Issues of Clinical Epidemiology - Assignment Example

Clinical Epidemiology Affiliation: Question The PICO model in framing the clinical question The PICO elements will include Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome, and (optional) Time element or Type of Study. my areas of work specialization is offering patient care in the recovery facilities, hence leading to the following clinical question; a) Research question; does regular exercising during inpatient hospitalization help in reducing weight gain among psychiatric patients? The question above will thus include the PICO elements as shown in the table below; Example P (Problem or Patient or Population) psychiatric patients I (intervention/indicator) of engaging in regular exercises C (comparison) lack of exercise for admitted psychiatric patients O (outcome of interest) reduced health complications such as excessive weight In this question, the PICO elements are present, whereby P (population) targeted in research question is psychiatric patients, I (intervention) being the process of engaging in regular exercises. C (comparison) to the research intention is lack of exercise for admitted psychiatric patients, and O (outcome of interest) is to figure out the reduced health complications such as excessive weight. b) Significance of this clinical question Many guidelines exist that address on the screening of many complications associated to the admitted psychiatric patients, but little information is available on the investigation and appropriateness of engaging in regular exercises among the inpatient psychiatric patients. The existing current practices that involve physical therapy rarely touches on the needs of those patients diagnosed with psychiatric disorders, thus making this clinical question important (McDevitt et al., 2005). Adequate literature has been able to indicate that physical and psychological health has intimate relationship. Through this study, the study is looking for fitness-training program targeting inpatients having mental illness through a cute hospital setting. The physical fitness program will consist of a group of exercise sessions that are subject to conduct at least three times a week for inpatients with psychiatric disorder. In terms of evidence, this research will be aiming to figure out how physical fitness may help in enhancing self-esteem and the body image of all psychiatric inpatients through a unique way (Voderholzer et al., 2011). This information will be subject to apply to the population and setting by broadening studies that address on the special needs of the mentally disabled through a cute hospital settings. Question 2: Considering the outcome of study a) In defining the clinical outcome, there is a popularly held notion that considers physical fitness and psychological well-being to have a relation. The existing relationship between physical and the mental health has been a subject under postulation since the ancient Greek days (Rovner & Katz, 1993). However, physical therapy intervention program for those patients diagnosed with mental health disorders has been a common subject restricted to the patients associated with medical problems. In a traditional outlook, the goal of physical therapy has been subject to direct for relieving physical problems rather than altering the mental health status. For the recent decades, some psychiatric clinicians have started supplementing the more efficient and standard mental health treatment protocols with some programs aimed at promoting physical fitness. The clinical outcome expected from the study is the improved physical health of the patients, such as reduced weight, good metabolism, and achieving an entirely physical healthy body. This outcome is appropriate to the clinical question in that it describes the collaboration of physical fitness program that exists between the psychiatric inpatient units as compared to the physical therapy department through the modern hospital settings (Holley et al., 2011). Extensive research has been able to demonstrate that in both the healthy and mentally ill subjects; body fitness has association with the mood, the body image, the attitude, and the self-concept that help in speeding the patient through the psychiatric process. It is possible to measure the outcome on the effectiveness of regular physical exercise by subjecting a number of psychiatric patients to the study, and then compare the outcome of the study with those psychiatric patients that did not engage in any physical exercise. b) Evaluation on the method of measurement of this outcome The research on the topic will employ the use of a qualitative and combined research method, followed by conducting some analysis. The entire study will involve the use of a structured observational study on participants, thus gaining insights on their improved health conditions. i) The purpose of the measurement and whether this was appropriate to the clinical question The purpose of measurement aims at highlighting the difference between those participants that exercised regularly and comparing to the outcome to those participants that did not participate in the study. The participants for the study will be subject to choose on a random basis and their willingness to complete the entire study, whereby there will be need to have an equal balance between participants and the control group. This measurement was appropriate to the clinical question in that it addressed a real medical issue that faces the current society and involves all the health standards of procedures of conducting studies in a clinical setting (Meyer & Broocks, 2000). ii) The content validity of the measure The content validity of the measure in relation to the research question will be subject to evaluate by applying appropriate scientific calculations, such as finding the body mass index (BMI), weight loss and weight gain, and their progress towards