Evidence-Based Practice Assessment Quiz
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Questions and Answers

In the context of evidence-based practice, what is the primary focus of step 5?

  • Evaluating the effectiveness and outcomes of the implemented strategies. (correct)
  • Implementing the chosen intervention strategies.
  • Identifying the initial problem and gathering related data.
  • Synthesizing all the available evidence for a specific case.

    • What aspect of evidence-based practice is directly addressed during the 'Assess the performance' step?

  • The practical application and impact of the intervention. (correct)
  • The planning phase of the investigation.
  • The theoretical basis of the proposed intervention.
  • The initial literature review process.

    • Why is 'Assess the performance' considered a crucial step in evidence-based practice?

  • It validates the effectiveness of chosen strategies leading to potential improvements. (correct)
  • It confirms adherence to the original research protocols.
  • It ensures financial resources are allocated correctly.
  • It streamlines the communication between researchers.

    • Which of the following activities is LEAST likely to be part of the 'Assess the performance' step?

    <p>Formulating a new research question based on identified gaps. (A)</p> Signup and view all the answers

    What would be considered an action to be taken after ‘Assess the performance’ step reveals the implemented strategies were ineffective?

    <p>Identifying and addressing the limitations and planning necessary adjustments. (C)</p> Signup and view all the answers

    For a clinical question focused on determining the effectiveness of a new treatment, what research methodology is considered the gold standard?

    <p>Randomized controlled trial (RCT) (D)</p> Signup and view all the answers

    When investigating the potential long-term effects of an environmental toxin, which type of study design would be most suitable?

    <p>Cohort study (A)</p> Signup and view all the answers

    A study aims to identify risk factors for a rare disease. Which research approach is optimally suited for this?

    <p>Case-control study (B)</p> Signup and view all the answers

    A researcher is developing a new test to diagnose a specific condition, what's the most appropriate study design to evaluate diagnostic accuracy?

    <p>Prospective, blind controlled trial comparison to gold standard (C)</p> Signup and view all the answers

    For a clinical question focused on understanding the factors that determine the course of a disease, which study type should be prioritized?

    <p>Cohort study (D)</p> Signup and view all the answers

    What is the primary focus of an etiology-based clinical question?

    <p>Investigating the link between a risk factor and a health condition. (C)</p> Signup and view all the answers

    In clinical research, what type of question would investigate if smoking increases the risk of lung cancer?

    <p>Etiology (C)</p> Signup and view all the answers

    Which scenario best exemplifies a clinical question focused on etiology?

    <p>Examining the risk factors associated with the development of heart disease. (D)</p> Signup and view all the answers

    If a study is designed to find out if a specific dietary habit is linked to a higher chance of developing a chronic illness, what type of clinical question is it primarily addressing?

    <p>An etiology question (D)</p> Signup and view all the answers

    A clinician is reviewing the literature to understand the risk factors for type 2 diabetes. Which type of clinical question are they actively seeking to answer?

    <p>Etiological factors (B)</p> Signup and view all the answers

    What is the primary focus of disease prevention strategies?

    <p>Identifying and changing factors that increase disease risk. (B)</p> Signup and view all the answers

    Which term describes the prediction of how a disease will progress, with or without medical treatment?

    <p>Prognosis (C)</p> Signup and view all the answers

    If a medical professional discusses a patient's 'prognosis', what are they most likely discussing?

    <p>The forecast for the disease's development or recovery. (D)</p> Signup and view all the answers

    A public health campaign focused on identifying and reducing smoking habits is an example of what type of strategy?

    <p>Preventative (A)</p> Signup and view all the answers

    What would be the primary reason to study the 'prognosis' of a disease?

    <p>To foresee the progression of a disease and its potential outcomes. (B)</p> Signup and view all the answers

    A novel diagnostic test shows high sensitivity but low specificity. What does this imply?

