Intro Chapter Flashcards
Improve knowledge of intro chapter, clinical decision making, nomogram, likelihood ratio, important people
Objectives of APTA Vision 20/20
Autonomous PT Practice Direct Access Doctoral Level Lifelong Education EBP Professionalism
_____/_____ people will have back pain but _____% will have serious pathology
6/10
1%
The Red Flags article which cites low back pain and serious pathology was written by
Greenhalgh and Selfe
Clinical Skills include the following combination of implicit and learned characteristics
Intellectual Aptitude Personality (eg. Humility, Curiosity, and Empathy) Knowledge Organization Communication Manual Skills Thinking Skills
The study of Expert Versus Novice Clinical Decision Making was done by:
Wainwright Et Al
Things that help Informative Factors and Directive Factors to come together for clinical decision making are:
Mentorship
Information from Literature
Clinical Experience
Critical Thinking
Experts are good ______
Thinkers
Characteristics of Evidence Based Practice Are:
Barriers
Conscientious, Explicit, and Judicious use of current best evidence
Evidence alone is never sufficient to make a clinical decision
The integration of best research evidence with clinical expertise and patient values.
Evidence Hierarchy
Characteristics of Evidence Informed Practice Are:
More Qualitative Emphasis
Evidence from Empirical Observation
The Hierarchy is not absolute
The Time Honored Craft of caring for the sick
Use of statistics in a way that is readily usable for clinical decision making
Barriers are a characteristic of evidence _____ practice
Based
________ stated “Conscientious, Explicit, and Judicious use of current best evidence
Sackett Et Al
“Conscientious, Explicit, and Judicious use of current best evidence” is a characteristic of evidence ______practice
Based
Evidence alone is never sufficient to make a clinical decision is a statement from ______
Guyatt G et al
Evidence alone is never sufficient to make a clinical decision is a characteristic of evidence ______ practice
Based
The integration of best research evidence with clinical expertise and patient values is a characteristic of evidence _____ practice
Based
Evidence Hierarchy is a characteristic of evidence ____ practice
Based
There is more qualitative emphasis in evidence _______ practice
Informed
Evidence from empirical observation and finding the relationship between events is a characteristic of evidence ____ practice
Informed
_____ stated “The Hierarchy is not absolute”
Guyatt G et al
“The Hierarchy is not absolute” is a characteristic of evidence _____ practice
Informed
“The Time Honored Craft of Caring for the Sick” is a quote from
Guyatt G et al
“The Time Honored Craft of Caring for the Sick” is a characteristic of evidence _____ practice
Informed
Use of statistics in a way that is readily usable for evidence informed decision making is a characteristic of evidence _____ practice
Informed
The emphasis of evidence based practice has been
Deduction
Clinical decisions based on prospective studies, designed to answer specific clinical questions or test specific clinical research hypotheses
Emphasis of evidence informed practice is becoming
Induction
Abdication
Deduction (as appropriate)
Clustering
A challenge to evidence based practice is that it denigrates clinical ____________
Experience
A challenge to evidence based practice is it ignores patient _______
Values and Preferences
A challenge to evidence based practice is it De-emphasizes ________
Basic Science Research
A challenge to evidence based practice is that many aspects of PT have __________
No Evidence
Evidence based practice is challenging because it requires new skills in ________ and ________ literature
Searching for and appraising
Challenges to the use of evidence is that it may not fit your ________ and it may ______ with other evidence
patient, conflict
Who stated and when did they state “A continuing challenge for evidence based medicine will be to better integrate the new science of clinical medicine with time-honored craft of caring for the sick
Guyatt G et al
What are the three parts of the three legged stool
Clinical Expertise, Research Evidence, Patient Characteristics
What part of the three legged stool describes “The ability to use skills and past experience to rapidly identify each patients unique health state and weight potential interventions”
Clinical Expertise
What part of the three legged stool describes “clinically relevant research into diagnostic tests, prognostic markers, interventions”
Research Evidence
What part of the three legged stool describes “unique patient preferences, concerns, and expectations of each patient which must be integrated into decision making”
Patient Characteristics
Who described the three legged stool
Sackett et al
What are the pathways of clinical decision making?
Algorithms/Arborization Exhaustion Hypothetical-Deductive Pattern Recognition Sense-Making and Small Wins
We often don’t search for the alternative that is optimal, just the first one that is
Acceptable
The type of bias which makes us systematically overconfident in our judgement is:
Clinically Delusional
Clinically Delusional Bias makes us :
Systematically overconfident in our judgements
The tendency to escalate commitment to a course of action that they have a lot of investment is:
Sunk-Cost Effect
Sunk Cost Effect Bias makes us:
Tend to escalate commitment to a course of action that we have a lot of investment in
Having too much emphasis on information and evidence that is most readily available to us when we are making a decision is ______ effect or _______ bias
Recency Effect or Availability Bias
Recency Effect or Availability Bias is
Putting too much emphasis on information and evidence most readily available to us when we are making a decision
Recency Effect (Availability Bias) would let us get fooled by recent _______
Hot Streaks
The most prevalent form of bias is
Confirmation Bias
A tendency to gather and rely on information that confirms our preexisting hypotheses is
Confirmation Bias
Confirmation Bias is:
A tendency to gather and rely on information that confirms our preexisting hypothesis
A type of bias that allows and initial reference point to distort our estimates is
Anchoring Bias
Anchoring Bias Allows for an _______ to distort our estimates
Initial Reference Point
Jumping to a conclusion about a relationship between two variables when no relationship exists is an
Illusory Correlation
An illusory Correlation is one in which
We jump to conclusions about the relationship between two variables when no relationship exists
Hindsight Bias is when we look back at past events and
Judge them as easily predictable when they were clearly not easily foreseen
A type of bias in which we judge past events as easily predictable when they were clearly not easily foreseen is ______
Hindsight Bias
Its important when combating biases to
Review past work after an action review
Not repeating mistakes
Having an effective group dynamic
The progression of the diagnostic process down one of a large number of potential, preset paths by a method in which the response to each diagnostic inquiry automatically determines the next inquiry to be carried out is ____________
arborization
The canadian C spine rules are an example of which type of clinical decision making pathway?
