skeptic and ebp

Question 1

What is skepticism?

Answer 1

Self-questioning, holding tentative conclusions and being open to changing ones view
Undogmatic
Open to change from good quality evidence

Question 2

What is EBP?

Answer 2

Evidence based practice: use of current best evidence whenever making decisions about the patients care
Promotes connection between scientific research and:
1) the individual clinical practice (clinical expertise)
2) Patient values (choices)

Question 3

What is efficacy?

Answer 3

Describes the capacity of a particular therapy to provide a desired effect.
Plausibility - Does is work in the lab?
“Can it work?”

Question 4

What is effectiveness?

Answer 4

How well the therapy works in actual practice

“Does it work in the real world?”

Question 5

An example of efficacy vs. effectiveness

Answer 5

DMs often show excellent benefit in lab tests in anechoic chambers BUT when used in a real restaurant setting factors such as reverb etc mean that the intervention shows only moderate effectiveness at best

Question 6

Efficiency

Answer 6

Is a treatment worth the cost?

In HAs case - financial/cosmetic etc.

Question 7

Mr X has severe mixed hearing loss bilaterally.

What HA style would be most appropriate for him?

Answer 7

Ultra-power BTE with occluding soft mould

- needs lots of output

Question 8

What if someone who needs a powerful HA won’t wear it for cosmetic reasons, what would you do?

Answer 8

1) effective counselling - provide evidence
2) ensure he is aware of what he will be compromising
3) suggest a trial of both?

As long as he has made conformed consent then we have done our job

Question 9

6 Steps to EBP

Answer 9

1) ASK - a focussed question
2) ACCESS - epidemiological evidence
3) APPRAISE - evidence for validity/effect size/precision
4) AGGREGATE - evidence with client/community, clinical/health and policy issues and make evidence based decision
5) APPLY - your decision
6) AUDIT - your pratice

Question 10

5 Steps of Quality Improvement/AUDIT

Answer 10

1) ASCERTAIN: Determine best practice
2) sURVEY: Assess current practice (survey)
3) DELINEATE: Compare with best practice - is there a gap?
4) IDENTIFY: Consider reasons for gap, identify processes to reduce gap and implement
5) TRY AGAIN: Re-survey: is there any improvement?

Question 11

Critiques of EBP

Answer 11

1) Promotes cookbook practice (not good critique)
2) Ignores individual/individual difference (not good critique)
3) Allows opportunity for political and managerial interference
4) A means of cost cutting
5) Too narrow a definition, denigrates non-randomised and observational research (what would be best? double blind, randomly assigned, peer reviewed, systematic) Just puts them in their place
6) Too much evidence to take in (Plausible critique)
7) Not enough research published in the particular field
8) Ignores prior plausibility and is too focused on empiricism

Question 12

What is science based practice?

Answer 12

Use of best scientific evidence available in light of cumulative scientific knowledge from all relevant disciplines

Question 13

What are the 3 factors noted by Ioannidis (2005) that cause most published research to be false rather than true?

Answer 13

1) Prior probability that it is true (plausibility)
2) Statistical power of the study (design)
3) The level of stat significance (how big was the effect)

Question 14

A study is less likely to be “true” when:

Answer 14

1) Few studies on the same topic
2) Size of the study is small
3) Effect size is small
4) Data Mining (greater number and less pre-selected variable are tested)
5) Greater flexibility of the study design, definitions or outcome measures
6) Greater financial and interests or prejudice
7) More teams competing to find a significant result

Question 15

What to do with plausible vs. implausible evidence?

Answer 15

Plausible claim - EBP

Less plausible claim - SBP

Question 16

What are 9 of the things that can influence our interpretation of evidence?

Answer 16

1) Self-confirming bias
2) Okham’s Razor
3) False dichotomy
4) File-drawer effect
5) Begging the question/Tautology
6) Argument from authority/antiquity
7) Ad Hominem argument (personal attack)
8) Argument from personal incredulity
9) Correlation does not equal causation and post hoc-ergo propter hoc

Question 17

Okham’s (Occam’s) Razor

Answer 17

Obliges us to favour, among otherwise equivalent theories or hypotheses, those that make the fewest unwarranted assumptions.
Not scientific law just a heuristic rule of thumb

Question 18

False Dichotomy

Answer 18

Arbitrarily reducing a large number of possible answers to a choice between the two

Also false continuum - e.g. no such thing as mental illness because everyone has some level of depression/anxiety etc.

Question 19

File Drawer Effect

Answer 19

The tendency not to publish negative results

Question 20

Begging the question/Tautology

Answer 20

When the conclusion is also the premise of the argument

Circular reasoning

Question 21

Argument from authority

Answer 21

A premise is said to be true because someone you look up to said it

Another is argument from antiquity - people have been doing it for thousands of years hence there must be something to it

Question 22

Ad Hominem

Answer 22

Attacks a person rather than the argument

Question 23

Argument from personal incredulitiy

Answer 23

arguing that because someone can not imagine how argument “a” could be true then it must be false

Question 24

Non Sequitur

Answer 24

Claim does not follow from the premise of the argument

Question 25

Special pleading

Answer 25

attempt to circumvent normal rules or conventions without any logical justification

Question 26

Cheerleader Effect

Answer 26

Try harder when encouraged

Question 27

Hawthorne Effect

Answer 27

Observing produces changes in behaviour

Question 28

The Placebo effect is a combination of:

Answer 28

1) Illusions of observation: regression to the mean
2) Bias: researcher and participant
3) Non-specific effects: Cheerleader effect, hawthorne effect
4) Physiological effects: relaxing during the treatment, pleasant conversation, mood changes etc.

Question 29

Argumentum ad populum

Answer 29

Argument from popularity

taking the fact that an opinion has been widely held is a reason to consider it as evidence

Question 30

Special Pleading

Answer 30

Arguments that attempt to circumvent normal rules or conventions without any logical justification

Question 31

Naturalistic Fallacy

Answer 31

“our HAs were designed to mimic the function of the human ear…”

Question 32

What is Science/the Scientific Method?

Answer 32

A system by which we acquire reliable knowledge
Reliable knowledge is that which has a high probability of being true
Use observable, empirical, and measurable evidence (subject to principles, logic, reason and skepticism) to construct models
Make predictions which can be falsified
emphasis on objectivity to reduce bias