Behavioral Science Flashcards
Case Control Study
- Retrospective observational study
- Looks at patients who have been diagnosed with a disease and then looks back at a risk factor that may have cause it.
- Most likely is an odds ratio (AD/BC) ratio diseased with/without risk factor over ratio not diseased with/not diseased without
- Patients who have COPD are selected and then asked about their smoking history
Cohort
- Finds two groups of people with certain characteristics or features and compares their liklihood of getting a specific disease
- Risk Ratio (A/A+B)/(C/C+D)
- Takes patients who smoke and look back to see if they have an increased risk of having COPD
Cross Sectional
- Looks at a population at A SINGLE POINT IN TIME to get disease prevalence
- Most associated with prevalence
- Can’t establish causality
Stages of Clinical Trial
1-small group of health volunteers
2 - small group of diseased
3 - large group of diseased
4 - post market surveilance
Sensitivity
TP/TP+FN
-Used to rule out a disease (picks up the most true positives)
Specificity
TN/TN+FP
-Used to rule in a disease (Picks out all the people who tested positive who actually have the disease)
PPV
TP/TP+FP
-The liklihood that given a positive test, the patient will actually have the disease
NPV
TN/TN+FN
-The liklihood that given a negative test result the patient will really not have the disease
Incidence
- The number of patients diagnosed with a disease over a specific time / The susceptible population
- Patients who are currently diagnosed or who are dead do not count as the susceptible population
Prevalene
-The proportion of people who currently have the disease over the total population
Odds ratio
- Descibes the ratio of disesed exposed to the risk factor over the non diseased exposed to the risk factor
- (a/c)/(b/d) = AD/BC
Relative Risk
- Describes the liklihood the role that a risk factor may play in the disease
- (a/a+b)/(c/c+d)
Attributable Risk
(a/a+b)-(c/c+d)
- When it is used to show how a treatment improves survival it is called number needed to treat
- When it is used to describe how a risk factor might increase the liklhood of disease is it number needed to harm
Selection Bias
-Not selecting right patients, berkson is a part
Berkson’s Bias
-Some patients are lost to follow up and thus interfere with interpretation
Lead Time
-Earlier Diagnosis does not mean improved survival
Hawthorne
-Patients will change their behavior when they know they are being studied.
Standard Error of Mean
SD/(sqrt(n))
-Used to calculate confidence intervals
Positive Skew
Mean is greater than the median.
-The tail will be in the positive direction
Negative Skew
Mean is less than the median
-Tail will be in negative direction
Standard Deviation and SEM
- Standard deviation is not the same as SEM
- SEM is used to report confidence intervals and is standard deviation over the sqrt(n)
Type I Error
- Alpha or false positive rates
- The liklihood that the study reject the null hypothesis, or comes to a positive conclusion when in fact one does not exist.
- Measured by alpha which is often a p value (SEM) or CI which is SEM
Type 2 error
- False negative rate. If the study is too small, it is possible that a true conclusion will be missed
- Measured with beta
- Power is 1-beta. Higher the number, the higher the power, the lower the beta.
T Test
-Used to compare two quantatitve variables
ANOVA
-Used to compare more than 2 quantatative variables
Chi Squared
-Used to compare 2 categorical variables
Primary Disease Prevention
-Vaccination
Secondary Disease Prevention
-Early Detections
Tertiery Disease PRevention
-Miimize disability associated with disease
Medicare
-Federal programs to help older patients (65), those with end stage renal disease, and certain disabilities
Medicaid
-State and federal program to care for lower income people
Autonomy
-Patient can decide
Beneficence
-Fiduciary obligation of physician (can compete with autonomy)
Nonmaleficence
-Don’t do harm (Don’t give bad procedures or medications)
Justice
a
Informed Consent
- Intelligent person, not coerced, given both sides,
- Patient can give waiver
Implied Consent
-In emergent situation it can be assumed
Minors
- Parental consent is foundation unless
- STD, Pregnancy, OCP, Emergency, Drug addiction
Oral Advance Directive
- If patient repeatadley stated what he wanted for a long time orally when in clear mind
- Can vary by state
Living Will
- Written document
- Patient who is in clear mind can revoke at any time
Living Power of Attorney
- More powerful than living will
- Informed patient can revoke at any time
Surrogates
Spouse > Adult Children > Parents > Adult Siblings > Other relatives
Confidentiality
- Keep it except in
- STD, Hepatities, Food Poisoning, TB (population at risk)
- Tarrasoff (tell someone if patient is going to harm them)
- Imparied drivers
- Suicidal/Homicidal patients
- Child and elder abuse (Separate and report)
APGAR
Appearance, Pulse, Grimmace, Activity, Respirations
-Normally less than 4 is pathologic
Low Birth Weight
- Less than 2500g
- Usually associated with IUGR and prematuritiy
- Increased risk of enterocolitis intraventricular hemorrhage, SIDS, mortality
Heroine Baby
- Has increased crying and increased startle response
- May have diahrrea, rhinorhea etc
- Treat with tinciture of opium
Cocaine
- May be delivered premature and carry those risks
- IUGR is also common
Smoking
-IUGR increased risk of premature rupture of membranes and prematurity
FAS
- Most common cuase of retardation
- Microcephaly and characteristic facial features
- VSD or ASD incresed
3 Month
-Social smile, responds to voice
7-9 months
-Sitting up, crawling, stranger anxiety
12-15 months
- Can stand and say a few words
- Separation anxiety
12-24 months
-can stack blocks and walk
3 years
toilet trained
Four
Zippers and Buttons
Elderly
Decrease REM increase latacency and awakenings
Normal Grief
-May have somatic symptoms and may last up to a year. Illusions are normal
Pathologic Grief
- Delayed or suppressed grief
- Intense grief with intense somatic signs
Childhood Illness
-Don’t tell kid everthing, ask child what he knows and ask parents what he can know
Abortions
Require notifying parents unless emancipated
Awake and Sleep Waves
Awake is high frequency and low amplitude
- Nonrem sleep is low frequency and high amplitutude
- REM sleep looks like awake where there is high frequency and low amplitude
REM Sleep
- Primarily Ach is released and NE is reduced
- Alcohol, Benzos, Barbs will decrease REM sleep
- Can be used as treatment for sleep walking
Depression
-Reduction in NE release leads to an increase in REM sleep
Narcolepsy
- Excessive daytime sleepiness, differentiate from OSA
- Patients will have hallucinations before and after sleep, will go straight to REM sleep often resulting in cataplexy
- Tx: Modafanil, amphetamines, GHB
Circadian Ryhtms
- Originate in suprachiasmatic nucleus
- Regulation of NE, Ach, Melatonin, ACTH, PRL
- SANS go to pineal gland through NE cause the release of melatonin
Sleep Terror
- Non REM
- Nightmare REM
