EVIDENCE BASED MEDICINE Flashcards by Tatsuhiko Naito

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)

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Construct validity definition? (2x)

Degree to which a test measures what it

intends to measure

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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?

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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?

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Meta-analysis of antidepressants in
pediatrics. Suicide-related events 4% with
medication, 2% with placebo. Number
needed to harm with medication?

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What is crucial for estimating the
probability of developing bipolar disorder
in a 9 yo?

Base rate of mood disorders in children

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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

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Data to review in a research study before
applying to clinical care of a particular
patient?

Demographic characteristics of patients in

study

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What trial design would help study the
duration of treatment required for
clonidine to control hyperarousal in
children with PTSD?

Discontinuation trial

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A new drug increases social reciprocity in
ASD study. What is a moderating variable of
treatment response?

IQ score

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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

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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

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In longitudinal pediatric studies, what

threatens internal validity?

Maturation

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Summative statistical measure of central

tendency

Median

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Which resource is most up to date on
potential complementary and alternative
medicine (CAM) and drug interactions?

Medline Plus: Drugs and Supplements

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Type of research design following 2 groups
of subjects (population of interest vs
control group) over 15 yrs from in-utero?

Prospective Cohort study

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As prevalence of dx increases, what would

also increase?

Positive Predictive Value

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Highest level of evidence for psychiatric

treatment interventions?

Randomized clinical trial

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Factor limiting generalization of a
treatment intervention presented in a
meta-analysis?

Significant internal validity variability

between studies

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Benefit of a clinical trial with randomized
controlled crossover design vs parallel
design:

Subjects serve as their own controls

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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?

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? ```

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