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STEP2 > Epidemiology and ethics 1 > Flashcards

Epidemiology and ethics 1 Flashcards

1
Q

Case fatality rate

A

percentage of people with a given disease who die within a certain amount of time

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2
Q

birth rate

A

live births per 1000

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3
Q

fertility rate

A

live births per 1000

of women aged 15-45 years

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4
Q

death rate

A

deaths/1000

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5
Q

neonatal mortality rate

A

neonatal deaths (first 28 days of life)/10000 live births

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6
Q

perinatal mortality rate

A

neonatal deaths+ stillbirths/1000 total births

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7
Q

infant mortality rate

A

deaths (from 0-1 yo)/1000 live births

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8
Q

maternal mortality rate

A

maternal pregnancy-related deaths (deaths while pregnant or in the first 42 days after delivery)/100,000 live births

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9
Q

relative risk

A

probability of getting disease in group that is exposed to risk factor, compared to (divided by) probability of getting that disease in people who are unexposed

A/(A+B)/C(C+D)

RR>1 positive disease
RR

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10
Q

Odds ratio

A

A/C divided by B/D

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11
Q

Attributable risk

A

difference in risk between exposed and unexposed

A/(A+B)- C/(C+D)

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12
Q

Absolute risk reduction

A

Conceptually similar to calculation of attributable risk, but opposute

C/(C+D)-A/(A+B)

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13
Q

NNT

A

1/ARR
The number of patients you would need to treat in order to save/affect one life

important to determine if a drug should be used or is cost effective

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14
Q

Sensitivity

A

Probability that a screening test will be positive in patients with a disease
A/(A+C)

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15
Q

Specificity

A

D/(B+D)

false positive rate= 1-specificity

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16
Q

PPV

A

PPV= A/(A+B)

what’s the value of the positive test result? likelihood that the person will be positive if they have tested positive

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17
Q

NPV

A

NPV= D/(C+D)

high prevalence gives high positive predictive value

low prevalence gives high negative predictive value

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18
Q

Likelihood ratio

A

does not depend on prevalence

odds of having a positive test result in individuals with a disease, compared with the odds of a positive result in those without the disease

(the positive person should test positive)

PLR= sensitivity/1-specificity
or sensitivity/false pos rate

NLR= 1-sensitivity/specificity
or false neg rate/specificity

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19
Q

Negative likelihood ratio

A

odds of having a negative test result in individuals with a disease compared with the odds of a negative result in those without the disease

NLR= 1-sensitivity/specificity
or false neg rate/specificity

PLR= sensitivity/1-specificity
or sensitivity/false pos rate

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20
Q

Accuracy

A

correct/true results

true pos/true neg/everything

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21
Q

Type i error

A

rejects null even though it’s true

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22
Q

Type II error

A

null hypothesis rejected even though it is false

beta error

23
Q

Statistical significance

A

statistically detectable difference between 2 groups (not the same as clinical significance)

measured by the arbitraty p value

24
Q

power

A

ability of study to detect a difference between 2 groups

25
Q

Confidence interval

A

range of values in which the examiner can be (90,95, 99%) confident that the value obtained from the study truly reflects reality

ranges from
[mean-z(SEM)] to
[mean+z(SEM)]

z= 1.645 for 90%

  1. 96 for 95%
  2. 57 for 99%

if CI crosses 1, no relationship
if CI for 2 treatment groups crosses 0, there may be no difference between the 2 groups

26
Q

What’s important in a screening test? in a confirmatory test?

A

sensitivity for screening (Catch everybody)

specificity for confirmation (eliminate false pos)

27
Q

what percentage falls within 1,2,3 sd’s of the mean in a normal distribution?

