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120 Cards in this Set
- Front
- Back
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study types:
observational retrospective observational prospective observational |
case-control
cohort cross-sectional |
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what measures are used for these studies?
case-control cohort cross-sectional |
odds ratio
relative risk prevalence |
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what kind and number of people are in phase 1 and phase 2 clinical trials?
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small # of healthy volunteers
small # with the disease |
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phase 1 purpose
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SToP
safety toxicity pharmacokinetics |
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phase 2 purpose
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AED
adverse effects efficacy dosing |
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sensitivity
specificity PPV NPV |
sensitivity = TP/(TP+FN)
specificity = TN/(TN+FP) PPV = TP/(TP+FP) NPV = TN/(TN+FN) |
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sensitivity in words
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true positives / everyone with disease
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specificity in words
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true negatives / everyone without disease
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positive predictive value in words
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probability that a person actually has the disease
given a positive test result |
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negative predictive value in words
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probability that someone is disease free
given a negative test result |
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point prevalence =
incidence = |
total cases / total population
new cases / total population |
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prevalence ~ =
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incidence x disease duration
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for acute disease,
prevalence = |
incidence
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odds ratio approximates _ if _
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relative risk
if prevalence is not too high |
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odds ratio vs. relative risk, defined in words
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odds of having disease in exposed group / odds in unexposed group
percent with disease in exposed group / percent with disease in unexposed group |
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formulas
--odds ratio --relative risk --attributable risk |
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number needed to treat =
number needed to harm = |
1/absolute risk reduction
1/attributable risk |
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selection bias
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nonrandom assignment to study group
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recall bias
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knowledge of presence of disorder alters recall
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late-look bias
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information gathered at an inappropriate time
e.g. survey to study a fatal disease (only pts alive will be answer survey) |
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procedure bias
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pts in different groups are not treated the same --
e.g. more attention is paid to treatment group |
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confounding bias
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occurs with 2 closely associated factors
effect of 1 factor distorts effect of the other |
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lead-time bias
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early detection is confused with ^ survival
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pygmalion effect
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researcher's belief in the efficacy of a treatment changes the outcome of treatment
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hawthrone effect
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group changes its behavior due to knowledge of being studied
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ways to reduce bias
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--blind studies
--placebo responses --crossover studies (each subject acts as own control) --randomization |
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skew means...
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skew, like screw, asks "where's the tail?"
e.g. positive skew has the tail toward positive x axis |
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R skew =
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positive skew
= mean > median > mode |
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type I error (3 definitions)
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finding a difference when none exists
(convicting an innocent man) mistakenly rejecting Ho |
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type II error (3 definitions)
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not finding a difference when one exists
(letting a guilty man go free) mistakenly accepting Ho |
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probability of making a type I error
probability of making a type II error |
p, alpha
beta |
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type I error is a false _
type II error is a false _ |
false positive
false negative |
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square diagram of
alpha error (type I) beta error (type II) power |
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power =
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1 - beta
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power means, in words
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probability of rejecting null hypothesis when you should
= probability of finding a difference if in fact one exists |
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power depends on
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^ sample size --> ^ power
--total number of end points --difference in compliance (mean values) between treatment groups --size of expected effect |
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standard error of the mean
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standard deviation / sqrt(n)
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confidence interval, in words:
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range in which a specified probability of the means of repeated samples are expected to fall
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in what cases specifically...if a confidence interval includes
--0 --1 --> Ho is not rejected |
CI for a mean difference includes 0
CI for odds ratio or relative risk includes 1 |
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if the CI between 2 groups overlaps...
