Safety and Protection; Professional Responsibilities; Research Flashcards
Standard precautions
for the care of all patients regardless of infection or diagnosis
Transmission based precautions
airborne
droplet
contact
These are in addition to standard precautions
Airborne Precautions
Private negative pressure room
N95 or higher respirator when entering room. Pt should be wearing surgical mask.
examples: measles, varicella (chickenpox), TB, SARS
Droplet Precautions
Requires close contact; infectious agents travel 3-6 feet or less
Private room but door can be open
Pts in the same room need to be 3 ft apart
Pt and healthcare professional need to be wearing a mask especially when going to be 3-6 feet apart
examples: meningitis, pneumonia, sepsis, flu, mumps, strep
Contact Precautions
skin-to-skin transmission
Private room
Pts in same room should be 3 ft apart
Gloves and gown
examples: GI, respiratory, skin or wound infections (C-diff, E coli, MRSA)
Donning PPE
hand hygiene
gown
mask
goggles
gloves
Doffing PPE
gloves
goggles
gown
mask
hand hygiene
Sterile field
gowns are only sterile in the front from the waist up, including sleeves
only top of surfaces are sterile
talking, sneezing or coughing will contaminate the sterile field
do not turn your back to a sterile field; constant observation of sterile field is required.
If object on the sterile field becomes contaminated the field is considered non-sterile and should be discarded.
Sterile fields should be prepared as close to the treatment time as possible
Anything that falls below the waist is considered contaminated
Asepsis
elimination of microorganisms that cause infection and the creation of sterile field
Nosocomial infection
hospital acquired
PT response to allergic reaction
First try to remove source.
Then check airway
Then Epipen if have it
PT response to Autonomic Dysreflexia
First placed in upright position
identify noxious stimulus
monitor vitals and call for assistance
PT response to a burn
Initially remove source
Liquid chemical-dilute with water
Powder chemical- brush off
Thermal burn- under cool tap water
Burn covers a large area- cold water should not be used as it can increase risk for hypothermia.
Electrical burn-HR and RR should be assessed
All clothing or jewelry near burn should be removed unless it is in the burn itself.
Clean towel or dressing over wound to prevent infection.
PT response to fractures
peripheral pulses and sensation should be assessed distal to injury
Signs of Ketoacidosis that occurs with hyperglycemia
fruity breath
deep, labored breathing
N/V
dry tongue
If there is arterial bleeding…
intermittent pressure to artery proximal to site of injury
If blood flow is excessive, then extremity should be elevated above level of heart.
Prolonged pressure with tourniquet should be avoided.
After 10 minutes of steady pressure, call EMS.
After seizure do what with pts head
turn to side in case they vomit
Positioning of pt when in shock
supine with feet elevated above the level of head
Fowler’s position
supine with HOB elevated between 45-60 degrees with knees supported
Semi-fowler’s position
supine with HOB elevated 30-45 degrees
Fowler’s positions and its variations are used for
cardiac conditions
respiratory conditions
breathing difficulties
those with NG tube
Trendelenburg is used for
postural drainage
hypotension
medical emergencies like hypovolemic shock
Workstation recs:
Monitor size
Monitor display direction
Monitor set how far
How many exercise breaks
Space under desk
18-20 in
10 degrees below horizontal
at least 20 inches away
30 second breaks every hour
30 in wide
19 in deep
27 in high
2-3 inches between top of thighs and desk
Elbows should be bent to what when working
90-120 degrees
Employment provisions for disabilities (Title I) applies to who?
Title II, Public accommodations applies to who?
employers of 15 or more
all businesses regardless of size
ADA does not require employers to make accommodations that pose what
undue hardship
(significantly difficult or expensive)
Ramps should possess
12 inches of horizontal run for each inch of vertical rize.
8.3% grade
Ramp should be
how wide?
with ….. if rise is greater than 6 inches or horizontal run of greater than 72 inches.
Needs a level ….. at the top and bottom. If ramp changes direction, the landing area must be a minimum of what?
36 inches
HR
landing
5x5
Doorways need to be how wide?
Deep?
Thresholds in doorways need to be less than ___ inch for sliding doors and less than ___ inches for regular doors.
Hallway clearance needs…
W/c turning radius: width and length
32 inches
24 inches
3/4
1/2
36 inches
60 inches
78 inches
Validity
closeness to the truth
Impact
size of effect
Applicability
usefulness in clinical practice
PICO
Patient or problem
Intervention
Comparison
Outcome
Levels of Evidence Hierarchy from most reliable to least
systematic reviews and meta-analyses
RCTs
Cohort studies
case control studies
cross-sectional studies
case series
case reports
ideas/opinions
Cohort study
longitudinal, observational study
prospectively or retrospectively from historical records
The measure of association between exposure and disease in cohort studies is known as
the relative risk
Limitations of cohort studies
excessive length
influence of other lifestyle variables
Case control study
retrospective, observational study
already have a particular disease matched with a comparison group of individuals without the disease
Measure of association between exposure and occurrence of disease in case control studies is the
odds ratio
(the ratio of odds of exposure in disease subjects to the odds of exposure in non-diseased subjects)
Cross-sectional study
observational study where the data or observations are made at only one point in time and all subjects are tested at relatively the same time
aims to describe relationships between a disease or condition and factors of interest that exist in a specified population at a given time.
