Term
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Definition
A process whereby research evidence,
clinical knowledge, and reasoning are
used to make decisions about
interventions that are effective for a
specific client(s) |
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Term
| Evidence-based practice includes: (4) |
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Definition
- Best research evidence
– Clinical expertise
– Patient values
– Patient circumstances |
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Term
| the 5 parts of every epidemiological study |
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Definition
participants
Exposure group
Compariosn Group
Outcomes
Time |
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Term
| The RAMMbo* acronym: assessing study bias |
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Definition
Recruitment
Allocation
Maintenance
Measurement
Blind or
Objective |
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Term
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Definition
| the number of people with an outcome at a single point in time |
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Term
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Definition
| the number of events (outcomes) in a period of time e.g., falls in the 2 yrs after an intervention |
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Term
| Continuous outcomes are usually... |
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Definition
| functional measurments i.e. grip strength |
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Term
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Definition
Epidemiologic Evidence
Patient Preferences
Policy Issues
Clinical Considerations |
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Term
| Hierarchy of Evidence of Treatment Effectivness (least-most) |
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Definition
Expert Opinion
Case series/studies
Case Control Studies
Cohort Studies
RCTs
Critically Appraised Individual Articles
Crtically Appraised Topics
Systamatic Reviews and Meta-analyses |
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Term
| What are Descriptive Studies |
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Definition
| Designed to describe occurence of disease or outcome by time, place and person |
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Term
| What are Analytic Studies |
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Definition
| Designed to examine etiology and causal associations, include both experimental and non-experimental |
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Term
| Analytic Studies: Experimental |
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Definition
| Assignment to intervention is controlled by the investigator. includes controlled and uncontrolled trials |
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Term
| Analytic Studies: Non-experimental |
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Definition
| Assignment to intervention not under investigator control. includes: cohort, case-control, cross-sectional, and ecological studies |
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Term
| Analytic Studies: Experimental: Uncontrolled Trials |
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Definition
| Experimental trials without control or comparison group |
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Term
| Analytic Studies: Experimental: Controlled |
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Definition
| Trials with control groups. Unit of randomization can be individual or groups/communities. Include RCTs, Quasi-Randomized and Non-Randomized |
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Term
| Analytic Studies: Experimental: Controlled: RCT |
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Definition
| Intervention allocated randomly. All participants have the same chance of receiving intervention |
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Term
| Analytic Studies: Experimental: Controlled: Quasi-randomized |
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Definition
-INtervention is under control of the researcher
-study participants are not randomized
-pre-post designs are th most commonly employed |
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Term
| Analytic Studies: Experimental: Controlled: Non-randomized |
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Definition
| Allocation to treatment group is arbitrary (no underlying random process) |
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Term
| Analytic Studies: Experimental: Controlled: Non-randomized |
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Definition
| Allocation to treatment group is arbitrary (no underlying random process) |
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Term
| Traditional, narrative reviews |
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Definition
| usually written by experts in the field, are qualitative, narrative summaries of evidence on a given topic |
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Term
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Definition
| Reviews in which there is a comprehensive search for relevant studies on a specific topic, and those identified are then appraised and synthesized according to a predetermined and explicit method |
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Term
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Definition
| is the statistical combination of at least 2 studies to produce a single estimate of the effect of the healthcare intervention under consideration |
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Term
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Definition
| involves obtaining raw data on all patients form eachof the trials directly and the re-analyzing |
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Term
| Steps in a systematic review |
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Definition
-Formulate the question to be addressed
-Identify the criteria that will be used to select studies
-Plan, implement, and disclose the literature search strategy
-Identify relevant studies
-Extract data form the selected studies
-Analyze the extracted data
-Draw conclusions based on the data |
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Term
| How are systematic reviews better? |
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Definition
-More objective
-Literature search is comprehensive
-Explicit criteria for choosing studies
-Redears can replicate or verify the review |
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Term
| Why arent traditional, narrative reviews good enough? |
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Definition
-Can be subjective
-Selective citation of literature
-Usually uses vote-counting
-Usually not quantitative
-Redears cant replicate or verigy the review
-Hard to separate research evidence form anecdotal experiences |
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Term
| What to look for in a systematic review |
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Definition
-Clearly defined, explicit question
-Comprehensive and systematic search for studies
-Assessment of quality of primary studies
-Appropriate analysis and reporting of results
-limitations and strength of evidence reviewed
-interpretation supported by data
-Implications for patient care and future research |
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Term
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Definition
| -How likely the results are to be the "truth" |
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Term
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Definition
| The importance and usefulness of the findings |
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Term
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Definition
-How well you can generalize the reuslts towards the general population
-It is the degree to which we can make a causal inferences about the true effect of the treatment in the wider population. |
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Term
| Source population vs population of interest vs study sample |
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Definition
-Who we really want to say something about
-Who the study represents
-Who was actually studied |
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Term
| How to reach internal validity |
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Definition
| By avoiding systematic errors in order to reduce bias |
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Term
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Definition
| features of a study design, controlled by the researcher, that create differences between the two groups |
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Term
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Definition
-Any factor that acts to deviate the results away from the "truth"
-Bias can lead to an over, or under, estimation of the true size of treatment effect |
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Term
| ________ reduces bias by distributing unknown (or known) factors evenly across the study groups |
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Definition
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Term
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Definition
| -Refers to hiding the status of the participants' group assignment (treatment or control) from the participant, the reseracher, or both |
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Term
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Definition
-Refers to hiding assignment from both researcher and participant
-can be hard to achieve with many "manual" intervention studies |
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Term
| T/F: When double-blind can't be achieved, assessments should not be conducted by the reseracher but by an independent evaluator |
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Definition
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Term
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Definition
| -occurs when there are safety issues or after all the data are collected |
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Term
