Post Midterm Behavioral Science Flashcards
1
Q
What is classical conditioning?
A
Association of a neutral stimulus with a stimulus that naturally & involuntarily produces some Physiological response.
2
Q
What is operant conditioning?
A
Association of a behavior & some event (stimulus) that follows the behavior (a reinforcing or punishing consequence)
3
Q
What experiment involved stimulus generalization?
A
White rat+noise, white Rabbit, cotton + fear
4
Q
What is the concept of classic extinction?
A
That a stimulus that once elicited a response, if given without the response for an extended time, will eventually stop eliciting the response.
5
Q
What is the Bell and the Pad study?
A
A study in which sleeping pads were given to children who were experiencing nocturnal enuresis. The pads, in the presence of moisture would give off an alarm, that would wake the child.
6
Q
What does PTSD treatment involve?
A
Most treatments involve exposure to fear -provoking stimuli (classical extinction) Exposure (recalling events associated with the trauma) leads to reduction in anxiety.
7
Q
What is the learning theory of Operant Conditioning?
A
Behavior is increased or decreased as a result of the consequences that follow it. Involves primarily voluntary behavior The ‘Law of Effect’
8
Q
What is Positive reinforcement in Operant conditioning?
A
A Stimulus is Applied following Behavior Behavior is Strengthened as a result Contingency
9
Q
What is Negative reinforcement in operant conditioning?
A
An Aversive Stimulus is removed, terminated, or avoided following Behavior. The Behavior is Strengthened as a result When the behavior allows the subject to avoid an unpleasant stimulus it is referred to as avoidance behavior Seeking medical care to have pain or Sx removed is an example of negative reinforcement.
10
Q
What factors effect reinforcement?
A
Immediacy, continuity, clarity of contingencies
11
Q
How can a phobias negative reinforcement result in continued phobia?
A
By staying away from fearful situations we are negatively reinforcing the phobia by alleviating the anxiety of the stimulus by not interacting with it, this results in continued phobia.
12
Q
How does the compulsive behavior in OCD relate to negative reinforcement in Operant conditioning?
A
In OCD PT’s obsession is dealt with by compulsive acts which reduce the anxiety brought on by the obsession, thus acting as Negative reinforcement for the obsession, by reducing the negative stimulus.
13
Q
What is Operant Extinction?
A
Occurs when reinforcement is consistently withheld following a previously reinforced behavior
14
Q
What is anticipitory immunosupression?
A
Women undergoing chemotherapy with an immunesuppressive drug showed immunosuppression prior to receiving drug when in presence of hospital CSs previously associated with its administration.
15
Q
What is the difference between drug like effects and drug opposite effects?
A
- Conditioning of responses similar to the drug’s effect ie direct, or ‘drug-like effects’ 2.Conditioning of responses opposed to the drug’s direct effects ie ‘drug-opposite effects’, which represent the body’s compensatory responses to the drug
16
Q
What does the term reggression to the mean refer to?
A
Natural tendency for a variable to change with time and return towards population average
17
Q
B.F. Skinner and Radical Behaviorism
A
Behavior and actions are the result of reinforcement and our environment
18
Q
What is the difference between obsessions and compulsions?
A
Obsessions are anxiety generating thoughts and compulsions are actions that are done to alleviate those thoughts.
19
Q
How many americans smoke and how many would like to quite?
A
Just under ¼ of Americans smoke, most of whom report they would like to quit
20
Q
What effect does physician counseling have on smokers?
A
A physician’s advice to quit increases cessation rates 30% (3 minutes of counseling doubles rate)
21
Q
What are the stages of change model?
A
PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE
22
Q
What are the indicators of physical dependance?
A
The presence of withdrawal symptoms Difficulty of previous cessation attempts Number of cigarettes smoked, & their level of nicotine The Fagerstrom Questionaire of of Nicotine Dependence
23
Q
What is the Fagerstrom test for nicotine dependance?
A
How soon after awakening in the morning does the smoker smoke the first cigarette?? Does smoker smoke more frequently inmornings?? How many cigarettes smoked per day? Which cigarette would be most difficult to give up? Is it difficult not to smoke in inappropriate places? Does smoker smoke even if ill ?
24
Q
When is Nicotine replacement therapy NOT recommended?
