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Evidence Based Clinical Practice > Midterm > Flashcards

Midterm Flashcards

1
Q

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

A

Evidence-based practice

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2
Q

What are the three essential components of EBCP?

A

External evidence, patient values and clinical expertise

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3
Q

Where do you get information?

A

Clinical observation, peers and experts, internet, books, popular press, peer-reviewed scientific publications

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4
Q

What is the relevance of EBCP?

A

Providers can use it to improve patient care and make referrals, patients use it to improve their health and government agencies use it to make policy decisions

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5
Q

What is at the top of the hierarchy of evidence?

A

Clinical practice guidelines

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6
Q

What are the two broad categories of health-related research?

A

Basic science, clinical

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7
Q

Basic or clinical science? Laboratory, usually not patients; investigates mechanisms, how treatment works

A

Basic science

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8
Q

Basic or clinical science? Treatment of patients; investigates clinical outcomes, shows effectiveness of treatment

A

Clinical science

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9
Q

The science (systematic study) of the factors that influence human health on the level of the population

A

Epidemiology

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10
Q

Health-related events do not depend on a single isolated cause, but develop as the result of complex interactions among factors

A

Web of causation

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11
Q

What is incidence?

A

The amount of new cases of the disease.

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12
Q

What is prevalence?

A

The existing cases of a disorder in a population at one point in time. Expressed as a number per 100,000 or a %.

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13
Q

What is primary research?

A

Investigators collect the data such as surveys, experiments with animals or humans and formal observations of animals or humans

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14
Q

What is secondary research?

A

Investigators use data that has already been collected such as narrative reviews, systematic reviews, meta-analyses and guidelines

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15
Q

What are the study design categories?

A

Observational and experimental

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16
Q

What type of study design is described? Investigators DO NOT control variables, often used for describing populations, best to use if there are many unknown factors

A

Observational

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17
Q

What type of study design is described? Investigators DO control variables, often used to investigation treatments, best for investigating effect of single factors

A

Experimental

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18
Q

What are the five A’s of EBCP?

A

Assess, ask, acquire, appraise, apply

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19
Q

General, broad questions

A

Background Questions

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20
Q

Questions specific to patients, focused, address diagnosis or therapy

A

Foreground Questions

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21
Q

What is an abstract?

A

Short summary, overview of methods and results

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22
Q

What is an introduction?

A

Background and purpose, establishes importance, includes relevant literature and identifies gaps in literature.

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23
Q

What is included in methods?

A

**Very important
Explains project’s study design, if sample is well described, procedures explained, outcome measures explained and justified and statistical analysis

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24
Q

What is included in results?

A

Summary of sample/groups. Compares groups to be sure they are equivalent in important characteristics and summary of outcomes with tables and figures at the heart of this section.

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25
Q

What is included in the discussion?

A

Limitations of the study (very important that this is included) and compare/contrast to other studies

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26
Q

What is included in the conclusion?

A

Conclusions of the results that should follow logically

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27
Q

What is included in references?

A

Establishes whether the authors have considered work of others. References older than 5 years should be minimal and references should apply directly to the study.

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28
Q

What are the two types of validity?

A

Internal and External

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29
Q

What is internal validity?

A

How well the study achieved it’s aim.

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30
Q

What is external validity?

A

“Generalizability” How well this could be applied to the outside world.

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31
Q

Internal or external validity?

Within the study only

A

Internal

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32
Q

Internal or external validity?

Generalizable to other groups of people, settings or interventions.

A

External

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33
Q

Internal or external validity?

If the results of the study are only applicable to it’s participants then this type of validity is lacking.

A

External

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34
Q

Internal or external validity?

If the intervention causes the outcome vs other variables which may have affected results.

A

Internal

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35
Q

Internal or external validity?

If outcomes are affected by bias.

A

Internal

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36
Q

Internal or external validity?

Related to the presence of extraneous variable and bias.

A

Internal

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37
Q

Bias, or _________ error in measurement, usually reproducible as it may be caused by faulty equipment or from mistakes in taking the measurement.

A

Systematic

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38
Q

This type of error occurs by chance.

A

Random

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39
Q

Excessive bias means the results of the study are __________.

A

Not trustworthy

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40
Q

Instruments/equipment may be non-standardized OR be used slightly differently by different investigators at different times.

A

Instrumentation bias or measurement bias

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41
Q

Measurements used should be both _____ and ______. (with references to support this)

A

Valid and reliable

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42
Q

Participants who are not representative of the population being studied create _________.

A

Selection bias

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43
Q

Groups who are unequal at baseline can also create __________.

