MCQ Quiz: Summarizing the Evidence

MCQ Quiz: Summarizing the Evidence

In the realm of evidence-based practice, the ability to effectively summarize vast amounts of biomedical literature is crucial for pharmacists and PharmD students. Tools like systematic reviews, meta-analyses, clinical practice guidelines, and drug evaluation monographs play a pivotal role in synthesizing existing research to inform clinical decision-making. Understanding the methodologies behind these summaries, how to critically appraise them, and where to find them are essential skills for providing optimal patient care. This quiz will test your knowledge on the various methods and types of resources used for summarizing evidence in healthcare.

1. Which of the following best describes a systematic review?

• a) A brief overview of a topic written by an expert.
• b) A review that uses explicit and systematic methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.
• c) A collection of all published articles on a specific drug.
• d) A statistical technique for combining the results of multiple studies.

Answer: b) A review that uses explicit and systematic methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.

2. A key difference between a narrative (nonsystematic) review and a systematic review is that a systematic review:

• a) Is always shorter and easier to read.
• b) Uses a reproducible and explicit methodology to minimize bias.
• c) Only includes studies with positive results.
• d) Does not involve critical appraisal of included studies.

Answer: b) Uses a reproducible and explicit methodology to minimize bias.

3. What is a meta-analysis?

• a) A qualitative summary of a few key studies.
• b) A statistical technique for combining the quantitative results from multiple studies addressing the same question to produce a pooled estimate.
• c) The first study conducted on a new drug.
• d) A review written by a single author without peer review.

Answer: b) A statistical technique for combining the quantitative results from multiple studies addressing the same question to produce a pooled estimate.

4. A forest plot in a meta-analysis is a graphical representation that typically displays:

• a) The number of patients in each study.
• b) The individual study results, their confidence intervals, and the overall pooled result.
• c) The funding sources for each study.
• d) The geographic location of each study.

Answer: b) The individual study results, their confidence intervals, and the overall pooled result.

5. Heterogeneity in a meta-analysis refers to:

• a) The similarity of the study populations.
• b) The variability in the results of the included studies beyond what would be expected by chance.
• c) The number of authors per study.
• d) The length of the studies.

Answer: b) The variability in the results of the included studies beyond what would be expected by chance.

6. If significant heterogeneity is present in a meta-analysis, which model might be more appropriate for pooling results?

• a) Fixed-effects model.
• b) Random-effects model.
• c) Primary-effects model.
• d) No model can be used.

Answer: b) Random-effects model.

7. Publication bias in the context of systematic reviews and meta-analyses refers to the phenomenon where:

• a) Studies with statistically significant or positive results are more likely to be published than those with non-significant or negative results.
• b) Journals only publish studies from certain countries.
• c) Only studies funded by industry are published.
• d) Reviewers are biased towards studies they personally conducted.

Answer: a) Studies with statistically significant or positive results are more likely to be published than those with non-significant or negative results.

8. A funnel plot is a graphical tool sometimes used in meta-analyses to assess:

• a) The clinical significance of the results.
• b) The potential for publication bias.
• c) The degree of heterogeneity.
• d) The quality of the included studies.

Answer: b) The potential for publication bias.

9. Clinical Practice Guidelines (CPGs) are best described as:

• a) Legally binding documents that dictate all aspects of patient care.
• b) Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.
• c) Summaries of individual patient case reports.
• d) Marketing materials produced by pharmaceutical companies.

Answer: b) Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.

10. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system is used in guideline development to:

• a) Determine the cost-effectiveness of interventions.
• b) Rate the quality of evidence and the strength of recommendations.
• c) Assign authors to guideline writing groups.
• d) Track the number of citations a guideline receives.

Answer: b) Rate the quality of evidence and the strength of recommendations.

11. A “strong recommendation” in a clinical practice guideline using the GRADE approach typically implies that:

• a) All patients should receive the intervention without question.
• b) Most well-informed patients would choose the recommended course of action, and clinicians can structure their interactions with patients accordingly.
• c) There is very little evidence to support the recommendation.
• d) The recommendation is based on expert opinion only.

Answer: b) Most well-informed patients would choose the recommended course of action, and clinicians can structure their interactions with patients accordingly.

12. Which organization is well-known for producing and disseminating systematic reviews in healthcare?

• a) The Food and Drug Administration (FDA).
• b) The Cochrane Collaboration.
• c) The World Health Organization (WHO) primarily for global health statistics.
• d) The National Institutes of Health (NIH) primarily for funding research.

Answer: b) The Cochrane Collaboration.

