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NRS204 > Unit 1 Preparation > Flashcards

Unit 1 Preparation Flashcards

1
Q

Dr David Sackett’s definition of evidence based practice

A

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating clinical expertise with the best available external clinical evidence from systematic research”

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2
Q

Integration of what 3 influences creates evidence based practice?

A

Clinical expertise
Patient values and preferences
Best research evidence

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3
Q

What are the 6 steps in evidence based practice?

A 
Assess (the patient)
Ask (the question)
Acquire (the evidence)
Appraise (the evidence)
Apply (talk with the patient)
Self evaluation
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4
Q

Step 1: assess

A

Start with the patient, a clinical problem or question arises from the care of the patient

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5
Q

Step 2: ask

A

Construct a well built clinical question derived from the case

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6
Q

Step 3: acquire

A

Select the appropriate resources and conduct a search

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7
Q

Step 4: appraise

A

Appraise the evidence for its validity and applicability for clinical practice

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8
Q

Step 5: apply

A

Return to the patient, integrate the evidence with clinical expertise and patient preference and apply to practice

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9
Q

Step 6: self evaluation

A

Evaluate your performance with this patient

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10
Q

ASK:

What mnemonic helps to remember key components of a well focused question?

A

PICO

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11
Q

PICO

P

A

P= patient problem

How to describe a group of patients similar to yours, what are the most important characteristics eg full term pregnant lady in early labour (long latent phase)

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12
Q

PICO

I

A

I= intervention
Which main intervention/ exposure are you considering? What do you aim to do for the patient? What factors may influence this for the patient- eg age

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13
Q

PICO

C

A

C= comparison

What is the main alternative to compare with the intervention? Eg comparing two possible drugs - oramorph vs diamorphine

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14
Q

PICO

O

A

O=outcome

what can you hope to accomplish/measure/improve/affect? What are you trying to do for the patient? Eg relieve pain

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15
Q

Most common types of questions:

4

A

Diagnosis
Therapy
Prognosis
Harm/etiology

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16
Q

Diagnosis question

A

How to select and interpret diagnostic tests

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17
Q

Therapy question

A

How to select treatments that so more good than harm and are worth the efforts and costs of using them

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18
Q

Prognosis question

A

How to estimate the patients likely clinical course over time and anticipate complications of these

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19
Q

Harm/etiology question

A

How to identify causes for disease

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20
Q

Type of study:

What is a case report (case study)

A

Collections of reports on the treatment of individual patients.

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21
Q

Why do case reports have little statistical validity?

A

Because they are reports of cases and use no control groups to compare outcomes- could have been many contributing factors

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22
Q

Types of study:

Case control studies

A

Studies to find the cause of conditions, in which patients who already have a specific condition are compared to those who don’t have the condition

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23
Q

Types of studies:

Cohort study

A

Studies patients already undertaking particular treatment/ have a condition and follow them over time and compare them to a group who don’t have the condition

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24
Q

Why do cohort studies lack reliability?

A

Because there may be other varying factors between the cohort and the unaffected group other than the condition/treatment

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25
Q

Type of study:

Randomised controlled clinical trials

A

Experimental intervention which introduce a treatment to study its effect on real patients and can compare to a non affected control group

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26
Q

Type of study:

Systemic reviews

A

Focused on a clinical topic and answer a specific question by extensively searching literature to identify previously conducted studies which are reliable and valid

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27
Q

Types of study:

Meta-analysis

A

Thoroughly examine a number of valid studies on a topic and combine the results mathematically

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28
Q

What is qualitative research?

A

Observational research is done to describe the health condition being studied with non-numerical results by studying beliefs, experiences, behaviours etc

29
Q

APPRAISE:

Three questions that need to be answered for every study when evaluating it (appraising)

A

Are the results of the study valid?
What are the results?
Will the results help in caring for my patient ?

30
Q

Validity of results

A

Validity is how true results are based upon how much they were influenced by bias

31
Q

Factors that increase validity

A

Randomisation for allocation
Concealed group allocation
Double bind
Patients in each group similar with minimal variables

33
Q

appraising results:
Experimental event rate and
Control event rate

A

Experimental event rate is the total number in the experimental group
Control event rate is the total number in the control group

34
Q

Absolute benefit increase

A

The difference between the rates of events between be experimental and control group eg if one is 75% and the other is 10% then the ABI is 65%

35
Q

Relative risk

A

The ratio of risk in experimental group compared to risk in control group

36
Q

Relative benefit increase

A

The proportional increase in benefit between the rates of events in the control group and the experimental group (eer-cer/cer)

37
Q

What 3 factors to consider when applying the results of a study to your patients

A

We’re the study patients similar to my population of interest?
We’re all clinically important outcomes considered?
Are all the likely treatment benefits worth the potential harm and costs?

