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Flashcards in Introduction to Evidence Based Medicine Deck (60):
1

The father of westernized medicine

-Questioned the idea that gods caused illness and disease

Hippocrates

2

A prominent example of how scientific findings are not always accepted

Pellegra

3

In the early 1900's Pellegra was contracted by over 100,000 Americans, mainly in the deep south. What are the symptoms?

The 4 D's
1.) Diarrhea
2.) Dermatiti
3.) Dimentia
4.) Death

4

Mostly seen in hospital for insane persons, orphanages, prisons, and very low income areas

-Attributed to a microbial infection

Pellegra

5

Worked in the US department of hygiene and was the first to postulate that Pellegra was due to dietary deficiencies. But his results were not accepted

Dr. Joseph Goldberg

6

In the 1920's it was demonstrated that Pellegra was caused by

Niacin (Vitamin B3) Deficiency

7

Demonstrated that stomach ulcers were caused by a bacterial infection from Heliobacter pylori in 1984. But their results were not accepted until 1997.

-Won nobel prize in 2005

Barry Warren and J. Robin Marshall

8

What are five types of medical evidence?

1.) Diagnostic Studies
2.) Prognostic Studies
3.) Treatment Studies
4.) Prevention Studies
5.) Etiology Studies

9

Ask, "how sure can I be that a patient has a diagnosis?"

Diagnostic Studies

10

Ask "What should this patient expect following this surgery, this exposure, this diagnosis?"

Prognostic Studies

11

Asks "What are the causes or risk factors for the condition?"

Etiology Studies

12

When an old treatment is tested, and the results find that the treatment makes the patient no better, or no worse

Reversal

13

When a new treatment is tested and the treatment is found to be beneficial

Replacement

14

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients

Evidence Based Medicine (EBM)

15

Who originated evidence based medicine?

-designed the first randomized control trial (RCT)

Sir Bradford Hill

16

According to Archie Cochrane (1971) an intervention is only "effective" if it has been demonstrated, preferably by a RTC to

Do more good than harm

17

Anything that has an "effect" can also have

Side effects and risks

18

Out of 100 children with strep throat,

86 correctly detected w/ the rapid tes

-14 will be missed

19

Out of 100 children with non-strep sore throat

95 will be correctly classified w/ the rapid test

-5 will be misdiagnosed

20

What are the five A's that evidence-based medicine includes to access the medical literature and determine its relevance to the patient?

Ask, Acquire, Appraise, Apply, Assess

21

"POEMS" are patient oriented outcomes that matter. They encompass the 5 D's, which are?

Death, Disease, Discomfort, Disability, Dissatisfaction

22

Addresses areas of uncertainty and change in medical practice

Evidence-based medicine

23

All the people in a defined setting or with certain defined characteristics that the researcher is interested in

Population

24

The subjects from the population who are studied

Samples

25

The goal of clinical research is to generalize the results to the rest of the

Population of interest

26

The confidence with which the results can be accurately generalized to the population

External validity

27

A representative sample looks like the

Population

28

Are non-representative samples that decrease external validity

Biased Samples

29

To get a more representative sample, we want

Larger sample sizes

30

Identify who will be in the study

Inclusion criteria

31

Makes the sampling more manageable, controls variability (improving internal validity), and limits generalizability (external validity)

Inclusion and Exclusion criteria

32

When each member of the population has an equal chance to be included in the research

Probability sampling

33

The most common form of probability sampling

Simple random sampling

34

To ensure that critical variables are represented in the sample, subjects are stratified by traits and then randomly sampled

Stratified random sampling

35

A type of random sampling done when subjects are ordered.

-For example, the 3rd person from each letter of the alphabet can be chosen

Systematic sampling

36

Systematic sampling can incorporate stratification if there is a

Meaningful order

37

Non-probability sampling methods do not involve random selection. Three examples are

Purposive sampling, convenience sampling, and quota sampling

38

Hand-picking patients

Purposive sampling

39

People are chosen based on availability of volunteering

Convenience sampling

40

Convenience sampling with specific quotas included. This is like stratified sampling

Quota sampling

41

Factors or attributes in a research study that can have different values (ex: occupation, height, BMI, etc)

Variables

42

Variables that can be manipulated by the researcher

Independent variables

43

Measured outcomes. These may be "primary endpoints" or "secondary endpoints" in a study, aka: response variables or outcome variables

Dependent variables

44

In a study that seeks to determine if a drug works to relieve pain, what is the

1.) Independent variable?
2.) Dependent variable?

1.) Drug: Drug has 2 levels, drug and no drug
2.) Pain reliefe

45

Other variables in the study that may affect the relationship between the independent and the dependent variables

Extraneous variables

46

If researchers wanted to examine whether relaxation therapy was better than drug therapy for reducing the number of tension headaches in medical students, what would be some extraneous factors to control or account for?

Diet, other medications, severity of headaches

47

A process at any stage of interference tending to produce results that depart from the true values

Bias

48

Occurs when comparisons are made between non-equivalent groups

Selection Bias

49

When extraneous factors, selection bias, or measurement bias occur, a study is

-A fatal flaw in research

Confounded

50

Occurs when the methods of measurement are dissimilar among groups of patients

Measurement bias

51

Occurs when two factors are associated (travel together) and the effect of one is confused with or distorted by the effect of the other

Confounding

52

The variation in the measurements that occurs for any reason

-expressed as spread in the data

Random Error (Chance error)

53

How can we limit the random error?

Limit the population, improve the measurements, and control the testing environment

54

The internal health of the study, i.e. how free it is from bias and chance

Internal validity

55

The degree to which you can generalize the results of the study back to the population of interest

External validity

56

If you wanted to study grade school kids, and you wanted to be absolutely sure you got a representative sample from each grade level, you would use

Stratified sampling (i.e. take a SRS from 1st grade, then 2nd grade, then 3rd, and so on)

57

Used less in clinical studies, but more in epidemiology studies

Probability sampling

58

Seen often in a qualitative study

Purposive sampling

59

If two groups you are studying have different diets or different types of headaches, or differ in any way, this is an example of

Selection bias

60

If extraneous variable are not controlled,they result in

Confounding

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