13. A drug evaluation monograph prepared for a Pharmacy and Therapeutics (P&T) committee typically includes all the following sections EXCEPT:

• a) Pharmacology and mechanism of action.
• b) Efficacy and safety data from clinical trials.
• c) Cost-effectiveness analysis.
• d) Detailed biographies of the drug’s inventors.

Answer: d) Detailed biographies of the drug’s inventors.

14. The primary purpose of a drug class review conducted by a P&T committee is to:

• a) Decide which single drug in a class is the best for all patients.
• b) Evaluate the comparative clinical and cost-effectiveness of drugs within a specific therapeutic class to make formulary decisions.
• c) Determine the patent expiration dates for all drugs in the class.
• d) Set the retail price for each drug in the class.

Answer: b) Evaluate the comparative clinical and cost-effectiveness of drugs within a specific therapeutic class to make formulary decisions.

15. When critically appraising a systematic review, an important first step is to assess:

• a) The number of authors.
• b) Whether the review addresses a clear, focused clinical question.
• c) The length of the review.
• d) The journal’s impact factor.

Answer: b) Whether the review addresses a clear, focused clinical question.

16. In a systematic review, the “search strategy” section should describe:

• a) The reviewers’ personal opinions about the topic.
• b) The databases searched, keywords used, and inclusion/exclusion criteria for studies.
• c) Only the studies that found positive results.
• d) The statistical methods used for meta-analysis if one was performed.

Answer: b) The databases searched, keywords used, and inclusion/exclusion criteria for studies.

17. What does “PRISMA” stand for in the context of systematic reviews?

• a) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
• b) Primary Research in Specific Medical Areas.
• c) Professional Review of Important Scientific Manuscripts and Articles.
• d) Patient-Reported Information Systems for Medical Assessment.

Answer: a) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

18. A “network meta-analysis” allows for:

• a) Combining only two studies at a time.
• b) The comparison of multiple interventions simultaneously, even if they have not all been compared directly in head-to-head trials.
• c) Excluding studies with negative results.
• d) Analyzing only observational studies.

Answer: b) The comparison of multiple interventions simultaneously, even if they have not all been compared directly in head-to-head trials.

19. When evaluating a clinical practice guideline, it is important to check if it:

• a) Was developed by a single expert.
• b) Is based on a recent systematic review of the evidence and considers patient values and preferences.
• c) Is sponsored by a company whose product is favored in the guideline.
• d) Is more than 10 years old without updates.

Answer: b) Is based on a recent systematic review of the evidence and considers patient values and preferences.

20. One potential limitation of meta-analyses is the “garbage in, garbage out” principle, which means:

• a) All meta-analyses are inherently flawed.
• b) If the individual studies included in the meta-analysis are of poor quality or highly biased, the results of the meta-analysis will also be unreliable.
• c) Meta-analyses should only include studies published in the last year.
• d) Only statistically significant studies should be included.

Answer: b) If the individual studies included in the meta-analysis are of poor quality or highly biased, the results of the meta-analysis will also be unreliable.

21. The “methods” section of a drug evaluation monograph for a P&T committee should detail:

• a) The pharmacy’s dispensing procedures.
• b) How the literature search was conducted and how evidence was evaluated.
• c) The marketing plan for the drug.
• d) The history of the pharmaceutical company.

Answer: b) How the literature search was conducted and how evidence was evaluated.

22. Recommendations made in a drug monograph (e.g., for formulary addition) are typically based on:

• a) The drug’s packaging and appearance.
• b) Evidence of its efficacy, safety, and cost-effectiveness compared to alternatives.
• c) The personal preferences of the P&T committee members.
• d) The number of sales representatives promoting the drug.

Answer: b) Evidence of its efficacy, safety, and cost-effectiveness compared to alternatives.

23. Subgroup analysis in a meta-analysis involves:

• a) Excluding certain subgroups from the analysis.
• b) Examining the treatment effect in specific subgroups of patients (e.g., by age, sex, disease severity) to see if it differs.
• c) Only analyzing the largest studies.
• d) Averaging the results of all subgroups.

Answer: b) Examining the treatment effect in specific subgroups of patients (e.g., by age, sex, disease severity) to see if it differs.

24. Sensitivity analysis in a meta-analysis is performed to:

• a) Determine how sensitive patients are to the drug.
• b) Assess how robust the findings are by repeating the analysis with different assumptions or by excluding certain studies (e.g., those of lower quality).
• c) Measure the specificity of diagnostic tests included in the review.
• d) Increase the statistical significance of the results.

Answer: b) Assess how robust the findings are by repeating the analysis with different assumptions or by excluding certain studies (e.g., those of lower quality).

25. The AGREE II instrument is a tool used for:

• a) Assessing the methodological quality of randomized controlled trials.
• b) Appraising the quality and reporting of clinical practice guidelines.
• c) Conducting meta-analyses.
• d) Writing drug monographs.

