Midterm Flashcards
bio-psycho-social model
Biological evidence is ___ in nature
objective
bio-psycho-social model
Psychological evidence is typically ___ in nature
subjective
bio-psycho-social model
Social evidence includes…
cultural background: support network, life circumstances of patient
What kind of patient is more likely to stick with treatment requirements?
Well informed patients
Well informed patients have ___ patient satisfaction
higher
Three ways to inform the patient
Theory
Mechanism of action
Literature
Clinical experience and expertise can only be developed with…
exposure, practice, and time
limitations of clinical experience
What is false attribution?
Believing one treatment was the cause of healing effect (against other possibilities)
limitations of clinical experience
What does “out of sight, out of mind” refer to?
Patients that don’t come back are assumed to be healed. Failure to recognize other treatments that may account for healing.
limitations of clinical experience
Are clinicians statisticians?
No. We often inflate good results and forget bad ones
limitations of clinical experience
What is the fallacy of making hasty conclusions?
If a treatment works for a few patients, it is now proven to work on all
limitations of clinical experience
What are “rose-colored glasses”?
The way you speak to patients may influence what and how they respond to you
limitations of clinical experience
What is reverse gullibility?
Stubbornness in the face of overwhelming evidence to the contrary
What kind of questions can healthcare research NOT answer?
Any question based on opinion, moral/religious imperatives, societal values, or that is politically motivated
Is this a research question or a clinical question?
“Is spinal manipulation associated with…”
Research question
Is this a research question or a clinical question?
“Is my patient likely to benefit from…”
Clinical question
Quality research will…
- Optimize objectivity
- Take a systematic approach
- Include detailed analysis
What does it mean to take a systematic approach?
Research is reproducible and verifiable
quality research
What is clinical equipoise?
Genuine uncertainty of an important question
Describe the sequence of the peer review process
- Author sends draft manuscript to reviewers as peers and gatekeepers
- Peers send editorial and production to publication
- Publication sends work out to audience
- Audience gives attention and reputation to author
What is the impact factor?
A/B
A= times published works are cited in a period
B= total number of citable items published
What is a strength of research?
What is a weakness?
Strength in evolution
Weakness when quality is poor and misleading
What is meta-analysis?
Statistical methods for contrasting and combining results from different studies
Tries to identify patterns
Weight of a study is closely related to…
the width of the study confidence interval: wider confidence= less weight
List five causes of heterogeneity
- Patients
- Interventions
- Comparison groups
- Outcomes
- Quality and methodology
What are the three key elements to appraising the usefulness of the source?
Quality
Relevance
Effort
What does PICOS stand for?
Patient
Intervention
Comparison
Outcome
Study design
What are the highest two levels of the evidence pyramid?
Meta-analysis and systematic reviews
If a meta-analysis or systematic review cannot be found, what study will have the highest level of evidence?
Randomized controlled trials
What type of study has the lowest level of evidence?
Animal studies/ laboratory studies
What is a prospective study?
Data collected going forward in time based on detailed protocol to answer specific questions
What is a retrospective study?
Data collected looking back through treatment records, may lead to bias
Observational research can be…
prospective or retrospective and may or may not include a control group
Observational studies include (5)…
- Case report
- Cross sectional study
- Case series
- Case control study
- Cohort study
What is a case report?
Detailed description of a unique case in clinical practice
What is a cross-sectional study?
Snapshot of specific population’s health and behaviors at one point in time
What is a case series?
Observation of a series of persons without a control group
What is a case control study?
Starts with a group of “cases” (with outcome of interest) and compares them to controls to see differences in exposure
What is a cohort study?
What is data collected on?
Starts with a “cohort” who do not have the outcome of interest and follows them for long periods of time to see if they develop the outcome of interest.
Data collected on levels of exposure to different risks.
What are pros of cohort studies?
- Good for rare or specific exposures
- Can include multiple disease states
What are cons of cohort studies?
- Bad for rare disease/injury
- Usually require long follow up window
What are pros of case control studies?
- Relatively simple to perform
- Works well for rare disease/injury
- Good for exposure with latent effects
What are cons of case control studies?