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then they're not significantly different
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CI interval formula
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t test
ANOVA chi^2 check... |
difference between means of 2 groups
difference between means of 3 or more groups difference between percentages or proportions of categorical outcomes |
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r^2
vs. r |
coefficient of determination
coefficient of correlation |
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disease prevention 1, 2, 3
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prevent
early detection reduce disability |
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reportable diseases
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Hep Hep Hep Horray, the
SSS MM ART Chick is Gone! --in all states [vary by state] --Hep A --Hep B [Hep C] [HIV] --Salmonella --Shigella --Syphilis --Measels --Mumps --AIDS --Rubella --Tuberculosis --Chickenpox --Gonorrhea |
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leading causes of death:
infants |
congenital
SIDS respiratory distress syndrome |
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leading causes of death:
age 1-14 |
ICCHH:
injuries cancer congenital homicide heart disease |
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leading causes of death
age 15-24 |
injuries
homicide suicide |
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leading causes of death
age 25-64 |
cancer
heart disease injuries |
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leading causes of death
age 65+ |
heart disease
cancer stroke |
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medicare is available to...
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> 65
ppl w. certain disabilities ESRD pts |
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medicare parts
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A
--inpatient hospital care --skilled nursing --hospice --home health B --outpatient care --doctors --PT/OT C --combination of A & B D --prescription drug coverage |
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informed consent requires
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--discussion of information (risks, benefits, alternatives -- no intervention)
--pt agreement to plan of care --freedom from coercion |
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exceptions to informed consent
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--lacks capacity
--legally incompetent --emergency implied consent --therapeutic privilege --waiver |
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therapeutic privilege exception to informed consent =
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withholding information when disclosure would severely harm pt
or undermine informed decision-making capacity |
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emancipation (4)
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married
self-supporting has children military |
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parental consent is not required... (5)
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emergency
contraceptives STD treatment care during pregnancy drug addiction treatment |
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capacity vs. competence
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psychological decision-making ability
legal competence |
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decision-making capacity (5)
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makes and communicates a choice
is informed decision is stable over time d. is consistent with patient's values d. is not a result of delusions or hallucinations |
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oral advance directives are more valid if (4)
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informed
specific choice repeated --pt was informed --directive is specific --pt made a choice --decision was repeated over time |
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confidentiality respects _
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privacy
autonomy |
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exceptions to confidentiality
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potential serious harm to others
high likelihood of harm to self no alternative means exist to warn or protect physician can take steps to prevent harm |
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examples of how physicians may need to violate confidentiality
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infectious diseases... tell
--public officials --people at risk Tarasoff decision: law requires physician to inform and protect potential victim child/elder abuse impaired automobile drivers suicidal/homicidal patients |
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negligence civil suit requires
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duty (the physician to the pt)
dereliction (breach of duty) damage (to patient) direct (the breach of duty caused the harm) |
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APGAR
= |
appearance
pulse grimace activity respiration |
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apgar
appearance |
0 blue
1 trunk pink 2 all pink |
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apgar
pulse |
0 -- 0
1 -- < 100/minm 2 -- > 100/min |
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apgar
grimace |
0
none 1 grimace 2 grimace + cough |
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apgar
activity |
0 -- limp
1 -- some 2 -- active |
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apgar
respiration |
0 -- none
1 -- irregular 2 -- regular |
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low birth weight is
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< 2500 g
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milestones
birth-3 months |
rooting reflex
orients to voice |
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milestones
3 months |
holds head up
Moro reflex disappears social smile |
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milestones
7-9 months |
sits alone
crawls stranger anxiety |
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milestones
15 months |
walks
babinski disappears a few words separation anxiety |
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toddler =
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12-36 months
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milestones
12-24 months |
climbs stairs
stacks 3 blocks at 1 year 6 blocks at 2 years ------------------------------------- object permanence 200 words 2 word sentences at 2 yrs old |
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24-36 months
milestones |
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core gender identity parallel play |
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milestones
30-36 months |
stacks 9 blocks
toilet training (pee at 3) |
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milestones
3 yrs |
rides tricycle
copies line or circle 900 words complete sentences |
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milestones
4 years |
simple drawings
hops on 1 foot -------------------------------- cooperative play imaginary friends grooms self brushes teeth buttons & zips |
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tanner stage 1
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1
childhood |
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tanner stage 2
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2
--pubic hair appears (adrenarche) --breasts enlarge |
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tanner stage 3
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3
pubic hair darkens, becomes curly penis size/length ^ |
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tanner stage 4
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4
penis width ^ darker scrotal skin development of glans raised areolae |
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tanner stage 5
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5
adult areolae are no longer raised |
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sexual changes in the elderly
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slower erection/ejaculation
longer refractory period vaginal --shortening --thinning --dryness |
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sleep changes in the elderly
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v REM
v slow-wave sleep (3 & 4) ^ latency ^ awakenings |
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psychiatric changes in the elderly
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v psychiatric disorders
^ suicide rate |
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highest suicide rate is in...
