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Question 1
Correct
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Which of the following is an example of selection bias?
Your Answer: Berkson's bias
Explanation:Types of Bias in Statistics
Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.
There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 2
Correct
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Which of the following statements accurately describes the standard error of the mean?
Your Answer: Gets smaller as the sample size increases
Explanation:As the sample size (n) increases, the standard error of the mean (SEM) decreases. This is because the SEM is inversely proportional to the square root of the sample size (n). As n gets larger, the denominator of the SEM equation gets larger, causing the overall value of the SEM to decrease. This means that larger sample sizes provide more accurate estimates of the population mean, as the calculated sample mean is expected to be closer to the true population mean.
Measures of dispersion are used to indicate the variation of spread of a data set, often in conjunction with a measure of central tendency such as the mean of median. The range, which is the difference between the largest and smallest value, is the simplest measure of dispersion. The interquartile range, which is the difference between the 3rd and 1st quartiles, is another useful measure. Quartiles divide a data set into quarters, and the interquartile range can provide additional information about the spread of the data. However, to get a more representative idea of spread, measures such as the variance and standard deviation are needed. The variance gives an indication of how much the items in the data set vary from the mean, while the standard deviation reflects the distribution of individual scores around their mean. The standard deviation is expressed in the same units as the data set and can be used to indicate how confident we are that data points lie within a particular range. The standard error of the mean is an inferential statistic used to estimate the population mean and is a measure of the spread expected for the mean of the observations. Confidence intervals are often presented alongside sample results such as the mean value, indicating a range that is likely to contain the true value.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 3
Incorrect
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Which of the following is not a method used in qualitative research to evaluate validity?
Your Answer: Reflexivity
Correct Answer: Content analysis
Explanation:Qualitative research is a method of inquiry that seeks to understand the meaning and experience dimensions of human lives and social worlds. There are different approaches to qualitative research, such as ethnography, phenomenology, and grounded theory, each with its own purpose, role of the researcher, stages of research, and method of data analysis. The most common methods used in healthcare research are interviews and focus groups. Sampling techniques include convenience sampling, purposive sampling, quota sampling, snowball sampling, and case study sampling. Sample size can be determined by data saturation, which occurs when new categories, themes, of explanations stop emerging from the data. Validity can be assessed through triangulation, respondent validation, bracketing, and reflexivity. Analytical approaches include content analysis and constant comparison.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 4
Correct
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What is the appropriate denominator to use when computing the sample variance?
Your Answer: n-1
Explanation:Measures of dispersion are used to indicate the variation of spread of a data set, often in conjunction with a measure of central tendency such as the mean of median. The range, which is the difference between the largest and smallest value, is the simplest measure of dispersion. The interquartile range, which is the difference between the 3rd and 1st quartiles, is another useful measure. Quartiles divide a data set into quarters, and the interquartile range can provide additional information about the spread of the data. However, to get a more representative idea of spread, measures such as the variance and standard deviation are needed. The variance gives an indication of how much the items in the data set vary from the mean, while the standard deviation reflects the distribution of individual scores around their mean. The standard deviation is expressed in the same units as the data set and can be used to indicate how confident we are that data points lie within a particular range. The standard error of the mean is an inferential statistic used to estimate the population mean and is a measure of the spread expected for the mean of the observations. Confidence intervals are often presented alongside sample results such as the mean value, indicating a range that is likely to contain the true value.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 5
Incorrect
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What is a true statement about standardised mortality ratios?
Your Answer: An SMR is the expected mortality divided by the observed mortality in a sample population
Correct Answer: Direct standardisation requires that we know the age-specific rates of mortality in all the populations under study
Explanation:Calculation of Standardised Mortality Ratio (SMR)
To calculate the SMR, age and sex-specific death rates in the standard population are obtained. An estimate for the number of people in each category for both the standard and study populations is needed. The number of expected deaths in each age-sex group of the study population is calculated by multiplying the age-sex-specific rates in the standard population by the number of people in each category of the study population. The sum of all age- and sex-specific expected deaths gives the expected number of deaths for the whole study population. The observed number of deaths is then divided by the expected number of deaths to obtain the SMR.
The SMR can be standardised using the direct of indirect method. The direct method is used when the age-sex-specific rates for the study population and the age-sex-structure of the standard population are known. The indirect method is used when the age-specific rates for the study population are unknown of not available. This method uses the observed number of deaths in the study population and compares it to the number of deaths that would be expected if the age distribution was the same as that of the standard population.
