Evidence based research/practice

Question 1

define critical appraisal (in evidence based research)

Answer 1

critical appraisal is the process of assessing the reliability, importance, and applicability of evidence

• assess validity, trustworthiness and value of research

Question 2

escribe the following terms; critical appraisal, bias, internal validity and external validity

• distinguish between different types of study designs and their strengths and limitations
• assess the appropriateness of methods used to conduct a randomised controlled trial, systematic review, diagnostic study and qualitative study
• interpret commonly reported results found in clinical papers
• identify different types of critical appraisal tools and their strengths and limitations

Question 3

define bias

Answer 3

systematic erros / deviation from truth in results

(leads to over OR underestimation of true intervention)

Question 4

define internal validity

Answer 4

extent to which design and conduct of study are likely to have prevented bias therefore, the results may be considered reliable

Question 5

define external validity

Answer 5

the extent to which the effect of an intervention, programme or policy being investigated in a study or review might be expected to occur in other participants or settings

Question 6

Different study designs (for example, randomised controlled trial, qualitative study, systematic review) are conducted using different methods.

Question 7

define what primary/ secondary research is, prospective/restrospective/snapshot and analytical/descriptive

Answer 7

Primary: generates data from patients.
Secondary: uses data from primary research sources.

Prospective: moves forward in time.
Retrospective: looks backwards in time.
Snapshot: takes a ‘snapshot’ of a single moment in time.

Analytical: Studies which test hypotheses about an exposure and/or intervention and an outcome. Analytical designs may be experimental (the researcher has control over an intervention or exposure) or observational (the researcher does not have control over an intervention or exposure).
Descriptive: Studies which describe the characteristics of a population or phenomena (the researcher does not have control over an intervention or exposure, but looks to observe and measure them).

Question 8

what is equality in health

Answer 8

giving everyone same opportunity to attain full health potential when some may need more help than others to attain same level due to social position or other socially determined circumstance

Question 9

what is equity in health

Answer 9

when everyone HAS OPPORTUNITY to attain full health potential and that no one should be disadvantages from achieving it due to social position or other socially determined circumstance

Question 10

define inequity

Answer 10

differences in health status or distribution of health resources b/w different population groups, arising from social conditions in which people are born, grow, live, work and age

• correct resources aren’t given for person to achieve full health potential

Question 11

why do inequities arise

Answer 11

Differences in health that are unnecessary, avoidable, unfair and unjust.

Question 12

whats meant by distribution of health resources

Answer 12

Disadvantaged populations may face barriers to accessing healthcare which in turn may increase health inequities.

Question 13

what acronym identifies 8 characteristics relating to individuals social position / cirucmstances

Answer 13

The PROGRESS acronym [5] : place, race, ethnicity and language, occupation, gender, religion, education, socioeconomic status and social capital.

Question 14

multiple health inequity :

People may experience multiple health inequities, for example, minoritised ethnic women. This can add further unique consequences to their health status (the state of a person’s health and wellbeing) and access to healthcare.

Question 15

what was do equity considerations impact critical appraisal

Answer 15

Internal validity: the extent to which the design and conduct of a study are likely to have prevented bias and, therefore, the results may be considered reliable.

External: the extent to which the effect of an intervention, programme or policy being investigated in a study or review might be expected to occur in other participants or settings [6].

Ethics: moral principles, standards and guidelines that govern how research should be conducted, for scientific integrity, human rights and dignity.

Question 16

what is RCT

Answer 16

randomised controlled trial

• participants randomly assigned into different groups (one treatment and one controlled) , to see if intervention has cause and effect relationship
• tests effectiveness of treatment

Question 17

Simple 2-arm RCT has 1 intervention and 1 control group

Answer 17

• random sample of population
• split into 2 gras, 1 intervention, 1 control
• after time, group results recieved
• different group results compared

Question 18

cons and pros with RCT

Answer 18

pro =
- minimal bias due to randomisatioon
- establish cause-effect relationship
- reiliable qualitative data

Con=
- expensive, time osnduming
- ethical concerns
- may not reflect real world due to strict control

Question 19

sample pop in RCT should rep wider target population so results can be applied to those who didnt take part in RCT (generalisability)

RCT can over or underestimate true effect of intervention if sample isnt REPRESENTATIVE of target population

Question 20

target population = ppl with specific symptom

sample = rate of people with same symptom but not necessarily same CAUSE of symptom (so not necessarily representative of target population)

Question 21

difference between simple, block, stratified and cluster randomisation

Answer 21

simple = everyone has equal chance of being assigned to any group

block = equal numbers of patients are allocated to the intervention and control groups at any given time.
e.g in blocks of 4, u want 2 ppl in each grp

stratified= dividing population into subgroups then randomly assigning ppl from each stratum to a treatment group (ensures balance within each subgroup)

cluster = entire groups/clusters e/g city or school are randomly assigned to different treatments (used when impracticable to randomise individuals)

Question 22

what is allocation concealment

Answer 22

patients shouldn’t know which group (intervention or control) themselves or another patient is in

• can manipulate randomisation and cause over or underestimate of true effect

Question 23

what is single, double and triple blinding

Answer 23

single = patient OR researcher
double = patient and researcher (doing test)
triple = patient, researcher (doing test) and researcher (measuring outcome)

DONT KNOW WHICH STUDY GRP PATIENTS ARE IN

Question 24

what does assessment of patient follow-up include and why does it matter

Answer 24

• looking at the duration of follow-up and the patients lost to follow-up (patients that withdraw, or drop out, from a study or cannot be located
• Patients lost to follow-up matters because:

it can decrease the power of a study (the ability of a study to detect a statistically significant difference between the intervention and control group if such a difference exists). The study is usually powered to the main outcome, so any patients leaving an RCT may reduce the statistical significance
it can lead to an imbalance of patient characteristics across the intervention and control groups

Question 25

define outcome

Answer 25

factor that you are measuring to determine an effect

Question 26

difference between validity and reliability of outcome

Answer 26

validity = if outcome is measured accurately to what its supposed to e.g ruler is valid to measure length but thermometer isnt reliability = if outcome measured would give similar results over time or b/w different assessors

Question 27

difference in treating equally and fairly

Answer 27

equally (received the same level of care) and fairly (not disadvantaging one group over another).

