Block 12 - part 2 Flashcards

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1
Q

confounding factor

A

distortion of the relationship between an exposure and outcome due to shared relationship with something else, can either increase associated between exposure and outcome, or decrease association between exposure and outcome

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2
Q

4 ways of limiting confounding

A

restriction, matching, stratification, multiple variable regression

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3
Q

restriction

A

limit participants of your study who have possible confounders - means will have less data so difficult with multiple confounders

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4
Q

matching

A

create comparison group that is matched on the possible confounder, make case and control group as similar as possible on the confounder and then ask about exposure status

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5
Q

when is matching used

A

for strong confounders such as age and sex

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6
Q

stratification

A

analyse exposure:outcome association in different subgroups of the confounder, recombine data and use a weighted average of the strata

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7
Q

limitations with stratification

A

to take into account all confounders would require lots of strata and you may run out of data to fill all possible options in your strata

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8
Q

multiple variable regression

A

adjust for effects of multiple confounders, try and produce a linear model between outcome and different exposures - allows for adjustment of estimates for confounding

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9
Q

standardisation

A

way to limit confounding, often used to control for differences in age groups when comparing rates of disease in two populations with different age structures

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10
Q

standardised mortality ratio (SMR)

A

ratio between the observed number of deaths in a study population to the number of expected deaths

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11
Q

calculation for SMR

A

SMR = Observed (number of deaths)/expected (n.o.d)

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12
Q

direct standardisation

A

required we know the age-specific rates of mortality in all populations under study

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13
Q

indirect standardisation

A

only requires that we know the total number of deaths and age structure of the study population

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14
Q

when is indirect standardisation preferable

A

small numbers in particular age groups

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15
Q

why do we have waiting lists

A

limitless demand for health, limited resources

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16
Q

importance of waiting times to patients

A

patients condition may deteriorate while waiting, effectiveness of proposed treatment may be reduced, waiting itself can be distressing, adverse effect on family life, employment circumstances

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17
Q

ways to measure waiting times

A

average waiting time (mean.median), proportion who waited longer than x number of days, average wait of people currently on the list

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18
Q

theories of NHS waiting lists

A

backlog - implies need of occasional emergency injection of funds, demand management - waiting acts as a price to deter frivolous use, allows NHS resources to be fully employed, waiting lists are caused by underfunding and inefficiency

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19
Q

4 ways to reduce NHS waiting ties

A

manage deman, manage the queue, manage capacity, provide leadership

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20
Q

manage demand (reduce NHS waiting ties)

A

ensure each referral represents the most appropriate decision for the care of the individual patient

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21
Q

manage the queue (reduce NHS waiting ties)

A

ensure waiting lists are well managed and patients are called for treatment in appropriate order

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22
Q

manage capacity (reduce NHS waiting ties)

A

provide efficient and effective services that meet the level of demand from appropriate referrals

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23
Q

provide leadership (reduce NHS waiting ties)

A

ensuring all parts of the local NHS work together to acheive waiting time improvements in the best interests of patients

24
Q

2000-2008 targets and terror

A

performance management of trusts and PCTs based on achievement of target waiting times, hospitals receive an overall performance score and managers could lose their jobs if targets missed

25
Q

pros of targets and terror

A

no inpatients waiting over 3 months, outpatients reduced, significant increased expenditure alongside this, however funding has now remained constant so NHS is struggling despite increased demand

26
Q

cons of targets and terror

A

sacrifice of professional autonomy - managers pressure drs to treat less urgent because of waiting times, unmeasured performance sufferers - things without target may suffer, adverse behavioural responses - emergency patients waiting in ambulances not classed as being in A&E until through door, data manipulation and fraud

27
Q

possible criteria for priority on a waiting list (6)

A

clinical urgency, clinical severity, potential health gain, productivity and ecnomic loss, equity waiting, length of time witing

28
Q

social impact of deafness

A

difficult to have conversations, isolation, intimacy issues, problems at work

29
Q

psychological impact of deafness

A

anger, low confidence, frustration, depression, embarrassment

30
Q

practical issues with deafness

A

doorbells, phones, theatre/cinema, TV, alarms

31
Q

3 ways stroke can affect communication

A

aphasia, dysarthia, dyspracia

32
Q

social consequences of speech and communication difficulties

A

not expressing self = isolating, depression, frustration, tiring, may not be able to participate in activities they used to enjoy

33
Q

medico-legal implications for people with epilepsy

A

determination of fitness to drive/other dangerous activities, determination of intent for criminal activities

34
Q

rules for driving with epilepsy

A
group 1 (cars, motorbikes) - seizure free for 12 months
group 1 (HGVs) - seizure free and no antiepileptic medication for 10 years
35
Q

new rules to whether people with epilepsy can drive depend on

A

only have seizures while they sleep, seizures don’t affect their consciousness, dr changed dose/meds but have now gone back to original

36
Q

CAMs

A

complementary and alternative medicine

37
Q

5 types of CAMs

A

acupuncture, chiropractic, herbal medicine, homeopathy, osteopathy

38
Q

acupuncture

A

fine needles inserted at cetain sites in the body for therapeutic or preventative purposes

39
Q

chiropractic

A

spinal manipulation aims to treat ‘vertebral subluxations’ which are claimed to put pressure on nerves

40
Q

herbal medicine

A

medicines with active ingredients from plant parts

41
Q

homeopathy

A

based on use of highly dilated substances, which practitioners claim can cause the body to heal itself

42
Q

osteopathy

A

moving, stretching and massaging a person’s muscles and joints

43
Q

underlying principles with CAMs

A

self-healing is triggered, longer term effects may be due to physiological and behavioural changes integral to treatment, each therapy has it’s own mechanisms whicha re mostly poorly understood

44
Q

percentage of CAMs covered by the NHS

A

10%

45
Q

barriers to CAMs on the NHS

A

regulatory issues, financial concerns in NHS, tribalism, inertia, mixed evidence of effectiveness

46
Q

reasons for CAMs to be provided by the NHS

A

patient choice, preventative healthcare agenda, commissioning changes, personal budgets, growing evidence base

47
Q

complementary therapy used most in MSK problems

A

osteopathy

48
Q

what is osteopathy used mainly to treat

A

back pain, repetitive strain injury, changes to posture in pregnancy, postural problems caused by driving or work strain, pain of arthritis and sports injuries

49
Q

What do chiropractors mainly treat

A

back, neck and shoulder problems, joint, posture and muscle problems, leg pain and sciatica, sports injuries

50
Q

acupuncture used to treat

A

MSK patients, fertility/pregnancy, neurological pain, depression, eczema, chronic pain, irritable bowel

51
Q

why do people use acupuncture

A

effectiveness gap - clinical area where available treatments are not fully effective or satisfactory for various reasons

52
Q

reasons for effectiveness gap

A

lack of efficacy, adverse effects, acceptability to patients

53
Q

evidence base for acupuncture

A

acupuncture correlated with physiological parameters, can be seen as having an overall effect vs usual care, more effective than no treatment or sham treatment for lower back pain, more and better research needed

54
Q

criticisms of acupuncture

A

effect too small and not clinically relevant,

NSAIDs commonly given for back pain - NSAID vs placebo and acupuncture vs placebo have similar effect for pain reduction

55
Q

NICE guidelines for CAMs management of lower back pain

A

consider manual therapy, do not offer acupuncture

56
Q

NICE guidelines for CAMs management of osteoarthritis

A

manipulation and stretching should be considered as an adjunct to core treatments, do not offer acupuncture

57
Q

NICE guidelines for CAMs management of headache/migraine

A

consider a course of up to 10 sessions of acupuncture over 5-8 weeks