NURS 6010 Exam #1

a pilot study is critical in determining the?

feasibility of subject enrollment, the intervention, the protocol or data collection plan for the study, and the likelihood that the subjects will complete follow up measures

an example of a cohort study

finding out whether daughters of mothers who had breast cancer have a higher incidence of the disease vs those who mothers did not have breast cancer two groups of daughters (those with and without a mother breast cancer) would be studied over time to determine the incidence of breast cancer in each group

cohort study

follows a group of subjects longitudinally over a period of time to describe the incidence of a problem or to determine the relationship between a predictor variable and an outcome

example of a nonintervention PICOT question where it is focused on the issue of interest

how do new mothers (patient population) who have breast related complications (issue of interest) perceive their ability to breastfeed (the outcome) past the first 3 months after their infants birth (the timeframe in which their perception matters)

quantitative research involves quantifying outcomes examples include

how many falls are prevented by a fall prevention intervention program or how many barriers to EBP clinicians list

an example of attrition

if individuals with the poorest outcomes felt that they were not ganging any benefit from the study, which led them to drop out of a study, differences between the two study groups may not surface during statistical analyses

example of clinical questions that could be answered through a systematic review include

in adult women with arthritis, how does massage compare with pharmacologic agents to reduce pain after 2 weeks of treatment

example of a well designed PICOT question

in teenagers (patient population), how does cognitive behavioral skills building (the experimental intervention) compared with yoga (the comparison intervention) affect anxiety (the outcome) after week weeks of treatment (the time taken for the interventions to achieve the outcome)

case control studies are those?

in which group of individuals (cases) with a certain condition (migraine headaches) is studied at the same time as another group of individuals who do not have the condition (controls) to determine an association between one or more predictor variables (family hx of migraine headaches, consumption fo red wine) and the condition (migraine headaches)

advantages of case control studies

include an ability to determine associations with a small number of subjects, which is especially useful in the study of rare types of diseases and an ability to generate hypotheses for future studies

all qualitative research designs do not have an intervention (something implemented to achieve an outcome) in those studies the condition is the ___.

independent variable condition such as smoking or a disease can be associated with an outcome which is the dependent variable

identifying the major variable in studies is essential to understanding the value of evidence to clinical decision making the ___ is what has been implemented to achieve an outcome the ____.

independent variable, dependent variable

__ validity includes ways that people make sure that the intervention is what caused the change, not something else (difference in groups, units, environment)

internal

why are systematic review and meta-analysis of RCTs the highest level of evidence?

rigorous search results and appraisal includes all RCTs that meet inclusion criteria reduce risk of bias uses a statistical approach to synthesize results across all studies

EBP is sustained in practice by?

testing the processes and adapting locally gathering clinical outcome data disseminating the data to your team your health system, local, and national channels (reports, posters and publications)

the difference between QI and evidence based QI is

that the former relies primarily on internal evidence and often does not involve a systematic search for and critical appraisal of evidence, where as the latter must include both internal and external evidence in decision making about a practice change to implemented to improve an important clinical outcome

level 7 evidence

the opinion of authorities and/or reports of expert committees

directness

two criteria include whether 1. evidence demonstrates association of interventions to specific outcomes 2. comparisons studies are head to head

mistakenly rejecting the null hypothesis when it is actually true.

type 1 error

making a __ error such as when an investigator accepts a false null hypothesis, which states there is no relationship between the independent and dependent variables.

type 2 error

mistakenly accepting (not rejecting) the null hypothesis when it is false.

type 2 error

Quasi-experiment

type of experimental design that tests the effects of an intervention or treatment but lacks one or more characteristic of a true experiment (random assignments a control or comparison group)

___ must be ascertained before the clinicians can make an informed assessment fo the size and precision of the effects reported.

validity

the first steps of critical appraisal can be efficiently accomplished by answering three key questions as part of a rapid critical appraisal process in which studies are evaluated for their?

validity reliability applicability

level 4 evidence

well designed case control and cohort studies

level 2 evidence

well-designed RCT

level 3 evidence

well-designed controlled trials without randomization

extraneous variables

Those factors that interfere with the relationship between the independent and dependent variables.

descriptive studies

Those studies that are conducted for the purpose of describing the characteristics of certain phenomena or selected variables.

components of evidence based practice

-Clinical Expertise (evidence from patient assessment, internal evidence, and use of healthcare resources) -Best Evidence (research evidence and evidence based theories) -Patient Values & Preferences (systematic reviews of RCT, descriptive and qualitative studies, evidence based theories, patient/family preferences, values, and concerns, clinician's expertise)

EBP is searching for best evidence and changing practice in a systematic way that?