38
Q

Key issues for diagnostic studies

A

Diagnostic uncertainty
Blind comparison to gold standard
Each patient gets both tests

39
Q

Sensitivity of results (true positive)

A

Measures the proportion of patients with a disease who also test positive for the disease in a diagnostic test

40
Q

Specificity of results (true negative)

A

Proportion of patients without the disease who also test negative for the disease in the diagnostic study

41
Q

Assessing the validity of results

A

Were the sample of patients representative?
Were the patients sufficiently homogenous with respect to prognostic factors
Was the follow up sufficiently complete?
Were objective and unbiased outcome criteria used?

42
Q

Numbers needed to treat

A

The number of patients who need to be treated to prevent one bad outcome or produce one good outcome

43
Q

What does adding ‘AND’ into your study research search term do?

A

It helps get fewer, more specific results.

Eg by putting “diabetes AND children” you will only get article results where both are included

44
Q

What will using the word “OR” in your article research search do?

A

This will help you get more results, for example if you search two synonyms “climate change OR global warming, you will get search results that coffin either words

45
Q

What does adding the word NOT when searching research articles combining search terms do?

A

NOT hells you to filter out unrelated topics, giving fewer results
Eg banks NOT river

46
Q

Why must you be careful when combining search terms using the word NOT?

A

Because it may exclude relevant results, this is because even if an article is about rivers and just mentions the word bank, it will not come up in your search results because of the “NOT banks”

47
Q

What do wildcards do in searching technique?

A

They allow you to search for spelling variations by substituting a letter with an Astrix. For example immuni*ation will search for results with both immunisation and immunization

48
Q

What does truncation do when searching for articles

A

Truncation allows you to search for variations of a word, for example safeguard* will find results for safeguarding, safeguards etc

49
Q

What does phrase searching allow you to do when searching for articles

A

It allows you to search for phrases rather than just individual words eg “maggot therapy” with speech marks will allow you to only recurved results for maggot therapy rather than maggots or therapy

50
Q

By what ways can your search be refined other than combing words or excluding words?

A 
Date of publication
Language
Publication type
Age
Geography
51
Q

Three most commonly used Boolean operators

A

And
OR
NOT

52
Q

What is the SQ3R acronym

A

A study strategy that helps you understand and remember what you’re reading and studying

53
Q

What does SQ3R stand for?

A

Survey- break down the task into manageable chunks, read headings, skim for an overall impression

Question- ask yourself what you already know/want to know etc

Read

Recite (recall)-remember what you read without looking at notes

Review- go over it

54
Q

Categorical data

A

Count of the number of cases in each mutually exclusive category

55
Q

Ordinal data

A

Data on a scale for sequential categories but can only take certain values eg rolling a dice can only gain values between 1-6

56
Q

Continuous data

A

Data which can be anywhere within a scale (not defined by certain numbers) eg weight or height

57
Q

Range

A

The highest and lowest values (highest-lowest)

58
Q

Mean

A

Average calculated by adding up all the numbers and dividing by the number of numbers

59
Q

Standard deviation

A

Variation of data around the mean

60
Q

Median

A

The middle value when numbers lined up in order

61
Q

Percentile

A

The percentage of the sample with scores below the state value

62
Q

Quartiles

A

Scores that mark the highest and lowest 25% of the sample

63
Q

Interquartile range

A

The range between the 25th percent and the 75th percent

64
Q

3 types of patient sampling

A

Convenience
Random
Purposive

65
Q

Purposive sampling

A

Non probability sample that reflects characteristics of the population

66
Q

Convenience sampling

A

Non-probability sampling that uses the first available primary data source

67
Q

Random sampling

A

Assigning people without any similarities into account eg names out of a hat

68
Q

What is Cochrane collaboration?

A

An organisation that produces systemic reviews from primary research

69
Q

What are variables

A

Measurable concepts that represent an object/ person/ circumstance/environment

70
Q

Independent variable and dependent variable

A

Independent- what is being changed

Dependent- what is being measured

NRS204 (3 decks)

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