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Year 3 revision > RESS revision > Flashcards

RESS revision Flashcards

1
Q

4 steps in clinical audit cycle

A 
1 = preparation and planning
2 = measuring performance
3 = implementing change
4 = sustaining improvement (including re-audit)
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2
Q

what does a service evaluation do

A

evaluates current service/proposed practice - intention of generating info to inform local decision-making

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3
Q

research cycle 8 steps

A
  1. identifying topics
  2. commissioning
  3. designing research
  4. managing research
  5. data collection
  6. analysis and interpretation
  7. dissemination
  8. evaluation
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4
Q

is NICE non governmental

A

yes

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5
Q

who funds NICE

A

department of health

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6
Q

who appoints board and chair of NICE

A

secretary of state

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7
Q

8 of NICE’s core principles

A 
scientific rigour
inclusiveness
transparency
independence
challenge
review
support for implementation
timeliness
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8
Q

what are NICE quality standards (not the same as NICE guidelines)

A

prioritised, concise set of statements (6-8) with associated measurable indicators, chosen and adapted from clinical guideline recommendation s

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9
Q

what do NICE guideline and development groups (GDGs) do

A

review and make judgements based on evidence and make recommendations - respond to consultation comments

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10
Q

what do NICE national collaborating centres (NCCs) do

A

convene GDGs, provide technical input to facilitate GDG, draft guidlines

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11
Q

4 things making up a GDG

A

chair (clinical leader)
clinical and academic experts
patients, carers, lay members
NCC technical team

equal status

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12
Q

what happens if an exposure occurs after an outcome

A

it is a consequence of it (descendant)

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13
Q

what are covariates

A

variables that might cause either the exposure and/or outcome

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14
Q

3 types of covariates

A

confounder
mediator
competing exposure

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15
Q

what does a confounder cause

A

both outcome and exposure

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16
Q

what does a mediator cause

A

outcome, and caused by exposure

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17
Q

what does a competing exposure cause

A

outcome only

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18
Q

why do we adjust for confounders

A

create a pseudo-causal path between outcome and exposure = generates statistical relationship between them even when none exists

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19
Q

why do we NOT adjust for mediators

A

part of the causal path between outcome and exposure - risk ‘adjusting out’ this pathway

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20
Q

why MIGHT we adjust for competing exposures

A

may cause a substantial amount of the variation in the exposure

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21
Q

4 types of variable which are necessary

A

exposure
outcome
measurable/available confounders
measurable/available competing exposures

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22
Q

are mediators necessary variables

A

no

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23
Q

example of a prospective study

A

cohort - measure/record variables during the study period with the outcome subsequently measured

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24
Q

example of a retrospective study

A

case-control - record/measure outcome then look back to find exposure and covariates

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25
Q

are cross-sectional studies prospective or retrospective

A

both

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26
Q

what is a latent variable

A

missing variable

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27
Q

what is target population

A

total finite population of those we wish to apply study results and from which any study sample is drawn

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28
Q

what is study sample

A

people/contexts from WITHIN the target population selected for analysis

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29
Q

what is complete sample

A

entire study population

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30
Q

what is unstratified random/probability sample

A

every member of target population has same chance of being sampled

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31
Q

what is stratified random/probability sample

A

randomly sample from target population within strata

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32
Q

what is quota sampling

A

sample taken from stratified population until pre-assigned quota in each stratum is represented

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33
Q

is quota sampling random

A

NO

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34
Q

what is cluster sampling

A

when ‘natural’ but homogenous groupings are evident in population e.g. regions of the UK - simple random sampling used within each cluster

