wk 1- research skills and EBP Flashcards
what is EBP ?
refer to the 3 legged stool
- best available research
- patient preferences and values
- clinical expertise
how to research
- clinical question
- acquire evidence through databases
- appraise the evidence for validity and relevance
- apply the evidence, clinical expertise and patients needs to their care plan
- evaluate the effectiveness of the outcome
hierachy of primary studies with strongest first
- RCT
- cohort study
- case control
- case series
- case report
hierachy of studies with strongest first
- systematic review
- critically appraised indivdual article
- RCT
- Cohort study
- case control study
- background info/expert opinion
what does PICO stand for
p- population/patient/problem
i- intervention
c- comparison
o-outcome
AND
search retrieves results with both words
OR
retrieves results with both, one and the other seperately also
what are examples of secondary literature
systematic reviews, EB summaries
what are examples of primary literature
clinical trials
what is an example of grey literature
professional body guidelines
appraising involves what steps
validity
reliability
clinical significance
applicability of results
CASP checklists
quantitative research questions aim to test
hypotheses and quantify relationships, differences or effects using numerical data
qualitative research questions aim to
explore and understand experiences, perceptions and meanings using non numerical data
difference of PICO question for qualitative questions v quantitative
quantitative- PICO
qualitative- PIC or SPICE
in pubmed using what will elimintate mesh terms from the search
“plantar fascitis”
quotation marks only looks for that exact word in papers
how would you search a result with plantar fascitis or plantar fasciopathy
“plantar” AND (“fascitis” OR “fasciopathy”)
how would you combine searches
11 AND #12
what is citation tracking
backward citation - references within papers searched
forward citation- google scholar/pubmed have cited by tabs
what is litmap
AI tool that helps link papers to relevant ones
inclusion criteria
characteristics the studies have to include to be considered for the review.
exclusion crtieria
characteristics which will exclude a study for the review
what shoould be captured in documenting a systematic search and review
-research question and inclusion/excusion criteria
-search terms/strategy
-databases searched and number of records retrieved from each
-how mnay duplicates
-screening process
-reason for exclusion
this can all be captured in a PRISMA flowchart
what is a critical appraisal tool for research to use
CASP checklist
critical appraisal tool for the body of research
GRADE approach
-risk of bias
-inconsistency
-indirectness
-imprecision
-publication bias
frameworks for evaluating AI
the ROBOT test
-reliability
-objective
-bias
-owner
-type
critical appraisal includes what steps
assessment papers for
- internal validity
- methological soundness
- risks of bias
- external validity
CASP checklist (ABCD)
A- are the results valid
B- is the study methologically sound
C- what are the results
D- are the results externally applicable?
to be included in a cochrane review database what do studies need to have for inclusion criteria
history
physical examination and
imaging diagnosis
what is an intention to treat analysis
once randomised into groups, they must be analysed in those groups, regardless of whether they dropped out or didnt adhere to the protocol
per protocol analysis
doesn’t include data from participants that withdraw, deviated, not in ideal conditions
focus’ on people who adhered to the protocol
provides insights to the treatment when followed as intended but introduces bias like excluding participants that may have responded differently, reducing sample size, doesn’t reflect real world experience
more risk factors or outcome measures you measure the more what?
false positives due to the chance related to p-value (1 in 20 risk factors to come up as statistical significant due to chance)
What is GRADE
CA tool used for systematic reviews or guidelines to assess the quality of evidence and recommend an intervention
GRADE reasons to downgrade
Risk of bias
-randomisation
-blinding
-allocation concealment
-intention to treat analysis
-drop outs/trial stopped
Inconsistency
Summary of findings:
-large variation in effect
-CI don’t overlap
-test for heterogeneity is p<0.05
-I2 value is large
Indirectness
-PICO of studies v PICO of research question- similar?
-intervention v comparison v intervention v control, intervention v control.
Imprecision
-wide confidence interval, does it cross line of null effect
-sample size
-number of events- too few
Publication bias
-negative results are unpublished
When to upgrade an observational study using GRADE
- Large effect in observational study
- Dose-response relationship
- Biases only reducing an apparent treatment effect
RCT is what quality of evidence in GRADE
HIGH
Observational study is what quality of evidence on GRADE
Low
Steps to GRADE
- Ranking
- Downgrading/upgrading
- Final grade (high, mod, low, very low)
- Factors affecting recommendation
- Recommendation made