Answer: b) Appraising the quality and reporting of clinical practice guidelines.

26. The “Conclusion” section of a systematic review should:

• a) Introduce new data not previously mentioned.
• b) Summarize the main findings and discuss their implications for practice and future research.
• c) Be based only on the largest study included.
• d) Heavily favor the authors’ preconceived notions.

Answer: b) Summarize the main findings and discuss their implications for practice and future research.

27. What is a key advantage of using well-conducted systematic reviews and meta-analyses for clinical decision-making?

• a) They provide a quick way to get an expert’s opinion.
• b) They synthesize evidence from multiple studies, potentially providing a more precise and reliable estimate of effect than individual studies.
• c) They eliminate the need for clinical judgment.
• d) They are always free from bias.

Answer: b) They synthesize evidence from multiple studies, potentially providing a more precise and reliable estimate of effect than individual studies.

28. If a forest plot shows that the confidence intervals for most individual studies and the pooled estimate cross the line of no effect (e.g., risk ratio of 1), it suggests:

• a) The treatment is highly effective.
• b) There is no statistically significant difference between the treatment and control groups.
• c) All included studies were flawed.
• d) The meta-analysis used the wrong statistical model.

Answer: b) There is no statistically significant difference between the treatment and control groups.

29. “Quality of evidence” in the GRADE system reflects the confidence that:

• a) The drug is affordable.
• b) The estimate of effect is correct.
• c) The guideline authors are experts.
• d) The recommendation will be easy to implement.

Answer: b) The estimate of effect is correct.

30. A “conditional recommendation” (or weak recommendation) in a GRADE-based guideline implies that:

• a) The intervention should be used in all circumstances.
• b) Different choices will be appropriate for different patients, and shared decision-making is particularly important.
• c) The evidence quality is very high.
• d) There is no need to discuss the intervention with the patient.

Answer: b) Different choices will be appropriate for different patients, and shared decision-making is particularly important.

31. A drug formulary system uses drug evaluation monographs and class reviews primarily to:

• a) Maximize pharmacy profits.
• b) Promote the rational, evidence-based, and cost-effective use of medications within an institution or health plan.
• c) Limit pharmacist autonomy.
• d) Ensure only brand-name drugs are used.

Answer: b) Promote the rational, evidence-based, and cost-effective use of medications within an institution or health plan.

32. When evaluating the “Applicability” or “External Validity” of a systematic review or guideline to your patient population, you should consider:

• a) Whether the studies included populations and settings similar to your own.
• b) Only the statistical significance of the findings.
• c) The number of pages in the document.
• d) The reputation of the journal it was published in.

Answer: a) Whether the studies included populations and settings similar to your own.

33. One of the first steps in conducting a systematic review is to:

• a) Perform a meta-analysis.
• b) Clearly define the research question (e.g., using PICO format: Population, Intervention, Comparison, Outcome).
• c) Write the discussion section.
• d) Contact drug manufacturers for funding.

Answer: b) Clearly define the research question (e.g., using PICO format: Population, Intervention, Comparison, Outcome).

34. The process of selecting studies for inclusion in a systematic review should ideally be done by:

• a) A single reviewer to save time.
• b) At least two independent reviewers to minimize bias, with a plan for resolving disagreements.
• c) The author of the largest primary study.
• d) A computer algorithm without human oversight.

Answer: b) At least two independent reviewers to minimize bias, with a plan for resolving disagreements.

35. Which of the following is NOT a typical component of a well-structured drug evaluation monograph?

• a) Introduction and pharmacology.
• b) Review of clinical efficacy and safety.
• c) Economic considerations.
• d) Advertisements for the drug.

Answer: d) Advertisements for the drug.

36. “Grey literature” in the context of a systematic review search refers to:

• a) Research published in very prestigious journals.
• b) Research that is not formally published in peer-reviewed journals, such as conference abstracts, theses, or government reports.
• c) Studies with inconclusive results.
• d) Fictional medical stories.

Answer: b) Research that is not formally published in peer-reviewed journals, such as conference abstracts, theses, or government reports.

37. The “Results” section of a meta-analysis typically presents:

• a) The authors’ opinions on the topic.
• b) A description of the search strategy.
• c) The pooled statistical estimate of the treatment effect and measures of heterogeneity.
• d) Recommendations for clinical practice.

Answer: c) The pooled statistical estimate of the treatment effect and measures of heterogeneity.

38. Clinical practice guidelines should ideally be updated regularly because:

• a) The formatting becomes outdated.
• b) New evidence emerges that may change recommendations.
• c) Authors like to publish frequently.
• d) The cost of printing decreases over time.