Arborization
The clinical decision making pathways were first described by who?
Sackett DL et al
The clinical decision making pathway that is characterized by a step by step protocol of pathways is _________
algorithm
The components of the ICF model are
Condition, Body Structures/Functions (Impairments) Activities Participation Restrictions Environmental Considerations
The ICF model was originally described by who in the PT literature
Atkinson and Nixon Cave
The clinical decision making pathway in which a search for all medical facts is conducted followed by sifting through the data for a diagnosis is
Exhaustion
The clinical decision making pathway in which early clues about a patient come up with a list of diagnoses and then maneuvers are performed to reduce that list of diagnoses are
Hypothetico-Deductive Reasoning
The Hypothetical Deductive Model was first named by who?
William Whewell
Scientific inquiry proceeds by formulating a hypothesis in a form that could be _________ by a test on observable data
Falsified
A test that could and does run contrary to the predictions of the hypothesis is taken as a _________ of the hypothesis
Falsification
A test that could but does not run contrary to predictions of the hypothesis ________ the hypothesis
Corroborates
Qualification of corroborating evidence is sometimes raised as __________ (The Raven Conflict)
philosophically problematic
The instantaneous realization that the patient’s presentation conforms to a previously learned picture (or pattern) of disease is the clinical decision making pathway known as
Pattern Recognition
Pattern recognition is also known as ________
Thin Slicing
Who came up with the term thin slicing?
John Gottman PHD
How do our minds make sense of a lot of new information in a very short time (Fast and frugal work in our adaptive unconscious)
Pattern Recognition/Thin Slicing
How is Pattern Recognition learned?
Experience
What other clinical decision making pathway is pattern recognition paired well with
Hypothetico-Deductive
What are other terms for Occam’s Razor
Law of Parsiomony, Economy, or Succinctness
What is the principle that recommends that, from among competing hypothesis, selecting the one that makes the fewest new assumptions usually provides the correct one
Occam’s Razor
What is the principle that the simplest explanation will be the most plausible until evidence is presented to prove it false?
Occam’s Razor
Novices don’t have the necessary experience to engage in the clinical decision making pathway of _________
Pattern Recognition
What situations obscures our pattern recognition ability?
Highly complex or ambiguous situations
When using pattern recognition you must be careful not to focus on the similarities between two analogous situations and downplay the __________
differences
What clinical decision making pathway focuses on finding cause and effect relationships and reflecting and learning from those experiences?
Sense Making
What clinical decision making pathway focuses on step by step processes for difficult, complexs, overwhelming problems?
Small Wins
What clinical decision making pathway focuses on breaking large, complex problems into smaller parts and then improving on those smaller parts
Small Wins
The determination of the predicted optimal level of improvement in function and amount of time needed to reach that level, also including a prediction of levels of improvement that may be reached at various intervals during the course of therapy is
Prognosis
What is the process of knowing how to estimate our patient’s likely clinical course over time and anticipate likely complications of the disorder
Prognosis
Prognosis should progress through these factors:
Qualitative Factors (Options for Outcome), Quantitative Factors (Probability of having that Outcome), Temporal Factors (Time for the outcome)
“clinical decisions based primarily on the advice of an expert” is an example of _________
Abdication
Who stated “If I have seen further than others, it is by standing upon the shoulders of giants”, in a letter to whom, and what is it in relationships to
Sir Issac Newton to Robert Hooker on Abdication.
What is the tool that allows you to take pre-test probability and use data to find a post-test reliability
Likelihood Ratio
This tells us how much the odds of having a disorder change with either a positive or negative test
Likelihood ratio
What is a moderate and great shift in probability with a positive likelihood ratio
Moderate - 5-10
Great Shift - >10
What is the formula for a Positive Likelihood ratio
Sensitivity/(1-Specificity)
What is a moderate and great shift in probability with a negative likelihood ratio
0.25-.1 Moderate
<0.1 - Great Shift
What is the formula for a Negative Likelihood ratio
(1-Sensitivity)/Specificity
The visual representation of the change in pre and post-test odds for a disorder is a _________
Nomogram
Nomograms are based on ________ Theorem
Bayes
Pre-Test odds for a likelihood ratio may be based on
Prevalence studies or a scientific estimate
The article for using a Nomogram to test Bayes Theorem was written by _____
Fagan TJ in N Engl J Med
The Masters do the Basics Well is an “________” by _________
Axiom for a friend - Jeff Ellis (1960-2001)
Talent is not a thing, it is a process is an “________” by _________
Axiom for a friend - Jeff Ellis (1960-2001)
Good habits are built by practice, practice, practice (Precise Practice) is an “________” by _________
Axiom for a friend - Jeff Ellis (1960-2001)
Steal from the best and get rid of the rest is a quote by __________ but it is in the section __________ by ___________
David Lamb, Axiom for a friend - Jeff Ellis (1960-2001)
Don’t Stop your Curiosity, Don’t Stop Yourself from Learning is a quote by
Jim Beazell (1960 - 2010)
When formulating a prognosis, qualitative factors are also known as
Options for outcome
When formulating a prognosis, quantitative factors are also known as
Probability for having that outcome
When formulating a prognosis, Temporal factors are also known as
Time for an outcome
