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74 Cards in this Set
- Front
- Back
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Case-control
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Retrospective; uses Odds Ratio
Compares group with disease to group without; looks for exposure/ risk factors |
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Cohort study
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Prospective; uses Relative Risk
Compares a group with a given exposure or risk factor to group without; looks to see if exposure increases the likelihood of disease |
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Cross-sectional study
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Instant snap shot of disease Prevalence
Collects data from a group of people to assess frequency of disease |
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Twin concordance study
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Measures heritabilty
Compares the frequency with which both monozygotic twins or dizygotic twins develop a disease |
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Adoption study
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Heritability and influence of environmental factors
Compares siblings raised by biologic vs. adoptive parents |
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Clinical trial
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Highest quality when randomized, controlled, and double-blinded
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Phase I clinical trial
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Assesses safety, toxicity, and pharmacokinetics
Usually healthy volunteers |
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Phase II clinical trial
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Assesses treatment efficacy, optimal dosing, and adverse effects
Patients with disease of interest |
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Phase III clinical trial
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Compares new treatment to current standard of care
Patients randomly assigned to new treatment or placebo |
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Phase IV clinical trial
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Detects rare or long-term side effects
Postmarketing surveillance trial or patients after approval |
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Meta-analysis
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Pools data from several studies. Affected by quality and/or bias in individual studies.
Highest echelon of clinical evidence. Acheives greater statistical power and integrates the results of similar studies. |
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Sensitivity
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= TP/(TP + FN)
= 1 - false negative rate Proportion of people with disease who test positive SNOUT = SeNsitivity rules out |
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Specificity
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= TN/(TN + FP)
= 1 - false-postive rate Proportion of people without disease who test negative SPIN = SPecificity rules IN |
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Positive Predictive Value
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= TP/(TP + FP)
Proportion of positive tests that are true positives Probability that a person actually has the disease given a positive test result |
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Negative Predicitive Value
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= TN/(FN + TN)
Proportion of negative test results that are true negative Probability that a person is actually disease free given a negative test result |
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Prevalence
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total cases/total population
at a give point in time Prevealence ~=incidence x disease duration Prevalence > incidence for chronic diseases (eg diabetes) Prevalence = incidence for acute disease |
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Incidence
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new cases over a given time period/total population at risk that time period
Incidence is new incidents Subtract out people currently with the disease or previously positive for it |
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Odds Ratio for case control studies
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=ad/bc
odds of having disease in exposed group divided by odds of having disease in unexposed group |
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Relative Risk for cohort studies
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= a/(a + b) / b/(c + d)
Relative probability of getting a disease in the eexposed group compared to the unexposed group |
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Table for evaluation of diagnostic tesrt
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4x4
Disease at top, test result on side |
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Table for OR, RR, etc
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Disease (+/-) at top
Risk factor (+/-) on side |
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Attributable risk
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= a/(a + b) - c/(c+d)
The proportion of disease occurences attributable to the exposure (eg cigaerette smoking). The difference in risk between exposed and unexposed groups, |
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Absolute risk reduction
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The reduction in risk associated with a treatment as compared to placebo
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Number needed to treat
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1/absolute risk reduction
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Number needed to harm
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1/attributable risk
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Case-control example
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Patients with COPD had higher odds of a history of smoking than those without COPD
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Cohort study example
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Smokers had a higher risk of developing COPD than did nonsmokers
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Prevalence
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cases/population
*at a given time |
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Incidence
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new cases/population at risk
*during that time period |
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Random error
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reduced precision in a test
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Systematic error
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reduced accuracy in a test
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Selection bias
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nonrandom assignment to study group
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Recall bias
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knowledge of presence of disorder alters recall by subjects
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Sampling bias
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subjects not representative relative to general population
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late-look bias
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info gathered at wrong time
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Procedure bias
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subjects in different groups not treated equally, eg one group gets more attention or better staff
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Confounding bias
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the effect of one factor distorts or confuses the effect on the other
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Lead-time bias
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early detection confused with increased survivial; eg improved screening (natural course of disease not altered, however, earlier detection makes survival seem increased
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Pygmalion effect
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researchers belief in treatment changes the outcome of that treatment
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Hawthorne effect
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group being studied changes their behavior because they know they are being studied
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Least affected by outliers
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Mode
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Normal distribution
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Mean = median = mode
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Positive skew
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mean>median>mode
assymetry w/ tail on right |
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Negative skew
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mean<median<mode
asymmetry w/ tail on left |
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Type I error (alpha)
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Mistakenly reject the null hypothesis
Stating that there is an effect or difference when there is not |
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Type II error (beta)
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Mistakenly accept the null hypothesis
Stating there is not an effect or difference when there is |
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Power (1-beta)
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Probability of rejecting the null hypothesis when it is in fact false, or the likelihood of finding a difference if one exists
Depends on: 1. Total # of end points in pop 2. Difference in compliance between treatment groups 3. Size of expected effect |
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p value
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probability of making a type I error (usally <0.05)
If p is less than 0.05 there is less than a 5% chance that the data will show something that is not really there |
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SEM
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standard deviation divided by square root of n
As n increases, SEM decreases |
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t-test
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checks for difference between the means of 2 groups
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ANOVA
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checks for difference between the means of 3 or more groups
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X2 (chi-square)
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check difference between 2 or more percentages or proportions of categorical outcomes (not mean values)
ie compares percentages or proportions |
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Disease prevention - primary, secondary, tertiatry
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Primary - prevent disease occurence (eg HPV vaccination)
Secondary - early detection of disease (pap smear) Tertiary - reduce disability from disease (eg chemotherapy) |
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Reportable diseases
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Hep Hep Hep Hooray, the SSSMMART Chick is Gone!
