CSD 803 Final Study Guide

In the PICO approach to applying evidence-based practice to clinical decision making, what does "C" stand for? (A) Control (B) Comparison (C) Client (D) Either A or B (E) None of the above

(D) Either A or B

ASHA Standard IV-D

"Applicant must have demonstrated *current knowledge of the principles and methods*...."

ASHA Standard IV-F

"Applicant must have demonstrated *knowledge of processes used in research and the integration of research principles into EBP clinical practice*."

ASHA Standard V-A

"Applicant must have demonstrated *skills in oral and written or other forms of communication* sufficient for entry into professional practice."

ASHA Standard IV-G

"Applicant must have demonstrated knowledge of *contemporary professional issues*."

ASHA Standard IV-E

"Applicant must have demonstrated knowledge of standards of *ethical conduct*."

Variable

"Something that varies" Has to do with the conditions under which observations are made, and the behavior to be observed

Nuremberg Trials

"doctor's trial" (1945-1949) Brought 23 German doctors to trial immediately after the war, prosecutors found 15 defendants guilty of war crimes and crimes against humanity; seven were hung Led to widespread discussion of protections for human subjects; ultimately contributed to development of safeguards for human participation

What is the name for a variable suspected to cause a change in behavior? (A) IV (B) DV (C) Attribute variable (D) Active variable

(A) IV

Which of the following ASHA standards discusses that an applicant should have knowledge of integration of research principles into evidence-based practice? (A) ASHA Standard IV-E (B) ASHA Standard IV-F (C) ASHA Standard IV-G (D) ASHA Standard V-A

(B) ASHA Standard IV-F

"Type of speech disorder" is most likely to be considered which of the following: (A) Active variable (B) Attribute variable (C) Manipulated variable (D) Extraneous variable

(B) Attribute variable

Consider the sequence of logical statements: "All birds have wings. A cardinal is a bird; therefore, a cardinal has wings." Which of the following types of logical reasoning does this represent? (A) Inductive reasoning (B) Deductive reasoning (C) Not enough information is provided to answer the question

(B) Deductive reasoning

What statement best characterizes the order in which authors of an article appear in a citation of a journal article? (A) Alphabetical order (B) In order of greatest to least contribution to the work (C) In order of seniority of the author (D) None of the above

(B) In order of greatest to least contribution to the work

Which property or properties must a measure have to be useful in science? (A) Reliability (B) Validity (C) Both A and B D) None of the above

(C) Both A and B

Why is it often necessary to use a nonmanipulated independent variable (IV) in a study design? (A) Because it would be unethical to manipulate the IV (B) Because it would be impossible to manipulate the IV (C) Because it would be impractical to manipulate the IV (D) All of the above

(D) All of the above

In which of the following sections are you likely to find an interpretation of the data in a study? (A) Introduction (B) Methods (C) Results (D) Discussion

(D) Discussion

Which is a recommended way to get started on a literature search? (A) Read a brochure (B) Ask a colleague (C) Do a search on Google (D) Do a PubMed search

(D) Do a PubMed search

Which of the following provides the best definition of evidence-based practice? (A) The selection of methodologies most likely to affect outcomes. (B) The synthesis of evidence from a variety of sources. (C) The thoughtful and wise use of current best evidence to guide client care decisions for improving outcomes. (D) Current knowledge of principles and methods of prevention, assessment, and intervention for people with communication and swallowing disorders.

(C) The thoughtful and wise use of current best evidence to guide client care decisions for improving outcomes.

How many phases were given in the lecture regarding the process for research? (A) 4 (B) 5 (C) 6 (D) 7

(D) 7

Which of the following does NOT describe a goal or enterprise of science? (A) Science as publicly verifiable knowledge (B) Science as knowledge creation (C) Science as the treatment of empirically soluble problems (D) Science as theory confirmation

(D) Science as theory confirmation

Which of the following "ways of knowing" underlie science? (A) Rationalism (B) Empiricism (C) Tenacity (D) Authority (E) A and B (F) All of the above

(E) A and B

Which of the following journal published by ASHA is freely available to ASHA members? (A) American Journal of Speech-Language Pathology (B) Journal of Speech, Language, and Hearing Research (C) Language, Speech, and Hearing Services in Schools (D) American Journal of Audiology (E) All of the above

