205 FINAL Flashcards

1
Q

Elements of a clinical question

A
  1. the situation
  2. the intervention
  3. the outcome
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2
Q

PICOT

A

Population/Problem
Intervention
Comparison
Outcome
Timeframe

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3
Q

SPIDER

A

Sample
Phenomenon of Interest
Design
Evaluation
Research type

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4
Q

Variables

A

Attribute/property in which organisms vary

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5
Q

Independent variable

A

Presumed effect on DV
Manipulated

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6
Q

Dependent variable

A

Presumed effect varies with a change in IV
Not manipulated

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7
Q

Research (scientific) hypothesis

A

States expected relationship between variables

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8
Q

Directional hypothesis

A

States which way the relationship exists

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9
Q

Nondirectional hypothesis

A

States the relationship exists, but not the direction

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10
Q

Null (Statistical) hypothesis

A

States that no relationship exists between variables

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11
Q

Level 1

A

Systematic review/meta-analysis of RCT

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12
Q

Level 2

A

One well-designed RCT

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13
Q

Level 3

A

Quasi-experimental trial

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14
Q

Level 4

A

Single non-experimental trial (case-control, cohort, correlational)

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15
Q

Level 5

A

Systematic reviews of qualitative studies

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16
Q

Level 6

A

1 qualitative study

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17
Q

Level 7

A

Opinions of authority/reports

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18
Q

Systematic Reviews

A

Type of literature review that uses rigorous methods - also called evidence studies

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19
Q

Basic Ethical Principles

A

Respect for Persons
Beneficence
Justice

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20
Q

Respect for Persons

A

Individuals as autonomous agents

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21
Q

Beneficence

A

Kindness/charity acts going beyond duty

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22
Q

Justice

A

Treating people fairly

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23
Q

Informed Consent

A

Ongoing communication and participant protection
- potential risks/benefits
- confidentiality and anonymity
- voluntary participation
- ongoing process of communication and mutual understanding

