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PUBH6005_Assessment Brief 4 Page 1 of 8 ASSESSMENT BRIEF Subject Code and Title PUBH6005: Epidemiology Assessment Assessment 4: Critical Appraisal Essay Individual/Group Individual Length 2,500 words Learning Outcomes This assessment addresses the following learning outcomes: 1. Apply common epidemiological concepts including incidence and prevalence of disease, mortality and survival and age standardisation 2. Recognise the role of exposure to biological, behavioural, social and environmental risks in disease patterns 3. Differentiate between different types of research designs, including observation and experimental and mixed methods designs 4. Assess levels of evidence and make recommendations 5. Interpret data arising from surveillance and research studies, including rates and ratios 6. Understand the difference between association and causation, statistical and public health significance 7. Analyse the role of epidemiology in screening and prevention programs, and assess the sensitivity and specificity of programs 8. Critically evaluate epidemiological studies, including potential for bias, confounding and chance errors 9. Identify key health indicators and sources of data Submission Due Sunday following the end of Module 6 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). PUBH6005_Assessment Brief 4 Page 2 of 8 Instructions: Thousands of health and medical research studies are published each year, often reporting conflicting conclusions for the same issue. Therefore, a critical appraisal of studies to determine the strengths and weaknesses of research articles is the cornerstone of evidence based policy development, program development and implementation, hospital and primary care, health promotion and chronic disease management. This module builds on the last one where we learned to evaluate the validity of observed associations. We saw in module 2 how well designed research studies emanate from a research hypothesis or a research question. In this module, students will learn to identify the objective of a published study, judge its appropriateness and determine the suitability of the study design against the stated objective(s). Students will also learn to critically appraise data collection procedures, identify possible sources of bias and the adequacy of the analysis, as well as the quality of reporting and interpretation of the findings. Whether the study addresses ethical issues such as conflicts of interest will also be considered. A number of frameworks have been developed to assist in the critical appraisal of published research articles. Students in this module will be introduced to some of the more commonly used frameworks, such as the Critical Appraisal Skills Program Checklists. In module 3 we learned how different study designs provide different levels of reliability to support their findings depending on the objective of the study. This has been codified into what is termed a ‘hierarchy of evidence’ – from the strongest (based on the synthesis of many studies) to the weakest (simple descriptive studies). Students will be introduced to the two hierarchies of evidence that are accepted by the Australian Government’s National Health and Medical Research Council (NHMRC) (GRADE Working Group 2004, Hillier et al. 2011). Students will have the opportunity to practice their appraisal skills in the final assignment which is due at the end of Module 6. To prepare for this assignment First consider this article on antimicrobial resistance. http://www.bbc.co.uk/guides/z8kccdm Antimicrobial resistance is an emerging global public health problem that has been linked to the use of antibiotics by the livestock industry, doctors over prescribing antibiotics and people not taking a full course of antibiotics. Construct a research question that seeks to address a specific aspect of the issue of antimicrobial resistant bacteria. Select 5 studies relevant to your research question about antimicrobial resistant bacteria (a mixture of observational and RCTs, supporting and not supporting the hypothesis). Rank the studies according to the FORM (Hillier et al., 2011) or GRADE levels of evidence (The GRADE Working Group, 2008). Review the frameworks in the Learning Resources (Bonita et al., 2006, Rychetnick et al.,2006, Young & Solomon, 2009 and the critical appraisal skills program (CASP) checklist). Write a 2,500-word paper that includes: http://www.bbc.co.uk/guides/z8kccdm PUBH6005_Assessment Brief 4 Page 3 of 8 An introduction - introduces the topic, outlines background information to your research question and finishing with the research question. This sets the context for the rest of the assignment. Methods - explain how you found the five articles that you critically reviewed, including the databases you used and the search strategy/keywords you searched with. Also mention which checklist/method you used to critically appraise the articles. o NOTE: be consistent and use the same source for all of your studies - suppose you had an RCT, a case-control study, a cohort study and a cross