Analysis of Bio-statistical Article Essay

Analysis of Bio-statistical Article Essay

Analysis of Biostatistical Article Identify a peer-reviewed article that presents statistical analysis of a pertinent topic of public health interest or importance. Provide a link to this article and give a brief summary of the article, including hypotheses, methods, and findings. Research the topic and available data sources. Analyze the article and its findings. Write a 15 page, double-spaced paper in Word format. Analysis of Bio-statistical Article Essay. Apply APA standards to citation of sources. Utilize at least 7–10 scholarly sources in your research and be sure to include a references page. Write in a clear, concise, and organized manner; demonstrate ethical scholarship in accurate representation. Here are some points to consider in your analysis: • A. What data are available on this topic? • B. What data does the article use? o Discuss the level of measurement, assumptions that can be made, statistics that can be calculated from these data, and the general quality of the data. • C. What is the type of study or study design used? o Explain the type of biostatistical study design that the author has used.

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o Describe the hypothesis or hypotheses that the author intends to test. o Explain the statistics that the author uses to test these hypotheses. • D. What are the article\’s statistical findings? o Describe the statistical results of the author\’s analysis. o Provide a substantive interpretation of these findings (What do the results mean in relation to the hypotheses and the public health topic?). o Describe the author\’s recommendations about this topic based on his or her findings and hypotheses. Analysis of Bio-statistical Article Essay. • E. If you had been the author, what changes, if any, would you have made in the study you analyzed? 1. Discuss whether the author made any statistical errors. 2. Were the correct data used for the questions asked? 3. Were the correct data available? 4. Were the correct statistics used for the data available? 5. What other data might you want to collect and why? 6. Do the statistical findings support the author\’s conclusions? Analysis of Bio-statistical Article Essay

Biostatistic method

Article description

The critique was conducted for Janghorbani et al. (2007). It was titled ‘Systematic Review of Type 1 and Type 2 Diabetes Mellitus and Risk of Fracture’ and had been published in 2007 in the 166th volume and 5thissue of the American Journal of Epidemiology. The article was authored by Mohsen Janghorbani, Rob M. Van Dam, Walter C. Willett, and Frank B. Hu. It presents the results of a systematic review that relies on secondary data to evaluate the risk of developing fractures with Type 1 and Type 2 Diabetes Mellitus (DM). Analysis of Bio-statistical Article Essay

Research problem

The study was conducted to determine whether Type 1 and Type 2 DM present a statistically significant and quantifiable risk for developing a fracture. It notes that some, and not all, DM patients (both types 1 and 2) have typically reported changes in bone mineral densities thus creating a possibility that that the condition could cause osteoporosis and low-trauma fractures. Type 1 DM causes a reduction in bone mineral density while type 2 DM causes an increase in bone mineral density. The present study intended to clarify the relationship and address the existing uncertainty from four perspectives. The first perspective was whether both types of DM are a risk factor for fractures. The second perspective is whether the relationship is influenced by gender. The third perspective is whether the relationship is influenced by the DM type. The final perspective is whether the relationship has an influence on the specific fracture site. Through clarifying these relationships, the study intended to improve DM management (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

The problem is important to medical personnel since it addresses an ongoing concern over the issues to note when managing DM. to be more precise, the intention of medical care is to address the health needs of the patient. By managing DM while ignoring an existing risk for fractures, medical personnel would simply be addressing one facet of care while ignoring another facet of care (the possibility of fractures) with the result that the patient’s medical needs are not addressed. Through the use of actual research data, medical personnel have the clinical justification to present medical care policies that prevent the acknowledged risk of fractures occurring among patients with DM (Janghorbani et al., 2007).In this respect, medical personnel can use the information presented in the article to recommend that fracture prevention strategies be included as part DM management strategies to improve the quality of care that patients receive.

Study purpose

The research was conducted to determine if there was a correlation between DM incidence and risk of fractures occurring. The study postulated that since DM patients reported changes in bone mineral density (either increase or decrease), then it was logical for them to develop fractures for reduced density and have protection from fracture for increased density as a consequence. As a result, the study proposed that quantifying the relationship between DM and fracture development through presenting statistically significant results would justify the presentation of DM care policies that include fracture prevention and management strategies (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

Research question

The research question was not explicitly stated. However, it was implied. The implied research question is that: Do types 1 and 2 DM act as a risk factor for fractures? In addition to the major research question, the research also answered three additional questions. Firstly, is the correlation between DM and fractures varied by gender? Secondly, is the correlation between DM and fractures varied by DM type? Finally, is the correlation between DM and fractures varied by fracture site? (Janghorbani et al., 2007).

