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From Flashcardlet > First Aid-Behavioral Science > Flashcards

First Aid-Behavioral Science Flashcards

0
Q

Cohort study

A

Observational and prospective. Compares a group with a given exposure or risk factor to a group without.
Looks to see if exposure increases the likelihood of disease.
Asks, “What will happen?”
Measure: Relative risk (RR)

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1
Q

Case-control study

A

Observational and retrospective; Compares a group of people with disease to a group without. Looks for prior exposure or risk factor.
Asks, “what happened?”
Measure: Odds ratio (OR)

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2
Q

Cross-Sectional Study

A

Observational. Collects data from a group of people to assess frequency of disease (and related risk factors) at a particular point in time.
Asks, “What is happening?”
Measure: Disease prevalence
Can show risk factor association with disease, but does not establish causality.

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3
Q

Twin concordance study

A

Compares the frequency with which both monozygotic twins or both dizygotic twins develop a disease. Measures heritability.

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4
Q

Adoption Study

A

Compares siblings raised by biologic vs. adoptive parents.

Measures heritability and influence of environmental factors.

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5
Q

Clinical trial

A

experimental study involving humans. Compares therapeutic benefits of 2 or more treatments, or of treatment and placebo. Highest-quality study when randomized, controlled, and double-blinded (neither patient nor doctor knows if the patient is in the treatment or control group).

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6
Q

Phase I (Clinical Trial)

A

Small number of patients, usually healthy volunteers. Assesses safety, toxicity, and pharmacokinetics.

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7
Q

Phase II (Clinical Trial)

A

Small number of patients with disease of interest. Assesses treatment efficacy, optimal dosing, and adverse effects.

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8
Q

Phase III (Clinical Trial)

A

Large number of patients randomly assigned either to the treatment under investigation or to the best available treatment (or placebo). Compares the new treatment to the current standard of care.

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9
Q

Phase IV (Clinical Trial)

A

Postmarketing surveillance trial of patients after approval. Detects rare or long-term adverse effects.

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10
Q

Meta-analysis

A

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 evidence. May be limited by quality of individual studies or bias in study selection.

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11
Q

Evaluation of diagnostic tests

A 
Uses 2 x 2 table comparing test results with the actual presence of disease. 
TP = true positive
FP = False positive
TN = True negative
FN = False negative
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12
Q

Sensitivity

A

proportion of all people with disease who test positive, or the ability of a test to detect a disease when it is present.
= TP / (TP + FN)
= 1 - false-negative rate
SNOUT = SeNsitivity rules OUT
Value approaching 1 is desirable for ruling out disease and indicates a low false-negative rate. Used for screening in diseases with low prevalence.
If 100% sensitive, TP / (TP + FN) = 1, FN = 0, and all negatives must be TNs.

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13
Q

Specificity

A

Proportion of al people without disease who test negative, or the ability of a test to indicate non-disease when disease is not present.
= TN / (TN + FP)
= 1 false-positive rate
Value approaching 1 is desirable for ruling in disease and indicates a low false-positive rate. Used as a confirmatory test after a positive screening test.
SPIN = SPecificity rules IN.

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14
Q

Positive Predictive Value (PPV)

A

proportion of positive test results that are true positive.
= TP / (TP + FP)
Probability that person actually has the disease given a positive test result. (Note: if the prevalence of a disease in a population is low, even tests with high specificity or high sensitivity will have low positive predictive values!)

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15
Q

Negative predictive value (NPV)

A

Proportion of negative test results that are true negative.
= TN / (FN + TN)
Probability that person actually is disease free given a negative test result

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16
Q

Point prevalence

A

= (total cases in population at a given time) / (total population at a given time)

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17
Q

Incidence

A

= (new cases in population over a given time period) / (total population at risk during that time period)

Incidence is new incidents

when calculating incidence, don’t forget that people currently with the disease, or those previously positive for it, are not considered at risk.

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18
Q

Prevalence

A

= incidence x disease duration

prevalence > incidence for chronic diseases (e.g., diabetes)
prevalence = incidence for acute disease (e.g., common cold)

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19
Q

Odds ratio (OR)

A

for case-control studies. Odds of having disease in exposed group divided by odds of having disease in unexposed group. Approximates relative risk if prevalence of disease is not to high.

