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IPAP > Research Evaluation Block 1 > Flashcards

Research Evaluation Block 1 Flashcards

1
Q

Define Prevalence

A

Number of occurrences at one particular time

Obtained from cross-sectional studies, no timeline, only snap shot in time

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2
Q

Define Incidence

A

Occurrence, rate, frequency of disease

Obtained from Cohort Studies and follows cohort through time

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3
Q

Define Correlation Coefficient

A

“r”
Absolute value of coefficient telling how strong relationship is between variables
-1 - 1, closer to them is stronger relationship
Closer to 0, weaker relationship

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4
Q

Define Relative Risk

A

Likelihood an event will occur w/in a population
Experimental Event Rate/Control Event Rate
Makes insignificant findings APPEAR significant

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5
Q

Define Sensitivity

A

People w/ disease compared to people with a positive test for the disease
(tests ability to identify correctly who have the test)
Rules out disease

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6
Q

Define Specificity

A

People without disease who have a negative test
(ability of test to correctly ID those who don’t have the disease)
Rules disease in

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7
Q

Define Two-Stage testing

A

Calculates net sensitivity and net specificity of using both tests in sequence
After completion, loss of net sensitivity and gain of specificity

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8
Q

Define Simultaneous Testing

A

PT is positive if tested pos on one or more tests
PT is negative if tested neg on ALL tests
Net gain in sensitivity and loss of specificity

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9
Q

Define External Validity

A

Ability to apply results obtained from studied population to broader populations
AKA generalization

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10
Q

Define Internal Validity

A

W/in confines of study, results appear to be accurate and investigators interpretation is supported

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11
Q

Define Confidence Interval

A

More important than p-value and a better determination of significance
95% CI= 95% certain that true value is within the CI range, narrower the better

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12
Q

Define Number Needed to Treat

A

of PTs needed to receive new intervention instead of standard alternative in order for ONE additional patient to benefit, used for prophylactic measures
Very effective treatments range: 2-4
10 or less for therapy
20 or less for prevention

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13
Q

Define Number Needed to Harm

A

Treatment is detrimental

Will have negative absolute risk reduction

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14
Q

Define P-Value

A

Probability level, chance of random error

Likelihood that difference observed between two interventions happened by chance

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15
Q

Define Efficacy Trial

A

Attempt to learn if drug, procedure or program works under ideal conditions

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16
Q

Define Type I Error

A

Reject the null when null was true
Finding an effect that isn’t real
Convicting innocent man to prison
Considered worse than Type II

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17
Q

Define Type II Error

A

Failure to reject null hypothesis
Missing an effect that does exist
Not convicting guilty man

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18
Q

Define Confounding

A

Variables that correlate in/directly with in/dependent variable

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19
Q

Define Case Report

A

Literature identifying single incident and discussing pertinent factors related to PT

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20
Q

Define Case Series

A

Study analyzes number of individual cases that share a commonality, usually w/ relatively low number of subjects

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21
Q

Define Case-Control

A

Studies w/ PTs already w/ condition/case compared to those who don’t have it (control)
Researcher looks back

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22
Q

Define Systematic Review

A

Thorough, comprehensive, explicit way of interpreting medical literature

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23
Q

Define Meta-analysis

A

Method for combining study data from several studies to justify quantitative summary to develop single conclusion with greater statistical power

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24
Q

Define Prospective Cohort Study

A

IDs group of PTs already taking treatment/have exposure and follows them forward over period of time

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25
Q

Define Retrospective Cohort Study

A

Starts w/ cohort and goes back in time to evaluate past exposures to risk factors

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26
Q

Define Cross-sectional Study

A

Examines relationship between outcome and other variables of interest at one particular time
Determines prevelance
Cannot show casuality
Does not establish temporal relationship

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27
Q

Define Quasi-experimental study

A

Non-randomized control study

Control group predetermined w/out random assignment and compared to control group

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28
Q

Define Case-Crossover study

A

Type of Case-Control study
Each case becomes own individual control
Used for transient exposures

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29
Q

Define Measures of Central Tendency

A

Mean- average, sum divided by number in set
Median- middle point
Mode- score occurring most frequently; least precise measure; bimodal distribution- 2 most common values

