liraglutide, a glucagon-like peptide-1 analogue), which has been proven to Help with weight administration in sufferers with diabetes and weight problems. Fred has been discovering it very troublesome to shed pounds for a number of years now as he has tried numerous way of life modifications. He asks whether or not the brand new oral hypoglycemic medicines may very well be an choice for him in weight discount.

Process [2 marks]

a. Write a targeted analysis Question Assignment for this explicit drawback that may Help you organise a search of the literature for a solution (use the PICO parts as acceptable).

b. Determine the PICO parts in your analysis Question Assignment

Q2: Prior to now 2 years, as an Infectious Illness Specialist in one of many tertiary hospitals in Australia, you’ve attended to 23 migrant sufferers who have been referred by their Basic Practitioners with signs not typical of pulmonary tuberculosis. After taking an in depth historical past and performing acceptable bodily examinations, in addition to reviewing a variety of related investigations, you clinically identified and microbiologically confirmed that these sufferers have multi-drug resistance pulmonary tuberculosis (MDR-TB). The Public Well being Division was notified of illness and the sufferers have been managed accordingly. Now, you and a few colleagues from Western Sydney College wish to examine the danger elements for MDR-TB.

Process [2 marks]

a. Write a targeted analysis Question Assignment for this explicit drawback that may Help you organise a search of the literature for a solution (use the PICO parts as acceptable).

b. Determine the PICO parts in your analysis Question Assignment

Q3: Please choose the only greatest reply for every of questions three.I – VII

I. Randomised managed trials present sturdy proof that an noticed impact is as a result of intervention. One essential purpose is as a result of [1 mark]:

a) When the research members are randomised, many traits and potential confounders are prone to be evenly distributed within the teams

b) It’s simpler to measure the end result variable with nice precision in randomised managed trials in comparison with different research designs.

c) The publicity stage and the end result are measured on the similar time
d) The research members are volunteers and due to this fact motivated to participate within the research
e) Not one of the above

II.Blinding is a vital function of a randomised managed trials as a result of [1 marks]:
a) It helps stop measurement bias – the biased Assessment of outcomes
b) It helps scale back contamination and compliance issues
c) It helps scale back confounding and choice bias
d) It’s required to do an intention-to-treat Assessment

e) It helps enhance likelihood occasion and scale back misclassification III. Which of the next is true [1 mark]?
a) Loss to follow-up can result in choice bias in cohort research.

b) Choice bias can come up from conditioning on the frequent impact of the publicity and an uncontrolled unbiased danger issue for the end result.

c) Case-control research aren’t any extra vulnerable to choice bias than are cohort research.
d) Loss to follow-up is just not a serious supply of bias in cohort research.
e) Not one of the above.

IV. When epidemiologists decide the proof to determine a attainable reason behind a well being final result, they

contemplate [1 mark]:
a) The power of the affiliation between an publicity and the end result
b) Proof that the publicity of curiosity has appeared earlier than the end result.

c) Proof exhibiting that reductions within the publicity stage will reverse the danger of the end result.
d) A, B and C
e) A and B solely

V. A double-blind research was designed to check the efficacy of a drug. One group of the sufferers consisting of 1227 members got a placebo and the opposite group of sufferers consisting of 1220 got the lively drug. Each teams have been to be adopted up for one 12 months. After 6-months of the trial, 35% of members within the placebo teams dropped out of the research and four% of the members taking the lively drug dropped out of the research. What’s the SINGLE BEST rationalization for this incidence [1 mark]?

a) Failure of the lively drug
b) Inadequate data to interpret knowledge
c) Systematic error
d) Likelihood occasion
e) Breakdown of the double-blind research

VI. The very best stage of proof supplied for most cancers therapy often comes from: [1 mark]
a) Randomised management trials
b) Part II medical trials
c) Part III medical trials

d) Systematic Assessments of observational research
e) Meta-analyses of intervention research

Web page three of seven

VII. A latest research examined the affiliation between tea consumption and ovarian most cancers. The research included 414 ladies with major epithelial ovarian, fallopian, or peritoneal most cancers and 868 age-and region-matched ladies with non-neoplastic circumstances. The adjusted odds ratio was zero.39 for these ingesting tea every day and zero.23 for these ingesting tea for >30 years, in contrast with non-tea drinkers. The research concluded that rising frequency and period of tea ingesting, particularly inexperienced tea, can scale back the danger of ovarian most cancers.

What sort of research was performed? [1 mark]
a) Cross-sectional research
b) Potential cohort research
c) Randomised managed trial
d) Retrospective cohort research
e) Case management research

This fall: Now choose ONLY ONE analysis Question Assignment from both Question Assignment 1 or 2 above that may Help you arrange a search of the medical literature for a solution. In case you have been to go looking Medline/PubMed/Internet of science for authentic analysis on this Question Assignment:

a. Describe what your search technique can be, together with key phrases, MeSH phrases, inclusion and exclusion standards, in addition to proof of the Boolean operators used [4 marks].

b. What sort of research design would greatest have the ability to tackle your chosen analysis Question Assignment? State why [1 mark].

c. Cite the very best article from amongst these you discover, utilizing any referencing type of your selection [1 mark].

Q5: Reply questions 5a-b based mostly on the next data:

A complete of 1800 sufferers have a screening check to determine a protein referred to as “FEN-59’ to find out sufferers vulnerable to lung carcinoma, adopted by a standardized lung biopsy process. Of the 1800 kids, 1533 have a destructive FEN-59 and 267 have a optimistic FEN-59. As well as, a lung biopsy (gold commonplace) was achieved on all sufferers. Of these sufferers with a destructive FEN-59, 1491 have a destructive lung biopsy. Within the group with a optimistic FEN-59, 259 have a optimistic lung biopsy.

