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RESS Flashcards

1
Q

What type of study generates new knowledge where there is limited research evidence available?

A

Research

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2
Q

Why type of study measures existing practice against evidence based standards?

A

Audit: does… reach a certain standard?

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3
Q

What type of study evaluates a proposed service or current practice with the intention of generating information to inform local decision making?

A

Service evaluation: What standard is being achieved?

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4
Q

What is an audit-cum- service evaluation?

A

Audit to find what is achieving the standard

Service evaluation to find factors as to why

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5
Q

What is PECOS?

A 
Patient 
Exposure 
Comparison 
Outcome 
Study design
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6
Q

What bias may occur in sampling and selection?

A
  • External validity: non-representative samples

- Confounding: Selection influences exposure and outcome

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7
Q

What bias may occur in Measurement?

A
  • Information: participants know different amounts
  • Observer: influenced by prior knowledge/belief
  • Recall
  • Response: what the interviewer wants
  • Prestige: what appears to be favourable
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8
Q

What bias may occur in analysis?

A
  • Failure to follow up
  • Omitted variable: imprecise confounding adjustment
  • Attributional Bias: interpretation of causality
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9
Q

What bias may occur in dissemination?

A

Publication bias: eventful results are more likely to be published

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10
Q

Hierarchy of studies designed to avoid bias

A 
Meta-analysis: Evidence of reproducibility and generalisability 
Trial: finding cause 
Cohort: Direction of link
Case-control: Links between
Cross-sectional: links within
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11
Q

What is an inductive approach to study?

A

Descriptive: observations: Case control and cross sectional

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12
Q

What is a deductive approach to study?

A

Analytical:
Observational - cross, case & cohort
Experimental - trial by selecting exposure

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13
Q

What is governance?

A

Permission

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14
Q

What are Belmont’s 3 ethical concepts?

A
  1. Respect
  2. Justice & equality
  3. Beneficence
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15
Q

What are the six methods for ensuring voluntary participation?

A
  1. Informed with sheet
  2. Consent with form
  3. Reward free
  4. Freedom to decline
  5. Freedom to withdraw
  6. Rights - confidential and anonymous
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16
Q

What are vulnerable groups?

A
  • Children
  • Diminished autonomy
  • Needs - poor/unwell
  • Unable to consent
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17
Q

High risk ethical issues?

A
  • Vulnerable participants
  • Covert data collection
  • Sensitive
  • Admin of drugs/fluid/food
  • Additional stress
  • Data transfer outside of EU
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18
Q

When is no approval required?

A
  • Data published
  • Non-humans
  • Existing data
  • New info but only on one existing service delivery
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19
Q

What should be in a project protocol?

A
  • Why
  • What involve
  • Ethical, legal and governance issues addressed
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20
Q

Unstratified and stratified sampling pros and cons

A

Unstratified
Pro: Easy. Con: Smaller groups under represented by chance.
Stratified
Pro: Representative of population & unequal sampling improved power for rare strata.
Con: Strata may not be known

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21
Q

Estimates and hypothesis

A

Estimation allows you to estimate an effect - hypothesis testing tells you how likely you are to see that effect by chance if there is no effect.

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22
Q

When are confidence intervals smallest?

A
  • When there is less variation and a larger sample size
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23
Q

What is power?

A

The probability of rejecting the null hypothesis when the null is false: ie the probability of finding an association is there is one to be found.

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24
Q

When is it easiest to detect power?

A
  • Greater mean effect
  • Smaller variation in effect
  • Sample size is larger: ONLY ONE WE CAN CHANGE
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25
Q

Reasoning for calculating power?

A
  • Ensure a study is well designed.
  • If nothing found to show there was power to detect an association.
    Estimate how small associated must be for it to be missed.
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26
Q

What is an odds ratio?

A

Probability event occurs /probability it does not.

Odds of an event for exposed individuals/ odds of an event for unexposed. (ad/bc)

27
Q

How do odds ratios form confidence intervals?

A

Exponential of long OR -/+ 1.96 root of 1/a+1/b + 1/c +1/d)

28
Q

How much of the observation will be within 3 standard deviations of the mean?
And what is the approximate difference between the highest and lowest values?

A

99.72%

6 x standard deviation

29
Q

What covariate causes the outcome AND exposure?