The SMR can be interpreted as follows: an SMR less than 1.0 indicates fewer than expected deaths in the study population, an SMR of 1.0 indicates the number of observed deaths equals the number of expected deaths in the study population, and an SMR greater than 1.0 indicates more than expected deaths in the study population (excess deaths). It is sometimes expressed after multiplying by 100.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 6
Correct
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Which of the following statements accurately describes the normal distribution?
Your Answer: Mean = mode = median
Explanation:The Normal distribution is a probability distribution that is continuous in nature.
Standard Deviation and Standard Error of the Mean
Standard deviation (SD) and standard error of the mean (SEM) are two important statistical measures used to describe data. SD is a measure of how much the data varies, while SEM is a measure of how precisely we know the true mean of the population. The normal distribution, also known as the Gaussian distribution, is a symmetrical bell-shaped curve that describes the spread of many biological and clinical measurements.
68.3% of the data lies within 1 SD of the mean, 95.4% of the data lies within 2 SD of the mean, and 99.7% of the data lies within 3 SD of the mean. The SD is calculated by taking the square root of the variance and is expressed in the same units as the data set. A low SD indicates that data points tend to be very close to the mean.
On the other hand, SEM is an inferential statistic that quantifies the precision of the mean. It is expressed in the same units as the data and is calculated by dividing the SD of the sample mean by the square root of the sample size. The SEM gets smaller as the sample size increases, and it takes into account both the value of the SD and the sample size.
Both SD and SEM are important measures in statistical analysis, and they are used to calculate confidence intervals and test hypotheses. While SD quantifies scatter, SEM quantifies precision, and both are essential in understanding and interpreting data.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 7
Correct
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A masters student had noticed that nearly all of her patients with arthritis were over the age of 50. She was keen to investigate this further to see if there was an association.
She selected 100 patients with arthritis and 100 controls. of the 100 patients with arthritis, 90 were over the age of 50. of the 100 controls, only 40 were over the age of 50.
What is the odds ratio?Your Answer: 3.77
Explanation:The odds of being married are 3.77 times higher in individuals with panic disorder compared to controls.
Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 8
Correct
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What is a true statement about searching in PubMed?
Your Answer: Truncation is generally not a recommended search technique for PubMed
Explanation:Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.
When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.
There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 9
Incorrect
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Which of the following is not considered a crucial factor according to Wilson and Junger when implementing a screening program?
Your Answer: There should be agreed policy on whom to treat
Correct Answer: The condition should be potentially curable
Explanation:Wilson and Junger Criteria for Screening
1. The condition should be an important public health problem.
2. There should be an acceptable treatment for patients with recognised disease.
3. Facilities for diagnosis and treatment should be available.
4. There should be a recognised latent of early symptomatic stage.
5. The natural history of the condition, including its development from latent to declared disease should be adequately understood.
6. There should be a suitable test of examination.
7. The test of examination should be acceptable to the population.
8. There should be agreed policy on whom to treat.
9. The cost of case-finding (including diagnosis and subsequent treatment of patients) should be economically balanced in relation to the possible expenditure as a whole.
10. Case-finding should be a continuous process and not a ‘once and for all’ project.The Wilson and Junger criteria provide a framework for evaluating the suitability of a screening program for a particular condition. The criteria emphasize the importance of the condition as a public health problem, the availability of effective treatment, and the feasibility of diagnosis and treatment. Additionally, the criteria highlight the importance of understanding the natural history of the condition and the need for a suitable test of examination that is acceptable to the population. The criteria also stress the importance of having agreed policies on whom to treat and ensuring that the cost of case-finding is economically balanced. Finally, the criteria emphasize that case-finding should be a continuous process rather than a one-time project. By considering these criteria, public health officials can determine whether a screening program is appropriate for a particular condition and ensure that resources are used effectively.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 10
Correct
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Which of the following statements accurately describes the features of a distribution that is negatively skewed?
Your Answer: Mean < median < mode
Explanation:Skewed Data: Understanding the Relationship between Mean, Median, and Mode
When analyzing a data set, it is important to consider the shape of the distribution. In a normally distributed data set, the curve is symmetrical and bell-shaped, with the median, mode, and mean all equal. However, in skewed data sets, the distribution is asymmetrical, with the bulk of the data concentrated on one side of the figure.
