Behavioral Science Flashcards
Phase 1 clinical trial
Assesses safety and toxicity
Type of study that measures odds ratio? Type of study that measures relative risk?
Case-control vs cohort
Phase 2 clinical trial
Efficacy and dosing and adverse effects
Incidence rate multiplied by the average disease duration is an estimate of?
Prevalence
Odds ratio?
(a/c) / (b/d)
Sensitivity
TP/(TP+FN)
Specificity
TN/(TN+FP)
PPV
TP/(TP+FP)
NPV
TN/(FN+TN)
Relative Risk?
a/(a+b) / c/(c+d)
Attributable Risk?
a/(a+b) - c/(c+d)
Absolute risk reduction
a/(a+b) - c/(c+d)
Number needed to treat?
1/absolute risk
Number needed to harm?
1/attributable risk
Selection bias
Nonrandom assignment to participation in the study group
Recall bias. Seen what type of studies
Knowledge of the presence of the disorder alters recall by subjects. A worry in retrospective studies
Late look bias
Information gathered at an inappropriate time
Procedure bias
Subjects in different groups are not Treated the same
Confounding bias
Occurs when one factor is related to both exposure and outcome but is not on the cost of pathway
Lead-time bias
Early detection confused with increased survival
Observer expectancy effect
Occurs when researchers believe in the efficacy of the treatment changes the outcome
Hawthorne effect
When the grouping study changes behavior when they know they’re being studied
1, 2, 3 SDs
68, 95, 99
Positive skew versus negative skew
Mean>median>mode
Null hypothesis
There is no association between the disease and the Risk factor
Type one error. Value?
Stating there is an effect when there’s none. Alpha
Type II error. Value?
Stating that there is no effect when there is. Beta.
Power. Increases with?
1-beta. Probability of rejecting null hypothesis when it is in fact faults. Increases with sample size, expected effect size and precision of measurement
If confidence interval includes this, Ho is not rejected. If odds ratio relative risk includes this Ho is not rejected
0, 1
T-test vs ANOVA Vs chi-squared test
Measures difference of Means of two groups
Measures difference of Means of three or more groups
Measures difference between two or more percentages or proportions
Primary secondary and tertiary disease prevention
Prevent disease occurrence, detect disease early, reduce disability
Non-malficence
Do no harm
When is consent not needed for minors
Emergencies, contraceptives, STD, pregnancy, treatment of drug addiction
When is it okay to break confidentiality?
Reportable diseases, child abuse, Elder abuse, driving while impaired, suicidal ideation
Patient is not adherent
Ask why
Patient wants an unnecessary procedure
Ask why
Patient has difficulty taking medications
Provide written instructions, attempt to simplify treatment regimens and asked patients repeat medication regimen back to physician
Family members ask for information
Avoid telling them
A child wishes tomorrow know more about their illness
Ask them what the parents have told them
A minor wants an abortion
Most states require parental notification or consent
A 15-year-old pregnant female wants to keep the child. Parents want to give up the child.
Patient retains right to make decisions regarding the child. Provide information about practical issues if child care
Terminally ill patient requests physician assistants in ending life
Refuse involvement. You may prescribe analgesics that shorten patient’s life
Patient is suicidal
Ask them to stay in the hospital
Patient find you attractive
Asked direct questions and use a chaperone
Woman feels ugly after mastectomy
Ask why she feels this way
Patient is angry about amount of time he’s been waiting
Acknowledge patients anger and apologize for any inconvenience
Patient is upset the way she’s been treated by another doctor
Suggest the patient speak directly to that physician. If the problem is with the staff member tell the patient you will speak to that individual
The drug company offers a referral fee for every patient enrolled in study
Patients must be told about the existence of a referral fee
Patient requires a treatment not covered by insurance
Discuss all treatment options even if some are not covered
Apgar scores
7+ is good
4-6 need to assist
<4 resuscitate
Low birth weight defined as? Complications?
Less than 2500 g. Infections, respiratory infant distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage.
Birth to three months. Milestones?
Rooting reflex, holds head up, Moro reflex disappears.
Social smile, responds to voice
7-9 month milestones?
Sits alone, crawls, transfers toys from hand to hand
Stranger anxiety, uses gestures, responds to name, plays peekaboo
12-15 mo milestones
Walks, the babinski sign disappears
Separation anxiety, few words
1-2 year milestones
Climb stairs, stacks blocks,
rapproachment (moves away from and then returns to mother)
200 words and two word phrases
2-3 years milestones
Feed self with fork and spoon, kicks ball
Core gender identity, parallel play, toilet training
3 yr milestone
Tricycle, copies line or circle drawings
Can spend part of day away from mother
4 yr milestones
Uses buttons and zippers, brushes teeth, hops on 1 foot, draws stick figures
Imaginary friends
Changes in sexual interest and intelligence in elderly?
None
Changes in sleep patterns in elderly
Decreased REM and slow wave, increased awakenings
Normal grief consists of?
Shock, denial, guilt, and somatic symptoms
Pathologic grief?
Lasting more than six months, delayed grief, inhibited, or denied
May experience depression delusions and hallucinations
Waveform when awake with eyes open
Beta
Waveform when awake with eyes closed
Alpha
Waveform in stage N2 sleep
Sleep spindles and K complexes. 45% of sleep
Waveform in stage N1 sleep
Theta. 5% of sleep
Waveform in stage N3 sleep
Delta
Beta waves verses delta waves?
Highest frequency lowest amplitude
Lowest frequency, highest amplitude
Sleep stage with sleepwalking night terrors and bedwetting
Slow wave sleep. Stage N3
Changes in REM sleep?
Most oxygen using brain, erections, dreaming, loss of motor tone
Neurotransmitter needed to initiate sleep?
5HT
Bedwetting treat with?
DDAVP over imipramine
Effect of alcohol benzodiazepines and barbiturates on sleep,
Reduce REM and Delta sleep
Drugs to use for night terrors and sleepwalking
Benzos
Neurotransmitter in REM sleep. NT that reduces REM sleep
ACh, NE
Aka REM sleep
Desynchronized sleep, paradoxical sleep?
Extra eye movements during REM sleep controlled by
PPRF
Changes in sleep in depression
Decreased slow wave sleep, REM latency
Increased REM early in Sleep Cycle, total REM sleep
Repeated awakenings, early-morning awakening.
Excessive daytime sleepiness, may involve hallucinations, sleep episodes begin with?
Narcolepsy. REM sleep
Loss of muscle tone following a strong emotional stimulus. Tx?
Narcolepsy. Treat with amphetamines modafinil, GHB
Circadian rhythm controlled by?
Suprachiasmatic nucleus of hypothalamus. Controls ACTH, prolactin, melatonin, and nocturnal and NE release.
Melatonin pathway of release?
SCN, NE release, pineal gland, melatonin
If you have a memory of a dream when did it occur?
During REM sleep
Sleep terror disorder occurs during what stage of sleep
Slow wave sleep. No memory.
