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  • Question 1 - The research team is studying the effectiveness of a new treatment for a...

    Incorrect

    • The research team is studying the effectiveness of a new treatment for a certain medical condition. They have found that the brand name medication Y and its generic version Y1 have similar efficacy. They approach you for guidance on what type of analysis to conduct next. What would you suggest?

      Your Answer: Cost benefit analysis

      Correct Answer: Cost minimisation analysis

      Explanation:

      Cost minimisation analysis is employed to compare net costs when the observed effects of health care interventions are similar. To conduct this analysis, it is necessary to have clinical evidence that demonstrates the differences in health effects between alternatives are negligible of insignificant. This approach is commonly used by institutions like the National Institute for Health and Care Excellence (NICE).

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      25
      Seconds
  • Question 2 - What is the accurate formula for determining the likelihood ratio of a negative...

    Correct

    • What is the accurate formula for determining the likelihood ratio of a negative test result?

      Your Answer: (1 - sensitivity) / specificity

      Explanation:

      Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and post-test odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating post-test probabilities.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      8.2
      Seconds
  • Question 3 - Which of the following statements accurately describes relative risk? ...

    Incorrect

    • Which of the following statements accurately describes relative risk?

      Your Answer: Relative risk = 1 / odds ratio

      Correct Answer: It is the usual outcome measure of cohort studies

      Explanation:

      The relative risk is the typical measure of outcome in cohort studies. It is important to distinguish between risk and odds. For example, if 20 individuals out of 100 who take an overdose die, the risk of dying is 0.2, while the odds are 0.25 (20/80).

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      15.2
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  • Question 4 - Which type of variable does the measurement of temperature on the Kelvin scale...

    Correct

    • Which type of variable does the measurement of temperature on the Kelvin scale represent?

      Your Answer: Ratio

      Explanation:

      The distinction between interval and ratio scales is illustrated by the fact that ratio scales have a non-arbitrary zero point and meaningful ratios between values. Celsius and Fahrenheit temperature measurements are examples of interval scales, while the Kelvin scale is a ratio scale due to its zero point representing the complete absence of heat and the meaningful ratios between its values.

      Scales of Measurement in Statistics

      In the 1940s, Stanley Smith Stevens introduced four scales of measurement to categorize data variables. Knowing the scale of measurement for a variable is crucial in selecting the appropriate statistical analysis. The four scales of measurement are ratio, interval, ordinal, and nominal.

      Ratio scales are similar to interval scales, but they have true zero points. Examples of ratio scales include weight, time, and length. Interval scales measure the difference between two values, and one unit on the scale represents the same magnitude on the trait of characteristic being measured across the whole range of the scale. The Fahrenheit scale for temperature is an example of an interval scale.

      Ordinal scales categorize observed values into set categories that can be ordered, but the intervals between each value are uncertain. Examples of ordinal scales include social class, education level, and income level. Nominal scales categorize observed values into set categories that have no particular order of hierarchy. Examples of nominal scales include genotype, blood type, and political party.

      Data can also be categorized as quantitative of qualitative. Quantitative variables take on numeric values and can be further classified into discrete and continuous types. Qualitative variables do not take on numerical values and are usually names. Some qualitative variables have an inherent order in their categories and are described as ordinal. Qualitative variables are also called categorical of nominal variables. When a qualitative variable has only two categories, it is called a binary variable.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      4.1
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  • Question 5 - What value of NNT indicates the most positive result for an intervention? ...

    Correct

    • What value of NNT indicates the most positive result for an intervention?

      Your Answer: NNT = 1

      Explanation:

      An NNT of 1 indicates that every patient who receives the treatment experiences a positive outcome, while no patient in the control group experiences the same outcome. This represents an ideal outcome.

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 6 - What is the meaning of the P in the PICO model used for...

    Incorrect

    • What is the meaning of the P in the PICO model used for creating a research question?

      Your Answer: Position

      Correct Answer: Population

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      6.2
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  • Question 7 - Which option is not a type of descriptive statistic? ...

    Incorrect

    • Which option is not a type of descriptive statistic?

