Pop Health and Ethics for Cardiovascular Block Flashcards
Doctors are allowed to act in ways others are not. What is that called?
Social permissions
3 special situations for doctors
- Power over patient
- privileged position in society, professional autonomy/self regulation
- reinforced by law
So why do we need ethics again? Two reasons:
- protect and respect patients
2. counter negative aspects of culture of medicine (the hidden curriculum)
do not cause or allow harm is called
Non-maleficence
Beneficence is:
provide help, do good
how to you respect someone’s autonomy?
get informed consent
how to you respect privacy?
confidentiality
Two tenants of informed consent
Informed
Voluntary choice
Doctors discussing a case, why is it NOT a breach of confidentiality?
Necessary good for the patient
3 ethically difficult situations:
- inadvertent breach of confidentiality
- patient non-consent (if anesthetized
- inappropriate procedure (miscommunication)
Feeling unsure what is right to do is called:
Moral confusion
Feeling unable to to what you know is right
Moral distress
Moral distress is:
feeling compelled to do what you think is wrong
Moral confusion is:
not sure what’s right or wrong
How to deal with moral confusion and distress?
- talk to peers
- advice from staff
- get more information
- acknowledge own feelings
- consider further action
How should you talk about patients? (3 ways)
- non-identifying
- purpose to learn
- respectfully
What’s the cause and effect study design called?
analytical
what is a cross-sectional design?
observational descriptive
what are clinical trials?
interventional analytical
what are case-control and cohort studies?
observational analytical
example of a descriptive observational?
Case study/series, ecological, cross-sectional
Which of the following are longitudinal? cohort cross-sectional case-control Case series/reports clinical trials ecological
Cohort and clinical trials
Which of the following are non-longitudinal? cohort cross-sectional case-control Case series/reports clinical trials ecological
ecological
cross-sectional
case-control
Case series/reports
What does non-longitudinal mean?
no follow-up, usually only one encounter
is cross sectional analytical?
Nope, descriptive
is there follow up in a cross sectional study?
No.
Data from cross sectional study collected via?
questionniares, examiniations, investigations
what’s the main purpose of a cross sectional?
make associations and hypothesis generating. kinda sucks at causality cause no temporal aspect
Case-control is?
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.
What is case-control useful for studying?
rare outcomes
key output of odds ratio is for what study design?
Case control
odds ratio is an approximation of what?
relative risk?
2 main features of cohort study?
- longitudinal
2. follow-up of subjects
what kind of data collected for cohort study?
incidence data
output for cohort study?
relative risk
Retrospective cohort study?
can research established cohorts for other things that you have good data for
disadvantages of cohort study?
- not good for rare outcomes
2. expensive, hard to organize
Example of how you can establish a cohort study with ‘routine’ clinical care?
RMH stroke service data collection
Active outcome follow-up
explicit surveillance
passive outcome follow up
database, retrospective
2 Bias types:
- selection bias
2. info/measurement bias
what is the ‘worried well’
people who are willing to participate are usually better than those who might now or can’t and are more open
how to minimize selection bias? 2 ways
- representative sample
2. case and control from same source
information bias is?
systematic differences in the way the info was collected esp. variability/subjectivity
eg. of measurement bias?
tight BP cuff on obese people
Minimize info bias? 2 ways
- standardized tools
2. objective assessment
confounding variable?
independently changes outcome at exposure
how to minimize confounding?
in the design of the study, not analysis
Most clinical trials involve what groups?
a control group
intervention group
What’s the ‘gold standard’ for causality?
clinical trials
How to reduce confounding variables?
Randomization
how do you deal with information bias?
blinding/masking
Selection bias (cross-over in parallel) is what?
sick subjects stop drug
control switches to drug or vice versa
healthier ppl stay on drug cause less side effects
How to deal with cross-over?
assume subjects remained in randomized group
Intention-to-treat Analysis involves what?
underestimates treatment effect because cross over would introduce overlap which is ignored
Hazard
continuously updated instantaneous rate
When do you use hazard?
longitudinal studies
Survival analysis is?
avoidance of the event
What’s Hazard ratio?
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.
Risk/Rate reduction is measured in two ways:
relative
absolute
Numer needed to treat is:
how many people needed to undergo intervention to prevent outcome in one
Equation for NNT?
NNT = 1/ absolute risk/rate
What the point of NNT anyways?
marks the efficiency of the intervention
NNT affected by what?
Relative effect
underlying likelihood of outcome
Number needed to harm is?
if interventions increase risk/rate of outcome
