EVIDENCE BASED MEDICINE Flashcards
Study of response to SSRI in children with depression, 60% of those given SSRI meet response rate criteria, 35% of those given placebo also meet criteria. NNT for this study? (2x)
4
Construct validity definition? (2x)
Degree to which a test measures what it
intends to measure
In an exposed group of 120, 4 have autism
vs. 10 children of 600 in unexposed group
(control), what is the odds ratio for
developing ASD?
2
Study of children with high risk of depression, 50% in observation group and 25% in treatment group developed depression. What is the number needed to treat to prevent 1 case?
4
Meta-analysis of antidepressants in
pediatrics. Suicide-related events 4% with
medication, 2% with placebo. Number
needed to harm with medication?
4
What is crucial for estimating the
probability of developing bipolar disorder
in a 9 yo?
Base rate of mood disorders in children
Consulting literature to see if children
w/Lyme disease have high risk of
developing anxiety/depression in the
future is what type of study?
Cohort
Data to review in a research study before
applying to clinical care of a particular
patient?
Demographic characteristics of patients in
study
What trial design would help study the
duration of treatment required for
clonidine to control hyperarousal in
children with PTSD?
Discontinuation trial
A new drug increases social reciprocity in
ASD study. What is a moderating variable of
treatment response?
IQ score
Prospective case control study to measure
growth of children with ADHD treated with
stimulants compared to control groups
with no stimulant exposure. What statistical
method would you use to calculate impact
of socioeconomic status on growth?
Logistic regression
Screening test for autism misdiagnosis 5% of children below 2 years, and correctly diagnoses 20% of children who later meet criteria at age 6. What is the sensitivity/specificity?
Low sensitivity, high specificity
In longitudinal pediatric studies, what
threatens internal validity?
Maturation
Summative statistical measure of central
tendency
Median
Which resource is most up to date on
potential complementary and alternative
medicine (CAM) and drug interactions?
Medline Plus: Drugs and Supplements
Type of research design following 2 groups
of subjects (population of interest vs
control group) over 15 yrs from in-utero?
Prospective Cohort study
As prevalence of dx increases, what would
also increase?
Positive Predictive Value
Highest level of evidence for psychiatric
treatment interventions?
Randomized clinical trial
Factor limiting generalization of a
treatment intervention presented in a
meta-analysis?
Significant internal validity variability
between studies
Benefit of a clinical trial with randomized
controlled crossover design vs parallel
design:
Subjects serve as their own controls
Way to explain a p value of 0.05 found in a
trial comparing a new antidepressant to
placebo?
These results would be only 5% likely if the
antidepressant were not effective.
Best type of study for estimating
heritability of ADHD?
Twin
Common methodology used in a crosssectional study of the point-prevalence of
sleep disorders of children in school?
Both parent and child surveys asking about
symptoms of disrupted sleep
What type of study looks at the outcome of
cognitive development in 2 groups of
children, 1 exposed to toxin and the other
not exposed?
Cohort study
Research term for assigning incorrect
diagnosis to patient
Commission error
Risk factor strength is established by
assessing the _____ between the factor and
the outcome
Consistency across developmental stages
Study shows concurrent increase in cancer
rate and suicide rate. If occurring in
different age groups can study draw
conclusions related to cancer and suicide?
No
Advantage of using a longitudinal vs cross
sectional study in studying mental
disorders and aggression?
You can discover which disorder is more
persistent, and causal relationship between
disorders
What system is described if a clinic
implements an EMR flag if kids on
antipsychotics have an increased BMI?
Continuous quality improvement
An antidepressant is moderately therapeutic and causes weight gain and transaminitis. To get IRB approval for conducting study with this medication in children?
Minimize potential risks by research
procedures, and risk benefit for child
should be within reason
Longitudinal prospective study finds infants of mothers with postpartum depression finds 3% met mood disorder criteria by 6 yo, this increased to 6% by 12 yo. Measurement of mood disorder occurrence?
Cumulative incidence
Determine sensitivity of new screening tool
for autism. 100 children assessed, 15
correctly identified with autism, 5 children
missed, and 3 children identified
incorrectly.
75%
Funnel plots assess what type of bias in
systematic reviews and meta-analysis?
Publication
Research study design that gives each
participant both placebo and active
medication?
within subjects
What would limit validity in a study that
looks at the efficacy of a medication to
decrease aggression in adolescent males in
a residential facility, when all included
participants scored highest on an
aggression rating scale?
Regression
How would you describe a p value of 0.05 in
a clinical trial where a new antipsychotic
outperformed the placebo?
Results would be only 5% likely if the
antipsychotic were not effective
Why are randomized trials at the top of the
hierarchy in evidence-based medicine?
Less risk of bias
Assent of a minor to participate in research
is?
Always needed and binding
What type of study should be given the
most weight when assessing benefit of
clinical intervention
Systematic review of RCTs
Critical IRB ethical consideration when evaluating a brain-imaging research project aimed at recruiting children with childhood-onset OCD, that will have no benefit to participants?
Determine if study involves only a minor
increase over minimal risk
Which of the following steps is considered
“lifelong learning” when an ER physician is
unclear about the etiology of a patient’s
new-onset symptoms of OCD who is
presenting to the hospital.
Consult evidence-based journals about
symptoms
Clinic sets up a flag in the EMR to alert
physicians to increases in BMI of 2 points
since baseline who are taking
antipsychotics. What is this process?
Continuous quality improvement
About 60% of depressed adolescents were
excluded from a recent study based on
standard inclusion/exclusion criteria for
clinical trials. What is the likely reason for
the exclusion?
High risk for suicide
What is the number needed to harm in a study looking at suicide related adverse events, when 4% of medication arm had an adverse events, compared to 2% in the placebo arm?
50
What type of articles would be helpful if a
psychiatrist is reviewing existing research
on a specific subject?
Meta-analysis
Difference between efficacy and
effectiveness study?
Effectiveness study is done under real
world conditions
Research design when 5 participants
assigned to receive intervention, while 5
others are assigned to control by lottery?
Cluster randomization
What is the best statistical test for a study
of TMS on adolescent depression, with
comparison of HAM-D scores between TMS
group and Sham TMS group?
T-test
What problem does elimination of studies
from a meta-analysis to reduce
heterogeneity create?
External validity limited and negative trials
may be eliminated from the study
Most important interpretation of a study
when there is a five-fold increased risk of a
rare side effect in those exposed to a
medication vs those not exposed to
medication during the same period of time?
Difference between absolute and relative
risk reduction
Child involved in study realizes he has to
get blood drawn and refuses, mother
attempts to coerce participation. Next step
for researcher?
Child must voluntarily assent to study
Researchers want to know if they can
predict suicidal thoughts based on
presenting medical condition in the ER.
What type of variable are suicidal thoughts?
Dependent
