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Undeleted > AAMC 5 > Flashcards

AAMC 5 Flashcards

1
Q

what is critical appraisal of research

A

apply rules of science and common sense in judging the quality of written articles

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2
Q

6 standards for evaluating quality (FiLCHeRS)

A

Falsifiability - can the results be proven wrong (no god)
logic - are they logically coherent
comprehensiveness - evidence offered must be exhuastive, all evidence is presented and don’t ignore contrary evidence
Honesty - claim must be evaluated with an open mind and without self deception
Replicability - time and populations
Sufficiency - evidence offered must be adequate to establish truth to that claim - extrodinary claims require extrdinary evidence

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3
Q

what is EBM

A

integrate clinical experience with the best available external evidence from the literature

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4
Q

5 As of EBM

A

Assess: recognize and priotize problems
Ask: construct clinical question that facilitate efficicent search
Aquire: gather evidence from quality soucres
Appraise: evaluate evidence
Apply: to inidivuals, taking into account their prefs/values

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5
Q

what is diff. in hypo between qual and quant

A

qual - hypo generatine

quant - hypo testing

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6
Q

what diff between inductive and deductive

A

indctive (qual) - works from instance to generalize

deductive (quant) - works from the general to the particular

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7
Q

3 quesions to evaluate qual research

A
  1. was the design rigorous
  2. was study execution rigorous
  3. can I tranfer results to my setting
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8
Q

7 factors to infer causal relats

A
  1. chronology
  2. strength of assoc.
  3. dose response
  4. specificity of assoc. - agent or risk only relates to this disease
  5. consistency - acrsoss studies and pops
  6. coherent or plausible - is there a reasonable explanation
  7. cessation of exposure - if remove does it go? best for population
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9
Q

5 steps of an experimental study

A
  1. formal hypothesis stated
  2. select people for exposure
  3. sample divided into 2 groups -can be:
    a. randomized (RCT)
    b. non-randomized (quasi experimental - inferior)
  4. one group given intervention while other group not
  5. outcomes recorded and compared
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10
Q

2 ways to administer intervention in RCT

A

single blind- participant doesn’t know

double blind - patient and researcher don’t know

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11
Q

what is triple blind

A

stats person doesn’t know

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12
Q

limits of RCT

A
  • very controlled conditions

- often very select populations

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13
Q

diff. between efficacy and effectivness

A

efficacy - impact in optimal conditions

effectiveness - impact in real world

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14
Q

3 ethical considerations to RCT

A
  1. unethical to deny treatment, so can’t know if one is better
  2. unethical to adopt new treatment without testing before
  3. unethical to continue trial if treatment is found to be good
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15
Q

4 phases of intervention study

A

before - animal studies
1 - tested in small group of healthy to assess safe dose and safety/SE
2 - given to a larger group at reccomended dose to determine efficacy and safety
3 - drug given to a larger group to confirm effectiveness, monitor SE and and compare to other treatments (often mutliple RCTs)
4. post-market surveillance

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16
Q

what is major problem with obs. studies

A

hard to infer causation

17
Q

2 types of obs. studies

A
  1. descriptive - simply describe how thing are - usually cros sectional
  2. analytical
18
Q

def. analytical study

A
  • designed to test hypothesis predicting an association
  • 3 types
  • cross-sectional
  • cohort
  • case control
19
Q

def. cross sectional study

A
  • subjects selected irrespecitve of presence or abscence of chars. of ineterst
  • similar to descriptive, but tests assoc. hypothesis
20
Q

def. cohort study

A

group of people that can be sampled and enumerated over time that share a defining characterisitc
- usually look at people with an exposure and statrt before they have a disease

21
Q

how is cohort study analyzed

A

gives you grid and can use RR to assess (incidence in exposed/incidence in not exposed)

22
Q

main adv. of cohort

A

exposure recorded before ourcome, so can establish temporal aspect of causality

23
Q

def. case control study

A

compare group with a particular outcome to a similar group without the outcome

24
Q

how is case control analysed

A

with OR (ad/bc)

25
Q

what is problem with giving RR

A

can seem scary and increase of 100% is not a big deal in rare disease (1/100000 becomes 2/1000000)

26
Q

what is attributable risk

A

takes into account the magnitiude of risk - indicates the number of cases of a disease among exposed indivs that can be attributed to that risk

27
Q

formula for attributable risk

A

incidence in exposed - incidence in unexposed

28
Q

what is exposed attributable fraction

A

proportion of the incidence in the exposed person caused by this factor
- eg. 89% of your lung CA risk is due to smoking

29
Q

formula for EAF

A

(incidence exposed-incidence unexposed)/incidence exposed

30
Q

formula for NNT

A

1/ARR

31
Q

2 general categories of bias

A
  1. sampling (and non-response)

2. measurment

32
Q

3 types of measurement bias

A
  1. social desirability
  2. instrument problems
  3. recall bias
33
Q

what is information bias

A

objectivity of the investigator

34
Q

what is confounding

A

thrid variable fucking shit up

35
Q

what is heirarchy of evidence

A

1 - at least one proper RCT
2a - well designed controlled trials without randomization
2b - well designed cohort or case control trials, prefer more than one center
2c - multiple time series studies, with or without intervention
3 - expert opinion, descriptive studies, consensus conferences

36
Q

quesitons to ask self about research

A
  1. are results valid? - study design and analysis
  2. what are results? size and precision
  3. can I apply to PT care? - similar PTs and env.
  4. what do I do with this PT?
37
Q

4 things to consider

A
  1. target population
  2. intervention - feasable? time?
  3. cost
  4. placebo effect

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