Ethics + SFSBM + EBM Flashcards
What is the Developmental Origins Hypothesis?
If the beginning and ending environments match, it’s okay; if not, a mismatch leads to increased health risks
What aspect of evolution lead to DM2?
energy conservation (environmental mismatch)
What aspect of evolution lead to coronary heart disease?
clotting after injury (environmental mismatch)
What aspect of evolution lead to autoimmunity?
co-evolution with rapidly mutating pathogens
What aspect of evolution lead to cystic fibrosis?
persistence of harmful alleles due to heterozygous advantage
What aspect of evolution lead to cancer?
selective pressure against post-reproductive maintenance and repair
What are the levels of the social ecological model?
- individual
- social networks
- institutional
- community
- society (policy, environmental change, cultural change)
What are the social and physical influences on health?
- inadequacies of healthcare system (10%)
- behavioral factors (50%)
- environmental hazards (20%)
- human biological factors (20%)
What are the major factors that contribute to health inequities among racial and ethnic minorities?
- timeliness
- effectiveness
- safety
- efficiency
What is primary intervention and its outcome?
intervention before disease/predisposition to disease onset –> no health event
What is secondary intervention and its outcome?
intervention before illness onset –> no symptoms
What is tertiary intervention and its outcome?
intervention once disease is diagnosed –> minimize risk of recurrence or clinical deterioration
What are the indications for immunizations?
infectious disease and select cancer prevention
Pharmaceuticals have a __ probability of non-specific effect.
low
Herbs have a __ probability of non-specific effect.
low
Chiropractic medicine has a __ probability of non-specific effect.
medium
Acupuncture has a __ probability of non-specific effect.
medium-high
Homeopathy has a __ probability of non-specific effect.
high
Distance healing has a __ probability of non-specific effect.
high
What are the theoretical mechanisms underlying the placebo effect?
expectancy and learned response
What is an impure placebo?
intervention with a non-zero but extremely low probability of producing a specific physiologic effects
What are the key attributes of a healthcare system?
- accessible to all (access + equity)
- high quality
- affordable
- prevention focused
- mutually accountable
What are the stakeholder groups that affect US healthcare?
- patients
- providers
- insurers
- employers
- government
What are the impacts of the ACA to date?
- 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
What is the healthcare system as a three legged stool?
Access, cost, quality
What is the Triple Aim?
- patient experience
- population health
- per capita cost
What is the Quadruple Aim?
- patient experience
- population health
- per capita cost
- care team well being
What are the components of Medicare?
A - hospital
B - doctor
C - Medicare advantage (A/B/D + additional benefits)
D - prescription
What is an externality?
An impact, positive or negative, on any party not involved in a given economic transaction or act
What does fee for service incentivize?
do more
What does bundle payment incentivize?
maximize the number of bundles among some, exclude bundles for others
What does global payment/capitation incentivize?
avoid risk, do less
What does salary incentivize?
no direct financial incentives, might incentivize laziness
What are the basic building blocks of family life?
- coherence
- organization
- communication
- values and beliefs
What are the significant components of parenting?
- nurturance
- structure
- affiliation
- attachment
What are the components of geriatric care management?
- reduce cost through prevention
- reduce number of medications
- improve cognition and function
- decrease fall risk
- reduce hospitalizations, expensive tests, etc.
What is the usefulness equation?
usefulness = (relevance x validity) / work
What is patient-oriented evidence geared towards?
morbidity, mortality, quality of life
What is disease-oriented evidence geared towards?
pathology, physiology, pharmacology, etiology of disease
What is sensitivity?
the percent of patients with the disease who have a positive test
What is specificity?
The percent of patients without the disease who have a negative test
What is positive predictive value?
the percent of patients with a positive test who have the disease
What is negative predictive value?
the percent of patients with a negative test who do not have the disease
What are summary reviews?
provide an overview of the disease etiology, diagnosis, prognosis, or management (background question)
What are synthesis reviews?
define one or two specific questions and carefully find all available evidence, evaluate its validity, and report their answer to the question (foreground question)
What is a meta-analysis?
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
What does a Chi-squared test indicate?
Higher p value is evidence of homogeneity between studies
What do the degrees of inconsistency (I^2) indicate?
0-40% - might not be important
30-60% - may represent moderate heterogeneity
50-75% may represent substantial heterogeneity
75-100% - considerable heterogeneity
What is a funnel plot?
Compares variability of data; balanced on both sides of the mean shows there was no publication bias
What is the hierarchy of evidence?
controlled trials > case controls > case series > expert consensus > pathophysiologic reasoning
What is the best approach to analyze the results of a study?
intention to treat analysis
What is the equation for number needed to treat?
NNT = 100 / (% in treatment group - % in control group)
What are the three types of guidelines?
- authority based guidelines
- evidence based guidelines
- evidence linked guidelines
