NR 503 Week 3 Discussion

NR 503 Week 3 Discussion

NR 503 Week 3 Discussion

This week we will explore current events related to epidemiology. You will present a scientific article to the class. Please focus on interpreting the research question, methodology, results, and conclusions from a sample of peer-reviewed scientific literature. Please be sure the article is related to epidemiology, summarizing its contents for the class, and providing a succinct written summary. Current events must have been published within the last six months. Written summaries should include: 

  • State the objectives of the study 
  • Summarize the study design and findings 
  • Provide a reference of the article 
  • Provide your opinion on how the “average” reader will respond to the article. Will the article influence decision making or thinking? Does the article leave out any important information? 

Zaire ebolavirus is a filovirus with five subspecies (Bundibugyo, Zaire, Restone, Tai Forest, and Sudan) with a case fatality ratio of 25-90% (Barry et al, 2018). It is transmitted through contact with the body fluids of infected patients (CDC, 2018). The way of stopping the transmission is by patient isolation and care, early diagnosis, infection control, rigorous tracking of contacts, and the use of targeted vaccination. 

On May 3, 2018, the Ministry of Health of the Democratic Republic of the Congo was notified from the Health Division of Equateur Providence that 40 cases of fever (95%) with gastrointestinal symptoms, general fatigue (37 [90%] cases), loss of appetite (37 [90%]), and hemorrhagic signs (14 [33%] people) were occurred including 17 deaths due to possible Ebola virus (Barry et al, 2018). These data were collected by health professionals attending to cases and field investigators.

On May 8, 2018, the Democratic Republic of the Congo reported 50 cases (13 probable, 37 confirmed) of Ebola virus disease in Equateur Province where is connected to the capital city (Barry et al, 2018). In order to confirm the cases, detection of Ebola virus RNA in body fluids or blood by reverse transcription PCR was required and used. Since the affected area is concentrated with high population, this outbreak is the highest and complex risk ever experienced by the Democratic Republic of the Congo. On May 20, 2018, 25 deaths from Ebola virus disease had been reported (Barry et al, 2018). In addition, they also reported that 1,458 contacts had been reported and addition 78 cases were confirmed, assuming heterogeneous transmissibility (Barry et al, 2018). The median age of people with probable or confirmed infection was 40 years and usually male (30 [60%]) (Barry et al, 2018). 

The design of the study is an epidemiological study with the case-controlled group since it studied people that have already contracted the disease. This study also reviewed published epidemiological evidence about clinical characteristics of Ebola virus disease and contrasted the results of past outbreaks. The aim of this study was to investigate and control the current Ebola virus disease outbreak in the Democratic Republic of the Congo. The results showed that the epidemiological characteristics and features of this outbreak in the Democratic Republic of the Congo, such as signs and symptoms of cases were consistent with previous outbreaks of Ebola virus disease in West Africa(Barry et al, 2018).

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It also reported that the most common exposures were caused by contact with infected people and participation in traditional burial rites for those who have died from this disease. The source of this outbreak is unknown; however, it’s possible that a new chain of transmission could occur after sexual contact with a male survivor (CDC, 2018). In addition, the case fatality ratio was higher than when this outbreak occurred in West Africa from 2014 to 2016 (Barry et al, 2018). Since West Africa has greater access to Ebola treatment, the case fatality ratio was decreased. The article concluded the study with the importance of safe and dignified burials, community engagement, early detection, and implementation of Ebola treatment along with vaccination for outbreak control (Barry et al, 2018). 

As the reader, I believe that this article was informative and written thoroughly with analytical data and literature reviews. The average reader would find this information useful since it’s easy to understand and follow without a lot of medical terminologies. The article is also reliable and credible by showing the author’s information on the article. The writer also believes that the article didn’t leave out any important information. The article will influence when the Ministry of Health of the Democratic Republic of the Congo reinforces the implementation of Ebola treatment and vaccination at community clinics, local hospitals, and public health centers since the study results show high mortality and fatality rate of Ebola virus disease. 

