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PHAR 271 > Midterm 1 > Flashcards

Midterm 1 Flashcards

(94 cards)

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1
Q

What is EBM?

A

integration of best research evidence and clinic expertise and patient values

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2
Q

What are the five A’s of EBM?

A

Ask- make question
Acquire- find info
Appraise- evaluate info
Apply- use results
Assess- evaluate performance

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3
Q

What is PICO?

A

P-population
I-intervention
C- versus
O-outcome

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4
Q

What are the top notch filtered information that we can access?

A

Systematic reviews
Critically apprasied

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5
Q

What are unfiltered information and rank them of descending quality?

A

RCT
Cohort
Case-Control
Cross sectional
Case report

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6
Q

What is external validity?

A

how generalizable it is

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7
Q

What is internal validity and what 3 threats are there?

A
  • due to something weird during the study
    Chance confounding and bias
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8
Q

What is chance?

A

random error in measurements or observations

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9
Q

What is bias?

A

Any systematic error in results

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10
Q

What is confounding?

A

Confusion of effects- some other factor is causing issues

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11
Q

What does P values mean?

A

> 0.05= support null= not statistically different
<0.05= reject null= statistically different

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12
Q

How can we lower chance?

A

increase sample size
use p values

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13
Q

REMEMBER STAT SIG MAY NOT BE CLINICALLY SIG

A
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14
Q

How can we lower confounding?

A

randomize or statistical models to adjust for it.

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15
Q

What is stratification vs matching randomization?

A

Strat- radnomize 2 groups separately so they get the same representation
Matching- often by sex and age so that they put 2 similar people in different groups

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16
Q

What is selection bias?

A

how they were selected
often effects external validity

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17
Q

What is volunteer bias?

A

people who volunteer are different than those who don’t

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18
Q

What is healthy worker bias?

A

employed= healthier

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19
Q

What is attrition bias?

A

people who leave study or die and not following up

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20
Q

What is recall bias?

A

individuals may remember differently. maybe remember negative better

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21
Q

What is interviewer bias?

A

ask/ probe different people if they know what group they are in

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22
Q

What is surveillance bias?

A

one group is studied/ followed more closely

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23
Q

How can we lower bias?

A

minimize through blinding
create everyone the SAME

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24
Q

What is publication bias?

