1

Question 1

5 steps in EBP

Answer 1

1. Assess the patient and identify your own knowledge gaps
2. Ask a well-built clinical research question
3. Acquire (research) evidence by conducting a literature search
4. Appraise the (research) evidence for its validity and applicability
5. Apply what you’ve learned, talk with the patient, integrate research
   evidence with your clinical expertise and patient preference

Question 2

efficacy

Answer 2

how well does it work in controlled environment

Question 3

effectiviness

Answer 3

how well does it work in real world

Question 4

efficiency

Answer 4

how well does it work considering resources

Question 5

multiple types of research evidence

Answer 5

• Clinical observation ➢ Sources of innovation
• Qualitative research ➢ Subjective experiences
• Systematic case studies
  ➢ Comparing individual patients
• Single-case exp. Design ➢ Causal relationships within patient
• Process-outcome studies ➢ Mechanisms of change
• Randomized controlled trials ➢ Causal inferences intervention
• Meta analyses ➢ Estimate effect size quantitatively

Question 6

Meta analysis

Answer 6

• A quantitative pooling of results
  from multiple studies that
  measure the same outcome
• A statistical approach
• Forest plots
• Often used in systematic review

advantages:
- Generalizability
* Influence of moderator / mediators
* Precision & Power (lots of data

disadvantages
- Heterogeneity in study designs/procedures
* Publication bias

Question 7

systemic reviews

Answer 7

• Synthesis of all available research
  on a given topic
• Comprehensive overview
• Transparency
• Replicability
• Often includes a meta-analysis
• Standardized (PRISMA)

Advantages
Research designs
* Reliable and unbiased overview of current evidence
* Reproducible
* Specificity in answering research question
(assessing efficacy of a common intervention

Disadvantages
- Selection and publication bias
* Time consuming
* Dependent on the number of studies available

Question 8

RCT

Answer 8

• Experimental design
• Random allocation to treatment or control
  condition
• Gold standard in efficacy research

Advantages
Minimizes selection bias
* Reproduceable (if protocols are available)
* Efficacy estimates of the treatment/intervention
Advantages
Disadvantages
* Heavily dependent on large sample-sizes
* Clinical equipoise (uncertainty about treatment benefits)
* Investment (time & costs

Question 9

types of randomization

Answer 9

• Simple randomization: each participant has an equal chance of being assigned
  to each group
• Stratified randomization: participants are divided into strata (subgroups) based
  on participant characteristics. Thereafter, subgroups are then randomized.
• Cluster randomization: groups of participants (e.g., families, communities) are
  randomized
• Adaptive randomization: the probability of being assigned to a group changes
  based on the participants already assigned to each group

Question 10

cohort study

Answer 10

• Observational design
• Longitudinal
• Participants are selected based on
  risk or exposure
• No experimental manipulation
• Prospective/Retrospective

Advantages
- Assessment of multiple outcomes associated with
risk / exposure factors
* Assessment of temporal relationship between
exposure and outcome
Advantages
Disadvantages
* Attrition (prospective)
* No control over potential influencing factor

Question 11

case control studies

Answer 11

• Observational design
• Cases are selected based on an outcome of
  interest (e.g., a psychological disorder)
• Cases are compared with well-matched
  controls (without the outcome)
• No experimental manipulation
• Retrospective / Cross-sectional

Advantages
-Easy to conduct, require less time, inexpensive
* Efficient for examining rare diseases
* Assessment of multiple risk-factors for an outcome
* Smaller sample than cohort

Disadvantages
* Recall bias (retrospective studies), selection bias
* Correlational (no causation

Question 12

single case designs

Answer 12

• Observational design
• Examine the effect of treatment on
  outcomes
• Repeated measurements
• Adaptive: monitor improvement, change
  intervention when needed
• Case serves as control

advantages
* Experimental control
* Easy to design and perform
* Patient-centered / precision-medicine
* Small sample size (viable alternative to RCTs

disadvantages
- Ethical concerns (potential of withholding treatment)
* Some behaviors can’t be reversed
* Time consuming

Question 13

PICO(T)

Answer 13

P opulation
I ntervention
C comparison
O outcome
T ime