Chapter 6 and 7: Evidence Flashcards
Certain consistencies are evident across different types of questions and their associated levels of evidence:
A systematic review of high-quality studies always provides the highest level of rigor.
An individual study using the optimal design for that type of clinical question is considered level 1.
Prospective data collection indicates higher study quality than retrospective data collection.
Expert opinion, bench research, conceptual frameworks/theories/first principles are always considered the lowest (level 5) evidence.
What is a grade A recommendation?
Consistent level 1 studies supporting a given conclusion.
What is a grade B recommendation?
Consistent level 2 or 3 studies supporting a given conclusion
What is a grade C recommendation?
Level 4 studies or extrapolations from level 2 or 3 studies.
What is a grade D recommendation?
Only level 5 evidence or at any time when the available studies are inconsistent and inconclusive
What is the grade system?
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.
What are types of critical appraisal tools?
Open-ended questions versus semi-structured versus structured
Interpretation of items guided or open
Why is biostatistics important for critical appraisals?
Need to have a working knowledge of biostatistics to comprehend, analyze, and put into practice evidence from clinical journals and other sources.
What are some difficulties with practicing EBP?
Constant demands on the time and resources available to clinicians
High quality literature is being published at too great a rate to be thoroughly analyzed by each practitioner.
Difficult for a clinician to remain unbiased in the evaluation of literature surrounding his or her question.
Tendency to appraise or find articles which support what was originally being sought.
What is a critical review?
A review sets out to analyze and summarize a specific subset of research information, and come to a conclusion based on the information included in the review.
What are the 2 main categories of quantitative review?
Narrative: A gathering of information by an individual that may be considered an expert in the field.
Systematic: A summary of the literature that uses clear methods to perform a thorough search and critical appraisal of individual studies.
What is the systematic review process?
- Formulate a review question
- Conduct a comprehensive search
- Critically appraising each of the studies
- Synthesize the findings
- Report the results
What is the best level of evidence to use when reviewing treatment and/or prevention?
RCT
What is the best level of evidence to use when reviewing diagnostic tests?
Comparison to a gold standard
What is the best level of evidence to use when reviewing prognosis?
cohort studies
