Comps review Flashcards

(134 cards)

1
Q

When/why ask an FQ?

A

Uncertain about clinical issue, want an answer

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2
Q

What is a PICO?

A

4 required elements of FQ (in any order)

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3
Q

What does PICO stand for?

A
  • Patient/problem
  • Intervention
  • Comparison/contrast
  • Outcome
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4
Q

What to use PICO for?

A
  • Research about treatment
  • about diagnoses/screening tools
  • How well one of the treatments/diagnosis tools worked for a client
  • How you would gather patient preferences about their treatment options
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5
Q

Oxford Hierarchy (top to bottom)

A
  • Systematic review and meta analyses of RCTs
  • RCTs
  • Cohort studies
  • Case control studies
  • Cross sectional surveys
  • Case studies
  • Ideas, expert opinions, editorials
  • Anecdotal
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6
Q

Lit reviews

A
  • Systematic review
  • Meta-analysis
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7
Q

Systematic review

A

Gather and summarize all relevant studies on a topicM

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8
Q

Meta-analysis

A

If the studies have similar enough methods, pool them and do stats over everything
- Numerical support for the conclusions across studies

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9
Q

Individuals works

A
  • Lit reviews
  • Original research
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10
Q

Professional association journals and websites

A
  • ASHA
  • American Academy of Audiology
  • American Psychological Association
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11
Q

Documenting steps

A
  • Heading: Where you searched + search terms
  • List full citations for articles that look relevant
  • List notes below the citation about the article’s usefulness for your current purpose
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12
Q

Citation parts

A
  • Authors
  • Year
  • Title (article, chapter)
  • Source (journal, book)
  • Publication details
  • Page numbers
  • DOI or website
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13
Q

Clinical Studies: Phase Model

A
  • Phase I & II: Exploratory, small groups
  • Phase III: Hypothesis testing, big samples
  • Phase IV: Translate to practice
  • Phase V: Practical matters
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14
Q

Phase I & II: Exploratory, small groups

A
  • Treatment effect
  • Refine operations, populations, methods, effects
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15
Q

Phase III: Hypothesis testing, big samples

A
  • Treatment efficacy
  • Pretest-posttest
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16
Q

Phase V: Practical matters

A
  • Cost-benefit
  • Quality of life
  • Satisfaction
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17
Q

Review Articles

A
  • Summarize results from Phase IV & V studies w/ common hypotheses
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18
Q

Review Styles

A
  • Narrative
  • Meta-analysis (quantitative)
  • Best evidence
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19
Q

Narrative Review - Traditional lit review

A
  • Thorough search
  • Describe results qualitatively
  • Overall conclusion
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20
Q

Narrative Review - Drawbacks

A
  • Subjective bias
  • Subjective interpretations
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21
Q

Systematic Review

A
  • Clear protocol for selecting and evaluating studies before beginning review
  • Has 6 steps
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22
Q

Steps to Systematic Review

A
  1. Formulate problem/question
  2. Locate, select studies (selection criteria)
  3. Assess study quality (uniform standards)
  4. Collect data (across studies, quantitative or qualitative methods)
  5. Analyze results
  6. Interpret results
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23
Q

Early Meta-Analysis Methods

A
  • Vote counting
  • Combined-probability
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24
Q

