Explain the difference between a Method and a Methodology in Qualitative Research. Please give at least three examples of each. (Word limit 100 words)
Place the following qualitative methodologies in order from least inductive to most inductive: Thematic Analysis, Ethnographic Research, Grounded Theory, Interpretive Phenomenological Analysis, Narrative Inquiry.
Place the following qualitative methodologies in order from least deductive to most deductive: Discourse Analysis, Content Analysis, Thematic Framework Analysis, Auto-Ethnography, Biographical Analyses.
For each of the following study descriptions, please state whether a Grounded Theory Analysis or Thematic Framework Analysis would be more appropriate.
A research question which attempts to understand a specific phenomenon, occurring in a specific population, in a specific context.
The research question: What has been the effect of the National Bereavement Care Pathway launched in 2018?’
The research question: What are the experiences of pregnancy loss, in women seeking asylum in the UK, who do not speak English?
A study with a research question which aims to understand policy implications on practice, where patients, healthcare professionals, and charity partners are all interviewed, and then data is analysed by type of participant.
Discuss how sample size is achieved in qualitative research, with reference to three key concepts in qualitative research philosophy: Data Saturation, Data Usability, and Data Adequacy. (Word limit 300 words)
PART 2 – Randomised Controlled Trials
Please use DataSet1 (Excel file attached) to determine the values for the bold red letters in the CONSORT Diagram and complete the table below.
CONSORT Diagram letter Answer
A
B
B1
B2
C
D
D1
E
E1
F
G
H – For an intention-to-treat analysis
I – For an intention-to-treat analysis
H – For an “as treated” analysis where all subjects 3 who complete follow-up are included in analysis
I – For an “as treated” analysis where all subjects 3 who complete follow-up are included in analysis
What are the advantages of an intention-to-treat analysis? (Word limit 50 words)
Answer the questions listed below:
Why would an “as treated” analysis be conducted? (Word limit 30 words)
What are the advantages of an “as treated” analysis? (Word limit 30 words)
What are the main problems with “as treated” analyses? (Word limit 50 words)
When assessing a clinical trial report, why is it important to review the number of participants who were assessed but not randomised, and the reasons these participants were excluded? (Word limit 50 words)
PART 3 – Public Health and Health Services Research
The Prevention Paradox
Describe the prevention paradox. (Word limit 50 words)
What is its importance in public health and what are the challenges? (Word limit 100 words)
Describe the benefits of the prevention paradox to improve health at population level, using a specific example. (Word limit 50 words)
Health Systems
What is a health system? (Word limit 30 words)
Describe the major components of a health system. (Word limit 30 words)
Describe how to assess health system performance. (Word limit 100 words)
Comparative health system performance assessment
Explain the potential benefits and the challenges of comparative health system performance assessment. (Word limit 100 words)
How would you set out to improve comparative health system performance assessment? (Word limit 100 words)
PART 4 – Observational Research
Question 1
A new beta (β)2 agonist bronchodilator has been marketed in the last year, and the uptake among children with asthma in your region has been rather successful. It is claimed by the company, that if used regularly in those with mild to moderate asthma, it will decrease the need for rescue inhalations during or soon after exercise, in comparison to salbutamol.
You wish to test this in 8–12-year-olds via a retrospective cohort study. To do so, you aim to identify asthmatic children via an established, well maintained, regional GP database.
Inclusion criteria include age 8-12 years, known asthmatic on regular β2 bronchodilators (either salbutamol or the new drug only), play a regular sport. The two most important exclusion criteria are:
(i) severe asthma as defined by >1 hospital admission for asthma in last year, need for oral steroids >2 times in the last year, maintenance high* dose inhaled steroid or alternative immunosuppressants),
(ii) use of alternative agents for exercise induced wheeze, such as mast cell stabilisers.
* note that maintenance, inhaled steroid at low-moderate doses is permitted.
You identify 700 children, of whom (fortuitously) 350 use the new bronchodilator and 350 use salbutamol. You send a questionnaire to their parents/carers, asking whether they have needed to use their inhalers during, or within 1 hour (either side) of undertaking their regular sport on the last two occasions. If they answer “no” then they are classified as having achieved the endpoint (i.e. no need for rescue medications).
