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1 Evidence Based Research > All Lectures Fall > Flashcards

All Lectures Fall Flashcards

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1
Q

Clinician Scientist

A

Healthcare professional that participates in the scientific method and evidence-based practice to improve care and outcomes

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2
Q

Evidence based practice model

A

Clinical experience
Patient preference
Research evidence

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3
Q

Hierarchy of evidence

A

Bottom:
Expert opinions
Case studies
Cross sectional studies
Cohort/case control
Randomized controlled
Systematic reviews

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4
Q

Patient preferences are based on

A

Patient expectations
Patient values
Patient circumstances

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5
Q

IHI Triple Aim

A

Population health
Experience of care
Per capita cost

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6
Q

EBP process

A

Identify need for info
Conduct research
Critically appraise research
Integrate research
Evaluate

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7
Q

5 A’s

A

Ask
Access
Appraise
Apply
Assess

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8
Q

Barriers to EBP

A

Time
General research vs specific research
Lack of skill
Lack of access
Money
Resistance

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9
Q

Types of research questions

A

Background
Foreground

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10
Q

Background Questions

A

General info about condition
Not specific to your current patient
Usually found in a general resource

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11
Q

Foreground Questions

A

Specific to a particular patient condition and clinical outcome
Answered via research studies, systematic reviews, or clinical practice guidelines

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12
Q

PICO Statements

A

P = patient/population
I = intervention
C= comparison/control
O = outcome
(T) = Time

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13
Q

I in PICO

A

Can relate to intervention, diagnosis, prognosis, etiology/harm

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14
Q

MEDLINE

A

National Library of Medicine’s premier database

searchable via the PubMed search engine

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15
Q

Boolean Terms

A

AND, OR, NOT

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16
Q

Combining Terms

A

MeSH Terms
using () and * to combine similar terms

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17
Q

MeSH Terms

A

Medical Subject Headings
predefined set of terms to connect info
organized medical articles by assigning them specific words to describe what they are about

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18
Q

*Truncation

A

search method in which symbols are used in place of letters to help broaden the search

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19
Q

Hierarchy of Evidence

A

Meta-analysis
Systematic Review
Narrative Review
CPG
RCT
Cohort
Case Control
Cross Sectional
Case Series/Studies
Expert Opinions

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20
Q

Clinical Practice Guidelines

A

3rd party organizations
Define the role of diagnostic tools and treatment modalities
Recommendations that are based on evidence from a rigorous systematic review

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21
Q

Meta-analysis

A

Type of systematic review
integrates quantitative data from many published studies
combines individual study data to perform new statistical analyses

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22
Q

Systematic Review

A

integrates findings from many published studies
specifically describes how databases were searched
Reduce bias over traditional reviews of literature

includes detailed and comprehensive plan and search strategy for sources

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23
Q

Narrative Review

A

current research studies on a topic
not systematic so chosen articles can have a selection bias

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24
Q

Randomized Controlled Trial (RCT)

A

Experimental process with a treatment/intervention
uses randomly assigned treatment and control groups
gold standard for reliable evidence testing

