MRTY 4043 Final Exam Notes - Week 6-19 - PDF

Week 6 Evidence-based Practice (EBP) To provide effective care ○ Rationale for clinical decisions Justify your choices with the best available evidence, ensuring transparency and trust with pts ○ Stay informed on latest treatme...

Week 6 Evidence-based Practice (EBP) To provide effective care ○ Rationale for clinical decisions Justify your choices with the best available evidence, ensuring transparency and trust with pts ○ Stay informed on latest treatments Keep up to date with the most recent advancements to provide the most effective care options ○ Pt centered approach Present evidence based options, empowering pts to make informed decisions aligned with their values To satisfy professional standards ○ Meet job expectations EBP is often a core competency in healthcare roles, mastering it enhances your professional standing ○ Adhere to regulatory standards Compliance with bodies like the MRPBA is essential for maintaining licensure and institutional accreditation ○ Continuous professional development Engage in lifelong learning to stay current, improving your practice and advancing your career The challenge of up to date vs best evidence Many official guidelines require healthcare to be delivered in line with the most up to date standards But does up to date is not always the best ○ It might not be most reliable or applicable evidence Best evidence involves making conscientious, explicit, and judicious use of the most relevant, well conducted, and applicable research when making clinical decisions How to effectively use evidence based practice Stay informed with current knowledge Critically appraise evidence Integrate pt values and preferences Apply clinical expertise Make informed, evidence based decisions Engage in continuous reflection Barriers to implementing EBP in practice Resistance to change ○ Challenge: senior staff may resist adopting new practices, preferring traditional methods ○ Impact: can create a culture of stagnation, hindering the integration of new evidence based approaches Conflicting evidence ○ Challenges: contradictory findings in different studies can lead to confusion and uncertainty ○ Impact: this may make it difficult to determine the best course of actions, slowing down the decision making process Overwhelming information ○ Challenge: the sheer volume of new research and data can be overwhelming ○ Impact: keeping up with the latest developments becomes challenging, potentially leading to the use of outdated practices. Week 7 Literature review Systematic, explicit, and reproducible method for identifying, evaluating, and synthesizing the existing body of completed and recorded work produced by researchers, scholars, and practitioners. Purpose of a literature review Investigates and appraises material that has been written on a particular topic Can serve as a framework for an ensuring study or piece of research, such as a thesis Raises questions and identifies areas (gaps) to be explored Type of literature reviews Narrative (traditional) review ○ Used widely in many disciplines ○ Literature search methods and criteria may be less systematic and are not typically reported in the review article ○ Include many sources of materials such as Original peer reviewed research articles Previous review articles Doctoral theses Patents Conference proceedings Scoping review Systematic review ○ Review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant primary research, and to extract and analyse data from the studies that are included in the review ○ Use and report Inclusion criteria Exclusion criteria Databases search and search terms Meta analysis ○ Can be thought of as conducting research about previous research ○ Contrasts and combines results from different studies aiming to identify patterns that can only be observed once several different studies are compared ○ Jby aggregating information from several different sources, a meta analysis can often reach greater statistical power than each single study Six tasks associated with carrying out5 a narrative literature review 1. Select your research question a. Possible questions i. Broad scope 1. What is the prevalence of neuropathy in obese diabetic pts ii. Narrow scope 1. What costs are associated with hospitalization of obese diabetic pts due to complication from neuropathy iii. Very narrow scope 1. What strategies have been utilized in NSW to reduce length of stay in hospital for obese diabetic pts presenting with complications from neuropathy b. How do research questions influence the results of your search c. Arguably the best type of research question is the narrow one 2. Select your sources a. Literature reviews depend on data acquired from several different sources, such as i. Online public bibliographic database, ex) google scholar, PubMed ii. Specialized bibliographic database, ex) Medline, Web of science iii. Manual or hand searches for reference lists 3. Choose appropriate search terms a. Select your database b. Break your questions into concepts c. Identify subject headings for each concept d. Identify text words for each concept 4. Run your search a. Start with your first concept i. Search for