RESS

Question 1

A research Study

Answer 1

Generate new knowledge when none is available

Question 2

Audit

Answer 2

Quality improvement process to improve patient care

Question 3

2 aims of an audit

Answer 3

1) Aspects of structure, process and outcomes are selected and evaluated
2) Is what ought to be happening actually happening

Question 4

Service evaluation

Answer 4

Evaluates a current service/practice to inform local decision making

Question 5

Difference between an audit and a service evaluation

Answer 5

Audit = designed to answer certain questions (Does this service reach a certain standard?) - Only interested in the proportion of patients who receive the care recommended (Outcome)
Service evaluation = What standard does this service achieve - Interested in variation in the characteristics of healthcare delivery (Exposure)

Question 6

What is the Commision for Patient and Public Involvement in Health (CPPIG)?

Answer 6

An organisation set up to make sure the public is involved in decision making about health and services - over 400

Question 7

What can/does a CPPIG do?

Answer 7

Have statutory powers to ensure they are listened to
Provided with training and development opportunities
Obtain views of the community
Influence design and access to NHS services

Question 8

What is the engagement cycle?

Answer 8

A strategic tool to help identify who needs what in order to engage communities at each stage of commisioning

Question 9

What are the burdens and risks of a study?

Answer 9

Anything that may harm the patient
The discussion of unsettling issues
Physical or mental discomfort,
Disclosure or loss of personal information

Question 10

3 situations when ethical approval + consent may not be required

Answer 10

1) Changes in practice are routine and not part of the study’s design and either;
2) All the data used have been collected during/ as an established part of routine practice
3) The collection of any additional data used do not impose excessive burdens or risks on participants

Question 11

4 Ethical responsibilities in the design and conduct of a study

Answer 11

1) Well designed and with potential benefits that justify the risks, burdens and resources involved
2) Seek to minimise the burden and risk
3) Ensure participants provide informed consent
4) Wary of expected and unanticipated burdens/risks during the study

Question 12

What do NICE do?

Answer 12

Independent organisation responsible for providing national guidance and advice to improve health and social care

Question 13

3 roles of NICE

Answer 13

1) Reduce variation in availability and quality of treatment
2) Help resolve uncertainty about which medicines and treatments work best and which represent best value for money
3) Set national standards on how people with certain conditions should be treated

Question 14

Define a Guideline

Answer 14

A comprehensive set of recommendations for a particular disease or condition

Question 15

Define a Quality Standard

Answer 15

A prioritised, concise set of statements with associated measurable indicators, chosen and adapted from the clinical guideline recommendations.

Question 16

What do National Collaborating Centres (NCC’s) do?

Answer 16

Provide technical input and draft the guideline

Question 17

What do Guideline development groups (CDG’s) do?

Answer 17

Review evidence base and make recommendations

Question 18

Who is involved in a CDG?

Answer 18

Chair - highly experienced and respected clinical leader
Clinical and academic experts
Patients and lay members
NCC technical team

Question 19

4 checks when choosing outcomes and exposures

Answer 19

1) Exposure must precede outcome
2) Exposure must be different to the outcome
3) Both must be something specific
4) Must be formatted as binary variables - A + B

Question 20

Define a Confounder

Answer 20

Can cause the outcome and the exposure
Must adjust for them as can create a pseudo-causal path which will generate a statistical relationship between the 2 events when non-exists

Question 21

Define a Mediator

Answer 21

Can cause the outcome and be caused by the exposure

Don’t need to adjust for them as not part of the causal pathway and they are an important pathway

Question 22

Define a competing exposure

Answer 22

Can only cause the outcome
Might adjust for these if they cause a substantial amount of variation in the exposure as it may make the association easier to detect

Question 23

3 criteria for a causal relationship

Answer 23

1) Only possible if the variable precedes the effect
2) Variables must be temporally distributed (Past to present)
3) Should only be ommited when there is very firm evidence that no causal relationship exists

Question 24

What does a Directed Acyclic Graph do?

Answer 24

1) Summarises the theoretical and speculative causal relationships between variables pertinent to our question
2) Identifies any measurable covariates acting as cofounders, competing exposures and mediators

Question 25

3 Pros of a Prospective study

Answer 25

1) Fewer sources of bias
2) Less chance of unmeasured confounding variable
3) Some variable can only be measured prospectively

Question 26

4 Cons of a Prospective study

Answer 26

1) Time and resource intensive
2) Tendency to collect data on more variables than you need or can use in your analysis
3) Participants can drop out during the study - bias
4) Usually infeasible for rare outcome

Question 27

2 Pros of a Retrospective study

Answer 27

1) Data collection is less time and resource intensive

2) Allows oversampling for rare outcome

Question 28

3 Cons of a Retrospective study

Answer 28

1) More susceptible to bias
2) Some variables cannot be measured directly
3) If data is from records, little control over how they have been measured

Question 29

Prospective or Retrospective?
Case Control
Cohort
Cross-sectional

Answer 29

Retrospective
Prospective
Mixture

Question 30

Define

1) Defining variables conceptually
2) Defining variables operationally

Answer 30

1) Establishing what they should mean

2) Establishing what they actually mean

Question 31

What does a data collection pro-forma do?

Answer 31

Ensures that project researchers measure/record the variable consistently, accurately and with minimal missingness

Question 32

What should a questionnaire be?

Answer 32

Series of clearly written questions that are unambiguous, definitive and instructive

Question 33

Preparing data for analysis - What is in the rows and collumns

Answer 33

Rows = Cases/Participants
Columns = Variables

Question 34

Define the target population

Answer 34

The total, finite population of people/context

Question 35

Define the study sample

Answer 35

The people/contexts from within the target population for which data is collected

Question 36

What is a complete sample - give pro and con

Answer 36

The entire study population
Pro - No bias
Con - Resource intense/expensive

Question 37

What is an unstratified/random sample - give pro and con

Answer 37

Every member of the target population have the same chance of being sampled
Pro - Easy to design and conduct
Con - Small groups may be misrepresented by chance

Question 38

What is a stratified random/probability sample - give pro and con

Answer 38

Random sample from the target pop within each stata - every member within each strata has the same chance of being sampled and the number of each stratum can be oversampled to strengthen analysis
Pro - Representative and improved power for rare strata
Con - Population may not be be easily divisible into strata

Question 39

Define the Odds Ratio

Answer 39

Represents the odds that an outcome will occur given a particular exposure, compared to the odds that the outcome will occur in the absence of that exposure

Question 40

Define the confidence interaval

Answer 40

A range of values so defined that there is a specified probability that the parameter lies within it.

Question 41

What does a 95% CI give us?

Answer 41

2 values between which the true value lies 95% of the time

Question 42

What does it mean if the CI round an odds ratio does not include 1?

Answer 42

We are confident the effect is genuine

Question 43

How to calculate an Odds Ratio

Answer 43

Look at notes