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Year 3 RESS > RESS 3 Lectures > Flashcards

RESS 3 Lectures Flashcards

1
Q

What is a ‘research’ type study in the context of clinically relevant studies?

A

Generates new knowledge where there is no or limited research evidence available and which has the potential to be generalisable or transferable.

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2
Q

What is a ‘audit’ type study in the context of clinically relevant studies?

A

a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.

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3
Q

What is a ‘service evaluation’ type study in the context of clinically relevant studies?

A

evaluates a proposed service or current practice (e.g. acceptability and uptake) with the intention of generating information to inform local decision-making

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4
Q

What is a ‘audit-cum-service evaluation’ type study in the context of clinically relevant studies?

A

Combined audit and service evaluation. Establishes to entent to which clinical practice is achieveing a particular standard as well as a to estabilish what factors might be associated with those contexts , those patients or those practitioners who succeed in achieving this standard; and those who do not)

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5
Q

What is NICE?

A

The National Institute for Health & Care Excellence (NICE) is the independent organisation responsible for providing national guidance and advice to improve health and social care

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6
Q

What are the roles of NICE?

A

1) To reduce variation in the availability and quality of treatments and care
2) To help resolve uncertainty about which medicines and treatments work best and which are the best value for money for the NHS
3) To set national guidelines on how people with certain conditions should be treated

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7
Q

What is the mneumonic used to define the search terms used in research literature searches?

A 
PECOS
Patient/participant/people
Exposure/event/experimental
Intervention
Comparison (if appropriate)
Outcome
Study design (if appropriate)
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8
Q

What are the 3 different options for locating studies with specific designs?

A

1) Free text searching using appropriate search terms
2) Using controlled vocab PECOS search terms
3) Using methodological/design PECOS search filters/limits

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9
Q

What does MeSH stand for?

A

Medical Subject Headings

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10
Q

What is Medlines controlled vocabulary thesaurus called?

A

MeSH

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11
Q

What are the 3 competing priorities that clinical studies require you to balance?

A

1) Design and conduct studies that provide the correct answers
2) Maximise the efficient use of resources
3) Comply with ethical, legal, institutional and professional regulations

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12
Q

Name the 4 potential sources of bias

A

Sampling/selection bias
Measurement bias
Analytical bias
Dissemination bias

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13
Q

What is sampling/selection bias?

A

Using non representative samples

This selection influences exposure and outcome

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14
Q

What are the 3 types of measurement bias?

A

Information bias - extent of information varies amongst participants
Observer bias - influence by prior knowledge/belief
Recall/response/prestige bias - influence by prior knowledge or belief

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15
Q

What are the 3 types of analytical bias?

A

Loss to follow up - specific participants excluded
Omitted variable bias - imprecise adjustment for confounding
Attribution bias - interpretation of causality

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16
Q

What is the 1 type of dissemination bias?

A

Publication bias: eventful results more likely to be published

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17
Q

What different types of studies have been developed to combat bias?

A 
Cross sectional (lowest effectiveness) 
Case control
Cohort
Trial
Meta analysis (highest effectiveness)
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18
Q

What are the 2 types of descriptive (inductive) studies?

A

Case study/series

Cross-sectional (descriptive)

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19
Q

What 2 categories are analytical studies further sub divided into?

A

Observational

Experimental

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20
Q

What are the 4 types of observational (selective sampling) studies?

A

Cross sectional (analytical)
Case/control
Cohort

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21
Q

What are the 2 types of experimental (selective exposure) studies?

A

Trial

Meta-analysis

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22
Q

What are the 3 key points outlined in the Belmont report in regards to ethics in research?

A

Respect for the person by gaining consent
Justice - equal burdens and benefits
Beneficence - risk is justified by knowledge gained by the study

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23
Q

What are the 4 types of potential sources of harm to participants?

A

Biological
Psychological
Social
Structural

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24
Q

What types of projects require formal ethical approval?