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30
Q

Define Positive Predictive Value

Define Negative Predictive Value

A

Pos- proportion of PTs who have disease and a pos test

Neg- PTs who do not have disease and a negative test

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31
Q

Define Likelihood Ratio

A

Likelihood of someone with disease/likelihood someone without disease
W/WO

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32
Q

Define Odds Ratio

A

Measures strength of association between exposure and disease

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33
Q

Define Epidemiology

A

Study of distribution and determinants of health-related events in populations and application of the study to control health problems

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34
Q

Define Biostatistics

A

Branch of stats dealing with data relating to living organisms

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35
Q

Difference between Descriptive and Analytical Research?

A

Descriptive:
observational
patterns of disease occurrence
generates hypothesis

Analytical:
analyzes
investigates relationships
tests hypothesis

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36
Q

Examples of descriptive studies?

A

Individual:
Case reports
Clinical series

Population:
Ecologic studies

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37
Q

Define Explanatory Studies

A

Attempt to provide insight into etiology/determine better PT outcome

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38
Q

What are the two types of Explanatory studies?

A

Experimental

Observational

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39
Q

Define an Experimental Explanatory Study?

Give examples

A 
Active intervention from investigator
Controlled trial
Clinical trial
Educational intervention
Healthcare trial
Intervention trial
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40
Q

Define an Observational Explanatory study?

Give examples

A 
Investigator observes nature
Case control
Follow up
Cross sectional
Cohort
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41
Q

What are the layers of Quality of Evidence Pyramid?

A 
Meta Analysis
Systematic Review
Critically Appraised literature
Evidence Based Practice
Randomized Control Trials
Non-Random Control Trials
Cohort Studies
Case series/studies
Individual case reports
Background info/expert opinion/non-EBM guidelines
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42
Q

What are the two types of Analytic Descriptive studies?

A

Experimental:
Clinical trial
Community trial
Education intervention

Observational:
Case control
Cohort f/u
Cross sectional

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43
Q

What are Case Series used for?

A

Examine adverse events/effects
Catalog new diseases/outbreaks
Determine feasibility/safeguards of new treatment/intervention
Potential efficacy of new treatment

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44
Q

What do both Case Reports and Case Series lack?

A

Sufficient methodological rigor

Evidence not applicable to large populations, may be circumstantial or confounding factors were present

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45
Q

Purpose of Descriptive Study Ecologic Study

A

Determine relationship between exposure and disease among a population, not just individuals

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46
Q

What are the strengths of Cross Sectional Studies?

A

Assesses multiple outcomes/exposures simultaneously
Completed quickly
Data gathered leads to further studies
Generates Prevalence

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47
Q

What are the limitations of Cross Sectional Studies

A 
No time reference- "snapshot"
Common conditions only
Doesn't calculate incidence, is a prevalence study
Results dependent on study population
Only useful for common conditions
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48
Q

What type of study may follow a case series study?

A

Case-control study, retrospective look at causes

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49
Q

What are the strengths of Case Control studies?

A 
Good for Rare Outcomes
Evaluates many exposures
Ideal for ideal/explanatory ides
Simple/fast/efficient
Inexpensive
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50
Q

What are the limitations of Case-control studies?

A

Single outcome
High risk of bias/confounding variables
No prevalence/incidence/relative risk

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51
Q

Define Nested Case-Control study?

A

A case control study

Large enrollment study within large cohorts for people at risk of disease/outcome

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52
Q

Define Case-Cohort

A

Same as nested case-control but with controls randomly chosen at beginning of study

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53
Q

Define Cohort

A

Groups of people who share common characteristic/experience and remain in a group for period of time

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54
Q

What is the strongest observational study?

A

Cohort Study

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55
Q

Potential biases in Case Control Studies

A 
Selection bias
Information bias
Researcher/observer bias
Voluntary response bias
Matching
Multiple controls
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56
Q

Potential biases in Cohort studies?

A

Selection bias- lost to f/u

Information bias- observer bias

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57
Q

What are the strengths of cohort studies?

