MDSC: Skills for medical sci: full notes PDF

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Page 1

Introduction to PBR Origins of Medicine & Epidemiology: -

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Originated from Hippocrates o 2000 years ago o Ancient Greek physician o Considered “Father of Medicine” Hippocrates separated religion from medicine o Disease was not punishment from the Gods – o Observation that diseases occurred as a result of environmental factors

Origins & Developments in Epidemiology: -

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John Snow o 1800s physician, considered one of the fathers of modern epidemiology o Risk of cholera infection traced back & related to contaminated drinking water in London By 1900s o Comparing rates of diseases in human population o Communicable diseases o Chronic non‐communicable diseases

Definition of Epidemiology:

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Study o Includes: surveillance, observation, hypothesis testing, analytical research, and experiments Distribution o Refers to: analysis of times, persons, places, and classes of people Determinants o Include factors that influence health: biological, chemical, physical, social, cultural, economic, genetic, and behavioural Health-related states & events o Refer to: diseases, causes of death, behaviours (e.g., tobacco use), positive health states, reactions to preventive regimes and provision of health services Specified populations o Includes: people with specific identifiable characteristics (e.g. occupational groups; elderly; children aged 4-16yo etc.) Application to prevention & control o The aims of public health – to promote, protect & restore health Lab research o Applies knowledge of basic sciences towards development of procedures and strategies to prevent, control and understand mechanisms of health-related states Disease Outbreak Investigations

Study of outbreaks of disease. For example, those that cross international borders ( ); or those in local populations ( ). Aim to identify agent(s), mode(s) of transmission, and control measure(s) for prevention Population-Based Research o study of distribution, determinants of health-related states in specified populations ▪ Investigating human populations ▪ Followed by application of relevant biostatistics to analyse results and apply knowledge to the general population o

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Scientific knowledge:

Epidemiology Research: -

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Lab research: applies knowledge of basic sciences towards development of procedures and strategies to prevent, control and understand mechanisms of health-related states Disease outbreak investigations: study of outbreaks of disease, e.g. epidemics (cross international borders); or endemics (local populations), aim to identify agent, mode of transmission, and control measures for prevention Population based research: study of distribution, determinants of health-related states in specified populations o Investigating human populations o followed by application of relevant biostatistics to analyse results and apply knowledge to the general population

Grant Assignment Database searches: -

Outline search terms and use (AND/OR/NOT)

Study design: -

The study design should highlight, what type of study are you undertaking, a double-blind, placebo control? Basically, has to discuss what is your design of the study and in hopes to achieve

Study population: -

It highlights the age range of participants It highlights the gender of the participant For example, children aged 6-12 as the trial specifically seeks to investigate the effect of the prophylaxis on children. Male and female; trial is not gender discriminatory (100 group a, 100 group b, 100 group c)

Inclusion criteria: -

The requirement required by the participant to be able to participate. For example, dealing with cranberry juice and PAC. o We should write the inclusion criteria as, ▪ Had at least one prior UTI to be able to test recurrence ▪ No neurological abnormalities as these may implicate the data collected ▪ Written consent from an English speaking and literate parent or guardian ▪ A parent or guardian present at all stages of testing to ensure child protection and consensual activity

Exclusion criteria: -

If the participants do not meet the requirement of the study, they would be excluded For example, dealing with cranberry juice and PAC o We would write the exclusion criteria as, ▪ Older than 12, younger than 6; old enough to be toilet trained but has not yet begun pubescent development ▪ Allergic to cranberries as this would prevent the participant from being able to ingest the treatment

Exposure or Exposure(s): -

It should highlight the type of exposures a particular study type is receiving What are the different exposures given to the participants?

Outcome measure(s): -

How will you measure or assess what you are observing or treating? For example, development of skin cancer assessed by medical examination / blood test / skin biopsy & microscopy examination

Ethical Consideration: -

Ethics is the branch of philosophy that deals with distinctions between right and wrong – with the moral consequences of human actions Ethical principles govern the conduct of population-based research, as they do all human activities o The ethical issues that arise in research include:

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Voluntary participation & informed consent o Not coerced to participate o Participant signs an informed consent form Privacy : Confidentiality & Anonymity o De-identify participant & their data o e.g. assign study code 10-DS-G1 for anonymity o Confidentiality e.g. confidentiality forms; password protected information Human rights o No risk of harm Scientific integrity o No conflicts of interest

Disease Outbreak investigation -

Epidemiology: study of distribution and determinants of health states Can use epidemiological methods (PBR) for surveillance, prevention, and control of diseases

Epidemic: -

a notable excess of any disease over time in given region Often associated with acute outbreak of infectious or communicable disease e.g. cholera, point source epidemic May include non-communicable diseases o e.g. outbreak of lung cancer over past decade

Pandemic: -

Disease affects a large number of people and crosses many international boundaries o Epidemic of world-wide proportions o For example, plagues such as , ‘Spanish’ influenza, HIV, drug- resistant tuberculosis, Coronavirus

Disease Outbreak Terms: -

Endemic: constant presence of disease agent within given geographical area or population o For example, malaria Cluster: aggregation of relatively uncommon diseases in space and/or time in amounts that are perceived to be greater than expected by chance

Investigating Outbreaks: -

WHAT is the disease or condition in excess? WHO is ill? WHERE are they ill (location)? WHEN did they become ill? WHY did they become ill?

