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Evidence Based Practice > Exam > Flashcards

Exam Flashcards

1
Q

What are the 5 steps of EBP?

A
  1. Access
  2. Ask
  3. Acquire - search lit in publically accessable databases
  4. Appraise - assess rigour/value
  5. Apply
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2
Q

What frame work would you use to ask an answerable question?

A

PICO!
Eg. What is the effectiveness of physiotherapy intervention for lumbar disc herniation in adults
P = adults I = physiotherapy intervention C = no treatment O = pain & functional movement

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3
Q

What does PICO stand for?

A 
P = patient/problem eg. Elderly with ankle sprain
I = Intervention eg. "Does ice and rest reduce swelling"
C = Comparison eg. Alternate treatment or treatment vs. no treatment
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4
Q

What does PECOT stand for??

A 
P = patient/problem
E = exposure (intervention) eg. Smoke
C = Comparison eg. No smoking
O = Outcome eg. Lung cancer
T = timeframe eg. 5-10 years
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5
Q

Define sensitivity: and state equation

A

Probability diagnostic test is positive in patients who DO have the disease (TP)

TP = (TP/TP+FN) X 100

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6
Q

Define specificity: and state equation

A

Probability the diagnostic test is negative in patients that DO NOT have the disease

TN = (TN/TN+FP) x 100

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7
Q

What does a sensitivity of 0.75 mean??

A

There is a 75% chance that if a test is positive the individual has the condition

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8
Q

What does a specificity of 0.85 mean?

A

There is a 85% probability that if the test is negative the person does not have the disease

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9
Q

What is the mode?

A
  • The most commonly occuring value in a data set

- works for both categorical and numerical data sets

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10
Q

What is the mean?

A
  • arithmetic average
  • continuous and discrete but NOT categorical
  • most severely influenced by outliers
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11
Q

What is the median?

A

Middle value in distribution arranged in ascending or descending order
- not affected by outliers

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12
Q

What are the steps in hypothesis testing?

A
  1. State the research question(PICO)
  2. Specify null and alternate..assume null is true, try and find evidence to support alternate
  3. Decide on significance - alpha = 0.05 ..”how much are you letting chance play a role”
  4. Calculate test statistic(z, t or other)
  5. Reject or fail to reject the null (usually through use of p-value)
  6. State conclusion
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13
Q

State the null:

A

There is no significant difference between specified groups/populations

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14
Q

State the alternate

A

There is significant difference between groups/populations

Meaning sample observations are influenced by non-random cause -> research hypothesis

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15
Q

Draw the errors in decision making table:

A
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16
Q

Describe quantitative research:

A
  • emphasis on control and objectivity, produce rigorous and generalisable results
  • required to describe cause and effect
  • tests a theory (deductive)
  • variables are controlled
  • numerical forms of data representation
  • conclusion is stated with predetermined degree of certainty(alpha)
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17
Q

Describe qualitative research:

A
  • describes in depth a phenomena
  • aiming to generate a theory -> inductive
  • data representation in narrative and verbal forms
  • it asks “why” and “how many” through looking @ social and cultural factors
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18
Q

What are the misconceptions of qualitative research?

A
  • unscientific and anecdotal
  • lack scientifically rigorous methods
  • personal perspective dominant
  • question applicability and relevance
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19
Q

Why are the misconceptions of qualitative research not true?

A

Clinical practice more than science, underpinned by personal observation, reflection and judgement
- when looking at view points it does not have focus on minimisation of chance, so p-value plays no role

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20
Q

Types of data collection in qualitative research?

A
  1. Focus group
  2. Interviews (clinical = diagnostic, opinion poll = deductive, qualitative research = inductive)
  3. Participant observation
  4. Document analysis
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21
Q

Why can you not use library data base?

A
  • not for evidence based information
  • non-replicable, other health professionals will be unable to replicate your search strategy and obtaining similar results using the same databases eg. Medline or CINAHL
  • search must be transparent and reproducible
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22
Q

Describe case report/case series + pros and cons

A
  • Usually a rare disorder
  • describe experience of single patient or group(report) or report on series of patients with an outcome of interest
    PRO: richness of info
    CON: isolated observations collected in uncontrolled unsystematic manner => cannot generalise to population
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23
Q

Describe crossectional study + pros and cons

A
  • ASSOCIATION between possible causal factors and a condition..done so by determining exposure to factor
    Eg. Recently given birth + cleft plate + drug during pregnancy
    PRO: easy, inexpensive, ethically acceptable
    CON: does not establish cause & effect, only association and exposure, depends on accuracy of recall
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24
Q

