Block 1 Flashcards
What is Statistical Normality?
Based on the normal (Gaussian) distribution
95% of the population should be within ± 2.5 standard deviations of the mean
What is Social Normality?
What society finds acceptable or desirable.
Changes within a given society, culture, and time.
What is Optimal Normality?
‘Normal’ value is determined by what is required for optimal health
Not the mean/median of a population.
Define Illness
Subjective experience, varying between people.
Can be ill in the absence of disease.
Define Sickness
A social role given to or taken on by a person perceived to be ill.
Define Disease
Objective diagnosis using specific signs and symptoms.
Deviation from the biological norm.
Changes with medical advances.
What are the key features of the medical model?
- Normality = State of health is the absence of disease
- Abnormality = Ill health is based upon pathological changes
- Ill health is caused by biological misfortunes that are identified by signs/ symptoms and the process of diagnosis
- Cure is to restore to a healthy (normal) state
- Medical knowledge is exclusionary (the job of expects)
- Model is disease orientated and concerned with pathology
What are the criticisms of the medical model?
- Majority of power is in the hands of the medical profession not patients
- Shift to chronic/degenerative diseases which are not linked to simple biological causes and not amenable by medial cure
- Model does not include social/cultural influences on health
- People do not view normal as the same. Different views
What is the social model?
- Health is socially constructed (varied, uncertain and diverse)
- Ill health is also caused by social/cultural factors not only biological
- Causes can be identified via beliefs and interpretation
- Knowledge is not exclusionary
- Model is holistic (concerned with people’s lives and experiences and how they define health)
What is the WHO definition of health?
Give 4 other definitions of health
A state of complete social, physical and mental wellbeing and not merely the absence of disease or infirmity.
Health as absence from disease.
Health as functionality (ADLs.)
Health as freedom.
Health as an equilibrium.
Define prevalence of disease
A measure of how common a disease is
As a proportion.
(% or number in 1000/10000 etc.)
How would you work out disease prevalence?
P = (no. people with disease/total number of people) x 100 (for a %)
What are the 3 types of prevalence?
1. Point prevalence:
The prevalence at a given time (burden of disease)
2. Period prevalence:
The prevalence through a set range
3. Lifetime prevalence:
Prevalence of disease with respect to patients lifetime
Give one pro and one con of using prevalence of disease
Pro:
Prevalence is good at gauging the burden of disease Con:
Can be affected by the duration of the disease.
Define incidence
The rate at which new events occur in a population, over a defined period of time.
Either expressed as per n people of n years, or as n-person years
How would you calculate the incidence?
Incidence = (number of new cases)/(no. people observed x years observed) x units (eg, 1000 for per 1000 people etc)
What is a 95% confidence interval?
P = prevalence N = total population
Definition:
95% confidence interval is the range in which we expect 95% of the results to lie; 95% certain that the true value lies within that range.
Importance:
Important because it adds power and weighting to results; allows understanding of how significant the results are
Interpretation:
Results that occur outside of this range (i.e. outside of the null hypothesis) are considered statistically significant; results that are not in the range are described at significantly different.
Therefore, can reject the null hypothesis.
How would you calculate a confidence interval?
First calculate p, then the SE (which is a given equation.)
then: CI = p ± (1.96*SE.)
Standard error is a representation of sampling error.
What is a P value?
A number somewhere between 0 and 1.
It is the probability of the data falling within the range.
If it is, <5% then reject the null hypothesis (there is a statistical significant difference)
But if >5% then accept the null hypothesis
What is a census?
The simultaneous recording of demographic data by the government at a particular time
Pertaining to all the persons living in a particular territory
Does the UK have a census?
Yes! Every 10 years, legal requirement.
Taken since 1841.
98% coverage but some low enumeration groups.
Data goes to the Office of National Statistics.
What does CARTA stand for with respect to assessing quality of health information?
Completeness
Accuracy
Reliability
Timeliness
Accessibility
What is the UK census used for?
- Demographic data – age/sex
- Cultural characteristics – ethnicity/religion
- Material deprivation – employment/home ownership/car assess
- Health – general/long-term illness/unpaid care
- Workplace and journey to work
Outline the protocol for Birth Registration
Birth Notification = by birth attendant (midwife) within 36 hours,
To the Health Authority Birth Registration = by parents within 42 days
All information is entered to the register for Births, Marriages and Deaths
This is then sent to the Office for National Statistics (Birth statistics)
Outline the protocol for death Registration
Death certificate is issued by a doctor
Death is registered by an informant (normally relative) within 5 days
All information is entered to the register for Births, Marriages and Deaths
This is then sent to the Office for National Statistics (Mortality statistics)
What information is on a death certificate?
What potentially useful information is not?
On a death certificate
Certifies the fact of death, Age, Place of death, Information on cause of death
Not on death certificate
Accurate depiction of what the patient died from, Ethnicity, Socioeconomic status
How would you work out the Crude Birth rate?
Live births/1000 people in population
How would you work out the General Fertility rate?
Live births/1000 women in population.
Of childbearing age. (Aged 15-44.)
How would you work out the total fertility rate?
The number of live babies that would be born if every woman lived to menopause and gave birth in accordance with the current, age-specific fertility rate.
What are population projections?
What are they used for?
Forecast future population size and structure
Based on assumptions about fertility/mortality/migration
Used for:
Planning services
Allocation of resources
In the past: to see what has happened to the population
The present: to make sense of present activity
In the future: to predict what is going to change
What are population estimates used for?
How would you work out the population estimate?
