Final Exam Flashcards
- internal validity refers to drawing conclusions from the findings in the study to the truth in the study
T/F
TRUE
- the diamond in a meta anaylsis indicates…
the size of the effect and its confidence interval
- SORT grades the evidence for
Both individual studies and a body of studies
Look @ #24
!!
- What is correct for evidence based decision aids (DA)?
A. DA should focus only on a specific tx option
B. pharmaceutical companies are in general good providers for DA
C. DA are helpful only for the dentist
D. DA are not recommended in medicine
E. DA should provide info of best available evidence on all tx options for a specific medical/dental condition
E. DA should provide info of best available evidence on all tx options for a specific medical/dental condition
- what is a characteristic of shared decision making
A. dr as “demigods in white”
B. pts evaluate tx options themselves
C. responsibility of both partners for the decision made
D. dr does not rate the info
E. assumption: pts know best what is good for them
C
- the default search in Pubmed searches for a term as?
a MeSH term and as a keyword
- which pair of odds ratios indicate the same absolute magnitude of effect?
A. odds ratios .5 and 1.5
B. odds ratios .5 and 5
C. odds ratios .5 and 2
C. odds ratios of .5 and 2
- Cochrane reviews are
reviews PUBLISHED online in The cochrane Library
- SORT (Strength of Recommendation Taxonomy) grades the evidence for…
Both INDIVIDUAL studies and a BODY of studies
- cohort studies are experimental studies
T/F
FALSE
- GRADE (Grading of Recommendations Assessment, Development and Evaluation) is similar to
SORT
- OHRQoL in pts with SDAs (RCT)
When compared to the SDA group, OHRQoL in the PRDP group was not different (-.6 OHIP points; 95%-CI: -7.1 to 5.9) during the study period
Minimal importance difference (MID) of OHIP score of 6 points, this result it
NOT statistically significant and NOT clinically relevant
- EBD and EBM are…
SIMILAR bc the principles how to phrase a question; to search; appraise; apply the evidence; and to evaluate the process are APPLICABLE ACROSS HEALTH CONDITIONS
- signs of oral diseases are
observed by the clinician
- risk ratios have
NEVER have units (unit less)
- an earlier version of the overlapping EBD/medicine circles had only 3 components:
- best research evidence
- clinical expertise
- patient values
Are these models different or similar?
The 3 circle version is SIMILAR to the 4 circle model because the research evidence is assessed with the PICO framework and “P” addresses the clinical/pt circumstances in the 4 circle model
- Which question contains the O of PICO
A. for a person w mild gingivitis, is an antiseptic mouthwash of essential oils as effective as flossing?
B. is mouthwash as effective as flossing?
C. For a pt w mild gingivitis, is rinsing with an antiseptic mouthwas of essential oils as effective in reducing plaque and eliminating gingivitis compared to flossing?
D. For a pt, is an antiseptic mouthwash of essential oils as effective compared to flossing?
C
O = OUTCOME
- EBD integrates…
Experience and judgement of the health care professional, clinical/pt circumstances, pt preferences/values, and scientific evidence
- statistical significance is a necessary condition for clinical relevance, i.e. only statistically significant results are informative for clinical decisions
T/F
FALSE
- what is a characteristic of paternalism
A. Dr as a service provider B. Pt makes decision alone C. all available info provided D. best compromise bn doctors freedom of tx + pts rights of participation E. pt in passive role
E
- paternalism is decision making model that is characterized by the following EXCEPT:
A. pt receives necessary info of intented tx
B. doctor seen as a service provider
C. doctor considers clinical + personal aspects of the pt alone
D. Dr makes decision alone
B. Doctor is seen as a service provider
- in PICO - the “I” stands for INTERVENTION. A breader term for this concept of interest would be “E” = EXPOSURE because…
Exposure stands for modifiable and nonmobifiable factors of interest - strictlyspeaking, intervention stands ONLY for tx and prevention efforts (the factor of interest is modifiable)
- Currently (December 2012) ADA EBD clinical recommendations are available for
Only for a couple topics (ALONG ASS LIST)
- in the 4S model, the Journal of Evidence based Dental Practice is an example for
Synopses
- what is the correct order of the hierarchy of evidence of studies?
RCT
Cohort Study
Case Control study
Case series
- when assessing the CLINICAL importance of the effect what is the LEAST IMPORTANT point?
