Administration & Statistics Flashcards
What is the incidence?
Number of new cases within a specific time period (usually 1 year)
What is the prevalence?
Proportion of the population with a certain condition at any given time
How can prevalence be calculated?
Prevalence = Number of existing cases / total population
What is the standard deviation?
Measure of dispersion for a subject data set from the mean
What does a high standard deviation mean?
The value is far from the mean of the group
What is the standard error of the mean?
How far a sample mean is likely to be from the population mean
How can standard error of the mean be calculated?
SD of multiple different data set means
SEM = SD / (square root of sample size)
What is the power of a study?
The ability of a study to detect a statistically significant result
How can the power of a study be defined in relation to the hypothesis of the study?
Power is the probability of correctly rejecting the null hypothesis if it is false
What is the null hypothesis?
Theory at start of a study that states there is no difference between current method and new proposed method
What is the alternative hypothesis?
Theory at start of a study that states there is a difference between current method and new proposed method
How can the power be calculated?
Power = 1 - (probability of a type 2 error)
How can the power of a study be increased?
Increasing the sample size or reducing the p value
What is the p value of a study?
The probability of getting the results that have been found if the null hypothesis is true
What value is usually ascribed to p?
<0.05
What does a p value of 0.05 mean?
There is 95% chance that the given results did not occur by chance
What are the names given to the normal distribution curve?
Bell curve or Gaussian curve
Where does the normal distribution curve occur?
In many natural phenomenon e.g. if you plotted the heights of all the people in a room
What is plotted along the x axis of the normal distribution curve?
Z score
What is the z score along x axis of normal distribution curve?
The standard deviations from the average
How can the mean, median, and mode be calculated from a normal distribution curve?
They are all the same and will occur at the zero line in the centre of the curve
In the normal distribution curve, what percentage of the results will lie within 1 standard deviation of the mean?
68%
In the normal distribution curve, what percentage of the results will lie within 2 standard deviations of the mean?
95%
In the normal distribution curve, what percentage of the results will lie within 3 standard deviations of the mean?
> 99%
How can the normal distribution curve be skewed?
Positively or negatively
What does a positively skewed distribution curve look like?
More of the data lies on the positive side of the graph, peak is moved to the left with long tail of data to right/positive side
What happens to the averages on a positively skewed distribution curve?
The mean > median > mode
What does a negatively skewed distribution curve look like?
More of the data lies on the negative side of the graph, peak is moved to the right with long tail of data to left/negative side
What happens to the averages on a negatively skewed distribution curve?
The mean < median < mode
What is a type 1 error?
Detection of an effect that is not present
i.e. rejecting the null hypothesis when it is true
What is a type 2 error?
Failing to detect an effect that is present
i.e. not rejecting the null hypothesis when it is false
What does lead time bias apply to mostly?
Screening tests
What is the term for overestimation of survival due to earlier detection of a disease by screening than by clinical presentation?
Lead time bias
What is the term for overestimation of survival due to relative excess of cases detected that are progressing slowly?
Length time bias
What is the name of the effect whereby subjects of a study alter their behaviour due to awareness that they are being observed?
Hawthorne effect
How does sampling bias occur?
Not selecting a truly random sample which is representative of the larger population
What is recall bias?
Differences in accuracy or completeness of recall of past events or experiences
Why is recall bias most commonly seen in case control studies?
They are often retrospective and rely on people memories
What is this an example of:
Patients with lung cancer when asked about smoking history are more likely to give an accurate history than those who have not had lung cancer
Recall bias
What is the Pygmalion effect?
Aka Rosenthal effect
Phenomenon whereby the expectations of a target person affect the performance of that person
What is an example of the Pygmalion effect?
Teachers belief in a student and high expectations lead to a student achieving a better outcome
What is the name of the bias that occurs from data gathering at an inappropriate time?
Late look bias
What is the lowest rung on the pyramid of evidence?
Editorials or expert opinion
Where do case reports and case series rank on the pyramid of evidence?
Just above expert opinion
What are the observational studies on the pyramid of evidence?
Case control studies and cohort studies
Why do case control and cohort studies lie above case reports/series on the pyramid of evidence?
Higher number of cases within a structured observational study
Which is less likely to be subject to recall bias - cohort studies or case control? Why?
Cohort studies - case control usually retrospective but cohort studies follow a group through time
Why do randomised control trials rank higher on pyramid of evidence than observational studies?
They are interventional studies with a random group of people, rather than observational which can be more susceptible to bias
What is a cohort study?
An observational study following a group of people with a characteristic in common, to observe outcomes over time
What is a case control study?