Barry, Ahmadou et al. (2018). Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May 2018: An epidemiological study. The Lancet, 392 (2) 213-221, doi.org/10.1016/S0140-6736(18)31387-4 

The Centers for Disease Control and Prevention (CDC). (2018). 2018 Democratic Republic of the Congo, Bikoro. Retrieved from https://www.cdc.gov/vhf/ebola/outbreaks/drc/2018-may.html NR 503 Week 3 Discussion

Thank you for opening up the discussion this week! You’ve selected a great study for discussion. Generally speaking, case control study designs, as well as cohort studies are good for understanding causation of disease (if the exposure is associated with the outcome). As you mention, case control studies are considered observational and researchers use this study design to compare persons with a disease to those without the disease when both groups have a history or exposure (e.g., vaccinated people who developed the flu compared to vaccinated peopled who did not develop the flu). This is an interesting study, especially since case control designs are often used in rare disease or outbreaks compared to cohort studies, which are more ideal for comparing exposure and disease. 

A 2005 study published in Nature and directed by Eric Leroy tested more than 1,000 small vertebrates in central Africa and found evidence of asymptomatic Ebola infection in three species of frugivorous bats, which led him to believe that perhaps these animals that sometimes they hunt to consume their meat, were the reservoir of the virus (Kupferschmidt, 2017). Humans can become infected by hunting and eating infected meat or by direct contact with bats. Once infected, the human can transmit the virus to others. 

Moreover, Ebola has an incredible ability to take over the body fluids of men who have survived the disease long after they have healed. In fact, one study found that more than half of men who survived the West African epidemic tested positive for Ebola in semen a year or more after recovery (CDC, 2016). In one case, the analysis yielded a positive result no less than 565 days after the cure (CDC, 2016). Because of the risk of the disease spreading, survivors are advised to avoid having unprotected sex until their semen has twice tested negative for the presence of the virus. It is estimated that each infected person infects an average of two other people (Doucleff, 2014).

The bodies of deceased people remain highly infectious for about seven days. Although Ebola has often been classified as a hemorrhagic fever, WHO and other experts begin to avoid the term as not all individuals present with visible hemorrhages (WHO, 2014). In fact, the evolution is as follows: the first symptoms (tiredness, nausea, fever, headache) are similar to those of diseases such as influenza and malaria, which makes early diagnosis difficult. As the infection progresses, muscle aches, fever and headache become more pronounced and diarrhea and vomiting appear. Often, there is bleeding from the nose or gums. Death occurs within two weeks after the onset of the first symptoms (WHO, 2014).  

The rVSV-ZEBOV vaccine, specific for the Zaire strain and not yet approved, was developed by the National Microbiology Laboratory of Canada, tested in Guinea and Sierra Leone during the 2014-2016 epidemic and then purchased by the company. Pharmaceutical Merck, which holds the rights. 100% of the people vaccinated did not develop the disease. However, it was the end of the outbreak and the actual efficacy of this compound must still be proven (Medaglini & Siegrist, 2017). The first trials with the candidate vaccines show that they are safe and that they induce an immune response. What is not yet known is the level of protection and the duration of it. Even if the vaccines do not confer lasting protection, they can be used in future outbreaks to protect the most exposed populations (health workers, among others). Moreover, there is currently no approve vaccine or specific treatments for Ebola. For now, the most effective way to limit in part the mortality caused by the virus is to provide intensive support care, which consists in restoring liquids and electrolytes lost by diarrhea and vomiting.  

CDC (2016). Virus Linger Longer than Expected in Semen. Retrieved on July 8, 2018 from https://www.cdc.gov/media/releases/2016/p0830-ebola-virus-semen.html  

Doucleff, M. (2014). No, Seriously, How Contagious Is Ebola?. Public Health. Retrieved on July 12, 2018 from https://www.npr.org/sections/health-shots/2014/10/02/352983774/no-seriously-how-contagious-is-ebola  

Kupferschmidt, K. (2017).Hunting for Ebola among the bats of the Congo. Since AAAS.  (361)6398. doi:10.1126/science. Aan6907  

WHO (2014). Ebola Response Team. Ebola virus disease in West Africa — the first 9 months of the epidemic and forward projections. N Engl J Med.371:1481-1495  

As future APNs, you will need to be able to identify best practices, which will include evaluating and incorporating published research into your practice.  

I’ve listed below some guidelines that you may find useful when critiquing research studies.  

