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Evidence-Based Practice > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Background questions (definition, 2 essential components, example)

A
  • General knowledge about a disorder
  • Has two essential components:
    1. A question root (who, what, where, when..)
    2. A disorder/aspect of a disorder or outcome of interest
  • Often broader in scope than foreground questions
  • Can normally be answered using textbooks

e.g.
What causes breast cancer?
What are the clinical manifestations of menopause?
What causes migraines?

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2
Q

Foreground questions (definition, 5 essential components, example)

A
  • Specific knowledge about diagnosing, treating or assisting patients with managing their prognosis
  • Can be answered from scientific evidence
  • Five (or four) essential components:
    1. Patient/problem
    2. Intervention
    3. Comparison intervention (if relevant)
    4. Clinical outcomes

e.g. In younger women with breast cancer is mastectomy with chemotherapy more effective than mastectomy alone in reducing the risk of cancer reoccurrence?

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3
Q

PICO

A

Patient population or disease of interest (e.g. age, gender, ethnicity with a certain disorder)

Intervention (e.g. therapy, exposure to a disease, prognostic factor A, risk behavior)

Comparison (e.g. alternative therapy, placebo, no disease, prognostic factor B, absence of risk factor)

Outcome (e.g. outcome expected from therapy, risk of disease, accuracy of diagnosis, rate of occurrence of adverse outcome)

Optional: Time (e.g. Time taken for intervention to achieve outcome, time over which population observed for an outcome)

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4
Q

the five types of foreground questions

A
  1. intervention
  2. prognosis/prevention
  3. etiology
  4. meaning
  5. diagnosis
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5
Q

foreground question: intervention (definition, example)

A

What interventions lead most effectively to the desired outcome

ex. In patients with recurrent furunculosis, do prophylactic antibiotics, compared to no treatment, reduce the recurrence rate?

“In _________(P), how does _________(I) compared to __________(C) affect __________(O) within ___________(T)?”

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6
Q

foreground question: prognosis/prevention (definition, example)

A

What indicators are most predictive of, or carry the most risk for, an outcome

“In _________(P) how does ___________(I) compared to ____________(C) influence ____________(O) over __________(T)?”

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7
Q

foreground question: etiology (definition, example)

A

to what extent a factor, process or condition is associated with an outcome

“Are _________(P) who have _________(I) compared with those without __________(C) at __________ risk for/of ___________(O) over ___________(T)?”

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8
Q

foreground question: meaning (definition, example)

A

how an experience influences an outcome, the scope of a phenomenon or the influence of culture on healthcare

“How do __________(P) with _______________(I) perceive _____________(O) during ___________(T)?”

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9
Q

foreground question: diagnosis (definition, example)

A

what mechanism or test most accurately diagnoses an outcome/disease

“In ___________(P) are/is __________(I) compared with __________(C) more accurate in diagnosing __________(O)?”

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10
Q

You are caring for a 75 year old man with a stroke (left sided weakness) who is having trouble ambulating, feeding, bathing and dressing himself. He has hypertension but it is well controlled with a diuretic. He is otherwise well and now that he is medically stable the medical and nursing team have decided after discussion with him to transfer him to a stroke unit. When they next visit his family talk to you, highlighting that they are concerned about this transfer. They live very close to the acute care hospital and wonder why he can’t stay on the general medical ward where he currently is. You suggest that they and the patient arrange to meet with the medical team, to discuss their concerns. In the meantime, you decide to review the evidence for the use of stroke units. What is PICO here?

A

P: 75 year old man with a stroke and left sided weakness with impaired functional status

I: Stroke Unit

C: General medical care

O: Improved functional status

T: 3 months

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11
Q

What is PICO here? A nurse in the PACU is interested in ways to decrease the use of pain medication in post-op patients. She’s wondering if classical music or guided imagery might be efficacious.

A

P: Post-op patients

I: Classical music or guided imagery

C: Using pain medication on its own

O: Way to decrease use of pain medication in post-op patients

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12
Q

What is PICO here? A hearing test is an important component of the physical exam of elderly patients. Dr. Smith knows that some clinicians simply ask patients about their hearing ability and others use a tuning fork to test it, but he thinks that a simple whispered voice test is very accurate. He needs to choose one as the guideline for practice in his outpatient clinic.

A

P: Elderly patients

I: Voice test

C: Tuning fork and asking

O: Finding the correct guideline for the outpatient clinic

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13
Q

5S Hierarchy of Evidence

A 
Top to Bottom:
Systems
Summaries
Synopses
Synthesis
Studies
(Expert Opinion)
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14
Q

What is the best evidence design to answer an “intervention” question?

A

Systematic Reviews and Meta-Analysis or RCT

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15
Q

What is the best evidence design to answer an “prognosis/prediction” question?

A

Cohort study

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16
Q

What is the best evidence design to answer an “diagnosis” question?

A

Cross sectional studies

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17
Q

What is the best evidence design to answer an “etiology” question?

A

Cohort study

Case control study

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18
Q

What is the best evidence design to answer an “meaning” question?

