Healthcare Operations Management (Authors: Daniel B. McLaughlin & Julie M Hays). Review Chapter 1: The Challenge and the Opportunity (Introduction to Health

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From the library access the following text: Healthcare Operations Management (Authors: Daniel B. McLaughlin & Julie M Hays). Review Chapter 1: The Challenge and the Opportunity (Introduction to Health

From the library access the following text: Healthcare Operations Management (Authors: Daniel B. McLaughlin & Julie M Hays). Review Chapter 1: The Challenge and the Opportunity (Introduction to Healthcare Operations).http://web.a.ebscohost.com.ezproxy.trident.edu:2048/ehost/ebookviewer/ebook/ZTAwMHhuYV9fMTgzOTA2OF9fQU41?sid=44a46398-7b0b-4f72-b0e1-5a39cd5bce6a@sessionmgr4007&vid=0&format=EB&rid=1

Then, review common hospital operations problems at http://www.beckershospitalreview.com/hospital-management-administration/5-common-hospital-problems-and-suggestions-for-how-to-fix-them.html.

Select two of the problems identified in the above article and develop a 2- to 3-page paper assessing the reasons for the problems and possible solutions (recommended solutions should include a brief plan of action). In your paper, identity which of the ten action steps recommended by Institute of Medicine (IOM) to close the quality chasm is applicable to each selected problem. The ten action steps can be found on pages 6 and 7 of  the text or at the following link: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf

SLP Assignment Expectations

  1. Conduct additional research to gather sufficient information to support your identification of problems and recommended solutions
  2. Limit your response to a maximum of 3 pages.
  3. Support your SLP with peer-reviewed articles, with at least 2 references. Use the following source for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.
  4. You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

According to the Agency for Healthcare Research and Quality (2002), “a central goal of healthcare quality improvement is to maintain what is good about the existing healthcare system while focusing

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According to the Agency for Healthcare Research and Quality (2002), “a central goal of healthcare quality improvement is to maintain what is good about the existing healthcare system while focusing

According to the Agency for Healthcare Research and Quality (2002), “a central goal of healthcare quality improvement is to maintain what is good about the existing healthcare system while focusing on the areas that need improvement” (para. 2). This assignment will familiarize you with the quality improvement (QI) approaches and models that health care administrators can effectively apply.

Case Assignment

Use the library to access the following book:

Joshi, M. S., Ransom, E. R., Nash, D. B., & Ransom, S. B. (Eds). (2014). The healthcare quality book: Vision, strategy, and tools. (3rd ed.) Chicago, IL: Health Administration Press. Retrieved from Trident Online Library. 

Link:https://library-books24x7-com.ezproxy.trident.edu/toc.aspx?site=EWMAW&bookid=74367

Review Chapter 4, Quality Improvement: Foundation, Processes, Tools, And Knowledge Transfer Techniques. There are six approaches/models of quality improvement discussed in Chapter 4.

Create an 8- to 10-slide PowerPoint (PPT) to discuss three of the six approaches/models of quality improvement discussed. Your presentation should address the following explicitly:

  1. Explanation and/or reasoning for the importance of using quality improvement as a health care administrator. 
  2. The steps, stages, or processes of each selected approach/model.
  3. Example of health care administrator’s applicable use of each selected approach/model.

Assignment Expectations

  1. Speaker notes, citations, and a reference slide are required.
  2. Conduct additional research to gather sufficient information to support the information presented in PPT.
  3. Support your case with peer-reviewed articles, with at least 2 references (you can use the book as one reference). Use the following source for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.
  4. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/

3.Which antihypertensive agents are recommended for patients with diabetes?

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Riquerments:  APA format.  at least 1 reference.  more 120 words,collage style.      L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine h

Riquerments:  

APA format.  

at least 1 reference. 

 more 120 words,collage style.     

 L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia.      L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.  Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.  Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.  One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.        

Questions    

1.What are the effects of controlling BP in people with diabetes?     

2.What is the target BP for patients with diabetes and hypertension?    

 3.Which antihypertensive agents are recommended for patients with diabetes?

Before starting the regimen, you need to develop a medication summary that includes: A) the most likely reason you are taking each medication, B) Any medication interactions C) Special administration

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Before starting the regimen, you need to develop a medication summary that includes: A) the most likely reason you are taking each medication, B) Any medication interactions C) Special administration

Before starting the regimen, you need to develop a medication summary that includes: A) the most likely reason you are taking each medication, B) Any medication interactions C) Special administration instructions D) the actual dosing schedule (when do you plan to take these medication) E) rationales for timing decisions. You may use any format (a table, pre-printed card, etc.) to develop a medication schedule. I need to see this schedule prior to you starting the regimen to receive points in this section.

List of medication

Acetaminophen 500mg. take 1 capsule by mouth twice daily.