Steps to Investigating Outbreaks: 1. Recognise and confirm problem – if possible, compare with current incidence 2. Determine extent of outbreak o rapid initial survey of health services o how locates moderately ill? 3. Determine ‘population at risk’ – who has/may/not exposed to possible cause of outbreak 4. Develop hypotheses on possible causes o Case definition o Clustering by action o Epidemic curve 5. Collect and analyse data to test hypotheses – e.g. analyse foods eaten by those at risk 6. Modify hypothesis based on results 7. Implement control measures based on results o Organise treatment for cases o Eliminate or control source of disease 8. Evaluate effectiveness of control measures 9. Develop prevention strategies Main Sources of Notification: 1. Those reported associated with a single event (for example, wedding receptions, school camps) - List of attendees to conduct statistical investigation of outbreak - Use cohort study design - List of potential sources (foods served) - Likely pathogens determined from incubation periods and symptoms experienced o Pathogens usually unknown - As rely on reports from public, often will remain unreported to health departments. 2. -

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Those reported through routine surveillance (for example, outbreak at small goods factory) Associated with commercial food distribution Those exposed to source is not known, and many potential sources Use case-control study design Pathogen usually known May involve a local, state, or national level Require cooperation in surveillance system between o Health department o Medical practitioners o Infection control practitioners o Public health officials o Medical scientists may be difficult to investigate o Separate out non-outbreak associated cases o Select appropriate control group

Attack rates: -

Percentage of those who became ill of those who ate the food - Attack Rate = number of ill/total x 100 For example, hot chicken: 156 / 343 = 45% (number of those who became ill and consumed = 156, while total number of those who ate the chicken = 343) Thus, of those who ate hot chicken, 45% became sick

Relative Risk: -

Risk of illness in those who eat each food, relative to those who did not Relative risk = Attack rate of those who ARE exposed to the risk/Attack rate of those NOT exposed to the risk For example, peas: attack rate if ate / attack rate did not eat 45% / 30% = 1.5 Therefore, those who ate peas were 1.5 times more likely to become ill than those who did not

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Writing a Literature Review What is literature review? -

Defined by research question An account of what has been published on a topic by accredited scholars and researchers Conveys knowledge established on a topic, and strengths and weaknesses Explain how studies are similar and how they vary Identify new ways to interpret and shed light on gaps in previous research

When are they used? -

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Grants are used to apply for research funds o Sell research idea o Why should it be funded? Journal articles o Background information/overview of research concerning area of experimental study o Sometimes whole paper - Review First chapter in Honours, PhD or master’s thesis

Purpose -

Place each work in the context of its contribution to the understanding of the subject under review Describe the relationship of each work to the others under consideration Identify new ways to interpret and shed light on any gaps in previous research Identify areas of prior scholarship to prevent duplication of effort Point the way forward for further research

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An overview of the subject or issue under consideration, along with the objectives of literature review Categorise other work research studies o e.g. those in support of a particular position, those against, and those offering alternative ideas Explain how each of those studies are similar and also how they vary from each other Conclusions o Which information make the greatest contribution to the understanding and development of their area of research o Where to from here? o Suggest a gap in the knowledge of that area and your research will redress that lack of knowledge

Writing a literature review demonstrates your skills in: -

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Information seeking o Your ability to search the literature efficiently to identify a set of useful articles or other sources Critical appraisal o Your ability to apply principles of analysis to identify and assess the findings of those studies

Structure Literature review must: -

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Be organised around and related directly to the research question you are developing Synthesise results of other studies already done in that area into a summary of what is known and not known Identify areas of controversy in the literature Formulate questions that need further research Use an introduction to state the scope of your review Group ideas into sections o This helps you make comparisons and show relationships o Write a few lines to introduce the focus of each section Your review should not be a list describing or summarising one piece of literature after another You need to synthesise and evaluate the literature according to your research question Do not start each paragraph with the name of a researcher! Conclusion o Where to from here?

What are types of literature review: -

Journal articles (they are most often used as it provides up to date information and are reputable journals Books (they are meant for teaching and not usually for research, but it may be a good point to make you understand the basics of the research) Government/corporate reports (many government departments and corporations commission can carry out a research and can be useful for deriving statistical analysis and values)

Database Searches Conducted Section: 1. Good number of unique searches (5) and wide range of databases searched (5). 2. Search terms have included “AND” “OR” and asterisk as search operators. Could have included “NOT” for osteoarthritis. Searches were clear and written at a level that could be re-run if needed; searches were not overcomplicated. 3. Searches are clear and Limits have been applied where necessary. Issue with limit on first search, asking for a review in the database for Cochrane Reviews. Could have included more relevant limits here e.g. last 5 years. 4. 4. Comments relating to how the individual searches were written well and were useful to the reader. General outline for a literature review: What is the issue being addressed? -

Significance of the issue o Disease or condition common/nasty/expensive

What studies have been conducted previously?

