Ethics/Quality/Epidemiology/Statistics

Question 1

What is the Belmont Report?.

Answer 1

A statement created by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research that summarizes basic ethical principles and guidelines for research involving human subjects
3 core principles identified are: respect for persons, beneficence, and justice

Question 2

True or false: A surrogate can change a patient’s advanced directive after the patient becomes incapable of making medical decisions, based on the surrogate’s own preference.

Answer 2

False

Question 3

Many states allow for physician-ordered unilateral do not resuscitate (DNR) in conjunction with the local ethics committee. Physicians are not ethically obligated to provide treatments that they deem futile.

Question 4

In the landmark case of Karen Ann Quinlan, the court affirmed that patients and their surrogates have the right to refuse any unvantd medical reatment, even if life-sustaining. Withdrawal of life- sustaining treatment is not legally considered killing, but rather allowing the patient to die from the underlying illness.

Question 5

Treatments with no beneficial physiologic effect are futile. Treatments with unlikely benefit, beneficial effect with extreme cost and uncertain or controversial benefit are all considered inappropriate and inadvisable but not futile.

Question 6

True or false: Withdrawal of and withholding life- support measures are ethically equivalent.

Answer 6

True

Question 7

True or false: If a patient is paralyzed, you should reverse the muscle relaxant prior to starting withdrawal of life- sustaining treatments.

Answer 7

True; you always want to be able to assess pain and discomfort

Question 8

True or false: Food and fluids can be withheld legally and ethically and withdrawn if congruent with a patient’s goals of care.

Answer 8

True

Question 9

True or false: Advance directives are not portable—they are valid only in the state where they were written.

Answer 9

False

Question 10

Studies suggest that patients managed in a closed ICU by physicians with critical care training have better outcomes than patients managed in open ICUs by generalists without critical care training.

Question 11

True or false: Physicians are not obligated to continue providing mechanical ventilatory support after brain death.

Answer 11

True

Question 12

Obtaining informed consent prior to a procedure is respecting which of the four basic principles of medical ethics?

Answer 12

Autonomy

Question 13

What is The Belmont Report?

Answer 13

A statement created by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research that summarizes basic ethical principles and guidelines for research involving human subjects; three core principles identified are respect for persons, beneficence, and justice.

Question 14

The aim of modern epidemiology is to understand the causal pathways of disease in a population and to identify appropriate public health interventions.

Question 15

Incidence rate (IRs) provide a direct measure of the rate at which new cases occur in the population.

Answer 15

IRs are calculated by dividing the total number of events in a specified time.

Question 16

Prevalence = incidence × duration.

Answer 16

Higher prevalence does not necessarily imply an increased risk of the health event or outcome, but rather it may indicate long duration of disease.

Question 17

Lower prevalence does not necessarily imply low incidence, but rather it may represent a rapidly fatal disease or a short duration of illness.

Question 18

Mortality rate approximates incidence rate when CFR is high and or duration of the diseases is short (e.g., H1N1).

Question 19

In a population of 1000 people in which 50 are sick with H1NI flu illness and 25 die from H1NI in 1 year, what is the mortality rate?

Answer 19

Mortality rate from H1NI in that year = 25/1000
= 0.025 or 2.5%; case rate for H1NI disease = 25/50 = 0.5 or 50%

Question 20

SnOut —A high Sensitivity test has few false negatives and effectively rules Out a disease.

SpIn—A high Specificity test has few false positives effectively rules In a disease)

Question 21

In observational studies nothing is done to alter the exposure, whereas experimental studies entail manipulation of exposure and randomization of subjects to treatment groups.

Question 22

Two-thirds of all observations fall within 1 SD of the mean, and roughly 95% of all observations will fall within ± 2 SD in a normally distributed population.

Question 23

Continuous data can be turned into categoric data (e.g., blood sugar values into normoglycemia, prediabetes, glucose intolerance, and diabetes).

Question 24

p-Values do not indicate the strength or direction of the association, and they depend on sample size and effect size.

Question 25

Precision of CI depends on sample size and variation (larger sample sizes and less variation will have narrower CIs, indicating more precision in results and vice versa).

Question 26

Bias is a measure of systematic error.

Question 27

Power is directly proportional to sample size. Smaller sample size lead to type II errors.

Question 28

Internal validity is essential for external validity.

Question 29

241 of 487 patients treated with salmeterol (49.5%) and 210 of 507 patients treated with salmeterol/fluticasone (41.4%) had at least one exacerbation over the 44- week trial. What is the NNT to prevent one exacerbation for salmeterol/fluticasone group?

Answer 29

The absolute risk reduction (ARR) of 49.5%–41.4% = 8.1%. NNT with salmeterol/fluticasone (rather than salmeterol alone) to prevent one additional patient from experiencing an exacerbation in 44 weeks = 1/0.081 = 12.3.