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Research Test Flashcards

1
Q

most treatment decisions not based on systematic review of evidence

A

Archie Cochrane

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2
Q

The term “Evidence-Based Medicine” was introduced in

A

1992

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3
Q

Purpose of “Evidence-Based Medicine”:

A

Shift decision-making from “intuition, unsystematic clinical experience, and pathophysiologic rationale” to increase use of scientific, clinically relevant research

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4
Q

Decision-making is the bringing together of what three components?

A
  1. clinical expertise
  2. best research evidence
  3. patient values and preferences
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5
Q

Benefits of Evidence-Based Practice?

A
  1. avoid biases from clinical experience
  2. used vast amount of literature
  3. efficient use of resources
  4. improved clinical care
  5. builds confidence in treatment
  6. stop ineffective practices
  7. builds consistence within/across professions
  8. promotes inquiry, continual improvements
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6
Q

Downsides of EBP?

A
  1. may reduce treatment options (lack of funding for research)
  2. challenging to study complex situations and interventions
  3. concerns about undermining naturopathic philosophy (individualized treatments)
  4. doesn’t capture significance
  5. gold standard studies are expansion and don’t always exist
  6. reduced emphasis on professional judgement
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7
Q

Doing EBPs: 5 A’s

A

Ask, acquire, appraise, apply, assess
ASK: formulate an answerable research question
ACQUIRE: find the best available evidence
APPRAISE: critically appraise/evaluate the evidence
APPLY: apply the evidence by integrating with clinical expertise and patient’s values
5. ASSESS: evaluate performance

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8
Q

Essential to understand and critically evaluate research to apply it properly. Conclusions from research studies may reflect the truth

A

Critically appraise

Presentation in the media aimed at generating attention and interest rather than accuracy

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9
Q

T or F: all research is open to bias

A

TRUE

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10
Q

The scientific method:

A
  1. observation/question
  2. research topic area
  3. hypothesis
  4. test with experiment
  5. analyze data
  6. report conclusion
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11
Q

a measurement of the size and direction of the relationship between 2 or more variables.

A

correlation

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12
Q

height and weight, taller people tend to be heavier

A

positive correlation

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13
Q

mountain altitude and temperature, as you climb higher it gets colder

A

negative correlation

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14
Q

margarine consumption and divorce rates

A

RANDOM CHANCE

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15
Q

studies show that people how have more birthdays live longer

A

Reserve Causality

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16
Q

A relationship where one variable (independent variable) CAUSES (is responsible for the occurrence) the other (dependent variable)

A

Causation

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17
Q

decapitation causes death

A

causation

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18
Q

T or F: Generally, it is very difficult to prove a causal relationship

A

TRUE

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19
Q

days with higher ice cream sales have more cases of drowning. What is the confounding factor?

A

warmer weather and swimming is the confounding factor

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20
Q

An additional variable causes the change in the dependent variable

A

Confounding factors

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21
Q

Not all associations are causal: Associations may APPEAR causal due to:

A
  1. confounding factors
  2. chance
  3. BIAS
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22
Q

Anything that systematically influences the conclusion or distorts comparisons

A

BIAS

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23
Q

Systematic differences between groups

A

selection bias

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24
Q

what is selection bias likely due to?

A

Likely due to inadequate randomization

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25
Q

Systematic differences in the care provided apart from the intervention being assessed

A

Performance Bias

Ex. Participants in the treatment group spend 10 hours with the researchers, and the control group spends 1 hour

Spending time with the researcher is therapeutic

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26
Q

Systematic difference in withdrawals from the trial

A

Attrition Bias

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27
Q

Ex. Participants who have a negative reaction (or no benefit) from the study treatment drop out more often than the people who find the treatment helpful

Inflates the positive result

A

Attrition Bias

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28
Q

Systematic differences in outcome assessment

A

Detection Bias

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29
Q

Ex. Study of the effects of working with radioactive material on skin cancer risk. More cases of skin cancer were discovered in patients who reported working with radioactive material.