(E) All of the above

Which of the following might be considered examples of constructs? (A) Discomfort (B) Speech effort (C) Hunger (D) Breathiness (E) All of the above

(E) All of the above

Peer-reviewed journals publishing primary source research

*General Topics* American Journal of Speech-Language Pathology* Journal of Speech, Language, and Hearing Research* Language, Speech, and Hearing Services in Schools* Journal of Communication Disorders Journal of Medical Speech-Language Pathology *Special Topics* (scroll down) American Journal of Audiology* *published by ASHA

Structure of a primary-source article

*Abstract* *Introduction* (sometimes called background) *Method* *Results* *Discussion* Optional -May be multiple method/results/discussion -General Discussion

Construct

*An abstract idea constructed by the researcher to explain observed events* Ex: Intelligence, gravity (Abstract concepts that we use to explain differences among individuals performance as well as physical behaviors in our external world-discomfort, hunger, breathiness Types of disorders are frequently constructs b/c there have to be certain quantifiable criteria that is inclusion and exclusion criteria to define the population of individuals with the disorder thus constituting operational definitions of those disorders Ex: Person who stutters (PWS); Operational definition-person who (a) has 3+ within-word disfluencies for 100 words of spontaneous speech, score on the stuttering severity instrument (SSI-4) < 77

APA for Books

*Author(s)* in the given order *Year* *Title of book* (usually in italics, only first letter capitalized) *Publisher info* (City: Publisher name) *Books may not be peer reviewed, however they may contain either primary or secondary sources or combo of both Ex: Calfee, R. C., & Valencia, R. R. (1991). APA guide to preparing manuscripts for journal publication. Washington, DC: American Psychological Association. -Title of book would be italicized

APA for Journals

*Author(s)* in the given order (Reflect order of credit awarded for the study; should never reorder; Last name, first initial) *Year* *Title of article* (only 1st letter capitalized) *Journal title* (Content = capitalized; Function = lowercase; Italicized) *Volume* *Issue number* (optional) *Page numbers* *DOI* (Digital Object Identifier, optional, web address which allows you to go directly to a PDF of the article on the web, often left out) Ex: Harlow, H. F. (1983). Fundamentals for preparing psychology journal articles. Journal of Comparative and Physiological Psychology, 55, 893-896. -Journal title would be italicized

Reliability

*Measure of consistency of data collected using the same methodology on more than one occasion; across different, but related test items; or by different individuals* Inherently invokes the notion of measurement error, how much error is there in measurement and how repeatable are those measurements one to the next

Affect vs. Effect

*Noun* -An affect: The physical expression of an emotional state; a feeling, mood, or disposition (He had a very depressed affect) -An effect: Something that is caused or produced; a result or consequence (There was a large, positive treatment effect of the drug) *Verb* -To affect: To influence or modify; to act upon something (The treatment will affect the outcome) -To effect: To bring about or accomplish; to cause something to happen (The policy is likely to effect many changes)

The PICO model

*P = patient/client population* -Age, sex, culture, health status, condition, disorder, disability, etc. *I = intervention issue* -Therapeutic strategy/approach; risk factor/behavior; assessment tool/technique, etc. *C = comparison/alternative* -Alternative therapeutic strategy/approach; placebo; no intervention; alternative assessment tool/technique, etc. *O = outcome* -Short-term or long-term goal; function; normalcy, ability, mastery, accuracy; cost effectiveness; satisfaction, etc. Example: For *P*, how does *I* compared with *C* predict or influence future *O*? (prediction)

Other templates/frameworks

*PESICO:* Adds "*E*" for communication environments, "*S*" for stakeholders *PICOT:* ADDS "*T*" for time frame *SPICE:* "*S*" for setting in which the intervention will occur, "*P*" for perspective of person or population affected, "*C*" for comparison, "*I*" for intervention, "*E*" for evaluation or measured effect *All of these templates allow a formalized way of formulating a clinical question in a way that research evidence can efficiently and effectively

Primary sources vs. Secondary sources vs. Tertiary sources

*Primary:* The first appearance of research results in literature (ex: peer reviewed journal articles on original research) *Secondary:* Explaining info contained in primary sources (ex: review articles, summaries) *Tertiary:* Summaries of summaries (ex: brochures, Wikipedia); involve distillation of info from both primary & secondary