A
few withdrawal SxSx relapse > 2 weeks low FTND
25
When is Nicotine replacement therapy recommended?
history of withdrawal SxSx relapse \< 1 week high FTND
26
What is motivational interviewing?
aimed at assisting Pt from one stage to another, 4 principles: 1.1.“Roll with the resistance” Expect resistance changing ingrained behavior takes time Don’t fight against it flow with it Patient must come to her/his own conclusion that it’s best to change The ‘righting reflex’: Can be hard for therapists & physicians to resist 2.2. “Develop Discrepancy" The patient is ‘stuck’, and needs your help to move along Help patient see the discrepancy between where they want to be, and where they are If they accept your invitation of assistance it will be because of their own reasons, not your brilliantly reasoned arguments. .3. “Express Empathy” Accepting the patient for who they are frees them up to change Judging or blaming is counterproductive Accepting & understanding the patient’s behavior does not necessarily mean agreeing with it. 4.4.“Enhance Self efficacy’ It is critical to behavior change You’ve got to believe you can do it if you are to have any hope of doing it Be supportive, get creative help the patient see what a difference behavior change will make in life
27
What is the ID?
The ‘Pleasure Principle’ The ‘Libido’
28
What is the Ego?
The ‘Reality Principle’
29
What is the superego?
The conscience
30
What is the Intrapsycich conflict?
Demands of Id, Ego & Superego are often in conflict When an unacceptable drive or impulse threatens to break into consciousness, defense mechanisms are employed Defense mechanisms are unconscious, distort reality, & allow for compromise in the satisfaction of the drive Defense mechanisms serve to protect our sense of self esteem They shield us from emotional pain by permitting only a distorted, non--threatening version of reality to be perceived
31
What are our defense mechanisms?
REPRESSION DENIAL PROJECTION REACTION FORMATION REGRESSION
32
When does a psychopathology occur?
Results when defense mechanisms are ineffective That is, when repressive defenses fail, forbidden drives threaten to intrude into voluntary behavior This results in the symptoms (psychological & physical) of different mental disorders Such symptoms are symbolically representative of the underlying conflict. These were originally considered Neuroses, but now are diagnosed as anxiety disorder, dissociative disorder or somatoform disorder.
33
What is the concept behind somatoform disorders?
Somatoform disorders involve physical symptoms without underlying organic pathology Freud referred to such disorders as ‘hysteria’ bodily symptoms reflect displaced unconscious conflict By focusing on these less threatening bodily symptoms, the patient avoids the anxiety associated with the unconscious conflict
34
How does the term Fixation relate to Freuds concept of psychopathology?
According to Freud the early years of development were crucial for proper development. If during this critical period needs are not sufficiently satisfied then Fixation can occur which can result in later pathology such as personality disorders.
35
What were the two methods that Freud used to access the unconscious?
1. Free Association 2. Dream analysis
36
How does analysis of dreams allow us to evaluate the subconscious?
During dream state, our defenses are relaxed and the subconscious is allowed to express itself. dreams are the by product of this and allow us to access the subconscious that we otherwise have defenses against.
37
How does pyschological testing relate to cultural and social background?
Depending on a persons background they will respond to illness differently, by evaluating their response we can better understand their past experiences, lifestyle and personality.
38
Reliability
How consistent a test is; underlying concept is error= random fluctuation across subjects
39
Validity
Extent to which a test measures what it is designed to measure.
40
What are two examples of predictive Validity vs concurrent validity
Predictive validity: MCAT predictive of med school GPA Concurrent: HAM-D test, used by clinicians to asses depression in Patients.
41
Whats are the types of psychological tests?
Intellectual Ability Aptitude Achievement Personality Neuropsychological Batteries Vocational/Interest Inventories
42
What is IQ?
‘INTELLIGENCE QUOTIENT’ Not absolute, but a comparison among people Tends to be stable throughout adulthood, but fluctuates in teens IQ is a Standard Score: Mean: 100 Standard Deviation: 15 The Wechsler Scales --most commonly used IQ tests
43
What are two examples of personality tests?
Objective; question format, norms & standardization e.g. MMPI--22 Projective; Subjective format & scoring e.g. Rorschach
44
What is the MMPI-2?