-gathers evidence from research and experts -combines the expertise of the team, the type of patients and the resources available (adapted for that setting and workflow) -while honoring the patient's preferences and values (individualized at patient level)

type ___ error is a false positive-could be the results of using a large sample size in which even an insignificant difference is statically significant.

1

The definition of EBP has broadened in scope and is referred to as a lifelong problem solving approach to clinical practice that integrates the following:

1. a systematic search for and critical appraisal of the most relevant and best research (i.e. external evidence) to answer a burning clinical question 2. one's own clinical expertise, including the use of internal evidence generated from outcomes management or evidence-based quality improvement projects, a thorough patient assessment, and evaluation and use of available resources necessary to achieve desired patient outcomes 3. patient/family preferences and values

key general critical appraisal questions

1. are the results of the study valid? (validity) 2. what are the results? (reliability) 3. will the results help me in care for my patients? (applicability)

clinician's expertise includes

1. clinical judgment (the ability to think about understand and use research evidence and to assess a patients condition through subjective history taking, thorough physical exam findings and lab reports) 2. internal evidence generated from evidence based QI or outcomes management projects 3. clinical reasoning (ability to apply the above information to a clinical issue) 4. evaluation and use of available healthcare resources needed to implement the chosen treatment 5. achieve the expected outcome

outcomes management four step process

1. define a clinical problem and outcome that need to be improved 2. establish how the outcome will be measured 3. identify practices supported by evidence that need to be implemented to improve the outcome 4. measure the impact of implementing the best practice on the targeted outcome

for example a descriptive study design would be appropriate to answer each of the following clinical questions

1. what is the incidence of complications in women who are on bed rest with preterm labor 2. what is the average number of depressive symptoms experienced by teenagers after a critical care hospitalization 3. in adults with type 2 diabetes, what are the most common physical comorbidites

type ___ error is a false negative-there is a difference in the intervention but the sample was too small to discern that difference.

2

correlation descrittive study

A study that is conducted for the purpose of describing the relationship between two or more variables.

correlation predictive study

A study that is conducted for the purpose of describing what variables predict a certain outcome.

case-control study

A type of research that retrospectively compares characteristics of an individual who has a certain condition (e.g., hypertension) with one who does not (i.e., a matched control or similar person without hypertension); often conducted for the purpose of identifying variables that might predict the condition (e.g., stressful lifestyle, sodium intake).

example of a theoretical framework

As an example, for decades, self-regulation theory (Johnson, Fieler, Jones, Wlasowicz, & Mitchell, 1997) has long provided an excellent theoretical framework for providing educational interventions to patients undergoing intrusive procedures (e.g., endoscopy) and chemotherapy/radiation. The basic premise of this theory is that the provision of concrete objective information to an individual who is confronting a stressful situation or procedure will facilitate a cognitive schema or representation of what will happen that is similar to the real-life event. As a result of an individual knowing what he or she is likely to experience, there is an increase in understanding, predictability, and confidence in dealing with the situation as it unfolds (Johnson et al., 1997), which leads to improved coping outcomes.

a systematic review of ____ provides a complication of what we know about a topic from multiple studies addressing the same research question, which ranks it higher in the hierarchy than single ____.

RCT, RCT

What is randomization and why is it important?

RCTs are prospective and predictive of cause and effect of treatment (support internal validity) randomization is the most important strategy to ensure the integrity of the experimental design compares treatment to control minimize bias minimizes confounding factors randomization is more important than a larger number

researchers generated new knowledge through rigorous research (external evidence) and _____ provides clinicians the process and tools to translate the external evidence into clinical practice and integrate it with internal evidence to improve quality of healthcare, patient outcomes, and cost reductions.

EBP

the ____ process involves rigorous critical appraisal, including synthesis and recommendations for practice, of a body of evidence comprised of multiple studies and combines it with the expertise of the clinician as well as patient/family preferences and values to make the best decision about patient care.

EBP

PICOT format

P=population of interest I= intervention or issue of interest C=comparison of interest O= outcome expected T=time for intervention to achieve the outcome

an ___ is the best research design for providing information about cause-and effect relationships.