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20
Q

OR, RR, AR picture

A

UPLOAD IN THE FUTURE (location 1752)

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21
Q

Relative Risk (RR)

A

for cohort studies. Relative probability of getting a disease in the exposed group compared to the unexposed group. Calculated as the percent with disease in exposed group divided by percent with disease in unexposed group

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22
Q

Attributable risk

A

the difference in risk between exposed and unexposed groups, or the proportion of disease occurrences that are attributable to the exposure (e.g., smoking causes one-third of cases of pneumonia).

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23
Q

Absolute risk reduction

A

the reduction in risk associated with a treatment as compared to a placebo.

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24
Q

Number needed to treat

A

1/absolute risk reduction

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25
Q

Number needed to harm

A

1/attributable risk.

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26
Q

Precision

A

Precision is:

  1. the consistency and reproducibility of a test (reliability)
  2. the absence of random variation in a test. Random error-reduced precision in a test
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27
Q

Accuracy

A

is the trueness of test measurements (validity).

Systemic error-reduced accuracy in a test

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28
Q

Bias

A

occurs when one outcome is systematically favored over another. Systematic errors.

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29
Q

Selection bias

A

nonrandom assignment to study group (e.g. Berkson’s bias)

1. Blind studies (double blind is better)

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30
Q

Recall bias

A

knowledge of presence of disorder alters recall by subjects

2. Placebo responses

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31
Q

Samling bias

A

subjects are not representative relative to general population; therefore results are not generalizable.

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32
Q

Late-look bias

A

information gathered at an inappropriate time—e.g., using a survey to study a fatal disease (only those patients still alive will be able to answer survey)

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33
Q

Procedure bias

A

subjects in different groups are not treated the same—e.g., more attention is paid to treatment group, stimulating greater compliance

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34
Q

Confounding bias

A

occurs with 2 closely associated factors; the effect of 1 factor distorts or confuses the effect of the other

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35
Q

Lead-time bias

A

early detection confused with ↑ survival; seen with improved screening (natural history of disease is not changed, but early detection makes it seem as though survival ↑)

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36
Q

Pygmalion effect

A

occurs when a researcher’s belief in the efficacy of a treatment changes the outcome of that treatment

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37
Q

Hawthorne effect

A

occurs when the group being studied changes its behavior owing to the knowledge of being studied

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38
Q

Normal distribution

A

≈ Gaussian ≈ bell-shaped (mean = median = mode).

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39
Q

Bimodal

A

s simply 2 humps (2 modal peaks).

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40
Q

Positive skew

A

mean > median > mode. Asymmetry with tail on right.

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41
Q

Negative skew

A

mean < median < mode. Asymmetry with tail on left.

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42
Q

Null hypothesis (H₀)

A

Hypothesis of no difference (e.g., there is no association between the disease and the risk factor in the population).

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43
Q

Alternative hypothesis (H₁)

A

Hypothesis that there is some difference (e.g., there is some association between the disease and the risk factor in the population).

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44
Q

Type I error (α)

A

Stating that there is an effect or difference when none exists (to mistakenly accept the experimental hypothesis and reject the null hypothesis). p = probability of making a type I error. p is judged against α, a preset level of significance (usually
< .05). “False-positive error.”

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45
Q

Type II error (β)

A

Stating that there is not an effect or difference when one exists (to fail to reject the null hypothesis when in fact H0 is false).
β is the probability of making a type II error. “False-negative error.”

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46
Q

p

A

If p < .05, then there is less than a 5% chance that the data will show something that is not really there.

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47
Q

α

A

α = you “saw” a difference that did not exist—for example, convicting an innocent man.

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48
Q

β

A

β = you did not “see” a difference that does exist— for example, setting a guilty man free.

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49
Q

Power (1 - β)

A

Probability of rejecting null hypothesis when it is in fact false, or the likelihood of finding a difference if one in fact exists. It depends on:

  1. Total number of end points experienced by population
  2. Difference in compliance between treatment groups (differences in the mean values between groups)
  3. Size of expected effect

If you ↑ sample size, you ↑ power. There is power in numbers.
Power = 1 - β.