A

Research involving animals
Service evaluations involving vulnerable people
Projects involving a new intervention
Projects collecting new information on more than only existing service delivery

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25
Q

What is the definition of a target population?

A

The total finite population we wish to know about from which your sample is drawn

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26
Q

What is the definition of a study sample?

A

The participants drawn from the target population that constitutes our data set

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27
Q

What are the 3 different types of samples?

A

Complete samples
Unstratified random sampling
Stratified random sampling

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28
Q

What are complete samples?

A

The entire study population

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29
Q

What is unstratified random sampling?

A

Every member of the target population has the same chance of being sampled

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30
Q

What is stratified random sampling?

A

Randomly sample from the target population within each different variable e.g. age, sex etc
Every memeber within each group has the same chance of being sampled

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31
Q

At what figure does the p-value show that something is statistically significant?

A

<0.05

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32
Q

A 95% confidence interval without the null is the same as what?

A

a p-value of 0.05

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33
Q

What is the definition of ‘power’ in the context of research?

A

The probability of rejecting the null hypothesis when the null hypothesis is false
Making sure the sample size is big enough to prove an effect

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34
Q

How is the odds ratio calculated in categorical data?

A

Odds of the exposed/unexposed groups

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35
Q

What value that if it is included in the confidence interval shows that it is not significant in categorical data ?

A

1

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36
Q

What 3 values are calculated in continuous data to calculate confidence interval?

A

Mean
Standard deviation
Estimated sample size

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37
Q

What value if not included in the confidence interval in continuous data shows it is significant?

A

0

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38
Q

How are the odds ratio for 2 groups calculated?

A

Odds of the event for exposed individuals/odds of an event for unexposed individuals

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39
Q

What is a covariante?

A

variables that affect the exposure/outcome

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40
Q

What 3 questions are used to assess which covarieantes may be important to include in an analytical study?

A

1) What are the (likely) causes of the exposure?
2) What are the (likely) causes of the outcome?
3) What are (likely to be) caused by the exposures?

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41
Q

The confounders are formed from what 2 covariates?

A

Causes the exposure

Causes the outcome

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42
Q

The competing exposure is formed from what 2 covariates?

A

Causes the outcome

Likely to be caused by the exposure

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43
Q

The mediators are also known as what covariate?

A

what is likely to cause the outcome

44
Q

What needs to be adjusted for?

A

Confounders

45
Q

What does DAG stand for?

A

Directed Acyclic Graph

46
Q

What is the function of a DAG?

A

1) Summaries functional, theoretical and speculate relationships between variables
2) Identifies covariants acting as competing exposures so this can be adjusted for
3) Identify covarients as mediators so they are not adjusted for

47
Q

Why do we need to adjust for confounders?

A

They create a psuedo-casual path between the outcome and the exposure which will generate a statistical relationship between the two even when non exists

48
Q

Why do we not adjust for mediators?

A

They are part of the casual path between the outcome and the exposure and if we adjust for these we are adjusting out this potentially important pathway

49
Q

Why might we adjust for competing exposures?

A

IF they cause a substantial amount of variation in the exposure, ‘adjusting this out’ can make any association between the remainder and the exposure easier to detect

50
Q

What are the 2 types of study that your variables can be sourced from?

A

Prospective study - records variables over the study period, with the outcome measured subsequently e.g. cohort
Retrospective study - measures the outcome and then look backwards to measure the exposure and other variables e.g. case-control/cross sectional

51
Q

What are the pro’s of prospective data collection?

A

Fewer sources of bias e.g. recall or ascertainment
Less chance of confounding
Some data can only be measured prospectively

52
Q

What are the cons of prospective data collection?

A

Time and resource intensive
Tendency to collect data on more variables that you need or can use in your analyses
Subjects can drop out (bias)
Usually unfeasible for rare outcomes

53
Q

What are the pro’s of retrospective data collection?