A

Selection bias

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44
Q

Usually table number __ in an article will compare groups at baseline and discuss differences

A

1

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45
Q

__________ may occur when participants drop out and are lost to follow-up

A

Attrition bias

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46
Q

T/F A decrease in sample size may affect representativeness and outcomes, particularly if the cause of attrition is able to be determined.

A

False, particularly if the cause of attrition is NOT able to be determined it’s likely to affect representativeness.

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47
Q

_____% attrition probably doesn’t create bias.

A

<5%

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48
Q

_____% probably creates attrition bias

A

> 20%

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49
Q

What are three ways to appraise an article?

A
  1. Apply ABCD FIX mnemonic (only for therapy articles)
  2. Use a worksheet
  3. Use CONSORT checklist
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50
Q

What does ABCD FIX stand for?

A 
Allocation concealed?
Blinding?
Comparable groups?
Drop-outs?
Follow-up?
Intention to treat?
X factor (other obvious source of bias)
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51
Q

What are the three purposes of diagnostic testing?

A
  1. To establish a diagnosis
  2. To provide prognostic information
  3. To monitor the response to treatment
52
Q

What three things determine diagnostic test discrimination (accuracy)?

A
  1. Sensitivity and specificity
  2. Predictive value
  3. Likelihood ratios
53
Q

T/F If a patient is very unlikely or very likely to have a disorder, there is probably no need for a test.

A

True

54
Q

Accepted diagnostic procedure which identifies disorder with certainty

A

Gold standard

55
Q

_________ may be riskier, more technically difficult, expensive or impractical than other diagnostic procedures.

A

Gold standard

56
Q

T/F: Some disorders may not have a gold standard.

A

True

57
Q

__________: probability that a person WITH a disorder will have a positive result

A

Sensitivity

58
Q

__________: probability that a person WITHOUT a disorder will have a negative test result

A

Specificity

59
Q

Positive disorder, positive test

A

True positive

60
Q

Positive disorder, negative test

A

False negative

61
Q

Negative disorder, negative test

A

True negative

62
Q

Negative disorder, positive test

A

False positive

63
Q

________: ability of a dx test to identify true disease without missing anyone who has it

A

Sensitivity

64
Q

T/F: High sensitivity test has few false negatives so is effective at ruling conditions in.

A

False: effective at ruling conditions out. (SnNout)

65
Q

T/F: High specificity test has few false positives so is effective in ruling conditions in.

A

True (SpPin)

66
Q

________: ability of dx test to identify absence of disease without mislabeling anyone who does not have it.

A

Specificity

67
Q

Prevalence is also known as a __________.

A

Pretest probability

68
Q

What is a positive predictive value (PPV)?

A

The likelihood of having the dx when the test is +

69
Q

What is the negative predictive value (NPV)?

A

The likelihood of not having the dx when the test is -

70
Q

A likelihood ratio of _____ generates large and often conclusive changes from pre-test to post-test probability.

A

Greater than 10 or less than 0.1

71
Q

A likelihood ratio of >10 is good for what?

A

Ruling the condition IN

72
Q

A likelihood ratio of <0.1 is good for what?

A

Ruling the condition OUT

73
Q

What are the four types of Nociceptive pain?

A
  1. Discogenic
  2. Facet
  3. SI joint
  4. Myofascial
74
Q

What are the four types of neuropathic pain?

A
  1. Compressive radiculopathy
  2. Non-compressive radiculopathy
  3. Neurogenic claudication
  4. Central pain
75
Q

_______ is the progressive resolution of or retreat of symptoms toward the midline

A

Centralization

76
Q

What are the descriptive study types?

A
  1. Case report
  2. Case series
  3. Survey
77
Q

What are the observational (analytic) study types?

A
  1. Cross-sectional
  2. Case-control
  3. Cohort studies
78
Q

What are the experimental (analytic) study types?

A
  1. RCT
79
Q

_________ studies are a slice of time that looks at prevalence. Not too expensive or time-consuming.

A

Cross-sectional

80
Q

________ studies follow a group of individuals over time.

A

Cohort

81
Q

The limitation of _________ studies is you can’t tell whether exposure preceded disease.

A

Cross-sectional

82
Q

_______ studies often use surveys, which may have bias

A

Cross-sectional

83
Q

______ studies start with exposure/risk factor and follow group over time to determine outcome

A

Cohort

84
Q

_______ studies are used to assessing risk/harm/adverse events.

A

Cohort

85
Q

What are the two types of cohorts?

A

Prospective and Retrospective

86
Q

__________ cohort: with or without risk factor of interest followed forward in time to record outcome. Is more expensive.

A

Prospective

87
Q

__________ cohort: usually uses secondary data, cohort is followed backward in time to examine risk factors present years in the past. Less expensive.

A

Retrospective

88
Q

What is a case-control study?

