Proposal for a Clinical Practice Guideline

Introduction

The issue of obesity is an alarming and urgent concern of the worldwide community in the current course of time. Obesity prevention refers to avoiding the occurrence of obesity, and it becomes as topical as its treatment as far as the currently discussed issue is progressing at escalating rates. Therefore, it is essential to develop a constructive set of clinical practice guidelines that will deal with both prevention and actual treatment of obesity. According to Fitch et al. (2013), “Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic and behavioral causes and consequences” (p. 6).

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Hence, it is critical to take into consideration all the aforementioned aspects in the course of clinical practice guidelines development. The notion of practice guidelines accounts for a particular document that involves a range of statements and proper recommendations aimed to “to assist health care professionals in medical decision making for specific clinical conditions. Most of their content is based on literature reviews” (Garber et al., 2012, p. 990).

Moreover, the given clinical guidelines are targeted not only at the specification of the course of treatment, but primarily at informing and educating the professionals in terms of medical practical performance. As a rule, such guidelines are developed and implemented in controversial cases of treatment. They require an in-depth investigation of the issue in question, the study of previous empirical experience in the outlined area, expert evaluation, and confirmation in order to provide credible and reliable data.

Hence, the present proposal deals with the research in the field of obesity development and its potential connection with hypothyroidism.

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Literature Review

According to Fitch et al. (2013), problems with excessive weight are considered to be “a national epidemic in the United States with 78 million obese adults. In 2009-2010, the prevalence of obesity was 35.5% among men and 35.8% among women. The prevalence of extreme obesity has also increased” (p. 6). Moreover, the statistics concerning children and obesity rates are also considerable disturbing, namely, 31.7% of children are obese (Fitch et al., 2013). Along with such, the youth aged 17-24 is disqualified from the U. S. military service as a result of the overweight factor (Fitch et al., 2013).

As a matter of fact, obesity is usually either a result of a predetermining factor of diverse psychological disorders. This aspect makes the whole problem associated with obesity more complicated and threatening for modern society. Finally, it is essential to underline that the issue in question is considered to be “the second leading cause of preventable death in the U.S., with only tobacco use causing more deaths. More than 112,000 preventable deaths per year are associated with obesity” (Fitch et al., 2013).

Biondi (2010) confirms the threat of obesity for modern people taking into consideration such essential contributing factors as the deficit of physical activity, prevailing unhealthy diet, and permanent stressful conditions of contemporary life. Moreover, Biondi (2010) emphasizes that “obesity is associated with an increased risk of diabetes, dyslipidemia, kidney disease, cardiovascular disease, all-cause mortality, and cancer” (p. 3614).

As a result, it is crucial to study the aspects that tend to increase the aforementioned risks. In fact, the abnormalities of the endocrine system are considered to be one of the strongest factors contributing to the development of obesity. Along with such, hypothyroidism is among central concerns in the given context. Thyroid dysfunction may consequently lead to serious problems with metabolism as well as thermogenesis (Verma, 2008).

Furthermore, “both subclinical and overt hypothyroidism is frequently associated with weight gain, decreased thermogenesis, and metabolic rate” (Biondi, 2010, p. 3614). Longhi and Radetti (2013) support the stance that is presented above and highlight the strong connection that exists between thyroid dysfunction and obesity as far as it leads to the development of diabetes and cardiovascular diseases.

Thus, the relationship between excessive weight and thyroid dysfunction is an important issue of concern that should be studied more thoroughly in order to provide constructive clinical practice guidelines for medical personnel.

Objectives

The objectives of the study that is outlined in the present proposal are as follows:

General Objective

  • to evaluate the connection between obesity development and progressing hypothyroidism.

Specific Objectives

  • to assess the current knowledge about the relationship between excessive weight development and hypothyroidism;
  • to evaluate the effect of the given disorder on obesity progress under the conditions of the present study;
  • to develop a set of constructive conclusions and recommendations aimed at a significant contribution to the field of obesity and predetermine the guidelines for further investigation of the issue in question.

Investigation Questions

The range of investigation questions guides the course of study and focuses the researcher on the most crucial aspects of the explored phenomenon.

  1. What is obesity in the contemporary type of comprehension?
  2. What is hypothyroidism?
  3. How are these two notions connected?
  4. What is the direct effect of thyroid dysfunction on weight change?
  5. What are the secondary factors that can impact the development of obesity?
  6. How should this relationship be treated and controlled?

Hypothesis

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Alternative Hypothesis

The development of obesity is closely connected with hypothyroidism as far as thyroid dysfunction contributes to its progress.

Null Hypothesis

The development of obesity is not closely connected with hypothyroidism as far as thyroid dysfunction does not contribute to its progress.

