Evidence-Based Practice in Healthcare

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Questions and Answers

What is the primary measure of association used in case-control studies?

Risk ratio

Odds ratio (correct)

Hazard ratio

Relative risk

What is the main purpose of meta-analysis in research?

To combine results of multiple studies to answer a clinical question (correct)

To improve the accuracy of individual studies

To evaluate the performance of clinical trials

To analyze statistical methods used in studies

Which factor is NOT considered when implementing evidence-based practice (EBP)?

Leadership involvement

Evidence dissemination (correct)

Individual practitioners

Health care cultures

What does the translation of research into practice (TRIP) involve?

Adoption of EBPs in healthcare service delivery Signup and view all the answers

What elements are integrated for effective evidence-based practice?

Clinical expertise, patient preferences, and external evidence Signup and view all the answers

What is a key feature of systematic reviews that should be scrutinized?

Potential bias and scientific rigor Signup and view all the answers

Which type of review is NOT based on a statistical analysis?

Scoping review Signup and view all the answers

What does the Cochrane Collaboration focus on in its systematic reviews?

Health care interventions Signup and view all the answers

What type of practice guidelines are based on expert opinions and existing research?

Expert-based practice guidelines Signup and view all the answers

Which of the following is NOT a component of clinical practice guidelines assessment?

Statistical significance Signup and view all the answers

Which tool is specifically designed for assessing observational studies in epidemiology?

MOOSE Signup and view all the answers

What type of review is characterized by a systematic yet rapid evaluation of literature?

Rapid review Signup and view all the answers

Which criterion is important to ensure clarity in clinical guidelines?

Descriptive evidence grading methods Signup and view all the answers

What is the relative risk of lung cancer for smokers compared to nonsmokers?

2.375 Signup and view all the answers

What is the odds ratio of lung cancer in smokers versus nonsmokers?

4.17 Signup and view all the answers

Which statement regarding sensitivity and specificity is correct?

Sensitivity measures the ability to detect true positives. Signup and view all the answers

In a test with 80% sensitivity, how many true positives would be missed if 500 individuals have the disease?

100 true positives Signup and view all the answers

If a test has 99% specificity, how many false positives would you expect in a sample of 500 patients who do not have the disease?

5 false positives Signup and view all the answers

What does a sensitivity of 99% indicate about a given test?

The test rarely misses true positives. Signup and view all the answers

What is the relationship between sensitivity and specificity as one increases?

One increases while the other decreases. Signup and view all the answers

What would be the specificity if a test correctly identifies 375 true negatives out of 500 patients who do not have the disease, missing 125?

75% Signup and view all the answers

What is the main purpose of calculating the positive predictive value?

To evaluate how likely it is that a patient has the disease given a positive test result Signup and view all the answers

Which statement about likelihood ratios is true?

They do not change based on the population being tested Signup and view all the answers

If 25 patients test positive for troponin, but only 12 actually meet the criteria for NSTEMI, what does this indicate about the test's specificity?

It is likely high since there are many false positives. Signup and view all the answers

How does the positive predictive value change in different populations?

It can vary significantly based on the prevalence of the disease. Signup and view all the answers

What is represented by a large negative likelihood ratio?

High certainty that the patient does not have the disease. Signup and view all the answers

In assessing predictive values, what should be taken into account?

The population being tested and the disease prevalence. Signup and view all the answers

Which factor differentiates predictive value from likelihood ratios?

Predictive value is affected by disease prevalence, while likelihood ratios are not. Signup and view all the answers

If a patient has a negative test result, what does the negative predictive value tell us?

How likely it is that they do not have the disease based on true negatives. Signup and view all the answers

What does the Number Needed to Treat (NNT) specifically measure?

The number of treatments required for one patient to benefit Signup and view all the answers

Which of the following is a characteristic of a meta-analysis?

It synthesizes data from studies of the same design using statistical techniques Signup and view all the answers

What is the purpose of a PRISMA diagram in systematic reviews?

To illustrate flow and criteria of study inclusion and exclusion Signup and view all the answers

Which type of systematic review examines an area of research without statistical analysis?

Integrative review Signup and view all the answers

What is typically contained within a 95% Confidence Interval (CI)?

Two standard deviations of the population mean Signup and view all the answers

What is the primary goal of conducting a systematic review?

To collect and synthesize studies to inform practice recommendations Signup and view all the answers

What is the purpose of calculating the effect size in a meta-analysis?

To estimate the population effect based on intervention and control group differences Signup and view all the answers

Lower Number Needed to Treat (NNT) values are associated with which of the following?

Cost-effective interventions Signup and view all the answers

What is the primary focus of translation science in healthcare?