Research hypotheses

The article did not explicitly state a hypothesis. However, the hypothesis can be implied from the research question. The implied hypothesis is that: If DM causes reduced bone mineral density, then does DM increase the risk for fractures. Three other hypothesis can be inferred from the minor research questions. Firstly, if there is an association between DM and risk fractures, then does gender influence the relationship. Secondly, if there is an association between DM and risk fractures, then does the DM type influence the relationship. Finally, if there is an association between DM and risk fractures, then does the fracture site influence the relationship (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

Research variables

The research study applied five variables that informed its results. These variables included gender, DM incidence, DM type, fractures incidence, and fracture site. The data collected from the variables informed the rest of the study by determining the correlation between DM and risk of fractures (Janghorbani et al., 2007).

The study included both independent and dependent variables. The independent variables are the research aspects that are manipulated to determine their effects on the population. In fact, they are the cause of any effect reported in the population (Flannelly, Flannelly & Jankowski, 2014). The independent variable applied in the present study is DM. All the participants were DM patients who had either been diagnosed with type 1 or 2 of the disorder. The effects of the variable were measured as incidences of fractures. Gender and DM type were also considered as independent variables (Janghorbani et al., 2007).

Dependent variables refer to the effects that are measured as scores for the independent variables, the presumed effect of the dependent variable (Flannelly, Flannelly & Jankowski, 2014). For the present study, the dependent variables are all the scores that were collected in the study then subjected to data analysis before conclusions were drawn. The variables includedfracture incidences and sites. The scores were then used to inform the research conclusion with changes in the variables measures attributed to DM incidence, DM type and gender as the independent variables (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

Theoretical framework

The article has explicitly described the theoretical framework in its introduction. In this case, the theoretical framework acts as the introduction where the authors provide the basis for the research. The framework makes it clear that most some patients who are diagnosed with either type 1 or type 2 DM will also report reduced bone mineral density. Given the negative effect on bone mineral density, the framework makes a logical supposition that fractures are likely to ensue. As a result, the study sought to show that since DM causes a reduction in bone mineral density that makes the bones fragile, then it is not hard to accept that the fragile bones have a higher risk of being fractured. Overall, the theoretical framework delivers the rational for predicting that DM patients are likely to develop fractures if no preventive actions is undertaken (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

The framework is based on scientific theory, relying on previous publications to show that DM has a negative effect on bone mineral density, and could have an effect on fracture development. The framework identifies, defines and describes relationships among concepts of interest. It shows that the type of DM has an influence on bone mineral density, which could have a consequential effect on fracture development/protection. It also shows that fracture management and prevention strategies should be included in the medical policies for management of DM, especially type 1 DM that causes a reduction in bone mineral density. As such, the framework has logically presented a justification for exploring the possible relationship between DM and bone fractures. It is important to note that the framework is related to the body of knowledge in nursing and medicine, correlating DM with bone mineral density and presenting the possibility of a relationship with fractures. Based on this information, medical personnel (including nurses) can understand that DM care should include routine bone density checks and fracture management (Janghorbani et al., 2007).

Review of related literature

The study relies on past publications that were considered relevant with previous studies and theories described. In this case, the articles develop the correlation between DM and bone mineral density to show that further analysis is necessary to explore if this relationship influences fracture development. For that matter, all the literature applied are related to and relevant to the research topic. Apart from the literature that were applied in discussing the health theory, research methods literature were also applied to inform the research on a suitable analysis approach (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

A total of 46 references were used in the article. The oldest literature was published in 1980 while the latest literature was published in 2006. The initial literature review identified three themes. Firstly, DM has an influence on bone mineral density with type 1 reducing bone mineral density while type 2 increases the density. Secondly, uncertainty exists about the relationship between DM and bone fractures incidence. Thirdly, gender could influence fracture development. Finally, fractures resultant from DM could show site preferences. The literature acknowledges that although DM influences bone mineral density, there is uncertainty about the relationship between DM and fractured development. This gap in knowledge justifies the present study (Janghorbani et al., 2007).Analysis of Bio-statistical Article Essay