A

Confounders

30
Q

What covariate causes the outcome NOT the exposure?

A

Competing exposures

31
Q

What covariate is caused by the exposure that causes the outcome?

A

Mediators

32
Q

What is DAG?

A

Directed ACYCLIC Graph to summarise relationship between variable

33
Q

Why should confounders be adjusted for?

A
  • Generate relationship between exposure and outcome even though there isn’t one
34
Q

Why should competing exposures be adjusted for?

A

Adjustment can make association easier to detect

35
Q

Why are mediators left alone?

A
  • Part of causal pathway between exposure and outcome
36
Q

What types of causal relationships are there?

A
  • Functional
  • Empirical - based on previous analysis
  • Theoretical
  • Speculative
37
Q

What is a retrospective study?

A

Case control, cross sectional: looking backwards to measure exposure.
Less time & resources
Allows over sampling for rare outcomes
More susceptible to bias: recall & recruitment

38
Q

What is a proforma?

A

Method of research collection: questionnaire

39
Q

What is the purpose of general linear modelling?

A

Indicates and association between two variables (using regress on stata)
If categorical variables:
xi regress i categorical variable (logistic regression)

40
Q

What is R2 and what does it mean if it = 1?

A

Proportion of variation explained by linear model.

1 = perfect fit

41
Q

What is research that assumes objectivity and includes critical examination for bias?

A

Positivist medical research

42
Q

What checklist may be used for qualitative research on patient experience?

A

COREQ

43
Q

What is purposive sampling?

A
  • People who provide relevant rich and diverse data.

- Increased explanatory power through inclusion of deviant cases.

44
Q

What can increase trustworthiness in obtaining qualitative data?

A
  • Prolonged engagement
  • Multiple sources
  • Not foreclosing prematurely
45
Q

What can be a threat to trustworthiness in qualitative data?

A
  • Stereotyping
  • Access
  • Misreading
  • Translation
46
Q

What are the three key aspects of health economics?

A
  1. Opportunity cost
  2. Efficiency
  3. Marginal analysis
47
Q

What is described as the benefit foregone from choosing something else?

A

Opportunity cost

48
Q

What are Quality Adjusted Life Years?

A
  • Measures output of healthcare and all types of effect: value
49
Q

What is used to ensure value of outputs is greater than value of resources?

A
  • Economic evaluation
50
Q

What type of economic evaluation measured benefits as clinical outcomes, considering life years gained?

A

Cost effectiveness analysis

51
Q

What type of economic evaluation considers both quantity and quality of life?

A

Cost utility analysis

52
Q

What type of economic evaluation considers resource use and health benefits in monetary terms?

A

Cost benefit analysis

53
Q

What is is technical efficiency?

A

Meeting an objective at the least cost

54
Q

What is allocative efficiency

A

Producing supply that meets demand.

55
Q

What is marginal analysis?

A

Compares benefit of next step (marginal benefit) with cost of next step (marginal cost)

56
Q

What is ICER?

A

Incremental cost effectiveness ratio: estimated cost per additional unit of health produced by a new service

57
Q

How is threshold of opportunity cost raised?

A
  • Opportunity cost is at level of current worst treatment in QUALYs - becomes displaced by new treatment within budget = new threshold
58
Q

What is the cost effectiveness threshold?

A
  • Maximum opportunity cost consistent with improving population health by introducing a new intervention
  • NICE £20-30K per QALY gained
59
Q

What is optional appraisal?

A

Evaluation alternative methods to achieve an agreed objective.
Involves weighing up non-monetary and monetary costs of each option

60
Q

What are non-monetary costs and benefits?

A
  • QoL
  • Access
  • Health outcomes
  • Quality of care indicators
  • Patient safety
  • Patient preference
  • Adherence and compliance
  • Staff experience
61
Q

What is the declaration of Helsinki?

A

Ethical research guidelines ensuring safety, effectiveness, efficiency and quality

62
Q

What is the Social Value Requirement?

A
  • Importance of objective outweighs risks and burdens to research subject. (improve health or important new knowledge/treatment )
63
Q

How is consenting patients who are unable to consent for research approached?

A
  • Consent gained ASAP from subject or legal representative
64
Q

How should opt out/tacit consent be approached?

A
  • Inform in advance and give easy option to opt out
  • Must know if they do not opt out then they have consented
  • Must be disseminated

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