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174 Cards in this Set
- Front
- Back
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What would be insufficient grounds for clinical decision making?
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Intuition, unsystematic clinical experience, pathophysiologic rational.
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What is Chiropractic EBP?
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ACTIVELY seeking support for improvement of chiropractic clinical practice through intergration of the best available research evidence, COMBINED with clinical expertise and patient values.
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Clinical uncertainty generates what?
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Anxiety that promotes default to authority.
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What is NIHILISM?
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Latin for nothing, a thing of no value. 1. total rejection of established practice or laws. 2. Extreme skepticism in regard to rule statements.
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Is EBP a cookbook method?
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No it is integration of best evidence with past training and expertise of the clinician.
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Evidence is added to patient care to do what?
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To supplant (take the place of) outdated information.
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What are the 3 parts to clinical decision making?
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1. Evidence. 2. Constraints. 3. Patient/physical factors.
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What is the biggest part of consraints with clinical decision making?
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Time.
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What are the 4 parts of evidence with clinical decision making?
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1. Patient data. 2. Basic, clinical, and epidemiological research. 3. Randomized Trials. 4. Systematic reviews.
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What type of research uses secondary research?
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Systematic reviews.
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What is the benefit of systematic reviews?
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Faster access to answers.
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What are the top 3 in order types of primary source evidence?
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1. RCT. 2. Cohort. 3. Case-control studies.
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What is evidence?
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Any empirical observation about apparent relation between events.
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What are 2 types of evidence?
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1. associated/ correlated events. 2. Causally related events.
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What should be look for when addressing a patients problem?
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The highest available evidence from the hierarchy.
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What type of studies look for association / correlated events?
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Observational like prospective cohort or retrospective case-control studies.
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What type of studies look for causally related events?
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RCT that test Hills postulates of causality.
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What are the 4 types of clinical questions?
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1. Therapy. 2. Harm. 3. Diagnosis. 4. Prognosis.
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What type of studies help to answer a diagnosis question?
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Cross-sectional.
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What type of studies help to answer a harm question?
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Cohort study.
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What type of studies help to answer a prognosis question?
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Cohort study.
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What type of studies help to answer a therapy question?
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RCT.
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What is the difference between systematic and random errors?
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Systematic errors are bias and random errors are due to chance.
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Why do we appraise literature?
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To see if they have no flaws, flaws, or if they have fatal flaws.
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Most research will or will not have flaws?
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Most will have flaws, but will still be clinically significant.
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What type of studies will have the leaset amount of systematic and random errors?
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RCT> cohort > case-control.
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What is the way to help prevent problematic form of systemic error?
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Peer-review.
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What is author/ reviewer filter bias?
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The explicit (conscious) and or implicit (unconscious) filtering of information to fit a previously generated explanation.
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How can you identify if a journal is a scientific peer-review journal?
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It will ALWAYS have a page that lists: 1. Editor in chief. 2. Editorial board. 3. manuscrip requirements page.
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What is the purpose of a blind peer-reviewed journal?
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Increase scientific quality, and decrease irrelevant bias in a paper.
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What are the goals of a peer-reviewed journal?
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Stamp of quality (getting rid of the bad). To assist submitting authors in the critical appraisal.
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What is another way for people to evaluate articals after they have been published?
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Letters to the editor.
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All the activities of a blind peer-reviewed journal are designed to be what?
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Self-critical.
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What is an epidemiologic study?
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Group comparisons. (experimental group and a control group). Scientific research of disease.
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Epidemilogic studys allow for what?
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Assessment of time dependent features holding other features constant. Uniform evaluation and uniform measurment.
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What is the weakness of an epidemilogic study?
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Systemiatic errors of biases depending on the research design. They may not be clinically applicable to your patients.
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name the 4 design types of epidemiologic studys and what they are good at doing?
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cross-sectional, case-control, cohort, RCT. They are all good at statistical estimate of Chance (or random errors).
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Which one of the 4 types of epidemilogic studies are good and bad at contolling for Bias aka systematic errors?
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RCT- good, Cohorts are modest, but case-controls and cross sectional are weak.
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Of the 4 epidemiologic studies which ones have the most ethical limitations?
