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EBP 1 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Three types of literature reviews

A

Narrative, systematic, and Meta-analysis

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2
Q

What is a narrative review?

A

A review that summarizes in general what is in the literature on a given topic

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3
Q

Characteristics of a narrative review

A
  • Often written by experts in the field.
  • A good source for background information
  • Fairly easy to write and read
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4
Q

______ review does not follow strict system methods like the other literatures

A

Narrative review

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5
Q

Which review is prone to bias and is low in the hierarchy of evidence?

A

Narrative review

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6
Q

How can narrative bias be seen?

A
  • During the literature research
  • During reporting of studies
  • In discussion and conclusion
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7
Q

How can narrative bias be seen during literature research?

A
  • Authors may be selective as to which articles are selected

- They may include articles that support their hypothesis & exclude those that do not

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8
Q

How can narrative bias be seen during reporting of studies?

A
  • Rigorous appraisal methods are not used to evaluate included articles
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9
Q

How can narrative bias be seen in discussion and conclusion?

A
  • The authors’ opinions may be mixed together with evidence
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10
Q

What is a systematic review?

A

A rigorous process of searching, appraising, summarizing, all the information on a selected topic

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11
Q

Systematic reviews most commonly address what type of questions?

A

Questions of effectiveness, but also diagnostic accuracy, prognosis, or other areas of research

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12
Q

What is the aim of a systematic review?

A

To find all studies addressing the review’s question using an OBJECTIVE & TRANSPARENT process

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13
Q

What is the gold standard of systematic reviews?

A

The cochrane collaboration

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14
Q

A systematic review is also called a

A

Study of studies

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15
Q

What is the process of a systematic review

A
  • State the study objective
  • Develop the protocol (set inclusion/exclusion criteria)
  • Develop a search strategy
  • Conduct the search
  • Retrieve relevant papers
  • Screen and select papers that meet established criteria
  • Evaluate Methodogical quality of selected studies
  • Analyze & synthesize findings
  • Determine if statistical data are sufficient for further analyses (If not report results of systematic review) (if it does move to the next step)
  • Analyze effects of size estimates
    _ Report results of meta-analysis
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16
Q

The results of the included studies of a systematic review are ____ or ____

A

Qualitative or quantitative

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17
Q

What happens when the results of a systematic review is qualitatively synthesized?

A

Written information is merged

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18
Q

What happens when the results of a systematic review is quantitatively synthesized?

A

Data are merged

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19
Q

Most known diagnostic study quality?

A

QUADAS

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20
Q

Most known interventional study quality?

A

PEDro

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21
Q

Information collected from a research can include

A

The method, participants, funding sources, and outcomes

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22
Q

Short line in forest plot represents

A

Better, more valid information

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23
Q

Long line in the forest plot represents

A

Not as good, weaker information

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24
Q

The diamond in the forest represents

A

The combined results of all data included

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25
Q

The diamond is considered____ and ______ evidence

A

more reliable and better

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26
Q

What is a meta-analysis?

A

The statistical technique involved in extracting and combining data produce a summary result

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27
Q

When can/should you do a meta-analysis?

A
  • When more than one study has estimated an effect
  • When there are to no differences in the study characteristics that are likely to substantially affect outcome
  • When the outcome has been measured in similar ways
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28
Q

What is the most common way to see the results of a meta-analysis summarized?

A

In a forest plot

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29
Q

What is a forest plot?

A

A type of graph often used in meta-analyses to illustrate the treatment effect sizes of the studies

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30
Q

Each study in a forest plot is represented by a black square that is ____

A

an estimate of their effect sizes. Ex: Cohen’s d

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31
Q

____ is appropriate with continuous data

A

Cohen’s d

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32
Q

_____ is appropriate when study’s outcome measure is dichotomous

A

Odds ratio (OR)

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33
Q

What is an odds ration (OR)

A

a comparison of odds of the outcome being present in the treatment group against the control group

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34
Q

What is a confidence interval?

