NR 503 Chamberlain mid term Exam with complete solutions

Epidemiology - ANSWER is the science of public health Population Health - ANSWER focuses on risk, data, demographics, and outcomes. Outcomes - ANSWER is the end result that follows an intervention aggregate - ANSWER is a defined population. community - ANSWER is composed of multiple aggregates data - ANSWER is complied information Prevalence - ANSWER measures the existence of a disease. Measures the number of all cases of a disease or attribute in a population at a given time Incidence - ANSWER measures the appearance of a disease. Measures the occurrence of new events in a population over a period of time. surveillance - ANSWER is the collection, analysis, and dissemination of data. high-risk - ANSWER is an increased chance of poor health outcome. Morbidity - ANSWER is the presence of illness in a population mortality - ANSWER is related to the tracking deaths in an aggregate vital statistics - ANSWER statistics on live births, deaths, fetal deaths, marriages and divorces. cases - ANSWER set of criteria used in making a decision as to whether an individual has a disease or health event of interest Social Justice - ANSWER the view that everyone deserves equal rights and opportunities —this includes the right to good health Inter-professional collaboration - ANSWER The idea of sharing and implies collective action oriented toward a common goal, in this case, improving the quality and safety of patient care. It involves responsibility, accountability, coordination, communication, cooperation, assertiveness, mutual respect, and autonomy. Healthy People 2020 - ANSWER aims to reach four overarching goals: 1.Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death, 2. Achieve health equity, eliminate disparities, and improve the health of all groups 3.Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages. Determinants of care/health - ANSWER The range of personal, social, economic, and environmental factors that influence health status are known ... risk analysis - ANSWER the characterization of the potential adverse health effects of human exposures to environmental hazards health disparities - ANSWER the difference in health statuses between various groups (populations). Sensitivity - ANSWER measures the proportion of actual positives that are correctly identified as such (e.g., the percentage of sick people who are correctly identified as having the condition) Specificity - ANSWER (also called the true negative rate) measures the proportion of actual negatives that are correctly identified as such (e.g., the percentage of healthy people who are correctly identified as not having the condition) Positive predictive value - ANSWER is the probability that subjects with a positive screening test truly have the disease epidemiological triangle - ANSWER 1. A traditional model of infectious disease causation, known as the Epidemiologic Triad is depicted in Figure 2. The triad consists of an external agent, a host and an environment in which host and agent are brought together, causing the disease to occur in the host. confounding variable - ANSWER is an "extra" variable that you didn't account for. They can ruin an experiment and give you useless results. They can suggest there is correlation when in fact there isn't. They can even introduce bias. That's why it's important to know what one is, and how to avoid getting them into your experiment in the first place Study Methods - ANSWER descriptive and analytic descriptive study - ANSWER describes person place and time. Provided data for program planning, resource planning, and generates a hypothesis. Types include correlational studies, case reports and studies, and cross-sectional studies. analytic study - ANSWER consists of observational and experimental. Observational include case control and cohort. Experimental includes random control trial (typically for new drug testing), field trial (conducted on those who have a high risk of obtained a disease), and community trial (research is conducted on an entire community or neighborhood). Test a hypothesis. Rapid Cycle Improvement (RCI) - ANSWER 1. "quality improvement method that identifies, implements and measures changes made to improve a process or a system." it implies that changes are made and tested over periods of three or months or less, rather than the standard eight to twelve months. It consists of fours stages: Plan: Identify an opportunity to improve and plan a change or test of how something works. Do: Carry out the plan on a small number of patients. The test period may be as short as one day for small PDSA cycles. Study:Examine the results. Did you achieve your goals? Act: Use your results to make a decision, incorporate changes into your workflow, and establish future quality improvement plans Is screening a tertiary intervention? If yes, why, if not, what is it? - ANSWER No, it is secondary. How does a provider determine the usefulness, appropriateness, of a screening test? Where would and NP look to find a screening test? What determines if a screening test should be used? - ANSWER Determining whether a screening test is appropriate requires the APRN to address several aspects of the disease of interest. The target population needs to be identifiable. There should be enough people to make