EBP Final Exam

1. ___ is a field that focuses on the interplay of human behavior and the environment related to health outcomes, problems of disease, and disease control. It addresses the spatial context of health-related issues; specifically the location of disease occurrence and contributing environmental factors.

a. Health Demography

b. Epidemiology

c. Medical Geography

d. Ethnography

e. Public Health

c. Medical Geography

2. ___ Is a theory that explains disease outbreak in terms of the relationships and interactions between the host, the agent, and the environment.

a. Case Definition

b. Screening

c. Disease Surveillance

d. Common Source Outbreak

e. Epidemiologic Triad

a. Case Definition

3. ___ is the event rate among those exposed to a factor divided by the event rate among those not exposed to the same factor.

a. Odds Ratio

b. Relative Risk

c. Relative Risk Reduction

d. Attack Rate

e. Absolute Risk

b. Relative Risk

4. ___ is the study of diseases in populations and the evaluation of interventions at a population level, as a method of solving the problems of diseases in individuals.

a. Epidemiology

b. Biomedical research

c. Public health

d. Endemic

e. Evidence-based practice

a. Epidemiology

5. ___ provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, the program has established benchmarks and monitored progress over time in order to: encourage collaborations across communities and sectors; empower individuals to make informed health decisions; and, measure the impact of prevention activities.

a. The Healthy People initiative

b. The Web of Causation

c. The Bradford Hill Institute

d. The US Preventive Services Task Force

e. The US Department of Health and Human Services

a. The Healthy People initiative

6. ___ refers to determining the factors that predispose someone to a specific disease.

a. Disease classification

b. Etiology

c. Risk identification

d. Differential diagnosis

e. Surveillance

c. Risk identification

7. When an exposure increases risk, it is referred to as _________________

a. point estimate

b. absolute risk reduction

c. attributable risk percent

d. absolute risk increase

d. absolute risk increase

8. Odds ratio is a measure of association that is calculated in _____________ studies.

a. case-control

b. cross-sectional

c. case report

d. cohort

a. case-control

9. ___________________ is the ability of the test to be positive given that the person tested has the disease/problem. It refers to the proportion of subjects with a given disorder who test positive for a specified disease, exposure, or risk factor.

a. Positive predictive value

b. Sensitivity

c. Specificity

d. Negative predictive value

b. Sensitivity

10. What is the name of the biomedical ethics document created by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and published in 1979?

a. The National Research Act

b. The Belmont Report

c. FDA Biomedical Research Guidance

d. The Tuskegee Proclamation

e. The Declaration of Helsinki

b. The Belmont Report

1. __ is the ability of a test to be negative given the person does not have the disease.

a. Specificity

b. Defensive medical practice

c. Gold standard

d. Sensitivity

e. Standard of care

a. Specificity

2. Which of the following four statistics can be computed using a 2x2 contingency table?

1. PPV

2. NPV

3. Sensitivity

4. Specificity

Select one:

a. Only sensitivity and specificity can be computed with a 2x2 contingency table, not PPV or NPV

b. Only PPV can be computed with a 2x2 contingency table

c. Only NPV and PPV can be computed with a 2x2 contingency table, not sensitivity or specificity

d. Only Specificity can be computed with a 2x2 contingency table

e. Sensitivity, Specificity, NPV, and PPV can all be computed with a 2x2 contingency table

e. Sensitivity, Specificity, NPV, and PPV can all be computed with a 2x2 contingency table

3. A reference standard test to which new diagnostic tests are compared, is also known as a

a. Sensitivity

b. Standard of care

c. Gold standard

d. Specificity

e. Defensive medical practice

c. Gold standard

4. The sensitivity of a new diagnostic tool was reported to be 92% (95% CI, 88 to 96). Considering the information provided by the confidence interval, identify the correct statement regarding the sensitivity scores.

