Ch 6

Question 1

Purpose of evaluating the evidence

Answer 1

Important in becoming a successful evidence-based practitioner

◦ Need to differentiate which studies are worth CHANGING YOUR PRACTICE

◦Which are valid and clinically useful

Question 2

Qualitative Methods Appraisal – Key Questions

Answer 2

1.Was the sample appropriate?
2.Were the data collected appropriately?
3.Were the data analyzed appropriately?
4.Can I transfer the results of this study to my own setting?
5.Does the study adequately address potential ethical issues?
6.Overall: is what the researchers did clear?

Question 3

Combination of two different research designs can be very informative.

Answer 3

Mixed-methods

Question 4

True/False: The most appropriate design to be used in a specific study depends more on the research question and the knowledge required than on a priori ideas of best methods.

Answer 4

True

Question 5

Ethnography, phenomenology, grounded theory

Answer 5

Study design

Question 6

Participant observation, interviews, focus groups, and review of documents or other material

Answer 6

Method

Question 7

Sampling redundancy or theoretical saturation of the data is achieve

Answer 7

Sampling

Question 8

Research Design Issues in Qualitative Research

Answer 8

Study design
Methods
Sampling
Data collection

Question 9

Critical Appraisal – Qualitative Studies

Answer 9

◦Levels of evidence do not apply

◦Use critical reviews forms for analysis – example – McMaster Qualitative Review Forms (Appendix C in the book)

Question 10

The “Classic” Levels of Evidence for Treatment Effectiveness

Answer 10

Level 1 - Systematic reviews, randomized
controlled trials
Level 2 - Cohort studies
Level 3 - Case control studies
Level 4 - Case series
Level 5 - Expert opinion, bench research, or
theoretical principles

Question 11

Certain consistencies are evident across different types of questions and their associated levels of evidence:

Answer 11

1. A systematic review of high-quality studies always provides the highest level of rigor.
   2.An individual study using the optimal design for that type of clinical question is considered level 1.
   3.Prospective data collection indicates higher study quality than retrospective data collection.
   4.Expert opinion, bench research, conceptual frameworks/theories/first principles are always considered the lowest (level 5) evidence

Question 12

Classic evidence rating system

Answer 12

Grades A through D

Question 13

Consistent level 1 studies supporting a given conclusion.

Answer 13

Grade A recommendation

Question 14

Consistent level 2 or 3 studies supporting a given conclusion

Answer 14

Grade B recommendation

Question 15

Level 4 studies or extrapolations from level 2 or 3 studies.

Answer 15

Grade C recommendation

Question 16

Only level 5 evidence or at any time when the available studies are inconsistent and inconclu

Answer 16

Grade D recommendation

Question 17

classifies the quality of evidence in one of four levels—high, moderate, low, and very low. Some of the organisations using the GRADE system combine the low and very low categories. Evidence based on randomised controlled trials starts as high quality evidence, but may be reduced for compromised quality including: study limitations, inconsistency of results (between studies), indirectness of evidence, imprecision (in effect estimates), and reporting bias.

Answer 17

GRADE system

Question 18

◦Sample Size
◦Allocation of treatment
◦Blinding (to treatment allocation and/or outcomes)
◦Outcome ascertainment
◦Follow-up
◦Statistical analysis

Answer 18

Sampling of subjects

Question 19

Critical appraisals tools

Answer 19

◦Quick scales or classification systems, or in some cases using more detailed rating scales
◦Range from very structured tools that contain specific questions and defined response categories to more open-ended scales where the assessor makes guided subjective judgments on the quality of aspects of study design using a framework provided by the assessment tool
◦Clinicians can select different critical appraisal instruments depending on the the clinical question/study design, their familiarity with critical appraisal, personal preferences, and the nature of the ratio betw

Question 20

Types of critical appraisal tools

Answer 20

◦Open-ended questions versus semi-structured (e.g., Law) versus structured (e.g., MacDermid)

◦Interpretation of items guided or open

Question 21

Learning Biostatistics and Critical Appraisal

Answer 21

Need to have a working knowledge of biostatistics to comprehend, analyze, and put into practice evidence from clinical journals and other sources.
◦Critical appraisal is most useful and most interesting when conducted in a group situation.
◦Journal Club