Week 3 Research Modules

strengths of most summary resources: meta-analysis, systematic reviews, guidelines, and evidence based textbooks

By identifying all the available studies on a particular topic, they are likely to provide a "true" picture of what is known about the topic and are less likely to be biased. They have critically appraised original studies and have assessed their validity and the extent to which they should be believed. They attempt to present an impartial summary with acknowledgement or consideration of the limitations of the original research. They are a potentially useful source of information because they are valid and require relatively little work for the reader.

Which of the following is true about narrative reviews? They: Critically appraise the original studies Can provide a broad perspective as well as the author's opinions on a topic Are generally more structured than other summary types of research Are less prone to bias than other types of summary research

Can provide a broad perspective as well as the author's opinions on a topic

his type of study identifies an outcome researchers want to know more about (for example Alzheimer's) and follows people who have developed this outcome. These people are then compared to controls (those without the outcome of interest) to see if there were differences in exposure. What is it? Case series Cohort study Case control study Case report

Case control study

This type of study is a detailed description of an interesting or unusual case in clinical practice. What is it? Case series Cohort study Case control study Case report

Case report

A rehabilitation group published a paper describing three patients who had suffered significant head trauma. All three had remarkable improvement in balance and cognitive symptoms after practicing Tai Chi Chuan. What type of study is this? Case series Cross-sectional study Cohort study Case control study

Case series

One of the most well known observational studies is the Framingham study, which began in 1948 and is still ongoing. This large study has enrolled approximately 15,000 individuals from Framingham, MA. The study has measured peoples' exposures to a variety of potential risk factors including cigarette smoking and high fat diets to see if they increase rates of heart disease. What type of study is this? Case series Cross-sectional Cohort Case control

Cohort

Which one of the following best defines prospective as it relates to observational studies? Collecting data on events that have already occurred Collecting data on events as they occur Collecting data only on control groups Collecting patient-oriented evidence that matters

Collecting data on events as they occur

A survey was conducted on 20,000 households in the United States in 2004. It found that 40% of individuals reported using some type of complementary and alternative medicine in the past year. What type of study is this? Case series Cross-sectional Cohort Case control

Cross-sectional

true statements about cross-sectional studies:

They look at a representative sample of a specific population. They assess relationships between interesting exposures and effects. Surveys are a type of cross-sectional study.

Which of the following is false about meta-analyses, systematic reviews, guidelines, and evidence based textbooks? They provide a trustworthy overview because they consider all available studies on a topic. They only include original studies that are positive. They use systematic methods to present an unbiased summary of the original research. They are useful to clinicians because they offer valid information for little work.

They only include original studies that are positive.

Select the false statement about meta-analyses: They use systematic search strategies to find all applicable original (primary) studies. They critically appraise original studies. They simply summarize studies (a "qualitative" synthesis). They use statistical analysis to combine the results of original studies.

They simply summarize studies (a "qualitative" synthesis).

Select the true statements about summary research sources: They use multiple sources of primary research to provide a summary, or overview. They always critically appraise the primary research. They never critically appraise the primary research. They can save you time.

They use multiple sources of primary research to provide a summary, or overview. They can save you time.

qualitative research

describes observations and relationships by analyzing perceptions, emotions and behaviors generally expressed through language understand what contributes to peoples' subjective understanding of reality.

Observational Research is usually done in what field?

epidemiology

limitations of most summary resources: meta-analysis, systematic reviews, guidelines, and evidence based textbooks

Although they attempt to include ALL studies on a particular topic, they are never truly up-to-date. All of these types of summary research are limited in that they are only as recent as the date of their last literature search. Often, this is a minimum of one year from the date of publication of the summary source (and often longer). The results of these types of summary sources are based on primary studies that reported results in terms of averages; this means that the results are sometimes difficult to apply to individual patients.