a. 95% of the sensitivity scores were 92%

b. 100% of the sensitivity scores fell between the range of 88% and 96%

c. 92% of the sensitivity scores fell between the range of 88% and 96%

d. There is an 8% chance that the true value for sensitivity is outside the range of 88% and 96%

e. 95% of the time the sensitivity scores fell between the range of 88% and 96%

e. 95% of the time the sensitivity scores fell between the range of 88% and 96%

5. ___ is the degree to which patients are able to sustain a treatment regimen according to how it was prescribed.

a. Relative Risk

b. Interaction

c. Contraindication

d. Side-effect

e. Adherence

e. Adherence

6. A differential diagnosis requires a healthcare practitioner to

a. Use pertinent negatives

b. Make a determination of a disease from two or more choices

c. Collect data from the patient through a history and physical exam

d. Conduct laboratory tests for diagnostic purposes

e. Collect data from imaging

b. Make a determination of a disease from two or more choices

7. An unanticipated problem that arises from having a diagnostic procedure is called a

a. Side effect

b. Indication

c. Contraindication

d. Harmful effect

e. Complication

e. Complication

8. The excessive use of diagnostic procedures to avoid medical malpractice is known as

a. Gold standard

b. Sensitivity

c. Defensive medical practice

d. Specificity

e. Standard of care

c. Defensive medical practice

9. A odds ratio (OR) greater than 1.0 means

Select one:

a. cannot be determine. An OR cannot be above 1.0

b. the odds are decreased

c. the odds are increased

d. the intervention was harmful to the treatment group

e. the odds are the same

c. the odds are increased

10. The usual practice by clinicians in the community or region is known as

a. Gold standard

b. Specificity

c. Sensitivity

d. Standard of care

e. Defensive medical practice

d. Standard of care

1. Treatment is ___ when it is utilized to intervene in an existing disease process or condition.

a. therapeutic

b. competent

c. remedial

d. evidence-based

e. preventive

c. remedial

2. ___ is the ability of an intervention to produce the desired beneficial effect.

a. efficacy

b. indication

c. interaction

d. compliance

e. adherence

a. efficacy

3. ___ are adverse events that have been identified as potentially associated with a given treatment and are closely monitored and reported.

a. Serious Adverse Events

b. Complications

c. Confounding factors

d. Adverse Events of Special Interest

e. Morbidities

d. Adverse Events of Special Interest

4. ___ are the circumstances in which a given treatment should not be used.

a. Defensive medical practices

b. Complications

c. Contraindications

d. Pertinent negatives

e. Serious adverse events

c. Contraindications

5. Studies on ___ explore questions such as identification of ___ strategies, evaluation of ___ strategies and programs, efficacy of screening modalities, and the necessity for population screening. [The same word goes in all three blanks.]

a. prognosis

b. epidemiology

c. prevention

d. harm

e. treatment

c. prevention

6. A(n) ___ is when one treatment reduces the effect of another treatment.

Select one:

a. temporal impact

b. administration effect

c. adherence problem

d. dosage effect

e. negative interaction

e. negative interaction

7. The minimum threshold for treatment effects to be considered meaningful is referred to as ___.

a. Contraindications

b. the WOMAC scale

c. Surrogate Outcomes

d. Indications

e. Minimal Clinically Important Differences

e. Minimal Clinically Important Differences

8. ___ are end points that are intended to be directly impacted by the intervention.

a. Principal effects

b. Minimal clinically important differences

c. Side effects

d. Primary outcome measures

e. Indications

d. Primary outcome measures

9. _I_ are unintended adverse events, while _II_ are unintended symptoms. Not all _II_ are harmful, but, generally, _I_ are considered harmful.

