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Decision Making (Cholley) > Exam > Flashcards

Exam Flashcards

1
Q

Describe: case-control studies

A

People w/ & w/out condition are compared on exposures/ interventions they had in the past

  • Prevalence
  • Controls are selected based on prior design
  • Starts w/ outcome & looks back at exposure
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2
Q

Describe: cohort studies

A

Groups that have an exposure or receive an intervention are compared to others who do not

  • Incidence
  • Disease vs. no disease, followed over time
  • Exposure 1st
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3
Q

Describe: cross-sectional studies

A
  • Prevalence
  • Exposure & outcome are measured at same time
  • “Snapshot”. Ex = survey
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4
Q

What type of research questions do RCTs address?

A

Prevention, screening, diagnostic accuracy, therapy

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5
Q

Define: incidence

A 
# of new occurrences in a population over a period of time 
- Conveys info about the risk of contracting the disease
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6
Q

Define: prevalence

A

Proportion who have a particular condition at a point in time
- Conveys info about how widespread the disease is

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7
Q

Define: absolute risk

A

Risk of developing the disease over a time period in a group of people

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8
Q

Define: relative risk (risk ratio)

A

Compares the absolute risk btwn groups of people

  • Ratio = 1 = no difference
  • Ratio < 1 = less risky
  • Ratio > 1 = more risky
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9
Q

Distinguish btwn observational vs experimental research designs

A

Both observe people & measure outcome

  • Observational: lower level of evidence & the investigator does NOT specify intervention
  • Experimental: investigator specifies intervention
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10
Q

What type of study designs are considered to be observational?

A
  • Ecologic
  • Cross-sectional
  • Case reports
  • Case control
  • Cohort
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11
Q

Distinguish btwn controlled vs uncontrolled studies

A

Controlled:

  • More than 1 group studied
  • At least 1 comparison or control group is compared w/ experimental group

Uncontrolled:

  • Single group studied
  • No comparison
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12
Q

Define: selection bias

A

People in comparison group may not be the same as the people in the experimental group

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13
Q

How do you solve selection bias?

A

Randomization, allocation concealment

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14
Q

Define: attrition bias

A

Differences in withdrawals or exclusions of people entered into a study, excluding pts from the analysis

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15
Q

What does attrition bias lead to?

A

Overestimation of benefit & underestimation of toxicity

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16
Q

How do you solve attrition bias?

A

“Intention to treat” analysis: Includes all study participants

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17
Q

Define: performance bias

A

Differences in the care provided & exposure to other factors
- If providers know which group a participant is in, they may act differently towards that person

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18
Q

How do you solve performance bias?

A

“Double” masking

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19
Q

Define: information bias

A

Differences btwn groups in how data are collected or assessed

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20
Q

How do you solve information bias?

A
  • All groups must be measured in the same way

- “Double” masking

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21
Q

What are the levels of evidence? From best to worst?

A
  1. Systematic review of RCTs –> 2. Single RCT –> 3. Systematic review of controlled observation –> 4. Single controlled observation –> 5. Single uncontrolled observation –> 6. Physiologic studies –> 7. Unsystematic clinical observation
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22
Q

Describe single controlled observation

A

Investigator compares 2 groups

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23
Q

Describe single uncontrolled observation

A

Gathering many pt experiences

- Can’t demonstrate cause & effect

24
Q

Describe physiologic studies

A

Data about a mechanism of action

  • May not reflect larger population
  • Can’t demonstrate cause & effect
25
Q

Describe unsystematic clinical observation

A

Stories we hear (subjective reporting)

  • May not represent the broader experience
  • Lowest level of evidence
26
Q

Define: surrogate endpoint

A

Short term outcomes are measured

27
Q

Define: equipoise

A

Uncertainty about whether experimental intervention is better
- Ethical requirement

28
Q

Define: placebo

A

Substance (or procedure) that looks, tastes, sounds, feels the same as experimental intervention

  • Controls for placebo effect
  • Allows for “masking”
  • Ethical in only certain settings
29
Q

Define: double masking

A

Participants & investigators don’t know who is getting control or experimental intervention
- Avoid bias

30
Q

Define: allocation concealment

A

Process used to ensure that the investigator does not know which group the person will be allocated

31
Q

Define: intent to treat analysis

A

Includes all study participants as part of the group @ which they were originally randomized whether or not they received or completed the intervention

32
Q

Describe: Ecologic studies

A
  • Comparisons of groups instead of individuals

- Ex. rates of disease in groups/regions

33
Q

Give an example of an ecologic study

A

Relationship btwn laws against smoking & prevalence of smoking under age 16

34
Q

Describe: case-report/series

A

Uncontrolled observational studies

- Describes unusual or new occurrences

35
Q

Give an example of a cross-sectional study

A

Association btwn amt of time adults report watching TV & their BMI

36
Q

Which types of studies have “no randomization, bias, or self-selection”?

A

Case control & cohort

37
Q

Give an example of a case-control study

A

Mothers of children w/ & w/out spinal malformations were asked about diet during pregnancy

38
Q

Define: risk

A

Probability of suffering harm/loss

- Proportion of people experiencing the event of interest in a given time

39
Q

Define: harm

A

Physical or psychological injury/damage

40
Q

Define: benefit

A

Promotes well-being

41
Q

Define: screening

A

Testing for a disease in a population w/ no sx

42
Q

Distinguish btwn sensitivity vs specificity

A
  • Sensitivity: How well the test finds the disease when it’s present
  • Specificity: How well the test excludes the disease when it’s not present
43
Q

Define: validity

A

Credibility or believability of research

  • Are the findings genuine?
  • External or internal
44
Q

Define: reliability

A

Repeatability of findings

- If the study was done a 2nd time, would you get the same results?

45
Q

Define: critical appraisal

A

Process of assessing & interpreting evidence by systematically considering its validity, results & relevance

46
Q

What is an abstract?

A

A condensed version of the full text of the paper, presenting the most important info

47
Q

What is included in an abstract?

A
  • Context/background
  • Study purposes
  • Basic procedures
  • Main findings
  • Conclusions
  • New/important aspects of study
48
Q

Define: type I error (False positive)

A

Concluding that a tx works, when it actually does not work

  • Also called “alpha”
  • Rejecting the null, when it is true
49
Q

Define type II error (False negative)

A

Concluding that there is no evidence that a tx works, when it actually does work

  • Accepting the null, when it is false
  • Also called “beta”
  • Risk of type II error decreases as participants in study increases
50
Q

Define: innumeracy

A

Inability to deal comfortably w/ notions of # & chance

  • Affects informed consent & decision-making
  • Interferes w/ appraisal
51
Q

Define: framing effect

A

The presentation & context of info given affects how it is received

52
Q

Define: absolute risk reduction

A

Change in the risk of an outcome of a given tx in relation to a comparative one

53
Q

Define: relative risk reduction

A

The absolute risk difference, divided by the risk of the control

54
Q

Define: odds

A 
# w/ event ÷ # w/out event 
- Expressed as decimal
55
Q

Define: odds ratio

A

Odds of an event in the exposed group ÷ odds of the event in the unexposed group
- When odds ratio = 1, means no difference or no effect

Decision Making (Cholley) (1 decks)

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