A

68,95,99.7%

28
Q

DMAIC for quality improvement

A

Define the problem
Measure: establish an objective baseline
Analyze- identify causes of the problem
Improve- identify and implement interventions (re-measure, re-analyze, and re-intervene as needed)
Control- maintain the improvement that you achieved

29
Q

Identifies 2 groups: diseased group and healthy group. Retrospectively compares them. Weakened by recall and selection biases

A

case- control study

30
Q

Seeks to estimate disease prevalence and exposure across a population

A

cross- sectional study

31
Q

examines a collection of studies on a given subject

A

meta-analysis

32
Q

prospective blinded study involving placebos, existing therapies, and experimental interventions

A

RCT

33
Q

Focuses on ONE group with a shared exposure or disease and either prospectively or retrospectively compares them

A

cohort study

34
Q

examines a collection of cases to seek insight into the disease of interest. Useful in rare diseases

A

case control

35
Q

Memory errors produce incorrect data

A

recall bias

36
Q

subject awareness of being studied alerts their answers and behaviors from normal

A

observational bias

37
Q

certain medical studies attract subjects with particular medical histories rather than general population

A

selection bias

38
Q

studies that show a difference are preferentially published and then later included in meta- analysis rather than studies that support the null hypothesis

A

publication bias

39
Q

screening tests designed to detect asymptomatic disease may miss rapidly- progressive disease because the interval between successive screenings only detects slowly- progressive ones

A

length bias

40
Q

screening test may allow earlier diagnosis of disease but does not translate into actual length of survival

A

Lead- time bias

41
Q

exemptions from condifentiality

A
  • patient allows physician to share information
  • disease is legally reportable (HIV, STD, hepatitis, Lyne, door-borne, meningitis, rabies, TB, impaired ability to drive, child abuse, elder abuse)
  • patient is suicidal or homicidal
  • penetrating wound from an assault
  • adolescent with a condition that is harmful to self or others

maintain adolescent confidentiality if pertaining to with STDs, pregnancy, or contraception

42
Q

Informed consent

A

potential risks and benefits of proposed treatment
alternative treatments
risks of refusing treatment

pt can always change their mind

not required in an emergency

43
Q

Capacity

A

patient has the mental ability to make decisions regarding his or her medical care

Competence is a legal thing

44
Q

Competence- legalities

A

not psychotic or intoxicated
have understanding of medical situation
capable of making decisions

45
Q

medical decisions by parents on behalf of minors may be legally overruled it…

A

considered harmful to the child

in an emergency, treat the patient despite the parents’ wishes and get the court order later

46
Q

Durable power of attorney

A

designates a surrogate decision maker

makes decisions consistent with the patient’s values

“substituted judgment”

47
Q

Living will

A

written document that details a patient’s wishes about specific medical situations

out of hospital DNR order

advance directive

48
Q

Physician- assisted suicide

A

physician supplies patient with means of ending his or her life

  • Oregon
  • Washington
  • Vermont
  • Montana (exceptions)
  • Canada
49
Q

Euthanasia

A

physician actively ADMINISTERS lethal agent to patient, to end suffering

This is illegal in the US

50
Q

Brain death

A
  • irreversible absence of all brain activity
  • > 6 hrs
  • absence of cranial nerve reflexes
  • apnea
  • absence of brainstem- evoked responses, absence of cerebral circulation, or persistent isoelectric EEG
  • Cannot be explained by a medical condition that mimics death (encephalopathy, hypothermia, intoxication, locked-in syndrome, Guillain-Barre syndrome)
51
Q

Medical malpractice

A

Duty of care (legal obligation to conform to a reasonable standard of care)
breach of duty (failure to conform to the standard of care)
harm
causation (breach of duty is the cause of injury or harm)

52
Q

What are the 2 ways that “standard of care” can be established in a malpractice case?

A
  1. expert testimony

2. Res ipsa loquitur “it speaks for itself” doctrine

53
Q

Vicarious liability principle

A

supervisors are responsible for the actions of their subordinates

54
Q

When can a physician refuse to treat a patient on the grounds of futility?

A
  1. no rationale for treatment
  2. maximal intervention has already failed
  3. treatment does not achieve the goals of care

STEP2 (34 decks)

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