Literature Eval Midterm Practice
(94).webp "Literature Eval Midterm Practice - Quiz")
Compilation of quiz and softchalk questions.
- 1.
What are the ultimate goals of medicine?
- A.
Improve health
- B.
Improve quality of life
- C.
Reduce cholesterol
- D.
Improve quantity of life
- E.
Save health care dollars
Correct Answer(s)
B. Improve quality of life
D. Improve quantity of lifeExplanation
Ultimately, the purpose of medicine comes down to two goals - improving quality and quantity of life. (Intro to EBP softchalk)Rate this question:
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- 2.
Evidence-based practice gives us the tools we need to know if the diagnostic tests and treatments we give actually contribute to achieving our ultimate goals.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
(Intro to EBP softchalk)Rate this question:
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- 3.
Which of the following are steps in the evidence-based approach to answering questions? Choose all that apply.
- A.
Applying evidence to the patient case.
- B.
Defining the question
- C.
Critically appraising the evidence
- D.
Searching PubMed
- E.
Assessing study size and power
Correct Answer(s)
A. Applying evidence to the patient case.
B. Defining the question
C. Critically appraising the evidenceExplanation
(Course Assessment #1) The evidence-based approach to answering questions includes 4 steps: 1.) define the question, 2.) Systematically search the literature, 3.) Critically appraise the evidence, and 4.) Apply the evidence to the patient or case.Rate this question:
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- 4.
Evidence-based practice is defined by three components. Select the three components of evidence-based practice.
- A.
Systematic searching
- B.
Clinical experience
- C.
The best available evidence
- D.
The most current evidence
- E.
Randomized controlled trials
Correct Answer(s)
A. Systematic searching
B. Clinical experience
C. The best available evidenceExplanation
(Course Assessment #1) The three components of evidence-based practice are using the best available evidence identified through systematic searching and using that evidence in combination with clinical experience.Rate this question:
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- 5.
Which of the following are components of a well-built clinical question? Choose all that apply.
- A.
Patient or Problem
- B.
Patient Prognosis
- C.
Intervention or treatment
- D.
Outcomes
- E.
Comparison
Correct Answer(s)
A. Patient or Problem
C. Intervention or treatment
D. Outcomes
E. ComparisonExplanation
(Course Assessment #1) PICO is an acronym we can use to help us define a well-built question. P=Patient or problem I = Intervention or treatment C = Comparison O = OutcomesRate this question:
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- 6.
Which of the following is not a low level question?
- A.
Is lithium available as an oral solution?
- B.
What are the storage requirements for dabigatran?
- C.
Does the evidence support the use of montelukast for migraine prevention?
- D.
What are the FDA-approved indications for gabapentin?
Correct Answer
C. Does the evidence support the use of montelukast for migraine prevention?Explanation
(Course Assessment #1) This is a high level question related to the therapeutic efficacy of montelukast. The other options are low level questions related to drug product availability, storage, and indications.Rate this question:
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- 7.
Setting filters on a search increases the number of results retrieved.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
(Course Assessment #1) Adding filters to a search decreases the number of results retrieved. This allows the searcher to zero in on the most relevant information to answer the question.Rate this question:
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- 8.
Systematic searching is important because it... (choose all that apply):
- A.
Ensures that we look for the right kind of information to answer the question.
- B.
Allows us to cherry pick evidence.
- C.
Helps us know when to stop searching.
- D.
Improves our efficiency in identifying evidence.
Correct Answer(s)
A. Ensures that we look for the right kind of information to answer the question.
C. Helps us know when to stop searching.
D. Improves our efficiency in identifying evidence.Explanation
(Course Assessment #1) Systematic searching is important because it ensures that we look for the right kind of information to answer the question, helps us know when to stop searching, improves our efficiency in identifying evidence, and prevents us from cherry-picking evidence.Rate this question:
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- 9.
You are conducting a systematic search in PubMed to identify guidelines for the treatment of prostate cancer. Which of the following filters would NOT be appropriate.
- A.