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25
Quasi-Experimental Designs
Is a TYPE of RCT but either the interventions are not randomly assigned OR/AND one group does not serve as a control
26
Cohort Study
compares groups with a shared characteristic observational, no experimental treatment can be prospective or retrospective prospective is stronger
27
Case-Control Study
Compares individuals with an existing condition or outcome to a group w/out condition observational, no experimental treatment almost always retrospective
28
Cross-Sectional Study
Participants are studied at one point in time, not retro or prospective Can be conducted quickly, may form a biases
29
Case Study/Series
detailed characterization of one or few participant observational often novel or unique conditions being described no control group
30
Expert opinion
lowest level of evidence can contain significant bias or even factual errors hard to determine accuracy
31
Appraising a Study
Applicability Quality Results Clinical Bottom Line
32
Questions for Applicability
Is the purpose relevant to my clinical question? Is the study population applicable to my patient? Is the intervention feasible within my clinic? Are the outcome measures relative to my clinical question? Was there sufficient long-term follow-up?
33
Eligibility criteria were specified
satisfied if the paper describes the source of subjects, list of criteria of who was eligible not included in PEDro scale. External validity
34
Subjects were randomly allocated to groups
paper must state allocation was random precise method does not need to be specified quasi randomized does not satisfy stratification can be used
35
Allocation was concelaed
does the researcher know who goes into control/trial group? if allocation is not concealed, the decision about whether to include a person in a trail could be influenced by knowledge of whether the subject was to receive treatment or not, which could produce systemic biases
36
The groups were similar at baseline
must describe: at least one measure of condition severity at baseline at least one different outcome measure at baseline that these measures are not different at baseline gives indication for potential bias
37
Gross differences between groups at baseline
may be indicative of inadequate randomization
38
Blinding
the person in question did not know which group the subject had been allocated to
39
There was blinding of all subjects
involves ensuring that subjects were unable to discriminate whether they had or had not received the treatment helps to eliminate placebo and hawthorne effects
40
There was blinding of all therapists
involves ensuring that therapists were unable to discriminate whether individual subjects had or had not received the treatment decreases chance that effect of treatment was due to enthusiasm or lack of enthusiasm of PT
41
There was blinding of all assessors
involves ensuring that assessors were unable to discriminate whether individual subjects had or had not received the treatment decreases chance that effect of treatment was due to enthusiasm or lack of or bias for treatment condition of assessor
42
Measures of at least one key outcome were obtained from more than 85% of the allocated subjects
only satisfied if explicitly states: -the # of subjects initially allocated to groups -the # of subjects from whom key outcome measures were obtained one outcome must be measured in 85% of subjects
43
All subjects received the treatment or control condition, or were analyzed by intention to treat
means that even when subjects dud not receive the treatment as allocated the analysis was performed with subjects still in the group they were allocated to satisfied if the report explicitly states that all subjects received treatment or control conditions as allocated may produce bias if analysis is done of how subjects were treated vs how they should have
44
Per protocol
comparison of treatment groups that includes only compliant participants who completed the treatment as originally allocated
45
As treated
comparison of treatment groups according to the actual treatment received, regardless of initial allocation
46
intention-to-treat
comparison of treatment groups strictly according to the initial group each participant was allocated to
47
The results of between group statistical comparisons are reported for at least one key outcome
statistical comparison is usually a t-test or ANOVA. p-value, alpha level are examples can either be between group or within group, but between group must be used for this
48
Between group statistical group
means the statistics compared 2+ groups of participants
49
Within group
means that the statistics compared 1 group across time
50
p-value
probability a significant result is due to chance
51
alpha level
probability threshold the researcher is willing accept that a significant result is due to chance usually set to .05. If p-value is less than alpha, groups are significantly different
52
The study provides both point measures and measures of variability for at least one key outcome
Point measure = measures the size of the treatment effect measures of variability = describe the dispersion of the data (standard deviation, error, range, confidence interval)
53
Clinical bottom line?
Minimal detectable change = smallest amount of change that can be safely attributed to real change, and not due to sampling variability or error minimal clinically important difference = smallest amount of change that is considered relevant or important to patients
54
Bottom line of implementation
should it be implemented? do you have a plan or process? have you overcome key barriers?
55
PubMed is the National Library of Medicine's premier database, accessed online via the MEDLINE search engine.
False
56
If your keyword search includes a truncated term (i.e. concuss*), PubMed will still apply automatic term mapping for that term.
False
57
MeSH terms do not
Automatically narrow your search to only the articles relevant to your question
58
MeSH terms do
Serve as a thesaurus that facilitates searching by pointing users to the preferred search term(s) Provide a comprehensive controlled vocabulary for the purpose of indexing journal articles and books Organize medical articles by assigning them specific words to describe what they are about, working as a label or "hashtag"
59
Which of the following search strategies works in both PEDro and the Cochrane Library?
Truncation
60
Cochrane Library is both a scholarly database and produces high-quality systematic reviews
True
61
Which of the following search engines allows you to find a diverse variety of articles across all levels of evidence?
PubMed
62
Which of the following databases include articles outside of the health sciences / medicine?
Academic search premier 1search google scholar
63
Which search engine is integrated within the OSU library, allowing you to see if OSU has access to the full-text, or if you may need to submit an interlibrary loan request (ILLiad)?
1search
64
Science Direct searches all articles published by Oxford Academic.
false
65
An observational study that compares groups defined by a shared characteristic.
cohort study
66
A study that uses a quantitative method to compile the results of multiple previous studies.
meta-analyses
67
A study that has two groups, one group that has the condition or outcome of interest and one group that does not.
case-control study
68
An experimental process that uses randomly assigned treatment and control groups to determine if the intervention has efficacy.
randomized control trial
69
A formal statement of recommendations with the intent to improve patient care based on a systematic review of the literature.
clinical practical
70
A detailed and comprehensive plan is developed a priori to search and synthesize the data from multiple studies.
systematic review
71
An intensive description of several patients, often times with a unique condition or presentation.
case series
72
The main difference between meta-analyses and systematic reviews are the methods to which the authors search previous literature.
False
73
Case-control, cohort, and cross-sectional studies are all observational studies.
True
74
Case series and case studies both report on novel or unusual phenoma from clinical settings.
True
75
Retrospective cohort studies are stronger than prospective cohort studies.
False
76
Quasi-experimental studies may be similar to randomized controlled trials, but without randomization or a control group, meaning they are usually a lower level of evidence.
True
77
Appraising the applicability and quality of an intervention study falls into which step of the EBP process?
Step 3
78
There are 4 steps to appraising an article. For an intervention study, which step(s) are covered by the PEDro scale?
Appraisal for quality appraising the results
79
Why is Question 1 of the PEDro scale not included in the final score?
It relates to external validity, while the PEDro scale looks at internal validity
80
How many questions on the PEDro scale relate to blinding?
3
81
External Validity
The extent to which study results may apply to other patients, groups, or situations
82
Internal Validity
The degree to of confidence that any differences observed between groups is due to the interventions and not limitations in study design

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