      Your Answer: Range

      Correct Answer: Student's t-test

      Explanation:

      A t-test is a statistical method used to determine if there is a significant difference between the means of two groups. It is a type of statistical inference.

      Types of Statistics: Descriptive and Inferential

      Statistics can be divided into two categories: descriptive and inferential. Descriptive statistics are used to describe and summarize data without making any generalizations beyond the data at hand. On the other hand, inferential statistics are used to make inferences about a population based on sample data.

      Descriptive statistics are useful for identifying patterns and trends in data. Common measures used to describe a data set include measures of central tendency (such as the mean, median, and mode) and measures of variability of dispersion (such as the standard deviation of variance).

      Inferential statistics, on the other hand, are used to make predictions of draw conclusions about a population based on sample data. These statistics are also used to determine the probability that observed differences between groups are reliable and not due to chance.

      Overall, both descriptive and inferential statistics play important roles in analyzing and interpreting data. Descriptive statistics help us understand the characteristics of a data set, while inferential statistics allow us to make predictions and draw conclusions about larger populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 8 - How can it be determined if the study on the effectiveness of a...

    Incorrect

    • How can it be determined if the study on the effectiveness of a new oral treatment for schizophrenia patients in preventing hospital admissions has yielded statistically significant results?

      Your Answer: p-value < (1 - type II error)

      Correct Answer:

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      14.1
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  • Question 9 - For a study comparing two chemotherapy regimens for small cell lung cancer patients...

    Incorrect

    • For a study comparing two chemotherapy regimens for small cell lung cancer patients based on survival time, which statistical measure is most suitable for comparison?

      Your Answer: Odds ratio

      Correct Answer: Hazard ratio

      Explanation:

      Understanding Hazard Ratio in Survival Analysis

      Survival analysis is a statistical method used to analyze the time it takes for an event of interest to occur, such as death of disease progression. In this type of analysis, the hazard ratio (HR) is a commonly used measure that is similar to the relative risk but takes into account the fact that the risk of an event may change over time.

      The hazard ratio is particularly useful in situations where the risk of an event is not constant over time, such as in medical research where patients may have different survival times of disease progression rates. It is a measure of the relative risk of an event occurring in one group compared to another, taking into account the time it takes for the event to occur.

      For example, in a study comparing the survival rates of two groups of cancer patients, the hazard ratio would be used to compare the risk of death in one group compared to the other, taking into account the time it takes for the patients to die. A hazard ratio of 1 indicates that there is no difference in the risk of death between the two groups, while a hazard ratio greater than 1 indicates that one group has a higher risk of death than the other.

      Overall, the hazard ratio is a useful tool in survival analysis that allows researchers to compare the risk of an event occurring between different groups, taking into account the time it takes for the event to occur.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      15.1
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  • Question 10 - How does the prevalence of a condition impact a particular aspect? ...

    Incorrect

    • How does the prevalence of a condition impact a particular aspect?

      Your Answer: Precision

      Correct Answer: Positive predictive value

      Explanation:

      The characteristics of precision, sensitivity, accuracy, and specificity are not influenced by the prevalence of the condition and remain stable. However, the positive predictive value is affected by the prevalence of the condition, particularly in cases where the prevalence is low. This is because a decrease in the prevalence of the condition leads to a decrease in the number of true positives, which in turn reduces the numerator of the PPV equation, resulting in a lower PPV. The formula for PPV is TP/(TP+FP).

      Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and post-test odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating post-test probabilities.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      15.3
      Seconds
  • Question 11 - A team of scientists aimed to examine the prognosis of late-onset Alzheimer's disease...

    Incorrect

    • A team of scientists aimed to examine the prognosis of late-onset Alzheimer's disease using the available evidence. They intend to arrange the evidence in a hierarchy based on their study designs.
      What study design would be placed at the top of their hierarchy?