Vote Counting

A
  • Number of studies with positive, negative, null results/conclusions
  • Drawback: no effect size
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25
Combined-probability
- Incorporate probabilities (account for different sample sizes) - But still no effect size
26
Modern Meta-Analysis Outcome
Overall effect size and significance across studies w/ similar quantitative methods
27
Modern Meta-Analysis
- Good way to combine results of studies on different populations, small samples, etc - Strong evidence for clinical decisions - Identify gaps, ideas for future research
28
Best Evidence Approach
- Combines "best" of narrative & meta-analysis - Attempts to avoid drawbacks
29
Combines "best" of narrative and meta-analysis
- Narrative intro, discussion, conclusion - Objectivity in selection criteria, evaluating quality - May use quantitative/meta-analysis
30
Attempts to avoid drawbacks
- Bias in study selection - Balance between big picture and important points from individual studies
31
Good review features
- Clear scope, purpose, theories - Systematic, thorough evidence search - Systematic appraisal of all studies for relevance, quality/rigor - Sound synthesis across studies - Reasonable conclusions based on synthesis
32
Reading Article Order
1. Abstract: is this article relevant? 2. Introduction: find the research question 3. Find answers in conclusion 4. Start from the top: get context from lit review 5. Methods: evaluate study quality 6. Results: evaluate rigor
33
Research Ethics
- Fair treatment of research participants - Honesty, accuracy in reporting
34
Fair treatment of research participants
- Minimized harm, maximized benefit - Informed consent - Protected private data
35
Honesty, accuracy in reporting
- Describing procedures - Minimizing subjective bias - Giving credit
36
Participant Rights
- First, do no harm - Nuremberg code - Institutional review boards - Belmont Reports
37
Nuremberg Code (1947)
- Voluntary consent: Free choice to participate
38
Institutional Review Boards (IRBs)
- Review research proposals BEFORE they begin - Participants' rights, protections; risks, benefits
39
Belmont Report (1979)
Codes for research with human subjects - Medical - Behavioral
40
Belmont Report
- Applies to human research participants - Applies to research, not practice - Respect for persons: informed consent - Beneficence: risk-benefit assessment - Justice: selection of participants
41
Respect: Informed Consent
- Informed of procedures, risks, alternatives - Understand, make free choice to participate - No coercion: Rewards can't be too enticing - Can quit any time and still get compensation - Extra protections for vulnerable populations
42
Deception
- Only when the truth upfront would make the experiment impossible - Must minimize risks of harm due to deception - Must debrief at end
43
Beneficence: Risk-Benefit
- Ensure well-being of participants - Do no harm - Minimize risks, maximize benefits to participants - Risk to participants doesn't exceed benefit to science
44
Justice: Participant Selection
- Fair distribution of risks and benefits - Minimize selection bias - Subject should correspond to research purpose
45
Convenience Sampling
- Easy-access populations - Prisoners - Students - Family members
46
Vulnerable populations
- Institutionalized - Children - Disabled - Students - Patients - Immigrants - Poor
47
Participants
- Anyone involved who's not a researcher
48
Distributive Justice
- Participant pool should match the purpose of the study - Inclusion/exclusion of participants based on need - Purposefully exclude people who may benefit - Purposefully include/select samples based on convenience or vulnerabilities
49
Other Issues
- Honoring commitments to participants - Withholding treatment - Conflicts of interest - Privacy, confidentiality - Data management, ownership, security
50
Honoring Commitments to Participants
- Compensation - Continued therapy - Summary of results
51
Withholding Treatment
- No treatment control groups: may feel unfair to "let people go untreated" - Risk-benefit: is no-treatment harmful?
52
Conflicts of Interest
- When researcher has another role/interest related to the research/outcomes - Teacher can't recruit own current students
53
Privacy, confidentiality
- Identifying into = confidential unless stipulated in consent form - Anonymize data: Use subject code w/ all data, store name-code key under lock and key
54
Data Management, Ownership, Security
- Follow collection, analysis protocols systematically - Store securely - Later: who "owns"
55
Reporting
- Honest, accurate description of study - Responsibility to publish publishable results
56
Author Order
- First author = did most work - Fields/labs differ on rest - Most to least work
57
Validity
How closely something reflects reality
58
Internal Validity
Accuracy of relation between observations and the subjects observed
59
External Validity
Generalizability
60
Generalizability
Applicability of patterns/results to a larger population
61
Internal Validity Parts
- Confounders - Subjective bias
62
Confounders
Unintended, uncontrolled, or unknown facts that should affect the results - Alternate explanation - Nullification - False conclusion
63
Subjective Bias
Could influence any stage of research
64
Ways to minimize subjective bias
- Blinding - Outside observer - Reliability checks
65
Blinding
Make involved people unaware of information that could bias findings
66
Single-blind
Either patient or practitioner are unaware of the patient's treatment group assignment
67
Double/triple-blind
- Other researchers are unaware of something - Researchers who interact with subjects, give treatments, evaluate progress, analyze data
68
Norm-Referenced Tests
- Standardized - Rank a score relative to normative sample - Not designed for multiple administrations
69
Criterion-referenced
Compare performance to reaching an expected level
70
Consistency of Measurement
- Train examiners - Monitor consistency of test admin procedures - Check intra-examiner reliability - Check inter-examiner reliability
71
Intra-examiner Reliability
Consistency of an examiner's measurements across test subjects
72
Inter-examiner Reliability
- Consistency of measurements across examiners - When examiners score same person/take same measurements, do they agree?