RCT

construct validity

The degree to which an instrument measures the construct it is supposed to be measuring.

statistical conclusion validity

The extent to which we can be certain that the researcher has drawn accurate conclusions about the statistical significance of the research. if you conducted a power analysis and the sample size was accurate enough

randomized controlled trials

a true experiment (one that delivers an intervention or treatment in which participants are randomly assigned to control and experimental groups) the strongest design to support cause and effect relationships

independent variable

The variable that is influencing the dependent variable or outcome; in experimental studies, it is the intervention or treatment.

The EBP team is frustrated with this pulmonary complication and is wondering how to reduce it. They wonder if they would need to do a research study. Select the relevant research question: a) Does oral care with chlorhexidine improve ventilator-associated pneumonia rates in patients receiving mechanical ventilation? b) Why are ventilator-associated pneumonia rates so high in our trauma patients? c) In trauma patients who are mechanically ventilated, how do probiotics compared with no probiotics affect ventilator-associated pneumonia development while on the ventilator?

a

The ICU EBP team consisting of critical care nurses, physicians, and respiratory therapist shave noticed an increase in ventilator-associated pneumonia in trauma patients who are intubated and on ventilators. This is a surprising outcome for the EBP team. the EBP team is frustrated with this pulmonary complication and is wondering how to reduce it. They wonder if they would need to do research study. Select the relevant research question a. does oral care with chlorhexidine reduce ventilator associated pneumonia in patients receiving mechanical ventilation? b. why are ventilator associated pneumonia rates so high in our trauma patients? c. in trauma patients who are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect ventilator associated pneumonia development?

a c is a intervention clinical question

double blind studies

a type of bias in RCT is introduced by participants, clinicians or researchers knowing who is receiving which intervention to minimize this bias participants and those evaluating outcomes of the study are kept blind or in the dark about who receives which intervention

power analysis is

a procedure used for determined the sample size needed for a study and helps to reduce type 2 error

translational research is often confused with EBP but it is?

a rigorous research that studies how evidence based interventions are translated to real world clinical settings

a systematic review is?

a synthesis of evidence on a particular topic, typically conducted by an expert or expert panel that uses a rigorous process for identifying, appraising, and synthesizing studies to answer a specific clinical question

Quality Improvement (QI)

a systematic process that often uses the plan, do , study, act PDSA model, is used by healthcare systems to improve their processes or outcomes for a specific population once a problem is identified and is often confused with EBP

validity

are the results ad close to the truth as possible did the researchers conduct the study using the best research methods possible for example in intervention trials, it would be important to determine whether the subjects were randomly assigned to treatment or control groups and whether they were equal on key characteristics prior to treatment

an important question when implementing external evidence is whether clinicians can?

achieve the same results with their patients that were obtained in the studies reviewed (can the findings from research be translated to real world clinical setting with the same outcomes)

one of the keys to well conducted, reliable quantitative evidence is that an appropriate sample size be used why is that?

adequate sample size provides reasonable confidence that chance was minimized as a contributor to the study results and that the true effect of the intervention was demonstrated

questions asked in a PICOT format result in?

an effective search that yields the best, relevant information and save an inordinate amount of time

a meta-analysis generates?

an overall summary statistic that represents the effect off the intervention across multiple studies when it can combine the samples of each study included in the review to create on larger study the summary statistic is more precise than the individual findings from any one of the contributing studies alone

the point of critical appraisal of all research and subsequent evidence-based decision making in healthcare is to?

apply research findings to improve clinical practice outcomes

evidence based clinical practice guidelines

are specific practice recommendations grouped together which have been derived from a methodologically rigors review of the best evidence on a specific topic they do not answer a single specific clinical question but rather a group of question about care

the first threat to internal validity is ___, or dropout of study participants, which may result in nonequivalent study groups.

attrition

what factors threaten internal validity

attrition confounding variables non adherence and failure to complete the intervention protocol measurement of change in outcome variable history maturation testing

