Block 4 Flashcards
Define ‘ethnicity’ and explain how it is different to ‘race’
Ethnicity is socially determined and can be linked
with countries of origin and residence, religion,
social networks etc, whereas race is biological and
genetic
Why is ethnicity important in medicine?
Prevalence of disease,
response/perception/effectiveness of treatment
all vary with different ethnicities. For example,
sickle cell disease is more prevalent in some
ethnic groups
Affects management such as carrier screening
etc
When is sickle cell disease screened for?
A universal blood spot neonatal screening for
sickle cell disease is carried out
Describe what a ‘cross sectional study’ is
A type of descriptive study that involves the
analysis of data collected from a population at one
specific point in time
What is a randomised controlled trial?
A rigorous study design in which participants are
randomly assigned either a placebo or the chosen
intervention that is being tested. The participants
are then followed up.
disdvantages of a randomised controlled trial?
Disadvantages = ethics of placebo, expensive and time
consuming
Advantages of a randomised controlled trial?
Advantages = can determine causality, randomised
allocation reduces confounding variables,
What is the difference between a cohort study and a case control study?
Cohort = start with participants with the same
exposure and compare the outcomes
Case control = start with participants with the
same outcomes and compare the exposures
Define ‘bias’ ?
Systematic error in measurement
State 5 reasons why patient confidentiality is important
It is central to establishing trust
Makes patients more likely to disclose personal
information that may be relevant to their care
Helps ensure that info is not disclosed to those
who may use it to harm the patient
Respects patient autonomy
It is a legal requirement and a professional
obligation
In which situations can information be disclosed without breaching confidentiality?
When imparting information about a patient to
those involved in the care and treatment of the
patient (healthcare team) – This is known as
implied consent
However if a patient is reluctant for some personal
information not to be shared within the
healthcare team, it must be justified to break this
confidentiality
In which situations can you breach confidentiality?
If demanded by court/stature
If it is necessary to prevent serious harm to
other people
If the patient lacks capacity (or is a child) and
disclosure is in the patient’s best interest
If it is necessary to prevent serious harm to a
competent adult patient and it is not practicable
to seek consent to disclosure (e.g. STI
disclosure to partner)
Define ‘risk’
The probability that an event will occur during a
specific time
What is the difference between ‘absolute risk’ and
‘relative risk’?
Absolute = the risk of getting an outcome in a
period of time
Relative = the difference between the probability
of an exposed group getting an outcome and the
probability of an unexposed group getting an
outcome – aka Risk Ratio
What are the top 5 demands for blood donation?
General surgery (23%)
General medicine (15%)
Cardiothoracic surgery (13%)
Orthopaedics (11%)
Blood diseases (9%)
How is the blood donation system funded?
By the taxpayers
At what time of year are blood supplies lowest?
December and January
Which blood types are in lowest supply
typically?
O positive and negative
Titmuss (1970) argued an ethical case against the
purchase and sale of blood. State 4 ethical points
he made.
It would repress altruism
It would erode the ‘sense of community’
It would sanction ‘profits’ in hospitals and
clinics, subjecting medicine to market place
rules
It would increase the blood supply from the
poor, unskilled and unemployed,
redistributing blood from the poor to the rich.
Commercialization may increase infection risks
Cooper and Culyer argued a case for the purchase
and sale of blood. State 2 points that they made.
Supply can be increased by removing obstacles
to donors
Offering financial rewards either by direct
payment or exemption from payment in the
future can also increase supply
Which are the top 4 organs in demand?
Kidneys
Livers
Heart/Lung or Heart and lung
Corneas
If a kidney transplant is not available, patients
must mechanically maintain their kidneys either
through dialysis at home or at hospital.
What are the advantages of a transplant over
mechanical maintenance?
Quality of life is much superior in those with
transplants in comparison to those on dialysis
More cost effective: transplant = £17,000 // dialysis =
£35,000 per year + £5000 for each subsequent year on
immunosuppressive drugs
How can the government/NHS increase the
supply of used body parts?
