Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
126 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
3 Sources of evidence that inform EBP
|
Patients unique values and circumstances
Best research evidence Clinical expertise |
|
|
|
What is the PECO approach to formatting clinical questions
|
P:patient/problem
E:exposure/ C: comparison O: outcomes |
|
|
|
What is the highest level of evidence according to the evidence pyramid? Level 1a and b
|
Systematic reviews
Randomized clinical trials |
|
|
|
What is the lowest level of evidence according to the evidence pyramid?
Level 5 |
Narrative reviews, expert opinion and textbooks
|
|
|
|
Level 2b on the evidence pyramid
|
Cohort studies
|
|
|
|
Level 3b on evidence pyramid
|
Case control studies
|
|
|
|
Level 4 on evidence pyramid
|
Case series
Case studies |
|
|
|
5 steps of EBP
|
1 ask a focusedclinical question
2 search for the best research evidence 3 appraise quality of research evidence 4integrate research evidence with information about pt 5 reflect on process to improve the future |
|
|
|
2 essential components of a background question
|
Question root (who, what, why....)
Condition |
|
|
|
2 types of clinical questions
|
Background
Foreground |
|
|
|
3 essential components of foreground questions
|
Patient and or problem
Exposure ( intervention)/ comparison intervention Clinical outcomes |
|
|
|
Source of knowledge described?
Something is thought to be true simply because people have always known it to be true |
Tradition
|
|
|
|
Source of knowledge described?
Information based on specialized training or experience |
Authority
|
|
|
|
Source of knowledge described?
Try something if it seems to work satisfactorily keep doing it |
Trial and error
|
|
|
|
Source of knowledge described?
Combines personal experience, intellectual faculties and formal systems of thought |
Logical reasoning
|
|
|
|
Sources of information described?
Systematic, empirical, controlled and critical examination of hypothetical propositions about associations among natural phenomena |
The scientific method (research)
|
|
|
|
T/F among peer reviewed journals there is no consistent process/ level of rigor by which the articles are evaluated
|
True
|
|
|
|
Hierarchy of study types (7)
|
1. Evidence based clinical guidelines
2. Systematic review and meta analysis of RCTs 3.RCTs 4. Non randomized intervention studies 5. Observational studies 6. Qualitative studies 7. Case series, case reports |
|
|
|
Literature reviews focused on a single question that try to identify appraise, select and synthesize all high quality research relevant to that question
|
Systematic review
|
|
|
|
Statistical analyses of a large collection of results from individual studies for the purpose of integrating the findings
|
Meta analysis
|
|
|
|
Experimental studies of cause and effect relationships between treatments and outcomes
|
Randomized controlled / clinical trials
|
|
|
|
Observational studies in which a defined group of people is followed over time. Aka longitudinal study
|
Cohort studies
|
|
|
|
Observational research where no Intervention is provided rather people who have the condition of interest are compared to people who do not
|
Case control studies
|
|
|
|
Descriptive research. A group/ series of case reports involving patients who were given similar treatment
|
Case series
|
|
|
|
Type of research or evidence that:
Describe practice. Can focus on patients or facilities. Can't prove effectiveness or test hypotheses or prove cause and effect |
Case studies/ reports
|
|
|
|
Clinical guidelines are considered obsolete after how many years?
|
5.8
|
|
|
|
Cochrane collaboration policy states that systematic reviews should be updated how often?
|
Every 2 years
|
|
|
|
Level of data measurement?
Qualitative/categorical level of data with no mathematical interpretation |
Nominal measures
|
|
|
|
Level of data measurement?
You specify only the order of the cases in greater than and less than e.g. Patient satisfaction |
Ordinal measures
|
|
|
|
Level of data measurement?
Numbers represent fixed measurement units but have no absolute zero point e.g, temperature |
Interval measures
|
|
|
|
Level of data measurement?
Fixed measuring units with an absolute zero. Numbers can be added, subtracted etc e.g. Goniometric measure of ROM |
Ratio measures
|
|
|
|
T/F
Reliability is not a property of an experiment/ study |
True. It's a property of a measurement instrument
|
|
|
|
Extent to which a measure produces the same result under different conditions ( consistency)
|
Reliability
|
|
|
|
Extent to which a measure indicates what it is supposed to measure
|
Validity
|
|
|
|
Type of validity?