      Your Answer: Follow up of untreated patients from randomised controlled trials

      Correct Answer: Systematic review of cohort studies

      Explanation:

      When investigating prognosis, the hierarchy of study designs starts with a systematic review of cohort studies, followed by a cohort study, follow-up of untreated patients from randomized controlled trials, case series, and expert opinion. The strength of evidence provided by a study depends on its ability to minimize bias and maximize attribution. The Agency for Healthcare Policy and Research hierarchy of study types is widely accepted as reliable, with systematic reviews and meta-analyses of randomized controlled trials at the top, followed by randomized controlled trials, non-randomized intervention studies, observational studies, and non-experimental studies.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      33.6
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  • Question 12 - A new medication aimed at preventing age-related macular degeneration (AMD) is being tested...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      26.6
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  • Question 13 - A study is conducted to investigate whether a new exercise program has any...

    Correct

    • A study is conducted to investigate whether a new exercise program has any impact on weight loss. A total of 300 participants are enrolled from various locations and are randomly assigned to either the exercise group of the control group. Weight measurements are taken at the beginning of the study and at the end of a six-month period.

      What is the most effective method of visually presenting the data?

      Your Answer: Kaplan-Meier plot

      Explanation:

      The Kaplan-Meier plot is the most effective graphical representation of survival probability. It presents the overall likelihood of an individual’s survival over time from a baseline, and the comparison of two lines on the plot can indicate whether there is a survival advantage. To determine if the distinction between the two groups is significant, a log rank test can be employed.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      1.5
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  • Question 14 - A team of scientists plans to carry out a placebo-controlled randomized trial to...

    Correct

    • A team of scientists plans to carry out a placebo-controlled randomized trial to assess the effectiveness of a new medication for treating hypertension in elderly patients. They aim to prevent patients from knowing whether they are receiving the medication of the placebo.
      What type of bias are they trying to eliminate?

      Your Answer: Performance bias

      Explanation:

      To prevent bias in the study, the researchers are implementing patient blinding to prevent performance bias, as knowledge of whether they are taking venlafaxine of a placebo, of which arm of the study they are in, could impact the patient’s behavior. Additionally, investigators must also be blinded to avoid measurement bias.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 15 - What factors affect the statistical power of a study? ...

    Correct

    • What factors affect the statistical power of a study?

      Your Answer: Sample size

      Explanation:

      A study that has a greater sample size is considered to have higher power, meaning it is capable of detecting a significant difference of effect that is clinically relevant.

      The Importance of Power in Statistical Analysis

      Power is a crucial concept in statistical analysis as it helps researchers determine the number of participants needed in a study to detect a clinically significant difference of effect. It represents the probability of correctly rejecting the null hypothesis when it is false, which means avoiding a Type II error. Power values range from 0 to 1, with 0 indicating 0% and 1 indicating 100%. A power of 0.80 is generally considered the minimum acceptable level.

      Several factors influence the power of a study, including sample size, effect size, and significance level. Larger sample sizes lead to more precise parameter estimations and increase the study’s ability to detect a significant effect. Effect size, which is determined at the beginning of a study, refers to the size of the difference between two means that leads to rejecting the null hypothesis. Finally, the significance level, also known as the alpha level, represents the probability of a Type I error. By considering these factors, researchers can optimize the power of their studies and increase the likelihood of detecting meaningful effects.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 16 - What is the calculation that the nurse performed to determine the patient's average...

    Incorrect

    • What is the calculation that the nurse performed to determine the patient's average daily calorie intake over a seven day period?

      Your Answer: Generalised mean

      Correct Answer: Arithmetic mean

      Explanation:

      You don’t need to concern yourself with the specifics of the various means. Simply keep in mind that the arithmetic mean is the one utilized in fundamental biostatistics.

      Measures of Central Tendency

      Measures of central tendency are used in descriptive statistics to summarize the middle of typical value of a data set. There are three common measures of central tendency: the mean, median, and mode.

      The median is the middle value in a data set that has been arranged in numerical order. It is not affected by outliers and is used for ordinal data. The mode is the most frequent value in a data set and is used for categorical data. The mean is calculated by adding all the values in a data set and dividing by the number of values. It is sensitive to outliers and is used for interval and ratio data.

