Term
| 5 steps in diagnostic process |
|
Definition
1. initial observation
2. recall differential diagnosis
3. ranking of differential diagnosis
4. data collection
5. diagnosis |
|
|
Term
| clinical signs observed are compared to descriptions of diseases in memory |
|
Definition
|
|
Term
| prevalence of disease for individuals w/ risk factors |
|
Definition
|
|
Term
| identify system and lesion using knowledge of disease mechanisms |
|
Definition
| pathophysiological reasoning |
|
|
Term
| How do you rank the differential diagnoses |
|
Definition
| clinical experience, patient risk factors, history and PE, previous tests |
|
|
Term
| anything that will predict the presence of a disease with a greater probability than chance alone |
|
Definition
|
|
Term
| 4 criteria for evaluating diagnostic tests |
|
Definition
1. reliability-precision
2. accuracy
3. usefulness
4. value |
|
|
Term
| degree of agreement among repeated observations |
|
Definition
|
|
Term
| degree of agreement between the observed value and the true value |
|
Definition
|
|
Term
| type of reliability that compares results when test is administered repeatedly by the same observer |
|
Definition
|
|
Term
| type of reliability that compares the results when measurements are made by different observers |
|
Definition
|
|
Term
| which is more important to have: precision or accuracy? |
|
Definition
|
|
Term
| takes into account the expensiveness, pain, and difficulty of a diagnostic test |
|
Definition
|
|
Term
| test results have a reasonable probability of changing decisions |
|
Definition
|
|
Term
| in a diagnostic test validation studies, what should your two test groups be? |
|
Definition
1. disease animals
2. non-diseased animals with similar clinical signs of the disease |
|
|
Term
| diagnostic test to evaluate |
|
Definition
|
|
Term
| definitive test for the disease (reference method) |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| can you ever improve both sensitivity and specificity by adjusting the cutoff? |
|
Definition
|
|
Term
| plot with sensitivity on the Y axis and varying threshold/cutoff points on the X axis |
|
Definition
| Receiver Operator Characteristic Curve (ROC Curve) |
|
|
Term
| identifying bias or errors within a study that can affect conclusions |
|
Definition
|
|
Term
| determining if a study is relative to your practice |
|
Definition
|
|
Term
| what is overestimated when the diseased group of a study is the "sickest of the sick"? |
|
Definition
|
|
Term
| what is overestimated when the non-diseased group of a study is the "wellest of the well" |
|
Definition
|
|
Term
| where would an ideal diagnostic test fall on the ROC curve? |
|
Definition
|
|
Term
| using a new test to decide whether or not to apply the gold standard |
|
Definition
|
|
Term
| verification bias --- sensitivity and ---- specificity? |
|
Definition
overestimates
underestimates |
|
|
Term
| people that interpret the tests are subconsciously influenced by knowledge of the cases |
|
Definition
|
|
Term
| probability that a patient whose test result is positive has the disease |
|
Definition
| positive predictive value |
|
|
Term
| the probability that a patient whose test result is negative does not have the disease |
|
Definition
| negative predictive value |
|
|
Term
| probability that the patient had the disease before test results were known |
|
Definition
|
|
Term
| how do you estimate pre-test probability? (3) |
|
Definition
1. literature
2. local database
3. clinical judgment |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| tests with high sensitivity have few _ _ results and high _ |
|
Definition
|
|
Term
| tests with high specificity have few _ _ results and high _ |
|
Definition
|
|
Term
| when do you want to use a highly specific test? |
|
Definition
rule in (confirm) a diagnosis
Spin! |
|
|
Term
| when do you want to use a highly sensitive test? |
|
Definition
rule out a diagnosis
Snout! |
|
|
Term
| predicting the progress or outcome of the disease |
|
Definition
|
|
Term
| 2 phases of natural history of a disease |
|
Definition
1. preclinical phase
2. clinical phase |
|
|
Term
|
Definition
1. death
2. cure
3. remission
4. recurrence |
|
|
Term
| subset of natural history of disease under medical care |
|
Definition
| clinical course of disease |
|
|
Term
| 2 ways to express prognosis as a proportion |
|
Definition
1. case fatality
2. one year survival |
|
|
Term
| way to express prognosis as time |
|
Definition
|
|
Term
| factor that can give info on the clinical outcome of each patient |
|
Definition
| prognosis factor or marker |
|
|
Term
| types and examples of prognosis factors |
|
Definition
1. demographic: age
2. disease specific: tumor size
3. co-morbidities: other disease the patient has |
|
|
Term
| study that follows a group of individuals over time to observe an outcome of interest |
|
Definition
|
|
Term
