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Y3R4 - BMS 🏥 > L13: Clinical Decision Making > Flashcards

L13: Clinical Decision Making Flashcards

1
Q

Def of Cinical Decision Making

A
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2
Q

Importance of Decision Making

A
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2
Q

What does decision making cover?

A
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3
Q

Steps of clinical decision making process

A
  • Identify client’s (patient’s) goals
  • Identify relevant impairments & abilities.
  • Formulate plan of care.
  • Investigate the literature.
  • Generate a clinical hypothesis.
  • Select & collect the relevant outcome measures.
  • Intervene.
  • Evaluate outcome of the intervention.
  • Report the results in the appropriate venue.
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4
Q

Identify relevant impairments
& abilities

A
  • The physician identify patients’ relevant abilities & impairments by
  • Appropriate tests & measures.
  • The physician & the patient formulate the treatment goals using
  • The information from the patient’s history Discussed In step 1
  • The tests & measures Discussed In step 2
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4
Q

Identify client’s (patient’s)
goals.

A

Interview patients to identify their goals.
- Proper history taking of the current medical condition helps subsequent selection of tests & measures.

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5
Q

Formulate plan of care

A

Different types of interventions:
* Non-pharmacological.
* Pharmacological.
* Surgical.

They have to be selected properly

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6
Q

Investigate the literature

A
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7
Q

Generate a clinical hypothesis

A
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8
Q

Select & collect the relevant outcome measures

A
  • Select the appropriate outcome measures: To test validity of the clinical hypothesis.
  • This requires reading some of the articles for;
  • The outcome of the intervention.
  • The measures used to capture the outcome.
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8
Q

Intervene

A
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9
Q

Evaluate outcome of the intervention

A

Evaluate the outcomes of a plan of care.
- So, reexamine in a follow-up visit.

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10
Q

Report the results in the appropriate venue

A
  • Reporting outcomes of applying a certain intervention “e.g., acupuncture in obesity” is important.
  • This would take the form of
  • A case report.
  • Case presentation with colleagues.
  • A conference in the form of a platform or poster which would have a published abstract.
  • Even better is the submission of a paper.
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10
Q

Questions to be asked during the course of taking care of patients

A
  • How may I be thorough yet efficient when considering the possible causes of my patient’s problem?
  • How do I characterize the information I have gathered during the medical interview and physical examination?
  • How should I interpret new diagnostic information?
  • How do I select the appropriate diagnostic test?
  • How do I choose among several risky treatments?
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11
Q

How may I be thorough yet efficient when considering the possible causes of my patient’s problem?

A
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12
Q

Effective VS Efficient

A
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13
Q

Conflict between Being Efficient & Being Throught

A
  • Trying to be efficient often conflicts with being thorough.
  • This conflict has no single solution:
    1. Listen to expert diagnosticians.
    2. See lots of patients & learn from your mistakes.
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14
Q

How do I characterize the information I have gathered during the medical interview and physical examination?

A
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15
Q

Expressing Uncertainity

A
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16
Q

Scale for expressing uncertainty

A
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17
Q

A probability may apply to …..

A
  • The present state of the patient “eg., patient has coronary artery disease”
  • Or express the likelihood that an event will occur in the future “e.g., patient will experience myocardial infarction within one year”
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18
Q

How should I interpret new diagnostic information?

A
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19
Q

Expressing Reducing Uncertainity

A
  • Avoid Describing uncertainty with words is difficult.
  • The solution is to use numbers “probability” to express uncertainty.
20
Q

what is Bayes’ theorem used to?

A
  • Estimate how much a clinician’s uncertainty about a patient’s true state should have changed.
21
Q

Steps of Bayes’ theorem

A
22
Q

How do I select the appropriate diagnostic test?

A
23
Q

The selection of diagnostic tests depends on ……

A
24
Q

Def of Treatment-Threshold Probability

A
  • The level of certainty at which a clinician is willing to start treatment.
  • Selection of diagnostic tests depends on
24
Q

How is Treatment-Threshold Probability assessed?

A
25
Q

A clinician must take two steps to assess the treatment-threshold probability of disease: ……

A
26
Q

How do I choose among several risky treatments?

A
27
Q

Def of Expected Value decision Making

A

“The best way to achieve a good outcome of a treatment”

  • Choosing the treatment alternative whose average outcome is best.
28
Q

Def of Target Condition

A

The disease that the clinician wants to diagnose.

29
Q

Example of Target Condition

A
  • A patient presents with central chest pain for one hour.
  • The clinician suspects acute myocardial infarction.
30
Q

Test Result can be expressed as

A
31
Q

what is The upper limit of normal (ULN)?

A

is usually all values up to two standard deviations above the mean.

32
Q

what is Sensitivity?

A

The frequency of a +ve test in patients
with the target condition

32
Q

what is The Cut point?

A

defined as the test result that divides the spectrum of test results into a positive region & a negative region

33
Q

What is Specificity?

A

The frequency of a -ve test in patients
without the target condition

34
Q

Clinical laboratories usually report: ……

A
  • The patient’s test result.
  • The test result that corresponds to the upper limit of normal.
34
Q

what is a perfect test?

A

Test with no false +ve results and no false -ve results

34
Q

Def of Test Performance

A
  • Ability of a test to discriminate between patients with a disease & all other patients.
35
Q

what is a Gold Standard test?

A

The procedure that defines the true state of patient

36
Q

What is Index test?

A

The test whose performance is being measured

37
Q

2* 2 table to assess test performance

A
38
Q

TPR

  • Name
  • Definition
  • Equation
  • Site in 2*2 Table
A
39
Q

FPR

  • Name
  • Definition
  • Equation
  • Site in 2*2 Table
A
40
Q

FNR

  • Name
  • Definition
  • Equation
  • Site in 2*2 Table
A
41
Q

TNR

  • Name
  • Definition
  • Equation
  • Site in 2*2 Table
A
42
Q

Def of Bayes’s Theorem

A
42
Q

Importance of Bayes’s Theorem

A

Without knowing how new information affects (or will affect) probability, the clinician may acquire too much, too little, or wrong information

43
Q

Explanatory Exam For Bayes’s Theorem

A
44
Q

**

Def of Prior (Pretest) Probability

A

The probability of an event before acquiring new information

45
Q

Def of Posterior (Posttest) Probability

A

The probability of an event after acquiring new information

45
Q

Def of Conditional Probability

A

The probability that an event is true given that another event is true

“i.e., conditional upon the second event being true”

46
Q

Example of Conditional Probability

A
47
Q

Conditional Probability Problem Solving

A

Y3R4 - BMS 🏥 (18 decks)

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