Testing implementation interventions to improve patient outcomes Signup and view all the answers

Which step in the Iowa Model involves comparing findings with current practice?

Decision making about practice change Signup and view all the answers

What does the selection of a topic in the Iowa Model involve?

Choosing between problem-focused and knowledge-focused triggers Signup and view all the answers

Which of the following is NOT included in the schemas for grading evidence?

Age Signup and view all the answers

How should studies be chosen for inclusion in the evidence synthesis phase?

Based on overall scientific merit and relevance to the topic Signup and view all the answers

What is one of the main challenges to implementing evidence-based practice (EBP)?

Building organizational capacity Signup and view all the answers

What is the purpose of a pilot evaluation in the Iowa Model?

To refine the evidence-based practice before wider implementation Signup and view all the answers

Which of the following is a strategy to promote the adoption of evidence-based practices?

Using quick reference guides Signup and view all the answers

What aspect does the decision to change practice consider according to the Iowa Model?

Consistency in findings and feasibility for use in practice Signup and view all the answers

Which of the following roles is considered essential in forming a team for implementing EBP?

Healthcare providers Signup and view all the answers

What is a key component of evaluating implemented evidence-based practices?

Monitoring both process and outcome measures Signup and view all the answers

What should be documented when developing evidence-based practice recommendations?

Evidence base using the agreed-upon grading schema Signup and view all the answers

Which of the following best describes evidence-based practice?

Conscientious use of current best evidence with clinical expertise Signup and view all the answers

In the context of EBP implementation, what does an environmental scan refer to?

Assessing the current healthcare environment for barriers and facilitators Signup and view all the answers

Study Notes

Research Methods

Research methods are discussed in module 13.
A quiz review is presented in module 13.
Quiz questions include: Which hypothesis (research vs. null) is involved in Type 1 and Type 2 Errors? What is probability? What is a p value?

Systematic Reviews & Meta-analyses

A systematic review is a review and summary of studies based on a focused clinical question.
If statistical methods are used to synthesize the studies, the review is known as a meta-analysis.
A meta-analysis combines the statistical data from all included studies to arrive at a more precise estimate of the effect or outcome.
Types of systematic reviews include Meta analysis, Integrative, Rapid, Scoping, Narrative, Scoping, and Realist.

Systematic Review: Process

A systematic review starts with a clearly focused question called a PICO(T) question.
PICO(T) includes: Population, Intervention, Comparison, Outcome, and Time.
The researcher locates published and unpublished studies consistent with the PICO(T) question.
Appraising the strength and quality of the evidence in each individual study is a key part.
Synthesizing the overall strengths and weaknesses of the studies in aggregate is another key part.
The researcher identifies studies based on inclusion and exclusion criteria (e.g., disease process, setting, population, geographic location, research method, statistical significance, sample size).
Researchers develop an explicit, reproducible methodology to search for, identify, and collect the included studies.
Using critical appraisal tools to assess the strength and quality of the evidence in each study, and overall is necessary.
General appraisal questions from earlier modules (e.g., modules 4, 10, 12) are applicable to quantitative or qualitative studies.
Determining the strength and quality of the evidence for practice based on internal and external validity; sampling, variable measurements, and data analysis are all factors that play a role.
Methods are reviewed for applicability of findings to practice, considering the PICOT question.

Evaluation of Research Results: Terminology Used in Meta-Analysis

Terminology used in meta-analysis includes confidence interval, likelihood ratio, predictive value, number needed to treat (NNT), odds ratio, relative risk, sensitivity, and specificity.

Relative Risk

Relative Risk (RR) is the probability of an outcome in an exposed group versus an unexposed group.
RR = 1 indicates no difference between groups.
RR < 1 indicates a reduced probability.
RR > 1 indicates an increased probability.
Examples include evaluating the risk of developing lung cancer in smokers versus nonsmokers, or thyroid cancer in a nuclear-radiation-exposed group versus a control group.
RR is calculated based on a table, such as the (A, B, C, D) table

Relative Risk Reduction

Relative Risk Reduction (RRR) estimates the percentage of baseline risk removed by a therapy/intervention.
Calculated as absolute risk reduction (ARR).
ARR = (EER – CER) / CER; where EER is experimental group event rate and CER is Control group event rate

Odds Ratio

Odds Ratio (OR) estimates the odds of an event occurring in a treatment group relative to the odds in a control group.
OR = 1 indicates no difference between groups.
OR < 1 indicates increased odds in the control group.
OR > 1 indicates increased odds in the treatment group.
OR = (a/b)/(c/d) = ad/bc. (a/b= odds of treatment group; c/d= odds of control group)
Used frequently in case-control studies.