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RCT> cohort. Case-control and cross-sectional have very minimal ethical limitations.
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Of the 4 epidemiologic studies which ones generate the best causality evidence?
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RCT> Cohort. Case-control and cross-sectional show minimal evidence of causality they show that there may be an association.
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In an epidemioloci study what is an Independent variable?
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Exposure to something.
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What type of study is retrospective?
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Case-control.
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What is the dependent variable in an epidemologic study?
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Measured clinical bench mark.
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Name Hills 5 postulates of causality?
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1. Temporality (cause before effect). 2. Repeatability. 3. Biological gradient (The bigger the dose the bigger the effect, the smaller the dose the smaller the effect). 4. Reversibility. 5. Plausablitiy (make biological sense).
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What is nomenal data?
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A yes or no. You have or do not have. Mutually exclusive conceptual catagories.
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What is ordinal data?
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Scale, grading, ordering. Mutually exclusive categories. Things are ranked in order.
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What is interval-ratio data?
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Common scale catagorical data.
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What is conceptual transformation?
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A way of conceptualizing the data.
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What are 3 measures of central tendency?
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Mean, median, mode.
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Define mean, median and mode?
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Mean- the average. Median- the 50th percentile. Mode- the most frequent occuring value.
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An outlier in data will pull what away from the center of the data?
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It will pull the mean away from the center of the data.
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What value is the highest bar in a histogram?
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The mode.
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When is the mean best?
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When the data is not skewed.
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When is the median best?
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For skewed data.
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When is the mode the best?
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For knowing the most frequent result.
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Histogram looks like a bar chart made from the study data and is based on what?
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Frequencies of data.
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With a box plot the line in the middle of the box is what? What is the line at the bottom and the top?
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Middle- Median or 50th percentile. Bottom is the lower quartile or the 25th percentile. Top- upper quartile or the 75th percentile.
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What are the wichers of the box plot for?
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They are the range that data will be used anything outside of them will be considered outliers.
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How is variance found?
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Standard deviation squared.
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What is range and what is interquartile range?
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Range- 0-100 percentile. Interquartile range is 25th- 75th percentile.
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What is needed for a Z score.
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Bell curve and standard deviation.
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What is variability besides SD squared?
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How spread out the data is. Or the average squared distanve from the mean in a set of data.
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What is Standard Deviation.
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A measure of variability in the data or how spread out they are.
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Confidence interval gets _____ as the population gets larger?
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Smaller.
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Standard deviation ________ as the population gets larger?
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Stays the same.
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What will the neighborhood of the truth be?
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Confindence interval.
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What is the standard error of the mean?
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How percise the mean is. The anticipated spread of sample means.
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Standard error is higher when?
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The samples Standard Deviation is larger or the sample size is small.
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Standard error is low when?
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Standard deviation is low or the sample size is large.
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What type of Standard error is perferable and why?
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Small because more precision is desirable.
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With a bell curve the area under a normal curve has what?
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Normal distribution.
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What is a normal distribution?
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Symmetric about its mean. Highest point is the mean. Height of curve decreases as one moves away from the mean in either direction.
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What % of people will be within 1, 2, 3 standard deviations in a normal bell shaped curve?
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1- 68.3%. 2- 95.5%. 3.- 99.7%.
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What is a Z-score?
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The number of Standard deviations that a specific score is above or below the mean of a normal curve.
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Z-scores are used to calculate what?
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Confidence intervals.
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What z-score will give us a 95% confidence interval?
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z=1.96.
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The size (width) of a confidence interval is related to what?
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the size of the sample and the size of the data variation.
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What will give a large and a small confidence interval?
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Large CI- small samples and large variation. Small CI- large sample and small variation.
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How will clinicians interpret the Confidence interval?
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It is based on opinion. If the CI falls completely within a defined benefit or defined harm then the decision is easy, but if the CI falls between no treatment and Harm or benefit then it is opinon that will decided.
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What will a P-value of .05 mean?
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The edge of the 95% CI touches the null line.
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What will a P-value greater than 0.5 mean?
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The edge of the 95% CI crosses the null line.
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What will a P-value less than 0.5 mean?
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The edge of the 95% CI does not cross nor touch the null line.