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50
Q

Standard deviation vs. standard error

A 
n = sample size.
σ = standard deviation.
SEM = standard error of the mean.
SEM = σ/√n.
Therefore, SEM < σ and SEM decreases as n
increases.
51
Q

Confidence interval

A

Range of values in which a specified probability of the means of repeated samples would be expected to fall.
CI = confidence interval.
CI = range from [mean - Z(SEM)] to
[mean + Z(SEM)].
The 95% CI (corresponding to p = .05) is often used. For the 95% CI, Z = 1.96.

52
Q

t-test

A

t-test checks difference between the means of 2 groups.

53
Q

ANOVA

A

ANOVA checks difference between the means of 3 or more groups.

54
Q

χ²

A

χ² checks difference between 2 or more percentages or proportions of categorical outcomes (not
mean values).

55
Q

Correlation coefficient (r)

A

r is always between −1 and +1. The closer the absolute value of r is to 1, the stronger the correlation between the 2 variables.
Coefficient of determination = r2 (value that is usually reported).

56
Q

Disease prevention

A

1°—prevent disease occurrence (e.g., HPV vaccination).
2°—early detection of disease (e.g., Pap smear). 3°—reduce disability from disease (e.g.,
chemotherapy).

57
Q

Reportable diseases

A 
Only some infectious diseases are reportable in all states, including AIDS, chickenpox, gonorrhea, hepatitis A and B, measles, mumps, rubella, salmonella, shigella, syphilis, and TB.
Other diseases (including HIV) vary by state.

Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gone!
Hep A
Hep B
Hep C
HIV Salmonella Shigella Syphilis Measles Mumps AIDS Rubella Tuberculosis Chickenpox Gonorrhea

58
Q

Infants Leading causes of death

A

Congenital anomalies, short gestation/low birth weight, sudden infant death syndrome, maternal complications of pregnancy, respiratory distress syndrome.

59
Q

Age 1-14 Leading causes of death

A

Injuries, cancer, congenital anomalies, homicide, heart disease.

60
Q

Age 15-24 Leading causes of death

A

Injuries, homicide, suicide, cancer, heart disease.

61
Q

Age 25-64 Leading causes of death

A

Cancer, heart disease, injuries, suicide, stroke.

62
Q

65+ Leading causes of death

A

Heart disease, cancer, stroke, COPD, pneumonia, influenza.

63
Q

Physicians’ payments

A

fee-for-service (payment
for each procedure), capitation basis (fixed payment for time period, regardless of number of procedures), salary based (hospitals, HMOs, universities pay fixed salary).

64
Q

Medicare and Medicaid

A

federal programs that originated from amendments to the Social Security Act.
Medicare Part A = hospital; Part B = doctor bills. Medicaid is federal and state assistance for very
low income people.

65
Q

CHIP (Children’s Health Insurance Program)

A

matching state and federal government funding

for child health care coverage.

66
Q

Third-party payers

A

insurance companies collect

money from large population to pay all or a portion of the medical bills of current patients.

67
Q

Autonomy

A

Obligation to respect patients as individuals and to honor their preferences in medical care.

68
Q

Beneficence

A

Physicians have a special ethical (fiduciary) duty to act in the patient’s best interest. May conflict with autonomy. If the patient can make an informed decision, ultimately the patient has the right to decide.

69
Q

Nonmaleficence

A

“Do no harm.” However, if the benefits of an intervention outweigh the risks, a patient may make an informed decision to proceed (most surgeries fall into this category).

70
Q

Justice

A

To treat persons fairly.

71
Q

Informed consent

A

Legally requires:
1. Discussion of pertinent information 2. Patient’s agreement to the plan of care 3. Freedom from coercion

Patients must understand
the risks, benefits, and alternatives, which include no intervention.

72
Q

Exceptions to informed consent

A
  1. Patient lacks decision-making capacity or is legally incompetent
  2. Implied consent in an emergency
  3. Therapeutic privilege—withholding information when disclosure would severely harm the patient or undermine informed decision-making capacity
  4. Waiver—patient waives the right of informed consent
73
Q

Consent for minors

A

Parental consent must be obtained unless minor is emancipated (e.g., is married, is self-supporting, has children, or is in military).