These studies cannot distinguish between newly occurring and long-established conditions, nor can they identify causal relationships.
Case reports or case series cannot
test hypotheses or establish cause and effect relationsips
Exploratory research
examines dimensions of a phenomenon of interest and its relationships to other factors.
Examples: cohort studies, case control studies, historical research and methodological studies
Descriptive research
recording, analyzing, and interpreting conditions that exist for the purpose of classification and understanding a clinical phenomenon.
Examples: developmental research, normative research, qualitative research, case report, case series
Experimental research
Comparing 2 or more conditions for the purpose of determining cause and effect relationships between independent or dependent variables.
Examples: RCTs, quasi-experimental studies and single-subject designs
Assent
childs affirmative agreement to participate in research.
A childs failure to object should
not be construed as agreement
Belmont Report articulated three ethical principles that guide human subjects’ research
respect
beneficence
justice
Continuous data
can assume any value along a continuous scale
Examples: ROM, distance, weight, time
Discrete data
measured in whole units
Examples: HR, those diagnosed with cancer, # of PT visits
Dichotomous data
type of discrete data with only two values
Examples: pass or fail, smoker or non-smoker
Qualitative data
Examples: eye color, blood type and hand dominance
Nominal
each object or person can only be assigned to one category.
Qualitative
Examples: blood type, type of breath sound, type of arthritis
Ordinal
ranking
Examples: MMT, level of assistance, pain
Interval
Intervals between adjacent values are equal but there is no true zero point.
Examples: temp, some developmental and functional status tests
Ratio
intervals between adjacent values and there is a true zero point.
Examples: ROM, distance, time, nerve conduction velocity
Reliability
reproducibility or repeatability of measurements
Internal consistency
measurement relates to function
Intrarater reliability
same person
Interrater reliability
more than one person
Test-retest reliability
same individual on separate occasions
Validity
degree to which a useful or meaningful interpretation can be inferred from a measurement
Face validity
tests what its supposed to
Content validity
measurement reflects meaningful elements of a construct and items test the interested elements
Examples: MPQ has more content validity than a visual analog scale because it assesses location, quality and duration of pain
Construct validity
theoretical construct is measured by a test
Examples: MMT have this for nerve innervation if there is a relationship between scores and EMG testing
Criterion-related validity
established by comparing it to a different measurement that is considered the gold standard
Concurrent validity
form of criterion
interpretation is justified by comparing measurement to the gold standard at the same time.
Examples: HR by palpation and ECG if they are associated
Predictive validity
form of criterion
if a measurement is considered predictive of future behavior
Example: GRE or GPA for admission to predict future academic success
Prescriptive validity
form of criterion
measurement suggests the form of treatment each person should receive based on successful outcome of treatment.
Examples: measurement of asystole on ECG if patients with this arrhythmia are successfully revived with CPR.
Sampling error
chance between statistic calculated from a sample and true value of the parameter in population
Sampling with replacement
putting those selected for the sample back into population before next unit is drawn.
This results in units having an equal chance of being selected
Rarely used on human subjects
Sampling without replacement
not replacing and results in decreasing size of population
Simple random sampling
table of random numbers or random number generator
not the most statistically efficient method
Systematic sampling
taking every nth subject
Stratified random sampling
divided into subgroups (strata) then a simple random sample is done.
this helps with representation of key subgroups of population
Cluster sampling
clustered together and then random clusters are sampled
Non-probability sampling
does not involve random selection
Independent variable
intervention or condition
Dependent variable
outcome or response
Completely randomized design
randomly assigned and each group receives a unique intervention and they are compared at the end.
Crossover design
subject receives both treatments in random order with a period of no treatment
Factorial design
two or more independent variables investigated
Repeated measures design
subjects are tested under all conditions and each person acts as their own control.