A retrospective observational study looking at a group of people with a certain outcome and a group without that outcome, and comparing a potential common causality
What is the best form of evidence/at the top of the pyramid of evidence?
Systematic reviews and meta-analysis
What is the difference between systematic reviews and meta-analysis?
Meta-analysis is a quantitative analysis of multiple RCTs to find an overall average.
Systematic reviews are a qualitative analysis of multiple RCTs to assess their quality.
What is the odds ratio?
Estimation of risk of being exposed to risk factor
What does it mean if the odds ratio is 2?
You are twice as likely to have the outcome if you were exposed to the risk factor
How is odds ratio calculated?
(exposed cases / non exposed cases) / (exposed controls / non exposed controls)
(a/c)/(b/d) which can also be written as ad/bc
What kind of study is odds ration relevant for?
Case control studies
What kind of study is relative risk relevant for?
Cohort study and Randomised Control Trial
What is the relative risk?
Ratio of probability of an event occurring in an exposed group to probability of event occurring in non-exposed group
How is relative risk calculated?
(exposed cases/(exposed cases + exposed disease free)) / (non exposed cases/(non exposed cases + disease free non exposed cases)
i.e. (a/a+b)/(c/c+d)
Which type of study is absolute risk relevant to?
Randomised Control Trials
What is absolute risk?
A persons risk of developing a disease
What are some examples of absolute risk calculations used in every day practice?
Q risk
CHADSVASC
Frax score
What is numbers needed to treat?
The number of people who need a particular intervention in order for 1 person to benefit or to prevent an adverse event in one person
How is numbers needed to treat calculated?
NNT = 1 / Absolute Risk Reduction
What is the name of the graph that shows meta-analysis of RCTs?
Forest Plot
What does a Forest plot allow us to see easily for meta-analysis?
Shows effect size of each study, precision of each study, and overall combined effect
What does box size indicate on a forest plot?
The size of contribution to overall effect
i.e. the larger the box, the larger the contribution
What do the horizontal lines from the box indicate on a forest plot?
Confidence interval
What is the line of no effect?
The line on a forest plot at odds ratio/risk ratio of 1
What does a confidence interval on the right of/crossing the RR=1 line mean?
There is potential for increased risk therefore the result is not statistically significant
What does a long line through the box mean on a forest plot?
The longer the line, the wider the confidence interval, the less precise the study is.
What graph can show if there is publication bias in a study?
Funnel plot
Describe how a funnel plot appears?
Scatter plot of treatment effect vs study precision. If the study falls within the funnel shaped bounds, publication bias is unlikely to be present
What are the 5 measures of Screening Test Validity?
- Sensitivity
- Specificity
- Positive Predictive Value
- Negative Predictive Value
- Likelihood Ratio
What is the term for the proportion of true positives successfully identified by a test?
Sensitivity
What is the term for the proportion of true negatives successfully identified by a test?
Specificity
How is sensitivity calculated?
= true positives / (true positives + false negatives)
How is specificity calculated?
= true negatives / (true negatives + false positives)
What is the term used to describe the likelihood of having a disease given a positive result?
Positive predictive value
How is positive predictive value calculated?
= true positives / (true positives + false positives)
What is the term used to describe the likelihood of not having a disease given a negative result?
= true negatives / (true negatives + false negatives)
What is the philosophy behind generalism?
Person not disease centred practice
On average, how many consultations do people in the UK have with their GP in a year?
> 5.5
What is the difference between the role of a GP and the role of a specialist in serious diseases?
GPs exclude serious disease, Specialists confirm the presence of serious disease
What is the difference between the role of a GP and the role of a specialist in managing uncertainty?
GPs tolerate uncertainty, specialists reduce uncertainty
Who is the first point of contact in the healthy system in UK?
The GP
What terms are used to designate any organisation providing NHS primary care services?
Primary care provider or practice
What is the practice list?
All patients registered with a particular primary care provider
What is a primary care network?
Multiple practices coming together in some form of collaboration
How often does revalidation occur?
Every 5 years
What is an appraisal?
Yearly assessment of doctors to maintain license to practice
What is the BMA?
British Medical Association - voluntary professional association and independent trade union of doctors
What is the Care Quality Commission (CQC)?
Independent public body that assesses and manages health and social care, regulates, publishes information about the state of health and social care, and coordinates reviews and assessments.
What is the GPC?
General Practitioners Committee
BMA committee with authority to deal with all matters affecting NHS GPs, representing all GPs regardless of if they are registered with the BMA
What is a local medical committee?
Committee of GPs representative of GPs in their area
What is the National Association of Sessional GPs?
Acts as voice and resource for all NHS GPs who work outside of traditional GP principle model
What categories of risk are relevant to general practice?
