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Terms in this set (42)
Whats Mary's most likely diagnosis?
info we have?
-72 years old
-retired school teacher
-has 2 grown children
-has been experiencing facial pain for the last month
need more information for diagnosis
If Mary is having a stroke
what is the best approach?
A. Ask a colleague who encounters more stroke patients than you
B. Utilize a practice guideline to navigate the available intervention choices
C. Go to the internet and research the causes of stroke
D. Do what you did the last time you had a patient in your office having a stroke
Where do you find the information to guide an answer to a questions on her prognosis?
A. You quickly do the math calculations in your head on how many stroke patients you have seen recover
B. You take the information from recent, well-done observational study on stroke recovery in women
C. You search the literature for a systematic review on the recovery rates for elderly women who have survived a stroke
D. You search for case reports on patients who fit Mary's profile
____- to apply the relevant literature to patient care in an effective, inter-professional team-based approach with the ultimate goal of improved patient outcomes.
purpose of the EBP course
2 fundamental principles of EBP?
not all evidence is of _____
____ alone is never sufficient in making a clinical decision
Evidence based triad includes?
o The ability to use one's clinical skills, knowledge base and past experiences in patient care.
____ & ______
individual clinical expertise
best external evidence
patient values and expectations
______- the ability to use one's clinical skills, knowledge base and past experience in patient care.
mostly these rules or short-cuts work well under most circumstances, but in certain cases lead to ___ or ____.
systematic errors or cognitive biases.
example of _____ is when you are more likely to diagnose mary smith with herpes zoster because you are more familiar with that condition.
____- est. what is more likely by what is more available in memory.
example of ______ is diagnosing mary smith with a stroke because you just had a patient of yours die from a stroke under circumstances that were extremely traumatic for you and your family.
_____-the tendency to avoid options for which missing information makes the probability seem "unknown."
example of ____- Mary is having difficulty hearing but you don't pick up on it because you are not familiar with an Audiologist who can effectively co-manage Mary's care
What is critical thinking?
• ___ & ____ pertinent information and data from all sources
• ____ accurate relevant information or ____ relevant information or
• Know when to seek additional information And how to seek it
• Make decisions about __ & __
• Develop ____
identifies and extracts
risks and benefits
____- come to well-reasoned conclusions and solutions
o Tests them against relevant literature and standards
Systematic errors, or ____ are reproducible inaccuracies that produce a consistently false pattern of differences between observed and true values
Both random and systematic errors can threaten the ____ of any research study
Which of the following best defines Accuracy (validity) as it related to research results?
A. How close to the truth the results of the study are
B. How closely the measurements in a study are to one another
C. How repeatable the measurements in a study are
D. How reliable the measurement in a study are
____- The ability of a measurement to be accurately reproduced i.e. how closely the measured values are to each other (____)
_____- : How close a measurement is to the actual truth (_____)
If you measure something several times and all values are close, they may all be wrong if there is ____
systematic error (bias)
accuracy is _____
and precision is just being ____
how close to the bulls eye
close together despite the bulls eye
All of the following are limitations to the typical hierarchies of evidence except:
A. Not all study design are represented
B. They can imply the assumption that all studies were conducted in an equally valid manner
C. They provide a rule of thumb to be used with respect for their known limitations
D. They do not take into account the type of clinical question being asked
hierarchy presented in slide 44 can still be useful as long as the limitations are being considered
Limitations with this model:
assumes all other factors aside from study design are equal
Not all forms of studies are represented
Different validity criteria for different Clinical questions
A recent, well done study concludes that rehabilitation by an occupational therapist decreases depression rates in patients who have had a stroke.
Which of the following is most TRUE in the applying of the study results:
A. Occupational therapy is effective in suicide prevention in patients who have had a stroke
B. All patients who have had a stroke should be participate in rehabilitation
C. Patients who are at risk for depression and have had a stroke should receive rehabilitation by an occupational therapist
D. All patients who have had a stroke have depression
In the recent, well done study that concludes that rehabilitation by an occupational therapist decreases depression rates in patients who have had a stroke, which of the following is most TRUE regarding the decreased risk of depression?