A clinical practice group on a unit identifies that their central line infection rate is higher than other hospital units with the same population. Which of the following were used to determine the best recommendations for change? a. traditional practices b. evidence from systematic review and/or meta-analysis of relevant RCTs c. systematic internet searches d. cohort studies without the use of control groups

b

A nurse scientist is conducting a randomized control trial to test whether acceptance control therapy is effective to support self management. To enhance the validity of the study, participants were matched in each group for certain characteristics that might influence the results. This is what type of validity? a. construct validity b. internal validity c. statistical conclusion validity d. external validity

b

Although the participants were randomized, the researchers were not able to recruit the number of participants that were recommended in the power analysis for a study of a new IV insertion device. What kind of error are they worried may occur? a. the researchers may have concluded that the device is an improvement when in fact it is not b. the team could have concluded that the device was not effective when it was effective c. the nurse may have committed a type 1 error d. the construct validity of the study may be lacking

b

The ICU EBP team consisting of critical care nurses, physicians, and respiratory therapist shave noticed an increase in ventilator-associated pneumonia in trauma patients who are intubated and on ventilators. This is a surprising outcome for the EBP team. Select the relevant QI questions. a. does oral care with chlorhexidine reduce ventilator associated pneumonia in patients receiving mechanical ventilation? b. why are ventilator associated pneumonia rates so high in our trauma patients? c. in trauma patients who are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect ventilator associated pneumonia development?

b

The intensive care unit evidence-based practice (EBP) team consisting of critical care nurses, physicians, and respiratory therapists have noticed an increase in ventilator-associated pneumonia in trauma patients who are intubated and on ventilators. This is a surprising outcome for the EBP team. Select the relevant QI question: a) Does oral care with chlorhexidine reduce ventilator-associated pneumonia in patients receiving mechanical ventilation? b) Why are ventilator-associated pneumonia rates so high in our trauma patients? c) In trauma patients who are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect ventilator- associated pneumonia development

b

a clinical nurse specialist would like to implement a post-partum care bundle to reduce the need for opioids at discharge from one post-partum unit in a health system. The department of nursing research advised they conduct a pilot study prior to the commencement of a large, multisite quantitative research project to implement this across the health system. A pilot study is used primarily to inform which of the following parameters of a larger study? a. relevance b. feasibility c. ethics d. generalizability

b

in a hospital, nursing care tradition dictates that ventilator be placed on the right side of the bed. This is most likely an example of which of the following phenomena? a. the prioritization of internal evidence of external evidence b. practice that lacks evidence to support its application c. the integration of personal expertise into nursing care d. evidence based practice

b

The nurses on a surgical unit want to create uniform guidelines for promoting early ambulation on the unit. Which of the following sources is most likely to provide the best evidence? A. Evidence from a study that is a regarded as a classic within the surgical nursing community. B. Evidence from a systematic review and meta-analysis of 30 RCT studies. C. Evidence from a randomized controlled trial (RCT) that had 2,500 participants. D. The consensus opinion of the most senior nurses on the unit

b A systematic review of RCTs with meta-analysis is stronger than a single RCT even with a large sample size.

A nursing unit is interested in supporting patient engagement to improve patient outcomes. They read a quality improvement project that assesses engagement by looking at patient experience scores. What error is this an example of? A. Internal validity B. Construct validity C. External validity D. Statistical conclusion validity.

b Patient engagement is not the same as patient experience. Those to concepts are related and may be correlated (when one improves so does the other), but positive experience scores do not reflect more engagement.

testing

completing measures repeatedly could influence an individual's response the next time a measure is completed example: answering the same depression scale three or four times could program someone to responding the same way on subsequent administration of the scale

A research team would like to conduct a study of patient outcomes using new online educational modules for supporting patients newly diagnosed with asthma. The team realizes that controlling for extraneous variables is important. Which of the following strategies will best accomplish controlling for extraneous variables? A. Experimental group participants pairing with like participants of the control group. B. Assigning participants to either the experimental or control groups randomly. C. Using multiple control groups. D. Assigning participants to groups after they take a pre-test.

b Random selection of participants and random assignment to experiment and control groups are the best way to reduce bias and extraneous variables (some other variable causes the outcomes).

