Evidence Based Practise Flashcards
What is the Science Practioner Model?
An integrative approach to science and practice wherein each must continually inform the other
Who and when was the term Clinical psychology developed?
20th Century by Witner
Who was the Editor of The Psychological Clinic?
Witner
When was mental/intelligence testing developed?
WW1
What did Freud and Jung introduce and what did they believe?
Psychoanalysis and that doctors should be only practitioners of psychotherapy
What is shell shock?
PTSD
When did Clinical Psychology become part of the the APA?
1919
When was APA founded?
1892
What happened in 1944?
APA accepted responsibility for credentialing and training
What is the Boulder Committee?
Group that created the curriculum for training psychologists
What were the recommendations for training?
Assessment: Improve accuracy and reliability of diagnostic procedures
Etiology, Formulation, Theory: Develop better understanding of human behaviour
Intervention: Develop more efficient methods of treatment
Inclusion of research training in the preparation of all clinical psychologists
What were the recommendations for practise?
Use scientific methodology in their practise
Work with clients using scientifically valid measures, tools and techniques
Inform clients of scientifically based findings and approaches to their problems
Conduct practice-based research
Who was opposed to Psychanalysis?
Eysenck
How much did patients treated with psychoanalysis improve compared to other eclectically and GP’s in Eysenck’s study?
Psychoanalysis 44%
Eclectically 64%
GP’s 72%
Why should we train practitioners as scientists?
Attainment of skills in critical thinking to understand research findings and to implement best practise interventions so clients get best on offer
Practitioners can justify the treatments and interventions they choose based on empirical grounds
Avoid Hard, reduce unnecessary treatment and increase the likelihood of better efficacy of treatment
MUST KNOW THIS:
What are the criticisms of the SP Model?
Applied work is incompatible with scientific work and research does not apply in practice.
Research skills are unnecessary as few publish after completed training
SP model does not produce many scientists practitioners
Question necessity of study on both research and practice orientation
What is the Practise- Scholar Model (Vespia & Sauer)?
Practitioners produce small scale clinical science studies
What is Evidence Based Practise (EBP)?
Integration of best research evidence with clinical research and patient values
What are the 5A’s in EBP?
Ask: the right question
Access: relevant evidence
Appraise: the evidence
Apply: the evidence
Assess: its effectiveness
What does PICO stand for?
Population/Patient/Problem
Intervention (Exposure in PECO)
Comparison
Outcome
Identify each part:
In patients with binge eating disorder, s interpersonal therapy or CBT more effective in reducing the effectiveness of binge episodes?
P: binge eating disorder
I: Interpersonal therapy
C: CBT
O: frequency of binge episodes
What is the hierarchy of evidence?
Systematic reviews/meta analysis
RCT’s
Case Control Studies
Cohort Studies
Systematic Review of Qualitative/Descriptive studies
Qualitative Studies
Opinions or Concensus
Disadvantage of Systematic reviews and meta analysis?
Time consuming
Advantages of RCT’s?
Eliminates bias and facilitates blinding
Disadvantages of RCT’s?
Expensive
Lacks generalisability
Ethical issues
Advantages of case control studies?
Quick, simple and inexpensive
Disadvantages of case control studies?
Always retrospective and proves association not causality
What are the advantages/disadvantages of Cohort study for measures?
incidence rate
relative risk
What are the advantages/disadvantages of Cohort study for Cost?
Expensive
What are the advantages/disadvantages of Cohort study for Study term?
Long term
What are the advantages/disadvantages of Cohort study for sample size?
Need large sample size
What are the advantages/disadvantages of Cohort study for exposure?
Good for rare exposure
What are the advantages/disadvantages of Cohort study for disease?
Poor potential for rare
Possible for several disease
What are the advantages/disadvantages of Cohort study for casual?
Potentially strong
What are the advantages/disadvantages of Cohort study for Generalisation?
Potentially generalisable
What are the advantages/disadvantages of Case Control study for measures?
Odds Ratio (OR) only
What are the advantages/disadvantages of Case Control study for Cost?
Inexpensive
What are the advantages/disadvantages of Case Control study for Study term?
short term
What are the advantages/disadvantages of Case Control study for Sample size?
Powerful with small sample cases
What are the advantages/disadvantages of Case Control study for Exposure?
Limited to rare exposures
What are the advantages/disadvantages of Case Control study for Disease?
Good for rare disease
Only one disease
What are the advantages/disadvantages of Case Control study for Causual?
Potentially less strong
What are the advantages/disadvantages of Case Control study for Generalisation?
Probably not generalisable
If the aim of the study was to describe a study population what would you use?
Descriptive (PO questions) - qualitative
If the aim of the study was to quantify a relationship between factors what would you use?
Analytical (PICO or PECO questions)
If analytic aim and the intervention was randomly allocated what would you use?
Experimental/RCT
If analytic aim and the intervention was not randomly allocated what would you use?
Observational study
What would you use if the outcomes were determined some time after the intervention or exposure?
Cohort (prospective) study
What would you use if the outcomes were determined at the same time as the intervention or exposure?
Cross sectional (eg survey) study
What would you use if the outcomes were determined before the intervention or exposure?
Case-control study (retrospective or historic study)
What 3 things should you consider when critically appraising the evidence?
is the evidence VALID?
What is the evidence and is it CLINICALLY SIGNIFICANT/IMPORTANT?
Is the evidence APPLICABLE/RELEVANT?
What does CASP stand for?
Critical Appraisal Skills Program
What does RAMMbo stand for?
Recruitment Allocation Maintenance Measurement
What questions should be asked to answer the R in RAMMbo?
Recruitment
Are p’s representative of target population?
What questions should be asked to answer the first M in RAMMbo?
Maintenace
Were the individuals within groups treated equally?
Were the outcomes ascertained and analysed for most p’s?
What questions should be asked to answer the A in RAMMbo?
Allocation
Was the assignment to treatment randomised?
Were the groups similiar at the start of the trial?
What questions should be asked to answer the second M in RAMMbo?
Measurements
Were the P’s and clinicians blinded to treatment?
Were measurements objective and standardised?
What does CONSORT stand for?
Consolidated Standards of Reporting Trials
What are CONSORTs?
25 item checklist for evidence based minimum set of recommendations for reporting RCTs
What is Event rate?
How often outcome is observed in control and treatment conditions
What is CER?
Control event rate
What is EER?
Experimental event rate
What is AAR?
Absolute risk reduction - simple difference
How do you calculate AAR?
CER-EER
What is NNT?
Number needed to treat to help one person
How do you calculate NNT?
1/AAR
What is Absolute risk?
individuals chance of developing a disease
What is relative risk?
Compares 2 groups of people
What is RRR?
Relative Risk Reduction - relative proportional difference
How do you calculate RRR?
(CER-EER)/CER
What is the Odds Ratio (OR)?
association between exposure and an outcome - used for control studies
How do you calculate OR?
OR=axd/bxc
Box where top left x bottom right divided by bottom left x top right
What is standard effect size?
Indication of the size of treatment effects.
Mean difference of 2 treatments divided by pooled variance
What is the formula for Cohen’s d?
M1-M2/SDpooled
What is a small effect size?
0.2
What is a medium effect size?
0.5
What is a large effect size?
0.8