A

a ratio of values that we are confident contains the population. Includes a point estimate

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35
Q

What is a point estimate?

A

A single value that represents the best estimate of the population value

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36
Q

_____ value on the confidence interval is probable

A

Not every

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37
Q

What is the line of no effect?

A

the line where there is no difference between the two sides of the forest plot

38
Q

The whole length of the bar in the forest plot is the

A

Confidence interval

39
Q

If the confidence interval includes the line of no effect, …

A

Then it is not statistically significant

40
Q

What does a meta-analyses typically produce?

A

A weighted average for the treatment effect estimate

41
Q

Small samples are more _____ than larger studies

A

susceptible

42
Q

_____ studies are given less weight that ____ studies

A

Smaller & larger

43
Q

Weighting is also based on____

A

study quality

44
Q

The diagnostic process includes…

A

Pattern recognition, and logical reasoning

45
Q

What are the components of pattern recognition?

A

History exam, and physical exam

46
Q

What is diagnosis from the EBP perspective about

A

All about probabilities and limiting uncertainty

47
Q

What are the key thresholds for diagnostic tests?

A

Test thresholds, and treatment threshold

48
Q

What is a test threshold?

A

the probability BELOW which diagnostic test will not be ordered or performed because the possibility of the diagnosis is so remote

49
Q

What is a treatment threshold?

A

The probability ABOVE which a diagnostic test will not be ordered or performed because the possibility of the diagnosis is so great that immediate treatment is indicated

50
Q

What is PEcO

A
  • Patient/Problem
  • Exposure: to the diagnostic test under consideration
  • c: rarely a comparison of multiple diagnostic tests ( can be with study clinical prediction rule)
  • Outcome: diagnosis or detection of the target diagnosis
51
Q

What is the gold standard study for a diagnostic test?

A

Cross-sectional study

52
Q

What is the basic structure of a diagnostic study?

A
  • Series of patients
  • Index test
  • Reference (gold) standard, - Compare the results of the index test with the reference standard (blinded)
53
Q

What is a true positive?

A

When a clinical test is positive and a condition is present

54
Q

What is a false positive?

A

When a clinical test is positive and a condition is absent

55
Q

What is a false negative?

A

When a clinical test is negative and a condition is present

56
Q

What is a true negative?

A

When a clinical test is negative and a condition is absent

57
Q

Key methodological aspects of a diagnostic study

A
  • Gold standard
  • Blinding
  • Spectrum of patients
  • Everybody should have both index test and gold standard test
58
Q

What is a spectrum bias?

A

a lack of sufficient heterogeneity of subjects

59
Q

What is a Work up/ verification bias?

A

a study that will distort properties of the proposed diagnostic test

60
Q

What are the three steps in appraising a diagnostic test?

A
  1. Are the results valid
  2. What are the results?
  3. Will they help care for my patient?
61
Q

What is the 2 by 2 table: sensitivity of a diagnostic accuracy?

A

The proportion of people with the disease that have a positive test result.

a/ a + c

A= true negative
C = false negative
62
Q

What are the important features of a 2 by 2 table that should be read?

A

Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio.

63
Q

What is the 2 by 2 table: specificity of a diagnostic accuracy?

A

The proportion of people without the disease who have a negative test result.

d/b+d

B = false positive
D = true negative
64
Q

Specificity is helpful for ______ the condition ( when test is positive)

A

ruling in

65
Q

Sensitivity is helpful for _______ the condition (when negative test)

A

ruling out

66
Q

What does SpPin stand for?

A

A test with HIGH specificity, that is positive, helps rule a condition In

67
Q

What does SnNout stand for?

A

A test with HIGH sensitivity, that is negative, helps rule a condition Out

68
Q

Postive and Negative predictive values look at…?

A

Positive: true positive & false positive

Negative: false negative and true negatives

69
Q

Why arent Postive and Negative predictive values really used anymore?

