CLIN Epi Online Quiz 2

CLINICAL EPIDEMIOLOGY II – ONLINE QUIZ 2 Topics Included: 1. 2. 3. 4.

Prognosis Economic Analysis Practice Guidelines Meta-analysis

These are systematically developed statements about appropriate health care for specific health circumstances. A. Clinical Practice Guidelines (CPG) B. Clinical Reviews C. Meta-analysis D. Treatment Which of the following threat to validity (bias) is tested by the question “Was follow-up sufficiently long and complete?”; A. Measurement B. Migration C. Sampling D. Susceptibility Which of the following is a sufficiently long follow-up for a prognostic study? A. Five-year survival in patients with complicated DM B. Twelve months survival in patients with resected pancreatic cancer C. Thirty-day survival in MI patients admitted at the ICU D. All of the above All probable direct and indirect cost should be included in costeffectiveness. Example of direct cost is? A. Transportation fare of patient going to hospital B. Salary of accompanying nurse C. Cost of the cleansing enema prior to colonoscopy

D. Professional fee of the attending physician For PTB screening of first year college students, chest x-ray is 70% effective with an actual cost of Php150 and sputum culture is 95% effective with an actual cost of Php800 pesos are being compared. What is the cost per unit outcome of sputum culture? A. 215 pesos B. 800 pesos C. 950 pesos D. 843 pesos (800/0.95) The most significant research study is? (evidence ba to?) A. Level I (rct,meta analysis) B. Level II (quasi exptal, casecont, cohort) C. Level III (case series,case study,expert) D. Level IV (expert??) Clinical Practice Guideline on the treatment of appendicitis should contain? A. Only the best option that is expected to result to the best outcome B. All options and all outcomes C. Most reasonable options and the corresponding outcomes D. All published options and corresponding outcomes Characteristic of a useful Clinical Practice Guideline (CPG); A. Monitored to be working B. Available to users C. Up-to-date D. All A patient was diagnosed with melanoma on his neck. A report you just read concludes that melanomaspecific mortality is increased in patients with invasive melanoma of the scalp/neck compared to those in the extremities. Assuming the study 1

was valid and generalizable to patients seen in your clinic, what will you tell your patient? A. He has a higher risk of dying because of melanoma B. He is more likely to die of other causes than his melanoma C. He needs a biopsy of a mole on his arm D. You need more time to study the journal article To assure that an adequate literature search is done in a meta-analysis, one should look for; A. Multiple computerized literature databases search must be found in the methodology section B. Medline search C. Use of the gray literature D. Literature search in English language only To address the possibility of publication bias in the search for titles in a meta-analysis, the authors should mention in the Methods section; A. No language restrictions B. Review of the reference lists to find further trials C. Showing the funnel plot of odds ratio against the sample size D. Key words that were used are listed This type of article provides an overview of original research using a precise protocol with a statement of objectives and a literature review conducted according to a specific and reproducible methodology. A. Systematic review B. Practice guideline C. Primary study D. Meta-analysis The PERSPECTIVE in an Economic Analysis pertains to the point of view of?

A. The one paying for the intervention B. The physician using the intervention C. The researcher doing the study D. The policy maker who will implement the program One reason why CPG’s were developed. A. Educate patients and physicians about current best practice B. Promote EBM C. Improve professional performance D. Provide opinions in clinical decision making This type of article provides an overview of original research using a precise protocol with a statement of objectives, literature review and that includes combining and analyzing the data of individual trials. A. Systematic review B. Meta-analysis C. Economic analyses D. Practice guidelines Cost-effectiveness integrates effectiveness study and costing. The best study design for the effectiveness portion is? A. Case series B. Case-control C. RCT D. Cross-sectional A study that summarize or draw conclusions from an original research is known as; A. Analytic B. Primary C. Integrative D. Cohort All probable direct and indirect cost should be included in costeffectiveness. Example of indirect cost is? 2

