FA - Behavioral Science Flashcards by Sarah Bash

Observational study: Case-control

Comparison? Variable? Time course? Reporting measure?

) Compares group of people with disease to group of people without disease
) Looks for prior exposure or risk factor
) Always retrospective
) Reported as ODDS RATIO (ad/bc)

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Observational study: Cohort study

Comparison? Variable? Time course? Reporting measure?

) Compares group of people with exposure to group of people without exposure
) Looks for incidence of disease
) Can be prospective OR retrospective
) Reported as RELATIVE RISK ((a/a+b)/(c/c+d))

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Observational study: Cross-sectional study

Method? Reporting measure?

) Collects data from a group of people to assess frequency of disease and related risk factors at a particular point in time
) Demonstrates disease prevalence and risk factor association

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Quantifying risk: Odds ratio

Odds that the group with the disease (cases) was exposed to a risk factor (a/c) divided by the odds that the group without the disease (controls) was exposed (b/d) = ad/bc

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Quantifying risk: Relative risk & attributable risk percent

1.) RR= Risk of developing disease in the exposed group divided by risk in the unexposed group = ((a/a+b)/(c/c+d))
If prevalence is low, RR~OR
2.) ARP= (Risk in exposed-risk in unexposed)/(risk in exposed)=(RR-1)/RR

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Quantifying risk: Attributable risk & NNH

) The difference in risk between exposed and unexposed groups, or the proportion of disease occurrences that are attributable to the exposure =((a/a+b)-(c/c+d))
) NNH=1/AR

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Quantifying risk: Absolute risk reduction & NNT

) Absolute reduction in risk associated with a treatment as compared to a control =(event rate in placebo group)-(event rate in treatment group)
) NNT=1/ARR

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Precision

Reliability; affected by random error

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Accuracy

Validity; affected by systematic error

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Bias: Selection bias

Definition? Examples? Ways to avoid?

) Nonrandom assignment to participation in a study group
) Berkson’s bias, loss to follow up
) Randomization

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Bias: Recall bias

Knowledge of presence of disorder alters recall by subjects

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Bias: Sampling bias

Subjects are not representative of the general population so results are not generalizable

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Bias: Late-look bias

Information gathered at an inappropriate time

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Bias: Procedure bias

Subjects in different groups are not treated the same

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Bias: Confounding bias

Definition? Ways to avoid?

) Occurs when factor is related to both exposure and outcome, but is not on the causal pathway; factor distorts or confuses effect of exposure on outcome
) Crossover studies, randomization, matching

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Bias: Lead-time bias

Early detection confused with increased survival; seen with improved screening

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Bias: Observer expectancy effect

Definition? Ways to avoid?

) When researcher’s belief in the efficacy of a treatment changes the outcome of that treatment
) Blinded studies

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Bias: Hawthorne effect

When the group being studied changes its behavior owing to the knowledge of being studied

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Statistical error type: Type 1 error (alpha)

Stating that there IS an effect or difference when none exists (mistakingly rejecting the null hypothesis/accepting the alternative)

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Statistical error type: Type 2 error (beta)

Stating that there is NO effect or difference when one does exist (mistakingly accepting the null hypothesis/rejecting the alternative)

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Power (1-beta)

Definition? Influenced by?

) Probability of rejecting the null hypothesis when it is actually false
) Increases with increased sample size, increased expected effect size, increased precision in measurement

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95% and 99% Confidence intervals

) 95% CI: mean +/- 1.96*SEM

2. ) 99% CI: mean +/- 2.58*SEM

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Ethics: Core principles

Definitions?

Study These Flashcards

) Patient autonomy - patient as individual/respect wishes
) Beneficence - duty to act in patient’s best interest
) Nonmaleficence - do no harm
) Justice - to treat persons fairly

Ethics: Exceptions to informed consent

Study These Flashcards

) Patient lacks decision making capacity/is legally incompetent
) Implied consent in emergency
) Therapeutic privilege
) Patient waives right of IC

Ethics: Exceptions to consent for minors

1. ) Emergency situations 2. ) Prescribing contraceptives 3. ) Treating STDs 4. ) Medical care of pregnancy 5. ) Treatment of drug addiction