A

It is highly influenced by prevalence of condition

70
Q

What are likelihood ratios (LRs)?

A

The sensitivity information combined with specificity information

71
Q

What yields a posttest probability?

A

Pretest probability of having a condition combined with LR yields a post-test probability

72
Q

How is a nomogram used?

A
  1. The pre-test probability is estimated
  2. Test LR is obtained from an article
  3. Draw a line between the pretest and the LR, extending to the posttest probability
73
Q

Where does the pre-test probability value come from?

A
  • Intuition based on patient demographics and nature of patient’s complaint or clinical experience
  • Find published values for prevalence of the condition in a population of patients similar to your patient
74
Q

Standard interpretations of LRs

A
  • Small: rarely important: LR+ is between 1-2 & LR- is between 0.5-1
  • Small: sometimes important: LR+ is between 2-5, LR- is between 0.5-0.2
  • Moderate shift: LR+ is between 5-10, LR- is between 0.1-0.2
  • Large and often conclusive: LR+ > 10, LR- < 0.1
75
Q

Where to find sensitivity, specificity, and LRs?

A

Pubmed, EBP textbooks

76
Q

It is not really accurate to use LRs in series due to ____

A

Shared variance (overlap of prediction)

77
Q

What is the best way to deal with a continuous diagnostic test variable?

A

With a receiver operator characteristics (ROC) curve

78
Q

What is an ROC curve?

A

A curve that plots the probability of true positives (sensitivity) against probability of false positives (1-specificity) for all possible cut scores

79
Q

Area under curve (AUC) is

A

the overall measure of sensitivity, specificity

80
Q

What is a best cut score?

A

A score on the continuous scale that yields the highest true positive rate while still minimizing the false positive rate

81
Q

What is the process for a clinical decision development process?

A

Derivation study, validation studies, and impact analysis

82
Q

Steps of a derivation study

A
  1. Is a clinical decision instrument(CDI) needed or possible?
  2. will the CDI be simple or complex?
  3. coming up with candidate variables (the larger you have, the larger the population examined)
  4. Statistical analysis: Measure candidate variables in a population, and follow the population to determine outcomes
83
Q

Reasons to validate a CDI

A
  • Confirming results
  • Make sure that CDI works in a different population than the one used in the derivation study
  • Need to make sure that CDI can be collected properly
84
Q

How to validate a CDI?

A

Take the CDI, and apply to the population of patients for which it was intended then follow them forward to determine if the outcomes are diagnostic or prognostic

85
Q

Types of validation studies

A

Internal, external, narrow or diverse

86
Q

What is an internal validation study?

A

Studies that are usually done on the same population that was used for the derivation study

87
Q

What is an external validation study?

A

Studies that are done on a different population than that from the derivation study

88
Q

What is a narrow validation study?

A

Studies that involve a specific group of patients that may or may not reflect patients seen in practice.

89
Q

What is a diverse validation study?

A

Studies that involve a broader range of clinical situations

90
Q

Things to look for when reading a validation study

A
  • Make sure that patients were selected in a non-biased fashion
  • Make sure that whoever was using the clinical instrument don’t know the outcome of the patient (blinding)
  • Make sure that whoever is measuring the gold standard doesnt know the outcome.
  • Any subjective measures should have been shown to have good inter-rater reliability
  • Follow up: make sure that the researchers followed up with the participants of the study
91
Q

Reasons for an impact analysis

A
  • Make sure that the study works in a real world
  • Make sure that CDI does what its supposed to in the real world
  • Make sure that CDI is useable
92
Q

How to do an impact analysis

A
  • Randomization of clinicians/institutions to usual care (what they normally do) or to use the CDI, look at benefits harm, and cost of the CDI. (best one)
  • Non randomized design of looking at pre and post CDI. Can result in a bias

EBP 1 (5 decks)

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