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males 65-74
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physical changes in the elderly
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decreased:
vision hearing immune response bladder control renal pulmonary GI function muscle mass ^fat |
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normal bereavement can last _
includes _ can include _ |
up to 2 months
shock denial guilt somatic symptoms can include: illusions |
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pathologic grief
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excessively intense
> 2 months delayed, inhibited, denied depression delusions hallucinations |
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grief stages
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denial
anger bargaining grief (depression) acceptance |
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stress effects
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production of free fatty acids
lipids cholesterol 17-OH corticosteroids catecholamines affects --water absorption --muscular tonicity --gastrocolic reflex --mucosal circulation |
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4 notable drugs that affect sexual performance
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you're not SANE if you trade drugs for sex...
SSRIs antihypertensives neuroleptics ethanol |
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BMI threshold values
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<18.5 underweight
>25 overweight >30 obese >40 morbidly obese |
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EEG waveforms
awake (eyes open) awake (eyes closed) stage 1 stage 2 stages 3-4 REM |
at night, BATS Drink Blood
beta alpha theta sleep spindles, K complexes delta beta |
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sleep stages % of total sleep time in young adults
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1 -- 5%
2 -- 45% 3-4 -- 25% REM -- 25% |
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sleep stages 3-4 feature...
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slow-wave sleep
deepest non-REM sleep sleepwalking night terrors bedwetting |
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sleep stage 1 & 2 feature...
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1: light sleep
2: deeper sleep; bruxism |
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REM sleep features
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dreaming
loss of motor tone possibly memory processing erections ^ brain O2 use |
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the two most extreme EEG waveforms
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beta
--highest frequency --lowest amplitude delta --lowest frequency --highest amplitude |
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EEG waveform in sleep stage 2
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sleep spindles
k complexes |
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things that reduce REM sleep
some of them also reduce _ sleep |
v with age
NE reduces REM sleep v REM and v delta: --alcohol --benzodiazepines --barbiturates |
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_ is key to initiating sleep
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serotonergic predominance of raphe nucleus
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extraocular movements during REM sleep are due to _ in the brain
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PPRF aka conjugate gaze center
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_ is used to treat enuresis because it
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imipramine
v stage 4 sleep |
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imipramine is a _
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TCA
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benzos are useful for _ sleep disorders
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night terrors
sleepwalking |
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REM cardiovascular effects
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^ and variable pulse
^ and variable BP |
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sleep changes in depressed patients
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v slow-wave
v REM latency ^ REM early in sleep cycle ^ total REM nighttime awakeneings early-morning awakening |
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REM sleep occurs every ... minutes
REM sleep duration ^ / v throughout the night |
^
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narcolepsy features (5)
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1^ characteristic: excessive daytime sleepiness
hypnagogic or hypnopompic hallucinations start off with REM sleep cataplexy strong genetic component |
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cataplexy
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loss of all muscle tone following a strong emotional stimulus
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rx for narcolepsy
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mnemonic: "SOMA"
sodium oxybate modafinil amphetamines |
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circadian rhythm is driven by _
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suprachiasmatic nucleus (SCN) of hypothalamus
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circadian rhythm controls
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ACTH
prolactin melatonin nocturnal NE release |
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circuit that releases melatonin
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~ light cycle ~ --> SCN --> NE release --> pineal gland --> melatonin
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sleep terror occurs during _
what does kid recall? |
slow-wave sleep
no memory of it |
