Decision Making and Interprofessional Communications

Question 1

What are the 6 things in Diagnostic Decision Making?

Answer 1

1. Data acquisition
2. Accurate problem representation
3. “Complete” differential diagnosis
4. Prioritized differential diagnosis
5. Testing hypothesis
6. Review and reprioritize differential

Question 2

What do we obtain in Data Acquisition?

Answer 2

1. H&P

2. Lab/C-ray information

Question 3

What do we create in Accurate Problem Representation? What do we include?

Answer 3

1. Problem (not diagnosis)

2. Pivotal points

Question 4

What are 3 pivotal points?

Answer 4

1. Acute or chronic
2. Changing or not?
3. Clinical risk factors (smoking, drinking, +FH)

Question 5

Explain “Complete” Differential Diagnosis

Answer 5

Narrowing down a disease systematically

Question 6

Are all diagnoses in differential diagnosis equal?

Answer 6

No

Question 7

How are common problems prioritized?

Answer 7

Odd numbers; 1 = dangerously acute, 5= not dangerous

Question 8

How are rare problems prioritized?

Answer 8

Even numbers; 2 = dangerously acute, 6 = not dangerous

Question 9

How do we perform “Testing Hypothesis”?

Answer 9

1. Look for specific disease “fingerprints” of lead diagnosis
2. Ideally use EBM methods

Question 10

Explain EBM methods

Answer 10

Using tests to get data for:

1. Pretest probability
2. Likelihood ratio
3. Posttest probability

Question 11

Can CDAs help? Are they readily available?

Answer 11

Yes; no

Question 12

What is death on the CDA? Good health?

Answer 12

0. 0

1. 0

Question 13

What are the 2 steps for Therapeutic Decision-Making?

Answer 13

1. What is the typical “treatment of choice” for the problem?
2. Is the “treatment of choice” the treatment of choice for your patient?

Question 14

What do we ask for trials?

Answer 14

Is this information valid, important, and applicable?

Question 15

Does Published = valid, important, or applicable?

Answer 15

No

Question 16

What are the 2 questions in Step 1 of reviewing a paper and where would they be found?

Answer 16

1. Was the assignment of patients to treatments randomized? (methods)
2. Were the groups similar at the start of the trial? (results)

Question 17

What are the 2 questions in Step 2 of reviewing a paper and where would they be found?

Answer 17

1. Aside from the allocated treatment, were groups treated equally? (methods, results)
2. Were all the patients who entered the trial accounted for? - and were they analysed in the groups to which they were randomized? (results)

Question 18

What is the 1 question in step 2 of reviewing a paper and where would it be found?

Answer 18

1. Were measures objective or were the patients and clinicians kept “blind” to which treatment was being received? (methods)

Question 19

What are the 2 measurement factors?

Answer 19

1. Relative Risk (RR)

2. Absolute Risk Reduction (ARR)

Question 20

Define Relative Risk (RR)

Answer 20

1. Risk of the outcome in the treatment group/risk of the outcome in the control group

Question 21

What does the RR mean?

Answer 21

It tells us how many times more likely it is that an event will occur in the treatment group relative to the control group

Question 22

What does an RR of 1 mean?

Answer 22

No difference between the control and treatment groups, thus treatment has no affect

Question 23

What does an RR < 1 mean?

Answer 23

Treatment decreases risk of outcome (decreases risk of death)

Question 24

What does an RR > 1 mean?

Answer 24

Treatment increased the risk of the outcome

Question 25

Define Absolute Risk Reduction (ARR)

Answer 25

Risk of the outcome in the control group - risk of the outcome in the treatment group

Question 26

What is ARR also known as?

Answer 26

Absolute risk difference

Question 27

What does the ARR mean?

Answer 27

Tells us absolute difference in the rates of events between the 2 groups and gives in indication of the baseline risk and treatment effect

Question 28

What does an ARR of 0 mean?

Answer 28

No difference between the two groups, thus treatment had no effect

Question 29

What s the absolute benefit of treatment in ARR?

Answer 29

5% reduction in death rate

Question 30

What is Relative Risk Reduction? (RRR)

Answer 30

Absolute risk of reduction/risk of the outcome in the control group

Question 31

What is an alternate way to calculate RRR?

Answer 31

RRR = 1 - RR

Question 32

What is the complement of RR? Is it the most commonly reported measure of treatment effects?

Answer 32

RRR; yes

Question 33

What is the Number Needed to Treat? (NNT)

Answer 33

Inverse of the ARR

Question 34

How is NNT calculated?

Answer 34

1/ARR

Question 35

What does NNT represent?

Answer 35

Number of patients we need to treat with experimental therapy in order to prevent 1 bad outcome and incorporates the duration of treatment

Question 36

Do we need to ask, "How precise was the estimate of the treatment effect"? What does it tell us?

Answer 36

Yes; point estimate - true risk of the outcome in the population is not known and the best we can do is estimate the true risk based on the sample of patients in the trial

Question 37

What can point estimate give us? When is it significant?

Answer 37

Confidence interval - significant at 0.05

Question 38

Should we ask, "Will the results help me incaring for my patient?

Answer 38

Yes

Question 39

How do we determine if the "treatment of choice" is correct for our patients?

Answer 39

1. Determine allergies for what they can and can't take 2. Any worrisome drug interactions to this drug in this patient? 3. Drug monitoring 4. Is my patient pregnant?

Question 40

What are 3 main things for written communications?

Answer 40

1. Full H&P 2. Focused office visit 3. Acute care visit

Question 41

What 5 types of notes are there?

Answer 41

1. Admission notes 2. Progress notes 3. Discharge summaries 4. Focused office visit notes 5. Acute problem notes

Question 42

Another way to define SOAP

Answer 42

1. S = already done 2. O = already done 3. A = assessment "what you think" a) Problem list b) Diagnoses 4. P = plan "what you're going to do" a) more labs, x-rays, etc b) treatment

Question 43

Do we sometimes pair the Assessment and Plan?

Answer 43

Yes

Question 44

Should we communicate like we are giving orders?

Answer 44

No

Question 45

Do we put DEA on orders?

Answer 45

Yes