Clinical health issues

Order Description
Answer questions 1-4 based on the followin” rel=”nofollow”>ing clin” rel=”nofollow”>inical scenario:
Asthma is a common medical condition caused by narrowin” rel=”nofollow”>ing of the small air passages (breathin” rel=”nofollow”>ing tubes) in” rel=”nofollow”>in the lungs. The narrowin” rel=”nofollow”>ing happens because the air passages become swollen and in” rel=”nofollow”>inflamed. This
makes it difficult for air to get through and causes wheezin” rel=”nofollow”>ing, coughin” rel=”nofollow”>ing and problems with breathin” rel=”nofollow”>ing. Approximately one in” rel=”nofollow”>in four children in” rel=”nofollow”>in Australia will have some symptoms of asthma durin” rel=”nofollow”>ing
childhood, but with the right medicin” rel=”nofollow”>ine and in” rel=”nofollow”>interventions, nearly all children with asthma will be able to join” rel=”nofollow”>in in” rel=”nofollow”>in sport and lead active lives. There are many different thin” rel=”nofollow”>ings that can trigger or
start an asthma attack, in” rel=”nofollow”>includin” rel=”nofollow”>ing in” rel=”nofollow”>infection, exercise, changes in” rel=”nofollow”>in the weather, cigarette smokin” rel=”nofollow”>ing, house dust mite, pollens and pets.
The Director of Paediatric Medicin” rel=”nofollow”>ine department in” rel=”nofollow”>in an urban hospital in” rel=”nofollow”>in Melbourne notices that many children with asthma admitted to the Emergency Department (ED) for acute asthmatic attack re-
represent to the hospital in” rel=”nofollow”>in weeks followin” rel=”nofollow”>ing the in” rel=”nofollow”>initial admission to the ED. He wants to reduce re-admission rates of acute asthmatic attack at the hospital, and wonders if a short community
in” rel=”nofollow”>intervention in” rel=”nofollow”>in the form of a follow-up telephone call (to assess how the patients were feelin” rel=”nofollow”>ing, and provide advice for community support such as avoidance of known allergies) might lead to
reductions in” rel=”nofollow”>in the number of re-admission due to acute asthmatic attack in” rel=”nofollow”>in children with asthma.

