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C1 Flashcards

1
Q

Define opportunity cost

A

The loss of other alternatives when one alternative is chosen.

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2
Q

What is sensitivity?

A

The percentage chance that the test will correctly identify a person who actually has the disease.

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3
Q

What is specificity?

A

The percentage of patients without the disease that receive a negative result

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4
Q

What is risk?

A

Probability that an event will occur during a specified time

Only works if a time period is fixed

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5
Q

What are measures of dispersion?

A
  • Standard deviation - How much the values in the data set differ from the mean. Variability or dispersion of values in the data set.
  • Interquartile range
  • Range
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6
Q

Absolute risk?

A

Risk of developing the disease over a time period

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7
Q

Relative risk?

A

The ratio of the probability of developing an outcome in those exposed compared to those not exposed (risk ratio)

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8
Q

Absolute risk vs relative risk

A

Absolute risk = Risk of developing the disease over a time period

Relative risk = The risk developing an outcome in those exposed compared to those not exposed

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9
Q

What is the biopsychosocial model?

A
  • Individuals must be an active participant in their own rehab and recovery
  • Management must relieve pain and prevent disability
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10
Q

What is a “risk factor”?

A

Patient characteristics associated with development of the condition in the first place

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11
Q

What are the sources of NHS funding?

A

Tax finance.

Some user charges (prescriptions).

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12
Q

What population of individuals are studied in a Case Controlled Study?

A

People with diseases are compared with controls without diseases, against risk factors exposed to them in the past.

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13
Q

Describe the professional attitude expected of medical staff and students?

A

First concern - patient

Protect and promote health

Good standard of practice and care

Updated

Dignity - respect patients dignity

Honest, open, integrity

Confidentiality

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14
Q

What is evidence?

A

Body of facts/information indicating whether a belief or proposition is true or valid

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15
Q

What is flat of the curve medicine?

A

The phenomenon where health care consumption (costs) continues to rise while health outcomes (usually defined by life expectancy), remain the same

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16
Q

What is the Bradford-Hill criteria?

A

Factors to consider when assessing whether an observed association is causal.

  • Strength of association: aka effect size, larger the association the more likely the causality
  • Specificity: are there other likely explanation for results?
  • Reproducibility: consistency, same relations seen in different places/cases?
  • Temporality: effect occurs after cause
  • Dose-response relationship - greater the exposure, greater the incidence of effect.
  • Plausibility: logical mechanism by which effect is achieved
  • Coherence - between lab findings and epidemiological findings.
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17
Q

What is culture?

A

System of knowledge, experience, belief, attitudes, meanings, signs, and symbols shared by a group of people

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18
Q

What do correlational studies measure?

A

Outcomes in relation to some factor of interest such as age, time, utilisation of services or exposure.

They use measures that represent characteristics of entire populations to describe outcomes in relation to factors of interest.

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19
Q

Typical grief reactions?

A

Affective - Depression, distress, guilt

Cognitive - Denial, lowered self-esteem

Behavioural - Fatigue, agitation, social withdrawal

Psychological - Loss of appetite, weight loss

Immunological - Disease, illness

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20
Q

What is a rejective response?

A

Doctor denies the reality of the disorder and implies it is a stigmatising psychological problem.

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21
Q

What is statistical power?

A

Probability of correctly rejecting a H0.

In general, the statistical power increases with sample size.

Also, called “Power”.

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22
Q

What is ‘experimental evidence’ in the Bradford Hill criteria?

A

A very strong proof of cause and effect comes from the results of experiments.

In experiments other variables are held stable to prevent them interfering with the results.

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23
Q

Standard error?

A

If the population was sampled many times, standard error is a measure of the variability of the mean in those samples.

Standard error shows how well the mean of the data (sample estimate) approximates the true value (population mean).

SD / square root of number of people in sample

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24
Q

What is the role of the GMC in ensuring students and doctors fitness to practice?

A

Tomorrow’s Doctors

Tells med schools what to teach

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25
Q

Name 3 community pharmacy teams?

A
  • Minor ailment schemes
  • Emergency contraception
  • Smoking cessation
  • Health education
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26
Q

How do you identify all relevant studies in systematic reviewing?

A
  • Search relevant databases
  • Develop complex search strategy
  • Include unpublished data
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27
Q

Why is it important to address both agendas?

