AAAA Therapy: Using information from research on populations to help with clinical decisions about treatments Flashcards
4 stages of AAAA framework
- Assess
- Access
- Appraise
- Act
What is the aim of “assess”
Define the clinical question, study design and clinical components
What format are the clinical components in “assess” arranged in?
- PICO
> Population
> Intervention
> Comparator
> Outcomes
What is the aim of “access”
Finding studies (that are clinically relevant to the question)
2 stages of appraisal
- Quality of the conduct of the study (risk of bias)
- Interpretation of results
Basic questions of assessing quality of the conduct of the study in appraisal
- First
> Does the study address a research question relevant to the clinical problem?
> Did researchers use the study design most likely to provide a valid answer? - Then
> Was the study done well/is it trustworthy?
> If done well, what were the results?
Comparator vs control group
- Control = placebo or standard, pre-existing treatment
- Comparator = another treatment being assessed
Why have a control/comparator group?
- Both increase sample size
- Comparator gives patients a choice about which treatment
- Control allows evaluation of whether patients would have gotten better anyway with no treatment
Additional features of an RCT to mitigate against bias
- Allocation concealment
- Blinding
What is allocation concealment
The allocation sequence is concealed from participants and those recruiting them so it cannot influence who actually receives treatment
Which type of bias does allocation concealment prevent?
Selection bias
How is allocation concealment carried out
- Computer generated random sequence is performed distant to where trial is being conducted
- Treatment allocation should be concealed until administration (eg. sealed envelopes) (where possible)
Which types of bias does blinding remove?
- Measurement bias
- Performance bias
How does blinding remove measurement bias?
- Stops patients’ perception of pain, etc. being influenced by preconceived ideas about effectiveness of a treatment
- Stops patients giving socially desirable responses if they know they are in the intervention arm
- Stops preconceived ideas about how effective a treatment is influencing how observers measure subjective outcomes
How does blinding remove performance bias?
- Stops HCPs delivering treatment differently to different groups because of preconceived ideas about effectiveness of a treatment
- Stops participants behaving differently because they are disappointed in which group they were allocated
