Research

Question 1

What are the weaknesses of RCT’s?

Answer 1

Question 2

What are the strengths of RCT’s?

Answer 2

Question 3

What is power?

Answer 3

The chance of a study succesfully showing a true result
Or
The probability of detecting a significant difference if one exists
Or
The likelihood of correctly rejecting the the null hypothesis when it is false

Question 4

What factors are important when determining appropriate sample size?

Answer 4

Desired power of the study
Effect size
Degree of variation within the variable
Distribution of the data

Question 5

What were the principal outcomes and overall recommendation from the HALT-IT trial regarding TXA use in UGI bleeds?

Answer 5

TXA doesn’t reduce the risk of death from UGI bleeds and shouldn’t be used routinely

Question 6

What were the principal outcomes and overall recommendation from the DEVICE trial regarding VL vs DL use in critically ill patients?

Answer 6

VL is superior to DL regarding 1st pass success in relatively inexperienced clinicians

Question 7

What were the principal outcomes and overall recommendations from the PATCH trial regarding pre-hospital TXA in major trauma patients?

Answer 7

TXA reduces early death due to haemorrhage, however there were more survivors with poor neurological outcomes

Question 8

What were the principal outcomes and overall recommendations from the INCEPTION trial regarding early ECPR for refractory out of hospital cardiac arrest?

Answer 8

ECPR overall was not superior to CPR, however in subgroup analysis of centres with high rates of ECPR (and better experience) there was a trend towards better outcomes

Question 9

What were the principal outcomes and overall recommendations from the CLOVER and the CLASSIC trials regarding restrictive vs liberal fluid use in sepsis induced hypotension?

Answer 9

No difference in outcomes between the two groups, although slightly higher rates of ICU admission in the restrictive group (CLOVER)
No change in 90 day mortality or ICU length of stay

Question 10

What were the principal outcomes and overall recommendations from the DOSEVF trial regarding strategies for refractory VF management?

Answer 10

Vector changed and double sequential defibrillation methods were more effective than continuing normal defibrillation for refractory VF

Question 11

What were the principal outcomes and overall recommendations from the FERRARI trial regarding diuretics vs fluids for acute PE?

Answer 11

Diuretics improved echo findings of R) heart strain, but no clinical outcomes were measured. Theoretically 1 shot diuretics may improve outcomes but needs further trials

Question 12

What were the principal outcomes and overall recommendations from the FAKT trial regarding Fentanyl use alongside Ket/Roc for controlling peri-intubation hypertension?

Answer 12

Fentanyl reduced rates of hypertension but also increased rates of hypotension.
Consider the relative risks from hypo and hypertension when using fentanyl

Question 13

What were the principal outcomes and overall recommendations from the “Endovascular therapy for large ischaemic stroke” trial?

Answer 13

Endovascular therapy lead to better functional outcomes at 90 days but also higher rates of haemorrhagic stroke conversion

Question 14

What were the principal outcomes and overall recommendations from the RePHIL trial regarding pre-hospital PRBCs with LyoPlas compared to N.Saline on mortality and lactate clearance?

Answer 14

No difference found between the 2 groups in the pre-hospital setting
Also logistically challenging carrying extra blood in the pre-hospital setting

Question 15

What were the principal outcomes and overall recommendations from the Prague OHCA trial regarding pre-hospital ECPR for refractory cardiac arrest?

Answer 15

Question 16

What were the principal outcomes and overall recommendations from the COCA trial regarding Calcium use in adults with OOHCA?

Answer 16

No difference shown between placebo and calcium use
Some suggestion of harm from point estimates with Calcium

Question 17

What were the principal outcomes and overall recommendations from the STYLETO trial regarding use of stylet on 1st pass intubation success?

Answer 17

Stylet use significantly increased the success of 1st pass intubation in operators of all levels

Question 18

What were the conclusions of the SAFE trial for albumin vs crystalloid?

Answer 18

Question 19

What were the principal outcomes and overall recommendations from the PARIS trial regarding high flow nasal cannulae for bronchiolitis?

Answer 19

Among infants with bronchiolitis treated outside ICU, HFNP reduced rates of escalation of care (ie intubation) due to treatment failure when compared to normal 02 nasal cannulae

Question 20

What were the results of the ADAPT trial for rapid rule out troponins for ischaemia?

Answer 20

• A TIMI score = 0
• 2 negative troponins at 0 and 2hrs
• No ECG ischaemic changes

If meet all 3 criteria then can safely be discharged from ED

Question 21

How are sensitivity, specificity, positive likelihood ratio and negative likelihood ratio, PPV and NPV calculated?

Answer 21

Sensitivity
- a/(a+c) OR True positive/(true positives + false negatives)
- ie true positives/all with disease
- ie the fraction of patients with the disease who test positive

Specificity
- d/(b+d) or True Negatives/(true negative + False positives)
- ie true negatives/All without disease
- ie the fraction of patients without the disease who test negative

Positive Likelihood ratio
- Sensitivity/(1-specificity)

Negative likelihood ratio
- (1-sensitivity)/specificity

Positive predictive value
- a/(a+b) x 100
- True positive/all who tested positive
- ie the fraction of patients who test positive who in fact have the disease

Negative predictive value
- d/(c+d) x 100
- True Negatives/all who tested negative
- ie the fraction of patients who test negative who don’t have the disease

Question 22

What is the definition of a confidence interval?

Answer 22

Question 23

What needs to be addressed when performing a literature review of a new medication?

Answer 23

1. Equivalence or superiority to conventional treatments (including risk of harm)
2. National/International recommendations (ie eTG)
3. Pharmacodynamic/Kinetic properties
4. Is it licensed in Australia
5. Cost effectiveness
   - Direct cost vs mainstay
   - Does it reduce LOS, less further testing, lowers ICU rates etc
6. Feasibility in your setting
   - Route of administration
   - time taken
   - Need for monitoring/sampling
   - Storage, staff training
   - Frequency of use
7. Use in special groups
   - Elderly, paeds, pregnant

Question 24

What were the principal outcomes and overall recommendation from the MOPETT trial regarding low dose thrombolysis vs no thrombolysis for submassive/intermediate/moderate PE’s?

Answer 24

• Low dose thrombolysis decreased RVSP by 15mmHg at 28months
• Unclear if this is clinically relevant
• No difference in bleeding rates
• Trend towards improved mortality and lower recurrence of PE in treatment group, but not statistically significant

Question 25

What were the principal outcomes and overall recommendation from the PEITHO trial regarding full dose thrombolysis vs no thrombolysis for submassive PE’s?

Answer 25

• Full dose thrombolysis had a modest haemodynamic benefit
• No 30 day mortality difference
• However there was a 10x increase in ICH and 5x increase in all major bleeding
• The trial did not support using full dose thrombolysis in submassive PE’s

Question 26

What are the main types of bias in research?

Answer 26

Question 27

What are the advantages of a meta-analysis?

Answer 27

• Reduces the probability of false negative results
• Combination of samples leads to an improvement in statistical power
• Increases external validity
• Increased sample size increases the accuracy and can normalise the distribution
• Can reveal publication bias
• Can resolve RCT heterogeneity

Question 28

What is a meta-analysis?

Answer 28

Question 29

What are the different forms of risk assessment in statistics?

Answer 29