EBP

Basic research goal

understand nature

translational research goal

apply basic research

clinical research goal

understand/treat disease with the ideas found in basic and translational research

What research classification correlates with the question "how are traits inherited?"

basic

What research classification correlates with the question "Can we create targeted mutations in stem cells?"

translational

What research classification correlates with the question "can we use gene therapy to treat immunodeficiency?"

clinical

What are the 3 research types

experimental, exploratory, descriptive

experimental/explanatory research

cause and effect (manipulates variables)

example of experimental research

RCTs

exploratory/observational research

find relationships (identify potential relationships)

examples of exploratory research

cohort, case-control, cross-sectional survey

descriptive/qualitative research

describe populations (describe a group/subgroup)

examples of descriptive research

normative and case studies

low bias/high quality study designs to high bias/low quality study designs

RCTs > cohort studies > case-control studies > cross-sectional studies > case studies > expert opinion

What is the gold standard study

RCTs

advantages to RCTs

-randomization
-blinding
-concealment minimizes bias

disadvantages to RCTs

-attrition bias may occur
-may be expensive
-requires pilot data to get appropriate sample size
-not able to detect rare events

cohort studies recruitment based on

exposure

cohort studies goal

determine outcome afterward (suggestive of causality)

case-control recruitment based on

outcome

case-control goal

determine exposure afterward

What study is good for rare diseases?

case control

cross-sectional pros

good for finding prevalence

cross-sectional cons

least suggestive of cause-and-effect

prospective

follow up studies

is prospective or retrospective considered better evidence

prospective

retrospective

historical analysis

What a con of retospective

subject to recall bias

recall bias

memory is not perfect

selection bias

subjects are not representative of the population

how is selection bias controlled

proper sampling (specific)

allocation bias

systematic differences in how subjects are allocated into groups

how is allocation bias controlled

randomization

performance/observation bias

differences in outcomes reporting or collection behavior due to knowledge of group allocation

how is performance/observation bias controlled

blinding

attrition bias

differential loss of subjects based on allocation or outcomes

how is attrition bias controlled

good communication and follow-up

EBP definition

use of best available external evidence and knowing the strength of that evidence in supporting his/her clinical practice decisions

benefits to patient care outcomes

compares improvements in one treatment vs another

risks to patient care outcomes

risk of negative outcomes (RCTs can't usually detect rare events)

costs of patient care outcomes

cost matters more at the level of populations than individuals

values of patient care outcomes

patient preference

efficacy study

highly controlled (RCT) study determining intervention capabilities

effectiveness study

pragmatic/flexible study determining intervention capabilities

reliability

data are repeatable

validity

data measure in the intended outcome

Steps to EBP

1. Ask an answerable question about diagnosis/prognosis/therapy
2. Collect the best available evidence.
3. Appraise the evidence (quality)
4. Apply the evidence to patient management with clinical expertise and patient's biology/values/circumstances
5. Assess efficacy and economy

What process can we use when creating an answerable question

PICO

what does PICO stand for

Patient
Intervention
Comparison (optional)
Outcome