      The appropriate measure of central tendency depends on the measurement scale of the data. For nominal and categorical data, the mode is used. For ordinal data, the median of mode is used. For interval data with a normal distribution, the mean is preferable, but the median of mode can also be used. For interval data with skewed distribution, the median is used. For ratio data, the mean is preferable, but the median of mode can also be used for skewed data.

      In addition to measures of central tendency, the range is also used to describe the spread of a data set. It is calculated by subtracting the smallest value from the largest value.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 17 - In a study of a new statin therapy for primary prevention of ischaemic...

    Incorrect

    • In a study of a new statin therapy for primary prevention of ischaemic heart disease in a diabetic population over a five year period, 1000 patients were randomly assigned to receive the new therapy and 1000 were given a placebo. The results showed that 150 patients in the placebo group had a myocardial infarction (MI) compared to 100 patients in the statin group. What is the number needed to treat (NNT) to prevent one MI in this population?

      Your Answer: 10

      Correct Answer: 20

      Explanation:

      – Treating 1000 patients with a new statin for five years prevented 50 MIs.
      – The number needed to treat (NNT) to prevent one MI is 20 (1000/50).
      – NNT provides information on treatment efficacy beyond statistical significance.
      – Based on these data, treating as few as 20 patients over five years may prevent an infarct.
      – Cost economic data can be calculated by factoring in drug costs and costs of treating and rehabilitating a patient with an MI.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
      71
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  • Question 18 - What is another term for case-mix bias? ...

    Incorrect

    • What is another term for case-mix bias?

      Your Answer: Incidence-Prevalence bias

      Correct Answer: Disease spectrum 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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 19 - What is the term used to describe the study design where a margin...

    Incorrect

    • What is the term used to describe the study design where a margin is set for the mean reduction of PANSS score, and if the confidence interval of the difference between the new drug and olanzapine falls within this margin, the trial is considered successful?

      Your Answer: Delta-controlled trial

      Correct Answer: Equivalence trial

      Explanation:

      Study Designs for New Drugs: Options and Considerations

      When launching a new drug, there are various study design options available. One common approach is a placebo-controlled trial, which can provide strong evidence but may be deemed unethical if established treatments are available. Additionally, it does not allow for a comparison with standard treatments. Therefore, statisticians must decide whether the trial aims to demonstrate superiority, equivalence, of non-inferiority to an existing treatment.

      Superiority trials may seem like the obvious choice, but they require a large sample size to show a significant benefit over an existing treatment. Equivalence trials define an equivalence margin on a specified outcome, and if the confidence interval of the difference between the two drugs falls within this margin, the drugs are assumed to have a similar effect. Non-inferiority trials are similar to equivalence trials, but only the lower confidence interval needs to fall within the equivalence margin. These trials require smaller sample sizes, and once a drug has been shown to be non-inferior, larger studies may be conducted to demonstrate superiority.

      It is important to note that drug companies may not necessarily aim to show superiority over an existing product. If they can demonstrate that their product is equivalent of even non-inferior, they may compete on price of convenience. Overall, the choice of study design depends on various factors, including ethical considerations, sample size, and the desired outcome.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 20 - What database is most suitable for finding scholarly material that has not undergone...

    Incorrect

    • What database is most suitable for finding scholarly material that has not undergone official publication?

      Your Answer: Cochrane Library

      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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 21 - A researcher wants to compare the mean age of two groups of participants...

    Incorrect

    • A researcher wants to compare the mean age of two groups of participants who were randomly assigned to either a standard exercise program of a standard exercise program + new supplement. The data collected is parametric and continuous. What is the most appropriate statistical test to use?

      Your Answer: Paired t test

      Correct Answer: Unpaired t test

      Explanation:

      The two sample unpaired t test is utilized to examine whether the null hypothesis that the two populations related to the two random samples are equivalent is true of not. When dealing with continuous data that is believed to conform to the normal distribution, a t test is suitable, making it appropriate for comparing weight loss between two groups. In contrast, a paired t test is used when the data is dependent, meaning there is a direct correlation between the values in the two samples. This could include the same subject being measured before and after a process change of at different times.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 22 - What is the term used to describe the percentage of a population's disease...

