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Health Management > Term Test 1 > Flashcards

Term Test 1 Flashcards

1
Q

define EBVM

A

the conscientious and judicious use of the current best evidence in the health care of individuals and populations…. combining clinical expertise with the best available external clinical evidence from systematic research

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2
Q

in a nutshell, EBVM combines (2)

A

clinical expertise and best available research

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3
Q

EBVM can be applied to what 3 types of clinical decisions

A

1) diagnostic decisions
2) treatment decisions
3) preventative health decisions

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4
Q

what is an example of EBVM in diagnostic decisions

A

tests and test performance

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5
Q

what is an example of EBVM in treatment decisions

A

interventions and strength of evidence

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6
Q

what is an example of EBVM in preventative health decisions

A

herd health or wellness and causation

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7
Q

what two types of studies are synthesis studies

A

SRs and MAs

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8
Q

what are the 6 parts to a BestBET

A

1) clinical scenario
2) PICO question aka 3 part question
3) literature search
4) evidence
5) comments
6) bottom line

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9
Q

what types of studies are hypothesis-testing studies

A

observational and experimental studies

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10
Q

what types of studies are observational studies

A

case-control, cohort and cross-sectional studies

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11
Q

what types of studies are experimental studies

A

experiments and RCTs

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12
Q

what type of observational study can establish a temporal sequence

A

cohort studies

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13
Q

how are cohort study results usually expressed

A

risk ratio

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14
Q

you can determine _________ risk in a cohort study

A

absolute

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15
Q

when are cohort studies not useful

A

rare diseases

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16
Q

how are the results of a case-control study expressed

A

odds ratio

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17
Q

what cannot be calculated from a case-control study

A

relative risk, true prevalence/incidence, absolute risk

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18
Q

what is an advantage of a case-control study

A

good for rare outcomes and is cheap and quick

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19
Q

what does PICO stand for

A

patient/problem, intervention, control, outcome

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20
Q

what are some issues with using medical records as evidencd

A

1) completeness
2) quality
3) case definition
4) follow-up

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21
Q

if using medical records as evidence we must consider:

A
  • case definition needed for incidence and prevalence
  • complications need to be recorded
  • probability of success relies on follow-up and outcomes
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22
Q

what is key for case definition

A

consistency across clinicians and clinics

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23
Q

what is the biggest issue in practice with finding evidence

A

not having access and ability to find the right articles

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24
Q

describe whether the following boolean operators narrow or broaden your search:
or:
and:
not:

A

or: broadens search
and: narrows search
not: narrows search

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25
Q

what are 3 databases for animal health and which is the best

A

1) CAB direct (best)
2) Agricola
3) PubMed/Medline

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26
Q

What sections of a journal article pertain to relevance and what sections pertain to quality

A

Relevance:
- title
- authors
- abstract/conclusion

Quality:
- materials and methods (objectives, data, outcomes
- conclusions

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27
Q

we tend to remember what types of cases

A

best and worst

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28
Q

why is having a clearly defined case definition important

A

it is needed to determine incidence and prevalence

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29
Q

are case reports/case series useful for decision making

A

no

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30
Q

what are case reports/case series useful for

A

generating questions for future research, describing rare cases, raising awareness

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31
Q

what are the 7 Hill’s Criteria for Causation

A

1) dose-response
2) temporal sequence
3) biological plausibility
4) reversal
5) repeatability
6) rule-out other potential causes
7) strength of association (OR and RR)

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32
Q

case control studies are best for rare _________ and cohort studies are best for rare _________

A

conditions/diseases; risk factors

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33
Q

what observational study type is best for arguing causation

A

cohort

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34
Q

are RCTs or laboratory experiments more controlled

A

laboratory experiments

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35
Q

what is a key aspect of intervention/experimental studies

A

random allocation of subjects to groups

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36
Q

T/F intervention studies support a causal relationship

A

T

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37
Q

every explanatory study needs 2 things:

A

hypothesis and objective

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38
Q

what is the p value

A

likelihood of the observed difference between the groups, given that the null hypothesis is true OR likelihood of the observed differences corresponding to no difference

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39
Q

what are measures of association

A

measure of the magnitude/strength of the relationship between E and O as a relative effect; the ratio of two estimates of disease frequency

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40
Q

what observational study designs can use:
1) RR
2) OR

A

1) RR: cross-sectional and cohort
2) OR: all study types

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41
Q

what are chi-square tests used for

A

to determine whether two categorical variables are related

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42
Q

how is RR calculated

A

risk of disease in exposed group / risk of disease in non-exposed group

[a/(a+b)] / [c/(c+d)]

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43
Q

is RR or OR more commonly reported in an observational study

A

OR

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44
Q

what does MERIDIAN stand for

A

MEnagerie of Reporting guIDelines Involving ANimals

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45
Q

what is the purpose of MERIDIAN

A

to establish guidelines for a variety of types of animal research in order to make it easier to assess quality

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46
Q

how can we determine if randomization worked

A

check the groups for similarity… age, breed, parity, species, severity of condition, etc.

