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Flashcards in Midterm Deck (74)
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1

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

EBM

2

integrating individual clinical expertise with the best available external clinical evidence from systematic research

EBM practice

3

EBM is the integration of what?

best research evidence, clinical expertise, and patient values (concerns)

4

what are the 5 steps to applying the medical literature to patient care? (evidence cycle of EBM)

1. ask
2. acquire
3. appraise
4. apply
5. act

5

what are the 2 different types of study design?

1. observational
2. analytical or experimental

6

what does an observational study design entail?

does not involve any intervention or experiment; seeks to measure the frequency in which disease occur or collect descriptive data on possible casual factors

7

what are 5 types of observational study designs?

Ecologic, cross-sectional, case report/case series, case control, cohort

8

what does an analytical or experimental study design entail?

manipulation of the study factor (exposure) and randomization of subjects to treat or control groups; attempts to specify in more details the causes of a particular disease or the effect of an intervention

9

what are 2 types of analytical/experimental study desgins?

Non-randomized control tried, RCT (double blind, placebo controlled)

10

describe the hierarchy of evidence

Bottom to top:
Studies (original journal articles)
Syntheses (systematic reviews)
Synopses (evidence based jouranl abstracts)
Summaries (evidence based textbooks)
Systems (computerized decision support)

11

describe the hierarch of study design

Bottom to top:
Editorials/expert opinions
Case series/Case reports
Case control Studies
Cohort studies
RCTs
Systematic reviews

12

What Study type?

Mathematically pools data from individual studies (does not have be as 'all-inclusive')

Meta analysis

13

What Study type?

Starts with patients with an exposure (self-selected) and follows them forward to an outcome
*Prospective

Cohort

14

What Study type?

Experimental design that introduces an intervention to modify the course of a disease

RCT

15

What Study type?

Starts with an outcome or disease and looks backwards to identify a possible exposure
*retrospective

Case control

16

What Study type?

Call attention to an unusual association, adverse event, or a unique case

Case series/case report

17

What Study type?

Focuses on a clinical topic, conducts a thorough review of the literature, validates quality of the studies and summarizes the data

Systemic Review
ie. Cochrane Database

18

What are strengths of a Meta Analysis and Systematic Review?

-summarizes literature
-prospective
-validates smaller studies

19

What are weaknesses of a Meta Analysis and Systematic Review?

- time consuming
- difficult to combine studies
- publication bias (positive studies are more likely to be published)
- requires studies to be 'similar enough'

20

What are strengths of a RCT?

- randomization
- controls for bias
- control over exposure
- best for proving efficacy

21

What are the weaknesses of a RCT?

- expensive
- ethical considerations
- time consuming

22

What are strengths of a Cohort?

- observing patients
- prospective

23

What are the weaknesses of a Cohort?

- time consuming
- possible cofounders
- can NOT prove causation
- Recall bias

24

What are strengths of a Case control?

- quick
- cheap
- convenient
- Good for rare disorders
- ethical

25

What are the weaknesses of a Case control?

- Based on recall
- Confounders
- Difficult to choose control groups

26

What are strengths of a Case series/ case report

- Identify new disease
- preliminary study

27

What are the weaknesses of a case series/ case report

- no control group
- no comparison

28

ID the highest quality of study to answer a clinical question from highest to lowest (the prevention and treatment hierarchy) (7)

-N of 1 randomized trial
- systematic reviews of RCTs
- Single RCT
- Systematic reviews of observational studies
- single observational study
- physiological studies
- Unsystematic clinical observation

29

What study types are best to answer a clinical question about:
Therapy

Systematic review/Meta analysis > RCT > Prospective Cohort

30

What study types are best to answer a clinical question about:
Diagnosis

Prospective, blind comparison to a gold standard