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ANCC - Fitzgerald Notecards > Nursing Research & Evidence-Based Medicine and Epidemiology > Flashcards

Nursing Research & Evidence-Based Medicine and Epidemiology Flashcards

1
Q

Evidence-Based Medicine (EBM)

A
  • 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
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2
Q

Hierarchy of Research Evidence

A
  1. Meta-analysis
  2. Systematic Reviews
  3. Randomized Controlled Trials (RCTs)
  4. Experiment
  5. Cohort Study
  6. Case Reports/Series
  7. Expert or Specialty Group
  8. Opinions, Editorials
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3
Q

Meta-analysis

A
  • 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
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4
Q

Systematic Review

A
  • 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
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5
Q

Randomized Controlled Trial

A
  • 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
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6
Q

Experimental Study

A
  • involves random subject selection; one placebo or control group, and one or more intervention group(s)
  • RCT is a type of experimental study
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7
Q

Cohort Study

A
  • 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)

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8
Q

Case Report

A
  • 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
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9
Q

Case Series

A
  • a series of care reports that involves a series of individuals who are given similar treatment
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10
Q

Opinions and Editorials

A
  • can be biased and may not be based on solid evidence
  • they are the weakest form of evidence
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11
Q

Research Databases: Cochrane Reviews

A

*GOLD STANDARD database and resource EBM
- these are systematic reviews
- the organization does NOT accept commercial or conflicted fudning
- aka Cochrane Collaboration

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12
Q

Research Databases: Medline

A
  • 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
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13
Q

Research Databases: PubMed

A
  • component of MEDLINE, contains >30 million citations of biomedical, medical, and other life science literature and abstracts
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14
Q

Research Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL)

A
  • world’s largest source of full-text nursing and allied health journals (>1,300 journals)
  • provides indexing of >4,000 journals
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15
Q

Grades of Research Evidence

A

A (best evidence)
B
C
D (poor evidence)

  • Well-designed double-blind RCTs → grade A (level 1)
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16
Q

How to solve Evidence-based Medicine Questions (Drag-and-Drop Format)

A
  • 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)

17
Q

Statistical Terms (Evidence-based Medicine): Confidence Interval (CI)

A
  • 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

18
Q

Statistical Terms (Evidence-based Medicine): Absolute Risk Reduction (ARR)

A

a measure of the difference b/w 2 different treatments in terms of their ability to reduce a particular outcome

Ex: MI, stroke

19
Q

Statistical Terms (Evidence-based Medicine): Relative Risk Reduction (RRR)

A

a measure of how much risk is reduced int he experimental group compared w/ the control group

20
Q

Statistical Terms (Evidence-based Medicine): Number Needed to Treat (NNT)

A

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

21
Q

Statistical Terms (Evidence-based Medicine): Positive Predictive Value (PPV)

A

The probably that a person w/ a positive screening test result has the ds

22
Q

Statistical Terms (Evidence-based Medicine): Negative Predictive Value (NPV)

A

probably that a person w/ a negative test result does not have the ds

23
Q

Epidemiology Terms: Active Immunity

A

immunity to a disease developed either through vaccination or by infection

24
Q

Epidemiology Terms: Passive Immunity

A

immunity to a ds after receiving antibodies (immunoglobins) from another host

Ex: colostrum from breastfeeding gives neonate antibodies from the mother

25
Q

Epidemiology Terms: Herd Immunity

A

resistance to a ds in a large # of people in the population, which is usually d/t immunization programs

26
Q

Epidemiology Terms: Health

A

refers to a state of complete physical, mental, and social well-being

27
Q

Epidemiology Terms: Horizontal Transmission

A

transmission of an infecting agent from one individual to another

Ex: horizontal transmission of HIV/other STDs or infections occurring through sexual intercourse

28
Q

Epidemiology Terms: Vertical Transmission

A

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

29
Q

Epidemiology Terms: Endemic

A

a baseline level of a particular ds in a population

30
Q

Epidemiology Terms: Epidemic

A

refers to the rapid increase of a ds in a population that involves a large number of people

31
Q

Epidemiology Terms: Pandemic

A

this is an epidemic that occurs over a large area (several countries or continents(
- it involves a large proportion of the global population

32
Q

Epidemiology Terms: Morbidity

A

refers to an illness or any departure from physical and/or mental health

33
Q

Epidemiology Terms: Mortality

A

death

34
Q

Epidemiology Terms: Infant Mortality

A

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)

35
Q

Epidemiology Terms: Sensitivity

A

refers to the ability of a screening test to correctly identify a person WITH the disease

36
Q

Epidemiology Terms: Specificity

A

Refers to the ability of a screening test to correctly identify a person WITHOUT the disease

ANCC - Fitzgerald Notecards (27 decks)

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