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What did they find? What are the issues that remain? o Issue has not been studied. o Limited evidence? o Problems with current evidence?

What is the research question? -

How is the proposed study original? Why is it worthwhile

Journal articles: -

Most often used Good for up−to−date information Keep in mind that it can take up to two years to publish articles Frequently used in literature reviews as they offer a relatively concise, up−to−date format for research All reputable journals are refereed o Experts in a particular research field will review the submitted manuscript and recommend whether it gets accepted for publication or rejected!

Books: -

Textbooks are intended for teaching, not for research, but may be good starting point from which to find more detailed sources Help you get a basic understanding of the topic area Tend to be less up to date as it takes longer for a book to be published than for a journal article

Government/corporate reports: -

Many government departments and corporations commission or carry out research Gov. reports are useful for statistics e.g. ABS or AIHW

Plagiarism and Paraphrasing Academic integrity is about: -

Being honest in your academic work about whose ideas you are presenting Behaving ethically so that everyone is judged on the basis of their own work Protecting the value and reputation of Flinders University degrees

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Returning library materials intact so others can use them Not submitting part or all of other people’s work as if it were your own Acknowledging other authors’ ideas through referencing Not buying assignments off websites And any other practices unlikely to be approved by your peers and lecturers

The academic community expects honesty at all levels of academic work. Breaches of academic honesty include: -

Cheating in exams Falsifying data or results Copying the work of others Submitting the same piece of work for more than one topic (unless lecturers have indicated that this is appropriate) Providing another student with means of copying an essay or assignment Plagiarism

What is plagiarism? -

Plagiarism consists of using other people’s work or ideas and representing them as if they were one’s own. Plagiarism consists of using other people’s work or ideas and representing them as if they were one’s own. Express useful ideas, sentences, paragraphs, etc in your own words where possible to exhibit your understanding.

Plagiarism could take the form of: -

Not acknowledging sources of information Poor paraphrasing – work that too closely resembles the original expression Using the same structure or organisation of ideas as another person Presenting another’s ideas as if you had written them Forgetting to use quotation marks for a quote

Are all sentences referenced? -

When you are writing assignments, your sentences set the direction of your paper. Evidence and information are introduced to support the ideas that you are presenting. Unreferenced sentences are seen as your ideas and words. Referencing indicates ideas or words that come from someone else’s work.

What are the types of plagiarism? -

Uncited sources Cited sources

Uncited sources:

Cited sources:

Is this ok? Why/why not? -

Jane and Raid decide to do the same essay topic. They sit down together and talk about their ideas. They write an outline together, swap some papers they have sourced to save time, then write up their essays separately. o Jane and Raid decide to do the same essay topic. They sit down together and talk about their ideas. They write an outline together, swap some papers they have sourced to save time, then write up their essays separately. – This is no problem

4 Good reasons to reference: 1. To acknowledge other people’s work and ideas. (To show respect for their intellectual property). 2. To allow your work to be checked for accuracy. (For assessment purposes). 3. To allow interested readers to pursue the topic. (To develop knowledge). 4. To avoid being accused of plagiarism. (To maintain academic standards and the value of your degree).

Database research methods What are databases? -

Specialised tools for identifying research literature Search thousands of different resources Find peer-reviewed literature Vary in scope and focus Provide you with either citations or full text More complex, detailed searching

Which databases should I utilise? -

PubMed Web of Science Informit Health Database Collection ProQuest (Health & Medicine) Cochrane Library

How do I structure a search? -

Think of search terms e.g. identify concepts, think of synonyms Think of how to combine them e.g. using connectors, truncation, etc. Think of appropriate ways to narrow or filter your search

Does exposure to UV radiation tanning beds increase the risk of developing skin cancer in adults? -

(UV OR ultraviolet) AND (“tanning beds” OR “indirect tanning” OR artificial tanning) AND (skin cancer OR melanoma)

Cochrane library? -

Contains ‘systematic review’ articles, which can be useful as a way to learn of primary research. Systematic reviews are very specialised and take a long time to produce. So you might not find something on your exact topic. Instead, you can search for one or two concepts at a time.

Informit? -

Informit is a database of resources primarily from Australia. You can do a simple search, or… … click on ‘Advanced Search’ and break your search into the different concepts you are interested in. Please be aware that this database only searches the title and summary of each article, so you may find a limited number of results (although they will still be very useful!)

Web of Science? -

Web of Science contains a wealth of literature on the s...