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EBP Flashcards

1
Q

What is EBP?

A

The integration of clinical expertise, evidence, and client/care-giver perspectives

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2
Q

What is clinical expertise?

A

knowledge, judgment, and critical reasoning acquired through training and professional experiences

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3
Q

What is evidence?

A

the best available information gathered from the scientific literature (external) and from data/observations collected on the individual client (internal)

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4
Q

Client/caregiver perspectives

A

the unique set of personal and cultural circumstances, values, priorities, and experiences identified

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5
Q

What is the purpose of EBP?

A

helps clinicians ask questions about assessment, treatment, and interventions (effectiveness? time? Consider the patient and family)

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6
Q

What is the Cochrane Library?

A

a collection of databases that contain different types of high-quality, independent evidence to inform healthcare decision-making

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7
Q

What is the history of the Cochrane Library?

A

Archie Cochrane developed the Cochrane Library when he was frustrated trying to distinguish between scientifically valid and invalid medical therapies
○ Best systematic reviews (strict criteria, high quality)

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8
Q

What is the Centre for Evidence-Based Medicine (CEBM)

A

develops, teaches, promotes, and
disseminates better evidence for health care

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9
Q

What is the history of CEBM?

A

David Sackett started the first CEBM in Britain
■ “Half of what you learn in medical school is dead wrong.”

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10
Q

What is the Joanna Briggs Institute Model of Evidence-Based Healthcare (JBI Model of EBHC)?

A

considers evidence-based healthcare as decision-making that considers the feasibility, appropriateness, meaningfulness, and effectiveness of healthcare practice
Good for systematic reviews

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11
Q

What are the challenges associated with EBP?

A
  1. Evidence changes quickly
    ■ Ex: The Taste Map of the Tongue
  2. People have their own agendas in disseminating information and influencing the acceptance of EBP
    ■ Ex: money, tobacco industry and lung cancer
  3. Sources of evidence are thought to be credible (are they?)
  4. How do we know what is good or bad evidence? (myth vs. opinion vs. evidence)
  5. Where do we look for evidence?
  6. How to keep up to date with evidence?
  7. What if there is no evidence?
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12
Q

What relevance is there to SLT?

A

Ex: rising costs of healthcare, is intervention really worth it? SLTs can justify that
with their intervention there are better outcomes and QOLs, shorter length of stay or
admission (e.g. 40 days → 12 days)

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13
Q

What are the 5 key EBP steps?

A
  1. Ask the right clinical question
  2. Acquire the best evidence
  3. Appraise the evidence
  4. Apply the evidence
  5. Assess your performance
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14
Q

What are epidemiology studies?

A

nature, risk, prevalence, course of the condition ● Helps us understand conditions, plan services, etc.
We can plan intervention better if we know the trajectory.

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15
Q

What is research evidence?

A

Focused on experimental design, carefully controlled interventions and measurable outcomes
Helps us understand the efficacy of intervention, diagnostic accuracy of tests etc.

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16
Q

What are RCTs?

A

A study design that randomly assigns participants into an experimental group and/or control setting.
- Only expected difference between control and experimental groups is the outcome variable being studied
- Outcomes analysed in terms of those defined at the beginning, difference is outcome is attricuted to the intervention

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17
Q

Research evidence Pyramid (1-7)

A
  1. Meta-analysis
  2. Systematic review
  3. RCTs
  4. Cohort studies
  5. Case control studies
  6. Case series/case reports
  7. Background info/expert opinion
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18
Q

What are qualitative studies?

A

Interview, surveys, QOL instruments, autobiographical accounts etc.
- Helps us understand perspectives of key stakeholders, impact of conditions on lives, tolerance of procedures etc.
- Treatment approaches: side effects may be too severe, patients may decide not to have treatment or discontinue treatment
- May be too expensive

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19
Q

PICO(T)

A

Purpose - convert clinical need into answerable question
P: problem/patient
I: Intervention (cause, prognostic factor, treatment)
C: comparison intervention (if necessary)
O: outcomes (hope to achieve, measurable)
T: time to demonstrate clinical outcomes

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20
Q

Databases and their controlled vocabularies:
1. CIHAHL Complete (Nursing)
2. EMBASE (Biomedical and Pharmacological)
3. PubMed (MEDLINE)
4. Web of Science Core (Interdisciplinary)

A
  1. CINHAL Headings
  2. Emtree
  3. MeSH
  4. N/a
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21
Q

What is controlled vocabulary?

