EBH Flashcards
In a cohort study, the outcome is measured before the exposure.
True/ false?
False. In a cohort study, patients with and without the exposure of interest are identified and followed up over time to see if they develop the outcome of interest, allowing comparison of risk.
What is the most appropriate type of study to answer a prognostic Qns?
Prognostic question: Cohort study. In a cohort study, patients with and without the exposure of interest are identified and followed over time to see if they develop the outcome of interest, allowing comparison of risk
What is the most appropriate type of study to answer a therapeutic qns?
Therapeutic question: Randomised controlled trial (RCT). In a RCT, similar subjects are randomly assigned to a treatment group and followed to see if they develop the outcome of interest.
What is the most appropriate type of study to answer a diagnostic qns?
Diagnostic question: Cross sectional study. A cross sectional study measures the prevalence of health factors (outcomes or determinants) at a point in time or over a short period.
What is the main benefit of Evidence Based Medicine (EBM) with regard to patient care?
a.
Impresses the patient with your scientific expertise
b.
Gives the patient information to read over between appointments
c.
Incorporates shared decision making and understanding of medicine between patient and doctor
d.
Useful to persuade the patient to follow the treatment approach you think would work best for them
c.
EBM links best research evidence with clinical expertise and patients values and circumstances. Therefore incorporates shared decision making.
List study design in order of hierarchy of evidence, starting with the most robust evidence?
Randomised controlled trial, systematic review, cohort study, case controlled study, cross sectional study, ecological study, case series
b.
Randomised controlled trial, systematic review, cross sectional study, case controlled study, cohort study, ecological study, case series
c.
Systematic review, randomised controlled trial, case controlled study, cohort study, cross sectional study, ecological study, case series
d.
Systematic review, randomised controlled trial, cohort study, case controlled study, cross sectional study, ecological study, case series
d.
a. Systematic review: A review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from studies that are included in the review.
b. Randomised controlled trial (RCT): In a RCT similar subjects are randomly assigned to a treatment group and followed to see if they develop the outcome of interest.
c. Cohort study: In a cohort study, patients with and without the exposure of interest are identified and followed over time to see if they develop the outcome of interest, allowing comparison of risk.
d. Case controlled study: In a case controlled study, patients who have developed a disorder are identified and their exposure to suspected causative factors is compared with that of controls who do not have the disorder.
e. Cross sectional study: Measures the prevalence of health factors (outcomes or determinants) at a point in time or over a short period.
f. Ecological study:An ecological study is an observational study defined by the level at which data are analysed, namely at the population or group level, rather than individual level.
g. Case series: A report on a series of patients with an outcome of interest. No control group is involved.
An 82 year old lady presents with frequency and dysuria and has nitrites on her urine dipstick. You diagnose a urinary tract infection (UTI). You decide to treat her with nitrofurantoin. She doesn’t like taking antibiotics and asks you if the treatment is really necessary?
When researching a question it is useful to create a clarified clinical question (CCQ) relating to the presentation. CCQ = P+I+C+O. Which of the following best represents the PICO.
a.
In elderly women who present with frequency and dysuria, we should consider the diagnosis of UTI
b.
In elderly women with clinical UTI, you should give antibiotics regardless of urine dipstick result
c.
In elderly women with symptoms of UTI, a urine dipstick should be done to further evaluate
d.
In elderly women with clinical UTI, does treatment with nitrofurantoin resolve symptoms quicker than no treatment?
d.
When engaging in each step of EBM it is important to understand study design and how to ask a research question. By using PICO (patient, intervention, comparison and outcome) we can accurately search for specific question we would like answered
A cross sectional study is the most appropriate type of study to answer a diagnostic question? true or false
A cross sectional study is the most appropriate study to answer a diagnostic question. A cross sectional study measures the prevalence of health factors (outcomes or determinants) at a point in time or over a short period.
When researching a clinical question it is important to identify the most appropriate study design to answer your question. Cross-sectional study design is useful to assess the diagnostic accuracy of compared tests. An example of a diagnostic question is “In women with a history of breast cancer, is lumbar spine x-ray more accurate than ESR measurement in the diagnosis of recurrence or metastasis in patients who present with back pain?”
In a case-control study, the outcome is measured before the exposure? true or false
False.
In case-control studies patients who have developed a disorder are identified and their exposure to suspected causative factors is compared with that of controls who do not have the disorder.
A 75 year old patient with a recent diagnosis of aortic stenosis comes in after seeing a cardiothoracic surgeon last week. The surgeon recommended open heart aortic valve replacement (AVR) to the patient over closed transcatheter AVR. The patient wants to know your opinion on this as they have been attending you for a long time and trust you. What are the four steps involved in EBM that will create a specific question?
a.
Appear, Attend, Analyse, Announce
b.
Address, Arrange, Alert, Administer
c.
Aid, Agree, Amend, Arrive
d.
Ask, Access, Appraise, Apply
d.
- Ask: Convert clinical query into answerable question.
- Access: Search efficiently to find evidence to answer question.
- Appraise: Critically evaluate evidence in terms of validity, qualitative value and clinical relevance.
- Apply: Decide what clinical action is best for patient.