APA for Book section/chapter

*Section author(s)* in the given order *Year* *Title of section* *Book editor(s)* in the given order *Title of book* *Section pages* *Publisher info (City: Publisher name)* *May or may not be peer reviewed Ex: O'Neil, J. M., & Egan, J. (1992). Men's and women's gender role journeys: A metaphor for healing, transition, and transformation. In B. R. Wainrib (Ed.), Gender issues across the life cycle (pp. 107-123). New York, NY: Springer. -Title of book italicized

A major source of research information is primary-source articles from peer-reviewed journals related to speech-language pathology *(TRUE or FALSE)*

*TRUE*

Interpreting research evidence for clinical practice involves categorizing types of clinical evidence and ranking it according to its strength *(TRUE or FALSE)*

*TRUE*

Testability and Falsifiability

*Testability: a criterion of adequacy for judging the worth of theories. A testable theory is one in which there is some way to determine whether the theory is true or false--that is, it predicts something other than what it was introduced to explain.* *A good theory satisfies the falsifiability criterion, i.e., methods of evaluating evidence include the possibility that the data will falsify the theory* Good to be wrong in science because it means that the endeavor has rested on theories that expose themselves to falsification allowing us to sift among different views of the world and arrive at a better understanding of a phenomenon When replacing an old theory with a new one, don't just throw out all the old facts; New theory is responsible for accounting for both the old facts as well as any new ones that have been derived

EBP Process

-Asking a well-built question -Selecting evidence sources -Implementing a search strategy -Appraising and synthesizing the evidence -Applying the evidence -Evaluating the application of evidence -Disseminating the findings

Purposes of EBP

-Assist in practicing based on the evidence and accepting clinical guidelines -Aim: reduce wide variations in individual clinicians' practices, eliminating worst practices, and enhancing best practices -Synthesize the best evidence and empower clinicians to do so -It's the clinician's responsibility to employ EBP to select the treatment shown to be the most likely to have large, positive effects on outcomes

How to get started on literature search

-Do a PubMed database search -"Quick start": Google Scholar search -Find citations (references) that allow you to find research articles -Look up ASHA's Compendium of EBP Guidelines and Systematic Reviews

What are the 3 responsibilities the IRB is charged with?

1. Protecting the rights and welfare of human subjects 2. Assuring that all applicable institutional policies and federal regulations related to research with human subjects are followed 3. Review subject recruitment materials and strategies

What are the three principles of the Belmont Report?

1. Respect for persons 2. Beneficence 3. Justice

Belmont Report

1979; important historical document in medical ethics Explained unified principles for using human subjects for research Requires that subjects freely choose to participate in research (voluntariness) and that they are adequately informed about a study (informed consent) Maximization of benefits; Minimization of risks

Different "ways of knowing": *Rationalism*

Believing something based on rational logic (e.g., deductive/inductive reasoning)

Different "ways of knowing": *Superstition*

Believing something based on things that you can't directly observe

Different "ways of knowing": *Tenacity*

Believing something because "it's always been that way"

Operational definition

A definition which turns an abstract concept into an empirical observation Can be defined in terms of another operational definition (ex: Type A personality)

What is APA?

A standard and common format for citing resources and references Provides all the info someone needs to be able to track down reference *APA = American Psychological Association*; professional organization that sets the guidelines for the APA format citations in the Publication Manual

Different "ways of knowing": *Authority*

Believing something because someone perceived to be an authority said it was so

Active variable

A variable that can be manipulated (changed) by the experimenter Ex: therapy type, sound pressure level, etc.

Attribute variable

A variable which can't be manipulated or changed by the experimenter Ex: age, gender, intelligence, type of speech disorder, degree of HL, etc.

Confound variable

A variable which has confused the picture of cause-effect relationship b/c it was left uncontrolled and presents an alternative explanation for findings Actual confusing factor

Extraneous variable

A variable which, if left uncontrolled, can potentially confuse the picture of a cause-effect relationship Potential confusing factor Ex: Carry-over, SES, Chronological age (kids who are older would have higher lung volume)

Which variables can a researcher control: active or attribute?