47
Q

what is the aim of a non-inferiority trial?

A

to demonstrate no difference between groups for outcome measures

48
Q

what 7 things should be on every controlled trial checklist

A

1) objectives and hypothesis
2) sample size calculation
3) random allocation
4) did randomization work
5) blinding and placebo
6) effect size
7) limitations and survival bias

49
Q

what is an important consideration with diagnostic accuracy

A

we estimate Sp and Sn by comparing to what we call the reference standard, which we assume to be “gold standard”

no test is actually perfect so we need to account for this so as not to over or under estimate the accuracy of a new test

50
Q

what does STROBE-VET stand for

A

strengthening the reporting of observational studies in epidemiology - vet extension

51
Q

define the type of observational study:

comparison of past histories of animals that have a disease with those in a comparable group of undiseased animals

A

case-control

52
Q

define the type of observational study:

simultaneous classification of a group of animals according to disease status and risk factors

A

cross-sectional

53
Q

define the type of observational study:

most useful for rare outcomes

A

case-control

54
Q

define the type of observational study:

cannot calculate true incidence/prevalence and RR

A

case-control

55
Q

define the type of observational study:

among observational studies is the best to argue causation

A

cohort

56
Q

define the type of observational study:

ID two groups of animals (one with the risk factor and one without) and subsequent follow-up over time to determine if disease develops

A

cohort

57
Q

what are 3 types of bias possible to see in narrative reviews

A

1) selection bias
2) information bias
3) publication bias

58
Q

what is a systematic review

A

review of a clearly formulated question that uses systematic and explicit methods to identify, select, appraise and summarize relevant research

59
Q

the systematic review team includes what two experts

A

content and methodological

60
Q

the answer to the review question in a systematic review is a

A

NUMBER

61
Q

what 4 types of studies are included in a systematic review

A

1) intervention studies (RCTs)
2) prevalence/incidence/proportion studies
3) diagnostic test accuracy studies
4) observational studies

62
Q

T/F you can draw conclusions from scoping reviews

A

F

63
Q

what are scoping reviews good for

A
  • finding gaps in the literature to help guide future research
  • assessing feasibility of a full systematic review
  • planning primary research or systematic reviews
64
Q

what are the 9 steps to a systematic review

A

1) define review question
2) develop review protocol
3) comprehensive search for studies
4) select relevant studies
5) collect data from relevant studies
6) assess relevant studies for bias
7) synthesize results
8) present results
9) interpret results

65
Q

what is the most important step in a systematic review

A

defining the review question

66
Q

what are the 4 types of review questions

A

1) prevalence/incidence (PO)
2) diagnostic test accuracy (PIT)
3) etiology (PECO)
4) intervention (PICO)

67
Q

what types of characteristics can explain variability between studies used in systematic reviews

A

population characteristics, intervention/comparator, outcomes

68
Q

what are the 4 ways to present data from a systematic review

A

1) narrative synthesis
2) meta-analysis
3) pair-wise meta-analyiss
4) network meta-analysis

69
Q

what is I^2 a test of

A

heterogeneity (higher number means there is a lot of differences between the studies)

70
Q

interpret the following I^2 values:
- 30-50%:
- 50-80%:
- 80-100%:

A

30-50% is moderate
50-80% is substantial
>80% is considerable

71
Q

how can we explore heterogeneity

A

by subgroup analysis and meta-regression

72
Q

T/F narrative synthesis and narrative review are the same thing

A

F

73
Q

what is the who, what, where of infectious disease control

A

health and disease is a balance of host, environmental and agent factors

74
Q

what is disease caused by and how do we control disease

A

disease is the result of a combination of risk factors, we control disease through management/manipulation of these risk factors

75
Q

Describe the following:
- between agent and host
- between agent and environment
- between host and environment

A
  • between agent and host: RESISTANCE
  • between agent and environment: EXPOSURE
  • between host and environment: STRESS
76
Q

what is infectious vs contagious

A

infectious: caused by or communicated by microorganisms in the tissue (about agent)

contagious: capable of being transmitted from individual to individual (about transmission)

77
Q

what is the relationship between contagious and infectious

A

contagious is always infectious, but infectious is not always contagious

78
Q

contagious diseases are spread by __________ whereas infectious diseases are spread by ____________

A

contact; infectious agents

79
Q

Match the following:
1) epidemic
2) sporadic
3) pandemic
4) endemic

a) predictable long-term balance between agent and host
b) agent is present but disease occurs infrequently and is not readily predictable
c) gross imbalance between agent and host, usually during initial exposure
d) a global epidemic

A

1) c
2) b
3) d
4) a

80
Q

is coliform mastitis contagious or infectious

A

infectious

81
Q

is s. aureus mastitis contagious or infectious

A

both

82
Q

what is a necessary vs sufficient cause

A

necessary: must be present to cause disease; always a component of a sufficient cause

sufficient: always produces disease; usually a group of host, agent and environment factors

83
Q

what is the Reed Frost equation and what are the components

A

Ct = S(1-Qct)
Ct = number of cases over time
S = number of susceptible individuals
1-Qct = probability of adequate contact

