-APA-825words-No plagiarism, will check with turnitin

-APA
-825words
-No plagiarism, will check with turnitin
Introduction to Clinical Epidemiology (401173)
FINAL ASSIGNMENT
Autumn, 2019
Due date: 11.59pm , May 29 2019
This assignment is based on the learning objectives and
concepts as described in the Unit Learning Guide. There are 9
questions worth a total of 64 marks and this assignment will
contribute 64% towards the total assessment for this subject.
Your assignment should be typed, with adequate space left
between questions. Assignments should be submitted via
vUWS. Be as concise as possible in your answers, and use the
number of marks allocated to each question as a guide for how
much to write.
Please note this is an individual exercise.
Late assignments will not be accepted without prior approval.
You are required to answer ALL questions (1-9)

of 7
Answer questions 1-2 based on the following scenarios:
Q1: Fred, a 65-year-old obese man with a history of type 2
diabetes mellitus and hypertension presents to the GP practice
for a follow-up appointment. During the consultation, he asks
whether there is a better medication to glicazide and
metformin, his oral hypoglycemic medications, which he has
been taking to control his blood sugar. His friend has recently
been put on a newer oral hypoglycemic medication
(Liraglutide, a glucagon-like peptide-1 analogue), which has
been shown to help with weight management in patients with
diabetes and obesity. Fred has been finding it very difficult to
lose weight for a few years now as he has tried various
lifestyle modifications. He asks whether the new oral
hypoglycemic medications could be an option for him in weight
reduction.
Task [2 marks]
a. Write a focused research question for this particular
problem that will help you organise a search of the literature
for an answer (use the PICO elements as appropriate).
b. Identify the PICO elements in your research question
Q2: In the past 2 years, as an Infectious Disease Specialist in
one of the tertiary hospitals in Australia, you have attended to
23 migrant patients who were referred by their General
Practitioners with symptoms not typical of pulmonary
tuberculosis. After taking a detailed history and performing
appropriate physical examinations, as well as reviewing a

range of relevant investigations, you clinically diagnosed and
microbiologically confirmed that those patients have multi -
drug resistance pulmonary tuberculosis (MDR-TB). The Public
Health Department was notified of disease and the patients
were managed accordingly. Now, you and some colleagues
from Western Sydney University want to investigate the risk
factors for MDR-TB.
Task [2 marks]
a. Write a focused research question for this particular
problem that will help you organise a search of the literature
for an answer (use the PICO elements as appropriate).
b. Identify the PICO elements in your research question
Q3: Please select the single best answer for each of questions
3.I – VII
I. Randomised controlled trials provide strong evidence that an
observed effect is due to the intervention. One main reason is
because [1 mark]:
a) When the study participants are randomised, many
characteristics and potential confounders are likely to be
evenly distributed in the groups
b) It is easier to measure the outcome variable with great
precision in randomised controlled trials compared to other
study designs.
c) The exposure level and the outcome are measured at the
same time

d) The study participants are volunteers and therefore
motivated to take part in the study
e) None of the above
II.Blinding is an important feature of a randomised controlled
trials because [1 marks]:
a) It helps prevent measurement bias – the biased assessment
of outcomes
b) It helps reduce contamination and compliance problems
c) It helps reduce confounding and selection bias
d) It is required to do an intention-to-treat analysis
e) It helps improve chance event and reduce misclassification
III. Which of the following is true [1 mark]?
a) Loss to follow-up can lead to selection bias in cohort
studies.
b) Selection bias can arise from conditioning on the common
effect of the exposure and an uncontrolled independent risk
factor for the outcome.
c) Case-control studies are no more prone to selection bias
than are cohort studies.
d) Loss to follow-up is not a major source of bias in cohort
studies.
e) None of the above.
IV. When epidemiologists judge the evidence to establish a