    <p>It correctly identifies most individuals with the condition, but often incorrectly flags those without it. (C)</p> Signup and view all the answers

    Which of the following best describes the primary goal when evaluating a therapy?

    <p>To identify if the therapeutic intervention has more desirable benefits than alternative approaches with a favorable risk profile for the patient. (C)</p> Signup and view all the answers

    A clinician is evaluating a new diagnostic tool. What should be their primary concern regarding its validity?

    <p>Whether the test accurately measures the specific condition it is intended to detect. (D)</p> Signup and view all the answers

    A therapeutic intervention demonstrates efficacy in clinical trials but shows limited effectiveness in real-world settings. What is the most likely explanation for this discrepancy?

    <p>Patients in the real-world population have more comorbidities that may not be present in the clinical study. (B)</p> Signup and view all the answers

    When assessing the reliability of a diagnostic method, what is the most appropriate area of focus?

    <p>The extent to which repeated measurements yield consistent results. (A)</p> Signup and view all the answers

    In the provided PICO framework, what does the 'P' most likely represent?

    <p>The specific patient population of interest. (C)</p> Signup and view all the answers

    Within the given PICO framework, what does 'I' typically specify?

    <p>The interventions or exposures being studied. (A)</p> Signup and view all the answers

    Based on the provided notes, which group would be considered the 'Population' in this PICO framework?

    <p>Babies of mothers who smoked. (C)</p> Signup and view all the answers

    Given the presented information, the 'C' in this PICO framework would probably represent what?

    <p>A control or comparison group for the mothers. (C)</p> Signup and view all the answers

    What does the information provided suggest about exposure for the babies?

    <p>Exposure is present during the first trimester of pregnancy (C)</p> Signup and view all the answers

    Flashcards

    Assess the Performance

    The step where you evaluate the effectiveness of the implemented intervention and assess its impact on the targeted health issue.

    Evidence-Based Practice (EBP)

    A systematic approach to healthcare decision-making that integrates the best available research evidence with clinical expertise and patient values.

    Intervention

    A carefully formulated plan of action designed to address a specific health issue, based on the gathered evidence.

    Multistep Evidence-Based Practice Process

    A systematic approach to identifying, evaluating, and applying research evidence to clinical practice.

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    Step 5: Assess the Performance

    The process of gathering, analyzing, and synthesizing relevant research to answer a specific clinical question.

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    Etiology

    The study of the causes of diseases and conditions.

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    Exposure or causal factor

    A factor that increases the likelihood of developing a disease.

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    Exposure-disease relationship

    The relationship between an exposure or causal factor and the development of a condition.

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    Etiology question

    A question that aims to understand the cause of a disease or condition.

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    Causal factor

    A factor that directly contributes to the development of a disease.

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    Randomized Controlled Trial (RCT)

    A research design where participants are randomly assigned to different groups, one receiving the treatment and the other a control (placebo or standard care). Considered the gold standard for evaluating the effectiveness of therapies.

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    Cohort Study

    A type of observational study where a group of individuals (cohort) is followed over time to see how their health outcomes differ based on their exposure to a specific factor (like a therapy or a risk factor).

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    Case-Control Study

    A type of observational study that compares individuals with a specific condition (cases) to those without the condition (controls) to identify factors associated with the condition.

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    Diagnostic Test

    Research designs that aim to establish the effectiveness of a diagnostic test by comparing it to the gold standard test in identifying a specific condition.

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    Prognosis Studies

    Studies that aim to predict the course of a disease or condition after diagnosis. They typically involve following a group of patients over time to see how their condition progresses.

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    Validity and Reliability of a Test

    The accuracy and consistency of a diagnostic test or screening method in identifying a particular condition.

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    Most Beneficial Intervention

    The best treatment or preventive measure for a health condition.

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    Intervention Types

    A range of treatments and preventive measures that can be used to address a health condition.

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    Intervention Effectiveness

    The effectiveness of a treatment or prevention strategy in achieving desired outcomes.

