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126 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
3 Sources of evidence that inform EBP
Patients unique values and circumstances
Best research evidence
Clinical expertise
What is the PECO approach to formatting clinical questions
C: comparison
O: outcomes
What is the highest level of evidence according to the evidence pyramid? Level 1a and b
Systematic reviews
Randomized clinical trials
What is the lowest level of evidence according to the evidence pyramid?
Level 5
Narrative reviews, expert opinion and textbooks
Level 2b on the evidence pyramid
Cohort studies
Level 3b on evidence pyramid
Case control studies
Level 4 on evidence pyramid
Case series
Case studies
5 steps of EBP
1 ask a focusedclinical question
2 search for the best research evidence
3 appraise quality of research evidence
4integrate research evidence with information about pt
5 reflect on process to improve the future
2 essential components of a background question
Question root (who, what, why....)
2 types of clinical questions
3 essential components of foreground questions
Patient and or problem
Exposure ( intervention)/ comparison intervention
Clinical outcomes
Source of knowledge described?
Something is thought to be true simply because people have always known it to be true
Source of knowledge described?
Information based on specialized training or experience
Source of knowledge described?
Try something if it seems to work satisfactorily keep doing it
Trial and error
Source of knowledge described?
Combines personal experience, intellectual faculties and formal systems of thought
Logical reasoning
Sources of information described?
Systematic, empirical, controlled and critical examination of hypothetical propositions about associations among natural phenomena
The scientific method (research)
T/F among peer reviewed journals there is no consistent process/ level of rigor by which the articles are evaluated
Hierarchy of study types (7)
1. Evidence based clinical guidelines
2. Systematic review and meta analysis of RCTs
4. Non randomized intervention studies
5. Observational studies
6. Qualitative studies
7. Case series, case reports
Literature reviews focused on a single question that try to identify appraise, select and synthesize all high quality research relevant to that question
Systematic review
Statistical analyses of a large collection of results from individual studies for the purpose of integrating the findings
Meta analysis
Experimental studies of cause and effect relationships between treatments and outcomes
Randomized controlled / clinical trials
Observational studies in which a defined group of people is followed over time. Aka longitudinal study
Cohort studies
Observational research where no Intervention is provided rather people who have the condition of interest are compared to people who do not
Case control studies
Descriptive research. A group/ series of case reports involving patients who were given similar treatment
Case series
Type of research or evidence that:
Describe practice. Can focus on patients or facilities. Can't prove effectiveness or test hypotheses or prove cause and effect
Case studies/ reports
Clinical guidelines are considered obsolete after how many years?
Cochrane collaboration policy states that systematic reviews should be updated how often?
Every 2 years
Level of data measurement?
Qualitative/categorical level of data with no mathematical interpretation
Nominal measures
Level of data measurement?
You specify only the order of the cases in greater than and less than e.g. Patient satisfaction
Ordinal measures
Level of data measurement?
Numbers represent fixed measurement units but have no absolute zero point e.g, temperature
Interval measures
Level of data measurement?
Fixed measuring units with an absolute zero. Numbers can be added, subtracted etc e.g. Goniometric measure of ROM
Ratio measures
Reliability is not a property of an experiment/ study
True. It's a property of a measurement instrument
Extent to which a measure produces the same result under different conditions ( consistency)
Extent to which a measure indicates what it is supposed to measure
Type of validity?
The methods used on the study are correct and the results are accurate
Internal validity
Type of validity?
The findings are applicable beyond that particular study
External validity
Type of validity?
Measure looks like its going to measure what it's supposed to measure
Face validity
Type of validity?
Measure covers full range of concepts meaning
Content validity
Type of validity?
Scores obtained with one measure can be accurately compared with scores obtained with another measure that's more established
Criterion validity
Type of validity?
Measure fits well with other measures of similar theoretical concept
Construct validity
Measure of central tendency that can be used with any type of data
Measure of central tendency that can be used with interval, ratio and sometimes ordinal data
Type of data that cannot be assessed with mean or median
Which measures of central tendency are unaffected by extreme score?
Median and mode
Mean is the preffered measure of central tendency except?
Extreme scores or skewed distributions
Non interval data
Discrete variables
Measure of spread and variability
Range and deviation
A number that measures how far away each number in a set of data is from the mean
Standard deviation
Approximate standard deviations within 1,2,3 standard deviations of the mean for any data set?
1: 68%
2: 95%
3: 99.7%
Parameters are?
Mathematical characteristics of populations
Mathematical characteristics of samples
What is the EPSEM method of sampling?
