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115 Cards in this Set
- Front
- Back
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Describe a case control study (4)
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- observational and retrospective
- compares group of people wiht disease to a group wiht out - asks "what happened?" - looks for prior exposure or risk factors |
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what does a case control study measure
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odds ratio
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what deso a cohort study measure
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releative risk
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what does a crosssectional study measure
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disease prevalence
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what does a twin concordance study measure
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heritablity
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what does an a adoption study measure
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heritability and influence of environmental factors
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what is the design of of a cross-sectional study (3)`
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- collects data from a group of people ot assess frequency of a disease
- observational - asks "what is happening |
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what is the design of a cohort study (4)
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- observation and prospective
- compares a group wiht a given exposure or risk factor to a group without - looks to see if expoure increases likelihood of disease - asks "what will happen" |
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what is the study sample for phase 1 clinical trials
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small number of pt, usually healthy volunteers
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wha tis the study sample for phase 2 clinical trials
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small number of patients with disease of interest
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what is the study sample for phase 3 clinical trials
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large number of patients randomly assigned either to the treatment unrder investigation or to the best available treatments
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what is the study sample for phase four clinical trials
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post marketing surveillance trials of patients after approval
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what is the purpose of phase 4 clinical trials
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detects rare or long term adverse affects
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wha tis the purpose of phase 3 clinical trials
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compares the new treatment to hte current standard of care
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wha tis the purpose of phase 2 clinical trials
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assess treatement efficacy, optimal dosing and adverse affects
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what is the purpose of phase 1 clinical trials
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assesses safety, toxicity, and pharmacokinetics
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what is the design of a meta-analysis
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- pools data from several studies to come to an overall conclusion
- achieves greater statistal power and integrates results of similar studies - highest echelon of clinical evidence |
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what is the limitation of metaanalysis
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qualitiy of individual studies or bias in study selection
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what is the formula for sensitivity
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- TP/ (TP+FN
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what is sensitivity
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- proportion of all people wiht disease who test positive
- approach 1 to rule oute disease |
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what are sensitivity tests used for
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screening in disease with low prevalence
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what is the formula for specificity
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TN/ (TN +FP)
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what is specificity (2)
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- proportion of all people without disease who test negative
- value approaching 1 to rule in disease |
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when is a specificity test used
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as a confirmatory test after a positive screening test
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what is positive predicitive value (2)
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- proportion of positive tests results that are true positive
- probability that a person actually has the disease given a positvive test result |
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what is the formula for positive predicitive value
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TP/ (TP+FP)
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what is a negative predictive value (2)
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- proportion of negative test results that are true negative
- probablitily that person actually is disease free given neg result |
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what is the formulat for negative predictive value
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= TN/ (FN + TN)
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waht is formulat for point prevalence
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- total cases in population at a given time/ total population at a given tme
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what is the formula for incidence
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= new cases in population over a given time period/ total population at risk during that time period
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what is the formula for prevalence
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incidence x disease duration
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when is prevalence greater than incidence
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for chronic disease
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when is prevalence the same as incidence
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in acute diseases
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what is the formula for risk factor
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= (risk factor and disease/ risk factor no disease) / ( no risk factor and disease/ no risk factor and no disease)
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what does odds ratio approximate
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relative risk if prevalence of disease is not too high
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What is relative risk
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relative probablity of getting a disease in teh exposed grroup compared to the unexposed group
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How is relative risk calculated
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percent with disease in exposed group divided by percent with disease in unexposed group
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what is attributable risk
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difference in risk between exposed and unexposed groups, i.e. portion of diseases that are attributed to the exposure
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what is absolute risk reduction
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reduction in risk asociated with a treatment as compared to a placebo
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how is number needed to treat calculate
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1/ absolute risk reduction
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how is number needed to harm calculated
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1/attributable risk
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what reduces precision in a test
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random error
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what reduces accuracy of a test
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systemic error
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what is the pygmalion effect
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occurs when a researcher's belief in the efficacy of a treatment changes the outcome of that treatment
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what is the Hawthorne effect
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occurs when the group being studied changes its behavior owning to the knowledge of being studied
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how do mean median mode compare for a positive skew distribution
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mean>median>mode
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how do mean median and mode compare for a negative skew
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mean < median < mode
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where is the asymmetry on a positive skew
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tail on the right
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where is the asymmetry on a negative scew
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tail on left
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what is least affected by outliers in a sample, mode, median or mean
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mode
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what is a null hypothesis
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hypothesis of no difference between two things
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what is an alternative hypothesis
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hypothesis that there is some difference between two things
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what is a type 1 (alpha) error
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saw a difference that did not exist
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what is a type 2 (beta) error
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you did no see a difference that does exist
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what is power (1-Beta)
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probability of rejecting null hypothesis when it is in fact fulls
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what does power (1-Beta) depend on (3)
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- total number of end points experienced by population
- difference in compliance between treatment groups - size of expected effect |
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what is SEM
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Standard error of the mean
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how is SEM calculated
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sigma/ sqrt(n)
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what are the three standard deviation levels
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68 percent
95 percent 99.7 percent |
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What is a confidence interval
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range of values in which a specified probablility of the means of repeated samples would be expected to fall
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what Z for a CI of 95 percent
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1.96
