evidence based health care midterm

chapter 1: 14 (flashcards 1-14) chapter 2: 14 (flashcards 15-32) chapter 3: 13 (flashcards 33-45) chapter 4: 10 (flashcards 46-66) chapter 5: 9 (flashcards 67-83) 56 total (30 mc, 2 matching sets, 12 true/false)

evidence-based practice

integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances

tenets of evidence-based care

• patient values and circumstances

• research evidence

• clinical expertise

skills needed for evidence-based care

• ability to solve complex problems

• self-awareness

• self-direction

• active engagement

• commitment to lifelong learning

• increased humility

• decreased ego

primary literature

• publications by the original author of a study or opinion

• example: findings from an original research study in a biomedical journal

secondary literature

• involves interpretation, synthesis, or evaluation of primary sources

• example: typical college research papers

tertiary literature

• collection of primary and secondary sources

• examples: textbooks, media

biopsychosocial influences

• influences that impact a patient’s care that are not caused by the provider

• examples: culture, change readiness, politics

process of evidence-based care

• formulate a focused question

• locate relevant evidence

• appraise trustworthiness

• make collaborative patient-centered decision

• evaluate results of actions taken

surrogate outcomes

• indirect outcomes or “proxy measures” that are associated with a more direct physiological or biological clinical endpoint

• easier and cheaper

• example: cholesterol test gives cholesterol levels but no specific evidence of heart disease

outcomes that matter

• direct measures of function or disease

• can be difficult and expensive to collect

• example: results from diagnostic test or imaging

naturalistic evidence

• qualitative research

• may precede or succeed a positivistic study

• information is gathered via structured interviews and focus groups

• time-consuming, laborious, and tedious

positivistic evidence

• quantitative research

• holds the reality that is both external and internal

• aim is to measure reality via systematic observations in the form of the scientific method

• compute numerical values that represent phenomena

• can precede or succeed a qualitative study

levels of naturalistic evidence

• highest: evidence synthesis

• confirmatory or transferability studies

• theory construction research

• single group research

• single case research (biography)

• lowest: review articles or analysis of documentary resources

levels of positivistic evidence

• highest: synthesized summaries or guidelines with ratings

• meta-analyses

• systematic reviews

• randomized controlled trials

• cohort studies

• case-control studies

• case series

• case reports

• lowest: reviews, syntheses, opinions, laboratory research

research paradigm

• highest level of categorization applied to research

• multiple designs, temporal/time perspectives, and methodologies

• complement knowledge

goals of naturalistic research

• describe routine and problematic moments and meanings in individual’s lives

• aim to get a better understanding of their subject matter at hand

• make sense of phenomena in natural settings

ethnography

• a type of quantitative research

• prolonged observation, interpretation, and description of a cultural or social group or system

• the researcher is typically immersed in the group’s natural happenings

biography

• a type of quantitative research

• study of an individual and their experiences as told to the researcher or found in documents and archival materials

phenomenology

• a type of quantitative research

• study of the lived experiences of several individuals centered

case study/report

• a type of quantitative research

• exploration of a case or multiple cases that typically follow the course of an illness and patient responses to intervention

• done in healthcare all the time!

grounded theory

• study of abstract problems and their processes

• systematically applied a set of methods to generate an inductive theory

applications of naturalistic research

• exploring the impacts of illnesses and interventions on individuals and communities

• study interactions between providers and patients

• examine barriers to accessibility, affordability, policy or practice changes

• explore sociocultural factors influencing healthcare

• healthcare quality examinations

• study phenomena related to patient compliance or behavior change

• understanding consumer motivations to better align marketing of products

• analyzing client and provider behavior, patient satisfaction

scientific method

• important part of positivistic research

• must formulate a hypothesis, perform experiments based on that hypothesis then interpret the data from the experiments

categories of quantitative research

• experimental

• quasi-experimental

• observational

experimental research

• selects subjects from the entire population or randomly assign subjects into experimental groups and control groups

• differences are measured between groups to determine a relationship between variables

• control is a very important factor

quasi-experimental research

• studying phenomenon in which researchers cannot randomly select subjects or randomly assign

• researcher can control independent and dependent variables

• ranks lower on the positivistic evidence pyramid

observational research

• outcomes are measured without employing any type of intervention

• examples are epidemiological studies, case studies or correlational studies

• lower on the positivistic evidence pyramid

retrospective research

• type of positivistic research

• looks back in time to examine exposures and suspected risks related to the outcome of a study

cross-sectional research

• a type of positivistic research

• looks at data from a population at a specific point in time

prospective research

• a type of positivistic research

• when groups are followed over time and data about them is recorded when variables increase or decrease

limitations to positivistic research

• time

• cost

• generalizability

• hypothesis formulation can exclude important information'