Hep A, Hep B, Hep C, HIV Salmonella, Shigella, Syphilis Measles, Mumps, Rubella, Tuberculosis Chickenpox Gonorrhea |
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Leading causes of death in the United States by age group
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Infants - congenital anomolies, SIDS, respiratory distress syndrome
Ages 1-14 Injuries, cancer, congenital anomalies, homicide, heart disease Ages 15-24 Injuries, homicidem, suicide Ages 24-64 Cancer, heart disease, injuries Ages 65+ heart disease, cancer, stroke |
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Medicare
Medicaid |
MedicarE is for Elderly
MedicaiD is for Destitute |
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Medicare parts A-D
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Part A = inpatient care in hospitals, skilled nursing, hospice, and home health care
Part B = outpatient care, doctors services, PT/OT Part C = combination of A & B Part D = stand-alone prescription drug coverage |
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Developmental milestones in the infant
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Birth - 3 mo: rooting reflex; orients to voice
3 mo: holds head up, Moro reflex disappears; social smile 7-9 mo: sits alone, crawls; stranger anxiety 15 mo: walks, Babinski disappears |
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Developmental milestones in the toddler
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12 - 24 mo:
-climbs stairs; -stacks 3 blocks at 1 year; 6 blocks at two years (b =n x 3); -object permanence -2 word sentences at age 2 24 - 36 mo: core gender identity, parallel play |
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Developmental milestones in the preschooler
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30 - 36 mo: stacks 9 blocks; toilet training (pee at age three)
3 yrs: rides tricycle; copies line or circle drawing; 900 words and complete sentences |
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Tanner stages
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1. Childhood
2. Pubic hair (adrenarche), breast buds 3. Pubic hair darkens and becomes curly; penis size/length increase 4. Penis width increases, darker scrotal skin, development of the glans, raised areolae 5. Adult; areolae are no longer raised |
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Kubler-Ross grief stages
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Denial, Anger, Bargaining, Grieving (depression), Acceptance
Stages do not necassarily occur in this order, more than one stage may be present Death Arrives Bringing Grave Adjustments |
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Normal grief
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shock, denial, guilt, somatic symptoms. can last up to 2 months. may experience illusions.
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Pathologic grief
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lasts longer than 2 months, or is delayed, inhibited, or denied. depressive symptoms, delusions, hallucinations.
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Stress
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Stress induces production of free fatty acids, 17-OH corticosteroids (immunosuppression), lipids, cholesterol, catecholamines; affects water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation
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Body mass index
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BMI = wieght in kg/(height in m )squared
< 18.5 underweight 18.5 - 24.9 normal 25-29.9 overweight >30 obese >40 morbidly obese |
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Sleep stages
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Awake: (a) eyes open - beta waves (highest frequency, lowest amplitude) - same as REM sleep
(b) eyes closed - alpha waves Stage 1 (light sleep; 5%) - theta waves Stage 2 (deeper sleep; bruxism; 45%) - sleep spindles and K complexes Stage 3-4: (deepest, non-REM sleep; 25%) sleepwalking, nightsweats, bedwetting - delta waves (lowest frequency, highest amplitude) MOST RESTORATIVE REM (25%): dreaming, loss of motor tone, possibly a memory processing function, increased brain use At night: BATS Drink Blood |
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Key to initiating sleep
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serotonergic predmoninance of raphe nucleus
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NE effect on sleep
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Reduces REM sleep
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Extraoccular movements during REM due to
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Activity of PPRF (paramedian pontine reticular formation/conjugate gaze center0
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Paradoxical sleep; desynchronized sleep
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REM sleep has same EEG pattern while awake and alert
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Imipramine
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Used to treat enuresis because it decreases stage 4 sleep
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Narcolepsy
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Disordered sleep. Nocturnal and narcoleptic sleep starts off with REM. Excessive daytime sleepiness.
Cataplexy - loss of all muscle tone following a strong emotional stimulus Hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations Tx w/ stimulants - amphetamines, modafinil, and sodium oxybate (GHB) |
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Circadian rythm
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Suprachiasmatic nucleus -> NE release -> pineal gland -> melatonin
SCN regulated by light |
