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Case control study A study that compares a group of people affected with a disease to a group without the disease (objective and retrospective)
Odds ratio (ex: pts with COPD have higher odds of having a histroy of smoking) What measure can a case control study tell you?
Cohort study Study that compares a given risk factor to a group without the risk factor (assesses whether risk factor increases likelihood of disease, objective and prospective)
Relative risk (smokers have higher risk of developing COPD than nonsmokers) What measure can a cohort study tell you?
Cross sectional study (doesn't establish a risk factor causality) Study that assesses frequency of disease (and risk factors) at a particular point in time
Disease prevalence What measure can a cross sectional study tell you?
Heritability What does twin concordance study measure?
Heritability and environmental influence What does an adoption study measure?
Phase I Small number of healthy volunteers. Assesses safty, toxicity, and pharmacokinetics.
Phase II Small number of diseased patients. Assesses efficacy, dosing and adverse effects.
Phase III Compares the new treatment to the current standard of care. Uses a large number of patients.
Meta-analysis (increases the power of the study) Pooled data from several studies integrated.
Quality of individual studies and bias What is meta analysis limited by?
Total cases in a given population at a given time / total at risk population (how many people at a single point in time have the disease) Prevalence
New cases during a given time period / total at risk population during that same time period Incidence
Prevalence Incidence X disease duration
a/(a+c) or 1-false negative rate Sensitivity equation
Sensitivity (1 low false negative rate)
Specificity (1 low false positive rate)
d/(d+b) or 1 - false positive Specificity equation
a/(a+b) Positive predictive value equation
Positive predictive value (probablity that person with positive test actually has the disease) Proportion of positive test results that are true positives
Negative predictive value (probability that a persond oesn't have the disease if they give a negative test) Proportion of test results that are true negative
d/(c+d) Negative predictive value equation
(a/b)/(c/d) Odds ratio equation
Odds ratio Chances of having a disease in an exposed group compared to an unexposed group
[a/(a+b)] / [c/(c+d)] Relative risk equation
Relative risk Probability of getting a disease in an exposed group compared to an unexposed group
[a/(a+b)] - [c/(c+d)] Attributable risk equation
Attributable risk The proportion of disease occurences that are a result of exposure to a risk factor
Precision Consistency and reproducability of a test.
Random Type of error that reduces precision in a test
Systematic Type of error tat reduces accuracy in a test
Accuracy Trueness of test measurements (validity)
Selection bias Caused by nonrandom assignment to a study group
Recall bias Caused by altered recall by subjects caused by knowing they have the disorder
Sampling bias Caused by subjects being not representative of the population
Late-look bias Caused by information being gathered at an innapropriate time
Procedure bias Caused by subjects in different groups not being treated the same.
1. blind studies (double blind best) 2. placebos 3. crossover studies 4. randomization
Crossover study Each subject acts as their own control (each pt gets placebo and treatment at some point)
Bimodal A statistical distribution with two humps
Gaussian Normal bell shaped curve (mean
Positive skew Asymetric distribution with tail on right (mean > median > mode)
Negative skew Asymetric distribution with tail on the left (mean < median < mode)
Null hypothesis (H0) Hypothesis that states there is no correlation
Alternative hypothesis (H1) Hypothesis that there is some correlation
Type I error (alpha) Stating that there is an effect when none exists (accepting an expirimental hypothesis when the null is true)
Type II error (beta) Stating there is not an effect when one exists (failure to reject null hypothesis when it's false)
Probability of making a type one error is judged against alpha (a preset level of significance usually <.05) Calculating probablity of making a type one error (p)
B (Beta) The probabiliy of making a type one error
Power 1 - Beta
1. total number of end points 2. difference in compliance (difference in mean values between groups) 3. size of expected effect Three things that effect power
Increase sample size How do you increase power?
n Variable used for sample size in biostatistics
Sigma Variable used for standard deviation in biostatistics
SEM (standard error of the mean, [sigma / sqrt(n)]) the standard deviation of the sampling distribution of the mean
Sampling distribution of the mean (SEM or Z) The range of means you might get if you averaged a subpopulation of values from a bigger population (will be slightly different than the whole populations mean due to chance)
SEM < sigma; as n increases, SEM decreases Relationships of SEM to standard deviation and sample size
68% Population range that falls within 1 SD of the mean
95% Population range that falls within 2 SD of the mean
99.7% Population range that falls within 3 SD of the mean
Confidence interval A range of numbers that encompasses the value that would be obtained if an experiment was performed many times (necessary because the valuemight change slightly each time) (a range from mean - Z to mean + Z; where Z is SEM; 95% (CI)
t-test (Mr. T is mean) Checks the difference between the means of two groups
ANOVA (ANalysis Of VAriance) Checks the difference between the means of 3 or more groups
x2 test A test that compares different percentages or proportions
Correlation coefficient (r) A range from -1 to 1 that describes how well two variables correlate
Coefficient of determination (r2) (correlation coefficient)2
PDR (1. prevent, 2. detect, 3. reduce disability) Mnemonic for stages of disease prevention
Hep, hep, hep, hooray, the SSSMMART Chick is Gone (hep a, b, c, HIV, Salmonella, shigella, syphilis, measles, mumps, aids, rubella, tuberculosis, chickenpox, gonorrhea) Mnemonic for reportable diseases
MedicarE Elderly, medicaiD
Medicare part A hospital; Medicare part B
Autonomy, beneficence, nonmaleficence, justice Core ethical principles of healthcare
Physicians have a fiduciary (special ethical) duty to act in the patient's best interest, and allow them the right to make an informed decision if possible Beneficence
"Do no harm" Nonmaleficence
1. discussion of pertinent information, 2. patient agrees with plan of care, 3. patient is free from coercion Legal requirements of informed consent (3)
1. Legally incompetent 2. Implied consent (emergency) 3. Therapeutic priveledge 4. Waiver What are the 4 exceptions to informed consent
Therapeutic priviledge Withholding information when disclosure would harm the patient or undermine the outcome
Minor is married or emancipated When do you not need parental consent for a minor?
