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3034PHM Evidence Based Prac > Reviews and Guidelines EBP > Flashcards

Reviews and Guidelines EBP Flashcards

1
Q

What are the strongest forms of evidence?

A

Has at least one systematic review or at least 1 properly designed R.C.T.

Evidence from well designed trials w/out randomisation

Another way:

- cochrane systematic review
- Other syst review and meta analysis 
- evidence guidelines 
- evidence summaries
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2
Q

How do reviews help in evidence based decision making?

A

Summarising and synthesising evidence

Identifying best practices

Evaluating risk and benefit

Informing policy developments

Public engagement

Strengthening accountability

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3
Q

List the types of reviews within evidence synthesis

A

Narrative review

Scoping review

Systematic review

Systematic review - meta analysis

Rapid review

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4
Q

What are some pros/cons about a narrative review?

A

traditional

lacks structure and protocol

Opinion driven?

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5
Q

What are some pros/cons about a scoping review?

A

Useful when research area is broad and diverse

Maps and summarise breadth of literature

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6
Q

What does a systematic review do?

A

answer a specific RQ by rigorously identifying, appraising, synthesizing existing research studies that meet predefined criteria

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7
Q

What does a systematic -meta analysis review do?

A

Systematic review + generation of new data from collapsing primary studies data (meta analysis)

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8
Q

What is a rapid review?

A

accelerated form of evidence synthesis that aims to provide timely and relevant information to inform decision making

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9
Q

What are the 6 key steps to a systematic review process?

A

Plan = method, RQ, planning

Search

Screen

Evaluate

Analyse

Communicate

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10
Q

List the steps involved in the development of systematic review

A

State objective of review and outline eligibility criteria

comprehensively search for trials

Tabulate characteristics of each trial identified and assess method quality

Apply eligibility criteria and justify any exclusions

Analyse results of eligible RCT using statistical analysis synthesis of data

Provide interpretation of results, strength/limitation of included study

Prep critical summary of review, aims, describing material, report results

Prove implication of research and practice in conclusion

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11
Q

What is PRISMA?

A

“Preferred reporting item for systematic reviews and meta analysis”

tool used to develop and critically appraise the quality of a systematic/meta analysis review

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12
Q

List some data sources for writing systematic reviews

A

Medical database (medline, cochrane)

Other medical or paramedical databases

foreign language literature

grey literature = non-peer reviewed literature, theses, pharmaceutical industry files)

References listed in primary resources

Unpublished sources know to experts in the field

Raw data from published trials

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13
Q

List the forms of bias commonly seen in reviews

A

Language bias

Selection bias

Publication bias

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14
Q

What is language bias?

A

Using only articles published in the author’s primary language –> may affect results of review

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15
Q

What is selection bias in reviews?

A

Selective screening of studies for inclusion

How reduce = review authors should be blinded to: names of study authors (avoid political/personal issue), institution of publication, results of studies

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16
Q

What is publication bias?

A

Tendency for negative results to be unequally reported in literature

e.g. ADR excluded in an efficacy review

17
Q

What is a meta-analysis?

A

Combination and analysis of results from multiple independent studies on same topic, aim to provide more comprehensive and precise estimate of overall effect

Draws more reliable and generalisable conclusion than achieved by analysing each study individually

18
Q

What is a forest plot? What is it used for?

A

Its a graphical representation of different studies and determine whether there is a consistent effect across them

Allows for visual representation of results of multiple studies that investigate the same RQ

Also measures heterogeneity and variability

19
Q

What are the two stages in the development of a meta-analysis?

A

First stage = calc of a measure of treatment effect w/ 96% CI for each study, results used to measure odds ration, relative risk, and risk difference

Second stage = overall treatment effect is calculated as weighted average

20
Q

What do the black squares on a forest plot indicate?

A

Odds ration of individual studies

21
Q

What do the horizontal lines on a forest plot indicate?

A

the 95% CI of individual studies

22
Q

What does the area of the black squares on a forest plot indicate?

A

Reflects the weight each trial contributes in the meta analysis

23
Q

What do the solid vertical lines on a forest plot indicate?

A

Corresponds to no effect of treatment arm against control

24
Q

What does the diamond on the bottom of a forest plot indicate?

A

overall treatment effect from the meta-analysis summarises the CI

25
Q

What can be used to assess heterogeneity in a meta analysis?

A

Cochran Chi square (Cochran Q)

If cochrane Q/df (degrees of freedom) ratio is >1 = possible heterogeneity

If cochrane Q/df ratio <1 = heterogeneity very unlikely

26
Q

What are evidence based guidelines?

A

Utilise rigorous systematic process involving review and critical evaluation of med literature to develop final recommendation

27
Q

What is a consensus based guidelines?

A

Utilise experience of expert in practice area to draw conclusions and develop recommendations

Useful for orphan disease, incomplete info, non conclusive info to allow for final recommendation

28
Q

What are evidence and consensus based guidelines?

A

Mixed evidence based and consensus-based practice guideline uses evidence to construct guideline and supplement steps without evidence with experience of the experts

29
Q

List the steps involved in development of guidelines

A

Identification of therapeutic area

Formation of guideline development group

Systematic review of evidence

Formulation of clinical statement

Evidence grading

Development of recommendation and pilot run

External review and implementation of recommendations

Revision/updates

30
Q

Highlight some important points about the application of guidelines

A

Outdated after 2 yrs

Practice guidelines created for facilitating clinical decision making, improving QOH, providing consistent tx across environment

Important attributes = clinical applicability, validity, clinical flexibility, accessibility, clarity, multidisciplinary development process, documentation, scheduled review

3034PHM Evidence Based Prac (15 decks)

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