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Therapy

Back 1

 Tests the effectiveness of a treatment such as a drug, surgical procedure, or other interven Tests the effectiveness of a treatment such as a drug, surgical procedure, or other interventiontion

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o Prognosis

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 Determines how the natural course of an illness will be affected by the introduction of an intervention

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o Etiology/Harm

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 Determines whether an agent is related to the development of an illness (including SEs)

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o Diagnosis

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 Measures the validity and reliability of a diagnostic test

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best level of evidence for therapy

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RCT --> cohort --> case control --> case series

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best level of evidence for etiology/harm

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RCT -->cohort --> case control --> case series

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best level of evidence for prognosis

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longitudinal cohort --> case control --> case series

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best level of evidence for diagnosis

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cross sectional survey comparing new test to gold standard

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o ACP Journal Club

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 Critical appraisal of previously published articles
 Adds conclusions and commentaries
 Limitis: Clinical studies categories
 Retrieve full article: EBM Article Review

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o Cochrane Database

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 Original high quality systematic reviews
 Adds implications for practice/research
 Limits; systematic reviews
 Retrieve full article: EBM Topic Review

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o DARE

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 Critical appraisal of previously published systematic reviews
 Adds results of review and author’s conclusions
 Retrieve full article: EBM Article Review

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o PubMed

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 Largest
 Basic limits
 Retrieve by Miami online icon

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steps to breaking bad news

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1-create a conducive environment
2-find out what person knows
3-find out what they want to know
4-share the information
5-respond to patients feelings
6-planning and follow-through

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defining geriatrics

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age least important, multiple chronic conditions, special needs, patient expresses his symptoms in terms of functional loss

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paradoxical care-giver

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when an old parent takes care of a disabled child

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5 Rs for pt considering quiting smoking

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relevance, risks, rewards, roadblocks, repetition

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3 components to succesful quiting of smoking

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social support, nicotine replacement, skills training

Front 18

signs of child abuse (bruises)

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to the buttocks, not over bony prominences

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signs of child abuse (fractures)

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at different stages of healing, spiral fractures

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most common cause of child abuse

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driving wo kid in seatbelt

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child sex abuse is

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chronic, perp is well known to child, not meant to hurt bc perp wants to repeat

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how often is PE indicative of sexual abuse

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5%, HX key

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what sign is a high risk for an abuser to kill a kid nex ttime

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BITES

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legal standard for child abuse in juvenile crt v. criminal crt

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preponderance of evidence v. beyond a reasonable doubt

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services on record provided indicated by

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CPT code

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diagnosis on record indicated by

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ICD-9-CM code

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CPT is

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level of care based on Hx, PE, medical decision making

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HCFA 1500

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claim submission form

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discounted fee for service

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hospital or md gets a % of current fees negotiated with plan

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capitation

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provider gets fixed about to provide care to a certain group

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basic policy

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covers initial expense (not including deductibles, co-pays/insurance) with upper limit

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major medical poluicy

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picks up where basic policy leaves off - for major events

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indemnity policy

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pays a fixed $ under certain conditions (not necesarily medical)

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medigap insurance

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pays most of health insurance charges not covered by Medicare Parts A and B

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Medicare Part A

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inpatient hospital, nursing facility, mode health agency care, hospice care
financed through mandataroy payroll tax

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part B medicare

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medical expenses
financed by contributions from premiums and US Tresury

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part C medicare

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medicare + choice program - HMO where medicare benefits assigned to plan and medicare cannot be used outside plan

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part D medicare

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durgs (has doughnut hole)

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what does it mean if an md "does not "accept assignment" for medicare

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may charge up to 15% more than emdicare rates

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POS plan

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HMO with out of network option at high co-insurance rate

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% of clinical decisions made with little evidence or only consensus

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51%

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CPT has how many levels

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4

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value-based purchasing

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create direct linkage between what is spent by purchaser of health care and the value

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pay-for-performance

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pay mroe to mdswho do better

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ABCs of behavioral developemtn

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all behavior is about communication
antecedent, behavior, consequence