A

Looks at the difference between group with the disease and one group without.

89
Q

T/F: In case-control studies risk factors are compared.

A

True

90
Q

T/F: In case-control studies “risk of outcome” can be assessed.

A

False, risk of outcome cannot be assessed, the outcome is already known.

91
Q

T/F: Case-control studies are useful for rare conditions, such as the association between stroke and SMT.

A

True

92
Q

T/F: Systematic reviews use secondary data.

A

True

93
Q

Systematic review methods include 3 things which are?

A
  1. Eligibility criteria for articles
  2. Databases and search strategies detailed
  3. Evaluation of the quality of the literature.***
94
Q

Primary evidence includes what?

A

RCTs, Observational studies (Case-control, cohort), expert opinion and case reports/series

95
Q

Secondary evidence includes what?

A

Clinical practice guidelines, meta-analyses and systematic reviews

96
Q

Observational or experimental study?

Who: People with specific condition/exposure; may be 2 groups.

A

Observational

97
Q

Observational or experimental study?

Who: Sample 1+ comparison sample(s)

A

Experimental

98
Q

Observational or experimental study?

Why: Evaluate the effect of an intervention using methods that minimize risk of bias.

A

Experimental

99
Q

Observational or experimental study?

Why: Gather “real-world” evidence

A

Observational

100
Q

Observational or experimental study?

There is no investigator-designed intervention

A

Observational

101
Q

This type of study usually includes RCTs, cohorts and sometimes lower-level studies and is used to synthesize and evaluate the best evidence available on a very specific topic from multiple sources.

A

Systematic review

102
Q

This type of study usually includes RCTs, cohorts and sometimes lower-level studies and is used to synthesize and analyze the best evidence available on a very specific topic COMBINING DATA from the included studies.

A

Meta-analysis

103
Q

This type of study includes the generalized population and is used to make recommendations on best practices, based on best available evidence.

A

Clinical practice guidelines

104
Q

What are some good databases to access?

A
  1. ) PubMed (legit)
  2. ) Index to Chiropractic Literature (ICL)
  3. ) CINAHL (whatever the heck that is lol)
105
Q

This recent type of literature was developed to help busy clinicians apply evidence in their practice - often at the time of care

A

Pre-appraised literature

106
Q

T/F: Many experts in EBP recommend using these pre-appraised sources first, before the primary literature.

A

True

107
Q

T/F: Pre-appraised literature is not useful.

A

False: pre-appraised literature uses an explicit review process to find and appraise evidence, so the sources are appraised for you by experts.

108
Q

What are pre-appraised databases we can use?

A
  1. Dynamed

2. UptoDate

109
Q

What is also apparently considered pre-appraised?

A
  1. Cochrane library

2. Systematic reviews and meta-analyses

110
Q

What are a couple special purpose resources for clinical practice guidelines?

A
  1. National guideline clearinghouse

2. Clinical practice guidelines database (this one is for Canada)….glad i know that now.

111
Q

What does R3C stand for?

A

Rapid Response Resource Center

112
Q

What is the R3C?

A

An open access online resource that summarizes and references current evidence on effectiveness and safety of chiropractic care

113
Q

T/F: The R3C is organized by topic such as commonly seen conditions by DCs and procedures/practices commonly used by DCs.

A

True

114
Q

T/F: Essentially the purpose of this R3C thing is to make searching easier because it gives you less irrelevant results to shuffle through compared to doing a Google or even PubMed search.

A

True

115
Q

If you don’t have access to a pre-appraised source then use: ________.

A

Clinical practice guidelines, Systematic reviews, RCTs and cohort studies.

116
Q

What is Type I error?

A

Alpha error… is a false positive

117
Q

What is Type II error?

A

Beta error… is a false negative

118
Q

Type I or II error?
Rejection of true null hypothesis, where a conclusion is drawn that the null hypothesis is false when, in fact, it is true. (false positive)

A

Type I

119
Q

Type I or II error?
Retaining a false null hypothesis, where a conclusion is drawn that the null hypothesis is true when, in fact, it is false. (false negative)

A

Type II

120
Q

Likelihood ratio score of 2-5 means what?

A

Small but sometimes important

121
Q

Likelihood ratio score of 5-10 means what?

A

Moderate & usually important

122
Q

Likelihood ratio score of 10+ means what?

A

Usually conclusive

123
Q

Type I or II error:

The patient has a disease but the study says they don’t.

A

Type II (false negative)

124
Q

Type I or II error: The patient does not have the disease but the study says they do.

A

Type I (false positive)

125
Q

To avoid Type I error do this:

A

Significance testing

126
Q

To avoid Type II error do this:

A

Power calculation

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