Equal Probability Of Selection Method
For any trait or variable as the sample grows larger the means will will be normally distributed. This describes?
Central limit theorem
What is the implication if p value<a (alpha)?
Reject null hypothesis
Report p value
Estimated effect
Precision of estimate
What is the implication if p value > a?
Fail to reject null hypothesis
Report p value
Power of your study
How big an effect you may have missed
A null hypothesis states
There will be no effect on the dependent variable due to independent variable and any observed effect is due to chance unless proven otherwise
Purpose of inferential statistics?
Test whether results achieve statistical significance, eliminating chance and sampling error as cause of change of dependent variable
You could be making a mistake whether you reject or fail to reject the null hypothesis. True or false
When you reject the null hypothesis concluding there is a diffence between groups when in fact there is none
Type 1 error
When you fail to reject the null hypothesis concluding there is no difference between groups when in fact there is
Type 2 error
In research when we say there is a real difference between 2 groups when it was just a chance what kind of error have we made?
Type 1
When we use our data to calculate the probability that our finding is just due to chance under the null hypothesis, we calculate the?
P value
What is the alpha value?
Level of significance
How small the p value can be for the null hypothesis to be rejected
How much I am willing to make a type 1 error
A p value larger than the alpha value indicates?
Our finding is largely due to chance
We should fail to reject null hypothesis otherwise we will make a type 1 error
A p value smaller than the alpha value indicates?
We can reject null hypothesis concluding there is a real difference between research groups
Probability of rejecting the null hypothesis when the alternative hypothesis is true ie not making a type 2 error
Difference between high power and low power?
The commonly accepted power is?
High power means decreased likelihood of type 2 error
Low power increased likelihood of type 2 error
0.80 or higher
Factors affecting power (4)
1 sample size: larger sample, greater power
2. Large or small difference in means ( what you are looking for)
3. Variation within the groups you are studying
4. Alpha level if it's really low e.g. 0.01 it's harder to reject so power goes down
Statement that population parameter will meet some test of difference for some specified probability / significance level for any sample
Hypothesis test
Statement that population parameter will fall within interval some specified probability / confidence level for any sample
Confidence interval
Hypothesis tests are more informative than confidence levels
True or False
CI levels are more informative since they provide a range of plausible values for unknown parameters
If alpha level is .05 confidence interval is?
Samples that have no effect on each other are known as
Independent samples
Samples which are matched pairs and one group is tested more than once are known as
Dependent samples
Which type of statistical test is appropriate for
2 independent samples
2 dependent samples
>2 independent samples
> 2 dependent samples
2 independent samples: Unpaired T test
2 Dependent samples: Paired T test
>2 Independent samples: ANOVA
>2 Dependent samples: Repeated measures ANOVA
Type of hypotheses where the researcher specifies which of the group means he expects to be greater than the other
Directional hypothesis
Type of hypothesis stating the group means will differ but not stating which ones will differ?
Non directional hypothesis
Which type of hypothesis uses a one tailed test/ analysis
Directional hypothesis
Which type of hypothesis uses a 2 tailed test / analysis?
Non directional hypothesis
How would an alpha level of .05 be interpreted in a one tailed vs a two tailed analysis?
One tailed it would simply stand as is
2 tailed : overall probability would be split so each tail will have an alpha level of .025
For an alpha level of .05 it is easier to reject the null with a 1 tailed test compared to a 2 tailed test? True or false
True. With a 1 tailed the .05 is in one direction but in a 2 tailed the probability has to reach .025 at one of the ends for the data to be statistically significant
If a researcher specified a directional hypothesis and uses a 1 tailed test but the direction turns out to be opposite than he expected what happens to null hypothesis?
Fail to reject the null hypothesis
What measure fits this description:
Examines relationships between variables with co efficients -1 to 0 to +1 quantifying strength and direction of association
Quantities for a medium correlation and
High correlation
Medium correlation: 0.30-0.45
Strong correlation: 0.50 - 1.00
Type of correlation?
Direct association between 2 variables (as one becomes large the other one becomes large)
Positive correlation
Type of correlation
As the value of one variable increases the other decreases
Negative correlation
What 3 assumptions must data fit to be analyzed using parametric statistics?
Must have a normal distribution therefore sample must be chosen randomly
Variances must be roughly equal
Data are interval or ratio scale ( can be manipulated mathematically)
Parametric or non parametric?

Test that can be done without an assumption of normality
Non parametric
Parametric or non parametric ?
Deals with mean rather than median
Parametric or non parametric ?