Looking “harder” for one outcome than another

A

Detection Bias

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30
Q

A researcher genuinely believes that the study drug will help psoriasis. If they know who is receiving the real drug, they may underestimate when measuring the psoriasis skin lesion

A

Detection bias

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31
Q

what strategy helps to eliminate detection bias?

A

Blinding
- the researcher should not know who is receiving the drug the placebo

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32
Q

When participants are aware of being observed, they alter their behaviour

A

Observation Bias
Ex. DIET DIARY

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33
Q

studies with negative findings are less likely to be submitted and published

A

Publication Bias

34
Q

When asked about things in the past, may have difficulty remembering and respond in an inaccurate way

A

Recall Bias

35
Q

Principles of Causation:

A
  • Temporality
  • Strength
  • Dose-response
  • Reversibility
  • Consistency
  • Biological plausibility
  • Specificity
  • Analogy
36
Q

The cause came before the effect

A

Temporality

37
Q

what are some study types that are limited in ability to detect temporality?

A

cross-sectional and case-control

38
Q

Stronger association is better evidence of cause/effect relationship

A

Strength of association

39
Q

Varying amounts of the cause result in varying amounts of the effect

A

Dose-response Relationship

40
Q

a number of cigarettes smoked per day and lung cancer risk. What is the risk of confounding here?

A

Dose-response Relationship

RISK OF CONFOUNDING: heavy smokers more likely to consume more alcohol

41
Q

The association between the cause and the effect is reversible

A

Reversibility

42
Q

Ex. people who quit smoking have a low risk of cancer. What is the possible confounding here?

A

Reversibility

confounding: people who quit may start other healthy lifestyle behaviours too!

43
Q

Several studies conducted at different times, in different settings and with different kinds of patients all come to the same conclusions

A

Consistency

44
Q

If the relationship between cause and effect is consistent with our current knowledge of the mechanisms of disease

A

Biological Plausibility

Challenges: homeopathy and energy medicine

45
Q

When biological Plausibility is present, does it strengthen the cause for effect?

A

YES!

46
Q

One cause → one effect (A only causes B) =stronger evidence

A

Specificity

47
Q

Vitamin c deficiency → scurvy

A

Specificity

48
Q

What is an example where Specificity is weak evidence against the cause?

A

smoking causes cancer

bronchitis, periodontal disease

49
Q

The cause-and-effect relationship is strengthened if there are examples of well-established causes that are analogous to the one in question

A

Analogy

Ex. if we know a virus can cause chronic, degenerative CNS disease (Subacute Sclerosing Panencephalitis) it is easier to accept that another virus might cause degeneration of the immunologic system (e.g. HIV and AIDS)

50
Q

Analogy is (strong/weak) evidence for cause

A

WEAK!

51
Q

what is near the top of the hierarchy?

A

meta-analysis

52
Q

Order of hierarchy?

A

top to bottom
Clinical practice guidelines
Meta
RCT
Cohort
Case-control
Case report
Animal and lab studies

53
Q

Do something to the patient, observe what happens

A

Experimental/intervention studies

does the treatment change the likelihood of the outcome?

54
Q

Randomized controlled trial

A
  • defined population (inclusion/exclusion criteria)
  • 2+ groups: treatment and comparison
  • is prospective
55
Q

Key Features of RCT

A

Randomized: Equal chance of being assigned to the intervention or control group - balanced baselined characteristics - sex, family history, age,

Control group: accounts for natural course of illness, placebo effect, confounding factors

May have blinding: minimize expectation effect

56
Q

RCT Use:

A

Best Design for confirming cause/effect

57
Q

Cross-over:

A

everyone gets intervention AND comparison

58
Q

Where would cross-over not be best?

