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IPE - Winter OD2 > Midterm 1 > Flashcards

Midterm 1 Flashcards

1
Q

Evidence Based Practice (EBP) is the integration of?

A

research, clinical expertise, and patient preferences to individualize care

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2
Q

What is the purpose of EBP?

A
  1. improve quality, effectiveness and appropriateness of clinical practice
  2. reduce variation in practice patterns
  3. substantiate the care to patients
  4. share decision making with the patients
  5. provide life long, self directed learning that is crucial for improved quality of care
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3
Q

What are the traditional methods of decision making?

A

personal experience, traditional practices, professional judgment, convention, habit, personal insight and deduction

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4
Q

Why should you chose to use EBP?

A

because you can’t make well informed decisions without good information and misinformation can be worse than no information

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5
Q

What is the fundamental difference between EBP and research?

A

PURPOSE
Research is just new knowledge or validating existing knowledge based on theory and EBP stems from research but also includes clinical expertise and patient values.

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6
Q

What are the 5 steps for the EBP process?

A
  1. Ask (identify a clinical problem)
  2. Attain/Acquire (find new and relevant literature)
  3. Appraise (critically review information for validity, impact and applicability)
  4. Apply (integrate appraised information with patient biology, values, and circumstances)
  5. Assess (evaluate outcomes)
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7
Q

What is the difference between a background and a foreground question?

A

Background: GENERAL questions (Who,What,When,Where,Why,How)

Foreground: SPECIFIC questions (more complex)
(PICO framework)

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8
Q

PICO is used to find the needle in the haystack of research information. What does PICO stand for?

A

Patient population
Intervention of interest
Comparison of intervention or status
Outcome
(Time - optional)

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9
Q

What should you think about when talking about patient population?

A

demographics, socioeconomic status, specific subgroups

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10
Q

What should you think about when talking about intervention?

A

treatment, patient perception, diagnostic test, exposure, diagnosis

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11
Q

Pick out the PICO categories from this example question: In patients with osteoarthritis of the knee, is hydrotherapy more effective than traditional physiotherapy in relieving pain?

A

P: patients with osteoarthritis of knee
I: hydrotherapy
C: traditional physiotherapy
O: relieving pain

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12
Q

What part of the 5 steps of EBP does PICO fall under?

A

Ask

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13
Q

What are the different types of ASK questions?

A

Therapy (Treatment)
Prevention
Diagnosis
Prognosis (Forecast)
Etiology (Causation)
Quality of Life

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14
Q

What type of ASK question is this: In school age children, how does being born premature compared to being born at term influence learning disabilities?

A

Prognosis (Forecast)

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15
Q

Evidence can be acquired from various sources such as:

A

Scientific levels of Evidence (Peer reviewed)

Professional Evidence (CE meetings, scientific meetings, trade shows, sales reps, ect.)

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16
Q

Rank the quality of evidence based off the pyramid.

A

(Highest)
Meta-Analysis
Systematic reviews
Critically appraised literature
EBP Guidelines
Randomized controlled trials
Non-Randomized controlled trials
Cohort Studies
Case Series or Studies
Individual Case Reports
Background info, expert opinions, non EBM guidelines
(Lowest)

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17
Q

What categories of the evidence pyramid fall under: Critical Appraisal?

A

Meta-analysis
Systemic Reviews
Critically appraised literature + EBP guidlines

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18
Q

What categories of the evidence pyramid fall under: Observational studies?

A

cohort STUDIES
case series or STUDIES
individual case REPORTS

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19
Q

What categories of the evidence pyramid fall under: Experimental Studies?

A

randomized controlled TRIALS
non-randomized controlled TRIALS

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20
Q

What are the 2 places you can find meta analysis?

A

Pubmed + Cochrane library

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21
Q

Which types of evidence are filtered resources?

A

meta analysis + systematic reviews

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22
Q

Define meta analysis and systematic reviews

A

summaries and analyses of existing research

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23
Q

Define critically appraised literature

A

literature on particular topic has been evaluated according to evidence based criteria

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24
Q

Define EBP guidlines

A

systematically developed statements based on best available evidence to assist practitioner and pt decisions about appropriate health care for specific clinical circumstance

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25
Q

What are considered Unfiltered resources?

A

controlled trials, cohort studies, case reports

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26
Q

What are the 3 characteristics of appraise?