• objectivity is difficult to determine

• biases in sampling and publication

applications of positivistic research

• determining prevalence and incidence of disease

• longevity of patients with and without treatment

• accuracy of diagnostic tools

• quality of life

• cost of care

• patient satisfaction

• many more

background questions

• those that ask for general knowledge about a condition, test or treatment

• first component is who/what/when/where/why/how and a verb

• second component is a disorder, test or treatment

foreground questions

• ask for specific knowledge to inform clinical decisions or actions

• essential components fall under either the PICO or PPAARE models

p in pico model

patient, population, predicament or problem

i in pico model

intervention, exposure, test or other agent

c in pico model

• comparison intervention, test, or other agent

• not always relevant

o in pico model

outcomes of clinical importance including time intervals when relevant

first p in ppaare model

problem

second p in ppaare model

patient or population

first a in ppaare model

action

second a in ppaare model

alternative

r in ppaare model

result

e in ppaare model

evidence

indexing a journal

• a way to measure the quality of a journal

• places where journals can be indexed include pubmed, cochrane library, etc

peer-reviewing a journal

• an academic term for quality control of a journal

• journal is sent to an editorial team, then to reviewers where a decision is made on whether the journal can be published or not

impact factor of a journal

• calculated based on the frequency of articles cited by authors in other journals in a given year

• measures relative importance of the journal

• higher impact factor means a more important journal

open-access of a journal

• whether or not a journal is free for all to read

• most free journals are good but some intentionally report inaccurate information

author guidelines of a journal

aspects that comment on the article type, structure of journal, and requirements for submission

publication bias

• when outcomes of a study bias whether or not the journal is published

• example of this is only publishing journals that show significant results

trustworthiness of quantitative research

• whether or not a journal is worthy of being used in the decision-making process

• based on internal/external validity, reliability and objectivity

internal validity

• can be checked in the methods section

• how closely the study design, sampling procedures, instrumentation, and statistical analysis accurately measure the outcomes

external validity

• can be checked in the methods section

• determines if the findings are generalizable, if the sampling procedure was randomized, or if there are clinically relevant procedures

relationship between internal and external validity

• when internal validity increases, the external validity decreases

• when external validity increases, the internal validity decreases

• can be impacted by

reliability

• based on the consistency and reproducibility of the data collection procedures

• assesses the amount of error that can occur in a study

objectivity

• assesses whether the researcher is unbiased, honest, and precise

• can be increased by using a collaborative research term, blinding techniques and decreasing conflicts of interest

critical appraisal

systematic evaluation of a study’s question, methods, results and applicability

trustworthiness of a qualitative study

• whether or not a journal is worthy of being used in the decision-making process

• measured by credibility, transferability, dependability and objectivity

credibility

• how credible the data is

• can be increased by having prolonged engagement, persistent observation, having peer reviewers and triangulating the data

prolonged engagment

when researchers collect data over a long period of time

persistent observation

researcher collects data in an extended and immersed manner

triangulation

using multiple participants, multiple methods, multiple researchers, and multiple theoretical frameworks to have well-rounded research

transferability

• measures if the data can be put into the reader’s context

• example: direct quotes from participants

dependability

• measures if the data and researcher interpretations are dependable

• revealing the audit process increases this

things to consider during decision-making

• authors and sources of evidence

• level of evidence

• publication dates of evidence

• benefits of the alternative suggested

• potential side effects of the action or alternative

• consistent outcomes in literature

• relevancy of the literature

how decisions should be made

• using the best available evidence

• patient-centered

independent variable

• variable being hypothesized to influence or affect the main outcomes

• example is time

dependent variable

• variable that is dependent on the changes made to the hypothesized variable

• example is prevalence

nominal data

• categorical data that must fall into one category

• example is gender

ordinal data

• categorical data that is ordered or ranked

• example is placement in a race

interval data

• categorical data that is in order and data points have equal distances between the categories

• example is SAT or GRE scores

ration data

• categorical data that is in order and data points have equal distance between them as well as a meaningful zero

• example is weight

ways to describe a categorical variable

• frequencies

• using crosstabs

single blinding

participants are blind, the researcher and analysts are not

double blinding

the participants and researchers are blind, the analysts are not

triple blinding

everyone is blind (participants, researchers, analysts)

types of interventions

• treatment

• placebo

p-value

• the probability that the point estimate represents a normal variation

• compared to the predetermined alpha level

p-value < 0.05

data is statistically significant and null hypothesis should be rejected

p-value > 0.05

data is not statistically significant and null hypothesis should not be rejected

standard error of measurement (sem)

an estimate of the expected error of measurement

minimal detectable change

• extension of the standard error of measurement

• interpreted as the boundaries of measurement error

effect size

• statistic that informs clinical meaningfulness

• “how large or small a difference did the intervention produce between the treatment and control groups?”