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24
Q

Process Consent

A

Informal - give consent by continuing participation

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25
Assent
Expression of approval/agreement
26
Research Ethics Board
Review research projects to assess whether ethical standards are met in relation to the protection of the rights of human subjects
27
Exempt
low risk, non-vulnerable, nonsensitive, short duration
28
Expedited review
Minimal risk, non-vulnerable, nonsensitive
29
Fraud
Data is falsified, fabricated, or subject have been coerced
30
Misconduct
Not keeping up to date on scientific evidence
31
Indigenous peoples
Represents numerous cultures, not a single population
32
Indian
Indigenous people in Canada who are not inuit
33
Status Indian
Registered under the indian act
34
Treaty Indian
Status indian who belongs to a FN under the crown treaty
35
First Nation(s)
Personal group of RN legally known as an Indian Band
36
Truth and Reconciliation Commission (TRC)
Discovering and revealing past wrongdoings in hopes of resolving many of the issues
37
Indigenous knowledge
Ways of knowing/knowledge systems based on Indigenous communities, language, traditions and history
38
Indigenous Methodologies
Theory and process of conducting research that reflects Indigenous worldviews
39
Two-eyed seeing
Seeing both Indigenous AND western knowledge
40
Critical Appraisal
Process of carefully and systematically examining research studies to ensure trustworthiness, value and relevance
41
Literature Review
Discover what is known about a topic - theoretical or conceptual framework - primary and secondary sources - research question and hypothesis - design and method - outcome of analysis
42
Phenomenological design purpose
compare finding to literature to further knowledge
43
Grounded theory design purpose
Constant comparison of findings to literature
44
Ethnographic design purpose
Literature concepts provide a framework
45
Historical design purpose
literature is the data source
46
Data-based literature
Literature and studies found in journals (empirical/scientific), starts with CINAHL
47
Conceptual literature
Reports of theories or reviews, “how-to” articles
48
Experimental research
manipulation of IV, randomization, control extraneous variables
49
Quasi-experimental research
no randomization, naturally occurring comparison of groups, statistical control of extraneous variables
50
Nonexperimental Research
Examine events, people and situations as they naturally occur
51
Antecedent variable
occurs before the study but may affect DV
52
Extraneous variable
May interfere with results
53
How to increase control of research
Objectivity Accuracy Feasibility Homogenous sample Constancy Manipulation Randomization
54
Objectivity
Absence of personal bias/feelings
55
Accuracy
appropriate design to questions
56
Homogenous sample
inclusion/exclusion criteria balance
57
Constancy
keep study the same
58
Manipulation
between groups (experimental/quasi-experimental)
59
Randomization
Gives the MOST control
60
Internal Validity
Did the IV change the DV, or was it something else
61
External Validity
if study can be generalized/extended to other populations
62
Threats to internal validity
History Maturation Testing Instrumentation Mortality Selection Bias
63
Threats to external validity
selection effects reactive effects measurement effects
64
Conceptual definition
Accepted definition of a concept
65
Operational definition
translates conceptual into something measurable
66
Data collection must be...
objective (free of bias) and systematic (collected in same methodical way)
67
Quantitative data collection methods
physiological/biological observation scientific observation interviews/questionnaires
68
Physiological/Biological measurements
biological and physical indicators of health A: Objective and precise D: Reactive effects, calibration, consistent use
69
Observation
Observation are consistent with study’s objectives and theoretical frameworks - standardized and systematic, trained data collectors
70
Scientific Observation
Concealment with intervention Concealment without intervention No concealment without intervention No concealment with intervention
71
Interviews and Questionnaires
Open-ended (qualitative) Closed-ended (quantitative) D: Social desireability
72
Process of constructing new instruments
1. define the construct to be measured 2. formulate questions 3. assess items for content validity 4. write instructions 5. pretest and pilot test new instrument 6. assess reliability and validity
73
Reliability
consistently measures what it is meant to measure
74
Inter-rater reliability
consistency between 2 or more observers
75
Test-retest reliability
similar results when same test is used more than once
76
Validity
Accurately measures what it claims to measure
77
Construct validity
does it measure the concepts its meant to?
78
Content validity
does the test represent what is aims to measure?
79
Face validity
is the content suitable to its aims?
80
Quantitative position of researcher
independent observer, objective
81
Quantitative approach
deductive
82
Quantitative sampling
Hypothesis testing, closed-ended and specific
83
Quantitative data collection
measurements, questionnaires, observation structured/consistent
84
Quantitative data analysis
Starts with numbers, uses variables, systematic, AFTER data collection
85
Qualitative position of researcher
Dependent participant, subjective
86
Qualitative approach
Inductive
87
Qualitative research questions
exploratory, descriptive and open-ended
88
Qualitative sampling
purposive, non-probability, theoretical data saturation
89
Qualitative data collection
interviews, focus groups, observation, documents, images/sounds unstructured/iterative
90
Qualitative data analysis
Starts with words, codes and categories, iterative. Concurrent with data collection (to achieve data saturation)
91
what design to use if looking to explore/describe
Inductive (primarily qualitative)
92
What design to use if confirming hypothesis or theory?
Deductie (primarily quantitative)
93
3 types of mixed methods
1. used together (done fully together) 2. linking (collected and then compared) 3. integration (converted and integrated)
94
QUAL + QUAL