Article type: Randomized Controlled Trial
- B.
Language: English
- C.
Species: Human
- D.
Article Type: Practice Guideline
Correct Answer
A. Article type: Randomized Controlled TrialExplanation
(Course Assessment #1) Filtering this search to randomized controlled trials would not allow you to efficiently and effectively identify guidelines for treating prostate cancer. Adding filters for English language, human subjects, and practice guidelines would be appropriate in this case.Rate this question:
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- 10.
You are writing a review article on HMG-CoA reductase inhibitors (statins) and need to gather clinical trials evaluating their efficacy. You are particularly interested in determining which, if any, of the statins have a mortality benefit in secondary prevention. After conducting your search and setting your filters you read through the article abstracts and choose only those studies which assessed patient mortality as an outcome. Thus, studies looking at mortality would meet your ___________ criteria.
- A.
Inclusion
- B.
Exclusion
- C.
Evidence
- D.
Cherry-picking
Correct Answer
A. InclusionExplanation
(Course Assessment #1) In order to further narrow a search after defining search terms and setting filters it is important to select appropriate inclusion and exclusion criteria. In this case, you are "including" articles that met a specific "criteria" (in this case mortality as a study outcome), hence the term "inclusion criteria".Rate this question:
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- 11.
Which of the following outcomes would be considered patient-oriented evidence?
- A.
HbA1c
- B.
Kidney failure
- C.
Hamilton D Rating Scale
- D.
LDL levels
- E.
Stroke
Correct Answer(s)
B. Kidney failure
C. Hamilton D Rating Scale
E. StrokeExplanation
(Course Assessment #1) Patient oriented outcomes are those that patients notice and care about. Kidney failure and stroke are serious conditions that significantly impact a patients quality of life. Similarly, the Hamilton-D rating scale measures symptoms of depression - another measure of how a patient feels.Rate this question:
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- 12.
Which of the following is NOT an experimental study design?
- A.
Crossover Study
- B.
Cohort Study
- C.
Randomized Controlled Trial
Correct Answer
B. Cohort StudyExplanation
(Course Assessment #1) Cohort studies is an example of a population or observational study. The others are experimental designs.Rate this question:
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- 13.
For most clinical questions regarding drug therapies, the most relevant research design is usually a:
- A.
Randomized controlled trial
- B.
Population Study
- C.
Cohort study
- D.
Case study
Correct Answer
A. Randomized controlled trialExplanation
(Course Assessment #1) Randomized controlled trials are typically preferred for evaluating therapies because they are capable of showing cause-and-effect. Other study designs are not capable of showing cause-and-effect.Rate this question:
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- 14.
Which of the following is included in "the big three" validity assessments?
- A.
Was patient allocation adequately concealed?
- B.
Were groups similar at baseline?
- C.
Was a per-protocol or intention to treat analysis used?
- D.
Were patients in each group treated similarly?
Correct Answer
A. Was patient allocation adequately concealed?Explanation
Allocation concealment is one of the big three validity measures, in addition to randomization and blinding.Rate this question:
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- 15.
For most clinical questions regarding diagnosis, the most relevant research design is a:
- A.
Prospective, blinded comparison to gold standard
- B.
Cohort Study
- C.
Case Control
- D.
Randomized controlled trial
Correct Answer
A. Prospective, blinded comparison to gold standardExplanation
(Assessing Relevance softchalk)Rate this question:
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- 16.
The preferred study type for a prognosis is:
- A.
Cohort study
- B.
Randomized controlled trial
- C.
Meta analysis
- D.
Public survey
Correct Answer
A. Cohort studyExplanation
(Assessing Relevance softchalk)Rate this question:
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- 17.
Randomized control trials are the best source when searching for information on harm and/or etiology.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
(Assessing Relevance softchalk)Rate this question:
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- 18.
Which of the following is a threat to validity? Choose all that apply.
- A.
Selection bias
- B.
Crossover study design
- C.
Financial conflict of interest
- D.
Confounding
- E.
