Biostats Flashcards
True or false? Any information shared by an adolescent must be kept confidential.
False
Explanation
Exceptions to confidentiality include child abuse, sexual abuse, suicidal ideation/attempt, and homicidal ideation.
What statistical measure helps determine the usefulness of a screening test?
Answer
Positive predictive value
Explanation
The positive predictive value (PPV) of a diagnostic test is the probability of disease in a patient with a positive test. It takes into account both the number of true positives and the number of false positives. This combination reflects prevalence. The formula is:
PPV = True Positives/(True Positives + False Positives) or PPV = TP/(TP + FP)
PPV predicts the percentage of positive tests that will actually be true positives. The closer this number is to 100%, the better the test is.
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The lead physician was concerned about the ages of patients being screened for streptococcal pharyngitis and the process of Streptococcus screening in the office, so he set up a performance improvement project to assess this clinical issue. The team agreed on using the guidelines for Streptococcus screening established by the American Academy of Pediatrics, and data was collected in cycles to assess the age at which testing was performed and clinical symptoms at presentation. The staff completed 3 cycles over a period of 3 months. They then analyzed the data, adjusted their practice standard, and assessed 3 more cycles, which showed lower false-negative rates of group A streptococcal pharyngitis.
This process of data analysis and adjustment over time is best described by what term?
Quality improvement
Explanation
Quality improvement is systematic analysis with actionable change leading to better health outcomes.
At a large medical facility in a major city, registration was taking too long, according to results from patient satisfaction surveys. The staff planned an electronic registration kiosk center to assist in registering less acute patients. They implemented the process and then sought feedback. They found the process to be beneficial, but realized they needed to adjust the process for non-English-speaking patients.
This activity of planning, implementing, observing the results, and acting on or adjusting to the information gathered is an example of what method of quality improvement?
Plan, do, study, act (PDSA)
Explanation
The goal of PDSA is to perform small tests of change, analyze those results, make adjustments if necessary, and then reevaluate. This is the scientific method used for action-oriented learning. When the process is stable and sustainable, it is implemented on a larger scale.
What statistical parameter identifies how well a test rules in those in a population who have a given disease?
Specificity
Explanation
Specificity = TN/(TN + FP) = TN/(# Not Diseased)
Highly specific tests convey with certainty that a positive result means the patient actually has the disease. Specific tests help rule in a disease because the false-positive rate is low. Remember SPIN: SPecific tests help rule IN disease.
What is the main advantage of randomized controlled trials (RCTs)?
Answer
Reduced risk of bias and confounding variables that can occur if patients choose or are assigned a specific treatment group
Explanation
In RCTs, the researcher assigns a single group of patients randomly into different study groups—an intervention vs. a control—in order to determine which treatment is better. This, in theory, will avoid confounding variables, as the 2 groups will be equal in characteristics that may affect the outcome. RCTs are the gold standard of testing for new medical interventions.
Autonomy is the framework for ethical reasoning in adults. What framework is used in most pediatric cases?
Beneficence
Explanation
Beneficence is the obligation of the practitioner to act in the best interest of the patient. Many factors must be taken into account, including the patient’s developmental capacity, the benefits/risks associated with the treatment, and input from the parents.
A 12-year-old patient was wheeled into the operating room (OR) to begin the time out process for his procedure. The surgeon was not yet in the room when the time out was begun by the OR coordinator. The scrub technician spoke up, advising the team to pause until the surgeon arrived. When the surgeon came in and the time out was restarted, the team realized this patient was mistaken for another who had a similar name. Due to this near-miss, the OR team instituted a 2-step process whereby patients are identified for surgery by the OR team while in preoperation first and then again upon transfer to the designated operating suite.
What is the importance of assessment and redesign of health care processes in either inpatient or outpatient facilities?
Avoid medical error and maintain the safety of patients
Explanation
Instituting processes in health care delivery and redesigning care practice to improve health outcomes can reduce the unnecessary harm that occurs yearly in health care settings. Failure modes and effects analysis (FMEA) is a process improvement tool used to identify how a process might fail and what the impact of that failure will be. FMEA is a proactive way to diagnose parts of a new or existing process that needs revision before a bad outcome occurs. The hope is to prevent a sentinel event before it happens.
