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PBL > EIDM > Flashcards

EIDM Flashcards

1
Q

What are three qs to ask when looking at a study?

A

1) Does the study answer my practice question?
2) Are the results of the study valid? (minimizes bias, results not due to other factrors, results can be applied to larger population, outcomes analyzed)
3) Can I apply these results to my nursing practice?

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2
Q

What are intervention studies?

A
  • address a treatment/therapy or prevention
  • RCT is the strongest design
  • determine how the interventions affects the outcome
  • RCT not always ethical, observational studies can be used
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3
Q

What observational studies exist?

A
  • cohort analytic study (one group, before and after)
  • case control study
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4
Q

How can participants be selected for an intervention study?

A
  • convenience sampling (volunteer); potential bias, making results less valid
  • random sampling (ideal)
  • better if allocation can be concealed
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5
Q

What is allocation sequence?

A
  • random process of allocating participants into experimental/control groups
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6
Q

What is allocation concealment?

A
  • researchers not aware of how allocation occurred, unpredictable (remote randomization, opaque envelopes, medications look similar)
  • participants blinded to what group they are in
  • prevents bias
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7
Q

How do we know whether randomization of participants occurred?

A
  • compare experimental and control groups - similar in all known determinants of the outcome
  • usually uses p-value to compare the two groups
  • assume unknown determinants corrected with randomization
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8
Q

Where could potential biases occur without blinding?

A
  • participants if they know what group they are in (Hawthorne effect)
  • people delivering the intervention could make intervention look more effective
  • people evaluating the outcome
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9
Q

What is intention-to-treat analysis?

A
  • outcome analysis should include the participants who dropped out before completion of the study within the group they were originally allocated
  • statistical analysis needs to include all participants, even those not completing the study
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10
Q

What should we ask about follow-up?

A
  • was it complete and was it long-enough?
  • were all participants accounted for?
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11
Q

What are the two types of variables?

A

1) dichotomous (yes/no)
2) continuous

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12
Q

What are the types of continuous data?

A
  • ordinal: sets of ordered categories (pain scale)
  • interval: ordered set where series of intervals are the same size (temperature)
  • ratio: interval with absolute 0 (weight)
  • can be reported as dichotomous data but not vice versa
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13
Q

How is treatment effect measured for continuous data?

A
  • uses “mean” values to show whether data changed after exposure to intervention
  • may include the range of values and/or standard deviation (variable around the mean)
  • line of no difference is 0
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14
Q

How is treatment effect measured for dichotomous data?

A
  • line of no difference is 1
  • outcomes reported as relative risk (RR) or odds ratio (OR)
  • RR or OR = 1 means there is no difference between the control and intervention group results
  • RR or OR > 1 means more of the outcome in the intervention group (less in the control group)
  • RR or OR < 1 there is less of the outcome in the intervention group (more in the control group)
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15
Q

What is OR/RR?

A

The odds or risk that an outcome will occur in the intervention group compared to the control group

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16
Q

If the outcome is bad, risk is reported as…

A
  • relative risk (RR) = relative benefit of a treatment
  • absolute risk diference/reduction (ARR) = how much of a reduced risk if the result of the treatment
17
Q

If the outcome is good, risk is reported as…

A
  • benefit increase
18
Q

How do we determine treatment effect?

A
  • determine if the outcome is a“good” (desirable) or “bad” outcome
  • treatment effect is the outcome difference between the control and treatment group
  • more/less of a good outcome?
  • more/less of a bad outcome?
19
Q

How do we determine whether results are valid?

A
  • 95% CI does not cross the line of no difference
  • p-value <0.05
20
Q

What is the 95% confidence interval?

A
  • 95 times out of a 100 the treatment effect represents an estimate of the true difference that is not due to chance
  • estimates the statistical significance of the intervention effect
  • wider the CI range, the less precise the estimate of the treatment effect
21
Q

What is number needed to treat (NNT)?

A
  • related to the effect of the intervention
  • only used with dichotomous outcomes
  • tells us whether the interventions is worth any potential harms or costs
  • number of participants that must receive the intervention in order to promote one additional good outcome or prevent one additional bad outcome
22
Q

What is an acronym for the critical appraisal process for RCTs?

A

Design appropriate
Allocation
Demographic (variables)
Follow up
Intention to treat
Bias, Blinding
Statistical significance

23
Q

What is a systematic review?

A
  • summary of multiple research evidence that answer the same specific and focused question
  • quantitative studies
  • attempt to overcome bias via rigorous searching, appraisal, data synthesis
  • 2 or more people select research evidence to include based on inclusion criteria
24
Q

What is a meta-analysis?

A

A systematic review which includes a quantitative (statistical) combination of the results of similar studies

25
Q

What is a meta-synthesis?

A

A systematic review of primary qualitative studies on a particular topic

26
Q

How is a literature search conducted for a SR?

A
  • studies that used most appropriate design for research question
  • uses exhaustive strategies: search terms, several databases, reference list of relative studies, hand-searching, consulting experts, multiple languages, inclusion dates
27
Q

How is the validity of the included studies assessed?

A
  • poorer quality of studies tend to overestimate the effectiveness of the intervention
  • uses a specific quality check list (rating tool)
  • identify any risks for potential bias
  • 2 or more “raters” used
  • disagreement resolution method
28
Q

How is heterogeneity between studies tested?

A
  • statistical test
  • compares any differences between the different study results
  • are the results of the studies similar?
    • the p-value is ≥ 0.05, any difference across the studies included in the review was due to chance alone
  • means they are homogenous
  • I2 test: 0% indicating the least amount of variability across the studies
29
Q

How can the SR be completed for heterogenous studies?

A
  • if study results are heterogeneous – the results can be combined statistically by using fixed effects model or random effects model - can do a meta-analysis
  • or, can synthesize data narratively
30
Q

How is treatment effect shown in an SR?

A
  • forrest plot or blob-o-gram
  • each study has a box and a line through it
  • size of box = sample size
  • line through the box = 95% CI
  • diamond = overall treatment effect, edges of the diamond = CI
  • statistically significant = does not cross the line of no difference
  • dichotomous outcome = 1
  • continuous outcome = 0

PBL (1 decks)

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