02 Research Methods

Question 1

With regard to risk of benefit or harm, how are these estimates calculated for evidence based medicine and what are these derived from.

Answer 1

Calculated mathematically. Derived from high quality research on population samples.

Question 2

What is the first step in the process of using clinical research to help your client?

Answer 2

Convert information needs into answerable questions - define the problem.

Question 3

What is the second step in the process of using clinical research to help your client?

Answer 3

Find the best available evidence to answer the questions from the first step, i.e. lab testing, case history assessments, reviewing published literature.

Question 4

What is the third step in the process of using clinical research to help your client?

Answer 4

Critically appraise and evaluate the evidence and assess it’s validity/accuracy/usefulness to the client - based on motivation, budget, product availability.

Question 5

What is the forth step in the process of using clinical research to help your client?

Answer 5

Implement results of search into clinical practice.

Question 6

What is the fifth step in the process of using clinical research to help your client?

Answer 6

Evaluate results (reflective practice).

Question 7

What does an EBM practitioner identify in the patient when assessing them?

Answer 7

Their background, psychological, social and any problems accounting for the patients perspective.

Question 8

How does an EBM practitioner rule out any differential diagnosis?

Answer 8

By performing sufficiently complex health assessment and suggests appropriate tests or referrals.

Question 9

What additional things does an EBM practitioner consider when assessing their client?

Answer 9

Additional problems and any risk factors that also need attention.

Question 10

What type of material does an EBM practitioner seek in his/her research and decision making?

Answer 10

Best available evidence from scientific literature.

Question 11

What does the EBM practitioner critically evaluate when assessing research literature?

Answer 11

Evaluates strength, quality and completeness of the evidence.

Question 12

In what two ways does an EBM practitioner apply found evidence?

Answer 12

By making sure it clinically relevant and justifiable.

Question 13

With regard to the patient, what does the EBM practitioner ensure?

Answer 13

That they have their informed consent after discussing pro’s and con’s of various options available, in a way that they can understand.

Question 14

What 10 types of research based evidence are there and list them in order starting with the best first?

Answer 14

1. Systematic review and meta-analysis.
2. Large Scale Double Blind Randomised Control Trials.
3. Small Scale Double Blind Randomised Control Trials.
4. Non-Randomised Control Trials.
5. Cohort Studies.
6. Case Control Studies.
7. Cross-sectional Studies.
8. Ecological Studies.
9. Case Series and Case Reports.
10. Expert Opinion.

Question 15

What do these acronyms stand for:

FSA, WHO, IOM, SCF, FDA, WMA, BMA?

Answer 15

FSA - Food Standards Agency.
WHO - World Health Organisation.
IOM - Institute of Medicine.
SCF - Scientific Committee on Food.
FDA - Food and Drug Administration.
WMA - World Medical Association.
BMA - British Medical Association.

Question 16

What type of books are we expected to use and reference when writing essays?

Answer 16

Good quality references based on primary research.

If using text books, then must be written aimed at academic or professional levels - not public or consumer levels.

Question 17

What is a systemic review?

Answer 17

Statistical study that combines results of lots of similar experiments to get an overall result.
This is more reflective of a much wider study population.

Question 18

What is the fundamental problem with systemic review and how does meta-analyses try to overcome this?

Answer 18

Combined results can be too different to interpret.

Meta-analysis try to overcome this by using statistical models that are appropriate to infer trends.

Question 19

When looking at systemic review and meta-anaysis, what is the key thing to look at?

Answer 19

The inclusion and exclusion criteria for the studies. IF it is biased, overall results will not be representative.

Question 20

What does epidemiology mean?

Answer 20

The ‘how and why’ of disease in different groups of people.

Question 21

What are epidemiological and observational studies NOT designed to identify, but what are is their aim to answer and what are they known as and what are they not?

Answer 21

Not designed to identify causal relationships between exposure and outcome.
Aim is to only answer questions about trends or pattens in population groups.
Known as correlations, but does not necessarily mean causation- only experimental control studies can help prove causation.

Question 22

What do epidemiological and observational studies often generate?

Answer 22

Ideas and questions for further experimental research.

Question 23

What is an intervention study?

Answer 23

Subjects are given a particular medicine or intervention, and researchers measure how their health changes.

Question 24

What is a control group?

Answer 24

A group that have not been given the intervention or medication, or have been given a placebo.

Question 25

What 3 types of control group are there?

Answer 25

Active - best treatment available.
Active Placebo - non-therapeutic agent given that mimics side effects of treatment being researched.
Inactive Placebo - non-medicinal agent, which has no obvious side-effects.

Question 26

What is blinding and what 3 types are there?

Answer 26

To reduce the risk of bias, where people unconsciously influence the results of a study.
Single - only patients do not know what group they are in.
Double - patients and researchers.
Triple - patients, researchers & statisticians.

Question 27

What is randomisation?

Answer 27

It reduces the risk by ensuring any direct or indirect influence in the study. Lot’s of types, but ideally, random computer generation is best.

Question 28

What is often considered the gold standard of research?

Answer 28

Randomised double blind, placebo controlled trials.

Question 29

Sum up qualitative and quantative.

Answer 29

Qualitative - models, hypotheses and theories.

Quantitative - numbers, measurements, stats, tables, graphs.

Question 30

What is the difference between primary and secondary source?

Answer 30

Primary is the piece of evidence at the time of the person researching the topic- raw material of the research topic i.e. scientific paper.
Secondary - article or documentation based on the primary source like magazines, books, newspaper articles.

Question 31

Why are nutritional studies very difficult to perform?

Answer 31

Because everyone’s day to day diet is different and the way people absorb and assimilate nutrients is also different.

Question 32

What is a peer review?

Answer 32

Evaluation by another people in the same field to avoid cronyism or favouritism shown by friends and associates.

Question 33

What are peer reviewed articles?

Answer 33

Evaluation of papers by peers, prior to publication.

Question 34

What are Hazard Ratio’s and how are they shown?

Answer 34

Shown as HR and represents how fast or likely and event or outcome occurs during treatment vs. the control group.
Given in decimals.
HR of 1 - no change
HR <1 - reduced rate of event (protective benefit)
HR >1 - increased risk of event (disease or death)
E.g. If death occurs twice as likely in the treatment group, then the hazard ratio would be 2.
If heart disease risk is 10 times more likely in men than women, then the HR would be 10.

Question 35

What are Confidence Intervals and how are they shown?

Answer 35

Written as CR and shows the maximum and minimum range of risk. Using this range, we can be 95% confident that the population will fall within this range of risk.
E.g. If an HR is given as 0.90, the actual CI range could actually be something like 0.66 to 1.23

Question 36

What are P-Values and what does it measure?

Answer 36

The Probability of obtaining a result, the same as the one that was actually observed.
Measures the consistency between results from the trial and the ‘pure chance’ results.

Question 37

What does a smaller P value mean and what is it’s usual range?

Answer 37

The more evidence there is that the outcome was by chance.

Ranges from 0 to 1, i.e. 0.03 = 3% chance

Question 38

What is the P value set at and what does this mean in say 20 people, and at what point is a hypothesis rejected?

Answer 38

Set at <0.05 (5%) which means one in 20 people.

Rejected >0.05.