In a negatively skewed distribution, the left tail is longer, and the bulk of the data is concentrated to the right of the figure. In contrast, a positively skewed distribution has a longer right tail, with the bulk of the data concentrated to the left of the figure. In both cases, the median is positioned between the mode and the mean, as it represents the halfway point of the distribution.
However, the mean is affected by extreme values of outliers, causing it to move away from the median in the direction of the tail. In positively skewed data, the mean is greater than the median, which is greater than the mode. In negatively skewed data, the mode is greater than the median, which is greater than the mean.
Understanding the relationship between mean, median, and mode in skewed data sets is crucial for accurate data analysis and interpretation. By recognizing the shape of the distribution, researchers can make informed decisions about which measures of central tendency to use and how to interpret their results.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 11
Incorrect
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What term is used to describe an association between two variables that is influenced by a confounding factor?
Your Answer: Spurious
Correct Answer: Indirect
Explanation:Stats Association and Causation
When two variables are found to be more commonly present together, they are said to be associated. However, this association can be of three types: spurious, indirect, of direct. Spurious association is one that has arisen by chance and is not real, while indirect association is due to the presence of another factor, known as a confounding variable. Direct association, on the other hand, is a true association not linked by a third variable.
Once an association has been established, the next question is whether it is causal. To determine causation, the Bradford Hill Causal Criteria are used. These criteria include strength, temporality, specificity, coherence, and consistency. The stronger the association, the more likely it is to be truly causal. Temporality refers to whether the exposure precedes the outcome. Specificity asks whether the suspected cause is associated with a specific outcome of disease. Coherence refers to whether the association fits with other biological knowledge. Finally, consistency asks whether the same association is found in many studies.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 12
Correct
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A new treatment for elderly patients with hypertension is investigated. The study looks at the incidence of stroke after 1 year. The following data is obtained:
Number who had a stroke vs Number without a stroke
New drug: 40 vs 160
Placebo: 100 vs 300
What is the relative risk reduction?Your Answer: 20%
Explanation:Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 13
Incorrect
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A new medication aimed at preventing age-related macular degeneration (AMD) is being tested in clinical trials. One hundred patients over the age of 60 with early signs of AMD are given the new medication. Over a three month period, 10 of these patients experience progression of their AMD. In the control group, there are 300 patients over the age of 60 with early signs of AMD who are given a placebo. During the same time period, 50 of these patients experience progression of their AMD. What is the relative risk of AMD progression while taking the new medication?
Your Answer: 0.06
Correct Answer: 0.6
Explanation:The relative risk (RR) is calculated by dividing the exposure event rate (EER) by the control event rate (CER). In this case, the EER is 10 out of 100 (0.10) and the CER is 50 out of 300 (0.166). Therefore, the RR is calculated as 0.10 divided by 0.166, which equals 0.6.
Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 14
Incorrect
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What is the most suitable statistical test to compare the calcium levels of males and females who developed inflammatory bowel disease in childhood, considering that calcium levels in this population are normally distributed?
Your Answer: Mann-Whitney test
Correct Answer: Unpaired t-test
Explanation:The appropriate statistical test for the research question of comparing calcium levels between two unrelated groups is an unpaired/independent t-test, as the data is parametric and the samples are independent. This means that the scores of one group do not affect the other, and there is no meaningful way to pair them.
Dependent samples, on the other hand, are related to each other and can occur in two scenarios. One scenario is when a group is measured twice, such as in a pretest-posttest situation. The other scenario is when an observation in one sample is matched with an observation in the second sample.
For example, if quality inspectors want to compare two laboratories to determine whether their blood tests give similar results, they would need to use a paired t-test. This is because both labs tested blood specimens from the same 10 children, making the test results dependent. The paired t-test is based on the assumption that samples are dependent.
