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1

What are the 5 steps of EBP?

1. Access
2. Ask
3. Acquire - search lit in publically accessable databases
4. Appraise - assess rigour/value
5. Apply

2

What frame work would you use to ask an answerable question?

PICO!
Eg. What is the effectiveness of physiotherapy intervention for lumbar disc herniation in adults
P = adults I = physiotherapy intervention C = no treatment O = pain & functional movement

3

What does PICO stand for?

P = patient/problem eg. Elderly with ankle sprain
I = Intervention eg. "Does ice and rest reduce swelling"
C = Comparison eg. Alternate treatment or treatment vs. no treatment

4

What does PECOT stand for??

P = patient/problem
E = exposure (intervention) eg. Smoke
C = Comparison eg. No smoking
O = Outcome eg. Lung cancer
T = timeframe eg. 5-10 years

5

Define sensitivity: and state equation

Probability diagnostic test is positive in patients who DO have the disease (TP)

TP = (TP/TP+FN) X 100

6

Define specificity: and state equation

Probability the diagnostic test is negative in patients that DO NOT have the disease

TN = (TN/TN+FP) x 100

7

What does a sensitivity of 0.75 mean??

There is a 75% chance that if a test is positive the individual has the condition

8

What does a specificity of 0.85 mean?

There is a 85% probability that if the test is negative the person does not have the disease

9

What is the mode?

- The most commonly occuring value in a data set
- works for both categorical and numerical data sets

10

What is the mean?

- arithmetic average
- continuous and discrete but NOT categorical
- most severely influenced by outliers

11

What is the median?

Middle value in distribution arranged in ascending or descending order
- not affected by outliers

12

What are the steps in hypothesis testing?

1. State the research question(PICO)
2. Specify null and alternate..assume null is true, try and find evidence to support alternate
3. Decide on significance - alpha = 0.05 .."how much are you letting chance play a role"
4. Calculate test statistic(z, t or other)
5. Reject or fail to reject the null (usually through use of p-value)
6. State conclusion

13

State the null:

There is no significant difference between specified groups/populations

14

State the alternate

There is significant difference between groups/populations

Meaning sample observations are influenced by non-random cause -> research hypothesis

15

Draw the errors in decision making table:

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16

Describe quantitative research:

- emphasis on control and objectivity, produce rigorous and generalisable results
- required to describe cause and effect
- tests a theory (deductive)
- variables are controlled
- numerical forms of data representation
- conclusion is stated with predetermined degree of certainty(alpha)

17

Describe qualitative research:

- describes in depth a phenomena
- aiming to generate a theory -> inductive
- data representation in narrative and verbal forms
- it asks "why" and "how many" through looking @ social and cultural factors

18

What are the misconceptions of qualitative research?

- unscientific and anecdotal
- lack scientifically rigorous methods
- personal perspective dominant
- question applicability and relevance

19

Why are the misconceptions of qualitative research not true?

Clinical practice more than science, underpinned by personal observation, reflection and judgement
- when looking at view points it does not have focus on minimisation of chance, so p-value plays no role

20

Types of data collection in qualitative research?

1. Focus group
2. Interviews (clinical = diagnostic, opinion poll = deductive, qualitative research = inductive)
3. Participant observation
4. Document analysis

21

Why can you not use library data base?

- not for evidence based information
- non-replicable, other health professionals will be unable to replicate your search strategy and obtaining similar results using the same databases eg. Medline or CINAHL
- search must be transparent and reproducible

22

Describe case report/case series + pros and cons

- Usually a rare disorder
- describe experience of single patient or group(report) or report on series of patients with an outcome of interest
PRO: richness of info
CON: isolated observations collected in uncontrolled unsystematic manner => cannot generalise to population

23

Describe crossectional study + pros and cons

- ASSOCIATION between possible causal factors and a condition..done so by determining exposure to factor
Eg. Recently given birth + cleft plate + drug during pregnancy
PRO: easy, inexpensive, ethically acceptable
CON: does not establish cause & effect, only association and exposure, depends on accuracy of recall

24

Describe case-control + pros and cons

- people with condition "cases" matched to people WITHOUT "control"
- retrospective...look back in time to determine proportion of people in each group exposed to suspected causal factor
PRO: quick, inexpensive, best for rare long time exposure & outcome
CON: recall basis, medical records inaccurate or incomplete

25

Describe cohort study + pros and cons

- treated or exposed vs. non-treated or non-exposed
- prospective..see how many develop disease or outcome
PRO: less expensive and easier to administer than RCTs, more ethically acceptable because potentially beneficial treatment is not withheld, and possibly harmful treatment is not given
CON: can never perfectly match cohorts, social/occupation factors

26

what is RCT + pros and cons

- The gold standard of experimental quantitative research
- involves blinding, randomisation, sample size justification and statistical analysis together have the greatest ability to minimise bias

27

Name the types of bias

1. Sampling/selection = randomly and methodically
2. Allocation = to treatment or control
3. Maturation = occurs naturally over time
4. Attrition = drop outs, how did it effect study?
5. Measurement = eg. wrongly calibrated tool => standardisation
6. Placebo = participants believe intervention will result in improvement
7. Hawthorne effect = experience changes due to attention..pleasing researcher

28

What is the importance of EBP in health care quality and safety?

- Improve quality, effectiveness and appropriateness of clinical practice
- Shares decision-making with patients
- Substantiates the care provided to patients
- Reduce variations in practice patterns resultant from geographical difference or gaps in current knowledge!

29

What is the central limit theorem??

It states that the distribution of the mean is approximately normal if sample size is large enough, regardless of underlying distribution of original measurements

--> DRAW NORMAL DISTRIBUTION CURVE

30

Venn diagram what 3 things combine to make EBP

-research evidence
- clinical expertise
- patient values