Exam 1: Evidence Based Practice Flashcards
We need EBP for 4 reasons.
- For ____ information
- There (is/is not) enough time to read all new studies
- Disparity between ______ judgement and ______ knowledge.
- _________ issues
- valid info
- Not enough time
- clinical vs current knowledge
- Reimbursement
True or False:
The three pillars of EBP are equal
False
what is the name of the scottish physician in EBP history
Archie Cochrane
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
RCT
Which physician argued for randomized control trials
Archie Cochrane
which medical doctor is the Father of EBP
David Sackett
Where did david sackett introduce EBM where he incorporated EBM education to medical students
McMaster University
who established cochrane centre and cochrane collaboration
Iain Chambers
what is the name of the international network of reviewers evaluating RCTs to produce and publish systemic review
cochrane centre and cochrane collaboration
_______ is based on the study of human knowledge
Epistemology
what are the three epistemological principles of EBM
- They are not equal
- Guide the provider to the most accurate objective info regarding the patient
- Patient values are applied for the final decision
EBP and its epistemological principles are like a _____
funnel
Principle 1 of EBP means viewing the best available evidence and the totality of the evidence, in other words you consider _____ of the evidence, ____!!!`
ALL; EVERYTHING
true or false:
With EBP, evidence includes only what is read in RCTs
False, it also includes descriptive studies, case studies, and what you have seen in the clinic
Principle 2 of EBP means using clinical expertise and synthesizing evidence. In other words you must make ____ of the evidence
sense
True or false:
The goal of clinical expertise is to support your idea but also to find the most accurate understanding
True
Which principle is the end of the EBP funnel
patent values/circumstances that involves educating patients on their options, and the decision is the patient’s because it is patient centered
What is the order of the EBM funnel
- Best available/ totality of evidence
- Clinical expertise
- Patient values and circumstances
True or False
Evidence alone is sufficient to make a clinical decision
False, it is never sufficient enough
A _____ of ____ should guide clinical decision making
hierarchy of evidence
The highest form of evidence from a single study comes from true experiments referred to as _____ _____ ____
randomized control trials
What is the lowest form of evidence of a single study
Foundational sciences
What are the four types of information PTs use to make clinical decisions
- Tradition
- Authority
- Intuition
- Trial and error
Over ____% of PTs based interventions on what was taught during initial training
90
We use the acronym ____ to frame a question
PICO
what does PICO stand for
Patient/problem
Intervention
Comparison
Outcome
True or False:
When using PICO to frame a question, you do not always need a comparison
true
What is precision of treatment effect
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
What is size of effect and what is considered an acceptable P value
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
True or False:
A P value of 0.00005 is more statistically significant than a P value of 0.05
False, as long as the value is equal to or less than 0.05, they have the same weight in significance
True or False:
P value is NOT a function of effect size
true
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
similar, outcomes
The diagnostic process is a (2/3/4) step process
2
In the first step of the diagnostic process, you _______ the diagnostic hypotheses and estimate their ______.
enumerate; likelihood
In the second step of the diagnostic process, you incorporate (old/new) information to choose the most likely diagnoses
new
True or False:
A question is considered to be a diagnostic test
true
What is the result of the diagnostic process
To establish a diagnosis or classification in order to specifically direct treatment
What term describes the probability of the target condition being present before the results of a diagnostic test are available
pretest probability
What term describes the probability of the target condition being present after the results of a diagnostic test are available
posttest probability
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
quantitative
A _____ hypothesis is the single best explanation given the preliminary data obtained which creates a (pretest/posttest) probability
leading; pretest
Once a leading hypothesis is made after the diagnostic process, you compare the hypothesis to two thresholds. What are those two thresholds
test and treatment thresholds
A (test/treatment) threshold is the probability below which a clinician dismisses a diagnosis and orders no further test
test threshold
A (test/treatment) threshold is the probability above which a clinical would consider a diagnosis confirmed and would stop testing and initiate treatment
treatment
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)
risk
A positive diagnostic test + a positive reference standard = ________
true positives
A positive diagnostic test + negative reference standard = _______
false positives
A negative diagnostic test + a positive reference standard = ______
False negative
A negative diagnostic test + a negative reference standard = _______
true negative
(sensitivity/specificity) is the true positive rate
sensitivity
(sensitivity/specificity) is the true negative rate
specificity
_____ is the proportion of patients with the condition who have a positive test result
sensitivity
Tests with (high/low) sensitivity have few false negatives, which rules out the condition (SnNout)
high
Why should I remember the acronym SnNout?
It means SeNsitivity with high Negatives can be ruled OUT
Why should I remember the acronym SpPin?
high SPecificity
A _______ ____ is the best way to tell if evidence is good or if an intervention is worth using.
likelihood ratio
What is the best statistic for evaluating the usefulness of a diagnostic test
LR
The LR can be used to quantify the shifts in _____ of the patient having a particular diagnosis once the test results are known
probability
How is LR calculated
from specificity and sensitivity
(positive/negative) LR expresses the change in odds favoring the disorder given a positive test
positive
The equation for (positive/negative) LR = sensitivity divided by (1-specificity)
positive
What is the equation of +LR
sensitivity/(1-specificity)
(positive/negative) LR expresses the change in odds favoring the disorder given a negative test
negative
The equation for (positive/negative) LR = (1-sensitivity)/specificity
negative
What is the equation for -LR
(1-sensitivity)/specificity
how would you interpret a +LR of 10 or more and a -LR of 0.1 or less
Generate large and often important conclusive in probability ….. this is really good
how would you interpret a +LR of 5-10 and a -LR of 0.1-02
Generate moderate shifts in probability. …..This is good
how would you interpret a +LR of 2-5 and a -LR of 0.2-0.5
Generate small but sometimes important shifts in probability …… this isn’t good but its not terrible
how would you interpret a +LR of 1-2 and a -LR of 0.5-1
Poor, little to no value
What values of LR generate a large and often conclusive shift in probabilty
\+LR = 10 or more -LR = less than 0.1
What values of LR generate moderate shifts in probability
\+LR = 5-10 -LR = 0.1 -0.2
What values of LR generate small but sometimes important shifts in probability
\+LR = 2-5 -LR = 0.2-0.5
What values of LR alter probability to a small, and rarely important degree
\+LR = 1-2 -LR = 0.5-1
When examining the evidence for effective interventions, would a number needed to treat (NNT) be better if it was higher or lower
lower, 1 would be the best number to have
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
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
Do you want to know WHY or IF a treatment works first
figure out if it works first, then find out why
True or False:
EBP builds on and reinforces, and even replaces clinical skills, clinical judgment, clinical experience, and patient values
False, it never replaces it