Choosing the right statistical test can be challenging, but understanding the basic principles can help. Different tests have different assumptions, and using the wrong one can lead to inaccurate results. To identify the appropriate test, a flow chart can be used based on three main factors: the type of dependent variable, the type of data, and whether the groups/samples are independent of dependent. It is important to know which tests are parametric and non-parametric, as well as their alternatives. For example, the chi-squared test is used to assess differences in categorical variables and is non-parametric, while Pearson’s correlation coefficient measures linear correlation between two variables and is parametric. T-tests are used to compare means between two groups, and ANOVA is used to compare means between more than two groups. Non-parametric equivalents to ANOVA include the Kruskal-Wallis analysis of ranks, the Median test, Friedman’s two-way analysis of variance, and Cochran Q test. Understanding these tests and their assumptions can help researchers choose the appropriate statistical test for their data.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 15
Incorrect
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What is the optimal number needed to treat (NNT)?
Your Answer: ∞
Correct Answer: 1
Explanation:The effectiveness of a healthcare intervention, usually a medication, is measured by the number needed to treat (NNT). This represents the average number of patients who must receive treatment to prevent one additional negative outcome. An NNT of 1 would indicate that all treated patients improved while none of the control patients did, which is the ideal scenario. The NNT can be calculated by taking the inverse of the absolute risk reduction. A higher NNT indicates a less effective treatment, with the range of NNT being from 1 to infinity.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 16
Incorrect
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Which of the following is not a factor considered when determining causality?
Your Answer: Specificity
Correct Answer: Sensitivity
Explanation:Stats Association and Causation
When two variables are found to be more commonly present together, they are said to be associated. However, this association can be of three types: spurious, indirect, of direct. Spurious association is one that has arisen by chance and is not real, while indirect association is due to the presence of another factor, known as a confounding variable. Direct association, on the other hand, is a true association not linked by a third variable.
Once an association has been established, the next question is whether it is causal. To determine causation, the Bradford Hill Causal Criteria are used. These criteria include strength, temporality, specificity, coherence, and consistency. The stronger the association, the more likely it is to be truly causal. Temporality refers to whether the exposure precedes the outcome. Specificity asks whether the suspected cause is associated with a specific outcome of disease. Coherence refers to whether the association fits with other biological knowledge. Finally, consistency asks whether the same association is found in many studies.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 17
Incorrect
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What is the typical measure of outcome in a case-control study investigating the potential association between autism and a recently developed varicella vaccine?
Your Answer: Relative risk
Correct Answer: Odds ratio
Explanation:The odds ratio is used in case-control studies to measure the association between exposure and outcome, while the relative risk is used in cohort studies to measure the risk of developing an outcome in the exposed group compared to the unexposed group. To convert the odds ratio to a relative risk, one can use the formula: relative risk = odds ratio / (1 – incidence in the unexposed group x odds ratio).
Types of Primary Research Studies and Their Advantages and Disadvantages
Primary research studies can be categorized into six types based on the research question they aim to address. The best type of study for each question type is listed in the table below. There are two main types of study design: experimental and observational. Experimental studies involve an intervention, while observational studies do not. The advantages and disadvantages of each study type are summarized in the table below.
Type of Question Best Type of Study
Therapy Randomized controlled trial (RCT), cohort, case control, case series
Diagnosis Cohort studies with comparison to gold standard test
Prognosis Cohort studies, case control, case series
Etiology/Harm RCT, cohort studies, case control, case series
Prevention RCT, cohort studies, case control, case series
Cost Economic analysisStudy Type Advantages Disadvantages
Randomized Controlled Trial – Unbiased distribution of confounders – Blinding more likely – Randomization facilitates statistical analysis – Expensive – Time-consuming – Volunteer bias – Ethically problematic at times
Cohort Study – Ethically safe – Subjects can be matched – Can establish timing and directionality of events – Eligibility criteria and outcome assessments can be standardized – Administratively easier and cheaper than RCT – Controls may be difficult to identify – Exposure may be linked to a hidden confounder – Blinding is difficult – Randomization not present – For rare disease, large sample sizes of long follow-up necessary
Case-Control Study – Quick and cheap – Only feasible method for very rare disorders of those with long lag between exposure and outcome – Fewer subjects needed than cross-sectional studies – Reliance on recall of records to determine exposure status – Confounders – Selection of control groups is difficult – Potential bias: recall, selection
Cross-Sectional Survey – Cheap and simple – Ethically safe – Establishes association at most, not causality – Recall bias susceptibility – Confounders may be unequally distributed – Neyman bias – Group sizes may be unequal
Ecological Study – Cheap and simple – Ethically safe – Ecological fallacy (when relationships which exist for groups are assumed to also be true for individuals)In conclusion, the choice of study type depends on the research question being addressed. Each study type has its own advantages and disadvantages, and researchers should carefully consider these when designing their studies.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 18
Incorrect
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What is a characteristic of skewed data?