Chance
Correct Answer(s)
A. Selection bias
D. Confounding
E. ChanceExplanation
(Course Assessment #1) Each of these factors (chance, confounding, and selection bias), can potentially invalidate study findings. Financial conflict of interest may prompt you to examine the study more closely, but is not evidence of bias in the study's design or conduct. Crossover study design does not inherently impact the validity of a trial.Rate this question:
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- 19.
In a randomized, double-blind clinical trial, researchers were evaluating patients to determine the effect of Zombrex on mortality compared to placebo. At baseline, 45% of the patients in the treatment group were considered obese. In the placebo group, 25% were considered to be obese. Based on this information, this study is at risk for which threat to validity?
- A.
Confounding
- B.
Measurement bias
- C.
Expectation bias
- D.
Analysis bias
Correct Answer
A. ConfoundingExplanation
(Course Assessment #1) Confounding is a concern because obesity is linked to mortality outcomes and it is occurring at a higher rate in one group than in another.Rate this question:
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- 20.
Which of the following is an appropriate method for random allocation?
- A.
Flipping a coin
- B.
Drawing straws
- C.
Assignment based on eye color
- D.
Drawing numbers from a hat
Correct Answer
A. Flipping a coinExplanation
(Course Assessment #1) Any random process such as flipping a coin is appropriate for randomization. The other methods listed cannot ensure a random result.Rate this question:
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- 21.
Which of the following is an adequate method for concealing allocation?
- A.
Third party random sequence assignment
- B.
Random allocation
- C.
Using a matching placebo treatment
- D.
Flipping a coin
Correct Answer
A. Third party random sequence assignmentExplanation
(Course Assessment #1) Using a third party, which separates the process of enrollment and randomization, is appropriate for allocation concealment.Rate this question:
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- 22.
Studies with larger sample populations are more likely to have good external validity or generalizability.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
(Course Assessment #1) Larger studies are more generalizable than smaller studies.Rate this question:
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- 23.
Which of the following are examples of mid-level questions? (Select all that apply):
- A.
Adverse drug reaction
- B.
Dosing
- C.
Indications
- D.
Formulations
- E.
Drug interactions
- F.
Tablet ID
- G.
Pharmacology
- H.
Storage
- I.
Pregnancy and lactation
- J.
Compatibility
- K.
Compounding
- L.
Natural products
Correct Answer(s)
A. Adverse drug reaction
E. Drug interactions
I. Pregnancy and lactation
J. Compatibility
K. Compounding
L. Natural productsExplanation
(Systematic Search softchalk)Rate this question:
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- 24.
What are the important questions to ask when assessing relevance?
- A.
What is the study type or research design?
- B.
Is the study capable of adequately addressing the question?
- C.
What is the therapy or intervention being studied? Is it feasible?
- D.
What is the primary outcome of the study? Is it disease oriented or patient oriented?
- E.
Was allocation adequately concealed?
- F.
Is the outcome measure apporpriate to adequately answer the question?
- G.
Were patients in the study randomly allocated?
Correct Answer(s)
A. What is the study type or research design?
B. Is the study capable of adequately addressing the question?
C. What is the therapy or intervention being studied? Is it feasible?
D. What is the primary outcome of the study? Is it disease oriented or patient oriented?
F. Is the outcome measure apporpriate to adequately answer the question?Explanation
(Assessing Relevance softchalk) Random allocation and adequately concealing allocation is used when assessing validity, NOT relevance.Rate this question:
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- 25.
