Drug Lit Test3 Set1

Front 1

Def of Evidence Based Medicine

Benefits of it (4)

Back 1

1)explicit use of current best evidence in making decisions about care of individual pts

1)stay up to date w/ current lit
2)communicate effectively w/ other HC ppl
3)make best use of info
4)avoid common pitfalls of clinical decision making

Front 2

4 step process in decision making

Back 2

1)recognize info needs and convert them into answerable Q's
2)conduct efficient searches for the best evidence w/ which to answer these Q's
3)critically appraise the evidence for its validity and usefulness
4)apply the results to pt situation to best assist clinical decision making

Front 3

Components of a Focused Q (4)

And focused Q's will allow... (2)

Back 3

PICO

Population
Intervention
Comparison
Outcome


1)clarifies lit search
2)allows application of study results to real world

Front 4

For this define PICO:
43 yo WF, presents with a complaint of fatigue and
loss of interest in her usual activities. She denies any suicidal ideation, and has a normal history and physical examination. After diagnosing her with minor depression, the physician asks you to recommend a selective serotonin reuptake inhibitor. However, the patient asks about St. John’s Wort. You wonder: “Is St. John’s Wort a reasonable choice for this patient?

Back 4

P: adult w/ minor depression
I: St. John's Wort
C: SSRI
O: Relief of s/sx

Front 5

What is POEM? (4)

Back 5

Patient Oriented Evidence that Matters
a)addresses clinical problem that you will encounter in practice
a)uses pt-oriented outcomes
a)potential to change practice

Front 6

What is DOE? (5)

Back 6

Disease-Oriented Evidence
1)common in medical lit
2)often used in promotional drug lit
3)may be misleading
4)use of surrogate markers of disease as outcomes

Front 7

Usefulness Equation?

Back 7

(Relevance x Validity) / Work

Front 8

Questions to ask in determining Relevance (3)

Back 8

1)Did the authors study an outcome that patients would care about?
2)Is the problem studied one that is common to my practice and the intervention feasible?
3)Will this information, if true, change the way I currently practice?

Front 9

Determining Validity (3)

Back 9

1)defines to what extent the knowledge gained as a result represents the "truth"
2)each clinician must accept responsibility for assuring that validity has been critically assessed
3)worksheets and tools to help assess validity of RCTs

Front 10

Determining Work (3)

Back 10

1)working too hard to establish the validity/relevance will lower usefulness
2)a low work-factor source may also have a low validity or relevance
3)best source of info would provide highly relevant and valid info (and minimal info reqd to obtain it)

Front 11

Defining Study Q of Systematic Review and Meta Analysis (2)

Back 11

1)all reviews should begin w/ this (like developing a hypothesis)
2)components of well developed Q's include PICO

Front 12

Searching for Studies in Systematic Review and Meta Analysis (3)

Back 12

1)goal is to obtain as comprehensive a list as possible of both published and unpublished studies that may meet the inclusion criteria
2)well-written reviews should include the reserachers search strategy (and it be repeatable)
3)use multiple primary studies and sources

Front 13

Publication Bias? (3) (Systematic Review and Meta Analysis)

Back 13

1)type of selection bias that can impact the results of systematic reviews and meta-analysis
2)studies that reveal sig tx effect are more likely to be published/cited
3)therefore more likely to be ID'd and included in systematic reviews

Front 14

Funnel plots (Systematic Review and Meta Analysis) (3)

Back 14

1)scatter plots of tx effects from inidividual studies against a measure of study size (sample size is vertical axis)
2)smaller studies on bottom of plot and spread widely (and v.v.)
3)IN ABSENCE OF BIAS THE PLOT LOOKS LIKE INVERTED FUNNEL

Front 15

Inclusion/Exclusion Criteria of Systematic Review and Meta Analysis
a)general (1)
b)should describe which studies are elgible for inclusion based on: (5)
c)inclusion criteria should also clearly state... (3)

Back 15

a)clear/concise criteria help to minimize bias/errors when studies are selectied for inclusion in the systematic review

b)population being studied
b)intervention that is studied (exposure)
b)control used
b)outcome measure used
b)study design

c)time period that studies were performed
c)languages of publication that were elgible
c)whether published and/or unpublished studies were eligible

Front 16

Assessing Study Quality of Systematic Review and Meta Analysis (5)

Back 16

1)fact that included studies are RCTs does NOT guarantee their quality
2)assess quality of studies based on methodology, precision (random error), external validity
3)atleast 2 independent reviewers should conduct quality assessments
4)authors should include method of handling disagreements b/w reviewers
5)quality scores for each study

Front 17

Collecting/Synthesizing Relevant Info in a Systematic Review and Meta Analysis (3)

Back 17

1)researchers must extract pertinent info from all studies included
2)check participants, interventions, study design
3)check results from each report

Front 18

Form Conclusions in Systematic Review and Meta Analysis (4)

Back 18

1)valid conclusions should be provided by researchers (supported by data extracted from all studies included)

2)can do subgroup analysis
a)useful in explaining heterogeneity (inconsistency in results across studies)
b)should be viewed w/ caution as they can lead to false conclusions

Front 19

Name of Database that provides full text articles reviewing the effects of HC

Back 19

COCHRANE database of systematic reviews

Front 20

Def of Meta-Analysis

Purpose of Meta-Analysis (2)

Main difference from Systematic Review

Back 20

a)statistical combo of atleast 2 studies to produce a single estimate of the effect of HC intervention under consideration

b)incr sample size by combining samples of individual studies
b)get incr statistical power and incr precision of tx effect estimates

c)Meta uses QUANTITATIVE methods to summarize results

Front 21

Results of Meta-analysis are depicted how? (and grab one to look at!!!) (7)

Back 21

1)FOREST PLOT
2)vertical line down middle = no effect
3)horizonal line associated w/ each trial show result of that trial and square in middle of line = point estimate and area of square = weight of trial in meta-analysis
4)width of line thru each square represents 95% CI
5)If CI crosses line of no effect then: no sig diff b/w tx's OR too small sample size to detect sig diff
6)dotted vertical line represents overall tx effect for combined trials
7)diamond @ bottom represents pooled data from all trials and center of it = tx effect (corners of diamond are 95% CI)

Front 22

Def of Heterogeneity (Meta-Analysis)

Clinical heterogenetiy?

Statistical Heterogeneity?

Back 22

a)individual trials are NOT compatible w/ each other

b)studies NOT similar based on populations, interventions, outcomes, methodology (look @ study designs)

c)study's NOT similar based on results (look @ individual and combined study results)

Front 23

Statistical methods for detecting heterogeneity
a)Cochran's Q? (4)

Back 23

a)"low" p-values (under 0.1) suggest that differences among studies are NOT due to chance alone and that combining studies may be inappropriate (you heard it right)
b)but this alone may not be able to accurately detect heterogeneity
c)it may be under/overpowered (too small/too big sample size)
d)so its GOOD if Cochran Q is over 0.1 (p is over 0.1)

Front 24

Statistical methods for detecting heterogeneity
a)I^2 (4)

Back 24

a)uses and improves Cochran's Q
b)describes variability b/w studies that is likely due to true differences b/w studies, rather than chance alone
c)when it = 0% differences likely due to chance alone and IS APPROPRIATE to combine them
d)0-25%=low; 25-50%=moderate; 50+%=high

Front 25

What else to look @ on Forest Plot to see if Meta-analysis is valid

Back 25

if CI's overlap and tx boxes on same side of the line its appropriate to combine them