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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, behavioural, social and environmental risks in disease patterns
  3. Differentiate between different types of researchdesigns, 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 andprevention programs, and assess the sensitivity and specificity of programs
  8. Critically evaluate epidemiological studies, including potential for bias, confounding and chance errors
  9. Identify key health indicators and sources of data

Choose one of the following research questions:

a) How effective are antimicrobial stewardship programs at reducing inappropriate prescription of antibiotics in aged care facilities?

b) How effective are community and primary care education interventions at reducing rates of antibiotic prescription?

c) How effective are hand hygiene compliance interventions in improving hand hygiene behaviours (thus reducing the risk of transmitting disease) in hospitals?

d) How effective is honey at treating bacterial wound infections?

Search the library database to find five studies that answer your research question. Try to include a mixture of observational studies and RCTs. Studies do not have to support  the hypothesis or agree with each other.

1.Knowledge (20 %)

  1. Demonstrates knowledge and understanding of critical appraisal concepts
  2. Shows evidence of reading beyond the required readings
  3. Shows a sophisticated understanding of the key issues

2.Synthesis (30 %)

  1. Shows ability to synthesise and analyse relevant information and literature to the topic
  2. Demonstrates expert use of credible and relevant research sources to support and develop arguments and position statements

3.Conceptual (30 %)

  1. Shows ability to interpret relevant information and concepts in relation to chosen topic
  2. Demonstrates a capacity to explain and apply relevant concepts

4.General Assessment Criteria (10 %)

Addresses assessment questions

Provides a lucid introduction and population definition

Justifies any conclusions reached with well-formed arguments and not merely assertions

5.Academic integrity, writing, presentation and grammar (10 %)

Complies with academic standards of legibility, referencing and bibliographical details (including reference list)

Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction

Appropriately and consistently applied citing and referencing conventions

Methods

Antibiotics are those medications, which are utilized to treat microbial infections either by executing them or by ceasing the development of microorganism.We are using anti-microbial drugs since 1950s, but now a new problem with the anti-microbial drugs has been raised. Microorganisms are now developing immunity against these drugs. Therefore, many bacteria and other microorganisms are becoming resistant to these drugs. Another problem raised in this topic is, we have already over-exploited the natural source of these anti-microbial drugs and now, it is very difficult to formulate new drugs for this purpose (Shi et al., 2014). There are certain natural remedies which can be used in the place of synthetic drugs. One of them is honey.  Peroxides present in the honey helps in the prevention of the microbial growth thus it is helpful in the treatment of infections. Further honey like ‘manuka’ has some healing properties which can be used to cure the wounds. Thus, when honey is applied on the wounds, it acts as both, it provide cure as well as it prevents the infection there by retarding the growth of the infectious pathogens. In this assignment we are going to discuss about the various studies on the use of honey as a remedy for the wounds and ulcers. We will critically analyze all the studiesby using CASP method and then we will grade it by using FORM framework.

In this assignment, five different studies and researches will be discussed which taken placed in the last five years. These articles will be based on different methods in which honey can be used in the treatment of wound. Journals of AB Null, the research papers ofAS Bischofberger, CM Dart, the studies done by AV Kamaratos and evidences collected by R Yaghoobi in the treatments of wounds with the help of honey will critically discussed below. Then, CASP checklist is been used as a critical appraisal tool.Keywords used are (manuka honey/ sulfadiazine treatment/ NDFU/ foot ulcers) (Yang, Center, Eisman, & Nguyen, 2015)

  1. Systematic review - Review was undertaken to determine the potential of honey when it is used in the place of other medications when applied on a wound.

Randomized control trials - 3011 participants participated in this review. 47 trials, including effects of honey on minor wounds, its effects on burnt area, trials on people having chronic wounds and impact of honey on the patients having ulcers on leg (Reiner et al., 2018) .

Cohort studies - When patients were treated with silver sulfadiazine and half of the patients of thin burning were treated with honey, it was found that silver sulfadiazine was more effective than honey. Other readings of normal patients who were treated with honey and then treated with SSD , in all cases it was found that honey is less effective than the synthetic drug.