the study cost effective. The preclinical period should be proficient to allow treatment before symptoms appear so that early diagnosis and treatment make a difference in terms of outcomes. The NP could look at the U.S. Preventative Services Task Force, Agency for Healthcare Research and Quality, and SAMHSA-HRSA to find a screening test. Sensitivity and specificity measure the validity of a test. Sensitivity is the number identified/ the number affected. Specificity is the number identified in the screening of not having the disease/ the actual number who do not have the disease. Can you explain what "descriptive epidemiology" means? What is the purpose? How is it used? - ANSWER It covers time place and person. First, by looking at the data carefully, the epidemiologist becomes very familiar with the data. He or she can see what the data can or cannot reveal based on the variables available, its limitations (for example, the number of records with missing information for each important variable), and its eccentricities (for example, all cases range in age from 2 months to 6 years, plus one 17-year-old.). Second, the epidemiologist learns the extent and pattern of the public health problem being investigated — which months, which neighborhoods, and which groups of people have the most and least cases. Third, the epidemiologist creates a detailed description of the health of a population that can be easily communicated with tables, graphs, and maps. Fourth, the epidemiologist can identify areas or groups within the population that have high rates of disease. This information in turn provides important clues to the causes of the disease, and these clues can be turned into testable hypotheses. How are causation and descriptive epidemiology related, how do they work together to aid evidence-based care? - ANSWER ______________- helps look at the cause of the issue or disease process. ________ ________ focuses on the person, place, and time. An example of how they are intertwined might be a person who was sick from E. Coli. The physician might look at what the individual ate to determine what made them sick. For instance, they may have decided to eat from the salad bar at a local restaurant. What does "causation" mean? Can you relate causation to primary, secondary and tertiary interventions? - ANSWER is an increase in a casual factor or exposure causes an increase in the outcome of interest (disease). It is related to primary intervention could be the use of flu vaccines yearly to prevent the flu from causing an illness. A secondary intervention would be to test for the influenza virus in a patient. A tertiary intervention would be giving Tamiflu to a flu positive patient. Since we know that the influenza virus causes the flu when can help to perform actions against it. Are you able to discuss "surveillance" and its relationship to "causation"? - ANSWER is the ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice closely integrated with the timely dissemination of these data to those who need to know. Passive surveillance involves using data to look at reportable diseases while active involves using individuals such as project staff interviewing physicians about cases. Using surveillance can help identify the causation of diseases particularly in a specific population. What is the case-control study and how does it differ (or how is it the same) as the cohort study design? - ANSWER The cohort study design identifies a people exposed to a particular factor and a comparison group that was not exposed to that factor and measures and compares the incidence of disease in the two groups. A higher incidence of disease in the exposed group suggests an association between that factor and the disease outcome. This study design is generally a good choice when dealing with an outbreak in a relatively small, well-defined source population, particularly if the disease being studied was fairly frequent. The case-control design uses a different sampling strategy in which the investigators identify a group of individuals who had developed the disease (the cases) and a comparison of individuals who did not have the disease of interest. The cases and controls are then compared with respect to the frequency of one or more past exposures. If the cases have a substantially higher odds of exposure to a particular factor compared to the control subjects, it suggests an association. This strategy is a better choice when the source population is large and ill-defined, and it is particularly useful when the disease outcome was uncommon. Examples of two real outbreaks will be used to illustrate these differences in sampling strategy. Can you talk about the ways bias shows up in a study design (such as, selection bias) etc? - ANSWER Selection bias occurs when subjects in a sample are not representative of the population of interest. For example, selecting only males for a study is not representative of the whole population. Informational bias can occur when information is not complete or may be inaccurate. For example, blood pressure reading taken from cuffs that are too small. What is different in a randomized control trial than, for instance, a case-control study (or a cohort study)? What does it mean to show a causal relationship? - ANSWER ___________ studies are studies in which patients who already have a specific condition are compared with people who do not have the condition. The researcher looks back to identify factors or exposures that might be associated with the illness. They often rely on medical records and patient recall for data collection. