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Fall EBM > Final Study Guide > Flashcards

Final Study Guide Flashcards

1
Q

The 3 pronged approach to EBM

A

1) Clinical Problem Solving
2) Medical Informatics
3) Critical Appraisal

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2
Q

Sources of info for patient care

A

Medical informatics

-PubMed, Cochrine Library, TRIP, DynaMed

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3
Q

Examples of POE

A

Patient Oriented Evidence (POE)

  • mortality
  • morbidity
  • quality of life
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4
Q

EBM prescription includes

A 
Formulate + ASK a question 
ACCESS the evidence
Critically APPRAISE the evidence
APPLY the evidence
ASSESS the use of information in practice
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5
Q

Highest quality literature

A

Meta-Analysis/ statistical systemic review

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6
Q

Uses for Meta-Analysis

A

Done to reconcile studies w/ different results
Looks at multiple negative studies to uncover Type II errors
Looks at clinical problems where there are some negative & positive studies to uncover Type I or II errors
Helps uncover a single study w/ totally different results d/t systematic error or research bias
May narrow a large CI in some studies by combining them

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7
Q

What is homogeneity in a meta analysis?

A

the results from a set of independently performed studies on a particular question are similar enough to make statistical pooling valid

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8
Q

Advantages to EBM

A

improves confidence through decision making, assists in communication with pt/provider, decreases time going through literature, fosters reading habits, lessons lag time for applying findings, dovetails with technology

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9
Q

Disadvantages to EBM

A

requires commitment & time, not everyone is skilled at database research, not everyone can afford resources, not everyone is equally skilled in appraising the literature, better known & chosen reliable filters, good evidence is not always there, risks “misinterpretation”

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10
Q

PICO question

A

1) Patient
2) Intervention
3) Comparison intervention
4) Outcome of interest
5) (T)ime

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11
Q

What does EBM serve to accomplish in genearl

A

1)Standardize practice while maintaining pt.-centered care
2)Promote life-long learning
3)Response to practice variability
4)Provide granularity on complex questions & gray areas
•Four elements: best evidence, clinical situation, clinical experience, pt. values

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12
Q

What is causation

A

one variable DOES cause the other

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13
Q

Hill’s Guidelines of Causation includes

A

i. Strength of association
ii. Consistency
iii. Specificity – cause should lead to a single effect
iv. Temporality
v. Biological gradient
vi. Biological plausibility
vii. Coherence with other data
viii. Analogy – similar relationships with other processes

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14
Q

What model of clinical reasoning is done by beginner clinicians

A

Exhaustive model
-comprehensive H&P, all things possible
good for zebras
time consuming

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15
Q

What is the best style of clinical reasoning?

A

Hypotheticoeductive

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16
Q

What model of clinical reasoning involves branching decision tree pathways?

A

Algorithmic

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17
Q

What model of clinical reasoning involves genitive shortcuts in prioritizing dx through patter recognition and informal methods?

A

Heuristic Model

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18
Q

What is anchoring bias?

A

getting stuck on one possibility

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19
Q

What is the best way to minimize selection bias?

A

random sampling

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20
Q

Clinical decision making tree

A

Info > Reasoning > Judgment > Communication > Shared Decisoin

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21
Q

Internal influences include

A

your own risk-taking nature, what questions you ask, jumping to conclusions, assumptions of objective findings

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22
Q

External influences include

A

Anatomical differences, different therapeutic responses, pt. biases (language, education, pain, etc.), personality traits, barriers (language, education, pain, coping mechanisms), co-worker biases

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23
Q

What EBM recommendations require strict adherence to correct etiquette?

A

Protocols

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24
Q

What EBM recommendations provide official recommendations of how something should be done?

A

Guidelines

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25
Q

What study is done for a descriptive study when there is little known about a disease

A

cross-sectional

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26
Q

What study is for prevalence studies?

A

cross-sectional

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27
Q

Pros of case control studies

A

easy, cheap, and quick

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28
Q

cons of case control studies

A

open to interpreter and referral bias

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29
Q

what is a prospective study done from a certain period in the past to the present

A

Cohort study

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30
Q

What study is best for answering etiology or harm and progress questions?

A

Cohort study

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31
Q

What study is good for rare exposures?

A

cohort study

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32
Q

what is the gold standard for studies?

A

RCT

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33
Q

What study is good for prognosis questions?

A

Cohort studies

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34
Q

Sections of a research paper

A 
Introduction
Review of related medical literature (inferences)
Methodology
Results
Summary/decisions
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35
Q

What defines qualitative study designs?

A

analyzing non-numerical data to answer questions
-Hypothesis generating
good precursor to quantitative
examples: narrative, research questions, interviews, focus groups

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36
Q

What defines a quantitative study design?

A

analyzing numerical data to answer questions

  • hypothesis answering
  • very structured
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37
Q

What is nominal data?

A

Represents categories with no order

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38
Q

What is ordinal data?

A

Categories that can be ordered

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39
Q

What is interval data

A

Ordered set of values with equal distances between but there is no absolute zero

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40
Q

What data can you perform descriptive stats on (mean, median, mode, etc)

A

Interval and ratio

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41
Q

What is ratio data

A

Ordered values with an absolute zero

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42
Q

What is validity?

A

accuracy of a study

43
Q

What is internal validity?

A

The degree that the test measures the content intending to be measured and how well it follows gold standard of criterion-related data.

44
Q

What is external validity?