-Clinical care
-Non clinical risks
-Risk to health of workforce
-Organisational risk
-Financial risk
What % of prescriptions contain a prescribing error?
20%
1 in 5
What is the main part of the money paid to GP practices called?
The global sum
What does the global sum consist of?
Costs for staff and practice running costs for essential services, additional services, and out of hours if not opted out
What are enhanced services that a practice may be paid for?
Services in addition to the global sum services that a practice may offer e.g. more advanced minor surgery, intrapartum care, childhood vaccine targets etc
What is the payment for premises and IT?
Part of GP funding for practices to reimburse those who rent their premises, and all IT costs
What are the quality payments made to a GP practice?
Payments made in relation to performance against QOF targets
What are QOF targets?
Quality and Outcomes Framework - quality incentive scheme which is updated and reviewed yearly
How can a practice prevent penalisation when unable to meet targets?
Exception Reporting e.g. reporting if a patient failed to attend a review or a medication is contraindicated
How long can a patient register at a surgery for temporarily?
> 24 hours but < 3 months
In what situations can a patient be removed from the practice list?
- Violence
- Crime & deception
- Relocation to an address out of practice area
What is urgent care?
Range of services provided to people who need or perceive they need urgent advice/care/diagnosis
What is the summary care record?
Electronic medical notes summary extracted from GP IT systems that can be viewed by healthcare staff in other NHS settings
What can be used for a patient to access their GP records online?
Patient Online
How should patient subject access requests be made?
Usually in writing (electronic or paper)
Can a practice charge for subject access requests?
No, although they may charge for repeat requests
How quickly should a record by provided after a subject access request?
Within 1 month
Who can request patient information?
-Any competent person may seek their own record, including children
-Any person with parental responsibility may request their child’s record under 18
-A third party with written permission from the patient e.g. solicitor/insurance company
How should manual records be stored?
Securely, closed, in a logical order, with a tracking system in place
How can electronic records be kept safe?
-Log out of a computer when you leave it
-Do not share logins or passwords
-Change passwords regularly
-Make sure passwords are secure
-Keep smart cards secure
What is the name of the fundamental rules and regulations that guide patient confidentiality?
Caldicott Principles
What are the Caldicott Principles?
- Justifiable purpose
- Don’t use patient identifiable information unless necessary
- Use minimum amount of patient identifiable information
- Share on strict need-to-know basis
- Everyone involved should be aware of their responsibilities
- Understand and comply with the law
Is there a right to information about a deceased individual?
Records since 1991 have permitted limited disclosure in order to satisfy a claim arising from death, but not otherwise
When MIGHT a breach of confidentiality be justified?
-Emergencies
-Statutory requirement
-Public interest or public health
-Required by law e.g. for court case
-Complaints
-Adverse drug reactions
What is defined as the willingness of a patient to undergo examination, investigation, or treatment?
Consent
What forms might consent come in?
-Expressed
-Implied
When a patient makes a complaint, who might they complain to?
-PCO
-PALS
-Practice
Who would PALS direct a complaint to?
The PCO or Practice
How quickly does a complaint need to be aknowledged?
48 hours
Following a complaint, how long does the complaints manager have to manage the complaint and respond to the complainant?
<25 days after the original complain
If after the practice has responded to a complaint the complainant is not happy with the outcome, where can they take their concerns?
The NHS Ombudsman
Until what time can someone make a complaint to a GP surgery?
Up to 1 year after the incident, or up to 1 year after the complainant became aware of the matter
What time limit is placed on civil clinical negligence cases?
3 years, although children can claim up to their 21st birthday
How should complaints be recorded?
In full and separately from patient notes
Should complaints documentation go to a new surgery with their notes if a patient moves?
No
What are the 4 steps of quality improvement?
RAID:
Review
Agree
Intervene
Demonstrate
What is a never event?
A validated list of events known to cause severe harm that are completely preventable
According to studies, what % of information given to patients in a consultation is believed to be forgotten within a few minutes of leaving the surgery?
> 50%
What are 4 useful resources for practicing evidence-based medicine?
-NICE
-Cochrane
-PubMed Central
-Google Scholar
What does the law require regarding the role of a doctor during death?
That the/a doctor who attended the patient during their final illness to issue a certificate detailing cause of death
What proportion of deaths occur at home?
1 in 4
How many doctors are involved in the cremation form?
2
Who fills out the Cremation 4 form?
The patient’s usual medical practitioner - in he community this is usually the GP
Who fills out the Cremation 5 form?
Another doctor with full GMC registration for 5 years or more who is not connected with the patient or the doctor who issued part 4
What 2 methods can be used to contact the coroner?