Describe case-control + pros and cons

A
  • people with condition “cases” matched to people WITHOUT “control”
  • retrospective…look back in time to determine proportion of people in each group exposed to suspected causal factor
    PRO: quick, inexpensive, best for rare long time exposure & outcome
    CON: recall basis, medical records inaccurate or incomplete
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25
Q

Describe cohort study + pros and cons

A
  • treated or exposed vs. non-treated or non-exposed
  • prospective..see how many develop disease or outcome
    PRO: less expensive and easier to administer than RCTs, more ethically acceptable because potentially beneficial treatment is not withheld, and possibly harmful treatment is not given
    CON: can never perfectly match cohorts, social/occupation factors
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26
Q

what is RCT + pros and cons

A
  • The gold standard of experimental quantitative research
  • involves blinding, randomisation, sample size justification and statistical analysis together have the greatest ability to minimise bias
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27
Q

Name the types of bias

A
  1. Sampling/selection = randomly and methodically
  2. Allocation = to treatment or control
  3. Maturation = occurs naturally over time
  4. Attrition = drop outs, how did it effect study?
  5. Measurement = eg. wrongly calibrated tool => standardisation
  6. Placebo = participants believe intervention will result in improvement
  7. Hawthorne effect = experience changes due to attention..pleasing researcher
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28
Q

What is the importance of EBP in health care quality and safety?

A
  • Improve quality, effectiveness and appropriateness of clinical practice
  • Shares decision-making with patients
  • Substantiates the care provided to patients
  • Reduce variations in practice patterns resultant from geographical difference or gaps in current knowledge!
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29
Q

What is the central limit theorem??

A

It states that the distribution of the mean is approximately normal if sample size is large enough, regardless of underlying distribution of original measurements

–> DRAW NORMAL DISTRIBUTION CURVE

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30
Q

Venn diagram what 3 things combine to make EBP

A
  • research evidence
  • clinical expertise
  • patient values
31
Q

Describe non-parametric testing:

A
  • no assumption on distribution or variance
  • ordinal, nominal data sets
  • spearman correlation coefficient used
  • median no mean used, due to catagorical data
32
Q

What is a systematic review??

A
  • focuses on a single issue within a topic
  • replaced literature review, should have same level of rigour reviewing research evidence as producing evidence in the first place
  • focuses on quantitative
  • methods to reduce/eliminate bias, reproducible results
33
Q

What is a meta-analysis??

A
  • a product of a systematic review
  • combine data of several studies that address a set of related research hypothesis
  • gain true effect of treatment
34
Q

When is meta-analysis useful?

A
  • studies that report different effects
  • small sample sizes
  • single studies rarely provide definitive conclusions, need a body of evidence
  • MUST HAVE: same pop, same intervention administered in same way, measure the same outcomes in same way, homogeneity
35
Q

What are clinical practice guidelines:

A
  • systematically developed statements to assist health professionals and patient make decisions about appropriate health care for specific circumstances
36
Q

Aims of Clinical Practice Guidelines?

A
  • improve quality of health care, increase chance of getting well as quickly as possible
  • provide recommendations for treatment and care of people by health professionals
  • develop standards to assess practice of health professionals
37
Q

What to remember about Participatory Action Research:

A
  • involves disempowered/marginalised individuals

- by involving them in research you will be able to create stratagies to help them

38
Q

What to remember about Ethnography?

A
  • focuses on the social and cultural influences on a persons view point
    Which can also influence their health decisions
39
Q

What to remember about grounded theory?

A
  • specific focus on theory development
  • generates new theory about particular phenomenon
  • interplay between data collection and data analysis
  • becomes a sort of circle
40
Q

What to remember about Phenomenology:

A

Focus on the INDIVIDUAL every day world from the perspective of the person who is experiencing it
Eg. Child abuse, rape survivors

41
Q

What to remember about feminist research:

A

Female health focus

Decisions for womens health not made by women

42
Q

What to remember about discourse analysis:

A
  • Uncovering dominant and marginalised discourses and locating inconsistencies
  • what drove the decision?
    Eg. White aus policy
43
Q

What to remember about GENERIC qualitative/quantitative description:

A
  • basic superficial over view
44
Q

What to remember about case study(qualitative)

A

Looks at particular case/community

45
Q

What are the key components which underpin health care quality?

A

Safety = no harm comes to patient
Effectiveness = if it has a sustainable and durable outcome
Timeliness = how quickly a person gets access to care
Efficiency = value for money
Patient centeredness = patient plays active role in decision making
Equity = everyone gets same care regardless of social/cultural factors

45
Q

When talking similarities and differences between studies what do you talk about?

