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OCS > EBP > Flashcards

EBP Flashcards

1
Q

5 steps of EBP

A
  1. Ask
  2. Acquire
  3. Appraise
  4. Apply
  5. Assess
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2
Q

PICO

A
  1. Patient/problem
  2. Intervention
  3. Comparison Intervention
  4. Outcomes
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3
Q

Foreground question

A

very detailed questions that can best be answered with the information contained in published research studies.

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4
Q

4 types of clinical questions

A
  1. Diagnosis
  2. Prognosis
  3. Intervention
  4. Harm
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5
Q

Hierarchy of evidence

A
  1. N=1 RCT
  2. Systematic review of RCTs
  3. Multiple RCTs
  4. RCT
  5. Systematic review of below studies
  6. Observational cohort or case control studies, large case series
  7. Case reports, small case series
  8. Unsystematic clinical observations (expert opinion)
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6
Q

MCID

A

Minimal clinically important difference

*smallest change in score associated with a patient’s perception of change in health status

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7
Q

“Positive trials”

A
  • rejecting null hypothesis
  • focus on lower end of confidence interval
  • if lower boundary of CI is GREATER than MCID, you can conclude it is a positive trial
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8
Q

“Negative” Trials

A
  • focus on upper end of CI

- IF upper boundary of CI excludes any important benefit of treatment, you can conclude it is definitively negative

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9
Q

Pre-test probability

A

baseline probability of a certain condition pre-testing

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10
Q

Post-test probability

A

application of a clinical diagnostic test that alters the baseline probability (special tests)

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11
Q

Diagnostic process

A
  1. pattern recognition
  2. hypothesis generation
  3. logical reasoning (hypothetico-deductive reasoning)
  4. Other types - algorithm and exhaustive
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12
Q

Spectrum bias

A

lack of sufficient heterogeneity of subjects

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13
Q

Sensitivity

A
  • proportion of patients with the condition who HAVE a positive result
  • true positive rate
  • tests w/ high sensitivity have few FALSE NEGATIVES
  • SnNOUT
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14
Q

Specificity

A
  • proportion of patients without the condition who have a NEGATIVE test result
  • tests w/ high specificity have few FALSE POSITIVES
  • True negative rate
  • SpPin
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15
Q

Likelihood ratios

A

used to reduce uncertainty about a patient’s likelihood of having a target condition

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16
Q

Pre-test porbability + LR =

A

= post test probability

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17
Q

Positive Likelihood Ratio

A
  • if a diagnostic test is POSITIVE - use PLR

- PLR always >1.0

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18
Q

Negative Likelihood Ratio

A
  • if diagnostic test is NEGATIVE - use NLR

- NLR always <1.0

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19
Q

Where does pre-test probability come from?

A
  • intuitive sense
  • patient demo and nature of c/o
  • clinical experience
  • published prevalence rates
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20
Q

Positive Likelihood ratio magnitude

A

> 10 - large and conclusive
5-10 - moderate
2-5 small (sometimes important)
1-2 - small (rarely important)

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21
Q

Negative likelihood ratio magnitude

A

<0.1 - large and often conclusive

  1. 1-0.2 - moderate
  2. 5-0.2 - small (sometimes important)
  3. 5-1.0 - small (rarely important)
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22
Q

CPRs

A

Synonyms (CPGs, clinical decision rules, test item clusters)

  • ID of cluster of diagnostic tests through multivariate method
  • important to validate CPR with independent study or separate group
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23
Q

Diagnostic reasoning

A
  • reasoning about what information to gather and how to interpret information from both the patient interview and physical exam
  • DEDUCTIVE
24
Q

Narrative reasoning

A
  • asking open ended questions
  • establishing and validating an understanding of the person who is the patient
  • explicit integration of understanding into reasoning process and decisions made
  • INDUCTIVE
25
Q

Intervention procedures reasoning

A
  • choice and administration of interventions
  • reasoning related to choice of re-exam strategies
  • both inductive and deductive
26
Q

