Research

Question 1

The basic objective of research is to acquire _______

Answer 1

new knowledge and justification for decision making in

medical practice

Question 2

______ refers to the ‘true’ answer, which must

be relevant, complete and accurate

Answer 2

Validity

Question 3

Three significant questions that evaluate validity are:

Answer 3

• Is the study useful or is the result inconclusive?
• Do you accept the results of this study as applied
to the source population?
• Do the results apply to the population in which
you would be interested?

Question 4

________ refers to the adequacy of the

study methods in reference to the study population

Answer 4

Internal validity

Question 5

_________refers to the generalisability of

the results to the general population

Answer 5

external validity

Question 6

______ refers to the stability of question-andanswer
response and is most successfully measured
by testing and then retesting (repeatedly).

Answer 6

Reliability

Question 7

The most frequently used method of testing for __________is to repeat application of the test.

Answer 7

repeatability

Question 8

_______ and _______, which are integral to
validity, are important considerations in decision
making in medicine, particularly in choosing
appropriate investigations for disease diagnoses

Answer 8

Sensitivity and specificity

Question 9

The_______ of a test depends on the proportion
of people with the characteristic (disease) in whom
the test is positive

Answer 9

sensitivity

Question 10

_____ is (i.e. percentage positive with disease).

Answer 10

Sn

Question 11

The________of a test depends on the proportion
of people without the characteristic (disease) in
whom the test is negative (i.e. percentage negative
of healthy people).

Answer 11

specificity

Question 12

The ultimate specific test is one

that detects all the_____

Answer 12

truly negative (disease-free) cases

Question 13

A _____test is one that is as close to 100%

specificity and 100% sensitivity as possible.

Answer 13

gold standard

Question 14

Predictive values that are useful indices of validity

can be expressed as ______ and _____

Answer 14

positive and negative values

Question 15

______ refers to the number of new cases of a disease (or factor of interest) occurring in a defined population within a specified period of time.

Answer 15

Incidence

Question 16

______ refers to the total number of
individuals who have the disease (or factor of
interest) at a particular time in a population. Thenumber is divided by the number of people in the population at that time

Answer 16

Prevalence

Question 17

This is any effect occurring during the investigation that tends to produce results that depart systematically from the true values

Answer 17

Bias

Question 18

types of bias
1.
2.
3.

Answer 18

1. measurement bias (
2. confounding bias
3. selection bias

Question 19

This is a situation in which a measure of the effect of exposure on risk is distorted by the association of exposure with other (known or unknown) factors that influence the outcome

Answer 19

Confounding

Question 20

A ______ is a factor that distorts the apparent magnitude of the effect of
a study on risk.

Answer 20

confounder

Question 21

The reasoning process of the researcher is based on the ________that is, an experimental group does not differ from a control ‘normal’ group in outcome.

Answer 21

null hypothesis

Question 22

Two basic components of subject selection are ______ and _______ The latter should
be selected in a well-controlled manner

Answer 22

sample size and sample representativeness.

Question 23

A useful rule is to aim to approach

_______patients if you wish to work with a sample size of n .

Answer 23

3n

Question 24

The two broad categories of research in general practice are _______research, which is based on observation and talking with people, and ____ research, which is based on measurement and analysis
of data collection

Answer 24

qualitative

quantitative

Question 25

Research can also be classified as _____ research, which includes both qualitative and quantitative methods, and _____research, which involves systematic reviews and meta-analysis.

Answer 25

primary secondary

Question 26

This research is basically concerned with evaluating human behaviour from the subject’s perspective. It is based on close observation and is expressed in a descriptive way.