The most commonly used personality test for objective personality assessment. Useful in assessing personality variables associated with tendency to develop physical symptoms in response to emotional stress. 567 True/False questions, which yield scores on several scales 10 Clinical Scales, including Scale 1: “Hypochondriasis Scale 2: “Depression” Scale 3: “Hysteria”
45
What does the HAM-D depression test asses?
HAM--DD contains 21 items assessing: Somatic symptoms Insomnia, Working capacity & interest, Mood, Guilt Psychomotor retardation, Agitation, Anxiety, Insight
46
What is the projective hypothesis?
That when exposed to an ambiguous stimulus and asked to make sense of it, a persons own unconscious dynamics and conflicts will be exposed in their response. Stimulus from the environment is interpreted according to an individuals own needs and desires. Two projective tests include Rorschach and the TAT test, thematic apperception test.
47
What does Frequency measure?
Rate, Ratio, proportion,
48
What is Rate?
change in one quantity per unit change in another over time.
49
Proportion
a ratio where the numerator is always part of denominator. The numerator is always part of the whole
50
Ratio
a number that is achieved by dividing one quantity by another.
51
Prevalence
•proportion of the population at a given time that has the factor of interest. •Numerator– all those with the attribute at a particular time •Denominator–population at risk of having the attribute during that same time period (often, size of pop.)
52
Point prevalence
existing cases at a point in time
53
What is the equation for prevalence?
P=# of cases/Size of population
54
What is incidence?
•Incidence describes the proportion of a population, initially free of the outcome of interest, that develops the condition over a given period of time. •Incidence refers to NEW cases of disease or NEW outcomes
55
What are the two ways to measure Incidence?
A) Cumulative Incidence (RISK): Measures the rate of new events in a group of people of fixed size. measures the risk of developing the disease. = # of new cases/total persons initially at risk in a given time period B) Incidence density: Measures the number of new cases in a dynamic population, with people entering and leaving •Provides the “density” of new cases of disease in time and place using person-time at risk for the outcome event = # of new cases in a given time period/total person time
56
What is the diasadvantage of Case report/Case series?
There is no comparison group so results cannot be used for Tx decisions.
57
What are the differences between a case report and a case series?
A case report is based on 1 person, a case series is a group of patients.
58
Cross sectional studies
Aka. Prevalence Study •Very commonly used method •Exposure and disease status assessed at the same time •Individual is unit of observation and analysis •Typically descriptive in nature to quantify magnitude of the problem
59
Case control studies
Key comparison: Disease vs. No Disease •Find all cases that meet a defined criteria •Choose a representative group of controls (that are very much like the cases except they don’t have the disease) •Measure the risk of exposure in the Disease group vs. the No Disease group
60
What are the benefits of a case control study?
Excellent for rare or unusual diseases •Smaller in size, quick, easy, cost-effective •Can evaluate multiple risk factors for one disease •Can use secondary data •Can test hypotheses
61
Cohort study
•Key comparison: Risk Factor or No Risk Factor •Starts with people free of outcome of interest, but with varying Risk Factors (measures Incidence) •Aka. longitudinal studies •Moves from potential cause to effect •Useful when the exposure may be or is known to be harmful, and could not be randomly assigned by an investigator •If previous information is available on exposure, can use historical data to go forward in time (see schematic) Problem is needs large sample size.
62
What are the strengths of Cohort studies?
Directly determine incidence and risk •Assess relationship between an exposure (i.e. risk factors) and many diseases/outcomes •Follow logic of clinical question, i.e., (if persons are exposed, do they get disease) •Measures exposure first, so reduces bias •Good method when exposure is rare
63
What is a Point Estimate?
The effect size observed in a particular study is called the point estimate of the effect. •(e.g., RR or AR in a cohort study; treatment effect in a RCT; OR in a case-control study) •Best estimate from the data of the true (but unknown) effect size in the population. •Best estimate from each study, but how precise is each estimate?
64
What is the equation for Risk Ratio (RR)?
Incidence exposed/incidence in non-exposed
65
What is the equation for Absolute Risk (AR)?
Incidence exposed -Incidence in non-exposed
66
What are some examples of Bias in testing?
