14 ⼀BIOSTATISTICS/BIOETHICS Flashcards

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1
Q

What is [Root Cause Analysis] ?

A

[5-part QA tool] that analyzes then addresses Root Causes leading to an adverse medical event

DCRSA

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2
Q

What are QALY and DALY?

________________

Describe both

________________

A

Quality-Adjusted Life Years | Disability-Adjusted Life Years

BOTH measures burden of disease for individuals or populations

________________

[TTO (time trade off)] is used for calculating QALY

________________

[Yeas of Life Lost (from premature Death)] and [Years of Life Lived with Disability] are used for calculating DALY

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3
Q

A patient, recently tested for Huntington’s disease, now declines to learn of the test result

What are the ethics guidelines regarding genetic information? (2)

A

🔲 Always Remember: PATIENTS HAVE RIGHT TO REFUSE GENETIC INFORMATION

BUT

⊙physicians should also be sensitive to psych impact of predictive screening and be willing to explore reasons for that pt’s anxiety

  • “Learning about your test results is a very personal decision; I’d like to understand more about what led you to change your mind.”*
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4
Q

describe Rate Ratio
_________________

what’s the purpose of Rate Ratio​?

A

[event occurred less in treatment group than control] < [RR = 1.0(null)] < [event occurred MORE in treatment group than control]

the difference from 1.0 indicates amount benefited or lost
_________________

measures effect of an intervention on an outcome over time

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5
Q

The ⬜ and ⬜ are common [test for heterogeneity]. What are [test for heterogeneity] useful for? (2)

A

▶[Q statistic(NO heterogeneity if P > 0.05)] :

a (small P<0.05) suggest there is a difference between the groups studied and that the [null hypothesis H0] should be rejected. A (Large P>0.05) suggest there is NO difference between groups studied and [null hypothesis H0] can NOT be rejected

▶[I2 index(heterogeneity level: [25%=low]/[50%=moderate]/[75%=HIGH])]

_________________

  1. performing meta analysis (of several trials as it can provide insight about combinability of multiple studies)
  2. comparing different trials
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6
Q

What does overlapping [Standard Error of Measurement] suggest?

A

suggest [NO significant statistical difference between 2 data sets]
(two data sets are similar)

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7
Q

[Case Control Study] is a study of the (⬜ past | present | future) that looks at [⬜ and ⬜ groups] to determine ⬜

_________________

What question does [Case Control Study] ask?

A

past ; ([Diseased] v [NONDiseased controls]) ; [RISK FACTORS that caused the disease]
_________________

After comparing the [Diseasded] and the [NONDiseased control], [what risk factor] increased odds of having the disease ?

observational and retrospective

  • ________________*
  • ” After review of* [group with new GI illness] and [group without new GI illness], having [history of eating at a particular restaurant] increased odds of having [new GI illness] “
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8
Q

in Medical law, the GINA act stands for ⬜

What is the GINA act? (2)

A

[GINA act] = Genetic Information Nondiscrimination Act ⼀

  1. prohibits employers and health insurance from requesting genetic testing

and/or

  1. requiring genetic testing to determine future employment and health insurance eligibility
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9
Q

[T or F] Sample Size and Power of a Study are interdependent
_________________

Explain?

A

TRUE
_________________

[power ⇪] and/or [small difference between groups] ➜ [⇪ Sample Size required]

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10
Q

Mortality prediction curves are useful for ⬜. How do you properly interpret these curves?

A

providing mortality risk while accounting for multiple other variables; each variable must be accounted for to arrive at the accurate predicted mortality

All-cause Mortality Curve
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11
Q

[T or F] Patients have a right to refuse knowledge regarding their diagnosis
_________________

What should Physicians do about this?

A

TRUE
_________________

nonjudgmental exploration into underlying reasoning ⼀ in order to understand patient’s concerns

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12
Q

state the inferiority designation for each event

A
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13
Q

A good ⬜ test will have high Sensitivity

How is Sensitivity related to NPV?

A

SCREENING; [⇪ sN = ⇪ NPV]

_________________

[⇪ sN = ⇪ NPV = ⬇︎FN]

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14
Q

Criteria for giving out Pt medical information? - 3

A

Pt must… PDA

1st: be Present (or otherwise available prior to disclosure)
2nd: have Decision Making Capacity (CURE)
3rd: Agrees to disclose information

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15
Q

Name and describe the [5 Ethical Principles in Medicine]

A

BJPAN

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16
Q

Describe how to interpret Standard Deviation chart

A

[68% of all observations will lie within 1 SD]

[95% | 2 SD]

[99.7% | 3 SD]

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17
Q

In terms of Medical Errors, describe

Near-Miss event

A
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18
Q

What is Statistical power?
_________________

How do you mitigate low statistical power?

A

ability to detect an association if that association exist. Based on sample size. Larger sample size helps control all confounders ➜ ⇪ Statistical power
_________________
META ANALYSIS (pools data from several studies to INC statistical power)

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19
Q

T or F

It is NEVER acceptable to allow industry-sponsored programs to influence lecture content

A

TRUE

Physicians have to retain FULL CONTROL over psntn content

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20
Q

What is the current recommendation regarding informal treatment of friends or family? (3)

A

for friends/family not technically your patient…

  • ONLY IF no other physician is available.. you can give
  • ACUTE care ONLY
  • LIMITED care ONLY

**writing a prescription automatically establishes a medicolegal physician-patient relationship; making MD liable for any/all outcomes

“I would like to help you, but I am uncomfortable prescribing for someone I am not treating.”

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21
Q

What are the guidelines regarding patients themselves requesting copies of their medical records? (3)

A

ADULTS CAN! Adult pts have the right to release their medical records even to themselves (for their own personal record/viewing).

PEDS REQUIRE PARENT CONSENT (unless emancipated or received care that did not require parental consent)

Ok to Charge “Records Fee” (for printing/mailing/etc)

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22
Q

which kind of study is used to backtrace a restaurant outbreak?

A

CASE control

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23
Q

What is the Formula for Positive Likelihood Ratio?

Are Positive/ Negative Likelihood Ratios dependent or indepedent of a disease’s prevalence?

A

P = N / (1-P)

Number 1 Nigga, Positivity” ….. “Positivity… Number 1 Plan”.
Negative LR = (1 - seNsitivity) / P

Positive LR = seNsitivity / (1 - sPecificity)

INDEPEDENT

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24
Q

Medical encounters may be the only way trafficked victims can get help

Describe what to do once you suspect a patient is being Human Trafficked

A
Human Trafficking Protocol
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25
Q

How should physicians approach [Complementary and Alternative medicine] with patients? (2)

A
  1. have open, explorative and collaborative discussion
  2. adequately research risk, benefit, and [proven treatment alternatives] for each CAM
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26
Q

[Per-Protocol Analysis] (3)

A
  • Excludes non-compliant participants = analysis of only data from participants who’ve followed rules Per Protocol
  • estimates true effect of an intervention but overestimate effect of intervention in a real world setting vs
  • opposite of [Intention-To-Treat analysis (which keeps participants in their allocated groups regardless of dropout or non-compliance = better estimate of real world)]
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27
Q

What is [Intention To Treat Analysis]? (3)

A

▶after subjects are initially randomized to tx vs control, those subjects are maintained to that intervention group regardless of what they do during study period [switch intervention/drops out]→ crossover/attrition …actually become apart of the subjects outcome data and are attributed to the intervention