A

extent the study can be generalized to the population. Can it be generalized?
Trying to avoid the Hawthorne effect by being blinded

45
Q

What does stability mean in terms of reliability of data

A

scores are consistent over time

test-retest

46
Q

Mean

A

average

47
Q

median

A

middle value in set of points

48
Q

mode

A

most common value

49
Q

range

A

highest to lowest, measure of dispersion

50
Q

parameter

A

numerical value that describes a population (N)

51
Q

variance

A

measure of variation

52
Q

standard deviation

A

square root of variance

53
Q

What is the most stable/best measure of variability?

A

Standard deviation

54
Q

Central tendency measurements include

A

mean, median, mode

55
Q

dispersion measurements include

A

range, standard deviation, variance

56
Q

relative position measurements include

A

percentile ranks, standardized scores (t & z scores)

57
Q

What was enacted in 1947 that set the stage for future laws regarding research on humans?

A

Nuremberg Code

58
Q

What did the Tuskegee Syphilis Study lead to?

A

National Research Act of 1974

59
Q

Define a confounding variable

A

third variable that is actually responsible for the outcome but wasn’t intended in the study. It influences both independent and dependent variables

60
Q

Control for confounding variables by

A

random selection
subject matching
increasing the power

61
Q

What is informed consent?

A

Written permission by the subject verifying that he/she agrees to participate with full understanding of what said participation would entail

62
Q

OR of 1=
>1=
<1=

A 
1= no impact
>1= significant impact
<1= possible protective effect
63
Q

What is relative risk?

A

probability of outcome in exposure group divided by probability of outcome in non-exposure group

64
Q

Ho=

A

Null Hypothesis

researcher hopes to reject this

65
Q

Ha=

A

Alternative hypothesis, any hypothesis that does not conform to the one being tested

66
Q

If p-value is greater than alpha you

A

fail to reject Ho, therefore results fall within two standard deviations of mean

67
Q

If p-value is< alpha (usually 0.05) you

A

reject the null hypothesis and accept alternative

68
Q

Who determines the critical value? What is it generally?

A

The researcher
Generally 0.05
sometimes less

69
Q

Type 1 error is

A

falsely rejecting a correct null hypothesis

70
Q

What kind of error fails to reject a false null hypothesis?

A

Type 2 error/ beta/ acceptance error

71
Q

How can you decrease type 1 error?

A

lower the critical value

72
Q

How can you decrease type 2 error?

A

increase sample size

73
Q

Continuous data is not significant if _____ is in the confidence interval

A

0

74
Q

Ratio data is not significant if _____ is in the CI

A

1

75
Q

A CI of 95% (α = 0.05) means if we

A

repeat the trial 100 times, 95/100 times the actual value will lie within the range (CI)

76
Q

Does correlation determine cause?

A

NO

77
Q

What does correlation measure?

A

strength of the relationship between 2 variables

78
Q

What is Pearson’s Correlation Coefficient (R)?

A

linear regression for continuous data

79
Q

Range of correlation coefficient is

A

-1 to 1

80
Q

How to control for confounding variables

A

randomization is best, can also match subject for subject and stratifying groups
use multivariate analysis calculations

81
Q

What is the gold standard for recommendation

A

Oxford University grading scheme

82
Q

Grading for level of recommendation is based on

A

quality of evidence A-D

strength of recommendation I-IV

83
Q

Strongest design for evaluation of clinical question

A

systemic review

84
Q

strongest single design to prove causation

A

RCT (then observational)

85
Q

strongest support of causation

A

cohort study (then case-control)

86
Q

What is used to test for null hypothesis and two categorical variables

A

chi-squared

87
Q

What is used to predict outcome of 1 variable from another

A

simple linear regression

88
Q

What is multiple regression used for

A

determines relationship between 2+ explanatory variables and a response variable

89
Q

What is Tukey’s test

A

used in conjunction with ANOVA to determine if the means are significantly different from each other

90
Q

What is Bonferroni test

A

used when multiple dependent or independent statistical tests are being performed simultaneously

As the # of hypotheses increases, the chance of witnessing a rare event leading to a type I error increases

Establish a more strict α level to obtain significance

91
Q

What is a non-parametric analogue to ANOVA

A

Kruskall-Wallace

1 normal and 1 measureable variable

92
Q

positive likelihood ratio

A

indicated how good a test is at RULING IN disease

93
Q

negative likelihood ratio

A

indicates how good a test is at ruling OUT disease

94
Q

positive predictive value

A

proportion of positive test that are true positives

95
Q

negative predictive value

A

proportion of negative tests that are TRUE negatives

96
Q

pre-test probability

A

initial intuition about a disease based on your pt.’s presentation + risk

97
Q

post-test probability

A

estimated likelihood of a disease after a test result

98
Q

treatment threshold

A

probability above which the dx is so likely you would treat the pt. without further testing (high suspicion)

99
Q

parallel testing

A

many tests run at once
ANY positive test is diagnostic
increases sensitivity
ex: CKMB, troponin, ECG for MI

100
Q

serial testing

A

ALL tests must be positive for a dx
increases specificity
reduces risks of unnecessary interventions
clinical breast exam, mammogram, bx

101
Q

In general what makes up a good screening test?

A
  • High true negatives & true positives
  • Low false positives & false negatives

oMore important to prevent false negatives  person would be walking around with undiagnosed illness/disease
oFalse negatives can be r/o with further testing

102
Q

Define gold standard broadly

A

1) An accepted test that is assumed to be able to determine the true disease state of a patient regardless of positive or negative test findings or sensitivities or specificities of other diagnostic tests used.
2) An acknowledged measure of comparison of the superior effectiveness or value of a particular medication or other therapy as compared with that of other drugs or treatments

103
Q

Why is an adequate sample size important?

A

1) Decreases risk of type 2 error
2) Compliance & drop-out need to be recognized (adequate numbers)
3) Stratify/sub-grouping data (adequate numbers)

Fall EBM (1 decks)

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