Review the following abstract and select the primary outcome below: Coenzyme Q10 (CoQ10) deficiency has been proposed to be causal in 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitor (statin)-induced myopathies. However, the clinical benefit of supplementation is unproved. The purpose of the present study was to assess the effect of CoQ10 supplementation on myalgias presumed to be caused by statins. Patients currently receiving a statin who developed new-onset myalgias in ≥ 2 extremities within 60 days of initiation or a dosage increase were eligible. Patients continued statin therapy and were randomized using a matched design to either CoQ10 60 mg twice daily or matching placebo. Double-blind treatment continued for 3 months, and patients completed a 10-cm visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire at baseline and at each monthly visit. The primary end point was the comparison of the VAS score at 1 month. A total of 76 patients were enrolled (40 in the CoQ10 arm and 36 in the placebo arm). The mean VAS score was 6 cm at baseline in both groups. At 1 month, no difference was seen in the mean VAS score between the 2 groups (3.9 cm in the CoQ10 group and 4 cm in the placebo group; p = 0.97). However, 5 patients in the CoQ10 group and 3 in the placebo group discontinued therapy during the first month because of myalgias. The baseline median score on the Sensory Pain Rating Index subscale was 10 in the CoQ10 group and 11.5 in the placebo group. At 1 month, these scores had decreased to 6.5 and 7.5, respectively, with no statistically significant difference (p = 0.34). In conclusion, CoQ10 did not produce a greater response than placebo in the treatment of presumed statin-induced myalgias.What was the primary outcome?
- A.
VAS Score at 1 month
- B.
McGill Pain Questionaire
- C.
Sensory Pain Rating Index at baseline
- D.
Statin-induced myalgia
Correct Answer
A. VAS Score at 1 monthExplanation
(Assessing Results softchalk) The VAS is a commonly used way to measure pain. It is quick and simple. The abstract specifically states that this was the primary endpoint.Rate this question:
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- 26.
A P value of 0.05 means that there is a 5% probability that an observed difference is actually due to chance. Similarly, there is a 95% probability that the observed difference represents a true difference that is not due to chance.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
(Assessing Results softchalk) As the P value gets smaller, the smaller probability there is that an observed difference is solely due to chance.Rate this question:
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- 27.
P value tells us the direction of the difference (better or worse, higher or lower, etc) and it tells us the strength or magnitude of the treatment effect.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
(assessing results softchalk) P vale does not tell us either of these things.Rate this question:
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- 28.
Read the abstract below. Which of the following is true about the finding related to the primary outcome? Coenzyme Q10 (CoQ10) deficiency has been proposed to be causal in 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitor (statin)-induced myopathies. However, the clinical benefit of supplementation is unproved. The purpose of the present study was to assess the effect of CoQ10 supplementation on myalgias presumed to be caused by statins. Patients currently receiving a statin who developed new-onset myalgias in ≥ 2 extremities within 60 days of initiation or a dosage increase were eligible. Patients continued statin therapy and were randomized using a matched design to either CoQ10 60 mg twice daily or matching placebo. Double-blind treatment continued for 3 months, and patients completed a 10-cm visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire at baseline and at each monthly visit. The primary end point was the comparison of the VAS score at 1 month. A total of 76 patients were enrolled (40 in the CoQ10 arm and 36 in the placebo arm). The mean VAS score was 6 cm at baseline in both groups. At 1 month, no difference was seen in the mean VAS score between the 2 groups (3.9 cm in the CoQ10 group and 4 cm in the placebo group; p = 0.97). However, 5 patients in the CoQ10 group and 3 in the placebo group discontinued therapy during the first month because of myalgias. The baseline median score on the Sensory Pain Rating Index subscale was 10 in the CoQ10 group and 11.5 in the placebo group. At 1 month, these scores had decreased to 6.5 and 7.5, respectively, with no statistically significant difference (p = 0.34). In conclusion, CoQ10 did not produce a greater response than placebo in the treatment of presumed statin-induced myalgias.
- A.
The difference is not statistically significant.
- B.
There is a statistically significant difference.
- C.
The difference is statistically significant, but not clinically significant.
- D.
The difference is clinically significant, but not statistically significant.
Correct Answer
A. The difference is not statistically significant.Explanation
(assessing results softchalk) The P value is 0.97 for the primary outcome of VAS. This is a p value > 0.05 which means that it is not statistically significant.Rate this question:
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- 29.
Confidence intervals can tell us if results are statistically significant just like a P value. They can also give us a much more descriptive picture of the true treatment effects.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
(Assessing results softchalk)Rate this question:
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- 30.