▶ will provide conservative (but more valid) estimate of the intervention effect

▶preserves benefits of randomization in superiority trials

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28
Q

define SpeciFicity
_________________
~~~

SpeciFicity formula ​?

A

SPeciFicity= [true negative] = [TN / (TN + FP)] = used for test conFirmation

= “a test’s probability (in the absence of disease) a patient test negative”

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29
Q

What is [MLR (Multiple linear regression)] used for?

A

evaluates association between [1 quantitative dependent variable] and [≥2 independent variables of interest] while controlling for adjustment variables

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30
Q

What does setting statistical significance at [α = 0.05] actually mean?

A

statistical significance [α = 0.05] means…

Researchers are willing to accept that there’s a LOE5% chance that the observed differences they see will be considered significant when no difference actually exist

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31
Q

What are the recommendations regarding MD and teenager patients having sex.

Should MD discuss with parents?

A

MD should maintain confidentiality of sexually active teens and ensure teen access to healthcare and counseling

MD MUST BREAK CONFIDENTIALITY IF THERE’S RISK OF HARM TO SELF/OTHERS OR CHILD ABUSE

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32
Q

What is the Doctrine of Implied Consent? (3)

A

❗️In pts who LACK DECISION-MAKING CAPACITY

❗️but who require 9-1-1 Tx

❗️can receive 9-1-1 tx per [Doctrine of Implied (NO explicit necessary) consent] (and must be tx reasonable people in similar situation would expect)

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33
Q

What’s unique about Survival Analysis ? (3)

A

-it doesn’t just account for # of events for both the [control group] and [treatment group] …
-but also the TIMING OF THOSE EVENTS throughout the follow-up period for these 2 groups.
-This produces [TIME-TO-EVENT/DEATH] for the [control group] and [treatment group], which may reveal overall superiority between the 2

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34
Q

In research, what is Lead-time bias?

A

overestimation of survival only solely because patients were diagnosed earlier
_________________

when a screening test appears to prolong survival when actually it’s just informing the patient of their diagnosis earlier on …(and as a result…) time from diagnosis until death is longer ⼀even though there isn’t actual increase in survival (just earlier detection)

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35
Q

What is Number Needed to Harm?
_________________

formula? (2)

A

Number of people Needed to be exposed to a tx before a harmful event occurs
_________________

NNH

=[1 / ARI]

= {1 / [(AERTX) - (AERPLACEBO)]}

AER: Adverse Event Rate | ARI: Absolute Risk Increase

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36
Q

What is a Pragmatic study?
_________________

What is a Nested study?

A

seeks to determine whether intervention works in real life conditions
_________________

retrospective observational study in which subsets of controls are matched to cases and analyzed for variables of interest

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37
Q

What should a Specialist do if their plan does not coincide with PCP?

A

BEFORE MAKING ANY CHANGES, Specialist should call/discuss plan with PCP since PCP has primary responsibility for patient’s care

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38
Q

How is Likelihood Ratio used to stratify clinical significance?

A

LRs does not change as disease prevalence changes

and LR can be used to grade clinical significance of various results when >2 different test results are possible
_________________

LR = probability of a given test result occurring in a patient with a disorder compared to the probability of the same result occurring in a patient without the disorder

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39
Q

Elder abuse occurs in patients age ⬜, and if [risk factors ( ⬜4 )] are present, physicians should automatically screen these patients for [major signs of abuse ( ⬜4 )]

A

> >65[age>80], female, physical impairment, psych impairment(dementia/depression)

  1. spiral fx
  2. abrasions in unusual locations
  3. malnutrition
  4. pressure ulcers

interview patient alone and alert [Adult Protective Services] if elder abuse suspicion supported

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40
Q

Sensitive diagnostic test have lower false (⬜ negative | positive) results

________________

Specific diagnostic test have lower false (⬜ negative | positive) results

A

test with:

⇪ seNsitivity = ⬇︎false Negatives

________________

⇪ sPecificity = ⬇︎ false Positives

PNct (sPecificity/seNsitivity contingency table)
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41
Q

When are IV medications preferred over oral? (4)

A
  1. HDUS
  2. PO INtolerance
  3. PO meds failed
  4. < 2 yo
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42
Q

Main features of a DNR order -4

A
  1. ✔︎ [Ok to treat temporary or correctable conditions (i.e. sepsis)]

—-but NO VAP ——

  1. NO Ventilator dependency
  2. NO ACLS
  3. NO Prolongation of terminal illness
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43
Q

Recite the breakdown formula for Standard Deviation Curve (3)

A

[(mean) +/- (SD)] =

[(external SD)% chance > (mean + SD)] and

[(external SD)% chance < (mean - SD)]

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44
Q

In terms of research, describe the 3 characteristics of

Internal validity

A
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45
Q

[T or F]

It is paramount to determine guardianship status for all adult patients with intellectual disability

A

TRUE

_________________

especially as to clarify medical decisions

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46
Q

▨ What is a meta-analysis? (2)

_________________

◮ What is the disadvantage to using meta-analysis?

A

▨ -pooling data from several single studies in order to INC power of 1 LARGER COLLECTIVE study (as to INC that LARGER COLLECTIVE study’s ability to detect (if one exist) a difference in outcome between groups)

▨ If an outcome is rare (or difference between groups is super small), this will be difficult for single small study to detect ➜ unlikely to reach statistical significance = use meta analysis

_________________

pooling from several studies will also pool their biases and limitations all into 1 analysis

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47
Q

Describe the 4 types of Disease Prevention

A

PSTQ = Prevent/Screen/Treat/Query

[Primary = Prevent future disease (* _P_revent future MI by reducing HLD*)]

[Secondary = Screen possible disease (_S_creen possible cervical CA with pap smear)]

[Tertiary = Treat current disease PATIENT CURRENTLY HAS to ⬇︎ disability from that current disease (_T_reat current severe CAD with CABG revascularization)]

[Quartenary = Query statistics of disease: to identify pts at risk for unnecessary treatment and prevent redundant or unnecessary therapies (shared EMR limits unnecessary or repeat procedures)

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48
Q

define Sensitivity
~~~
_________________
~~~

Sensitivity formula ​?

A

seNsitivity = [true positive] = [TP / (TP + FN)]

= “a test’s probability (in the presence of disease) a patient test positive”

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49
Q

define

Specificity

A

sPecificity = [true negative] = Negative In Health

= “a test’s probability (in the ABSENCE of disease) a patient test negative”

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50
Q

What does Confidence Interval describe

A

