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Management of MS Disorders > Exam 1: Evidence Based Practice > Flashcards

Exam 1: Evidence Based Practice Flashcards

1
Q

We need EBP for 4 reasons.

  1. For ____ information
  2. There (is/is not) enough time to read all new studies
  3. Disparity between ______ judgement and ______ knowledge.
  4. _________ issues
A
  1. valid info
  2. Not enough time
  3. clinical vs current knowledge
  4. Reimbursement
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2
Q

True or False:

The three pillars of EBP are equal

A

False

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3
Q

what is the name of the scottish physician in EBP history

A

Archie Cochrane

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4
Q

Archie Cochrane was a scottish physician who argued for the use of _____ to ensure that finite health resources were used on treatments shown to be effective

A

RCT

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5
Q

Which physician argued for randomized control trials

A

Archie Cochrane

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6
Q

which medical doctor is the Father of EBP

A

David Sackett

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7
Q

Where did david sackett introduce EBM where he incorporated EBM education to medical students

A

McMaster University

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8
Q

who established cochrane centre and cochrane collaboration

A

Iain Chambers

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9
Q

what is the name of the international network of reviewers evaluating RCTs to produce and publish systemic review

A

cochrane centre and cochrane collaboration

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10
Q

_______ is based on the study of human knowledge

A

Epistemology

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11
Q

what are the three epistemological principles of EBM

A
  1. They are not equal
  2. Guide the provider to the most accurate objective info regarding the patient
  3. Patient values are applied for the final decision
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12
Q

EBP and its epistemological principles are like a _____

A

funnel

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13
Q

Principle 1 of EBP means viewing the best available evidence and the totality of the evidence, in other words you consider _____ of the evidence, ____!!!`

A

ALL; EVERYTHING

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14
Q

true or false:

With EBP, evidence includes only what is read in RCTs

A

False, it also includes descriptive studies, case studies, and what you have seen in the clinic

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15
Q

Principle 2 of EBP means using clinical expertise and synthesizing evidence. In other words you must make ____ of the evidence

A

sense

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16
Q

True or false:

The goal of clinical expertise is to support your idea but also to find the most accurate understanding

A

True

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17
Q

Which principle is the end of the EBP funnel

A

patent values/circumstances that involves educating patients on their options, and the decision is the patient’s because it is patient centered

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18
Q

What is the order of the EBM funnel

A
  1. Best available/ totality of evidence
  2. Clinical expertise
  3. Patient values and circumstances
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19
Q

True or False

Evidence alone is sufficient to make a clinical decision

A

False, it is never sufficient enough

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20
Q

A _____ of ____ should guide clinical decision making

A

hierarchy of evidence

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21
Q

The highest form of evidence from a single study comes from true experiments referred to as _____ _____ ____

A

randomized control trials

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22
Q

What is the lowest form of evidence of a single study

A

Foundational sciences

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23
Q

What are the four types of information PTs use to make clinical decisions

A
  1. Tradition
  2. Authority
  3. Intuition
  4. Trial and error
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24
Q

