Chapter 3: Evidence-Based Decision Making
___ calculated as the probability related to chance or "p" value
statistical significance Statistical significance refers to the likelihood that the results are unlikely to have occurred by chance at a specified probability level and that the differences would still exist each time the experiment was repeated. Statistical significance is reported at the probability related to chance or "p" level. Levels of statistical significance are set at thresholds at the point where the null hypothesis will be rejected.
Levels of evidence exists that there is a hierarchy of evidence available to guide clinical decision making. All of the following are implications of this hierarchy except one. Which one is the exception? A. as one moves up the hierarchy, the number of published studies increases B. not all evidence is equal C. research designs allow more control so that treatment outcomes differences are not due to chance D. more clinically relevant studies occur as one moves up the hierarchy
A. as one moves up the hierarchy, the number of published studies increases Feedback: Levels of evidence exists that there is a hierarchy of evidence available to guide clinical decision making. As one moves up the hierarchy, the number of published studies decreases. Not all evidence is equal, research designs allow more control so that treatment outcomes differences are not due to chance and more clinically relevant studies occur as one moves up the hierarchy.
Which of the following are true in regards to clinical practice guidelines? A. changes over time as new evidence evolves B. referred to as primary evidence C. incorporates the best available scientific evidence to support clinical practice D. incorporates evidence that is known about a topic in a subjective manner
A. changes over time as new evidence evolves Feedback: Clinical practice guideline is secondary evidence that incorporates evidence that is known about a topic in an objective manner. It incorporates the best available scientific evidence to support clinical practice and changes over time as the evidence evolves, underscoring the importance of keeping current with the scientific literature.
All of the following statements are true regarding EBDM except one. Which one is the exception? A. is unique to medicine but not unique to dentistry B. requires new online searching and evaluation skills C. integrates research evidence with clinical expertise and client interest D. requires an understanding of research design
A. is unique to medicine but not unique to dentistry Feedback: EBDM is not unique to medicine or any specific health discipline; a reason why it is not referred to as evidence-based dentistry or evidence-based dental hygiene.
Evidence-based decision making (EBDM): A. Considers evidence alone as sufficient to make a clinical decision B. Maintains that the use of current best evidence does not replace clinical expertise or input from the client C. Considers scientific evidence as the key component in the decision-making process D. Considers evidence only from randomized controlled trials
B. Maintains that the use of current best evidence does not replace clinical expertise or input from the client Feedback: Evidence from clinical research is only one key component of the decision-making process and does not tell a practitioner what to do. The use of current best evidence does not replace clinical expertise or input from the client, but rather provides another dimension to the decision-making process, which is also placed in context with the client's clinical circumstances. It is this decision-making process that is referred to as evidence-based decision making.
Evidence resources that include pre-appraisal or filtered research that is research on already conducted individual studies is referred to as: A. primary research B. secondary research C. formal research D. informal research
B. secondary research Feedback: Secondary research including evidence-based clinical practice guidelines, meta-analyses (MAs), systematic reviews (SRs), and evidence-based article reviews are pre-appraised or filtered research on already conducted individual studies.
A well-constructed PICO question includes which of the following four parts? A. Client problem, implementation, clinical context, outcome B. Plan, implementation, clinician, outcome C. Client problem, intervention, comparison, and outcome D. Problem, client, intervention, outcome
C. Client problem, intervention, comparison, and outcome Feedback: PubMed is designed to provide access to both primary and secondary research from the biomedical literature. PubMed provides access to MEDLINE, the National Library of Medicine's premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the preclinical sciences. The database contains over 12 million citations dating back to 1966, and it adds more than 520,000 new citations each year. The PICO question provides the foundation for the search terms used in the MEDLINE database. By combining the client problem or population (P) description with the intervention (I), a comparison (C), and an outcome (O) being considered, one can quickly pinpoint a set of citations that will potentially provide an answer to the question being posed. Although online databases provide quicker access to the literature, knowing how databases filter information and having an understanding of how to use PICO and database features allow a more efficient search to be conducted.
Evidence sources that include original research, experimental research and observational studies are referred to as: A. meta-analyses B. systemic reviews C. primary research D. secondary research
C. primary research Feedback: Primary research includes original research studies that include experimental research (randomized controlled trials) and non-experimental or observation research (cohort and case control studies).
Types of research studies in which the researcher does not give a treatment, intervention, or provide an exposure include which of the following? A. observational research B. cohort studies C. randomized control trials D. case control studies
C. randomized control trials Feedback: Observational research, cohort studies, and case control studies are used when the possibility exists that testing a treatment or intervention has the potential to cause harm.
The highest level of evidence for evidence-based decision making is which of the following? A. In vitro (test tube) research B. Case reports C. Observational studies D. Meta-analysis and systematic reviews
D. Meta-analysis and systematic reviews Feedback: The highest level of evidence consists of the systematic review (SR) and meta-analysis using two or more randomized controlled trials (RCTs) of human subjects. SRs and meta-analyses are considered Level I for evidence because of their strict protocols to reduce bias. These reviews provide a summary of multiple research studies that have investigated the same specific question. SRs use explicit criteria for retrieval, assessment, and synthesis of evidence from individual RCTs and other well-controlled methods. Meta-analysis is a statistical process often used with SRs. It involves combining the statistical analyses of several individual studies into one analysis. When data from these studies are pooled, the sample size and power usually increase. As a result, the combined effect can increase the precision of estimates of treatment effects and exposure risks.
The type of research that provides the strongest evidence for demonstrating cause and effect is: A. case control studies B. cohort studies C. systematic reviews D. randomized controlled trials
D. randomized controlled trials Feedback: Randomized controlled trials provide the strongest evidence for demonstrating cause and effect. An example is when the treatment demonstrates that it has caused the effect rather than it happening by chance.
___ determines the practical or clinical implications of data
clinical significance Clinical significance is used to distinguish the importance and meaning of the results reported in a study and is not based on a comparison of numbers. It determines the practical or clinical implications of the study.
___ not based on the comparison of numbers
clinical significance Clinical significance is used to distinguish the importance and meaning of the results reported in a study and is not based on a comparison of numbers. It determines the practical or clinical implications of the study.
___ results are unlikely to have occurred by chance
statistical significance Statistical significance refers to the likelihood that the results are unlikely to have occurred by chance at a specified probability level and that the differences would still exist each time the experiment was repeated. Statistical significance is reported at the probability related to chance or "p" level. Levels of statistical significance are set at thresholds at the point where the null hypothesis will be rejected.
___ thresholds are set at the point where the null hypothesis will be rejected
statistical significance Statistical significance refers to the likelihood that the results are unlikely to have occurred by chance at a specified probability level and that the differences would still exist each time the experiment was repeated. Statistical significance is reported at the probability related to chance or "p" level. Levels of statistical significance are set at thresholds at the point where the null hypothesis will be rejected.