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Management of MS Disorders > Exam 1: Evidence Based Practice > Flashcards

Exam 1: Evidence Based Practice Flashcards

1
Q

We need EBP for 4 reasons.

  1. For ____ information
  2. There (is/is not) enough time to read all new studies
  3. Disparity between ______ judgement and ______ knowledge.
  4. _________ issues
A
  1. valid info
  2. Not enough time
  3. clinical vs current knowledge
  4. Reimbursement
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2
Q

True or False:

The three pillars of EBP are equal

A

False

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3
Q

what is the name of the scottish physician in EBP history

A

Archie Cochrane

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4
Q

Archie Cochrane was a scottish physician who argued for the use of _____ to ensure that finite health resources were used on treatments shown to be effective

A

RCT

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5
Q

Which physician argued for randomized control trials

A

Archie Cochrane

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6
Q

which medical doctor is the Father of EBP

A

David Sackett

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7
Q

Where did david sackett introduce EBM where he incorporated EBM education to medical students

A

McMaster University

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8
Q

who established cochrane centre and cochrane collaboration

A

Iain Chambers

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9
Q

what is the name of the international network of reviewers evaluating RCTs to produce and publish systemic review

A

cochrane centre and cochrane collaboration

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10
Q

_______ is based on the study of human knowledge

A

Epistemology

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11
Q

what are the three epistemological principles of EBM

A
  1. They are not equal
  2. Guide the provider to the most accurate objective info regarding the patient
  3. Patient values are applied for the final decision
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12
Q

EBP and its epistemological principles are like a _____

A

funnel

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13
Q

Principle 1 of EBP means viewing the best available evidence and the totality of the evidence, in other words you consider _____ of the evidence, ____!!!`

A

ALL; EVERYTHING

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14
Q

true or false:

With EBP, evidence includes only what is read in RCTs

A

False, it also includes descriptive studies, case studies, and what you have seen in the clinic

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15
Q

Principle 2 of EBP means using clinical expertise and synthesizing evidence. In other words you must make ____ of the evidence

A

sense

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16
Q

True or false:

The goal of clinical expertise is to support your idea but also to find the most accurate understanding

A

True

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17
Q

Which principle is the end of the EBP funnel

A

patent values/circumstances that involves educating patients on their options, and the decision is the patient’s because it is patient centered

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18
Q

What is the order of the EBM funnel

A
  1. Best available/ totality of evidence
  2. Clinical expertise
  3. Patient values and circumstances
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19
Q

True or False

Evidence alone is sufficient to make a clinical decision

A

False, it is never sufficient enough

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20
Q

A _____ of ____ should guide clinical decision making

A

hierarchy of evidence

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21
Q

The highest form of evidence from a single study comes from true experiments referred to as _____ _____ ____

A

randomized control trials

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22
Q

What is the lowest form of evidence of a single study

A

Foundational sciences

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23
Q

What are the four types of information PTs use to make clinical decisions

A
  1. Tradition
  2. Authority
  3. Intuition
  4. Trial and error
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24
Q

Over ____% of PTs based interventions on what was taught during initial training

A

90

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25
Q

We use the acronym ____ to frame a question

A

PICO

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26
Q

what does PICO stand for

A

Patient/problem
Intervention
Comparison
Outcome

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27
Q

True or False:

When using PICO to frame a question, you do not always need a comparison

A

true

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28
Q

What is precision of treatment effect

A

A 95% confidence interval which is a range given indicated that if a study were to be duplicated, the stats of the duplicated study would fall between

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29
Q

What is size of effect and what is considered an acceptable P value

A

A P value that states whether data is statistically significant or not. A P value is significant if it is equal or less than 0.05

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30
Q

True or False:

A P value of 0.00005 is more statistically significant than a P value of 0.05

A

False, as long as the value is equal to or less than 0.05, they have the same weight in significance

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31
Q

True or False:

P value is NOT a function of effect size

A

true

32
Q

When appraising the evidence, it is important that I can apply the results to my current patient care. Three ways to do this is make sure the study’s subjects are (different/similar) to my patients, consider all clinical _______, and weight the benefits, harms and costs

A

similar, outcomes

33
Q

The diagnostic process is a (2/3/4) step process

A

2

34
Q

In the first step of the diagnostic process, you _______ the diagnostic hypotheses and estimate their ______.

