Block 8 Flashcards
Define prognosis
an assessment of the future course and outcome of a patient’s disease, based on knowledge of the course of disease in other patients together with the general health, age and sex of the patient
Why is prognosis important?
- knowledge of prognosis with or without treatment can help treatment decisions
- it’s important for patients to understand the likely course of their disease
- different patients will value different outcomes and this will need to be taken into account during decision making
What are prognostic factors?
Characteristics of the patient which can be used to predict outcomes more accurately. They can be:
- demographic e.g. age, gender
- disease-specific e.g. grade of tumour
- co-morbid e.g. other coexisting disease condition
What type of research questions can be asked about prognosis?
- which outcomes could happen? (qualitative aspect)
- how likely are the outcomes to happen? (quantitative aspect)
- over what time period will the outcomes happen? (temporal aspect)
What are the most appropriate study designs for assessing prognosis?
- cohort study
- case-control study
What are the advantages of Cohort Studies?
- measurement of exposure to risk factor is not biased by presence or absence of the outcome
- can provide data on time course of outcome development
- more than one outcome can be examined at once
- useful for investigating rare exposures
What are the disadvantages of Cohort Studies?
- potential for bias due to selection of subjects
- danger of losses to follow-up
- historical studies are dependent on accuracy of records or recollection
- exposure to risk factors/existence of prognostic factors may change over the course of the study
- can be timely and costly to carry out
What are the advantages of Case-Control Studies?
- relatively quick to carry out
- can be used to examine outcomes that are relatively rare
What are the disadvantages of Case-Control Studies?
- problems with possible bias in selection of cases and controls
- potential for recall bias
- measurement of exposure to risk factors may be biased by prevalence or absence of the outcome
How can the likelihood of an outcome occurring over a period of time be presented?
- as a percentage survival/specified outcome at a particular point in time e.g. 40% survive at 5 years
- as median survival; the length of time by which 50% of people have experienced the outcome e.g. at least half of all patients survive 5 years
- as survival curves which depict each point in time the percentage of the original sample who have not yet experienced the outcome
What did the Bisexuality Report 2010 show?
- bisexual peoples experiences differ from heterosexual and lesbian and gay people
- biphobia is distinct from homophobia
- bi people can experience discrimination from within heterosexual, lesbian and gay communities
- bisexual populations have significantly higher levels of distress and mental health difficulties than equivalent heterosexual, lesbian or gay populations
What is heterosexism?
The widespread social assumption that heterosexuality may be taken for granted as normal, natural and right
What is homophobia?
An irrational fear and dislike of lGBT people which can lead to hatred resulting in verbal and physical attacks and abuse
- MSM are ___ times more likely to commit suicide
- LGBTQ young people are ___ times more likely to self harm and ___ more likely to have depression
- Lesbians are ___ more likely to have an eating disorder than women in general
- 4
- 4
- 3
- 4
What were the recommendations of the Stigma Report?
- increase all staff’s capacity for meaningful communication
- all surgeries to develop and prominently display equality policies, statements and guidelines which explicitly include sexual orientation
- to adhere to clear guidelines around confidentiality and patient notes
- require all staff to act according to guidelines
What prohibits discrimination in provision of goods, facilities or services?
The Equality Act 2007
What does the GMC say about personal beliefs in medical practice?
You must not allow personal beliefs that you hold about patients to prejudice your assessment of their clinical needs or delay or restrict their access to care. This includes age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital status, race, religion, sex, sexual orientation or SES
What is meant by falsifiability?
- scientific knowledge is invariably vulnerable and may be false
- scientific theories cannot be asserted as true categorically but can only be maintained as having some probability of being true
- Popper said that theories that are unfalsifiable are pseudoscience
What are the Bradford Hill criteria?
Factors to consider when assessing causation (TESSERACTC)
- Temporality
- Exposure-response
- Strength of association
- Specificity
- Experiment
- Reversibility
- Analogy
- Consistency
- Theoretical plausibility
- Coherence
What is Temporality? (BHC)
A cause must precede its effect but is all that can be said with any degree of certainty. It does not follow that if exposure to a proposed causative agent precedes an effect that the latter is the direct consequence of the former.
What is Reversibility? (BHC)
Does removal of a presumed cause lead to a reduction in the risk of ill-health? Reduction in a particular exposure if followed by a reduced risk of a particular disease may strengthen the presumption of a real cause-effect relationship.
What is Strength of Association? (BHC)
AKA - effect size
A small association does not mean that there is not a casual effect but the larger the effect, the more likely that it is casual.
What is Exposure-response? (BHC)
AKA - Biological gradient
Is increased exposure to the possible cause associated with an increased response (i.e. an increased likelihood of an effect)? Greater exposure often leads to a greater incidence of the effect, however in some instances the mere presence of the cause can trigger the effect