A. Merienda of patient and companion while waiting B. Alcohol and cotton balls used during injection C. The patient record fee D. Delivery cost of drug One area where CPG is needed. A. There is lack of evidence backing up protocols B. Presence of variations on the current management C. Clinical practice changes are not applicable in your area of practice D. Very few cases met in your practice Which design establishes the temporal relationship between factors and outcome? A. Cross-sectional B. Cohort C. Case report D. Case series Multivariate analysis in a prognostic study is performed to: A. Minimize bias B. Make the results more complex C. Examine the effect of prognostic factors one at a time D. All of the above Economic analysis compares alternative strategies in terms of the cost and the outcome. When the outcomes of strategies are equal and only the costs are compared, this is? A. Cost-effectiveness B. Cost-benefit C. Cost-minimization D. Cost-utility For PTB screening of first year college students, chest x-ray is 70% effective with an actual cost of Php150 and sputum culture is 95% effective with an actual cost of Php800 pesos are

being compared. What is the cost per unit outcome of chest X-ray? A. 150 pesos B. 800 pesos C. 215 pesos D. 950 pesos To reduce bias, which approach is engaged in a prognostic study? A. Random sampling B. Restriction C. Matching D. All of the above A valid Clinical Practice Guideline? A. Must satisfy all validity criteria B. Must satisfy at least one validity question C. Do not include literature search in the validity guides D. Must satisfy two thirds of the criteria Essential for the dissemination and implementation of CPG is? A. Level of knowledge, attitudes and practices of physicians about practice guidelines B. Comprehension ability of practitioners C. Level of compliance of physicians D. Adaptability of physicians to changes In appraising an article on prognosis, which of the following is a validity guide? A. Are the study patients similar to my own? B. How large is the likelihood of outcome to occur in those with the prognostic factor in a specified period of time? C. Is the objective of the article similar to your clinical dilemma? D. Was there adjustment for other prognostic factors?

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A study on survival of breast cancer patients after combined surgery and anti-estrogen treatment is planned, the study design should be; A. RCT B. Cross-sectional C. Case-control D. Cohort Which one is a threat to the validity of a meta-analysis? A. Combining studies that are dissimilar B. Selection bias C. Including quantitative studies in the analysis D. High confidence interval Health care strategies that are compared in a economic analysis should always include the newly introduced strategy and? A. Any other strategy B. The current standard strategy C. Another new strategy D. A discarded strategy

Which of the following is an integrative study? A. Systematic review B. Review C. Meta-analysis D. All are correct Although recently some have attempted, with varying degrees of success, to apply this technique to epidemiologic research, ideally, metaanalyses are applied to. A. Randomized clinical trials (RCTs) B. Case series C. Cohort D. Cross sectional designs The following are true of valid prognostic study designs: A. True cohort designs are usually valid

B. A point in time in the course of illness to start the observation C. Long enough time to observe the outcomes D. All of the above To be able to assess the benefits and costs of a recommendation in the CPG, the said recommendation must be? A. Simple B. Specific C. Comprehensive D. All The PERSPECTIVE in an Economic Analysis influences? A. Relevance of study to the case scenario B. Significance of the study C. Validity of the study D. Results of the study To assure that an adequate literature search is done in a meta-analysis, one should look for searches made in; A. MEDLINE B. EMBASE C. Current Contents D. All of the above should be included in the search For PTB screening of first year college students, chest x-ray is 70% effective with an actual cost of Php150 and sputum culture is 95% effective with an actual cost of Php800 pesos are being compared. This economic analysis is? A. Cost-effectiveness B. Cost-benefit C. Cost-minimization D. Cost-utility A major advantage of a meta-analysis over other integrative studies; A. It can combine several smaller studies, thus increasing the number of subjects in the final analysis and subsequently improving the power to detect a 4

treatment effect if one is present B. It might answer questions about whether an overall study result differs among various subgroups C. It is an excellent critical review of the literature that points out the strengths and weaknesses of previous research on a given topic D. It is an easy way to get published Is the guideline likely to account for important recent developments? This can be answered by checking; A. Date of publication of the guideline B. Date of expiration of guideline C. Date of guideline implementation D. Guideline bibliography for dates of most recent articles included

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