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PHAR 271 > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

What is EBM?

A

integration of best research evidence and clinic expertise and patient values

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2
Q

What are the five A’s of EBM?

A

Ask- make question
Acquire- find info
Appraise- evaluate info
Apply- use results
Assess- evaluate performance

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3
Q

What is PICO?

A

P-population
I-intervention
C- versus
O-outcome

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4
Q

What are the top notch filtered information that we can access?

A

Systematic reviews
Critically apprasied

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5
Q

What are unfiltered information and rank them of descending quality?

A

RCT
Cohort
Case-Control
Cross sectional
Case report

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6
Q

What is external validity?

A

how generalizable it is

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7
Q

What is internal validity and what 3 threats are there?

A
  • due to something weird during the study
    Chance confounding and bias
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8
Q

What is chance?

A

random error in measurements or observations

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9
Q

What is bias?

A

Any systematic error in results

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10
Q

What is confounding?

A

Confusion of effects- some other factor is causing issues

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11
Q

What does P values mean?

A

> 0.05= support null= not statistically different
<0.05= reject null= statistically different

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12
Q

How can we lower chance?

A

increase sample size
use p values

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13
Q

REMEMBER STAT SIG MAY NOT BE CLINICALLY SIG

A
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14
Q

How can we lower confounding?

A

randomize or statistical models to adjust for it.

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15
Q

What is stratification vs matching randomization?

A

Strat- radnomize 2 groups separately so they get the same representation
Matching- often by sex and age so that they put 2 similar people in different groups

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16
Q

What is selection bias?

A

how they were selected
often effects external validity

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17
Q

What is volunteer bias?

A

people who volunteer are different than those who don’t

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18
Q

What is healthy worker bias?

A

employed= healthier

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19
Q

What is attrition bias?

A

people who leave study or die and not following up

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20
Q

What is recall bias?

A

individuals may remember differently. maybe remember negative better

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21
Q

What is interviewer bias?

A

ask/ probe different people if they know what group they are in

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22
Q

What is surveillance bias?

A

one group is studied/ followed more closely

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23
Q

How can we lower bias?

A

minimize through blinding
create everyone the SAME

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24
Q

What is publication bias?

A

tend to only publish positive findings

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25
Q

What is the difference between parallel and cluster RCT?

A

parallel= split into two groups
cluster= cluster of individuals are randomized

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26
Q

What is study power?

A

ability to show difference between the groups= need a good in-between number

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27
Q

What is a hard vs soft endpoint?

A

hard= death, heart attack
Soft= blood pressure

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28
Q

What is a primary vs a secondary endpoint?

A

primary= what the study was designed for
secondary= additional findings

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29
Q

What is the issue with secondary endpoints?

A

study was not designed for it so confounding may be an issue. harder to trust results

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30
Q

What is a composite endpoint?

A

Primary endpoint with several events
ie) MACE

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31
Q

Issue with composite endpoints?

A

hard to determine true effect of intervention on each event

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32
Q

What are the tree methods of randomization?

A

Complete= no limits= not same numbers in each group
Block= force equal numbers by 6 subjects three must go in each group
Stratified= by age or sex usually

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33
Q

What is ITT?

A

Analyze data of all patients even those that died or dropped out

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34
Q

What is per protocol?

A

Analyze data from subjects who followed it exactly

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35
Q

What can’t observational studies do?

A

PROVE CAUSATION

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36
Q

What’s a benefit of observational studies?

A

feasible, real world, ethical always

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37
Q

What are the 3 main types of Observational studies?

A

Case reports/series
cross-sectional
case-control
cohort

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38
Q

What is a case report study? also what is a case series :)

A

interpret one case
pros= useful for new disease or side effects, further research, identify new drug effects
Cons= hard to interpret, CONFOUNDING
series= individual reports in short time

39
Q

What is cross-sectional studies? Pro, Cons?

A

Look at sample at one point in time
Pros= prevalence, look for association, cheap, quick
Cons= don’t know incidence, can’t prove, confounding

40
Q

What is case control?

A

Compare 2 groups retrospective
look for people who had outcome and this ewho did not
Try to make two groups as similar as possible
Cons= not randomized, bias, can’t prove
Pros= good for rare, quick

41
Q

What is a cohort study?

A

Follow the two cohorts
similar to RCT but NO randomize
Can be prospective and retro
Cons= bias, no randomize, costly
Pros= highest level of evidence

42
Q

How to calculate ARR/ARD and what does it mean?

A

ARR= %placebo- %outcome
tells us that drug X is % outcome less than placebo

43
Q

How to calculate RR

A

Prob of event in intervention/ Prob of net in placebo

44
Q

What does an RR of <1 mean?

A

less risk of outcome in intervention

45
Q

How to calculate RRR?