Guidelines and Evidence Based Textbooks answer the following types of questions

Answer a broad scope of questions Usually about a condition Use systematic methods

Narrative reviews answer the following types of questions

Answer a range of questions Related to a treatment, condition, or both Use unsystematic methods

systematic and meta-analysis address the following types of questions

Answer specific questions Usually about treatment Use systematic methods

Mixed methods research combines quantitative and __________ research.

qualitative

case series strengths

relatively inexpensive and quick to do and can lead to further research if positive associations between exposures and effects are found. usually involve several subjects, which increases the validity of study results

strengths of cross-sectional studies

they are relatively inexpensive and quick to do. An identification of positive associations between exposures and effects suggests that more rigorous studies should be performed.

Strengths of Case reports

they can draw attention to unique cases that were previously unrecognized. This can set the stage for new research opportunities.

cohort study strengths

they usually collect data prospectively (limits bias since retrospective collection of data can often be biased)

Epidemiologic research

to study how health and disease occur in different groups of people and why.

1Summary research provides an overview of multiple sources of primary (original) research. True False

true

Maria, a massage therapist, decides to look back at her records over the past 5 years to see the number of individuals to whom she's provided massage for fibromyalgia. This approach would best be described as a retrospective review of records. True False

true

Observational research observes people in real-world settings. True False

true

Qualitative research seeks to explain and find meaning in experiences and uses unstructured or semi-structured data collection methods. True False

true

2Case series studies include a control group. True False

false

Guidelines typically focus on a specific question such as, "Is spinal manipulation effective for tension headache?" True False

false

Meta-analyses and systematic reviews typically address a broad range of questions related to a healthcare condition, such as, "What is the prevalence of tension-type headache, how is it diagnosed, and what types of treatment are available?" True False

false

The following are strengths of quantitative research: It is generally considered objective The results can be analyzed statistically It requires smaller sample sizes True False

false

Observational Research

observing and measuring people in real-world settings

similarities between quantitative and qualitative

Both research traditions are rigorous in their methods. Both demand the highest ethical standards in regard to the treatment of human subjects.

Which one of the following types of summary research is the most susceptible to bias because of the methods used? Systematic Reviews Meta-Analyses Narrative Reviews Guidelines

Narrative reviews

Characteristics of observational studies

-Are performed in real world settings. -Observe study subjects without intervening—except to ask questions or conduct physical examinations and tests at various intervals. -Can be prospective (looking forward) or retrospective (looking back). -May or may not include a control group (a comparison group). -Measure "exposures" (possible causes) and "effects" (outcomes) and assess associations between them.

meta-analysis and systematic reviews both:

-Commonly answer a specific question (such as, "Is treatment X effective for condition Y?") -Attempt to find all the available studies to answer the question by using systematic search strategies -Critically appraise original studies and attempt to synthesize or summarize them

Quantitative strengths

-It considers the feelings, attitudes, perceptions, and emotions that are important for understanding the human aspect of healthcare. -Issues can be examined in detail and depth. -Because data collection methods are usually less structured, it allows a researcher to be more responsive and adjust methods so they are appropriate to the situation; this allows the researcher to pursue the most relevant information. -The research framework and direction can be quickly revised as new information emerges. -Qualitative research requires smaller sample sizes; this makes it easier to collect data and complete the research in shorter time frames.

summary research authors:

-Pull together multiple sources of original, or primary, research to provide a summary or overview. -Critically appraise the original research. If this was well done, these forms of evidence are valid. Note: narrative reviews do not generally critically appraise the research. saves time and is usually valid and relevant, therefore very useful

Qualitative research characteristics

-Seeks to explain and find meaning in experiences -Usually takes an inductive approach; examines data and builds an understanding from the data -Uses un- or semi-structured data collection methods -Data collected is usually words or Language -Data collection methods include interviews, focus groups and observations that are less standardized; questions are typically open-ended allowing flexibility in response -Usually uses a small number of participants (less than 30) -Results are analyzed by organizing and interpreting information using categories, themes, and patterns that don't typically rely on statistics -Generally considered more subjective

