discussion

SOURCES OF ERROR IN POPULATION-BASED RESEARCH

INTRODUCTION

This week, you will review different sources of error in population-based research, focusing on bias and confounding. Bias refers to deviations of results, or inferences, from the truth (Friis & Sellers, 2021). There are two overarching types of bias: information bias and selection bias. Both types can be detrimental to the validity and reliability of results. Several strategies exist to help prevent bias, but it is virtually impossible to eliminate bias altogether.

 

In addition to bias, confounding variables can pose challenges for epidemiologists. Confounding is the masking of an association between an exposure and an outcome because of the influence of a third variable that was not considered in the study design or analysis. For example, if weight loss is the topic of study and exercise is the only variable considered, diet could mask the results of the study.

 

LEARNING OBJECTIVES

 

Students will:

 

· Analyze nursing practice implications of bias, confounding, and random error in epidemiologic and population health research

 

· Propose strategies to minimize sources of error in population research

 

· Differentiate epidemiologic measures and measurement errors 

 

This is a graded discussion: 100 points possible

 

Week 6: Blog

 

BLOG: CRITIQUING SOURCES OF ERROR IN POPULATION RESEARCH TO ADDRESS GAPS IN NURSING PRACTICE

 

As a DNP-educated nurse, part of your role will be to identify the differences, or gaps, between current knowledge and practice and opportunities for improvement leading to an ideal state of practice. Being able to recognize and evaluate sources of error in population research is an important skill that can lead to better implementation of evidence-based practice.

 

In order to effectively critique and apply population research to practice, you should be familiar with the following types of error:

 

Selection Bias

 

Selection bias in epidemiological studies occurs when study participants do not accurately represent the population for whom results will be generalized, and this results in a measure of association that is distorted (i.e., not close to the truth). For example, if persons responding to a survey tend to be different (e.g., younger) than those who do not respond, then the study sample is not representative of the general population, and study results may be misleading if generalized.

 

Information Bias

 

Information bias results from errors made in the collection of information obtained in a study. For example, participants’ self-report of their diet may be inaccurate for many reasons. They may not remember what they ate, or they may want to portray themselves as making healthier choices than they typically make. Regardless of the reason, the information collected is not accurate and therefore introduces bias into the analysis.

 

Confounding

 

Confounding occurs when a third variable is really responsible for the association you think you see between two other variables. For example, suppose researchers detect a relationship between consumption of alcohol and occurrence of lung cancer. The results of the study seem to indicate that consuming alcohol leads to a higher risk of developing lung cancer. However, when researchers take into account that people who drink alcohol are much more likely to smoke than those who do not, it becomes clear that the real association is between smoking and lung cancer and the reason that those who consume alcohol had a higher risk of lung cancer was because they were also more likely to be smokers. In this example, smoking was a confounder of the alcohol-lung cancer relationship.

 

Random Error

 

The previous three types of errors all fall under the category of  systematic errors, which are reproducible errors having to do with flaws in study design, sampling, data collection, analysis, or interpretation.  Random errors, on the other hand, are fluctuations in results that arise from naturally occurring differences in variables or samples. While unavoidable to a small degree even under the most careful research parameters, these types of errors can still affect the validity of studies.

 

RESOURCES

 

Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources. 

 

WEEKLY RESOURCES

 

LEARNING RESOURCES

 

Required Readings

 

· Curley, A. L. C. (Ed.). (2020).  Population-based nursing: Concepts and competencies for advanced practice (3rd ed.). Springer.

 

· Chapter 4, “Epidemiological Methods and Measurements in Population-Based Nursing Practice: Part II”

 

Friis, R. H., & Sellers, T. A. (2021).  Epidemiology for public health practice (6th ed.). Jones & Bartlett.