the healing process. In the case where the outcome will show that people participating in regular exercise do not show any positive progress towards healing on their psychiatric disorders and no improvement on their weight, then the outcome of the study will not be valid. However, if the outcome will show some positive outcome from those participants in regular physical study than those who do not participate, then the outcome of the research will be valid. iii) The conceptual approach The conceptual approach of the study needs to achieve a number of purposes. These may include having priority setting and achieving the targeting of interventions, followed by monitoring on the effectiveness of the interventions together with the health care services, and summarizing with the help set that monitors and improves standards of care (Craft & Perna, 2004). iv) Validity and reliability On the validity and reliability of the study, the measurement of reliability will be under the limit of the true variation recorded in health status, such as diurnal rhythms and other biological variability, combined with instrument variability and observer variability. It is possible to evaluate on this by looking if the true blood pressure has been able to change following the biological variation, observations on the inherent variation through instruments, intra-observer variability and inter-observer variability (Blumenthal et al., 2007). Interpretation of reliability and agreement of statistics will rely on the following guidelines; Statistic Value Interpretation Pearson >0.85 Acceptable Cronbach’s Alpha >0.8 Acceptable Kappa 0.8 Excellent – Perfect v) Mode and ease of administration The mode and ease of administration will depend with the standard consideration of the entire study. There will be need of absolute transparency and that all participants must be willing to participate by their own will. The administration will allow the exercise to go as planned if the study follows the protocol and all the health conditions of the medical facility, combined with the standard protocols of care. vi) Scoring, analysis and interpretation Scoring, analysis and interpretation of results will follow the standard health measures, namely the diagnostic, discriminative, predictive, prognostic, and evaluative protocols. Health outcome measures may be in the design aimed at measuring on the health status or some changes in health of the individuals or in groups. Interpretation of results may also focus on the particular organ system, disease or the functions, or by measuring the overall health and the quality of life. vii) Responsiveness to change Finally, responsiveness to change will be subject to measure either by an objective approach or through the subjective process. The objective process is whereby there are automated laboratory tests, while the subjective process is whereby judgment is required even if a clinician, an individual, or a member of the family makes the rating. Question 3: addressing the clinical question by showing some evidence from online sources The question “does regular exercising during inpatient hospitalization helpful in reducing weight gain among psychiatric patients?” is a subject of the recent debates through the increased study on the subject of physicality in relation to mental health complications. The literature that reports on the effect of physical fitness in regards to mental health and the emotional health is extensive. Even though universal agreement may not exist, the abundant bulk of research provides a suggestion that the level of physical fitness has negative correlation with depression, anxiety and self-centeredness, while it correlates positively with self-satisfaction and the social judgment (Weitzen et al., 2004). The source of information chosen for answering this clinical question is a scholarly article by Chastain P B and G E Shapiro titled ‘Physical fitness program for patients with psychiatric disorders: A clinical report.’ In this article, the authors have been able to perform extensive research with support of various online sources in regards to how regular physical in the inpatient hospitalization is helpful at reducing weight gain among psychiatric patients. While identifying this source of information, the key search terms used were ‘physical fitness’ and ‘psychiatric disorders.’ The outcome of the search was able to provide a number of possible articles that relate to the topic of regular physical fitness in the healthcare settings, thus giving the reader an abundant number of sources that could be effective at obtaining the information. Through this chosen article of Chastain P B and G E Shapiro, the authors were able to conduct their study, which yielded the results indicating that physical exercise enhances the patient’s self-esteem and their body images through a unique manner. This study ended up giving a suggestion that physical therapy should be broadened as means of addressing on the special needs of the mentally disabled (Chastain & Shapiro, 1987). Question 4: a piece of evidence addressing the research question One meta-analysis performed on this topic is by employing the use of boundaries of evidence. Through this technique, meta-analysis on the exercise interventions for the mental health complications have been able to examine on the problem through evaluating on factors explaining heterogeneity upon the effect sizes as from different studies. The only problem is that these analyses could be limited through the small number of studies available for comparison and the limited variety of the confounding parameters and the study characteristics. Another approach will be comparing different kinds of exercise and the doses by head-to-head through a clinical trial. The last approach would be employing the summary on the most common parameters in exercise interventions that indicate to be having helpful effect on the