Simultaneous, 1 method is dominant
95
QUAL - QUAL
Sequential - 1 dominant, 2 supplement
96
QUAL + QUAN
Simultaneous, inductive drive
97
QUAL - QUAN
Sequential, inductive drive
98
QUAN + QUAN
Simultaneous, 1 method dominant
99
QUAN - QUAN
sequential, 1 method dominant
100
QUAN + QUAL
Simultaneous, deductive drive
101
QUAN - QUAL
Sequential, deductive drive
102
Method
particular strategies researchers use to collect evidence necessary for building and testing theories
103
Methodology
Discipline-specific principles, rules and procedures that guide knowledge-acquiring process
104
3 main mixed method designs
1. Convergent 2. Explanatory sequential 3. Exploratory sequential
105
Convergent
Requires researcher to collect and analyze data using both qual + quan - merged to give a more comprehensive understanding CHALLENGE: equal qual + quan data, transformation
106
Explanatory sequential
QUAN 1st qualitative data helps to explain/build on quantitative results STRENGTH: straightforward, one at a time, single researcher can do it CHALLENGE: lengthy time, qualitative takes more time than quantitative
107
Exploratory Sequential
QUAL 1st Qualitative data is used to inform quantitative STRENGTH: straightforward, multi-phase OR single-phase CHALLENGE: qualitative takes time, difficulty transforming QUAL, hard to develop instruments
108
Health Technology Assessment (HTA)
Quantitative data Environmental considerations Qualitative data Environmental scan Ethics Legal Economics
109
Key components of HTA
Systematic review with meta-analysis to test hypotheses Economic evaluation to inform decisions
110
What is HTA used for?
a) clinically effective b) cost effective
111
Economics
Study of choice under conditions of scarcity - each choice includes opportunity cost (ensures resources are allocated in most efficient way)
112
Value
Combines benefits and costs (ex. 100mill, 200 mill reward is the best value)
113
Affordability
how much the proposed intervention costs (10, 11 reward is affordable)
114
Economic evaluation
determines what additional benefit an intervention provides at what additional cost focus on INTEGRATING GAINS
115
High value + unaffordable
IRRELEVANT
116
Purpose of Evidence Based Guidelines
Effective care delivery Resolve inconsistency Excellence in care delivery Benefits vs Harm Introduce innovation Remove outdated treatment
117
Pushbacks of evidence-based guidelines
Can be opinion-based CPG not used enough
118
dessemination
communication of research findings
119
Mini study
Identify variables, data collection method, sample size
120
Translation science
Investigation of methods, interventions and variables that influence adoption of EIP
121
Knowledge translation
Includes synthesis, dissemination, exchange and application of knowledge to improve health of Canadians
122
Plain Language
Language, structure and design are very clear so information can be easily found
123
Non probability
Inclusion in a group is NOT random, less generalizable, less representative
124
Types of non probable studies
1. Convenience (quantitative) 2. Quota (quantitative) 3. Purposive (qualitative)
125
Probability
randomization, more generalizable, more representative
126
Types of probable studies
1. Simple random sampling 2. Stratified random sampling 3. Systematic sampling
127
Simple random sampling
population identified, units random
128
Stratified random sampling
similar to quota but random selection
129
Systematic sampling
select every kth person
130
Convenience
units/population are the easiest to find
131
Quota
non random selection of predetermined units
132
Purposive
selected because they have certain characteristics
133
Advantages of Non-experimental
useful in forecasting, good when randomization/control/manipulation are not possible, tests theoretical models of how variables work together
134
Disadvantages of non-experimental
hard explaining cause-and-effect, must first develop knowledge
135
Advantage of Surveys
large population economically, small number of participants can be representative of population
136
Disadvantage of Surveys
info may be superficial, breadth instead of depth, research expertise, expensive and time consuming
137
Types of Relationship/Difference Studies
Correlational Developmental
138
Correlational Advantages
Relationship between 2+ variables flexibility, clinical application, examine variables that are NOT manipulated
139
Correlational disadvantages
Cannot manipulate variables, no randomization, cannot determine causal relationship
140
Cross-sectional studies
studies data at one point in time from many subjects
141
Longitudinal Advantages
prospective/repeated measures participant control increased depth early trends analyzed
142
Longitudinal Disadvantages
increased time and money testing effects mortality
143
Retrospective Advantages
post-facto, past events similar to correlational increased control
144
Retrospective Disadvantages
no causal link Alternate hypothesis may be the cause hard finding group members
145
Types of Developmental studies
Correlational Longitudinal Retrospective
146
Psychometric research
measuring a concept with reliable and valid tools 1. define a construct/concept 2. formulate tools items 3. develop instructions 4. test tools reliability and validity
147
Epidemiological
Factors affecting health/illness of population - prevalence: number of people affected - incidence: number of cases occurring in a period of time
148
Secondary analysis
previous data is re-analyzed
149
Odds Ratio
Measures association between variables
150
OR = 1
NO association
151
OR < 1
Association favouring intervention
152
OR > 1
Association favouring NO intervention
153
Diamond shape on forest plot
average! answer to a research question
154
Difference size of shape
population size of the study
155
Goals for Rigour
1. account for method and data which must be independent so another researcher can replicate 2. Produce credible and reasoned explanation of phenomenon
156
Credibility
truth value: “are the results the true results?”
157
Techniques to enhance credibility
- prolonged engagement - reflexivity - peer debriefing - member checking - attention to negative cases - triangulation
158
Triangulation