possible cause of a health outcome, they
consider [1 mark]:
a) The strength of the association between an exposure and the
outcome
b) Evidence that the exposure of interest has appeared before
the outcome.
c) Evidence showing that reductions in the exposure level will
reverse the risk of the outcome.
d) A, B and C
e) A and B only
V. A double-blind study was designed to test the efficacy of a
drug. One group of the patients consisting of 1227 participants
were given a placebo and the other group of patients
consisting of 1220 were given the active drug. Both groups
were to be followed up for one year. After 6-months of the
trial, 35% of participants in the placebo groups dropped out of
the study and 4% of the participants taking the active drug
dropped out of the study. What is the SINGLE BEST
explanation for this occurrence [1 mark]?
a) Failure of the active drug
b) Insufficient information to interpret data
c) Systematic error
d) Chance event

e) Breakdown of the double-blind study
VI. The highest level of evidence provided for cancer
treatment usually comes from: [1 mark]
a) Randomised control trials
b) Phase II clinical trials
c) Phase III clinical trials
d) Systematic reviews of observational studies
e) Meta-analyses of intervention studies
Page 3 of 7
VII. A recent study examined the association between tea
consumption and ovarian cancer. The study included 414
women with primary epithelial ovarian, fallopian, or peritoneal
cancer and 868 age-and region-matched women with non-
neoplastic conditions. The adjusted odds ratio was 0.39 for
those drinking tea daily and 0.23 for those drinking tea for 30
years, compared with non-tea drinkers. The study concluded
that increasing frequency and duration of tea drinking,
especially green tea, can reduce the risk of ovarian cancer.
What type of study was conducted? [1 mark]
a) Cross-sectional study
b) Prospective cohort study
c) Randomised controlled trial

d) Retrospective cohort study
e) Case control study
Q4: Now select ONLY ONE research question from either
Question 1 or 2 above that will help you organize a search of
the clinical literature for an answer. If you were to search
Medline/PubMed/Web of science for original research on this
question:
a. Describe what your search strategy would be, including
keywords, MeSH terms, inclusion and exclusion criteria, as
well as evidence of the Boolean operators used [4 marks].
b. What type of study design would best be able to address
your selected research question? State why [1 mark].
c. Cite the best article from among those you find, using any
referencing style of your choice [1 mark].
Q5: Answer questions 5a-b based on the following information:
A total of 1800 patients have a screening test to identify a
protein called “FEN-59’ to determine patients at risk of lung
carcinoma, followed by a standardized lung biopsy procedure.
Of the 1800 children, 1533 have a negative FEN-59 and 267
have a positive FEN-59. In addition, a lung biopsy (gold
standard) was done on all patients. Of those patients with a
negative FEN-59, 1491 have a negative lung biopsy. In the
group with a positive FEN-59, 259 have a positive lung biopsy.
Construct a 2×2 table using the information provided above,
and answer the following questions (a and b):
a) Calculate the sensitivity of the FEN-59 [2 marks]

b) Calculate the positive predictive value of the FEN-59 [2
marks]
c) The negative predictive value is dependent on all of the
following: prevalence, incidence, sensitivity and specificity
[True/False] [1 mark]
Please select the SINGLE BEST answer in questions 5e to f
d) Using the image below, which value in the test result units
is the point of maximum specificity? [1 mark]
a) 30
b) 15
c) 5
d) 20
e) 25
e) A study was conducted in which 10,000 women
participated. All women underwent a cervical smear. 1,000 of
10,000 women had a positive smear. Of these, 100 developed
cervical cancer. 10 women who had negative smear developed
cancer. What is the SINGLE most likely terminology to
describe the 10 women with negative results who developed
cervical cancer?
The future of healthcare is focused upon improving patient
outcomes and patient satisfaction. Through the application of
research studies and theory, evidence based practice
development will lead the profession of nursing into the future
whereby knowledge and skills support the practice of providing