Select one:

a. I. complications; II. side-effects

b. I. contraindications; II. indications

c. I. interactions; II. NNH

d. I. harms; II. hazards

e. I. serious adverse events; II. adverse events

a. I. complications; II. side-effects

10. Studies on ___ explore adverse consequences of treatment or the natural progression of disease, as well as harm caused by complications from interactions between treatments.

a. epidemiology

b. harm

c. prognosis

d. prevention

e. treatment

b. harm

1. In most medication package inserts, comparisons are made between the drug and ___.

Select one:

a. a surgical intervention

b. a non-drug intervention

c. placebo

d. another effective treatment regimen

e. the gold standard medication

c. placebo

2. ___ is a practice of tracking the patterns of clinicians' prescribing practices and sales practices that have been effective on them.

a. Personality Palate Assessment

b. Gifting

c. Data mining

d. Sampling

e. The sales technique

c. Data mining

3. A minimum requirement to become a PSR is a(n) ___.

a. health professional Master's degree

b. doctorate

c. 4-year degree

d. Associate degree in biology

e. certificate in pharmaceuticals

c. 4-year degree

4. PSRs have extensive training in ___ as well as effective communication.

a. biology

b. outside sales

c. medicine

d. telemarketing

e. pharmaceutical science

e. pharmaceutical science

5. ___ is a website sponsored by drug manufacturers that connects patients to pharmaceutical assistance programs.

a. Drug.com

b. PhRMA

c. Meds4U

d. FreeMed

e. RxAssist

e. RxAssist

6. ___ are medications available either over-the-counter or with a prescription that reduce inflammation. Examples include ibuprofen and naproxen.

a. Statins

b. Analgesics

c. NSAIDs

d. Blood thinners

e. Anticoagulants

c. NSAIDs

7. The goal of the sales call is to provide ___ that identify solutions for the provider's patients.

a. patient education training and tools

b. marketing brochures

c. FDA and corporate-approved messages

d. medications and package inserts

e. the best available sources of evidence

c. FDA and corporate-approved messages

8. PSRs use tools like the Personality Palate to ___.

a. decide on the size of the gift offered to the healthcare practitioner for using the medications in the practice

b. offer continuing education courses to healthcare practitioners

c. select a medication that best suits the health care practitioner's patients

d. identify own strengths and weaknesses as well as self-behavior patterns that influence decision making

e. help patients become educated about their medications based on their personality

d. identify own strengths and weaknesses as well as self-behavior patterns that influence decision making

9. The ___ is a communication in which the PSR aims to seek objections or concerns expressed by the healthcare provider related to the use of the product.

a. package insert

b. clinician sales encounter

c. direct to consumer advertisement

d. no-of-1 drug trial

e. sales call

e. sales call

10. PhRMA guidelines now limit gifts for prescribers to ___.

a. vacations and educational seminars

b. foods only

c. not applicable. There are no limits created by PhRMA.

d. a maximum of $100

e. medication samples

d. a maximum of $100

1. Identify the characteristic of research design that relates to the degree to which the outcomes of the study can be attributed to the interventions.

Select one:

a. Randomization

b. External validity

c. Inter-rater reliability

d. Intra-rater reliability

e. Internal validity

e. Internal validity

2. The data for a study on blood pressure being collected by four health care practitioners. The researchers have to establish consistent data collection methods among the four nurses. What is this procedure called?

a. Intra-rater reliability

b. Inter-rater reliability

c. Internal validity

d. Randomization

e. External validity

b. Inter-rater reliability

3. What variables interfere with the intended purpose of the investigation by introducing error to the study?

a. Extraneous and intervening variables

b. Extraneous variables

c. Independent variables

d. Dependent and independent variables

e. Dependent variables

a. Extraneous and intervening variables

4. How many times should you read a research report in order to completely understand all of its components?

a. Five

b. Two

c. One

d. Four

e. Three

e. Three

5. Once the qualitative data are analyzed, the analysis is verified by the participants to ensure the researcher correctly interpreted their experiences. This process is known as

a. Transferability

b. Triangulation

c. Saturation

d. Member check

e. Prolonged engagement

d. Member check

6. Researchers conducting quantitative and qualitative studies need to carefully establish the characteristics of the participants they want to study. Participants must meet these characteristics; otherwise they are not eligible to participate. This description defines what concept?