    Incorrect

    • What is the term used to describe the percentage of a population's disease that would be eradicated if their disease rate was lowered to that of the unexposed group?

      Your Answer: Population attributable risk

      Correct Answer: Attributable proportion

      Explanation:

      Disease Rates and Their Interpretation

      Disease rates are a measure of the occurrence of a disease in a population. They are used to establish causation, monitor interventions, and measure the impact of exposure on disease rates. The attributable risk is the difference in the rate of disease between the exposed and unexposed groups. It tells us what proportion of deaths in the exposed group were due to the exposure. The relative risk is the risk of an event relative to exposure. It is calculated by dividing the rate of disease in the exposed group by the rate of disease in the unexposed group. A relative risk of 1 means there is no difference between the two groups. A relative risk of <1 means that the event is less likely to occur in the exposed group, while a relative risk of >1 means that the event is more likely to occur in the exposed group. The population attributable risk is the reduction in incidence that would be observed if the population were entirely unexposed. It can be calculated by multiplying the attributable risk by the prevalence of exposure in the population. The attributable proportion is the proportion of the disease that would be eliminated in a population if its disease rate were reduced to that of the unexposed group.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 23 - Which of the following methods is most effective in eliminating of managing confounding...

    Correct

    • Which of the following methods is most effective in eliminating of managing confounding factors?

      Your Answer: Randomisation

      Explanation:

      The most effective way to eliminate of manage potential confounding factors is to randomize a large enough sample size. This approach addresses all potential confounders, regardless of whether they were measured in the study design. Matching involves pairing individuals who received a treatment of intervention with non-treated individuals who have similar observable characteristics. Post-hoc methods, such as stratification, regression analysis, and analysis of variance, can be used to evaluate the impact of known or suspected confounders.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 24 - How can the pre-test probability be expressed in another way? ...

    Incorrect

    • How can the pre-test probability be expressed in another way?

      Your Answer: Post test odds / (1 + post-test odds)

      Correct Answer: The prevalence of a condition

      Explanation:

      The prevalence refers to the percentage of individuals in a population who currently have a particular condition, while the incidence is the frequency at which new cases of the condition arise within a specific timeframe.

      Clinical tests are used to determine the presence of absence of a disease of condition. To interpret test results, it is important to have a working knowledge of statistics used to describe them. Two by two tables are commonly used to calculate test statistics such as sensitivity and specificity. Sensitivity refers to the proportion of people with a condition that the test correctly identifies, while specificity refers to the proportion of people without a condition that the test correctly identifies. Accuracy tells us how closely a test measures to its true value, while predictive values help us understand the likelihood of having a disease based on a positive of negative test result. Likelihood ratios combine sensitivity and specificity into a single figure that can refine our estimation of the probability of a disease being present. Pre and post-test odds and probabilities can also be calculated to better understand the likelihood of having a disease before and after a test is carried out. Fagan’s nomogram is a useful tool for calculating post-test probabilities.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 25 - Researchers have conducted a study comparing a new blood pressure medication with a...

    Incorrect

    • Researchers have conducted a study comparing a new blood pressure medication with a standard blood pressure medication. 200 patients are divided equally between the two groups. Over the course of one year, 20 patients in the treatment group experienced a significant reduction in blood pressure, compared to 35 patients in the control group.

      What is the number needed to treat (NNT)?

      Your Answer: 15

      Correct Answer: 7

      Explanation:

      The Relative Risk Reduction (RRR) is calculated by subtracting the experimental event rate (EER) from the control event rate (CER), dividing the result by the CER, and then multiplying by 100 to get a percentage. In this case, the RRR is (35-20)÷35 = 0.4285 of 42.85%.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 26 - What is a true statement about statistical power? ...

    Correct

    • What is a true statement about statistical power?

