COVID-19 is having a dramatic impact on the delivery of health services as well as on the nation’s economy. A cornucopia of research topics will become available for study once the pandemic has been relegated to the past tense. As an illustration, eventual findings from retrospective reviews to create improved understandings of how to keep patients from being assigned to various settings, such as intensive care units could influence health professions education by enabling students through the use of case studies to learn about what worked effectively and what failed to do so in patient care during a pandemic.
Research wise, each year approximately 40% of the manuscripts submitted to the Association’s Journal of Allied Health are rejected, often because of serious research methodology flaws. An article that appeared in the May 2020 issue of the Journal of Clinical Epidemiology sheds light on a common obstacle encountered by many investigators, which is the ability to recognize how “confounding” threatens the process of causal inference. The authors posit that a sound understanding of confounding within the counterfactual framework of causation enables better anticipation and dealing with this source of bias in research practice.
As a remedy, they propose a simplified explanation of the counterfactual definition of confounding based on a non-technical and graphical presentation of the central role of exchangeable background risks. As a first step, the following definition from the Dictionary of Epidemiology is offered: “The distortion of a measure of the effect of an exposure on an outcome due to the association of the exposure with other factors that influence the occurrence of the outcome. Confounding occurs when all or part of the apparent association between the exposure and the outcome is in fact accounted for by other variables that affect the outcome and are themselves not affected by the exposure.”
An exposure is broadly defined as being subjected to some kind of determinant, either harmful (risk factor) or beneficial (protective factor), or to a certain intervention or treatment. Like exposures, outcomes of interest in clinical epidemiological research also are broadly defined, for example, the occurrence or cure of a certain disease or health-related condition. It is assumed for ease of explanation that exposures and outcomes are dichotomous and are related positively, e.g., exposure to a risk factor leads to more disease or exposure to treatment produces a cure. Concepts to be explained also apply, however, to exposures and outcomes that are non-dichotomous or inversely related.
Consequently, when not appropriately accounted for by design or in the analysis of an investigation, confounding may bias study findings by distorting the association measures used for quantifying the nature and magnitude of the relation between the primary exposure and outcome. A key implication regarding what may need to be emphasized from an educational perspective is that this approach could serve in a valuable way for introducing researchers and students to the underlying concepts of confounding as explained from a counterfactual viewpoint.
More May 2020 TRENDS Articles
RESEARCH AND EDUCATION AFTER THE PANDEMIC
Indicates the importance of recognizing how “confounding” as a source of bias threatens the process of causal inference in research practice. Read More
PRESIDENT’S CORNER
ASAHP President Phyllis King presents information about the Association’s five strategic objective areas and associated success measures. Read More
HEROES ACT PASSED IN HOUSE
Contains details about a proposed piece of legislation to furnish additional financial assistance to deal with economic consequences resulting from the COVID-19 pandemic. Read More
HEALTH REFORM DEVELOPMENTS
Points out how the federal-state Medicaid program is being augmented to provide insurance coverage and paid sick leave benefits for individuals negatively affected by job loss. Read More
DEVELOPMENTS IN HIGHER EDUCATION
Describes how Mad magazine’s Alfred E. Neuman’s motto of Quid Me Anxious Sum serves as a motivational factor for enjoying life once governmental lock-down provisions are relaxed and also how coronavirus stimulus funding is being distributed to colleges and universities. Read More
QUICK STAT (SHORT, TIMELY, AND TOPICAL)
Births: Provisional Data for 2019
Effects Of The COVID-19 Pandemic On Routine Pediatric Vaccine Ordering And Administration
Non-Invasive And Reversible Modulation Of Neuronal Activity To Diagnose And Treat Brain Disorders
Cracking Nature’s Most Common Chemical Bond To Improve Drug Effectiveness Read More
AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
What COVID-19 Epidemiologic Models Can And Cannot Tell Us
Supporting Student Health And Mental Well-Being
Caregiving In The United States 2020 Read More
RETHINKING THE “BENCH” AND “BEDSIDE” DICHOTOMY
Mentions how research activities might be understood better in the context of “discovery-invention” cycles rather than a basic/applied dichotomy that translates loosely to notions of bench and bedside research. Read More
ADDRESSING THE 60-30-10 CHALLENGE
Refers to a study that discusses how 60% of health care adheres to guidelines; 30% is represented by care that is waste, duplication, or low value; and 10% accounts for iatrogenic harm or adverse events. Read More