quality care.
Locate one nursing theory and one non-nursing paper theory.
Describe how two practitioners can bring these separate theories
together to provide meaningful patient care.
at least 4 reference and 3 parragraf
Please review the Discussion Board Participation grading rubric
under Course Resources. This is important information that will
ensure that you earn maximum points. Your postings should be
qualitative and provide substantive depth that advances the
discussion. Please see the Academic Success Center located in
the student portal for assistance with writing, APA, and online
communication.
[1 mark]
a. True negative
b. False negative
c. True positive
d. False positive
e. Chance event
Q6: Answer questions 6a-d based on the following information:
You have brought to the attention of the hospital medical
services that a published trial reported reduced body weight 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
findings during the weekly seminar series. In your
presentation, she has asked you to address the following
questions (6a-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
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 maintain through
lifestyle 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,
injected subcutaneously.
Methods: We conducted a 56-week, double-blind trial
involving 3731 patients who did not have type 2 diabetes and
who had a body-mass 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 a 2:1 ratio to
receive once-daily subcutaneous injections of liraglutide at a
dose of 3.0 mg (2487 patients) or placebo (1244 patients); both
groups received counselling on lifestyle modification.
Results: At week 56, patients in the liraglutide group had lost
a mean of 8.4±7.3 kg of body weight, and those in the placebo
group had lost a mean of 2.8±6.5 kg (a difference of -5.6 kg;
95% confidence interval, -6.0 to -5.1; P 0.001). A total of
63.0% of the patients in the liraglutide group as compared with
37.0% 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.
Q6a. Construct a 2×2 table using relevant figures shown in the
abstract, and answer the following questions: [4 marks]
(i) What is the risk of losing at least 5% of body weight in all
patients included in the study?
(ii) What is the risk of losing at least 5% of body weight in
patients who were treated with liraglutide?
(iii) What is the risk of losing at least 5% of body weight in
patients who were treated with placebo?
(iv) What is the relative risk of treatment with liraglutide
verus placebo with regard to weight manageme nt? How would
you interpret this relative risk estimate?
Q6b. If equal numbers of patients 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 interpret this measure?
[4 marks]
Q6c. 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 interpret this measure
[4 marks]?
Q6d. How does the measure in question 5b differ from
question 5c? [4 marks]

Read the attached original research article (Khorana et al.,
2019), available in vUWS), and now answer Questions 7 to 9:
Epidemiology paper – Family Nurse Practitioner
Requirements:
This paper should clearly and comprehensively identify the
chronic health disease:
Alcohol Addiction, as this is a chronic disease that is in high
prevalence here in Miami Florida that causes many health
disparities for the community
The paper should be organized into the following sections:
Introduction (Identification of the problem) with a clear
presentation of the problem as well as the significance and a
scholarly overview of the paper’s content. No heading is used
for the Introduction per APA current edition.
Background and Significance of the disease, to include:
Definition, description, signs and symptoms, and current
incidence and/or prevalence statistics by state with a
comparison to national statistics pertaining to the disease. 
Create a table of incidence or prevalence rates by your
geographic county/city or state with a comparison to national
statistics. Use the APA text for formatting guidelines (tables).
This is a table that you create using relevant data, it should not
be a table from another source using copy/paste.
Surveillance and Reporting: Current surveillance methods and
mandated reporting processes as related to the chronic health

condition chosen should be specific.
Epidemiological Analysis: Conduct a descriptive epidemiology
analysis of the health condition. Be sure to include all of the 5
W’s: What, Who, Where, When, Why. Use details associated
with all of the W’s, such as the “Who” which should include an
analysis of the determinants of health. Include costs (both
financial and social) associated with the disease or problem.
Screening and Guidelines: Review how the disease is diagnosed
and current national standards (guidelines). Pick one screening
test (review Week 2 Discussion Board) and review its
sensitivity, specificity, predictive value, and cost.
Plan: Integrating evidence, provide a plan of how a nurse
practitioner will address this chronic health condition after
graduation. Provide three specific interventions that are based
on the evidence and include how you will measure outcomes
(how will you know that the interventions have utility, are
useful?) Note:  Consider primary, secondary, and tertiary
interventions as well as the integration of health policy
advocacy efforts. All interventions should be based on evidence
– connected to a resource such as a scholarly piece of research.
Summary/Conclusion: Conclude in a clear manner with a brief
overview of the keys points from each section of the paper
utilizing integration of resources.
The paper should be formatted and organized into the following
sections which focus on the chosen chronic health condition.
Preparing the Paper:
Page length: 7-10 pages, excluding title page and references.
APA format current edition

