Reverse Yonkadonk Flashcards
- Critical problem solving2. Medical informatics3. Critical appraisal of med. literature
3 prong approach to EBM?
Ask for specific knowledge about managing Pts with a disorder
What are foreground questions?
- Formulate & ask a question2. Access the evidence3. Critically appraise the evidence4. Apply the evidence5. Assess the use of info. in practice
EBM prescription
- Texts2. Pharmaceutical texts3. Journals4. Drug company info.5. Self made info6. Other people
Where do we find info. for caring for Pts?
Systematic reviews
What is the best source of information?
- Improves confidence w/ decision-making2. Assists communication w/ Pts/other providers3. Dec. time wading through literature4. Fosters focused & productive reading habits5. Dovetails w/ technology (PDAs, electronic databases)
Advantages of EBM?
- Requires commitment in time & effort2. Not everyone is skilled at database searches3. Not everyone can afford resources4. Not everyone is skilled in appraising the literature5. Better know & choose reliable filters6. Good evidence not always out there7. Risks misinterpretation
Disadvantages of EBM?
- Etiology2. Diagnosis3. Therapy4. Prognosis
Kinds of clinical questions?
- Cohort2. Cross-sectional3. Case-control
Best type of study for etiology & diagnosis?
RCT
Best type of study for therapy?
- Cohort2. RCT
Best type of study for prognosis?
- Pt2. Intervention3. Comparison intervention4. Outcome
How do you ask a PICO question?
- Standardize practice while maintaining Pt centered core2. Promote life-long learning3. Response to practice variability4. Provide granularity on complex questions & gray areas
What does EBM serve to do?
Hill’s guidelines1. Strength of assoc.2. Consistency3. Specificity4. Time5. Biological gradient6. Biological plausibility7. Coherence w/ other data8. Analogy
What are the components of a causal relationship?
- Diseases commonly occur2. Uncommon manifestations of common diseases are more common that common manifestations of uncommon diseases3. No disease is rare to the Pt that has it
What are the 3 maxims of clinical decision making?
- DDx model2. Hypotheticodeductive model3. Exhaustive model4. Algorithmic model5. Heuristic model
What are the styles of clinical reasoning?
Hypotheticodeductive model Based on probability, comes w/ experience
What is the best style of clinical reasoning?
- Assumptions of objective findings2. Jumping to conclusions3. Personal biases4. What ?s you ask5. Your own risk taking nature
What are internal influences of medical decision making?
- Anatomical differences2. Diff. therapeutic responses 3. Pt biases & barriers 4. Co-worker biases
What are external influences of medical decision making?
P - Must followG - recommended to follow
Protocol vs. Guideline
- Know what you know2. Know what you don’t know3. Understand your scope4. Understand your pt (ex. insurance status)
When should you refer Pts?
- Intro2. Review of Related Medical Literature3. Methodology4. Results5. Summary/discussion
What are the sections of a research paper?
- Understand, explore & develop theory2. Describe & provide foundation3. Process of collecting/analyzing info to develop theoryMore focused on developing theory
What is basic research?
- Apply & test theory2. Predict, compare & explain cause3. Results either support or don’t support thoery4. Action research More focused on testing theory
What is applied research?
- Analyzing non-numerical data to answer questions2. Narrative data3. Less structured4. Fairly flexible 5. Design can evolve during study
Qualitative research
- Analyzing numerical data to answer questions2. Highly structured3. Very specific4. Strict rules/principles studies must adhere to
Quantitative research
Whole numbers
What is a discrete variable?
Any number
What is a continuous variable?
Numbers only used to differentiate subjectsCan’t do math on them
What is a nominal level of measurement?
Numbers are categories but they have an order ex. 1st, 2nd, 3rd
What is an ordinal level of measurement?
Ordered set of values w/ no absolute zero Differences btwn values is equalex. IQ scores
What is an interval level of measurement?
Ordered set of values w/ an absolute zero
What is a ratio level of measurement?
