Fundamentals

Question 1

What comprises a “bit”, “nimble”, “byte” and “word”?

Answer 1

A bit is either a binary “0” or “1”.
Nimble = 4 bits
Byte = 8 bits
Word = 16 bits

Question 2

What are the forms of control structures?

Answer 2

Sequential blocks
Conditional blocks
Iterative blocks
Recursive blocks

Question 3

Software Quality

Answer 3

Functional suitability: gets the right result
Performance Efficiency: gets there in a reasonable time using few resources
Compatibility: Friendy towards other software
Usability: Minimizes user frustration
Reliability: does not crash the computer or light things on fire
Security: cannot be misused by bad actors or unwise users
Maintainability: can be understood/updated by the next programemer (esp oneself)
Portability: can be moved or replaced easily

Question 4

Computational thinking

Answer 4

the mental skills and practices for designing computations that get computers to do jobs for us and explaining and interpreting the world as a complex of information processes

Question 5

Pseudocode

Answer 5

Is not another programming language. A programmer describes roughly what they want to accomplish with each code section to complete the solution

Question 6

Ascertainment bias

Answer 6

Thinking is shaped by prior expectation
Ex: stereotyping or gender bias

Question 7

Availability

Answer 7

Overestimating probability of unusual events because of recent or memorable instances

Question 8

Representativeness

Answer 8

Overestimating rare diseases by matching patients to ‘typical picture’ of that disease
“representative heuristic is insensitive to pretest probabilities”

Question 9

Confirmation bias

Answer 9

Tendency to look for confirming evidence rather than disconfirming evidence to refute it
“cherry-picking” results from a large set of negative results

Question 10

Diagnosis momentum

Answer 10

Things that are initially diagnostic considerations, as they are passed from clinician to clinician, become “stickier” and more certain

Question 11

Anchoring

Answer 11

Failure to adjust probaiblity of a disease or outcome based on new information

Question 12

Premature closure

Answer 12

Tendency to accept a diagnosis before it’s fully confirmed

Question 13

Value-induced bias

Answer 13

Overestimate probability of an outcome based on value associated with that outcome

Question 14

Defending against cognitive bias

Answer 14

Decrease reliance on memory (orderset for dx of rheum d/o)
Cognitive forcing strategies (CDS for clinical pathways)
Make task easier (display of complex info like trends and outliers)

Develop insight/awareness
consider alternatives
meta-cognition (“thinking about how you think”)
Specific training
Simulation
Minimize time pressures
Establish accountability
Feedback about diagnostic errors

Question 15

Expected utlity

Answer 15

function of value and also risk aversion, personal preferences/circumstances

Question 16

Conditional probabilities

Answer 16

probability of X given Y

Question 17

Sequential events

Answer 17

Chance tree or graph - model a decision using the sum of conditional probabilities

Question 18

Decision tree conventions

Answer 18

Decisions node = square
Chance node = circle (each branch assigned a probability, all branches at a node must ad to 1
Outcome node = triangle (assigned a “value” - cost, utility, QALY, relative value; if life or death are the outcomes : life = 1, death = 0)

Question 19

Rollback analysis

Answer 19

multiplying the conditional probabilities and comparing the expected value of each branch of a decision node

Question 20

“What-if” or sensitivity analysis

Answer 20

Use a range of values to see how model changes

Question 21

Cost effectiveness analysis

Answer 21

The “value” of outcome nodes become units of cost instead of the valuese used in our example (life =1/ death =0)

Question 22

Quantifying patient utility

Answer 22

Adjust the value of the outcome based on the perceived utility of that outcome for that patient
-standard gamble
-time trade-off
-visual analogue

Question 23

Quality-Adjusted Life Year (QALY)

Answer 23

Often calculated using time-trade-off
For many patients, there are states of health that are worse than death, so it is possible for QALY to have a negative value
Another way of asking “how many years of your current life would you trade to live in perfect health?” - way to ascertain what utility they assign their current sate of health
Ex: suppose pt says 4 yrs of perfect health = 10 yrs of current illness, TTO = 0.4; therefore, 3 yrs in current sate = 3x 0.4 = 1.2 QALY

