Quiz 1 Material Flashcards
(49 cards)
three component of EBM
- patients values and expectations
- individual clinical expertise
- best available clinical evidence
relationship between clinical expertise and quality of healthcare
the quality of healthcare goes down when using just clinical expertise over time.
Two fundamental principles of EBO
- Hierarchy of evidence
2. Evidence is never enough
what does hierarchy of evidence mean?
it means that the most bias control comes from experimental designs, where as the least bias control can come from a case report.
what does “evidence is never enough” mean?
sometimes things in the literature can’t work because patients have values, or clinical expertise disagrees or the risks outweigh the benefits. Additionally may not have the circumstances, like setting and cost to perform what was in the literature
Hierarchy of Evidence from most confident (top) to least
MOST CONFIDENT: SR of RTCs or N of 1 RTC SR of cohort study cohort studies SR case-control case-control case study/series clinical expertise or expert opinion (LEAST)
CEBM
center for evidence based medicine, and a good resource
What does absence of evidence is not evidence of absence mean?
just because there aren’t many studies on a particular treatment does not mean that the treatment isn’t good
Background vs foreground questions
Background questions are like the medical aspects of the situation (like what is the most common ligament injured in the knee). Foreground questions are the PICO (help to make a treatment decision)
the most important secants of a study to read would be the….
methods and results (only good sections can be used)
Seven requirements of ethical research
- Social or scientific value
- Scientific validity
- Fair subject selection
- Favorable risk/benefit ratio
- independent Review
- Informed Consent
- Respect for potential and enrolled subjects
ethical research
to improve life and well being
Primary ethical dilemma in research
the goal of research is to improve health of future patients, but the goal of clinical care is to help current patients.
what is an EBM a-hole? what do you need to think about?
Sees new research and holds onto it because they think it is gospel. You really need to think about how EBM will affect a patient and how the evidence will affect everyone else.
Components of a PICO question
P: the questions about a person or a population (elderly people)
I: the intervention or treatment you have in mind
C: a comparative treatment
O: the outcome of the treatment
EX: the use of ice on a pulled hamstring vs heat in a geriatric population to decrease pain.
Boolean operators
NOT (everything without what is listed after this word)
OR (gets you everything with those words in it)
AND (articles with both words)
Independent variable
Usually the treatment, listed right in the methods section. what you manipulate or specify, then can be made into levels. Must have two levels. If the IV is treatment, then the levels are the multiple kinds of treatment (like the experimental and the control).
Dependent Variables
what you measure.
Active vs attribute of the IV
active is when something is set, and manipulated. Attribute is something that cannot change or be manipulated like age of the participants
Repeated vs. Independent factors
the repeated factor is something that the same group of people test. Like is there is an exp. and a control group, but all participants are tested. The independent factor is if there are two groups to test the two variables.
Levels of measurement
LOWEST: 1. nominal (no values, two values. like boy or girl, or race)
- ordinal (ranked, but not with numbers, rather on an arbitrary scale (like MMT, or hottness)
- Interval variables: ranked in EQUAL intervals, but no true zero (shoe size or years)
- ratio variable: interval scale with a true zero (height weight age) and can do ratios
How can time be an active IV
because you can choose when to start counting
Taking the primary and secondary IV, you can make ____.
factorial designs
IV’s level of measurement is usually…
ordinal or nominal