A

Validity
Bias
Applicability

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27
Q

What questions should we ask before APPLYING to EBP?

A

-Are the participants similar enough to my patient?
-What alternatives are available?
-Is the treatment available and is health care system prepared to fund it?

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28
Q

What are the categories of APPLY?

A

Recognize
Discuss
Integrate

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29
Q

What are the categories of ASSESS?

A

Practitioner level?
Patient level?
Organizational level?

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30
Q

What are the downfalls to EBP?

A

Time consuming
Publication bias
Requires medical literature
Requires knowledge of stats
Conflicts of interest

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31
Q

What are the 2 modes of EBP?

A

Doing mode: steps 1-5 done and applied to more common conditions we see everyday

Using mode: skip step 3 (appraise) and applied to less common conditions

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32
Q

Define constant

A

something that does NOT vary

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33
Q

Define variable

A

something that varies

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34
Q

Define independent variable

A

(CAUSE) the theorized cause for the event you are trying to predict, categorize or influence

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35
Q

Define dependent variable

A

(EFFECT) the event or phenomenon you are attempting to predict, categorize or influence

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36
Q

What is publication bias?

A

selective publication of studies that are unrelated to the scientific merit of study

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37
Q

What are the results of the Lancet study on publication bias?

A
  • only half of the studies were analyzed
  • half of those analyzed studies were published
  • 1/3 of studies got published
  • the biggest predictor for being published was statistical significance
    (lots that we don’t know that was never published due to publication bias)
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38
Q

Where can you find AMA citation templates?

A

AMA style guide

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39
Q

(T/F) Web pages must be added manually in Endnote

A

True

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40
Q

Where can you find instructions/product key to download EndNote?

A

emailing the library

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41
Q

What is another name for the AMA citation style?

A

JAMA

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42
Q

What are some ways to filter articles in Pubmed?

A
  • filtering column on left
  • Advanced search box
  • mesh terms
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43
Q

What are boolean operators?

A

AND
OR
NOT

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44
Q

How do we use parenthesis in Pubmed?

A

used to ORGANIZE the search rather than use exact phrase that you type in

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45
Q

How do we use asterisk in Pubmed?

A

it uses TRUNCATION to bring up results with different endings
(ex: child* would bring up children, childs, childrens, ect…)

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46
Q

How do we use quotation marks in Pubmed?

A

it helps us find an exact phrase

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47
Q

What turns off mesh mapping?

A

quotation marks

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48
Q

The mesh terms pull up in order from (more/less) specific to (more/less specific)

A

more, less (broad)

49
Q

What are the 3 requirements of causation?

A
  1. temporal precedence of independent variable
  2. independent variable COVARIES with dependent variable
  3. all CONFOUNDS ELIMINATED (no other possible explanation for the dependent variable
50
Q

Define a confound

A

a variable more likely to be present in one group of subjects than another that is related to the outcome of interest and thus potentially confuses, or “confounds,” the results
(It is a variable that coincides with the independent and dependent variable but uses it to be ambiguous that the independent variable caused the dependent variable)

51
Q

How do you eliminate cofounds?

A

the only difference between the treatment and comparison groups is the intended difference in your independent variable
- randomization (sampling)
- good study design
- goal: balanced study design

52
Q

Define baseline

A

characteristics of your sample before any treatment has begun
(if groups are comparable at baseline, factors are not confounds)

53
Q

What do baseline characteristics usually include?

A

age, sex, ethinicity

54
Q

If you measure a confound and find that groups are imbalanced what is the mathematical correction to get rid of the confound?

A

measure the confound at baseline = covariate

55
Q

Explain reliability as a concept

A

the degree to which something is reproducible and consistent
- you can relate this to cohen’s kappa and cronbach’s alpha (if something is reliable it also has to have reproducibility)

56
Q

What is Cohen’s Kappa?

A

inter-rater reliability of categorical outcomes; the DEGREE to which something is RELIABLE
(you can categorize the outcomes….ie flu or no flu, pregnant or not pregnant…)
Range: 0.00 - 1.00
Reliable: >=0.70

57
Q

What would be a more reliable outcome for a Cohen’s Kappa: 0.03 or 0.89?

A

0.89 because its closer to 1.00 which means it would be more reliable

58
Q

What does it mean to have a 0.00 Cohen’s Kappa?