Your Answer: For skewed data the mean is always positioned between the mode and the median
Correct Answer: For positively skewed data the mean is greater than the mode
Explanation:Skewed Data: Understanding the Relationship between Mean, Median, and Mode
When analyzing a data set, it is important to consider the shape of the distribution. In a normally distributed data set, the curve is symmetrical and bell-shaped, with the median, mode, and mean all equal. However, in skewed data sets, the distribution is asymmetrical, with the bulk of the data concentrated on one side of the figure.
In a negatively skewed distribution, the left tail is longer, and the bulk of the data is concentrated to the right of the figure. In contrast, a positively skewed distribution has a longer right tail, with the bulk of the data concentrated to the left of the figure. In both cases, the median is positioned between the mode and the mean, as it represents the halfway point of the distribution.
However, the mean is affected by extreme values of outliers, causing it to move away from the median in the direction of the tail. In positively skewed data, the mean is greater than the median, which is greater than the mode. In negatively skewed data, the mode is greater than the median, which is greater than the mean.
Understanding the relationship between mean, median, and mode in skewed data sets is crucial for accurate data analysis and interpretation. By recognizing the shape of the distribution, researchers can make informed decisions about which measures of central tendency to use and how to interpret their results.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 19
Incorrect
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How do the odds of excessive drinking differ between patients with liver cirrhosis and those without cirrhosis?
Your Answer: 4
Correct Answer: 16
Explanation:Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 20
Incorrect
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When conducting a literature review, it is advisable to do the following:
Your Answer: Attempt to restrict searching to just one database
Correct Answer: Include grey literature
Explanation:When conducting a literature review, it is important to broaden your search beyond traditional academic sources. This means including grey literature, such as reports, conference proceedings, and government documents. Additionally, it is crucial to consider both primary and secondary sources of evidence, as they can provide different perspectives and insights on your research topic. To ensure a comprehensive review, it is recommended to use multiple databases and search engines, rather than relying on a single source.
Evidence-based medicine involves four basic steps: developing a focused clinical question, searching for the best evidence, critically appraising the evidence, and applying the evidence and evaluating the outcome. When developing a question, it is important to understand the difference between background and foreground questions. Background questions are general questions about conditions, illnesses, syndromes, and pathophysiology, while foreground questions are more often about issues of care. The PICO system is often used to define the components of a foreground question: patient group of interest, intervention of interest, comparison, and primary outcome.
When searching for evidence, it is important to have a basic understanding of the types of evidence and sources of information. Scientific literature is divided into two basic categories: primary (empirical research) and secondary (interpretation and analysis of primary sources). Unfiltered sources are large databases of articles that have not been pre-screened for quality, while filtered resources summarize and appraise evidence from several studies.
There are several databases and search engines that can be used to search for evidence, including Medline and PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, and OpenGrey. Boolean logic can be used to combine search terms in PubMed, and phrase searching and truncation can also be used. Medical Subject Headings (MeSH) are used by indexers to describe articles for MEDLINE records, and the MeSH Database is like a thesaurus that enables exploration of this vocabulary.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 21
Incorrect
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What is a true statement about correlation?
Your Answer: Correlation can take any value between 0-10
Correct Answer: Complete absence of correlation is expressed by a value of 0
Explanation:Stats: Correlation and Regression
Correlation and regression are related but not interchangeable terms. Correlation is used to test for association between variables, while regression is used to predict values of dependent variables from independent variables. Correlation can be linear, non-linear, of non-existent, and can be strong, moderate, of weak. The strength of a linear relationship is measured by the correlation coefficient, which can be positive of negative and ranges from very weak to very strong. However, the interpretation of a correlation coefficient depends on the context and purposes. Correlation can suggest association but cannot prove of disprove causation. Linear regression, on the other hand, can be used to predict how much one variable changes when a second variable is changed. Scatter graphs are used in correlation and regression analyses to visually determine if variables are associated and to detect outliers. When constructing a scatter graph, the dependent variable is typically placed on the vertical axis and the independent variable on the horizontal axis.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 22
Correct
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What is the term used to describe the likelihood of correctly rejecting the null hypothesis when it is actually false?
