PUBH6005: Epidemiology Assessment Assessment 3: Critical Appraisal

ASSESSMENT BRIEF
Subject Code and Title PUBH6005: Epidemiology
Assessment Assessment 3: Critical Appraisal
Individual/Group Individual
Learning Outcomes This assessment addresses the following learning outcomes:
1. Assess levels of evidence and make recommendations
2. Interpret data arising from surveillance and research studies, including rates and ratios
3. Understand the difference between association and causation, statistical and public health significance
4. Critically evaluate epidemiological studies, including potential for bias, confounding and chance errors
Submission Due Sunday following the end of week 11 at 11:55pm
AEST/AEDT*
Weighting 40%
Total Marks 100 marks
*Please Note: This time is Sydney time (AEST or AEDT). Please convert to your own time zone
(eg. Adelaide = 11:25pm).
Context:
This assessment requires you to apply the knowledge and skills gained in all the modules to undertake a
critical appraisal. You will need to appraise 3 articles of a topic and research question given to you by your
11/26/2019 52359 – ASSESSMENT BRIEFSubject Code and Title PUBH6005: EpidemiologyAssessment
https://www.australiabesttutors.com/Recent_Question/52359/ASSESSMENT-BRIEFSubject-Code-and-Title-PUBH6005-EpidemiologyAssessment 3/8
facilitator.
1. Search the library database to find three studies that answer your research question. All three studies
must be of different study designs. For instance, you could include case control, cohort and RCTs. These
studies do not have to prove their hypothesis or agree with each other. Please note that marks will be
deducted if all identified papers are of similar study.
2. Critically appraise all three articles you found. Your answers are to be written in the tables provided to
you which was based on CASP checklist and other types of checklist.
3. In the table, you are required to answer either “Yes”, “No”, “Unclear”.
4. For each of the answer of “Yes”, “No” or “Unclear”, you will need to provide the “Evidence” that you
found in the article to support your answers.
5. For each of the “Evidence”, you will need to critically appraise stating your justification, compare and
contrasting or/and providing solution. Please see table for an example of how “evidence” is written.
References: The quality of references used is important. “high quality
reference” is defined as articles which are peer-reviewed and published in notable international and
national journals. Articles such as
newspaper, websites, social media statements, unsolicited articles and
non-peer reviewed articles are not of “high quality reference”. You shall
Include all the sources you have used within your text and organize them in alphabetical order according
to APA 6th edition style. Please see
example of the quality and the style of referencing.
Table 3 Cohort study: The predictive and diagnostic accuracy of vascular endothelial growth factor and
pentraxin-3 in severe dengue (Low et al., 2018)
Critical appraisal questions Underline your answer
Did the study address a clearly focused issue? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The objective of this study was to evaluate VEGF and PTX-3 as predictive and diagnostic markers in
differentiating severe dengue from non-severe dengue. The objective is specific to evaluating the two
biomarkers among so many markers mentioned in the pilot study that was conducted before this study.
(Low, Gan, & Ho, 2015) The dengue classification (severe and non-severe) was validated, specific and
measureable. It was derived from the World Health Organisation dengue guideline. (World Health
Organization, 2009) The study also specifically evaluated the predictive and diagnostic accuracy of the
two markers.
Critical appraisal questions Underline your answer
Was the cohort recruited in an acceptable way? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The participants were recruited prospectively based on the eligibility criteria. All participants who are 15
years or older, presented only in the first 3 days of illness and a positive NS1 Ag test. However, it was
unclear of the definition of the “illness” as it can represent a specific onset of a symptoms or whether it is
due to fever. Majority of the existing studies defined the illness begin when patient developed fever.
(Ahmed, 2010; Kumar, Gittens-St Hilaire, & Nielsen, 2013; Mahboob et al., 2010) Based on Table 1, we
can assume that all patients were recruited based on the fever presented within the first 3 days of illness.