A

Qualitative/Descriptive study

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19
Q

National Guideline Clearinghouse

A

Summaries of best practice guidelines

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20
Q

DynaMed

A

Synthesis of the most recent medical information into evidence-based recommendations

[for background questions]

21
Q

Cochrane Library

A

Database of Cochrane systematic reviews, plus quality assessments of other systematic reviews and database of randomized controlled trials

[for foreground questions]

22
Q

PubMed

A

Free resource: MEDLINE (medical literature) plus life sciences and book chapters [for foreground questions]

23
Q

OVID MEDLINE

A

Database of medical journal publications [for foreground questions]

24
Q

EBSCO CINAHL

A

Database of nursing and allied health publications

25
Q

What are MeSH terms in searching?

A

MeSH stands for Medical Subject Headlines

MeSH is the National Library of Medicine’s controlled vocabulary thesaurus. It consists of sets of terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity.

MeSH descriptors are arranged in both an alphabetic and a hierarchical structure.

26
Q

Search operator: “AND” when used in example search: Surgical site and infection

A

The search will find items containing “surgical site” and “infection”. AND narrows a search resulting in fewer hits.

27
Q

Search operator: “OR” when used in example search: Cardiac or coronary

A

The search will find items containing either “cardiac” or “coronary” or both. OR broadens a search, resulting in more hits.

28
Q

Search operator: “NOT” when used in example search: Surgery not neurosurgery

A

The search will find items containing “surgery” but not “neurosurgery”. Caution! It’s easy to exclude relevant terms.

29
Q

5 principles of searching

A
  1. Construct PICO question
  2. Identify correct ‘type’ of evidence to answer the question (do you need a guideline, evidence summary, systematic review, primary research study?)
  3. Identify the resource which is appropriate to retrieve the type of evidence you want
  4. Construct a search strategy – using your PICO question to determine search terms
  5. Carry out search – using Boolean operators and limits where appropriate
30
Q

2 experimental study designs used to answer therapy/intervention questions

A
  1. Randomized Controlled Trials
    - Pretest Posttest
    - Posttest (after only) design
    - Crossover trial design
  2. Quasi-experimental study designs
    - Non equivalent control group
31
Q

Syntheses

A

systematic reviews

32
Q

Synopses

A

critically appraised journal articles

33
Q

Summaries

A

evidence that has already been collected and put together for you—guidelines, critically appraised topics, evidence-based guidelines are the most valuable

34
Q

System

A

all evidence put into a computerized support system

35
Q

Studies

A

RCTs, cohort studies, case control studies, case series, reports

36
Q

Boolean Operators

A

Boolean Operators are simple words (AND, OR, NOT or AND NOT) used as conjunctions to combine or exclude keywords in a search, resulting in more focused and productive results. This should save time and effort by eliminating inappropriate hits that must be scanned before discarding.

37
Q

what research databases are best suited to answering foreground questions?

A

Medical databases such as Medline (via PubMed or OvidSP), Embase, Cochrane Database of Systematic Reviews and ACP Journal Club

38
Q

what research databases are best suited to answering background questions?

A

Medical textbooks, point-of-care tools such as DynaMed and FirstConsult, and narrative reviews

39
Q

example of MeSH indexing for article titled, “The role of coenzyme Q10 in heart failure.”

A 
Antioxidants/therapeutic use*
Coenzymes
Heart Failure/drug therapy*
Heart Failure/pathology
Heart Failure/physiopathology
Humans
Oxidative Stress/drug effects
Ubiquinone/analogs and derivatives*
Ubiquinone/therapeutic use
Ventricular Remodeling/drug effects
40
Q

pretest-posttest designs

A

obtaining a pretest measure of the outcome of interest prior to administering some treatment, followed by a posttest on the same measure after treatment occurs

these designs are employed in both experimental and quasi-experimental research and can be used with or without control groups

41
Q

crossover trial design

A

A crossover clinical trial is a repeated measures design in which each patient is randomly assigned to a sequence of treatments, including at least two treatments (of which one “treatment” may be a standard treatment or a placebo).

42
Q

posttest-only design

A

In the posttest-only design, data are collected only once from participants, immediately after they complete the program

43
Q

Nonequivalent Control Group quasi-experimental design

A

structured like a pretest-posttest randomized experiment, but it lacks the random assignment

you’re trying to make the groups as similar as possible (ex. comparable classrooms or similar communities)

So, what does the term “nonequivalent” mean? In one sense, it just means that assignment to group was not random

44
Q

Quasi-Experiments

A
  • used when true experiments are not possible

- typically lack random assignment

45
Q

Cohort study

A

a non-experimental study design that follows a group of people (a cohort), and then looks at how events differ among people within the group

Example: A cohort study was designed to assess the impact of sun exposure on skin damage in beach volleyball players. During a weekend tournament, players from one team wore waterproof, SPF 35 sunscreen, while players from the other team did not wear any sunscreen. At the end of the volleyball tournament players’ skin from both teams was analyzed for texture, sun damage, and burns. Comparisons of skin damage were then made based on the use of sunscreen. The analysis showed a significant difference between the cohorts in terms of the skin damage.

46
Q

RCT

A

a trial in which participants are randomly assigned to two or more groups: at least one (the experimental group) receiving an intervention that is being tested and another (the comparison or control group) receiving an alternative treatment or placebo. This design allows assessment of the relative effects of interventions.

47
Q

cross-sectional studies

A

examines the relationship between disease (or other health related state) and other variables of interest as they exist in a defined population at a single point in time or over a short period of time (e.g. calendar year)

48
Q

case control study

A

is always retrospective because it starts with an outcome then traces back to investigate exposures

When the subjects are enrolled in their respective groups, the outcome of each subject is already known by the investigator.

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