8/30b Intro to Evidence Based Practice

Question 1

Why is evidence based medicine important?

Answer 1

it integrates the best research evidence with clinical expertise

Question 2

6S Model Breakdown

Answer 2

LEAP Practices - summary of systematic reviews are helpful for review
Summaries - whole group of experts get together to get more information on a broader topic and evidence based practices
Studies are primary original research
then synopses of studies
then syntheses
then synopses of syntheses
then summaries
then systems

Question 3

Breakdown of Primary Original Research - Studies

Answer 3

Level 2 - Randomized Control Trials (RCTs)
Level 3 - Cohort Studies (observational)
Level 4 - Case Control Studies (observational)
Level 4 - Cross Sectional Studies (Observational)
Level 4 - Case Reports/Case Studies (Descriptive)

Question 4

Define RCT

Answer 4

Randomized Control Study - control group is limited because random groups are input into the control groups and it is the highest level of individual studies

Question 5

Cohort Studies

Answer 5

Level 3, follow a group of people around over a TIME period

Question 6

Case Control Studies

Answer 6

Level 4, retrospective
-re-hospitalization for patients who had heart failure and were educated after vs patients who weren’t educated after their heart failure. The rate of rehospitalization between the two is measured and compared

Question 7

Cross sectional studies

Answer 7

Level 4, analyzes data from a population or a representative subset at a specific point in time

Question 8

Case Reports/Case Studies

Answer 8

Level 4, descriptive, best available evidence - 5 people are put through the same exercise program and analyzed

Question 9

Research Evidence

Answer 9

Diagnosis - cross sectional
prognosis - longitudinal (cohort)
intervention - experimental studies (RCT)

Question 10

Evidence Based Practice (EBP) Steps

Answer 10

1. ASK: Answerable clinical question formulated
2. ACQUIRE: Systematic literature review
3. APPRAISE: Research evidence critically analyzed
4. APPLY: Integrated with expertise and patient circumstances
5. ANALYZE AND ADJUST: Steps Evaluated

Question 11

How do you ask your question when doing research for EBPs

Answer 11

P - who is the Patient you care about?
I - what is the necessary Intervention after understanding the diagnosis (test and measures) and prognosis (how much should they/did they change)?
C - Compare between different interventions and solutions
O - what is the necessary Outcome?

Question 12

How do you find a legit and valuable piece of systematic literature?

Answer 12

1. Start with google/google scholar
2. look in pubmed
3. focus on PICO
4. summarize* multiple individual studies can be dropped in a forest plot to get the std mean difference (SMD**)

Question 13

How do you estimate error?

Answer 13

Standard Error of Measurement (SEM) 95% confidence interval (what would I expect for the measurement 95% of the time?)
Calculated value from SD and reliability
If the variability is too large, then it is not trustworthy

Question 14

MDC**

Answer 14

Minimal Detectable Change - based on SEM (standard error of measurement) and is the minimum amount of change that ensures the change isn’t the result of a measurement error

Question 15

MCID***

Answer 15

Minimal Clinically Important Difference - published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring
**smallest change that might be considered important to a clinician, at least MDC, defined for a population or patient group

Question 16

EBP CPG****

Answer 16

Evidence Based Practice Clinical Practice Guidelines:
Peer reviewed document written by a panel of experts that makes recommendations for treatment. It should:
-be based on systematic research
-include ratings of the quality of the evidence and the strength
-Level of evidence: Level I (highest quality) to V
-Grade of Evidence: “A” is strong evidence

Question 17

Systematic review

Answer 17

review of existing studies that includes:

• systematic/comprehensive/transparent search strat
• clear eligibility
• evaluation of individual study quality
• ordered way to deal with lots of evidence
• very long

Question 18

Meta-analysis

Answer 18

statistical approach that pools data from multiple studies to estimate the overall “effect” of an intervention

Question 19

Results in meta-analysis

Answer 19

1. Absolute: in the unites of the outcome - how much did the group change? how much effect between groups? comparison between groups
2. Standardized: unit-less and are therefore useful for comparing effects from diff studies to determine the effect of intervention on measures (SMD-standard mean difference)

Question 20

Example of a meta-analysis

Answer 20

forest plot on systematic reviews

Question 21

Absolute effects

Answer 21

the magnitude of the effect likely to be clinically important, based on

• your experience
• established minimally clinically important difference (MCID)

Question 22

Standardized Effect Sizes

Answer 22

0.2-0.5 = small, unlikely to be clinically meaningful
0.5-0.8 = moderate
>0.8 = large, likely to be meaningful
creates a way to compare different studies that used different units

Question 23

when comparing multiple studies, use:

Answer 23

standardized effect because it has no units

Question 24

forest plot, absolute vs standardized

Answer 24

absolute shows the size of the change

standardized shows no units

Question 25

Intervention studies

Answer 25

Know effect - understand sample and dose by breaking down the effect size and the 95% CI