Evidence - Based Medicine Flashcards

1
Q

*A _________, biomedical perspective

A

What is Evidenced-Based Medicine?
FITB (fill in the blank) Positivistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

______ - ______ approach to the practice of medicine

A

What is Evidenced-Based Medicine?
Problem-oriented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Seeks to improve patient care by considering the quality of clinical evidence.

A

What is Evidenced-Based Medicine?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Founded upon an ideal that decisions about the care of individual patients should involve the “conscientious, explicit and judicious use of current best evidence.”

A

What is Evidenced-Based Medicine?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Evidenced-Based Medicine?

A

Clinical Judgement
Relevant Scientific Evidence
Patients’ Values and Preferances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

EBM Hierarchy - Primary Studies

A

Randomized Control Trial
Cohort Studies
Case Control Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

EBM Hierarchy - Primary Studies which of the 2 of the three are Observational Studies?

A

Cohort Studies
Case Control Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

EBM Hierarchy - Secondary, Pre-appraised, or filtered Studies

A

Clinical Practice Guidelines
Meta-Analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

EBM Hierarchy - No Design

A

Case Report or Case Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

EBM Hierarchy - Not involved w/ Humans

A

Animal and Lab Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

EBM uses “_______ -standards”

A

gold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F A Randomized Control Trial (RCT) is a research study “gold standard”

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F An RCT is the most accepted scientific method of determining the (ideally) unbiased evaluations of the benefit of a drug or a therapeutic procedure.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F EBM is considered to represent the “best” evidence available, which ideally should be integrated with clinical judgement and patient values into the final decision about the management of a condition by healthcare practitioners.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The Randomized Controlled Trial is a study design that _______ assigns participants into an experimental group or a control group.

A

randomly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

As the study is conducted, the only expected difference between the control and experimental groups is the ______ or ______ variable being studied.

A

intervention or outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

RCT Otherwise known as:
_______ AND ______

A

CAUSE AND EFFECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Any tendency that limits impartial consideration of a question or issue.

A

Bias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In academic research, bias refers to a type of ______ ______ that can distort measurements and/or affect investigations and their results.

A

systematic error

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Confounder Bias
Selection bias
Performance bias
Detection bias
Attrition bias
Reporting bias
Other biases

A

Types of bias in Research

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Distorts the treatment effect due to a variable ______ ______ ______ ______ that causes an imbalance between treatment groups.

A

Confounder Bias
associated with the outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Differences between baseline characteristics of the groups that are compared.

A

Selection bias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Differences between groups in the care that is provided, or in exposure to factors other than the interventions of interest.

A

Performance bias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Differences between groups in how outcomes are determined.