Simvastatin 10mg tabs. Take 1 tablet by mouth.

Senokot 8.6mg tabs, take 1tablet by mouth twice daily.

Captoril 25 mg tabs, take 1 tablet by mouth twice daily.

Furosemide 40mg tabs, take 1 tablet by mouth daily 

1 page urgent task. The topic in briefDifferentiation and Management of Abdomen, Anus/Rectum, and Genitourinary Disorders- code 0030005002019AAType of Service Assignment Urgency: 2 to 3 hoursNo.

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1 page urgent task. The topic in briefDifferentiation and Management of Abdomen, Anus/Rectum, and Genitourinary Disorders- code 0030005002019AAType of Service Assignment Urgency:  2 to 3  hoursNo.

1 page urgent task. 

The topic in brief

Differentiation and Management of Abdomen, Anus/Rectum, and Genitourinary Disorders- code 0030005002019AA

Type of Service Assignment 

Urgency:  2 to 3  hours

No. of Pages/Wordcount 

1 page

*******************************

Topic 1: Differentiation and Management of Abdomen, Anus/Rectum, and Genitourinary DisordersPlease select a disorder of the GU, abdomen, anus/rectum systems (pelvic inflammatory disease, cervicitis, STDs, UTI, prostatitis, balanitis, urethritis, epididymitis, testicular torsion, hydrocele, epispadias, rectal prolapse, hemorrhoids, GERD, appendicitis, cholecystitis) and answer the following questions:1.What are the presenting symptoms?2.How is it distinguished from other similar disorders (assessment findings, common in particular age/sex or ethnic group, etc.)?3.What is your first intervention?4.How will you confirm the diagnosis?5.What is the appropriate treatment?6.Write a prescription to treat the illness (if applicable or refer to appropriate specialty if needed) that includes (patient name, date, name of drug, dose, and strength, quantity to dispense, directions of how often to take the medicine, and number of refills).7.When will you schedule a follow-up appointment and what is your plan on the follow up visit

***************

Attached file available to the selected winning bidder 

· Describe the follow-up and referral for this patient.

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Diabetes Case StudyChief Complaint“My left foot feels weak and numb. I have a hard time pointing my toes up.”History of Present IllnessD.T. is 42-year-old Caucasian woman who has had an elevated b

Diabetes Case Study

Chief Complaint

“My left foot feels weak and numb. I have a hard time pointing my toes up.”

History of Present Illness

D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.

Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.

Past Medical History

·         Seasonal allergic rhinitis (since her early 20s)

·         Breast biopsy positive for fibroadenoma at age 30

·         Gestational diabetes with second child 10 years ago

·         Multiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bath

·         Hypertension for 10 years

Past Surgical History

C-section 14 years ago

OB-GYN History

·         Menarche at age 11

·         Last pap smear 3 years ago

Family History

·         Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.

·         Mother alive and well

·         Father has COPD

·         Two other siblings alive and well

·         All three children are alive and well

Social History

·         Married 29 years with 3 children; husband is a school teacher

·         Family lives in a four bedroom single family home

·         Patient works as a seamstress

·         Smokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per week

·         Denies illegal drug uses

·         Never exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.

Allergies

NKDA

Medications

·         Lisinopril 10 mg daily

·         Loratadine 10 mg daily

Review of Systems

General

Admits to recent onset of fatigue

HEENT

Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking

Cardiac

Denies chest pain, palpitations, and difficulty breathing while lying down

Lungs

Denies cough, shortness of breath, and wheezing

GI

Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation

GU

Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence

EXT

Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tingling or numbness in arms or legs prior to this episode

Neuro

Has never had a seizure and denies recent headaches

Derm

Has a rash under her bilateral breast and in groin area

Endocrine

Denies a history of goiter and has not experienced heat or cold intolerance

Vital Signs

BP 165/100, T 98 F, P 88 regular, HT 5 feet 4 inches, RR 20 non labored, WT 210 lbs

What you need to do:

·         Develop an evidence-based management plan.

·         Include any pertinent diagnostics.

·         Describe the patient education plan.

·         Include cultural and lifespan considerations.

·         Provide information on health promotion or health care maintenance needs.

·         Describe the follow-up and referral for this patient.

·         Prepare a 3–5-page paper (not including the title page or reference page).

Format

The paper should be no more than 3–5 pages (not including the title page and reference pages

Diabetes Case Study

Chief Complaint

“My left foot feels weak and numb. I have a hard time pointing my toes up.”

History of Present Illness

D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.

Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.

Past Medical History

·         Seasonal allergic rhinitis (since her early 20s)

·         Breast biopsy positive for fibroadenoma at age 30

·         Gestational diabetes with second child 10 years ago

·         Multiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bath

·         Hypertension for 10 years

Past Surgical History

C-section 14 years ago

OB-GYN History

·         Menarche at age 11

·         Last pap smear 3 years ago

Family History

·         Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.