A

no better than random guessing…can flip a coin to get your results

59
Q

What is Cronbach’s Alpha?

A

inter-reliability of continuous items…continuous scale is used (rather than categories)
(you can have a range of numbers)
Range: 0.00 - 1.00
Reliable: >= 0.70

60
Q

Explain validity?

A

validity refers to appropriateness; face validity
- “Does this make sense”

61
Q

What is face validity?

A

is your method appropriate or relevant for what you’re trying to investigate?

62
Q

What is internal validity?

A

are you sure your independent variable caused these effects for these test subjects?
- related to people in study
-CAUSATION

63
Q

What is external validity?

A

How sure are you that the result can be replicated/applied to the general population? (outside of controlled settings of the research)

64
Q

What is the difference between validity and reliability?

A

validity can not be quantified and reliability CAN!
(no numerical measure in validity)

65
Q

How do you measure validity? What are the 3 factors?

A

judgement
logic
ability to write clear arguments

66
Q

What are systematic errors?

A

Variations that distort data systematically in one direction and can introduce bias (ex: measuring and weighing patients while wearing shoes)

67
Q

What is random error?

A

Variations that are random and can make readings too high or too low and do not introduce bias

68
Q

What is a normal distribution also know as?

A

Gaussian distribution

69
Q

What are the axes of the Gaussian distribution?

A

y = frequency with which the corresponding values
x = values expected to be found

70
Q

What are some properties of the mean that allow it to enable the development of advanced statistics?

A
  1. unbiased estimator of the mean of population from which it came
  2. it is the mathematical expectation
  3. sum of squared deviations of the observations from the mean is SMALLER than sum of square deviations from any other number
  4. sum of squared deviations from mean is FIXED for a given set of observations
71
Q

Define probability

A

the number of times an outcome occurs divided by the total number of trials (p)
- it can be expressed as a percent or a proportion (0.53 = 53%)
EX: what is the probability of rolling an even number on a dice? 3 possible even numbers divided by 6 possible outcomes = 0.5 = 50%

72
Q

p=1 is reserved for what types of values?

A

Assured values

73
Q

p=0 is reserved for what types of values?

A

impossible events

74
Q

Define p-value

A

probability that the outcome you observed occurred by random chance

75
Q

What is statistical significance alpha level?

A

largest p-value for which you are willing to risk that these results happened by random chance
(AKA statistical significance alpha, alpha level, statistical alpha)

76
Q

What is a statistically significant p value?

A

p < 0.05

77
Q

What type of statistical alpha level would you want for higher risk research (such as COVID)?

A

something like a p<0.01 because you don’t want the results to be likely due to random chance

78
Q

Describe the central limit theorem

A

as you obtain more and more observation, the distribution of your observations takes on a normal distribution shape

79
Q

If data does not tell you the shape of the distribution, then what can you assume?

A

there is normal distribution

80
Q

What are the features of a normal distribution?

A
  1. central tendency
  2. distribution of observations (std deviation)
  3. area under the curve
81
Q

What is central tendency?

A

a single number that describes a typical example of an observation from the sample

  • usually that number is the mean, median or mode
82
Q

What is the standard deviation?

A

a number that tells you the shape of the normal distribution graph (how wide or how skinny)
- spread and diversity of the data

83
Q

A larger SD means….

A

more diverse data, more widely spread around the mean

84
Q

A smaller SD means….

A

less diverse data, more closely clustered around the mean

85
Q

What are standardized scores?

A

transformed scores, or Z-scores
(the average score is always 0 and SD is always 1)

86
Q

In a normal distribution graph, how much of the data is under the curve with a lower bound of -1SD and upper bound of +1SD?

A

2/3 = 68%

87
Q

In a normal distribution graph, how much of the data is under the curve with a lower bound of -2SD and upper bound of +2SD?

A

95%

88
Q

How much data is in the extremes of a normal distribution graph (at least 1.65SD away from the mean)?

A

5%
2.5% less than 2SD of the mean and 2.5% more than 2SD of the mean

89
Q

What is a hypothesis?

A

proposed, unverified, relationship between 2 variables
(if … then statements)

90
Q

What is a null hypothesis?

A

there is no relationship between the independent variable and dependent variable (the proposed relationship is not true)

91
Q

What is the alternate hypothesis?