⭐Range of values in which a [specified probability (usually 95%)] of the [means of repeated samples] are expected to fall within
⭐CI = mean +/- Z(Standard Error of Mean) (ex: [95% CI, Z=1.96] and [99% CI, Z=2.58]

⭐Statistical difference:
a.[95% CI for (mean difference between 2 variables)] that includes 0 = [NSD = H0 not rejected]
b. [95% CI for (odds|relative risk ratio)] that includes 1 = [NSD = H0 not rejected]
c.

CI of an [Odds Ratio] indicates (with a certain confidence level) whether a given OR is statistically different from [null OR = 1].

a CI that excludes [null OR = 1] is statistically significant

H0 = null hypothesis = [NO statistically significant difference exist]

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51
Q

In terms of research, describe the 3 characteristics of

EXTERNAL validity

A

if relationship is seen in populations outside study also??

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52
Q

[T or F] Romantic relationships between pediatric physicians and parents of their patient is ethically acceptable with full disclosure

_________________

Why or Why not? (3)

A

FALSE

  • Pediatricians dating their patients’ family members is ethically PROBLEMATIC.
  • Physicians are ethically obligated to act in best interest of patient .. so intimate involvement may blur judgment =
  • these pediatricians need to transfer patient care
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53
Q

In the Kaplan-Meier survival curve graph, ≥2 study groups can be compared and are associated with p-value

What does p-value delineate?

A

p ≥ 0.05 means

the study groups are NOT statistically different

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54
Q

In terms of Medical Errors, describe the difference between

[Preventable adverse event] and [Negligent adverse event]

A

PAE = preventable event 2/2 faulty human Practice

NAE = preventable event 2/2 Not adhering to Standard of Care

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55
Q

Recall the [2 x 2 Test vs. Disease] diagram

A
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56
Q

[Cross Sectional Study] is a study of the (⬜ past | present | future) that looks at [⬜ and ⬜ groups] to determine ⬜

_________________

What question does [Cross Sectional Study] ask?

A

present ; ([Group with Risk Factor] v [Group wihout Risk Factor]) ; PREVALENCE of a disease
_________________

How prevalent is this [disease and its risk factors] right now?​?

________________

Collects data from a group of people to determine [frequency of disease and its risk factors] at a specific point in time

________________

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57
Q

what is the Hawthorne effect

A

when pts modify their behavior just because they know they’re being studied

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58
Q

What are the ethical guidelines regarding receiving gifts from patients? (4)

A

Since these influence professional judgment, it is Unethical to accept patient gifts that are ___X___

  1. given with expectation of preferential tx (vs genuine tokens of appreciation)
  2. LARGE
  3. EXPENSIVE
  4. intimate
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59
Q

A patient’s Employer hands you a signed “release of information” for that patient’s medical information.

How does this affect HIPPA?

A

If given written authorization, HIPPA allows MDs to give the minimum necessary information to satisfy the employer’s request

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60
Q

What is Hazard Ratio?

A

HR = the likelihood an event will occur in a treatment group (relative to the control)

[not likely/protective] < HR 1.0 < [LIKELY/DETRIMENTAL]

________________

[EVENT less LIKELY to occur in the treatment group than the control group] < HR 1.0

HR 1.0 < [EVENT MORE LIKELY to occur in the Treatment Group than the control group]

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61
Q

Sampling bias

A

selection bias that → unrepresentative sample

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62
Q

What is [External Validity] ?

A

how generalizable the results of a study are to other populations

(i.e. a study for middle aged women has low external validity for elderly men)

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63
Q

A 95% Confidence Interval that does not include the [null value 1.0] corresponds to p-value ⬜

A

<0.05
_________________

95% | <0.05

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64
Q

Describe the ANOVA test (2)

_________________

ANOVA: Analysis Of Variance

A

▶compares the mean between ≥3 groups

_________________

requires [quantitative dependent variable (outcome)] and [quaLitative independent variable (exposure/risk factor)]

example of ANOVA test
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65
Q

▶[Standardized Mortality Ratio] is ⬜

▶▶Formula?

________________

Explain the overall takeaway

A

▶adjusted measure of overall mortality

——-▶▶by calculating ——–

[observed # of deaths in population of interest]

[expected # of deaths in population of interest]

________________

SMR of 1.75 = “observed # of deaths (in this population of interest) is 75% higher than expected”

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66
Q

What is Number Needed to Treat?
_________________

formula? (2)

A

of patients needed to treated in order to [prevent 1 disease] or [cure 1 condition] = measures efficacy of a therapy
_________________

NNT

= [1 / ARR]

= {1 / [(failure ratePLACEBO) - (failure rateTX)]}

ARR: Absolute Risk Reduction

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67
Q

What are Advance directives used for?

A

AD (living will, DNR/DNI) are invoked ONLY WHEN PATIENT LACKS DECISION-MAKING CAPACITY

If patient still retains Decision-Making Capacity, M.D. should still ask patient if they want to refuse intervention (like Intubation) in the treatment of temporary / reversible illness (like PNA).

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68
Q

Describe the recommendations regarding Physicians asking for financial support from patients?

A

MD altogether should avoid soliciting financial support from patients (espeicially for personal endeavor)

talking about personal experiences is fine, as long as its relevant to patient

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69
Q

What’s the major takeaway with interpreting a ROC Curve Graph? -2

A

They use (1-specificity)

so

[⇪ (1-specificity) by 12%] actually = [⬇︎ specificity by 12%]

________________

moving up-and-right on ROC = [⇪ N but ⬇︎P]

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70
Q

What are the 5 primary components of a safe and effective patient handoff?

A

PCPAF

Patient Handoff

Patient

Clinical_Status

Plan of Care/Summary with anticipated d/c

Anticipated problems with recommended mitigation

Follow ups/Pending Actions/TO DOs

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71
Q

What is the difference between doing research with Incarcerated individuals vs general population? (2)

A
  1. IRB requires ADDITIONAL OVERSIGHT than gen pop (to ensure fairness to this vulnerable population)
  2. otherwise, same rights to refuse or consent to participate
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72
Q

In terms of disclosure, how should physicians approach medical errors? (4)

A
  1. ERRORS DISCUSSED WITH PATIENT AND FAMILY IN TIMELY MANNER = OLBIGATION!
  2. Empathetic apology
  3. Explanation
  4. Event prevention discussed
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73
Q

Your colleague’s patient informs you that your colleague performs inappropriate breast exams, that to which your colleague denies

What should you do?

A

REPORT SUSPECTED (SEXUAL) MISCONDUCT TO STATE MEDICAL BOARD FOR INVESTIGATION = ETHICAL OBLIGATION
_________________

advising your colleague to terminate their physician-patient relationship is NOT ENOUGH