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what does a t-test check
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differenve between the means of two groups
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what does an ANOVA check
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difference between the means of 3 or more groups
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what does a chi-square test check
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difference between 2 or more percentages or proportions of categorical outomes (not mean values)
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what is primary disease prevention
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- prevent disease occurrence
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what is secondary disease prevention
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early detection of disease
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what is tertiary disease prevention
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reduce disability form disease
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what are the reportable disease
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Hep A, Hep B, Hep C
HIV Salmonella Shigella Syphilis Measles Mumps AIDS Rubella TB Chickenpox Gonorrhea |
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what are the three leading causes of death in infants
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- Congenital abnormalities
- SIDS - RDS |
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what are the five leading causes of death in children 1-14 years old
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- Injuries
- Cancer - Congenital nomalies - Homicide - Heart disease |
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what are the three leading causes of death in 15-24 year olds
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- injuries
- Homicide - Suicide |
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what are the three leading causes of death in 25-64 year olds
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- cancer
- heart disease - Injuries |
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what are the three leading causes of death in 65+
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- heart disease
- cancer - stroke |
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what three groups of people is medicare available to
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- greater than 65 years old
- less than 65 years old with certain disabilities - pts with ESRD |
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what is medicaid
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federal and state health assistance for people with very low income
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what is medicare part A for
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inpatient care in hospitals, skilled nursing, hospice and home health care
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what is medicare part B for
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outpatient care, doctors services, PT/OT
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what is Medicare part C for
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combination of A and B
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what is medicare part D for
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stand alone prescription drug coverage
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what are the four core ethical principles
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- autonomy
- beneficence - nonmaleficence - Justice |
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what is Autonomy
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- obligation to respect patients as individuals and to honor their preferences in medical care
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wha tis beneficience
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- ethical duty to act in pts best interest, which may conflict wiht autonomy. If pt can make informed decision, ultimately the patient has the right to decide
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what is nonmaleficence
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- do non harm unless the pt makes an informed dicision when the benefits outweigh the risks
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what is justice
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to treat persons fairly
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what three things are required legally for informed concent
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- discussion of pertinent information
- pts agreement to the plan of care - freedom from coercision |
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what is medicare part A for
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inpatient care in hospitals, skilled nursing, hospice and home health care
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what is medicare part B for
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outpatient care, doctors services, PT/OT
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what is Medicare part C for
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combination of A and B
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what is medicare part D for
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stand alone prescription drug coverage
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what are the four core ethical principles
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- autonomy
- beneficence - nonmaleficence - Justice |
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what is Autonomy
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- obligation to respect patients as individuals and to honor their preferences in medical care
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wha tis beneficience
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- ethical duty to act in pts best interest, which may conflict wiht autonomy. If pt can make informed decision, ultimately the patient has the right to decide
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what is nonmaleficence
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- do non harm unless the pt makes an informed dicision when the benefits outweigh the risks
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what is justice
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to treat persons fairly
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what three things are required legally for informed concent
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- discussion of pertinent information
- pts agreement to the plan of care - freedom from coercision |
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What are the four exceptions to informed consent
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- pt lacks decision making capacity or is legally incompetent
- implied during emergency - therapeutic privilege - Waiver |
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what is parental concent not required in for treating minors (6)
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- emancipated
- emergency situation - contraceptives - treatment involving STDs - medical care during pregnancy - management of drug addiction |
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what is an oral advance directive
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- incapacitated pt's prior oral statements commonly used as a guide
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what is a written advance directive
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- describes treatments the patient wishes to recieve or not recieve if they become incapacitated and cannot communicate about treatments
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what is durable power of attorney
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patient designates a surrogate to make medical decisions in the event that he/she loses decision making capacity
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whatare the three exceptions to confidentiality
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- potential harm to others is serious
- likelihood of harm to self is great - no alternative means exists to warm or protect those at risk |
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what is the tarasoff decision
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law requiring physcian to directly infrom and protect potentital victum from hardm
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what are the four D's of malpractice
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- physician had a duty to the pt
- physcican breached that duty - pt suffers harm - breach of duty was what caused the harm |
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what is the most common factor leading to litigation
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poor communication between physician and patient
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what is the appropriate response to noncompliance
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- identify reason
- determine willingness to change - do not attempt to coerce the pt into complying or refer the pt to another physcian |
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what is the correct response when a pt desires an unnecessary procedure
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- understand why pt wants proceedure
- do not refuse to see pt or refer him to another physician - address the underlying concern - avoid unnecessary proceedure |
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wha tis the correct response to a pt with difficulty taking medications
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- provide written instructions and attempt to simplify treatment regimens
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what is the correct response to family members asking for information about patients prognosis
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- avoid discussing issues with relatives without the permission of the pt
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what is the correct response if a child wants to know more about his illness
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ask parents what they have told child and they can decided what information can be relayed
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what is the correct response to a 17yr old girl who requests an abortion
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- unless she is at medical risk do not advise a patient to have an abortion regardless of her age or condition of the fetus
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what is the correct response if a 15 year old girl is pregnant and her parents want her to give up the child for adoption but she wants to keep it
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- pt retains righ tto make decisions regarding her child even if her parents disagree
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what is the correct respoonse to a terminally ill pt who requests physician assistance in ending life
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- physicians may prescribe medically appropriate analgesics tha tcoincidentally shorten pts life
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what is correct response to a pt who had a mastectomy and feels ugly when she undresses at night
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- find out why pt feels this way
- do no toffer falsely reassuring statements |
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what is the correct response to a patient tha ti sangry about the amount of time he spent in teh waiting room
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- acknowledge angar
- appologize for any inconvenience - stay away from efforts to explain the delay |
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what is the correct response if a patient is upset wiht the way he was treated by another doctor
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- have pt speak directly to that physician
- if problem is with member of office staff tell the patient you will speak to that individual |