Quantitative research characteristics

-Seeks to test hypotheses -Usually takes a deductive approach; collects and examines data to see if relationships exist -Uses structured data collection methods -Data collected is usually Numbers -Uses standardized data collection methods including documentation of observations, questionnaires, laboratory tests, imaging, and other methods that can be coded and numerated -Usually involves a large number of participants (30 or more) -Results are usually analyzed using statistics -Generally considered more objective

limitations of quantitative research

-Some things are not easily counted or measured (for instance emotions, feelings, experiences, and perceptions). -Sometimes our methods for measuring and counting clinical observations aren't very accurate. -Human beings are very complex; sometimes it is not possible to measure all important variables. -Quantitative research produces results in terms of "averages;" these maybe difficult to apply to an individual patient. -Important contextual detail of observations or results may be missed.

Qualitative research limitations

-The volume of data produced from discussions and interviews is large; it can be time consuming to analyze. -The researcher tends to become subjectively immersed in the subject matter in an effort to analyze the results; this can introduce bias when results are being interpreted. -Data is usually collected from a few cases, which means findings cannot be generalized to the larger population. -Rigor is more difficult to maintain, assess, and demonstrate due to the flexibility and subjectivity associated with the data collection methods. -It is not as well recognized as quantitative research; it is therefore difficult to convince others of the importance of its contributions.

strengths of quantitative research

-Through measuring and counting, precise estimates and observation can be made. -If done well, bias is minimized, which makes the research more objective. -The results can be analyzed statistically; this allows researchers to determine to what extent results or observations are due to chance. -Hypotheses can be tested. -The results can be generalized or applied to other, similar populations.

Observations research answers questions such as:

-how common is a disease in a given population? -what is the association between an exposure and an effect? -what exposures increase the risk of disease?

Advantages to Mixed method studies

1. One approach can inform the other and be used to develop further research. For example, the results of qualitative interviews can be used to design a survey instrument for quantitative research. 2. Qualitative and quantitative data can be used to complement one another by adding words to numbers and vice versa. This helps with the interpretation and understanding of results. 3. Using qualitative and quantitative data together can create new lines of thinking by offering different and fresh perspectives.

strengths of observational studies

1. because they are done in real world settings, the results are more applicable 2. provide important information that helps direct futures research

limitations of observational research

1. inability to identify true cause and effect because of: - susceptibility to certain types of bias, leading to appearance of causal relationship when one doesn't exist -problems with cofounders ( a third variable that is independently related to both the exposure and the effect.)

A study found that breast-fed babies have fewer stomach problems than bottle-fed babies; however, previous research has shown that breast-fed babies also have mothers that are of a higher socio-economic class and come from environments with better hygiene and less crowding. In this example, socio-economic class represents which one of the following? The cause that produces the effect (stomach problems) An unrelated variable that has no impact on the results A nuisance variable that complicates the results A confounding variable that is associated with both the exposure (breast-feeding) and effect (stomach problems)

A confounding variable that is associated with both the exposure (breast-feeding) and effect (stomach problems)

After several treatments for pain associated with severe osteoarthritis of the knee, your patient isn't getting better. She asks about what the research shows about knee replacement surgery. Which of the following types of research should you examine to provide a balanced, evidence-informed answer? A quantitative study evaluating the effectiveness of knee-replacement therapy in reducing knee pain. A qualitative study describing patients' experiences post-knee replacement. No need to look at any research; you don't believe in surgery and tell her it's a bad option. A quantitative study assessing pain severity in osteoarthritis sufferers who don't undergo surgery.

A quantitative study evaluating the effectiveness of knee-replacement therapy in reducing knee pain. A qualitative study describing patients' experiences post-knee replacement. A quantitative study assessing pain severity in osteoarthritis sufferers who don't undergo surgery.