Why is this design described as retrospective cohort rather than case control? (Word limit 50 words)
What are two limitations of this type of study design? For each of these two limitations, please describe how it might influence this study. (Word limit 150 words)
Remarkably, you achieve a 100% response rate! The table below contains the results of your survey. The bottom table (orange) shows overall results, and the top two sections (grey) shows the population split between those who use maintenance low-mod dose steroid inhalers and those who do not. On the right of the table are the 95% confidence intervals for the odds ratios.
What do you conclude from this about the overall association (in the whole group analysis) between the new drug and the outcome, compared with the old drug? (Word limit 50 words)
Are the sub-group analyses consistent with the whole group result? Why / why not? (Word limit 100 words)
Name an alternative method to analyse these data, which may provide you with more information to answer the previous question. (Word limit 10 words)
Question 2
You read a journal article which aims to develop a predictive model for rapid diagnosis of bacteraemia (culture proven blood stream infection) for children presenting to Accident & Emergency who are acutely unwell. The model’s emphasis is on pragmatism, in that it will only include clinical signs taken within the first hour of presentation and/or laboratory tests with rapid turnaround times (i.e. typically less than 4 hours).
After an extensive literature review, the investigators consider a total of 15 potential candidate variables, which they evaluate using logistic regression. A “positive” outcome is defined as subsequent proven bacteraemia from blood cultures taken at presentation. Variable selection for the final model was via “forward stepwise” logistic regression, with p<0.05 being the criteria for variable inclusion/retention. All variables tested were either categorical or continuous; and for continuous variables, the only potential relationship with the outcome variable that was tested was a linear one.
Over 1 year, they evaluate 600 children, of whom 32 have a positive blood culture.
Their results are expressed in the table below.
Explain in words the multivariable relationship between heart rate and bacteraemia. (Word limit 100 words)
The test of a good predictive model is that it exhibits comparable accuracy when applied to external environments. A follow up study evaluates this model in a neighbouring city on 850 children across three A&E units, and concludes that it is poorly predictive (area under curve 0.69, compared with 0.96 in the original study).
Does the new study suggest a problem with external validity or internal validity of the original study? (Word limit 10 words)
Give three possible reasons for this discrepancy. (Word limit 100 words)
Describe three ways the authors of the original study could have altered the study design to minimise the chance of this subsequent disappointing result. (Word limit 100 words)
PART 5 – Evidence Based Medicine, Systematic Reviews & Meta-Analysis
You are designing a systematic review and aggregate data meta-analysis into maternal nutritional status and pregnancy outcomes. From background reading, you have identified multiple studies reporting the impact of malnutrition during pregnancy and wish to concentrate your study on this area.
In bullet points, summarise the stages of your approach, including examples of databases selected and resources used. (Word limit 300 words)
Design a search strategy, using Boolean operatives “AND”, “OR” and “NOT”, that you will use as your basis for searching multiple databases, to perform your systematic review. Limit your search to 20 search terms.
Your study identifies an association between maternal vitamin B12 status and birthweight. You produce the following graph to investigate whether there is evidence of bias in your findings:
What is the name of this type of graph? (Word limit 5 words)
Is there any evidence of bias? Explain your answer. (Word limit 50 words)
Name a statistical test that can be used to assess any bias. (Word limit 5 words)
You produce the following graph of the impact of vitamin B12 deficiency on preterm birth, comparing women with normal vitamin B12 levels to those with low concentrations. Increasing rates of preterm birth are demonstrated towards the right of the page.
What is this type of graph called? (Word limit 10 words)
Explain what the graph is showing overall (Word limit 100 words)
What information is given in the first column? (Word limit 20 words)
What information is given in the second column, with heading “No.”? (Word limit 50 words)
What information is given in the last column, with heading “RR (95% CI)”? (Word limit 20 words)
What is the meaning of the boxes and lines, including their position and size? (Word limit 50 words)
What is the meaning of the diamond? How do you interpret the result shown by the diamond? (Word limit 50 words)
What does the I2 test is used to assess and how do you interpret the result shown here? (Word limit 50 words)