A study provides results for the relative risk of myocardial infarction in patients receiving drug X: 95% CI = 0.75 (0.6-0.93)What is the relative risk for myocardial infarction?
Correct Answer
0.75
.75Explanation
(Assessing results softchalk)Rate this question:
- 31.
A study provides results for the relative risk of myocardial infarction in patients receiving drug X: 95% CI = 0.75 (0.6-0.93)Drug X appears to reduce the risk of myocardial infarction somewhere in the range of: ___-___%
Correct Answer
7-40
7-40%
7%-40%
40-7
40-7%
40%-7%Explanation
(Assessing results softchalk) in this example risk REDUCTION is calculated as follows:
1-0.6 = 0.4 = 40%
1-0.93 = 0.07 = 7%Rate this question:
- 32.
When there is a 1 to 1 ratio or a relative risk of "1" then there is a statistical difference
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
(assessing results softchalk) Most treatment studies assess relative risk or odds ratios. This data is expressed as percentage or ratio. For these studies, confidence intervals that cross or contain 1 are not statistically significant. This is because "1" is within the range of possibilities. When there is a 1 to 1 ratio or a relative risk of "1" then there is no differenceRate this question:
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- 33.
Review the following study abstract. Note that the primary outcome is knee pain severity as measured by the WOMAC scale. Which of the answers below correctly identifies the type of data for this outcome? OBJECTIVE:To determine whether vitamin D supplementation reduces symptom and structural progression of knee OA.DESIGN, SETTING, AND PATIENTS:A 2-year randomized, placebo-controlled, double-blind, clinical trial involving 146 participants with symptomatic knee OA (mean age, 62.4 years [SD, 8.5]; 57 women [61%], 115 white race [79%]). Patients were enrolled at Tufts Medical Center in Boston between March 2006 and June 2009.INTERVENTION:Participants were randomized to receive either placebo or oral cholecalciferol, 2000 IU/d, with dose escalation to elevate serum levels to more than 36 ng/mL.MAIN OUTCOME MEASURES:Primary outcomes were knee pain severity (Western Ontario and McMaster Universities [WOMAC] pain scale, 0-20: 0, no pain; 20, extreme pain), and cartilage volume loss measured by magnetic resonance imaging. Secondary end points included physical function, knee function (WOMAC function scale, 0-68: 0, no difficulty; 68, extreme difficulty), cartilage thickness, bone marrow lesions, and radiographic joint space width.RESULTS:Eighty-five percent of the participants completed the study. Serum 25-hydroxyvitamin D levels increased by a mean 16.1 ng/mL (95% CI, 13.7 to 18.6) in the treatment group and by a mean 2.1 mg/mL (95% CI, 0.5 to 3.7) (P < .001) in the placebo group. Baseline knee pain was slightly worse in the treatment group (mean, 6.9; 95% CI, 6.0 to 7.7) than in the placebo group (mean, 5.8; 95% CI, 5.0 to 6.6) (P = .08). Baseline knee function was significantly worse in the treatment group (mean, 22.7; 95% CI, 19.8 to 25.6) than in the placebo group (mean, 18.5; 95% CI, 15.8 to 21.2) (P = .04). Knee pain decreased in both groups by a mean -2.31 (95% CI, -3.24 to -1.38) in the treatment group and -1.46 (95% CI, -2.33 to -0.60) in the placebo group, with no significant differences at any time. The percentage of cartilage volume decreased by the same extent in both groups (mean, -4.30; 95% CI, -5.48 to -3.12 vs mean, -4.25; 95% CI, -6.12 to -2.39) (P = .96). There were no differences in any of the secondary clinical end points.CONCLUSION AND RELEVANCE: Vitamin D supplementation for 2 years at a dose sufficient to elevate 25-hydroxyvitamin D plasma levels to higher than 36 ng/mL, when compared with placebo, did not reduce knee pain or cartilage volume loss in patients with symptomatic knee OA.
- A.
Continuous
- B.
Nominal
- C.