A unit nurse educator wrote proposal for a quasi-experimental study that tests the effect of simulation based mock code teaching on nursing student's psychomotor skills and outcomes of resuscitations. which of the following is a characteristic of quasi-experimental design? a. the design includes a posttest but does not apply a pretest b. participants are assigned to groups by a method other than random assignment c. the results of the study provide description but do not identify association d. the effects of an intervention are identified by examining characteristics of participants histories

b d=case control study

a theoretical or conceptual framework is?

compromised of a number of interrelated statements that attempt to describe, explain, and/or predict a phenomenon its purpose is to provide a framework for selecting the study's variables, including how they relate to one another, as well as to guide the development of the interventions in experimental studies

pilot study

before conducting a large experimental study it is extremely beneficial to first conduct a pilot study which is a preliminary study that is conducted with a small number of subjects vs a full scale clinical trial with large number of subjects

a major strength (advantage) of prospective cohort studies include

being able to determine the incidence of a problem and its possible cause

what may compromise the validity of the findings?

bias and confounding variables

A nurse is searching for recent information concerning the most effective method to use to support hypertensive women during pregnancy in testing their blood pressure. which of the following questions is appropriate for the nurse to consider when appraising a study? a. were the control groups in my area? b. did the studies cover at least a year in follow up? c. were the subject randomly assigned to a group? d. will these methods be effective for everyone?

c

A study related to nurse adherence to isolation PPE protocols began one month before the COVID 19 pandemic. What kind of threat to internal validity does this represent? a. attrition b. testing c. history d. maturation

c

In their brainstorming session, they discuss several options that members of the team have heard other agencies are doing and consider two interventions they feel will work in their organization: (1) starting a chlorhexidine mouthwash protocol and (2) probiotics for their mechanically ventilated patients. The EBP mentor acknowledges their frustration and desire for a quick fix, guides the group to understand that formulating a clinical question is a better choice to consider when the goal is to improve patient outcomes, and the team moves forward with the EBP process. Select the intervention clinical question: a) Why are ventilator-associated pneumonia rates so high in our trauma patients? b) Which is more effective in reducing ventilator-associated pneumonia in patients receiving mechanical ventilation, chlorhexidine, or probiotics? c) In trauma patients who are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect ventilator- associated pneumonia development while on the ventilator?

c

A research group tested the effectiveness of an innovative new mattress. While it seemed to improve outcomes, they had no significant results. This led them to think that their sample size may have been too small. This may be an example of: A. Type I error, finding positive results statistically due to large sample size (false positive). B. Lack of randomization to either the experimental or control groups. C. A type II error, results due to a small sample size (false negative). D. Lack of construct validity.

c Type I and type II errors are why doing a power analysis is so important. A very small difference can be statistically significant when the sample size is very large; but may not be clinically relevant (Type I error). If a sample size is too small is may not be statistically significant but could be clinically significant (Type II error). Since randomized control trials are very expensive, most researchers work with statisticians to find just the right number of participants needed to support the causal relationship of the intervention. Randomization of the right number of participants is stronger than just a large sample.

Prognosis question: in college students (P), how does past experience with group studying(I) compared with past experience with individual studying(C) influence/predict success in standardized teasing (O) at the end of a degree program (T)? best evidence design to answer the question is?

case control or cohort studies

one type of longitudinal, retrospective study that compares two groups is a?

case-control study

the search for best evidence should first begin by?

considering the elements of the PICOT question each keyword from the PICOT question should be used to being the systematic search

these designs are the study of choice when the independent variable cannot be manipulated experimentally because fo some individual characteristics or ethical consideration (i.e individuals cannot be assigned to smoke or not smoke).

correlational descriptive and correlational predictive designs they examine the relationships between two or more variables (what is the relationship between smoking and lung cancer in adults)

the steps of the evidence based practice process

cultivate a spirit of inquiry within an evidence based practice culture and environment ask the burning clinical question in a PICOT format search for and collect the most relevant best evidence critically appraise the evidence (rapid critical appraisal, evaluation, and synthesis) integrate the best evidence with one's clinical expertise and patient/family preferences and values in making a practice decision or change

A nurse scientist is interested in nurse's experience with transitioning to a new job. to support the generalizability of the result, a reliable and valid survey related to nurse transition was chosen for this study. Using this survey enhances what type of validity? a. construct validity b. internal validity c. statistical conclusion validity d. external validity

d

A nurse submitted a proposal for conducting a study looking at the use of specific exercise program to decrease the average blood sugar of people with type 2 diabetes. The proposal was rejected because no theoretical framework was included. Why should the nurse include a theoretical framework? a. identifies potential ethical issues b. limits the variable sin the study c. establishes the best study design d. assists in selecting the study's variables

d

In a hospital, nursing tradition dictates that a full set of vital signs be completed every shift per physician order. This is an example of which of the following phenomena. A. Evidence-based practice (EBP) B. Integration of personal expertise into nursing care C. The prioritization of internal evidence over external evidence D. Practice that lacks evidence to support its application.