| in a cohort study, a measure on a subject who does not have the outcome/event under study (may have dropped out or it just didn't happen) |
|
Definition
|
|
Term
1 year survival = 95%
median survival unknown |
|
Definition
| good prognosis (or study was too short) |
|
|
Term
1 year survival = 20%
median survival = 3 months |
|
Definition
| poor prognosis early, then slow mortality |
|
|
Term
1 year survival = 20%
median survival = 9 months |
|
Definition
| good prognosis early, then gets worse |
|
|
Term
1 year survival = 20%
median survival = 7 months |
|
Definition
|
|
Term
| What do you use the Kaplan-Meier Method for? |
|
Definition
| estimating the survival at each point in time when each death occured |
|
|
Term
| 3 things to look at when critically appraising prognosis studies |
|
Definition
1. "inception cohort"
2. referral patterns
3. follow-up completeness |
|
|
Term
| a clinical center that conducted a prognostic study is a referral center. This affects _ _ |
|
Definition
|
|
Term
| how do you asses the completeness of a follow-up study? |
|
Definition
|
|
Term
| causality can explain what 3 things |
|
Definition
1. disease etiology and risk factors
2. effects of therapy
3. disease prevention |
|
|
Term
| factor that changes the probability of developing a disease in the future |
|
Definition
|
|
Term
| statistical relationship between two or more events |
|
Definition
|
|
Term
| a change in one variable is directly or indirectly responsible for an observed change in another variable |
|
Definition
|
|
Term
| do epidemiologic studies prove causation? |
|
Definition
|
|
Term
| what can an association be due to? (4) |
|
Definition
1. chance
2. bias
3. confounding
4. causation! |
|
|
Term
| hierarchy of study design (strong to weak) |
|
Definition
1. randomized clinical trial
2. cohort
3. case-control/cross-sectional
4. case series
5. case resport |
|
|
Term
| 3 types of descriptive studies |
|
Definition
1. case report
2. case series
3. survey |
|
|
Term
| 4 types of analytical studies |
|
Definition
1. cross-sectional
2. cohort
3. case-control
4. randomized/non-randomized control |
|
|
Term
| major characteristic of a descriptive study |
|
Definition
| no comparison group so you CANNOT establish associations |
|
|
Term
|
Definition
|
|
Term
| descriptions of more than one case |
|
Definition
|
|
Term
| look at a defined population and gather data on exposure and disease at the same time |
|
Definition
|
|
Term
| look at a defined population, divide them into groups based on whether or not they have the disease, and determine if they were exposed |
|
Definition
|
|
Term
| define a population, look at previous history to determine if they were exposed or not |
|
Definition
|
|
Term
| define a population, follow them in the future to determine if they will develop a disease |
|
Definition
|
|
Term
| the groups being studied cannot be compared (unbalanced) |
|
Definition
|
|
Term
| formula for relative risk |
|
Definition
|
|
Term
| formula for attributable risk |
|
Definition
|
|
Term
| formula for population attributable risk |
|
Definition
|
|
Term
| formula for population attributable proportion |
|
Definition
| AFp = ARp / [(Pexp x Ie) + (1-Pexp x Ine)] |
|
|
Term
|
Definition
1. temporality
2. strength of association
3. consistency
4. biological gradient |
|
|
Term
|
Definition
1. specificity
2. plausibility
3. coherence
4. experimental evidence
5. analogy |
|
|
Term
| how do you decide what treatment for prescribe? |
|
Definition
1. induction
2. deduction
3. faith |
|
|
Term
| all study participants have the same chance of being assigned to each of the study groups |
|
Definition
|
|
Term
| dividing into groups based on characteristics such as sex or age before randomization |
|
Definition
|
|
Term
| clinicians and patients should be unaware of which treatment the next patient is receiving |
|
Definition
|
|
Term
| being included in a scientific study causes a perceived response |
|
Definition
|
|
Term
| Types of comparison groups (4) |
|
Definition
1. no intervention
2. observation
3. placebo treatment
4. standard drug treatment |
|
|
Term
|
Definition
| single, double, and triple |
|
|
Term
|
Definition
1. minimize observation bias
2. improve patient compliance and retention
3. reduce co-interventions |
|
|
Term
| using every subject who was randomized according to randomized treatment assignment regardless of outcomes |
|
Definition
| intention-to-treat analysis |
|
|
Term
| no real difference between 2 groups to be compared |
|
Definition
|
|
Term
| probability of obtaining results observed due to chance |
|
Definition
|
|
Term
| observing a difference in outcome among groups when there isn't (false positive) |
|
Definition
|
|
Term
| concluding that a treatment doesn't work when it does (false negative) |
|
Definition
|
|
Term
| probability to identify effect of treatment (like sensitivity but not) |
|
Definition
|
|
Term
| more likely that studies with positive results will be published |
|
Definition
|
|
