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54 Cards in this Set
- Front
- Back
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Prevalence vs Incidence |
Prevalence = number of cases existing at given time
Incidence = new cases per given unit of time |
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Studies to measure incidence vs prevalence |
Incidence - cohort study (developing dz)
Prevalence - cross-sectional study |
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Mortality effect on prevalence |
Prevalence = incidence x duration so if mortality decreases, prevalence increases |
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Use of a prevalence study |
Shows cases at given time, can use to allocate resources or for basis of testing BUT NO cause/effect or ability to measure risk/incidence |
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Sensitivity |
Sensitivity = probability if have dz will have positive test, RULE OUT.
=TP/TP+FN |
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Specificity |
Probability if do not have dz will have negative test. RULE IN
=TN/TN + FP |
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False positive and negative ratio |
False positive ratio = 1-sensitivity
False negative ratio = 1-specificity |
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PPV and NPV |
PPV - chance a positive test result is TRUE = TP/(TP+FP)
NPV - chance negative test result is negative = TN/(TN+FN) |
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Modulators of PPV and NPV |
PPV - higher prevalence = higher PPV
NPV - lower prevalence = higher NPV, more sensitive test = higher NPV |
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Positive and Negative likelihood ratio, and post test odds |
how likely to have a true positive compared to nondiseased group
P LR = sensitivity/1-specificity
N LR = 1-sensitivity/specificity
Posttest odds = pretest odds times LR |
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Cohort study |
Group of people WITHOUT dz, but who could get. Divide group by risk factors (exposure), follow over time to analyze incidence
Prospective - prior to development Retrospective - look back
Require many subjects and expensive |
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Case-control studies |
Study a population Pick cases and controls then analyze frequency of exposure to a possible risk factor
"matching" by making all same gender, age, etc to reduce confounding variable
use smaller groups, but cannot calculate prevalence or incidence but can give odds ratio |
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Absolute risk vs attributable risk |
absolute risk = incidence
Attributable risk = incidence of dz in exposed - incidence in unexposed |
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Relative risk |
how much more likely to get
=incidence in exposed/incidence in unexposed
= [a / (a+b)] / [ c/(c+d)] |
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Odds ratio |
estimate of relative risk used in case control. Ie. how likely is it that someone with dz was exposed
= ad/bc |
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RCT, cohort, cross-sectional, case control
Purpose, advantages and bias risks |
RCT - causality test through randomization, reduces bias and confounding but not possible if very rare outcome or adverse outcome
Cohort - take association and follow over time to see if get dz, determines incidence and temporality but expensive and selection bias if retrospective
Cross-sectional - point prevalence, no claim on incidence or causality
Case-control - take known disease and evaluate for risk factor contributing to dz. cheaper but at risk for recall biases and selection bias |
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Selection bias |
participants in study self-select or selected b/c have some attribute |
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Measurement bias |
different ways of measuring |
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confounding bias |
Third variable |
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Recall bias |
retrospective studies chance of remembering something more likely in dz group usually |
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Lead-time bias |
Earlier detection does not equal greater survival |
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Length bias |
Screening tests detect slow growing dz but miss rapid fatal ones giving false impression of benefits |
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Type I vs Type II error |
Type I - concluding there is a difference when there is not (false positive), p<0.05
Type II (B) - concluding no difference when there is one (false negative)
Power - 1-B |
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Confidence Interval |
whatever p value is (usually .05) makes it 95% confident that true value iss within interval |
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Prevention types |
1) decrease dz incidence, actions to reduce risk
2) identify dz early and slow progression, i.e. screening test to identify subclinical dz
3) prevent morbidity or mortality - treatment of dz |