84
Q

what are the 3 overarching ways to approach infectious disease control

A

1) eliminate
2) prevent
3) control

85
Q

how can we eliminate infectious disease (3)

A

1) eradicate infected animals
2) vaccinate at-risk animals
3) test and slaughter and vaccination

86
Q

what are the 3 ways to eradicate infected animals as a form of infectious disease elimination

A

1) depopulate all animals
2) test and slaughter (high Sp)
3) treatment

87
Q

which of the approaches to infectious disease elimination will cause the disease to ‘die out’

A

test and slaughter and vaccination

88
Q

what are the 3 options for preventing disease as a method of disease control

A

1) increase resistance
2) decrease exposure
3) decrease stress

89
Q

what are ways to decrease exposure

A
  • biosecurity (closed herds)
  • reduce contact
90
Q

what are ways to enhance resistance

A
  • vaccination
  • genetics (long-term)
  • nutrition (Vitamin E and selenium)
91
Q

what are 3 methods of disease control through strategic/routine medication

A

1) metaphylaxis
2) medicated feed
3) fleas
4) heartworm

92
Q

what is metaphylaxis

A

treatment of a group of animals without evidence of disease but who were in close contact with other animals that are showing evidence of disease

93
Q

how do we decide whether to control infectious disease through elimination vs prevention vs control

A

risk-based decision

94
Q

what are the two components of risk

A

probability and magnitude

95
Q

what 3 things can influence magnitude of risk

A

1) zoonotic potential
2) economic impact
3) distribution (endemic, epidemic, pandemic, sporadic)

96
Q

define biosecurity

A

the protection of people, animals and ecological systems against disease and other biological threats

97
Q

how is biosecurity achieved

A

through systems that protect people, animal and plant industries and the environment from the ENTRY, ESTABLISHMENT and SPREAD of diseases

98
Q

management/prevention of what 3 disease categories forms the basis of Canadian Biosecurity

A

1) foreign disease
2) endemic disease
3) zoonotic disease

99
Q

define disease surveillance

A

continuous investigation of a population to detect the occurrence of disease for control purposes; can be active or passive

100
Q

what are the 2 biggest challenges for preventing the introduction of foreign diseases

A

1) movement of animals within and across borders
2) many commodities

101
Q

what are the two approaches to managing risk when developing biosecurity protocols for endemic diseases

A

1) all peril
2) targetted

102
Q

what are some challenges to on-farm biosecurity programs

A

1) acceptance across commodity groups for all peril vs targeted approaches
2) hard to measure success of programs (lack of a challenge)
3) programs built on biological plausibility rather than evidence

102
Q

what are the main targets of biosecurity for endemic diseases

A

herd-herd and animal-animal transmission

102
Q

how do farms get introduction of a new endemic disease

A

1) animal movement
2) dirty equipment

103
Q

what are some benefits of targetted vs all peril approach

A

1) can be maintained
2) can be cost-effective
3) is focused and defined

104
Q

what are the 6 steps to a targetted biosecurity approach for endemic diseases

A

1) identify disease of concern
2) determine current prevalence of disease
3) limit animal movement
4) implement a prevention program
5) monitor compliance
6) review annually

105
Q

what is a tool that can be used to help farmers reduce the risks of endemic diseases and improve biosecurity

A

RAMP - risk assessment and management plan

106
Q

what are 3 challenges to zoonotic disease control

A

1) many pathogens cause both animal and human disease
2) some pathogens that may cause the most risk to humans may not cause disease in animals
3) some pathogens that make animals sick may not be zoonotic or may not be easily detectable

107
Q

what are 7 methods to manage zoonotic disease risk

A

1) limit introduction of infectious disease
2) limit movement of animals within and between farms
3) treat or cull sick animals
4) collect meat and milk products hygienically
5) pasteurize milk products
6) maintain potable water
7) wash your hands

108
Q

in regards to tests and test interpretation, what variables stay constant and what variables can change based on true prevalence of disease

A

constant: Sn and Sp
changes: NPV, FN, PPV

109
Q

what are 10 things to consider when assessing vaccine efficacy

A

1) was there a laboratory and field RCT
2) were controls current or historical
3) how were the animals challenged
4) were outcome measures meaningful
5) was underlying biology and physiology considered
6) were other biases considered
7) were groups randomly assigned
8) was there blinding
9) how likely were the findings due to chance
10) how do the animals in the trial differ from your practice

110
Q

define vaccine

A

a substance used to stimulate antibody production and provide immunity against 1 or several diseases, prepared from the agent, its products, or a synthetic substitute treated to act as an antigen without stimulating disease

111
Q

what is the purpose of a vaccine

A

to prime the immune system so that the animal can better defend itself against infection with the agent when it is challenged

112
Q

what are some desirable outcomes of vaccination

A

1) less animals get sick
2) animals get less sick
3) animals get sick for less time
4) fewer animals die
5) the vaccinated animal produces protective antibodies

Health Management (2 decks)

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