Evidence Based Practice Test 1

The four eras of EBDM

the age of expert —> age of professionalization —> age of science —> age of evidence

What are the five steps of EBDMin practice in order

Ask, access, appraise, apply, assess

Who were the two drivers of Evidence Based Movement?

Archie Cochrane and David Sackett

what are the 3 components of EBD?

scientific evidence, clinicians expertise, patients needs ad preferences

Five steps of using EBD in clinical practice?

Ask, access, appraise, apply and assess

What are the two types of clinical questions?

background and PICO/Foreground

What are background questions?

general knowledge broad, ask who, what, where when etc, narrow broad scope

What are foreground questions?

Specific, PICO

What question should be asked first?

Background

At all stages you ask both questions, but as experience increases the PICO questions ________.

increase

What does PICO stand for

Patient/Population/Problem

Intervention

Comparison

Outcome

PICO modifications

PICOT: T = time/time frame

PIO

PIC

What are the four categories of EBDM questions

ethology, diagnosis, treatment/therapy and prognosis

What’s an etiology question?

science of causation, focuses on what happened before condition began. The who and the why.

What’s a. diagnosis question?

is the what and the where

What’s a treatment/therapy question?

focuses on guiding the process through time to a desired conclusion. The what to do and what not to do

What’s a prognosis question?

studies that estimate the clinical course or progression of a disease or condition over time and anticipate likely complications and prevent them

What are the two major research categories?

Quantative and qualitative research

What’s qualitative research?

aim is to discover meaning or gain understanding of a phenomena; investigates a phenomenon in depth. How people feel or experience a certain situation

Does qualitative research sample a large or small group?

small

How is qualitative research data collected?

unstructured interviews, observation, focus groups and diaries

What format is qualitative research findings in?

narrative

What is quantitative research?

goal is the discovery of relationships, or causation (cause and effect)

what is quantitive research based on?

scientific method (hypothesis formation and testing)

How many groups do quantitive designs compare?

2 or more

What format is quantitive research collected in?

numerical

How is quantitive research conducted?

Randomized Controlled Trials (RCT)

Cohort Study

Case-Control Study

Case Report/Study

What are the two categories of quantitative research?

observational and interventional

What’s observational research?

researchers observe

What’s interventional research?

researchers control the intervention in the study

What are examples of interventional ways of research?

non controlled trials, RCT, controlled clinical trials

Examples of observational research?

cross-sectional, case-control, cohort, case report, case series

Examples of qualitative research?

case report, case series, case control study

What is a cross sectional study?

attempts to gather information about a population at a point in time (snap shot)

What information is gathered through a cross-sectional study?

exposure and disease status

What are strengths of a cross-sectional study?

direct approach

What are weaknesses of a cross-sectional study?

recruitment bias, inaccuracies in reporting, examiners may introduce bias

What’s a retrospective study?

analysis data collected in past

What’s a case control study?

includes cases and controls to answer a question (no intervention), retrospective

What’s the case group?

diseased

What’s the control group?

healthy

When is a case control study used?

need a quick answer

Weaknesses of a case-control study?

recall bias, clients with a disease or condition are more likely to recall or remember events that they feel may have been associated with their condition

What are the strengths of case control study?

rare disease investigation

What’s a cohort study?

group of individuals with similar baseline characteristics is oberseved over time

What’s a prospective study?

data is collected in the present and moving forward

What are strengths of cohort studies?

elimination of recall bias

Weaknesses of cohort study?

behaviour can change over time, complicating exposure parameters.

What’s a Case report-one case of unusual findings?

does not involve sampling or comparisons, reports of isolated cases or rare cases, client case, x rays etc

Weaknessess of case report- one case of unusual findings

reviews only one client as a means of illustrating disease, no control, masking or randomization of subjects

What is a case series-multiple cases of findings?

reports two or more similar cases (advantage over case report); cherry picking

what’s an interventional study?

characteristics of an experiment or clinical trial, manipulation of the environment to strengthen the study and eliminate bias

What’s a non controlled trials?

observation of effects of an intervention without a control group

when are non controlled trials useful?

when detrimental to clients health to NOT treat them

Weaknesses of non controlled trials

lack os masking, potential lack of any comparison group

What are randomized controlled trials?

randomization of subjects, masking of subjects and clinicians, introduction of a control group

What is the superior study design?