Ordinal
- D.
Categorical
Correct Answer
A. ContinuousExplanation
(assessing results softchalk) As described in the abstract, the WOMAC scale measures pain on a scale of 0-20. This data is sequenced and has a set value distance or value between each. Another clue is that in the results section, the authors provide a mean value for the data. Mean values or averages can be calculated for continuous data. They cannot be calculated for other data types.Rate this question:
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- 34.
In a randomized, controlled trial, Phil's Heart Supplement was compared to placebo for reducing the risk of myocardial infarction in patients with existing cardiovascular disease. One hundred (100) patients received Phil's Heart Supplements and 100 patients received placebo. After 2 years of treatment, 25 patients receiving Phil's Heart Supplement experienced a myocardial infarction. In the placebo group, 35 patients experienced a myocardial infarction. The difference was statistically significant (P < 0.05).What is the probability for the treatment group and the control group?
- A.
Treatment = 25% Control = 35%
- B.
Treatment = 75% Treatment = 75% Control = 65%
- C.
Treatment = 35% Control = 25%
- D.
Treatment = 71% Control = 40%
Correct Answer
A. Treatment = 25% Control = 35%Explanation
(assessing results softchalk) To calculate probability take the number of events in a group and divide by the total number in that group. So for the treatment group, probability = 25/100 = 25%. For placebo, 35/100 = 35%Rate this question:
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- 35.
In the 4S study 4444 patients with high cholesterol and CHD were given either simvastatin or placebo. After treatment for 5.4 years the following results were found: Simvastatin group: 182 (8%) diedPlacebo group: 256 (12%) diedRR = 8% / 12% or 0.08 / 0.12 = 0.66From this we can conclude what about simvastatin and the risk of the chance of death:
- A.
Since the result is < 1, then we can determine that simvastatin reduced the risk or the chance of death.
- B.
Sine the result is < 1, then we can determine that simvastatin increased the risk or the chance of death.
- C.
There is no significant difference between groups.
- D.
We do not have enough information to answer.
Correct Answer
A. Since the result is < 1, then we can determine that simvastatin reduced the risk or the chance of death.Explanation
(assessing results softchalk) Note: RR is always expressed as a decimal, not as a percentage. When we are interpreting a RR, we look to see if that decimal is above or below 1. Then we can assess HOW MUCH it is above or below 1 by calculating the RR increase or RR decrease.Rate this question:
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- 36.
In a randomized, controlled trial, Phil's Heart Supplement was compared to placebo for reducing the risk of myocardial infarction in patients with existing cardiovascular disease. One hundred (100) patients received Phil's Heart Supplements and 100 patients received placebo. After 2 years of treatment, 25 patients receiving Phil's Heart Supplement experienced a myocardial infarction. In the placebo group, 35 patients experienced a myocardial infarction. The difference was statistically significant (P < 0.05).Calculate the the relative risk of myocardial infarction and select the correct answer below.
- A.
0.71
- B.
1.4
- C.
0.69
- D.
0.61
Correct Answer
A. 0.71Explanation
(assessing results softchalk) Relative risk is probability in the treatment group divided by probability in the control group. In this question, RR = 25/35 = 0.71Rate this question:
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- 37.
In a randomized, controlled trial, Phil's Heart Supplement was compared to placebo for reducing the risk of myocardial infarction in patients with existing cardiovascular disease. One hundred (100) patients received Phil's Heart Supplements and 100 patients received placebo. After 2 years of treatment, 25 patients receiving Phil's Heart Supplement experienced a myocardial infarction. In the placebo group, 35 patients experienced a myocardial infarction. The difference was statistically significant (P < 0.05). Calculate the the relative risk reduction or increase for myocardial infarction and select the correct answer below.
- A.
29% reduction
- B.
39% increase
- C.
71% reduction
- D.
39% reduction
Correct Answer
A. 29% reductionExplanation
(assessing results softchalk) RRR or RRI is calculation by determining how far above or below 1 the RR is. In this example, we are calculating a RRR because the RR is below one. RRR = 1-0.71 = 29%Rate this question:
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- 38.