A

enumerate; likelihood

35
Q

In the second step of the diagnostic process, you incorporate (old/new) information to choose the most likely diagnoses

A

new

36
Q

True or False:

A question is considered to be a diagnostic test

A

true

37
Q

What is the result of the diagnostic process

A

To establish a diagnosis or classification in order to specifically direct treatment

38
Q

What term describes the probability of the target condition being present before the results of a diagnostic test are available

A

pretest probability

39
Q

What term describes the probability of the target condition being present after the results of a diagnostic test are available

A

posttest probability

40
Q

If we know the properties of the diagnostic tests that we choose, then we can be highly (qualitative/quantitative) in our ability to move from the pretest probability to the posttest probability

A

quantitative

41
Q

A _____ hypothesis is the single best explanation given the preliminary data obtained which creates a (pretest/posttest) probability

A

leading; pretest

42
Q

Once a leading hypothesis is made after the diagnostic process, you compare the hypothesis to two thresholds. What are those two thresholds

A

test and treatment thresholds

43
Q

A (test/treatment) threshold is the probability below which a clinician dismisses a diagnosis and orders no further test

A

test threshold

44
Q

A (test/treatment) threshold is the probability above which a clinical would consider a diagnosis confirmed and would stop testing and initiate treatment

A

treatment

45
Q

The ____ of treatment determines when it is appropriate to start treating based on the percentage of confidence of what is being diagnosed (Ex: Brain surgery vs riding a stationary bike as intervention)

A

risk

46
Q

A positive diagnostic test + a positive reference standard = ________

A

true positives

47
Q

A positive diagnostic test + negative reference standard = _______

A

false positives

48
Q

A negative diagnostic test + a positive reference standard = ______

A

False negative

49
Q

A negative diagnostic test + a negative reference standard = _______

A

true negative

50
Q

(sensitivity/specificity) is the true positive rate

A

sensitivity

51
Q

(sensitivity/specificity) is the true negative rate

A

specificity

52
Q

_____ is the proportion of patients with the condition who have a positive test result

A

sensitivity

53
Q

Tests with (high/low) sensitivity have few false negatives, which rules out the condition (SnNout)

A

high

54
Q

Why should I remember the acronym SnNout?

A

It means SeNsitivity with high Negatives can be ruled OUT

55
Q

Why should I remember the acronym SpPin?

A

high SPecificity

56
Q

A _______ ____ is the best way to tell if evidence is good or if an intervention is worth using.

A

likelihood ratio

57
Q

What is the best statistic for evaluating the usefulness of a diagnostic test

A

LR

58
Q

The LR can be used to quantify the shifts in _____ of the patient having a particular diagnosis once the test results are known

A

probability

59
Q

How is LR calculated

A

from specificity and sensitivity

60
Q

(positive/negative) LR expresses the change in odds favoring the disorder given a positive test

A

positive

61
Q

The equation for (positive/negative) LR = sensitivity divided by (1-specificity)

A

positive

62
Q

What is the equation of +LR

A

sensitivity/(1-specificity)

63
Q

(positive/negative) LR expresses the change in odds favoring the disorder given a negative test

A

negative

64
Q

The equation for (positive/negative) LR = (1-sensitivity)/specificity

A

negative

65
Q

What is the equation for -LR

A

(1-sensitivity)/specificity

66
Q

how would you interpret a +LR of 10 or more and a -LR of 0.1 or less

A

Generate large and often important conclusive in probability ….. this is really good

67
Q

how would you interpret a +LR of 5-10 and a -LR of 0.1-02

A

Generate moderate shifts in probability. …..This is good

68
Q

how would you interpret a +LR of 2-5 and a -LR of 0.2-0.5

A

Generate small but sometimes important shifts in probability …… this isn’t good but its not terrible

69
Q

how would you interpret a +LR of 1-2 and a -LR of 0.5-1

A

Poor, little to no value

70
Q

What values of LR generate a large and often conclusive shift in probabilty

A 
\+LR = 10 or more
-LR = less than 0.1
71
Q

What values of LR generate moderate shifts in probability

A 
\+LR = 5-10
-LR = 0.1 -0.2
72
Q

What values of LR generate small but sometimes important shifts in probability

A 
\+LR = 2-5
-LR = 0.2-0.5
73
Q

What values of LR alter probability to a small, and rarely important degree

A 
\+LR = 1-2
-LR = 0.5-1
74
Q

When examining the evidence for effective interventions, would a number needed to treat (NNT) be better if it was higher or lower

A

lower, 1 would be the best number to have

75
Q

If you, the PT, are wondering if the treatments being done are really helping the patient, what is the solution to ensure the treatments are helping

A

Take the patient and ask a relevant question in order to search the literature using a PICO format then use that info to guide treatment

76
Q

Do you want to know WHY or IF a treatment works first

A

figure out if it works first, then find out why

77
Q

True or False:

EBP builds on and reinforces, and even replaces clinical skills, clinical judgment, clinical experience, and patient values

A

False, it never replaces it

Management of MS Disorders (18 decks)

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