A

Studies multiple effects of single exposure
IDs temporal relationship between exposure and outcome
Confirms cause/effect and the magnitude
Measures incidence
Calculates relative risk

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58
Q

What study has the highest validity of observational study design?

A

Cohort study

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59
Q

What are the limitations of Cohort Studies?

A 
Expensive/time consuming
Ineffective for rare diseases
Lose participant f/u
Risk of confounding variables
Presence of records/recall
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60
Q

What is the purpose of randomization?

A

Prevent potential bias by investigator, strives for comparability

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61
Q

The term “controlled” in randomized control studies implies predefined 6 things

A 
Hypothesis
Endpoint to address hypothesis
Enrollment/ f/u methods
Eligibility/exclusion criteria
Rigorous monitoring
Analysis plan/stop rules
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62
Q

Why are randomized control studies controlled?

A

Eliminate confounding variables

Minimize bias

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63
Q

Define single, double and triple blind

A

Single- concealed from one group
Double- concealed from both groups
Triple- concealed from subjects, administers and interpreters

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64
Q

What is the Gold Standard?

A

Double blinded Randomized Control Trial, minimizes chance of bias
Huge strength of randomized control studies

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65
Q

What are the limits of Randomized Control Studies?

A 
Large trials
Long term f/u
Compliance
Expensive
Ethics
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66
Q

What does “Primum Non Nocere” mean?

A

First do no harm

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67
Q

What are the limitations of Non-randomized control studies?

A

Study group characteristics not balance w/ baseline confounding study’s results

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68
Q

What are the 4 major areas of methodological concern in Non/randomized control studies?

A

Enrollment
Allocation
F/u
Analysis

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69
Q

What parts of the EBM pyramid represent the strongest evidence?

A

Top 2
Systematic reviews
Meta-analyses

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70
Q

What are the strengths of systematic reviews?

A 
Review of current literature
Less costly
Less time
Generalized results
Reliable/accurate than individual studies
Evidence-based resource
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71
Q

What are the limitations of Systematic reviews?

A

Time/labor consuming

Not easy to combine studies

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72
Q

What is the meta-analysis conclusion statistically stronger than any single study?

A

Increased subject numbers
Diversity
Accumulated effects/results

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73
Q

What are the limitations of meta-analysis?

A 
Difficult/time consuming
Lack of adequate data
Advanced statistic techniques
Hetergeneity
Non-reproducible results
Publication/Selection/Misclassification bias
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74
Q

Define Variance

A

Quantifies amount of variability around mean

75
Q

Define Standard Deviation

A

Measure of variation of scores about the the mean

76
Q

What is the empirical rule for data when discussing standard deviation?

A

68-95-99
Only applicable to bell curves
68% fall within 1 standard deviation of mean
95% fall within 2 standard deviations of mean
99.7% fall within 3 standard deviations of mean

77
Q

Scatterplots are useful summary of sets of ______ data

A

Bivariate- two continuous variables

Visual relationship between two variables and helps interpret correlation coefficient or regression model

78
Q

What type of graph/visual grouping aids w/ interpreting correlation coefficient/regression model?

A

Scatter plots

79
Q

Define Pearson Correlation and what it’s associated with?

A

Correlation coefficient
Most common measure of association
Misleading if relationship is non-linear

80
Q

Define Alternative Hypothesis

A

AKA Research Hypothesis

Establishes expected relationship between variables being tested

81
Q

Define Null Hypothesis

A

Statement of no difference/relationship between variables

82
Q

When is the Null Hypothesis accepted/rejected?

A

Statistical difference is present, alternative is accepted and reject null hypothesis

If no statistical difference is present, researchers retain/fail to reject null hypothesis

83
Q

Define Significance

A

Probability of rejecting a true Null Hypothesis

.05= 5:100 times, Null wold be falsely rejected; 5% chance results happened by chance

84
Q

What 3 criteria must exist to conduct a screening test?

A

Target disease is important cause of mortality/morbidity
Proven/acceptable tests exist to detect early stage of disease
Treatment is available to prevent mortality/morbidity once results are known

85
Q

Pros/cons of Sensitivity Testing

A

Screening test ability to ID disease presence
High sensitivity= few PTs w/ disease will be missed
Rules out disease, low probability of false negative

86
Q

Pros/Cons of Specificity

A

Tests ability to truly ID absence of disease
Rules disease IN
High specificity, low false positive

87
Q

When are high sensitivity and high specificity tests useful to clinicians?