      Your Answer: The larger the sample size of a study the greater the power

      Explanation:

      The Importance of Power in Statistical Analysis

      Power is a crucial concept in statistical analysis as it helps researchers determine the number of participants needed in a study to detect a clinically significant difference of effect. It represents the probability of correctly rejecting the null hypothesis when it is false, which means avoiding a Type II error. Power values range from 0 to 1, with 0 indicating 0% and 1 indicating 100%. A power of 0.80 is generally considered the minimum acceptable level.

      Several factors influence the power of a study, including sample size, effect size, and significance level. Larger sample sizes lead to more precise parameter estimations and increase the study’s ability to detect a significant effect. Effect size, which is determined at the beginning of a study, refers to the size of the difference between two means that leads to rejecting the null hypothesis. Finally, the significance level, also known as the alpha level, represents the probability of a Type I error. By considering these factors, researchers can optimize the power of their studies and increase the likelihood of detecting meaningful effects.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 27 - What is the standardized score (z-score) for a woman whose haemoglobin concentration is...

    Correct

    • What is the standardized score (z-score) for a woman whose haemoglobin concentration is 150 g/L, given that the mean haemoglobin concentration for healthy women is 135 g/L and the standard deviation is 15 g/L?

      Your Answer: 1

      Explanation:

      Z Scores: A Special Application of Transformation Rules

      Z scores are a unique way of measuring how much and in which direction an item deviates from the mean of its distribution, expressed in units of its standard deviation. To calculate the z score for an observation x from a population with mean and standard deviation, we use the formula z = (x – mean) / standard deviation. For example, if our observation is 150 and the mean and standard deviation are 135 and 15, respectively, then the z score would be 1.0. Z scores are a useful tool for comparing observations from different distributions and for identifying outliers.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 28 - What is the term used to describe how a person's age affects their...

    Incorrect

    • What is the term used to describe how a person's age affects their likelihood of reporting past exposure to a certain risk factor?

      Your Answer: Observer bias

      Correct Answer: Recall bias

      Explanation:

      Recall bias pertains to how a person’s illness status can influence their tendency to report past exposure to a risk factor. Confounding arises when an additional variable is associated with both an independent and dependent variable. Observer bias refers to the possibility that researchers’ cognitive biases may unconsciously impact the results of a study. Publication bias refers to the tendency for studies with positive results to be more likely to be published. Selection bias occurs when certain individuals of groups are overrepresented, leading to inadequate randomization.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 29 - A new treatment for elderly patients with hypertension is investigated. The study looks...

    Incorrect

    • 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: 4

      Correct 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.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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  • Question 30 - What is the appropriate denominator for calculating cumulative incidence? ...

    Incorrect

    • What is the appropriate denominator for calculating cumulative incidence?

      Your Answer: The number of cases in a defined population at a specified point in time

      Correct Answer: The number of disease free people at the beginning of a specified time period

      Explanation:

      Measures of Disease Frequency: Incidence and Prevalence

      Incidence and prevalence are two important measures of disease frequency. Incidence measures the speed at which new cases of a disease are emerging, while prevalence measures the burden of disease within a population. Cumulative incidence and incidence rate are two types of incidence measures, while point prevalence and period prevalence are two types of prevalence measures.

      Cumulative incidence is the average risk of getting a disease over a certain period of time, while incidence rate is a measure of the speed at which new cases are emerging. Prevalence is a proportion and is a measure of the burden of disease within a population. Point prevalence measures the number of cases in a defined population at a specific point in time, while period prevalence measures the number of identified cases during a specified period of time.

      It is important to note that prevalence is equal to incidence multiplied by the duration of the condition. In chronic diseases, the prevalence is much greater than the incidence. The incidence rate is stated in units of person-time, while cumulative incidence is always a proportion. When describing cumulative incidence, it is necessary to give the follow-up period over which the risk is estimated. In acute diseases, the prevalence and incidence may be similar, while for conditions such as the common cold, the incidence may be greater than the prevalence.

      Incidence is a useful measure to study disease etiology and risk factors, while prevalence is useful for health resource planning. Understanding these measures of disease frequency is important for public health professionals and researchers in order to effectively monitor and address the burden of disease within populations.

    • This question is part of the following fields:

      • Research Methods, Statistics, Critical Review And Evidence-Based Practice
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