•Lead time (early detection of disease is confused with increased survival) •Length time (slow developing conditions are more likely to be picked up in screening) •Over diagnosis (over interpretation of tests as positive when FP)
67
What is Bias?
-Systematic errors in collecting or interpreting data such that there is deviation of results or inferences from the truth. •Bias results from systematic flaws in study design, data collection, or the analysis or interpretation of results.
68
What is confounding?
A mixing of effects–between the exposure, the disease, and other factors associated with both the exposure and the disease such that the effects of the two processes are not separated. •Occurs when two factors are associated with each other, and the effect of a third factor confuses the association
69
What are the 2 criteria needed for something to be confounding?
1.A variable must be associated with (i.e., a risk factor for) the outcome, independent of the exposure (i.e., even in unexposed group) 2. A variable must be associated with the exposure, but not a consequence of it.
70
What kind of variables should be seen as confounders?
•Age •Known risk factors •Known prognostic factors
71
What are some examples of ways that we can control for confounding in studies?
Randomization: ensures known and unknown confounders are evenly distributed in study groups •Restriction: limit subjects to one category of a confounder e.g. only men; no variability, so no confounding •Matching: enroll controls to be similar to cases on the potential confounders; however must follow matched analysis
72
What are some ways we can control for confounding in data analyses?
-Stratification: separating data into strata of confounder -Mantel-Haenszel adjusted RR: weighted strata -Multivariate analysis / modeling: advanced statistical techniques, logistic regression
73
What are the types of random assignment?
–Simple –Random block (blocks of k subjects) –Randomization of pairs of subjects
74
If blinding/masking is used in a study, who can be blinded?
–Those who allocate patients to treatment groups –Patients in the study –Physicians and investigators –Researchers who assess outcomes
75
How do you calculate RRR?
(Control event rate-Experimental event rate)/Control event rate
76
How do you calculate ARR?
Control Event Rate–Experimental Event Rate
77
What is Number needed to treat?
•Describes how many patients need to be treated to prevent one of them from experiencing the outcome •Inversely related to proportion of patients in the control group (i.e., untreated / baseline risk) who suffer an adverse event •Represents an easy number to understand, especially when comparing the effect of different interventions
78
What is the equation for NNT
1/(Control event-Experimental event Rate)
79
What are the two approaches for analysis of results?
•Intention-to-treat–Analyze according to group assigned by randomization regardless of whether they actually received treatment –Were patients offered the treatment? •Explanatary–Analyze according to treatment actually received, regardless of randomization –Did the treatment make a difference?
80
What is the difference between Efficacy and Effectiveness?
Efficacy: Does the Tx work in ideal setting Effectiveness: Does Tx work in ordinary setting?
81
What is the difference between Clinical and statistical significance?
•Statistical significance: is this difference likely to be real (beyond random variation)? •Clinical significance: is this difference likely to be clinically important? Both are effected by size, to small and clinical significance my not reach statistical and if too large, results may look more significant then they really are.
82
What is the benefit of using Relative Risk?
If you can estimate a patient's risk of outcome(s) without treatment, then you can tailor clinical trial data about treatment results to an individual by calculating risk differences. •Presenting data as risk differences makes the benefits and harms of intervention easier to compare.
83
Risk Vs Prognosis
•Both involve a set of probabilities of various outcomes over time •A distinction should be made between factors associated with: –increased risk of developing a disease (risk factors) –those that predict a worse outcome once the disease is present (prognostic factors)
84
What are used to make estimates about prognosis?
•5 year survival •Median survival •Response to treatment (improvement) •Time to recurrence •Case fatality •Disease-specific mortality
85
How does prognosis change based on individual death?
The probability of surviving to any point in time is estimated from the cumulative probability of surviving each time interval that preceded it
86
what are some of the disadvantages to the US health care system?
• Outcomes: –Americans are not the healthiest among the industrialised countries • Access – Americans more likely to have unmet health needs • Inequalities – significant disparities in access and care
87
What are the costs associated with US health care?
• The US has the most expensive health care system in the world: 17% of GDP – $8000 per capita almost $2.5 trillion
88
what are some of the challenges to health care in the US?
–Malpractice and defensive medicine –Some ineffective inappropriate care -Higher prices and medical inflation –Administrative waste –Pressures of profit in medical care
89
What is Bodenheimers paradigm?