Sensitivity & Specificity

Sensitivity is the ability of a test to detect true positives (few false negatives).
Specificity is the ability of a test to detect true negatives (few false positives).
Sensitivity and specificity have an inverse relationship.
Predictive value of a test is determined by sensitivity and specificity of the test and the prevalence of the disease in the tested population.
Values are calculated using a formula (e.g. True positives/ (true positives + false negatives) and True negatives/ (true negatives + false positives).

Predictive Value

Predictive value is how clinicians use sensitivity and specificity.
Positive predictive value (PPV) is the likelihood a patient has a disease given a positive test result.
Negative predictive value (NPV) is the likelihood a patient does not have a disease given a negative test result.
These values depend on the population being tested and the prevalence of the disease.

Likelihood Ratio

Likelihood ratio (LR) is a measure of how much a given test result is expected in patients with a specified disorder versus patients without the disorder.
It measures the power of a test to change the pre-test probability into the post-test probability of a disease being present for a patient.
Large LR values indicate strong evidence for a diagnosis.
LR can be positive or negative.

Number Needed to Treat (NNT)

NNT is a measure of the effectiveness of an intervention.
It represents the number of people who need to receive a treatment/intervention for one patient to experience a benefit.
Lower NNT values are associated with cost-effective interventions.
High NNT values are associated with higher costs and relatively lower efficacy.

Confidence Intervals (CI)

CI is a range of values based on a sample of a population.
The likelihood that the population parameter will fall within a certain range on repeat testing.
CI of 95% is most common, which means in a normal distribution of values, it contains all values within two standard deviations of the population mean.

Types of Systematic Reviews

Types categorized by the methods they employ–including meta-analysis, integrative reviews, rapid reviews, scoping reviews, narrative reviews, and realist reviews.

Meta-Analysis

Statistical techniques to assess and combine studies of the same design to get a precise estimate of effect.
Provides Level I evidence.
Determines the impact of a number of studies.

Effect Size

Calculated using the difference in average scores between two groups in studies.

Forest Plot

Visually depicts the results of analyzing multiple studies.
Shows the results in an easy-to-understand graphical format.

Integrative Review

Critical review of an area without statistical analysis or hypothesis synthesis.
Broadest category of review.
May include theoretical/methodological studies or results of different research studies (quantitative or qualitative).
Statistics are not used for summarizing or drawing conclusions.
Although systematic reviews are useful, they must also be reviewed for potential bias and critiqued for scientific rigor.

Cochrane Collaboration

Largest repository that prepares and maintains health care interventions and reviews.

Systematic Review Tools

Tools like PRISMA and MOOSE are used in the process.

Clinical Practice Guidelines

Guidelines that serve as practice standards.
Link research to practice.
May be evidence based (a scientific process) or expert based (using the opinion of experts).

Critical Appraisal

Method for evaluating the quality/strength of guidelines, evidence, studies, etc that are being used in the practice.
Questions include, but are not limited to those about the PICO question applicability, the review’s comprehensiveness, the dates of inclusion, criteria for assessment, whether studies were conducted individually or collectively, the method of study combination, and whether the clinical conclusions are relevant and supported.

Developing EBP: Clinical Inquiry

Strategy 1: Asking a focused clinical question that outlines the population, intervention, comparison, and outcome.
Question categories including prognosis, harm, therapy, and diagnosis categories.

Developing EBP: Literature Search

Factors influencing a literature search (information literacy, librarian consultation, electronic indexes/databases, tutorials to search databases).
Screening results (peer-reviewed journals, similar settings/samples, study sponsorship).

Developing EBP: Critical Appraisal

Criteria for appraising therapy, diagnosis, prognosis, and harm articles.

The Iowa Model

The Iowa Model framework includes methods and structures that guide a process that ensures EBP strategies are employed in practice
Includes the stages of a clinical question, development of a team, evidence collection/synthesis, and dissemination/implementation of the resultant findings.
Includes strategies for addressing the EBP topic and for managing the different areas of the process, including user adoption, social systems, implementation strategies, and evaluation of the results.

Using the lowa Model

Methods for reading and critiquing articles, for deciding which studies to use, defining summary tables, identifying critical evaluation points for research designs and findings; and identifying strategies for promoting EBP implementation.

Evidence-Based Practice & the AGCNS

Challenges and expectations for meeting EBP expectations (e.g., building capacity, education of clinicians, engaging patients), and the emerging body of knowledge in translation science.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on evidence-based practice (EBP) and related concepts in healthcare research. This quiz covers key elements such as systematic reviews, meta-analysis, and clinical practice guidelines. Challenge yourself to understand the measures and frameworks utilized in EBP.