Interactive reasoning

A
  • choices of approach and manner of interacting with patients
  • establishing rapport
  • inductive and deductive
27
Q

Collaborative reasoning

A
  • negotiation of a working relationship, including distribution of power in decision making
  • consensual approach in interpretation of exam data, setting, and prioritization
  • inductive and deductive
28
Q

Reasoning about teaching/patient education

A
  • directed towards approaches and strategies for educating patients
  • deductive and/or inductive
29
Q

Predictive reasoning

A
  • process of developing a prognosis

- deductive and/or inductive

30
Q

Deductive reasoning

A

development and systematic testing of hypotheses

31
Q

Inductive reasoning

A

Coming to an understanding of the patient’s situation from his or her point of view through communication

32
Q

Over focus on early/superficial recognition error

A

acceptance of the validity of a diagnosis/clinical pattern ID based on a presentation’s superficial similarity to another familiar case

33
Q

Premature anchoring error

A

fixation on first impressions that is unaltered with new or conflicting information

34
Q

Premature closure error

A

acceptance of a diagnosis without challenge through adequate consideration of likely alternatives

35
Q

Framing effect error

A

Decision is influenced by the perception of relative risk, whether or not that risk if presented in a positive or negative light, and/or based on a tendency to avoid versus seek risk

36
Q

Commission bias error

A

Deciding to do something regardless of evidence that would contradict the decision

37
Q

Extrapolation error

A

Inappropriately choosing to do something that was done successfully in another dissimilar situation

38
Q

Confirmation bias

A

Tendency to look for, notice, and remember only the information that fits with pre-existing expectations

39
Q

Outcome bias

A

Tendency for an overreliance on outcome information to indicate accuracy or quality of the clinical reasoning that determined the choice of intervention

40
Q

EBP

A
  1. evidence
  2. clinical experience/expertise
  3. Patient values
41
Q

Over-generalization

A

application of research evidence to clinical practice when the information is not applicable/relevant

42
Q

over-valuing a test finding

A

erroneous interpretation or unwarranted weighting of a “+” or “-“ clinical test finding when determining the likelihood of a specific diagnosis, prognosis, or intervention effectiveness

43
Q

Omission of quality assessment of literature

A

focus on the results of the study without consideration of the relative quality of the study design

44
Q

Lack of scrutiny for outcome measure choice

A

superficial or incomplete consideration when deciding which outcome measure to choose

45
Q

Lack of confidence

A

undervaluing one’s own clinical experiences and expertise, inadequate confidence that clinical knowledge is sound and applicable

46
Q

Over valuing clinical experiences

A

Over-inflating importance of past experiences and over confidence in one’s own clinical knowledge and skill set

47
Q

Inappropriate clinical pattern recognition

A

misreading when general clinical patterns learned through clinical experience are appropriate for specific clinical patient case

48
Q

Work up (verification) bias

A

If all patients don’t receive the gold standard test

49
Q

95% confidence interval

A

95% certainty that the values will fall within a certain range
-NARROW IS BETTER

50
Q

Efficacy

A

determine whether an intervention produces the expected result under ideal circumstances

51
Q

Effectiveness

A

measure the degree of beneficial effect under “real world” clinical settings.

52
Q

Type I Error

A
  • incorrect rejection of a true null hypothesis

- detection of an effect that is not actually present

53
Q

Type II Error

A
  • incorrectly retaining a false null hypothesis

- failure to detect an effect that is actually present

54
Q

Double blind

A
  • in PT treatments you can’t usually blind both groups

- if you blind both patients and clinician than it is double blinded

55
Q

Drop outs

A

->20% drop out rate is too much

56
Q

Intention to treat

A
  • based on the initial treatment assignment, not the actual treatment received
  • intended to avoid misleading artifacts such as non-random participants or cross overs
  • if no dropouts, then no need to perform ITT

OCS (13 decks)

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