74
Q

Decision-making capacity

A
  1. Patient makes and communicates a choice
  2. Patient is informed
  3. Decision remains stable over time
  4. Decision is consistent with patient’s values and
    goals
  5. Decision is not a result of delusions or
    hallucinations

The patient’s family cannot require that a doctor withhold information from the patient.

75
Q

Oral advance directive

A

Incapacitated patient’s prior oral statements commonly used as guide. Problems arise from variance in interpretation. If patient was informed, directive is specific, patient made a choice, and decision was repeated over time, the oral directive is more valid.

76
Q

Living will

A

describes treatments the patient wishes to receive or not receive if he/she becomes incapacitated and cannot communicate about treatment decisions. Usually, patient directs physician to withhold or withdraw life-sustaining treatment if he/she develops a terminal disease or enters a persistent vegetative state.

77
Q

Durable power of attorney

A

patient designates a surrogate to make medical decisions
in the event that he/she loses decision-making capacity. Patient may also specify decisions in clinical situations. Surrogate retains power unless revoked by patient. More flexible than a living will.

78
Q

Confidentiality

A

Confidentiality respects patient privacy and autonomy. Disclosing information to family and friends should be guided by what the patient would want. The patient may waive the right to confidentiality (e.g., insurance companies).

79
Q

Exceptions to confidentiality

A
  1. Potential harm to others is serious
  2. Likelihood of harm to self is great
  3. No alternative means exist to warn or to protect those at risk 4. Physicians can take steps to prevent harm
    Examples include:
  4. Infectious diseases—physicians may have a duty to warn public officials and
    identifiable people at risk
  5. The Tarasoff decision—law requiring physician to directly inform and protect
    potential victim from harm; may involve breach of confidentiality
  6. Child and/or elder abuse
  7. Impaired automobile drivers
  8. Suicidal/homicidal patients—physicians may hold patients involuntarily for a
    Malpractice
    period of time
80
Q

Civil suit under negligence requires

A
  1. Physician had a duty to the patient (Duty) 2. Physician breached that duty (Dereliction) 3. Patient suffers harm (Damage)
  2. The breach of the duty was what caused
    the harm (Direct)
    The most common factor leading to litigation is
    poor communication between physician and patient.
81
Q

burden of proof

A

The 4 D’s.
Unlike a criminal suit, in which
the burden of proof is “beyond a reasonable doubt,” the burden of proof in a malpractice suit is “more likely than not.”

82
Q

Good Samaritan law

A

Relieves health care workers, as well as laypersons in some instances, from liability in certain emergency situations with the objective of encouraging health care workers to offer assistance without expectation of compensation.

83
Q

Patient is noncompliant

A

Work to improve the physician-patient relationship.

84
Q

Patient has difficulty taking

medications.

A

Provide written instructions; attempt to simplify treatment regimens.

85
Q

Family members ask for information

about patient’s prognosis.

A

Avoid discussing issues with relatives without the permission of the patient.

86
Q

A 17-year-old girl is pregnant and

requests an abortion.

A

Many states require parental notification or consent for minors for an abortion. Parental consent is not required for emergency situations, treatment of STDs, medical care during pregnancy, and management of drug addiction.

87
Q

A terminally ill patient requests physician assistance in ending his life.

A

In the overwhelming majority of states, refuse involvement in any form of physician-assisted suicide. Physicians may, however, prescribe medically appropriate analgesics that coincidentally shorten the patient’s life.

88
Q

Patient states that he finds you attractive.

A

Ask direct, closed-ended questions and use a chaperone if necessary. Romantic relationships with patients are never appropriate. Never say, “There can be no relationship while you are a patient,” because it implies that a relationship may be possible if the individual is no longer a patient.

89
Q

Patient refuses a necessary procedure or desires an unnecessary one.

A

Attempt to understand why the patient wants/does not want the procedure. Address the underlying concerns. Avoid performing unnecessary procedures.