The methods used on the study are correct and the results are accurate |
Internal validity
|
|
|
|
Type of validity?
The findings are applicable beyond that particular study |
External validity
|
|
|
|
Type of validity?
Measure looks like its going to measure what it's supposed to measure |
Face validity
|
|
|
|
Type of validity?
Measure covers full range of concepts meaning |
Content validity
|
|
|
|
Type of validity?
Scores obtained with one measure can be accurately compared with scores obtained with another measure that's more established |
Criterion validity
|
|
|
|
Type of validity?
Measure fits well with other measures of similar theoretical concept |
Construct validity
|
|
|
|
Measure of central tendency that can be used with any type of data
|
Mode
|
|
|
|
Measure of central tendency that can be used with interval, ratio and sometimes ordinal data
|
Mean
Median Mode |
|
|
|
Type of data that cannot be assessed with mean or median
|
Nominal
|
|
|
|
Which measures of central tendency are unaffected by extreme score?
|
Median and mode
|
|
|
|
Mean is the preffered measure of central tendency except?
|
Extreme scores or skewed distributions
Non interval data Discrete variables |
|
|
|
Measure of spread and variability
|
Range and deviation
|
|
|
|
A number that measures how far away each number in a set of data is from the mean
|
Standard deviation
|
|
|
|
Approximate standard deviations within 1,2,3 standard deviations of the mean for any data set?
|
1: 68%
2: 95% 3: 99.7% |
|
|
|
Parameters are?
|
Mathematical characteristics of populations
|
|
|
|
Statistics
|
Mathematical characteristics of samples
|
|
|
|
What is the EPSEM method of sampling?
|
Equal Probability Of Selection Method
|
|
|
|
For any trait or variable as the sample grows larger the means will will be normally distributed. This describes?
|
Central limit theorem
|
|
|
|
What is the implication if p value<a (alpha)?
|
Reject null hypothesis
Report p value Estimated effect Precision of estimate |
|
|
|
What is the implication if p value > a?
|
Fail to reject null hypothesis
Report p value Power of your study How big an effect you may have missed |
|
|
|
A null hypothesis states
|
There will be no effect on the dependent variable due to independent variable and any observed effect is due to chance unless proven otherwise
|
|
|
|
Purpose of inferential statistics?
|
Test whether results achieve statistical significance, eliminating chance and sampling error as cause of change of dependent variable
|
|
|
|
You could be making a mistake whether you reject or fail to reject the null hypothesis. True or false
|
True
|
|
|
|
When you reject the null hypothesis concluding there is a diffence between groups when in fact there is none
|
Type 1 error
|
|
|
|
When you fail to reject the null hypothesis concluding there is no difference between groups when in fact there is
|
Type 2 error
|
|
|
|
In research when we say there is a real difference between 2 groups when it was just a chance what kind of error have we made?
|
Type 1
|
|
|
|
When we use our data to calculate the probability that our finding is just due to chance under the null hypothesis, we calculate the?
|
P value
|
|
|
|
What is the alpha value?
|
Level of significance
How small the p value can be for the null hypothesis to be rejected How much I am willing to make a type 1 error |
|
|
|
A p value larger than the alpha value indicates?
|
Our finding is largely due to chance
We should fail to reject null hypothesis otherwise we will make a type 1 error |
|
|
|
A p value smaller than the alpha value indicates?
|
We can reject null hypothesis concluding there is a real difference between research groups
|
|
|
|
Probability of rejecting the null hypothesis when the alternative hypothesis is true ie not making a type 2 error
|
Power
|
|
|
|
Difference between high power and low power?
