Flashcards
evidence-based interventions 2
Flashcards do conjunto (21)
- 1difference between efficacy and effectiveness- Refers to the patient group
- Efficacy: trial in "high-scoring" sample, in efficacy trials you try to find if something is possible
- Effectiveness: trial in clinical practice, it includes participants with all kinds of characteristics - 2Where do i find guidlines how to CONDUCT trials?SPIRIT provides the standards
- 3hierarchy of evidence- Lowest: Case report/ case series (also expert opinion
- 2nd Lowest: Case controll study: e.g. teacher with a class: on monday rewarding good behavior, on tuesday acting normally, on wednesday punishing bad behavior, and then back to rewarding (to set up a controlled experiment, in which you can pbserve one child and how it behaves under different conditions)
- 3rd lowest: Cohort studies: randomization is not fully possible
- 3rd highest: RCT way to establish causality
- 2nd highest: SR summary search, qualitative summary of rcts
- Highest: meta analysis, quantitative summary of rcts - 4bias- systematic deviation from the truth that distorts the results of research
- a) Common sources of a bias: selection bias (low external validity), intervention bias, follow up bias, measurement bias, information bias
- b) Bias is an issue of study design and in order to decrease bias one has to identify possible areas that could be affected and change the design accordingly. Possible ways to decrease different bias are randomisation, single- or double-blind experiments, repeated measures, training of the researcher etc. - 5Confounding- Situation in which the effects of two processes are not separated so that the apparent effect is not the true effect and our interpretation of the result is likely to be faulty (pitfall in all kind of observational research).
- a. Confounding can partially be controlled in either the design or analytical phase of the study.
a.i. In design phase: Selection of the subjects improves internal validity, but limits generalisability. Matching subjects with the same value of the confounder preserves generalisability but is irreversible and should only be used for controlling very strong confounders.
a.ii. In analysis phase: Stratification means grouping of subjects with similar characteristics/levels of a confounder, and relation exposure-outcome within each stratum estimated separately (leaving low numbers in some strata due to limited simultaneously controlling of confounders). Statistical modelling enables adjustment for several confounders simultaneously (using multiple linear/logistic regression).
b. Effects of confounders in observational studies do not diminish with increasing n - 6Chance- can create very different groups even though they have been randomised. The effect of chance can be diminished by recruiting larger numbers of by adjustment for known confounders in the analysis.
- 7Aim of evaluative studies1. Aim of evaluative studies is comparison: Determine the existence and strength of a possible association between exposure/intervention and outcome.
- 82. Experimental studies for studying new treatments:2. Experimental studies for studying new treatments: RCT’s are seen as gold standard. Expensive and may lack generalisability because of exclusion criteria.
- 93. Experimental non-RCTs/community trials3. Experimental units are assigned non-randomly to different types of services (often externally but not internally valid; e.g. study design: North Staffordshire Trauma centre trial)
- 104. RCT’s not always best method4. RCT’s may be:
- Unnecessary (effects of intervention are dramatic; likelihood of confounders small),
- Inappropriate (rarely large enough to measure accurately infrequent outcomes; for events that occur in the future),
- Impossible (e.g. ethically unacceptable), - Inadequate (usually internal but lack external validity). - 11Observational studies- No controlling of treatment but making valid comparisons between people with/without diseases or between those naturally exposed/unexposed to a factor of interest.
- 12Case-control studiesComparison between people with/without diseases in i.o.t. identify differences in previous exposures to identify the cause of the event
- 13Problem of observational studies- Internal validity may be undermined by
unrecognised confounding factors. - 14Qualitative research may be useful- a) In preliminary stages of research before quantitative research can begin
- b) To supplement quantitative methods.
- c) Provide explanations of unexpected findings in quantitative data. - 15Review- General term for all attempts to synthesise the results and conclusions of
separately conducted studies
on a given topic - 16Spirit 2013Standard Protocol Items: Recommendations for
Interventional Trial - 17clinical trialstudy where you test one or more health related interventions on human
participants, hoping to find a successful effect for someone’s health. - 18current evaluative systems for evidence-based psychotherapies have a significant weakness:- they focus on evidence of data support for (psycho)therapeutic packages while ignoring whether there is any evidence for the proposed theory –
this:
(a) allows pseudoscientific interventions to enter classification schemes o
(b) biases the scientific research in a dangerous direction (claiming a treatment as efficacious while it’s not based on the correct theory) - 19There are two levels in the analysis of evidence supporting psychological treatments:1. The psychological theory
concerning therapeutic change (e.g. mechanisms of change) should be scientifically evaluated
2. The therapeutic
package
(psychological treatment) is derived from the theory
about the mechanism of change and
should be
scientifically evaluated - 20factors:1. Theory (factor): the mechanism of change – the hypothesized psychological
factors involved in pathology and health which are targeted by the therapeutic package
2. Therapeutic package
(factor) - 21Each factor is organized by three levels:- Empirically well supported: there is evidence of beneficial data
o
Equivocal/ No clear data
:
((a) not yet being collected, (b) preliminary data (PD) less
than minimum standards, (c) mixed
–
both supporting and contradictory evidence)
o
Strong contradictory evidence
(SCE)
:
invalidating evidence
>
evidence of absence of
benefit (inert) and/or evidence of harm (malfeasanc
Informações
- Descrição
- FlashCards sobre evidence-based interventions 2, criado por Adrian Mayer em 09-10-2020.
- Criado por
- Adrian Mayer · out 2020
- Atualizado
- 27 out 2020
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