Active variables *In general, research designs which use active variables are stronger

Tuskegee Study

Also known as Tuskegee Syphilis study, Tuskegee Experiment (1932-1972) Involved untreated syphilis on poor, mostly illiterate African American male sharecroppers to observe the natural progression of the disease First clinical data published 1934, first major report in 1936; several papers published

Validity

An indication of how sound your research is; validity in data collection means that *your findings truly represent the phenomenon you are claiming to measure* Property of data, concepts or research findings whereby they are useful for measuring or understanding phenomena Ex: Ratings of breathiness vs. lung volume as ways of operationally defining "breathy voice"

Deductive reasoning

Application of generalizations to specific circumstances Ex: All apples are fruits, A granny Smith is an apple; Therefore, a Granny Smith is a fruit

Different "ways of knowing": *a priori method*

Believing something based on a premise which is "a priori" (without evidence) believed to be true, then using reasoning to go forward Ex: If a patient has Parkinson's, then their movement deficits can be dealt with using dopaminergic drugs; however, if the patient doesn't have Parkinson's to begin with, then their movement deficits might not be sufficiently dealt with the use of such drugs

Different "ways of knowing": *Intuition*

Believing something based on feelings

Different "ways of knowing": *Empiricism*

Believing something based on observable evidence

Discussion

Briefly restate hypothesis and provide summary of the main findings of the study Offer interpretation, evaluation, and discussion of the implications of the findings Consider applications or implications of results Suggest future research: to pick up where they left off

Non-manipulated IVs

Cannot be directly controlled or manipulated by the experimenter b/c to do so is unethical, impractical, or impossible Attribute IVs cannot be manipulated or controlled by the experimenter-they are necessarily non-manipulated IVs Ex: sex/gender, hearing loss in humans, racial ethnicity

APA in-text citations

Citing references "in the text" All we need to provide is *author/authors* and the *year of publication*, comma before year When names of authors occur entirely outside the sentence an ampersand is being used to link the author's names together Avoid direct quotations, prefer paraphrasing

Institutional Review Board (IRB)

Committee established to review and approve research involving human subjects Agencies set up within institutions in charge of reviewing research proposals to determine their compliance with existing regulations Consist of researchers' peers and members of the community (scientists & nonscientists) Detailed plan must be submitted describing background, significance, methods, risks/benefits to participants and how informed consent obtained Evaluate the risk-benefit ratio to participants and society Purpose: To protect the rights and welfare of individuals who serve as participants of research conducted by researchers

Abstract

Concise summary of the paper Should include: statement of the general problem, what was done (summary of method), what was found (summary of results), conclusions and implications of the research (why was this research important? what did we learn from the study/studies?) Should be less that specified limit for the journal

Method

Detailed description of how the study was carried out; readers should have enough info to replicate the study Subsections: design, participants, apparatus/materials, procedure

Levels of an IV

Different values of the IV that can be taken Conditions: means same thing as 'levels' when there is exactly one IV Ex: Gender (Male, Female), Age of Adolescent (Young Adults, Older Adult), SPL (20 dB, 40 dB, 60 dB)

Manipulated IVs

Directly controlled by the experimenter Active IVs can be manipulated IVs-they can be directly controlled by the experimenter

Nazi human experiments

During WWII, Nazi doctors conducted as many as 30 different types of experiments on concentration-camp inmates Doctors performed these studies w/o the consent of the victims, who suffered indescribable pain, mutilation, permanent disability, or in many cases death as a result Experiments on prisoners who were coerced into participating; typically resulted in disfigurement, death, or permanent disability Experiments were supposedly designed to help German military in combat situations, develop new weapons, advance ideology Led to indictment on conspiracy to commit war crimes and crimes against humanity

Verbatim passages are often reported in formal scientific writing with ample and appropriate referencing (TRUE or FALSE)

FALSE

Inductive reasoning

Gathering of observations and hypotheses into a unifying whole, i.e., going from specific examples to generalizations Ex: Seeing lots of white dogs; Generalization: "All dogs are white"

IRB: Likelihood of Approval

High Risks and High Benefits: ??? Low Risks and Low Benefits: ??? Low Risks and High Benefits: Likely approve High Risks and Low Benefits: Likely disapprove

Failures of Tuskegee Study

High risk to individuals No informed consent Deception, with no debriefing Inadequate institutional review and approval process Inadequate treatments for negative outcomes of research

What is the process of research?