A

Article is tagged with standardised terms: can miss out on jargon, slang, newer terms, and most recent articles if subject terms have not been assigned

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22
Q

What is critical appraisal?

A

the process of systematically examining research evidence to assess the validity, results, and relevance before using it to inform a decision

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23
Q

What knowledge is needed for critical appraisal?

A

■ Understanding what should be in a research paper, clinical guideline document, a position paper
■ Understanding different research designs
■ Recognizing the importance of matching the right design to the research question

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24
Q

What are the key components of a research article?

A

Title, abstract, introduction, methods, results, discussion/conclusion, references

25
Q

Title:

A

should indicate research design

26
Q

Abstract:

A

a succinct description of the article that matches the article itself
■ Includes: introduction, methods, results, discussion

27
Q

Introduction:

A

■ Why is a study needed? What research has been done before? Build up to the
research question and aims (at the end of this section)
■ PICO question should come back if the study is about an intervention

28
Q

Methods:

A

describe the design of the study, materials used, participants, how the data
was collected, and how the data was analyzed
■ Must describe how the research question was answered

29
Q

Results:

A

main findings of the study, research question answered, statistical analysis if
appropriate
■ All data must be accounted for, if there were 12 participants, there must be
data for 12 children

30
Q

Discussion/conclusion:

A

■ Research questions addressed? Findings expected or unexpected? Do the
findings agree with other findings? Implications for clinical practice? Next
phrase of research? Limitations of the study

31
Q

What makes an article difficult to read?

A

■ Introduction: poor English, unclear research justification, poorly written
research question
■ Methods: doesn’t match the research question, different to find who the
participants are, difficult to find how the project was conducted, unclear how
data was collected and analyzed
■ Results: doesn’t answer the question asked, not supported with tables or
figures, data left out
■ Discussion: long-winded, does not discuss the results or the research
question, does not put the findings in context of other literature, does not
provide directions for further research or clinical practice, does not consider
limitations

32
Q

What is the Equator network?

A

an international initiative that seeks to improve the reliability and value of
published health research literature by promoting transparent and accurate reporting
guidelines

33
Q

Compare qualitative and quantitative research:

A

Qualitative: research questions or aims about perceptions, beliefs, opinions
■ An in-depth exploration of the lived experience of a condition cannot be
obtained from questionnaires alone
■ Ex: What is the psychosocial impact of dysarthria on the speaker?

Quantitative: research questions or aims are about numbers
■ Differences in scores between interventions x and y
■ Ex: What is the efficacy of one intervention compared to another in a specific
population?

34
Q

Compare single-blind and double-blind:

A

○ Single-blind: the participants do not know which treatment they were receiving
○ Double-blind: investigators and participants did not know which treatment they were
giving or receiving

35
Q

What is placebo-controlled:

A

control group receives a placebo

36
Q

What is the Robey and Schultz Model (1998)?

A

○ Phase 1: exploring therapy procedures and proving that it is safe and worth exploring
further
○ Phase 2: attempt to define how the therapy works. Select appropriate clients,
assessments, and outcome measures
○ Phase 3: design large-scale efficacy study (RCTs)
○ Phase 4: effectiveness study to see if therapy works clinically
○ Phase 5: effectiveness studies continue to look at cost-effectiveness, consumer
satisfaction, and effects on QOL

■ E.g. cost effectiveness, side effects, could it be delivered in a more
cost-effective way (group, less frequently), and how long do the effects last

37
Q

What is selection bias?

A

a distortion in a measure of association (such as a risk ratio) due to a
sample selection that does not accurately represent the target population
■ Avoided by using random sequence generation and allocation concealment

38
Q

What is allocation concealment?

A

the person randomizing the participants to
experimental and control groups could not predict what group the person will
be allocated to

39
Q

What is random sequence generation?

A

researchers randomly assign participants into groups (ideally computer-generated)

40
Q

What is performance bias?

A

the effects of unequal treatment between study groups
■ Can occur when participants know which group they were assigned to,
changing their responses or behaviors and affecting the outcome of the study
■ Control for it by double-blinding the participants and clinicians

41
Q

What is detection bias?

A

when the person or people measuring the outcomes know which
participants received the intervention
■ Control for it by blinding the person completing the outcome measurement

42
Q

What is attrition bias?