Economic evaluation – It was found that honey was ten – times cheaper than the synthetic medications used for wound healing.

Qualitative study – when feedback as taken from the patients after treatments, it was found that, most of them voted for SSD as quicker medication, but they also supported honey as it was natural medication without any side effects and was 10 times cheaper than the SSD (Yang, Center, Eisman, & Nguyen, 2015).

Results

Clinical prediction rule –this study was valid because the result produced was practically. Te result was that; honey can be used in the treatment of the wounds but it is not as much effective as SSD and other synthetic drugs, some plus points for the usage of honey are , firstly it is ten times cheaper than other medications and secondly, it is natural , and thus produce negligible amount of side effects (Dobloug et al., 2015).

  1. Systematic review - Experimental study was done on the horses for the treatments of wounds with the manuka honey.

Control trials – 10 horses were selected randomly and wounded with exact 4cm sq. area on the metacarpals. Half of the horses were treated with manuka honey, manuka honey gel for 12 days and with manuka honey gel for the 2 days and remaining were left untreated. Study was done for 42 days until results were recorded (Winnier et al., 2015).

Qualitative study – it was found that wounds which were treated with manuka honey gel throughout the treatment was showing the bet results and wound which were left untreated were the worst.

Economic evaluation – using expensive medication can be avoided for the treatment o small wounds in animals by using honey for the healing.

Clinical prediction rule – from this study we came to know that among all the forms, if manuka honey gel is applied on the wound for the treatment throughout the medication process then it shows the best results. This will help in the medication process and in the better treatments of the patients. This study also shows that honey can also be used for the treatment of wounds in animals. Therefore, expensive medications can be avoided for the healing process of wound by applying honey on them.

  1. Systemic review – investigation on the effect of manuka honey impregnated dressings on the treatment of NDFU.

Randomized control trials –63 patients suffering from diabetes were divided into two categories, first were given normal treatments with CDs while others were provided with manuka honey impregnated dressings (Kawaguchi et al., 2016).

Economic evaluation – it was found that conventional dressings were costlier than the honey impregnated dressings.

 Qualitatively study – patients who were treated with MHID produced better results than the patients who were treated with conventional dressings.

Clinical prediction rule – the result of the study helps in the treatment of foot ulcers effectively in the low costs.Sterility can be achieved on faster rate than the conventional dressings and this result can be very helpful in the future for the treatment of microbial infections without the use of synthetic drugs (Gordon et al., 2017).

  1. Studies were done to know the antimicrobial properties of honey. In this study, honey was reacted with different chemicals and then it was reacted with different microorganisms.

All the literature and journals from the pat were collected and compiled to know about the facts of the honey.

Economical evaluation – moderate rate even it was applied twice a day.

Qualitative study – it was found that honey has bactericidal and fungicidal actions; it enhances the wound healing processes (Boillot et al., 2015).

Clinical predictions – uses of honey as medication is very comfortable and there is ease of application. Therefore, usage of honey can be administered in the hospitals as the cure for wound healing and it will also be appreciated by the patients.

  1. Research based on the usage of honey dew for the treatment of lower leg ulcers.

Control trials – 25 patients with the disease of lower leg ulcers. They were given the treatment of gamma radiated honey dew for the six weeks and results were recorded.

Conclusion

Economical evaluation – for the treatment of ulcers honey proved to e cheaper medication than the synthetic drugs and for this reason, even poor people can use honey for the healing of ulcers (Poongothai et al., 2015).

Qualitative study - there was decrease in the wounded area after applying gamma treated honey dew. It even helped 80% of the patient in the reduction of the pain.

Clinical predictions – honey dew ha enough potential to be used in the treatments of ulcers. It can be used effectively in the treatment of same.

All the above researches are ‘GRADE’by using FORM (Hillier et al., 2011). This framework will help in logical and intuitive way to formulate the findings of the paper.

