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90 Cards in this Set
- Front
- Back
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Empathetic skills |
1. Reflection*
2. Validation* 3. Support* 4. Partnership 5. Respect *=3 most important skills |
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Sensitivity |
*rate of TRUE POSITIVES (implies rate of false neg) = (100-false neg) = (true pos)/(true pos+false neg) |
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Specificity |
*rate of TRUE NEGATIVES (implies rate of false pos) =(100-false pos) =(true neg)/(true neg+false pos) |
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sensitivity & specificity |
- are mutually exclusive (one does not imply anything about the other) - independent of the population of interest subjected to the test - 2 most common measures of the effectiveness of tests |
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PPV & NPV |
- used when considering the value of the test -dependent on the prevalence of the disease in the population of interest |
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PPV |
*likelihood that patient HAS the disease if the test result is POSITIVE =(true pos)/(true pos+false pos) |
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NPV |
*likelihood that patient does NOT HAVE the disease if the test result is NEGATIVE =(true neg)/(true neg+false neg) |
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Likelihood ratio (LR) |
*how much more likely it is that a patient who tests positive (+) HAS the disease compares w/ ones who tests negative = (sens)/(1-spec) - refers to the utility of tests - can be pos. LR or neg. LR |
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Reliability |
*reproducibility of the results - degree of consistency w/ which an instrument or person measures a particular attribute (kappa values; in-class correlation [ICC]) |
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Validity |
*accuracy of a test, determined by the measure of agreement w/ a gold standard (sens/spec, PPV/NPV, +/- LR) - basis for determining the clinical usefulness of a test |
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Top 3 ranked Preventive Health Interventions |
1. Aspirin chemoprophylaxis (w/ men over 40, women over 50, and others at increased risk) 2. Childhood immunization series 3. Tobacco-use screening & brief intervention (screen adults for tobacco use, provide brief counseling, and offer pharmacotherapy) |
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The 6 elements of being Professional |
Be: 1. Present (physically/mentally) 2. Presentable (dress/image) 3. Punctual 4. Prepared 5. Positive (Respectful; calm during stress) 6. Proficient (self-improvement/self-educate) |
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Clinical Preventive Services that clinicians should provide (USPSTF) |
1. Screening Tests 2. Counseling Interventions 3. Immunizations 4. Chemoprophylaxis |
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Screening Tests |
specialized tests or examination procedures for early detection of preclinical conditions or risk factors in asymptomatic persons |
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Counseling Interventions |
efforts to educate patients about the consequences of personal health behaviors and to work in a collaborative manner on strategies for risk factor modification |
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Immunizations |
use of vaccines and immunoglobulins to prevent infectious disease |
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Chemoprophylaxis |
use of drugs and supplements by asymptomatic persons to prevent future disease |
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Primary Prevention |
-Goal: to prevent new disease cases by reducing risk factors
- precedes disease or dysfunction - health promotion - specific promotion (ie. vaccinations, exposure reduction) |
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Secondary Prevention |
- Goal: to detect disease, thereby leading to early treatment and improved diagnosis
- early diagnosis and prompt tx - disability limitation - screening activities - treating early stages of disease to limit disability by averting or delaying consequences of advanced disease |
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Tertiary Prevention |
- Goal: to restore a pt w/ existing disease to highest function, minimize neg consequences of disease, and prevent disease-related complications
- occurs when defect or disability is permanent and irreversible -restoration and rehabilitation |
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TTM Stages (of Behavioral Change) |
-Precontemplation -Contemplation -Preparation/Determination -Action -Maintenance -Relapse |
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HP 2020 Vision |
A society in which all peoplelive long, healthy lives. |
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HP 2020 (4) Overarching Goals |
1. Attain high quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities,and improve the health of all groups. 3. Create social and physical environments thatpromote good health for all. 4. Promote quality of life (QOL), healthy development and healthy behaviors across all life stages. |
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Cost Effectiveness (CE) |
*the average net cost per QALY gained in typical practice by offering the clinical preventive service at recommended intervals to a U.S. birth cohort over the recommended age range
- estimated over lifetime of U.S. cohort rather than across the current U.S. cross-sectional population |
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Clinically Preventative Burden (CPB) |
*the total QALYs that could be gained if the clinical preventive service were delivered at recommended intervals to a U.S. cohort of 4 million individuals over the years of life for which a service was recommended - measured the total potential health benefits (health impact) from the service among both receivers & non-receivers of service (of relevant population)-assumed that 100% of population was offered service, but less that 100% used service |
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"Cost of the service"
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*medical costs for screening, counseling, pharm tx, follow-up tests, hospitalizations
and *value of patients' time assoc w/ receiving service and follow-up tx |
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List the steps to delivering bad news (SPIKES protocol) |
S: Set up the interview P: assess patient's Perspective I: obtain the patient's Invitation K: give Knowledge/ information to the patient E: assess pt's Emotions w/ empathetic responses S: Set goals |
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Reactance |
people are motivated to maintain a sense of autonomy and to resist coercion by others |
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Describe Motivational Interviewing |