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74
Q

Relative Risk measures ⬜
_________________

What’s the ​Formula?

A
ratio between (probability of event<sup>ET</sup> : probability of event<sup>cp</sup>)]

RR = [IET / Icp]

RR = [Incidence of disease in (Exposed/Treated) group] / [Incidence of disease in (control/placebo)* *group]

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75
Q

T or F

  • Patient p/w financial hardship at end of her visit.*
  • You tell her that Co-pays can be 100% completely waived or partially adjusted based on standardized proof of need*

[T or F] ?

Explain

A

TRUE

⼀(True if there is standardized proof of need - but note: waiving copays for ALL patients = insurance fraud due to total charge discrepancy and potential inducement of unnecessary medical services)

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76
Q

In Research, describe what a [Type 1 error] is (3)

A

⭐detecting a difference between groups when a difference does NOT in fact exist lol
or (AKA)
⭐: Mistakenly rejecting [a null hypothesis] … that is actually true and should NOT be rejected = false positive(since rejecting = positive)

⭐{probability of [Type 1 error] occurring = α } and this reflects significance of a test

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77
Q

On a Central Tendency Graph below Identify

Mean, Median, Mode

A

cOIN

central tendency graph =

1: mOde
2: medIan
3. meaN

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78
Q

What case control statistical device can be used to measure association (if one exist) between a Disease and a specific [exposure or risk factor] ?

A

Odds Ratio

[(aD) / (bc)]

[(DISEASEOOE)/ (controlOOE)]
_________________
• OOE = Odds of Exposure
• first draw contingency table | • [(OR >1) indicates there IS an association between a DISEASE and the [exposure or risk factor] in question

contingency table (odds ratio)
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79
Q

What is the difference between [Case fatality rate] and [Mortality rate]?

A

For (Event J)…

Case fatality rate = [proportion of people with (Event J) who die from (Event J)]

_________________

Mortality rate = [proportion of general population who die from (Event J)]

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80
Q

What is the [Family Medical Leave Act]?

A

[solid employees > half time ≥1y] of [Large companies > 50 employees] have legal federally protected [≤12 weeks unpaid leave] if :

  • postpartum
  • serious illnes
  • caring for immediate family with serious illness
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81
Q

What is Correlation Coefficient (r)?

[{r < 0} indicates ⬜]

& [{r>0} indicates ⬜]

A

describes

[Direction {neg inverse} vs {positive direct}]

and

[STRENGTH (-1 0 1) - furthest from 0 = stronger]

  • of two quantitative variables to each other*
  • _________________*
  • [{r<0} = {neg inverse} = {A⇪ ⼀B⬇︎}]* 🆚 [{r>0} = {pos direct} = {A⇪ ⼀B⇪ }]
82
Q

Cross sectional studies are majorly used to determine ⬜, but may also be used to ⬜

A

prevalence of disease;

obtain snapshots = examines associations between risk factors and outcomes in a well-defined population at one particular time

=takes snapshot of a population and measures freq of risk factors and outcomes simultaneously

although this leaves out temporal relationship between the two

83
Q

Describe the 3 key components of the “Affordable Care Act

A
  1. Uninsured pts who don’t qualify for [Medicaid federal health insurance] but also can’t afford [private health insurance] – can purchase insurance through the [ACA Health Insurance Marketplace Exchange]
    * * *
  2. ACA asserts all insurance plans adhere to 3 guidelines:
    a. can not deny coverage/INC premium due to preexisting health condition
    b. must coverfull or partial the [10 essential health benefits (i.e. Rx, mental health)] ⼀pt may incur copay on certain benefits
    c. must coverFULL100% all [Preventative Health Care] services = $0 copay
    * * *
  3. ACA applies to both HMO and PPO

_________________

HMO: Health Maintenance Organizations / PPO: Preferred Provider Organizations

84
Q

In terms of Medical Errors, describe

Sentinel event

A
85
Q

Conflict arises between multiple children of a terminally ill patient regarding his medical decisions

Management?

A

Hospital ETHICS Committee

86
Q

What is the IRB? (3)

A

✏️IRB = Institutional Review Board
✏️primary authority on human research
✏️that approves research protocol initiation and/or modifications

87
Q

Predictive values varies based on disease prevalence

How does disease Prevalance affect Positive Predictive Value?

and Negative Predictive Value?

A

⇪ Prevalence = ⇪ PPV

and

⇪ Prevalence = ⬇︎ NPV

88
Q

highly SPecific test are useful for test [⬜ (screening | confirmation)]

A

PCD = [ProoF|ConFirmation|Diagnostic]
_________________
sPeci_F_icity= [true negative] = [TN / (TN + FP)] = used for PCD test

= “a test’s probability (in the absence of disease) a patient test negative”

PCD = [ProoF|ConFirmation|Diagnostic]

89
Q

[T or F]

[Preventative Health Care (i.e. mammograms)] cost is covered 100% by all health insurance companies, and patient’s don’t have to pay anything.

Explain

A

TRUE

For [Preventative Health Care (i.e. screening mammogram)], Federal law mandates ALL insurance plans cover 100% the cost so that patients incur $0 out-of-pocket co-pay!

90
Q

How do you manage a breach of patient privacy? (5)

A
  1. Patients must be notified IN WRITING about:
  2. breach mechanism
  3. information disclosed
  4. actions taken to [fix current breach]
  5. actions taken to [prevent future breach] ​

_________________

breach = disclosure of patient info to unauthorized person or for improper purpose

91
Q

What is EMTALA?

A

EMTALA = [Emergency Medical Treatment Active labor Act] enacted by Congress 1986, imposes

[3 (SSS) primary requirements of Hospitals to EVERY patient before discharge (regardless of payment)].

Hospitals MUST :

  1. SCREEN patient- medical exam
  2. STABILIZE patient prn
  3. SEND patient/transfer only after patient stabilized
92
Q

What is the Kappa Statistic?

A

measures inter-rater RELIABILITY (or Concordance).

represents the extent to which inter-rater agreement is an improvement on chance agreement alone.

93
Q

What is the [two-sample t-test]? (2)

A

[compares MOQVGroup 1 to MOQVGroup 2]

(I.e. comparing mean of a construct score between 2 intervention groups

_________________

MOQV: [mean (of the quaNtitative variable)]

94
Q

A 99% Confidence Interval that does not include the [null value 1.0] corresponds to p-value ⬜

A

<0.010
_________________

99% | <0.010

95
Q

What is a [Kaplan Meier graph] used for?

A

survival analysis that [real-time analyzes⼀throughout the study] period from [entry into study] to the [event of interest (death)] and compares the rate at which [events of interest] occur for different participants.

  • HR
  • CI that EXcludes [null = HR = 1] is statistically significant
96
Q

Selection bias occurs when ⬜. This often seen in ⬜ and ⬜.

_________________

Explain

A

a sample is unrepresentative of the target population (this leads to incorrect measures of association) ; Surveys / Polls

_________________

In Survey/Polls, nonresponses may cause selection bias, as responders may have responded 2/2 a particular bias = sample group is unrepresentative of target population

97
Q

Treating a friend or family member involves ethical issues that compromise both [beneficence (⬜)] and [nonMaleficence (⬜)]

_________________

When is it Ok to consider treating friends or family? (3)

A

acting in pts best interest;

do no harm

_________________

  • ONLY IF no other physician is available.. you can give
  • ACUTE care ONLY
  • LIMITED care ONLY