A
  • observational/descriptive/experimental

- cause and effect/incidence/prevalence

46
Q

How is sample size determined in qualitative research?

A
  • data saturation: point in time when no more new info

- researcher runs out of time/money/resources

47
Q

What are the 2 pairs of centrality and dispersion?

A

Mean + standard d = normally distributed

Median + interquartile range = skewed data

48
Q

You get a question “based on p-values and confidence”… how do you answer?

A
  • state alpha = 0.05
  • state p value
  • is p > or < alpha
  • only 5% of studies will have the result due to chance
49
Q

When justifying from sensitivity and specificity whether it is a good test or not?

A

No cut off, just want values to be as close to 1 as possible

50
Q

Are qualitative research findings generalisable?

A
  • No, as we’re not interested in distribution but rather just describing phenomenon of interest
  • do not get representative sample, want to get depth of phenomenon
  • not interested in role of chance
51
Q

What are the strengths and limitations of literary review?

A

Strengths = answers background questions, good starting point for research, gets breath of topic, highlights gaps in knowledge, easy immediate access to broad info on topic
Limitations: no methodology, selective reporting

52
Q

Limitations of systematic reviews

A
  • publication bias, limited to whats being published..could be only positive studies
  • inappropriate aggregation of studies
  • heterogenous data = > meta-analysis
53
Q

what denotes correlation?

A
  • r is pearsons correlation coefficient, measure of linear association.
  • scale -1 -> +1
54
Q

describe confidence intervals

A

Confidence intervals provide information the precision of the estimate, range of values likely to a certain degree of confidence will contain populaiton parameter
- confidence level of 95% is usually selected

55
Q

you get a question that says “based on confidence intervals” how do you answer?

A
  • can do separate from p-value or together
  • for “treatment” group, they are 95% confident that “what is being measured”(eg. disability/pain etc.) will be from 0.5->2.8, do same from control group
56
Q

what does cohort and crosssectional studies actually measure?

A

cohort = incidence..measures at multiple points in time

cross sectional = prevalence..number of people at this point in time

57
Q

when would you use PICO and when would you use PECOT?

A 
PICO = singular focus on intervention
PECOT = exposure, diagnosis/prognosis
58
Q

what does confidence level of 95% mean?

A

if 100 samples were collected from population, confidence intervals calculated, 95 of these would contain the true pop mean

60
Q

what is a type 1 error? give an example

A

rejecting the null if it is actually true

- saying a particular treatment has an effect when really it doesnt

60
Q

whats the difference between parametric and non-parametric data?

A

parametric assumes normal distribution, data sets typically ratio or interval, can draw more conclusions from sample to population
non-parametric has no assumption of distribution or variance, ordinal or nominal data, more simple, less effected by outliers

61
Q

what is a type 2 error?

why is it bad and in what kind of testing is it the worst?

A

failing to reject the null when it is false

  • bad because it could mean withholding effective medication from people with disease
  • diagnosic testing
62
Q

what are some limitations of EBP?

A
  • need time to develop new skills
  • limited time & resources
  • shortage of coherent, consistent scientific evidence
  • difficulties applying evidence to care of individual patients
63
Q

what are the misconceptions of EBP?

A
  • promotes cookbook approach to patient management
  • its just a cost cutting tool
  • decisions made solely from research data
64
Q

example of continuous data

A

nominal

height, weight, temp

65
Q

example of discrete data

A

nominal

counts, number of students/children

66
Q

example of ordinal

A

catagorical

grades, clothing size, mild-moderate-severe

67
Q

example of nominal catagorical

A

gender, eye colour, buring-tingling-shooting

68
Q

what is the hierarchy of evidence?

A

ranking system(levels) of various study designs like a ladder from most to least bias. Bias relating to internal and external validity

69
Q

define internal validity:

A

relates to how you conduct research, so you’re sure effects seen is from exposure/intervention

70
Q

define external validity:

A

generalisability of research findings from sample to reference population

71
Q

what affects internal validity of study?

A
  • Chance: random error, only minimised through sufficient sample size
  • Bias: systematic error
  • Cofounders: variables not taken into account, random allocation takes this into account by spreading cofounding events equally across groups
72
Q

how can qualitative data be analysed?

A
  1. thematic: organise data into themes, code

2. content: systematic coding and categorisation eg. out of 10 ppl 8 said taste was most important

Evidence Based Practice (3 decks)

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