In a randomized, controlled trial, Phil's Heart Supplement was compared to placebo for reducing the risk of myocardial infarction in patients with existing cardiovascular disease. One hundred (100) patients received Phil's Heart Supplements and 100 patients received placebo. After 2 years of treatment, 25 patients receiving Phil's Heart Supplement experienced a myocardial infarction. In the placebo group, 35 patients experienced a myocardial infarction. The difference was statistically significant (P < 0.05). Calculate the the absolute difference for myocardial infarction and select the correct answer below.
- A.
10%
- B.
4%
- C.
0.71
- D.
29%
Correct Answer
A. 10%Explanation
(assessing results softchalk) Absolute difference is probability in one group minus probability in the other. In this case, AD = 35% - 25% = 10%. Remember AD has no + or - associated with it.Rate this question:
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- 39.
In a clinical trial, a new drug for hypertension was compared to an ACE inhibitor for preventing stroke. The study found no statistically significant difference between the two drugs. Both p values and confidence intervals were reported in the study. Which of the following statements is TRUE? Select all that apply.
- A.
The P value was ≥ 0.05
- B.
The confidence interval included the number 1.
- C.
The power of the study should be determined.
- D.
If power was inadequate, there is a risk for type 2 error.
Correct Answer(s)
A. The P value was ≥ 0.05
B. The confidence interval included the number 1.
C. The power of the study should be determined.
D. If power was inadequate, there is a risk for type 2 error.Explanation
(course assessment #2) All answers are correct. When there is no significant difference involving a binomial outcome, P is >0.05, CIs include 1, and the power should be checked (for all negative primary outcomes).Rate this question:
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- 40.
In a study, 100 people were treated with vitamin D and 100 people received placebo control during the flu season. The researchers wanted to determine if vitamin D treated was associated with the risk of developing the flu. In the vitamin D group 22 patients developed the flu. In the placebo group, 29 patients developed the flu. The finding was statistically significant with a p < 0.05. Calculate the number needed to treat.
- A.
14
- B.
7%
- C.
4
- D.
Cannot be calculated with the values given.
Correct Answer
A. 14Explanation
(Course assessment #2) NNT = 100/AD. In this case the absolute difference is 7%. 100/7 = 14.Rate this question:
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- 41.
Which of the following should be used to determine the clinical significance of a study finding?
- A.
Relative risk reduction
- B.
P value < 0.05
- C.
Study power
- D.
Confidence interval crosses zero
Correct Answer
A. Relative risk reductionExplanation
(Course assessment #2) Relative risk tells us information about the size of the treatment effect. This can therefore tell us whether the observed difference is clinically meaningful.Rate this question:
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- 42.
In a study, 100 people were treated with vitamin D and 100 people received placebo control during the flu season. The researchers wanted to determine if vitamin D treated was associated with the risk of developing the flu. In the vitamin D group 22 patients developed the flu. In the placebo group, 29 patients developed the flu. The finding was statistically significant with a p < 0.05. Which of the following is TRUE?
- A.
Vitamin D is reducing the risk of flu compared to placebo.
- B.
Vitamin D is increasing the risk of flu compared to placebo.
- C.
The relative risk reduction is 24%.
- D.
The relative risk increase is 76%.
- E.
The absolute difference is 7%.
Correct Answer(s)
A. Vitamin D is reducing the risk of flu compared to placebo.
C. The relative risk reduction is 24%.
E. The absolute difference is 7%.Explanation
(Course Assessment #2) The probability of flu in the two groups is 29% (control) and 22% (treatment). Therefore, vitamin D reduced risk of flu compared to control. AD = 7%; RRR = 24%.Rate this question:
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- 43.
When a clinical trial provides a hazard ratio for the primary outcome, it is appropriate to also calculate the relative risk.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
(Course assessment #2) It doesn't make sense to calculate a Relative Risk when a Hazard Ratio is provided because the Hazard Ratio is more informative than a simple Relative Risk.Rate this question:
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- 44.