Magnitude of the effect
Presence of statistical significance of effect
Precision of the effect
presence of statistical significance of the effect
- studies should have internal and external validity to be useful for clinical decisions
T/F
TRUE
- Which part of PICO missing/incomplete:
For a pt with dry mouth, will pilocarpine be more effective to increase the production of saliva?
C = comparison
- likelihood ratios for diagnostic tests are important measures of diagnostic test accuracy: 2 versions of the likelihood ratios (LR) exist, one for positive and one for negative test results. they are called:
Positive likelihood ratios and negative likelihood ratios
- randomized controlled trials are
always prospective
- study types are ranked in the hierarchy of evidence
Better to worse
RCT > cohort study > case series
- Which publication type limit in Pubmed DOES NOT retrieve a high level of evidence?
Editorial
- The P in PICO sometimes = PATIENTS
Why is PATIENTS less preferable than POPULATION?
Bc we are sometimes interested in prevention strategies/risk factors that apply to HEALTHY ppl
- all interpretations for a 95% confidence interval of 8 to 10 OHIP units for a mean difference of 9 OHIP units (the point estimate) between intervantion and the comparison are TRUE, EXCEPT FOR
A. there is a 95% chance that OHIP mean differences of 8 and 10 will be statistically significant
B. we are 95% confident that the real/true OHIP mean difference is between 8 and 10 units
C. 8 to 10 OHIP units is the range of possible tx differences compatible with the data
D. 8 to 10 OHIP units is the range within which the true tx difference is likely to lie
A. there is a 95% chance that OHIP mean differences of 8 and 10 will be statistically significant
- The Oral Health Impact Profile (OHIP) is a questionnaire to assess perceived oral health.
It is a _______ outcome measure
It is a PATIENT ORIENTED outcome measure
- a clinical recommendation from the ADA EBD website is
A recommendation for pt tx made by an expert panel based on the best evidence available
- EBD is MAINLY concerned with…
Pts (diseased individuals) and their tx
LOOK AT #52
;LAJS
- in the 4S model, the Journal of Evidence based Dental Practice is an example for
Synopses
- what do MeSH (medical subject headings) terms in PubMed describe?
Biomedical subjects
- “n.s” is often mentioned when statistical testing is performed. it means…
the test was NOT statistically significant
- The PICO framework is mainly applicable for…
Foreground questions
- systematic reviews + meta analyses can be performed for:
case series
case control studies
cohort studies
randomized controlled trials
- the highest/best category in SORT is
Consistent, good quality, pt-oriented evidence
- study quality is important. therefore, guidelines/recommendations exist how study results should be reported. What is the correct assignment?
PRISMA = ?
CONSORT = ?
STARD = ?
PRISMA = systematic review and meta-analyses
CONSORT = randomized clinical trials
STARD = diagnostic test studies
- cohort studies are always prospective
T/F
FALSE
- statistically significant results are more important than than statistically non significant results
T/F
FALSE
PICO =
Population
Intervention
Comparison
Outcome
- odds ratios are often used to approximate
risk ratios
- All points about shared decision are true EXCEPT FOR ONE:
A. info exchange in both directions
B. considers knowledge of both dialog partners regarding selection options for tx
C. After having received all info, pt alone is responsible for decision
D. active and = submission of decision criteria from both partners in decision making process
C. after having received all info, pt alone is responsible for decision
- This feature in PubMed allows you to refine your search
Filters
- Is the “I” in PIC always a dental/medical tx?
NO - sometimes we are interested in an “EXPOSURE”
i.e. a factor of interest for an outcome
- a confidence interval around an effect measure (e.g. around mean differences of OHIP scores in a RCT comparing pts with implant-supported dentures with conventional denture pts) can be understood as
a range of other plausible values for the effect measure
- pocket depths is a
disease oriented outcome
- the preferred model to communicate with OLDER PATIENTS is
shared decision making
- in RCTs all points are important to establish internal validity EXCEPT
Method of generating the random sequence Allocation concealment Blinding Multivariable statistical analysis Adequacy of follow up
miltivariable statistical analysis
- Symptoms of oral diseases are
reported by the pts
- SORT stands for…
Strength of Recommendation Taxonomy
- according to the scientific evidence, the average dental pt prefers when tx decisions are made:
A. by the pt alone
B. by the dentist alone
C. by the pt jointly w the dentist
C
- Which database uses MeSH (Medical Subject Headings)
Pubmed
- an effect size of .1 for a difference between OHIP scores between a new tx vs. a comparison tx favors the NEW tx. When guidelines are used to interpret the magnitude of the effect size, it means
the new tx has no effect
- an online repository of freely available full text is:
PubMed Central
- What resource can you use to find unfiltered (primary) research?