Question 24

Incremental Cost/Effectiveness Ratio (ICER)

Answer 24

How much do you have to spend to increase effectiveness by one unit
Compare calculated ICER to the “willingness to pay” to determine if a therapy is cost effective and worth implementing

Question 25

Sensitivity

Answer 25

likelihood of positive test given disease aka True Positive Rate aka Recall

Question 26

Specifity

Answer 26

likelihood of a negative test given no disease aka True Negative Rate

Question 27

PPV

Answer 27

likelihood of disease given a positive test aka Precision

Question 28

NPV

Answer 28

likelihood of no disease given a negative test

Question 29

Pragmatic ambiguity

Answer 29

conflicting recommendations within a guideline

Question 30

Semantic ambiguity

Answer 30

insufficient detail (ex: "specimens should be sent to the lab for further handling" - does not answer "which lab?")

Question 31

Syntactic ambiguity

Answer 31

due to language that prevents translation into a machine-interpretable condition or syntax like not having appropriate parenthesis for interpretation of and/or statements

Question 32

Conditional ambiguity

Answer 32

Component of a condition is insufficiently detailed like "suggestive of appendicitis"

Question 33

According to social influence theory, what are the four social computing phenomena which exert influence on adoption of technology?

Answer 33

Action, authority, consensus and cooperation

Question 34

Logic model

Answer 34

commonly used to represent the next proposed change for the process redesign cycle

Question 35

Process maps

Answer 35

tools used to represent workflow analysis

Question 36

Spaghetti diagrams

Answer 36

physical maps of the movements of people in a workflow

Question 37

Gap analysis

Answer 37

determines the gaps between current state and the ideal future state

Question 38

The six IOM quality domains

Answer 38

Safe, Effective, Efficient, Timely, Patient-Centered & Equitable

Question 39

"Five Rights" of CDS

Answer 39

1. Getting the right information 2. To the right person 3. In the right format 4. Through the right channel 5. At the right time

Question 40

6 pillars of quality

Answer 40

1. Safety 2. Effectiveness 3. Efficiency 4. Patient-centeredness 5. Timeliness 6. Equity

Question 41

Expected value

Answer 41

summation of the independent probabilities of events

Question 42

Expected utility

Answer 42

includes expected value but also takes into account factors like risk aversion, personal preferences, or circumstances

Question 43

Multiplication rules P(A and B)

Answer 43

= P(A) x P(B|A) the probability of A and B occurring is and equal to the probability of A times the probability of B, given A

Question 44

Decision tree - decision nodes (shape & representation)

Answer 44

square represent branching points in the decision tree

Question 45

Decision tree - chance nodes (shape & representation)

Answer 45

circle represent the probability of a specific outcome occurring

Question 46

Decision tree - outcome nodes (shape & representation)

Answer 46

triangle assigned a value (cost, utility, QALY, relative value, etc)

Question 47

Time Trade Off (TTO) utility

Answer 47

the indifference point is the length of remaining life in perfect health divided by the length of reaming life with the evaluate state ex: one might choose to give up 5 years of life in their current state in order to live a more healthy life vs 10 years in current state. The TTO utility would be 5 years/10years or 0.5

Question 48

Cost-Effectiveness Analysis (CEA)

Answer 48

typically expressed in terms of a ratio where the denominator is a gain in health from a measure and the numerator is the cost associated with health gain (cost/QALY)

Question 49

Incremental Cost/Effectiveness Ratio (ICER)

Answer 49

"willingness to pay" to determine if a therapy is cost effective ICER = (Cost A - Cost B)/(Effect A - Effect B)

Question 50

Type I error

Answer 50

incorrect rejection of a true null hypothesis (i.e. a false positive) --> leads one to conclude that a supposed effect or relationship exists when in fact it doesn't Ex: telling an old man he's pregnant

Question 51

Type II error

Answer 51

failure to reject a false null hypothesis (i.e. a false negative) --> leads one to conclude that a relationship does not exist when it truly does Ex: telling a pregnant woman you're not pregnant