Evidence base

From the above studies it was found that honey can be used for the cure of wounds of burnings on the skin, wounds of the animals, as an antibacterial agent and for the treatments of ulcers. To support these, it was found that when honey was applied over wounds in place of the general medications, honey help in the healing of wounds. When honey was reacted with certain microorganisms, there was retardation in the rate of growth of those microorganisms which supports that honey can be used as an antibacterial agent. It is worth to note here that, as honey is doing both the jobs , i.e., it is helping in the healing of wounds as well as it is helping in the prevention of the growth of microorganisms, honey can be effectively applied on the wounds as it will prevent the infection and also provide cur to the wounds (Philpott et al., 2015).

Consistency in the treatment

As honey is natural remedy, it can be applied several times over the affected area and it will not provide any side effects or negative impact on the health. If honey is applied in more amount than it was needed then also it does not do any harm to the body. In this way, honey provides consistency in the treatment of wounds.  Wrapping the wounded area after application of manuka honey over it is very much effective. Even now, a pre-packaged wound dressing which already contains the manuka honey inside is prepared by many pharmaceutical companies. These can be applied anytime without the need of any training (Yusuf et al., 2015).

Clinical impact

When we talk about the clinical impact of honey in the treatment of wounds, it was found that, antibiotics which are been used in the treatment of wounds and other treatments are getting less effective day by day. According to researches,it is estimated that after 20 years, no antibiotics can be used in the treatment of microbial diseases. Therefore, it can be said that remedies like honey can be used in future on large scales for the treatments of wounds and other disorders. Very soon honey can be used for the treatment of small and chronic wounds, and for the treatments of ulcers. Even many pharmaceutical companies have formulated certain pre-packaged wound dressings which contains honey inside them which can be used instantly on any wound without the any training (Kashani et al., 2017).

Future Directions

Generalisability of the use of honey in the treatments

Along with the use of honey in the cure of burnt wounds and on ulcers on foot, which were discussed in the researches above, honey can b used in many more treatments and other medical purposes. It can be taken on daily basis to develop immunity against many diseases. Ulcers of the bucccal cavity and that of in stomach can also be treated with the honey. Many medications whose preservation is very difficult can be preserved by adding honey into it (Kim et al., 2016).

Applicability

Honey was not found to be as much efficient as the synthetic drugs in the treatments of thin and chronic wounds. It was found honey dew gel is most effective among all the honey products against the infection and in the treatments of wounds. Further, the use and application of honey is very simple and easy. Therefore honey can be used in the treatments but not as much effective than the synthetic drugs (Bassig et al., 2017). Synthetic drugs are still preferred above the honey for the immediate treatment, cure and relief.

Discussions

As already discussed above, as day by day we are running out of antibiotics, in near future it will be very difficult for the surgeons to perform surgeries due to lack of antibiotics which I needed in the prevention of the microbial growth and for the sterilization. In this approach, natural remedies like honey can be very useful.

From the above five studies, study about the effect of honey in the control of growth of microorganisms and for the cure of wounds were very important (Kim, Lim, Choi, & Park, 2015). It so because, it helps us in identifying the uses of honey effectively in the medication purposes. When any synthetic medication is applied on the wounds, very soon bacteria and other microorganisms starts developing immunity against that drug, but when we use natural remedies, this thing is less likely to occur. And if it happens then too after that we can use synthetic medications in the treatment of wounds effectively. From these studies we also come to know the antimicrobial property of the honey which means that when we will apply honey on any wounds, we are not required to apply any other antimicrobial medications because honey itself is working as an anti microbial agent. Where the synthetic medications are very expensive, honey is ten-times less expensive than these synthetic medications. Further, the application of honey is also very easy (Hilmi et al., 2015).

