Decision Making and Interprofessional Communications Flashcards
What are the 6 things in Diagnostic Decision Making?
- Data acquisition
- Accurate problem representation
- “Complete” differential diagnosis
- Prioritized differential diagnosis
- Testing hypothesis
- Review and reprioritize differential
What do we obtain in Data Acquisition?
- H&P
2. Lab/C-ray information
What do we create in Accurate Problem Representation? What do we include?
- Problem (not diagnosis)
2. Pivotal points
What are 3 pivotal points?
- Acute or chronic
- Changing or not?
- Clinical risk factors (smoking, drinking, +FH)
Explain “Complete” Differential Diagnosis
Narrowing down a disease systematically
Are all diagnoses in differential diagnosis equal?
No
How are common problems prioritized?
Odd numbers; 1 = dangerously acute, 5= not dangerous
How are rare problems prioritized?
Even numbers; 2 = dangerously acute, 6 = not dangerous
How do we perform “Testing Hypothesis”?
- Look for specific disease “fingerprints” of lead diagnosis
- Ideally use EBM methods
Explain EBM methods
Using tests to get data for:
- Pretest probability
- Likelihood ratio
- Posttest probability
Can CDAs help? Are they readily available?
Yes; no
What is death on the CDA? Good health?
- 0
1. 0
What are the 2 steps for Therapeutic Decision-Making?
- What is the typical “treatment of choice” for the problem?
- Is the “treatment of choice” the treatment of choice for your patient?
What do we ask for trials?
Is this information valid, important, and applicable?
Does Published = valid, important, or applicable?
No
What are the 2 questions in Step 1 of reviewing a paper and where would they be found?
- Was the assignment of patients to treatments randomized? (methods)
- Were the groups similar at the start of the trial? (results)
What are the 2 questions in Step 2 of reviewing a paper and where would they be found?
- Aside from the allocated treatment, were groups treated equally? (methods, results)
- Were all the patients who entered the trial accounted for? - and were they analysed in the groups to which they were randomized? (results)
What is the 1 question in step 2 of reviewing a paper and where would it be found?
- Were measures objective or were the patients and clinicians kept “blind” to which treatment was being received? (methods)
What are the 2 measurement factors?
- Relative Risk (RR)
2. Absolute Risk Reduction (ARR)
Define Relative Risk (RR)
- Risk of the outcome in the treatment group/risk of the outcome in the control group
What does the RR mean?
It tells us how many times more likely it is that an event will occur in the treatment group relative to the control group
What does an RR of 1 mean?
No difference between the control and treatment groups, thus treatment has no affect
What does an RR < 1 mean?
Treatment decreases risk of outcome (decreases risk of death)
What does an RR > 1 mean?
Treatment increased the risk of the outcome
Define Absolute Risk Reduction (ARR)
Risk of the outcome in the control group - risk of the outcome in the treatment group
What is ARR also known as?
Absolute risk difference
What does the ARR mean?
Tells us absolute difference in the rates of events between the 2 groups and gives in indication of the baseline risk and treatment effect
What does an ARR of 0 mean?
No difference between the two groups, thus treatment had no effect
What s the absolute benefit of treatment in ARR?
5% reduction in death rate
What is Relative Risk Reduction? (RRR)
Absolute risk of reduction/risk of the outcome in the control group
What is an alternate way to calculate RRR?
RRR = 1 - RR
What is the complement of RR? Is it the most commonly reported measure of treatment effects?
RRR; yes
What is the Number Needed to Treat? (NNT)
Inverse of the ARR
How is NNT calculated?
1/ARR
What does NNT represent?
Number of patients we need to treat with experimental therapy in order to prevent 1 bad outcome and incorporates the duration of treatment
Do we need to ask, “How precise was the estimate of the treatment effect”? What does it tell us?
Yes; point estimate - true risk of the outcome in the population is not known and the best we can do is estimate the true risk based on the sample of patients in the trial
What can point estimate give us? When is it significant?
Confidence interval - significant at 0.05
Should we ask, “Will the results help me incaring for my patient?
Yes
How do we determine if the “treatment of choice” is correct for our patients?
- Determine allergies for what they can and can’t take
- Any worrisome drug interactions to this drug in this patient?
- Drug monitoring
- Is my patient pregnant?
What are 3 main things for written communications?
- Full H&P
- Focused office visit
- Acute care visit
What 5 types of notes are there?
- Admission notes
- Progress notes
- Discharge summaries
- Focused office visit notes
- Acute problem notes
Another way to define SOAP
- S = already done
- O = already done
- A = assessment “what you think”
a) Problem list
b) Diagnoses - P = plan “what you’re going to do”
a) more labs, x-rays, etc
b) treatment
Do we sometimes pair the Assessment and Plan?
Yes
Should we communicate like we are giving orders?
No
Do we put DEA on orders?
Yes