A

differences between experimental and control groups because of
withdrawals from a study
■ Withdrawals from the study lead to incomplete outcome data
■ Control for it by explaining the reasons for withdrawal and account for all of
the data
■ Authors must do an intention-to-treat analysis: analyze all of the data
available from the study cohort regardless of participation

43
Q

What is reporting bias?

A

differences between reported and unreported findings
■ Statistically significant differences between intervention groups are more
likely to be reported than non-significant differences

44
Q

What is the placebo effect?

A

improvement of illness following a placebo intervention

45
Q

What is the nocebo effect?

A

disimprovement of illness following a placebo intervention

46
Q

What is the Critical Appraisal Skills Programme (CASP)?

A

contains a checklist of questions for readers
to appraise RCTs critically
○ Used for readers when evaluating an RCT

47
Q

What is the Consolidated standards of Reporting Trials (CONSORT Guidelines)?

A

help researchers
report their trial protocols and finish RCTs completely and transparently
○ Used for authors when publishing their RCT

48
Q

What is a systematic review?

A

(secondary research): a summary of all of the available research
or evidence in response to a research question
■ Often required by research funders to establish the state of existing
knowledge
■ Frequently used in guidelines development

49
Q

Why are systematic reviews used?

A

● Uncover the international evidence
● Confirm current practice/address any variation/identify new practices
● Identify and inform areas for further research
● Identify and investigate conflicting results
● Produce statements to guide decision-making

50
Q

What are the types of systematic reviews?

A
  • Effectiveness review
  • Qualitative (experiental) reviews
  • Costs/economic evaluation reviews
  • Prevalance and/or incidence reviews
  • Diagnostic test accuracy reviews
51
Q

What are the steps of a research study?

A

● Step 1: Prepare your topic
○ Ask a narrow, specific PICO question with enough research
○ Why is it important? Gap in the literature?
● Step 2: Search for studies
○ Gather information (unpublished research, academic
conferences, gray literature)
● Step 3: Screen your studies
○ Filter out irrelevant information (www.covidence.org)
● Step 4: Extract the data
● Step 5: Analyze and synthesize your evidence
● Step 6: Rate the quality of evidence
○ GRADE (Grading of Recommendations, Assessment, Development, and Evaluations)

■ A transparent framework for developing and presenting summaries of evidence
■ Provides a systematic approach for making clinical
practice recommendations
■ Most widely used took for grading the quality of evidence and making recommendations

● Step 7: Report your findings
○ Highlight steps took, research gaps, etc.

52
Q

What are scoping reviews?

A

exploratory projects that systematically map the literature available
on a topic identifying key concepts, theories, sources of evidence and gaps in the research

53
Q

What is a meta-analysis?

A

a combination of a group of studies to reach a conclusion statistically
about the effect of an intervention
- results usually depicted in a forest plot

54
Q

When should you not conduct a meta-analysis?

A

○ Heterogeneity of studies (can also be tested statistically)
○ Poor quality of studies
○ Publication bias (selective publication of positive studies and
exclusion of negative studies)
○ Small number of studies or limited sample size
■ Provide less information to summarize or pool the
results, can yield inaccurate/unstable/erroneous
results, too few studies impede the exploration of
publication bias and can confound conclusions

55
Q

What are PRISMA guidelines?

A

provide guidance for the reporting of systematic reviews evaluating
the effects of interventions

56
Q

What are cross-over trials?

A

participants receive multiple interventions and effect of intervention measured on the same individuals

57
Q

What is a cohort study?

A

a group of people who are observed frequently over a period of many years – for instance, to determine how often a certain disease occurs. In a cohort study, two (or more) groups that are exposed to different things are compared with each other: For example, one group might smoke while the other doesn’t. The researchers then observe how the health of the people in both groups develops over the course of several years, whether they become ill, and how many of them pass away.

58
Q

What are case-control studies?

A

Case-control studies compare people who have a certain medical condition with people who do not have the medical condition, but who are otherwise as similar as possible, for example in terms of their sex and age. Then the two groups are interviewed, or their medical files are analyzed, to find anything that might be risk factors for the disease. So case-control studies are generally retrospective.

59
Q

What are cross-sectional studies?

A

The classic type of cross-sectional study is the survey: A representative group of people – usually a random sample – are interviewed or examined in order to find out their opinions or facts. Because this data is collected only once, cross-sectional studies are relatively quick and inexpensive. They can provide information on things like the prevalence of a particular disease (how common it is). But they can’t tell us anything about the cause of a disease or what the best treatment might be.

EBP (1 decks)

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