Replace ‘opt in’ donor cards with ‘opt out’
donor cards
Use transplant coordinators and clinical leads
in hospital to increase supply
Financial incentives (used in the USA) –
However there are debates about ethics and quality
control
Name the methods / criteria for rationing
Ability to pay: this method favours the rich and
is accepted in most markets though not usually
in healthcare
Need: (but what is need?) Ability to benefit as
measured against cost. Therefore this method
favours those who can benefit the most per unit
cost
How can you select who will benefit most
from a treatment?
Age
Behaviour: smoking, alcohol etc
Family circumstances
Social class (may also be related to behaviour)
What is the definition of confidentiality?
The principle of not divulging or disclosing
information about patients to others
Under what circumstances does the GMC allow
you to breach confidentiality?
Demanded by court or statute
Disclosure is in the public interests (e.g.
necessary to prevent serious harm to other
people)
The patient lacks capacity (or is a child) and
disclosure is in the patient’s best interests
Necessary to prevent serious harm to a
competent adult patient and it is not practicable
to seek consent to disclosure
If a patient has a serious communicable disease
and still having sex with unaware partner what
should you do?
Should tell the patient before you make the
disclosure.
Try and get them to disclose.
If practicable you should not disclose the
identity of the patient.
Only disclose the necessary information
Ratio?
Odds ratio: The ratio of odds of exposure
amongst subjects with disease compared to the
odds of exposure amongst a control group. It is
equal to the cross-product ratio.
Odds ratio (OR) = odds in exposed odds in non-exposed
What is a Cross-sectional Study?
A study that examines the relationship between
diseases (or other health-related
characteristics) and other variables of interest
in a particular population at one particular time.
Cross-sectional studies may be used to estimate
the prevalence of disease, but not the incidence
of disease.
What is a case-control study?
An epidemiological study design where subjects are recruited on the basis of the presence or absence of disease (cases or controls) and exposure is measured retrospectively.
In this way it is possible to estimate the risk of
disease associated with exposure usually by
calculating an odds ratio.
What is an occupational cohort study?
The definition of the cohort is based primarily
on a common occupational exposure e.g.
workers in the nuclear power industry.
In this way the risk of disease can be compared
with the general population or other
occupational groups to determine the
occupational risk.
What are the 2 key elements of randomised
control trials?
The key elements of randomised controlled
trials are:
The comparison of a group receiving the
treatment (or intervention) under evaluation
With: a control group receiving either best
practice, or an inactive intervention.
What is “allocation concealment” in RTCs
Successful implementation of a randomisation
scheme depends on:
Making sure that those responsible for recruiting
and allocating participants to the trial have no
prior knowledge about which intervention they
will receive (this is called allocation concealment)
What is a double blind trial?
A trial in which neither participants nor study
personnel knows what treatment has been
received until the code is broken after the
end of the trial. This is achieved by using a
placebo.
If a double-blind design is not possible then
outcome assessment should be done by an
investigator blind to the treatment received.
What is a Systematic Review
An attempt to systematically review the
research evidence on a particular topic:
Systematic means a defined methodology that
could be repeated by someone else and retrieve
the same publications and the same results.
The results of the review might be expressed in
words or mathematically.
What is a Meta-Analysis?
Mathematically combination of the individual
results of studies in the review to get a more
precise estimate of what is happening.
What is a focus group?
An evaluation activity comprising of a
semi-structure discussion with a group of
people.
Focus groups, comprising of stakeholders, are
used to inform test-designers on the
significance of each topic to be administered
within a certification exam.
What is a participant observation?
A research method
involving direct participation of the researcher
in the events being studied. The researcher may
either reveal or hide the true reason for
involvement.
what is a non-participant
observation?
Researchers
do not partake in the activity of the study.
‘cross sectional study’ advantages
Advantages = allows researchers to compare many different
variables at one time, quick and easy to conduct
‘cross sectional study’ disadvantages
Disadvantages = the study may not represent the population
well, difficult to determine a causal relationship between
risk factors and outcomes