Answer: b) New evidence emerges that may change recommendations.

39. A key strength of a well-conducted systematic review is its ability to:

• a) Prove causation definitively.
• b) Provide a comprehensive and unbiased summary of current evidence on a specific topic.
• c) Eliminate the need for individual patient assessment.
• d) Guarantee positive treatment outcomes.

Answer: b) Provide a comprehensive and unbiased summary of current evidence on a specific topic.

40. When a P&T committee decides on formulary restrictions for a drug (e.g., prior authorization, step therapy), these decisions are often based on evidence summarized in:

• a) Patient testimonials.
• b) Drug advertisements.
• c) Drug evaluation monographs and class reviews.
• d) Newspaper articles.

Answer: c) Drug evaluation monographs and class reviews.

41. If a systematic review concludes that there is “insufficient evidence” to support a particular intervention, it means:

• a) The intervention is definitely ineffective and harmful.
• b) There is a lack of high-quality studies addressing the question, so no firm conclusion can be drawn.
• c) The intervention should be widely adopted.
• d) The reviewers did not search enough databases.

Answer: b) There is a lack of high-quality studies addressing the question, so no firm conclusion can be drawn.

42. The “Discussion” section of a systematic review often includes:

• a) A list of all included studies.
• b) An interpretation of the findings in the context of existing knowledge, limitations of the review, and implications for practice or research.
• c) The raw data from each study.
• d) The funding sources for the review.

Answer: b) An interpretation of the findings in the context of existing knowledge, limitations of the review, and implications for practice or research.

43. The credibility of a clinical practice guideline is enhanced if it is developed by a:

• a) Single pharmaceutical company.
• b) Multidisciplinary panel of experts and patient representatives, with a transparent process and management of conflicts of interest.
• c) Marketing agency.
• d) Group of anonymous authors.

Answer: b) Multidisciplinary panel of experts and patient representatives, with a transparent process and management of conflicts of interest.

44. What does “indirect comparison” in a network meta-analysis refer to?

• a) Comparing drugs that have never been studied.
• b) Comparing two drugs (A vs B) based on their individual comparisons to a common comparator (A vs C and B vs C), when no direct A vs B trial exists.
• c) Comparing a drug to a placebo only.
• d) Comparing different doses of the same drug.

Answer: b) Comparing two drugs (A vs B) based on their individual comparisons to a common comparator (A vs C and B vs C), when no direct A vs B trial exists.

45. When a pharmacist uses a drug monograph to make decisions, they should consider:

• a) Only the cost information.
• b) The totality of the evidence presented on efficacy, safety, and cost, and how it applies to their specific patient population or formulary needs.
• c) The length of the monograph.
• d) The date the drug was first approved.

Answer: b) The totality of the evidence presented on efficacy, safety, and cost, and how it applies to their specific patient population or formulary needs.

46. A common reason for excluding a study from a systematic review during the screening process is that it:

• a) Was published in a foreign language (unless translation resources are available and pre-specified).
• b) Does not meet the pre-defined inclusion criteria (e.g., wrong patient population, intervention, or outcome).
• c) Has too many authors.
• d) Was funded by a government grant.

Answer: b) Does not meet the pre-defined inclusion criteria (e.g., wrong patient population, intervention, or outcome).

47. The “strength of recommendation” in a guideline (e.g., strong, conditional) considers not only the quality of evidence but also:

• a) The guideline authors’ publication records.
• b) The balance of benefits and harms, patient values and preferences, and resource implications.
• c) The number of drugs available in that class.
• d) The ease of pronouncing the drug name.

Answer: b) The balance of benefits and harms, patient values and preferences, and resource implications.

48. The primary audience for a drug evaluation monograph prepared for a P&T committee is usually:

• a) The general public.
• b) Pharmaceutical sales representatives.
• c) The members of the P&T committee who make formulary decisions.
• d) The FDA.

Answer: c) The members of the P&T committee who make formulary decisions.

49. The ultimate goal of summarizing evidence through systematic reviews, meta-analyses, and guidelines is to:

• a) Create more publications for researchers.
• b) Support evidence-based healthcare and improve patient outcomes.
• c) Reduce the need for critical thinking by clinicians.
• d) Increase the complexity of medical practice.

Answer: b) Support evidence-based healthcare and improve patient outcomes.

50. When encountering a new systematic review or guideline, a pharmacist should first:

• a) Immediately implement all recommendations without question.
• b) Critically appraise its validity, relevance, and applicability to their practice setting and patient population.
• c) Assume it is outdated.
• d) File it away without reading.

Answer: b) Critically appraise its validity, relevance, and applicability to their practice setting and patient population.