What are the 2 common errors that statistical analyses attempt to prevent?
Type 1 errors and Type 2 errors
Explanation
Type 1 error = concluding there is a difference between groups or outcomes when there is not (i.e., rejecting the null hypothesis when the null hypothesis is actually true). Type 1 errors are exposed by investigating the p value (statistical significance).
Type 2 error = concluding there is no difference between groups or outcomes when one actually exists (i.e., failing to reject the null hypothesis when it is actually false). Type 2 errors are typically exposed by investigating the power of a study
The nurse manager noticed during her inventory review of vaccines that doses for the combination measles, mumps, rubella, varicella vaccine (MMRV) vs. single-dose varicella + MMR were inaccurate. She noticed the vials for the combination vaccine and the single-dose varicella were color-coded different shades of blue. After review of records, she was able to identify that some patients received single-dose varicella + combination MMRV, hence additional doses of varicella vaccine. She also interviewed parents to look for symptoms that could be related to overvaccination and reported those cases to the Vaccine Adverse Event Reporting System registry. To prevent future errors, she changed the color coding for these 2 immunizations to make them noticeably different and gave further training to the staff. Another chart review a month later revealed a significant decrease in vaccine error.
What analysis method did this nurse use to find the contributing factors that led to this error?
Root-cause analysis
Explanation
Root-cause analysis (RCA) is a structured process used by a team to identify potential causes that led to a serious undesired outcome. RCA is a tool used to analyze circumstances surrounding a serious adverse event (or a near miss that could have had a serious outcome). RCA helps identify how and why a particular error occurred. Each RCA uses a structured method that includes data collection, cause charting, root cause identification, and recommendation generation to determine the sequence of events that resulted in the error. An interdisciplinary team usually conducts the investigation, which often includes chart and policy reviews, as well as participant interviews.
You are consulted to evaluate a child in the intensive care unit for brain death.
How many examinations are required to determine brain death?
2 separate examinations
Explanation
In the U.S., children must undergo 2 separate physical examinations (including apnea testing) before brain death can be declared. The examinations must be separated by an observation period, the length of which depends on the age of the child.
An 8-year-old boy presents to the emergency department with abdominal pain and vomiting. He has no known medication allergies. His physical examination is suggestive of appendicitis, which is confirmed by abdominal ultrasound. Preoperatively, he is given an intravenous dose of cefazolin, a cephalosporin antibiotic. Shortly thereafter he develops hives and airway compromise with hypotension, which is reversed with a dose of intramuscular epinephrine.
Is this adverse event preventable or nonpreventable?
Answer
Nonpreventable
Explanation
This is nonpreventable because the patient did not have a prior known allergy, so it is a general risk of treatment.
Parents of a 5-year-old girl refuse treatment for her diabetic ketoacidosis due to religious beliefs.
Is the physician obligated to comply with their refusal?
Answer
No
Explanation
The physician must provide treatment for reversible, life-threatening conditions, even if the parents disagree. Other situations in which parental consent for treatment is not necessary include emancipated minors or mature minors (≥ 14 years of age in certain states) who can provide their own informed consent.
Currently, IV solutions are compounded in the main pharmacy once a provider places the order in the electronic medical record. Nursing staff feels there is often a delay in care to the patient, who waits for the order to be placed upon admission then compounded by pharmacy. They asked for a review of the process in ordering, identifying, and administering the IV fluids. A team of medical staff reviewed the process and suggested changes that led to improved quality care and patient safety.
What is the name of this technique for process improvement that can be applied to prevent medication error?
Lean
Explanation
The lean methodology works to enhance patient value by reducing waste. It is often performed in conjunction with six sigma methods that aim to reduce variation in a process, leading to safer and more predictable outcomes.
A provider sees a teenager in the clinic with fever and cough, and he is found clinically to have community-acquired pneumonia. The provider writes a prescription for penicillin but realizes upon chart review that this patient has an allergy (hives) to this antibiotic.
What type of medical error is this?
Answer
Preventable error or harm
Explanation
A medical error is a failed process that may or may not result in adverse harm to the patient. One of the foremost safety goals of all health care providers is to minimize preventable harm—events that occurred due to error or failure to apply an accepted strategy for prevention.
