WEEK 1-9 Flashcards
What is Evidence-based health care?
The contentious use of current best evidence in making decisions about the care of individual patients or the delivery of health care
What is “current best evidence”
Up to date information from relevant and valid research
What is evidence-based medicine
Means integrating the clinical expertise with the best available external clinical evidence from systematic research and patient values
What is evidence-based clinical practice?
Problem based approach, whereby research is used to inform clinical decision making
Why is EBP important?
Aims to provide the most effective care available and improve patient outcomes
5 main steps of EBP process
- Answerable question (develop)
- Best evidence (find info to answer question)
- Critically appraise (the evidence)
- Integrate (evidence into practice)
- Evaluate (how well you did in steps 1-4)
What is research
The systematic and rigorous process of enquiry which aims to describe phenomena and develop and test explanatory concepts and theories
What is critical appraisal
Process of deciding whether a piece of research will be useful to your practice
What are the 3 questions you need to ask about research
Is it valid?
Is it important?
Is it relevant?
Explain the systematic review process
- Develop review protocol
- Ask answerable questions
- Finding the evidence
- Appraising the evidence
- Judging the applicability of the evidence
What is qualitative research?
Examine a particular issue in terms of people’s feelings and values etc.
Explores the human subjective experience
What is the aim of taking a qualitative approach?
Aims to understand the world of the participants from their perspectives
What are the types of sampling?
Non-probability
Convenience sampling
Purposive sampling
Snowball sampling
Theoretical sampling
What is convenience sampling
People invited to participate because of convenience
What is purposive sampling
Participants recruited due to preselected criteria
2 types: quota sampling and maximum variation sampling
What is snowball sampling
Aka chain referral or networking
What is theoretical sampling
Mostly used in grounded theory
What are the 3 types of sampling criteria
Inclusion criteria
Exclusion criteria
Sample size
Data collection
Direct data
Indirect data
Data obtained through archives or internet
Examples of data collection in qualitative research
Interviews
Focus groups
Observation
Documents
2 methods of data analysis (qualitative)
Thematic
Coding and categorising
Advantages if qualitative research
Uses subjective info
Build new theories
In-depth examination of phenomena
Disadvantages of qualitative research
Subjectivity can lead to procedural problems
Difficult the replicate
Researcher bias is unavoidable
What are paradigms in research
The set of values, beliefs and practices that are/should be shared by the people conducting and appraising/judging research
What is quantitative research?
Measuring ‘stuff’
Using numbers and stats the can be used to describe, compare and correlate aspects of the issue
Examples of quantitative research data collection
Observation
Questionnaire
Physiological/biological measurement
What is a sample
Subset of the population that participate in a study
What are descriptive stats
Allow the researcher to describe, organise and summarise raw data
4 main measures of quantitative data
Mode - occurs most frequently
Median - middle
Mean - average
Normal distribution
What are inferential stats
Enable inferences and conclusions to be drawn from the data
Based on probability theory
Role of quantitative research in health care
Describes the size of issues
Describes relationships (causal links)
Compares and contrasts populations
Advantages of quantitative research
Objective
Ability to determine causality
Easy to replicate
Disadvantages of quantitative research
Doesn’t allow in-depth examination
Test theories rather than building new ones
Objectivity - di3snt allow for further examination of feelings etc.
Why is triangulation used
To provide data from two or more perspectives to increase understanding of topic of interest
What is a mixed methods study
Mixing two approaches within a study (qualitative and quantitative)
Provides greater depth of understanding
Why do we use mixed method studies
To achieve a deeper understanding
Limitation of mixed method studies
Time consuming
Resource intensive
What is a PICO question
Describes the elements of a well-formed clinical question
Works with experimental studies
What does PICO stand for
P = patient/problem I = intervention of interest C = comparison O = outcome
What is a PIO question
Describes the elements for a well formed question for qualitative studies
What does PIO stand for
P = population/patient I = intervention/exposure O = outcome OR Co = context
What is literature
Total body of writing the deals with the topic being researched
What is a literature review?