Randomized controlled trials

What’s a controlled clinical trial?

controlled trial without randomization (bias), has a comparison group similar to an RCT, masking may or may not be

What’s inter-rater reliability?

degree to which examiners are calibrated; achieve same results

What’s intra-rater reliability?

degree to which an examiner achieves the same results with himself

What are primary sources of evidence?

original research publications, not filtered, not synthesized, consists of quantitative and quantitive research

What are secondary sources of evidence?

filtered and synthesized, systematic review and meta analysis W

What’s reliability?

its the extent to which the outcomes are consistent when the experiment is repeated more than once

What’s validity?

extent to which the instruments that are used in the experiment measure exactly what you want them to measure

all of the following are true about scientific evidence except:

a. it is the most important component of the decision process

b. it doesn’t tell the practitioner what to do

c. it doesn’t replace clinical expertise

d. it does not replace client input

A

All of the following are components of the evidenced based decision making process except?

1. Patient preferences or values

2. Education

3. Scientific Evidence

4. Experience and judgement

B

3. All of the following are benefits of EBDM process except?

1. Improves outcomes

2. Contributes to continual improvement of effective, quality care

3. Helps clinicians stay current

4. Increases gaps in knowledge

D

4. What is the purpose of EBDM?

a) To open the gap between what is known and what is practice
b) To close the gap between what is known and what is practice
c) To improve patient care based on informed decision making
d) Both B and  C

D

1. The evidence based decision making process requires the integration of four important elements which are:

a) scientific evidence, experience and judgment, patient preferences or values, clinical/patient circumstances
b) scientific evidence, judgment, caring, trust
c) knowledge, judgment, client needs, clinical expertise
d) scientific evidence, experience, judgment, values

A

1. All of the following are steps in the EBDM process except?

a) converting information into clinical questions
b) evaluating the outcomes and your performance
c) critically appraising the evidence
d) quickly doing the research

D

1. PICO stands for the following:

a) problem, intervention, conclusion, outcomes
b) problem, information, comparison, outcomes
c) problem, intervention, comparison, outcomes
d) process, implementation, comparison, order

c

What types of questions are general knowledge inquiries and answers the who what when where and why of a topic?

1. Foreground

2. General

3. Specific

4. Background

d

What type of question is formulated using PICO?

1. Foreground

2. General

3. Specific

4. Background

a

Which of the following is the only optional PICO component?

1. P

2. I

3. C

4. O

C

This type of question determine relationships between risk factors, potentially harmful agents, and possible causes of a disease or condition

1. Foreground

2. Diagnosis

3. Harm/Etiology

4. Therapy/Prevention

c

This type of question estimates the clinical course or progression of a disease or condition over time and anticipates likely complications?

1. Diagnosis

2. Harm/Etiology

3. Therapy

4. Prognosis

D

Which evidence based source is NOT a secondary source?

A) Meta- Analysis

B) Case Report

C) Systematic Review

D) Evidence-based article reviews

B

What defines a Randomized Control Trial best?

A) Systematically describing and interpreting conditions that already exist

B) Looking back in time to find risk factors

C) Reporting on observations to compare outcomes

D) Estimating the extent to which a variable causes a change

D

Which studies are considered non- experimental?

A) Cohort study

B) Case Control study

C) Randomized control trials

D) A and B

D

     

Which study design has no statistical validity?

A) Meta- Analysis

B) Cohort study

C) Case Report

D) Case Control Study

C

Which provides the strongest evidence for demonstrating cause and effect?

a) COHORT

b) Case studies

c) Randomized Control Trials

d) In-Vivo studies

C

What type of study is one in which neither the patient nor the investigator knows whether the patient is receiving the experimental treatment or the control treatment?

a) Cohort study

b) Double-blind randomized control trial

c) Case series

d) Case control study

B

Case control studies are:

a) Prospective

b) Experimental

c) Gold Standard Tests

d) Retrospective

D

Which of the following is an example of secondary research?

a) Randomized control trial

b) Cohort study

c) Systematic review

d) Case report

C