Bodenheimer: paradigm of “excess and deprivation” A case of excess –Daniel Taylors prostate surgery • A case of deprivation Mary McCarthy’s pregnancy
90
Why has health care developed over time?
To mitigate the fluctuating cost of health care and the unbalanced cost of different procedures.
91
What percentage of Americans rely on private insurance?
5%
92
What do the majority of americans rely on for health insurance?
Employement based=48% Government insurance is #2 with 30%
93
What is the order is insurers for the American public?
•Employment -based insurance •Government programs •Uninsured •Individual private insurance
94
what are the types of payment for health care?
•Government financing •Employment-based •Out-of-pocket payment •Private and individual insurance
95
What are some of the issues of out of pocket payment?
•Problematic for patients – May not be able to afford direct costs –Does not know what the total bill will be in advance • Problematic for physicians and hospitals – Difficulty in getting paid –Fluctuation in demand
96
How does individual private insurance work?
• A third party payer “insures” health care services •Two financial transactions – Individual pays a premium (contribution) to a health insurance plan – When the individual needs care, the insurer reimburses the provider of care Large administrative costs are problematic, costs get higher when people get sick
97
How does employment based heath insurance work?
•Employers pay part of the premium (contribution) to purchase health insurance for employees insurance • Subsidized by the federal government through tax exemptions for employers ($260 billion in 2009)
98
What are the benefits of employment based health insurance?
•Cost lower than individual insurance •Administrative cost high, but not as high as individual insurance •People obtain insurance as part of their pp employment benefit package
99
What are some of the cons of employment based insurance?
Costs can rise steeply from year to year •Employer has no obligation to provide • The employer can require you to pay a greater % of the premium
100
what is experience rating?
insurers differentiate premiums for individuals based on potential risk of getting sick
101
What is community rating of health insurance?
•Insurer sets premiums based on the community of its subscribers $400 per month for all • Health insurance principle of redistribution enhanced by this – From healthier to more at risk From more well off to less well off
102
What will the affordable care act cause?
•No denial of coverage based on pre-existing conditions For children under 19 as of September 2010 –For everyone as of 2014 •No rescision of coverage based on illness; No lifetime limits on coverage •Cap on co-payments and out-of-pocket payments •Delayed until 2015: Employer mandates
103
What is medicare?
•Federal insurance program that covers 47 million Americans •Covers about half of a beneficiaries expenses • Subject to deductibles, copayments and coverage gaps (“Medigap” insurance)
104
What are the ABC's of medicare?
–Medicare Part A • Contributory hospital insurance –Medicare Part B • Supplementary medical insurance -Medicare Part C • Incentives for managed care -Medicare Part D • Optional drug coverage benefits
105
What is part A of Medicare?
•Contributory social insurance program – Everyone with an income must contribute through social security taxes – Everyone who pays in is covered • Administered through Social Security – Employers and employees contribute 1.45 % each of wages and salaries – Self-employed pay 2.9 % Covers Americans 65 and older-must have paid in for at least 10 years.
106
When does part A of medicare cover people under 65?
•Covers Americans under 65 with permanent disability – Waiting period: after they have been receiving Social Security disability for 24 months – Exceptions to waiting period: • Chronic Renal Disease (permanent kidney failure requiring dialysis or transplant) • ALS (Amyotrophic Lateral Sclerosis)
107
What does medicare B cover?
• All “medically necessary” services – Physician services – Physical, occupational, speech therapy –Medical equipment – Diagnostic testing • Medicare reimburses 80 % of amount minus $162 yearly deductible minus $162 yearly deductible
108
What will affordable care act change?
•As of 2011 Medicare will •Pay for an annual check-up Eliminate co-payments for preventive services and screenings •Provide a 10 % payment bonus to primary care physicians and general surgeons in areas with a shortage of physicians (2011-2015)
109
Who is covered in Medicare C and what does it cover?
•Those eligible for Medicare can enrol in a private health plan : “Medicare Advantage” • Combines Part A and B (usually under an HMO) • Medicare then subsidizes the plan premium rather than direct reimbursement to providers
110
What did Medicare D add to medicare?