sectional study, you need to use checklists from the same source (for example, each of the different CASP checklists). This ensures that your approach to reviewing the articles is consistent across the different study types. Results – first rank the studies using either the FORM (Hillier et al 2011) or GRADE levels of evidence (The GRADE Working Group, 2008), then critically appraise the studies using one of the frameworks outlined in the Learning Resources (Bonita et al. 2006, Rychetnick et al. 2002, Young and Solomon, 2009 or the CASP checklists). You can put this information in a table. Include an assessment of the suitability of the study design to answer the research question, analysis of the potential for bias, confounding and chance errors, and an evaluation of ethical considerations, but stick to factual statements here – interpretation of the findings should be written in the: Discussion - outline your interpretation of the findings, conclude which is (are) the highest quality study(ies) and why, discuss the potential for study findings to be implemented in policy and practice, and make recommendations to address any gaps in the literature. Also include a discussion of limitations near the end of that section.; Conclusion – one concluding paragraph summarising the key points from the paper. Resources for this assignment Required Resources Bonita, R. Beaglehole, R., & Kjellström, T. (2006). Basic epidemiology (2nd ed.). Geneva, Switzerland: World Health Organization. o Chapter 11, “First Steps in Practical Epidemiology” NHMRC (2009). NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Retrieved from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evid ence_120423.pdf Hillier, S., Grimmer-Somers, K., Merlin, T., Middleton, P., Salisbury, J., Tooher, R. & Weston, A. (2011) FORM: An Australian method for formulating and grading recommendations in evidence- based clinical guidelines. BMC Medical Research Methodology. 11:23. Laurier Library. (2013, October 13). Developing a research question. [Video file]. Retrieved from: http://www.youtube.com/watch?v=Ga7w-czB7lo [5:07] Rychetnick, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluating evidence on public health. Journal of Epidemiology and Community Health, 56, 119-127. Skelly, A. C., Dettori J. R., & Brodt, E. K. (2012). Assessing bias: the importance of considering confounding. Evidence Based Spine Care Journal, 3(1), 9-12 The GRADE Working Group (2004) Grading quality of evidence and strength of recommendations. British Medical Journal. 328 1490-1494. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf http://www.youtube.com/watch?v=Ga7w-czB7lo PUBH6005_Assessment Brief 4 Page 4 of 8 Young, J.M., & Solomon, M.J. (2009). How to critically appraise an article. Nature Clinical Practice Gastroenterology and Hepatology. 6, 82-91. Critical appraisal skills program checklists. Retrieved from http://www.casp-uk.net/#!casp-tools- checklists/c18f8 Assessment Criteria: Knowledge and understanding critical appraisal procedures including search strategies and the hierarchy of evidence accepted by the Australian Government National Health and Medical Research Council (20%). Critical analysis of five articles using one of the frameworks listed in the Learning Resources (30%). Interpretation of the findings of the critical appraisal to reach a conclusion as to the quality of the studies and their potential to be implemented in policy and practice (30%). General assessment criteria (20%): o Provides a lucid introduction o Shows a sophisticated understanding of the key issues o Shows ability to interpret relevant information and literature in relation to chosen topic o Demonstrates a capacity to explain and apply relevant concepts o Shows evidence of reading beyond the required readings o Justifies any conclusions reached with well-formed arguments and not merely assertions o Provides a conclusion or summary o Correctly uses academic writing, presentation and grammar: Complies with academic standards of legibility, referencing and bibliographical details (including reference list) Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction Uses appropriate APA style for citing and referencing research http://www.casp-uk.net/#!casp-tools-checklists/c18f8 http://www.casp-uk.net/#!casp-tools-checklists/c18f8 PUBH6005_Assessment Brief 4 Page 5 of 8 Marking Rubric: Assessment Attributes 0-34 (Fail 2 – F2) Unacceptable 35-49 (Fail 1 – F1) Poor 50-64 (Pass -P) Functional 65-74 (Credit - CR) Proficient 75-84 (Distinction – DN) Advanced 85-100 (High Distinction – HD) Exceptional Grade Description (Grading Scheme) Evidence of unsatisfactory achievement of one or more of the learning objectives of the subject, insufficient understanding of the subject content and/or unsatisfactory level of skill development. Evidence of satisfactory achievement of subject learning objectives, the development of relevant skills to a competent level, and adequate interpretation and critical analysis skills. Evidence of a good level of understanding, knowledge and skill development in relation to the content of the subject or work of