Study methodology

The study applied a systematic review approach that relied on past publications that presented statistical data relevant to the research topic. This approach sought to summarize other primary medical studies that presented quantitative results. To be more precise, the approach identifies and uses medical studies that offer a high level of evidence on the research topic. In using past publications, the study made judgments about the evidence while informing recommendations about health care. The systematic review relied on how data was collected and their outcomes as measured in terms of health outcomes. In addition, it relied on meta-analysis to pool numerical data that were then assessed for influence on the research topic. In this respect, the methodology applied in the study sought to summarize the existing clinical research on the study topic (Janghorbani et al., 2007; Maltby et al., 2013).Analysis of Bio-statistical Article Essay

The systematic review was an appropriate methodology for the study since it collected relevant information that informed the study. It is important to note that although a primary research approach would have presented more reliable information when compared to a systematic review, it would have made the study more expensive and made the data analysis more cumbersome (Harvey & Land, 2017; Janghorbani et al., 2007). As such, a systematic review was the more appropriate research approach for the study.

Research sample and setting

The study applied a secondary research approach that identified past studies relevant to the research topic. The inclusion criteria set three conditions for the relevant publications. Firstly, the past publications were restricted to journal articles published before 2006 and presented in MEDLINE database. Secondly, the specific search terms were fracture, diabetes mellitus, diabetes, glucose and insulin. Thirdly, focus was on epidemiology studies that either applied case-control or cohort approach in evaluating the relationship between DM and low-trauma hip, distal forearm, proximal humerus, ankle, foot, non-vertebral, and vertebral fracture. The exclusion criteria set one condition, multiple publications from the same population and cohort would only accept the latest publication (Janghorbani et al., 2007).Analysis of Bio-statistical Article Essay

The sampling approach identified 20 epidemiological studies with 14 of them being cohort studies while six of them were case-controls. No power analysis was conducted to determine the sample size of articles. Rather, the size was based on convenience and availability. All the studies were collected from MEDLINE database. This method was appropriate since it allowed the research to access the relevant material to answer the research question and inform the topic (Janghorbani et al., 2007).

Study instruments/tools

The study relied on data extraction to collect the relevant data that informed its results. The data extraction applied a structured approach. The approach identified six strategies that informed the data extraction. They included the first author’s surname, year when the article was published, country of study and publication, study design, number of participants in the control and experimental groups, source of the controls for the case control studies, follow up period for the cohort studies, age, gender, type of diabetes (type 1, type 2 or both), statistical figures for the estimated risk of fracture and corresponding confidence intervals, andfactors controlled for by matching or multivariable analysis. For each study, the focus was on identifying the quantified estimated risk that was determined after controlling for the confounding variables. The collected data was presented in a codebook that identified the research design, characteristics of the participant, fracture measurements, adjustment of the confounding variables, and estimated association between the variables of interest. All the data was extracted by two reviewers the coalesced into a single codebook to reduce the possibility of bias. It is important to note that the reliability of the instrument (codebook) was not tested since there were not controls. However, the codebook was used by two reviewers who resolved any differences in opinion through discussion thus reducing the potential for researcher bias. Some reliability has been established by the fact that the initial data relied on standard medical tests that are considered reliable (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

In addition, the validity of the data collection instrument was not established. Still, the statistical measures for the variables of interest show that the measures were strongly correlated thus implying that the population had the same characteristics. Some validity was established by the fact that the data was subjected to the same statistical tests(Rauta et al., 2017). Overall, the reliability and validity of the data collection instrument was not established.

Data collection methods

Data was collected through a secondary research approach that relied on research reports from other journal articles published in MEDLINE database. This data collection approach is appropriate since it measured the variables of interest to the research, showing how the independent and dependent variables are related in terms of statistical and clinical significance. There was no issue with the rights of participants or unethical research practices since the study relied on secondary data that were well referenced for their sources (Janghorbani et al., 2007).Analysis of Bio-statistical Article Essay

Statistical analysis procedures

The study focused on relative risks as reported in the articles evaluated in the studies. The ratios were reported as odds ratio for the case-control studies, incidence rate ratio for the cohort studies, and standardized incidence ratio for cohort studies that applied an external comparison group. The odds ratio quantified the strength of the correlation between fracture occurrence as an incidence and fracture not occurring as a non-incidence. The incidence rate ratio compared the incidence rates of fractures occurring over the same time interval for the study population. The standardized incidence ratio reported on the proportion between the observed and expected cases(see Table 1) (Everitt& Palmer, 2011; Janghorbani et al., 2007).