**writing a prescription automatically establishes a medicolegal physician-patient relationship; making MD liable for any/all outcomes”

“I would like to help you, but I am uncomfortable prescribing for someone I am not treating.”

98
Q

AUC of a ROC curve is a reflection of ⬜. Explain

A

diagnostic accuracy;

Greater AUC = Greater Accuracy and discrimination (outperforms)

99
Q

describe Observer bias (3)

A
  • occurs in the absence of blinding,
  • observers misclassify data due to preconceived expectations about the tx
  • usually occurs when studied outcome is QUALitative
100
Q

What is the Formula for Negative Likelihood Ratio?

Are Positive/ Negative Likelihood Ratios dependent or indepedent of a disease’s prevalence?

A

NLR⊝ = [(1-N) / P]
_________________
INDEPENDENT

Number 1 Nigga, Positivity”….

Positive LR = seNsitivity / (1 - sPecificity)

Negative LR = (1 - seNsitivity) / P

101
Q

This type of study (known as ⬜ ) can only provide what type of information?

A

[ecologic correlational study] ;

population-level information

102
Q

guidelines regarding patients refusing treatment (2)

A
  • patients with untreatable disease and poor quality of life, who’ve already tried different therapies, may sometimes refuse to accept any types of treatment (including general). Under principle of autonomy, this is ok.
  • -Unless court rules pt is incompetent*, principle of autonomy includes a patient’s right to refuse treatment, which must be respected
103
Q

How should Warfarin be adjusted if a patient starts taking amiodarone?

A

⬇︎Warfarin by 25% (since amiodarone inhibits CYP2C9)

104
Q

What is Sensitivity Analysis?

A

modifying sensitivity of a study’s criteria .. and then repeating the initial analysis ⼀in order to determine if those modifications played a significant role initially

105
Q

Define | Formula?

[(LR+) Positive likelihood ratio]

________________

[(LR-) Negative likelihood ratio]

A
106
Q

what is Length-Time Bias

A

[progressive benign] disease cases have LONGER lifetime duration -> they are more likely to be detected incidentally by a screening xm -> artificially inflates the “detection success” of that screening xm

107
Q

a laboratory facility that reimburses a physician for each test ordered is an example of ⬜ , which is an [ acceptable | unacceptable] type of referral practice.

A

kickback; UNacceptable

_________________

kickback = financial incentive paid to referring physician for each referral sent

108
Q

What is Effect modification?

_________________

Give an example

A

▶occurs when magnitude or direction of the [independent variable’s effect] on the [dependent variable outcome] varies based on level of a third variable = EFFECT MODIFIER

▶ Separate Stratified Analysis should be conducted for each level of the EFFECT MODIFIER

Example: “Study showing Vitamin D’s outcomes on Cancer Mortality in patient groups separated by BMI”

  • independent variable = Vitamin D
  • dependent variable = Cancer Mortality
  • EFFECT MODIFIER = BMI[<25 / 25-29 / ≥30]
  • ⼀each level (i.e. BMI<25, BMI 25-29, BMI ≥30) will have separate stratified analysis for [independent Vitamin D’s effect] on [dependent outcome Cancer Mortality]*
109
Q

Explain what the [Principle of Beneficence and Nonmaleficence] means for Doctors

A

Doctors have ethical duties to prioritize patient global well being (beneficence)

while also [AVOIDING (either directly or indirectly by inaction) causing unwarranted patient harm] (nonmaleficence)

(ie so…DOCTORS must EXPLICITY and clearly state recommendations against or in support) Patient autonomy does NOT extend to the recommendations by the Doctor

110
Q

Typically, risk and benefits of thrombolysis are discussed with patients to obtain consent for treatment

When is there an exception to this informed consent? -3

A
  • life threatening emergencies when

  • there is inadequate time to obtain consent
  • and/or patient’s capacity is impaired to consent
111
Q

[Cohort Study] is a study of the (⬜ past | present | future) that looks at [⬜ and ⬜ groups] to determine ⬜

_________________

What question does [Retrospective Cohort Study] ask?

What question does [Prospective Cohort Study] ask?

A

[past (retrospective)] and [future (prospective] ; ([group WITH Risk Factor] v [group WITHOUT Risk Factor]) ; [INCIDENCE (development)] of a disease
_________________

  • retrospective = Using past records, between [GWF] and [GWOF] who developed the disease?*
  • Prospective = Between [GWF] and [GWOF] Who WILL develop disease?*

“Smokers (exposed/risk factor group) had higher RISK of developing COPD than Nonsmokers (NOT exposed/NO risk factor group) had”

112
Q

What kind of screening test are good for identifying individuals with NO disease? (2)

A

HIGH SPECIFICITY

High Negative Predictive Value

113
Q

Observational studies are classified as Descriptive or Analytical

Name the Descriptive Observational studies? (3)

_________________

What do they do?

A

case report , case series, cross-sectional

_________________

  • Descriptive* studies describe disease patterns by time, place and person and GENERATE HYPOTHESIS about the association between risk factors and disease
  • (i.e. study showing high proportion of people with lung CA also smoked cigarettes)*
114
Q

a child, brought in by their grandmother needs non-emergent care

What are the guidelines for this?

A

For minors, in NON-emergent situations, informed consent should be obtained from parent or legal guardian (written > verbal) before intervention
_________________
if 911 situation: consent does NOT need to be obtained before intervention (as long as reasonable attempts to contact parent/legal guardian are made)

115
Q

What kind of study should be used to investigate an

acute infectious disease OUTBREAK?

A

Case-Control Study

________________

allows quick localization of outbreak source

116
Q

How do you deal with a patient who has a large family system?

A

have family establish [primary POINT OF CONTACT who will communicate concise questions/concerns from family] to careteam

117
Q

Describe the PDMP (Prescription Drug Monitoring Program) (3)

A
  • STATEWIDE interoperable (clinician, pharmacy, inpatient, outpatient) database with patient’s complete controlled substance hx
  • accessed by clinicians to avoid duplicate Rx and to identify high-risk drug use
  • clinicians accessing PDMP database (for patient care) = exempt from HIPPA = does NOT require patient consent
118
Q

how do you mitigate Observer bias

A

Blinding

(Observer bias = Observer [researcher] alters elements of the study (like over reporting a dz) either consciously or subconsciously)

119
Q

Draw a [Specificity/Sensitivity contingency table]

A
PNct (sPecificity/seNsitivity contingency table)
120
Q

Adverse Hospital events can be divided into 4 Major groups

What are they?

In Non-Surgical population, Which group occurs most frequently?

A
  1. Surgical (operation/procedural)
  2. [MEDICATION = MOST FREQUENT in non-surgical population (1/5 of all Adverse Hospital Events)]
  3. Gen Care
  4. Hospital-acquired infection
121
Q

In terms of sharing a pt’s PHI with family members
when can physician-patient confidentiality be broken?

A

If sharing a patient’s PHI with family can/will resolve an imminently modifiable risk to those family members = potential duty to relatives

122
Q

Define

Internal Validity (3)

A
  • IV = causality (did your [independent variable-EFFECT] Cause the ∆ in the [dependent variable-OUTCOME] you observed?
  • If Yes = [⇪ Internal Validity] 👍
  • If No ➜ [solution = double blind]
123
Q

Define

EXTERNAL Validity (2)

A
  • EV = GENERALIZABILITY ( is the observed relationship seen in the study GENERALIZEABLE (meaning can we see the SAME observed relationship OUTSIDE THE STUDY-IN THE REAL WORLD?
    • If Yes ➜ ⇪ External Validity)
124
Q

Observational studies are classified as Descriptive or Analytical

Name the Analytical Observational studies? (3)