90
Q

Patient is angry about the amount of time he spent in the waiting room.

A

Apologize to the patient for any inconvenience. Stay away from efforts to explain the delay.

91
Q

Patient is upset with the way he was treated by another doctor.

A

Suggest that the patient speak directly to that physician regarding his/her concerns. If the problem is with a member of the office staff, tell the patient you will speak to that individual.

92
Q

A child wishes to know more about his illness.

A

Ask what the parents have told the child about his illness. Parents of a child decide what information can be relayed about the illness.

93
Q

Patient continues to smoke, believing that cigarettes are good for him.

A

Ask how the patient feels about his/her smoking. Offer advice on cessation if the patient seems willing to make an effort to quit.

94
Q

Minor (under age 18) requests condoms.

A

Physicians can provide counsel and contraceptives to minors without a parent’s knowledge or consent.

95
Q

A drug company offers a “referral fee” for every patient a physician enrolls in a study.

A

Eligible patients who may benefit from the study may be enrolled, but it is never acceptable for a physician to receive compensation from a drug company.

96
Q

Apgar score

A

Appearance Pulse Grimace Activity Respiration

97
Q

Low birth weight

A

Defined as < 2500 g. Associated with greater incidence of physical and emotional problems. Caused by prematurity or intrauterine growth retardation. Complications
include infections, respiratory distress syndrome, necrotizing enterocolitis,
intraventricular hemorrhage, and persistent fetal circulation.

98
Q

Birth-3 mo

A

Rooting reflex; Orients to voice

99
Q

3 mo

A

Holds head up, Moro reflex disappears; Social smile

100
Q

7-9 mo

A

Sits alone, crawls; Stranger anxiety

101
Q

15 mo

A

Walks, Babinski disappears; Few words, separation anxiety

102
Q

12-24 mo

A

Climbs stairs; stacks 3 blocks at 1 year, 6 blocks at 2 years (number of blocks stacked = age in years × 3); Object permanence; 200 words and 2-word sentences at age 2

103
Q

24-36 mo

A

Core gender identity, parallel play

104
Q

30-36 mo

A

Stacks 9 blocks; Toilet training (“pee at age 3”)

105
Q

3 yrs

A

Rides tricycle (rides 3-cycle at age 3); copies line or circle drawing; 900 words and complete sentences

106
Q

4 yrs

A 
Simple drawings (stick figure), hops on 1 foot; cooperative play, imaginary
friends, grooms self, brushes teeth, buttons and zips
107
Q

Sensorimotor stage

A

(birth to age 2)—egocentric exploration of the world with the 5 senses. Novel use of objects to obtain a goal (e.g., use of stick to reach something).
Understanding of object permanence is achieved.

108
Q

Preoperational stage (ages 2-7)

A

acquisition of motor skills. Magical thinking

predominates, with no “logical” thinking

109
Q

Concrete operational stage

A

(ages 7-12)—start of logical thinking, but confined to

concrete concepts. No longer egocentric.

110
Q

Formal operational stage

A

(age 12+)—development of abstract reasoning.

111
Q

Tanner stages of sexual development
Motor milestone
Rooting reflex
Holds head up, Moro reflex disappears Sits alone, crawls
Walks, Babinski disappears
Climbs stairs; stacks 3 blocks at 1 year, 6 blocks at 2 years (number of blocks stacked = age in years × 3)
Stacks 9 blocks
Rides tricycle (rides 3-cycle at age 3); copies line
or circle drawing
Simple drawings (stick figure), hops on 1 foot

A
  1. Childhood
  2. Pubic hair appears (adrenarche); breasts enlarge
  3. Pubic hair darkens and becomes curly; penis size/length ↑
  4. Penis width ↑, darker scrotal skin, development of glans, raised areolae 5. Adult; areolae are no longer raised
112
Q

Changes in the elderly

A 
1. Sexual changes:
Men—slower erection/ejaculation, longer
refractory period
Women—vaginal shortening, thinning, and
dryness
2. Sleep patterns— ↓ REM, slow-wave
sleep; ↑ latency and awakenings
3. Common medical conditions—arthritis, hypertension, heart disease, osteoporosis
4. ↓ incidence of psychiatric disorders
5. ↑ suicide rate (males 65-74 years of age have the highest suicide rate in the United States) 6. ↓ vision, hearing, immune response, bladder
control
7. ↓ renal, pulmonary, GI function 8. ↓ muscle mass, ↑ fat
113
Q

Grief

A

Normal bereavement characterized by shock, denial, guilt, and somatic symptoms. Typically lasts 6 months to 1 year. May experience illusions.
Pathologic grief includes excessively intense or prolonged grief or grief that is delayed, inhibited, or denied. May experience depressive symptoms, delusions, and hallucinations.

