Clinical Epidemiology 401173: Research Questions and PICO Analysis

This assignment focuses on the application of the PICO (Population, Intervention, Comparison, Outcome) framework in formulating research questions within the field of clinical epidemiology. It presents several scenarios related to public health issues such as malaria prevention, stroke treatment, multi-drug resistant tuberculosis, and childhood obesity. For each scenario, the task involves crafting a focused research question and identifying the corresponding PICO elements. Additionally, the assignment requires the development of a search strategy for locating relevant clinical literature, including the selection of appropriate keywords, MeSH terms, and Boolean operators. It also explores suitable study designs, such as systematic reviews, for addressing the research questions. The final part includes citing a relevant article using a referencing style. Desklib is a valuable resource for students, providing access to a wide range of past papers and solved assignments to support their learning.

RUNNING HEAD: INRODUCTION TO CLINICAL EPIDEMIOLOGY 1
Introduction to clinical epidemiology
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INTRODUCTION TO CLINICAL EPIDEMIOLOGY 2
Introduction to clinical epidemiology
Answer questions 1-4 based on the following scenarios:
Q1: You have just travelled to Thailand for a 4-week student exchange program, where you
now have the opportunity to work with experts in a leading research institute in the country.
During your visit, you observed that malaria remains a significant health issue, particularly
among children and pregnant women. The Institute Director wants to reduce the number of
child deaths and maternal mortality due to malaria in a particular endemic-community. She
has proposed that insecticide-treated bed nets may be appropriate for use among children and
pregnant women, and has asked for you to gather evidence to inform the development of a
malaria prevention study. 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).
The research question in this case would be: Is insecticide treated nets an appropriate
method in the prevention of Malaria among children and pregnant women?
b. Identify the PICO elements in your research question
PICO is a scientific process that guide on research about a clinical problem.
Apparently, PICO is an acronym where P means population, the patient or problem in
question as well. I stands for the Intervention measures while C is comparison, control
or comparator as well .Finally, O stands for the Outcome. Based on this scenario, the
patients or population are both children and pregnant women while the problem is
mortality due to malaria infection. The other I element of the PICO is intervention and
in this scenario it is the Insecticide treated nets. Apparently for outcome in this scenario
is absent since the Intervention under study is not being compared to any other
intervention process. Finally O for outcome in this case implies reduced mortality rates
after the intervention of insecticide treated nets is in full swing.
Q2: Scott, a 78-year-old man with a history of hypertension and atrial fibrillation was
discharged from the hospital following a fall. At a follow-up appointment in your GP
practice, his wife Julie asks whether there is a better alternative to warfarin, a blood thinning
medication, which he has been taking to prevent stroke. Her friend’s husband has recently
been put on a newer blood-thinning medication (Rivaroxaban) which doesn’t require regular
international normalisation ratio (INR) testing, a standardised measurement of the time it
takes for blood to clot. Julie finds it difficult to get her husband to the pathology collection
centre because he is quite immobile. She asks what whether the new blood-thinning
medication could be an option for her husband in stroke prevention. 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).Based on this
Scenario, the best research question would be: Is blood thinning medication an effective
method of treating stroke among aged males as compared to warfarin?
b. Identify the PICO elements in your research question
PICO stands for patient, problem and population. In my research question in this
scenario, P are the aged individual’s i.e. 78 year old Julies husband as well as the
husband to her friend. The problem in this case is stroke. I stands for intervention and
in this case it is warfarin since this was the initial prescription to Julies Husband by the
doctors. C stands for comparison or comparator and in my research question it is Blood
thinning medication since we are to compare its effectiveness to the warfarin
medication. Finally it is the outcome and in this scenario, the desired outcome is to
prevent or rather treat stroke among the aged males.

INTRODUCTION TO CLINICAL EPIDEMIOLOGY 3
Q3: In the past 2 years, as a Consultant in Infectious Diseases in one of the tertiary hospitals
in Sydney, you have attended to 15 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).Based on this
scenario, my research question would be, what are the risk factors associated with
MDR-TB among the Migrant populations?
b. Identify the PICO elements in your research question. In my research question, P stands
for the problem and the population or patient. The patient in this scenario are the
migrants and the problem is the risks due to the MDR-TB. Apparently, Intervention
and comparison are missing in my research question because we are only investigating
the risk factors.
Q4: The Director of the Research and Strategic Policy Unit in New South Wales (NSW)
Health has just read a non-government health report for Western Sydney, which indicates that
the region has the highest burden of childhood obesity in Australia. You have been
approached to gather evidence (to submit a research proposal) on patterns of overweight and
obesity, and provide advice on strategies to reduce the burden of childhood obesity in the
community because she wants an independent research facility to conduct a study to better
understand the health issue. 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). According to
this scenario, the general research question could be: What are the main causes of
obesity in children and what can be the best strategies to reduce obesity in children?
b. Identify the PICO elements in your research question Page 3 of 7.
As explained earlier, PICO is an acronym used in research for clinical problems and it
stands for population, patient and Problem. In this case therefore stands for children as
the patient and population the Obesity is the Problem. I stands for intervention and in
this case it is missing and that is the focus of the research now. C for comparison in this
case is also missing since there is no alternative intervention measures being compared
to. Finally, O stands for outcome and based on this scenario, the outcome is reduced
cases of Obesity among Australian children.
Q5: Now choose ONLY ONE research question from any of the questions above (Q1–4) that
will help you organise 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]. In this
scenario, I would use the evidence-based literature search approach. The key words I
would search for are obesity, children and Australia and finally strategies to reduce
obesity in children. The MeSH terms in this case would be Obesity as well as
Interventions for Obesity. The inclusion criteria would be anything related to obesity
among children while the exclusion criteria will involve around anything that is not
related to children. The Boolean operators are AND, OR. In this case I will use AND to
relate obesity and intervention strategies among the children.

INTRODUCTION TO CLINICAL EPIDEMIOLOGY 4
b. Explain your rationale for taking this approach and explain your reasoning [2 marks]. The
aim of using the evidence based search strategy is to find out the work that has already
been published in that line and build on that to make a new research and conclusion.
c. What type of study design would best be able to address your selected research question?
State why [1 marks]. The best study design that I would utilise in this scenario is the
Systematic review design. Which involves reviewing different literature materials to
come up with a substantial information and conclusion.
d. Cite the best article from among those you find, using any referencing style of your choice
[1 marks].
(Dobbins, DeCorby, Robeson, Husson, & Tirilis, 2009)

INTRODUCTION TO CLINICAL EPIDEMIOLOGY 5
References
Dobbins, M., DeCorby, K., Robeson, P., Husson, H., & Tirilis, D. (2009). School-based
physical activity programs for promoting physical activity and fitness in children
and adolescents aged 6-18. Cochrane Database of Systematic Reviews.
doi:10.1002/14651858.cd007651