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Peds vaccine schedule |
HepB birth
2 mo - RV, DTaP, HiB, PCV, IPV, HepB 4 mo - RV, DTaP, HiB, PCV, IPV 6 mo - RV, DTaP, HiB, PCV, IPV (6-18 mo need last dose), Hep B (6-18 mo need last dose)
1 year - MMR, Varicella Hep A
Flu yearly starting at 6 months
DTaP - also 4-6 yr, 11-12 yr,
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Behavioral counseling stages |
Precontemplation - denial or ignorance Contemplation - assessing risk vs benefit, barriers Preparation - small change, visiting doctor to ask Action - choosing to stop or getting help Maintenance - avoiding temptation |
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Cancer types most common men and women, most lethal |
Most common Men - Prostate > Lung > Colorectal Women - Breast > Lung > Colorectal
Most lethal - Lung |
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Leading causes of death men vs women |
Men - CV > cancer > accident > Resp > Stroke > DM
WOmen - CV > cancer > stroke > resp |
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Reportable dz |
STDs Tick-borne dz Bioweapons Vaccine preventable dz Woter/food borne illness Zoonoses
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4 Main Principles of Ethics |
Autonomy Beneficence Nonmaleficence Justice |
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Informed consent parts |
BRAIN
Benefits, Risks, Alternatives, Indications, Nature |
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When do minors not require consent from parents |
Life-threatening emergency Legally emancipated (married, armed services, legally) STD Substance abuse Pregnancy related
Parents CANNOT refuse treatment if a serious threat is posed to child (vaccines are not considered serious threat) |
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Competence and decision making capacity |
Competence - global and legal capacity to make decisions and be held accountable. LEGAL definition
Decision-making capacity - ability to understand medical information and situation and make a decision. Assessed by physician. Differs based on complexity |
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Futile treatment standards |
No evidence or rationale for treatment Intervention has already failed Maximal intervention currently failing Will not achieve goals of care |
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Overriding confidentiality |
Wounds Automobile-driving impairment (DUI) ID Tarasoff-violent crimes Suicide Elder abuse Child abuse
3rd party at risk , significant risk of harm, disclosure can mitigate, and other attempts have failed (ie pt refusing to tell) |
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Elements of malpractice |
4 Ds
Duty to patient Derelection of that duty Damage to the patient Damage is a direct result of dereliction of duty
Only a preponderance of evidence burden of proof |
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Milestones: 2 months |
Lift head, social smile
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Milestones: 4 months |
rolls, laughs and squeals, grasps
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Milestones: 6 months |
sits, babbles, raking |
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Milestones: 9 months |
crawl, pincer grasp, mama/dada |
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Milestones: 1 year |
walks, mature pincer, 1-3 words |
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Milestones: 2 years |
stairs, 6 cubes, 2 word phrases |
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Milestones 3 years |
tricycle, copies circle, |
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Milestones: 4 years |
Hops, cross, colors, numbers, coopoerative play |
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Milestones: 5 years |
copies triangle, skips, 5 word sentences |
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Fabry's Dz |
alpha galactosidase A def, ceramide trihexoside in brain, heart, kidney
angiokeratomas, telangiectasias, renal failure, neuropathic limb pain |
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Krabbe's Dz |
Galactosylceramidase deficiency, galactocerebroside accumulates in brain |
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Gaucher's Dz |
Glucocerebrocidase deficiency, "crinckled paper" gaucher cells, anemia, thrombocytopenia, normal life span in adult form, fatal in infant form |
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Niemann-Pick dz |
Sphingomyelinase deficiency. Cherry red spot and hepatomegaly |
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Tay-Sachs Dz |
Hexosaminidase abscence, GM2 ganglioside buildup, normal child till 3-6 months, then weakness and regression. Cherry red spot but no hepatomegaly |
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Metachromatic leukodystrophy |
Arylsulfatase A deficiency, progressive ataxia and dementia |
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Hurlers syndrome |
a-L-iuronidase deficiency, corneal clouding, MR |
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Hunter's syndrome |
iduronate sulfatase deficiency, milder X-linked Hurlers' no corneal clouding, mild MR. |
