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EBM > Yonkadonk > Flashcards

Yonkadonk Flashcards

1
Q

3 prong approach to EBM?

A
  1. Critical problem solving
  2. Medical informatics
  3. Critical appraisal of med. literature
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2
Q

What are foreground questions?

A

Ask for specific knowledge about managing Pts with a disorder

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3
Q

EBM prescription

A
  1. Formulate & ask a question
  2. Access the evidence
  3. Critically appraise the evidence
  4. Apply the evidence
  5. Assess the use of info. in practice
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4
Q

Where do we find info. for caring for Pts?

A
  1. Texts
  2. Pharmaceutical texts
  3. Journals
  4. Drug company info.
  5. Self made info
  6. Other people
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5
Q

What is the best source of information?

A

Systematic reviews

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6
Q

Advantages of EBM?

A
  1. Improves confidence w/ decision-making
  2. Assists communication w/ Pts/other providers
  3. Dec. time wading through literature
  4. Fosters focused & productive reading habits
  5. Dovetails w/ technology (PDAs, electronic databases)
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7
Q

Disadvantages of EBM?

A
  1. Requires commitment in time & effort
  2. Not everyone is skilled at database searches
  3. Not everyone can afford resources
  4. Not everyone is skilled in appraising the literature
  5. Better know & choose reliable filters
  6. Good evidence not always out there
  7. Risks misinterpretation
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8
Q

Kinds of clinical questions?

A
  1. Etiology
  2. Diagnosis
  3. Therapy
  4. Prognosis
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9
Q

Best type of study for etiology & diagnosis?

A
  1. Cohort
  2. Cross-sectional
  3. Case-control
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10
Q

Best type of study for therapy?

A

RCT

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11
Q

Best type of study for prognosis?

A
  1. Cohort

2. RCT

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12
Q

How do you ask a PICO question?

A
  1. Pt
  2. Intervention
  3. Comparison intervention
  4. Outcome
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13
Q

What does EBM serve to do?

A
  1. Standardize practice while maintaining Pt centered core
  2. Promote life-long learning
  3. Response to practice variability
  4. Provide granularity on complex questions & gray areas
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14
Q

What are the components of a causal relationship?

A

Hill’s guidelines

  1. Strength of assoc.
  2. Consistency
  3. Specificity
  4. Time
  5. Biological gradient
  6. Biological plausibility
  7. Coherence w/ other data
  8. Analogy
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15
Q

What are the 3 maxims of clinical decision making?

A
  1. Diseases commonly occur
  2. Uncommon manifestations of common diseases are more common that common manifestations of uncommon diseases
  3. No disease is rare to the Pt that has it
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16
Q

What are the styles of clinical reasoning?

A
  1. DDx model
  2. Hypotheticodeductive model
  3. Exhaustive model
  4. Algorithmic model
  5. Heuristic model
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17
Q

What is the best style of clinical reasoning?

A

Hypotheticodeductive model

Based on probability, comes w/ experience

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18
Q

What are internal influences of medical decision making?

A
  1. Assumptions of objective findings
  2. Jumping to conclusions
  3. Personal biases
  4. What ?s you ask
  5. Your own risk taking nature
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19
Q

What are external influences of medical decision making?

A
  1. Anatomical differences
  2. Diff. therapeutic responses
  3. Pt biases & barriers
  4. Co-worker biases
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20
Q

Protocol vs. Guideline

A

P - Must follow

G - recommended to follow

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21
Q

When should you refer Pts?

A
  1. Know what you know
  2. Know what you don’t know
  3. Understand your scope
  4. Understand your pt (ex. insurance status)
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22
Q

What are the sections of a research paper?

A
  1. Intro
  2. Review of Related Medical Literature
  3. Methodology
  4. Results
  5. Summary/discussion
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23
Q

What is basic research?

A
  1. Understand, explore & develop theory
  2. Describe & provide foundation
  3. Process of collecting/analyzing info to develop theory

More focused on developing theory

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24
Q

What is applied research?

A
  1. Apply & test theory
  2. Predict, compare & explain cause
  3. Results either support or don’t support thoery
  4. Action research

More focused on testing theory

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25
Q

Qualitative research

A
  1. Analyzing non-numerical data to answer questions
  2. Narrative data
  3. Less structured
  4. Fairly flexible
  5. Design can evolve during study
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26
Q

Quantitative research

A
  1. Analyzing numerical data to answer questions
  2. Highly structured
  3. Very specific
  4. Strict rules/principles studies must adhere to
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27
Q

What is a discrete variable?

A

Whole numbers

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28
Q

What is a continuous variable?

A

Any number

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29
Q

What is a nominal level of measurement?

A

Numbers only used to differentiate subjects

Can’t do math on them

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30
Q

What is an ordinal level of measurement?

A

Numbers are categories but they have an order

ex. 1st, 2nd, 3rd

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31
Q

What is an interval level of measurement?

A

Ordered set of values w/ no absolute zero

Differences btwn values is equal

ex. IQ scores

32
Q

What is a ratio level of measurement?