Some of the thing, which is missing in all the studies is overuse of the honey. As everyone knows, human beings always exploit the things which are available to them without thinking about its vulnerability. Honey is very easily available in the market but there is some limit in which it is produced by the honeybees. If anyone wants to get honey on a large scale then it will be very cumbersome process. No machinery can produce honey and therefore if it is used for the medication purposes then this point should be undertaken. There should be certain policies which government should make in this aspect (Han et al., 2017). The policies should contain the limited use of honey for the commercial purposes, a limit to which honey can be taken for any treatment, and policies to motivate and promote apiculture. Plantations of flowering plants should be promoted, or the over production of bees will lead to the decline of the production of flowers and at last bees will also get disappeared. Certain limitations in the apiculture are that it cannot be done in city areas, because bees can be proved dangerous sometimes (Kim et al., 2016).

Conclusion

As all the microorganisms are developing immunity against antimicrobials, it is very necessary to check the use of antimicrobials to a limited amount. To overcome this problem, natural remedies like honey can be used for this. One of the uses of honey in the field of medication is in the healing of wounds. The research papers which were studied shows that honey can be used in the treatment of wound. Homey have some properties through which it can help in the healing of wounds. The peroxisomes present in the honey enables it to prevent the growth of microorganisms and because of these reasons, honey can be used on the wounded area (Tan et al., 2017). From the studies it as found that honey is not that much effective then the synthetic drugs. Patients prefer drugs like SSD on the honey to get faster cure and relief from the itchiness. Honey is cheaper than the synthetic drugs and its applying process is also very easy. It helps in preventing the spread of diseases or infections. Also many diseases like ulcers can be cured by applying honey on them. In near future honey can be used on large scale for the control of the spread of infections due to unavailability of the proper antimicrobials and the antimicrobial properties of the honey. Manuka honey is preferred among all other varieties in the treatment of wounds and many countries gave manuka honey as recommendation for the wound treatment. Like all natural resources, availability of honey is also limited, therefore certain policies should be made for the commercial use of honey and government should promote the apiculture in rural areas. In near future honey can play a vital role in the field of epidemiology.

References

Bassig, B. A., Dai, Y., Vermeulen, R., Ren, D., Hu, W., Duan, H., ... & Pinto, L. A. (2017). Occupational exposure to diesel engine exhaust and alterations in immune/inflammatory markers: a cross-sectional molecular epidemiology study in China. Carcinogenesis, 38(11), 1104-1111.

Boillot, A., Demmer, R. T., Mallat, Z., Sacco, R. L., Jacobs, D. R., Benessiano, J., ... & Desvarieux, M. (2015). Periodontal microbiota and phospholipases: The oral infections and vascular disease epidemiology study (INVEST). Atherosclerosis, 242(2), 418-423.

Dobloug, G. C., Antal, E. A., Sveberg, L., Garen, T., Bitter, H., Stjärne, J., ... & Molberg, Ø. (2015). High prevalence of inclusion body myositis in Norway; a population?based clinical epidemiology study. European journal of neurology, 22(4), 672-e41.

Gordon, J. S., Griest, S. E., Thielman, E. J., Carlson, K. F., Helt, W. J., Lewis, M. S., ... & Henry, J. A. (2017). Audiologic characteristics in a sample of recently-separated military Veterans: The Noise Outcomes in Servicemembers Epidemiology Study (NOISE Study). Hearing research, 349, 21-30.

Han, S. J., Kim, H. J., Kim, D. J., Lee, K. W., & Cho, N. H. (2017). Incidence and predictors of type 2 diabetes among Koreans: a 12-year follow up of the Korean Genome and Epidemiology Study. Diabetes research and clinical practice, 123, 173-180.

Hilmi, I., Jaya, F., Chua, A., Heng, W. C., Singh, H., & Goh, K. L. (2015). A first study on the incidence and prevalence of IBD in Malaysia—results from the Kinta Valley IBD Epidemiology Study. Journal of Crohn's and Colitis, 9(5), 404-409.

Kashani, K., Shao, M., Li, G., Williams, A. W., Rule, A. D., Kremers, W. K., ... & Lieske, J. C. (2017). No increase in the incidence of acute kidney injury in a population-based annual temporal trends epidemiology study. Kidney international, 92(3), 721-728.

