Step 2 ck lecture notes kaplan epidemiology pdf download

Recover your password. Get help. Related posts:. Hi Admin Thanks for your great website. Thanks Abdul. Do you know when will it be ready to download? Been enjoying your posts. Used by thousands of medical students each year to succeed on.

More than in-depth cases covering every discipline. Designed to work with Kaplan's Step 2 High Yield course, this edition features exam-style questions. This edition includes a section on Patient Safety Science, a topic that was recently added. Eating Disorders Chapter Personality Disorders Chapter Normal Sleep and Sleep Disorders Chapter Human Sexuality Chapter Psychopharmacology Chapter Suicide Chapter Chapter Epidemiology Chapter Biostatistics Chapter Ethics Chapter Psychopharmacology Learning Objectives Describe the classes of drug, mechanism of action, and common adverse effects of typical antipsychotic, atypical antipsychotic, antidepressant, mood-stabilizing, and anxiolytic medications Describe the indications and procedural steps for electroconvulsive therapy.

Antipsychotic Medication Antipsychotic medications APMs are used to treat manifestations of psychosis and other psychiatric disorders. The precise mechanism of action is unknown; however, APMs block several populations of dopamine D2, D4 receptors in the brain.

The newer APMs also block some serotonin receptors 5HT , a property that may be associated with increased efficacy. APMs also variably block central and peripheral cholinergic, histaminic, and alpha-adrenergic receptors.

Typical: work mostly on dopamine receptors, treat the positive symptoms hallucinations and delusions and have many side effects haloperidol, fluphenazine, chlorpromazine, etc. Atypical: work mostly on dopamine and serotonin receptors, treat both positive and negative symptoms flat affect, poor grooming, social withdrawal, anhedonia, etc , and have fewer side effects; always used as first-line agents risperidone, olanzapine, etc.

Hypotension: effect due to alpha-adrenergic blockade and most common with low-potency APMs. Anticholinergic Symptoms: dry mouth, blurred vision, urinary hesitancy, constipation, bradycardia, confusion, and delirium. Other Effects: cardiac conduction abnormalities especially with thioridazine , agranulocytosis with clozapine. Treatment: anticholinergics, such as benztropine, diphenhydramine, or trihexyphenidyl Can occur within hours after treatment.

Tardive Dyskinesia TD. Characterized by choreoathetosis and other involuntary movements Movements often occur first in the tongue or fingers and later involve the trunk.

Patients who take high doses of older antipsychotic medication for long periods of time are at highest risk, and movements gradually worsen with continued use. Treatment: Use newer antipsychotic medications. Seen more frequently in elderly females Can occur after 3—6 months after treatment. The primary adverse effect of antipsychotic medication use is neuroleptic malignant syndrome. It is a fairly rare and potentially life-threatening condition characterized by muscular rigidity, hyperthermia, autonomic instability, and delirium.

CPK will be elevated. Usually associated with high dosages of high-potency antipsychotic medication. Treatment: Immediate discontinuation of the medication and physiologic supportive measures; dantrolene or bromocriptine may be used. Recent suicide attempt Complaints of suicidal thoughts Admission of suicidal thoughts upon questioning Demonstration of possible suicidal behavior. Psychotherapies Learning Objectives Describe and compare the major forms of psychotherapy and behavioral therapy used in practice today.

Resolution 1. Psychologically 1. Psychoanalysis week of neurosis minded for years. Focus on 1. Intact reality week 1. Insight interpersonal testing, capacity for oriented goals for insight months to years. Support 1. Days 1. Healthy patients to 1. Those with 1. Modify maladaptive learned 1. Time 1. Behavioral behaviors or behavior limited psychophysiologic patterns disorders.

Alleviation of 1. Groups target 1. Group 1. Change 1. Depressive 1. Epidemiology Learning Objectives Define incidence, prevalence, specific rates, adjusted rates, and other statistical measures, as they relate to morbidity and mortality Perform survival analysis including accounting for potential life lost Describe the types of prevention Show how prevalence, sensitivity, and specificity relate to the value of screening tests Answer questions about study design and bias in research.