A

Acute - would become resolved after medication A

self - limited

Only works for things that respond temporarily to medication

59
Q

Intervention study where participants are given the option between arms

A

Preference (controlled, not randomized)

(ex. Cancer survivors: pick MBT or Tai Chi)

60
Q

intervention study where everyone gets the intervention (knows it), and assesses changes before and after the intervention

A

Open-label, Pre/Post

61
Q

OBSERVATIONAL STUDIES

A

Exposure NOT controlled by the researcher

They ask: Is there a relationship between a risk factor (or health factor) and an outcome (harm or benefit)

62
Q

Ex. Is a high intake of blueberries associated with a lower risk of cancer? Is increased stress associated with an increased risk of a heart attack?

A

OBSERVATIONAL STUDY

63
Q

Types of observation studies:

A
  1. cohort
  2. case-control
  3. cross-sectional
64
Q

highest quality observational study

A

cohort

65
Q

COHORT STUDY

A
  • Recruit the cohort (outcome is NOT present)
  • Assess risk/health factors (create a comparison group)
  • Follow over time
  • See who develops the outcome
  • “longitudinal” “prospective”

Compare INCIDENCE

66
Q

People without CVD.
High saturated fat diet, low saturated fat diet. Who developed CVD?

A

cohort

67
Q

Case-Control

A

The outcome is PRESENT at the beginning of the study

RETROSPECTIVE
Looks backward in time for exposure (how much meat did you eat 10 years ago?)

68
Q

Find people with AND and CVD. Ask them to think about the past. High or low saturated diet. Is there a difference?

A

Case-control

69
Q

Case-control strengths

A
  • can look at rare outcomes
  • faster (no waiting times, minimal loss of participants)
70
Q

Case-control weaknesses

A

Assignment to comparison group is NOT random
- there could be differences (confounding factors)

Hard to assess temporality (ex. recall bias)

71
Q

CROSS-SECTIONAL STUDIES

A

The outcome is PRESENT at the beginning of the study
- assess exposure and outcome at ONE time point

Ex. Patients with CVD and healthy controls, ask about CURRENT meat intake

72
Q

Find people with AND without CVD
Ask about saturated fat in diet
Is there a difference?

A

Cross-sectional

73
Q

Strengths of observational studies

A
  • can study any questions
    don’t have to purposefully deprive pregnant women of B12, can look at people who are already doing this
  • can be less expensive or faster
74
Q

CASE Reports, Case Series

A
  • Report previously undocumented events (success, adverse reaction)
  • May lead to further action
  • Real patients and real clinical approaches
  • BUT concerns about bias and generalizability
75
Q

Preclinical Studies:

A
76
Q

outside the body: cell lines, organs

A

In vitro:

77
Q

in the non-disease model: healthy human to study pharmacokinetics (absorption, elimination), animal models

A

In vivo:

78
Q

Types of Synthesis Research

A

Narrative
Systematic
Meta-analysis

79
Q

Narrative Reviews

A
  • Researcher combines some of the research on a topic
  • reports on the collection of evidence
  • often does NOT describe how they searched and how they decided to include certain studies
  • HIGH risk of bias - results often consistent with their hypothesis
80
Q

Systematic reviews

A

Explicit and rigorous methods to:
1. identify (2+ databases, specific inclusion/exclusion criteria)
2. critically appraise
3. synthesize (combine)

Scientific investigation with pre-planned methodology

Enormous effort to minimize bias

81
Q

Meta-Analyses:

A

Statistically combine the results of studies in a systematic review

Goes one step further - combines the data

Visual representation of the studies (Forest Plot)

Ex. 5 studies with 20 participants → 1 study with 100
participants

82
Q

WHOLE PRACTICE RESEARCH NEED:

A
  • Do the results of RCTs apply to real clinical practice of
    naturopathic medicine?
  • Issues: RCT often use one intervention to treat one disease in
    a uniform patient population
  • Naturopathic medicine: often complex interventions,
    prescribed in an individualized way, to patients with complex
    health conditions

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