Midterm Flashcards
Evidence-based medicine
The integration of the best research evidence with clinical expertise and patient values
Two main categories of research
Basic research
Applied research
4 sources of evidence-based medicine
- Clinical expertise
- Research evidence
- Information from the practice context
- Clients values and circumstances
How to determine the strength of evidence:
First, classify the type of information as primary or secondary. Then, identify the level of evidence.
Primary sources
Publications that are written but the author; first-person reports and are often referred to as original sources.
Purpose of primary source:
To present new findings or discoveries about a topic, and to build or add new information to previous findings.
Examples of primary sources:
- Randomized control trial (RCTs)
- Controlled clinical trial (CCT)
- Experiments
- Surveys
- Case-control or a cohort study
- Case study
- Case reports or case series
Secondary sources:
Seek to describe, review, or summarize the available information on a topic by gathering data from several primary resources
Examples of secondary sources:
- Narrative reviews
- Systematic literature reviews
Level I evidence:
Evidence provided by one or more well-designed, randomized, controlled clinical trial, including overviews (meta-analyses) of such trials
Level II evidence:
Evidence provided by well-designed observational studies with concurrent controls (e.g., case control or cohort studies)
Level III evidence:
Evidence provided by expert opinions, case series, case reports and studies with historical controls
The purpose of EBP:
Assist in clinical decision making
Why is EBP important?
- Aim of improving client outcomes
- Promotes an attitude of inquiry
- Encourages professional accountability
When practicing EBP as a practitioner, you should aim for these 4 things:
- Awareness
- Consultation
- Judgment
- Creativity
Five specific steps that you should follow when applying evidence-based practice:
Step 1: answerable question Step 2: find evidence Step 3: appraise evidence Step 4: integrate appraisal and evidence Step 5: evaluate steps effectiveness and efficiency
Interprofessional education competencies:
Competency 1: values and ethics for interprofessional practice
Competency 2: roles and responsibilities for collaborative practice
Competency 3: interprofessional communication practices
Competency 4: interprofessional teamwork and team-based practice
Aims for interprofessional collaboration:
- Improving population health
- Improving patient experience
- Reducing costs of healthcare
- Reducing burnout for health care providers
Benefits of interprofessional education:
-Provides opportunities to learn and practice skills that improve communication and collaboration
-Build professional identity and pride by articulating one’s scope of practice
-Dispel stereotypes about other disciplines or team members through understanding each other’s’ roles and responsibilities
-Establish rapport and trust among team members that leads to valuing interdisciplinary collaboration
Positive changes in teamwork
IPP means…
Interprofessional practice
Professionals practicing IPP participate in non-hierarchical interdisciplinary team approach
IPP is seen as a means of:
Improving the client/patient/student experience of care.
In IPP teams:
The emphasis od on consensus-building and mutual respect
Parts of a PICO question:
P: population/patient/problem Who are the patients? What are the problems? I: intervention/exposure What do we do to them? What are they exposed to? (can include diagnostic or screening procedures) C: comparison/contrast What do we compare the intervention with? O: outcome What happens? What is the outcome?
PICO Example Question #1: In toddlers with expressive vocabulary delays, does focused stimulation lead to significantly greater vocabulary gains than no treatment?
P: in toddlers with expressive vocabulary
I: does focused stimulation
C: no treatment
O: lead to significantly greater vocabulary gains
Question #2: In adults who sustained a severe traumatic brain injury at least 1 year previously, does a program of cognitive strategy instruction lead to significantly better job performance ratings than no intervention?
P: in adults who sustained a severe TBI at least 1 year previously
I: does a program of cognitive strategy instruction
C: no intervention
O: lead to significantly better job performance ratings
Steps in selecting articles to read:
- Select the right article: determine the type of article(s) that will best help you get the information needed
- Perform an analysis: perform a quick analysis to determine if the article contains relevant information
True or false: Evidence from systematic research is the only acceptable basis for clinical decision making
False
True or false: the EBP framework recognizes that the experiences, values and preferences of ourselves and our clients can and should contribute to our clinical decisions
True
True or false: the amount of information available for review is overwhelming, so you should focus on “high-yield” sources in your area
True
True or false: only people who have completed years of specialized study can do a critical appraisal of research studies
False
Steps to searching the literature:
Find and gather a manageable amount of relevant literature using a wide range of contemporary tools and resources
Steps to reviewing the literature:
Analyze information for effectiveness and efficacy of interventions. It requires that you review the clinical application of the ideas to ensure evidence-based practice.