Either you have it or you don’tex. STD - yes or no
What is dichotomous data?
aka accuracyDoes study measure what it’s supposed to measure
What is validity?
Consistency of results to each other
What is reliability?
NO ma’am
Can you eliminate random error?
Sample may not be representative of population due to chance
What is sampling error?
Sample not representative cuz you messed up boiii
What is sampling bias?
A numerical value that describes a population
What is a parameter?
A numerical value that describes a sample
What is a statistic?
- Central tendency - mean, median, mode2. Variation - range, STDev, variance3. Relative position - %ranks, standard scores
What is descriptive statistics?
Belmont Report
Where did research ethics come from?
Accept null hypothesisNo significant difference p value shows strength of relationships - not cause
If p>alpha, what do you do?
Yelling fire when there isn’t fire Reject null hypothesis when it’s trueDec. by lowering the critical value
Type 1 error
Yelling fire when there IS a fireAccept null hypothesis when it’s false More serious errorDec. by inc. sample size
Type 2 error
Not statistically significant
If a CI for continuous data contains 0, what does that mean?
Not statistically significant
If a CI for ratios contain 1, what does that mean?
- Dec. Type 2 error2. Anticipate compliance & dropout3. Stratify data
Why is an adequate sample size important?
cohort
What type of study is best for rare exposures?
Variables that obscures the effect of another variable Form of bias
What are confounding variables?
Look at multiple variables/factors/parameters at once & adjust for their effects
What is the purpose of multivariate analysis?
Cross-sectional
Best test for descriptive studies?
Case control studies
What is the best test for rare diseases?
The probability of one event occurring over another OR = 1 no effectOR > 1 inc. oddsOR < 1 dec. odds, possible protective effect
What is an odds ratio?
- Rare diseases2. Explore multiple exposures3. Info. needed ASAP 4. Exposure data hard to obtain5. Little known about disease6. Long latency period7. Underlying population is dynamicWeaknesses:1. Bad for rare exposures2. Bias may be introduced b/c it’s retrospective3. Temporal relationships hard to determine
When to use case-controlled studies & weaknesses
- Risk/benefit2. Evidence quality3. Values & preferences4. Cost
Grading criteria
- Mean2. Median3. Mode
Central tendency
Compare 2 sets of observations in a single sample Tests the hypothesis that the mean diff. btwn 2 msmts is 0
When do you use paired t-test?
The linear relationship btwn 2 pairs of variables for quantitative data
What does the Pearson Correlation Coefficient tell you?
Test null hypthesis btwn 2 categorical vaiablescompare expected vs observed results
What does chi square tell you?
To compare more than 2 grous
When is ANOVA used?
Tukey’s test
How do you compare 2 means?
Compare 2 independent samples from the same population when the data are not normally distributed
What is Mann-Whitney U test?
When dealing w/ 1 nominal variable & 1 measureable variable & the data are not normally distributedNon-parametric analog to ANOCA
When is Kruskall-Wallace used?
= 1 no diff. in risk btwn groups> 1 inc. risks< 1 dec. risk
Risk ratios
- Only direct means to establish an absolute risk2. Unbiased measure of exposure3. Can assess relationship btwn single exposure & many diseases
Advantages of cohort studies
- Impractical for rare diseases where thousands required to be enrolled to get a few cases2. $$$ & time3. Can only assess 1 or few exposures at a time
Disadvantages of cohort studies
- Prognosis2. Etiology3. Prevention
When do you use cohort studies?
Proportion of people w/ disease who have a positive testFew false -
What is sensitivity?
Proportion of people w/o a disease who have a negative testFew false +
What is specificity?
+ How good a test is at ruling in diseaseLarger the number, better the test 10 is excelente 1 is useless- How good a test is at ruling out a disease
Likelihood ratios
Sensitivity, specifity, PPV
What tests can you calculate with prevalence of a disease?
- Sensitivity & specificity must be high2. Prevalence matters 3. A low cost conf. test must be avail.
3 rules for good screening tests
Sensitivity less false -
What does parallel testing inc?
Specificity
What does serial testing inc?
