Exam 1 Flashcards
best and worst study designs in vetmed
best - meta-analysis and systemic reviews
worst - case reports, opinion papers and letters
which study shows strongest evidence about clinically important questions
systemic reviews and meta-analyses
which study provide the greatest control of bias and confounding but are not clinically applicable
randomized controlled trials
which study is clinically applicable but do not have great control of bias and confounding
observational studies
which study has Strongest evidence for cause-effect
randomized controlled traisl
which study has a follow-up; temporal cause-effect
cohort study
type of bias:
veterinarian using a patient’s signalment, history, comorbid conditions, and
other variables to develop diagnostic and treatment plans
selection bias
type of bias:
when the degree of scrutiny differs among animals or groups; occur when certain animals or groups of animals are observed more closely, with different observation or monitoring methods, or for a longer period than other animals or groups of animals because of characteristics such as breed, age, housing conditions, severity of clinical signs, or convenience
information bias
type of bias:
factors are associated with each other but not evenly distributed among the subjects evaluated, making it difficult to identify which factor is truly associated with the outcome of interest; when clinical observations are used to make assumptions about disease causation or treatment effectiveness
confounding bias
type of bias:
“false positive” rejects a null hypothesis that is actually true in the population
Statistical association is found, but are false
type I error
type of bias:
“false negative” fails to reject a null hypothesis that is actually false in the population
NO statistical association
type II error
type of bias:
controlled by a good diagnostic test; individual is assigned to a different category than the one to which they should be assigned
misclassification bias
type of bias:
gatekeepers are the “journals” deciding what to publish and what not to publish
publication bias
adverse event, which is “an unintended injury caused by medical management that resulted in measurable disability.
medical error
the failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation
negligence
a failure of one charged with exercising ordinary diligence, care and skill commensurate with members of his profession
malpractice
list 6 intrinsic errors
- time pressure
- overconfidence
- faulty or incomplete data gathering
- knowledge gap or inexperience
- physical factors
- conscious or unconscious bias by the doctor (appearance, behavior, body language, prejudice, gender bias, etc.)
list 7 systemic errors
- wrong site surgery
- failure of clinician/nurse/tech to recognize documented drug interactions or patient allergies
- miscommunication/ misunderstanding of verbal orders
- mislabeling of syringes, fluids, or other items contains meds
- improper rate of administration of fluids or CRI
- equipment failure
- poor lay out of the facility
Concluding evidence gathering and making a diagnosis prior to thorough reflection on all the data. The error is commonly associated with pattern recognition
premature closure
form of premature closure; limited analysis and/or information because you believe others have reached an identical conclusion
false consensus
The tendency to seek or favor data that confirms one’s preferred diagnosis while ignoring or disregarding data that would disfavor the diagnosis; run diagnostics first – tests/treatment
confirmatory bias
Pertinent information is unintentionally omitted by someone on the team, e.g., clinical sign, previous medical history, etc
Unintentional sequestration of data
associated to the way people store/retrieve knowledge; deceptive sense of security that because you’re working with a team, someone before you got all the data that you need (e.g. someone must have read the chart)
Illusory transactive memory system
Respect for authority or desire for consensus allows data to be interpreted as valid by others; usually associated someone with a position of power
contagious illusion
expectations influence your senses such that you can feel, hear or see something that you expect to hear
selective perception
initial events in the patient’s medical history or disease are weighted more heavily than events that occur later
primacy effect
most recent events in the patient’s medical history or disease are weighted more heavily than the events that occurred earlier
recency effect
estimating what is more likely by what is most available in your memory, which is inherently biased toward vivid, unusual, or emotionally charged examples
availability heuristic
if someone has already made a medical error are they more likely to make another in the future
yes - functional impairment
distressed after an error are at an increased risk of making medical errors in the future
are males or females more affected by medical errors
females - women report more work-related stress, anxiety, depression, and burnout than men; higher incidence of psychological distress, including suicidal ideation and depression, in female versus male veterinarians