a. Randomization

b. External validity

c. Exclusion criteria

d. Inclusion criteria

e. Internal validity

d. Inclusion criteria

7. Qualitative data are collected until what situation occurs?

a. Saturation

b. Triangulation

c. Transferability

d. Prolonged engagement

e. Member check

a. Saturation

8. Identify the type of evidence that combines the statistically analyses of multiple independently conducted studies.

a. Cross-over study

b. Meta-analysis

c. Systematic review

d. RCT

e. Cohort study

b. Meta-analysis

9. What is the procedure called for assigning subjects to intervention groups (placebo group, control group, experimental group.)?

a. Intra-rater reliability

b. Randomization

c. External validity

d. Inter-rater reliability

e. Internal validity

b. Randomization

10. Researchers strive to remain unbiased, honest, and precise when making decisions regarding the planning, conducting, and reporting of a quantitative and qualitative study. The previous statement defines

a. Objectivity

b. Validity

c. Credibility

d. Reliability

e. Dependability

a. Objectivity

What type of studies would odds ratio be used?

retrospective studies

_______ is the minimum threshold for treatment to be perceived by patients as beneficial. They are outcomes that matter.

Minimum Clinically Important Difference (MCID)

T/F: Statistically significant is the same as clinically important.

False

What does it mean & what is it called if the RR = 1.0?

It is called nonfactor and it means there is no association between the disease and exposure.

What does it mean & what is it called if the RR > 1.0?

It is called a risk factor and it means that there is an increase in risk of disease among those exposed.

What does it mean & what is it called if the RR < 1.0?

It is called a protective factor and it means that there is a decrease in risk of disease among those exposed.

_______ ______ is the only type of study where relative risk (RR) can be calculated.

cohort design

________ is the ability of the test to be positive given that the person tested has the disease.

sensitivity

_________ is the ability of the test to be negative given that the person tested does not have the disease.

specificity

As prevalence or incidence decreases, PPV ___ and NPV ___.

PPV decreases and NPV increases

If the AR is a positive number then we see Absolute Risk _____.

Reduction

If the AR is negative then we see Absolute Risk _____.

Increase

The proportion of disease cases among the population both exposed and not exposed. It is the reduction in incidence of a disease in the population if the exposure were eliminated.

Population Attributable Risk (PAR)

The percent of the incidence of a disease in the exposed population that is due to the exposure.

AR%

The incidence of a disease or condition in the exposed (or at risk) population that would be eliminated if the exposure (or risk) were removed. This describes _______ ______.

Attributable Risk (AR)

The percent of the incidence of a disease in the population (exposed and unexposed) that is due to exposure.

PAR%

% of those exposed who have the disorder.

Experiment Event Rate (EER)

% of those not exposed with the disorder

Control Event Rate (CER)

the proportion of a population with a given disease at a single point in time.

Prevalence

the number of new cases of disease or condition during a specified time frame.

Incidence

During which phase of clinical trials are animals or laboratory studies conducted?

A. Phase 0 (pre-clinical)

B. Phase 1

C. Phase 2

D. Phase 3

E. Phase 4

A. Phase 0, the pre-clinical phase

What three ethical principles for biomedical research were detailed in the Belmont Report?

Respect for persons, beneficence, and justice.

What are the three essential applications of the ethical principles detailed in the Belmont Report?

informed consent, assessment of risks & benefits, and selection of subjects.

What is the role of the Food and Drug Administration (FDA)?

regulate food additives, cosmetics, institutional review boards, ethical studies, prescription meds, OTC meds, medical devices, dietetic supplements, & recalls.

What are the four entities of epidemiology application?

Healthy People Initiative, Center for Disease Control (CDC), World Health Organization (WHO), and the US Preventative Task Force

The proportion of those who have the disease who test positive.

