Week 5 Flashcards
4 Primary Ethical principles in medicine
1) Beneficience
2) Automony
3) Justice
4) Nonmalficence
What is meant by Beneficence?
Acting for the benefit of OTHERS
What is meant by Autonomy?
Respecting individual has the right to choose/refuse
Ability to make their own choices for their care
What is meant by Justice?
Fairness in terms of access and distribution of resources
What is meant by Non-maleficence?
DO NO HARM
Cause no unnecessary risks or needless harm to patients
Why is it important to develop a rapport with patients?
Relationship will determine QUALITY of info received and completeness of information
What are tenets of the Patient-centered clinical approach
Explore patient disease/illness experience
Understanding of WHOLE person not just the disease
Enhancing Doc/Patient relationship
Importance of confidentiality in healthcare?
Respect for patients and their privacy - don’t discuss them in public
Allows patients to discuss more sensitive topics with provider
Fosters sense of care-seeking - more willing to seek care
Prevent harm from coming to patients - lose jobs, etc.
Define a boundary in terms of patient-doctor relationship
Edge of appropriate, professional and clinical behavior
Why are boundaries a fine line?
Deciding what is considered exploitive or non-exploitive
What might be some instanced of boundary issues?
Treating family
Accepting gifts from patients
Provider ideology
Any sort of sexual conduct
Touch - necessary but ONLY WHEN necessary
Social gatherings - avoid on social media!
Referrals:
When to use?
When NOT to use?
1) ONLY if clear benefit to patient - if outside scope of practice of provider
2) NEVER to avoid death at facility (for statistical purposes)
3) If someone promises you charges/fee splitting - NOPE!
Ethical issues in patients refusing treatments?
When in doubt on treating a patient - autonomy wins out
Consent v. Assent
Consent: anyone over legal age of consent (>18yo)
Assent: more for minor to signal willingness to participate
Informed consent
Allowing patient to know all risks/benefits involved with refusal of care
Patient MUST posses proper decision making capacity in order to UNDERSTAND consequences
Consent must be obtained without coercion or manipulation
Define: population
Group of individuals who share common characteristic
Define: Sampling
Process of selecting subset group from a larger population for purpose of study
Define: sampling frame
List of individuals that are eligible for selection in research study
Pros to sampling frame
More confidence in generalized results of study as applied to a larger population
Sampling external validity
How well findings can be applied to other situations
Sampling Internal Validity
whether design, conduct, analysis of the study ITSELF answers the questions without bias
Subtypes of Sampling Categories:
1)
2)
1) Probability/Random Sampling
2) Non-probability/Nonrandom Sampling
Describe simple random sampling
Selection of individuals from population using random number generator
Describe Stratified random sampling
Divides population into SUBGROUPS based on certain characteristics
Random selection done of all subgroups
Describe Cluster sampling
Divides population into clusters (based on geography)
Randomly will select clusters to sample from
Describe Systematic sampling
Selection of every “n”th member of population at a randomized starting point
Describe Convenience sampling
Selection of individuals with easy access/willingness to participate in study
Describe Snowball sampling
Selection of few individuals from population
Those few individuals refer others who fit criteria as wel
Describe Purposive sampling
Selection of individuals who meet specific criteria FOR the study
Describe Quota sampling
Researcher has liberty to select sample based on THEIR strata
Two people cannot exist under 2 different conditions
Describe Self-selection
Specific type of people are more likely to participate in research study
Describe Non-response
Certain type of people more likely to refuse to participate in study
Define inclusion criteria:
Characteristics/features permitting someone to be eligible participant in study
Define exclusion criteria
Characteristics/features disqualifying someone from participation in research study
Principles of inclusion/exclusion criteria:
1)
2)
3)
4)
1) Relevance
2) Feasibility
3) Exclusivity
4) Representative
Importance for inclusion/exclusion criteria:
1)
2)
3)
4)
1) Enhance study validity
2) Reduce participation risk
3) Increase generalizability = include representative population
4) Facilitate feasibility
Define sampling error
Statistical error when analyst does NOT select sample representative or entire population of date
Types of sampling errors:
1)
2)
3)
4)
1) Population specific error - wrong population included for study
2) Sample frame error/coverage error - Wrong list of people to deal with
3) Selection error - Chose wrong sent of respondents
4) Non-response error - people didn’t show up or respond
Methods to deal with sampling errors
1) Choosing correct sample for study
2) Increase the sampling size
3) Ensure baseline characteristics of participants
4) Weighted sampling of participants
Non-sampling errors -
No matter what they cannot be fixed by increasing sampling size.