_________________

What do they do?

A

[case control], [COHORT R/P], [some cross-sectional]

_________________

  • Analytical* studies TEST HYPOTHESIS about association between risk factors and disease
  • (i.e. study determining that smoking cigarettes is a statistically significant risk factor for Lung CA)*
125
Q

what are the rules regarding Physicians observing misconduct from another Physician ? -5

A

Physicians are ethically obligated to report colleagues (to State Medical Boards) who are

  • impaired
  • incompetent
  • unethical
  • or who [subject patients to potentially harmful tx]
126
Q

In research, what is a confounder? (2)

A

▶Confounder = extraneous variable a/w both the [dependent variable-OUTCOME] … and the [independent variable-EXPOSURE] …… individually

▶If Study does not correct for the potential skewed effect these confounders may have (Randomization helps to remove confounding variables) = Confounding Bias

127
Q

characteristics of

Crossover design (4)

A
  1. smaller sample size
  2. more precise estimates of treatment effect than studies with parallel design - (since crossover = each subject gets ALL TREATMENTS = acts as their own control) (versus parallel = subjects receive single treatment thoughout entire study)
  3. takes longer to complete (since subjects have to move from 1 phase to another multiple times during the study)
  4. carryover effect (1st treatment effect carrysover into the 2nd treatment phase - can be avoided with lengthy washout)
128
Q

what is sampling bias?

A

sampling pts in a NON-random manner -> lky to exclude certain members of the target population than others

129
Q

[T or F] It is inappropriate for Physicians attending a pharmaceutical conference to accept travel reimbursement from that pharmaceutical company

_________________

Is there any caveat to this?

A

TRUE ⼀physicians are NOT ALLOWED TO ACCEPT travel expense reimbursement from pharmaceutical companies

_________________

unless….they are the [faculty physician LECTURER] ⼀who can accept reasonable honoraria and/or travel reimbursement

130
Q

What is the purpose of [Home Health Services]?

HHS = PT/OT/wound care

A

allows patients that are both [infirmed (weak in health)] and [homebound**] to receiveskilled care at home
_________________

  • **homebound = ≥1 of*
  • -[uses mobility device (wheelchair/cane/walker)]*
  • -can only leave home with assistance*
  • -leaving home medically contraindicated*
131
Q

what’s the most effective way to improve patient sign out/handoff between providers?

A

systematic template checklist (i.e. “PCPAF”)

132
Q

How do you deduce predictive value from [(r) correlation coefficient]? (3)

A
  • [(r) correlation coefficient] range from {-1 to +1} with [0 = NO CORRELATION AT ALL].
  • The closer to +1 = VERY POSITIVELY CORRELATED
  • The closer to -1 = VERY NEGATIVELY CORRELATED
(ex: Enterococci has (r) closest to 0
133
Q

Briefly describe each term:

a. Premium
b. copayment
c. coinsurance

A
Health Insurance terminology
134
Q

Briefly describe each term:

d. deductible
e. Out-Of-Pocket Maximum

A

d. [deductible = (Out-Of-Pocket minimum)] = min patient has to pay before health plan starts to cover any part of health expenses
e. [Out-Of-Pocket MAX] = MAX patient has to pay before health plan starts to cover ALL (100%) of health expenses

Health Insurance terminology
135
Q

Both RR and OR measure the association between ⬜
_________________

Name the difference ​

Relative Risk | Odds ratio

A

exposure and outcome

RR = observational / experimental / follow up studies / cohort

OR = case-control / cross-sectional studies

136
Q

Name and describe the 8 components of (writing) a Prescription

A

DP dRIVRS

(DP dRIVRS) How to write Prescription
137
Q

lead toxicity levels ⬜ are a/w permanent cognitobehavioral problems and levels of ⬜ require Chelation therapy

A

10-20 ; ≥45

note: Chelation does not improve cognitive complications

138
Q

What does the [standardized incidence ratio] describe?
_________________
Formula?

A

SIR describes if occurrence of a disease in a small population is high or low relative to an expected value derived from a larger comparison population
_________________

SIR = [observed cases] / [expected cases]

139
Q

Treating a friend or family member involves ethical issues that compromise both [beneficence (⬜)] and [nonMaleficence (⬜)]

_________________

List reasons for why this is true (3)

A

acting in pts best interest;

do no harm

_________________

disadvantages friend/family from MD possibly ___

  1. treating conditions beyond expertise/training
  2. lack of follow up and documentation
  3. inadequate assessment of sensitive H/P
140
Q

Medical encounters may be the only way trafficked victims can get help

If you suspect human trafficking, recite the 8 questions you can use to screen for it

A

Interview Patient ALONE

Human Trafficking
141
Q

Medical encounters may be the only way trafficked victims can get help

Name the common warning signs for Human Trafficking (5)

A

Interview Patient ALONE

Human Trafficking
142
Q

what does [Intention To Treat analysis] describe?

A

Compares tx groups in a randomized trial by including

  1. [all subjects],
  2. [their first (randomized) tx group allocation] and

3. any personal acts of attrition (dropout, loss to f/u, crossover)

to overall benefit of the drug = conservative estimates of effect if acts of attrition are significant, however, results will better reflect expectefd effect in practical clinical (i.e. real world) setting

143
Q

What is the purpose of Palliative Care? -2

A

★ [interdisciplinary ⬇︎of unnecessary medical interventions] while [⇪ quality of life for terminal/seriously ill patients (and their family)].

★ Can occur concurrently with life-prolonging tx

144
Q

What are the 2 absolute requirements for hospice eligibility?
_________________

Name the other main features of hospice (4)

A

RQ1. [PATIENT (or Patient’s Surrgate) FOREGOS ALL CURATIVE TX]

RQ2. prognosis LOE6mo

_________________

  1. interdisciplinary palliative team
  2. Patients can leave hospice for curative tx then return later if desired
  3. [comorbid conditions /non-curative interventions are OK]
  4. [Full informed consent from patient is NOT required (since, if needed, Patient’s Surrogate can offer substituted judgment on pt behalf)]
145
Q

What is the Formula for Positive Likelihood Ratio?

Are Positive/ Negative Likelihood Ratios dependent or indepedent of a disease’s prevalence?

A

P = N / (1-P)

Number 1 Nigga, Positivity” ….. “Positivity… Number 1 Plan”.
Negative LR = (1 - seNsitivity) / P

Positive LR = seNsitivity / (1 - sPecificity)

INDEPENDENT

146
Q

In research, how does [Double Blinding] (which means ⬜ ) affect a study’s internal validity?

A

keeping individuals involved unaware of participants’ treatment assignments

________________

[Double Blinding] ⇪ internal validity

147
Q

In Research, describe what a [Type 2 error] is (4)

_________________

What is the formula for [Type 2 error]

A
  • failure to detect a difference between groups when a difference does in fact exist
  • or (AKA): failure to reject a null hypothesis … that is actually false and should be rejected = false negative (since rejecting = positive)
    • *
    • *

—{probability of [Type 2 error] occurring = β } and this is inversely related to [power (which is how large a study has to go to detect a difference when a difference does exist)**]

  • smaller study = ⬇︎power = [⇪ β = INC chances of Type 2 Error occurring]
  • _________________*

[T2E = β = (1 - power)]

148
Q

what is lead time bias

A

occurs when, even though [pt Test A] and [pt Test B] both die 5 years after the same disease..

bc [pt Test A] test diagnosed their dz 2yrs earlier…it’ll SEEM like [pt Test A] had longer survival time when actually they’re both only 5 years

149
Q

Boundary Violations are defined as ⬜

