Midterm Flashcards by Ashley Susie

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

Evidence-based practice

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What are the three essential components of EBCP?

External evidence, patient values and clinical expertise

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Where do you get information?

Clinical observation, peers and experts, internet, books, popular press, peer-reviewed scientific publications

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What is the relevance of EBCP?

Providers can use it to improve patient care and make referrals, patients use it to improve their health and government agencies use it to make policy decisions

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What is at the top of the hierarchy of evidence?

Clinical practice guidelines

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What are the two broad categories of health-related research?

Basic science, clinical

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Basic or clinical science? Laboratory, usually not patients; investigates mechanisms, how treatment works

Basic science

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Basic or clinical science? Treatment of patients; investigates clinical outcomes, shows effectiveness of treatment

Clinical science

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The science (systematic study) of the factors that influence human health on the level of the population

Epidemiology

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Health-related events do not depend on a single isolated cause, but develop as the result of complex interactions among factors

Web of causation

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What is incidence?

The amount of new cases of the disease.

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What is prevalence?

The existing cases of a disorder in a population at one point in time. Expressed as a number per 100,000 or a %.

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What is primary research?

Investigators collect the data such as surveys, experiments with animals or humans and formal observations of animals or humans

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What is secondary research?

Investigators use data that has already been collected such as narrative reviews, systematic reviews, meta-analyses and guidelines

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What are the study design categories?

Observational and experimental

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What type of study design is described? Investigators DO NOT control variables, often used for describing populations, best to use if there are many unknown factors

Observational

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What type of study design is described? Investigators DO control variables, often used to investigation treatments, best for investigating effect of single factors

Experimental

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What are the five A’s of EBCP?

Assess, ask, acquire, appraise, apply

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General, broad questions

Background Questions

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Questions specific to patients, focused, address diagnosis or therapy

Foreground Questions

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What is an abstract?

Short summary, overview of methods and results

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What is an introduction?

Background and purpose, establishes importance, includes relevant literature and identifies gaps in literature.

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What is included in methods?

**Very important
Explains project’s study design, if sample is well described, procedures explained, outcome measures explained and justified and statistical analysis

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What is included in results?

Summary of sample/groups. Compares groups to be sure they are equivalent in important characteristics and summary of outcomes with tables and figures at the heart of this section.

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What is included in the discussion?

Limitations of the study (very important that this is included) and compare/contrast to other studies

What is included in the conclusion?

Conclusions of the results that should follow logically

What is included in references?

Establishes whether the authors have considered work of others. References older than 5 years should be minimal and references should apply directly to the study.

What are the two types of validity?

Internal and External

What is internal validity?

How well the study achieved it's aim.

What is external validity?

"Generalizability" How well this could be applied to the outside world.

Internal or external validity? | Within the study only

Internal

Internal or external validity? | Generalizable to other groups of people, settings or interventions.

External

Internal or external validity? | If the results of the study are only applicable to it's participants then this type of validity is lacking.

External

Internal or external validity? | If the intervention causes the outcome vs other variables which may have affected results.

Internal

Internal or external validity? | If outcomes are affected by bias.

Internal

Internal or external validity? | Related to the presence of extraneous variable and bias.

Internal

Bias, or _________ error in measurement, usually reproducible as it may be caused by faulty equipment or from mistakes in taking the measurement.

Systematic

This type of error occurs by chance.

Random

Excessive bias means the results of the study are __________.

Not trustworthy

Instruments/equipment may be non-standardized OR be used slightly differently by different investigators at different times.

Instrumentation bias or measurement bias

Measurements used should be both _____ and ______. (with references to support this)

Valid and reliable

Participants who are not representative of the population being studied create _________.

Selection bias

Groups who are unequal at baseline can also create __________.

Selection bias

Usually table number __ in an article will compare groups at baseline and discuss differences

__________ may occur when participants drop out and are lost to follow-up

Attrition bias

T/F A decrease in sample size may affect representativeness and outcomes, particularly if the cause of attrition is able to be determined.