Methodology

It is crucial to admit that the given research incorporates both primary and secondary research. Such an approach is justified by the necessity to use credible and reliable data concerning the subject of research. This data can be provided only by means of in-depth insight into previous research experience within the given area. As a matter of fact, the course of secondary research is expected to provide the relevant background that will predetermine further research, topical objectives, and research questions. The secondary research will involve close inspection of the empirical studies conducted by Velivala et al. (2013), Biondi (2010), and Fitch et al. (2013). The given studies are relevant, constructive, and up-to-date. Therefore, they will serve as a proper basis for the given research course.

The primary research will be based on both qualitative and quantitative methods of research. The reason is that such a choice is expected to provide an objective and complete picture of the issue in question. Moreover, the quantitative research will provide statistics, the data that will reflect the empirical activities and their results, whereas qualitative research aims at the provision of more detailed and subjective information. To be more precise, the qualitative methods guarantee that properly selected respondents will reflect on the major research questions incorporating not only their factual experience in the field of concern, but also providing perceptions, approaches, and paradigms they follow in their medical practice.

The answers of correspondent doctors and scientists will contribute not only to the actual conclusions and recommendations concerning the dependence of the obesity development on thyroid dysfunction but also will help to design the guidelines for the main studies that are needed to fill in the gaps the professionals have in the given scope of medical knowledge.

The chosen methods are questionnaires and personal interviews. These methods reflect the aforementioned properties of qualitative and quantitative types of research properly. Furthermore, they help focus the research on the most significant aspects and do not involve data of secondary importance.

The questionnaire is designed to cover the practical outcomes of the professional activities of the contemporary doctors who work both empirically and theoretically within the given field. To be more precise, the particular cases of their professional performance will be explored as well as specific disparities in comparison with the previous studies’ results will be collected in order to conduct a constructive and thorough analysis. The statistics will be provided with the purpose to determine the level of connection between obesity and hypothyroidism.

Furthermore, the most common irregularities or specific influential factors will be identified due to the given method of research. There will be twelve questions, both close-ended and open-ended. Such a structure is necessary in order to guarantee not only maximally detailed responses, but also proper focus, clear, and precise answers.

Personal interviews are expected to provide an in-depth insight into the issue of concern. As a matter of fact, every selected professional will be asked ten questions aimed to maximize the overall level of comprehension of the connection between excessive weight and thyroid dysfunction. Moreover, every respondent will be able to add as much information as he or she considers necessary and appropriate. Along with such, extra questions and commentaries will also be permitted and even welcomed. It is also expected to identify new concepts that are related to the development of obesity or thyroid dysfunction.

Scoping Stage and Objectives

The scoping stage of the proposed study helps to evaluate its potential feasibility, a level of its perspective and significance for further research as well as a contribution to the area of concern. Moreover, the scoping stage provides an excellent opportunity to reveal the drawbacks of the course of study and correct them timely and constructively. Such an approach is expected to decrease the number of potential mistakes and decrease the level of accurateness and credibility of the results.

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The scoping stage of the study should be conducted according to the aforementioned objectives of the study. Hence, the first step within the scoping stage will be aligned with the first objective, namely, to assess the current knowledge about the relationship between excessive weight development and hypothyroidism. To follow this step, it is necessary to perform the analysis of one article among the outlined list of secondary sources. It is recommended to start with the study by Biondi (2010) as far as it is the one prior to the more thorough and innovative researches on the given topic.

Moreover, the given study demonstrates a constructive approach. It does not only present a well-structured and precise definition and description of each phenomenon that is in the area of concern of the present research but also aligns the impact of thyroid dysfunction with the increase of weight and other potential ramifications. The conclusions made by Biondi (2010) should be considered to be the basis for the analysis and assessment of the relation between hypothyroidism and obesity.

The second step will be aligned with the next objective. It is recommended to evaluate the effect of the given disorder on obesity progress under the conditions of the present study. Personal interviews will be conducted according to the prepared form that has been designed for the currently discussed study. It is apparent that the responses of each participant will be different in terms of content and overall efficiency. Nonetheless, such interviews will demonstrate what data can be collected during the preliminary primary research phase.

Moreover, responses are expected to guide the researcher which aspects should be taken into consideration more, and what extra questions should be included in the initial form of the questionnaire. The same approach should be incorporated in terms of the questionnaire. Three respondents selected on a random basis should answer the questions that will be provided in the written form. The answers will be analyzed thoroughly in order to reveal drawbacks, deficits, and excessive focuses.

