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EBM > Midterm > Flashcards

Midterm Flashcards

1
Q

The conscientious, explicit, and judicious use of current based evidence in making decisions about the care of individual patients

A

EBM

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2
Q

integrating individual clinical expertise with the best available external clinical evidence from systematic research

A

EBM practice

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3
Q

EBM is the integration of what?

A

best research evidence, clinical expertise, and patient values (concerns)

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4
Q

what are the 5 steps to applying the medical literature to patient care? (evidence cycle of EBM)

A
  1. ask
  2. acquire
  3. appraise
  4. apply
  5. act
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5
Q

what are the 2 different types of study design?

A
  1. observational

2. analytical or experimental

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6
Q

what does an observational study design entail?

A

does not involve any intervention or experiment; seeks to measure the frequency in which disease occur or collect descriptive data on possible casual factors

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7
Q

what are 5 types of observational study designs?

A

Ecologic, cross-sectional, case report/case series, case control, cohort

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8
Q

what does an analytical or experimental study design entail?

A

manipulation of the study factor (exposure) and randomization of subjects to treat or control groups; attempts to specify in more details the causes of a particular disease or the effect of an intervention

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9
Q

what are 2 types of analytical/experimental study desgins?

A

Non-randomized control tried, RCT (double blind, placebo controlled)

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10
Q

describe the hierarchy of evidence

A 
Bottom to top:
Studies (original journal articles)
Syntheses (systematic reviews)
Synopses (evidence based jouranl abstracts)
Summaries (evidence based textbooks)
Systems (computerized decision support)
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11
Q

describe the hierarch of study design

A 
Bottom to top:
Editorials/expert opinions
Case series/Case reports
Case control Studies
Cohort studies
RCTs
Systematic reviews
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12
Q

What Study type?

Mathematically pools data from individual studies (does not have be as ‘all-inclusive’)

A

Meta analysis

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13
Q

What Study type?

Starts with patients with an exposure (self-selected) and follows them forward to an outcome
*Prospective

A

Cohort

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14
Q

What Study type?

Experimental design that introduces an intervention to modify the course of a disease

A

RCT

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15
Q

What Study type?

Starts with an outcome or disease and looks backwards to identify a possible exposure
*retrospective

A

Case control

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16
Q

What Study type?

Call attention to an unusual association, adverse event, or a unique case

A

Case series/case report

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17
Q

What Study type?

Focuses on a clinical topic, conducts a thorough review of the literature, validates quality of the studies and summarizes the data

A

Systemic Review

ie. Cochrane Database

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18
Q

What are strengths of a Meta Analysis and Systematic Review?

A
  • summarizes literature
  • prospective
  • validates smaller studies
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19
Q

What are weaknesses of a Meta Analysis and Systematic Review?

A
  • time consuming
  • difficult to combine studies
  • publication bias (positive studies are more likely to be published)
  • requires studies to be ‘similar enough’
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20
Q

What are strengths of a RCT?

A
  • randomization
  • controls for bias
  • control over exposure
  • best for proving efficacy
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21
Q

What are the weaknesses of a RCT?

A
  • expensive
  • ethical considerations
  • time consuming
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22
Q

What are strengths of a Cohort?

A
  • observing patients

- prospective

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23
Q

What are the weaknesses of a Cohort?

A
  • time consuming
  • possible cofounders
  • can NOT prove causation
  • Recall bias
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24
Q

What are strengths of a Case control?

A
  • quick
  • cheap
  • convenient
  • Good for rare disorders
  • ethical
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25
Q

What are the weaknesses of a Case control?

A
  • Based on recall
  • Confounders
  • Difficult to choose control groups
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26
Q

What are strengths of a Case series/ case report

A
  • Identify new disease

- preliminary study

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27
Q

What are the weaknesses of a case series/ case report

A
  • no control group

- no comparison

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28
Q

ID the highest quality of study to answer a clinical question from highest to lowest (the prevention and treatment hierarchy) (7)

A
  • N of 1 randomized trial
  • systematic reviews of RCTs
  • Single RCT
  • Systematic reviews of observational studies
  • single observational study
  • physiological studies
  • Unsystematic clinical observation
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29
Q