False, particularly if the cause of attrition is NOT able to be determined it's likely to affect representativeness.

_____% attrition probably doesn't create bias.

<5%

_____% probably creates attrition bias

>20%

What are three ways to appraise an article?

1. Apply ABCD FIX mnemonic (only for therapy articles) 2. Use a worksheet 3. Use CONSORT checklist

What does ABCD FIX stand for?

``` Allocation concealed? Blinding? Comparable groups? Drop-outs? Follow-up? Intention to treat? X factor (other obvious source of bias) ```

What are the three purposes of diagnostic testing?

1. To establish a diagnosis 2. To provide prognostic information 3. To monitor the response to treatment

What three things determine diagnostic test discrimination (accuracy)?

1. Sensitivity and specificity 2. Predictive value 3. Likelihood ratios

T/F If a patient is very unlikely or very likely to have a disorder, there is probably no need for a test.

True

Accepted diagnostic procedure which identifies disorder with certainty

Gold standard

_________ may be riskier, more technically difficult, expensive or impractical than other diagnostic procedures.

Gold standard

T/F: Some disorders may not have a gold standard.

True

__________: probability that a person WITH a disorder will have a positive result

Sensitivity

__________: probability that a person WITHOUT a disorder will have a negative test result

Specificity

Positive disorder, positive test

True positive

Positive disorder, negative test

False negative

Negative disorder, negative test

True negative

Negative disorder, positive test

False positive

________: ability of a dx test to identify true disease without missing anyone who has it

Sensitivity

T/F: High sensitivity test has few false negatives so is effective at ruling conditions in.

False: effective at ruling conditions out. (SnNout)

T/F: High specificity test has few false positives so is effective in ruling conditions in.

True (SpPin)

________: ability of dx test to identify absence of disease without mislabeling anyone who does not have it.

Specificity

Prevalence is also known as a __________.

Pretest probability

What is a positive predictive value (PPV)?

The likelihood of having the dx when the test is +

What is the negative predictive value (NPV)?

The likelihood of not having the dx when the test is -

A likelihood ratio of _____ generates large and often conclusive changes from pre-test to post-test probability.

Greater than 10 or less than 0.1

A likelihood ratio of >10 is good for what?

Ruling the condition IN

A likelihood ratio of <0.1 is good for what?

Ruling the condition OUT

What are the four types of Nociceptive pain?

1. Discogenic 2. Facet 3. SI joint 4. Myofascial

What are the four types of neuropathic pain?

1. Compressive radiculopathy 2. Non-compressive radiculopathy 3. Neurogenic claudication 4. Central pain

_______ is the progressive resolution of or retreat of symptoms toward the midline

Centralization

What are the descriptive study types?

1. Case report 2. Case series 3. Survey

What are the observational (analytic) study types?

1. Cross-sectional 2. Case-control 3. Cohort studies

What are the experimental (analytic) study types?

1. RCT

_________ studies are a slice of time that looks at prevalence. Not too expensive or time-consuming.

Cross-sectional

________ studies follow a group of individuals over time.

Cohort

The limitation of _________ studies is you can't tell whether exposure preceded disease.

Cross-sectional

_______ studies often use surveys, which may have bias

Cross-sectional

______ studies start with exposure/risk factor and follow group over time to determine outcome

Cohort

_______ studies are used to assessing risk/harm/adverse events.

Cohort

What are the two types of cohorts?

Prospective and Retrospective

__________ cohort: with or without risk factor of interest followed forward in time to record outcome. Is more expensive.

Prospective

__________ cohort: usually uses secondary data, cohort is followed backward in time to examine risk factors present years in the past. Less expensive.

Retrospective

What is a case-control study?

Looks at the difference between group with the disease and one group without.

T/F: In case-control studies risk factors are compared.

True

T/F: In case-control studies "risk of outcome" can be assessed.

False, risk of outcome cannot be assessed, the outcome is already known.

