EBPP FINAL (MODULE 3)

What are the components of a research paper?

Title

Author's names, credentials, and affiliation

Abstract

Introduction

Methods

Results

Discussion

Conclusion

References

Disclosure of conflicting interest

Disclosure of funding source

When analyzing a research paper what info can be gathered from the abstract?

A brief summary of what's going on in the paper

Wterm-1hen analyzing a research paper what info can be gathered from the author's names, credentials, affiliations and conflict of interest?

Allows reader to get a perception of author(s)

When analyzing a research paper what info can be gathered from the funding source?

Potential biases if source has potential benefit

What should you look for when evaluating the purpose of the introduction?

Clear intention

Identifiable investigated variables

Identifiable primary and secondary outcomes

Identifiable population studied

What should you look for when evaluating the hypotheses and research questions of the introduction?

Alignment with intended purpose

Variables Identified

One hypothesis and question per dependent variable

What should you look for when evaluating research design in methods section?

Alignment with purpose

Appropriateness

Use of control or comparison group

Researchers are blind to participants' assignments

Limited extraneous variables

What should you look for when evaluating sample in methods section?

Description of population that sample represents

Appropriate sampling frame

Clear and appropriate inclusion and exclusion criteria

Randomness of participant assignment to treatment vs control/comparison groups

Sufficient sample size

Sample size calculation discussed

Drop-out rate computed into sample size

What should you look for when evaluating research protocol in methods section?

Thorough and detailed description of protocol

Protocol followed appropriately

Study continued long enough

Protocol consistency administered

Steps to control extraneous variables

Ethical protocol approved by Institutional Review Board (IRB)

What should you look for when evaluating data collection in methods section?

Appropriate collection methods

Procedures consistently applied to participants

High level validity and reliability of collection instrument

High level reliability of collectors

What should you look for when evaluating sample in results section?

Similar demographics of intervention and control group or impact by lack thereof

Treatment and control similar at baseline measurement of outcome variable and impact of differences

How participants are accounted for

Comparable discontinuance rate between treatment and control group

What should you look for when evaluating data analysis in results section?

Power analysis indication

Analyzed via on-protocol (per-protocol), intention to treat (ITT), or both

Appropriate statistical analysis for level of data, hypotheses, and answer to research questions

What should you look for when evaluating findings in research section?

Relevance to hypotheses, research question, and variables

Statistically or not statistically significant

When upper and lower limits of confidence levels are enough to implement change

Practical or clinical significance

What should you look for when evaluating the discussion?

Thorough explanation of findings

Logical explanations

Comparison of findings with other studies

Identification and discussion of limitations

Implications for practice

Future recommendations

What should you look for when evaluating conclusions?

Alignment with purpose

Logically follows from findings and interpretation

How to initially assess an article?

Multiple reads

Underline important aspects (purpose, primary outcomes)

Notes for questions needing outside resources (statistics, strengths, limitations)

Reading strategies

Read title and abstract first then read 3 times

How can journal quality be determined when assessing a journal?

If it's found in databases (Pubmed, Cochrane Library, CINAHL)

Directory of Open Access Journal (DOAJ) to determine transparency and best practices in publishing

Why is peer review important when assessing a journal?

Proves that the journal went through the rigorous review process

Refereed publication

What is impact factor based on?

Frequency of articles cited by authors in other journals within the same field of study in a following year

What does a high journal citation report (JCR) signify?

Greater significant within discipline

What information does the Scrimago Journal and Country Rank (SLR) give?

Visibility of Jornals in Scopus Database

T/F: An article analyzed by the intention to treat analysis will use a method to input the data for participants that drop out early

True

1 multiple choice option

Aspects of background and overview

Study citation

purpose/background

study objective

Historical context

Study citation

Cite article with proper format

Purpose/Background

Brief description of importance study and background

Study objective

Clearly state the objective, study aim, or goal and copy directly to not change the meaning

Historical context

Other related trials prior to this study

Aspects of methods

Study design

Funding

Population

Interventions or study procedures

Outcomes

Statistical analysis

Things to consider in study design

Retrospective vs. prospective

Randomization

Blinding

Case control vs. RCT vs. meta-analysis

Superiority vs. non-inferiority

Multicenter vs. single site

etc

Funding

Disclose funding and consider potential conflicts of interest

Aspects of population in methods section

Inclusion and exclusion criteria

Inclusion criteria

List the major inclusion criteria

Exclusion criteria

List the major exclusion criteria

Consider appropriateness

Reason not needed but should be a point of discussion

Interventions or study procedures considerations

Was it active-controlled

Dose

How often it was administered

Washout period

Enrollment period to determine adherence

Randomization

Duration of intervention period

Median follow-up frame time-frame

Similar follow-up between groups

Outcomes

Primary and secondary outcomes/endpoints

Statistical analysis

Statistical tests used for eat data set

If there's a sample size calculation

Evaluation of appropriateness of statistical tests to discussion

Aspects of results

Study sample

Results

Summary

Aspects of study sample

Sample size

Baseline characteristics

Sample size

Amount of participants

Baseline characteristics

Well matched between treatment groups

Noteworthy characteristics of the sample

Results

Tables/bullet points to describe and summarize main results

Amount of dropouts and why

Results of primary and secondary outcomes

Statistical significance

Number needed to treat (NNT)

Number needed to harm (NNH)

Noteworthy adverse event rates

Summary

Key takeaways form trial

No interpretations

Aspects of Discussion and Conclusion

Evaluation of study quality

Author's discussion and conclusion

Personal discussion and conclusion

Application to patient care

Aspects of evaluation of study quality

Strengths of the study

Limitation of the study

Strengths of the study

List strengths

Examples of strengths of a study

large sample size, external validity, etc

Limitations of the study

What could be improved

what weakened overall impact

Examples of limitations of a study

internal/external validity, statistical vs. clinical significance, inclusion/exclusion criteria appropriateness

Author's discussion and conclusion

Summary of conclusion

Personal discussion and conclusion

List conclusions

Reference other articles and how their findings play a role in interpretation

Application to patient care

How information will be used in practice

Potential Background and Overview Questions

1. What are the current guideline recommendations for this particular disease state or topic?

2. If applicable, how do we stratify the severity of disease being studied (i.e. A1C for patients with diabetes, CKD stages, COPD GOLD classifications, etc.)?

