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Jason's Cardiovascular Block > Pop Health and Ethics for Cardiovascular Block > Flashcards

Pop Health and Ethics for Cardiovascular Block Flashcards

1
Q

Doctors are allowed to act in ways others are not. What is that called?

A

Social permissions

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2
Q

3 special situations for doctors

A
  1. Power over patient
  2. privileged position in society, professional autonomy/self regulation
  3. reinforced by law
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3
Q

So why do we need ethics again? Two reasons:

A
  1. protect and respect patients

2. counter negative aspects of culture of medicine (the hidden curriculum)

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4
Q

do not cause or allow harm is called

A

Non-maleficence

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5
Q

Beneficence is:

A

provide help, do good

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6
Q

how to you respect someone’s autonomy?

A

get informed consent

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7
Q

how to you respect privacy?

A

confidentiality

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8
Q

Two tenants of informed consent

A

Informed

Voluntary choice

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9
Q

Doctors discussing a case, why is it NOT a breach of confidentiality?

A

Necessary good for the patient

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10
Q

3 ethically difficult situations:

A
  1. inadvertent breach of confidentiality
  2. patient non-consent (if anesthetized
  3. inappropriate procedure (miscommunication)
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11
Q

Feeling unsure what is right to do is called:

A

Moral confusion

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12
Q

Feeling unable to to what you know is right

A

Moral distress

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13
Q

Moral distress is:

A

feeling compelled to do what you think is wrong

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14
Q

Moral confusion is:

A

not sure what’s right or wrong

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15
Q

How to deal with moral confusion and distress?

A
  1. talk to peers
  2. advice from staff
  3. get more information
  4. acknowledge own feelings
  5. consider further action
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16
Q

How should you talk about patients? (3 ways)

A
  1. non-identifying
  2. purpose to learn
  3. respectfully
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17
Q

What’s the cause and effect study design called?

A

analytical

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18
Q

what is a cross-sectional design?

A

observational descriptive

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19
Q

what are clinical trials?

A

interventional analytical

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20
Q

what are case-control and cohort studies?

A

observational analytical

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21
Q

example of a descriptive observational?

A

Case study/series, ecological, cross-sectional

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22
Q 
Which of the following are longitudinal?
cohort
cross-sectional
case-control
Case series/reports
clinical trials
ecological
A

Cohort and clinical trials

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23
Q 
Which of the following are non-longitudinal?
cohort
cross-sectional
case-control
Case series/reports
clinical trials
ecological
A

ecological
cross-sectional
case-control
Case series/reports

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24
Q

What does non-longitudinal mean?

A

no follow-up, usually only one encounter

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25
Q

is cross sectional analytical?

A

Nope, descriptive

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26
Q

is there follow up in a cross sectional study?

A

No.

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27
Q

Data from cross sectional study collected via?

A

questionniares, examiniations, investigations

28
Q

what’s the main purpose of a cross sectional?

A

make associations and hypothesis generating. kinda sucks at causality cause no temporal aspect

29
Q

Case-control is?

A

comparing previous exposure status of someone who had it vs. someone who didn’t have it but they are both similar characteristic people. age. sex.

30
Q

What is case-control useful for studying?

A

rare outcomes

31
Q

key output of odds ratio is for what study design?

A

Case control

32
Q

odds ratio is an approximation of what?

A

relative risk?

33
Q

2 main features of cohort study?

A
  1. longitudinal

2. follow-up of subjects

34
Q

what kind of data collected for cohort study?

A

incidence data

35
Q

output for cohort study?

A

relative risk

36
Q

Retrospective cohort study?

A

can research established cohorts for other things that you have good data for

37
Q

disadvantages of cohort study?

A
  1. not good for rare outcomes

2. expensive, hard to organize

38
Q

Example of how you can establish a cohort study with ‘routine’ clinical care?

A

RMH stroke service data collection

39
Q

Active outcome follow-up

A

explicit surveillance

40
Q

passive outcome follow up

A

database, retrospective

41
Q

2 Bias types:

A
  1. selection bias

2. info/measurement bias

42
Q

what is the ‘worried well’

A

people who are willing to participate are usually better than those who might now or can’t and are more open

43
Q

how to minimize selection bias? 2 ways

A
  1. representative sample

2. case and control from same source

44
Q

information bias is?

A

systematic differences in the way the info was collected esp. variability/subjectivity

45
Q

eg. of measurement bias?

A

tight BP cuff on obese people

46
Q

Minimize info bias? 2 ways

A
  1. standardized tools

2. objective assessment

47
Q

confounding variable?

A

independently changes outcome at exposure

48
Q

how to minimize confounding?

A

in the design of the study, not analysis

49
Q

Most clinical trials involve what groups?

A

a control group

intervention group

50
Q

What’s the ‘gold standard’ for causality?

A

clinical trials

51
Q

How to reduce confounding variables?

A

Randomization

52
Q

how do you deal with information bias?

A

blinding/masking

53
Q

Selection bias (cross-over in parallel) is what?

A

sick subjects stop drug
control switches to drug or vice versa
healthier ppl stay on drug cause less side effects

54
Q

How to deal with cross-over?

A

assume subjects remained in randomized group

55
Q

Intention-to-treat Analysis involves what?

A

underestimates treatment effect because cross over would introduce overlap which is ignored

56
Q

Hazard

A

continuously updated instantaneous rate

57
Q

When do you use hazard?

A

longitudinal studies

58
Q

Survival analysis is?

A

avoidance of the event

59
Q

What’s Hazard ratio?

A

like RR, but applies to WHOLE period of time so HR of 0.5 would mean that the probability of outcome in control is HALF that of other group any ANY GIVEN TIME in the study.

60
Q

Risk/Rate reduction is measured in two ways:

A

relative

absolute

61
Q

Numer needed to treat is:

A

how many people needed to undergo intervention to prevent outcome in one

62
Q

Equation for NNT?

A

NNT = 1/ absolute risk/rate

63
Q

What the point of NNT anyways?

A

marks the efficiency of the intervention

64
Q

NNT affected by what?

A

Relative effect

underlying likelihood of outcome

65
Q

Number needed to harm is?

A

if interventions increase risk/rate of outcome

Jason's Cardiovascular Block (15 decks)

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