Ethics + SFSBM + EBM

Question 1

What is the Developmental Origins Hypothesis?

Answer 1

If the beginning and ending environments match, it’s okay; if not, a mismatch leads to increased health risks

Question 2

What aspect of evolution lead to DM2?

Answer 2

energy conservation (environmental mismatch)

Question 3

What aspect of evolution lead to coronary heart disease?

Answer 3

clotting after injury (environmental mismatch)

Question 4

What aspect of evolution lead to autoimmunity?

Answer 4

co-evolution with rapidly mutating pathogens

Question 5

What aspect of evolution lead to cystic fibrosis?

Answer 5

persistence of harmful alleles due to heterozygous advantage

Question 6

What aspect of evolution lead to cancer?

Answer 6

selective pressure against post-reproductive maintenance and repair

Question 7

What are the levels of the social ecological model?

Answer 7

• individual
• social networks
• institutional
• community
• society (policy, environmental change, cultural change)

Question 8

What are the social and physical influences on health?

Answer 8

• inadequacies of healthcare system (10%)
• behavioral factors (50%)
• environmental hazards (20%)
• human biological factors (20%)

Question 9

What are the major factors that contribute to health inequities among racial and ethnic minorities?

Answer 9

• timeliness
• effectiveness
• safety
• efficiency

Question 10

What is primary intervention and its outcome?

Answer 10

intervention before disease/predisposition to disease onset –> no health event

Question 11

What is secondary intervention and its outcome?

Answer 11

intervention before illness onset –> no symptoms

Question 12

What is tertiary intervention and its outcome?

Answer 12

intervention once disease is diagnosed –> minimize risk of recurrence or clinical deterioration

Question 13

What are the indications for immunizations?

Answer 13

infectious disease and select cancer prevention

Question 14

Pharmaceuticals have a __ probability of non-specific effect.

Answer 14

low

Question 15

Herbs have a __ probability of non-specific effect.

Answer 15

low

Question 16

Chiropractic medicine has a __ probability of non-specific effect.

Answer 16

medium

Question 17

Acupuncture has a __ probability of non-specific effect.

Answer 17

medium-high

Question 18

Homeopathy has a __ probability of non-specific effect.

Answer 18

high

Question 19

Distance healing has a __ probability of non-specific effect.

Answer 19

high

Question 20

What are the theoretical mechanisms underlying the placebo effect?

Answer 20

expectancy and learned response

Question 21

What is an impure placebo?

Answer 21

intervention with a non-zero but extremely low probability of producing a specific physiologic effects

Question 22

What are the key attributes of a healthcare system?

Answer 22

• accessible to all (access + equity)
• high quality
• affordable
• prevention focused
• mutually accountable

Question 23

What are the stakeholder groups that affect US healthcare?

Answer 23

• patients
• providers
• insurers
• employers
• government

Question 24

What are the impacts of the ACA to date?

Answer 24

• number of uninsured has fallen
• healthcare is more affordable for lower-income
• delivery system innovation is accelerating
• overall health spending growth is down
• 37 states have expanded Medicaid

Question 25

What is the healthcare system as a three legged stool?

Answer 25

Access, cost, quality

Question 26

What is the Triple Aim?

Answer 26

- patient experience - population health - per capita cost

Question 27

What is the Quadruple Aim?

Answer 27

- patient experience - population health - per capita cost - care team well being

Question 28

What are the components of Medicare?

Answer 28

A - hospital B - doctor C - Medicare advantage (A/B/D + additional benefits) D - prescription

Question 29

What is an externality?

Answer 29

An impact, positive or negative, on any party not involved in a given economic transaction or act

Question 30

What does fee for service incentivize?

Answer 30

do more

Question 31

What does bundle payment incentivize?

Answer 31

maximize the number of bundles among some, exclude bundles for others

Question 32

What does global payment/capitation incentivize?

Answer 32

avoid risk, do less

Question 33

What does salary incentivize?

Answer 33

no direct financial incentives, might incentivize laziness

Question 34

What are the basic building blocks of family life?

Answer 34

- coherence - organization - communication - values and beliefs

Question 35

What are the significant components of parenting?

Answer 35

- nurturance - structure - affiliation - attachment

Question 36

What are the components of geriatric care management?

Answer 36

- reduce cost through prevention - reduce number of medications - improve cognition and function - decrease fall risk - reduce hospitalizations, expensive tests, etc.

Question 37

What is the usefulness equation?

Answer 37

usefulness = (relevance x validity) / work

Question 38

What is patient-oriented evidence geared towards?

Answer 38

morbidity, mortality, quality of life

Question 39

What is disease-oriented evidence geared towards?

Answer 39

pathology, physiology, pharmacology, etiology of disease

Question 40

What is sensitivity?

Answer 40

the percent of patients with the disease who have a positive test

Question 41

What is specificity?

Answer 41

The percent of patients without the disease who have a negative test

Question 42

What is positive predictive value?

Answer 42

the percent of patients with a positive test who have the disease

Question 43

What is negative predictive value?

Answer 43

the percent of patients with a negative test who do not have the disease

Question 44

What are summary reviews?

Answer 44

provide an overview of the disease etiology, diagnosis, prognosis, or management (background question)

Question 45

What are synthesis reviews?

Answer 45

define one or two specific questions and carefully find all available evidence, evaluate its validity, and report their answer to the question (foreground question)

Question 46

What is a meta-analysis?

Answer 46

A statistical technique for combining finding from independent studies; used to treat the data from different studies as if they were from one large study

Question 47

What does a Chi-squared test indicate?

Answer 47

Higher p value is evidence of homogeneity between studies

Question 48

What do the degrees of inconsistency (I^2) indicate?

Answer 48

0-40% - might not be important 30-60% - may represent moderate heterogeneity 50-75% may represent substantial heterogeneity 75-100% - considerable heterogeneity

Question 49

What is a funnel plot?

Answer 49

Compares variability of data; balanced on both sides of the mean shows there was no publication bias

Question 50

What is the hierarchy of evidence?

Answer 50

controlled trials > case controls > case series > expert consensus > pathophysiologic reasoning

Question 51

What is the best approach to analyze the results of a study?

Answer 51

intention to treat analysis

Question 52

What is the equation for number needed to treat?

Answer 52

NNT = 100 / (% in treatment group - % in control group)

Question 53

What are the three types of guidelines?

Answer 53

- authority based guidelines - evidence based guidelines - evidence linked guidelines