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Behavioral Science Flashcards

1
Q

What are types of observational studies?

A

1) Cross sectional
2) Case controlled
3) Cohort
4) Twin Concordance
5) Adoption

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2
Q

What is cross sectional study?

A

1) Collects data from groups to assess frequency of disease

2) Measures prevalence

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3
Q

What is case controlled study?

A

1) Compares group of people with a disease, to those without a disease
2) Will have an odds ratio

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4
Q

What is a cohort study?

A

1) Compares group with the exposure, compared to those without (see if exposure will affect the liklihood of disease)
2) Can be prospective or retrospective

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5
Q

What is a twin concordance study?

A

1) Frequency that monozygotic twins get same disease

2) Heritability, and influencd of the envrionment

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6
Q

What is adoption study?

A

1) Mesures heritability and influance of environmental factors.

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7
Q

What are the phases of clinical trials, and what is purpose?

A

Phase 1: Small healthy individuals (is it safe)
Phase 2: Small number of patients with diease (does it work, dose, and adverse effect)
Phase 3: Large number of patients assigned to treatment or best available treatment (is it good or better)
Phase 4: Postmarketing surveillence after approval (can it stay, detect long-term adverse effects.

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8
Q 
How to evaluate the diagnostic tests? 
How to calculate sensitivity?
How to calculate specificity?
Positive predictive value? 
Negative predictive value?
A

2 x 2 table

            Disease Test             +                     -

+ TP FP

  • FN TN

Sensitivty TP/ (TP+FN) (proportion of sick people who are identified as such)
Specificity TN/(TN+FP) (healthy people correctly identified as not having the disease)

Positive predicitve (number of positive tests, with patients have the disease) TP/ (TP+ FP)

Negative predictive (number of negative tests, with patients without diease (TN/ (TN+FN)

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9
Q

What does high sensitivity mean?

A

High sensitive tests, means when negative, then rules out

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10
Q

What does high specificity mean?

A

High specificity, when the test is positive, diease is ruled in.

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11
Q

what affects the PPV?

A

The prevalence of the disease

If have high prevalence, have high pretest probability, and high PPV

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12
Q

What affects the NPV?

A

If have high pretest probability, then have low NPV

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13
Q

What is the incidence?

What is the prevalence?

A

Incidence: Number of new cases/ number of people at risk

Prevalence: Number of existing cases/total number of people

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14
Q

What is the effect of prevalance and incidence depending on the disease?

A

Prevalence and incidence approximately equal when short duration of disease.

Prevalence > incidence when have chronic disease

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15
Q

What are ways of quantifying risk?

A

1) Odds ratio
2) Relative risk
3) Attibutable risk
4) Relative risk reduction
5) Absolute risk reduction
6) Numbers needed to treat
7) Numbers needed to harm

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16
Q

What is the table to quantify risk?

A

Disease
+ -
Risk of intervention

+ a b

  • c d
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17
Q

What is odds ratio?

A

Case controlled studies

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18
Q

What is relative risk?

A

Cohort studies (risk of developing disease if exposed or not)

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19
Q

What is attributable risk?

A

The difference in risk between the exposed and unexposed group

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20
Q

What is relative risk reduction?

A

Risk reduction due to an intervention

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21
Q

Absolute risk reduction?

A

The difference attributable to an intervention (controlled study)

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22
Q

What is number needed to treat?

A

Number of patients treated for 1 patient to benefit

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23
Q

What is the number needed to harm?

A

Number of patients that need to be exposed to a risk factor for 1 patient to be harmed.

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24
Q

What is precision?