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    Prognosis

    The likely course of a disease for a patient, considering treatment or no treatment.

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    Disease Prevention

    Identifying potential risk factors for a disease and modifying them to decrease the chance of developing the disease.

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    Risk Factor

    Any factor that increases the chance of a person developing a particular disease.

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    Study Notes

    Evidence-Based Medicine (EBM)

    • Evidence-based medicine (EBM) is a process that integrates the best research evidence with clinical expertise and patient values to achieve the best possible patient management
    • EBM is about improving the quality of information used for medical decisions
    • EBM uses the scientific method to organize and apply current data to improve healthcare decisions
    • EBM combines the best available science with clinicians' clinical experience, and patients' values, preferences, concerns, and expectations to arrive at optimal medical decisions

    Learning Objectives

    • Definition of Evidence-based Medicine
    • Identification of the basis of medical practice
    • Identification of the Multistep of EBP process
    • Differentiation between expert/opinion based medicine and EBM
    • Formulate EBM questions using PICO format
    • Content of EBM-including hierarchy/level of Evidence, Medical Knowledge vs Clinical Experience, Opinion/consensus/expert-based vs Evidence-based Medicine, The basis of medical practice, clinial state and circumstances, the needs and uses of EBM, Multistep of EBP process, EBM-Appraise the evidence/information critically-Step-3, EBM-Clinical/ Research Question using PICO Format.

    A Brief History of EBM

    • The term "evidence-based medicine" (EBM) was first used by a Canadian, David Sackett and his colleagues at McMaster University in Ontario, Canada in the early 1990s
    • They have subsequently refined the definition of EBM as integrating the best research evidence with clinical expertise and patient values to achieve the best possible patient management
    • EBM is about trying to improve the quality of the information on which decisions are based

    Basic Concept of EBM

    • EBM is a model for evidence-based clinical decisions: Best evidence available information + Physician clinical expertise + the patient's preferences → make optimal decisions about patient care
    • Don't forget to consider individual human differences and personal preferences and clinical circumstances
    • The model incorporates the needs and expectations of the patient as well as the physician's expertise and current knowledge, which is critical to optimal patient care

    Hierarchy of Evidence

    • There are 5 main steps for applying EBM.
    • The hierarchy of evidence:
      • Randomized controlled double-blind studies - Considered the gold standard
      • Controlled trials without randomization
      • Well-designed cohort or case-control studies
      • Expert committees/opinions

    Levels of Evidence

    • Level I: At least 1 RCT with proper randomization
    • Level II.1: Derived from controlled trials without randomization
    • Level II.2: Well-designed cohort or case-control studies
    • Level III: Expert committees/opinions

    Evidence-Based Practice Leads to

    • Reduced variations in a clinician's practices
    • Enhancement of best practice
    • Reduced costs
    • Improved quality of health care
    • Increased patient satisfaction

    Size of Medical Knowledge

    • Linear growth of medical research: 1,600 new articles per day, 5000 biomedical, 95 Trials in 2005
    • 11,000 diseases, 1 disease per day for 30 years
    • 30,000 abnormalities (symptoms, signs, lab, X-ray)
    • 3,200 drugs
    • Past knowledge and practice might be outdated or inadequate
    • Clinicians are (currently) poorly equipped to distinguish good from bad research

    Medical Knowledge vs Clinical Experience

    • Knowledge graph decreases from graduate medical school to practicing physician
    • Clinical skills and experience graph increases from graduate medical school to practicing physician

    "Opinion/Consensus-Based" Medical Practice

    • The traditional method of medical practice involves:
      • Knowledge
      • Reading
      • Experience
      • Experts and peers opinions

    Expert Based vs Evidence Based

    • Expert Based: Patho-physiological reasoning, Personal observation, Expert based guidelines
    • Evidence Based: Clinical Studies, Best evidence available, Evidence based guidelines

    Evidence Pre vs Post EBM

    • Pre-EBM: Reliance on expertise, Need for research results, Trust in a paper in top journal, Medline, Evidence from basic research, Textbooks as evidence source, Good review, What to read in a paper, Significance
    • Post-EBM: - , + , + , - , - , Consensus, systematic methods/results, Statistical, Statist+clinical, Life-long self-directed learning, Critical appraisal ability.