Ethics: Exceptions to confidentiality and examples

1. ) Potential harm to others is serious 2. ) Likelihood of harm to self is great 3. ) No alternative means exists to warn or to protect those at risk 4. ) Physicians can take steps to prevent harm 5. ) Reportable diseases, Tarasoff, Child/elder abuse, impaired automobile drivers, suicidal/homicidal patients

Ethical situation: Non-adherent patient

ID patient's reason for non-adherence and determine willingness to change; do not coerce or refer

Ethical situation: Unnecessary procedure

ID patient's desire for procedure and address underlying concerns; do not refuse to see pt., refer, or submit

Ethical situation: Difficulty taking meds

Provide written instructions, simplify treatment regiment, use teach-back method

Ethical situation: Family members ask about patient's prognosis

Do not provide information about patient without permission

Ethical situation: Child wishes to know about illness

Ask what parents have told child about illness. Parents have ultimate control over their child's knowledge

Ethical situation: Minor female requests abortion

Advise her not to get abortion if she is not at medical risk

Ethical situation: Pregnant minor wants to keep the child, parents want her to give up for adoption

Patient retains right to make decision about child; counsel her on her options and facilitate discussion

Ethical situation: Physician assisted suicide

Refuse involvement

Ethical situation: Suicidal patient

If serious threat, keep patient in hospital on voluntary/involuntary basis

Ethical situation: Patient is attracted to you

Can never have romantic relationship

Ethical situation: Female patient feels ugly after mastectomy

Find out why patient feels this way. Do not compliment.

Ethical situation: Patient angry about time spent in waiting room

Apologize, but do not provide excuses

Ethical situation: Patient is upset by treatment by another doctor/office staff

Suggest patient confront doctor personally OR assure patient that you will speak to office staff

Ethical situation: Referral fee for enrollment in study

Physician cannot accept gifts from drug companies for enrolling patients in studies

Ethical situation: Physician orders an invasive test for the wrong patient

Physician has to inform the patient of the mistake

Ethical situation: Patient requires Tx not covered by insurance

Never limit or deny care because of expense in time and/or money. Discuss all treatment options with patient

APGAR

Appearance, Pulse, Grimace, Activity, Respiration | >7 is good, 4-6= assist and stimulate, <4 resuscitate

Low birth weight

<2500 g; prematurity or IUGR

Developmental milestones: 0-3 mos

1. ) Rooting reflex 2. ) Loss of Moro reflex 3. ) Holds head up 4. ) Social smile 5. ) Orients and responds to voice

Developmental milestones: 7-9 mos

1. ) Sits alone 2. ) Crawls 3. ) Transfers toys from hand to hand 4. ) Stranger anxiety 5. ) Responds to name and simple instructions, uses gestures, peek-a-boo

Developmental milestones: 12-15 mos

1. ) Walks 2. ) Loss of Babinski 3. ) Separation anxiety 4. ) Few words

Developmental milestones: 12-24 mos

1. ) Climbs stairs 2. ) Stacking blocks (age x 3) 3. ) Rapprochement 4. ) 200 words and 2 word phrases at age 2

Developmental milestones: 24-36 mos

1. ) Feeds self with utensils 2. ) Kicks ball 3. ) Core gender identity 4. ) Parallel play 5. ) Toilet training

Developmental milestones: Preschool (3 yrs)

1. ) Rides tricycle 2. ) Copies line or circle drawings 3. ) Comfortably spends part of day away from mother 4. ) 900 words and complete sentences

Developmental milestones: Preschool (4 yrs)

1. ) Uses buttons and zippers 2. ) Grooms self 3. ) Hops on 1 foot 4. ) Makes simple drawings 5. ) Cooperative play, imaginary friends 6. ) Can tell detailed stories and use prepositions

Sleep stages: awake (eyes open)

Alert, active mental concentration with beta waves on EEG

Sleep stages: awake (eyes closed)

Alpha waves on EEG

Sleep stages: Stage N1 (5%)

Light sleep with theta waves on EEG

Sleep stages: Stage N2 (45%)

Deeper sleep, bruxism, with sleep spindles and K complexes on EEG

Sleep stages: Stage N3 (25%)

Deepest, non-REM sleep (slow-wave sleep); sleepwalking; night terrors; bedwetting with delta waves on EEG

Sleep stages: REM (25%)

Dreaming, loss of motor tone, possible a memory processing function, erections, increased brain O2 use, with beta waves on EEG

FA - Behavioral Science Flashcards

(57 cards)