Chapter 1 Flashcards
rule of thumb the book recommends is that if you want to find a comparsion of the most commonly used treatments for a well researched disorder, start with __
the in-dept sources
levothyroxine sodium is the treatment of choice for ___
hypothyroidism
slow progress disease, abnormally low secretion of thyroid hormone
hypothyroidism
as you move away from EB sources like Cochrane Library, you must be increasingly wary of resources that are based on ___ rather than ___
opinion rather than research
the objective of this step in the process is tohave a search plan that includes sources with the highest level evidence available in your area of inquiry
Identify target resources
when you go to a search page that has just one search field on it and you type words into that field and click a button
single field search
most common search procedure
single field search
__ will allow you to add criteria to your search that will produce more focused results
advanced search option
it is important to use an effective organizational strategy to track your findings in this step..
organize findings
trustworthy could also be called __ and __
reliability and validity
looking for bias, errors and untested assumptions will help you ___
appraise trustworthiness
factors that consider ___ include: the histories of the patients selected for the study, the age of the patients, the type of intervention, the length of the study, the gender and race or ethnicity of patients
relevance
the ___ could be one of the following: nothing besides monitoring, or stop treatment after learning about potential adverse effects or interactions, or patient education - depends on the information you gathered
action
what is essential in whatever treatment is selected, especially if it involves lifestyle change or adherence to a drug regimen?
patient compliance
with or without - the patient you should select the action that fits the health situation, can be achieved with available resources and matches the patients values.
with
__ is a practice that incorporates effective patient communication with engagement of the patient in choosing a course of action
motivational interviewing
the __ step is to implement the action you and your patient have selected and to evaluate its effectiveness.
FINAL!! WOO HOO!
measures of effectiveness can include __ and ___
objective and subjective data
information you observe or measure
objective
the patients perceptions
subjective
the growth of knowledge in health care depends on ___
communication of real experiences with patients
the purpose of using ___ for medical information is twofold:
1- give you a vocabulary to assist with formulating search terms
2- to make it easier to discuss and explain the EBP process
categories
we create ___ to organize information and to enable communication
categories
another means of categorizing medical information is to ___
assign the level of evidence
a visual representation and system for categorizing healthcare information according to level of evidence
evidence pyramids
the top of the pyramid represent the highest level of evidence, those resources that re considered to be the most ___
trustworthy
randomized control trials are shown to be wrong ___
25% of the time
nonrandomized studies are shown to be wrong __
80% of the time
large, high quality randomized control trials are shown to be erroneous nearly __ of the time
10%
systemic reviews and meta analyses is where on the pyramid?
the top/peak
cochrane review would be where on the pyramid?
top
critically appraised synthesis or synopsis resources, evidence based reviews, critically appraised topics, patient oriented evidence that matters are where on the pyramid?
second from top
sources like DynaMed, Physicians information and Education resource and BMJ Point of Care are where on the pyramid?
second from top
randomized control trials are where on the pyramid?
middle of the pyramid or third from the top
this level is sometimes subdivided by the size of the study and the levels of blinding. large size, longitudinal, multicenter, double or triple blind studies are generally ranked ___ in its group
highest
case control studies, case series and case reports are where on the pyramid?
4th or second from bottom
textbooks, literature review articles, laboratory research and expert opinion pieces are where on the pyramid?
5th or bottom
__ provides a grading system for its recommendations
USPSTF
what drug demonstrated the hazard of selecting a treatment without sufficient research?
thalidomide - was used as a treatment for morning sickness to help pregnancy women sleep
many newborns of mothers who had taken thalidomide were afflicted with ________.
phocomelia - knows as “seal limb”
caused limb deformities, but also deafness, blindness, cleft palate, and other internal problems. Most frequently the diseases affected the formation of the arms, which ended up look like flippers.
phocomelia - because mothers were prescribed thalidomide for morning sickness
_____ is a translational form of critical thinking.
Evidence - based practice
the theoretical skills and concepts of critical thinking are translated into real world applications
translational critical thinking
What are the 4 learning strategies native to critical thinking that are applied to evidence based practice?
- solve ill structured problems
- self awareness
- self direction
- active engagement
which learning strategy = knowing that the world is far more complex that it first appears
solving ill structured problems
which learning strategy = must ale interpretive arguments and decision judgements that entail real consequences for which they must make responsibility and form which they may not flee by disclaiming expertise
solving ill structured problems
T/F it is very common for a patient care decision to be a simple right/wrong choice.
false
being aware of their own knowledge, skills and beliefs = which learning strategy?
self awareness
We need the ability to accept mistakes so that we can learn from them is under which learning strategy?
self awareness
T/F Self Awareness involves reflecting on successes, as well as your mistakes ; have the curiosity to seek new knowledge and possess the humility to admit they need that knowledge.
true
What is meant by the saying “don’t be so open minded that your brain falls out”?
it is a common fear that critical thinking causes people to become indecisive or loose their core values
- consideration of multiple perspectives can cause you to believe there is no right answer, and hence forever vacillate between choices
- self awareness prevents this
Indecision is caused by _____, not by information.
fear
_____ causes you to recognize fear, and be able to use information to choose a course of action.
self awareness
____ is also referred to as independent thinking, and leads to independence.
self- direction
seeking to expand your knowledge and skills; being intrinsically motivated by a desire to learn and continuously improve. Seek knowledge without the provocation of an external award = ______ learning strategy.
self direction
what trait is evident in clinicians who participate in continuing education beyond the minimum required hours to retain their licenses or who learn about topics outside of their specialties
self- direction
which learning strategy = focuses on the responsibility for learning on the student, feather than on the instructor
active learning
give some examples of active learning
asking questions, taking notes, complete assigned readings prior to lecture. (and take notes on the reading)
active learning takes many forms but the key ingredient is ______.
student accountability
what is the one area where active learning is most evident within a student?
exams
the process of combining the best available research evidence with you knowledge and skill to make collaborative, patient - or population - centered decisions within the context of a given healthcare situation.
evidence base practice
best available research, knowledge and skill, collaborative, patient centered decisions, and context of a given clinical situation are the four key concepts of ______>
evidence base practice
study design and funding sources are key consideration sod ______. which key concept of EBP?
best available research
form the basis for every decision you make. critical thinking is competency to this aspect of healthcare decision making. Which key concept of EBP?
knowledge and skill
research deals with representative samples, but individual patients each have unique needs and responses to treatment as well as individual desires and circumstances. which key concept of EBP?
collaborative, patient centered decisions.
many situational factors influence health decisions such as the specialties of clinical team members, the setting in which the patient is seen, available resources, urgency of the patients complaint, the patients ability to pay, and the preference of the patient and the family. Which key concept of EBP?
context of a given clinical situation
the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients
evidence base medicine