Positive Predictive Value (PPV)

The proportion of those who do not have the disease who test negative.

Negative Predictive Value (NPV)

The event rate among those exposed to a factor divided by the event rate among those not exposed to the same factor.

Relative Risk (RR)

An interprofessional collaborative team consists of _____________________.

members of multiple healthcare disciplines

Each discipline in an interprofessional team is governed by _________ that define the discipline's ________.

practice laws & regulations, scope of practice

___________ includes collecting data such as a medical history and physical exam to make a diagnosis.

Assessment

The determination of the cause of a disease/condition using tools such as xrays and labs is known as ______.

diagnosis

The ratio of the odds of an event occuring in one group to the odds of an event occuring in another group is known as _____.

Odds Ratio (OR)

A healthcare practitioner collects information from a construction worker about the nature of an on-the-job injury is:

a. assessment

b. diagnosis

a. assessment

A healthcare practitioner performs a physical exam of the injured leg.

a. assessment

b. diagnosis

a. assessment

X-rays are taken of the injured leg.

a. assessment

b. diagnosis

b. diagnosis

A healthcare practitioner determines that the leg is fractured in two places.

a. assessment

b. diagnosis

b. diagnosis

_____________ is the relative likelihood of having the disease when the diagnostic test is positive.

Positive Likelihood Ratio (LR+)

_______ is the relative likelihood of having the disease when the diagnostic test is negative.

negative likelihood ratio (LR-)

What are some ways to tell if a reference is APA?

APA has periods after the initials, coma after the last names, the full journal name and the year is after the last author.

What are some clues that a reference is AMA?

no periods after initials, no comas after the last names, period after the last author's name, and the journal name is abbreviated.

What is primary prevention?

immunizations, increase in nutrition, decrease environmental risk factors

What type of prevention includes screening exams?

secondary prevention

What is tertiary prevention?

rehabilitation services

What type of prevention is considered quaternary?

overdiagnosis and overmedicated

What does PPAARE stand for?

Patient/Population:demographics & comorbidities

Problem: condition of interest

Action: experimental treatment

Alternative: placebo, control, no int.

Results: primary/secondary outcomes

Evaluation: level of evidence

Which of the following is an example of secondary prevention?

A. A screening program is instituted in the workplace to achieve early detection of sleep disturbances, such as insomnia, in order to reduce the duration of insomnia.

B. A medication management program is instituted to identify workers with long-term usage of insomnia medications (either prescription or OTC) in order to transition them away from long-term medication use.

C. An education session and materials are produced that encourage employees to maintain good sleep hygiene habits and educate them about sleep hygiene in order to prevent workers from developing insomnia.

D. A protocol is developed for treatment of long-term insomnia to improve workers' quality of life.

A. A screening program is instituted in the workplace to achieve early detection of sleep disturbances, such as insomnia, in order to reduce the duration of insomnia.

Which of the following is an example of primary prevention?

A. A screening program is instituted in the workplace to achieve early detection of sleep disturbances, such as insomnia, in order to reduce the duration of insomnia.

B. A medication management program is instituted to identify workers with long-term usage of insomnia medications (either prescription or OTC) in order to transition them away from long-term medication use.

C. An education session and materials are produced that encourage employees to maintain good sleep hygiene habits and educate them about sleep hygiene in order to prevent workers from developing insomnia.

D. A protocol is developed for treatment of long-term insomnia to improve workers' quality of life.

C. An education session and materials are produced that encourage employees to maintain good sleep hygiene habits and educate them about sleep hygiene in order to prevent workers from developing insomnia.

What is the difference between statistically significant and minimum clinically important difference (MCID)?

Statistically significant is a mathematical difference driven by variability, sample size, & data type.

MCID the minimum threshold for treatment to be perceived by patients as beneficial.

What is the distinguishing characteristic of a hazard ratio?

Time