Deals with median rather than mean
Non parametric
Category of research that identifies cause and effect between variables and comprises of: RCTs, non RCTs, single subject designs
Experimental research
Best control for bias is ?
3 ways to randomize for a study
1. Random selection of a sample
2. Random assignment of sample to groups
3. Random assignment of groups to treatment and control conditions
What category of research do these fall in: developmental, normative, qualitative, evaluation research ?
Descriptive research
Which category of research identifies relationships between variables usually using correlation statistics e.g. Cohort and case control studies, methodological studies
Exploratory research
Category of research that rigorously integrates findings from more than one study on the same topic e.g. Meta analysis, evidence based clinical guidelines, systematic reviews
Integrative research
3 explanations for an observed effect in RCTs
Tx had an effect
Chance variation between 2 groups
Sources of potential bias
Natural history of a disease
Placebo effect
Drop outs ( intention to treat analysis)
Efficacy vs effectiveness
Whether an intervention works under ideal circumstances vs in the real world
Systematic or random error?
Captured in the validity of the inference rather than its precision
Systematic error
Systematic or random error?
Causes distortion of truth in a predictable direction
Systematic error or bias
Systematic or random error?
Occurs because one cannot study everyone, obscures real difference and is reduced with larger sample sizes
Random error or chance
Quantitative or qualitative research?
Explicitly acknowledges bias instead of attempting to eliminate it
Qualitative research
Selection bias is?
Bias resulting from a problem in selection of subjects or in the process that determines which subjects drop out of the study
Sources of selection bias
Inappropriate population studied
Inadequate participation
Selection of most accessible subjects or of volunteers
what is prospective subject recruitment?
Selecting subjects as they come along and present themselves to researchers
Retrospective subject recruitment is?
Potential subjects are identified and contacted by the researchers to participate in the study and may involve review of pts charts to collect data
* can also occur such that actual patients are not seen but their information is compared to test hypothesis
Identify common types of sample selection
Consecutive sample
Selective sample
Convenience sample
Consecutive: subjects chosen on a first come first serve basis
Selective: sampling that screens out certain characteristics
Convenience: selected at the convenience of researcher
True or false?
Reducing number of observers increases the bias
False. Having the same observer gives greater reliability than having 2 or more
Placebo effect
Measurable, observable or felt improvement in health not attributable to actual treatment
Why does blinding increase internal validity?
Decreases placebo effectl
What is NNT?
Number needed to treat for one person to benefit associated with confidence interval levels and where CI levels overlap there is no difference between groups
Relative risk is?
Probability of developing a disease ( or other event) relative to exposure
RR =1 no difference in risk between 2 groups
RR <1 less likely in experimental than control (.8 or 80%)
RR>1 more likely in experimental than in control (1.25 or 125%)
Odds ratio?
Ratio of the odds of an event occurring in one group to the odds of it occurring in another
= 1 event equally likely in both groups (1:1)
>1 more likely in first group (2:1)
<1 less likely in first group (.5:1)
Which is recommended as an accurate measure when the disease in consideration is more common,Relative risk or odds ratio?
Relative risk because odds ratio can overestimate and magnify risk
What level on the evidence pyramid do literature reviews fall under and why?
Level 5, grade D (expert opinion)
Because the possibility of bias is large since researchers can pick whichever articles they want
The statistical analysis of a a large collection of results from individual studies for the purpose of integrating the findings
Meta analyses
Which one is more comprehensive and transparent?
Traditional peer reviewed literature review OR textbook summary of literature
Traditional peer reviewed literature review
Which has more potential for bias?
Course review paper OR clinical expert opinion
Clinical expert opinion
What is the main outcome of a meta analysis?
Overall magnitude of the effect
Why are meta analysis subject to publication bias?
They reflect only what is published and statistically significant effects are more likely to be published hence biased toward Positive outcomes
What is the cohens d measure?
A generic dimensionless measure for standerdized change in mean used in meta analysis
On a forest plot what do the following represent?
Size of box
Line w/ arrow
Horizontal line crosses vertical line
Box: point estimate
Size of box: magnitude of effect
Line w/ arrow: CI so large it goes off the page
Diamond: summary of point estimates
Crossing line: effect could be due to chance
Recommended time span of publications for a systematic review?
20-25 years if not researcher should indicate why they limited it more
How many raters are typically used to select studies for a systematic review?
At least 2 each blinded to the other
A 3rd rater used to break ties
Process of assessing methods and results of each study to determine if the study is adequate to answer the question is known as
Critical appraisal
Recommended number of databases to collect literature for a systematic review
More than 2