expansion of research strategies - data: variety of data sources - investigator: different researchers with divergent backgrounds - theory: multiple perspectives during interpretation - methodological: multi methods to study a single topic - interdisciplinary: more than one discipline
159
Auditability
Trustworthiness, audit trail that is understood
160
Techniques to enhance auditability
audit trail
161
Authenticity
Fairness in presentation of all viewpoints
162
Techniques to enhance authenticity
reflexivity attention to negative cases
163
Transferability/fittingness
Results are applicable to other contexts, setting ot groups
164
Defendability
Consistency in repetition (not identical)
165
Techniques to enhance dependability
poor debriefing audit trail triangulation
166
Confirmability
degree to which results are neutral and value-free (neutrality of data, not researcher)
167
Techniques to enhance confirmability
audit trail triangulation attention to negative cases reflexivity
168
qualitative term for internal validity
credibility
169
qualitative term for external validity
transferability
170
qualitative term for reliability
dependability
171
qualitative term for objectivity
confirmability
172
Constructivist lens
humans uniquely attribute meaning to their experiences
173
Qualitative methods
Grounded theory Ethnography Phenomenology Case study Historical research Participatory action research
174
Grounded theory
Used to explore BASIC SOCIAL PROCESS that guide human interaction - uncovering social processes
175
Ethnography
Scientifically describes a cultural group and goal is to understand participants view of the world (emic) vs outsiders view (etic)
176
Phases of ethnographic study
1. ‘getting in’ and ‘negotiating entry’ 2. acquainting with routines, start trust development 3. trust developed, ‘acculturated’ 4. withdrawal
177
Phenomenology
(meanings and experiences) answer questions of personal meaning - understand human experiences
178
2 assumptions of phenomenology
1. perceptions present us with evidence of the world 2. human existence is meaningful and we are always conscious
179
Intersubjectivity
sharing a common world
180
bracketing
researcher identified personal biases to clarify
181
Case--study
in-depth description of dimensions/processes - seeks to understand social situations (capturing unique stories)
182
Historical research
researches occurrences of the past
183
Primary source
eyewitness
184
Secondary source
another perspective
185
Participatory action research
researcher studies particular setting to identify problem areas to improve practice - works with people to improve the present
186
Data analysis
make meaning out of massive amount of tect
187
Data management
organize/group data
188
Phase 1: Data generation (coding)
1. Absorb content 2. determine unit of analysis 3. develop unique codes 4. conduct preliminary coding 5. code content
189
Phase 2: Data analysis (categorization/interpretation)
6. identify categories across codes 7. identify themes/patterns in categories 8. draw interpretations and implications
190
Stages of data analysis
1. data reduction 2. data display 3. conclusion drawing and verification
191
data reduction
selecting focusing and simplifying data themes are structured and data is coded
192
Coding
Progressive marking, sorting, resorting and defining/redefining data
193
Descriptive coding
tracking factual knowledge
194
Topic coding
data grouped by topic
195
Analytic coding
leads to development of themes
196
Data display
organized, compressed assembly of info that permits conclusion drawing and action - graphs, flowcharts, matrices, etc.
197
Conclusion drawing and verification
description of relationship between themes verification occurs as the data is collected
198
Types of analysis
1. phenomenological 2. ethnographic 3. grounded theory 4. case study
199
Phenomenological analysis
determine relationships among themes and describe phenomena and synthesis themes into a consistent description
200
Ethnographic analysis
identify patterns/themes, compare findings to literature, take cultural inventory
201
Grounded theory analysis
divide and compare data, uses constant comparative method
202
Case Study analysis
identify unit of analysis, code continuously, analyze field notes
203
Code-and-retrieve
data collector
204
Theory builders
GSR Nvivo
205
Conceptual network builders
inspiration
206
Research utilization phases
1. identify problem 2. review literature 3. translate to practice 4. implementation 5. evaluate the outcome
207
Barriers to research utilization
communication, finding studies, bad studies, cost/time, lack of knowledge, negative attitudes, lack of time to implement research
208
Hardest part of EIP
implementation
209
Iowa model of EIP
knowledge/problem-focused triggers cause desire to improve
210
I-PARIHS model
must understand - nature of evidence - context - facilitation needed
211
Roger’s diffusion of innovation models
innovation influenced by... - type/nature of innovation - manner in which it is communicated (disseminated) to members of a social system
212
Steps of EIP
1. select a topic 2. form a team 3. evidence retrieval 4. critique the evidence 5. provide recommendations for practice 6. implement practice change 7. evaluation
213
1. select a topic
problem-focused vs knowledge focused Criteria: problem, applicability, likelihood of change, potential problems, availability of data, multi-disciplinary, interest, availability of evidence
214
2. Form a team
development, responsibilities for implementing/evaluating multi-disciplinary relevant stake holders
215
4. Critique the Evidence
216
5. Recommendations for Practice
quality and generalizability of results strength and breadth of evidence
217
6. Implement practice change
dissemination, communication of research findings
218
7. Evaluation
mini-study
219
CIHI
Accelerates improvements in healthcare in Canada
220
CCSA
National direction on substance use
221
MHCC
Makes tools to support mental health/wellness in Canada
222
CSA
Enhance lives of Canadians through advancement of standards in public/private sectors
223
HQC
aim to.. - monitor/assess quality of healthcare - help partners build capacity for quality improvement - promote research/education leading to improvement in healthcare
224
RxFiles
Program providing objective, comparative drug information to clinicians