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What will it mean if the value specified as the difference between groups in the null hypothesis is inculded in the 95% CI?
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Then the test is not statistically significant.
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The null Hypothesis (Ho) states what?
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There is no difference between groups.
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What is the p-value that shows no difference between group means?
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Zero.
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What is the p-value will the null hypothesis be for odds ratios, Risk ratios, and hazard ratios?
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one.
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What will it mean if the Ho or null hypothesis is not included in the 95% Confidence interval of a point estimate of an observed difference between groups?
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The test is statistically significant.
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What is done with a null hypothesis?
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We either reject or fail to reject the null hypothesis.
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What is the goal of research?
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TO reject the null hypothesis.
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What is the alternative hypothesis?
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The reason to conduct the research at hand, but it is not tested directly.
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When will P-values be calculated?
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After the study.
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The P-value is the probability of what?
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False positive study result.
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The P-value must be _______in order to reach a level of statistical significance.
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equal or less than 5%.
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What is a type I error?
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Incorrectly rejecting the null hypothesis. (we say there is a difference and there is no difference).
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What is the type I error or alpha error usually at? When it the alpha level set?
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It is usually 0.05 and should be set before the study.
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What is the accepted risk with a 0.05 alpha or type I error?
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There is a 5% chance of false-positive results.
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What is Fishing?
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Researchers perform lots of tests trying to get atleaste 1 statistically significant study since there is always a chance of a false-positive.
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What is Power?
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Correctly rejecting the null hypothesis.
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Power depends on what?
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The sample size, assumed difference between groups, the acceptable risk of reporting false-positives.
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if a 95% CI is too wide then what will this mean for the power?
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Not enough power.
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A power value of what is considered adequate?
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.80 is adequate.
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if a 95% CI is sufficiently narrow then what will this mean for the power?
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There was enough.
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What is a type II error aka beta error?
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Failure to reject the null hypothesis. (there is a difference between groups and you say there is no difference).
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Type II errors or beta errors are the risk of what?
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false-negativity in a study.
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Power + type II error = _____.
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100%.
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What happens to type I errors when type II error increase?
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Type I would decrease.
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What happens to Type II errors when type I errors increse?
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Type II errors would decrease.
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The alpha 0.05 level is a compromise between what?
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Type I and Type II errors.
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Which is worse type I or Type II errors?
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Type I because it could lead to innecessary procedures for patients so we limit Type I errors to 5% and type II errors to 20%.
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What happens with alpha with one sided and two sided tests?
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One sided- alpha is doubled. Two sided- alpha is split between the two-directions.
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When are parametric tests chosen?
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When the data is in a bel-shaped curve.
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What are 3 types of parametric tests?
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1. T-test. 2. ANOVA. 3. Regression.
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When are non-parametric tests done?
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Data is not normally distributed (bell shaped Curve). Harder to interpret.
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What are 2 catagories of non-parametric tests?
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rank tests, and categorical tests.
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What are 2 types of rank tests?
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Wilcoxon, mann-whitney U test.
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What are 2 types of categorical tests?
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Chi-squared, fisher's exact test.
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Students T-tests are used to for what?
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Comparison of means of 2 groups.
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What is a paired T-test?
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Groups are dependent the same subjects are in each group or subjects are matched.
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What will a paired T-test tell us?
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If there is a statistically significant change (per subject).
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Rank tests are used for what?
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Comparison of 2 groups that do not follow a bell-shaped curve.
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Rank tests are useful for what?
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Ordinal or heavily skewed data.
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What is reported when a rank test is used?
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Medians.
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The mann-Whitney U test is approptiate for what type of data?
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Skewed unpaired data.
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Chi-squared tests are used to interpret what type of data?
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Comparison of categorical unpaired data.
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Chi-squared tests what?
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Whether observed frequencies are different from the expected frequencies in a data table.
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With Chi-squared tests what must happen?
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Observation must be independent and no small expected frequencies (no counts of less than 5).
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What test should be done instead of a CHI-squared with counts of less than 5?
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Fisher's exact test.
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How much data is needed to use a fisher's exact test?
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At leaste one data value in each row and one data value in each column.
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Fishers exact tests are not recommended for what sample sizes?