A

Consistency and reproducible of a test

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25
How does precision affect random error? How does it effect standard deviation? How does it affect statistical power?
Decrease random error Decreases standard deviation Increases statistical power
26
What is the accuracy of the test?
The trueness of the measurement
27
What does systemic error do to accuracy of test?
decreases
28
What are types of selection bias?
Berkson bias: study population from hospital is less healthy Healthy worker population effect: study population is healthier then normal population Non response bias: participating subjects differ from non respondants
29
How to prevent selection bias?
Randomization
30
What is recall bias?
Patients with disease more likely to remember exposure
31
Measurement bias?
Association between the disease and the exposure not seen in non-standardized tests
32
What is procedure bias?
Subjects in different groups not treated the same
33
what is observer-expectancy bias?
Reasercher believes in the treatment
34
What is confounding bias?
Factor related to exposure and outcome, but not causal
35
How to reduce the confounding bias?
1) Mutliple studies 2) Crossover studies 3) Matching 4) Restriction 5) Randomization
36
How to reduce recall bias?
Decrease time from exposure to followup
37
What is a lead time bias?
Early detection, confused with increased survival | survival has not increased, earlier detection
38
What are measures of central tendency?
Mean: sum of values/total number of values Median: Middle value when sorted from least to greatest Mode: The most common value
39
Which is measure of central tendency is most affected by outliers?
Mean
40
What is less affected by outliers?
Mode
41
What is the stadard deviation?
How much variability exists from the mean in set of values
42
What is the standard error of the mean?
estimate of how much variability exists between sample mean and the true population mean
43
what happens to the standard error mean when the n increases?
The n will decrease
44
How to calculate the variance?
(SD) (SD)
45
What happens to mean/mode/median if bell shaped, or Gaussian distribution?
Mean=median=mode
46
what are the numbers on the bell shaped curve for standard deviation?
- 1 to + 1 (omega after each) (68%) - 2 to + 2 (95%) - 3 to +3 (99.7%)
47
What are the non-normal distributions?
Bimodal Positive skew Negative skew
48
What does a bimodal distribution suggest?
Two different populations
49
what does a positive skew mean?
mean > median > mode (peak is toward the negative side?)
50
What does the negative skew mean?
Mean
51
What is the null hypothesis? (H0)
No difference
52
What is the alternative hypothesis? (H1)
There is a difference between the relationship
53
What is the table for the H1 and the H0? | What is an alpha error?
H1 H0 H1 Power (1-B) alpha (type 1 error) ``` H1 Beta (type 2 error) Correct ``` 1) Alpha type 1 error: finding a difference, but there is none (alpha) 2) Beta type 2: finding no difference, but there is one (1-beta)
54
How can you increase the power, and decrease the Beta?
1) Increase the sample size 2) Increase the expected effect size 3) Increase the precision of the measurement
55
How to interpret the confidence interval?
1) If the two confidence intervals do not overlap, there is a statistically significant difference 2) If they overlap, there is no significant difference 3) If CI includes 0, there is no significant difference 4) If CI for odds ratio includes 1, there is no difference
56
When to use t-test? When to use ANOVA? When to use Chi-Square?
1) Mean between 2 groups 2) Between 3 or more groups 3) X 2 (two or more groups, categorical data)
57
What is a Pearson coefficient?
1) r is between -1 and 1 2) The close the variable to 1, the stronger the correlation 3) Postitive r value (as one variable increases, so does the other one) 4) Negative r value (as one variable increases, the other decreases)
58
``` What are core ethics? Autonomy Beneficence Nonmaleficence Justice ```
1) Autonomy: honor the patient preferences 2) Beneficence: Act in patient's best interest (may conflict with autonomy or what is best for society) 3) Nonmaleficence: Do no harm 4) Justice: treat person fairly and equitably.
59
What are necessary for informed consent?
1) Disclosure 2) Understanding 3) Capacity 4) Voluntary
60
When can informed consent be bypassed?
1) Patient not competent 2) Implied in emergency 3) Therapeutic privlege (with holding information because it would harm patient or undermine decision making capabilities 4) Waiver: the patient explicitly waivers the need for consetn
61
When is parental consent needed? when is it not needed?
1) everything, unless it's an emergency 2) Not required for sex (pregnancy/contraception) 3) Drugs (substance abuse) 4) Emergency (trauma)
62
How to know if a patient is capable of making a decision?
1) More then 18 years old 2) Can make and communicate the choice 3) Is informed (knows and understands) 4) Decision remains stable over time 5) Decisions is consistant with patient's values and goals, and not clouded by mood disorder) 6) Not a result of altered mental status
63
What is an advanced directive?
Instruction given by patient in need of medical decision
64
When is an oral advance directive used?
NO written, then go on statements of the past | If consistent and repeated to many people, this is better.
65
What is a living will?