Other than the reported ratios, the study reported the relative risk with the standard error for meta-analysis. This was based on a 95% confidence interval. The heterogeneity of the studies was evaluated using Cochran’s Q test. The test sought to determine if the treatments applied in the researches had identical effects even as they were sought from matched populations samples, presented as persons diagnosed with MD.In addition, meta-regression analysis was conducted to determine how other variables affected the overall results, with the focus on region, gender, fracture size, study design, follow-up duration, and type of DM. A funnel plot was applied to evaluate publication bias, with the focus on axis of treatment effect to note asymmetry funnel and skewness as indicators of publication bias, particularly with regards to reporting, small study effects, and methodology. Further analysis of publication was conducted using Begg’s adjusted rank correlation test and Egger’s regression asymmetry to determine if the bias is an indication of a perceived statistical validity that is resultant of low power (see Table 1) (Borenstein et al., 2011; Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

Table 1. Analysis techniques applied in the study

Statistical Procedure Statistical Findings Significance
Odds ratio Quantified the strength of the correlation between fracture occurrence as an incidence and fracture not occurring as a non-incidence The research focus to show how DM is related to fracture occurrence
Incidence rate ratios Compared the incidence rates of fractures occurring over the same time interval for the study population. The research focus to show how DM is related to fracture occurrence
Standardized incidence ratios Reported on the proportion between the observed and expected cases The research focus to show how DM is related to fracture occurrence
Relative risk with the standard error for meta-analysis Compared the risk of fractures (incidence) for the experiment group (persons with MD) and control group (persons without MD) The research focus to show how DM is related to fracture occurrence
Cochran’s Q test Determine if the treatments applied in the researches had identical effects even as they were sought from matched populations samples To assess the publications used in the study for reliability
Meta-regression analysis Determine how other variables affected the overall results To evaluate the effects of confounding variables on the results
Funnel plot Evaluate publication bias To evaluate the precision of the studies collected, and if there was bias.
Begg’s adjusted rank correlation test Evaluate publication bias to note low power effects on statistical validity To determine the source of the reported publication bias, and if it was erroneously as a result of low power effects
Egger’s regression asymmetry to determine Evaluate publication bias to note low power effects on statistical validity To determine the source of the reported publication bias, and if it was erroneously as a result of low power effects

Study results

The initial analysis identified 20 epidemiological studies that were considered relevant to the research topic based on their titles, reporting on 836,941 participants and 139,531 fracture incidents. These studies were subjected to evaluation using the inclusion and exclusion criteria before 16 independent studies were finally selected for in-depth analysis. Analysis based on research approach showed that 2 studies applied case-control approach, 13 applied cohort approach with the results reported as incidence rate ratio, and 1 study applied a cohort approach with the results reported as standardized hospitalization ratio. Regional analysis of the articles showed that 7 were based on studies conducted in the USA, 8 were based on studies conducted in Europe, and 1 was based on a study conducted in Australia. Analysis of the studies based on DM type showed that 6 articles reported on type 1 DM, 12 articles reported on type 2 DM, and 3 studies reported on both types of diabetes (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay

