AAMC 5

Question 1

what is critical appraisal of research

Answer 1

apply rules of science and common sense in judging the quality of written articles

Question 2

6 standards for evaluating quality (FiLCHeRS)

Answer 2

Falsifiability - can the results be proven wrong (no god)
logic - are they logically coherent
comprehensiveness - evidence offered must be exhuastive, all evidence is presented and don’t ignore contrary evidence
Honesty - claim must be evaluated with an open mind and without self deception
Replicability - time and populations
Sufficiency - evidence offered must be adequate to establish truth to that claim - extrodinary claims require extrdinary evidence

Question 3

what is EBM

Answer 3

integrate clinical experience with the best available external evidence from the literature

Question 4

5 As of EBM

Answer 4

Assess: recognize and priotize problems
Ask: construct clinical question that facilitate efficicent search
Aquire: gather evidence from quality soucres
Appraise: evaluate evidence
Apply: to inidivuals, taking into account their prefs/values

Question 5

what is diff. in hypo between qual and quant

Answer 5

qual - hypo generatine

quant - hypo testing

Question 6

what diff between inductive and deductive

Answer 6

indctive (qual) - works from instance to generalize

deductive (quant) - works from the general to the particular

Question 7

3 quesions to evaluate qual research

Answer 7

1. was the design rigorous
2. was study execution rigorous
3. can I tranfer results to my setting

Question 8

7 factors to infer causal relats

Answer 8

1. chronology
2. strength of assoc.
3. dose response
4. specificity of assoc. - agent or risk only relates to this disease
5. consistency - acrsoss studies and pops
6. coherent or plausible - is there a reasonable explanation
7. cessation of exposure - if remove does it go? best for population

Question 9

5 steps of an experimental study

Answer 9

1. formal hypothesis stated
2. select people for exposure
3. sample divided into 2 groups -can be:
   a. randomized (RCT)
   b. non-randomized (quasi experimental - inferior)
4. one group given intervention while other group not
5. outcomes recorded and compared

Question 10

2 ways to administer intervention in RCT

Answer 10

single blind- participant doesn’t know

double blind - patient and researcher don’t know

Question 11

what is triple blind

Answer 11

stats person doesn’t know

Question 12

limits of RCT

Answer 12

• very controlled conditions

- often very select populations

Question 13

diff. between efficacy and effectivness

Answer 13

efficacy - impact in optimal conditions

effectiveness - impact in real world

Question 14

3 ethical considerations to RCT

Answer 14

1. unethical to deny treatment, so can’t know if one is better
2. unethical to adopt new treatment without testing before
3. unethical to continue trial if treatment is found to be good

Question 15

4 phases of intervention study

Answer 15

before - animal studies
1 - tested in small group of healthy to assess safe dose and safety/SE
2 - given to a larger group at reccomended dose to determine efficacy and safety
3 - drug given to a larger group to confirm effectiveness, monitor SE and and compare to other treatments (often mutliple RCTs)
4. post-market surveillance

Question 16

what is major problem with obs. studies

Answer 16

hard to infer causation

Question 17

2 types of obs. studies

Answer 17

1. descriptive - simply describe how thing are - usually cros sectional
2. analytical

Question 18

def. analytical study

Answer 18

• designed to test hypothesis predicting an association
• 3 types
• cross-sectional
• cohort
• case control

Question 19

def. cross sectional study

Answer 19

• subjects selected irrespecitve of presence or abscence of chars. of ineterst
• similar to descriptive, but tests assoc. hypothesis

Question 20

def. cohort study

Answer 20

group of people that can be sampled and enumerated over time that share a defining characterisitc
- usually look at people with an exposure and statrt before they have a disease

Question 21

how is cohort study analyzed

Answer 21

gives you grid and can use RR to assess (incidence in exposed/incidence in not exposed)

Question 22

main adv. of cohort

Answer 22

exposure recorded before ourcome, so can establish temporal aspect of causality

Question 23

def. case control study

Answer 23

compare group with a particular outcome to a similar group without the outcome

Question 24

how is case control analysed

Answer 24

with OR (ad/bc)

Question 25

what is problem with giving RR

Answer 25

can seem scary and increase of 100% is not a big deal in rare disease (1/100000 becomes 2/1000000)

Question 26

what is attributable risk

Answer 26

takes into account the magnitiude of risk - indicates the number of cases of a disease among exposed indivs that can be attributed to that risk

Question 27

formula for attributable risk

Answer 27

incidence in exposed - incidence in unexposed

Question 28

what is exposed attributable fraction

Answer 28

proportion of the incidence in the exposed person caused by this factor - eg. 89% of your lung CA risk is due to smoking

Question 29

formula for EAF

Answer 29

(incidence exposed-incidence unexposed)/incidence exposed

Question 30

formula for NNT

Answer 30

1/ARR

Question 31

2 general categories of bias

Answer 31

1. sampling (and non-response) | 2. measurment

Question 32

3 types of measurement bias

Answer 32

1. social desirability 2. instrument problems 3. recall bias

Question 33

what is information bias

Answer 33

objectivity of the investigator

Question 34

what is confounding

Answer 34

thrid variable fucking shit up

Question 35

what is heirarchy of evidence

Answer 35

1 - at least one proper RCT 2a - well designed controlled trials without randomization 2b - well designed cohort or case control trials, prefer more than one center 2c - multiple time series studies, with or without intervention 3 - expert opinion, descriptive studies, consensus conferences

Question 36

quesitons to ask self about research

Answer 36

1. are results valid? - study design and analysis 2. what are results? size and precision 3. can I apply to PT care? - similar PTs and env. 4. what do I do with this PT?

Question 37

4 things to consider

Answer 37

1. target population 2. intervention - feasable? time? 3. cost 4. placebo effect