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Definition
-Potential to be associated with both the exposure and the outcome
-The estimate of the association between the exposure and the outcome must change when the potential confouder is controlled |
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Term
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Definition
-Both create false association between treatment and outcome (or mask true associations)
-Confounders: 3rd factor, potentially controllable
Bias: Systematic error, fatal flaw |
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Term
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Definition
-Respects the question of did the subjects stay in their original random assignments
-Are people in the tx group actually getting the tx? |
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Term
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Definition
| -the benefit of an intervention as compared to a control or standard program |
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Term
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Definition
| -the benefits and use of the procedure under 'real world' conditions |
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Term
| Analytic studies: observational |
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Definition
| -the research simply observes the participants at one point in time (cross-sectional) or over time (longitudinal) |
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Term
| Types of Descriptive studies (4) |
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Definition
-Prevelance surveys
-Survelliance data
-Case series
-Registries |
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Term
| If observations are made looking forward they are called _______ |
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Definition
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Term
| If observations are made from existing data they are called ______ |
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Definition
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Term
| T/F: Randomization increases internal validity, reduces potential for bias |
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Definition
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Term
| Characteristics of True Experiments (4) |
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Definition
-Exposures (independnet variables) are manipulated by the reseracher
-Participants are randomly allocated
-A control group is incorporated
-cause & effect relationship |
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Term
| Types of Experimental Design (2) |
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Definition
Between-group Comparison
Within-group Comparison |
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Term
| Types of Experimental Design: Between-group comparison (3) |
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Definition
- Pretest-postest control group design
- Factorial design
- Randomized block design |
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Term
| Types of Experimental Design: Within group Comparison (2) |
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Definition
- One way repeated measures design
- Crossover design |
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Term
| Pretest- postest control group design |
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Definition
Single factor
Two or more groups
pretest establishes baseline |
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Term
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Definition
- include 2 or more independent variables
- subjexts randomly assigned to various combination of levels of the two variables
- two way factorial design (2x2) |
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Term
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Definition
| - used when an extraneous factor might influence differences between groups |
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Term
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Definition
| - one group of subjects is tested under all conditions and each subject acts as their own control |
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Term
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Definition
| Half of the subjects received tx A followed by tx B, and the other half recieved tx B followed by tx A |
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Term
| The Well Elderly 2 study design is an example of a _______ Design |
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Definition
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Term
| Advantages of within-group designs |
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Definition
- Ability to control for the potential influence of individual differences, such as age, gender IQ etc
-Using subjects as their own control provides the most equivalent comparison group possible |
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Term
| Disadvantages of within-group design |
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Definition
-potential for practice effects or learning effect
-carryover effects based on subjects being exposed to multiple treatment conditions. |
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Term
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Definition
-Researcher observes the intervention
but does not control it
Researcher observes but does not
assign participants to
– Active treatment group
– Control or comparison group |
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Term
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Definition
-A type of retrospective observational
study where people with a disease or
condition are compared to people
without the disease to see if they had
different risk factors or exposures.
-Objective: To identify variables that may predict the condition |
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Term
| Pros and cons of prospective studies |
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Definition
-Can identify “diagnosis” &
confounders clearly at outset
-Intervention can be more clearly
documented
-Temporal sequence of onset and outcome |
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Term
| Pros and cons of retrospective studies |
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Definition
- Data already available
- Often involves largenumbers
- Definitions may change over time
- Follow-up times may be inconsistent |
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Term
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Definition
- Alcohol use as a risk factor for lung cancer can be confounded by smoking
-alcohol and smoking can be confounders when examinng gambling as a risk factor for cancer |
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Term
for a variable to be a
confounder it has to meet the following
conditions: |
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Definition
1. Relationship with the exposure
2. Relationship with the outcome even in the absence of the exposure
3. Not on the causal pathway
4. Uneven distribution in comparison groups |
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Term
| Controlling for Confounding (3) |
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Definition
– Randomization
– Restriction (restricts admission to the study to a certain category of a confounder)
– Matching (equal representation of subjects with certain confounders among study groups) can overcome a great deal of confounding. |
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Term
| Most Relevant Sources of Bias: Ascertainment Bias. |
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Definition
- Systematic error arising from the kind of individuals or patients that the individual observer is seeing.
– Systematic error arising from the diagnostic process. |
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Term
| Most relevant sources of bias: Detection bias |
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Definition
| The risk factor investigated itself may lead to increased diagnostic investigations and increase the probability that the disease is identified in that subset of persons |
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Term
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Definition
- A flaw in measuring outcome or exposure that results in differential accuracy of information between compared groups.
– Many different biases (recall, reporting,measurement, withdrawal etc.) are collectively grouped in this class. |
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Term
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Definition
– Systematic error arising from inaccurate measurement (or classification) of subjects on the
study variables. |
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Term
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Definition
– Caused by differences in accuracy of recalling past events by cases and controls.
– There is a tendency for diseased people (or their relatives) to recall past exposures more efficiently
than healthy people (selective recall). |
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Term
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Definition
– Unless the sampling method ensures that all members of the 'universe' or reference population have the same probability of inclusion in the
sample, bias is possible. |
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Term
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Definition
– Non-respondents to a survey often differ from respondents.
– Volunteers also differ from non-volunteers, late respondents from early respondents, and study
dropouts from those who complete the study.
– Also called response bias: systematic error due to difference in characteristics between those who
choose to participate in a study and those who do not. |
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Term
| Common case control bias: |
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Definition
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Term
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Definition
- Loss to follow-up (attrition) would be the greatest danger
- Selection bias in retrospective studies |
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