·         Mother alive and well

·         Father has COPD

·         Two other siblings alive and well

·         All three children are alive and well

Social History

·         Married 29 years with 3 children; husband is a school teacher

·         Family lives in a four bedroom single family home

·         Patient works as a seamstress

·         Smokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per week

·         Denies illegal drug uses

·         Never exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.

Allergies

NKDA

Medications

·         Lisinopril 10 mg daily

·         Loratadine 10 mg daily

Review of Systems

General

Admits to recent onset of fatigue

HEENT

Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking

Cardiac

Denies chest pain, palpitations, and difficulty breathing while lying down

Lungs

Denies cough, shortness of breath, and wheezing

GI

Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation

GU

Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence

EXT

Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tingling or numbness in arms or legs prior to this episode

Neuro

Has never had a seizure and denies recent headaches

Derm

Has a rash under her bilateral breast and in groin area

Endocrine

Denies a history of goiter and has not experienced heat or cold intolerance

Vital Signs

BP 165/100, T 98 F, P 88 regular, HT 5 feet 4 inches, RR 20 non labored, WT 210 lbs

What you need to do:

·         Develop an evidence-based management plan.

·         Include any pertinent diagnostics.

·         Describe the patient education plan.

·         Include cultural and lifespan considerations.

·         Provide information on health promotion or health care maintenance needs.

·         Describe the follow-up and referral for this patient.

·         Prepare a 3–5-page paper (not including the title page or reference page).

Format

The paper should be no more than 3–5 pages (not including the title page and reference pages

Approx 150-180 words APA format with references and in-text citations response to the discussion below.

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Approx 150-180 words APA format with references and in-text citations response to the discussion below. The term “Evidence-Based Practice” (EBP) was fairly new when I was entering nursing schoo

 Approx 150-180 words APA format with references and in-text citations response to the discussion below. 

The term “Evidence-Based Practice” (EBP) was fairly new when I was entering nursing school in 1999. Although it made sense that nursing practice was based on academic research and findings, many nurses have passed down traditions simply based on the notion that “it has always been done this way”. I can remember this new term, and the exciting thought that nursing would be more valued and respected with a greater emphasis on practice based in facts and best outcomes. I became an RN in 2004, and I have worked in the psychiatric field for the majority of my career. The American Psychiatric Nurses Association (APNA) was my chosen healthcare organization website. This can be found at https://www.apna.org/i4a/pages/index.cfm?pageid=1 . Although I was already somewhat familiar with what the website had to offer, I gained a greater understanding and admiration for this site as I dug a little deeper.

The Institute of Medicine’s Roundtable on Evidence-Based Medicine put an emphasis on three major areas: a learning healthcare system, generating evidence to support effective healthcare strategies, and improving public awareness regarding the importance of EBP in healthcare (Melnyk, & Fineout-Overholt, 2018). The APNA website contributes to the IOM’s goal of improving public awareness related to EBP. This is evident in the numerous resources on the website from academic journals, continuing education (conferences and CEU’S), standards of practice updates, and also the ability to find information about academic programs and scholarships. The Journal of the American Psychiatric Nursing Association is a peer-reviewed journal which publishes original research, practice-focused articles, editorials, and interviews. One tab entitled “Reports & Surveys” shares the latest national reports and surveys covering topics related to the future of nursing and nurses’ health.

Although the website is not entirely based in EBP (some tabs are related to the organization and membership) it is clear that its goal is to promote the understanding of psychiatric nursing through the recent solid research. One item available for free via ebook to members (and for sale to non-members) is “Psychiatric-Mental Health Nursing: Scope and Standards of Practice”. This spells out important aspects of psychiatric-mental health nursing- the who, what, when, where, and how of practice- at various levels and in multiple settings. The latest edition was published with the input and expertise of psychiatric nurses from the APNA and the International Society of Psychiatric-Mental Health Nurses (ISPN). Goals established prior to the easy access of the internet are able to be met not only through scholarly articles, but with new styles of sharing information and with a culture of networking to filter out the most relevant, and timely information.

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. doi:10.1111/wvn.12126

https://www.apna.org/i4a/pages/index.cfm?pageid=1

Laureate Education (Producer). (2018). Introduction to Evidence-Based Practice and Research [Video file]. Baltimore, MD: Author.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.Hide 

150-180 words APA format with references and in-text citations.

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150-180 words APA format with references and in-text citations. Health literacy, along with health numeracy skills, can influence the quality of care delivery across the spectrum of settings and is v

150-180 words APA format with references and in-text citations. 

Health literacy, along with health numeracy skills, can influence the quality of care delivery across the spectrum of settings and is vital to maintaining patients’ engagement in their own health. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness” (Health Resources and Services Administration [HRSA], 2015).  