d As we all know, assessment of patient status is one of the two aspects of nursing care that cannot be delegated. You can delegate taking the vitals but not the assessment of patient condition based on those vitals. Nursing assessment is not driven by physician order but by the needs and changes of the patient, or as we read in the study "how worried are you?". Orders for vital signs is a hold-over from the days in which physicians were told to order vital signs based on "how often you want the nurse to check on the patient."

A nurse midwife is disturbed by the apparently high incidence of pregnancy among women who have recently given birth. As a result, the nurse has formulated an idea for a research study addressing effective postpartum birth control methods. What should the nurse do after formulating an idea for research? a. investigate funding options b. assemble a research team c. recruit participants d. search for systematic review on the subject

d after identifying a clinical problem, the next step is to find the highest level of evidence to suggest an evidence-based intervention to implement as a solution

Since the sample size of the study was smaller than recommended, there was no significant difference in the outcomes of the treatment and control group. What type of validity was affected by this? a. construct validity b. internal validity c. external validity d. statistical conclusion validity

d=inferences of the statistical analysis are correct

theoretical framework

describes a theory related to a process or system that guides the variables of a study example: chronic care model which describes the elements needed to support improved outcomes for people with diabetes in a systematic review

Background question: What are the coping mechanisms of parents who have lost a child to AIDS? best evidence design to answer the question is?

descriptive studies

together __ and __ determine the reliability of the study findings.

effect size and CI

Clinicians planning to use the results of quantitative studies need a general understanding of how to interpret the numerical results. The main corners are the size of the interventions effect termed ___ and how precisely the effect was estimated termed ___.

effect size, CI

in qualitative studies reliability includes

evaluating whether the research approach fits the purpose for the study along with evaluating other aspects of the study

how client preferences and values factor into EBP

even if the evidence from a rigorous search and critical appraisal strongly supports a certain treatment is beneficial a discussion with a patient may reveal an intense fear of developing breast cancer while taking HRT or other reasons that the treatment is not acceptable also when taking part of the history or physical exam a comorbidity or contraindication may be found therefore, even if the evidence is strong to support the benefits of a treatment a decision against its use may be made after a thorough assessment of the patient and a discussion fo the risks and benefits of treatment

Multiple intervention questions in one question: What are the national standards for the prevention and management of wandering in patients with Alzheimers disease who live in long term care facilities? best evidence design to answer the question is?

evidence based clinical practice guidelines

___ enhances healthcare quality, improves patient outcomes, reduces costs, and empowers clinicians this is known as the quadruple aim in healthcare.

evidence based practice

if the research question or hypothesis concerns itself with the testing effects of an intervention or treatment on patient outcomes, the study calls for an ?

experimental design

hierarchy of evidence for intervention questions bottom of pyramid to top

expert opinion case studies and case series, qualitative and descriptive studies, EBP implementation and QI projects uncontrolled cohort studies controlled cohort studies nonrandomized controlled studies RCTs systematic reviews

internal validity

extent to which a study's design, conduct, and analysis have minimized selection, measurement and confiding biases

history is another major threat to the internal validity of a study this condition happens when

external events take place concurrently with the treatment that may influence the outcome variables example: if a study were being conducted to determine the effects of a violence prevention intervention on anxiety in school age children and school shooting occurred that received extensive media attention during the course of the trials, children's anxiety levels at the end of the study could be high despite any positive effects of the intervention

the components of evidence based practice include

external evidence from research, evidence based theories, opinion leaders and expert panels clinical expertise (internal evidence generated from outcomes management or quality improvement projects, a thorough patient assessment and evaluation and use of available resources patient preferences and values

____ addresses the generalizability of research results i.e. our ability to apply what we learn from a study sample to the larger population from which the sample was drawn.

external validity

reliability

for example in an intervention trials this include: 1. whether the intervention worked 2. how large a treatment effect was obtained 3. whether clinicians could expect similar results if they implemented the intervention in their own clinical practice setting

knowledge generated from research must be usable by clinicians beyond the researchers and clinicians who generated the research this is the definition of?