Assemble a 2×2 desk utilizing the data supplied above, and reply the next questions (a and b):

a) Calculate the sensitivity of the FEN-59 [2 marks]
b) Calculate the optimistic predictive worth of the FEN-59 [2 marks]

c) The destructive predictive worth relies on the entire following: prevalence, incidence, sensitivity and specificity [True/False] [1 mark]

Please choose the SINGLE BEST reply in questions 5e to f

d) Utilizing the picture under, which worth within the check end result models is the purpose of most specificity? [1 mark]

a) 30
b) 15
c) 5
d) 20
e) 25

e) A research was performed by which 10,000 ladies participated. All ladies underwent a cervical smear. 1,000 of 10,000 ladies had a optimistic smear. Of those, 100 developed cervical most cancers. 10 ladies who had destructive smear developed most cancers. What’s the SINGLE almost certainly terminology to explain the 10 ladies with destructive outcomes who developed cervical most cancers?
[1 mark]
a. True destructive
b. False destructive
c. True optimistic
d. False optimistic
e. Likelihood occasion

Q6: Reply questions 6a-d based mostly on the next data:

You’ve gotten delivered to the eye of the hospital medical companies revealed trial reported diminished physique weight in sufferers with morbid weight problems who have been handled with liraglutide, a glucagon-like peptide-1 equal. You talked about this revealed paper to your Director, and given the proof reported, he requested you to provide a presentation in regards to the research findings through the weekly seminar collection. In your presentation, she has requested you to handle the next questions (6a-d) based mostly on the outcomes of the revealed paper (Edited summary is proven under):

A Randomized, Managed Trial of three.zero mg of Liraglutide in Weight Administration (Xavier Pi-Sunyer, M.D., Arne Astrup, M.D., D.M.Sc., Ken Fujioka et al. N Engl J Med 2015;373:11-22.

DOI: 10.1056/NEJMoa1411892)

Background: Weight problems is a power illness with critical well being penalties, however weight reduction is troublesome to keep up by means of way of life intervention alone. Liraglutide, a glucagonlike peptide-1 analogue, has been proven to have potential profit for weight administration at a once-daily dose of three.zero mg, injected subcutaneously.

Strategies: We performed a 56-week, double-blind trial involving 3731 sufferers who didn’t have sort 2 diabetes and who had a body-mass index of at the very least 30 or a BMI of at the very least 27 if that they had handled or untreated dyslipidemia or hypertension. We randomly assigned sufferers in a 2:1 ratio to obtain once-daily subcutaneous injections of liraglutide at a dose of three.zero mg (2487 sufferers) or placebo (1244 sufferers); each teams obtained counselling on way of life modification.

Outcomes: At week 56, sufferers within the liraglutide group had misplaced a imply of eight.four±7.three kg of physique weight, and people within the placebo group had misplaced a imply of two.eight±6.5 kg (a distinction of −5.6 kg; 95% confidence interval, −6.zero to −5.1; P<zero.001). A complete of 63.zero% of the sufferers within the liraglutide group as in contrast with 37.zero% within the placebo group misplaced at the very least 5% of their physique weight (P<zero.001).

Conclusion: On this research, three.zero mg of liraglutide, as an adjunct to weight-reduction plan and train, was related to diminished physique weight and improved metabolic management.

Q6a. Assemble a 2×2 desk utilizing related figures proven within the summary, and reply the next questions: [4 marks]

(i) What’s the danger of shedding at the very least 5% of physique weight in all sufferers included within the research?

(ii) What’s the danger of shedding at the very least 5% of physique weight in sufferers who have been handled with liraglutide?

(iii) What’s the danger of shedding at the very least 5% of physique weight in sufferers who have been handled with placebo?

(iv) What’s the relative danger of therapy with liraglutide verus placebo with regard to weight administration? How would you interpret this relative danger estimate?

Q6b. If equal numbers of sufferers within the inhabitants have been handled with liraglutide vs placebo therapy, what can be the anticipated inhabitants relative danger discount (RRR) for liraglutide therapy? How would you interpret this measure? [4 marks]

Q6c. What number of sufferers should be handled with liraglutide for yet another affected person to profit in contrast with the placebo? What is that this measure referred to as? How would you interpret this measure [4 marks]?

Q6d. How does the measure in Question Assignment 5b differ from Question Assignment 5c? [4 marks]

Learn the connected authentic analysis article (Khorana et al., 2019), accessible in vUWS), and now reply Questions 7 to 9:

Q7. What traits of the research would you contemplate with the intention to decide if its findings are legitimate? Embrace wider issues of research high quality/validity and provides examples. (Q8 will tackle relevance, and the following Question Assignment will ask learn how to decide the significance of the findings…for this Question Assignment, deal with the interior validity of the research) [8 marks]

Q8. What traits of the findings would you contemplate, so as, to find out if they’re clinically significant and statistically vital? Embrace examples. (You’ve already addressed validity…for this Question Assignment, deal with learn how to decide the medical significance and statistical significance of an impact reported within the research) [8 marks]

Q9. What traits of the research would you contemplate, so as, to find out whether it is generalizable to your context? Clarify your solutions and supply examples. (Questions 6 and seven have requested learn how to decide if the research is legitimate, and the way vital the findings are….for this Question Assignment, deal with learn how to decide whether it is actually related or generalizable to your observe.) [8 marks]

Observe:

zero Please don’t record the traits in questions eight–10, however clarify your solutions succinctly.

zero You too can obtain the article from the College Library utilizing your scholar login particulars.

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