Behavioral Science
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Created by:
jrmayers on April 4, 2011
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Boards!, COMLEX, Test Krushers
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121 terms
Terms | Definitions |
|---|---|
 Case Control Study "What Happened?" | Observational and retrospective. Compares a group of people with a disease to a group without. Meausres Odds Ratio (OR) |
| Cohort Study "What will happen?" | Observation and prospective. Compares a group with a give risk factor to a gropu without to assess whether the risk factor increases the likelihood of disease. Measures relative risk (RR) |
| Cross Sectional Study "What is happening?" | observational. collects data from a group of people to assess frequency of disease (and related risk factors) at a particular point in time. Measures disease prevalence and may show risk factor association with disease, but will not establish causality |
| Sensitivity | TP/(TP+FN), 1- false negative rate; proportion of all people with disease who test positive, or the ability of a test to detect a disease when it is present. Sensitivity rules out (SNOUT) |
| Specificity | TN/(TN+FP); 1- false positive rate; proption of all people without disease who test negative, or the abiliyt of a test to indicate non-disease when disease is not present; Specificity rules in (SPIN) |
| Positive Predicitve Value (PPV) | TP/(TP+FP) proportion of postive test results that are true positive. Probablity that a person actually has the disease given a positive test result (Note: if prevalence really low, even test with high specificity or high sensitivity will have low PPV) |
| Negative predicitive value (NPV) | TN/(TN+FN). Proportion of negative test results that are true negative. Probability that person actually is disease free given a negative test result |
| Prevalence | total number of cases in population at a given time/total population at risk |
| Incidence | new cases in population over a given time period/total population at risk during that period. Incidence = new incidents |
| Odds ratio | odds of having disease in exposed group/odds of having disease in unexposed group |
| Relative risk | relative probability of getting a disease in the exposed group compared to the unexposed group (% with disease in exposed group/% with disease in unexposed) |
| Attributable risk | difference in risk between exposed and unexposed group |
| Absolute risk reduction | The reduction in risk associated with a treatment as compared to a placebo |
| Number needed to treat | 1/absolute risk reduction |
| Number need to harm | 1/attributable risk |
| 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? |
| 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. |
| Confounding bias | occurs with 2 closely associated factors, the effect of 1 factor distorts or confuses the effect of the other |
| Lead-time bias | early detection confused with increased survival; seen with improved screening |
| Pygmalian effect | occurs when a researcher's belief in the efficacy of the treatment changes the outcome of that treatment |
| Hawthorne effect | occurs when the group being studied changes its behavior owing to the knowledge of being studied |
| 1. blind studies (double blind = best) 2. placebos 3. crossover studies 4. randomization | 4 ways to reduce bias |
| 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 = median = mode) |
| 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 | The likelihood of finding a difference if one exists |
| 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) = 0.05 (p) = 1.96 (Z)) |
| 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 = Destitute | Medicare versus medicaid |
| Medicare part A = hospital; Medicare part B = doctor bills | Medicare parts A and 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 |
| obligation to respect patients and indiviuals and to honor their preferences in medical care | autonomy |
| to treat persons fairly | justice |
| 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? |
| decision making capacity | patient makes and communicates a choice, patient is informed, decision remains stabled over time, decision is consistent with patient's values and goals, decision is not a result of delusions or hallucinations |
| 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) | 4 things a civil malpractice suit must prove |
| 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) |
| Sensorimotor stage (birth to age 2) | egocentric exploration of the world with the 5 sense. Novel use of objects to obtain a goal (e.g. use of stick to reach something). understanind og object permanence is achieved |
| preoperational stage (2-7yo) | aquisition of motor skills. magical thinking predominantes, with no "logical" thinking |
| concrete operational stage (7-12yo) | start of logical thinking, but confined to concrete concepts. no longer egocentric |
| Formal operational stage (age 12+) | development of abstract reasoning |
| 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 |
| circadian rhythm | drive by suprachiasmatic nucleus (SCN) of hypothalamus, controls ACTH, prolactin, melatonin, norturnal NE release; SCN-->NE release-->pineal gland-->melatonin. SCN is regulated by environment (i.e. light) |
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