Reference no: EM133266496
Question 1: Barbara, aged 75 years, has osteoarthritis in both her knees and is currently taking long-acting paracetamol for her pain. She says her daughter had read that vitamin D improves knee pain and protects against loss of knee cartilage. Barbara had her vitamin D levels checked recently, and the level was in the normal range. Barbara would like to know if she should start taking vitamin D to help with her knee pain.
(a) List focused research question for this particular problem that will help you organize a search of the clinical literature for an answer.
(b) Identify the PICO elements in your research question.
Question 2: George, 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 normalization ratio (INR) testing, a standardized measurement of the time it takes for blood to clot. Julie finds it difficult to get her husband to the pathology collection center because he is quite immobile. She asks whether the new blood-thinning medication could be an option for her husband in stroke prevention
(a) List focused research question for this particular problem that will help you organize a search of the clinical literature for an answer.
(b) Identify the PICO elements in your research question.
(c) Describe the search strategy you would use to answer the research question you posed above. Include keywords, MeSH terms, inclusion and exclusion criteria, and how you would combine search terms using Boolean operators
(d) What type of study design would best be able to address your selected research question? State why?
(e) Run the search strategy you describe in Question 2(c) above, and cite the best article from among those you find, using any referencing style of your choice.
Question 3: A prospective cohort study of women, recruited in their first trimester of pregnancy from three hospitals in Norway, investigated whether acetaminophen use during pregnancy was associated with the subsequent development of Attention Deficit Hyperactivity Disorder (ADHD) among offspring over a 7-year follow-up period. Of the 9,386 women who were recruited into the study, 7,532 women completed questionnaires on acetaminophen use (and other factors) during the first, second, and third trimesters of their pregnancy. 'Acetaminophen use during pregnancy was reported among 3,849 women, and 'No acetaminophen use' was reported among 3,683 women. Cases of ADHD among offspring were obtained from the Norwegian Patient Registry (NPR), with cases defined based on an International Classification of Diseases, 10th Edition (ICD-10) diagnosis of ADHD. There were 87 cases of ADHD where the mother had reported 'acetaminophen use during pregnancy, and 63 cases of ADHD where the mother had reported 'no acetaminophen use during pregnancy over the 7-year follow-up period. Construct a table of these data, and use this information to answer the following questions:
(a) Calculate the risk of ADHD in offspring among all participants included in the study?
(b) Calculate the risk of ADHD in offspring among mothers who reported the use of acetaminophen during pregnancy.
(c) Calculate the risk of ADHD in offspring among mothers who reported no acetaminophen use during pregnancy?
(d) What is the relative risk of ADHD in offspring associated with acetaminophen use during pregnancy? How would you interpret this relative risk estimate?
(e) What would be the expected attributable proportion in the total population of mothers for acetaminophen use during pregnancy? How would you interpret this measure?
(f) How many mothers would need to use acetaminophen during pregnancy for one child to be diagnosed with ADHD, compared to mothers who do not use acetaminophen? What is this measure called? How would you interpret this measure?