Finally, the scoping stage will include preliminary development of conclusions and recommendations concerning the enhancement of the content of the research as well as its process. The modification of the questionnaire and interview forms will be a constructive step targeted at the consistent improvement of the course of research.

Furthermore, as far as the third objective is to develop a set of constructive conclusions and recommendations, aimed at significant contribution to the field of obesity and predetermine the guidelines for further investigation of the issue in question, it is necessary to align the results of the study of the previous experience with the responses in terms of the primary research course.

Consultation with Experts in the Field

It should be pointed out that it is crucial to consult with the experts in the area of the present research. The expert opinion, evaluation of the research proposal, and recommendation will enhance the whole model of investigation, and the acquired outcomes will be more constructive, credible, and reliable.

  • First, it is important to explore previous experience and studies that have already been conducted in the field of interest.
  • Second, it is also helpful to consult with the supervisor and professionals in the scope of hypothyroidism as well as obesity.

As it has been already highlighted, the present study will rely on such authors as Biondi (2010), Velivala et al. (2013), and Fitch et al. (2013). It is evident that the constructive and efficient studies have been conducted by many scientists. Therefore, expert consultation is obligatory for the proposal of such a scale. The consultation will be conducted with the supervisor and the other two professors from our department. They have significant theoretical as well as empirical knowledge. Therefore, the advice and commentaries will be a valuable contribution to the present proposal and consequently study.

Search

The process of search should be well-structured and consistent. First, it is necessary to determine the scope of the research. The participants of the questionnaire will be selected randomly from three medical databases of the city hospitals. Participation in the currently discussed activity will be on a voluntary basis. Moreover, the principle of confidentiality will be followed. The potential respondents for the personal interviews will be selected from the range of experienced and innovative doctors who either had a particular experience or worked as scientific researchers in the given medical area. The process of the search will be conducted in two phases.

To be more precise, the first phase will include the organization of the questionnaire conduct, whereas the second one will involve personal interviews. There will be 40 participants for the first phase and 10 respondents for the second one. The acquired data will be grouped properly and subsequently analyzed. The preliminary groups will be aligned with every particular question, whereas consequent ones will be more general and thematic.

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Evaluation and Synthesis of Scientific Evidence

Once the data that has been acquired during the primary research process is grouped, it is appropriate to start the course of synthesis and evaluation. The correspondence of the acquired responses with the outcomes of the secondary research and expected results should be discussed in order to conclude and provide the objective, trustworthy picture of the correlation between obesity and thyroid dysfunction. The responses will be synthesized and evaluated according to the commonly accepted statistics. The comparison and alignment of the ramifications will result in relevant conclusions and constructive recommendations for further research. Hence, the scientific evidence will be synthesized and evaluated both in correspondence to the prior knowledge and to the primary research.

Development of the Recommendations

The course of development of recommendations is another significant part where the researcher will discuss and organize the received information properly. First, the conclusions should be followed by the identification of the major drawbacks of the current study or gaps in research. These recommendations will concern the guidelines for further research. Second, the recommendations will refer to the new perspectives that have appeared as a result of the conducted primary research. In such a way, the recommendations will be constructive and consistent.

External Review

One of the cornerstones of the efficient and perspective research proposal is the relevant external review. From my perspective, this part contributes to the overall credibility of the study. The topicality of the investigation theme as well as the constructiveness of the approach to the research course and clear structure of data collection augment the level of competitiveness of the present proposal.

Nonetheless, even the scoping stage is not a guarantee of the proper and complete enhancement of the research proposal. Therefore, external review is considered to be a final and authoritative checking point concerning drawbacks and advantages, hidden focuses of search, and particularly significant aspects that need more profound insight or more serious consideration.

The potential reviewers include three professors from the department and the application for external review has been issued for seven weeks before the final date of the proposal presentation.

Assessment of the Questionnaires by the Expert Group

The assessment of the questionnaires and interviews will be conducted not only by the researcher directly but also by the expert group. In such a way, propriety, feasibility, and reliability of the acquired outcomes will be evaluated. Moreover, the basic criteria will reflect the main focus of the whole research, and it will help the expert group put emphasis properly and accordingly. To be more precise, the assessment of the questionnaires and interviews by the expert group will be performed on the basis of such criteria as correspondence to the research objectives, the potential response to the research questions, and the depth of the expected insight into the issue in question.

Moreover, theoretical and empirical scopes will also be evaluated. The given research is oriented primarily on the acquisition of the data that will be incorporated for the purpose of practical implementation. Therefore, the expert group will also assess the level of empirical significance of the research proposal. Along with such, the criterion of the actual contribution to the medical field will be taken into consideration. The conclusion of the expert group will be detailed, justified, and provided with recommendations and commentaries.

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