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MRCPsych Part B > EBM Principles 1 > Flashcards

EBM Principles 1 Flashcards

1
Q

Steps in EBM

A 
Identify clinical problem
Define structured problem
Find best evidence
Examine validity of evidence
Assess results and apply to patient care
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2
Q

The two principles of EBM

A

Posits a hierarchy of evidence to guide clinical decision-making
Evidence alone is never sufficient to make a clinical decision.

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3
Q

Hierarchy of evidence base

A 
Systematic reviews & Meta analyses
RCTs
Cohort
Case control
Cross sectional survey
Case reports
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4
Q

Where do n of 1 trials occupy in the hierarchy of evidence?

A

Highest grade

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5
Q

The five types of clinical problems

A 
Therapy
Harm
Diagnosis
Prognosis
Causation
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6
Q

What is the therapy clinical problem?

A

Determining the effect of interventions on patient-important outcomes

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7
Q

How are therapy questions usually answered?

A

RCTs

Meta-analysis

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8
Q

What is the harm question?

A

Ascertaining the effects of potentially harmful agents on patient-important outcomes

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9
Q

How are harm questions answered?

A

RCTs

Meta-analysis

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10
Q

What is the diagnosis question?

A

Establishing the power of a test to differentiate between those with and without the condition

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11
Q

How is the diagnosis question answered?

A

Cross-sectional studies

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12
Q

How is the prognosis question answered?

A

Cohort studies

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13
Q

How is the causation question answered?

A

Case-control

Cohort studies

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14
Q

How is a clinical question structured

A

Patients
Intervention/exposure
Comparison
Outcomes

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15
Q

Explain the patient part of the clinical question

A

The group which you need to make a clinical decision on

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16
Q

Explain the intervention part of the clinical question

A

The treatment or cause being evaluated

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17
Q

Explain the cause part of the clinical question

A

The alternative to decide for or against

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18
Q

Explain the outcome part of the clinical question

A

The effect that will be produced by the outcome

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19
Q

How much scientific literature can be covered in a typical literature search?

A

60-70%

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20
Q

Name some databases to use in a literature search

A 
Medline
Embase
CINAHL
PsycLIT
Cochrane Library
SIGLE
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21
Q

Who produces Medline?

A

National Library of Medicine

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22
Q

When did Medline start?

A

1966

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23
Q

What does Embase consist of?

A

3 linked databases Excerpta Medica and 2 specialised databases for pharmacology and psychiatry

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24
Q

What does CINAHL stand for?

A

Cumulative Index to Nursing & Allied Health

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25
Q

What does CINAHL specialise in?

A

Literature relating to nursing and allied health professionals

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26
Q

Who produces the PsycLIT database?

A

American Psychological Association

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27
Q

What does PsycLIT cover?

A

Psychological journals and books from 1887 to present

28
Q

What does the Cochrane Library consist of?

A

Collection of databases including Database of Systematic reviews, Database of abstract of reviews of effectiveness, Cochrane controlled trials register and Cochrane Methodology register.

29
Q

What does SIGLE stand for?

A

System of Information on Grey Literature in Europe

30
Q

What does SIGLE contain?

A

Dissertations and conference abstracts

31
Q

How is the impact factor calculated?

A

Based on 3 year period

Considered to be the average number of times published papers are cited up to two years after publication

32
Q

Describe the formula to calculate the impact factor

A

A/B = IF for 2010

A = number of times articles published in 2009-9 were cited in indexed journals in 2010
B = number of articles, reviews, proceedings or notes published in 2008-9
33
Q

Types of bias when searching literature

A 
Publication
Time lag
Language
Database
Citation
Duplication publication
Outcome reporting
34
Q

What is time lag bias

A

Significant results are published sooner than non-significant

35
Q

What is language bias

A

Significant results are submitted to english-language journals, non-significant to non-english language journals

36
Q

What is database bias?

A

Studies with significant results are more likely to be published in a journal that is indexed in a database

37
Q

What is citation bias?

A

Likelihood of an article being cited depends on significance of results and size of trial

38
Q

What is duplicate publication bias?

A

Results of same study appear in more than one publication

39
Q

What is outcome reporting bias?

A

Selective reporting of some study results and not reporting other analyses

40
Q

What does * mean when searching a database?

A

To search for all terms that begin with that word e.g. schizo*

41
Q

How to find a specific name in the author field in a database?

A

“name” [au]

42
Q

What is internal validity

A

Extent to which a study can be used to draw conclusions about cause and effect

43
Q

What can threaten internal validity?

A

High levels of bias
Confounding factors
Measurement errors

44
Q

What improves internal validity?

A

Random assignment

45
Q

What can help with external validity?

A

Random sampling

Reducing inclusion criteria

46
Q

What are consensus statements?

A

Statements to regulate reporting of various types of studies

47
Q

Name some consensus statements

A 
CONSORT
QUORUM
PRISMA
ASSERT
STROBE
MOOSE
STARD
48
Q

What does CONSORT stand for?

A

Consolidated standards of reporting trials

49
Q

What is Consort?

A

Evidence-based, minimum set of recommendations for reporting RCTs.

50
Q

What does Consort offer?

A

Offers a standard way for authors to prepare reports of trial findings, facilitating their complete and transparent reporting and aiding their critical appraisal and interpretation

51
Q

What does QUOROM stand for?

A

Quality of reporting of meta-analyses

52
Q

What is Quorum?

A

Evidence-based, minimum set of recommendations for improving the quality of reporting of meta-analyses of clinical RCTs

53
Q

What does Quorum help with?

A

Aids authors in preparing reports of trial findings, enabling more complete and transparent reporting and is essential for critical appraisal and interpretation of the data

54
Q

What does PRISMA stand for?

A

Preferred reporting items for systematic reviews and meta-analyses

55
Q

What is PRISMA?

A

Evidence-based minimum set of items for reporting in systematic reviews and meta-analyses

56
Q

PRISMA vs QUOROM

A

PRISMA replaced QUOROM as of 2009

57
Q

Aim of PRISMA

A

To help authors improve reporting of systematic reviews and meta-analyses.

58
Q

What does STROBE stand for?

A

Strengthening the reporting of observational studies in epidemiology

59
Q

What does ASSERT stand for?

A

A standard for the scientific and ethical review of trials

60
Q

What does ASSERT do?

A

Proposes a structured approach whereby research ethics committees review proposals for and monitor the conduct of clinical RCTs.

61
Q

When does ASSERT checklist need to be addressed?

A

Before applying for approval to conduct a clinical trial

62
Q

What is STROBE?

A

Checklist of 22 items that are considered essential for good reporting of observational studies

63
Q

What does MOOSE stand for?

A

Meta-analyses of observational studies in epidemiology

64
Q

What does STARD stand for?

A

Standards for the reporting of diagnostic accuracy studies

65
Q

Structure of STARD

A

A flowchart

MRCPsych Part B (64 decks)

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