•Medicare Prescription Drug, Improvement and Modernization Act of 2003 • added partial prescription drug coverage – contributory (monthly premiums plus yearly deductible) – administered by private insurance plans; subsidies to enroll Medicarebeneficiaries
111
What does the doughnut hole refer to?
• Medicare Part D had a problem with a coverage gap, known as the donut hole – Medicare temporarily stops paying for prescriptions once you reach your drug coverage limit – Until 2010, the initial drug coverage limit was $2,830; once you reach that, you are in the donut hole and pay the full cost of prescription drugs until your total out-of-pocket cost reaches $4,550 As of 2011, if you reach the donut hole you are given a 50% discount on the total cost of brand name while in the gap.
112
What is Medicaid?
•public assistance program • jointly administered by federal govt & states – Varies by state per capita income –States determine eligibility (via Medicaid States determine eligibility waivers) and federal government pays at least 50% of cost – Covers hospital, medical, long-term care
113
Who is eligible for medicaid?
•Designed for the poor who qualify as“low-income” • Prior to 2014: also have to meet “categorical” criteria – Young children –Pregnant – Disabled
114
How is medicaid funded and who is covered?
•All taxpayers pay through general revenues but only those meeting eligibility requirements are covered • Medicaid now covers 58 million low-income Americans •Medicaid pays physicians about 72 % of Medicare fees
115
According to medicaid what must be covered?
–Hospitals – Physicians –Diagnostics – Prenatal & preventive -Nursing Home Home care
116
State Children’s Health Program (SCHIP)
•Created in 1997 to provide federal funds to states for child health • Provides coverage for kids in families with incomes at or below 200% of the federal poverty level. Medicaid expansion through SCHIP one of the largest social expansions in past decade. -provides coverage to over 9 million children.
117
RCT are very important, what are some ways that they are inaccurate?
To reduce variability it is common to: • Restrict the age range, perhaps gender too • exclude patients with co -morbidity (other diseases). This can lead to over simplifications of results.
118
what is a systemic review and what is its purpose?
A careful, unbiased study of the various RCTs – as if it were an experiment- specifying the procedures in advance ....The intent is to present the results of all the quality RCTs on the same treatment .(Only feasible if they have similar methods and measurements)
119
What are some alternatives to Evidence Based Medicine?
AUTHORITY-BASED MEDICINE TRADITION-BASED MEDICINE TEXTBOOK-BASED MEDICINE INTERNET-BASED MEDICINE
120
What is a consumer Union?
• "To maintain its independence and impartiality, CU accepts no outside advertising, and no free samples and employs several hundred mystery shoppers and technical experts to buy and test the products it evaluates."
121
What are some of the difficulties of Meta Analysis?
•Quality is dependent on the quality of the trials • Publication bias, unpublished data - Cochrane controlled trials register -US Govt register recently being used • A large RCT is preferable for clinical decisions • Trials may be too heterogeneous to combine: age of patients, dosages of drugs, outcomes measured..... May require stratified presentation of data as in examples in textbook
122
What are the benefits of drug formularies?
•A hospital or a Health Maintenance Organization may decide to adopt a standard list of drugs which they have reviewed and found to be effective in the community, safe, and reasonably priced. • Their doctors become familiar with this list and are less often surprised by bad side- effects, are not visited by drug reps, and the patients save money
123
What are some of the issues with efficacy of Tx?
Efficacy of Tx studies are done in a controlled environment where all drugs are taken and all follow up visits are done, this is all that is required for a drug company by the USDA and it is the basis for most drug adds. This may not look mimic the drugs use in the real world 100%.
124
What was one of the cons to the HIV vaccine study?
The results were compared to every group that was tested until some significance was reached, even though initial significance was NOT present when the large group was studied.
125
How does doing multiple comparisons in a group effect the P number used?
•Bonferroni correction says that if you make 9 comparisons, (as in this study) and want to have only 5% error for the whole study, you need to use a t value which is 9 times the usual critical value from the t table.
126
What is the payment per Pt model?
– Patient registers with physician group Emphasis on primary care – Fixed sum of money per patient, regardless of number of services provided
127
What are 4 types of payment for service?
–Fee for service – Per episode of illness –Per patient – Per time
128
What are the 4 types of hospital payments?
