T1-Diagnostic Reasoning/Health Promotion Flashcards
Read Goolsby Ch1
Mary Breckinridge and Dixie - Frontier Nursing in Appalachia
Lilian Wald - Henry Street Settlement in New york
Heuristics
Bayesian
Illness Scripts
Bernoulli Equation
What sticks? Trial and Error -potential for bias
Pre-test probability of diagnosis directly affects the post-test probability of that disease
Extensive experience, knowledge driven model of pattern recognition
Logic equation/utility hypothesis
What is the VINDICATE acronym for DDx?
V Vascular
I Infectious
N neoplasticism
D Degenerative
I Iatrogenic/intoxication
C Congenital
A Autoimmunie
T Traumatic
E Endocrine/Metabolic
What are some pivotal points to consider when evaluating DDx’s?
Epidemiology
Time Course
Typical Features
Mechanism of Illness
Make a template for slide 16 (Troutman)
Make a Excell template for condition tracking.
What is a scarletiniform rash?
Sand paper, red, pinpoint, rough — associated with Strep.
Probability of disease if the screening test is POs = probability of a positive test in presence of disease (sensitivity) x prevalence (probability of disease in the population) / overall probability of a positive screening test.
Strep - usually no cough, sudden onsiet, palatial petichiae, cervical adenitis, scarlatiniform rash +/- vomiting.
DOC for strep
PCN.
Ottawa ankle rules
Gail model for breast cancer screening.
Amenorrhea AFMS clinical decision tree.
Rule Algorithm links on slide 34 trautmann.
Health promotion theories are on board exams - look into some:
Health belief Model
Pender’s Health Promotion Model
Lewin’s Theory of Change
Roger’s Theory of Diffusion
Transtheoretical model of change TTM
What influences health-related behavior
Desire to avoid getting sick or get better if sick (perceived susceptibility)
Belief that a certain health action will prevent or cure illness.
(Perceived benefit)
Pender Health Promotion belief Model increase ____ rather than _____ of ______
Used more for _____ diseases.
Wellness
Disease
Chronic
Individual characteristics and experiences + behavior-specific cognitions and affect = behavioral outcome = Pender’s Model.
Lewin’s Theory of change:
1. Unfreezing
2. Moving
3. Refreezing
Driving and restraining forces battling for change
Stages of Roger’s theory of diffusion and innovation:
Knowledge (exposed to new idea)
Persuasion (develop attitude about the idea)
Decision (adopt or reject)
Implementation (use and seek additional evidence)
Confirmation (continue?)
Innovators -> Early adopters -> Early majority -> Late majority -> laggards. What change theory are these types of adopters a part of?
Roger’s Theory of diffusion and innovation
What things predict the rate of adoption according to Roger’s?
Relative advantage
Compatability
Complexity
Trialability
Observability
What model of change does smoking cessation follow?
Transtheoretical model of change:
Pre-contemplation
Contemplation
Preparation
Action
Maintenance.
Change is a _____ process - not ______
Dynamic
Linear.
T/F: Climate change has a huge impact on human health
True
Top 5 risk behaviors that cause many chronic diseases?
Tobacco use
Second hand smoke
Poor nutrition
Lack of physical activity
Excessive alcohol use.
Healthy People 2030
8 global outcome measures
355 measurable public health objectives
23 high priority core objectives
What are some examples up UPstream factors?
Is addressing social, individual needs and screening examples of upstream?
Community Impact - laws, policies, regulations to support health for all people and improve community conditions.
No these are midstream
Examples of Primary, secondary and tertiary levels of prevention
Primary: before the disease occurs (seatbelt, vaccinations)
Secondary: reduce impact of disease or injury that already occurred (mammogram to detect breast cancer EARLY, diet/exercise programs)
Tertiary: soften impact of ongoing illness (cardiac or stroke rehab)
USPSTF: A, B, C, D and I
A - offer or provide this service - high certainty that net benefit is substantial
B - offer or provide this service - high certainty net benefit is moderate.
C - offer or provide this service for select patients depending on individual circumstances.
D - discourage use of this service - harms outweigh benefits
I - insufficient evidence. Patients should understand this uncertainty.
USPSTF Colorectal screening in 50-75yo - Grade?
45-49?
>76?
A, B, C
colorectal screening guidelines:
Annual FOB test, flex sig q5yrs, colonoscopy q10yrs, CT q5yrs or stool DNA every 3yrs.
Review USPSTF guidelines and become familiar with usual recs,
Review HEDIS and become familiar with usual Recs
Difference between sensitivity and specificity; PPV and NPV - find a good resource! - check out 3 articles on Canvas