the subject headings first ii. Search text keywords iii. Combine synonymous searches with or using your search history b. Repeat for your second, third, and subsequent concepts i. Also combine each concept within itself with or c. Finally combine search results with AND 5. Apply appropriate screening criteria a. Two types of screening for the papers that you get in your search i. Practical 1. Allows you to identify a broad range of potentially useful studies 2. Criteria a. Publication date b. Research design c. Publication language ii. Methodological 1. Allows you to identify the best available studies 2. Criteria  a. You are interested in evaluating the quality of each study that you are considering in your literature review b. Internal validity i. Only applies to studies that try to establish a causal relationship 1. Not relevant in observational or descriptive studies ii. Key question if whether the observed changes can be attributed to the intervention described in the study or to other possible causes c. External validity i. Measures the extent to which the results of a study can be generalized to other populations or to other circumstances d. Validity i. The extent to which a concept, conclusion of measurement is well founded and corresponds accurately to the real world e. Reliability i. Consistency, stability, or dependability of the data 6. Synthesize the results a. Structuring your literature review as an inverse pyramid i. Start broadly ii. Slowly converge to the focus of the problem you are studying b. Don't forget to address your research question along the way c. Use the results of your search to i. Describe the current knowledge about your research topic ii. Highlight the gaps in the literature and emphasize the need for new research that can cover these gaps iii. Explain the major findings that are consistent across all the studies you gathered Week 8 Types of research Basic research ○ Foundation ○ Guided by interest and desire ○ May have no relevance to real world problems Applied research ○ Potential to solve real world problems ○ Assumes that real world problems can be solved Hypothesis Something that has not been yet proven Have no data or picture or record to back up your claim All you have is an argument, so you better lay it out clearly Make the argument simple and by small steps Evidence Most research projects start from a base of facts Take some logical steps Make a conclusion It is crucial that you have good evidence Defining good research question Needs to be answerable either by collecting observable evidence or empirical data Refel to the relationship between at least 2 variables Follow logically and consistently from what is already known about the topic this leads to sustained innovations Overall picture of a research project Formulate a good research question Define your variables ○ What is measured ○ Who is independent ○ Who is dependent ○ Who may influence who Carry out a literature review ○ Better your search, less you risk wasting your time Collect your data, test your ideas, quantitative vs qualitative ○ Qualitative Observational data Include interview, focus group, data captured using certain types of recording media ○ Quantitative  Deals with quantities, numbers Include epidemiological, experimental and quasi-experimental studies Qualitative inquiry Grounded theory: construction of theory from gathered data, clarification of behaviour, influential relationships Ethnography: used to explain wider cultural issues or narrow specific segments of society Phenomenology: investigates the meaning of existence, how do people describe experiences in their lives Biography Case study: life story, interpretation, long time line of evidence Ethics Recognise the power relationship between interviewer or observer and the participants Can the interview, focus group or observations prompt stress, reflection of traumatic events, highly personal Clear strategies for recognising distress or need to intervene Recognise that researcher may be causing a change in behaviour\ Faithful recording of events Quasi-experiment: type of study in which one estimate the impact of an independent variable - No randomization of subjects or other factors may be possible, which leads to a number of significant issues Epidemiology: study of patterns, causes and effects of disease in certain population Statistics: science of collecting, analysing, and interpreting data Helps in making informed decisions based on data Descriptive statistics: summarizes data Inferential statistics: makes predictions or inferences about a population based on a sample Visualizations: 1. Histogram: shows the distribution of data points 2. Scatter plot: displays relationships between two variables 3. Box plot: shows the spread and central tendency of data Sensitivity Proportion of people with the disease who have a positive test for the disease Specificity Proportion of people without the disease who have a negative test for the diesease Decision analysis Systematic, explicit, quantitative way of making decisions in health care that lead to both enhanced communication about clinical controversies and better decisions ○ Identify and bound the problem ○ Break into components Treatment options Events Outcomes ○ Decide on the information needed to fill tree ○ Decision tree analysed ○ Estimate value of different decision options Summary There are 2 types of research design ○ Quantitative ○ Qualitative To prepare your research project ○ Determine your research question ○ Figure out your hypothesis ○ Carry out a literature review ○ Determine how you will do the actual experiment ○ Determine how you will analyse the data Week 9 Motion of the head during CT scanning causes blurring and ghosting artifacts that intervene with diagnosis No remedy other than to rescan Hypotheses Radiology staff: 1. Motion is a common problem in head CT imaging. 