Overview Epidemiology is the study of the distribution and determinants of health-related states within a population. It refers to the patterns of disease and the factors which influence those patterns. Endemic: The usual, expected rate of disease over time; the disease is maintained without much variation within a region. Epidemic: Occurrence of disease in excess of the expected rate; usually presents in a larger geographic span than endemics epidemiology is the study of epidemics.

Pandemic: worldwide epidemic. Incubation period is the period of time from the point of infection to the onset of clinical illness.

Figure II Efficacy: performance of an intervention under optimal conditions, e. Biostatistics Learning Objectives List the basic principles of probability and describe the connection to statistics Demonstrate how to calculate mode, mean, median, standard error, and standard deviation, and describe how they differ Describe the purpose of inferential statistical tests, such as student T test, chi-square, and analysis of variance Select an appropriate statistical test for a set of data to be analyzed.

Probability Independent events : the occurrence of one event does not affect the occurrence of another. For instance, the chance of a child being born with brown eyes is 0. The eye color of the first-born child does not affect the eye color of the second-born. Calculate the probability of multiple independent events occurring by multiplying each individual probability together.

For instance, the probability of having one child with brown eyes and one child with blue eyes is 0. Nonindependent events : the occurrence of one event affects the occurrence of another. For instance, a box has 5 white and 5 black balls inside.

When picking the first ball, the probability of white is 0. Calculate the probability of multiple nonindependent events by multiplying each new probability, given that each previous event has occurred. Mutually exclusive events : the occurrence of one event precludes the occurrence of another. For instance, if a coin flip lands heads, it cannot land tails.

Determine the combined probability of mutually exclusive events by addition. For instance, the probability of a coin flip landing heads or tails is 0. If events are not mutually exclusive, determine the combined probability chance of either occurring of two events by adding the two individual probabilities together and subtracting their product.

Therefore, the chance of meeting someone who is diabetic or obese is 0. Combine probabilities for mutually exclusive events by addition. Mutually exclusive means that the occurrence of one event precludes the occurrence of the other i.

If a coin lands heads, it cannot be tails; the two are mutually exclusive. So if a coin is flipped, the chance that it will be either heads or tails is 0. If 2 events are not mutually exclusive, the combination of probabilities is accomplished by adding the two together and subtracting out the multiplied probabilities.

Ethics Learning Objectives Identify some important Supreme Court cases related to medical ethics, and explain their significance Distinguish between the ethical and legal principles, and explain how they affect medical practice.

In the Quinlan case, Karen Ann was in a persistent vegetative state, being kept alive only by life support. Substituted judgment begins with the premise that decisions belong to the competent patient by virtue of the rights of autonomy and privacy.

In legal terms, the patient has the right to decide but is incompetent to do so. Therefore, the decision is made for the patient on the basis of the best estimate of his or her subjective wishes. The New York Court of Appeals, in its decision of Eichner vs Dillon, held that trying to determine what a never-competent patient would have decided is practically impossible. Obviously, it is difficult to ascertain the actual subjective wishes of incompetents. Therefore, if the patient has always been incompetent, or no one knows the patient well enough to render substituted judgment, the use of substituted judgment standard is questionable, at best.

Under these circumstances, decisions are made for the patient using the best interest standard. Note here the issue of who makes the decision is less important. All persons applying the best-interest standard should come to the same conclusions.

As a general rule, parents cannot withhold life- or limb-saving treatment from their children. Yet, in this exceptional case they did. Baby Boy Doe was born with Down syndrome trisomy 21 and with a tracheoesophageal fistula. Infant Doe died at 6 days of age, as Indiana authorities were seeking intervention from the U.

Supreme Court. This case is simply an application of the best-interest standard. The court agreed with the parents that the burdens of treatment far outweighed any expected benefits. Because the mother gets to decide, even in the face of threats to the fetus, by extension, all patients get to decide about their own bodies and the health care they receive.

In the United States, the locus for decision-making about health care resides with the patient, not the physician. Note that courts have held that a pregnant woman has the right to refuse care e. A student visiting a counselor at a counseling center in California states that he is going to kill someone. When he leaves, the counselor is concerned enough to call the police but takes no further action.