A

Sensitivity- when test is neg

Specificity- when test is pos

88
Q

What is the use/benefit of regression analysis?

A

Method of predicting change in dependent variable by changing one or more independent variables

89
Q

What are the 4 types of data?

A

Categorical: nominal/ordinal
Continuous: interval/ratio

90
Q

Define Nominal and Ordinal Data

A

Categorical data
Nominal: categories w/ no order (gender, race, blood type)
Ordinal: sequence/ranked (small to large, light to heavy, easy to difficult)

91
Q

Define Interval and Ratio

A

Continuous data
Interval: interval along scale (temperature)
Ratio: presence of an absolute zero on scale is present (weight)

92
Q

What is the benefit of using a Chi-Square test?

A

Most common ways to examine relationships between two or more categorical variables
Does not give info on strength of relationship

93
Q

Define Control Event Rate

A

How often particular event occurs w/in scientific control group

94
Q

Define Experimental Event Rate

A

How often particular event occurs w/in experimental group

95
Q

What type of cohort is cumulative incidence used in?

A

Fixed

96
Q

What type of cohort is incidence rate used in?

A

Open

97
Q

Define Ecological Fallacy

A

Bias specific to ecological studies

Occurs when relationships for groups are assumed to be true for individuals

98
Q

Case-control studies may follow what type of study?

A

Case-series as retrospective look at cause

99
Q

What study attempts to capture cause and effect relationship by comparing frequency of risk factor among the exposed/not exposed

A

Case control study

100
Q

Define selection bias

A

inappropriate selection for case studies/controls
Cases: selected from hospital/clinic/registry, single source selection may not be generalized to all PTs
Control: controls from same reference population as cases

101
Q

Define Information Bias

A

Recall/subject bias occuring when there is difference in recalling info of exposure

102
Q

Define Researcher/Observer Bias

A

When researcher/observer evaluates cases vs controls differentially

103
Q

Define Voluntary Response Bias

A

Case subject think they’ve been exposed respond at higher rate to control

104
Q

Define matching

A

Process of selecting controls so they are similar to cases in characteristics (age, race, sex, occupation)

105
Q

What type of investigation is a cohort study?

A

Epidemiologic

106
Q

When must the criteria for determining selection be specified?

A

Before study has begun

107
Q

What is the best approach in the design of a trial?

A

Randomization

108
Q

What is the critical element of randomization?

A

Unpredictability of the next assignment

109
Q

How/what are methods of randomization accomplished?

A

Computer programs

Envelope system- only opened after consent is given and subject meets eligibility criteria

110
Q

Define stratified randomization

A

Used when concern about comparability of groups and one/few important characteristics
Stratifies study population by each variable considered important then randomized into treatment groups

111
Q

Define blinding

Why is it used?

A

Concealment of group allocation from one/more individuals involved in clinical research study
Used to make sure knowing type of treatment doesn’t effect participants response to treatment, healthcare providers behavior, or assessment of treatment effects

112
Q

When is blinding usually used?

A

When comparing two or more types of interventions

113
Q

Define Planned Crossover

A

After time on certain therapy, PT is switched to alternate therapy
PT serves as own control, but must have washout period

114
Q

Define Unplanned Crossover

A

Subjects are randomized cross-over to other group, randomization is broken/lost

115
Q

What is the effect of non-compliance?

A

Reduce any observed differences since treatment group will include some who didn’t receive therapy

116
Q

Systematic reviews and meta-analysis are both subject to bias based on what?

A

Inclusion/exclusion criteria

117
Q

What is the difference between systematic review and meta-analysis?

A

Review- thorough comprehensive way of interpreting medical literature
Analysis- statistical approach to combine data from selected studies

118
Q

Systematic reviews _____ and ____ all empirical evidence to answer a research question

A

Appraise

Synthesize

119
Q

What are the strengths of meta-analyses?