A

tend to only publish positive findings

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25
What is the difference between parallel and cluster RCT?
parallel= split into two groups cluster= cluster of individuals are randomized
26
What is study power?
ability to show difference between the groups= need a good in-between number
27
What is a hard vs soft endpoint?
hard= death, heart attack Soft= blood pressure
28
What is a primary vs a secondary endpoint?
primary= what the study was designed for secondary= additional findings
29
What is the issue with secondary endpoints?
study was not designed for it so confounding may be an issue. harder to trust results
30
What is a composite endpoint?
Primary endpoint with several events ie) MACE
31
Issue with composite endpoints?
hard to determine true effect of intervention on each event
32
What are the tree methods of randomization?
Complete= no limits= not same numbers in each group Block= force equal numbers by 6 subjects three must go in each group Stratified= by age or sex usually
33
What is ITT?
Analyze data of all patients even those that died or dropped out
34
What is per protocol?
Analyze data from subjects who followed it exactly
35
What can't observational studies do?
PROVE CAUSATION
36
What's a benefit of observational studies?
feasible, real world, ethical always
37
What are the 3 main types of Observational studies?
Case reports/series cross-sectional case-control cohort
38
What is a case report study? also what is a case series :)
interpret one case pros= useful for new disease or side effects, further research, identify new drug effects Cons= hard to interpret, CONFOUNDING series= individual reports in short time
39
What is cross-sectional studies? Pro, Cons?
Look at sample at one point in time Pros= prevalence, look for association, cheap, quick Cons= don't know incidence, can't prove, confounding
40
What is case control?
Compare 2 groups retrospective look for people who had outcome and this ewho did not Try to make two groups as similar as possible Cons= not randomized, bias, can't prove Pros= good for rare, quick
41
What is a cohort study?
Follow the two cohorts similar to RCT but NO randomize Can be prospective and retro Cons= bias, no randomize, costly Pros= highest level of evidence
42
How to calculate ARR/ARD and what does it mean?
ARR= %placebo- %outcome tells us that drug X is % outcome less than placebo
43
How to calculate RR
Prob of event in intervention/ Prob of net in placebo
44
What does an RR of <1 mean?
less risk of outcome in intervention
45
How to calculate RRR?
RRR= 1- RR
46
HOW to calculate OR
Prob risk of event/prob risk of not = for one drug do it again for the other drug then do intervention Odds/placebo Odds
47
What does a OR>1 mean?
higher odds of outcome in intervention
48
What is NNT? Same with NNH
NNT= 100/ARD% Orrrr if it is in decimal then 100/the decimal always round up
49
How do you use survival curves?
look at how many years to get 50% survival
50
WHat does Hazard ration of <1 mean. What about>1?
<1= less hazard in intervention >1= higher hazard
51
WHat does confidence interval mean?
means that in 95% of the time the drug reduced __________ and true value is between __________
52
What is threshold of no difference for mean or proportions?
0
53
What is a washout period?
period of time to let the drug be fully eliminated from the body
54
What is a cross over RCT
intervention then gets placebo and vice versa
55
Why do you need to make sure that a study is designed before it begins (a priori)?
limit bias
56
Which has better generalizability? RCT or observe?
Observe
57
If I increase my sample size in my study, what will this help to reduce?
Chance
58
Randomization helps to minimize:
confounding
59
How can we find out if ITT or per protocol
If they randomized certain number and if the results have the same table
60
Who is blinded in single blind trials
the evaluators
61
What does NNT mean?
it takes _____ treated for ______days for one ADDITIONAL person to see benefit
62
What is typically a good NNT?
depends on treatment and length of time But for CVD anything less than 50
63
What can CI help us see?
best case and worst case scenario
64
What is threshold of no difference for RR and OR?
1
65
Is this CI significant mean weight -3-19
NO
66
IS this CI significant mean weight 30-40
YES
67
Is this CI significant? RR 1.9-5
Yes
68
Is this CI significant OR 0.4-5
NO
69
Why is CI more informative than p values?
shows us range and direction of the effect. Also help us see clinical and statistical significance
70
What does ITT help prevent?
confounding
71
Why is ITT not great for non-inferiority RCT?
may accidentally show non-inferiority
72
If a lack of superiority in a superiority trial does this mean it is non-inferior?
NOOOOOOO
73
What do we ABSOLUTELY need to have established before a non inferior trial?
Need the margin of inferiority
74
What is a propensity score
probability of a subject would be in a certain treatment group based on observed characteristics
75
When do we use propensity scores?
OBSERVATIONAL studies
76
What does propensity scores limit?
selection bias and confounding
77
Does propensity scores replace randomization?
FUCK NO
78
What is a adaptive clinical design?
planned review of the data, make modifications and redo conducting
79
What examples for Adaptive clinical designs?
Adjust sample size, stop treatment arms (if really bad), change allocation, stopping early(positive or negative)
80
What is a con of adaptive clinical trials?
interim data analysis= operational bias as you are aware of the effects.
81
True or false all systematic reviews are very good
False
82
What do systematic reviews reduce?
confounding
83
What is a meta-analysis?
use stats to integrate results, extract data from each study and weight the numbers based on if study provides more info
84
When can't we do Meta-analysis
if different population, comparisons check if similar enough by use Q
85
Why is systematic reviews important?
hard to stay up to date
86
What is Cochrane collaboration?
highest standard. international volunteers to review
87
What are the components of a systematic review?
Make question- establish protocol, eligibility, RCT and/or Observe Comprehensive literature search Identify inclusion studies (look at abstract) Assess Quality Extract data Analyze data (only for meta) Interpret
88
Issues with systemic reviews
no transparency bad criteria poor quality papers
89
What are clinical practice guidelines and why are they important?
Systematically developed statements to assist practitioners and patients make decisions. Important for good informed choices
90
What are the components of a CPG
Systematic reviews (+/- MA) Set of recommendations target population target audience expert panel-range of HCP+ info on them (qualifications) How they developed recommendation (voting/consensus) external review updates funding statements
91
What is the grading system for CPG?
Numbers=1 (we recommend) 2 (we suggest) Letters= A-D A is best
92
What are some potential problems of CPG?
Poor quality studies Publication bias not user-friendly liability- sued if not followed
93
How can we appraise CPG?
AGREE II- has 23 items and 6 domains to check CPG check scope, stakeholders, rigour, clarity, applicability editorial independence
94

PHAR 271 (5 decks)

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