Q1 Write a focused clin” rel=”nofollow”>inical question for this particular problem that will help you organise a search of the clin” rel=”nofollow”>inical literature for an answer. [4 marks]
Q2 If you were to search Medlin” rel=”nofollow”>ine/PubMed/Web of science for origin” rel=”nofollow”>inal research on this question [8 marks]
(i) Describe what your search strategy would be. Be as specific with your response, and consider specific keywords, MeSH terms, and delimiters.
(ii) Explain” rel=”nofollow”>in your rationale for takin” rel=”nofollow”>ing this approach and explain” rel=”nofollow”>in your reasonin” rel=”nofollow”>ing.
(iii) Cite the best article from among those you fin” rel=”nofollow”>ind, usin” rel=”nofollow”>ing any referencin” rel=”nofollow”>ing style of your choice.
Q3 What type of study design would best be able to address this question? Discuss why. [5 marks]
Q4 What in” rel=”nofollow”>information sources would you use to fin” rel=”nofollow”>ind an answer to questions such as the above? [5 marks]
(i) Name at least four (4) possible types or categories of in” rel=”nofollow”>information sources as you can that could be used to fin” rel=”nofollow”>ind relevant evidence.
(ii) Discuss at least three (3) types of in” rel=”nofollow”>information sources to demonstrate your awareness of the convenience, relevance and quality of common in” rel=”nofollow”>information sources in” rel=”nofollow”>in clin” rel=”nofollow”>inical practice.
2
Answer questions 5a-d based on the followin” rel=”nofollow”>ing in” rel=”nofollow”>information:
You have brought to the attention of the hospital medical services that a published trial reported reduced body weight in” rel=”nofollow”>in patients with morbid obesity who were treated with liraglutide, a glucagon-
like peptide-1 equivalent. You mentioned this published paper to your Director, and given the evidence reported, he asked you to give a presentation about the study fin” rel=”nofollow”>indin” rel=”nofollow”>ings durin” rel=”nofollow”>ing the weekly
semin” rel=”nofollow”>inar series. In your presentation, she has asked you to address the followin” rel=”nofollow”>ing questions (5a-d) based on the results of the published paper (Edited abstract is shown below):
A Randomized, Controlled Trial of 3.0 mg of Liraglutide in” rel=”nofollow”>in Weight Management (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: Obesity is a chronic disease with serious health consequences, but weight loss is difficult to main” rel=”nofollow”>intain” rel=”nofollow”>in through lifestyle in” rel=”nofollow”>intervention alone. Liraglutide, a glucagonlike peptide-1
analogue, has been shown to have potential benefit for weight management at a once-daily dose of 3.0 mg, in” rel=”nofollow”>injected subcutaneously.
Methods: We conducted a 56-week, double-blin” rel=”nofollow”>ind trial in” rel=”nofollow”>involvin” rel=”nofollow”>ing 3731 patients who did not have type 2 diabetes and who had a body-mass in” rel=”nofollow”>index of at least 30 or a BMI of at least 27 if they had treated
or untreated dyslipidemia or hypertension. We randomly assigned patients in” rel=”nofollow”>in a 2:1 ratio to receive once- daily subcutaneous in” rel=”nofollow”>injections of liraglutide at a dose of 3.0 mg (2487 patients) or placebo
(1244 patients); both groups received counsellin” rel=”nofollow”>ing on lifestyle modification.
Results: At week 56, patients in” rel=”nofollow”>in the liraglutide group had lost a mean of 8.4±7.3 kg of body weight, and those in” rel=”nofollow”>in the placebo group had lost a mean of 2.8±6.5 kg (a difference of ?5.6 kg; 95%
confidence in” rel=”nofollow”>interval, ?6.0 to ?5.1; P<0.001). A total of 63.0% of the patients in” rel=”nofollow”>in the liraglutide group as compared with 37.0% in” rel=”nofollow”>in the placebo group lost at least 5% of their body weight (P<0.001).
Conclusion: In this study, 3.0 mg of liraglutide, as an adjunct to diet and exercise, was associated with reduced body weight and improved metabolic control.
Q5a. Construct a 2×2 table usin” rel=”nofollow”>ing figures shown in” rel=”nofollow”>in the abstract, and answer the followin” rel=”nofollow”>ing questions:
(i) What is the risk of losin” rel=”nofollow”>ing at least 5% of body weight in” rel=”nofollow”>in all patients in” rel=”nofollow”>included in” rel=”nofollow”>in the study? [2 marks]
(ii) What is the risk of losin” rel=”nofollow”>ing at least 5% of body weight in” rel=”nofollow”>in patients who were treated with liraglutide? [2 marks]
(iii) What is the risk of losin” rel=”nofollow”>ing at least 5% of body weight in” rel=”nofollow”>in patients who were treated with placebo? [2 marks]
(iv) What is the relative risk of treatment with liraglutide versus placebo with regard to weight management? How would you in” rel=”nofollow”>interpret this relative risk estimate? [4 marks]
Q5b. If equal numbers of patients in” rel=”nofollow”>in the population were treated with liraglutide vs placebo treatment, what would be the expected population relative risk reduction (RRR) for liraglutide
treatment? How would you in” rel=”nofollow”>interpret this measure? [4 marks]
Q5c. How many patients need to be treated with liraglutide for one more patient to benefit compared with the placebo? What is this measure called? How would you in” rel=”nofollow”>interpret this measure [4 marks]
Q5d. How does the measure in” rel=”nofollow”>in question 5b differ from question 5c? [4 marks] 3
Imagin” rel=”nofollow”>ine that you have read the full report of the origin” rel=”nofollow”>inal research study discussed in” rel=”nofollow”>in Question 5, now answer Questions 6 to 8:
Q6. What characteristics of the study would you consider in” rel=”nofollow”>in order to determin” rel=”nofollow”>ine if its fin” rel=”nofollow”>indin” rel=”nofollow”>ings are valid? Include wider considerations of study quality/validity and give examples. (Q8 will address
relevance, and the next question will ask how to determin” rel=”nofollow”>ine the importance of the fin” rel=”nofollow”>indin” rel=”nofollow”>ings…for this question, focus on the in” rel=”nofollow”>internal validity of the study) [16 marks]
Q7. What characteristics of the fin” rel=”nofollow”>indin” rel=”nofollow”>ings would you consider, in” rel=”nofollow”>in order, to determin” rel=”nofollow”>ine if they are clin” rel=”nofollow”>inically meanin” rel=”nofollow”>ingful and statistically significant? Include examples. (You’ve already addressed
validity…for this question, focus on how to determin” rel=”nofollow”>ine the clin” rel=”nofollow”>inical significance and statistical significance of an effect reported in” rel=”nofollow”>in the study) [8 marks]
Q8. What characteristics of the study would you consider, in” rel=”nofollow”>in order, to determin” rel=”nofollow”>ine if it is generalizable to your context? Explain” rel=”nofollow”>in your answers and provide examples. (Questions 6 and 7 have asked how
to determin” rel=”nofollow”>ine if the study is valid, and how important the fin” rel=”nofollow”>indin” rel=”nofollow”>ings are….for this question, focus on how to determin” rel=”nofollow”>ine if it is really relevant or generalizable to your practice.) [8 marks]

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