1) Systematic error - Selection bias
2) Chance
3) Confounding
Conditions of Informed Consent
FULL disclosure of information -
1) Procedures and purpose of study
2) Risk vs Benefits of study
3) Alternatives to research pool
4) Conditions of participation
What is meant by conditions of participation in informed consent?
Participants have right to refuse or leave study at any time without penalty
Contact info for questions concerning study, participants rights WITHIN study
Persons with limited decision making capacity
LEGALLY authorize someone to make decisions
Approach someone with intermittent incapacitation when lucid
Those considered part of the vulnerable population
Children
Pregnant women
Prisoners
Define coercion
Threats (either explicit or implicit)
Define undue influence
Excessive compensation
Historical Highpoints arising in medical research
Nuremburg Trials
Thalidomide
Tuskegee Syphilis study
Describe Primary Research
Research that has been collected BY researcher
Describe Applied Research
Use of either animal testing or cell cultures to test
Describe Theoretical Research
Usually used in test development
Describe Descriptive Research
Used in prognosis determination of certain diseases
Describe Interventional Research
Something is being tested for
Drug trials
Describe Epidemiological research
Research done at a much larger scale
Happening within a population
Describe Analytical Observational Studies
Cohort Studies:
Observation of people over time
Association of risk factors and outcomes
Describe Analytical Observational Studies
Case Control Studies
Comparison of one group to control group
Association of risk factors vs rare outcomes
Describe Analytical Observational Studies
Cross-sectional Studies
Take a group of people, gather average amount of information
Prevalence of diease!
Describe Analytical Interventional Studies (with RCT’s)
Doing research at a larger level
Exploration of cause/effect of something
Define Secondary Research
Using data collected via other people for own research purposes
Describe Reviews
Cochrane Library
Used to find reviews of medical literature for average layperson
Describe Meta-analyses
Statistical combo of various studies wo come up with overall result for studies in certain area
Describe Databases
Collection of data to be used for research purposes
Describe Scientific Method
Ask
Hypothesis
Gather
Analyze
Conclude
Recommend
Goals of Descriptive Research
Summation of characteristics of group
Goals Predictive Research
Forecast outcomes of something
Goals of Explanatory/Causality Inference Research
Establish causal link/mechanism
Types of Info from Research
Descriptive
Describe X and Y and how they relate to ones another
Types of Info from Research
Correlational
Is there a relationship between X and Y
Types of Info from Research
Experimental
Change in X will affect Y in what way?
Types of Info from Research
Literature Review
Look at all studies and find which conclusions work best for X and Y
Variables seen in research
Types of responses
Different levels observed
Describe Hypothesis testing
Formulation hypothesis based on question being asked
Null hypothesis
No difference in relationship
Alternate hypothesis
There is some difference
Two types of Alternate Hypotheses
One-sided: Directional relationship
Two Sided: Non directional; some impact occurs
Types of Errors
Type I
Type II
Explain Type I error
Rejection of the null hypothesis when it should have been accepted
Alpha error
Relationship demonstrated
Explain Type II Error
Failure to reject the null hypothesis - should have and didn’t
Beta error
No relationship demonstrated
Describe Case Study
Advantages?
Disadvantages?
Study of one patient/case
Advantage: Observe someone with unusual circumstances
Disadvantage:
Define power
Probability of NOT making a Type II error
Probability of finding a difference between groups IF one exists
Describe Observation
Advantages?
Disadvantages?
Real-life observations of patients/case
Advantage: Real-life, real-time
Disadvantage:
Describe Surveys
Advantages?
Disadvantages?
Written/oral questionnaires
Advantage: Quick, cheap, familiar
Disadvantage:
Describe Archival research
Advantages?
Disadvantages?
Using existing records/databases
Advantage: cheap, data exists already
Disadvantage: Data quality not great
Describe Interviews
Advantages?
Disadvantages?
Interview of someone
Advantage: In-depth understanding/explanation of phenomenon
Disadvantage:
Describe Experiments
Advantages?
Disadvantages?
Cause and effect
Advantage: Causality
Disadvantage: Ethical considerations
Calculation of power of study
1- beta
Ways/means to increase power in study
Increase sample size
Have marked differences between groups
Lower SD
Define p-value
How much of observed data disagrees with null hypothesis
Greater the difference = lower the p-value
Low p-value
Reject null hypothesis
High p-value
Failure to reject the null hypothesis
Alpha level
Probability of making Type I error
If less than 5% = statistically significant
Bias
Systematic error in collection/interpretation of data found in study design
Hierarchy of Evidence Pyramid
Stages of Mitotic Cell Division and What Occurs There:
G1
All Cellular contents (except DNA) replicate
Preparation of Replication proteins ramps up