Estimate the population size and structure between census
Applies what is known on birth/deaths/migration to present
Census baseline + births – deaths ± migration.
What are the pros and cons of a population estimate?
Pros:
More up to date than the census
More accurate than projections
Cons:
Less reliable further away from the census
Migration info isn’t great
Says nothing about future trends
What data from the UK census is used by healthcare workers?
Population size and structure (young, old, ethnic minorities)
Services
Base population
Measure of material deprivation
Identify and target inequalities
What are the pros and cons of population projections?
Pros:
Can aid in planning, more long term.
Cons:
Less accurate the further forward you go.
Unforeseen changes can render invalid.
Why are population pyramids useful?
Useful in planning resources
Because they allow the comparison of different groups over time.
Where would you find the following sources of health data?
Mortality
Morbidity
Determinants of health
Mortality
Death registration
Morbidity
Cancer registration system, Notification of infectious disease, NHS activity data
Determinants of health
Census about socioeconomic and deprivation, Surveys about lifestyle factors
What are the key concepts of Client Directed Care?
Patient is treated how they they wish to be treated
Care is tailored to them,
Shared in the decision making
Hollistic.
What are the 3 main principles of person centred care?
Personalised
Seeing the whole person, putting their needs first, as they define them.
Coordinated
Continued across episodes, time, from childhood to adulthood
Enabling
They are part of the decision making and are taught to manage their own condition
Why is person centred care important?
Evidence of positive outcomes for patients
Better care satisfaction
Less emergency visits
Social and political drivers
Concurs with the ethical principles underpinning the duties of a doctor
What are the social and political drivers of policy and practice developments around person-centred care?
Patient dissatisfaction with the NHS – survey evidence
Wider society – less hierarchical relationships
patients want to get involved
Spiralling economic cost of NHS – better outcomes will control costs
Recent reports on appaling care standards
Essentially its just better more compassionalte care
What organisational system oversees the cancer registration system?
ONS - office for national statistics
Cancer diagnosis leads to registry on 12 registers in the west midlands
What are the uses of the cancer registration system?
Evaluation of screening programmes
Clinical and epidemiological research
Planning services for prevention and care
What are the pros and cons of the cancer registration system?
Pros:
Detailed up to date information
Record linkage to cancer deaths
Cons:
Expensive, access is hard due to confidentiality
Outline the process of notification of infectious diseases
31 Notifiable diseases
eg. Chlorea, Botulism, plague, mumps.
Doctor suspects case of notifiable disease
Notifies the Local Health Protection Unit
Which then notify the Health protection agency (PHE)
What are the uses of notification of infectious diseases?
Action to prevent further infection
Identiy outbreaks
Surveillance to monitor trends
What are the pros and cons of notification of infectious diseases?
Pros:
Linked to other data
Increase in accuracy,
Routine national data that is returned weekly to HPA
Cons:
Poor or variable completeness of some diseases
Accuracy can be questionable due to diagnostic uncertainty
What is NHS activity data?
Give some examples
Large amounts of information about the NHS activity collect for administrative and clinical purposes
Such as:
Hospital episode statistics (HES)
All admissions, outpatients, A&E visits
Quaity and Outcomes Framework (QOF)
Linked to GP payments, voluntary, rewarding good practice
(practices score points against 4 indicators)
What are the pros and cons of hospital episode statistics
Pros:
Good completeness as it covers all hospitals
Good accuracy as standard codes are all used, routine national data used
Cons:
Differences between individuals/hospital diagnostic coding
Allows accessibility to individuals data
What are the 4 indicators used in the quality and outcomes framework?
- Clincial
- Public Health Domain & additional services
- Quality and Productivity
- Patient experience at the practice
What are the pros and cons of the quality of outcomes framework?
Pros:
100% completeness
Representative of all population
Updated annually
Online access.
Cons:
Excludes practices that don’t participate
Not that accurate
Only aggregated data
What are the main problems with surveys?
- Reporting bias
- Responder bias
What are the differences between patient centred consultation and person centred care?
Person centred consultation:
Common terminology in medical literature
Refers to interaction in a induvial appointment
Episode orientated
Concerned with the evolution of patients diseases
Uses coding system that prefect professionally defined conditions.
Person centred care:
Common terminology in nursing and social science literature
Refers to relationships over time
Considers episodes as part of a life course experiences with health
Concerned with the evolution of peoples experienced health problems as well as disease
Uses coding systems that allow for specification of peoples health concerns
What are the challenges of person centred care in rge NHS?
- One size fits all focused on easily measurable quantitative outcomes
- Increasing sub-specialisation in secondary care
- Increasing practice sizes in primary care
- Increased healthcare complexity of patients
- Increasing geopgraphical mobility of individual patients
What is a patient centred consultation?
Focuses on the patients needs in the interview
What are the key features of a patient centred consultation?
- Makes history-taking and problem-solving more accurate
- Promotes an active role for the patient in planning and carrying out treatment
- Enables efficient practice
Outline evidence to back up the use of patient centred consultations
- Positive outcomes for patients
- Better outcomes due to enabling patients to express their major concerns
- Better outcomes from seeking patients specific requests
- Facilitating patients expressions of feelings
- Giving patients information
What are the key components in person centred care?
- Seeing the patients as a person – persons own experiences are valued
- Putting the persons needs and preferences first and above those as identified by clinicians
- Shared decision making – doctors and patients are partners in decision-making and management of conditions
- Recognising the persons strengths in self-care and management of their condition
- All interactions and care underpinned by values of compassion, dignity and respect
- Patient and public involvement in the design and delivery of services