Answer 26

Qualitative research

Question 27

``` Qualitative approaches to research 1 2 3 4 ```

Answer 27

* Phenomenology * Ethnography * Grounded theory * Biography (life story, narrative enquiry) * Case study

Question 28

Methods used in qualitative research

Answer 28

* interviews (open-ended, semi-structured) * focus groups * participation observation * document analysis

Question 29

What type of research | The central focus of philosophy/method is the lived experience of the world of everyday life

Answer 29

Phenomenology

Question 30

What type of research • effects of Viagra (and other agents) on marital/ sexual relationships • experience of carers in Alzheimer disease • effects of workplace bullying on absenteeism

Answer 30

Phenomenology

Question 31

This examines cultures, peoples and societies including subgroups, e.g. adolescents. It is the basis of anthropology. The investigator usually identifies one or more key witnesses (informants) and interviews them to clarify observations.

Answer 31

Ethnography

Question 32

This is the development of new theory through the collection and analysis of data. It seeks to identify the core social processes within a given context in order to build theory that is grounded in the reality of those being studied

Answer 32

Grounded theory

Question 33

_____is research based on the collection of data in numerical quantities and asks a specific narrow question, such as ‘What is the chance that . . .?’ or ‘What proportion of . . .?’

Answer 33

Quantitative research

Question 34

Quantitative research: It can be classified broadly as _____ which includes case control, cross-sectional and cohort studies, and ____ which includes the classic controlled trial

Answer 34

observational, experimental,

Question 35

is an observational study in which people with a disease (cases) are compared with those without it (control group).

Answer 35

Case control (or retrospective) stud

Question 36

What type of research?

Answer 36

Patients with mesothelioma | were investigated for exposure to asbestos or other agents;

Question 37

_________follows a correlation approach using existing databases. It is a survey of the frequency of disease, risk factors or other characteristics in a defined population at one particular time

Answer 37

Cross-sectional or prevalence study

Question 38

What type of study? ``` The prevalence of diabetes mellitus (diagnosed and undiagnosed) was investigated in an Aboriginal community living in a particular area of metropolitan Sydney. ```

Answer 38

Cross-sectional or prevalence study

Question 39

_______ is also referred to as ‘follow-up’. The study follows a group (cohort) of individuals with a specified characteristic or disease over a period of time. Comparisons may be made with a control group

Answer 39

Cohort (or prospective) study

Question 40

What type of research?

Answer 40

120 patients with chronic sciatica were followed over 10 years to determine the outcome of their pain and neurological deficit. These were compared with a matched group who had undergone laminectomy

Question 41

______ is an experimental study that tests for hypothesised outcomes. An intervention is conducted on a randomly selected group of people and compared with a matched control group not subject to the specific intervention.

Answer 41

Clinical controlled trial

Question 42

What is the objective of a Clinical controlled trial?

Answer 42

The objective is to establish a | causal relationship between the intervention and the hypothesised outcome

Question 43

The ideal scientific trial is a ______ where neither staff nor the participating patient are aware the participant is in the intervention or control group.

Answer 43

double-blind trial

Question 44

______ is the process that systematically assesses compatible randomised controlled trials by merging the data (from usually smaller and inconclusive trials) to draw a ‘firmer’ conclusion from larger numbers of subjects

Answer 44

Meta-analysis

Question 45

___________) is a process of basing clinical practice on validated information

Answer 45

Evidence-based medicine (EBM

Question 46

_______is the integration of the best available scientific evidence with your clinical expertise and knowledge, your intuition, your wisdom’.

Answer 46

EBM

Question 47

Steps for EBM

Answer 47

The proposed five steps of EBM are similar to basic research methodology: 14 1 Construct a clinical question or define the problem. 2 Search for the evidence. 3 Appraise the quality and relevance of the evidence. 4 Apply it to the care of an individual patient. 5 Evaluate how effective it is.

Question 48

What level of evidence? Evidence obtained from a systematic review of all relevant randomised trials

Answer 48

1

Question 49

What level of evidence? Evidence obtained from at least one properly designed randomised controlled trial.

Answer 49

2

Question 50

What level of evidence? Evidence from well-controlled trials that are not randomised, or well-designed cohort or case-control studies, or multiple time series (with and without the intervention).