Your Answer: Power of the test
Explanation:Understanding Hypothesis Testing in Statistics
In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.
The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.
Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.
P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 23
Incorrect
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Which category does convenience sampling fall under?
Your Answer: Cluster sampling
Correct Answer: Non-probabilistic sampling
Explanation:Sampling Methods in Statistics
When collecting data from a population, it is often impractical and unnecessary to gather information from every single member. Instead, taking a sample is preferred. However, it is crucial that the sample accurately represents the population from which it is drawn. There are two main types of sampling methods: probability (random) sampling and non-probability (non-random) sampling.
Non-probability sampling methods, also known as judgement samples, are based on human choice rather than random selection. These samples are convenient and cheaper than probability sampling methods. Examples of non-probability sampling methods include voluntary sampling, convenience sampling, snowball sampling, and quota sampling.
Probability sampling methods give a more representative sample of the population than non-probability sampling. In each probability sampling technique, each population element has a known (non-zero) chance of being selected for the sample. Examples of probability sampling methods include simple random sampling, systematic sampling, cluster sampling, stratified sampling, and multistage sampling.
Simple random sampling is a sample in which every member of the population has an equal chance of being chosen. Systematic sampling involves selecting every kth member of the population. Cluster sampling involves dividing a population into separate groups (called clusters) and selecting a random sample of clusters. Stratified sampling involves dividing a population into groups (strata) and taking a random sample from each strata. Multistage sampling is a more complex method that involves several stages and combines two of more sampling methods.
Overall, probability sampling methods give a more representative sample of the population, but non-probability sampling methods are often more convenient and cheaper. It is important to choose the appropriate sampling method based on the research question and available resources.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 24
Incorrect
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What database is most suitable for finding scholarly material that has not undergone official publication?
Your Answer: EMBASE
Correct Answer: SIGLE
Explanation:SIGLE is a database that contains unpublished of ‘grey’ literature, while CINAHL is a database that focuses on healthcare and biomedical journal articles. The Cochrane Library is a collection of databases that includes the Cochrane Reviews, which are systematic reviews and meta-analyses of medical research. EMBASE is a pharmacological and biomedical database, and PsycINFO is a database of abstracts from psychological literature that is created by the American Psychological Association.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 25
Correct
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Which type of bias is the second phase of the study intended to address if the second phase involved home visits to those people who did not reply to the mailed questionnaire on levels of physical activity in adults aged 50 and above?
Your Answer: Participation bias
Explanation:Types of Bias in Statistics
Bias is a systematic error that can lead to incorrect conclusions. Confounding factors are variables that are associated with both the outcome and the exposure but have no causative role. Confounding can be addressed in the design and analysis stage of a study. The main method of controlling confounding in the analysis phase is stratification analysis. The main methods used in the design stage are matching, randomization, and restriction of participants.
There are two main types of bias: selection bias and information bias. Selection bias occurs when the selected sample is not a representative sample of the reference population. Disease spectrum bias, self-selection bias, participation bias, incidence-prevalence bias, exclusion bias, publication of dissemination bias, citation bias, and Berkson’s bias are all subtypes of selection bias. Information bias occurs when gathered information about exposure, outcome, of both is not correct and there was an error in measurement. Detection bias, recall bias, lead time bias, interviewer/observer bias, verification and work-up bias, Hawthorne effect, and ecological fallacy are all subtypes of information bias.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 26
Incorrect
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A new clinical trial has found a correlation between alcohol consumption and lung cancer. Considering the well-known link between alcohol consumption and smoking, what is the most probable explanation for this new association?
Your Answer: Bias
Correct Answer: Confounding
Explanation:The observed link between alcohol consumption and lung cancer is likely due to confounding factors, such as cigarette smoking. Confounding variables are those that are associated with both the independent and dependent variables, in this case, alcohol consumption and lung cancer.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 27
Incorrect
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What is the likelihood of weight gain when a patient is prescribed risperidone, given that 6 out of 10 patients experience weight gain as a side effect?
Your Answer: 1.6
Correct Answer: 1.5
Explanation:1. The odds of an event happening are calculated by dividing the number of times it occurs by the number of times it does not occur.