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35
Q

what is the odds ratio if there is NO EFFECT

A

1

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36
Q

how to use confidence interval and OR to see if effect is genuine

A

if 95% Cl round the OR does NOT include 1 = genuine

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37
Q

how to improve OR confidence interval

A

increase sample size - OR stays same but CI increases to above 1

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38
Q

what STATA command is used to build linear models/regressions

A

regress command

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39
Q

how to use STATA regress command if data is categorical

A

use same regress command but precede ‘regress’ with ‘xi’ then indicate which variables are categorical by putting ‘i’ in front of their name

e.g. xi: regress weight i.sex

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40
Q

2 types of categorical data

A

nominal (names etc)
ordinal (scale)

no numerical value

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41
Q

how to make ordinal data numerical

A

rank scale to each category - but will still be classed as categorical

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42
Q

type of analysis for continuous outcome data

A

multivariable linear regression analyses

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43
Q

type of analysis for binary outcome data

A

multivariable logistics regression analyses

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44
Q

what is model misspecification

A

incorrectly specified multivariable regression model in terms of:

  • non linear relationships
  • omitting important variables e.g. confounding bias
  • overadjustment
  • transformation of variables e.g. categorising continuous data
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45
Q

when does heterogeneity bias (group difference bias) occur

A

natural group structures in data and there are differences in the groups that are correlated with the study variable

46
Q

how many authors used before ‘et al’

A

6/7

47
Q

what is the Likert scale (example of ordinal data)

A

strongly disagree, disagree … strongly agree

48
Q

what type of data is age

A

numerical continuous - but often grouped as discrete

49
Q

what is relative frequency

A

percentage of total frequency accounted for by particular variables

50
Q

how to calculate incidence rate

A

number of new cases occurring in set time / number of people at risk in set time

51
Q

epidemiological triad

A

time
person
place

52
Q

how to calculate mortality rate

A

number of people who die from disease in period / number of people who die in period of all causes

53
Q

how to calculate case fatality

A

number of people who die from a disease in period / number of people with the disease

54
Q

how to calculate OR

A

odds for disease of exposed group / odds of disease of unexposed group

55
Q

when can ORs be used in RCTs

A

when the RCT is dichotomous

56
Q

what are dichotomous variables

A

variable takes 1 of 2 forms that are completely different e.g. dead or alive

57
Q

type of data for histograms

A

numerical continuous

58
Q

measure of distribution in non-normally distributed data

A

median and IQR (so isnt affected by outliers)

59
Q

what is standard error a measure of

A

precision - how reliable the sample population mean is from that of the population

60
Q

when is correlation the appropriate statistical analysis

A

when both the outcome and exposure are numerical

61
Q

appropriate statistical analysis for if the outcome is numerical and the exposure is categorical (independent groups)

A

T test or Mann-Whitney test

62
Q

what is an inductive hypothesis

A

hypothesis proposed after analysis - explains why two sets of info are related to one another

63
Q

what is a deductive hypothesis

A

proposed before analysis - think that at least 2 variables are related

64
Q

what does adding an asterisk to the end of a word mean when refining a search

A

truncated ending where alternative ending would be accepted

65
Q

what are boolean operators

A

to refine searches e.g. AND, OR, NOT

66
Q

what type of study is a census

A

cross-sectional - looks at entire population at defined time assessing prevalence

67
Q

what is Ansecomb’s quartet

A

4 sets of data with same statistical properties which look very different when displayed graphically

68
Q

what is responsiveness

A

whether a measure can detect real change (over time)

69
Q

what is type 1 error

A

incorrect rejection of a true NULL hypothesis (false positive for alternative)

70
Q

what is type 2 error

A

failure to reject a false null hypothesis (false negative for alternative)

71
Q

what is chi squared used for

A

determine association between categorical variables

72
Q

how is standard error calculated

A

standard deviation / square root of sample size

73
Q

what is interval sampling

A

taking samples at set intervals e.g. drugs company take a sample of every 100th drug etc

74
Q

what phase of a clinical trial assesses effectiveness and dosages of drugs on a few hundred patients WITH the disease?