generalizability

researchers ___ new knowledge that can be used in practice to influence what we do; clinicians use the EBP process to ___ research into clinical practice to achieve best outcomes; and QI ___ how well the practice is working through generation and evaluate of PBE.

generate, translate, monitors QI=quality improvement data or internal evidence PBE=practice based evidence

unplanned events occurring at the same time as the study may have an impact on the observed outcomes. this is often referred to as?

history

what are threats to internal validity

history maturation attrition testing

limitations of case control studies

is bias (inability to control the confounding variables that may influence the outcome)

internal evidence

is generated through practice initiatives, such as outcome management or evidence based QI projects

external evidence

is generated through rigorous research (RCT or predictive studies) and is intended to be generalized and used in other settings

internal validity

is the extent to which it can be said that the independent variable (i.e. intervention) causes a change in the dependent variable (i.e. outcome) and that the results are not attributable to other factors or alternative explanations

a major limitation of cohort studies

is the lengthy nature of this type of study the costs of which often become prohibitive

purpose of descriptive studies

is to describe, observe, or document a phenomenon that can serve as a foundation for developing hypothesis or testing theory

best way to deal with the threat of maturation

is to use random assignment to allocate subject to experimental and control groups as well as to recognize it as a potential alternative explanation for a study's findings

study limitations

likelihood of studies included in the synthesis are adequately protected against bias by the suited design and how the study was conducted

__ is developmental change that occurs even in the absence of the intervention.

maturation

Meaning question: How do spouses with a loved one (P) who has Alzheimers diseases (I) perceive their ability to provide care (O) during the course of the disease (T)? best evidence design to answer the question is?

meta analyses or single qualitative studies

many systematic reviews incorporate quantitative methods to compare the results from multiple studies these reviews are called?

meta-analyses

for meaning questions search first for?

meta-syntheses of qualitative studies

generalizability is often referred to as?

new knowledge generation, research offers insights into how healthcare best operates

If RCTs are not available the search process should then include other types of studies that generate evidence to guide clinical decision making such as?

nonrandomized, descriptive or qualitative studies to determine the best available body of evidence

type 2 errors

occur when there truly is a difference between interventions but researchers conclude that one does not (false negatives)

type 1 errors

occurs when researchers conclude from an experiment that a difference exists between interventions (false positive) when in reality there is no difference

what is the purpose of a PICOT question?

once the PICOT question is formulated, the components of the question are the basis for keywords used to search databases such as CINAHL and MEDLINE to find the evidence to answer the question

if systematic review or meta-analyses are not available to answer a clinical practice treatment question the next step should be a search for?

original RCTs found in databases such as MEDLINE

maturation

passage of time alone can have an impact on the outcomes of a study example: when studying infants who are growing rapidly an acceleration in cognitive development may occur, regardless of the effects of an intervention that is aimed at enhancing cognition

clinical question are asked in PICOT format which is?

patient population intervention or issue of interest comparison intervention or group outcome time frame

example of cohort study

people living in one town might be put into one cohort and those in antlers town into a second cohos-the town they lived in would be the selection criterion all of the participants would be followed over a number of years to identify differences between the two charts that might be associated with differences between the twos and specific outcomes (e.g. environmental factors and breast cancer)

RCTs are difficult and expensive to conduct in a clinical setting usually start with a ___ to test if it will work in that setting/population.

pilot study other reasons why they are difficult include: need dedicated researchers and funding to complete sometimes it is not logistical or ethical to withhold treatment from one group

researchers should conduct an a priori (done before starting this study) calculation called a ____ to assist them in determine what the sample size should be to minimize chance findings.

power analysis

designs in which the independent variable (treatment) is manipulated or introduce but where there is a lack of random assignment or control group are called?

quasi-experimental designs

what are study designs that do not randomly allocate participants and risk introduction of selection bias into the research?

quasi-experimental, cohort, case studies

what is the best way to minimize the threat of history

random assignment because at least both groups then should be equally affected by the external event

___ is more important than a larger number

randomization

the best strategy to control for or minimize the influence of confounding variable is to?

randomly assign subjects to study groups or establish thoughtful inclusion and expulsion criteria or maintain consistent study condition by establishing clearly written study protocols so that every individual on the team understands the intricacies of when and how the interventions will be delivered

in case control study participants respond to surveys about what they did in the past this is referred to as recall. Studies that rely on patients remembering data are subject to?