114
Q

Kübler-Ross grief stages
Normal bereavement characterized by shock, denial, guilt, and somatic symptoms. Typically lasts 6 months to 1 year. May experience illusions.
Pathologic grief includes excessively intense or prolonged grief or grief that is delayed, inhibited, or denied. May experience depressive symptoms, delusions, and hallucinations.
Denial, Anger, Bargaining, Grieving (depression), Acceptance.

A

Denial, Anger, Bargaining, Grieving (depression), Acceptance.

Stages do not necessarily occur in this order, and > 1 stage can be present at once.

Death Arrives Bringing Grave Adjustments.

115
Q

Stress effects

A

Stress induces production of free fatty acids, 17-OH corticosteroids (immunosuppression), lipids, cholesterol, catecholamines; affects water absorption, muscular tonicity, gastrocolic reflex, and mucosal circulation.

116
Q

Sexual dysfunction

A

Differential diagnosis includes:

  1. Drugs (e.g., antihypertensives, neuroleptics, SSRIs, ethanol) 2. Diseases (e.g., depression, diabetes)
  2. Psychological (e.g., performance anxiety)
117
Q

Body-mass index (BMI)

A

BMI is a measure of weight adjusted for height.

BMI = (weight in kg) / (height in meters)²

118
Q

Sleep stages

A

1 (5%)
2 (45%) 3-4 (25%)
REM (25%)

119
Q

1 (5%)

A

Light sleep; Theta

120
Q

2 (45%)

A

Deeper sleep; bruxism

Sleep spindles and K complexes

121
Q

3-4 (25%)

A

Deepest, non-REM sleep; sleepwalking; night terrors; bedwetting (slow-wave sleep)

Delta (lowest frequency,
highest amplitude)

122
Q

REM (25%)

A

Dreaming, loss of motor tone, possibly a memory processing function, erections, ↑ brain O2 use

Beta
At night, BATS Drink Blood.

123
Q

More sleep info

A
  1. Serotonergic predominance of raphe nucleus key to initiating sleep
  2. NE reduces REM sleep
  3. Extraocular movements during REM due to activity of PPRF (paramedian pontine
    reticular formation/conjugate gaze center)
  4. REM sleep having the same EEG pattern as while awake and alert has spawned the
    terms “paradoxical sleep” and “desynchronized sleep”
  5. Benzodiazepines shorten stage 4 sleep; thus useful for night terrors and sleepwalking
  6. Imipramine is used to treat enuresis because it ↓ stage 4 sleep
124
Q

REM sleep

A

↑ and variable pulse, REM, ↑ and variable blood pressure, penile/clitoral tumescence. Occurs every 90 minutes; duration ↑ through the night. ACh is the principal neurotransmitter involved in REM sleep. REM sleep ↓ with age.

REM sleep is like sex: ↑ pulse, penile/ clitoral tumescence, ↓ with age.

125
Q

Narcolepsy

A

Disordered regulation of sleep-wake cycles. May include hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations. The patient’s nocturnal and narcoleptic sleep episodes start off with REM sleep. Cataplexy (loss of all muscle tone following a strong emotional stimulus) in some patients. Strong genetic component. Treat with stimulants (e.g., amphetamines, modafinil).

126
Q

Circadian rhythm

A

Driven by suprachiasmatic nucleus (SCN) of hypothalamus; controls ACTH, prolactin, melatonin, nocturnal NE release. SCN → NE release → pineal gland → melatonin. SCN is regulated by environment (i.e., light).

From Flashcardlet (18 decks)

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