Module 1 Highlighted Slides Flashcards
Key Questions in an Article Appraisal
- Valid study?
- What are the results?
- Will results help my patients?
CASP Elements when Appraising an Article
Rigor
Credibility
Relevance
CASP Rigor
methodological rigor and appropriateness of methods
CASP Credibility
presentation and meaningfulness of results
CASP Relevance
relevance of study and usefulness of applicability
What is the research question for Etiology?
What cause illness?
What is the research question for diagnosis?
What does the test result mean in this patient?
What is the research question for prognosis?
What is likely to happen?
What is the research question for harm?
If having been exposed to this substance likely to do harm and if so, what?
What is the research question for effectiveness?
If this treatment likely to help patients with this illness?
What is the research question for qualitative questions?
What outcomes are most important to the patients with this condition?`
Study design for this question:
Etiology and Risk Factors
cohort and case-cntrl studies
Study design for this question:
Incidence and prevalance
cohort or cross-sectional
Study design for this question:
Harm
cohort and case-control studies
Study design for this question:
Prognosis
cohort/survival studies
Study design for this question:
Value for money
economic valuation
-cost-effectiveness or cost-benefit study
Study design for this question:
Effectiveness
randomized control trial
Study design for this question:
Diagnosis
Diagnostic test study or RCT
Study design for this question:
Patient experience
qualitative study (questionnaires, focus group, interview)
Sources for strength of evidence
-sampling
-research methods: hierarchy for strength of evidence and oxford center for evidence based medicine hierarchy
Oxford Center for Evidence Based Medicine 5 Levels of Evidence
- RCTs and prospective studies
- Cohort Studies
- Case-control studies
- Case series, poorly designed cohort and case control studies
- anecdotal evidence, animal research, bench research, unpublished clinical observations
Research Evidence Pyramid Levels (top to bottom)
Systematic reviews
Randomized clinical trials
Cohort studies
Case-control studies
Case series
Case studies
Narrative reviews, expert opinion, textbook
Prospective Study Design
gold standard
followed over time
Retrospective Study Design
patients already have impairment of interest
Sections of Research Article
Title
Abstract
Body:
-Introduction
-Methods
-Results
-Discussion (conclusions and/or clinical significance)
Clinical research categories
basic science or bench research
field research
translational research
Basic science or bench research
lab environment with tightly controlled conditions
Field research
conducted away from the lab in a natural setting
Translational research
investigations that apply results from basic science to care of patients
EBP 5 A’s
Assess
Ask
Aquire
Appraise
Apply
Steps to implement PICOTT
- form picott question
- identify keywords
- plan search strategy
- execute search (Refine results and review lit findings)
- assess evidence
Boolean search
using AND, OR, and NOT search words
AND
combines concepts and items must contain both/all words
OR
items can contain one or more of the terms
-inclusive, not exclusive
NOT
high limiting by removing any records containing the word/phrase
3 important things for code of research ethics
Nuremberg Code
Declaration of Helsinki
Belmont Report
Nuremberg Code
voluntary consent
benefit > risk
ability to withdraw
Declaration of Helsinki
interest of participant must prevail
Belmont Report
Respect for persons
beneficence
justice
Beneficence
ability of PI to secure and stabilize client well beings
assessment of risk and benefit where client gets max benefit and minimal harm
Justice
who benefits from findings?
fair selection of subjects
injustice if benefactors of research are from a better social class
Hayward’s Evidence based information cycle
- Assess situation
- Get relevant literature
- Appraise literature
- Apply findings to clinical decision making
- Assess success
3 part approach to evidence based clinical practice patient care
- valid research findings grounded in theory and science
- clinical expertise and practical experience
- medical needs, psycho-social interests, and ethical/religious values of pt
PICO and focused clinical question
P- person, location, condition, and patient characteristics
I- length, location, type
C- another intervention, no intervention, location of intervention
O- outcome (dec falls, avoid hospitalization?)
Stages of Scientific Research Process
- Identify topic
- Search and review literature
- define topic
- state general question or topic
- phrase operationally defined hypothesis
- methods to test hypothesis
- collect data
- analyze data and interpret the results
- write about findings
