This document discusses various study designs used in medical research. It describes descriptive study designs like case reports, case series, ecological studies, and cross-sectional studies which are used to describe characteristics of subjects. It also describes analytical study designs like case-control studies and cohort studies which are used to analyze associations between exposures and outcomes. Experimental study designs like randomized controlled trials are also discussed which are used to evaluate interventions. Key aspects of each study design like their strengths, weaknesses and steps are highlighted.
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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5. Case report
• Identifying an unusual feature of a disease.
• First clue in identification of new disease.
• Documents an interesting medical oddity.
6. BMJ Case Reports 2016;
Severe hyponatraemia associated with pre-eclampsia
Breffini Anglim1, Kirk Levins1, Neidin Bussmann2, Mendinaro Imcha1
+ Author Affiliations 1Limerick Maternity Hospital, Limerick, Ireland
Summary
Pre-eclampsia is a multisystem disorder with incidence rates ranging from 2%
to 5%. Hyponatraemia is a rare complication of pre-eclampsia. A 41-year-old,
para 0+1 in vitro fertilisation monochorionic diamniotic triplet pregnancy woman
presented at 25 weeks with dyspnoea and general malaise. Her antenatal course was
complicated by the diagnosis of intrauterine growth restriction in triplet one at 27 weeks
of gestation. At 27+3 weeks gestation, she was diagnosed as having pre-eclampsia.
Subsequent biochemical analysis demonstrated hyponatraemia
with serum sodium falling steadily to 117 mmol/L over the next
19 days. She was admitted to intensive care unit for stabilisation of fulminant pre-
eclampsia and severe hyponatraemia at 30+5 weeks of gestation. Hypertonic saline and
intravenous labetolol were administered prior to delivery by caesarean section. She
recovered well postdelivery with stabilisation of her blood pressure and normalisation of
her sodium level to 135 mmol/L. Awareness and frequent monitoring of
hyponatraemia should become an integral part of monitoring
women with pre-eclampsia.
7. Case series
• Also known as clinical series.
• Study that tracks subjects with a known
exposure, such as patients who have received
a similar treatment, or examines their medical
records for exposure and outcome.
8. Delayed care seeking for fatal pneumonia in
children aged under five years in Uganda: A
case-series study (WHO Bulletin 2008)
• Objective To review individual case histories of children who had died of
pneumonia in rural Uganda and to investigate why these children did not
survive.
• Methods This case-series study was done in Uganda, where 67000 people were
visited once every 3 months for population-based data and vital events. Children
aged 1–59 months from November 2005 to August 2007 were included. Verbal
and social autopsies were done to determine likely cause of death and care-
seeking actions.
• Findings Cause of death was assigned for 164 children, 27% with pneumonia. Of
the pneumonia deaths, half occurred in hospital and one-third at home.
Most first received drugs at home: 52% antimalarials and 27% antibiotics. Most
were taken for care outside the home, 36% of whom first went to public hospitals.
• Conclusion There was mistreatment with antimalarials, delays in seeking
care and likely low quality of care for children with fatal pneumonia. To
improve access to and quality of care, the feasibility and effect on mortality of
training community health workers and drug vendors in pneumonia and malaria
management with prepacked drugs should be tested.
9. • What is the difference between Case report &
Case series?
10. Ecological studies (Correlational study)
• Associations between exposures and
outcomes in populations rather than in
individuals.
• Use data that has already been collected.
• Quick and cheap to conduct.
• Prone to Ecological fallacy.
12. Steps in cross-sectional studies
1) State the Objective
2) Define Study population
3) Define study setting
4) Specify study variables
5) Sample Size calculation
6) Describe sampling method
7) Data collection
8) Analysis
13. Prevalence of hypertension and its risk factors among
individuals attending outpatient department of rural
health training centre, Uttarakhand
INDIAN JOURNAL OF COMMUNITY HEALTH / VOL 26 / ISSUE NO 01 / JAN – MAR 2014
Abstract
Objectives: 1) To find out the prevalence of Hypertension in
study subjects 2) To identify the risk factors associated with
Hypertension. Materials and Methods: A Cross-sectional study
was carried out among 369 individuals of 30 years and above
attending Out Patient Department (OPD) in Rural Health Training
Centre (RHTC) under the Department of Community Medicine,
Government Medical College, Haldwani during June 2013-August
2013. A pretested predesigned questionnaire was used to collect
demographic data by interview technique .The blood pressure
was recorded and classified using JNC VII criteria to grade
hypertension.
18. Steps in Case-control studies
1) Selection of cases
2) Selection of controls
3) Matching
4) Measurement of exposure
5) Analysis – Odds ratio (strength of association
between risk factor and outcome).
20. Effect of potentially modifiable risk factors associated with
myocardial infarction in 52 countries ( INTERHEART
study): Case-control study
• Methods -Established a standardised case-control
study of acute myocardial infarction in 52 countries,
representing every inhabited continent. 15,152 cases
and 14,980 controls were enrolled.
• The relation of smoking, history of hypertension or
diabetes, waist/hip ratio, dietary patterns, physical
activity, consumption of alcohol, blood apolipoproteins
(Apo), and psychosocial factors to myocardial infarction
are reported here. Odds ratios and their 99% CIs for
the association of risk factors to myocardial infarction
were calculated.
21. Strengths of Case-control Study
• Relatively easy
• Rapid and inexpensive
• Establishes association (Odds ratio)
• Useful for generating hypotheses (multiple risk
factors can be explored)
22. Weakness of Case-control study
• Selection bias (appropriate controls)
• Recall bias.
• Incidence can not be calculated.
32. Strengths of cohort studies
• Incidence
• Can study multiple outcomes of a single
exposure.
• Dose-response ratios can be calculated.
33. Drawbacks of cohort studies
• Expensive
• Often need long follow-up period or a very large
population.
• Loss to follow-up can affect validity of findings.
42. RCT
• India’s first clinical trial to reduce hair loss in
cancer patients.
• To address hair loss after chemotherapy.
• Scalp cooling machine attached with two scalp
coolers.
( The Hindu Jan 19, 2017)
43. Non randomized controlled Trial
Types-
1) Uncontrolled trials
2) Natural experiments
3) Before and after comparison trials
44. Which study design do I choose?
1) Measuring incidence
2) Measuring disease burden (Prevalence)
3) Odd case
4) Comparing cases with others
5) Doing an intervention