A. It is a primary outcome measure B. It is not an outcome measure
C. It is a surrogate outcome
D. It is a composite outcome
You find a study that measure the effect of statin medication on lower a patient's LDL Cholesterol. The authors of the study conclude that it therefore also must decrease a patient's risk of cardiovascular events. This is an example of:
A. Composite outcome measure
B. Primary outcome measure
C. Surrogate outcome measure
D. Secondary outcome measure
____- endpoints are often physiological or biochemical markers that can be relatively quickly and easily measured, and that are taken as being ____ of important clinical outcomes
• EX: Measurement of LDL Cholesterol and making inferences regarding heart attack and stroke
* Can be misleading particularly if they results of these types of studies are driving Practice Guidelines, Public Health Recommendations, etc.
____- consists of two or more component outcomes
• Patients who have experienced any one of the events specified by the components are considered to have experienced the composite outcome
• Can be misleading
A drug leads to a large reduction in a _____ of "death or difficulty breathing."
This could mean that the drug resulted in fewer deaths and less difficulty in breathing.
It also could be that the composite was driven entirely by a reduction in difficulty in breathing with no change, or even an increase, in death.
POEM: stands for?
Most relevant for clinicians to know about
Problems seen ______
Potential to _____ an approach to practice
Patient Oriented Evidence that Matters
problems seen in our practice
______ for clinicians to know about
Intermediate or _______
Should not change or guide practice because it is _____
Disease Oriented Evidence
disease- oriented outcomes
A. Is an example of a disease oriented outcome measure
B. Is a patient important outcome measure
C. Routinely measured in randomized controlled trials
D. Is a poorly defined endpoint
Patient at the center of care by emphasizing outcomes that matter to patients:
___, ____, _____, _____
Symptoms Morbidity/Mortality Quality of life Cost
Over 97% of medical literature is ___ and other material
Focusing on POEMs frees you from reading the majority of the medical literature
Major Categories of ______
• Questions relating to ____
• Questions relating to ____
• Questions relating to _____
• Questions relating to ___
Define and apply the evidence based cycle
_____ clinical expertise
Best ____ evidence
values and expectations
Your patient has a visual impairment and you read a practice guideline recommending vitamins to help prevent further progression
All of the following are TRUE regarding Practice Guidelines EXCEPT:
A. Expert panels are involved in their formation B. Best available evidence is used to support the
C. They are peer reviewed and tested
D. Their application to the needs of a particular patient are not necessary in order to achieve the best patient outcomes
_____- used to be primarily expert opinion alone
Now based on the combination of best available evidence from the ____ AND ____ to define guidelines
• Was an explicit and sensible process used to identify, select and combine evidence?
• Was an explicit and sensible process used to consider the relative value of different outcomes?
• Were the important recent developments included?
• Has the guideline had peer review and testing?
• Expert panels decide on quality and applications of evidence at the level
medical literature and expert panels
______- The main goal of the data collection. For example, if the clinical question asks if a does of a certain medication lowers blood sugar levels, then the primary outcome measure would be the reduction in blood sugar levels.
Primary outcome measure
____- This would be information that is measured during a study aside from the primary outcome measure. In the above example, it would be information regarding the side effect of the medication that is given to lower blood sugar levels
Secondary outcome measure
_____- When an outcome is measured and then inferences are made regarding the meaning behind that outcome. In the above example, it would be measuring the blood sugar levels and making assumptions based upon those measurements about the patients risk for diabetic retinopathy.
Surrogate outcome measure
______- When two component outcomes are described and the results of the study are based upon one or the other of the two outcomes occurring. In the above example, the surrogate outcome measure would be answering the question as to whether or not a certain medication reduces blood sugar levels or decreases a patient's risk for diabetic retinopathy.
Composite outcome measure
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