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49 Cards in this Set
- Front
- Back
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Case-control study
Design? measures? |
observational and retrospective
compares a group of people with disease to a group without (asks, "what happened?") ODDS ratio (OR) |
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Cohort study
Design? Measures? |
observational and prospective
compares a group with a given risk factor to a group w/o to assess whether the risk factor increases the likelihood of disease (asks, what will happen?) measure relative risk (RR) |
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Meta-analysis
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pools data from several studies to come to an overall conclusion. Achieves greater statistical power and integrates results of similar studies. Highest echelon of clinical service
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Positive predictive value (PPV)
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Proportion of positive test results that are true positive. Probability that person actually has the disease given a positive test result.
TP/ (TP + FP) |
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Negative predictive value (NPV)
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proportion of negative test results that are true negative. Probability that person actually is disease free given a negative test result.
TN / (FN + TN) |
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Association b/t prevalence and disease duration?
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prevalence = incidence x disease duration
an approximation |
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Incidence?
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new cases in population over a given time period / total population at risk during that time
people currently with the disease, or those previously positive for it, are not considered at risk. |
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Odds ratio
define. equation? |
Odds of having disease in exposed group divided by odds of having disease in unexposed group.
Odds ratio = a/b / c/d |
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Relative risk
define. equation? |
relative probability of getting a disease in the exposed group compared to the unexposed group.
RR = a/(a+b) / c/(c+d) |
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Attributable risk
define. equation? |
the difference in risk b/t exposed and unexposed groups. or the proportion of disease occurrences that are attributable to the exposure.
attributable risk = [a/(a+b)] - [c/(c+d)] |
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Absolute risk reduction
define equation |
the reduction in risk associated with a tx compared to a placebo.
ARR = (event rate in placebo) - (event rate in tx) |
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number needed to tx?
number needed to harm |
NNT = 1/ absolute risk reduction
NNH = 1/attributable risk |
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Loos of follow-up after the study.
what kind of bias? |
selection bias
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Crossover studies
define. used to? |
each subject acts as own control
to reduce bias |
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confounding bias
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occurs with 2 closely associated factors; the effect of 1 factor distort or confuses the effect of the other
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Pygmalion effect
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occurs when a researcher's belief in the efficacy of a tx changes the outcome of that tx.
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Hawthorne effect
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occurs when the group being studied changes its behavior owing to the knowledge of being studied.
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Positive skew
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Mean > Median > mode
asymmetry with tail on right |
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negative skew
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Mean < Median < mode
asymmetry with tail on left |
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type 1 error (alpha)
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stating that there is an effect or difference when none exists.
"false-positive error" |
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type II error (beta)
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stating that there IS NOT an effect or difference when one exists.
"false-negative error" |
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define Power (stats)
how do you increase the power? |
1 - beta
probability of rejecting null hypothesis when it is in fact false, or the likelihood of finding a difference if one in fact exists. increase sample size -> increase power |
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What does power depend on (3)?
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1. total # of end points experienced by population
2. difference in compliance b/t tx goups 3. size of expected effect |
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Define SEM
how do you minimize SEM? |
standard error of the mean
SEM = sd / square root of sample size (n) SEM < sd and SEM decreases as n increases |
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define confidence interval mathematically.
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CI = range from [mean - Z(SEM)] to [mean + Z(SEM)]
Z= 1.96 for 95% CI |
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t-test
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checks difference b/t the means of 2 groups
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ANOVA
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checks difference b/t the means of 3 or more groups
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X^2
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checks difference b/t 2 or more percentages or proportions of categorical outcomes
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Z-test
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used to compare 2 means but population variance are utilized in calculations
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List reportable infectious diseases.
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Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gone.
Hep A, B, C HIV Salmonella Shigella Syphilis Measles Mumps AIDS Rubella Tb Chickenpox Gonorrhea |
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List and explain core ethical principles.
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1. Autonomy: obligation to respect pts as individuals and to honor their preferences in medical care
2. Beneficence: physicians have a special ethical (fiduciary) duty to act in the pt's best interest. If pt can make an informed decision, ultimately the pt has the right to decide. 3. Nonmalficence: do no harm. However, if the benefits of an intervention outweigh the risks, a pt may make an informed decision to proceed (most surgeries) 4. Justice: to tx persons fairly |
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List exceptions to informed consent.
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1. pt lacks decision-making capacity or is legally incompetent
2. implied consent in an emergency 3. therapeutic privilege: withholding info when disclosure would severely harm the pt or undermine informed decision-making capacity 4. waiver |
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List examples to confidentiality.
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1. infectious diseases
2. The Tarasoff decision: law requiring physician to directly inform and protect potential victim from harm 3. child and/or elder abuse 4. impaired automobile drivers 5. suicidal/homicidal pts |
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4 requirements for negligence
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the 4 D's:
1. Duty 2. Dereliction: breached the duty 3. Damage: suffers harm 4. Direct: the breach of the duty was what caused the harm the burden of proof in a malpractice suit is more likely than not |
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List situations where parental consent is not required for minors.
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emergency situations
tx of STDs medical care during pregnancy management of drug addiction |
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when you made a medical error, what should you do?
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always be truthful with pts.
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What should you when religion is mentioned?
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respect and recognize the belief system of the pt's religion regardless of your own belief
only discuss religion when introduced by the pt. do no harm |
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What should you do if pt does not want to know the result of a test?
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pts have the right to refuse knowledge of their own medical information and diagnosis.
have a surrogate decision maker (even in competent pts) |
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5 measurements of Apgar score.
when is it measured? |
Appearance
Pulse Grimace Activity Respiration measure at 1 minute and 5 minutes |
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Kubler-Ross grief stages
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Denial, Anger, Bargaining, Grieving, Acceptance
stages do not necessarily occur in this order, and > 1 stage can be present at once |
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What 2 thing do not decrease in the elderly?
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sexual interest does not decrease
intelligence does not decrease |
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Describe sleep stages 3, 4.
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deepest, non-REM sleep; sleepwalking; night terrors, bedwetting (slow-wave sleep)
EEG wave: Delta (lowest frequency, highest amplitude) |
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Describe the REM sleep.
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dreaming, loss of motor tone, possibly a memory processing fxn, erections, increased brain O2 use
Beta wave on EEG (highest frequency, lowest amplitude); same waveform as awake state |
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REM sleep.
what NT reduces REM? What is the principal NT during REM sleep? what NT initiates sleep. |
NE reduces REM sleep
Ach is the main NT during REM sleep 5HT predominance of raphe nucleus key to initiating sleep. |
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What class of drug is used to reduce night terrors and sleep walking? why?
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Benzodiazepine
shortens stage 4 sleep, which is involved in sleepwalking and night terrors |
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What drug is used to tx enuresis during sleep?
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imipramine b/c it reduces stage 4 sleep.
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Narcolepsy
Describe. tx? |
disordered regulation of sleep-wake cycles. May include hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations.
The pt's nocturnal and narcoleptic sleep episodes start off with REM sleep. tx: stimulants (amphetamines, modafinil) |
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What is cataplexy? what is it associated with?
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loss of all muscle tone following a strong emotional stimulus.
seen in some narcoleptic pts |
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what area of the brain drives the Circadian rhythm?
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suprachiasmatic nucleus (SCN) of hypothalamus
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