*an interview style that emphasizes empathy, curiosity, self-determination, acceptance and exploration of ambivalence (roll w/ resistance, not against it) - the best way to influence patient's behavior is build on their own motivation to change - help pt to: weigh the pros/cons, see importance/value of behavior, identify barriers to change and address them |
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Motivational Interviewing Principles |
EE: Express empathy DD: Develop discrepancy RR: Roll w/ resistance SS: Support self-efficacy |
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Goal of the (Priorities Among Effective Preventive Clinical Services) Study |
summarize the best available data on clinical preventive services to assist all types of decision makers in choosing where to focus their prevention efforts clinical preventive services that will lead to: -the largest improvements in pop health and -most efficient allocation of resources |
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Steps for Self-evaluation/Self-reflection |
1. Stop. What did I just do? What happened? 2. How did I do at what I just did or how was i perceived when that just happened? 3. How can I do better the next time? How can I change the outcome? |
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Anticipatory guidance |
- the psychological preparation of a person to help relieve the fear and anxiety of an event expected to be stressful - the preparation of a patient for an anticipated development and/or situational crisis |
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Precontemplation Stage |
- problem exists but pt minimizes or denies it - problem has been identified by others - reluctance to talk/think about it |
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Contemplation Stage |
- open to discussion w/ little prompting and may even initiate - appears interested, asks for more info, weighs pros/cons - can be prolonged or obsessive - partial action (may dabble w/o commitment) |
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Preparation/ Determination Stage |
- pt talks about having made the decision to change -has chosen a specific goal/ specific time/ specific course of action - ready to pay "costs" of change |
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Action Stage |
- has begun set of actions intended to solve the problem - requires daily effort -uses frequent reminders as reinforcement of commitment to overcome goals/obstacles -unexpected discomfort/resistance/temptations may waiver course |
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Maintenance Stage |
- has achieved a period of success (self-defined) - may assume a positive identity - initial intensity of effort may be tapering off - may begin to tolerate/justify "slips" |
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Relapse Stage |
- pt may now talk/act like a person in an earlier stage of change - stories are more complex (if relapsed vs. not relapsed) - reasons for relapse give clues to necessary steps to reinforce/reinvigorate motivation - 2/3 relapse within 1 year |
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Self-efficacy/Social-learning Theory |
motivation to change behavior comes from belief that the desired behavior is necessary/valuable and that they have the ability (self-efficacy) to successfully change the unwanted behavior |
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___% of patients do not follow the treatment recommendations from a medical visit |
40% |
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More than __% of patients fail to adhere to recommended lifestyle changes |
75% |
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Strategies for behavior change |
1. Ask, tell, ask 2. Elicit, provide, elicit, provide 3. Roll with resistance 4. Let the pt do the heavy lifting |
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Transference |
redirection of a patient's feelings from previous encounter(s) w/ another person towards a practitioner |
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Counter-transference |
redirection of a practitioner's feelings from pervious interaction(s) w/ another person towards a patient |
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Empathy Definition |
an intellectual identification with, or vicarious experiencing of, the feelings, thoughts, or attitudes of others |
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Sympathy Definition |
a formal expression of feelings of pity and sorrow (condolences) for someone else's misfortune |
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NCPP Acronym |
National Commission of Prevention Priorities |
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USPSTF Acronym |
U.S. Preventive Services Task Force |
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USPSTF Recommendation rating categories (Grades) |
A: Always offer/provide (substantial benefit) B: Offer/provide (moderate/substantial benefit) C: Circumstantial offer/provide (small benefit) D: Discourage (harms>benefits) I: Evidence is Insufficient (harms?benefits) *based on the strength of evidence and the balance of benefits/harms of a preventive service |
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The 5 A's for Behavioral Counseling and Health Behavior Change |
Assess (risks and behaviors) Advise (give clear personal behavior advice) Agree (w/ pt on appropriate goals and methods) Assist (using self-help resources to help pt achieve goals) Arrange (for follow-up to provide ongoing assistance if needed) |
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Incidence Rate (IR) |
the # of new cases of disease in a specific population during a specified time interval
- a measure of the risk of disease |
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Prevalence |
total # of cases of disease in a specific population during a period or time (period prev) OR at a specific point in time (point prev)
- grows until MR=IR (mortality rate=incidence rate) |
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Quality of Adjusted Life Year (QALY) |
- based on # of life years that would be added by intervention - way of measuring both quality and quantity of life - perfect health=1.0 yr (if not full health- given value between 0 and 1.0) |
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Biomedical Model |
focuses on purely biological processes, and excludes psychological, environmental, and socialinfluences (does not take into account the role of social factors or individual subjectivity)
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Patient-Centered Model |
- pt's ideas of what is wrong - pt's feeling about illness - how problem affecys pt's daily life - what are pt's expectations regarding illness |
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Principles of medical ethics |
1. Autonomy 2. Beneficience 3. Nonmaleficence 4. Justice |
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Criteria needed for screening |
