Week 4 Midterm Study Guide

Week 1

Terms

Epidemiology -     The science of public health.

Population Health- Focuses on risk, data, demographics, and outcomes.

Outcome-        The result that follows an intervention.

Aggregate- Defined population.
A provider is working on collecting outcome data for an intervention to increase the quality of
life for spouses providing care to their spouses with dementia. What would the family members
who received the intervention (those spouses receiving the intervention) be referred to?

Community- Composed of multiple aggregates.

Data- Compiled information.

Prevalence- Measures the existence of all current cases within a time

frame.

Incidence- Measures the appearance of new cases.

A nurse practitioner and physician’s assistant are collaborating on a project to determine the
number of new cases of traumatic brain injury per year from football in their community. What
word best describes the data they are looking for?

Surveillance- Collection, analysis, and dissemination of data.

High-risk- Increased chance of poor health outcome.

Morbidity- Presence of illness in a population.

Mortality - is related to the tracking of deaths within an aggregate.
Primary Prevention- refers to preventing disease before it occurs. Usually, primary prevention
occurs through applying epidemiological concepts and databases to assess risk factors and then
target populations with the greatest impact on outcomes to ward off impending disease or
unhealthy outcomes. For example, suppose the APN has assessed epidemiological data and
observes a high incidence and prevalence of lung cancer in those individuals and populations
who smoke before the fifth grade. This epidemiological data can be the basis for planning a
smoking cessation educational program for school-age children before the fifth grade.

Secondary prevention- You are a nurse practitioner providing hypertension screening at a local
health fair. This screening is categorized as what type of prevention?
Tertiary Prevention- Consists of interventions aimed at facilitating the rehabilitation of the
patient to the highest level of functioning while addressing the risk factors that could further
deteriorate the patient's health. For example, an APN would counsel a patient with a myocardial
infarction about the risk factors that could elicit further debilitation.

Health Disparities- Refers to the differences in health status between various groups
(populations). For instance, the difference in childbirth mortality between African Americans
and other populations.

Connecting social justice theory to advocacy, health disparities, and outcomes is

vital.

How are outcomes determined? Where can morbidity, mortality, incidence, and

prevalence data be found at the state and national level?

Primary, secondary, and tertiary prevention practices/interventions are critical to

understanding this course. These interventions relate to all the assignments/courses.

How do social justice and health inequities influence population healthcare

provision? Why is this critical information for the provision of evidence-based
care?

Can you define and apply key terms, such as vital statistics, morbidity, mortality,
cases, social justice, epidemiology, population health, incidence, prevalence,
outcomes, inter-professional collaboration, HP2020, determinants of health, and
risk analysis?

What is the Campaign for Action?

Explain the differences between primary, secondary, and tertiary interventions.

 Week 2
Validity- any screening test is the test's ability to distinguish who has a disease
correctly. For example, as the provider, you might want to know the validity of the
tuberculin skin test for identifying TB or the rates of people who have the disease but
might be missed, and vice versa. Validity is based on both specificity (the ability of a test
to identify those who do not have the disease correctly) and sensitivity (the ability of a
test to identify those who have a disease correctly). This can be defined in the following
fractional representation.

SENSITIVITY = Those who are TRUE POSITIVES

TRUE POSITIVES + FALSE NEGATIVES
SPECIFICITY = Those who are TRUE NEGATIVES
TRUE NEGATIVES + FALSE POSITIVES
Screening/diagnostic tools are often created for population specific use; for instance,
gender, age, culture.

1. Screening/diagnostic tools should be tested and have available statistics that

speak to their specificity, sensitivity, and positive predictive value.
2. Descriptive epidemiology: Did you see this definition on the CDC web site ...these
elements connect to understanding causation:

https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section6.htmlLinks to an
external site.
The 5W's of descriptive epidemiology:

1. What = health issue of concern

2. Who = person
3. Where = place
4. When = time
5. Why/how = causes, risk factors, modes of transmission

Links to an external site.

Key Points
Can you answer these?

1. Is screening a tertiary intervention? If yes, why, if not, what is it?

 2. How does a provider determine the usefulness, appropriateness, of a screening
test? Where would a NP look to find a screening test? What determines if a
screening test should be used?
3. Can you explain what "descriptive epidemiology" means? What is the purpose?
How is it used?
4. How are causation and descriptive epidemiology related, how do they work
together to aid evidence-based care?
5. What does "causation" mean? Can you relate causation to primary, secondary and
tertiary interventions?