A

phase II

75
Q

what is a systematic review

A

mini reports that are peer reviewed - focus on specific topic

76
Q

what is a consensus study

A

consensus statement developed by professionals via a group consensus process that is intended to advance health professional and/or public understanding of a targeted health problem

77
Q

how to calculate risk

A

risk = number of new cases / number at risk

78
Q

in what type of study do you use a risk ratio

A

cohort - used to find risk factors (exposures) of disease

79
Q

what type of study to use OR

A

case-control study or RCT

80
Q

what is relative risk reduction

A

RRR = 100-RR - i.e. the difference the new treatment makes to the condition (compared to old/untreated group)

81
Q

range of values of risk

A

0-1

82
Q

correlation coefficient used for normally distributed data

A

Pearson correlation coefficient (r) -1 to 1

83
Q

correlation coefficient used for not normally distributed data, when 1 or both of the variables are ordinal, or when the sample size is small

A

Spearman’s

84
Q

do larger or smaller studies have a larger confidence interval

A

smaller studies = large CI

85
Q

what is opportunity cost

A

value of something when a particular course of action is chosen - what you must forgo in order to get something

benefit foregone from not using the same resources in the next best activity

86
Q

when have you made the wrong choice in opportunity cost

A

if it is greater than the value of what you choose - should aim to minimise the opportunity cost of choices

87
Q

what is economic evaluation

A

comparison of 2+ alternative courses of action in terms of their costs and their outcomes

88
Q

2 types of efficiency

A

technical efficiency

allocative efficiency

89
Q

what is technical efficiency

A

meeting a given objective at least cost

90
Q

what is allocative efficiency

A

producing the output (supply) that matches consumer want (demand) - is an activity worthwhile?

91
Q

2 things marginal analysis involves

A

comparing:
- the benefit from that next step (Marginal Benefit) with
- the cost of taking the next step (Marginal Cost)

NOT interested in average cost and benefit

92
Q

type of cost analysis when we want to compare alternatives WITHIN a condition

A

cost effectiveness analysis - benefits measured in terms of standard clinical outcome e.g. change in blood pressure

93
Q

3 types of cost analysis when we want to compare ACROSS conditions

A
  • cost effectiveness analysis (also considers life years gained)
  • cost utility analysis (considers both quality and quantity of life)
  • cost benefit analysis (considers resource use and health benefits in monetary terms)
94
Q

what is the Incremental Cost Effectiveness Ratio (ICER)

A

expected cost per additional unit of health produced by a new intervention compared to current practice

95
Q

what is the cost effectiveness threshold

A

maximum amount the health service will pay per unit of health gained - represents maximum opportunity cost consistent with improving population by introducing a new intervention

96
Q

NICE threshold for cost effectiveness per QALY gained

A

£20-30k

97
Q

what is option appraisal

A

process for identifying, describing and evaluating alternative methods (options) of achieving an agreed objective

98
Q

hierarchy of evidence top to bottom

A 
meta-analysis
systematic review
critically appraised topic
RCTs
cohort studies
case-controlled studies/case series/reports
background info/expert opinion
99
Q

what is a case control study

A

select participants on basis of their outcome and works back to exposure = cheap, bias

100
Q

what is a cohort study

A

longitudinal study following group of people over time, selects participants before the outcome but no control over exposure

101
Q

what does a service evaluation do

A

evaluates a current service/proposed practice

102
Q

difference between audit and service evaluation

A

audit = does it reach a standard (practice against target)

service evaluation = what standard does/might this achieve (current practice)

103
Q

what does an audit-cum-service evaluation examine

A

whether variation in practice may cause variation in compliance - variation in compliance may cause variation in benefit?

104
Q

what is response bias

A

what interview wants/gets

105
Q

what is prestige bias

A

what appears favourable

106
Q

what is over adjustment bias

A

controlling for an intermediate variable or mediator in multivariable regression analysis

107
Q

what is multicollinearity

A

when there are strong associations or correlations among covariates in a multivariable regression model

108
Q

what is pharmacodynamics

A

what the drug does to the body

109
Q

what is pharmacokinetics

A

what the body does to the drug

110
Q

what does ADME stand for

A

absorption
distribution
metabolism
elimination

for pharmacokinetics

Year 3 revision (9 decks)

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