 

· Chapter 10, “Data Interpretation Issues”

 

· Enzenbach, C., Wicklein, B., Wirkner, K., & Loeffler, M. (2019).  Evaluating selection bias in a population-based cohort study with low baseline participation: The LIFE-Adult-StudyLinks to an external site. .  BMC Medical Research Methodology,  19(1), Article 135. https://doi.org/10.1186/s12874-019-0779-8

 

· Khalili, P., Nadimi, A. E., Baradaran, H. R., Janani, L., Rahimi-Movaghar, A., Rajabi, Z., Rahmani, A., Hojati, Z., Khalagi, K., & Motevalian, S. A. (2021).  Validity of self-reported substance use: Research setting versus primary health care settingLinks to an external site. .  Substance abuse Treatment, Prevention, and Policy,  16(1), Article 66. https://doi.org/10.1186/s13011-021-00398-3

 

· Karr, J. E., Iverson, G. L., Isokuortti, H., Kataja, A., Brander, A., Öhman, J., & Luoto, T. M. (2021).  Preexisting conditions in older adults with mild traumatic brain injuries.  Brain Injury, 1–9  Download Preexisting conditions in older adults with mild traumatic brain injuries. Brain Injury, 1–9 . Advance online publication. https://doi.org/10.1080/02699052.2021.1976419

 

TO PREPARE:

 

· Review this week’s Learning Resources, focusing on how to recognize and distinguish selection bias, information bias, confounding, and random error in research studies.

 

· Select a health issue and population relevant to your professional practice and a practice gap that may exist related to this issue.

 

· Consider how each type of measurement error may influence data interpretation in epidemiologic literature and how you might apply the literature to address the identified practice gap.

 

· Consider strategies you might use to recognize these errors and the implications they may have for addressing gaps in practice relevant to your selected issue.

 

Post a cohesive scholarly response that addresses the following:

 

· Describe your selected practice gap.

 

· Explain how your treatment of this population/issue could be affected by having awareness of bias and confounding in epidemiologic literature.

 

· Explain two strategies researchers can use to minimize these types of bias in studies, either through study design or analysis considerations.

 

· Finally, explain the effects these biases could have on the interpretation of study results if not minimized.

A 41-year-old man presents to his PCP with feelings of hopelessness, sadness, and helplessness. He says that he cries for no reason, and has difficulty sleeping. He noticed that the problems began about 6 weeks before, and he did not feel able to shrug them off. He has been drinking more alcohol than usual and has stopped going to work. When on his own, he admitted that he had thought of driving his car into the nearest canal.

 

1. Summarize the clinical case.

 

2. What is the DSM 5-TR diagnosis based on the information provided in the case?

 

3. Which pharmacological treatment would you prescribe including the name, dose, route and frequency of the drug in accordance with the clinical guidelines? Include the rationale for this treatment.

 

4. Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment  excluding a psychotherapeutic modality.

 

5. Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5

Getting started with your literature review

 

Activity 1: Module 1 Discussion Board

 

This is the second foundational course for your dissertation project. Much of your success is contingent on working closely with your chair. Thus, communication is essential. You will have both formal and informal touchpoints through this course and throughout your dissertation journey. Each touchpoint is aimed to gauge your progress, answer questions, provide and clarify feedback, and to provide general guidance and support.

 

1. Post the final version of chapter one

 

2. Post any literature review you completed in the comp exam class

 

3. Propose ideas for gathering research as you begin the process of developing a literature review

 

Post your response to the prompt and schedule an appointment with your chair.

 

Organizing your literature

 

Activity 3: Module 3 Discussion Board

 

Complete an initial search of 5-10 research studies to gain ideas for your literature review. Search for key words from your research questions for your initial review. Save the research studies, you find interesting for your literature review. If it is easier for you to complete a summary of the research as you read it, then write a few paragraphs for each study.

 

Organizing your research is also important as you begin to gather quite a few sources. Think about how you might organize your literature to easily find studies when needed. You can also refer to the file system you created in the Comp Exam class.

 

1. Discuss your findings from your initial research, what you found interesting and any apparent gaps in the literature.

 

2. Discuss how you will organize the literature you collect.

 

Post your response to the prompt.

 

Submit a detailed outline for your literature review that includes all key ideas for your study. Your chair must approve your outline before moving forward.

 

Gathering research and writing your literature review

 

Activity 5: Module 5 Discussion Board

 

Now that your chair has approved your outline, you can begin to gather research studies for each section of your literature review and write your literature review. You should write at least five pages every week for your literature review. Your completed literature review will be a minimum of 30 full pages. Begin by reading your research, hi-lighting the information you want to summarize, and then in your own words writing a few paragraphs about each reference.

 

Discuss any issues that arise as you begin to gather your research for the literature review.