In a study using a time-to-event analysis and measuring healing rates, the hazard ratio gives the odds that a patient receiving treatment will heal faster than a patient receiving placebo. What additional information does the median ratio give?
- A.
How much faster healing occurred with treatment compared to placebo
- B.
The relative risk of healing faster
- C.
The probability of healing faster with treatment compared to placebo
- D.
The median ratio cannot be used with time-to-event analyses
Correct Answer
A. How much faster healing occurred with treatment compared to placeboExplanation
(Course assessment #2) The median ratio gives information on how much faster healing might occur.Rate this question:
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- 45.
Most of us feel more comfortable interpreting relative risk than odds ratio; however, in some study designs, a relative risk cannot be used. Which study design cannot use a relative risk calculation to estimate risk?
- A.
Case control study
- B.
Cohort study
- C.
RTC
- D.
Cross sectional study
Correct Answer
A. Case control studyExplanation
(course assessment #2) Relative risk cannot be used with case-control studies because participants are selected based on an outcome rather than an exposure.Rate this question:
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- 46.
When deciding how to use the findings of a clinical trial, which of the following should be considered?
- A.
Validity of the evidence
- B.
Clinical significance of the findings
- C.
Risk versus benefit
- D.
All the above
Correct Answer
D. All the aboveExplanation
(course assessment #2) All of these factors should be considered in making a determination about whether a study's findings should change our practice.Rate this question:
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- 47.
Practice guidelines in the United States use the same evidence-grading system, so an evidence rating of 2C can be universally applied across all guidelines.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
(course assessment #2) Practice guidelines use a wide variety of evidence-grading systems to grade their recommendations. A rating of 2C in one guideline may be based on different criteria than a 2C rating in another guideline.Rate this question:
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- 48.
From top to bottom, which of the following is in the correct order with regard to the hierarchy of evidence?
- A.
Systematic Reviews, Randomized Controlled Trials, Cohort Studies, Expert Opinion
- B.
Cohort Studies, Systematic Reviews, Expert Opinion, Randomized Controlled Trials
- C.
Randomized Controlled Trials, Cohort Studies, Systematic Reviews, Expert Opinion
- D.
Expert Opinion, Randomized Controlled Trials, Systematic Reviews, Cohort Studies
Correct Answer
A. Systematic Reviews, Randomized Controlled Trials, Cohort Studies, Expert OpinionExplanation
(course assessment #2) Evidence at the top of the hierarchy is generally of higher quality and has more authority than evidence at the bottom. The hierarchy of evidence from top to bottom follows: systematic reviews and meta-analyses, randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, case series, case reports, editorials, and expert opinion.Rate this question:
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- 49.
A physician asks you about the interaction between proton pump inhibitors and clopidogrel. After researching the question, you make a recommendation to the physician to use rabeprazole 20mg daily in his patient. You base your recommendation on a handful of conflicting studies that use patient-oriented evidence. Most trials agree that rabeprazole is a safe and effective option, but they don't all agree. Based on the kind of evidence used, what SORT rating would you give this recommendation?
- A.
B
- B.
A
- C.
C
Correct Answer
A. BExplanation
(Course assessment #2) A SORT rating of B is given when the evidence supporting the recommendation is inconsistent or limited quality patient oriented evidence.Rate this question:
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- 50.
A patient comes to your pharmacy and asks if the supplement SAM-e will help with her fibromyalgia symptoms. You do some research and find that a few limited quality trials with patient oriented evidence found SAM-e to be beneficial for reducing fibromyalgia symptoms. You recommend that the patient give SAM-e a try. True or False: You should tell the patient that your recommendation has an evidence rating of B.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
(course assessment #2) Grading evidence is done to better communicate the confidence of specific recommendations to healthcare professionals. Including an evidence rating when discussing therapy with a patient would likely lead to confusion.Rate this question:
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Current Version
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Mar 06, 2024Quiz Edited by
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Feb 18, 2017Quiz Created by
Ashleynecole
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