Include scholarly in-text references throughout and a reference
list.
ASSIGNMENT CONTENT
Identification of the Health Problem
Comprehensively and succinctly states the problem/concern.
Clear presentation of the problem as well as the significance
with a scholarly overview of the paper’s content.
Background and Significance of the Health Problem
Background and significance is complete, presents risks, disease
impact and includes a review of incidence and prevalence of the
disease within the student’s state compared to national data.
Evidence supports background. A student created table is
included using APA format.
Current Surveillance and Reporting Methods
Current state and national disease surveillance methods are
reviewed along with currently gathered types of statistics and
information on whether the disease is mandated for reporting.
Supported by evidence.
Descriptive Epidemiological Analysis of Health Problem
Comprehensive review and analysis of descriptive
epidemiological points for the chronic health problem. The 5
W’s of epidemiological analysis should be fully identified.
Supported by scholarly evidence.

Screening, Diagnosis, Guidelines
Review of current guidelines for screening and diagnosis.
Screening tool statistics related to validity, predictive value,
and reliability of screening tests are presented.
Plan of Action
Integrating evidence, provide a plan of how a nurse practitioner
will address this chronic health condition after graduation.
Provide three specific interventions that are based on the
evidence and include how you will measure outcomes (how will
you know that the interventions have utility, are useful?) Note: 
Consider primary, secondary, and tertiary interventions as well
as the integration of health policy advocacy efforts. All
interventions should be based on evidence – connected to a
resource such as a scholarly piece of research.
Conclusion
The conclusion thoroughly, clearly, succinctly, and logically
presents major points of the paper with clear direction for
action. Includes scholarly references
Rubric
Introduction of Healthcare Problem/Concern
Comprehensively and succinctly states the problem/concern.
Clear presentation of the problem as well as the significance
with a scholarly overview of the paper’s content.
Background/Significance
Background and significance is complete, presents risks, disease
impact and includes a review of incidence and prevalence of the

disease within the student’s state compared to national data.
Evidence supports background. A student created table is
included.
Surveillance and Reporting
Current state and national disease surveillance methods are
reviewed along with currently gathered types of statistics and
information on whether the disease is mandated for reporting.
All writing is supported by evidence.
Descriptive Epidemiology
Comprehensive review and analysis of descriptive
epidemiological points for the chronic health problem. The 5
W’s of epidemiological analysis should be fully identified.
Supported by scholarly evidence.
Screening, Diagnosis, Guidelines
Comprehensive review of current guidelines for screening and
diagnosis. Screening tool statistics related to validity,
predictive value, and reliability of screening tests are presented
Plan
Integrating evidence, provide a plan of how a nurse practitioner
will address this chronic health condition after graduation.
Provide three specific interventions that are based on the
evidence and include how you will measure outcomes (how will
you know that the interventions have utility, are useful?) Note: 
Consider primary, secondary, and tertiary interventions as well
as the integration of health policy advocacy efforts. All
interventions should be based on evidence – connected to a
resource such as a scholarly piece of research.

Summary/Conclusion
The conclusion thoroughly, clearly, succinctly, and logically
presents major points of the paper with clear direction for
action. Includes scholarly references.
Format
APA is consistently utilized according to the 6th edition
throughout the paper.
Q7. What characteristics of the study would you consider in
order to determine if its findings are valid? Include wider
considerations of study quality/validity and give examples.
(Q8 will address relevance, and the next question will ask how
to determine the importance of the findings…for this question,
focus on the internal validity of the study) [8 marks]
Q8. What characteristics of the findings would you consider,
in order, to determine if they are clinically meaningful and
statistically significant? Include examples. (You’ve already
addressed validity…for this question, focus on how to
determine the clinical significance and statistical significance
of an effect reported in the study) [8 marks]
Q9. What characteristics of the study would you consider, in
order, to determine if it is generalizable to your context?
Explain your answers and provide examples. (Questions 6 and
7 have asked how to determine if the study is valid, and how
important the findings are….for this question, focus on how to
determine if it is really relevant or generalizable to your
practice.) [8 marks]
Note:
0 Please do not list the characteristics in questions 8–10, but

explain your answers succinctly.
0 For assistance with finding sources, refer to the
Current Peer-Reviewed, and Other Scholarly
Citation Sources
document. Carefully review the
Grading Rubric
for the criteria that will be used to evaluate your assignment.
0 You can also download the article from the University
Library using your student login details.

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