Over ____% of PTs based interventions on what was taught during initial training

A

90

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25
We use the acronym ____ to frame a question
PICO
26
what does PICO stand for
Patient/problem Intervention Comparison Outcome
27
True or False: When using PICO to frame a question, you do not always need a comparison
true
28
What is precision of treatment effect
A 95% confidence interval which is a range given indicated that if a study were to be duplicated, the stats of the duplicated study would fall between
29
What is size of effect and what is considered an acceptable P value
A P value that states whether data is statistically significant or not. A P value is significant if it is equal or less than 0.05
30
True or False: A P value of 0.00005 is more statistically significant than a P value of 0.05
False, as long as the value is equal to or less than 0.05, they have the same weight in significance
31
True or False: P value is NOT a function of effect size
true
32
When appraising the evidence, it is important that I can apply the results to my current patient care. Three ways to do this is make sure the study's subjects are (different/similar) to my patients, consider all clinical _______, and weight the benefits, harms and costs
similar, outcomes
33
The diagnostic process is a (2/3/4) step process
2
34
In the first step of the diagnostic process, you _______ the diagnostic hypotheses and estimate their ______.
enumerate; likelihood
35
In the second step of the diagnostic process, you incorporate (old/new) information to choose the most likely diagnoses
new
36
True or False: A question is considered to be a diagnostic test
true
37
What is the result of the diagnostic process
To establish a diagnosis or classification in order to specifically direct treatment
38
What term describes the probability of the target condition being present before the results of a diagnostic test are available
pretest probability
39
What term describes the probability of the target condition being present after the results of a diagnostic test are available
posttest probability
40
If we know the properties of the diagnostic tests that we choose, then we can be highly (qualitative/quantitative) in our ability to move from the pretest probability to the posttest probability
quantitative
41
A _____ hypothesis is the single best explanation given the preliminary data obtained which creates a (pretest/posttest) probability
leading; pretest
42
Once a leading hypothesis is made after the diagnostic process, you compare the hypothesis to two thresholds. What are those two thresholds
test and treatment thresholds
43
A (test/treatment) threshold is the probability below which a clinician dismisses a diagnosis and orders no further test
test threshold
44
A (test/treatment) threshold is the probability above which a clinical would consider a diagnosis confirmed and would stop testing and initiate treatment
treatment
45
The ____ of treatment determines when it is appropriate to start treating based on the percentage of confidence of what is being diagnosed (Ex: Brain surgery vs riding a stationary bike as intervention)
risk
46
A positive diagnostic test + a positive reference standard = ________
true positives
47
A positive diagnostic test + negative reference standard = _______
false positives
48
A negative diagnostic test + a positive reference standard = ______
False negative
49
A negative diagnostic test + a negative reference standard = _______
true negative
50
(sensitivity/specificity) is the true positive rate
sensitivity
51
(sensitivity/specificity) is the true negative rate
specificity
52
_____ is the proportion of patients with the condition who have a positive test result
sensitivity
53
Tests with (high/low) sensitivity have few false negatives, which rules out the condition (SnNout)
high
54
Why should I remember the acronym SnNout?
It means SeNsitivity with high Negatives can be ruled OUT
55
Why should I remember the acronym SpPin?
high SPecificity
56
A _______ ____ is the best way to tell if evidence is good or if an intervention is worth using.
likelihood ratio
57
What is the best statistic for evaluating the usefulness of a diagnostic test
LR
58
The LR can be used to quantify the shifts in _____ of the patient having a particular diagnosis once the test results are known
probability
59
How is LR calculated
from specificity and sensitivity
60
(positive/negative) LR expresses the change in odds favoring the disorder given a positive test
positive
61
The equation for (positive/negative) LR = sensitivity divided by (1-specificity)
positive
62
What is the equation of +LR
sensitivity/(1-specificity)
63
(positive/negative) LR expresses the change in odds favoring the disorder given a negative test
negative
64
The equation for (positive/negative) LR = (1-sensitivity)/specificity
negative
65
What is the equation for -LR
(1-sensitivity)/specificity
66
how would you interpret a +LR of 10 or more and a -LR of 0.1 or less
Generate large and often important conclusive in probability ..... this is really good
67
how would you interpret a +LR of 5-10 and a -LR of 0.1-02
Generate moderate shifts in probability. .....This is good
68
how would you interpret a +LR of 2-5 and a -LR of 0.2-0.5
Generate small but sometimes important shifts in probability ...... this isn't good but its not terrible
69
how would you interpret a +LR of 1-2 and a -LR of 0.5-1
Poor, little to no value
70
What values of LR generate a large and often conclusive shift in probabilty
``` +LR = 10 or more -LR = less than 0.1 ```
71
What values of LR generate moderate shifts in probability
``` +LR = 5-10 -LR = 0.1 -0.2 ```
72
What values of LR generate small but sometimes important shifts in probability
``` +LR = 2-5 -LR = 0.2-0.5 ```
73
What values of LR alter probability to a small, and rarely important degree
``` +LR = 1-2 -LR = 0.5-1 ```
74
When examining the evidence for effective interventions, would a number needed to treat (NNT) be better if it was higher or lower
lower, 1 would be the best number to have
75
If you, the PT, are wondering if the treatments being done are really helping the patient, what is the solution to ensure the treatments are helping
Take the patient and ask a relevant question in order to search the literature using a PICO format then use that info to guide treatment
76
Do you want to know WHY or IF a treatment works first
figure out if it works first, then find out why
77
True or False: EBP builds on and reinforces, and even replaces clinical skills, clinical judgment, clinical experience, and patient values
False, it never replaces it

Management of MS Disorders (18 decks)

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