AAAA THERAPY

Question 1

Outline the AAAA framework

Answer 1

• Assess - what type of healthcare question or study
• Access - Find the best evidence
• Appraise - evaluate the quality of the evidence
• Act - is the evidence relevant to clinical practice

Question 2

What type of study design is used for questions of frequency e.g frequency of disease or frequency of who is affected?

Answer 2

• Ecological
• Cross - sectional

Question 3

What type of study design is used for questions concerning aetiology and risk factors?

Answer 3

• Case-control
• Cohort

Question 4

What type of study design is used for questions concerning the effectiveness of something e.g benefits and harms?

Answer 4

• RCT

Question 5

What is the framework used to assess a study?

Answer 5

PICO
Population - those who are eligible for treatment with the intervention or comparator
Intervention - The new treatment
Comparator - Existing treatment or no treatment
Outcome - Mortality/ morbidity/ physiological measure e.g BP

Question 6

What is forming a PICO important for?

Answer 6

• Efficient searching for evidence in electronic databases like MEDLINE
• Can be used to assess the applicability of research to your patients

Question 7

What two things does ‘access’ achieve

Answer 7

• Finding studies with the best study design
• Finding studies that are clinically relevant to your question

Question 8

Where to look for RCTs?

Answer 8

• Cochrane library
• Bibliographic databases - MEDLINE, PUBMED, EMBASE

Question 9

What does appraisal ask?

Answer 9

• Does the study address a research question which is relevant to my clinical problem (is there a match between the PICO and study question?)
• Did researchers use the study design that would be most likely to provide a valid answer to a clinical question

Question 10

If the study addresses the right type of question, what does appraisal then ask?

Answer 10

• Was the study done well and were there steps to reduce bias
• If the study was valid, what were the results

Question 11

What are the two key features of an RCT?

Answer 11

• Randomisation
• Having a comparator group

Question 12

Why have a control or comparator group? (3)

Answer 12

• It increases sample size
• Gives patient a choice about which treatment they receive
• Can evaluate which option is better between two treatments or a treatment and a control

Question 13

Why randomise patients to intervention and groups? (3)

Answer 13

• Stops a drug manufacturer from deciding which treatment a patient gets
• Patients don’t get to decide
• Dr input is minimised
• All of these can result in some form of bias