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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
Qualitative research
1. Analyzing non-numerical data to answer questions 2. Narrative data 3. Less structured 4. Fairly flexible 5. Design can evolve during study
26
Quantitative research
1. Analyzing numerical data to answer questions 2. Highly structured 3. Very specific 4. Strict rules/principles studies must adhere to
27
What is a discrete variable?
Whole numbers
28
What is a continuous variable?
Any number
29
What is a nominal level of measurement?
Numbers only used to differentiate subjects Can't do math on them
30
What is an ordinal level of measurement?
Numbers are categories but they have an order ex. 1st, 2nd, 3rd
31
What is an interval level of measurement?
Ordered set of values w/ no absolute zero Differences btwn values is equal ex. IQ scores
32
What is a ratio level of measurement?
Ordered set of values w/ an absolute zero
33
What is dichotomous data?
Either you have it or you don't ex. STD - yes or no
34
What is validity?
aka accuracy Does study measure what it's supposed to measure
35
What is reliability?
Consistency of results to each other
36
Can you eliminate random error?
NO ma'am
37
What is sampling error?
Sample may not be representative of population due to chance
38
What is sampling bias?
Sample not representative cuz you messed up boiii
39
What is a parameter?
A numerical value that describes a population
40
What is a statistic?
A numerical value that describes a sample
41
What is descriptive statistics?
1. Central tendency - mean, median, mode 2. Variation - range, STDev, variance 3. Relative position - %ranks, standard scores
42
Where did research ethics come from?
Belmont Report
43
If p>alpha, what do you do?
Accept null hypothesis No significant difference p value shows strength of relationships - not cause
44
Type 1 error
Yelling fire when there isn't fire Reject null hypothesis when it's true Dec. by lowering the critical value
45
Type 2 error
Yelling fire when there IS a fire Accept null hypothesis when it's false More serious error Dec. by inc. sample size
46
If a CI for continuous data contains 0, what does that mean?
Not statistically significant
47
If a CI for ratios contain 1, what does that mean?
Not statistically significant
48
Why is an adequate sample size important?
1. Dec. Type 2 error 2. Anticipate compliance & dropout 3. Stratify data
49
What type of study is best for rare exposures?
cohort
50
What are confounding variables?
Variables that obscures the effect of another variable | Form of bias
51
What is the purpose of multivariate analysis?
Look at multiple variables/factors/parameters at once & adjust for their effects
52
Best test for descriptive studies?
Cross-sectional
53
What is the best test for rare diseases?
Case control studies
54
What is an odds ratio?
The probability of one event occurring over another OR = 1 no effect OR > 1 inc. odds OR < 1 dec. odds, possible protective effect
55
When to use case-controlled studies & weaknesses
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
Grading criteria
1. Risk/benefit 2. Evidence quality 3. Values & preferences 4. Cost
57
Central tendency
1. Mean 2. Median 3. Mode
58
When do you use paired t-test?
Compare 2 sets of observations in a single sample Tests the hypothesis that the mean diff. btwn 2 msmts is 0
59
What does the Pearson Correlation Coefficient tell you?
The linear relationship btwn 2 pairs of variables for quantitative data
60
What does chi square tell you?
Test null hypthesis btwn 2 categorical vaiables compare expected vs observed results
61
When is ANOVA used?
To compare more than 2 grous
62
How do you compare 2 means?
Tukey's test
63
What is Mann-Whitney U test?
Compare 2 independent samples from the same population when the data are not normally distributed
64
When is Kruskall-Wallace used?
When dealing w/ 1 nominal variable & 1 measureable variable & the data are not normally distributed Non-parametric analog to ANOCA
65
Risk ratios
= 1 no diff. in risk btwn groups > 1 inc. risks < 1 dec. risk
66
Advantages of cohort studies
1. Only direct means to establish an absolute risk 2. Unbiased measure of exposure 3. Can assess relationship btwn single exposure & many diseases
67
Disadvantages of cohort studies
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
When do you use cohort studies?
1. Prognosis 2. Etiology 3. Prevention
69
What is sensitivity?
Proportion of people w/ disease who have a positive test Few false -
70
What is specificity?
Proportion of people w/o a disease who have a negative test Few false +
71
Likelihood ratios
+ 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
What tests can you calculate with prevalence of a disease?
Sensitivity, specifity, PPV
73
3 rules for good screening tests
1. Sensitivity & specificity must be high 2. Prevalence matters 3. A low cost conf. test must be avail.
74
What does parallel testing inc?
Sensitivity | less false -
75
What does serial testing inc?
Specificity

EBM (3 decks)

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