–Fee for service –Per diem (hotel approach-per day pay) –Diagnosis-related groups (payed on episode of illness req hospitalization) –Global budgets(hospital recieves total budget for year)
129
What are some of the downsides to Per Diem hospital pay model?
• the insurer continues assumes risk for the number of days a patient may have to stay in the hospital •The Hospital is at risk for the number of procedures performed per day because it encures more cost to the hospital without any extra pay.
130
How much of the US health care is primary care accountable for?
80-90%
131
How does the US model differ from the UK?
In the UK there is a gatekeeper model, where primary-2ndry-tertiary care is structured like a pyramid, and multiple gate keepers and found along each step, vs the US where there are many points of entry into the health care system. The US has less distinction in the health care system and there is overlap between GP and specialists.
132
What are some of the downsides to the dispersed care model of health care?
–Higher costs involved –Tendencies toward fragmentation – Lack of organizational coherence -Difficulty of integrating care and maintaining continuity of care –Possibility of unnecessary procedures – Risk of medical error increases
133
How does an HMO work for a Patient?
–you receive most or all of your health care from a network provider, you choose a primary care physician (internist, family doctor, pediatrician) responsible for managing and coordinating care specialist care diagnostic services require an approved referral
134
What does verticle integration mean for a health care provider?
Kaiser Permamente is an example of vertical integration, it includes all services under one roof.
135
What is an Independent Practice Association (IPA)?
•An IPA is a loose collection of private doctors who work in their own practices •IPA contracts with HMO on behalf of the doctors •The IPA receives a capitation payment from the HMO and pays its doctors either through capitation or fee-for-service • Both usually involve fee-for-service referrals with bonus arrangements
136
What is a preffered provider Organization?
• Emerged in the 1980s for Medicare patients • The PPO payer receives monthly premiums from subscribers and employers • Patients are required to select physicians and hospitals approved (“preferred”) by the payer • Providers discount their fees or allow payer to “manage” the care they give • About 50 million people enrolled in PPOs today
137
What fraction of US physicians are primary care?
1/3
138
Who are the uninsured?
Mainly employed, but part time, 25% of those making less then 25,000 are uninsured. More likely to be Hispanic and African American.
139
What is COBRA?
COBRA was an act that allowed employees to keep their health insurance after loosing their job. for up to 18 months after, must continue to pay premium.
140
What does the phrase "Res Ipsa Loquitur" mean?
The thing speaks for itself- the act is itself the proof-barrel example, barrel cannot come free if not kicked, even though no one was witness . In medicine, the negligence may be so blatant that no expert witness is needed.
141
What should a Pt be told in order to obtain informed consent?
Diagnosis Procedure or Treatment Risks and Consequences Feasible Treatment Alternative No Treatment Outcome
142
What are the exceptions to needing informed consent?
Emergencies Unconscious or Incapacitated Patient Patient Waiver
143
What happened in the 1980's in medical ethics?
There was a large shift in many countries to move away from the Hippocratic oath and move towards the creation of other oaths or codes of ethics.
144
What did the Neremberg code state?
That the medical Dr must always work to benefit good, imposes requirement of informed consent.
145
What are the three oriented views of death?
1. Cardiac orientation 2. Brain Orientation 3. Higher brain oriented view
146
How does Medicare pay for hospital related bills?
DRG Diagnosis related groups
147
What is the difference between an emancipated minor and a mature minor?
An emancipated minor is one who can make all medical decisions as an adult, a mature minor is one who is able to make a few medical decisions in regards to their care, for example Tx of STD's and birth control
148
What is an exceptional difference between the declaration of Geneva and the Hippocratic Oath?
One critical difference in the declaration of Geneva is the exceptional commitemnet to confidentiality.
149
How can we tell we are looking at a Kaplan Myer curve?
It evaluates mortality, so the curve starts on the lower left corner Vs looking at survival, where the curve starts at upper left
150
What is the WAIS-III used for?
Adults 17 and older
151
What is the WISC-III intelligence scale used for?
Children 6-17
152
What is the WPPSI-III Test used for?
Preschool 2-7 yr olds
153
What does the MMPI validity scale involve?
Validity tests for how someone may be faking an interview, faking good (L-scale) or faking bad (F-scale)?
154
What study must you use an odds ratio for to estimate RR?
Case-control studies