Which characteristics of qualitative research are listed below? A relatively small sample size. Semi-structured data collection method. Results typically not analyzed statistically. Generally considered more objective. Data is in the form of numbers.

A relatively small sample size. Semi-structured data collection method. Results typically not analyzed statistically.

Which one of the following best applies to both meta-analyses and systematic reviews? Both summarize and synthesize original studies in the same way. Both commonly answer a broad scope of questions about a condition. Both attempt to locate ALL available studies by using systematic search strategies. Both leave the critical appraisal of original studies up to the reader.

Both attempt to locate ALL available studies by using systematic search strategies.

quantitative research answers questions such as:

Does acupuncture increase rates of in-vitro fertilization? How many adjustments are needed to treat acute back pain? What is the association between smoking and back pain? Is massage more effective than medication in reducing the number of lost work days for low back pain sufferers?

experiemental research vs. observational research

Experimental research is cause and effect observational research can help with exploratory questions such as: what is a healthy human diet?

Qualitative research is less useful in healthcare because it addresses issues that aren't easily quantified or measured. True or False

False

In 2001, a group described a small case series of three patients suffering from severe head trauma whose rehabilitation included Tai Chi Chuan. All three patients had moderate to excellent improvement in imbalance and cognitive symptoms over several years time. This study proves Tai Chi Chuan improves symptoms for patients with head trauma. True or False

False: it suggests an association between Tai Chi chaun and improvement in head trauma patients, but does not prove it. It is not a cause and effect. randomized clinical trial would be needed to prove cause and effect.

You find a review article on spinal manipulation for common pediatric conditions. You notice that the authors don't describe their search criteria for the studies they've included in their review, and that there seems to be some studies missing. In particular, it seems the authors only included negative studies, and you are aware of some positive ones. They also haven't done a critical appraisal of the studies they included. This is an example of a systematic review or meta-analysis. True False

False; this is a narrative review where the authors have NOT searched for and included ALL available studies on a topic.

qualitative research answers questions such as:

How do cancer patients describe the effects of massage after chemotherapy? Why do patients seek care from complementary and alternative medicine practitioners? How do patients decide whether or not to seek complementary and alternative medicine care?

Which question could be answered by qualitative research? Is acupuncture more effective than prescription medication for reducing neck pain scores? What percentage of patients experience adverse events with prescription pain medication? What proportion of patients choose acupuncture instead of pharmaceuticals for the treatment of neck pain? How do patients feel about the risks associated with prescription medications?

How do patients feel about the risks associated with prescription medications?

Which of the following questions would best be answered by quantitative research? Is massage effective for reducing the number of asthma attacks in school-age children? What is the teacher's experience when a child has an asthma attack in the classroom? How does it feel to experience an asthma attack? What percentage of parents with asthmatic children seek complementary and alternative care for their children?

Is massage effective for reducing the number of asthma attacks in school-age children? What percentage of parents with asthmatic children seek complementary and alternative care for their children?

Which of the following best describes the limitations of observational research? Only collects data on events that have already occurred Is conducted in laboratory settings Is susceptible to bias and confounding variables Answers exploratory questions

Is susceptible to bias and confounding variables

Which of the following is a characteristic of qualitative research? It is generally considered objective It can help us understand the human aspect of healthcare Hypotheses can be tested It requires precise measurement

It can help us understand the human aspect of healthcare

In a study, 624 children with autism were compared to 1824 children without autism. Matching occurred on age, gender, and school. Vaccination data were collected from immunization forms required for school entry. No significant differences were found between cases and controls vaccinated between 12 to 24 months of age. 70% of children with autism and 68% of those without had been vaccinated. Which of the following statements are true about this study? It is an example of a case control study It proves that vaccines do not cause autism It is an experimental study The children without autism are considered controls

It is an example of a case control study The children without autism are considered controls

