Nursing Research & Evidence-Based Medicine and Epidemiology Flashcards
Evidence-Based Medicine (EBM)
- the “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”
- AKA evidence-based practice
- There will be several questions on the ANCC exam that will test your ability to sort and rate articles by the level of evidence
Hierarchy of Research Evidence
- Meta-analysis
- Systematic Reviews
- Randomized Controlled Trials (RCTs)
- Experiment
- Cohort Study
- Case Reports/Series
- Expert or Specialty Group
- Opinions, Editorials
Meta-analysis
- a statistical method combining data from multiple studies (systematic review), resulting in a higher statistical power and a single conclusion
- considered the *GOLD STANDARD for evaluating research evidence for EBM
Systematic Review
- a type of literature review that identifies, selects, and analyzes multiple research articles concerning a health condition, disease, or other health-related practice
- follows specific methodology to identify all the relevant studies on a specific topic
- studies to be included must meet explicit criteria
- studies are ranked from grade A (best evidence) to grade D (poor evidence)
- after a systematic review is done, the acceptable studies are pooled together, and statistical testing of the data (meta-analysis) is performed
Randomized Controlled Trial
- subjects are randomly assigned to either the controlled group or the treatment group(s)
- intervention may be a drug, procedure, or device
- some RCTs use a double-blind design (the intervention is hidden from the pt, clinician, and/or researchers)
- RCTs are experimental studies
Experimental Study
- involves random subject selection; one placebo or control group, and one or more intervention group(s)
- RCT is a type of experimental study
Cohort Study
- type of research that is used to investigate risk factors for diseases, death, and other conditions
- research subjects are observed for a long period
- there is no intervention done (not an experiment)
Goal:
- identify risk factors and associations (not causations) of a disease(s)
Ex: The Nurses’ health Study is a large cohort study of female RNs age 30-63 who reside in the state of MAss. A cohort study can be a type of prospective study (present to future)
Case Report
- a detailed report of one pt w/ a ds or an unusual condition that includes demographics, s/sx, diagnosis, response to treatment, and so forth
Case Series
- a series of care reports that involves a series of individuals who are given similar treatment
Opinions and Editorials
- can be biased and may not be based on solid evidence
- they are the weakest form of evidence
Research Databases: Cochrane Reviews
*GOLD STANDARD database and resource EBM
- these are systematic reviews
- the organization does NOT accept commercial or conflicted fudning
- aka Cochrane Collaboration
Research Databases: Medline
- US National Library of Medicine (NLM) premier bibliographic database containing more than 26 million journal articles in the life sciences w/ a concentration in biomedicine
- these articles are from 5,200 current biomedical journals published around the world
Research Databases: PubMed
- component of MEDLINE, contains >30 million citations of biomedical, medical, and other life science literature and abstracts
Research Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL)
- world’s largest source of full-text nursing and allied health journals (>1,300 journals)
- provides indexing of >4,000 journals
Grades of Research Evidence
A (best evidence)
B
C
D (poor evidence)
- Well-designed double-blind RCTs → grade A (level 1)
How to solve Evidence-based Medicine Questions (Drag-and-Drop Format)
- The ANCC exam uses the “Drag-and-Drop” format to assess your knowledge of EBM
- on the left side are 3 blue boxes w/ research articles/studies
- on the right side there are 3 yellow boxes # 1, 2, and 3
- you must rate the 3 articles in terms of evidence as best (1), moderate (2), or worst (3)
The best way to answer this type of question:
- easiest way to answer this type of question is to memorize and understand the highest level of evidence (meta-analysis, systematic review, RCT) and the type of studies that has the lowest level of evidence (opinion, editorials)
- the leftover study belongs in the middle (#2)
- the first sentence usually give a clue about the study design
Steps to follow:
1. Identify the article with the strongest level of evidence (#1 ranking); look for keywords such as meta-analysis; systematic review; RCTs; and the Cochrane, Medline, and/or CINAHL databases
2. Next, look for the research study that has the weakest evidence (#3 ranking); it has keywords such as expert opinion, opinion, or editorial
3. You are left w/ one article, which you drag to the middle (#2 ranking)
Statistical Terms (Evidence-based Medicine): Confidence Interval (CI)
- a measure of the degree of certainty in a sampling method
Ex: a 95%CI is a range of values that you can be 95% certain contains the true mean of the population
Statistical Terms (Evidence-based Medicine): Absolute Risk Reduction (ARR)
a measure of the difference b/w 2 different treatments in terms of their ability to reduce a particular outcome
Ex: MI, stroke
Statistical Terms (Evidence-based Medicine): Relative Risk Reduction (RRR)
a measure of how much risk is reduced int he experimental group compared w/ the control group
Statistical Terms (Evidence-based Medicine): Number Needed to Treat (NNT)
the number of pts you have to treat to avoid one bad outcome (e.g., MI, stroke)
Ex: an NNT of 7 means that it is necessary to treat 7 pts to avoid 1 bad outcome
Statistical Terms (Evidence-based Medicine): Positive Predictive Value (PPV)
The probably that a person w/ a positive screening test result has the ds
Statistical Terms (Evidence-based Medicine): Negative Predictive Value (NPV)
probably that a person w/ a negative test result does not have the ds
Epidemiology Terms: Active Immunity
immunity to a disease developed either through vaccination or by infection
Epidemiology Terms: Passive Immunity
immunity to a ds after receiving antibodies (immunoglobins) from another host
Ex: colostrum from breastfeeding gives neonate antibodies from the mother
Epidemiology Terms: Herd Immunity
resistance to a ds in a large # of people in the population, which is usually d/t immunization programs
Epidemiology Terms: Health
refers to a state of complete physical, mental, and social well-being
Epidemiology Terms: Horizontal Transmission
transmission of an infecting agent from one individual to another
Ex: horizontal transmission of HIV/other STDs or infections occurring through sexual intercourse
Epidemiology Terms: Vertical Transmission
transmission of n infecting agent from mother to infant
- congenital infections from mother to infant can be passed through vertical transmission
- also, HIV-positive mother who breastfeeds her infant can infect her infant w/ HIV through vertical transmission
Epidemiology Terms: Endemic
a baseline level of a particular ds in a population
Epidemiology Terms: Epidemic
refers to the rapid increase of a ds in a population that involves a large number of people
Epidemiology Terms: Pandemic
this is an epidemic that occurs over a large area (several countries or continents(
- it involves a large proportion of the global population
Epidemiology Terms: Morbidity
refers to an illness or any departure from physical and/or mental health
Epidemiology Terms: Mortality
death
Epidemiology Terms: Infant Mortality
refers to infant deaths per 100,000 live births
- the leading cause of death in an infant’s first year of life is congenital malformations (including chromosomal abnormalities)
Epidemiology Terms: Sensitivity
refers to the ability of a screening test to correctly identify a person WITH the disease
Epidemiology Terms: Specificity
Refers to the ability of a screening test to correctly identify a person WITHOUT the disease