Evidence Based Practice Flashcards
What is the difference between Evidence Based Medicine and Evidence Based Practice?
applying best research in managing care plans for patients
What are the components of EBP?
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
What is the order of least to most valuable levels in hierarchy of evidence?
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
What is a randomized controlled trial?
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
What is a cohort study?
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.
What is a case controlled study?
Retrospective study of patients compared with characteristic matched subjects who are not ill or have no received an intervention
What is a case series?
in this expansion of a case study, the investigator describes observation so a series of similar cases
What is a descriptive study?
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
Why are randomized controlled trials considered to be the strongest methology in studies of treatment effectiveness?
- 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
What is a systematic review?
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
What is a meta-analysis?
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
What are some good options when searching for evidence to clinically generated questions?
EBP journals
- internet websites
- PEDro
- hooked on evidence
- Cochrane
List two useful mnemonics for EBP practitioners to filter studies for clinical practice?
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
What is a gold standard versus a reference standard in a study of a diagnostic test?
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)
What are Baye’s theorems?
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
Express Baye’s theorems in form of simple equations
Pretest prob + LR= posttest prob
what we thought before + test info = what we think after
pretest odds x LR= posttest odds
List the principal sources for pretest probability
- personal/professional experience and knowledge
- hx of injury, symptoms, experience and other elements
- clinical databases
- published data on prevelance
How is pretest probability determined?
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
In regard to diagnostic test studies, what is a likelihood ratio?
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
What is the difference between a positive LR and a negative LR?
+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
What are spin and snnouts?
SpPin- specific higher means higher change of a + score to rule in
SnNout- sensitive higher means negative higher change of ruling out
What are the advantages of sensitivity, spec, LR over PPV and NPV?
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
What is a nomogram?
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.
What is a clinical prediction rule?
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.
What are some CPRs for diagnosis?
- Ottowa ankle/knee
- Canadian C-spine rules
- NEXUS cervical
What is an example of back CPR?
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