A

Data collection is less time and resource intensive

Allows oversampling of rare outcomes

54
Q

What are the con’s of retrospective data collection?

A

More susceptible to bias (recruitment and data recall)
Some variables cannot be measured directly e.g. BMI
If data are from records, little control over these

55
Q

Name an example of a prospective data collection study

A

Biobank

56
Q

Name an example of a retrospective data collection study

A

Genome project

57
Q

Name 2 ways to ensure a standardised data collection

A

A research diary - ensures you keep a timely record of what you do and any observations on data collection processes influencing data quality and completeness
A data collection proforma - ensures that variables are measured/recorded consistently

58
Q

What is the requirement of a questionnaire styled data collection proforma for collecting participants responses?

A 
Clearly written questions
Unambiguous
Definitive
Instructive 
Closed/pre-coded answers
59
Q

What is a proxy?

A

Not the variable you require but something close to it e.g. to know what people eat you could ask about how much veg they eat

60
Q

What are 3 sources of measurement errors?

A

Inherent variation/Instability in variables: can be further exacerbated when using proxies
Imperfect measurement equipment/technique
The same variable arising from the same questions may be biased in different ways depending on the context

61
Q

Name 4 types of biases that occur from the same variable arising from the same questions may be biased in different ways depending on the context

A

1) response bias - what the interviewer wants/gets
2) prestige bias - what appears favourable
3) recall bias - prospective/retrospective
4) multiple transcription from sources to proforma

62
Q

What is a latent key variable?

A

A key variable that is missing

63
Q

What should be done if a latent variable occurs?

A

If it is an exposure/outcome then you must find an alternative
If it is a potential cofounder, try using a proxy

64
Q

What are the 3 different options if there is missing data in some key variables?

A

1) compare participants with complete and missing data - are they comparable? if not missing may cause bias
2) create a missing category for missing measurements
3) interpolate/statistically estimate what the missing measurement might/are likely to have been

65
Q

What is the function of general linear modelling?

A

Tests the relationship between 2 variables

Works for many different types of variables

66
Q

What is a nuisance variable?

A

aka confounders and competing exposures 0 need to adjust for these

67
Q

What is the equation of the line used in the simplest linear model?

A

y=mx+b+e

e = residual variation (noise) - want this value to be as low as possible

68
Q

If the exposure is categorical, what is written before regress in the stata command?

A

xi:

69
Q

When is logistic regression used?

A

if the outcome is binary

70
Q

What does R2(squared) represent?

A

The proportion of the variation explained by the linear model
Value is between 0-1
The higher the value, the more variable that is explained by your model - this is good

71
Q

What is the adjusted R2(squared) used for?

A

When there are more variables, the R2(squared) will always improve so this accounts and adjusts for this for each variable

72
Q

If the confidence interval includes 0, what does this mean?

A

There is a significant association

73
Q

What are the advantages of qualitative studies?

A

Assume objectivity - researchers seek to avoid their own presence, behaviour or attitude affecting the results
Positivist researchers critically examine their methods and conclusions for possible bias therefore studies are able to be replicated
Can interrogate taken for granted concepts to give new insight, define problems/solutions or connect wider political and social views
Complex issues can be researched in depth
Give reasons WHY peoples behaviour is a certain way

74
Q

What are the 4 steps of a qualitative study design?

A

1) theoretical framework
2) participant selection
3) setting
4) data collection

75
Q

What is meant by ‘theoretical framework?’

A

Assumption on how you think the world works

76
Q

What is ‘induction’ in the context of theoretical framework?

A

Generate universal statement from individual cases

77
Q

What is ‘deduction’ in the context of theoretical framework?

A

Use theories to explain individual cases

78
Q

How many people would you want to choose to sample in a qualitative study?

A

The amount that will reach saturation which is around 15-25 people per variable

79
Q

What are the different groups of people that can be sampled in a qualitative study?

