Layers Of Knowledge & Study Design (Modules 2,3,4) Flashcards
Foundational knowledge
Textbooks, lecture material, training guidelines
Revisiting knowledge
Continuing education, checking old texts
Keeping current
Regularly scan table of contents of a few relevant journals
Specific interest
Specialization, practice focus, sport, injury
Original source
Work done by authors
Summary sources
Aggregation of many sources/articles:
1 systematic reviews
2 meta-analysis
3 guidelines + Evidence-based textbooks
4 narrative review
Systematic reviews
Specific treatment questions
All available articles/studies
Critical appraisal of included articles
Meta-analysis
Specific treatment question
Critical appraisal of included articles
provides combined stats
Guidelines + Evidence based textbooks
Answers broad scope of questions
All available articles/studies
Critical appraisal
Narrative review
Answer range of questions on treatment, condition, or both
not all articles/studies
no critical appraisal
Simple summary of findings
Importance of original article
Much is lost in translation(think of game telephone)
How useful is a source?
Quality- is it well done?
Relevance - will it matter to my patients?
Effort - time it takes to read/interpret
The 6 A’s
1 Analyze
2 Ask
3 Acquire
4 Appraise
5 Apply
6 Assess
The 6 A’s: #1
Analyze - look at practice/procedure, etc.
The 6 A’s: #2
Ask - formulate question (PICO)
The 6 A’s: #3
Acquire - find studies
The 6 A’s: #4
Appraise - evaluate studies: quality, relevance, effort
The 6 A’s: #5
Apply - put into practice
The 6 A’s: #6
Asses - how did it work?
Doctor as an authority?
Everyday there are over 12.5 million searches conducted online regarding healthcare
How much health info is available?
~30% of medical info is available
How good is google at healthcare?
7% of medical info
Just a PubMed search?
No one database has it all
How much research do I have access to VS. how much do I use?
(See Image)
Total research done on mother earth > published evidence > indexed evidence > evidence I can find > evidence I can access > evidence that I choose to use
Boolean
Combining concepts:
- AND narrows
- OR broadens
- NOT narrows
- “around + near” broaden
Searchable questions
PICOS:
Patient description
Intervention used
Comparison group
Outcome
Study design
Translation literature (summary source)
How do I use this in my office?
What’s the latest:
Original work (new journal articles)
Abstracts (conferences)
Ongoing studies (clinicaltrials.gov)
Proposed research (NIH funding)
Descriptive VS Analytic
What’s happening? VS. How exactly does this happen?
All studies (13) SEE HIERARCHY CHART
SEE HIERARCHY CHART
Survey, Qualitative, Experimental, Observational, Randomized parallel, Randomized crossover, Cohort, Cross-sectional, Case study, Case-control, Basic science, Descriptive, Analytic
Studies: Survey
Questionnaires
Studies: Qualitative
General description
Studies: Experimental
Intervention
Studies: Observational
Risk, exposures, effects (real world)
Studies: Randomized parallel
2 groups - intervention VS control
Studies: Randomized crossover
2 groups - intervention AND control
Studies: Cohort
Identify exposure, follow prospectively
Studies: Cross-sectional
All people at doctor’s office that walk through door
Studies: Case study
Interesting case + treatment
Studies: Case-control
Find population w/ condition then look back to find factors
Studies: Basic science
General biologic principles
Studies: Descriptive
Any study that isn’t experimental
Studies: Analytic
Hypothesis testing difference btwn 2 groups
Observational study types
Case report
Case-control
Cross-sectional
Cohort
Case series
RCT
2 groups assigned randomly - intervention VS control
Can establish cause + effect, & minimize bias
ALWAYS prospective
When won’t an RCT work?
Small disease prevalence
Can’t blind treatment
Treatment may cause harm
No access to many subjects
Too costly
Single blinding
Clinician or patient
Double blinding
Any 2 of the 3 (clinician, patient, assessor)
Triple blinding
Clinician, patient, AND assessor