The student subsequently kills the person he threatened. The court found the counselor and the center liable because they did not go far enough to warn and protect the potential victim. The counselor should have called the police and then should also have tried in every way possible to notify the potential victim of the potential danger.

In similar situations, first try to detain the person making the threat, next call the police, and finally notify and warn the potential victim.

All 3 actions should be taken, or at least attempted. Introduction The purpose of this chapter is to provide you with an approach to reading and understanding research articles and pharmaceutical advertisements. It is based on principles of epidemiology. An understanding of these concepts is fundamental to the comprehension of medical literature. Clinical Applications of Patient Safety and Quality Improvement Learning Objectives Define the principles of patient safety, system-based practice, and continuous quality improvement Recognize and classify the different types of medical error Describe the types of reporting systems which can identify and analyze medical errors.

Principles of Patient Safety Case: Within the past 2 years, a major tertiary care referral hospital experiences separate cases of a blood transfusion reaction due to incompatibility, 2 inpatient falls leading to significant injury, a wrong-site surgery, and a medication-dosing error resulting in a patient death. Health care is not a single system, but rather multiple systems which all interact.

These clinical microsystems are defined as a group of clinicians and staff working together with a shared clinical purpose to provide health care for a population of patients. Individual health care organizations contain multiple microsystems which evolve over time. It is the complexity of these systems that predispose patients to harm from medical error.

Health care in the United States is capable of achieving incredible results for even the most severely ill patients. However, it does not do so reliably and consistently. Medical errors plague our health delivery systems. In , the Institute of Medicine IOM estimated that 44,—98, patients die each year in the United States from preventable medical errors ; some of the more recent estimates report an even higher rate of death.

In addition to the toll that this takes in the form of human suffering, medical errors also represent a significant source of inefficiency and increased cost in the health care system. The causes of these adverse events are not usually from people intentionally seeking to harm patients, but rather from the complexity of the health care system together with the inherent capability for human error.

The causes of these errors are varied and can include failures made in administering medication, performing surgery, reporting lab results and making a diagnosis, to name a few. The most severe of these medical errors are referred to as sentinel events. A sentinel event is an adverse event in which death or serious harm to a patient has occurred; it usually refers to an event that is not at all expected or acceptable e.

The choice of the word sentinel reflects the severity of the injury e. It is unacceptable for patients to suffer preventable harm caused by a health care system whose purpose is to provide healing and comfort. Improving patient safety is the responsibility of every health care professional and requires a comprehensive team effort.

Collectively, health care needs to learn from past errors e. Systems in health care delivery can be redesigned to make it difficult for health care personnel to do the wrong thing and easier for them to consistently do the right thing. Population Health Management Learning Objectives Define population health and value-based care Describe how population health management principles can be put into practice.

Case example: A year-old woman presents to the emergency department at AM with the acute onset of an asthma attack. She is treated with steroids and nebulizer treatments to stabilize her respiratory status. This is the third such presentation in the past 9 months.

During her course of treatment it becomes evident that the patient is not able to get time off from work to see her primary care physician during clinic hours, did not receive an influenza vaccination this year, and continues to smoke 1 pack of cigarettes per day. Address the day-to-day factors present at home which impact the patient's health outcomes with asthma.

Health care in the United States has traditionally focused on the management of acute medical problems such as trauma, myocardial infarction, and stroke. Incredible advances have been made in these areas and outcomes from acute presentation of disease have steadily improved over the years, with outcomes among some of the best observed in any health system in the world.

However, the health care system here has lagged significantly in the area of disease prevention and health maintenance. Major disparities in access to preventative care services such as prenatal care, cancer screening and diabetes management; together with social inequalities with respect to patient education and income; as well as persistent individual behaviors such as poor diet, lack of exercise and cigarette smoking have contributed to the very poor overall health status observed in the United States.

Problems with quality and variations in health delivery that do not follow evidence-based standards further erode the value of patient care. Ironically, the United States spends more on health care than any other nation in the world, yet ranks among the lowest in health measures, compared to other developed nations. Furthermore, the current rate of health care spending in the United States is unsustainable.

Population health is an approach to health care that addresses both individual and public health concerns in order to achieve optimal patient results.