Stats/ethics/IT Flashcards
A prospective randomized controlled study is being conducted to assess whether patients with bronchiolitis benefit from nebulized hypertonic saline treatments given at home. A cohort of 600 patients diagnosed with bronchiolitis is randomly assigned to 3 groups receiving either no treatment, once-daily treatment, or treatment 3 times per day. Symptoms are analyzed by means of a symptom checklist daily over 7 days. Of the 600 enrolled patients, 510 appropriately completed all 7 daily checklists. There is concern about how this might influence the results of the study.
Of the following, the BEST way to maintain study power and avoid compliance bias in this study is to
A. decrease the duration of the study B. increase study enrollment C. use intention-to-treat analysis D. use per-protocol analysis
use intention-to-treat analysis
Intention-to-treat analysis includes data from all patients who were randomly assigned to a group even if they did not complete the study.
Intention-to-treat analysis preserves sample size and improves the power of a study.
Intention-to-treat analysis can help reduce bias.
When per-protocol analysis is used, only those who complete the study are included in the final analysis.
An 11-year-old girl is discharged from the hospital with a prescription for levetiracetam after hospitalization for newly diagnosed generalized epilepsy. She returns to the emergency department 2 weeks later with suicidal ideation and agitation and is admitted to the child psychiatry unit. Upon medication reconciliation, it is discovered that she is taking 4 times the intended dose of levetiracetam. Investigation shows that her discharge prescription was written incorrectly by a resident physician. Her neurologist is contacted and the correct dose is confirmed. The correct dose is administered in the hospital and her psychiatric symptoms resolve.
Of the following, the BEST person to disclose the error to the family would be the
A. child psychiatrist B. hospital risk management supervisor C. prescribing resident physician D. supervising attending neurologist
supervising attending neurologist
Timely and transparent disclosure of medical errors is the standard of care and an ethical obligation of the physician.
Disclosure should be led by the physician responsible for the patient’s care at the time of the medical error.
Medical error disclosure supports the principle of autonomy by providing patients with the information needed to understand their care.
A 5-year-old boy remains hospitalized after experiencing septic shock complicated by acute kidney injury. He is improving but has continued to receive diuretics. On routine laboratory surveillance, he was found to have hypokalemia. The team decided to replace his potassium with an intravenous bolus dose. Repeat testing after the dose was administered demonstrated hyperkalemia. A review revealed that he had received a larger-than-appropriate dose of potassium.
Of the following, the strategy MOST likely to decrease this type of error is to
A. ensure family-centered rounds B. enter orders on a computer C. limit trainee order prescribing D. use verbal orders
enter orders on a computer
Pharmacist involvement as well as computerized order entry, education, and preprinted order sheets have been shown to decrease medication errors.
A barcode medication administration system has been shown to decrease medication administration errors.
An 11-year-old boy is brought to the pediatric intensive care unit with severe hypoxic brain injury after self-inflicted hanging. He is initially treated with conservative neurological protection. After 72 hours of care, his neurological examination shows apnea on the ventilator, decorticate posturing to painful stimulation that is determined via electroencephalography not to be a spinal reflex, fixed and dilated pupils, and diabetes insipidus. After a family conference to discuss the child’s current status, the mother asks if her son could be an organ donor.
Of the following, the BEST response to the mother is that the child
A. is brain dead, so organ donation is an option and consultation with organ procurement should proceed as requested
B. is not a candidate for organ donation because he did not give prior assent
C. is not a candidate for organ donation because the mechanism of injury was attempted suicide
D. would be a candidate for donation after cardiac death
would be a candidate for donation after cardiac death
Brain death requires clinical evidence of irreversible cessation of all functioning of the brain, including the brainstem.
The Uniform Anatomical Gift Act provides the legal foundation on which human organs and tissues can be
donated for transplantation.
the requisite findings in brain death are persistent coma of a known cause in the absence of metabolic derangements or pharmacologic confounders, absence of brainstem reflexes, and apnea. Reversible conditions that can interfere with the neurological examination must be excluded before brain death testing is performed
In addition to decorticate posturing, which indicates intact brainstem reflexes, the child has not undergone formal apnea testing and thus determination of brain death cannot yet be made.
A mother calls the pediatrician to report that her 5-year-old daughter revealed last night that her 12-year-old brother has been coming into her room at night and asking her to touch his “privates.” When questioned by his mother, the boy denies that this has happened. The mother plans to sleep in the same room as her daughter until an evaluation is completed.
Of the following, in addition to scheduling an appointment for this child, the MOST appropriate next step is to
A. advise the mother that the brother should be immediately removed from the home to stay with relatives B. reassure the mother that she has taken all necessary steps to ensure the safety of her children C. report the situation to local child protective services D. report the situation to local police
report the situation to local child protective services
As mandated reporters, pedatricians are required to report known or suspected child abuse to local child protective services.
When sexual abuse is disclosed or alleged, it is usually not necessary for the clinician to hear directly from the child about the abuse; in fact, it is typically best to defer questioning to the trained forensic interviewer.
n 11-year-old who was assigned female at birth is seen for a health supervision visit. He has been diagnosed with gender dysphoria by a psychologist who has followed him for several years. He asks to be called “Michael” and uses the pronouns “he” and “him.” His mother states that he displays typical male play behaviors; prefers typical male clothing, including underwear; and has insisted that he is a boy since about age 3 years. He became very distressed when he recently began showing signs of typical female puberty. An interdisciplinary gender team has recommended that he start receiving a gonadotropin-releasing hormone agonist to suppress puberty. His parents have consented, and he has provided assent for this therapy. They understand the potential adverse effects, including that on bone health. He is wearing typical male clothing and has a typical male hair style. His sexual maturity rating is 2 for breast and pubic hair development. The remainder of his physical examination findings are normal.
Of the following, the team’s action that BEST represents the ethical principle of beneficence is
A. ensuring that the parents have consented to therapy B. ensuring that the child and family understand potential adverse effects of therapy C. making the recommendation to initiate therapy D. obtaining assent of the child before the initiation of therapy
making the recommendation to initiate therapy
Therapy with a gonadotropin-releasing hormone agonist for youth undergoing gender-affirming care shows beneficence by suppressing pubertal progression with the goal of improving gender dysphoria.
Guidelines recommend waiting until youth undergoing gender-affirming care achieve sexual maturity rating 2 to initiate gonadotropin-releasing hormone agonist. This timing allows confirmation of the gender dysphoria diagnosis (gender dysphoria worsens with the onset of puberty), and prevents unnecessary treatment in a prepubertal child