Only if the patient revokes the power. In a written advance directive, when is the surrogate's power revoked?
1. Potential harm to others 2. Likely to harm self 3. No alternative means to wanr/protect those at risk 4. Physician can prevent harm What are the 4 exceptions to confidentiality
Tasaroff decision Law requiring physician to directly inform and protect a potential victim from harm (even if it breaches confidentiality)
1. the Dr had a duty to that patient 2. The doctor breached that duty 3. The patient suffered harm 4. The breach of duty caused the harm (4 D's Duty, Dereliction, Damage, Direct)
Depends on the state Can a teenager request an abortion?
1. emergency situations 2. STD treatment 3. during pregnancy 4. drug addiction management 5. contraception 5 times when parental consent is not required
Parents decidewhat a child will be told about their illness Does a child have a right to know about their illness?
APGAR score Appearance, pulse, grimace, activity, respiration (2 is perfect, 0 is nothing)
Low birth weight < 2500 g at birth, increased incidence of infections, persistent fetal circulation, respiratory distress syndrome
Development from birth - 3 months Rooting reflex
Development at 3 months Hold head up, social smile, moro (startle) reflex disappears (baby holds his head up and smiles)
Development from 4-5 months Rolls front to back, sits up when propped, recognizes people (baby recognizes mom as she props him up)
Development from 7-9 months Sits alone, crawls, stranger anxiety
(baby crawls away from a stranger)
Development from 12-14 months Babinski disappears
Development at 15 months Walks, few words, separation anxiety (child can walk and is experiencing rapprochement (goes from mom then returns))
Development at year 1 Climbs stairs, object permanence, stacks 3 cubes, rapprochement
Development at year 2 Two-word sentences (telegraphic), stacks 6 blocks, 200 word vocab, says "no," names objects, transition objects (security blanket)
Development at year 3 Complete sentences, stacks 9 blocks, 900 word vocab, rides tricycle, toilet training (pee at three) alternates feet upstairs, strangers can understand, can take turns, draws a circle (child goes to preschool)
Development at year 4 Uses compound sentences and can tell stories, counts 3 objects, imagination and imaginary fears, alternates feet down stairs, draws a cross (then a rectangle at 4 1/2)
Development at year 5 Asks the meaning of words, counts 10 objects, complete sphincter control, dresses and undresses, oedipal phase, conformity to peers important, brain 75% of adult size, draws a square (child goes to kindergarden)
Development from ages 6-12 Refined motor skills, rides bicycle, rules of the game, demonstrates competence, law of conservation, develops conscience, shifts from egocentric speech
Development at > 12 years Growth spurts, onset of sexual maturation, personal identity and conformity is important, personal speech patterns, systematic problem solving, handles hypotheticals
Changes in elderly Slower erection, vaginal dryness, (dec) REM sleep, (inc) REM latency, (dec) incidence psychiatric illnesses, (inc) suicide, (dec) renal / GI function, (dec) muscle; (intelligence and sexual interest do not decrease)
Tanner stages of sexual development 1. Childhood, 2. adrenarche (pubic hair), (inc) testes / breast size, 3. (inc) darkness of pubic hair, penis length, 4. development of glans, (inc penis length), raised areolae 5. Adult, areolae no longer raised
Normal grief symptoms (lasts 6 months to 1 year)
Shock, denial, guilt, illusions
Pathologic grief (can last 1 year or be excessively intense) Depressive symptoms, delusions, hallucinations, can be caused if grief is denied or inhibited
Kubler-Ross grief stages Denial, anger,bargaining, grief, acceptance
Effects of stress (inc) free fatty acids, corticosteroids, lipids, catecholamines, cholesterol; affects water absorption, muscle tone, gastrocolic reflex
Causes of sexual dysfunction Drugs (neuroleptics, SSRIs, etc.), diseases (depression), psychological (performance anxiety)
BMI (body mass index) Weight in kg / height in m squared
Sleep stages "at night" BATS Drink Blood
Beta (awake), alpha (drowsy), Theta (light sleep), sleep spindles and K complexes (deeper sleep), delta (deepest sleep), beta (REM)
Features of delta sleep Night terrors, sleep walking, bed wetting, imipramine and benzodiazapines reduce stage 4 sleep
Features of REM sleep Erection, increased O2 use, memory functions; 5-HT from raphe nucleus initiates sleep, ACh mediates REM sleep, NE reduces REM sleep, PPRF activity (eye movements)
Narcolepsy symptoms Hypnagogic / hypnapompic hallucinations, narcoleptic episodes and normal sleep start with REM sleep
Cataplexy Loss of all motor tone after a strong emotional stimulus
Created by: ykirti



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