2. It compromises diagnosis and treatment decisions. 3. There are some types of scan in which motion is a particularly serious problem. 4. Currently available remedies are not adequate. 5. Repeating the scan is not always possible 6. MC could improve patient safety by removing the need for repeat scans, repeat radiation doses, and anesthesia. 7. Repeating scans reduces throughput, causes inconvenience, and involves a cost. CT manufacturers: 1. Companies perceive head motion as an important problem in CT imaging 2. Companies are aware of what remedies are currently available and their limitations 3. Companies are not offering a solution at present 4. Companies are aware of the emotional, health and social, as well as clinical, impacts of head motion in current CT imaging 5. Companies are interested in offering a solution to their customers 6. Having a solution could give a company a reputational advantage as a market leader 7. Having a solution could give a company a market edge. Key Learnings and Insights Additional potential customers identified – Emergency, ICU, Trauma, Stroke departments CT Manufacturers seemed preoccupied with AI applications. Should we include an AI component? Sales people of some manufacturers seem unconcerned about motion–but sample too small so far to reject the hypothesis. Software companies may also be potential customers. Additional causes of patient motion identified Drugged, drunk, sepsis New motion–related problems identified: Some patients are actually excluded from CT scans due to perceived probability of motion Motion delays diagnosis and treatment (and other patients) The role of radiographers in this research Use their unique perspective and professional expertise to identify needs/deficiencies Advocate for solutions Contribute to team formation, research planning, ethics approvals, and data collection Apply specialist knowledge during data analysis, interpretation of results, and publication Further publicize research findings through presentations, conversations with colleagues and vendors, discussion at professional forums Week 10 DM limitations Overlapping of breast tissue layers Small differences in x-ray attenuation Pt discomfort DBT Derivative digital mammographic imaging technology Produces volumetric 3D images Using x-ray equipment Advantages of DBT over DM Provides a series of images reconstructed to a stack of slices ○ Each slice has much less of overlapping tissue than DM ○ Helps discrimination between tissue structures and lesions ○ Potentially better visualisation of malignancy ○ Hence DBT could improve cancer detection - DBT at least equal or better accuracy than standard DM - Adding DBT to mammo for diagnosis of screen-recalled abnormalities significantly improves accuracy - Comparisons of DBT and DM using ca-enriched reader studies yielded variable accuracy estimates: improved accuracy from DBT was from increased Ca detection and or reduction of false positive recalls - Many observer studies did not find significant differences in screening accuracy between DBT and DM - Subjective interpretation of cancer conspicuity showed that cancers were equally or more conspicuous on DBT vs DM In Australia DBT used in the diagnostic setting, and assessment of screen detected abnormalities, and in many radiology services and breast services Temporary medicare funding for DBT in clinically referred pts DBT not used for primary screening Mammo is only screening test endorsed for population BC screening Current challenges for DBT Interpretation time burden: roughly 2-4 times longer than DM Radiation dose: roughly same or higher for DBT depending on breast thickness but much higher if DBT+DM acquisitions Optimal clinical protocol not established IT storage and display: increased infrastructure requirements, and costs Level of evidence: evidence on detection metrics is matched with evidence on health benefit, no impact on interval cancer rates despite higher BC detection Week 11 Purpose of scientific peer review Service to authors ○ Eliminate errors (ideally) ○ Ensure sufficient details is provided ○ Improve clarity Ensure the research is novel, scientifically sound and suitable for the journal based on ○ Journal scope ○ Quality of science ○ Originality of research ○ Importance Review process Normally require two referee reports ○ Could be 1-3 ○ Referees send their reports back to the editor ○ Typically single blind referee process is used Referee knows who the author is Authors are not informed who the referee