Evidence Based Practice

Question 1

What is the difference between Evidence Based Medicine and Evidence Based Practice?

Answer 1

applying best research in managing care plans for patients

Question 2

What are the components of EBP?

Answer 2

1) asking clear, concise and relevant questions about ones patients that are readily answerable with a literature search
2) efficiently and effectively searching the available literature for articles that might answer the questions
3) evaluating the merits of the most relevant articles from the search result, and assessing the validity and value of the most important things and strongest articles for practice
4) implement findings in care of patients

Question 3

What is the order of least to most valuable levels in hierarchy of evidence?

Answer 3

1) unsystematic clinical observation
2) case reports, small case studies
3) observational cohort or case control studies
4) systematic review of the studies above
5) RCT
6) multiple RCTs
7) systematic reviews and meta-analysis of RCTs

Question 4

What is a randomized controlled trial?

Answer 4

people are selected at a specific time in the hx of dx and randomly allocated to two+ groups. 1 is intervention and other control. Randomization reduced bias and used for evaluating cause-effect and therapeutic efficiency

Question 5

What is a cohort study?

Answer 5

people are assembled at a specific time in hx of dx and randly allocated to 2+ groups. 1 is intervention and 1 is control. Efforts are made to match the groups by characteristics.

Question 6

What is a case controlled study?

Answer 6

Retrospective study of patients compared with characteristic matched subjects who are not ill or have no received an intervention

Question 7

What is a case series?

Answer 7

in this expansion of a case study, the investigator describes observation so a series of similar cases

Question 8

What is a descriptive study?

Answer 8

This case study is designed to analyze factors important to cause, care and outcome of the patients problem. These are most important for generating hypothesis

Question 9

Why are randomized controlled trials considered to be the strongest methology in studies of treatment effectiveness?

Answer 9

• randomization of subject assignment- reduce bias
• blinding of the assignment of interventions to the patients and their provider (double blinding)
• conceal outcomes
• monitor for contamination
• discern causal relationships with interventions from other causes

Question 10

What is a systematic review?

Answer 10

thorough review and summary of research on a particular topic about a clinical problem. Specific methodology that align

more weight with large studies and RCTS

Question 11

What is a meta-analysis?

Answer 11

variety of systematic reviews using statistical techniques to combine and summarize quantitative results for similar studies.

estimates magnitude of intervention or risk factor effect and subgroup analysis

high degree of homogeneity

narrow presentations of relevant research on a particular topic, provides more precisely the positive or negative direction of an effect

Question 12

What are some good options when searching for evidence to clinically generated questions?

Answer 12

EBP journals

• internet websites
• PEDro
• hooked on evidence
• Cochrane

Question 13

List two useful mnemonics for EBP practitioners to filter studies for clinical practice?

Answer 13

POEM- patient oriented evidence that matters- article about quality of life, mortality and morb. can lead to change in practice patterns and is usually foreground knowledge

DOE- disease oriented evidence- organ or systemic physiology, biochem, pathophys, anatomy, biomechanics. Usually background knowledge

Question 14

What is a gold standard versus a reference standard in a study of a diagnostic test?

Answer 14

gold standard- near as possible to 100% specificity and 100% sensitivity

reference standard- criteria tests that approx definitive dx but are not as accurate as gold standard tests (imaging or surgical examination)

Question 15

What are Baye’s theorems?

Answer 15

apply to the incidence of the disease in a population, incidence of a specific clue in a disease and incidence of the clue in persons with the disease compared with persons without the disease

Question 16

Express Baye’s theorems in form of simple equations

Answer 16

Pretest prob + LR= posttest prob

what we thought before + test info = what we think after

pretest odds x LR= posttest odds

Question 17

List the principal sources for pretest probability

Answer 17

• personal/professional experience and knowledge
• hx of injury, symptoms, experience and other elements
• clinical databases
• published data on prevelance

Question 18

How is pretest probability determined?

Answer 18

personal experience and cognitive process.

Mechanism of injury, natural history and factors from pt history. For example knee twist of soccer is 50% pretest probability

Pre-test odds=prevelance / (1-preveleance) = pretest probability/ (1- pretest probability)

50%= .5/1 - .5 =1:1

Question 19

In regard to diagnostic test studies, what is a likelihood ratio?

Answer 19

likelihood that a tests results would be expected in a patient with a target disorder compared with the likelihood of the results with a patient without the disorder. The relationship of likelihood ratio can be remembered with WOWO (with over without)

LR= with/without

Question 20

What is the difference between a positive LR and a negative LR?

Answer 20

+LR=Sn/100% - Sp or probability of + test if the disease is present divided by prob of - test if disease is absent

-LR= 100%-Sn/Sp or prob of negative test if disease is present divided by prob of negative test if disease is absent

Question 21

What are spin and snnouts?

Answer 21

SpPin- specific higher means higher change of a + score to rule in

SnNout- sensitive higher means negative higher change of ruling out

Question 22

What are the advantages of sensitivity, spec, LR over PPV and NPV?

Answer 22

NPV and PPV- affected by the variable or population prevelance of a disease or pretest probability of having a disease

Sn/Sp/LR are parts of test and stable, constants can be used to compare studies

Question 23

What is a nomogram?

Answer 23

a diagram representing the relations between three or more variable quantities by means of a number of scales, so arranged that the value of one variable can be found by a simple geometric construction, for example, by drawing a straight line intersecting the other scales at the appropriate values.

Question 24

What is a clinical prediction rule?

Answer 24

A clinical prediction rule is a type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome.

Question 25

What are some CPRs for diagnosis?

Answer 25

• Ottowa ankle/knee
• Canadian C-spine rules
• NEXUS cervical

Question 26

What is an example of back CPR?

Answer 26

CPR for those with low back pain who would benefit from a spinal manipulation:

    Duration of symptoms < 16days
    No symptoms distal of the knee
    FABQ work subscale < 19
    At least 1 hypomobile segment
    Greater than or equal to 1 hip with >35degreee of IR