clinical trials (Keller, 2008). The experienced difficulty when it comes to measuring depression occurs when one tries to distinguish between the feelings of sadness, which normally occurs in everyday life, and distinguishing on the disorders of the mood that are subject to associate to depression. Thorough “The Diagnostic and Statistical Manual of the American Psychological Association,” it identifies on depression mood through major part of the day, and identifies a decreased interest in the daily activities as being the central feature of depression. These symptoms require being constant for nearly every day, but for at least the two weeks duration. However, in case a person experience four or more symptoms, which may include change in appetite, inability of getting sleep, fatigue, difficulty in concentration, and some suicidal thoughts, then this population may be subject to consider as to be having severe or moderate depression. The Centre for Epidemiologic Studies Depression Scale (CES-D) was a randomized control trail developed by the National Institute of Mental Health USA, back in 1972. The instrument is a 20-item self-report questionnaire that has been subject to develop for identifying depression through the general population. The instrument is helpful at assessing on the frequency of which one may experience major components of depression as compared to the previous week, which may include the mood, feelings of guilt and being worthless, feeling of helplessness and being hopeless, cases of psychomotor retardation, loss of appetite, or sleep disturbance (Keller, 2008). This particular meta-analysis also measures on the positive feelings that form the separate dimension of the measurement. Upon looking at the reliability of this evidence in relation to the clinical question, one could figure out that alpha coefficients of the internal consistency in regards to the CES-D has been able to report at the 0.85-0.9 for the various populations. The inter-rater reliability that is at 0.76 together with the test-retest reliability that is at 0.32 to 0.67 has been subject to report. On the validity aspect, basing on the fact that depression is part of the clinical disorder that is possible to diagnose through the clinical procedures, then it may be possible to asses on the concurrent validity of the questionnaires. The high sensitivity of 99% has been subject to report (Boettger et al., 2009). Question 5: The entire search of evidence was very useful at addressing the clinical question in that it provided adequate insights with real time examples of the expected outcome of the study. Backup with abundant sources of information, the search of evidence gains more usefulness through its depth of research, which can thus make the recommended outcome to be reliable. However, the only aspect that might limit on its usefulness is some inconsistencies that might be subject to record while conducting the study, hence limiting on its usefulness as it lacks adequate reasons for explaining these inconsistencies. a) From the outcome of the study that examines how regular exercising during inpatient hospitalization may be helpful in reducing weight gain among psychiatric patients, I consider it to be reliable and having scientific facts. Additionally, the evidence was subject to obtain by following the standard clinical procedures, hence making it justified to for me to state that I can apply this evidence to my patients and settings. b) Finally, the only remaining areas of uncertainty when studying how regular exercising during inpatient hospitalization may be helpful in reducing weight gain among psychiatric patients is the fiscal support for implementing the exercise program through a psychiatric treatment centre occurring due to the increased problem of the climate that shrinks resources among healthcare professionals. Additionally, such program also demands more time of the staff members coming from more than one department, thus making the entire activity vulnerable to the shifting of staff priorities. References Blumenthal, J. A., Michael, A., & Babyak, A. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med 69:587–596 Boettger, S., Wetzig, F., Puta, C., Donath, L., Müller, H. J., Gabriel, H. H., & Bär, K. J. (January 01, 2009). Physical fitness and heart rate recovery are decreased in major depressive disorder. Psychosomatic Medicine, 71, 5, 519-23. Chastain, P. B., & Shapiro, G. E. (1987). Physical fitness program for patients with psychiatric disorders. A clinical report. Physical Therapy, 67, 4, 545-8. Craft, L. L., & Perna, F. M. (2004). The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry 6:104–111 Holley, J., Crone, D., Tyson, P., & Lovell, G. (2011). The effects of physical activity on psychological well-being for those with schizophrenia: A systematic review. Br J Clin Psychol.;50:84-105. Keller, K. (2008). Encyclopedia of obesity. Los Angeles: Sage Publications. McDevitt, J., Wilbur, J. E., Kogan, J., & Briller, J. (2005). A Walking Program for Outpatients in Psychiatric Rehabilitation: Pilot Study. Biological Research for Nursing, 7, 2, 87-97. Meyer, T., & Broocks, A. (2000) Therapeutic impact of exercise on psychiatric diseases. Guidelines for exercise testing and prescription. Sports Med 30:269–279 Rovner, B. W., & Katz, I. R. (1993). Psychiatric disorders in the nursing home: A selective review of studies related to clinical care. International Journal of Geriatric Psychiatry, 8, 1, 75-87. Voderholzer, U., Dersch, R., Dickhut, H. H., Herter, A., Freyer, T., & Berger, M. (2011). Physical fitness in depressive patients and impact of illness course and disability. Journal of Affective Disorders, 128, 160-164. Weitzen, S., Lapane, K. L., Toledano, A. Y., Hume, A. L., & Mor, V. (2004). Principles for modeling propensity scores in medical research: a systematic literature review. Pharmacoepidemiology and Drug Safety, 13, 12, 841-853. Read More