A

1) purposive: participants who have the potential to provide rich, relevant ans diverse data relevant to the research question
2) Maximum variability: people with a wide range of experiences and no preconceptions
3) Deviant cases: People who will increase explanation as they do not fit the norm
4) Convenience: e.g. using students at research based uni’s - may lead to bias
5) Theoretical: allowing new theories to be found

80
Q

What data sources are used in qualitative studies?

A

Interviews
Focus groups
Be aware of when to use each one e.g. sensitive topics, confidentiality, stigmatised topics etc.

81
Q

What is the definition of ethnography?

A

The scientific description of peoples and cultures with their customs, habits, and mutual differences

82
Q

What does IPA stand for?

A

Interpretive Phenomological Analysis

83
Q

What is IPA (Interpretive Phenomological Analysis )?

A

A method to focus on how interviewees make sense of things

84
Q

What is the grounded theory?

A

Focuses on identifying shared meanings in the data without reference to existing theories

85
Q

What different parts have to be assessed to deem a qualitative study trustworthy?

A

Demonstration of knowledge of the researcher
Demonstration of skill and systematic approach
Volume and richness of data supporting the claims made
Systematic formulation of tentative claims, testing and refinement
Plausibility of the claims in light of earlier theory and evidence

86
Q

What is opportunity cost?

A

the value of something when a particular course of action is chosen e.g. going on holiday vs replacing a car

87
Q

What does it mean if the opportunity cost is greater than the value of what you have chosen?

A

You have made the wrong choice

88
Q

What does QALY stand for?

A

Quality adjusted life years

89
Q

What is the definition of quality adjusted life years?

A

A measure of the output of healthcare that can measure all types of healthcare

90
Q

What is the definition of economic evaluation?

A

the comparison of two or more alternative courses of action in terms of their costs and their outcomes

91
Q

What does economic evaluation do?

A

Ensures the value of the outputs from an activity is greater than the value of the resources consumed by the activity

Provides information about how much it costs per unit of health gain to choose one course of action over another

92
Q

What is the definition of efficiency?

A

maximising the benefit for the resources used - helps the most people at the least cost

93
Q

What are the 2 types of efficiency and their definition?

A

Technical efficiency: meeting an given objective at the least cost

Allocative efficiency: producing the output the matches what the consumer wants (supply vs demand)

94
Q

What are the 2 aspects of marginal analysis?

A

1) Marginal Benefit = the benefit from the next step

2) Marginal cost = the cost of taking the next step

95
Q

What are the 3 types of economic evaluation that we use when we want to compare across conditions?

A

1) cost effectiveness analysis - life years gained
2) cost utility analysis - quality and quantity life
3) cost benefit analysis

96
Q

What is the definition of cost effectiveness analysis?

A

benefits measured in terms of standard clinical outcomes

97
Q

What is the incremental cost effectiveness ratio? (ICER)

A

A calculation of the (expected) cost per additional unit of health produced by a new intervention compared to the current practice

98
Q

What is the cost effectiveness threshold?

A

The maximum amount the health service will pay per unit of health gained

99
Q

What are monetary costs?

A

the physical money cost

100
Q

What are non monetary costs?

A

E.g. Quality of life/access/health outcomes etc.

101
Q

What is the deceleration that codes for medical ethics?

A

Deceleration of Helsinki

102
Q

What does the deceleration of Helsinki say in regards to consent?

A

Free informed consent is required by participants, though there can be exceptions

If unable to gain consent then:

Their condition must be characteristic for the study
They must get consent as soon as possible
Gain approval from an ethics committee

103
Q

What is the definition of tacit?

A

Opt out consent

104
Q

What is the social value requirement?

A

Allows you to ask people to participate in research if there is a substantial gain for others - as being part of clinical trials is normally not in the best interest of the patient

105
Q

What are the 3 requirements that qualify a research project to be ethical?

A

1) consent
2) well designed project
3) social value requirement

Year 3 RESS (1 decks)

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