73
Randomized Controlled Trials (RCTs)
Best for causal inferences about average effects across a population
74
What are RCTs not appropriate for?
- Diagnostic accuracy - Etiology - Risk factors - Rare/slowly-progressing conditions - Risky/unethical experimental procedure
75
Experimental Design
Include active manipulations
76
Observational/Non-Experimental Design
- No active manipulations - Observe systematically, don't alter
77
Controlled Studies
Include control comparison group
78
Uncontrolled Studies
No control group
79
Controlled Trial
- One group receives treatment/manipulation, control group does not
80
Multiple Baseline Controlled Trial
Treatment group/patient is its own control: - Measure multiple times before treatment, part-way through, after, later follow-up
81
Uncontrolled Trial
All participants receive treatment - No control/comparison group
82
Cohort
Groups differing on a variable are followed over time to observe differences in outcomes
83
Case-control
Compare group with disorder to controls (w/o disorder), usually at one or a few points in time
84
Cross-sectional
Examine relationships between variables in a sample at one point in time
85
Case Study/Report
Describe single patient
86
Case Series
Describe series of similar patients
87
Prevalence/Surveillance Studies
Examine rates of occurrence in a sample
88
Prospective
- Hypothesis testing, methods planned out before data collection - Experimental studies must be prospective
89
Retrospective
- Analyze pre-existing data - Ranked lower than prospective: no control over systematic or unknown influences, can't assess validity of procedures
90
Random Assignment
- All subjects have equal chance of being assigned to any condition, determined by chance - Applies to prospective, controlled, experiments - "Best way" to assure that groups don't differ systematically before beginning
91
Matched Assignment
- Create groups that differ on the variable of interest but not others that are expected to influence results - Weaker validity than random assignment: unknown, unanticipated confounders possible
92
Confounders
Unintended, uncontrolled, or unknown factors that could affect the results
93
Statistical Significance
Math that says whether or not your result was probably a fluke
94
P < .05
There is a 95% chance that the samples were not drawn from the same population
95
Generalizability
Applicability of patterns/results to a larger population
96
Subjective Bias
Minimize bias in participant selection
97
Random Assignment in Observational Studies
All members of the population have equal chance of being selected for observation
98
Attrition
- In studies with multiple measurement points, not all participants complete all steps - Must report in published results
99
Replicability
Enough detail reported that another researcher could repeat the procedures? And get the same results
100
Continuous
Can have infinitely small, intermediate values - Interval - Ratio
101
Categorical/Discrete
Completely separate bins - Nominal - Ordinal - Interval or Ratio data that has been binned into categories or ranges
102
Nominal - Unordered, named category labels
- Categories aren't better/worse, higher/lower - Demographics, type - Best if every participant fits into just one category
103
Nominal - Can't do most stats
- Even if assigning arbitrary numbers to categories - Can count numbers of members
104
Ordinal
- Categories are ordered but there's no "amount" of difference between levels - Likert, rating, severity scales - Hard to do stats on these, must transform
105
Interval
- Ordered with equal intervals: can compute differences between scores but not ratios - Good for transformations and stats
106
Ratio
- Like interval plus true zero, can compute differences and ratios - Great for transformations and stats
107
Frequency Distribution
How many data points fell in each interval - AKA frequency polygon
108
Skewed
Long tail - Positive/right skew = positive tail - Negative/left skew = negative tail
109
If mean = mode
Skewness is 0
110
If mean > mode
Skewness is positive
111
If mean < mode
Skewness is negative
112
Bimodal
Two modes - Mean misleading - Really represents 2 distributions
113
Data Transformations - Modify raw values to simplify data structure
- Make distribution more symmetrical/normal -- Many stats require a normal distribution - Make validity more constant - Make relationships more linear - Convert ordinal data to interval/ratio scales
114
Data Transformations - Inspect distribution of data
- Looks normal? Outliers? Mistakes? - Calculate skew, kurtosis to confirm
115
Nonlinear Transformations
Reduce relative spacing between values on the right more than left side of distribution
116
Square Root
Take square root of each value - First add constant to make lowest value > 1
117
Log
Changes spread of distribution
118
Inverse: 1/x
- Makes big numbers small and small numbers big - Reverses order of values, so first multiply each value by -- 1 and add a constant so the lowest value is > 1
119
Descriptive Stats
Summarize characteristics of data set
120
Counts
- Frequency - Percentage
121
Location/Central Tendency
- Mean - Median - Mode
122
Individual Location
- Rank - Percentile rank - Standard score
123
Variability (spread)
- Range - Variance - Standard deviation
124
Frequencies
How many subjects/items in each category
125
Percentages, proportions
Divide each frequency count by total
126
Location/Central Tendency
- Single values that describe whole data set for one measure - Central location/tendency - Fractiles/Quantiles
127
Central Location/Tendency
- Mean (average) - Median (middle value) - Mode (most common value)
128
Fractiles/Quantiles
Divide rank-ordered date into even-ish bins - Median split (2) - Quartiles (4) - Deciles (10) - Percentiles (100)
129
Individual Location
Location of participant in relation to group
130
Rank
The Xth best score (out of?)
131
Percentile Rank
- Rank-order scores -- Divide individual's rank by total number of participants - 80th percentile = scored better than 80% of class
132
Standard Score (z-score)
Number of standard deviations from the mean - X - mean/st dev
133
Variability (Spread)
- How spread out the data values are - Adds necessary meaning to central tendency and individual location -- Number of categories -- Range -- Interquartile Range
134