Pubmed
- The Minimal Important Difference (MID) for pt-reported outcome measures has a unit, e.g. if calculated for the OHIP scores it would be in OHIP points
T/F
TRUE
- For risk ratios, the neutral point of no effect between the intervention and the control group is
always 1
- which is NOT a model of decision making
A. paternalism
B. consent deicison making
C. informed deicision making
D. shared decision making
B
- what is the recommended model for decision making in medicine + dentistry
shared decision making
- mouth opening is a
disease oriented outcome
LOOK AT #55 AND 56
LAKJS
- what does sensitivity of a test mean
sensitivity is the proportion of individuals with the condition who have a positive test result
- the highest/best category in SORT is…
(Consistent), good quality, pt-oriented evidence
- T/F
meta analyses summarize only randomized clinical trials
false
- a negative number would not be presented as a NNT, rather, as the intervention is harmful, it is expressed as a number needed to hard (NNH)
T/F
TRUE
- statistical significance is a necessary condition for clinical relevance, i.e. only statistically significant results are informative for clinical decisions
T/F
FALSE
- the CONSORT (Consolidated Standards of Reporting Trials) Statement is a tool to improve the quality of reports of…
only randomized controlled trials (RCTs)
- During decisions-making, info about intended txs should contain
Patients personal benefits + drawbacks
- OHIP stands for
Oral Health Impact Profile
- You can find quality, filtered dental research from
pubmed
ADA center for EBD
Cochrane
- for the clinician who is interested in a new test to diagnose approximal caries instead of using an xray exam, what are the most useful measures of diagnostic accuracy
positive and negative predictive value of the new test for the pt population where the clinicain wants to use the test
- SORT distinguishes between
Disease-oriented outcomes and pt-oriented outcomes
- dental anxiety is a
pt oriented outcome
- according to the scientific evidence, pts perceived role in decision making is on average
A. more active than preferred
B. more passive than preferred
C. exactly as preferred
B
- oral health related quality of life (OHRQoL) was investigated in pts with shortened dental arches (SDA). In a randomized controlled trial (RCT), 2 txs were compared. Pts received molar replacement by partial removeable denture prosthesis (PRDP) or the shortened dental arches (SDA) was restored. Pt’s oral health-related quality of life was measured over a period of 10 yrs. 1-2 months after tx was provided, the 1st follow up assessment was performed =
OHRQoL substantially improved from baseline to 1st follow up in both groups, indicated by a mean decrease in OHIP scores of 20 points (95%-CI: 12.5-27.5)
Given a minimal important difference (MID) of OHIP score of 6 points, this result is
statistically significant and clinically relevant
- cohort studies are…
usually PROSPECTIVE studies, but RETROSPECTIVE cohort studies exist too
- the premier database for medical info is:
Medline
- what is a characteristic of informed decision making
A. dr makes decision alone B. dr dominates communication C. pt alone is responsible for decision D. info exchange in both directions E. dr considers clinical + personal aspects of the pt alone
C
- T/F
there is evidence that dental pts prefer to be more involved in the decision process
true
- what is the positive predictive value
of the individuals who had a positive test result, it is the proportion of individuals who truly have the condition
- The Minimal Important Difference (MID) is defined as “the smallest difference in score in the domain of interest which pts perceive as beneficial and which would mandate, in the abscence of troubesome side effects and excessive cost, a change in the pt’s management”
It is…
an important benchmark for defining what is clinically significant for continuous outcomes
LOOK AT 58 and 59
LKAJSF
- the dimensions of oral health related quality of life are
Oral function
Orofacial pain
Orofacial appearance
Psychosocial impact
- the ideal number to treat (NNT) is
1
- Case control studies are
Always retrospective
- the Center of EBD website of the American Dental Association is a source of
Synopses of systematic reviews covering oral health topics
- for differences between means, e.g. the difference between mouth opening measured in mm in subjects tx with a new type of splint vs. a standard splint, the neutral point (no difference between the 2 txs) is…
always 0
- when using Pubmed this Boolean operator is often used to narrow your results
AND
- Boolean operators are used to associate terms in a PubMed search. Which operator would you use to combine “like” terms?