2. The odds of an event happening in a given situation are 6 to 4.
3. This translates to a ratio of 1.5, meaning the event is more likely to happen than not.
4. The risk of the event happening is calculated by dividing the number of times it occurs by the total number of possible outcomes.
5. In this case, the risk of the event happening is 6 out of 10.Measures of Effect in Clinical Studies
When conducting clinical studies, we often want to know the effect of treatments of exposures on health outcomes. Measures of effect are used in randomized controlled trials (RCTs) and include the odds ratio (of), risk ratio (RR), risk difference (RD), and number needed to treat (NNT). Dichotomous (binary) outcome data are common in clinical trials, where the outcome for each participant is one of two possibilities, such as dead of alive, of clinical improvement of no improvement.
To understand the difference between of and RR, it’s important to know the difference between risks and odds. Risk is a proportion that describes the probability of a health outcome occurring, while odds is a ratio that compares the probability of an event occurring to the probability of it not occurring. Absolute risk is the basic risk, while risk difference is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group. Relative risk is the ratio of risk in the intervention group to the risk in the control group.
The number needed to treat (NNT) is the number of patients who need to be treated for one to benefit. Odds are calculated by dividing the number of times an event happens by the number of times it does not happen. The odds ratio is the odds of an outcome given a particular exposure versus the odds of an outcome in the absence of the exposure. It is commonly used in case-control studies and can also be used in cross-sectional and cohort study designs. An odds ratio of 1 indicates no difference in risk between the two groups, while an odds ratio >1 indicates an increased risk and an odds ratio <1 indicates a reduced risk.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 28
Incorrect
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What is a criterion used to evaluate the quality of reporting in randomized controlled trials?
Your Answer: MOOSE
Correct Answer: CONSORT
Explanation:As an AI language model, I do not have personal opinions of beliefs. However, I can provide information and guidance on the standards of reporting for different types of research studies. The guidelines mentioned above are essential for ensuring that research studies are reported accurately and transparently, which is crucial for the scientific community to evaluate and replicate the findings. It is important for researchers to be familiar with these standards and follow them when reporting their studies to ensure the quality and integrity of their research.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 29
Incorrect
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Which of the following would make the use of the unpaired t-test inappropriate for comparing the mean ages of two groups of participants?
Your Answer: Unequal sample sizes in both groups
Correct Answer: Non-normal distribution of data
Explanation:The t test is limited to parametric data that follows a normal distribution. However, inadequate statistical power due to a small sample size does not necessarily invalidate the t test results. While it is likely that a small sample size may not reveal any significant differences, it is still possible that large differences may be observed regardless of prior power calculations.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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Question 30
Correct
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What is the term used to describe the point at which a researcher chooses to reject a null hypothesis?
Your Answer: Alpha level
Explanation:If the p-value is lower than the predetermined alpha level of 0.05, the outcome is considered significant.
Understanding Hypothesis Testing in Statistics
In statistics, it is not feasible to investigate hypotheses on entire populations. Therefore, researchers take samples and use them to make estimates about the population they are drawn from. However, this leads to uncertainty as there is no guarantee that the sample taken will be truly representative of the population, resulting in potential errors. Statistical hypothesis testing is the process used to determine if claims from samples to populations can be made and with what certainty.
The null hypothesis (Ho) is the claim that there is no real difference between two groups, while the alternative hypothesis (H1 of Ha) suggests that any difference is due to some non-random chance. The alternative hypothesis can be one-tailed of two-tailed, depending on whether it seeks to establish a difference of a change in one direction.
Two types of errors may occur when testing the null hypothesis: Type I and Type II errors. Type I error occurs when the null hypothesis is rejected when it is true, while Type II error occurs when the null hypothesis is accepted when it is false. The power of a study is the probability of correctly rejecting the null hypothesis when it is false, and it can be increased by increasing the sample size.
P-values provide information on statistical significance and help researchers decide if study results have occurred due to chance. The p-value is the probability of obtaining a result that is as large of larger when in reality there is no difference between two groups. The cutoff for the p-value is called the significance level (alpha level), typically set at 0.05. If the p-value is less than the cutoff, the null hypothesis is rejected, and if it is greater or equal to the cut off, the null hypothesis is not rejected. However, the p-value does not indicate clinical significance, which may be too small to be meaningful.
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This question is part of the following fields:
- Research Methods, Statistics, Critical Review And Evidence-Based Practice
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