    Common Clinical Questions/Examples

    • What is the best diagnostic modality?
    • What is the best treatment?
    • What is the best treatment for arthritis/back pain?

    Basis of Medical Practice

    • Training and expertise, clinical experience, consultations
    • Current evidence from articles
    • Patient preferences, beliefs, expectations
    • Active search of research (RCTs, systematic reviews, meta-analysis)

    Clinical State and Circumstances

    • Evidence recommends surgery but patient is unfit
    • Evidence recommends a drug but it is unavailable/expensive
    • Evidence recommends ICU admission but no beds are available

    Skills and Learning Needs

    • The overload problem of rapidly evolving new research (11,000 diseases; 1,600 new articles per day)
    • Learning need, Validity, Learning efficiency
    • Skills needed in information management:
      • Recognize learning needs
      • Efficiently find the best evidence
      • Discriminate good from poor evidence
      • Understand how to apply evidence with patients

    What is EBM?

    • EBM uses clinical expertise to integrate current best research evidence, patient preferences and values, and clinical state and circumstances to optimize patient care decisions
    • In EBM, the physician's duty is to find and apply current information
    • Best practice = evidence + expertise + patient context and values

    Best Evidence Available Information

    • Best evidence available information + Physician clinical expertise + the patient's preferences → make optimal decisions about patient care

    Multistep of Evidence-Based Practice Process

    • Step 0: Cultivate a spirit of inquiry
    • Step 1: Formulate answerable clinical questions (PICO)
    • Step 2: Acquire the evidence systematically
    • Step 3: Appraise the evidence critically
      • What is the research question?
      • What is the study design?
      • Assess the study's validity
      • Assess the study results
      • Assess the study's generalizability/applicability
    • Step 4: Apply the best evidence
    • Step 5: Assess the performance
    • Step 6: Disseminate EBP results

    Why We Need EBM

    • New research is rapidly evolving
    • Gaps between growing research and clinical practice
    • Patients are demanding more involvement
    • Hospitals/Insurances are using algorithms and stricter criteria

    What are the Uses of EBM?

    • Common language for decisions
    • Introducing new drugs
    • Allocating resources
    • Buying equipment
    • Cost-benefit analysis
    • Post-graduate education and lifelong learning
    • Identifying questions for which no evidence exists

    Three Factors Influencing Learning Impact

    • Learning need: How important are knowledge gaps?
    • Validity: How valid is the learned information?
    • Learning efficiency: How quick and complete is learning?
      • Effect = need x validity x efficiency

    Basic Steps of EBM

    • Ask a question
    • Search for evidence
    • Critically appraise evidence
    • Implement the best evidence
    • Evaluate/improve the process

    PICO Question Format

    • (P) Population/patient
    • (I) Intervention/indicator
    • (C) Comparator/control
    • (O) Outcome

    Examples of Clinical Questions/Research Questions using PICO

    • Examples of clinical research questions/EBM questions.
    • Various examples presented in PICO format.

    What Made Spread of EBM Possible?

    • Availability of cheap computers/internet
    • Progress in information technology
    • Development of statistical methods for tracking/appraising evidence
    • Creation of systematic reviews (e.g., Cochrane Library)
    • Creation of evidence-based journals, databases, and websites

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    Description

    Test your understanding of the assessing phase in evidence-based practice. This quiz covers various aspects, including performance assessment, research methodologies, and study designs relevant to clinical questions. Challenge yourself to ensure a solid grasp of evidence-based practices!

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