OR
- for differences between means, e.g. the difference between mouth opening measured in mm in subjects treated w a splint vs. an ultrasound application, the neutral point of no effect is
Always 0
- Name 2 journals devoted to EBD
Journal of Evidence based Dental Practice
Evidence based Dentistry
- What study design is this?
In a study where tx allocation for pts was performed by chance, pilocarpine increased the production of saliva as compared to no tx in individual with opiod-induced dry mouth
Randomized clinical trial
LOOK AT #48
LKAJS
- effect measures need to be large in magnitude and precise to be clinically informative (to decide whether the intervention or the comparison tx should be chosen for the pt)
T/F
FALSE
- an effect size of .5 for a mean difference is considered a
medium effect
- the effect size for differences has a unit, e.g. if calculated for the OHIP scores it would be in OHIP points
FALSE
- which publication type is an example of filtered (pre-appraised) research?
systematic review
- T/F
a meta analysis is often, but not always, performed together with a systematic review
true
- Select the PICO component that is missing/incomplete from following:
For a pt with perio disease, will antimicrobial therapy (minocycline HCl) in conjuction w SRP be more effective compared with SRP alone?
O = outcome
- What is the correct order of the 5 steps of EBD?
Formulate question Conduct search Appraise evidence Apply results Evaluate process
- T/F
a likelihood ratio of 1 indicates a useless test
true
- the overall effect in the meta analysis is usually presented as
a point estimate and confidence interval (location and size of the diamond)
look at 66
lakfjs
- The P in PICO =
population
- Which pair of odds ratios indicare the same absolute magnitude of effect
A. odds ratios of .25 and 1.25
B. odds ratios of .75 and 1.25
C. odds ratios of .25 and 4
C. odds ratios of .25 and 4
- odds ratios approximate risk ratios when
outcome is rare (<10%)
- if a p value larger than .05 is calculated in a statistical analysis, wer are not able to reject the null hypothesis. which of the following is NOT correct?
A. there is truly no difference between groups
B. the date could not reject the hypothesis that no effect exist
C. there is not enough evidence to reject the null hypothesis
A. there is truly no difference between groups
- What is the ADA’s definition of EBD?
EBD is an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relatig to the pt’s oral and medical condition and hx, w the dentist’s clinical expertise and the pt’s tx needs and preferences
- What study design is this
A study in which colon cancer pts are asked what kinds of food they have eaten in the past and the answers are compared w a selected control group
case-control study
- major aspects of pt’s right are:
Information
Participation
Consent
- for numbers needed to treat (NNT) is…
lower numbers are BETTER
i.e. a NNT of 2 is better than 5
- Oral health related quality of life can be used as an outcome measure. It is
a patient oriented outcome
- SORT grades individual studies as
1, 2, 3
- All of the below are checklists/guidelines about how to report systematic reviews, RCTs, and diagnostic test accuracy studies EXCEPT:
PRISMA
SORT
CONSORT
STARD
SORT
look at 75/76
;lakdjsf
- In general, pts want to make the decisions
Jointly w the doctor
- Pubmed is an interface for searching the database MEDLINE. MEDLINE indexes which types of publications?
articles from scholarly journals in the health sciences
- T/F
good diagnostic tests have large positive likelihood ratios and small negative likelihood ratios?
true
- SORT grades a body of evidence as
A, B, C
- the cross sectional study is similar to…
the case control study
- the line of no effect when the odds ratio is used as the outcome measure is
always at 1
- the difference between the 4S and 6S model of preappraised evidence is
the category SYNOPSES is separated into SYNOPSES FOR STUDIES and into SYNOPSES FOR SYNTHESES. in addition, SUMMARIES are added (evidence based clinical practive guidelines, EBD textbooks)
- Case control studies are prospective studies
T/F
FALSE
- outcomes that matter to pts and help them live longer or better lives are known as
patient oriented outcomes
- in the 4S model, the correct order of the levels is
studies
synthesis
synopses
systems
- in the 4S model, publications that are NOT peer reviewed are
in “studies” “synthesis” or “synopses” depending on the type of manuscript
