6. EBM - Kate Stewart Flashcards
Name the 5 steps of evidence based practice
- Asking focused questions
- Finding the evidence
- Critical appraisal
- Making a decision
- Evaluating performance
When we critically appraise evidence, what 3 things are we looking for?
Validity
Clinical relevance
Applicability
Name the 7 things on the traditional hierarchy of EBM
- Systematic reviews and meta analyses
- RCTs with definitive results
- RCTs with non-definitive results
- Cohort studies
- Case-control studies
- Cross sectional studies
- Case reports
What 4 domains can we use to grade the strength of evidence?
Risk of bias
Consistency
Directness
Precision
Define EBM
The integration of best research evidence with clinical expertise and patient values and expectations
Screening
- Define screening
- Name an advantage of screening
- Name 3 disadvantages of screening
- Identifying apparently healthy people who may be at an increased risk of a disease or condition. They can then be offered further information/tests that can lead to appropriate treatment to reduce the risk
- Early detection of disease = treatment successful
- Overdiagnosis, false alarms and missed cases
Screening &diagnosis
Define diagnosis
Establish presence/absence of disease as a basis for treatment decisions in symptomatic/screen positive individuals
Probabilistic reasoning (Bayesian reasoning)
- Define pre-test probability
- Define post-test probability
- Probability of having the disease before having the test
2. Probability of having the disease after having the test
- Define prevalence
2. What is the equation for prevalence?
- Proportion of people in a population who have a given disease or attribute (target condition)
- (TP➕ FN) ➗ (TP ➕ TN ➕ FP ➕ FN)
- What is a false positive result?
2. What is a false negative result?
- Individual referred for further assessment who does not have the target condition
- Individual not referred for further assessment who does have the target condition
- Define sensitivity
- Define specificity
- What is the equation for sensitivity?
- What is the equation for specificity?
- Proportion of people who have the disease and are correctly identified as such by the test AKA test catches right people
- Proportion of people who do not have the disease, and are correctly identified as such by the test AKA test has few false positives
- TP ➗ (TP➕ FN)
- TN ➗ (TN ➕ FP)
- Define positive predictive values
- Define negative predicative values
- What is the equation for PPV?
- What is the equation for NPV?
- Proportion of people with a positive test result who actually have the disease
- Proportion of people with a negative test result who do not actually have the disease
- TP ➗ (TP➕ FP)
- TN ➗ (TN ➕ FN)
- What kind of test result would we want a high likelihood ratio for?
- What kind of test result would we want a low likelihood ratio for?
- What is the equation for positive LR?
- What is the equation for negative LR?
- Positive result
- Negative result
- Positive LR = sensitivity ➗ (1 ➖ specificity)
- Negative LR = (1 ➖ sensitivity) ➗ specificity
What does 95% confidence interval mean?
0.95 probability of containing the population mean
What are 4 qualitative data collection methods?
- Observation
- Interviews
- Group methods
- Diaries and documents