The act of reading, sorting and analysing the literature and putting it into some kind of order
Why review the literature?
Develop a comprehensive understanding of the topic
Narrow the scope of the topic for the study
Find out if it has been investigated in the past
Types of literature sources
Primary - written by the author
Secondary - referred to by another author
What is a systematic review
A high level overview of primary research on a particular question that trie to identify, select, synthesise and appraise all high quality research evidence relevant to that question in order to answer it
What is a population
All of the individuals the researchers are interested in studying
What is a sample
A subset of the overall population
Representation of the population
Possible problems with sampling process and outcomes
Subjects may fail to follow up or withdraw
Participants rate may be too low
Excluding/including criteria may narrow down the sample too much
Incomplete info may be collected
How do we measure/access rigor
Quantitative = reliability and validity Qualitative = different measures
What are the 2 types of validity (explain)
Internal validity - related to participants and research design
External validity - related to sampling plan and data collection instrument
What is reliability
Has to do with the accuracy and consistency of the measurement technique
What is a pilot study
A way to test the data collection tool on a small sample prior to the research
What is confirmability
Reflects objectivity in the study
Congruence between 2 or more independent people in terms of accuracy of data, relevance or meaning
What is authenticity
The extent to which researchers fairly and faithfully show a range of different realities
Qualitative research measures of rigor
Reliability
Validity
Objectivity
Research measure of Qualitative rigor (aka: trustworthiness)
Credibility Confirmability Authenticity Dependability Transferability
What are ethics
A branch of philosophy concerned with moral principles and values, with what ought to be the case and how people ought to live their lives
What is the framework for ethical research
Non-maleficence (do no harm)
Beneficence (do only good)
Respect for human dignity
Justice
UNESCO core principles
- Respect for autonomy and individual responsibility (informed consent)
- Respect for privacy, anonymity and confidentiality
- Respect for human vulnerability and personal integrity
- Respect for cultural diversity
What is anonymity
Mean that no person (not even the researchers) will be able to identify a on individual participating in the study
What is confidentiality
This means that the identities of the participants will not be linked to the information they provide
Ethics committees - what do they do
Consider research proposals prior to commencement
What are some codes and policies for research ethics in general?
Honesty Integrity Openness Legality Confidentiality Carefulness
What is clinical governance
A systematic and integrated approach to assurance and review of clinical responsibility and accountability that improves quality and safety resulting in optimal patient outcomes
Characteristics of high quality health care
Safe Efficient Person centred Evidence based Effective Accessible
4 pillars of clinical governance
Consumer value
Clinical performance and evaluation
Clinical risk
Professional development and management
Biggest impact of clinical governance
Positive change in people’s attitudes
Move towards a culture of enquiry
Critical requirements for successful clinical governance
Suppotive, open and inclusive culture
Active involvement from patients, carers and the public
Multidisciplinary teamwork
What are clinical audits
Method of evaluating and improving clinical practice
What is the aim of a clinical audit
To identify how close the current practice is to best practice
What are the steps in a clinical audit
Identify issue/problem
- Set criteria, define standards to be reviewed
- Collect data
- Compare performance against criteria and standards
- Implement change
- Repeat cycle
Barriers to dissemination and publication
Lack of confidence and experience Organisational restraints Fear of scrutiny Lack of time Structure Interactions
How to overcome barriers
Be confident Start small & work your way up Work with others Be patient Keep it simple and brief
What is inquiry
Rigorous and systematic thinking about professional practice, and the context in which it occurs
Three types of reflective practice
Reflect-for-practice
Reflect-in-practice
Reflect-on-practice
What is inquiry based health care
Involves a commitment to personal professional development
Includes developing and refining an inquiry toolbox. Of approaches and skills
What is a culture of inquiry
A culture that supports individuals in making decisions that are based upon finding and using the best available evidence and combining that with their clinical expertise and knowledge of the patient to guide decision making in health care
What is needed to build a culture of inquiry
Removal of well identified barriers
Capacity/resources
Structures, process and policies and are consistent with inquiry