 

Post your response to the prompt

 

Unbiased research

 

Activity 7: Module 7 Discussion Board

 

When writing your literature review, it is important to remain unbiased. You should not develop an idea of where you want the research to go because you will follow your opinion. There is no opinion in a literature review. If you feel strongly about a subject, you may have difficulty seeing the research in an unbiased way.

 

 

 

A literature review is about reporting a summary of the research you read without bias. You may read one study, hi-light information contained in that study, and then summarize the study in your own words while writing several paragraphs for your literature review. Complete research about what bias means as it relates to research.

 

Write a few paragraphs about what bias means as it relates to research. What can you do to avoid using bias while writing your literature review?

 

Post your response to the prompt.

 

The ethical research process.

 

Activity 9: Module 9 Discussion Board

 

Giving credit where credit is due means you are ethically using valid research and citing it properly in your literature review. Part of the process of completing your dissertation is to be open and honest when gathering research. It is important that you read the study, summarize in your own words what you read, and write that summary with the proper citations.

 

Discuss the ethical research process and how that applies to your literature review Post your response to the prompt.

 

Gaps in the literatures

 

Activity 11: Module 11 Discussion Board

 

As you research and write your literature review, you may notice gaps in the literature. When this occurs, it is important that you add a section to your literature review mentioning those gaps. These may become ideas for future research when you are in chapter five of your dissertation.

 

Discuss the literature gaps you found while researching for your literature review, and how this information might change the direction of your study.

 

Post your response to the prompt.

 

Literature review revisions

 

Activity 13: Module 13 Discussion Board

 

Using background of the problem information in your study is important, but it should not be the focus of your literature review. Ensure that you use the background information appropriately and that it has a place in your literature review.

 

Review feedback received from your committee about your literature review.

 

Discuss the feedback received from your committee with your chair.

 

Post your response to the prompt.

 

Literature review revisions

 

Activity 15: Module 15 Discussion Board

 

Depending on your dissertation topic, you may identify business systems and themes that need to be covered in your literature review. If needed, you will need to add a section to your literature review for these business systems and themes.

 

Your committee may have additional changes or updates they would like to see for your literature review.

 

Discuss any additional chapter revisions with your chair and create a path forward to finalizing the chapter.

 

Post your response to the prompt.

1. Follow these guidelines when completing the paper.

 

a. Select a “Speak Up Campaigns” brochure from The Joint Commission website.

 

b. Write a short paper reviewing the brochure. Use the Grading Criteria (below) to structure your critique.

 

c. Include current nursing or healthcare journal articles (must be Evidence from a recent (5 years) scholarly nursing journal article ) to support your critique.

 

2. INCLUDE THE FOLLOWING SECTIONS IN PAPER:

 

a. Introduction of brochure (10 points/10%)

 

i. Includes brochure title

 

ii. Identifies date published

 

iii. Describes individuals or groups

 

iv. Brochure properly cited, included on reference list and submitted with assignment

 

b. Summary of brochure (20 points/20%) -brochure citation required

 

i. Review the main topics in the brochure.

 

ii. Includes information to promote communication between patients and healthcare providers.

 

iii. Reflects on why this topic is of interest to you?

 

c. Evaluation of brochure (30 points/30% total (4 points each) (Brochure & nursing article must be cited)

 

i. Was the information provided in the brochure beneficial? Could you incorporate it in your patient education?

 

ii. What was done well, and what could have been improved in the brochure?

 

iii. Was the information presented clearly?

 

iv. Did current nursing or healthcare related research support the information presented in the brochure?

 

v. What population or individuals does this brochure apply to (i.e., who will benefit the most from this brochure)?

 

vi. Who else can use this information?

 

vii. Will this information increase patient safety?

 

d. Clarity of Writing (20 points/20%)

 

i. Information presented in a logical progression.

 

ii. Section headers used:

 

iii. Summary of Brochure

 

iv. Patient Communication

 

v. Personal Reflection

 

vi. Evaluation of Brochure

 

vii. Evidence Review and Application

 

viii. Conclusion

 

e. Conclusion (10 points/10%)

 

i. Restates the purpose of the paper.

 

ii. Summarizes the main points of the paper.

 

iii. Summarizes the benefits of following the brochure’s advice to a person at risk.

 

f. APA style and structure (10 points/10%)

 

i. Uses appropriate APA format and is free of errors. 