Suggestion to the author is to clearly define what is “illness”.
NS1 Ag is a standard diagnostic test but again, most other studies used Dengue IgM as confirmatory
method. (Mahboob et al., 2010; Tang et al., 2015; Thein et al., 2014) However, the author justified that
Dengue IgM and a more highly accurate RT-PCR was used to double confirm the NS1 Ag positive cases.
Critical appraisal questions Underline your answer
Was the exposure accurately measured to minimise bias? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
11/26/2019 52359 – ASSESSMENT BRIEFSubject Code and Title PUBH6005: EpidemiologyAssessment
https://www.australiabesttutors.com/Recent_Question/52359/ASSESSMENT-BRIEFSubject-Code-and-Title-PUBH6005-EpidemiologyAssessment 4/8
This study did not measure any exposure (environmental, social determinants, etc). Perhaps, the exposure
in this study was not the objective in assessing the biomarkers. The “exposure” here for this cohort study
should be defined as the biomarkers itself. Thus, the “exposure” is considered accurately measured by the
laboratory technique called as ELISA. (Dussart et al., 2008)
Critical appraisal questions Underline your answer
Was the outcome accurately measured to minimise bias? Yes/No/Unclear
_Assessment Brief 3 Page 3 o
Evidence: justification, compare and contrasting or/and providing solution
The outcome was the use of clinical dengue classification (World Health Organization, 2012). It was used
by the clinician/treating physician to diagnose the patients recruited. The accuracy of the WHO clinical
classification is well documented in other study citing that the “severe dengue” category has good
sensitivity and specificity. (Alexander et al., 2011)
Critical appraisal questions Underline your answer
Have the authors identified all important confounding factors? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Confounding factors such as age, sex and ethnicity have been identified. There were other confounding
factors such pregnancy; patient with autoimmune disorder, haematological disorder, cancer, cardiovascular
disease or on long term warfarin and aspirin. These were identified and it was excluded from the analysis.
The different days of illness could also affect the biomarker results and thus, this confounding factor has
been included into the statistical analysis.
Critical appraisal questions Underline your answer
Have they taken account of the confounding factors in the design and/or analysis? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
Confounding factors have been controlled for by exclusion (restricted analysis) and included into the
multivariate regression analysis.
However, possible confounding factor that the author has not taken into account was the treatment effect.
No analysis on the treatment in regards to the biomarker prediction. Perhaps, future study to evaluate these
biomarkers must include the types of treatment. Treatment for dengue are mainly fluid resuscitation and it
should be noted down on the different commonly used fluids for resuscitation in dengue. (World Health
Organization, 2012)
Critical appraisal questions Underline your answer
Was the follow up of subjects complete enough? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The follow up of the subjects were up to the day of discharge from the hospital or health care facility. This
should suffice as the patient recovered and free of the symptoms or complication of the disease. Other
studies did not have long follow-up, instead they used cross-sectional study as their study design. This
could possibly due to the availability of resources to support the long term follow-up. (Colbert et al., 2007;
Mairuhu et al., 2005; Thein et al., 2014)
Critical appraisal questions Underline your answer
Was the follow up of subjects long enough? Yes/No/Unclear
Evidence: justification, compare and contrasting or/and providing solution
The follow up of the subjects were up to the day of discharge from the hospital or health care facility. It
was the maximum duration of the patients can be follow-up. Though some patients might develop another
episode of dengue known as secondary dengue, this study has addressed their objective. It will be
interesting to have future study that also follow-up even longer period of time to identify sequelae and
11/26/2019 52359 – ASSESSMENT BRIEFSubject Code and Title PUBH6005: EpidemiologyAssessment