Which of the following is a limitation of quantitative research? It may miss important contextual details The results can be applied to other, similar populations If done well, it is objective It tests hypotheses

It may miss important contextual details

Which of the following is the best example of mixed methods research? Measuring blood pressure before and after an adjustment Asking a patient whether they think spinal adjustments are a good treatment for high blood pressure Measuring blood pressure before and after adjustment followed by an interview asking how the adjustment felt Measuring blood pressure and cholesterol before and after a short course of medication

Measuring blood pressure before and after adjustment followed by an interview asking how the adjustment felt

Summary research types

Meta-analyses and systematic reviews Guidelines Evidence based textbooks Narrative reviews

Which of the following are true strengths of high quality quantitative research? Precise estimates and observation can be made. It can measure all important variables. The results can be generalized. Bias is minimized. Results can always be directly applied to an individual. The results can be analyzed statistically.

Precise estimates and observation can be made. The results can be generalized. Bias is minimized. The results can be analyzed statistically.

Which of the following is NOT a characteristic of quantitative research? Uses structured data collection methods Questions are typically open-ended Data collected is usually numbers Usually involves a large number of participants Results are usually analyzed using statistics

Questions are typically open-ended

Researchers conduct a case control study and find an association between cell phone use and brain cancer. This study: Confirms that cell phones cause brain cancer Suggests that cell phone use and brain cancer may be related Has no confounding variables Is like a randomized clinical trial

Suggests that cell phone use and brain cancer may be related

Which of the following is a characteristic of cohort studies? The cohort, or group of people, share common characteristics Some of the people in the study have the outcome of interest Researchers follow the cohort for only a short period of time The data is usually collected retrospectively

The cohort, or group of people, share common characteristics

Which of the following is true about meta-analyses, systematic reviews, guidelines, and evidence based textbooks? They always include the most up-to-date original, or primary, research studies. The results may be difficult to apply to individual patients. They are likely to be biased. They are not very useful for clinicians.

The results may be difficult to apply to individual patients.

How do guidelines differ from meta-analyses and systematic reviews? They critically appraise original studies. They summarize original studies. They address a range of questions. They attempt to find all available studies.

They address a range of questions.

Which of these is a NOT a strength of systematic reviews, meta-analyses, guidelines, and evidence based textbooks? They are likely to provide a "true" picture of what is known about the topic and are less likely to be biased. They have assessed the validity of original studies. They require relatively little work for the reader. They are based on primary studies that produced results in terms of averages.

They are based on primary studies that produced results in terms of averages.

guidelines are similar to meta-analysis and systematic reviews in the following ways:

They attempt to find all the available studies. They critically appraise the original studies and attempt to synthesize, or summarize them.

Which of the following is considered a strength of observational studies? They are conducted in laboratory settings. They randomly assign patients to different treatment groups. They can address questions that would be unethical, impractical or impossible to address with experimental studies. They are susceptible to confounding.

They can address questions that would be unethical, impractical or impossible to address with experimental studies.

True statements about characteristics of observational studies

They can be prospective or retrospective. They observe study subjects without intervening. They can address questions that experimental studies can't. They measure associations between exposures and effects.

Which statement applies to observational studies? They can measure associations between exposures and effects. They can determine cause and effect relationships. They randomly assign patients to different treatment groups. They are always retrospective (looking back at data already collected).

They can measure associations between exposures and effects.

true statements about case series studies

They do not usually include a control group. They can be retrospective or prospective. They usually involve several subjects.

Which one of the following applies to meta analyses, systematic reviews, guidelines, and evidence based textbooks? They only include studies that are relevant to your patients. They always answer a broad range of questions about a healthcare condition. They include a critical appraisal of the primary research studies. They are less trustworthy than narrative reviews.

They include a critical appraisal of the primary research studies.

Select the true statements about guidelines: They use systematic search strategies to find all applicable original studies. They critically appraise original studies. They address various aspects of broad topics, like health care conditions. They are written by individual researchers.