1. Does the significance of the disorder warrant its consideration as a community problem? 2. Can the disease be detected by screening? 3. Should the screening for the disease be done? |
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SpPin |
a Positive test result "rules in" the case (if test is Specific) |
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SnNout |
a Negative test result "rules out" the case (if test is Sensitive) |
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USPSTF Description |
* an independent, volunteer panel of national experts in prevention and evidence-based medicine - works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services - intended to help PCP and patients decide together whether a preventive service is right for a patient's needs - annual report to Congress: identifies critical gaps in research (clinical prev services) and recommends priority areas that deserve further examination |
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Preventive Medicine Categories |
- Aerospace med: (health of crewmembers/pasengers of air & space vehicles, and support personnel) - Occupational med: (health of workers, workplace environments, & outcomes of environ exposures) - Public Health and General Prev med: (health of communities and defined populations) |
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Biopsychosocial Model |
*more holistic approach to health; how socioeconomic status effects person; culture
-Social (peers, family circumstances, school, family relationships, trauma) -Biological (physical health, disability, genetic vulnerabilities) -Psychological (self-esteem, coping skills, social skills)
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absolute risk |
the actual proportion of people with the risk factor who will develop the disease
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relative risk |
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self-determination theory |
distinguishes between motivations that are autonomous vs. those that are controlled by external conditions or persons other than oneself
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social learning theory |
*Learning is not purely behavioral; rather it is a cognitive process that takes place in a socialcontext. *Learning can occur by observing behavior and the consequences of a behavior. - Reinforcement plays a role in learning but is not entirely responsible for learning. - The learner is not a passive recipient of information.
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self-efficacy |
the extent/ strength of belief in one’s own ability to complete tasks and reach goals.
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Tavistock Principles |
1. Rights 2. Balances 3. Comprehensiveness) 4. Cooperation 5. Improvement 6. Safety 7. Openness |
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Autonomy Duties |
- be honest w/ patients - respect pt privacy - protect pt confidentiality - obtain informed consent - help pts w/ important decisions (per their request) |
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Beneficence Duties |
- promote well-being of self and others (using morally-permissable means; not incurring disproportionate costs) - maintain one's competence - reasonable efforts to protect patients/public from harm (incompetent/unethical) of other practitioners - promote health needs of one's community - promote (self) mental/physical/emotional/spiritual development |
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Nonmaleficence Duties |
Do not: - kill/harm others without justified cause - impose unreasonable risk of harm (no negligence) - harm others by insult/ridicule - break promises -agree to do something morally-impermissable - engage in sexual acts w/ patients |
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TTM Description |
- based on empirical evidence that individuals progress througha series of stages when making lifestyle changes - key principle: individuals at different stages of change utilize different behavioral and experiential changestrategies and respond best to interventions that are tailored to their stage of change |
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5 A's: ASSESS |
beliefs, behaviors, knowledge, motivation, and past experience |
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5 A's: ADVISE |
give clear, specific, well-time, and personalized behavior change advice |
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5 A's: AGREE |
collaboratively select goals and methods based on the patient’s interest in and willingness to change the behavior |
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5 A's: ASSIST |
help the patient to achieve goals by acquiring skills, confidence, and social and environmental supports for behavior change |
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5 A's: ARRANGE |
schedule follow up to provide ongoing assistance and support and to adjust the plan as needed |
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Tavistock Principles: BALANCE |
care of the individual patient is central, but the health of the populations is also our concern |
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Tavistock Principles: COOPERATION |
health care succeeds only if we cooperate with those we serve, each other, and those in other sectors |
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Tavistock Principles: RIGHTS |
people have a right to health and health care |
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Tavistock Principles: IMPROVEMENT |
improving health care is a serious and continuing responsibility |
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Tavistock Principles: SAFETY |
do no harm |
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Tavistock Principles: COMPREHENSIVENESS |
in addition to treating illness, we have an obligation to ease suffering, minimize disability, prevent disease, and promote health |
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Tavistock Principles: OPENNESS |
being open, honest, and trustworthy is vital in health care |
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Autonomy definition |
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Beneficence definition |
the obligation to benefit others or to seek their good |
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Nonmaleficence definition |
an obligation to not inflict harm nor to impose risks of harm |
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Justice definition |
- the ethics of fair and equitable distribution of burdens and benefits within a community - to treat everyone equally and fairly, do not show prejudice of favoritism |
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Justice Duties |
- promote treatment of all patients equally - distribute benefits/resources/burdens fairly - advance policies/procedures for fair access of healthcare to all members of the community |