How are they managed? -3

A

serious transgressions against physician safety and/or well-being (such as unwanted touching)
_________________
1st: reinforce hospital code of conduct with patient

2nd: REASSIGN PHYSICIAN
3rd: document alert in patient’s chart

150
Q

What is Recall bias?

A

inaccurate recall of past exposure by participants ➜ MISCLASSIFICATION OF EXPOSURE (applies mostly to case control studies)

_________________

individuals with dz are more likely to search their memories for (possibly inappropriate) association between an exposure and their dz ⼀compared to individuals w/out dz

151
Q

In statistics, what is [Power]?

A

the ability to detect an effect

________________

(depends on sample size = larger sample size ➜ INC power)

152
Q

Describe the central role of each Medicare entity (A, B, C, D)

A

A = [inpatient (includes SNF, Hospice and Home health)]

B= Outpatient

C = (Medicare Advantage) ⼀allows private health care to provide Medicare benefits

D= prescription drugs

153
Q

explain how [chi-square] is related to [significance level α]?

A

[chi-square] determines whether distribution of a categorical variable is different across ≥2 independent groups = p-value

IF

• [chi-square p] ≥ [significance level α] = NO SIGNIFICANT DIFFERENCE between distribution of categorical variable between groups = NOT ENOUGH EVIDENCE TO REJECT NULL HYPOTHESIS = NOT STATISTICALLY SIGNIFICANT

154
Q

When can a Physician reveal PHI about a patient to family members? (3)

A

PCP can share PHI when patient p-C-p

​1. is [present (or otherwise available prior to disclosure)]

  1. has Capacity
  2. gives permission
155
Q

describe [Factorial Study fully crossed Design]

A

study design that utilizes ≥ 2 interventions and all combinations of these interventions

156
Q

In terms of [Correlation Coefficient ( r )], the null is ⬜. Why is this?

_________________

How is this related to Confidence Interval? (3)

A

[null = r = 0] ⼀since this indicates no linear relationship _________________

  • a CI for r is statistically significant if it EXcludes 0
  • CI of a r indicates, with a certain confidence level, whether r is significantly different from its [null= r =0]
  • so… if study states [linear relationship between 2 variables ( r )] is significantly different from 0 (i.e. statistically significant | p<0.050) ➜ further illustrated by [CI for that ( r ) must EXclude 0]
157
Q

You have a patient admitted to Hospice

Which 3 groups of drugs should be discontinued?

________________

Why?

A

[CV prevention] / anti-HTN / [PRN Insulin]

________________

meds taken at end of life should be comfort meds only

158
Q

negative likelihood ratio (LR-) represents ⬜ and

positive likelihood ratio (LR+) represents ⬜

________________

What does this mean?

A

[NLR-] = value of a negative test result = [(1-N) / P]

[PLR+] = value of a positive test result = [N / (1-P)]

________________

LR varies from 0 to infinity. [⇪LR = ⇪ likelihood disease is actually absent/present]

159
Q

In research, what is a Case Series?

A

purely observational study in which small group of patients with [similar dx or similar tx] is described [at one point in time] or [over period of time/followed].

There is no comparison group

160
Q
A
Standard Deviation Curve - normal distribution
161
Q

Sensitivity

Formula(2) & meaning

A
162
Q

Explain How:

to determine 95% Confidence Interval

for the difference in percentage of patients who achieved primary efficacy endpoint between Drug X and Drug Y? (4)

A

Confidence interval contain [sample value (∆ between 2 sample percentages) at the center of the interval] = [sample value +/- margin of error]

1st: determine sample value [(Drug X 74.0%) - (Drug Y 85.4%) = (-11.4%)]
2nd: determine if [p < 0.001] –(if yes)-> significantly different from 0 and excludes 0 = CI% will also not include 0
3rd: Find range that does not include 0 and has [sample value -11.4%] its the center =

(-13.9% to -8.9%)

163
Q

Between assigning team roles with redundancy vs specific team roles, which is preferred and why?
_________________

A

SPECIFIC;

task overlap between team members may ➜ duplication errors! [Ideal = clear specific roles with continuous refinement of clinical processes via quality improvement and by tracking outcomes]

164
Q

What kind of study should be used to investigate an

acute infectious disease OUTBREAK?

A

Case-Control Study

________________

allows quick localization of outbreak source

165
Q

Explain how Confidence Intervals work? (4)

A

Confidence interval contain the [sample value (∆ between 2 sample percentages) at center of the interval] = [sample value +/- margin of error]

_________________

when comparing ≥2 groups (i.e. treatment 1 vs treatment 2), if their Confidence Intervals DO NOT overlap = There is a Statistically Significant Difference ✔︎ between those 2 groups ​
_________________

when comparing 1 group to placebo, if that groups’ Confidence Interval DO NOT contain the null value (0) = Overall Statistically Significant ​
_________________

If 2 groups’ CI overlap = there may or may not be a statistically significant difference between those 2 groups

166
Q

Between Median and Mean, which is a better measure of central tendency in strongly skewed distributions?

A

MEDIAN

167
Q

How do you calculate ARR?

A

[ARR= (riskPLACEBO - riskTreatment)]

168
Q

How do you calculate RRR? (2)

A

RRR=

[ARR/riskCTRL]

–or–

[(riskCTRL - riskTreatment)/riskCTRL)]

_________________

[ARR: Absolute| RRR: Relative _ Risk Reduction]

169
Q

How do you calculate NNT? (2)

A

[ARR= (riskCTRL - riskTreatment)]

[RRR = ARR/riskCTRL ]

  • [ARR: Absolute| RRR: Relative _ Risk Reduction]*
    • *

NNT = [1 / ARR] = {1 / [(failure ratePLACEBO) - (failure rateTX)]}

170
Q

Describe the major difference between Confounding bias and [Effect modification interaction bias]

A

[extraneous (3rd) variable] that’s associated with both the [independent exposure] and the [dependent outcome] ____x____ the effect the [independent exposure] has on [dependent outcome]

C: [CONFOUNDS(obscures)]

E: [MODIFIES direction & strength]

  • Separate stratified analysis should be conducted for EACH level of an Effect modifier*
171
Q

A good ⬜ test will have high Specificity

How is Specificity related to PPV?

A

PCD ; [⇪ sP = ⇪ PPV]

_________________

[⇪ sP = ⇪ PPV = ⬇︎FP]

PCD = [Proof/Confirmatory or Diagnostic]

172
Q

What does [ARP - Attributable Risk Percent] measure? (2)
_________________

formula?

A

In a [group with an outcome], the percentage of that group that can attribute that outcome to a specific exposure
_________________

ARP = [(RiskEXPOSED - Risknonexposed) / RiskEXPOSED] x 100

_________________

Risk = Risk of getting outcome

173
Q

[T or F]

Referrals to Specialist physician (from a referring physician who know the Specialist physician personally) is generally considered unethical

A

FALSE

  • referrals to specialist, even if personally known to the referring physician, is OK as long as it is medically indicated and there’s no financial compensation exchanged for said referral*
174
Q

What does [PARP - Population Attributable Risk Percent] measure?
_________________

formula?

A

estimates proportion of the [population with disease] that actually acquired that disease from the exposure
_________________

PARP = [{(Prevalence) x (RR-1)}] / [{(Prevalence) x (RR-1)} + 1]

175
Q

the [chi square test] and the [Fisher’s exact test] evaluate ⬜

_________________

What is the primary difference?

A

association between [2 categorical (quaLitative) variables] (i.e. study evaluating association between sex and [Y/N presence of MI])

_________________

FET is commonly used to analyze 2x2 contingency tables when the sample sizes are small

176
Q

In most states, if there is no [advance directive (i.e. DPOA)], default surrogates are prioritized via “Surrogate” hierarchy.