They use systematic search strategies to find all applicable original studies. They critically appraise original studies. They address various aspects of broad topics, like health care conditions.

If a researcher observes a group of patients who, on their own, have chosen to eat a low fat diet, and compares them to patients who choose to eat a high fat diet, this is observational research. True or False

True

guidelines and other summary resources differ in the following ways:

WHO performs them and the SCOPE of the topic. Guidelines are usually developed by professional organizations (e.g., professional societies, government agencies) and typically involve a range of stakeholders including clinicians, researchers, and patients. Guidelines address various aspects of broad topics, like health care conditions. They usually address a range of questions including the prevalence of the condition, the tests and procedures used to diagnose it, and how to prevent and treat it.

Which of the following questions would best be answered by qualitative research? When patients say they are satisfied with treatment, what do they mean? What percentage of patients in the campus clinic are satisfied with the care they receive? How would patients describe a satisfactory treatment? How many patients in the campus clinic are dissatisfied with their wait time?

When patients say they are satisfied with treatment, what do they mean? How would patients describe a satisfactory treatment?

case report

a detailed description of a unique case in clinical practice.

cross-sectional study

a snapshot, or a cross-section, of a specific population's health and behaviors at one point in time. Surveys are an example of this type of study.

case series

an observation of a series of persons without a control group. can be retrospective or prospective.

five types of observational research can be done:

case report cross-sectional study case series case-control study cohort study

Mixed method studies

combines qualitative with quantitative research

evidence based textbooks

common source of clinical information often provide a well-organized consensus of knowledge in a given field includes best available research and summarized and critically appraised it

One day in your busy clinical practice, a patient comes to you with multiple sclerosis (MS). You haven't seen many patients with MS in your practice and would like to learn what the most recent evidence shows regarding prevalence, diagnosis, management, and treatment approaches for this condition. The best type of summary research would be a systematic review of drug therapy for MS. true or false

false, guidelines or evidence based textbooks would probably be most useful

Researchers want to know whether or not Vitamin D is an effective treatment for multiple sclerosis (MS). They conduct a study in which they randomly assign participants with MS to take Vitamin D or placebo daily. This is an example of a summary type of research. True False

false; this is an example of a randomized clinical trial, which is a type of original research

Meta-analysis and systematic reviews differ in

how they synthesize or summarize the original studies Meta-analyses use numerical methods (statistical analysis) to combine the results of several original studies. This is sometimes called "pooling" or a "quantitative synthesis."

Guidelines

intended to provide guidance to practicing clinicians.

characteristics of narrative reviews

less structured don't attempt to find all the available studies don't critically appraise the studies they include

evidence based textbooks limitations

may be outdated since it takes years to write a textbook may need to be evaluated to determine if it is evidence based

cohort study

start with a "cohort" of people. In contrast to a case-control study, participants have NOT developed the outcome of interest yet. Researchers follow the cohort for long period of times and categorize them into different levels of exposure.

case-control study

starts with a group of "cases" who have developed the outcome of interest. Cases are then compared to "controls"; (those without the outcome of interest) to see if there were differences in exposure.

The researcher tends to become subjectively immersed in the subject matter in an effort to analyze the results and this can introduce bias Data is usually collected from a few cases, which means findings cannot be generalized to the larger population It is not as well recognized as quantitative research; it is therefore difficult to convince others of the importance of its contributions. True False

true

case-control study strengths

useful for studying rare diseases and outcomes that take a long time to develop.

Quantitative research

uses structured methods to describe an observation or relationship in numerical terms. It is based on the assumption that reality can and should be measured. Most basic science and clinical research is quantitative.

evidence based textbooks strengths

well-organized consensus of knowledge in a given field, based on best available research defines terms, introduces key concepts, place the subject in the larger context, includes an index of hallmark references, including original research heavily edited