A

RRR= 1- RR

46
Q

HOW to calculate OR

A

Prob risk of event/prob risk of not = for one drug
do it again for the other drug then do
intervention Odds/placebo Odds

47
Q

What does a OR>1 mean?

A

higher odds of outcome in intervention

48
Q

What is NNT? Same with NNH

A

NNT= 100/ARD% Orrrr if it is in decimal then 100/the decimal always round up

49
Q

How do you use survival curves?

A

look at how many years to get 50% survival

50
Q

WHat does Hazard ration of <1 mean. What about>1?

A

<1= less hazard in intervention
>1= higher hazard

51
Q

WHat does confidence interval mean?

A

means that in 95% of the time the drug reduced __________ and true value is between __________

52
Q

What is threshold of no difference for mean or proportions?

A

0

53
Q

What is a washout period?

A

period of time to let the drug be fully eliminated from the body

54
Q

What is a cross over RCT

A

intervention then gets placebo and vice versa

55
Q

Why do you need to make sure that a study is designed before it begins (a priori)?

A

limit bias

56
Q

Which has better generalizability? RCT or observe?

A

Observe

57
Q

If I increase my sample size in my study, what will this help to reduce?

A

Chance

58
Q

Randomization helps to minimize:

A

confounding

59
Q

How can we find out if ITT or per protocol

A

If they randomized certain number and if the results have the same table

60
Q

Who is blinded in single blind trials

A

the evaluators

61
Q

What does NNT mean?

A

it takes _____ treated for ______days for one ADDITIONAL person to see benefit

62
Q

What is typically a good NNT?

A

depends on treatment and length of time
But for CVD anything less than 50

63
Q

What can CI help us see?

A

best case and worst case scenario

64
Q

What is threshold of no difference for RR and OR?

A

1

65
Q

Is this CI significant mean weight -3-19

A

NO

66
Q

IS this CI significant mean weight 30-40

A

YES

67
Q

Is this CI significant? RR 1.9-5

A

Yes

68
Q

Is this CI significant OR 0.4-5

A

NO

69
Q

Why is CI more informative than p values?

A

shows us range and direction of the effect.
Also help us see clinical and statistical significance

70
Q

What does ITT help prevent?

A

confounding

71
Q

Why is ITT not great for non-inferiority RCT?

A

may accidentally show non-inferiority

72
Q

If a lack of superiority in a superiority trial does this mean it is non-inferior?

A

NOOOOOOO

73
Q

What do we ABSOLUTELY need to have established before a non inferior trial?

A

Need the margin of inferiority

74
Q

What is a propensity score

A

probability of a subject would be in a certain treatment group based on observed characteristics

75
Q

When do we use propensity scores?

A

OBSERVATIONAL studies

76
Q

What does propensity scores limit?

A

selection bias and confounding

77
Q

Does propensity scores replace randomization?

A

FUCK NO

78
Q

What is a adaptive clinical design?

A

planned review of the data, make modifications and redo conducting

79
Q

What examples for Adaptive clinical designs?

A

Adjust sample size, stop treatment arms (if really bad), change allocation, stopping early(positive or negative)

80
Q

What is a con of adaptive clinical trials?

A

interim data analysis= operational bias as you are aware of the effects.

81
Q

True or false all systematic reviews are very good

A

False

82
Q

What do systematic reviews reduce?

A

confounding

83
Q

What is a meta-analysis?

A

use stats to integrate results, extract data from each study and weight the numbers based on if study provides more info

84
Q

When can’t we do Meta-analysis

A

if different population, comparisons
check if similar enough by use Q

85
Q

Why is systematic reviews important?

A

hard to stay up to date

86
Q

What is Cochrane collaboration?

A

highest standard. international volunteers to review

87
Q

What are the components of a systematic review?

A

Make question- establish protocol, eligibility, RCT and/or Observe
Comprehensive literature search
Identify inclusion studies (look at abstract)
Assess Quality
Extract data
Analyze data (only for meta)
Interpret

88
Q

Issues with systemic reviews

A

no transparency
bad criteria
poor quality papers

89
Q

What are clinical practice guidelines and why are they important?

A

Systematically developed statements to assist practitioners and patients make decisions. Important for good informed choices

90
Q

What are the components of a CPG

A

Systematic reviews (+/- MA)
Set of recommendations
target population
target audience
expert panel-range of HCP+ info on them (qualifications)
How they developed recommendation (voting/consensus)
external review
updates
funding statements

91
Q

What is the grading system for CPG?

A

Numbers=1 (we recommend) 2 (we suggest)
Letters= A-D A is best

92
Q

What are some potential problems of CPG?

A

Poor quality studies
Publication bias
not user-friendly
liability- sued if not followed

93
Q

How can we appraise CPG?

A

AGREE II- has 23 items and 6 domains to check CPG
check scope, stakeholders, rigour, clarity, applicability
editorial independence

94
Q
A

PHAR 271 (5 decks)

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