A

Greater statistical power
Confirmatory data analysis
Greater ability to extrapolate to general population

120
Q

Define Positive correlation on scatter plot

Define negative correlation on scatter plot

A

Pos- X inc, Y inc

Neg- X inc, Y dec

121
Q

Pearson’s correlation is very sensetive to what?

A

Outlying values

122
Q

Define Spearman Correlation

A

Non-parametric version of pearson’s correlation

Calculation based on ranks of data points of x/y values

123
Q

When is the alternative hypothesis accepted?

A

Statistically significant difference

Accept alternative, reject null

124
Q

Define power analysis

A

Calculates number of participants a study must have to draw accurate calculations

125
Q

What happens when p-value is less than/equal to .05?

What happens when p-value is greater than .05?

A

Reject Ho, results are statistically significant

Fail to reject Ho, results are not significant

126
Q

What does it mean if a CI includes 1 (null value)?

A

Results are clinically insignificant

127
Q

What does high sensitivity mean?

What does high specificity mean?

A

Low probability of false negative

Low probability of false positive

128
Q

What happens to the Positive Predictive Value with low prevalence?

A

Lower PPV
False positives increase
Less reliable pos test results

129
Q

What happens to Negative Predictive Value with low prevalence?

A

Higher NPV
False neg test decreased
Neg test is more reliable

130
Q

What calculation can be done to determine the probability of a disease in a low prevalence setting?

A

Likelihood ratio

131
Q

Define positive and negative likelihood ratio

A

Pos- Pos test (sensitivity) / non-diseased (specificity)
Rules disease in
1-infinity, desirable is 5 or more

Neg- diseased people with neg test (sensitivity)/non-diseased people with neg test (specificity)
Ruling out disease
0.0-1.0
Smaller the better, desirable is 0.2 or less

132
Q

How is relative risk calculated?

A

Cumulative incidence data to measure probability of developing disease
Experimental Event Rate / Control Event Rate
EER/CER

133
Q

Define T-test

A

AKA student’s t-test
Used to analyze continuous data by comparing means and standard deviations of two populations, computes a p-value to test null-hypothesis

134
Q

What are examples of T-tests?

A

Histogram

Statistical tests

135
Q

Define reliability

A

Degree to which measurements are reproducible

136
Q

Define Independent Variable

A

Condition/intervention that predicts an outcome
Age/gender/marital status
Experimental treatment doesn’t change the value

137
Q

Define Dependent Variable

A

AKA Outcome variable

Result that is presumed depending on independent variable

138
Q

Definition of Evidence Based Medicine

A

Systematic approach to clinical problem solving allowing integration of best variable research evidence with clinical expertise and patient values

139
Q

What are the 3 fundamental principles of EBM

A

Optimal clinical decision making requirements
Deciding if evidence is more/less trustworthy
Evidence alone is never sufficient enough to make decisions

140
Q

What is the simplified process of EBM?

A 
Assess
Ask
Acquire
Appraise
Apply
141
Q

What are the 5 types of clinical questions?

A 
Therapy
Harm
Differential
Diagnosis
Prognosis
142
Q

Define Quantitative Research

A

Research w/ formal, objective info about the world with math quantification
Used to describe test relationships and examine cause/effect relationships

143
Q

Define Qualitative Research

A

Research with phenomena that are difficult/impossible to mathematically quantify

144
Q

What study design does not have a comparison group?

A

Case Series Study

145
Q

What analytical design is simultaneous evaluation of exposure and outcome?

A

Cross Sectional Study

146
Q

What type of study design can explore potential relationships between exposure and disease between two communities?

A

Ecological

147
Q

What observational study design provides best casual estimate of relationship between exposure and outcome?

A

Prospective Cohort Study

148
Q

What observational study allows designer to explore prevalence in a population?

A

Cross Sectional

149
Q

What study design are control and cases selected/identified within framework of a cohort study?

A

Nested Case-Control

150
Q

Which study design can calculate relative-risk?

A

Prospective cohort

151
Q

Which study design can calculate incidence?

A

Prospective cohort

152
Q

Which study design can not calculate odds ratio?

A

Case Report

153
Q

Which study design is the participant’s disease/outcome free at the beginning of the study period?