Sequential clinical trial
data analyzed as they become available so trial can be stopped as soon as evidence is sufficient to show a difference
Quasi-experimental design
one without control group, random assignment or both
One group pretest and posttest design
time is independent variable, with two levels (pretest and posttest)
One way repeated measures design over time
measurements made on one group of subjects at multiple, prescribed time intervals
Intervention can be administered once or may be repeated
Time series design
multiple measurements made before and after treatment to observe patterns or trends during pre and post treatment periods
Internal validity is when there is
confidence that the intervention caused the outcome
Double blind
subjects and some of the research team are unaware of hypothesis and group each subject was assigned to
Triple blind
subject, some of the research team and data analyzers unaware
When an effective treatment is available, it is
unethical to use placebo
Matching pairing classical example
identical twins
Intention to treat analysis
all subjects randomly assigned to one of the treatments are analyzed together regardless of whether they received or completed treatment
External validity
degree to which the results of research can be generalizable to populations or circumstances beyond those in the study
Hawthorne effect
untreated subjects experience changes just by participating in study.
Alternate hypothesis
differs from null hypothesis.
Null hypothesis
statistical hypothesis
p-value
probability that a particular statistical result could have happened by chance.
When the p-value is smaller than the stated alpha value the null hypothesis
is rejected
When p-value is larger than states alpha value, the null hypothesis
is accepted
Alpha level
significance level
probability of rejecting the null when it is true (chance of committing a type I error)
Traditional values= 0.05- 0.01
Type I error (alpha error)
wrongly deciding to reject the null hypothesis
concluding there is a difference when there isnt.
a false positive
If the level of significance is set at 0.01 there is a ___% chance of a Type I error.
1
Type II error (beta error)
wrongly deciding to not reject the null hypothesis
deciding there is no difference when there is
a false negative
Statistical power
refers to chance that a statistical test will lead to rejection of false null hypothesis
Larger the effect size, the more likely it will be
statistically significant
Effect size index:
<0.1=
0.1-0.3=
0.3-0.5=
>0.5=
trivial effect
small effect
moderate effect
large effect
Minimal clinically important difference
smallest difference in a patient’s conditions that the patient or clinician considers worthwhile
Minimal detectable difference
smallest difference or change that would be statistically significant
Parameter
greek letters for mean, standard deviation
Statistic
english letters used for mean and standard deviation
Forest plots are used in
meta-analyses
Histogram is a
frequency distribution
Line graphs
relationship between two or more quantitative variables
variable on y-axis=dependent variable
x-axis= independent
ideal for showing trends
Scatter plot
relationship between two quantitative variables
Step and leaf plots
observe entire distribution of data without losing any information
Descriptive stats
summarize or describe important characteristics of a population
Kurtosis
peakedness of a distribution
Within a normal distribution:
68% of all values fall within ___ SD.
95% of all values fall within ___SD.
99% of all values fall within ___SD.
1
2
3
Negatively skewed distribution
mean and median are to the left of mode and left tail is elongated
Positively skewed distribution
mean and median are to the right of mode and right tail is elongated
20th percentile is
value or score below which 20% of scores are found
Standard Deviation
measure of the spread or dispersion of data
Inferential stats
uses sample data to make inferences about a population
test hypotheses
parametric or nonparametric
ANOVA
test the equality of means between two or more populations
One way ANOVA
one independent variable is examined
Two way ANOVA
two or more independent variables examined
Regression analysis
predicts change in one or more independent variables affecting dependent variables
Confidence interval
range of values used to estimate a population parameter
Confidence level
probability that the confidence interval actually contains the unknown population parameter.
Pearson product moment correlation (r)
-1.0- +1.0
Positive sign= two variables increase or decrease together
Negative sign= increase in one variable is associated with decrease in other
0= no relationship
t-test
estimates a population mean or compares two means when the population is normally distributed and variance is unknown
paired t-test
samples are matched pairs
independent t-test
differences between male and females for example because cannot be in both groups
z-test
estimating the mean or comparing two means
Nonparametric
do not assume that samples come from populations that are normally distributed and do not assume homogeneity of variance
usually applied to nominal, ordinal, interval or ratio data are not normal
Kruskal-Wallis test
equivalent to one way ANOVA
Mann-Whitney test
alternative to independent t-test
Spearman rank correlation coefficient
equivalent to Pearson product
Wilcoxon Signed Rank test
alternative to dependent or paired t-test
Sensitivity
test positive for those that have the disease
Specificity
test negative for those that do not have the disease
SpPin
test with high specificity= positive diagnostic test rules in the diagnosis.
SnNout
test with high sensitivity=negative diagnostic test rules out the diagnosis
Relative risk of 1.0=
greater than 1.0=
less than 1.0=
aka
event is equally probable in both groups
exposure increases risk
exposure decreases risk
risk ratio
Odds ratio of 1.0=
>1.0=
<1.0=
aka
exposure probably does not increase risk of developing disease
exposure may increase risk of getting disease
may reduce risk
relative odds
Number needed to treat
of patients that need to be treated to prevent one bad outcome or result in one good additional outcome.
ideal number=1
higher the number the less effective the treatment