Recite the [Surrogate Hierarchy] (8)

_________________

DPOA: Durable Power Of Attorney

A

**P-C-P-A-P-AAU**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. **P**t designated
2. **C**ourt appointed<sup>*(only occurs if multiple surrogates disagree, none is designated or surrogate acting in self interest)*</sup>
3. **P**artner/Spouse
4. **A**dult children
5. **P**arents
6. **A**dult siblings
7. **A**dult relatives*other*
8. **U**nrelated friends

## Footnote

<sub>*✏️Court-appointed guardianship only occurs if multiple surrogates cannot agree, no healthcare surrogate is identified, or surrogate is clearly acting in his/her own self-interest*</sub>

177
Q

What are the guidelines regarding [Reproductive Sterilization]? (2)

A

THE PATIENT THEMSELF has to freely consent to [reproductive sterilization] on their own

▶ legal guardians/appointed health care decision-makers CAN NOT consent on patient’s behalf for [reproductive sterilization]

Involuntary sterilization (especially in retarded patients) is unethical

178
Q

highly Sensitive test are useful for test [⬜ (screening | confirmation)]

A

screeNing

_________________

seNsitivity= [true Positive] = [TP / (TP + FN)] = used for test screeNing

= “a test’s probability (in the presence of disease) a patient test positive”

179
Q

Length-time bias

A

Since [slow progressive benign cases] outlive [rapid progressive malignant cases], Length-time bias occurs when a test only ends up detecting those [slow progressive benign cases (which naturally have better prognosis)] ➜ false appearance that the test actually INC survival benefits
_________________

survival benefits of a screening test are overstated due to detection of a disproportionately higher # of [slowly progressive benign cases]

180
Q

A good ⬜ test will have high Specificity

How is Specificity related to False Positives?

A

PCD ; [⇪ sP = ⬇︎False Positives] ⼀which is why good Confirmatory test have HIGH sPecificity

_________________

[⇪ sP = ⇪ PPV = ⬇︎FP]

PCD = [Proof/Confirmatory or Diagnostic]

181
Q

Define [p-value] and its relation to Null hypothesis

A

[p-value] = Chance that study results happened randomly

[(At CI 95%) [p-value] < 0.05] means you can Reject Null hypothesis since it means there’s lil chance the results happened randomly

182
Q

what does Odds ratio indicate?
_________________

if H Pylori infection has [OR=0.351] in a study for stomach bleeding. what does that indicate?​

A

[exposure has lower ODDS of causing Outcome] ⬅︎ [OR 1.0] ➜ [exposure has HIGHER ODDS of causing Outcome]

if (OR = 1) = exposure NOT ASSOCIATED with Outcome
_________________

[1.0 - (0.351)] = (0.649) = 64.9% = [[exposure (HPylori+)] has 64.9% lower ODDS of causing [Outcome (stomach bleeding)] …as compared to [non-exposure(HP-)]

183
Q

What are the components of [Root Cause Analysis]? -5

A

DCRSA

  1. Data Collection
  2. [Causal Factor flow chart] (main steps leading up to event that, if eliminated, could have prevented or reduce adverse event)
  3. Root Cause (reason behind each causal factor)
  4. Solutions recommended (for each root cause)
  5. Assessment (assess success of Recommendations)
184
Q

What does overlapping [Standard Error of Measurement bars] indicate?

A

Non-Statistically significant difference between the two data sets being compared

185
Q

What kind of test are best to rule out a diagnosis? (2)

A

SnNOut

Sensitivity HIGH + Negative test result = rules Out a disease

186
Q

[T or F]

Referrals that result in financial gain (gifts, kickbacks, fee-splitting) for the referring physician are illegal

A

TRUE

  • Physician Referrals resulting in financial gain for that Physician are generally illegal and/or unethical* .
  • Routine referrals should only be made to facilities with evidence-based & medically-indicated care*
187
Q

Define__X__ (2)| What’s the Formula?

[(NPV) Negative Predictive Value]

A

NPV= [TN / (TN + FN)] = probability (in the presence of a Negative test result) a patient DOES NOT actually have the disease = ability of test to accurately predict Negative test result_

How much can we trust this test?

188
Q

A physician (⬜ can | cannot) unilterally terminate a patient solely for nonpayment

_________________

When is a physician considered “abandoning” a patient? -2

A

CAN
_________________

Abandoning Patient if:

  1. Patient terminated whilst in immediate medical need
  2. Patient NOT given reasonable time to find alternate provider
189
Q

[T or F] Pt confidentiality shuld be maintained even when a pt is having Active suicidal ideation

A

FALLLSEE!!!!

Active (i.e. plans to hang themself) suicidal or homocideal ideation warrants breaking confidentiality and informing parents or whomever

190
Q

What is Verification bias?

A

using gold standard testing to verify/confirm results of a preliminary test (which ➜ over/underestimation of seNsitivity or sPecificity)

191
Q

Asymmetry in a funnel plot suggest ⬜ bias

A

publication

192
Q

Standardized Mortality Ratio

Explain the overall takeaway

A

SMR of 1.75 = “observed # of deaths (in this population of interest) is 75% higher than expected”

193
Q

In the terms of [dose response relationship]

An association between a risk factor and a disease is more likely to be causative if what?

A

If the [disease strength] increases as [risk factor exposure level] increases = dose response relationship = likely causative

{although this is not necessary to infer causation}

194
Q

Describe the Approach to a patient who’s resistant to disclosing genetic test results with relatives also at risk? -2

A

[acknowledge their resistance] + [open ended questioning/motivational interviewing]

________________

“You have reasons for not wanting to contact your brother; what are some possible benefits of sharing the results?”

195
Q

How do you describe a survival analysis study, in which although [80% control group died] and [80% of treatment group died] also, investigators still reported treatment was more effective than the control?

A

investigators must have analyzed [TIME-TO-EVENT/DEATH] data instead and saw that, although both groups had 80% die ultimately, the treatment group must have had longer [TIME-TO-DEATH] = Treatment group lived longer = Treatment overall more effective

[TIME-TO-EVENT/DEATH] often used in survival analysis

196
Q

Describe the current recommendations regarding Sex between a physician and patient

A

UNETHICAL PROFESSIONAL MISCONDUCT
_________________

SEX/ROMANANCE between physician and [patient (current OR former✳)] is UNETHICAL PROFESSIONAL MISCONDUCT

✳ = if MD exploits pre-existing knowledge

197
Q

What is the majority recommendation for Romantic or Sexual relationships between Physicians and current Patients?

________________

what about former patients?

A

current patient = UNETHICAL 100%

________________

former patient = Unethical if MD exploits knowledge or influence derived from previous professional relationship

198
Q

Define__X__ | What’s the Formula?

[(PPV) Positive Predictive Value]

A

PPV = [TP/ (TP+FP)] = probability (in the presence of a Positive test result) the patient actually has the disease = ability of test to accurately predict Positive test results_

________________

PPV = ability of test to accurately predict Positive test results

How much can we trust this test?

sPecificity seNsitivity contingency table (PNct)
199
Q

Odds Ratio

formula

A

[(aD) / (bc)]

[(DISEASEOOE)/ (controlOOE)]
_________________
• OOE = Odds of Exposure
• first draw contingency table | • [(OR >1) indicates there IS an association between a DISEASE and the [exposure or risk factor] in question

contingency table (odds ratio)
200
Q

What type of Nonnormal distribution is this?
_________________
How does it affect Mean, Median and Mode?

A

POSITIVE skew

( “it’s skewing away from the POSITIVE direction = POSITIVE SKEW)

mea(N) > med(i)an > m(O)de