Electronic referral (preferred) or via the police
Does reporting a death to the coroner automatically entail a post-mortem?
No
What is the job of the local medical examiner as of April 2019?
To check all death certificates issued by treating doctors for accuracy and coroner notification obligations
What benefits may be available to family etc after a death?
-Benefits for widows/widowers
-Budgeting loans for funerals
Do the following circumstances require that the death is reported to the coroner?
Patient dies following injuries sustained in a fight
Yes - violent or suspicious death
Do the following circumstances require that the death is reported to the coroner?
A patient who has not seen their GP for a number of years despite multiple health issues is brought into ED malnourished and unkempt, and dies soon after.
Yes - death may be due to self-neglect or neglect by others
Do the following circumstances require that the death is reported to the coroner?
A patient who was released from prison a week ago was found dead in the street
Yes - this could be either due to violence/suspicious cause, or death that occurred during or shortly after police/prison custody
Do the following circumstances require that the death is reported to the coroner?
A patient dies of mesothelioma
Yes - if industrial disease or related to employment
What are the 4 absolute contraindications to any organ donation?
-Creutzfeldt-Jakob disease (or any neurodegen condition assoc with infection)
-Ebola virus infection
-Cancer that has spread in last 12 months
-HIV or hepatitis C
Is organ donation opt-in or opt out in England?
Opt-out (as of the last few years)
What different blood components can people donate?
Whole blood or platelets
What are the two groups of driving licence holders?
Group one - cars and motorcycles
Group two - large lorries and buses
Which driving group has higher medical standards?
Group 2 (large lorries/buses)
After what age is a group 1 driving licence renewal required every 3 years?
70
How long is a group 2 driving licence valid for?
5 years maximum
What is the role of a medical practitioner in renewing a group 2 licence?
New applicants for group 2 licence require a medical examination
Beyond what age do group 2 drivers require a medical examination every year?
65
What is the responsibility of the driver to the DVLA regarding injury or illness?
To inform then if injury/illness would have a likely impact on safe driving ability
Respond fully and accurately to requests for information
Comply with the regulations of the issued licence
What is the responsibility of the doctor to the driver/DVLA regarding injury or illness?
-Advise the driver of impact of illness/injury on safe driving ability
-Advise the individual of legal requirements re informing DVLA
-Notify DVLA directly if an individual cannot or will not themselves
Where can a notification to DVLA be made in UK?
via GOV.UK website, or nidriect.gov.uk for those living in Northern Ireland
Where can a doctor find comprehensive written guidance about notifying the DVLA if a patient won’t or can’t?
GMC guidelines 2017
What principles underpin the GMC guidance regarding notification to DVLA when a patient will not or cannot do it themselves?
Doctors owe a duty of confidentiality to the patient, but also have a wider duty to protect and promote health of patients and the public
What DVLA resource can be used to assess fitness to drive?
Assessing fitness to drive guidance or DVLA medical advisor
What can be suggested if a patient refuses to accept a diagnosis that can affect their ability to drive?
Offer/get a second opinion, and advise them not to drive in the meantime
What does the DVLA classify as epilepsy?
2 or more unprovoked seizures over a period greater than 24 hours
A patient who was diagnosed with epilepsy with a group 1 licence had their last seizure 8 months ago.
How much longer do they need to wait before they can drive again?
They must be seizure free for 4 more months
A large lorry driver has just been diagnosed with epilepsy. What do you need to tell them about their group 2 licence?
They must be seizure free without medication for 10 years before licencing may be considered again
A previously well patient with a group 1 licence presented to ED with a first episode of seizure, but they forgot the advice they were given about driving when they left.
What advice should you give them regarding driving?
-Must not drive and must notify DVLA
-Driving must stop for 6 months from date of seizure, or 12 months if there is an ongoing underlying risk factor
A previously well lorry driver with a group 2 licence presented to ED with a first episode of seizure, but they forgot the advice they were given about driving when they left.
What advice should you give them regarding driving?
-Must not drive and must notify the DVLA
-Driving must cease for 5 years from date of the seizure
-Licence may be restored after 5 years if full medical evaluation shows risk of <2% of a further seizure
How long must a driver (group 1 and 2) cease driving following a provoked seizure e.g. from alcohol/ilicit drugs?
Group 1 - 6 months
Group 2 - 5 years
How long must a driver (group 1 and 2) cease driving following a dissociative seizure?
Group 1 - 3 months
Group 2 - 3 months if other criteria are met
What exemption may apply to seizures and driving?
If seizures only happen during sleep and this is a provable and established pattern
What advice is given regarding driving while weaning down of anti-epilepsy medication?