A

the proposed relationship between the variables is correct
(this is the same as just the normal hypothesis)

92
Q

When you are testing the hypothesis your starting point should always be that the the alternate hypothesis is true. (T/F)

A

False, your NULL HYPOTHESIS ASSUMED TO BE TRUE

93
Q

What does it mean when you fail to reject the null hypothesis?

A

there is no statistical significance in your alternate hypothesis (in other words your alternate hypothesis failed and the results proved this because you got the exact same scores for the placebo group)

94
Q

What does it mean when you reject the null hypothesis?

A

the statistical significance is achieved and the experimental group scores are different enough from the placebo group (you were able to prove your hypothesis was correct with evidence)

95
Q

What is statistical significance in relation to the null hypothesis?

A

we are willing to accept a 5% (p<0.05) risk that the null hypothesis is CORRECT and that your results were due to random chance

96
Q

What is a two tailed test?

A

results statistically significant if the experimental group performs WORSE or BETTER than the placebo group and makes it into the zone of statistical alpha on one of the two tails

97
Q

What is a one tailed test?

A

your results are statistically significant if the experimental group makes it into the zone of statistical alpha in the APPROPRIATE DIRECTION

98
Q

What is an example where we would likely use a one tailed test?

A

“non-inferiority trial”: demonstrate that an alternative treatment is either the same or not significantly worse than the standard treatment so that if the alternative treatment is better you have a viable alternative, if its comparable to the standard then it is a viable alternative, but if the alternative is worse than standard then it is not a viable new alternative

99
Q

If you have a 2 tailed test and an alpha of p<0.05 but your obtained result is p<0.04 then is this statistically significant?

A

NO; because the threshold for statistical significance of a 2 tailed test is p<(alpha/2) so it would be p<0.025 and p<0.04 is not within the 0.025

100
Q

What is the purpose of a linear regression?

A

to utilize the e

101
Q

What is the purpose of a linear regression?

A

to utilize the equation of a line to use one independent variable to predict ONE dependent variable that is measured on a continuous scale

102
Q

What is the predictor?

A

the independent variable
(can be continuous or categorical)

103
Q

In y = a +bx what does the a stand for?

A

the y-intercept = CONSTANT

104
Q

In y = a +bx what does the b stand for?

A

slope of the line = REGRESSION COEFFICIENT
(AKA unstandardized beta, beta weight, beta)

105
Q

In y = a +bx what does the x stand for?

A

the PREDICTOR = independent variable

106
Q

In y = a +bx what does the y stand for?

A

(POINT) ESTIMATE (AKA dependent variable)

107
Q

Where are predictors plotted on a graph?

A

x axis

108
Q

What is standard error of estimate?

A

tells us how closely the data points cluster around the line of best fit

109
Q

A smaller standard error of estimate refers to…

A

data more tightly clustered around line of best fit (and estimates are more precise)

110
Q

A larger standard error of estimate refers to…

A

data more less clustered around line of best fit (and estimates are less precise)

111
Q

The more observations what happens to the standard error of estimate?

A

data will be more clustered and a smaller standard error estimate

112
Q

How does the standard error behave?

A

similar to the central limit theorem: 95% of observed results are located in the area bounded by 2 standard errors above and below the estimate

113
Q

How is the 95% confidence interval calculated?

A

point estimate (y-intercept) +/- 2 SE

114
Q

What is the definition of 95% confidence interval?

A

range of values for which there is a 95% probability that the true population value is somewhere in that range

115
Q

What is r^2?

A

Pearson’s coefficient of determination; a measure of how much the variance is accounted for by the line of best fit
“explaining the variance” or “accounting for the variance”
Range: 0.00 - 1.00
closer to 1.0 = closer fit to best fit line

116
Q

What are the effect sizes of r^2?

A

0.01 = small
0.10 = medium
0.25 = large

117
Q

Define univariate linear regression

A

predicts one dependent variable with one predictor

118
Q

Define multiple linear regression

A

predicts one continuous outcome variable with TWO OR MORE predictors

  • dependent variable must be continuous
  • predictors can be continuous or categorical
119
Q

In a study, if the table they offer is a multiple linear regression and the parenthesis include (Ref = …) what coefficient would you label the coinciding x value?

A

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IPE - Winter OD2 (2 decks)

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