A

Prospective Cohort

154
Q

In general a p

value > 0.05 represents which of the following?

A

A statistically insignificant result

155
Q

Which of the following p

values rejects the null hypothesis if the α value is set to 0.05?

A

P = 0.01

156
Q

Which of the follow statement best defines a type II error?

A

A type II error occurs if we fail to reject the null hypothesis when the null hypothesis is false

157
Q

Which of the following terms describes the probability of correctly rejecting the null hypothesis?

A

Power

158
Q

Which of the following correlation coefficients represents the strongest positive correlation between two variables?

A

0.99

159
Q

Which of the following best describes a p value ≤0.05?

A

Means there is a 5% chance that the results occurred by chance alone

160
Q

Which of the following statements best describes an alternative hypothesis?

A

The alternative hypothesis represents the expected relationship between the independent and dependent variable

161
Q

Which of the following represents the most common measure of variability in research?

A

Standard Deviation

162
Q

Which of the following is a measure of central tendency?

A

mean

163
Q

Which of the following is the least precise measure of central tendency?

A

Mode

164
Q

What type of error is made when we reject the null hypothesis when the null hypothesis is true?

A

Type I error (α error)

165
Q

Which characteristic of a diagnostic test is most helpful in ruling-in a disease if the result of the test is positive?

A

Specificity

166
Q

Which of the following test characteristics defines a tests ability to correctly identify the presence of disease?

A

Sensitivity

167
Q

Which of the following is the most valuable in determining the statistical significance of an effect estimate?

A

Confidence interval

168
Q

In which of the following study designs can incidence be calculated?

A

Cohort study

169
Q

Which of the following is an example of a categorical variable?

A

Gender

170
Q

Which of the following is an example of a continuous variable?

A

BP

171
Q

The term that describes the probability of patients who test positive and truly have the disease is:

A

Positive Predictive Value

172
Q

Sequential (two-stage) testing results in which of the following?

A

Loss in net sensitivity and net gain in specificity

173
Q

Simultaneous testing results in which of the following?

A

Net gain in sensitivity and net loss in specificity

174
Q

Which of the following terms best describes the current disease burden in a community and population?

A

Prevalence

175
Q

Assuming a disease has no cure and low risk of subsequent death. What is the likely effect on prevalence if an aggressive screening program is initiated?

A

Prevalence is likely to increase

176
Q

A prospective cohort study exploring the relationship between coffee consumption and Gastric Cancer in a large urban city found that the risk of gastric cancer was higher among coffee drinkers; however, the researchers did not adjust for potentially confounding variables. Is the inference that coffee drinkers are at greater risk of developing Gastric Cancer likely to be correct or incorrect?

A

Incorrect as there may be other relevant factors that may explain this relationship

177
Q

Which of the following represents the highest level of evidence based research?

A

Meta-analysis of Randomized Controlled Trials

178
Q

Which observational study design provides highest level of validity?

A

Prospective Cohort Study

179
Q

Which of following is the best method of determining if randomization was successful when conducting a randomized controlled trial?

A

Confirm that researchers did not alter the allocation participants into treatment or control groups

180
Q

You work in a family practice clinic and order a rapid strep test for a patient with a sore throat. The rapid strep test has a sensitivity of 90% and specificity of 98%. What does a positive test likely represent?

A

The patient likely has an infection

181
Q

The current rapid strep test has a sensitivity of 90% and specificity of 98%; however, a new generation test has a sensitivity of 99% and a specificity of 98%. What is the likely result utilizing the new test?

A

The new test will identify more people with an infection

182
Q

The results of study reports a relative risk (RR) of 2.50 (95% CI: 1.50-3.50). Which of the following is best interpretation of the RR and 95% CI?

A

The reported RR is statistically significant

183
Q

Which of the following is most appropriate definition of a confounder?

A

A variable related the factor and outcome, but not in the causal pathway

184
Q

What is the relation between a Positive Predictive Value and prevalence?
What is the relation between a Negative Predictive Value and prevalence?

A

PPV- directly related to prevalence

NPV- Inversely related to prevalence

IPAP (212 decks)

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