8. Evidence Based Dentistry II Flashcards

1
Q
Justifying the decisions we make
● Asking \_\_\_\_
● Asking peers
● Telling \_\_\_\_
● Panels of experts
● Looking at \_\_\_\_
● Paying attention to what’s happened recently
● Narrowing our \_\_\_\_
● Going to youtube
● Doing what we think “\_\_\_\_” is doing
● Going with our “gut”
A
mentors
stories
textbooks
focus
everyone else
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
Why we need EBD
● Constant new \_\_\_\_
● Constant new techniques
● Need to \_\_\_\_ our decisions to insurance companies and our patients
● Eliminate overuse underuse misuse
● Triple aim
○ Improve \_\_\_\_ of care
○ Improve \_\_\_\_ of care
○ Decrease \_\_\_\_ of care
A
products
defend
quality
standard
cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
Limitations and Criticisms of EBD
● Limitations
○ Some things are not studied for the \_\_\_\_ reasons
○ Some things have \_\_\_\_ quality evidence
○ Sometimes there is too much \_\_\_\_

● Criticisms
○ “____” medicine
○ About younger clinicians vs. older clinicians
○ Really about ____ and being told “what to do”

• Some things are not studied because it seems \_\_\_\_
A

wrong
poor
information

cook book
surveillance

obvious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
Formulating PICO questions
P: \_\_\_\_ problem or population 
I: \_\_\_\_
C: \_\_\_\_
O: \_\_\_\_
A

patient
intervention
comparison
outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to search for evidence
____
____
____

A

ADA library
cochrane
pubmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SORT Criteria
A: ____ and good quality ____ oriented evidence
B: ____ or limited quality ____ oriented evidence
C: Recommendation based on ____, usual practice, opinion, disease- oriented evidence and case series

A
consistent
patient
inconsistent
patient
consensus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Validity, reliability, and generalizing

● Validity - Whether the questions asked by the study are answered by the method
○ Requires that the test is highly ____, specific, and ____
● Reliability - the ____ and ____ of a test
● Generalizability - the ability to make ____ about a larger group or a
different group, based on the sample

A
sensitive
unbiased
repeatbility
reproducibility
assumptions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
Types of scientific articles
Human subjects research: Case \_\_\_\_
Case \_\_\_\_
\_\_\_\_ study
\_\_\_\_ study 
\_\_\_\_ control study

“Bench” science

A
report
series
cohort
case-control
randomized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
Sampling strategies
Drawing conclusions about an entire population based on a sample from that population
● \_\_\_\_ of sample
○ Expense,time,practicality
● \_\_\_\_ of sample 
○ Random sample
○ Convenience sample 
○ Snowball sample
A

size

type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Avoiding bias
● ____
○ a study in which all subjects have an equal chance of being assigned
to either the study or control group
○ a sample in which individuals are selected randomly from the
population

● ____
○ When subjects are unaware of whether they are in a test or control group. Often necessitates use of placebos.
○ When neither participants or examiners are aware of what the groups are → “____”

A

randomization
blinding
double blind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

X and Y

Independent variable - variable whose value ____ that of others. Most often “____”

Dependent variable - variable whose value ____ on those of others. Most often “____”

Assignment of these variables is ____ and based on the ____ design.

A
determines
x
depends
y
subjective
study
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Case-Control: Literacy/Missed appts

Take a look!

A

Ya!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Effect Modification

• \_\_\_\_ variable that has an effect on X, Y
A

third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Missed appointments

Patient or diseased centered outcome?

A

Disease-centered`

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Basic terminology
Frequency

The ____ of disease in a population.
A number with no ____.

• No denominator - do not know \_\_\_\_ of problem
A

distribution
denominator
magnitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Frequency
For some purposes, ____ is enough.
If I have 5 sets of sealant materials and 5 children who need sealants, I have enough material.