T/F: Case-control studies are useful for rare conditions, such as the association between stroke and SMT.

True

T/F: Systematic reviews use secondary data.

True

Systematic review methods include 3 things which are?

1. Eligibility criteria for articles 2. Databases and search strategies detailed 3. Evaluation of the quality of the literature.***

Primary evidence includes what?

RCTs, Observational studies (Case-control, cohort), expert opinion and case reports/series

Secondary evidence includes what?

Clinical practice guidelines, meta-analyses and systematic reviews

Observational or experimental study? | Who: People with specific condition/exposure; may be 2 groups.

Observational

Observational or experimental study? | Who: Sample 1+ comparison sample(s)

Experimental

Observational or experimental study? | Why: Evaluate the effect of an intervention using methods that minimize risk of bias.

Experimental

Observational or experimental study? | Why: Gather "real-world" evidence

Observational

Observational or experimental study? | There is no investigator-designed intervention

Observational

This type of study usually includes RCTs, cohorts and sometimes lower-level studies and is used to synthesize and evaluate the best evidence available on a very specific topic from multiple sources.

Systematic review

This type of study usually includes RCTs, cohorts and sometimes lower-level studies and is used to synthesize and analyze the best evidence available on a very specific topic COMBINING DATA from the included studies.

Meta-analysis

This type of study includes the generalized population and is used to make recommendations on best practices, based on best available evidence.

Clinical practice guidelines

What are some good databases to access?

1. ) PubMed (legit) 2. ) Index to Chiropractic Literature (ICL) 3. ) CINAHL (whatever the heck that is lol)

This recent type of literature was developed to help busy clinicians apply evidence in their practice - often at the time of care

Pre-appraised literature

T/F: Many experts in EBP recommend using these pre-appraised sources first, before the primary literature.

True

T/F: Pre-appraised literature is not useful.

False: pre-appraised literature uses an explicit review process to find and appraise evidence, so the sources are appraised for you by experts.

What are pre-appraised databases we can use?

1. Dynamed | 2. UptoDate

What is also apparently considered pre-appraised?

1. Cochrane library | 2. Systematic reviews and meta-analyses

What are a couple special purpose resources for clinical practice guidelines?

1. National guideline clearinghouse | 2. Clinical practice guidelines database (this one is for Canada)....glad i know that now.

What does R3C stand for?

Rapid Response Resource Center

What is the R3C?

An open access online resource that summarizes and references current evidence on effectiveness and safety of chiropractic care

T/F: The R3C is organized by topic such as commonly seen conditions by DCs and procedures/practices commonly used by DCs.

True

T/F: Essentially the purpose of this R3C thing is to make searching easier because it gives you less irrelevant results to shuffle through compared to doing a Google or even PubMed search.

True

If you don't have access to a pre-appraised source then use: ________.

Clinical practice guidelines, Systematic reviews, RCTs and cohort studies.

What is Type I error?

Alpha error... is a false positive

What is Type II error?

Beta error... is a false negative

Type I or II error? Rejection of true null hypothesis, where a conclusion is drawn that the null hypothesis is false when, in fact, it is true. (false positive)

Type I

Type I or II error? Retaining a false null hypothesis, where a conclusion is drawn that the null hypothesis is true when, in fact, it is false. (false negative)

Type II

Likelihood ratio score of 2-5 means what?

Small but sometimes important

Likelihood ratio score of 5-10 means what?

Moderate & usually important

Likelihood ratio score of 10+ means what?

Usually conclusive

Type I or II error: | The patient has a disease but the study says they don't.

Type II (false negative)

Type I or II error: The patient does not have the disease but the study says they do.

Type I (false positive)

To avoid Type I error do this:

Significance testing

To avoid Type II error do this:

Power calculation

Midterm Flashcards

(126 cards)