Idea-generating phase (inspiration) Problem-definition phase (ideas must be clarified and refined) Procedures-design phase (planning of procedures) Observation phase (data collection) Data-analysis phase (determine meaning & patterns) Interpretation phase (hand-in-hand w/ data-analysis; make sense of data) Communication phase (public presentations of the findings

Impacts of Tuskegee Study

Led to the requirement of establishment of institutional review boards (IRB's) Led to 1979 Belmont Report

Example to compare reliability vs. validity: different ways of measuring intelligence

On one hand, we could use an IQ test Numerous studies, and clinical data speak to the reliability and validity of IQ tests, overall for measuring intelligence Ex: shoe size; reliable, but not valid way of measuring intelligence

*Q: Why know the research on a particular topic?* *A: Knowledge is power*

Power to... -enhance treatment effectiveness and outcomes -communicate the potential benefits of the research -understand why an approach might (or might not!) work

Peer-reviewed journals

Primary-source articles; where scientists go to publish the latest and greatest research

Introduction

Provides background and orientation that introduces a reader to the study Gives a broad statement providing an overview of a topic then a review of relevant literature Ideas go from broad to specific (inverted pyramid) Finally, discuss specific problem or question the study addresses: brief summary of how study was conducted and hypothesis

References

Provides complete info about each item cited in the paper

Interpreting evidence

Relating research to clinical practice requires evaluating the *strength of evidence* This involves categorizing different types of clinical evidence and ranking according to the strength of the research Not all research studies are equally strong in the evidence they provide

Research which does not require IRB approval

Research conducted in established or commonly accepted educational settings Research involving educational tests, survey processes, interview processes, or observation of public behavior Study of or collection of existing, publicly available data, documents, records

Four views of science

Science as... 1) publicly verifiable knowledge 2) knowledge creation 3) treatment of empirically soluble problems 4) attempt to find the strongest, unambiguous evidence supporting a view

Results

Summarizes the data and statistical analysis Describes general findings of the study and then goes into the details Includes tables and figures Data is NOT interpreted in this section Often the most technical part of the paper

During World War II, Nazi doctors conducted as many as 30 different types of experiments on concentration-camp inmates without their consent, causing them to suffer indescribable pain, mutilation, permanent disability, or in many cases death (TRUE or FALSE)

TRUE

Evidence-based practice (EBP)

The conscientious and judicious use of current best evidence to guide client care decisions for improving outcomes The clinician's responsibility is to employ EBP to select the treatment shown to be most likely to have large, positive effects on outcomes The expert clinician should consistently seek new information to improve therapeutic effectiveness

Operationism

The idea that concepts in scientific theories must in some way be grounded in, or linked to, observable events Scientists are operationists-like to use data from observable events to help make sense of the world around them

Essentialism

The idea that the only good theories are those that give ultimate explanations of phenomena Ex: Someone who dismisses science as an endeavor b/c we don't have an explanation of all the phenomena in the universe just yet

Causality

When a study or experiment is conceived of in terms of an IV and DV, there is an assumption of causality The IV is the hypothesized cause of change in the DV

Strength of study conclusions

The strength of conclusions from a study follow largely from the study design Determining the study design is a significant step toward determining the strength of evidence of that study; relates to how much weight the evidence should be given clinically

Multivalent

The study has IV with three or more levels Ex: IV or therapy type = Experimental Tx A, Experimental Tx B, Standard Tx

Bivalent

The study has one IV with 2 levels Ex: IV of Autism Diagnosis (Child w/ ASD diagnosis, Control Group)

Parametric

The study has two or more IV's Ex: Effects of two IV's-Intervention type (Standard, Experimental) and Diagnosis (Language Delay, SU) on academic achievement

Independent Variable (IV)

The variable related to conditions in an experiment or study suspected to *cause a change in behavior* Relates to the conditions that the researcher sets up Example: A study of varying vocal intensity in talkers with nodules on sound pressure level; IV-Vocal intensity (Comfortable, Loud)

Dependent Variable (DV)

The variable related to the behavior that may be *changed in response to the IV* Aspects of the study that might be measurable Example: A study of varying vocal intensity in talkers with nodules on sound pressure level; DV-sound pressure level (SPL)

Research studies which use ____________ ____________ present a clearer picture of cause-and-effect

manipulated IVs However, it's often necessary to use non-manipulated IV's, b/c to do otherwise would be unethical, impractical, or impossible

Whether the researcher can manipulate the IV affects the ____________ of the conclusions from the study

strength