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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...

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PUBH6005_Assessment Brief 4 Page 1 of 8

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,
ehavioural, social and environmental risks in disease
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 e
9. Identify key health indicators and sources of data

Submission Due Sunday following the end of Module 6 at 11:55pm
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

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
esearch 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
esearch 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 XXXXXXXXXXStudents 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:
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:

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
 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 e
ors, 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 XXXXXXXXXXBasic epidemiology (2nd ed.). Geneva,
Switzerland: World Health Organization.
o Chapter 11, “First Steps in Practical Epidemiology”
 NHMRC XXXXXXXXXXNHMRC additional levels of evidence and grades for recommendations for
developers of guidelines. Retrieved from:

 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-
ased clinical guidelines. BMC Medical Research Methodology. 11:23.
 Laurier Li
ary. (2013, October 13). Developing a research question. [Video file]. Retrieved from:
http: [5:07]
 Rychetnick, L., Frommer, M., Hawe, P., & Shiell, A XXXXXXXXXXCriteria for evaluating evidence on
public health. Journal of Epidemiology and Community Health, 56, XXXXXXXXXX.
 Skelly, A. C., Dettori J. R., & Brodt, E. K XXXXXXXXXXAssessing bias: the importance of considering
confounding. Evidence Based Spine Care Journal, 3(1), 9-12
 The GRADE Working Group XXXXXXXXXXGrading quality of evidence and strength of
ecommendations. British Medical Journal XXXXXXXXXX.

PUBH6005_Assessment Brief 4 Page 4 of 8

 Young, J.M., & Solomon, M.J XXXXXXXXXXHow to critically appraise an article. Nature Clinical
Practice Gastroenterology and Hepatology. 6, 82-91.
 Critical appraisal skills program checklists. Retrieved from http:!casp-tools-
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
 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
o Provides a conclusion or summary
o Co
ectly uses academic writing, presentation and grammar:
 Complies with academic standards of legibility, referencing and
ibliographical 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

PUBH6005_Assessment Brief XXXXXXXXXXPage 5 of 8

Marking Ru
(Fail 2 – F2)

(Fail 1 – F1)

(Pass -P)

(Credit - CR)

(Distinction – DN)

(High Distinction –

Grade Description (Grading
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
elevant skills to a
competent level, and
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
Answered Same Day May 11, 2020 PUBH6005


Soumi answered on May 13 2020
130 Votes
Table of Contents
Introduction    3
Research Question    3
Methods    3
Results    4
Ranking using the FORM framework    4
Critically evaluating using the FORM framework    5
Critically Appraising using the CASP Tool    6
Discussion    7
Conclusion    8
References    10
    Antibiotic resistance has become a serious concern for healthcare professionals, as it has restricted the effectiveness of a large number of antibiotics and disrupted the treatment processes for many diseases. As defined by Godziszewska, Guzek, Głąbski and Wierzbicka (2016), antibiotic resistance can be refe
ed to as the capability of the bacteria to resist the lethal actions of the drugs that they are subjected to. This is becoming a growing issue in the global health status of the public because the pathogenic bacteria are not being able to be killed or restricted from being spread. As a result, the occu
ence of bacterial diseases is also increasing day by day. Therefore, it has been realised as an immediate need to address this problem, for which is critical appraisal essay has been framed (Li, Plesiat & Nikaido, 2015).
The aim of this essay is to identify the reasons behind the occu
ence of antibiotic resistance in the pathogenic bacteria, critically appraising five relevant articles for their opinions on the same, using suitable tools. This is have been accomplished finally, by presenting an interpretation of the findings generated from the chosen articles, that could help to conclude in terms of the quality of the papers so that these could be used for future implications in the research area, in terms of addressing antibiotic resistance. For that purpose, firstly, five scholarly papers have been critically appraised using FORM framework of Hillier et al. (2011) and then their quality as well as reliability has been assessed using CASP framework by CASP (2018).
Research Question
Therefore, the following research question has been framed in order to address the issue and assess articles that support these:
“What are the reasons behind the development of resistance by the pathogenic bacteria against their antibiotics and what could be the solution to this?”
    For addressing the research question that has been framed above, an aggregate of five articles were searched that were related to the research question. Only authentic databases were used for conducting the method of research. For entering the keywords fir searching the articles, three databases were accessed that are Google Scholar, Medline and PubMed. Initially Google Chrome was used as the search engine in which three databases were visited distinctively on distinct tabs. It was done for checking the availability of the articles related to the research using a definite keyword on all the databases.
The used keywords were ‘development of resistance by pathogenic bacteria’, ‘antibiotics’, ‘antibiotic resistance of bacteria’ and ‘improper use of antibiotics leading to antibiotic resistance’. In order to search articles following a specific king of methodology such as randomised trial (RCT) or observational, the mentioned keywords were preceded by certain phrases. Such phrases are ‘systematic review on inappropriate use of antibiotics causing antibiotic resistance’, ‘randomised controlled trial on inappropriate use of antibiotics causing antibiotic resistance’ and ‘observational study on inappropriate use of antibiotics causing antibiotic resistance’.
The mentioned keywords were entered one after the other on the search bar of each database. The information was combined together to further refine the search. After continuous search and with the use of search limiters such as ‘Fill Text Only’ in Medline, ‘English only’ in PubMed and since 2014 in Google Scholar, the researcher was able to find the appropriate articles. Two articles were found from Medline- one of them supported the hypothesis that was imposed by the framed research question and the other was a systematic review. The article that did not support the hypothesis was found from Google Scholar. Finally, an observational study and a Randomised Controlled Trial study were found from PubMed.
All the articles or papers that did not match the requirement of the research question or did not match with keywords, inclusion criteria and search limiters were rejected as per the exclusion criteria. The found articles were further used for the critical appraisal in the context of addressing the research question. FORM framework by Hillier et al. (2011), was used for critical appraisal as it is not only limited to a contemporary framework. It also helps in quantifying the extent to which one can use such research in practical context.
As per the opinion of The GRADE Working Group (2004), the GRADE level of evidence helps in qualification of paper based on five criteria that are- accuracy and the findings and he reporting bias, indirectness of the evidence, limitation of research and inconsistency of the results. However, the following cannot be used to cause quantification of the level of the papers. In addition to this, the Critical Appraisal Skills Programme (CASP) tool was used as checklist for ensuring that the research paper met all the mentioned parameters of an authentic and a valid study. The selection of the checklist of the CASP was done based on the research paper type that was to be appraised.
Ranking using the FORM framework
    Following the process of online literature search conducted by the method mentioned above, the following five articles were chosen.
    Type of Methodology Followed
    Rank of the Article according to...

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