The commonly accepted power is? |
High power means decreased likelihood of type 2 error
Low power increased likelihood of type 2 error 0.80 or higher |
|
|
|
Factors affecting power (4)
|
1 sample size: larger sample, greater power
2. Large or small difference in means ( what you are looking for) 3. Variation within the groups you are studying 4. Alpha level if it's really low e.g. 0.01 it's harder to reject so power goes down |
|
|
|
Statement that population parameter will meet some test of difference for some specified probability / significance level for any sample
|
Hypothesis test
|
|
|
|
Statement that population parameter will fall within interval some specified probability / confidence level for any sample
|
Confidence interval
|
|
|
|
Hypothesis tests are more informative than confidence levels
True or False |
False
CI levels are more informative since they provide a range of plausible values for unknown parameters |
|
|
|
If alpha level is .05 confidence interval is?
|
95%
|
|
|
|
Samples that have no effect on each other are known as
|
Independent samples
|
|
|
|
Samples which are matched pairs and one group is tested more than once are known as
|
Dependent samples
|
|
|
|
Which type of statistical test is appropriate for
2 independent samples 2 dependent samples >2 independent samples > 2 dependent samples |
2 independent samples: Unpaired T test
2 Dependent samples: Paired T test >2 Independent samples: ANOVA >2 Dependent samples: Repeated measures ANOVA |
|
|
|
Type of hypotheses where the researcher specifies which of the group means he expects to be greater than the other
|
Directional hypothesis
|
|
|
|
Type of hypothesis stating the group means will differ but not stating which ones will differ?
|
Non directional hypothesis
|
|
|
|
Which type of hypothesis uses a one tailed test/ analysis
|
Directional hypothesis
|
|
|
|
Which type of hypothesis uses a 2 tailed test / analysis?
|
Non directional hypothesis
|
|
|
|
How would an alpha level of .05 be interpreted in a one tailed vs a two tailed analysis?
|
One tailed it would simply stand as is
2 tailed : overall probability would be split so each tail will have an alpha level of .025 |
|
|
|
For an alpha level of .05 it is easier to reject the null with a 1 tailed test compared to a 2 tailed test? True or false
|
True. With a 1 tailed the .05 is in one direction but in a 2 tailed the probability has to reach .025 at one of the ends for the data to be statistically significant
|
|
|
|
If a researcher specified a directional hypothesis and uses a 1 tailed test but the direction turns out to be opposite than he expected what happens to null hypothesis?
|
Fail to reject the null hypothesis
|
|
|
|
What measure fits this description:
Examines relationships between variables with co efficients -1 to 0 to +1 quantifying strength and direction of association |
Correlation
|
|
|
|
Quantities for a medium correlation and
High correlation |
Medium correlation: 0.30-0.45
Strong correlation: 0.50 - 1.00 |
|
|
|
Type of correlation?
Direct association between 2 variables (as one becomes large the other one becomes large) |
Positive correlation
|
|
|
|
Type of correlation
As the value of one variable increases the other decreases |
Negative correlation
|
|
|
|
What 3 assumptions must data fit to be analyzed using parametric statistics?
|
Must have a normal distribution therefore sample must be chosen randomly
Variances must be roughly equal Data are interval or ratio scale ( can be manipulated mathematically) |
|
|
|
Parametric or non parametric?
Test that can be done without an assumption of normality |
Non parametric
|
|
|
|
Parametric or non parametric ?
Deals with mean rather than median |
Parametric
|
|
|
|
Parametric or non parametric ?
Deals with median rather than mean |
Non parametric
|
|
|
|
Category of research that identifies cause and effect between variables and comprises of: RCTs, non RCTs, single subject designs
|
Experimental research
|
|
|
|
Best control for bias is ?
|
Randomization
|
|
|
|
3 ways to randomize for a study
|
1. Random selection of a sample
2. Random assignment of sample to groups 3. Random assignment of groups to treatment and control conditions |
|
|
|
What category of research do these fall in: developmental, normative, qualitative, evaluation research ?
|
Descriptive research
|
|
|
|
Which category of research identifies relationships between variables usually using correlation statistics e.g. Cohort and case control studies, methodological studies
|
Exploratory research
|
|
|
|
Category of research that rigorously integrates findings from more than one study on the same topic e.g. Meta analysis, evidence based clinical guidelines, systematic reviews
|
Integrative research
|
|
|
|
3 explanations for an observed effect in RCTs
|
Tx had an effect
Chance variation between 2 groups Bias |
|
|
|
Sources of potential bias
|
Natural history of a disease
Placebo effect Drop outs ( intention to treat analysis) |
|
|
|
Efficacy vs effectiveness
|
Whether an intervention works under ideal circumstances vs in the real world
|
|
|
|
Systematic or random error?