The goal of reviewing the literature:
Find out what is known about the topic based on these four things:
- Theory
- Facts
- Opinions
- Methods
Example of reviewing literature:
- Identify the quality and relevance of the information
- Evaluating the type and source of information for the most current information
- Comparing the outcomes of more than one treatment
- Understanding research design and statistical analysis
Example of searching literature:
- Using a google scholar to locate journal articles on a topic
- Developing a research question and key words
- Locating relevant literature on an electronic database such as pubmed
- Determining parameters to limit the type and amount of information found
Basic components of a scientific article:
- Title: a succinct description of the study topic
- Abstract: a concise summary of the study
- Introduction: a statement of purpose and rationale for the study with relevant background information including a concise literature review of the topic. The hypothesis and/or resear ch questions are stated at the end of this section
- Methods: a detailed outline of the procedures and evaluation instruments used as well as the variables measured.
- Results: a succinct and organized statement of the data and analysis, which includes pertinent figures, tables and graphs.
- Discussion: a discussion that includes an analysis and interpretation of the results and the implications and limitations of the study
- References: a list of sources of information cited or used in the study
Steps to analyzing a research article:
Step 1: identify the conclusions
What are the key conclusions of the study?
Do they help answer my research question?
Step 2: determine the purpose and rationale
What is the research problem?
What is the research question or hypothesis?
Step 3: understand methods and materials
What procedures were followed?
How were participants selected?
What variables are being measured?
Step 4: understand results and data analysis
Do the results make sense?
What are the important outcomes?
Are the results valid and reliable?
Step 5: interpret outcomes and draw conclusions
Are the outcomes reasonable and logical?
Are the results useful in clinical practice?
What are the strengths and limitations of this study
Academic integrity
The commitment to demonstrate honest and moral behavior in the academic setting; includes expectations that you must follow in your writing, but can also be thought of as a mindset.
4 principles of ethical research
- Principle of Beneficence
- Principle of Nonmaleficence
- Principle of Utility
- Principle of Autonomy
Principle of beneficence:
Beneficence is the moral obligation to act in a way that will benefit or help others
- Beneficence in clinical practice: it is providing interventions that will help patients. This goes a step beyond not doing harm to a patient. It ensures that you are actively attempting to help them.
- Beneficence in research: it means that you are doing things that promote participants’ welfare and safety. It also includes protecting participants from exploitation and keeping the participants’ interests as a priority. You minimize risks to participants while maximizing benefits.
Principle of Nonmaleficence:
Nonmaleficence is the moral obligation to protect from harm, specifically physical or mental danger. This principle also indicates that you should not expose people to unnecessary risk.
- Nonmaleficence in clinical practice: this means not intentionally harming a patient or client, but it also entails not causing unintentional harm through carelessness. Although therapy might, at times, require that you expose people to some risk so that they can progress towards their goals, you must be particularly cautious and use your clinical judgement to minimize the risks.
- Nonmaleficence in research: this focuses on ensuring that what is being done is not harming the participants or putting them at unnecessary risk. This means you are also making sure that harm is not done by omitting care or treatment.
Principle of Utility:
Utility is the moral principle that actions and behaviors are right if they promote happiness and pleasure. Utility also means that actions are wrong if they promote unhappiness or pain. Another way to think of this is to consider the usefulness of the action or behavior to achieve happiness. This principle is often thought of in terms of what action brings about the greatest good for the greatest number of people.
- Utility in clinical practice: Think of this principle from the utilitarian point of view. Think of what gives the most benefit while causing the least harm. In clinical practice you can look at this principle by considering how you prioritize what interventions you might use. Think about what’s most cost effective for your patients that gives the most benefit. Think about who needs immediate treatment vs. who will be harmed least by delaying services?
- Utility in research: In research consider utility when prioritizing a research agenda or when making decisions on allocation of funds. Look at utility as a type of cost-benefit analysis. What actions will give society the most benefit with the least risk? When considering utility, you need to also look at what are the most pressing problems for the largest number of people.
Principle of autonomy:
The moral obligation to respect that a person can make their own decisions about what they can and agree to do. We must respect the decisions people make regarding their own lives. This is often referred to as ‘human dignity’.
- Autonomy in clinical practice: This means respecting and acknowledging patients’ decisions regarding therapy, even if their wishes or decisions oppose our own. Autonomy DOES allow for educating your client or patient, but it DOES NOT allow you to make decisions for them. When you violate the principle of autonomy in the best interest of the other person, even though it is not what they want, this is known as paternalism.
- Autonomy in research: often addressed as informed consent. The participant has a right to know and to be given adequate information so that they can make an informed and calculated decision about the benefits and the risks of participation. The participants must freely agree to take part in research. There are four essential components to autonomy in research.
Informed consent must include:
- Disclosure
- Comprehension
- Voluntariness
- Competence