recall bias bias can be a challenge with these studies in that people may not remember things correctly

the answers the validity, reliability and applicability ensures?

relevance and transferability evidence to the specific population for whom the clinical provides care

selection bias is reduced when?

researchers randomly assign participants to experimental and comparison groups

case control study

researchers select a group of people with an outcome of interest, the case (e.g. case of infection), and another group of people without that outcome, the controls (e.g. no infection) both groups are surveyed in an attempt to find the key differences between the groups that may suggest why one group had the outcome (i.e infection) and the other group did not

level 6 evidence

single descriptive or qualitative study

why is it important to design a realistic intervention?

so that it will eventually be transportable to the real clinical practice world feasibility and user-friendliness should be considered if there are multiple sessions with ongoing phases of the intervention it is important to record which and how many sessions are attended and completed by the study participating

power analysis

statistical analysis to find the number of participants needed (a large enough sample) to ensure that there can be meaningful assessment of the effect of the intervention this should be in the methods but may not be reported it is limitation if it not there without a power analysis you cannot know if the results for that sample are valid

level of evidence plus the quality of evidence=?

strength of the evidence which provides clinicians the confidence needed to change clinical practice

systematic reviews of RCTs has been regarded as the ___ level of evidence.

strongest level 1 evidence

the domains to evaluate to establish quality of evidence were updated to include the following

study limitations directness consistency precision reporting bias

for etiology questions search first for?

syntheses of cohort or case-control studies

for diagnosis questions search first for?

syntheses of randomized controlled trials or cohort studies

for prognosis or prediction questions search first for?

synthesis of cohort case-control studies

what is the strongest and least biased method to provide confidence that the intervention will consistently bring about a particular outcome.

systematic review of a large number of high quality RCTs of similar design (have homogeneity)

level 1 evidence

systematic review or meta-analysis of all relevant randomized controlled trials

intervention questions: in patients with acute respiratory distress syndrome (P), how does prone positioning (I) compared with supine positioning (C) affect weaning parameters (O) during weaning protocol (T)? best evidence design to answer the question is?

systematic reviews and meta-analyses single RCTs well controlled, nonrandomized experimental studies

level 5 evidence

systematic reviews of descriptive and qualitative studies

for treatment questions search first for?

systematic reviews of randomized controlled trials

the type of study that would provide the best answer to an intervention or treatment question would be?

systematic reviews or meta-analysis which are regarded as the strongest level fo evidence on which to base treatment decisions

reporting bias

the bias inherent in selectively publishing or reporting only research findings that are in the desired direction or magnitude of effect

precision

the extent to which certainty surrounds the effect estimate and if sufficiency of sample size and number of event assumptions are me t

external validity supports?

the generalizability of a research study (power analysis, randomization, use of valid tools)

qualitative research focuses on?

the human experience to help clinicians understand the context of the experience and the intervention delivery

evidence based theories

theories that are empirically supported through well designed studies

applicability

this third rapid critical appraisal question includes asking whether 1. the subjects in these study are similar to the patients for whom care is being delivered 2. the benefits are greater than the risks of the treatment 3. the treatment is feasible to implement in the practice setting 4. the patient desires the treatment

cohort study

this type of study focuses prospectively on one group of people who have been exposed to a condition and another group that has not

power analyses help?

to minimize type 1 and type 2 errors and should be reported in the methods section of the research report if it is not reported the adequacy or inadequacy of the sample size cannot be assumed

the best way to to deal with testing threat to internal validity is

to think very carefully about how many times subjects are being asked to complete study measures and provide a strong rationale for these decisions

an example of a QI initiative

triggered by a sudden increase in ventilator-associated pneumonia that, when practice data was evaluated, indicated that an oral care protocol was not being implemented on a regular basis the PDSA cycle culminated in an educational booster for the staff about the oral care protocol and further monitoring of the process to reduce a high rate of ventilator associated pneumonia in critically ill patients

consistency

whether investigations with both similar and different study designs report similar findings (requires numerous studies)

True experiments or RCTs possesses three characteristics

■ An experimental group that receives the treatments or intervention ■ A control or comparison group that receives standard care or a comparison intervention that is different from the experimental interventions ■ Randomization or random assignment which is the use of a strategy to randomly assign subjects to the experimental or control group