Week 3

1. Critique the randomized control trial when used in epidemiology to determine prevention
and related outcome measures.
2. Appraise case-control and cohort study designs for their utility in informing the provision
of care by the Advanced Practice Nurse.

Review journal-required readings

Causal Relationships

Chronic Disease Resources

There are many resources available to address chronic disease. Under the
auspices of the CDC, the National Center for Health Statistics (NCHS) is considered the
nation's principal health statistics agency.

(Review Table 4.2 in your text on strengths and weaknesses of study designs. For
example, what is the best fit for studying association? Which study is typically least
expensive and shorter? What are study methods?)

1. The Randomized Control Trial is the gold standard for research and it utilizes
intervention testing.
2. Case-control designs
3. Cohort study designs
4. Ask what the fundamental difference is between a randomized control trial and a
cohort study? (Hint: Assignment to group in a cohort study is not random)
5.

Consider recruitment methods, costs of study, retrospective versus prospective analysis

results, bias (systematic errors (information bias, etc.), errors (random and systematic),
data collection, causality, scientific misconduct (fraud). (See table 4.2 in your text on
strengths and weaknesses of study designs.)
The 5W's of descriptive epidemiology:
What = health issue of concern
Who = person
Where = place
When = time
Why/how = causes, risk factors, modes of transmission

Key Points
Can you answer these questions?

1. What is a case-control study and how does it differ (or how is it the same) as the
cohort study design?
2. Can you talk about the ways bias shows up in a study design (such as, selection
bias) etc.?
3. 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?
4. What is each type of study used for, its purpose, and its outcomes? How are the
outcomes different in each study design? Measured?
5. What is an intervention group? Where is it found?
6. Can you explain a retrospective versus a prospective study design? What are the
pros and cons of each?
7. How are groups selected for each of the study designs?
8. What is meant by "scientific misconduct"?
9. Differentiate: random error, systematic error, confounding error.
There are four types of causal relationships.

1. Necessary and sufficient: A factor is both necessary (i.e., disease will occur only if the
factor is present), and sufficient (i.e., exposure always leads to disease). This type of
relationship is rarely encountered. For example, consider infectious diseases. One
hundred people can be exposed to an infectious disease, but not everyone develops the
disease because there are other variables involved (e.g., immune status, low infectivity
rate, etc.).
2. Necessary but not sufficient: More than one factor is required, usually in a temporal
sequence. The initiation and promotion stages associated with carcinogenesis models
examples of this type of causal relation. For example, when considering tuberculosis,
the tubercle bacillus is a necessary factor, but even its presence may not be sufficient to
produce the disease in every individual.
3. Sufficient but not necessary: A specific factor can cause a disease process, but other
factors by themselves can cause the same disease. For example, vitamin B12 deficiency
can cause anemia, but other factors can result in anemia as well.
4. Neither sufficient nor necessary: A specific factor can be combined with other factors to
produce disease. However, the disease may be produced even in the absence of the
factor.
This is a causal model observed frequently in chronic disease. For example, multiple risk factors
for the development of heart disease are neither sufficient nor necessary.
 

Week 4

1. What is the highest level of data findings? How is evidence appraised?

2. Can you describe the various levels of studies and how they are rated in terms of
their use for integration into practice?
3. What factors determine the quality of care?
4. How is a website's credibility determined?
5. What are key indicators when assessing a model of care?
6. How would you explain the Triple Aim initiative (model) to a colleague?
7. What are methods to measure health outcomes?
8. What are elements of the Action Model?
9. Terminology, such as: morbidity, mortality, incidence, prevalence, cases,
epidemiology, population health, social justice, period prevalence rate, sensitivity,
specificity, positive predictive value, epidemiological triangle, confounding
(variables), study methods.
10. Levels of Evidence
11. Web site reliability
12. Rapid cycle improvement model

Discern models of practice which facilitate the implementation of evidenced-

based practice.

Integrate the process of data gathering to the application of evidence.

Critique data sources for validity, reliability, credibility

Review assigned Journal readings