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1,000 or more.
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Is a fishers exact test done on paired or unpaired data?
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Unpaired.
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What is ANOVA?
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Analysis of variance.
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ANOVA is used to explain what?
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Variance in the data.
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ANOVA is useful for what?
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Comparison of means when more than 2 groups are involved.
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ANOVA determines what?
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Whether or not one of the groups is significantly different from the others.
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Can an ANOVA test tell you which group is signigicantly different from other groups?
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No.
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What test is done to determine which on of the groups (more than 2) is significantly different after an ANOVA test tells you that there is one?
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ANOVA post-hoc.
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What is ANCOVA?
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Analysis of Covariance.
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ANCOVA is used to explaine what?
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Variance in the data.
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ANCOVA besides explaining the difference between groups it can do what?
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Adjust for differences like age, sex, smoking.
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What are covariants?
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The differences like age, sex, smoking, etc.
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Interpretation of the F-test for the ANCOVA model is like what?
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Similar to the ANOVA model.
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What can be seen on a scatter plot?
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Form, direction and strength of the relationship between variables.
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What would curvilinear scatter plot look like?
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Kind of like a bell curve.
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A strong relationship between 2 variables does not mean what?
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That one caused the other to change.
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What is correlation?
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A measure of association that may exist between 2 or more variables.
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What coefficient is used for correlation?
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r
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What are the ranges of correlation r values? What do they mean?
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negative 1 to positive 1. negative 1= a perfect negative correlation. Positive 1 equals a perfect positive correlation.
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What will a linear regression do?
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Explains the differences in means, and predictions can be made about the direction and amount variables change.
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Why are multiple linear regressions done?
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To explain the differences in means when outcomes are affected by more than one predictor variable like age, sex, smoking (covariates).
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What is logistic regression for?
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Allows for comparison of differences in odds between groups. Frequently used in medical literature.
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What are the reported results for logistic regression?
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odds ratio which is a slight over estimate of the relative risk.
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What are multiple logistic regressions for?
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Used to explaine the differences in odds ratios between groups with covariants.
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What is the use of proportional hazards regression?
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Allows for comparison of differences in time-to-event between groups.
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What is the reported result for proportional hazards regressions?
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Hazard ratios.
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What will a negative and a positive sensitivity mean?
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Negative- probably don’t have disease. Positive- more tests are needed.
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What will a positive specificity mean?
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They probably have the disease.
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What is NNH/NNT?
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The number of people who need to be exposed before one person experiences harm/benefit.
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What is incidence?
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The number of diseased people newly diagnosed during a specific period.
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What is prevalence?
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The number of people who are currently diagnosed with the disease in the population.
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What is relative risk?
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A way to assess the influence of treatment/prevention strategies or potential hazards upon the prevalence of a given condition in a given population.
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How are RR (relative risk) interpretated?
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If the RR is different from 1 it is considered a risk factor. Greater than 1 makes it a positive association. Less than 1 makes it a negative association.
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What is absolute risk?
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Represents the excess risk due to exposure to the factor under investigation.
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Numbers needed to harm (NNH) is what?
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The number of patients who would need to be treated in order for one bad outcome to occur.
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What is a great way to study rare diseases?
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Case-control.
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Name a disadvantage of a case-control study?
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Does not permit calculation of true disease rates in the population.
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Since case-control studies wont allow us to calculate the true disease rates in a population how are they estimated?
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Odds ratios and relative risk.
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What would a statistically significant confidence interval be for an ODDS ratio or Relative risk?
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The CI will not include the null which is 1.
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What is harder to determine the OR or RR?
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RR so OR will often approximate the RR.
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What is the Kaplan-meier curve?
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Shows time-to-event on a graph. Measures how many people have survived over time.
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What is a hazard ratio?
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Relative risk over time.
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When will absolute risks be used?
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Mainly in RCT's.
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What is an absolute risk?
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The difference in the probability of disease between the treatment and control groups.
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What is NNT (numbers needed to treat)?
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The number of patients who would need to be treated in order to prevent one additional bad outcome.
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What would a NNT of 3.6 mean?
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3.6 patients would need to be treated for one to get appreciable benefit from treatment.
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