What study types are best to answer a clinical question about:
Therapy

A

Systematic review/Meta analysis > RCT > Prospective Cohort

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30
Q

What study types are best to answer a clinical question about:
Diagnosis

A

Prospective, blind comparison to a gold standard

31
Q

What study types are best to answer a clinical question about:
Prognosis

A

Cohort study > Case control > case series

32
Q

What study types are best to answer a clinical question about:
Etiology/harm

A

RCT > Cohort> case control > case series

33
Q

What study types are best to answer a clinical question about:
Prevention

A

RCT > cohort > case control > case series

34
Q

What study types are best to answer a clinical question about:
Cost

A

Economic Analysis

35
Q

What study types are best to answer a clinical question about:
Clinical Exam

A

Prospective, blind comparison to a gold standard

36
Q

Define the parts of a PICOTT question

A

P- patient/population/problem
I- intervention (prognostic factor, exposure)
C- comparison
O- outcome (you would like to measure or achieve)
T- type of question
T- type of study wanted

37
Q

what is a likelihood ratio?

A

the probability that a test result will occur in a patient WITH DISEASE compared to the probability that the same result would occur in a patient WITHOUT DISEASE

38
Q

usually for diagnostic tests to let you know how ‘good’ your diagnostic test is

A

likelihood ratio

39
Q

Draw out the 4 square table for diagnostic tests

A

across top: disease +, disease -
1st column: test +, test -
a-b = (TP - FP)
c-d = (FN - TN)

40
Q

true positive rate

and calculation

A

sensitivity

a/(a+c)

41
Q

how to calculate false negative rate

A

1- sensitivity

42
Q

true negative rate

and calculation

A

specificity

d/(b+d)

43
Q

how to calculate a false positive rate

A

1- specificity

44
Q

TPR/FPR

A

LR +

45
Q

FNR/TNR

A

LR -

46
Q

LR

A

rule out

47
Q

LR > 10 means

A

rule in

48
Q

how much more likely?

LR 2 –> 5 –> 10

A

Increase probability by

15% –> 30% –> 45%

49
Q

how much more likely?

LR 1/2 –> 1/5 –> 1/10

A

decrease probability by

15% –> 30% –> 45%

50
Q

what is a relative risk

A

the ratio of risk in the treated group (Y) to the risk in the control group (x)
RR = Y/X or (X-Y)/X x 100%

51
Q

how do you calculate the RRR

A

1- RR = RRR

52
Q

The percentage reduction in risk in the treated group (Y) compared to controls (X)

A

Relative Risk reduction (RRR)

53
Q

chance of benefit

A

Absolute Risk reduction

54
Q

the difference in risk between control group (X) and the treated group (Y)

A

Absolute risk reduction

55
Q

how do you calculate ARR?

A

ARR = X- Y

56
Q

How do you calculate NNT`

A

NNT = (100/ARR) x 100%

57
Q

a NNT of 15 means what?

A

you must treat 15 patients to prevent 1 adverse outcome

58
Q

how accurately a test identifies those WITH disease

A

Sensitivity

“Rules in”

59
Q

How accurately a test identifies those WITHOUT disease

A

specificity

“rule out”

60
Q

How do you calculate sensitivity and specificity

A 
Sensitivity = TP / (TP + FN)
Specificity = TN / (TN + FP)
61
Q

the probability that the patient has the disease when the test result is positive

A

PPV

62
Q

the probability that the patient does NOT have the disease when the test result is negative

A

NPV

63
Q

How do you calculate PPV and NPV

A 
PPV = TP / (TP + FP)
NPV = TN / (TN + FN)
64
Q

How does prevalence of a disease affect sensitivity?

A

no impact

65
Q

How does prevalence of a disease affect specificity?

A

no impact

66
Q

How does prevalence of a disease affect PPV?

A

increases as prevalence increases

67
Q

How does prevalence of a disease affect NPV?

A

decreases as prevalence increases

68
Q

What tells you how precise the results are?

A

confidence interval

69
Q

a narrow ranged CI means what?

A

the more accurate the researcher believes the point estimate to be

70
Q

a wider ranged CI means what?

A

the less sure the researcher is of the actual value

71
Q

When is a CI statically significant?

A

when P

72
Q

When is a CI suggestive of a beneficial trend?

A

RR

73
Q

When is a CI suggestive of a harmful trend

A

RR > 1

74
Q

When is a CI inconclusive?

A

P > 0.5 AND crosses 1

EBM (1 decks)

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