8. Evidence Based Dentistry II Flashcards
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”
mentors stories textbooks focus everyone else
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
products defend quality standard cost
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 \_\_\_\_
wrong
poor
information
cook book
surveillance
obvious
Formulating PICO questions P: \_\_\_\_ problem or population I: \_\_\_\_ C: \_\_\_\_ O: \_\_\_\_
patient
intervention
comparison
outcomes
How to search for evidence
____
____
____
ADA library
cochrane
pubmed
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
consistent patient inconsistent patient consensus
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
sensitive unbiased repeatbility reproducibility assumptions
Types of scientific articles Human subjects research: Case \_\_\_\_ Case \_\_\_\_ \_\_\_\_ study \_\_\_\_ study \_\_\_\_ control study
“Bench” science
report series cohort case-control randomized
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
size
type
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 → “____”
randomization
blinding
double blind
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.
determines x depends y subjective study
Case-Control: Literacy/Missed appts
Take a look!
Ya!
Effect Modification
• \_\_\_\_ variable that has an effect on X, Y
third
Missed appointments
Patient or diseased centered outcome?
Disease-centered`
Basic terminology
Frequency
The ____ of disease in a population.
A number with no ____.
• No denominator - do not know \_\_\_\_ of problem
distribution
denominator
magnitude
Frequency
For some purposes, ____ is enough.
If I have 5 sets of sealant materials and 5 children who need sealants, I have enough material.
frequency
Prevalence
When frequency is not enough.
Prevalence = ____/ ____
• Population is \_\_\_\_, out of 100 children this day, etc, a moment of time
frequency
population
arbitrary
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)
DMFT
explicit
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
accepting
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
x
new x
new
Incidence
____/____
(within a specified period of ____)
new cases
population
time
Incidence vs Prevalence: HIV
• Progrsms that target people with HIV are different from thos tht target the \_\_\_\_ HIV people
____ have highest incidence of HIV
new
homosexual men
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.
prevalnce
Easy statistics
Descriptive statistics describe a ____
Inferential statistics - ____ about your sample and to the broader population
population
generalizations
Categorical data
Categorical data - ____ values
discrete
Nominal data
Form of categorical, cannot be ____
(colors)
ordered
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)
arbitrary
significance
data
likert
Interval data - ____ scale where we know the ____ between values in addition to the order.
• More precisison bt the data points
numerical
differences
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 ____
median
accurate
Frequency Distributions Normal distribution ● Most commonly observed ● “\_\_\_\_” ● Mean, median, and mode are \_\_\_\_ value
Skewed distribution
● Asymmetrical
● Mean, median, mode are ____
bell curve
same
not equal
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
mean
mean
squared deviation
9
range
directly
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
sample size magnitude type correlation continuous categorical p values
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!
classified
disease
disease
disease
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 ____
continuous
60%
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
false-positive
false-negative
PSA
______ is defined as the percent of persons without the disease who are correctly classified as not having the disease
specificity
Barriers to adherence: Lack of \_\_\_\_\_\_ Lack of familiarity Lack of \_\_\_\_\_\_ Sense of self-efficacy \_\_\_\_\_\_ about outcomes of guidelines Intertia of previous practices
awareness
agreement
expectations
Just introducing guidelines has ______ effect in changing behavior.
More promising avenues:
Reliance on______ leaders
Need overlapping ______ strategies
little
opinion
implementation