Article Title 

  • Is the title concisely stated? 
  • Does the title convey the content of the study? 
  1. Introduction
  2. Statement of the Problem
  • Is the problem significant? 
  • Is the problem clearly and completely formulated? 
  • Is the general scope of the study adequately presented? 
  • Is the purpose of the study precisely stated? 
  1. Related Research
  • Is previous research related to the study presented? 
  • Is the cited research relevant to the study presented? 
  • Is a succinct and meaningful summary presented? 
  1. Hypotheses or Questions
  • Are the hypotheses to be tested or the questions to be answered clearly stated? 
  1. Assumptions and Delimitations
  • Are the assumptions underlying the study made explicit? 
  • Are these assumptions reasonable? 
  1. Operational Definitions
  • Are essential concepts or terms clearly defined or explained? 
  • Are the definitions or explanations meaningful? 
  1. Method
  2. Population and Sample
  • Are the characteristics of the selected population and sample (size, source, nature, etc.) fully presented?  
  • Is the sampling method indicated? 
  1. Research, Instruments and/or Apparatus
  1. Are the techniques employed (e.g. interview, questionnaire, apparatus, tests, etc.) clearly and fully described?  
  1. Are the instruments or techniques appropriate for collecting the data? 
  1. If tests were used, what evidence is presented regarding their rationale, reliability, and validity?  
  1. Procedure
  1. Is the design or procedure clearly and fully reported? 
  1. Are appropriate statistical methods used in analyzing the data? 
  1. Can the study be replicated? 

III. Results and Conclusions  

  1. Are the findings intelligibly reported in textual presentation? 
  1. Are the conclusions logically drawn (i.e. based on the data presented)? 
  1. Are tables and figures used appropriately? 
  1. Discussion
  1. Are the findings discussed adequately and meaningfully? 
  1. Does the investigator indicate the possible implications of the study? 
  1. Are these implications meaningful? 
  1. Are limitations of the study recognized? 
  1. What are some other limitations that were not mentioned? 
  1. Are any suggestions offered regarding avenues for further research? 
  1. Are these suggestions worthwhile? 
  1. Summary
  1. Are the problem and methodology restated? 
  1. Are the major findings, generalizations, implications, and limitations succinctly 

synthesized?  

Communication  

  1. Is the report well organized? 
  1. Is the report well written? 

 

Here’s a link to a good guidance document for critiquing research- 

http://www.flinders.edu.au/slc_files/Documents/Blue%20Guides/Critiquing%20Research%20Articles.pdf Links to an external site. 

The Center for Disease Control and Prevention (CDC) lists current outbreaks in the US and Internationally.  Contamination of food during processing is prevalent in the US currently where Ebola continues to be a problem in Africa and Measles and Yellow Fever Continue to affect some areas around the world (CDC, 2018).  One issue also currently being monitored is Zika virus.  

A study from the Morbidity and Mortality Weekly Report (MMWR) seeks to properly attribute birth defects to Zika.  In the real world, birth defects exist. They can be for a variety of reasons, not all are clear. Cragan et al (2017) examined 774 pregnancies with evidence of birth defects at various stages of gestation to determine if they are attributed to Zika.  Cragan et al (2017) examines the severity of fetal defects based on stage and mode of Zika exposure to mother. Although Zika is transmitted by mosquitoes, the effects can vary determining on gestational stage, if father is infected at the time of conception(CDC, 2018).

The study frequently references the CDC for information regarding parameters for testing. The live virus is only in the system 2-7 days, but its effects can last for weeks.  Antibody and RNA testing is not indicated unless there is birth defect evidence and there is high risk potential in exposure of other or father which almost always refers to travel (Cragan et al, 2017).  The average reader would understand that there is no cure for Zika and that travel advisories are most crucial. 

Cragan, J. D., Mai, C. T., Petersen, E. E., Liberman, R. F., Forestieri, N. E., Stevens, A. C., & … Meaney-Delman, D. M. (2017). Baseline Prevalence of Birth Defects Associated with Congenital Zika Virus Infection – Massachusetts, North Carolina, and Atlanta, Georgia, 2013-2014. MMWR: Morbidity & Mortality Weekly Report, 66(8), 219-222. doi:10.15585/mmwr.mm6608a4 

 

Centers for Disease Control and Prevention. (July 5, 2018). Zika Virus. Retrieved from https://www.cdc.gov/zika/index.htmlLinks to an external site. 

See Also: NR 503 Week 7 Discussion