 

ii. Paper is no longer than three (3) pages, excluding title page, reference page, and copy of brochure.

 

iii. Evidence from a recent (5 years) scholarly nursing journal article was integrated within the Evaluation of Brochure section to support your answers.

 

iv. Grammar and mechanics are free of errors.

In 3 pages, As a presenter, you will propose an evidence-based plan to improve the outcomes the patient in the provided case study, and examine how remote collaboration provided benefits or challenges to designing and delivering the care.

CASE STUDY:

 

INTRODUCTION

Hypothyroidism is a medical condition that occurs when the thyroid gland doesn’t produce enough thyroid hormone. Providing evidence-based care for hypothyroidism can be challenging, especially when care is being provided remotely. In this case study, we will observe how healthcare professionals collaborate remotely and virtually to provide care for a patient with hypothyroidism.

 

PATIENT INFORMATION

 

The patient is a 50-year-old female diagnosed with hypothyroidism. She lives in a rural area and has limited access to specialized endocrine care. The patient experiences symptoms such as fatigue, weight gain, and depression.

 

COLLABORATION PROCESS

 

The patient’s primary care nurse, Lisa, collaborates remotely with a team of healthcare professionals, including an endocrinologist, a pharmacist, and a nutritionist, to provide evidence-based care for hypothyroidism.

 

• Lisa: “Good afternoon, everyone. Thank you for joining this virtual meeting to discuss the care of our patient with hypothyroidism. Based on the patient’s symptoms and medical history, I believe she would benefit from a comprehensive treatment plan. I would like to hear your input and recommendations.”

 

• Endocrinologist: “Thank you, Lisa. I have reviewed the patient’s medical records and thyroid function test results. I agree that the patient has hypothyroidism and requires a comprehensive treatment plan. I recommend initiating hormone replacement therapy, including levothyroxine, to restore her thyroid hormone levels and improve her symptoms.”

 

• Pharmacist: “I have reviewed the patient’s medication list and potential drug

 

interactions. It is crucial to ensure that the patient understands the proper use of

 

levothyroxine and the importance of adherence. I recommend providing education and counseling to the patient and her family on the correct medication administration and potential side effects.”

 

• Nutritionist: “I have been working with the patient to address any dietary factors that may be contributing to her hypothyroidism. We have discussed the importance of a balanced diet, including foods rich in iodine and selenium. I recommend providing education and counseling to the patient and her family on the importance of nutrition and lifestyle modifications.”

 

• Lisa: “Thank you all for your valuable input. I will incorporate your recommendations into the patient’s treatment plan. Let’s schedule regular virtual follow-up visits to monitor her progress, adjust medications if necessary, and provide ongoing support.”

 

Consider additional consultations that might be necessary as you develop your plan of care for this patient

 

Instructions:

 

For this assessment, you are a presenter!

 

Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in the case study presented. Add your thoughts on what more could be done for the patient and what more information may have been needed.

 

Discuss the ways in which an Evidence Based Practice model and relevant evidence helped you to develop and make decisions about the plan you proposed

 

Wrap up your assessment by identifying the benefits of the remote collaboration in the scenario, as well as discuss strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaborations challenges you observed in the scenario.

 

Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform your assessment. Discuss why these sources of evidence are credible and relevant. Important:

 

The following media is an example learner submission in which the speaker successfully addresses all competencies in the assessment.

 

Make sure that your assessment addresses the following grading criteria:

 

· Propose your own evidence-based care plan to improve the safety and outcomes for a patient in the provided case study. Proposes your own evidence-based care plan to improve the safety and outcomes for the Vila Health patient with the new case study added. Notes areas in which further information or data could have been useful in developing the plan.

 

· Explain the ways in which you used an EBP model to help develop your plan of care for the client. Explains the ways in which you used the specific evidence-based practice model to help develop your plan of care for the client. Notes ideas for how to evaluate the positive benefits to patient outcomes.

 

· Reflects on which evidence you collected in your search that was most relevant and useful when making decisions regarding the care plan. Discusses the rationale or criteria that was used to determine relevance and usefulness.

 

· Identifies benefits and proposes strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team. Discusses how interdisciplinary collaboration could be better leveraged to improve outcomes in future care situations.

 

· Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style.

 

· The reference list is from relevant and evidence-based (published within five years) sources, exhibiting flawless adherence to APA format.