Individuals should not drive while it is being withdrawn or for 6 months after the last dose
Regarding transient loss of consciousness and driving licence:
What 3 ps are considered when assessing a patient?
Provocation
Posture
Prodrome
A group 1 licence holder has a single episode of simple vasovagal syncope while standing - do they need to inform the DVLA?
No
A group 2 licence holder has a single episode of simple vasovagal syncope while standing - do they need to inform the DVLA?
Yes and must not drive
A group 1 licence holder has a single episode of simple vasovagal syncope while sitting - do they need to inform the DVLA?
If there is an avoidable trigger that will not occur while driving - No
Otherwise yes they must inform the DVLA and not drive
A group 2 licence holder has a single episode of simple vasovagal syncope while sitting - do they need to inform the DVLA?
Yes and must not drive for 3 months. They will require investigation.
A group 1 licence holder has a single episode of triggered syncope (reversible cause) while standing - do they need to inform the DVLA?
No and they may drive
A group 1 licence holder has a single episode of triggered syncope (reversible cause) while sitting - do they need to inform the DVLA?
Yes and they must not drive for 4 weeks - they can drive again after 4 weeks if a cause is identified and treated
A group 2 licence holder has a single episode of triggered syncope (reversible cause) while standing - do they need to inform the DVLA?
Yes and they must not drive
A group 2 licence holder has a single episode of triggered syncope (reversible cause) while sitting - do they need to inform the DVLA?
Yes and must not drive for 3 months until a cause is identified and treated
A group 1 licence holder has a transient loss of consciousness due to a cardiac cause - do they need to notify the DVLA?
Yes and they must not drive - if cause is identified and treated after 4 weeks, they can drive.
If no cause identified, licence is revoked for 6 months.
A group 2 licence holder has a transient loss of consciousness due to a cardiac cause - do they need to notify the DVLA?
Yes and they must not drive - if cause is identified and treated after 3 months, they can drive.
If no cause identified, licence is revoked for 12 months.
A driver with a group 1 licence experiences cough syncope - what are the rules regarding driving?
Must not drive, must notify DVLA
No driving for 6 months after a single episode, or 12 months following multiple episodes over a 5 year period
A driver with a group 2 licence experiences cough syncope - what are the rules regarding driving?
Must not drive, must notify DVLA
No driving for 12 months after a single episode, or 5 years following multiple episodes over a 5 year period
A patient with a group 1 licence is diagnosed with narcolepsy. What are the rules here regarding driving?
Must not drive and must notify DVLA
May be reissued a licence when there has been symptom control for 3 months or more
A patient with a group 2 licence is diagnosed with narcolepsy. What are the rules here regarding driving?
Must not drive and must notify DVLA
May be reissued a licence when there has been symptom control for 3 months or more if they pass a specialised assessment
A patient with a group 1 licence is diagnosed with motor neurone disease. What are the rules regarding driving and chronic neurological disorders?
They must notify the DVLA, but may drive if they can keep safe control at all times
A short duration licence may be issued
A patient with a group 2 licence is diagnosed with motor neurone disease. What are the rules regarding driving and chronic neurological disorders?
They must notify the DVLA, but may drive if they can keep safe control at all times
A short duration licence may be issued and subject to yearly review and medical reports
Does a patient with sudden and unprovoked disabling dizziness episodes need to inform the DVLA?
Yes and they must not drive
A patient with a group 1 licence had a stroke 1 month ago and wants to know about driving rules. What does this depend on?
If satisfactory clinical recovery has occurred, driving may resume after 1 month without informing the DVLA
If there is residual neurological deficit that affects safe driving, DVLA should be informed
A patient with a group 2 licence had a stroke and wants to know about driving rules. What do you tell them?
They must notify the DVLA and must not drive - relicensing may be considered after 1 year.
This is the same for a single or multiple TIAs
A patient has visual inattention. Does it matter what type of licence they have?
No - both group 1 and group 2 need to stop driving and notify the DVLA
A patient with a group 1 licence is diagnosed with carotid artery stenosis. Do they need to inform the DVLA?
No, and they can continue driving
A patient with a group 2 licence is diagnosed with carotid artery stenosis. Do they need to inform the DVLA?
Yes - they must not drive unless they have been specifically assessed
What is the Wilcoxon signed-rank test used for?
To assess the change in a particular measure in a single sample before and after an intervention
What is the Fisher’s exact test?
A significance test used to assess whether there is a statistically significant difference between 2 frequencies.
What is Pearson correlation coefficient?
Significance test used to assess if there is a correlation between 2 sets of continuous data