Question 28

whats odds ratio

Answer 28

odds ratio (OR) is a measure of association between an exposure and an outcome. - if OR<1 exposure is associated with lower odds of the outcome (decreased occurrence of outcome). If OR>1 exposure is associated with higher odds of the outcome (increased occurrence of outcome). If OR=1 exposure does not affect the odds of the outcome.

Question 29

define risk, relative risk and absolute risk

Answer 29

Risk is the probability that an outcome will occur - RR compares the risk of having an outcome between 2 groups. - absolute risk reduction (ARR) (also known as the risk difference) is the absolute difference in risk between 2 groups.

Question 30

what is NNT/ number needed to be treated

Answer 30

The number of patients that need to be treated for one to benefit compared with a control.

Question 31

A p-value assesses whether the results of a study are: …likely to have occurred simply through chance (assuming that there is no real difference between new treatment and old, and assuming, of course, that the study was well conducted). [

Question 32

what a systematic review

Answer 32

secondary research design that aims to locate, appraise and synthesise (bring together) all the evidence on a particular topic.

Question 33

what are 2 stages of study selection for systematic reviews

Answer 33

1 = screening of titles and abstracts against the inclusion criteria. 2 = screening of the full text against the inclusion criteria.

Question 33

whats eligibility criteria in systematic review, why's it needed

Answer 33

- clear set of inclusion criteria that a study must satisfy to be included in a systematic review. - removes ambiguity over why some studies are included in a systematic review and others are not

Question 34

what is search strategy

Answer 34

search strategy is the process of identifying evidence to include in a systematic review. - reduced publication bias

Question 35

what tool can be used to assess quality of included studies

Answer 35

Critical Appraisal Skills Programme (CASP) tools,

Question 36

Synthesis is the process of combining and evaluating the results from across the individual studies included in a systematic review to provide an overall summary of the evidence.

Question 37

what is qualitative study

Answer 37

descriptive research design which aims to explore patients, carers and healthcare professionals' views, beliefs or experiences of a particular phenomenon.

Question 38

4 types of qualitative approcaes/ studies: ethnography, grounded theory, narrative and phenomenology, what are these

Answer 38

ethnography = studying culturres/grps in their natural setting phenomenology = explore lived experience of ppl based on specific phenomenon grounded = developing theories based on data systematically gathered and analysed narrative = exploring and interpreting stories to understand experiences

Question 39

4 types of sampling in qualitative study?

Answer 39

convenience volunteer purposive snowball (participates refer other ppl)

Question 40

4 methods of data collection in qualitative study

Answer 40

interview focus group observation document analysis

Question 41

what is the thematic analysis approach of formation of a theory

Answer 41

- observation of data collected - patterns identified - hypothesis made - theory formulated

Question 42

what are 5 ethical considerations of research

Answer 42

benevolence (research acts in best interest of patient) autonomy (right to refuse) non-maleficence (no harm) justice (fair) confidentiality

Question 43

whats researcher reflexivity

Answer 43

Researcher reflexivity recognises the influence of the researcher in the qualitative research process.

Question 44

To assess the ability of the test to identify patients with a target disease or syndrome and those without the target disease or syndrome, we need to consider the sensitivity, specificity, accuracy, Positive Predictive Value, Negative Predictive Value and cut-off value. define

Answer 44

sensitivity = ability of the test to detect true cases of a disease or syndrome. ​ specificity = ability of the test to exclude patients without a disease or syndrome.​ accuracy = ability of the test to give consistent and reliable results.​ PPV = proportion of patients in the study who get a positive test result and do have the disease.​ NPV = proportion of patients in the study who get a negative test result and don't have the disease.​ cut off value= accepted fixed point of sensitivity and specificity that a test has to achieve so that it can be used in practice.​

Question 45

what are critical appraisal tools

Answer 45

Critical appraisal tools aim to guide readers through a list of questions to help them to assess the methodological rigour of research papers.

Question 46

internal validity is the extent to which the methods are robust and minimise bias. External validity is the extent to which the study results can be expected to occur in other populations and settings.

Question 47

watch out for: Critical appraisal tools that include questions that assess the quality or clarity of reporting, rather than assess the methodological rigour (the robustness and appropriateness of the methods).

Question 48

Critical Appraisal Skills Programme (CASP) systematic review checklist questions are asked by the tool to either assess reporting quality or methodological rigour of a systematic review, know which type is being asked about know difference b.q them

Question 49

what are the 3 types of critical appraisal tools, compare pros and cons of them

Answer 49

scoring tool (forms overall score) pro = quick and easy to interpret, good reliability cone = multiple areas with same score assuming areas will have equal relevance but not true checklist tool (criteria based, generate narrative response) pro = quick and easy, greater deatil, good for appraising studies con= lack of guidance on when to the yes/no so low reliability (repeatability) domain based tool ( assess risk of bias across specific domains relevant to a particular study design. Risk of bias is assessed at the outcome level rather than study level) pro = in depth appraisal, risk of bias assessed at outcome rather than study level, good for appeasing studies cons = time intensive, assumes high level understanding of bias terminology thats hard for beginners to understand