Block 8 Flashcards
What is a long-term illness? (3)
lasts 12 months
palliative aspect
uncertainty in diagnosis,prognosis and symptoms
What is the prevalence of long-term illnesses currently (2)
19% of the population
This will probably increase due to our aging population
•
In what ways can diagnosis be positive and negative?
2) + (2
Gives closure to patients
Explains their symptoms
Uncertainty
Also gives access to the sick role
What is Biographical Disruption? (2)
Seeing chronic illness as a ‘disruptive event’
disrupting structures of everyday life
What are the 3 aspects of biographical disruption (3)
Disruption of taken-for-granted assumptions/behaviour about body
Disruption to biography: self identity; re-examine plans for future
Response to disruption: mobilise resources
Define Stigma
Deliberate exclusion of certain types of person – inflicting social pain – due to either physical or social attribute
What is Bias?
Systematic error in the collection or analysis of information.
• E.g. Researchers not blinded to the source of information may treat results differently, consciously or sub-consciously
What is Confounding?
Both factors are not directly associated but are linked by a third factor.
What is the importance of causation?
Explains why things happen
• Prevents disease by removing cause
• Improve treatment through greater understanding of cause
What Criteria are used to prove a causal relationship?
BRADFORD HILL CRITERIA
Strength of association: greater risk=more likely caused
Temporal association: does result always follow exposure?
Experimental evidence: Does an animal model exist? What does it show
Analogy: Are there similar studies with similar results?
Consistency: is the relationship seen in different cases/places?
Theoretic Plausibility: Can we see the biological pathway
Coherence: does the association make sense?
Specificity: How much effect is there when you remove the cause?
Dose Response relationship: does risk increase with increased exposure?
‘Stop Taking Ecstasy And Cocaine, This Cocaine Smells Dangerous’
What is a prognosis?
An assessment of the future course and outcome of a patients’ disease, based on knowledge of the course of disease in other patients together with the general health, age, and sex of the patient.
What is the importance of prognosis?
Can aid diagnostic and treatment options
• Important for patients to know more about their disease
What are the 3 prognosis factors?
(characteristics of the patients that can be used to predict their outcomes more accurately) Demographic: age, gender
• Disease-specific: severity of condition e.g. stage of cancer
• Co-morbid: co-existing disease conditions
What are the 3 aspects of diagnosis and their meanings?
_What are the possible outcomes
What is a cohort study?
- Patients are not randomised into groups
- Outcomes observed over a period of time
- Prospective and retrospective
What is a case group vs control group?
Case group
• Have disease or exposed to possible risk factors
• Clear diagnosis
• Patients are at compatible stage of the disease process
Control group
• Similar individuals without disease or exposure to risk factors
• Or people with disease but different prognostic factors
What is selection bias?
- Systematic error
- E.g. selecting people for study who are not representative of population
- Variations in socio-economic class
What are the advantages and disadvantages of cohort studies?
Advantages • Data provided on time course • Can examine multiple outcomes at the same time • Good for investigating rare exposures Disadvantages • Potential for selection bias • Losses at follow-up potential • Timely and costly to carry out
What is the difference between baseline data and follow-up data?
important to have an accurate measure. Reassess over time as status changesFollow-up Objective, data on all individuals. E.g. mortality rate, illness episodes
What are the advantages and disadvantages of cohort studies?
Advantages • Data provided on time course • Can examine multiple outcomes at the same time • Good for investigating rare exposures Disadvantages • Potential for selection bias • Losses at follow-up potential • Timely and costly to carry out
What are case-control studies?
Cases of the outcome of interest are compared to controls to identify factors contributing to the outcome
Similar problems to cohort studies
What are the advantages and disadvantages of case-control studies?
Advantages • Quick and easy • Examine rare outcomes Disadvantages • Recall bias – accurate recall of info • Measurement bias • Selection bias
What is a systematic review?
review that evaluates and interprets all the available research evidence relevant to a particular question
What is the process of a systematic review?
- Well formulated question
- Population
- Intervention
- Comparator treatments
- Outcomes
- Study design
- Comprehensive data search
- Unbiased selection and abstraction process
- Critical appraisal of data
- Synthesis of data
- Objective interpretation of the findings
- Structured report with clearly reported methods and results
What makes a systematic review valid?
- Clear inclusion criteria
- Good strategy for literature searching
- Selection of studies performed in duplicate by two reviewers
- Assessing quality of included studies
- Randomisation
- Allocation cocealment
- Blinding
- Withdrawals and intention to treat analysis
- Assessment of study quality performed in duplicate by two reviewers
- Data extraction performed according to a template