Further statistical analysis was conducted based on the type of fracture reported. Firstly, results were reported for incidences of hip fracture as indicated in 12 studies. They indicated that there is a statistically significant positive correlation between hip fracture and type 2 DM (RR=1.7, 95% CI, 1.3-2.2; Q=58.1, phet<0.001). In addition, they indicated that there is a statistically significant positive correlation between hip fracture and type 1 DM (RR=6.3, 95% CI, 2.6-15.1; Q=89.2, phet<0.001) (Janghorbani et al., 2007). Secondly, analysis was conducted for correlation between DM and other fracture sites. The results reported a statistically significant positive correlation between all fractures and type 2 DM (RR=1.3, 95% CI, 1.1-1.5; Q=10.5, phet=0.11).Statistically significant results were reported for foot fracture and type 2 DM, although this was based on only two studies (RR=1.3, 95% CI, 1.1-1.7) (Janghorbani et al., 2007). Finally, the results reported no statistically significant correlation between distal forearm fractures and type 2 DM (RR=0.98, 95% CI, 0.8-1.2), ankle fractures and type 2 DM (RR=1.3, 95% CI, 0.9-2.0), proximal humerus fractures and type 2 DM (RR=1.3, 95% CI, 0.8-2.2), and vertebra fractures and type 2 DM (RR=1.2, 95% CI, 0.7-1.2) (Janghorbani et al., 2007). Analysis of the publications bias reported that there was low probability of publication bias (Funnel plot = no asymmetry; Begg's adjusted rank correlation test = 0.41; Egger's regression asymmetry test = 0.42) (Janghorbani et al., 2007) The research results showed that there is a positive correlation between DM and fractures. The research results indicate that DM management (both type 1 and type 2 DM) should include fracture prevention since there is a high risk of their occurrence as the condition acts as a contributing factor (Janghorbani et al., 2007). Analysis of Bio-statistical Article Essay Study strengths and limitations The study has eight major strengths. Firstly, it relied on data collected from primary research studies thus increasing the research validity and reliability. Secondly, the study was based on the population of interest thus presenting relevant results and implications. Thirdly, it coalesced results from multiple studies thus providing the more population themes concerned the research topic. Fourthly, it applied explicit methods that limit bias when collecting the data that was analyzed. Fifthly, effectively increases the sample size by offering reliable and precise estimates from combined studies. Sixthly, it offers consistent and generalizable results from systematic comparisons. Seventhly, it presents clinical heterogeneity that is useful for presenting new hypothesis, such as correlating specific DM type with fracture incidence and site. Eighthly, it defines the limits of known information, by drawing conclusions and implications from available data,thus helping in directing future research. Finally, the study approach is useful for supporting evidence-based practice and decision-making in medicine since it relies on evidence collected from many sources (Katz et al., 2014).Analysis of Bio-statistical Article Essay There were three major limitations in the study. Firstly, there was no control over the collected data since each study focused on a different areas reducing the statistical and clinical significance of the results. For instance, the study that reported that the association between type 2 DM and foot fractures was collected from two studies, and this is a very small sample that cannot be used to make inferences for the whole population of type 2 DM patients. Secondly, the results are off average effects that may not apply to individual patients. Finally, there is a possibility that there could be a disharmony between the collected results and a large-scale clinical trial conducted with the same number of participants. These limitations should be addressed by increasing the number of studies evaluated to improve the statistical and clinical significance of the results (Goertz& Mahoney, 2012). Reflection The study makes use of the required data to make recommendations for medical care, showing that there is a correlation between DM and fractures incidences thus justifying the recommendation that DM management should include fractures prevention as standard practice. The study collected the right data, relying on the statistical results reported as ratios to show the relationship between the research variables. In fact, the collected data answered the major research question about the relationship between DM and fracture incidences. However, the collected data did not answer the minor research questions to show if the results varied by gender, DM type and fracture site. A significant shortcoming in the study is the initial assertion in the results that 16 studies met the inclusion criteria and were included in the study, and yet it later details that 6 studies reported on type 1 DM, 12 on type 2 DM and 3 studies on both types of DM for a total of 21 studies. This error should be addressed by specifying the actual number of studies that met the inclusion criteria and provided data for the statistical analysis.Analysis of Bio-statistical Article Essay The study used the correct statistics. The collected data was of the dichotomous type thus justifying the use ofodds ratio, risk ratio and risk differences to answer the research question and show that there is a correlation between DM and fractures. Egger's, Begg'sand funnel plot tests show that there was no publication bias in the sources of data used, an indication that they can be trusted to provide valid and reliable data. Other than the statistics that was used, mean difference and standardized mean difference should have been calculated for the continuous data to show the absolute difference in mean values for the treatment and control groups, as well as for the comparing fracture incidence and non-incidence among persons with DM (Ahn& Kang, 2018). ORDER NOW References Ahn, E. & Kang, H. (2018). Introduction to systematic review and meta-analysis. Korean Journal of Anesthesiology, 71(2), 103-112. doi: 10.4097/kjae.2018.71.2.103 Borenstein, M., Hedges, L., Higgins, J. & Rothstein, H. (2011). Introduction to meta-analysis. New York, NY: John Wiley & Sons. Everitt, B. & Palmer, C. (2011). Encyclopaedic companion to medical statistics (2nded.). New York, NY: John Wiley & Sons. Flannelly, L., Flannelly, K. & Jankowski, K. 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