Describes the patient wishes, and does not wish to recieve (can with-hold life sustaining treatment)
66
What is a medical power of attorney?
Patient designates an agent to make a medical decision Can depend on clinical situation Can be revoked if the patient regains capacity
67
What is a surrogate decision maker?
Those that know the patient makes the decision: spouse > adult children> parents> adult siblings > other relatives
68
What are exceptions to confidentiality?
1) Potential serious harm to one self or others 2) reportable disease 9STI, TB, hep, food poisoning) 3) Child and elder abuse 4) Impaired automobile driving (epileptics) 5) Suicidal/homocidal
69
What are developemental milestones (0-12)?
``` Parents Primtive reflex ( Moro 3 months), rooting (4 months), palmer (6 months), Babinski (12 months( ``` Posture: lifts head by 1 month, rolls and sits 6 months, crawl by 8 months), stands (10 months), (12-18 months walks) Picks: passes toys hand to hand by 6 months Points to objects by 12 months START: Social: smile by 2 months Stranger anxiety (6 months) Separation anxiety (9 months) OBSERVING: Orients: first to voice at 4 months Object permanence (by 9 months) Oratory : says mama and dada by 10 months
70
What are developmental milestones (12-36)
``` CHILD Cruises : takes first steps bu 12 months Climbs: stairs at 18 months Cubes stacked: number=age Cultured: feeds self with fork and spoon Kicks ball: by 24 months of age ``` REARING: Recreation: parallel play (24-36 months) Rapproachement (moves away at returns to mother at 2 years) Realization (Core gender identity by 36 months) WORKING Words: 200 by age 2, and 2 word sentences
71
What are preschool (3-5 years old) milestones?
DON'T Drive: tricycle, 3 wheels at 3 years old Drawings: copies line, circle, or stick figure (at 4 years old) Dexterity hops on one foot (4 years old), uses buttons or zippers FORGET THEY'RE STILL L Freedom: comfortably spends part of the day away from mother Friends: Cooperative play with imaginary friends by 4 years old LEARNING: Language: 1000 words by 3 years old Legends: Can tell stories by 4 years old
72
What are sexual changes in elderly men?
1) slower erection and ejaculation, longer refractory period | 2) Libido is the same
73
what are sexual changes in women as they age?
1) Vaginal shortening, thinning, and drynesss | 2) Lower sex drive
74
What happens to elderly with regards to sleep?
1) decrease the REM and slow-wave sleep | 2) Increase sleep latency, increase early awakening
75
What happens to the suicide rate?
1) Increases suicide rate
76
What are physiologic changes?
1) Decrease muscle mass 2) Decrease hearing, immune response, bladder control 3) Decrease renal, pulmonary and GI function 4) Decrease muscle mass 5) Increase fat
77
What is presbycusis?
Sensineural hearing loss (higher frequencies) due to destruction of hair cells at the cochlear ear base
78
What are the stages of disease prevention?
1) Primary: vaccines 2) Secondary Screen early and manage existing asymptomatic 3) Tertiary: Treatment to reduce complications from disease 4) Quaternary: identifying patients at risk of unnecessary treatment, and protecting from harm of new interventions
79
What is medicaid and medicare?
Medicare (federal): > 65 years old,or
80
What are the 4 components of medicare?
1) Hospital bill 2) Basic medical bills (doctor fees and testing) 3) 1 and 2 are by approved private companies 4) Perscription drugs
81
what are most common cause of death
1) Congential malformations 2) Premature 3) SIDS
82
what are causes of death 1-14 years old?
1) Unintentional 2) Cancer 3) Congenital malformations
83
What is cause of death 15-34?
1) Unintentional 2) Suicide 3) Homocide
84
what most common death 34-44?
1) Unintentional 2) Cancer 3) Heart Disease
85
Cause of death 45-65?
1) Cancer 2) Heart disease 3) Injury
86
Cause of death > 65?
1) Heart disease 2) Cancer 3) COPD
87
Most common readmission?
Medicare Medicaid Private Uninsured CHF Mood disorder Chemo Mood
88
What is safety culture?
Organization environment where everyone can bring up safety concerns without censure
89
What is human factor design?
forcing functions (those that prevent undesirable actions) Standardization (clincal pathways) Simplifications (reduce wasteful activities) Deficient designs (hinder workflow and lead to staff workarounds)
90
What is the PDSA cycle?
Plan: define problem and solution Do: test new process Study: measure and analyze data Act: integrate new process into regular workflow
91
What are possible Quality measurements?
1) Outcome: impact on patients 2) Process: performance of system as planned 3) Balancing: Impact on other systems or outcomes
92
what is the swiss cheese model?
1) Complex system, flaws in multiple process and systems may align to cause patient harm. 2) Focus on systems and conditions rather then individual error
93
What are the types of error?
1) Active error (at the front lines of operator) wrong IV pump dose programed (immediate impact) 2) Latent error (indirect from the operator but impacts patient care: different types of IV pumps within a hospital (accident waiting to happen)
94
what are the two ways of medical error analysis?
1) Root cause analysis (retrospective after failure, look at records and interviews) 2) Failure mode and effects analysis : inductive reasoning to identify all the ways a process might fail and prioritize

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