Captured in the validity of the inference rather than its precision |
Systematic error
|
|
|
|
Systematic or random error?
Causes distortion of truth in a predictable direction |
Systematic error or bias
|
|
|
|
Systematic or random error?
Occurs because one cannot study everyone, obscures real difference and is reduced with larger sample sizes |
Random error or chance
|
|
|
|
Quantitative or qualitative research?
Explicitly acknowledges bias instead of attempting to eliminate it |
Qualitative research
|
|
|
|
Selection bias is?
|
Bias resulting from a problem in selection of subjects or in the process that determines which subjects drop out of the study
|
|
|
|
Sources of selection bias
|
Inappropriate population studied
Inadequate participation Selection of most accessible subjects or of volunteers |
|
|
|
what is prospective subject recruitment?
|
Selecting subjects as they come along and present themselves to researchers
|
|
|
|
Retrospective subject recruitment is?
|
Potential subjects are identified and contacted by the researchers to participate in the study and may involve review of pts charts to collect data
|
* can also occur such that actual patients are not seen but their information is compared to test hypothesis
|
|
|
Identify common types of sample selection
Consecutive sample Selective sample Convenience sample |
Consecutive: subjects chosen on a first come first serve basis
Selective: sampling that screens out certain characteristics Convenience: selected at the convenience of researcher |
|
|
|
True or false?
Reducing number of observers increases the bias |
False. Having the same observer gives greater reliability than having 2 or more
|
|
|
|
Placebo effect
|
Measurable, observable or felt improvement in health not attributable to actual treatment
|
|
|
|
Why does blinding increase internal validity?
|
Decreases placebo effectl
|
|
|
|
What is NNT?
|
Number needed to treat for one person to benefit associated with confidence interval levels and where CI levels overlap there is no difference between groups
|
|
|
|
Relative risk is?
|
Probability of developing a disease ( or other event) relative to exposure
RR =1 no difference in risk between 2 groups RR <1 less likely in experimental than control (.8 or 80%) RR>1 more likely in experimental than in control (1.25 or 125%) |
|
|
|
Odds ratio?
|
Ratio of the odds of an event occurring in one group to the odds of it occurring in another
= 1 event equally likely in both groups (1:1) >1 more likely in first group (2:1) <1 less likely in first group (.5:1) |
|
|
|
Which is recommended as an accurate measure when the disease in consideration is more common,Relative risk or odds ratio?
|
Relative risk because odds ratio can overestimate and magnify risk
|
|
|
|
What level on the evidence pyramid do literature reviews fall under and why?
|
Level 5, grade D (expert opinion)
Because the possibility of bias is large since researchers can pick whichever articles they want |
|
|
|
The statistical analysis of a a large collection of results from individual studies for the purpose of integrating the findings
|
Meta analyses
|
|
|
|
Which one is more comprehensive and transparent?
Traditional peer reviewed literature review OR textbook summary of literature |
Traditional peer reviewed literature review
|
|
|
|
Which has more potential for bias?
Course review paper OR clinical expert opinion |
Clinical expert opinion
|
|
|
|
What is the main outcome of a meta analysis?
|
Overall magnitude of the effect
|
|
|
|
Why are meta analysis subject to publication bias?
|
They reflect only what is published and statistically significant effects are more likely to be published hence biased toward Positive outcomes
|
|
|
|
What is the cohens d measure?
|
A generic dimensionless measure for standerdized change in mean used in meta analysis
|
|
|
|
On a forest plot what do the following represent?
Line Box Size of box Line w/ arrow Diamond Horizontal line crosses vertical line |
Line:CI
Box: point estimate Size of box: magnitude of effect Line w/ arrow: CI so large it goes off the page Diamond: summary of point estimates Crossing line: effect could be due to chance |
|
|
|
Recommended time span of publications for a systematic review?
|
20-25 years if not researcher should indicate why they limited it more
|
|
|
|
How many raters are typically used to select studies for a systematic review?
|
At least 2 each blinded to the other
A 3rd rater used to break ties |
|
|
|
Process of assessing methods and results of each study to determine if the study is adequate to answer the question is known as
|
Critical appraisal
|
|
|
|
Recommended number of databases to collect literature for a systematic review
|
More than 2
|
|
