The Director of Psychiatry in a large metropolitan hospital notices that many people admitted to the Emergency Department for deliberate self-harm re-present to the hospital in the weeks and months following a subsequent incident of deliberate self-harm. She wants to reduce the re-admission rates of deliberate self-harm at the hospital, and wonders if a brief contact intervention in the form of a follow-up telephone call (to assess how individuals are feeling, and suggest avenues for community support) might lead to reductions in the number of re-admissions due to deliberate self-harm.

Q1Write a focused clinical question for this particular problem that will help you organise a search of the clinical literature for an answer. [4 marks]

Q2 If you were to search Medline/PubMed for original research on this question, describe what your search strategy would be. Be as specific as you can about keywords, MeSH terms, and delimiters. Explain your rationale for taking this approach and explain your reasoning. Cite the best article from among those you find.  [8 marks]

Q3 What type of study (study design) would best be able to address this question? Discuss why?

Q4What information sources would you use to find an answer to questions such as the above? Name as many possible types or categories of information sources as you can that could be used to find relevant evidence. Although some sources are better than others, discuss a few to demonstrate your awareness of the convenience, relevance and quality of common information sources in clinical practice. [5 marks]

Answer questions 5a-d based on the following information:

You have brought to the attention of the hospital obstetrics service that a published trial reported an increased risk of attention-deficit/ hyperactivity disorder (ADHD) in children aged 7 years when acetaminophen was used during pregnancy. You suggested that given this evidence the unit should publish an information sheet for women attending the service. The results of the study are depicted in the table below:

After the director read the paper he asked you to answer the following questions so an information sheet could be published:

Q5a. What is the risk of a child having ADHD among (i) all women included in the study, (ii) women who used acetaminophen, and (iii) women who did not use acetaminophen? What is the relative risk of acetaminophen compared with no acetaminophen with regards to ADHD? How would you interpret each of these measures?

Q5b. If equal numbers of women in the population used acetaminophen vs no acetaminophen, what would be the expected population relative risk increase (RRI) for acetaminophen? How would you interpret this measure?

Q5c. How many women need to be treated with acetaminophen for one more child to be harmed? What is this measure called? How would you interpret this measure

Q5d. How does the measure in question 5b differ from question 5c?

Imagine that you have read a report of the original research study discussed in Question 5, now answer Questions 6 to 8: 

Q6. What characteristics of the study would you consider, in order, to determine if its findings are valid? Include wider considerations of study quality/validity and give examples. (Q8 will address relevance, and the next question will ask how to determine the importance of the findings…for this question, focus on the internal validity of the study)

Q7. What characteristics of the findings would you consider, in order, to determine if they are clinically meaningful and statistically significant? Include examples. (You’ve already addressed validity…for this question, focus on how to determine the clinical significance and statistical significance of an effect reported in the study)

Q8. What characteristics of the study would you consider, in order, to determine if it is generalizable to your context? Explain your answers and provide examples. (Questions 6 and 7 have asked how to determine if the study is valid, and how important the findings are….for this question, focus on how to determine if it is really relevant or generalizable to your practice.

 
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