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EBM > EBM FINAL > Flashcards

EBM FINAL Flashcards

1
Q

guidelines vs. protocols

A

o “guidelines are systematically developed statements to assist practitioner decisions about appropriate health care specific clinical circumstances”
o guidelines: allow room for professional judgment

o protocols: are explicit instructions used in specific, predictable circumstances and restrict judgment
 takes away your professional judgment

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2
Q

what are some drawbacks of guidelines?

A
  1. reflect expert opinion, UNSOUND PRACTICE
  2. average rather than best practice
  3. inhibit INNOVATION and prevent individuality
  4. may not reflect LOCAL needs
  5. may not recognize PRIMARY care setting
  6. undesirable shifts in balance of power
  7. out of date guidelines might hold back implementation of NEW research
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3
Q

what are 3 ways to implement guidelines

A
  1. develop guidelines based on board medicine
  2. disseminate through educational intervention
  3. provide patient specific reminders at time of visit (Ex. yearly eye exams)

from book: internal development, specific educational intervention, and patient specific reminder

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4
Q

types of economical analyses

cost minimization
cost effectiveness
cost utility
cost benefit ratio

A

minimization: no outcome measure, compare brand name with generic (cheaper)
effectivness: compare two looking at ONE variable
cost utility: compare two looking at MULTIPLE variables
made up ratio!!
cost benefit ratio: MONEY:: buying new equipment ($$$)

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5
Q

how do we measure costs?

A
  1. questionaires (most common!)
    2.Health state preference value: value which a healthy person places on a particular deterioration in health in a hypothetical situation
  2. QALY: calculate: health state preference value x time patient is likely to be in that health state
    .4. Cost consequences analysis: expresses outcomes in terms of natural units (e.g months of survival, legs amputated or babies going home
    -allows individuals to assign their own values to differing interventions
    -allows for health state preference values to change over time
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6
Q

continuous variable vs. discrete

A

continous: infinite variable
discrebe: whole

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7
Q

types of scales:

  1. ratio/interval
  2. ordinal
  3. nominal
A
  1. provides greatest amount of information (ratio:: weight)
  2. ordered
  3. gender, race, etc
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8
Q

distribution of sample pattern:

normal

skewed

A

normal:symmetrical, bell shaped distribution of values where the mean represent the highest point of the curve and whose spread is defined by the standard deviation

• Skewed: asymmetrical distribution of values

  • transforming skewer values into a normal distribution is sometimes possible by taking the log of the original values
  • mean, median, mode more helpful here!
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9
Q

types of statistics:
quantitative

qualitative

A

• Quantitative
o parametric test: underlying assumption is the sample population(s) has a normal distribution ; based on the MEANS of the samples
o non-parametric test: make the assumption the sample population(s) is skewed ; basis of MEDIANS
• Qualitative: used to make a relative comparison
o ex. Ranking from high to low or likert scale

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10
Q

regression

A

•Regression: a mathematical equation that allows the TARGET variable to be predicted from the INDEPENDENT variable. These relationships must be linear
o overall, their function is to describe the relationship between variables
o linear regression

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11
Q

relative strength of relationship

A

random chance
association
correlation
CAUSATION: GOLD STANDARD

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12
Q

basic assumptions for PEARSON’S R

A
  1. normal distribute data
  2. 2 variable are independent of each other
  3. single pair of measurements on successive subjects
  4. every r should be accompanied by p==due to chance
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13
Q

reasons not to reject null (you WANT to reject it!)

A

o 1. there is no different between the groups in reality
o 2. there were too few subject to demonstrate such a difference existed
 remember: Power, sample size is important
o 3. Logical flaw is the assumption for the cut-offs values as significant or not arbitrary when the reality is that values fall on a continuum.

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14
Q

Confidence intervals

the smaller=_____

A

the more precise, wider confidence intervals due to size and standard deviation

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15
Q

quality of pre-appraisal reports (low to HIGH)

A

studies: original journal articles, NOT PRE-APPRAISED
synthesis: systemic reviews for specialized services
synposis
summaries: textbook like guidelines
systems: computerized decision support;; ex compulink

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16
Q

set null at ___ if dealing with ratios

set null at ___ if dealing with comparions

A

1; 0

17
Q

8 poster principles

A

• 1. uncluttered delivery of your message within 5-10 minutes
• 2. use graphical elements to grab readers
o no centerfolds please- Dr. F with the jokes!
• 3. be aware of requirements for design by meeting
o submissions are generally online in order to get approved
• 4. If not otherwise specified follow the IMRAD or abstract format with references, acknowledgments and disclosures
o disclosure such as industry funded ex. Alcon
o remember the idea of transparency
• 5. should be able to read the title at 25ft
o use 72 point font in times new roman or arial (use the same font throughout setting off the headings)
• 6. body of the text should be visible from 4-6 feet
o use 20-25 point font, same style as the title
• 7. no more than two fonts and simple color scheme
• 8. Recommended fonts: times, Arial, Century Schoolbook

18
Q

power point, effective elements

A
  • use design templates
  • standardize position, colors, and styles
  • include only necessary information
  • limit it to the essential information
  • content should be self-evident→ should not require a lot of interpretation
  • use contrasting colors
  • be consistent with effects, transitions, and animations
  • too many slides can lose an audience
19
Q

text guidelines on powerpoint

A
  • no more than 6 words per line
  • no more than 6 lines per slide
  • avoid long sentences
  • key points with larger fonts
  • font size 18-48pt (Dr.F doesn’t like to go below 24)
  • should contrast with the background and not fade in
  • avoid fancy fonts
  • words in all uppercase are hard to read
  • Avoid acronyms and abbrev.
  • Limit punctuation marks!?$
20
Q

costs

A

direct: treatment, indirect: transportation

intangible

21
Q

what are some purposes of guidelines?

A
  1. to make EBM standards explicit AND accesible
  2. to make decision making more objective
  3. to provide a yardstick
  4. deliniate the division of labor
  5. educate about current best practice
  6. serve as a tool for external control
22
Q

Sensitivity vs specificity

A

include good information vs. exclude unnecessary

23
Q

ways to organize EBM information

A
  1. quality of original studies (high to low )
    interventional: RCT/NRT
    observational
    descriptive- case studies
  2. quality of pre-appraised studies
24
Q

name different study designs

A 
RCT: prospective, 
cohort(one disease): prospective; 
case-control:retrospective (association), 
cross-sectional
case
25
Q

outline framework for assessing a clinical guideline

A 
OBJECTIVE
options
outcomes: health AND economic
evidence 
values:: to outcomes
benefits, harms, and costs
recommendations
validation
sponsors
26
Q

examples of benefit of health interventions

A

economic:: prevention of expensive illness, avoid hospital
clinical:: postpone death
quality of life: increased well being

27
Q

qualitative vs quantitative

A

qualitative: : observation, what is x, inductive, theoretical, and VALIDITY
quantitative: experiment, how many, deductive, statistics, reliability

28
Q

Measuring costs

health state preference value
–> rating scale, time-trade off, standard gamble
Quality adjusted life years
cost consequence

A

health state preference value: value which person places on deterioration on health
–> rating scale:: perfect to death
–> time-trade off::years sacrificed to be CURED
–> standard gamble:: full health//success and KILL THEM with failure!!
quality adjusted life years:: health state x time person is in that state
cost consequence:: express outcomes in terms of NATURAL UNITS

EBM (3 decks)

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