A

Detection bias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
* Differences between groups in withdrawals from a study that leads to incomplete outcome data * Exclusion * Attrition
Attrition bias
26
* Differences between reported and unreported findings. * Focus on the positive reports, omit the negative. Other biases
Reporting bias
27
* Trial design and appropriate statistical analysis.
Other biases
28
The most effective way to prevent confounding in a RCT?
Randomization of the Groups
29
Randomization ______ result in the balanced distribution of all potential confounders (known or unknown) across all treatment groups at baseline
should
30
T/F Essentially Randomization of the Groups, thus creating a level playing field in order to compare apples to apples or same to same
True
31
T/F Well-designed and executed RCT’s allow one to ______ causation rather than correlation
Infer
32
to derive as a conclusion from facts or premises - we see smoke and infer fire— L. A.White— compare IMPLY
Infer
33
GUESS, SURMISE - your letter ... allows me to infer that you are as well as ever— O. W. Holmes †1935
Infer
34
The _______ is a schematic created to help us understand how to weigh different levels of evidence in order to make health-related decisions. It provides perspective for the results of each study design, based on the relative strengths and weaknesses of each design.
Pyramid
35
Information and expert opinion Background information Can be influenced by beliefs, opinions, or even politics. This level might also include anecdote. This level is where questions are Asked NOT Answered.
Level 1: Foundation
36
Case control studies or case series reports Early stages of research. Studies help identify variables that might predict a condition, or treatment response. Case Studies look at individuals who have a unique presentation and provide detail on the history, intervention and outcome. Detailed and descriptive. Case Series reports usually include only a few participants who are given a similar intervention and follow-up. Detailed and descriptive. Case Control Studies look retrospectively at individuals and compare with a similar group who did not have the intervention. Small numbers of participants, frequently not randomized and confounding variables not controlled.
Level 2: Stage 1 Testing
37
Cohort studies - Also called longitudinal or epidemiological Follow a large group of people over an extended period to see how their exposures affect their outcomes. Normally used to look at the effect of suspected risk factors that cannot be controlled experimentally – for example, the effect of smoking on lung cancer. Frequently used to determine long term effects of a lifestyle, diet, or other interventions. May include a second group that did not engage in the same intervention as a control comparison. Can be generalized to a larger population, but can be difficult to blind, can’t control for outside variables, and are usually not randomized.
Level 3: Effect
38
The Randomized Control Trial
Level 4: RCT
39
TRUE experimental design =
Randomized
40
T/F A large Double Blinded Randomized Control Trial is the most reliable “test”
TRUE
41
Y/F study design and depending on the question, provides the strongest support of a cause and effect relationship.
TRUE
42
Critically Appraised Topics Not actually a study design They are short summaries of the best available evidence Considered a secondary source An abbreviated systematic review created to answer a specific question
Level 5/6: Pre-Systematic Review
43
Systematic Reviews Almost the pinnacle of the Evidence-Based Medicine Pyramid Panoramic view of all of the evidence about an intervention, considered the strongest and highest quality of evidence Comparison of the results of studies side by side. Considered a secondary source.
Level 7: Systematic Review
44
_______ ________ guidelines are recommendations for clinicians about the care of patients with specific conditions. They should be based upon the best available research evidence and practice experience.
Level 8 (not shown): Clinical Practice Guidelines
45
The foundation is a systematic review of the research evidence bearing on a clinical question, focused on the strength of the evidence on which clinical decision-making for that condition is based.
Clinical Practice Guidelines
46
. A set of recommendations, involving both the evidence and value judgments regarding benefits and harms of alternative care options, addressing how patients with that condition should be managed, everything else being equal.
Clinical Practice Guidelines
47
A collection of beliefs or practices mistakenly regarded as being based on scientific method
Pseudo = Fake:
48
“A new phenomenon in clinical trials has arisen over the past 20 years. Complementary and alternative medicine (CAM) or integrative medicine (IM) modalities based on principles that bespeak infinitesimally low prior probability of success or that even violate_____________________________________ are being tested in randomized clinical trials (RCTs).”
well-established laws of physics and chemistry
49
the major assumption underlying EBM is that by the time an investigational treatment is ready for RCTs it has passed all preclinical tests and has thus demonstrated ________ plausibility.”
biological
50
“In RCTs testing modalities with low pre-test probability (i.e., low plausibility), confounding effects are vastly________, easily producing false-positives.”
magnified
51
* Accumulated body of scientific knowledge describing the basic principles of nature. * Physics, Chemistry and Biology * Facts, laws and theories established through proper scientific methodology that form a basic understanding of how the world works. * It would take extraordinary evidence to overturn them.
Basic Sciences
52
* Real-world applications of the facts, laws and theories from the basic sciences. * Uses the principle of reductionism * Applied science observations can be explained via basic science fundamentals.
Applied Sciences
53
Applied Sciences uses the principle of__________
reductionism
54
In RCTs testing modalities with low pre-test probability (i.e., low _______ ), confounding effects are vastly magnified, easily producing false-positives.”
What is Low Plausibility? (fitb) plausibility
55
randomized experiments oversimplify causation
Objections to RCTs summarized
56
cannot be carried out in complex institutional and other settings or to test complex ________
Objections to RCTs summarized interventions
57
ignore the role of theory in understanding intervention effectiveness
Objections to RCTs summarized
58
perfectly good alternatives to RCTs that pose none of these problems exist and should therefore be used instead.
Objections to RCTs summarized
59
Medical decision-making draws upon a broad spectrum of knowledge including basic science, scientific evidence, individual scientific medical education, personal experience, personal biases and values, ______ ______ , economic and political considerations, and philosophical and social principles.
patient values
60
T/F Theory choices are never determined exclusively by the _________
TRUE Evidence
61
Theory choices are never determined exclusively by the evidence. A body of evidence may support many different or even contradicting theories. * The ‘most_________ adequate’ theory must be chosen Choice is subject to preference, bias, the social, political, or research agenda at play
empirically
62
T/F Non cis het men have been underrepresented as subjects in clinical trials.
TRUE
63
The disease, not the patient dictates the direction of the study, but the results are applied to the patient.
EBM is disease oriented