Non Clinical Content

Professional Role (Non-Clinical Content)

• AANP and ANCC exams include non-clinical questions.

• AANP: Few non-clinical questions.

• ANCC: Potentially significant portion on non-clinical topics.

• Do not skip these videos.

Hierarchy of Evidence

• Pyramid structure with three levels.

Top Tier: Elite Evidence

• Meta-analyses and systematic reviews.

• Gold standard: strongest evidence.

• Combines data from multiple studies for reliable conclusions.

Middle Tier: The Action

• Controlled studies.

• Cohort studies.

• Case-control studies.

• Cross-sectional studies.

• Individual studies where researchers test hypotheses and observe outcomes.

Base Tier: Lowest Tier

• Opinions and editorials.

• Weakest level of evidence.

• Doesn't involve new research, but provides insights and perspectives.

Exam Strategy

• Distinguish between levels rather than within levels.

• Identify the lowest tier (opinions/editorials) first.

• Then, identify the highest tier (meta-analyses/systematic reviews).

• Everything else falls into the middle tier.

Commonly Confused Research Terms

Randomized Controlled Trials vs. Quasi-Experimental Designs

• Both fall into the middle tier of evidence.

• Randomized Controlled Trials (RCTs):

  • Participants are randomly assigned to treatment or placebo groups.

  • Reduces bias and systematic errors.

• Quasi-Experimental Designs:

  • Similar setup to RCTs, but without random assignment.

  • Researchers choose group assignments, which introduces bias.

Validity vs. Reliability

• Validity: "Are we truly measuring what we intended to measure?"

• Reliability: "If we run the same test again, will we get the same results?"

Independent vs. Dependent Variables

• Independent variable: The cause; the variable that is changed or manipulated.

• Dependent variable: The effect; the outcome or response that is measured.

• Example: Cholesterol-lowering drug study.

  • Independent variable: The drug.

  • Dependent variable: Cholesterol levels.

Statistical Terms

Null Hypothesis

• States there is no effect or relationship between variables.

• Researchers aim to disprove the null hypothesis.

• Example: "The new cholesterol medication has no effect on lipid levels."

P-Value

• Probability that study results occurred by chance.

• Low P-value (typically < 0.05): Statistically significant; not due to chance.

• High P-value: Results could be coincidental.

N (Sample Size)

• Uppercase N: Total number of participants or observations in a study.

• Lowercase n: Represents a smaller segment or subgroup of the total.

• Example: N = 100 total participants, divided into two groups with n = 50 each.

Sensitivity and Specificity

• Sensitivity: Ability to correctly identify individuals who have a disease (true positives). High sensitivity means good at detecting the disease.

• Specificity: Ability to correctly identify individuals who do not have the disease (true negatives). High specificity means good at ruling out the disease.

Positive and Negative Predictive Values (PPV and NPV)

• Positive Predictive Value (PPV): Likelihood that a positive test result is correct.

• Negative Predictive Value (NPV): Likelihood that a negative test result is correct.

Research Planning

Institutional Review Board (IRB)

• Reviews and approves research plans to ensure ethical standards.

• Must obtain IRB approval before data collection and major study changes.

Consent and Assent

• Consent: Clear agreement from participants who fully understand study details.

• Assent: Agreement from participants who are children or unable to fully make decisions; supplements consent from legal guardians.

Literature Review

• Understanding the existing research landscape.

• Distinguish between primary and secondary resources.

  • Primary resources: Direct sources of data.

  • Secondary resources: Analyses or summaries of primary data.

PICO Method

• Framework for crafting a research question.

• P: Patient/Population - Who are we focusing on?

• I: Intervention - What is our action plan?

• C: Comparison - What is the alternative?

• O: Outcome - What are we measuring?

• T: Time - How long will we study this?

• Example: In adults with type 2 diabetes (P), how does aerobic exercise (I) compared to no exercise (C) affect blood sugar levels (O) over six months (T)?

Genetics

Autosomal Dominant Disorders

• If one parent has the disorder, the child has a 50% chance of inheriting it.

• Example: Marfan Syndrome.

Autosomal Recessive Disorders

• Both parents must carry the gene for the child to have the disorder.

• 25% chance of having the disease.

• 50% chance of being a carrier.

• 25% chance of being unaffected.
  *Punnett Squares: Used to visualize gene combinations from parents to child.

Epidemiology

Prevalence

• Total number of existing and new cases of a disease during a specific period.

Incidence

• Number of new cases within a set timeframe.

Morbidity and Mortality

• Morbidity: Number of people affected by a disease in a population.

• Mortality: Death rates from a disease.

• Infant Mortality: Infant deaths per 1,000 live births.

Disease Occurrence

• Endemic: Consistently present in a specific area or population (e.g., malaria in tropical regions).

• Epidemic: Sudden increase in the number of cases in a community or region.

• Pandemic: Disease spreads rapidly worldwide.

Immunity Types

Active Immunity

• Develops after exposure to an antigen (e.g., vaccination).

Passive Immunity

• Temporary protection through antibodies (e.g., from mother to baby, or through treatments).

Disease Transmission

Horizontal Transmission

• Disease passes from one person to another (e.g., coughs, handshakes, sharing food).

Vertical Transmission

• Disease passes from one generation to another (e.g., mother to child during pregnancy).