3. If this is a new therapy, what is the biological rationale for why it might be useful for a particular disease state?

Potential Methods Questions

1. How do the inclusion/exclusion criteria limit the population you can apply the results to?

2. Were the patients appropriately randomized to their treatment groups? Was there stratification in the process?

3. Did the authors include a power analysis? Did enrollment achieve desired power?

4. Was everyone (patients, physicians, study personnel, etc.) blinded to treatments?

5. Was this an active controlled trial? If yes, does the active control depict the standard of care? Was it appropriately dosed?

6. Was the method used to study the primary outcome appropriate? For example, if a study is assessing agitation, was the chosen behavioral scale appropriate and validated? Have other studies assessing similar outcomes used it?

Potential Results Questions

1. How do the baseline characteristics of the population in the study compare to the disease state being studied? Did exclusion criteria eliminate outliers and patients who may be at increased harm?

2. For statistically significant results, how does the NNH compare to the NNT? Are they similar, or are the two significantly different from each other? Are these results clinically significant?

3. Was the trial long enough to detect a difference?

4. Are the potential treatment benefits worth the potential harm and costs?

Potential Discussion Questions

1. For your personal conclusions, would you change guideline recommendations based on the study? If so,how? Will this study change how you practice?

2. Would it be feasible/appropriate to apply the study to your specific institution?

3. What additional limitations would you note besides the limitations described in the study?

4. Is the population in the study similar to patients in your practice?

5. Was there any bias present in the study? Who funded the study and what was the sponsor's role in the study?

6. How would you apply this to your practice?

Descriptive statistics

statistics used to summarize the data and tables or graphs that display and communicate the observations

Scale of measurement

the precision with which a characteristic is measured

What determines the statistical methods for analyzing the data

scale of measurement

Used for the simplest level of measurement when data values fit into categories.

Nominal scales

In a mortality study, patients who die may be labeled with a 1 while those that live may be labeled with a 0. This is an example of?

dichotomous or binary observations

Dichotomous or binary

Outcome can take on only one of two values (yes or no)

Data evaluated on a nominal scale are sometimes called ___

Qualitative or categorical observations

Nominal or qualitative data are generally described in terms of ___

percentages or proportions

What is often used to display nominal data?

Contingency tables and bar charts

What section are contingency tables and bar charts found?

"Tables and Graphs for Nominal and Ordinal Data."

When should observation be measured on an ordinal scale?

When an inherent order occurs among the categories (more/greater than observations)

What type of ordered scale has observations that are ranked from highest to lowest (or vice versa)?

rank-order scale

What statistical measure may be used for an entire set of data on an ordinal scale?

median

Observations for which the differences between numbers have meaning on a numerical scale

quantitative observations

What are the two types of numerical scales?

Continuous and discrete

Which numerical scale has values on a continuum (e.g., age)?

Continuous

Which numerical scale has values equal to integers (e.g., number of fractures)?

Discrete

What are the three measures of central tendency used in medicine and epidemiology?

The mean, the median, and, to a lesser extent, the mode

T/F: All measures of central tendency used for numerical data

True

1 multiple choice option

What is the arithmetic average of the observations that is symbolized by X-bar?

Mean

What is formed by multiplying each data value by the number of observations that have that value, adding the products, and dividing the sum by the number of observations?

weighted average

What is the middle observation symbolized by M or Md?

Median

What is the value that occurs most frequently?

Mode

For frequency tables or a small number of observations, what is the mode estimated by?

modal class

What is another measure of central tendency not used as often as the arithmetic mean or the median?

geometric mean

When outliers are noticed in one direction this is known as?

Skewed distribution

What is it called when the distribution the same shape on both sides of the mean?

Symmetric distribution

mean = median

symmetric

mean > median

skewed right

mean < median

skewed left

What is used for numerical data and for symmetric distributions?

Mean

What is used for ordinal data or for numerical data if the distribution is heavily skewed?

Median

What is used primarily for ordinal data and bimodal numeric distributions?

Mode

What is generally used for observations measured on a logarithmic scale or data with moderate skewness?

Geometric mean

What is the difference between the largest and the smallest observation

Range

What is a measure of the spread of data about their mean

standard deviation

What ignores the sign of the number and is denoted by vertical bars oneach side of the number

Absolute value of a number

The name of the statistic before the square root is taken

Variance

More can be said about the percentage of observations that lay between the mean and ±2 standard deviations when the distribution is what shape?

Bell-shaped

What is the standard deviation divided by the mean times 100% known as?

Coefficient of variation

What is the percentage of a distribution that is equal to or below a particular number?

Percentile

What is a measure of variation that makes use of percentiles?

Interquartile range

What is the difference between the 25th and 75th percentiles?

first and third quartiles

What is useful to compare an individual observation with a norm?

Percentiles