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woman w/ anxiety about gyn exam is told to relax and imagine going through the steps of the exam. What process does this exemplify
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systematic desensitization
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65 y/o man is dx w/ incurable pancreatic adenocarcinoma. His family asks you, the doctor, not to tell the pt. What do you do?
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assess whether telling the pt will negatively affect his health. If not, tell him
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Man admitted for chest pain is medicated for ventricular tachycardia. The nexxt day he jumps out of bed and does 50 push ups to show the nurses he did not hav a heart attack. What defense mechanism is he using
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denial
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you find yourself attracted to your 26 y/o pt. What do you say.
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nothing! be professional. It is not acceptable to have a relationship with your pts.
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large group of people is followed over 10 years. Every 2 years. It is determined who develops heart dz and who does not. What type of study?
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cohort study
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girl can groom herself, hop on one foot and has an amaginary friend. How old is she?
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4 y/o
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man has flashbacks about his girlfriends death 2 mo. ago follwooingt a hit-and-run accident. He often cries and wishes for the death of the culprit. What is the dx?
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normal bereavemnt
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36 y/o woman with strong family hx of breast CA refuses mammogram because she heard it hurts. What do you do?
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discuss the risks and benefits of not havign a mammogram. Each pt must give her own informed consent to each procedure; if the pt refuses, you must abide by her wishes.
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4 y/o girl complains of burning feeling in her genetalia; otherwise she behaves and sleeps normally. Smear of the discharge shows N. gonorrhea. How was she infected
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sexual abuse
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72 y/o man insists on stopping tx for his heart conditon because it makes him feel "funny" What do you do?
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encourage pt to take his meds but pt has final say in his tx regimen. Investigate the "funny" feeling and determine if there are drugs available that don't elicit this particular side effect.
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This is an observational study. The sample is chosen based on presence (cases) or absence (controls) of dz. Info is collected about risk factors. It is often retrospective
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case control study
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this is an observational study. Sample is chosen based on presence or absense of risk factors. Subjects are followed over time for development of dz. Often prospective
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cohort study
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Framingham heart study is an exampel of this type of study
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cohort study
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This involves pooling data from several studies (often via a literature search) to achieve greater statistical power.
Limitations of individual studies prevail
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meta-analysis
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this is an experimental study. It compares the terapeutic benefits of 2 or more tx or tx & placebos
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clinical trial
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highest quality clinical trials are double ______
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blind
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this negative study finding occurs when 1 outcome is systematically favored over another.
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bias
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this type of bias is a nonrandom assignment to a study group
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selection bias
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this type of bias occurs when knowledge of the presence of a disorder alters recall by the subjects
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recall bias
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this type of bias occurs when subjects are not representitive; tehrefore results are not generalizable
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sampling bias
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this type of bias occurs when information is gathered at an inappropriate time
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late-look bias
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Give 4 ways to reduce bias:
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1) blind studies (single/double)
2) placebo responses
3) crossover studies (each subject acts as own control
4) randomixation
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this describes total cases in population at a given time over total population
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prevalence
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this describes new cases in population over a given time over total population at risk during that time
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incidence
mneu: incidence is new incidents.
note: when calculating incidence, don't forget that people previously positive for dz are no longer considered at risk
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this is approximately equal to the incidence multiplied by the dz duration
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prevalence
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what is greater for chronic dzs like diabetes. prevalence or incidence
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prevalence.
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which is greater for acute dzs like the common cold. prevalence or incidence
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they are equal
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this describes the number of true positives divided by the number of all the people with the dz. It is the probability a positive test, given a person has the desease
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sensitivity
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sensitivity rules ______
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out
mneu: SNOUT
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this is equal to 1-sensitivity
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false negative
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high sensitivity is desirable for this type of test
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screening
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This is the number of true negatives divided by number of all people without the desease. It is the probability of a negative test given taht a person is free of the dz.
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specificity.
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specificity rules _____
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IN
mneu: SPIN
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this is equal to 1-specificity
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false positive rate
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high specificity is desirable for this type of test
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confirmatory test
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This is the number of true positives divided by number of people who tested positive for the dz.
It is the probability of having a condition given a positive test
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positive predictive value (PPV)
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This is the number of true negatives divided by number of people who tested negative for the dz.
It is the probability of not having the condition given a negative test
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negative predictive value (NPV)
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unlike sensitivity and specificity, predictive values are dependent on this
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prevalence of the dz
the higher the prevalence off the diz the higher the positive predictive value of the test.
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p. 63 predictive value graphic
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--
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this descrives the odds of having a dz in the exposed gorup divided by the odds of having dz in unexposed group.
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odds ratio (OR)
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how are odds are calculated within a group
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as number with dz divided by number without the dz
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if the prevenance of the dz is not too high the OR approximates this
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relative risk
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OR is used in this type of study
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case-control
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this describes the disease risk in exposed group divided by dz risk in uneposed gorup
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relative risk (RR)
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how is relative risk calculated within a group
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number with dz divided by total number of people in the gourp.
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relative risk is used for what type of studies
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cohort studies
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graphic odds ratio v. relative risk p. 63
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--
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the consistency and reproducibility of a test (reliability)
the absense of random variation in a test
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precision
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the trueness of test measurements (validity)
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accuracy
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random error leads to reduced this in a test
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precision
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