is ○ Editor or associate editor makes decision based on referee reports ○ Adjudicator or additional reviewers may be selected if the reports are conflicting Models for peer review Single blind ○ Referee knows who the author is ○ Authors are not informed who the referee is Double blind ○ All identifying information is removed from the manuscript prior to review ○ The authors and reviewers are blinded to each other Open (unblinded) review ○ Open identities Authors and reviewers are aware of each other’s identity ○ Open reports Review reports are published alongside the relevant article ○ Open participation The wider community are able to contribute to the review process What to look for in a manuscript Is the problem the authors are trying to address clear Is there sufficient background information and references to put the work in proper context Is the work scientifically valid ○ No errors, flows, mistakes in the manuscript ○ Mathematics and statistics correct Are the conclusions valid ○ Any unsupported claims ○ Would a reader who is from same field understand the work and be able t6o replicate it Is the work novel and interesting Are the results interesting Is the research important ○ Do the authors explain why it is important or how it advantages our understanding of the field Is the work original ○ Does it contain new materials ○ Have any part of it been published before How relevant is this work to researches in your field Is this only an incremental advance over previous work or is it a significant advance Is the work well presented Does the title reflect the contents of the articles Does the abstract contain the essential information Are the figures and tables correct, legible and informative, are there too many or too few Does the conclusion summarize what has been learned and why it is interesting and useful Is it clear Is the manuscript an appropriate length Other relevant topics in scientific publishing Bibliometrics ○ Impact factor ○ Journal rankings Scientific fraud Use of AI in scientific publishing Field-weighted citation impact (FWCI) FWCI is the ratio of total citations received by the publication output of a researcher, and the total citations that would be expected based on the average of the subject field FWCI takes into account differences in research behaviour across disciplines Bibliometrics summary The journal impact factor and journal ranking can be useful metrics, but only when applied and interpreted appropriately Ex, they are intended for comparisons within a field or discipline, comparisons across fields may be misleading Field-weighted citation impact is a more useful metric for comparing researches across diverse fields of interest Summary Scientific peer review serves an important purpose in ensuring the validity of published research and its importance to the field There are several models of peer review but the most common is where peers from your field assess the merits of the work and the authors are blinded to who they are Bibliometrics can be useful but need to be used carefully Scientific fraud in publishing is rare but it happens Most journals are developing policies and guidelines for the use of large language models (AI) in scientific publishing to increase transparency and accountability There are several useful, free online resources to support continuing education in the field of MRS Week 12 Need for ethics in research Protection of participants Protection of researchers Quality assurance related to animal research Integrity of outcomes Conflicts of interest Research ethics Fundamental to the process of conducting research Types of research that requires ethics ○ Clinical research ○ Clinical trials ○ Epidemiological research ○ Health services research ○ Population health research ○ Qualitative research ○ Animal research Nuremberg trial and code Voluntary informed consent Likelihood of some good resulting Based on prior research Avoidance of physical or psychological injury or harm Benefits should outweigh risk Proper experience of researcher Right to withdraw consent Research must stop if harm is resulting Types of ethics Human ethics Animal ethics Full HREC and low risk HREC Low risk HREC for each of health, business and psychology Human research Human research is conducted with or about people, their data or tissue Hunam participation in research is therefore to be understood broadly, to include ○ Surveys, interviews, focus groups, testing, observations, collection of body tissues, access to human information Human ethics: respect for participants Respect ○ Human participants must be afforded the right to Participate in research that has some justification or merit Designed to address the aims of the project Carried out by researchers with expertise Without exploitation and with some expectation of benefit, even if minor Reduce any risks or harm to the participants Fully informed Consent ○ Participants, where possible, must give informed consent ○ Participants cannot be coerced into participation and must be able to withdraw freely at any time ○ Research should not conceal the true purpose of the research, unless it is unavoidable ○ Institutions can give consent for de-identified