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49 Cards in this Set

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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)
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)
Meta-analysis
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
Positive predictive value (PPV)
Proportion of positive test results that are true positive. Probability that person actually has the disease given a positive test result.

TP/ (TP + FP)
Negative predictive value (NPV)
proportion of negative test results that are true negative. Probability that person actually is disease free given a negative test result.

TN / (FN + TN)
Association b/t prevalence and disease duration?
prevalence = incidence x disease duration

an approximation
Incidence?
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.
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
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)
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)]
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)
number needed to tx?

number needed to harm
NNT = 1/ absolute risk reduction

NNH = 1/attributable risk
Loos of follow-up after the study.

what kind of bias?
selection bias
Crossover studies

define.
used to?
each subject acts as own control

to reduce bias
confounding bias
occurs with 2 closely associated factors; the effect of 1 factor distort or confuses the effect of the other
Pygmalion effect
occurs when a researcher's belief in the efficacy of a tx changes the outcome of that tx.
Hawthorne effect
occurs when the group being studied changes its behavior owing to the knowledge of being studied.
Positive skew
Mean > Median > mode
asymmetry with tail on right
negative skew
Mean < Median < mode
asymmetry with tail on left
type 1 error (alpha)
stating that there is an effect or difference when none exists.

"false-positive error"
type II error (beta)
stating that there IS NOT an effect or difference when one exists.

"false-negative error"
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
What does power depend on (3)?
1. total # of end points experienced by population
2. difference in compliance b/t tx goups
3. size of expected effect
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
define confidence interval mathematically.
CI = range from [mean - Z(SEM)] to [mean + Z(SEM)]

Z= 1.96 for 95% CI
t-test
checks difference b/t the means of 2 groups
ANOVA
checks difference b/t the means of 3 or more groups
X^2
checks difference b/t 2 or more percentages or proportions of categorical outcomes
Z-test
used to compare 2 means but population variance are utilized in calculations
List reportable infectious diseases.
Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gone.

Hep A, B, C
HIV
Salmonella
Shigella
Syphilis
Measles
Mumps
AIDS
Rubella
Tb
Chickenpox
Gonorrhea
List and explain core ethical principles.
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
List exceptions to informed consent.
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
List examples to confidentiality.
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
4 requirements for negligence
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
List situations where parental consent is not required for minors.
emergency situations
tx of STDs
medical care during pregnancy
management of drug addiction
when you made a medical error, what should you do?
always be truthful with pts.
What should you when religion is mentioned?
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
What should you do if pt does not want to know the result of a test?
pts have the right to refuse knowledge of their own medical information and diagnosis.

have a surrogate decision maker (even in competent pts)
5 measurements of Apgar score.

when is it measured?
Appearance
Pulse
Grimace
Activity
Respiration

measure at 1 minute and 5 minutes
Kubler-Ross grief stages
Denial, Anger, Bargaining, Grieving, Acceptance

stages do not necessarily occur in this order, and > 1 stage can be present at once
What 2 thing do not decrease in the elderly?
sexual interest does not decrease
intelligence does not decrease
Describe sleep stages 3, 4.
deepest, non-REM sleep; sleepwalking; night terrors, bedwetting (slow-wave sleep)

EEG wave: Delta (lowest frequency, highest amplitude)
Describe the REM sleep.
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
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.
What class of drug is used to reduce night terrors and sleep walking? why?
Benzodiazepine

shortens stage 4 sleep, which is involved in sleepwalking and night terrors
What drug is used to tx enuresis during sleep?
imipramine b/c it reduces stage 4 sleep.
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)
What is cataplexy? what is it associated with?
loss of all muscle tone following a strong emotional stimulus.

seen in some narcoleptic pts
what area of the brain drives the Circadian rhythm?
suprachiasmatic nucleus (SCN) of hypothalamus