Layers Of Knowledge & Study Design (Modules 2,3,4)

Question 1

Foundational knowledge

Answer 1

Textbooks, lecture material, training guidelines

Question 2

Revisiting knowledge

Answer 2

Continuing education, checking old texts

Question 3

Keeping current

Answer 3

Regularly scan table of contents of a few relevant journals

Question 4

Specific interest

Answer 4

Specialization, practice focus, sport, injury

Question 5

Original source

Answer 5

Work done by authors

Question 6

Summary sources

Answer 6

Aggregation of many sources/articles:
1 systematic reviews
2 meta-analysis
3 guidelines + Evidence-based textbooks
4 narrative review

Question 7

Systematic reviews

Answer 7

Specific treatment questions
All available articles/studies
Critical appraisal of included articles

Question 8

Meta-analysis

Answer 8

Specific treatment question
Critical appraisal of included articles
provides combined stats

Question 9

Guidelines + Evidence based textbooks

Answer 9

Answers broad scope of questions
All available articles/studies
Critical appraisal

Question 10

Narrative review

Answer 10

Answer range of questions on treatment, condition, or both
not all articles/studies
no critical appraisal
Simple summary of findings

Question 11

Importance of original article

Answer 11

Much is lost in translation(think of game telephone)

Question 12

How useful is a source?

Answer 12

Quality- is it well done?
Relevance - will it matter to my patients?
Effort - time it takes to read/interpret

Question 13

The 6 A’s

Answer 13

1 Analyze
2 Ask
3 Acquire
4 Appraise
5 Apply
6 Assess

Question 14

The 6 A’s: #1

Answer 14

Analyze - look at practice/procedure, etc.

Question 15

The 6 A’s: #2

Answer 15

Ask - formulate question (PICO)

Question 16

The 6 A’s: #3

Answer 16

Acquire - find studies

Question 17

The 6 A’s: #4

Answer 17

Appraise - evaluate studies: quality, relevance, effort

Question 18

The 6 A’s: #5

Answer 18

Apply - put into practice

Question 19

The 6 A’s: #6

Answer 19

Asses - how did it work?

Question 20

Doctor as an authority?

Answer 20

Everyday there are over 12.5 million searches conducted online regarding healthcare

Question 21

How much health info is available?

Answer 21

~30% of medical info is available

Question 22

How good is google at healthcare?

Answer 22

7% of medical info

Question 23

Just a PubMed search?

Answer 23

No one database has it all

Question 24

How much research do I have access to VS. how much do I use?

Answer 24

(See Image)
Total research done on mother earth > published evidence > indexed evidence > evidence I can find > evidence I can access > evidence that I choose to use

Question 25

Boolean

Answer 25

Combining concepts: - AND narrows - OR broadens - NOT narrows - “around + near” broaden

Question 26

Searchable questions

Answer 26

PICOS: Patient description Intervention used Comparison group Outcome Study design

Question 27

Translation literature (summary source)

Answer 27

How do I use this in my office?

Question 28

What’s the latest:

Answer 28

Original work (new journal articles) Abstracts (conferences) Ongoing studies (clinicaltrials.gov) Proposed research (NIH funding)

Question 29

Descriptive VS Analytic

Answer 29

What’s happening? VS. How exactly does this happen?

Question 30

All studies (13) SEE HIERARCHY CHART

Answer 30

SEE HIERARCHY CHART Survey, Qualitative, Experimental, Observational, Randomized parallel, Randomized crossover, Cohort, Cross-sectional, Case study, Case-control, Basic science, Descriptive, Analytic

Question 31

Studies: Survey

Answer 31

Questionnaires

Question 32

Studies: Qualitative

Answer 32

General description

Question 33

Studies: Experimental

Answer 33

Intervention

Question 34

Studies: Observational

Answer 34

Risk, exposures, effects (real world)

Question 35

Studies: Randomized parallel

Answer 35

2 groups - intervention VS control

Question 36

Studies: Randomized crossover

Answer 36

2 groups - intervention AND control

Question 37

Studies: Cohort

Answer 37

Identify exposure, follow prospectively

Question 38

Studies: Cross-sectional

Answer 38

All people at doctor’s office that walk through door

Question 39

Studies: Case study

Answer 39

Interesting case + treatment

Question 40

Studies: Case-control

Answer 40

Find population w/ condition then look back to find factors

Question 41

Studies: Basic science

Answer 41

General biologic principles

Question 42

Studies: Descriptive

Answer 42

Any study that isn’t experimental

Question 43

Studies: Analytic

Answer 43

Hypothesis testing difference btwn 2 groups

Question 44

Observational study types

Answer 44

Case report Case-control Cross-sectional Cohort Case series

Question 45

RCT

Answer 45

2 groups assigned randomly - intervention VS control Can establish cause + effect, & minimize bias ALWAYS prospective

Question 46

When won’t an RCT work?

Answer 46

Small disease prevalence Can’t blind treatment Treatment may cause harm No access to many subjects Too costly

Question 47

Single blinding

Answer 47

Clinician or patient

Question 48

Double blinding

Answer 48

Any 2 of the 3 (clinician, patient, assessor)

Question 49

Triple blinding

Answer 49

Clinician, patient, AND assessor