data, such as scan sets, does profiles, test results What is data Pieces of information ○ What people say in interviews ○ Focus groups ○ Questionnaires ○ Personal hx and biographies Analysis of existing information (clinical, social, observational or other) Information derived from human tissue such as blood, bone, muscle and urine Types ○ De-identified ○ Identified ○ Re-identified ○ Master code, how it is stored ○ RDS and RedCap Confidentiality One of the most important concepts for participants How it is maintained ○ Are images identifiable ○ Is care taken to make sure you cannot find out the participants ○ Are response codes for qualitative research deidentified ○ What is the risk of identifying the institution or HREC Clinical trial Form of human research designed to find out the effects of an intervention, including a treatment or diagnostic procedure Clinical trial can involve testing ○ Drug ○ Surgical procedure ○ Other therapeutic procedures and devices ○ Preventive procedure ○ Diagnostic device or procedure Checking for a difference Research methods intended to avoid or reduce bias include ○ Randomisation and blinding participants and researchers to the identity of agents being compared ○ Ex, placebo ro traditional doses ○ Comes with its own ethical considerations Special human ethics Women and foetuses children/ young people Unequal relationships: students-teachers, etc, vulnerable people Critically ill pts Animal ethics Animals are used in research, normally at the pre-clinical or molecular level Animals are used in MRS research to determine ○ Radiation dose, damage, impact ○ Acquisition of scans for modelling ○ Contrast and radio-isotope trials ○ Normally rats, mice Underlying principles Respect for animals must underpin all decisions and actions including ○ Using animals only when it is justified ○ Supporting the wellbeing of the animals involved ○ Avoiding or minimising harm, including pain and stress, to those animals ○ Applying high standards of scientific integrity 3Rs of animal ethics Replacement ○ Methods that permit a given purpose of an activity or project to be achieved without the use of animals Reduction ○ Methods for obtaining comparable levels of information from the use of fewer animals in scientific procedures or for obtaining more information from the same number of animals Refinement ○ Methods that alleviate or minimise potential pain and distress and enhance animal wellbeing Vaccine trials Generally involve intention infection of human participants either through live or extinct viruses Usually performed with low virulent viruses, those less likely to cause serious illness/ death Other trial, including human challenge trials, include measuring how much infection is necessary to achieve a positive infection result COVID 19, animal trial generalisation has been poor to date Vaccine may be: immune booster, virus modification Ethical use of successful vaccine Who should be prioritized How will it be funded Should we aim for herd immunity Research integrity Conduct of researchers Authorship and published material  Intellectual property and future commercialisation Academic honesty Week 13 Implementation Science has been designed to deepen your knowledge of evidence-based practice (EBP) and its practical application. You have learned about the evidence-based practice cycle, which begins with formulating a clinical question, searching for relevant evidence, critically appraising it, and finally, implementing it into practice. Implementation science equips us with the tools to examine the process of translating evidence into practice, enabling change in healthcare systems and improving patient outcomes. Studies estimate that the time it takes for an innovation to be fully integrated into clinical practice is approximately 17 years. This gap between research and application has far-reaching implications, including: Patient outcomes Economic impact Professional development The primary goal of implementation science is to bridge the knowledge-practice gap by accelerating the adoption of research into clinical settings. It offers a structured, evidence-based approach to plan, implement, and evaluate practice changes. While the field of implementation science is extensive, this module serves as an introduction, providing you with foundational knowledge when you begin your career. Evidence-based practice (EBP) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research... and compassionate use of individual patients' predicaments, rights and preferences in making clinical decisions about their care. Knowledge translation (KT) is "a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the healthcare system Implementation science (IS) is "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness" of health services and care. Innovation: Your innovation is the practice change that you're trying to implement. Barrier: Any factor that obstructs the implementation of your innovation. Enabler: Any factor that helps facilitate the implementation of your innovation. When there is a substantial difference between the best available evidence and current clinical practice this is known as the knowledge-practice gap.