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
what is the most commonly reported beneficial outcome of medical errors
a desire to improve oneself to prevent something similar from happening again
reasons to report near misses and adverse events
- ethically correct
- preempt potential legal ramifications
- system change or feedback or advice
- trust with supervisor and client
reasons people do not report near misses and adverse events
- no need since nothing actually happened
- dislike confrontation or not wanting to upset supervisor
- not wanting to upset client and damage relationship
4 pillars of quality improvement
- system-based approach
- leadership commitment to quality - safety culture
- medical error reporting
- improvement & implementation science
epidemiological triad
host, agent, environment
sharp rise in cases followed by rapid decline
point source
series of progressive peaks of illness
propagated outbreak
no temporal or spatial pattern
sporadic
around all the time
endemic
widespread occurrence of an infectious disease in a community at a particular time
epidemic
variable associated with increased risk of disease or infection
risk factor
variable associated with a decreased risk of disease or infection
protective factor
any causal factor (host, agent, environment), “piece of pie”
component
set of component causes capable of causing disease; when sufficient cause is present, disease can occur
sufficient cause
component cause that is required for disease to occur
necessary cause
what do each measure
odds ratio
relative risk
attributable risk
attributable fraction
strength
strength
effect
effect
identifies at risk groups at the start of the outbreak
attack rate
what do you use in case-control studies, odds ratio or relative risk?
odd’s ratio
explain 95% CI
CI overlaps 1 → non-sig
CI below or less 1 → significant
The ability of the test to correctly identify individuals who HAVE the disease
used for screenings
fewer false negatives
sensitivity
The ability of the test to correctly identify individuals who do NOT have the disease
diagnostic tests
fewer false positives
specificity
Predictive Values are NOT fixed, they depend on…
- Se & Sp
- prevalence of disease in population
the proportion of individuals who test positive who actually have the disease
PPV
the proportion of individuals who test negative who are actually free of disease
NPV
higher the PPV means…
fewer false positives
higher the NPV means…
fewer false negatives
every test run must be positive to classify individual as positive; individual is classified as positive if each test is positive
testing in series
every test run must be negative to classify individual as negative; individual is classified as positive if a single test is positive
testing in parallel
Proportion of disease positive animals that test positive
Se
Proportion of non-diseased animals that test negative
Sp
parts of periodontium
gingiva
periodontal ligament
cementum
alveolar bone
how much should the attached gingiva have
2-3 mm each
horse occlusal angle
10-15 degrees
rabbit occlusal angle
0 degrees
guinea pig occlusal angle
30-40 degrees
which part of periodontal disease can be prevented
plaque accumulation
how long does calculus take to accumulate
within 3-5 days of plaque formation
what stage of periodontal disease is reversible?
stage 1 gingivitis
most common cause of endodontic disease? what are key features of ED?
tooth fracture
- wide pulp chamber
- periapical lucency
- root end resorption
understand the current knowledge of the correlation between systemic disease and dental disease in dogs and cats.
Strong associations between periodontal disease and chronic inflammatory lesions in the kidneys & hearts of dogs
conditions related to overgrowth in horses (preventable)
buccal lacerations
lingual lacerations
hooks
steps/waves
what other pathologies can equine get besides PD and ED
equine caries
EOTRH (equine odontoclastic tooth resorption and hypercementosis)
goals of preventative equine dentistry
Remove causes of pain
Maintain tooth alignment and jaw range of motion
Identify disease
Prevent 2o complications
what should odontoplasty not exceed
no more than 3-4 mm every 3 months
what is the most common cause of dental disease in small mammal species
poor diet
(e.g. rabbits should be fed hay too not just pellets)
is PD or ED more commonly found in pet ferrets
periodontal disease
