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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