https://www.australiabesttutors.com/Recent_Question/52359/ASSESSMENT-BRIEFSubject-Code-and-Title-PUBH6005-EpidemiologyAssessment 5/8
secondary which is more common in dengue endemic countries/ tropical countries. (Guzmán et al., 2002;
Ludolfs, Schilling, Altenschmidt, & Schmitz, 2002) However, this depends on the resources available to
conduct such long-term study.
Add additional pages if needed
Reference:
Ahmed, M. M. (2010). Clinical profile of dengue fever infection in King Abdul Aziz University Hospital
Saudi Arabia. The Journal of Infection in Developing Countries, 4(8).
Alexander, N., Balmaseda, A., Coelho, I. C. B., Dimaano, E., Hien, T. T., Hung, N. T., … on behalf of the
European Union, W. H. O. (WHO-T. supported D. S. G. (2011). Multicentre prospective study on dengue
classification in four South-east Asian and three Latin American countries. Tropical Medicine &
International Health, 16(8), 936–948. http://doi.org/10.1111/j.1365-3156.2011.02793.x
Colbert, J. A., Gordon, A., Roxelin, R., Silva, S., Silva, J., Rocha, C., & Harris, E. (2007). Ultrasound
measurement of gallbladder wall thickening as a diagnostic test and prognostic indicator for severe dengue
in pediatric patients. The Pediatric Infectious Disease Journal, 26(9), 850–852. Retrieved from
http://journals.lww.com/pidj/Fulltext/2007/09000/ULTRASOUND_MEASUREMENT_OF_GALLBLADD
ER_WALL.18.aspx
Dussart, P., Petit, L., Labeau, B., Bremand, L., Leduc, A., Moua, D., … Baril, L. (2008). Evaluation of two
new commercial tests for the diagnosis of acute dengue virus infection using NS1 antigen detection in
human serum. PLoS Neglected Tropical Diseases, 2(8), e280. http://doi.org/10.1371/journal.pntd.0000280
Guzmán, M. G., Kourí, G., Valdés, L., Bravo, J., Vázquez, S., & Halstead, S. B. (2002). Enhanced severity
of secondary dengue-2 infections: death rates in 1981 and 1997 Cuban outbreaks. Revista Panamericana
de Salud Pública, 11(4), 223–227. http://doi.org/10.1590/S1020-49892002000400003
Kumar, A., Gittens-St Hilaire, M., & Nielsen, A. L. (2013). Epidemiological trends and clinical
manifestations of dengue among children in one of the English-speaking Caribbean countries.
Transactions of The Royal Society of Tropical Medicine and Hygiene, trt007.
Low, G. K. K., Gan, S.-C., Zainal, N., Naidu, K. D., Amin-Nordin, S., Khoo, C.-S., … Hatta, N. M.
(2018). The predictive and diagnostic accuracy of vascular endothelial growth factor and pentraxin-3 in
severe dengue. Pathogens and Global Health, 112(6), 334–341.
http://doi.org/10.1080/20477724.2018.1516417
Low, G. K. K., Gan, S. C., & Ho, S. C. (2015). Biomarkers in differentiating clinical dengue cases: A
prospective cohort study. Journal of Coastal Life Medicine, 3(12), 967–970.
Ludolfs, D., Schilling, S., Altenschmidt, J., & Schmitz, H. (2002). Serological differentiation of infections
with
dengue virus serotypes 1 to 4 by using recombinant antigens. Journal of Clinical Microbiology, 40(11),
4317–4320. http://doi.org/10.1128/JCM.40.11.4317-4320.2002
Mahboob, A., Iqbal, Z., Javed, R., Taj, A., Munir, A., & Saleemi, M. A. (2010). Clinical characteristics of
patients with dengue fever: Report of 48 patients in 2010. Journal of Ayub Medical College Abbottabad,
22(4), 23– 120.
Mairuhu, A. T. A., Peri, G., Setiati, T. E., Hack, C. E., Koraka, P., Soemantri, A., … Mantovani, A. (2005).
Elevated plasma levels of the long pentraxin, pentraxin 3, in severe dengue virus infections. Journal of
Medical Virology, 76(4), 547–552.
Tang, Y.-L., Chiu, C.-Y., Lin, C.-Y., Huang, C.-H., Chen, Y.-H., Destura, R. V, … Wu, H.-C. (2015).
Establishment and comparison of two different diagnostic platforms for detection of DENV1 NS1 protein.
International Journal of Molecular Sciences, 16(11), 27850–64. http://doi.org/10.3390/ijms161126069
Thein, T., Wansaicheong, G., Gan, V., Dimatatac, F., Go, C., Lye, D., & Leo, Y. (2014). Ultrasound and
chest X-ray in an adult patient with dengue. In 63rd Annual Meeting of the American Society of Tropical
Medicine and Hygiene, ASTMH 2013 (p. 91 (5 SUPPL. 1): 321). New Orleans, LA United States.
World Health Organization. (2009). Dengue guidelines for diagnosis, treatment, prevention and control.
(New ed). Geneva, Switzerland: WHO Press.
World Health Organization. (2012). Handbook for clinical management of dengue. Geneva, Switzerland:
WHO Press.

The post PUBH6005: Epidemiology Assessment Assessment 3: Critical Appraisal appeared first on Versed Writers.

WE WRITE ESSAYS FOR STUDENTS

Tell us about your assignment and we will find the best writer for your paper.

Write My Essay For Me