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Midterm

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18 views4 pages

Midterm

Uploaded by

mpramila.sunil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Research skills 4: midterm

Lecture 1:

1. Evidence based medicine: is the integration of best research evidence with clinical
expertise and patient values
EBM can help you to check claims made by your famously or the media
EBM can help improve medical practice
Objective evidence rather than the subjective views of medical professionals
EBM can help healthcare professionals keep up to date
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of
current best evidence in making decisions about the care of individual patients."
2. The five step EBM model:
1) Formulate answerable clinical questions
2) Finding the evidence
3) Appraising the evidence
4) Applying the evidence
5) Evaluating performance
3. Limitations:
1) Sometimes the best available evidence is not available
2) Current management environment changes more rapidly than in the past, which
limits the relevance and applicability of scientific and experiential evidence that
was generated in an organizational context that was diff than today’s
3) Some managers see evidence-based practice as a tool to reduce staff expenses

Lecture 2:

1. Clinical questions are 2 main types:


1) Background >> asks about general knowledge about a condition, test or
treatment

Ask for general knowledge about a disorder

Have two essential components

A question root

A disorder / aspect of a disorder


2) Foreground >> ask for specific knowledge to inform clinical decision. These
questions typically concern a specific patient or particular population

2. The PICO process >> used in EB practice (specifically EBM) to frame and answer a
clinical or healthcare question
P= Problem, patient or population
I= Intervention
C= Comparison, control or comparator
O= Outcome

If T is the T= time period

Lecture 3:

1. What is the best study design for a diagnosis question?


Questions focused on the cause, prognosis (course), diagnosis, prevention,
treatment, or economics of health problems are best answered using quantitative
designs, whereas questions about the meaning or experience of illness are best
answered using qualitative designs.
2. Randomized control trial >> strongest design for questions of whatever healthcare
interventions are beneficial >> randomly allocating people to receive new
intervention or receive conventional intervention
Disadvantages: cost of conducting the trial, long period to follow up
3. Cohort analytic study (non-random): 2 groups to be compared (those who receive or
don’t receive)
Disadvantages: expense, time
4. Case-control (eligible patients) >>When the outcome of interest is rare or takes a
long time to develop, neither RCTs nor cohort analytic studies may be feasible. In
these circumstances, a case control design is often used.
5. Meta-analysis >>
The statistical combination of the results of >1 study, or meta-analysis, effectively
increases the sample size and results in a more precise estimate of effect than can
be obtained from any of the individual studies used in the meta-analysis.
Lecture 4:

1. Comparing the study groups:


Confidence interval (CI) or Fiducial limits >> Confidence limits are two extremes
of a measurement within which 95% observations would lie.
2. Null hypothesis (statistical hypothesis) >> we make assumption that there exist no
differences between the 2 groups
3. Alternative hypothesis (research hypothesis) >> states that there is difference
between the 2 groups
4. Error types:
• Type1 error (false positive) >> alpha error>> It is the probability of finding a
difference; when no such difference actually exists, which results in the
acceptance of an inactive compound as an active compound.

A type I error (or error of the first kind) is the incorrect rejection of a true null
hypothesis. Usually a type I error leads one to conclude that a supposed effect
or relationship exists when in fact it doesn't.(man being told he’s pregnant)

• Type2 error (false negative) >> beta error>> It is the probability of inability to
detect the difference when it actually exists, thus resulting in the rejection of an
active compound as an inactive. (A pregnant woman being told she is not
pregnant)

A type II error (or error of the second kind) is the failure to reject a false null
hypothesis.

• Type 2 error is more serious than type 1 error

5. P value>> means the probability for a given statistical model that when a null
hypothesis is true, the statistical summary would be equal to or more extreme than
the actual observed results.
It is a number calculated from the statistical test that describes how likely you are to
have found a particular set of observations if the null hypothesis were true.

Good p-value <or = 0.05

6. Outliers >> one value being very extreme from the others >> referred to as outliers
Due to mistake or due to typographical or measurement errors.
Lecture 5:

1. Critical appraisal >> process of carefully and systematically assessing the outcome
of scientific research to judge its trustworthiness, value and relevance in
particular context. (Internal validity, generalizability, relevance)
2. Relevance>> considers the importance of information for your research needs.
3. 5-and-20 rule of thumb:
5% probably leads to little bias (acceptable)
>20% possess serious threats to validity. (Not valid)

Lecture 6:

1. 2x2 table >> generally obtained by cross-classifying data from 2 binary variables
2. Risk>> refers to the probability of occurrence of an event or outcome
risk = chance of the outcome of interest/all possible outcomes.
3. Relative risk>> A measure of the risk of a certain event happening in one group
compared to the risk of the same event happening in another group.
RR=1 >> no difference
RR>1 or<1 >>difference exists
4. RRR (relative risk reduction) >> Relative risk reduction (RRR) tells you by how much
the treatment reduced the risk of bad outcomes relative to the control group who
did not have the treatment.
5. Number needed to harm (NNH) >> indicates how many patients need to be exposed
to a risk factor to cause harm in one patient who would not otherwise have been
harmed.
6. NNT= 1/ARR (proportion) or 100/ARR (%)
7. NNH= 1/ARI (proportion) or 100/ARI (%)

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