A

Ordered set of values w/ an absolute zero

33
Q

What is dichotomous data?

A

Either you have it or you don’t

ex. STD - yes or no

34
Q

What is validity?

A

aka accuracy

Does study measure what it’s supposed to measure

35
Q

What is reliability?

A

Consistency of results to each other

36
Q

Can you eliminate random error?

A

NO ma’am

37
Q

What is sampling error?

A

Sample may not be representative of population due to chance

38
Q

What is sampling bias?

A

Sample not representative cuz you messed up boiii

39
Q

What is a parameter?

A

A numerical value that describes a population

40
Q

What is a statistic?

A

A numerical value that describes a sample

41
Q

What is descriptive statistics?

A
  1. Central tendency - mean, median, mode
  2. Variation - range, STDev, variance
  3. Relative position - %ranks, standard scores
42
Q

Where did research ethics come from?

A

Belmont Report

43
Q

If p>alpha, what do you do?

A

Accept null hypothesis

No significant difference

p value shows strength of relationships - not cause

44
Q

Type 1 error

A

Yelling fire when there isn’t fire

Reject null hypothesis when it’s true

Dec. by lowering the critical value

45
Q

Type 2 error

A

Yelling fire when there IS a fire

Accept null hypothesis when it’s false

More serious error
Dec. by inc. sample size

46
Q

If a CI for continuous data contains 0, what does that mean?

A

Not statistically significant

47
Q

If a CI for ratios contain 1, what does that mean?

A

Not statistically significant

48
Q

Why is an adequate sample size important?

A
  1. Dec. Type 2 error
  2. Anticipate compliance & dropout
  3. Stratify data
49
Q

What type of study is best for rare exposures?

A

cohort

50
Q

What are confounding variables?

A

Variables that obscures the effect of another variable

Form of bias

51
Q

What is the purpose of multivariate analysis?

A

Look at multiple variables/factors/parameters at once & adjust for their effects

52
Q

Best test for descriptive studies?

A

Cross-sectional

53
Q

What is the best test for rare diseases?

A

Case control studies

54
Q

What is an odds ratio?

A

The probability of one event occurring over another

OR = 1 no effect
OR > 1 inc. odds
OR < 1 dec. odds, possible protective effect

55
Q

When to use case-controlled studies & weaknesses

A
  1. Rare diseases
  2. Explore multiple exposures
  3. Info. needed ASAP
  4. Exposure data hard to obtain
  5. Little known about disease
  6. Long latency period
  7. Underlying population is dynamic

Weaknesses:

  1. Bad for rare exposures
  2. Bias may be introduced b/c it’s retrospective
  3. Temporal relationships hard to determine
56
Q

Grading criteria

A
  1. Risk/benefit
  2. Evidence quality
  3. Values & preferences
  4. Cost
57
Q

Central tendency

A
  1. Mean
  2. Median
  3. Mode
58
Q

When do you use paired t-test?

A

Compare 2 sets of observations in a single sample

Tests the hypothesis that the mean diff. btwn 2 msmts is 0

59
Q

What does the Pearson Correlation Coefficient tell you?

A

The linear relationship btwn 2 pairs of variables for quantitative data

60
Q

What does chi square tell you?

A

Test null hypthesis btwn 2 categorical vaiables

compare expected vs observed results

61
Q

When is ANOVA used?

A

To compare more than 2 grous

62
Q

How do you compare 2 means?

A

Tukey’s test

63
Q

What is Mann-Whitney U test?

A

Compare 2 independent samples from the same population when the data are not normally distributed

64
Q

When is Kruskall-Wallace used?

A

When dealing w/ 1 nominal variable & 1 measureable variable & the data are not normally distributed

Non-parametric analog to ANOCA

65
Q

Risk ratios

A

= 1 no diff. in risk btwn groups
> 1 inc. risks
< 1 dec. risk

66
Q

Advantages of cohort studies

A
  1. Only direct means to establish an absolute risk
  2. Unbiased measure of exposure
  3. Can assess relationship btwn single exposure & many diseases
67
Q

Disadvantages of cohort studies

A
  1. Impractical for rare diseases where thousands required to be enrolled to get a few cases
  2. $$$ & time
  3. Can only assess 1 or few exposures at a time
68
Q

When do you use cohort studies?

A
  1. Prognosis
  2. Etiology
  3. Prevention
69
Q

What is sensitivity?

A

Proportion of people w/ disease who have a positive test

Few false -

70
Q

What is specificity?

A

Proportion of people w/o a disease who have a negative test

Few false +

71
Q

Likelihood ratios

A

+ How good a test is at ruling in disease
Larger the number, better the test
10 is excelente
1 is useless

  • How good a test is at ruling out a disease
72
Q

What tests can you calculate with prevalence of a disease?

A

Sensitivity, specifity, PPV

73
Q

3 rules for good screening tests

A
  1. Sensitivity & specificity must be high
  2. Prevalence matters
  3. A low cost conf. test must be avail.
74
Q

What does parallel testing inc?

A

Sensitivity

less false -

75
Q

What does serial testing inc?

A

Specificity

EBM (3 decks)

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