Kawaguchi, T., Koh, Y., Ando, M., Ito, N., Takeo, S., Adachi, H., ... & Ichinose, Y. (2016). Prospective analysis of oncogenic driver mutations and environmental factors: Japan molecular epidemiology for lung cancer study. Journal of Clinical Oncology, 34(19), 2247-2257.

Kim, J., Lee, S. J., Choi, K. M., Lee, S. K., Yoon, D. W., Lee, S. G., & Shin, C. (2016). Obstructive sleep apnea is associated with elevated high sensitivity C-reactive protein levels independent of obesity: Korean genome and epidemiology study. PloS one, 11(9), e0163017.

Kim, M. J., Lim, N. K., Choi, S. J., & Park, H. Y. (2015). Hypertension is an independent risk factor for type 2 diabetes: the Korean genome and epidemiology study. Hypertension Research, 38(11), 783.

Kim, N. H., Seo, J. A., Cho, H., Seo, J. H., Yu, J. H., Yoo, H. J., ... & Shin, C. (2016). Risk of the development of diabetes and cardiovascular disease in metabolically healthy obese people: the Korean Genome and Epidemiology Study. Medicine, 95(15).

Pérez, L. J., Perera, C. L., Coronado, L., Rios, L., Vega, A., Frías, M. T., ... & de Arce, H. D. (2015). Molecular epidemiology study of swine influenza virus revealing a reassorted virus H1N1 in swine farms in Cuba. Preventive veterinary medicine, 119(3-4), 172-178.

Philpott, C., Hopkins, C., Erskine, S., Kumar, N., Robertson, A., Farboud, A., ... & Jervis, P. (2015). The burden of revision sinonasal surgery in the UK—data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study. BMJ open, 5(4), e006680.

Poongothai, S., Pradeepa, R., Indulekha, K., Surendar, J., & Mohan, V. (2015). Association of depression with common carotid artery intima media thickness and augmentation index in a large Urban South Indian population-The Chennai Urban Rural Epidemiology Study (CURES-138). Indian journal of endocrinology and metabolism, 19(1), 136.

Reiner, A. S., Sisti, J., John, E. M., Lynch, C. F., Brooks, J. D., Mellemkjær, L., ... & Tischkowitz, M. (2018). Breast Cancer Family History and Contralateral Breast Cancer Risk in Young Women: An Update From the Women’s Environmental Cancer and Radiation Epidemiology Study. Journal of Clinical Oncology, 36(15), 1513-1520.

Shi, Y., Au, J. S. K., Thongprasert, S., Srinivasan, S., Tsai, C. M., Khoa, M. T., ... & Yang, P. C. (2014). A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non–small-cell lung cancer of adenocarcinoma histology (PIONEER). Journal of thoracic oncology, 9(2), 154-162.

Tan, L. M., Qiu, C. F., Zhu, T., Jin, Y. X., Li, X., Yin, J. Y., ... & Liu, Z. Q. (2017). Genetic polymorphisms and platinum-based chemotherapy treatment outcomes in patients with non-small cell lung cancer: a genetic epidemiology study based meta-analysis. Scientific reports, 7(1), 5593.

Winnier, D. A., Fourcaudot, M., Norton, L., Abdul-Ghani, M. A., Hu, S. L., Farook, V. S., ... & Dyer, T. D. (2015). Transcriptomic identification of ADH1B as a novel candidate gene for obesity and insulin resistance in human adipose tissue in Mexican Americans from the Veterans Administration Genetic Epidemiology Study (VAGES). PloS one, 10(4), e0119941.

Yang, S., Center, J. R., Eisman, J. A., & Nguyen, T. V. (2015). Association between fat mass, lean mass, and bone loss: the Dubbo Osteoporosis Epidemiology Study. Osteoporosis International, 26(4), 1381-1386.

Yusuf, E., Halewyck, S., Wybo, I., PiÚrard, D., & Gordts, F. (2015). Fusobacterium necrophorum and other Fusobacterium spp. isolated from head and neck infections: a 10-year epidemiology study in an academic hospital. Anaerobe, 34, 120-124.

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