The ineffectiveness of healthcare literacy in the current health care climate is not a new issue, however it is as relevant as ever. People need information they can understand and use to make the best decisions for their health. When organizations or people create and give others health information that is too difficult for them to understand, we create a health literacy problem. When we expect them to figure out health services with many unfamiliar, confusing or even conflicting steps, we also create a health literacy problem (Brach, C., Keller, D., Hernandez, L. M., Baur, C., Dreyer, B., Parker, R., … Schillinger, D., 2012).

 Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease (Marshall, E., & Broome, M., 2017).  Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.

Despite the growing interest in health literacy, little research has been done around health professionals’ knowledge of health literacy or understandings of the barriers to health literacy that patients face when navigating the health care system.  Improving both the healthcare workers knowledge and those of their patients decreases the barriers that prevent patients from seeking and receiving proper care (Loan, L., Parnell, T., Stichler, J., Boyle, D., Allen, P., & Barton, A., 2017).

Health literacy may cover choosing and comparing different health plans, prescription drug premiums, copays, and deductibles. As medical science is continuously evolving and progressing, it is easy to understand how health information can confuse and even overwhelm the average healthcare consumer. Improving health literacy is the responsibility of health organizations, healthcare systems, and healthcare professionals worldwide. It is critical for patients to develop health literacy so that they can take a more proactive role in their health. When patients are actively engaged, they are able to make more informed decisions which increases patient satisfaction, adherence, and can ultimately improve outcomes(Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., & Smylie, J., 2015).  Patient empowerment, engagement, activation, and maximized health outcomes will not be achieved unless assurance of health literacy is applied universally for every patient, every time, in every health care encounter, and across all environments of care (Loan, L., Parnell, T., Stichler, J., Boyle, D., Allen, P., & Barton, A., 2017).

References

Brach, C., Keller, D., Hernandez, L. M., Baur, C., Dreyer, B., Parker, R., … Schillinger,

  D. (2012). Ten attributes of health literate health care organizations. Washington, DC:

    Institute of Medicine. Retrieved from http://www.ahealthyunderstanding.org/

         Portals/Documents1/IOM Ten Attributes Paper.pdf

Health Resources and Services Administration. (2015). Health literacy. Washington, DC:

     Author. Retrieved from http://www.hrsa.gov/publichealth/healthliteracy/

Lambert, M., Luke, J., Downey, B., Crengle, S., Kelaher, M., & Smylie, J. (2015). Health

   literacy: Health professionals’ understandings and their perceptions of barriers that

     Indigenous patients encounter. Biomed Central Health Services Research,14.

      doi:10.1186/s12913-014-0614-1

Loan, L., Parnell, T., Stichler, J., Boyle, D., Allen, P., & Barton, A. (2017). Call for

   action: Nurses must play a critical role to enhance health literacy. The Journal of the

     American Academy of Nuring,66(11), 97-100. doi:10.1016/j.11003

Marshall, E., & Broome, M. (2017). Transformational Leadership in Nursing (2nd ed.).  

    New York, NY: Springer.

b. Describe whether the program is effective and offer evidence to support your rationale.

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Medicaid and the Middle ClassDescriptionPart I: Medicaid is not just for low-income people. The American middle class benefits significantly from the Medicaid program. In a 4 page synopsis, analyze a

Medicaid and the Middle Class

Description

Part I: Medicaid is not just for low-income people. The American middle class benefits significantly from the Medicaid program. In a 4 page synopsis, analyze a specific Medicaid program that seeks to benefit the middle class in the state in which you reside (Illinois). Please keep in mind the position and facility you selected. Make sure to include the following:

a. Discuss the purpose of the program.

b. Describe whether the program is effective and offer evidence to support your rationale.

c. Discuss other viewpoints or opposing viewpoints to the program.

d. This portion of your assignment will require you to research and examine information from various sources. Use a minimum of five credible sources for your paper, with three being an academic source from the Rasmussen College Online Library (don’t forget to include in-text citations throughout your paper with paraphrasing or quoting)

e. Make sure to include your APA formatted reference page. 

Part II: It’s tough for healthcare professionals to keep up with all the programs offered through the government. Based on the position and facility you selected, create a one-page information sheet for our staff that they can use to answer questions. SkillSurfer in the online tutoring platform offers beginner, intermediate, and advanced tutorials on Microsoft Office products. 

a. The information sheet should give your staff enough information to have an educated conversation with a patient about their healthcare coverage options through Medicaid.

b. Make sure to use audience specific language and tone in your information sheet. Remember, you are writing this information sheet for your staff.

c. Be creative and make your information sheet fun and organized.

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 Un

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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 Un

 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) Page 1 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? [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 management? 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: 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 You can also download the article from the University Library using your student login details. Hide