A

frequency

17
Q

Prevalence
When frequency is not enough.
Prevalence = ____/ ____

• Population is \_\_\_\_, out of 100 children this day, etc, a moment of time
A

frequency
population
arbitrary

18
Q

Incidence vs Prevalence: Caries

____ = decayed, missing and filled teeth
Prevalence of sever caries is going down
Go from passive to ____ consent (parents are more wiling to participated)

A

DMFT

explicit

19
Q

Prevalence example: Access to care

* Just becoasue offices exist, doesn’t mean it's \_\_\_\_ patients
* Says there are enough patients to treat low income folks - but dentists don't take all of these patients - saying there's no need to expand care, but this is not the case
A

accepting

20
Q

Incidence
How are things changing over time?
Number of ____ vs. Number of ____

… smokers (prevalence) vs ____ smokers (incidence)
… people with breast cancer vs. new breast cancer cases
… fluoridated communities vs. communities that are becoming fluoridated

A

x
new x
new

21
Q

Incidence

____/____

(within a specified period of ____)

A

new cases
population
time

22
Q

Incidence vs Prevalence: HIV

• Progrsms that target people with HIV are different from thos tht target the \_\_\_\_ HIV people

____ have highest incidence of HIV

A

new

homosexual men

23
Q

The ______ of disease is the proportion of existing cases of disease in a population at one point in time or during a specified period of time.

A

prevalnce

24
Q

Easy statistics

Descriptive statistics describe a ____

Inferential statistics - ____ about your sample and to the broader population

A

population

generalizations

25
Q

Categorical data

Categorical data - ____ values

A

discrete

26
Q

Nominal data

Form of categorical, cannot be ____

(colors)

A

ordered

27
Q

Ordinal data

an ____ numerical scale where the exact numerical quantity of a particular value has no ____ beyond its ability to establish a ranking over a set of ____ points. Sounds like “order” (i.e. a ____scale: 1, 2, 3, 4, 5)

A

arbitrary
significance
data
likert

28
Q

Interval data - ____ scale where we know the ____ between values in addition to the order.

• More precisison bt the data points
A

numerical

differences

29
Q

Measures of central tendency
Mean Median Mode

Household income is more commonly used for ____, instead of mean to prevent skewing of data due to the small proportion of mega-rich - more ____

A

median

accurate

30
Q
Frequency Distributions
Normal distribution
● Most commonly observed
● “\_\_\_\_”
● Mean, median, and mode are \_\_\_\_ value

Skewed distribution
● Asymmetrical
● Mean, median, mode are ____

A

bell curve
same
not equal

31
Q

Measures of dispersion

Standard deviation: how much on average each value in the distribution deviates from the ____ - has same units as ____

Variance: average ____ about the mean (the square of the standard deviation)

a normal distribution with mean = 10 and sd = 3 is exactly the same thing as a normal distribution with mean = 10 and variance = ____

____: the difference between the highest and lowest value in a distribution

* How much variacne around the mean
* Variance and std devition are \_\_\_\_ related
A

mean
mean

squared deviation
9

range
directly

32
Q

Inferential statistics
“Is it statistically significant?”
● Based on the sample ____ and the ____ of effect
● Depending on the ____ of data (categorical, continuous), the statistical
tests that are used will vary …
○ ____ coefficients - used to compare continuous data
○ T-tests - used to compare ____ data
○ Chi-square tests - used to compare ____ data
○ ____ - gives us the confidence to accept or reject the null
hypothesis

A
sample size
magnitude
type
correlation
continuous
categorical
p values
33
Q

Sensitivity and Specificity

Sensitivity : the persons of persons with the disease who are correctly ____ as having the ____

Specificity: the percent of persons without the ____ who are correctly classified as not having the ____

LOOK AT TABLE!

A

classified
disease
disease
disease

34
Q

Sensitivity and Specificity: PSA test

PSA levels are ____. Only 1 man in 4 with a PSA value between 4 and 10 ng/ml will be found to have cancer.
If you use a higher cut off (PSA > 10), sensitivity rises to ____

A

continuous

60%

35
Q

Sensitivity and Specificity: PSA test
• Clinically insignificant cancers may be detected causing needless worry and further medical procedures for the patient
• Men without cancer may have a ____ result (particularly those with borderline PSA values)
• A ____ result may provide unwarranted reassurance
• Those undergoing biopsy are exposed to the risks of bleeding and infection

• Unsure of what \_\_\_\_ threshold to use
A

false-positive
false-negative
PSA

36
Q

______ is defined as the percent of persons without the disease who are correctly classified as not having the disease

A

specificity

37
Q
Barriers to adherence:
Lack of \_\_\_\_\_\_
Lack of familiarity
Lack of \_\_\_\_\_\_
Sense of self-efficacy \_\_\_\_\_\_ about outcomes of guidelines
Intertia of previous practices
A

awareness
agreement
expectations

38
Q

Just introducing guidelines has ______ effect in changing behavior.
More promising avenues:
Reliance on______ leaders
Need overlapping ______ strategies

A

little
opinion
implementation