- Bad for rare exposure
- Prone to recall bias
What is concealed allocation?
The study personnel have no way to predict, alter, or affect the randomized treatment group
What is blinding?
Participants, treatment providers, and/or data anylsis personnel have no way to know which treatment group a participant has been placed
Randomized control trials are ___ in nature
experimental
What is single blinding?
Blinding to participant
What is double blinding?
Blinding to participant and provider
clinical research bias
What is selection bias?
Sample is unrepresentative of true population
What is triple blinding?
Blinding to participant, provider, and data analyzer
clinical research bias
What is channeling bias?
An allocation bias, treatments with similar intent are prescribed to groups based on different baseline characteristics
clinical research bias
What is interviewer bias?
Partiality towards a preconceived response based on structure, phrasing, or tenor of questions
clinical research bias
What is chronology bias?
Historic controls are used as a comparison group for patients undergoing intervention
clinical research bias
What is recall bias?
Inaccuracy or incompleteness of recollections retrieved
clincal research bias
What is transfer bias?
Too many subjects are lost to follow-up or unequal loss of subjects between two groups
clinical research bias
What is misclassification of exposure or outcome?
Participants are placed into the wrong population subgroup or category because of some observational or measurement error
clinical research bias
What is performance bias?
Patients are not blinded to treatment group and may change their behavior based on expectations
clinical research bias
What is citation bias?
Reporting bias; selective revealing or suppression of information
clinical research bias
What is confounding?
Effect or association between an exposure and outcome is distorted by the presence of another variable
randomized clinical trials are always:
A. Retrospective
B. Prospective
prospective
the philosophy that a patient’s well-being can be evaluated in 3 domains is known as ____
bio-psycho-social model
Which of the following has a higher level of evidence:
A. cohort
B. meta-analysis
meta-analysis
list the following in order of highest to lowest level of evidence:
- RCT
- Cohort
- Meta-analysis
- Case study
meta-analysis
RCT
cohort
case study
What study design would allow for the identification of children infected with COVID, and then make conclusions based on comparisons of various exposures made to similar individuals known not to have had the infection?
Case control
true or false:
a systematic review should strive to obtain all the relevant literature available
true
Identify the study type:
- Overall aim: to determine the ability of 2 selected clinical tests to detect or predict neck pain, mid back pain, and low back pain.
- Baseline data were collected at age 11 to 13 (n=1224) and again 2 years later (n=963). Spinal pain was assessed by electronic survey during school time.
- Comparison groups were defined by demographics (height, weight, age).
cohort
A patient asks you about a new clinical trial on echinacea that isn’t effective in preventing colds. This contradicts an earlier systematic review. What should you do if patients ask if they should take echinacea?
Examine the quality of evidence of both the new trial and the systematic review before providing a recommendation
the process of having experts in the field look over scientific work is called ____ and has ____ impact on the credibility of the work
peer review, great
First, a clinician tries a therapy for her own aches and pains. She also asks some family members to try it. She decides it
was a good therapy and began using it on all of her patients. This is an example of which limitation of clinical experience?
Fallacy of making hasty conclusions
true or false:
An original source includes only data collected (and/or analyzed) by the authors
true
Can healthcare research answer the following:
Should chiropractic scope of practice include the treatment of concussions?
NO
true or false:
If a treatment results in a change that that reaches MCID it is clinically important
true
When assessing an article the background/introduction section should state the ____ of the study
Hypothesis
Systematic review should assess the risk of ____ across studies
bias
Which step of the 6A process requires the clinician to analyze the situation and determine gaps in her knowledge?
Analyze
When historic controls are used as a comparison group for patients undergoing an intervention, it may result in ____
chronology bias
When too many subjects are lost to follow-up or there is an unequal loss of subjects between two groups, it may result in…
transfer bias
Are case studies retrospective or prospective?
Either
Which step of the 6A process requires the clinician to acquire literature on the topic of interest?
Acquire
When treatment is prescribed to groups based on different baseline characteristics this is an example of…
channeling bias