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean than one factor necessarily caused the other. _________ are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control (no intervention) groups. A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect. A cause relationship means that a cause is linked to the effect. Such as smoking causes increased blood pressure and the effects of increased blood pressure is heart disease. What is each type of study used for, its purpose, and its outcomes? How are the outcomes different in each study design? Measured? - ANSWER Case control studies are studies in which patients who already have a specific condition are compared with people who do not have the condition. The researcher looks back to identify factors or exposures that might be associated with the illness. They often rely on medical records and patient recall for data collection. These types of studies are often less reliable than randomized controlled trials and cohort studies because showing a statistical relationship does not mean than one factor necessarily caused the other. Cohort studies identify a group of patients who are already taking a particular treatment or have an exposure, follow them forward over time, and then compare their outcomes with a similar group that has not been affected by the treatment or exposure being studied. Cohort studies are observational and not as reliable as randomized controlled studies, since the two groups may differ in ways other than in the variable under study. Randomized controlled clinical trials are carefully planned experiments that introduce a treatment or exposure to study its effect on real patients. They include methodologies that reduce the potential for bias (randomization and blinding) and that allow for comparison between intervention groups and control (no intervention) groups. A randomized controlled trial is a planned experiment and can provide sound evidence of cause and effect. Cross-sectional studies describe the relationship between diseases and other factors at one point in time in a defined population. Cross sectional studies lack any information on timing of exposure and outcome relationships and include only prevalent cases. They are often used for comparing diagnostic tests. Studies that show the efficacy of a diagnostic test are also called prospective, blind comparison to a gold standard study. This is a controlled trial that looks at patients with varying degrees of an illness and administers both diagnostic tests — the test under investigation and the "gold standard" test — to all of the patients in the study group. The sensitivity and specificity of the new test are compared to that of the gold standard to determine potential usefulness. What is an intervention group? Where is it found? - ANSWER The _________ group is the group in a randomized control trial that receives the treatment. prospective study - ANSWER Is a study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. The outcome of interest should be common; otherwise, the number of outcomes observed will be too small to be statistically meaningful (indistinguishable from those that may have arisen by chance). All efforts should be made to avoid sources of bias such as the loss of individuals to follow up during the study. Prospective studies usually have fewer potential sources of bias and confounding than retrospective studies. Pros- High Quality Data, Future Proof, Strong Validity, Cons- Expensive and time consuming. retrospective - ANSWER study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. Many valuable case-control studies, such as Lane and Claypon's 1926 investigation of risk factors for breast cancer, were retrospective investigations. Most sources of error due to confounding and bias are more common in retrospective studies than in prospective studies. For this reason, retrospective investigations are often criticized. If the outcome of interest is uncommon, however, the size of prospective investigation required to estimate relative risk is often too large to be feasible. In retrospective studies the odds ratio provides an estimate of relative risk. You should take special care to avoid sources of bias and confounding in retrospective studies. Pros: Inexpensive, Quick Results-------Cons- Missing Data (potential bias), definitions adapted to bias, Unmeasured confounder (Afterthoughts) Cohort study - ANSWER A well-defined group of individuals who share a common characteristic or experience. Participants classified according to exposure status and followed-up over time to ascertain outcome. Can be used to find multiple outcomes from an exposure. Appropriate for rare exposures or defined cohorts. Ensures temporality (exposure occurs before observed outcome). Used when an exposure is rare and outcome is common (agricultural pesticide and cancer). Used to learn about multiple outcomes from a single exposure (health effects of a nuclear power plant exposure). Case-control study - ANSWER Used to study rare diseases. Used to study multiple