Answer 50

3

Question 51

What level of evidence? Opinions of respected authorities; based on clinical experience; descriptive studies; or reports of expert committees.

Answer 51

4

Question 52

What is the strength of EBM

Answer 52

The strength of EBM is that it can provide the answers to very important everyday decisions, especially in screening and preventive medicine, where guidelines have fluctuated over the decades

Question 53

The absolute difference in event rates between two intervention or treatment groups. It gives an indication of the baseline risk and treatment effect.

Answer 53

ARR

Question 54

What does an ARR of 0 mean?

Answer 54

An ARR of 0 means no difference and | thus the treatment has no effect

Question 55

A UK journal on EBM with excellent summaries on NNT for a host of common interventions

Answer 55

Bandolier: www.medicine.ox.ac.uk/bandolier/

Question 56

This allows comparisons between | the means of two samples of similar populations with a normal distribution.

Answer 56

Analysis of variance

Question 57

The statistically derived range of | values around a trial result in which the probability is that the true result will be within the range.

Answer 57

Confidence interval

Question 58

It is a measure of the | certainty that the figures are correct

Answer 58

Confidence interval

Question 59

_________ The percentage of subjects | in the control group that experienced the event of interest.

Answer 59

Control event rate (CER)

Question 60

_______The percentage of subjects in the intervention group that experienced the event of interest

Answer 60

Experimental event rate (EER)

Question 61

measures the agreement between the evaluations of two raters when both are rating the same object. A value of 1 indicates perfect agreement. A value of 0 indicates that agreement is no better than chance.

Answer 61

Cohen’s kappa

Question 62

The number of people who must be treated over a given period of time with the experimental therapy (specific intervention) to achieve one good outcome or prevent one adverse outcome.

Answer 62

NNT

Question 63

T or F the lower the NNT, the better the treatment

Answer 63

T

Question 64

How to compute NNT

Answer 64

It is calculated as 100/ ARR (%); that is, the reciprocal of | the ARR.

Question 65

T or F The NNT will be different for different patient populations depending on their baseline risk for developing the outcome of interest

Answer 65

T

Question 66

The probability of the occurrence of an | event to its non-occurrence

Answer 66

Odds ratio

Question 67

The probability that an observed | difference occurred by chance.

Answer 67

P value

Question 68

What is the standard convention for obtainiing P value?

Answer 68

The standard convention is that there is only a 5% (1 in 20) probability that the difference would fall outside this range by chance alone (i.e. a P value of 0.05 or 5%).

Question 69

The ratio of the risk of the outcome | (e.g. disease or death) in the treatment/exposure group compared with the control/unexposed group

Answer 69

Relative risk (RR)

Question 70

How to compute RR

Answer 70

RR = EER / CER

Question 71

How to interpret RR

Answer 71

RR = 1 means no difference, so treatment has no effect RR > 1 means the treatment increases the risk of disease/death RR < 1 means the treatment decreases the risk

Question 72

The proportional reduction of adverse events between the treatment/experimental and the control groups in a trial`

Answer 72

Relative risk reduction (RRR)

Question 73

How to compute RRR

Answer 73

RRR is the ratio of the absolute risk reduction to the risk of the outcome in the control group)

Question 74

An alternative way to calculate the | RRR _____

Answer 74

is to subtract the RR from 1 (i.e. RRR = 1 - RR ).

Question 75

_______ is probably the most commonly reported measure of treatment effects but the _____ gives a more realistic picture

Answer 75

RRR ARR

Question 76

_____ The probability that an event (death or disease) will occur.

Answer 76

Risk (R)

Question 77

_______The likelihood of a difference between two groups being real. It is the possibility that the difference occurred by chance alone.

Answer 77

Statistical significance

Question 78

_____error occurs when a study | concludes that there is a difference between two groups when there is no difference

Answer 78

A type I

Question 79

occurs when a study concludes that no difference exists between groups when there is a true difference

Answer 79

Type II error

Question 80

Questions to ask in critical appraisal

Answer 80

1 What were the objectives of the study? 2 Were the ethical aspects properly followed? 3 What was the study design? 4 Were there any potential problems associated with the design

Question 81

Questions to ask in critical appraisal

Answer 81

5 Were all the patients who entered the study properly accounted for at its conclusion? 6 What were the important results? 7 How would you interpret and explain these results?