A
  • Disease - Means you treat the correct condition, improves biomedical health
  • Illness - Can discover how illness is impacting patient’s life, patient more satisfied, enhances doctor-patient relationship
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28
Q

Bias?

A

Non-random (directional) deviation of the truth.

Systematic error in the collection/analysis of info.

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29
Q

Standard deviation?

A

How much the values in the data set differ from the mean.

Variability or dispersion of values in the data set.

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30
Q

Risk ratio?

A

Ratio of the risk of an event between 2 groups.

1 indicates risk is the same.

Use cohort studies

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31
Q

Misinformation

A

Lying to save from distress

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32
Q

Barriers to help-seeking?

A
  • Provision and availability of services
  • Car ownership, transport cost, availability
  • Disruption to work
  • Attitudes of staff – Previous bad experience
  • Inverse care law – Better off areas get better health provision that poorer areas
  • Geographical distance
  • Time, effort
  • Long waiting times
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33
Q

Primary health prevention?

A
  • Aims to prevent onset of disease
  • Screening risk factors
  • Health protection
  • Health education
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34
Q

What is secondary health prevention?

A
  • Detect and cure disease at early stage

* E.g. cancer screening

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35
Q

What is the gini coefficient?

A

Measure of inequality

36
Q

Name some government initiatives to help reduce child poverty.

A
  • National minimum wage
  • Increase child benefit
  • Increase income support
  • Teenage pregnancy strategy
37
Q

Why has child poverty increased?

A
  • Unemployment/part-time work
  • Lower pay
  • More single parent families
  • Freezing or abolition of some benefits
  • More indirect taxation
38
Q

What is acculturation?

A

Process of taking on another groups culture.

39
Q

When can confidentiality be broken?

A

Sharing directly related to individual care.

Disclosures for the protection of patients.

Disclosures for the protection of others.

Legislative - laws that oblige doctors disclose:

  1. Public health act 1984
  2. Road traffic act 1988
  3. Prevention of terrorism act 1989
40
Q

What can cross-sectional studies be used to estimate?

A

Prevalence of disease but not incidence of disease.

41
Q

What type of studies measure odds ratio?

A

Case-controlled studies.

42
Q

What type of studies and trials measure relative risk?

A

Cohort studies + RCTs

43
Q

What is odds ratio calculated with?

A

Odds / Odds

Chance that something will happen compared to chance that it will not.

Used in case control studies.

44
Q

What is relative risk (aka risk ratio) calculated with?

A

Probability / Probability

RR = 1 (indicates risk is the same)

45
Q

Define odds

A

A ration of the likelihood of an event happening compared to the likelihood of an event not happening.

46
Q

Define probability

A

Ranges between 0-1.

Basically same as percentage.

47
Q

In normally distributed data what is 1 SD?

A

1 SD either side of the mean = 68%

48
Q

In normally distributed data what is 2 SDs?

A

2 SD either side of the mean = 95%

49
Q

In normally distributed data what is 3 SDs?

A

3 SD either side of the mean = 99.7%

50
Q

Absolute risk

A

One population’s risk in its own right.

E.g. women have a 3% risk of getting cervical cancer (not real number)

51
Q

Relative risk

A

One population’s risk compared to another population.

E.g. women are 100 times more likely to get cervical cancer than men.

52
Q

Do case-control or cohort studies have recall bias?

A

Case control usually because they tend to be retrospective.

But Cohort studies can be retrospective too!

53
Q

Which study is good for rare risk factors and can assess multiple risk factors at once?

A

Cohort studies

54
Q

What does correlation coefficients measure?

A

Strength of an association.

Correlation coefficient of 0 = no correlation
CC of 1 = strong positive correlation
CC of -1 = strong negative correlation

55
Q

Is Pearson’s correlation normally or not normally distributed?

A

Normally

56
Q

Is Spearman’s correlation normally or not normally distributed?

A

Not normally

57
Q

What is a type 1 error?

A

Incorrectly rejecting the null hypothesis

58
Q

What is type 2 error?

A

Incorrectly accepting the null hypothesis.

Incorrectly saying there is no difference when there is.

Relies on statistical power.

Due to small sample size. Increase sample size to prevent this.

59
Q

Risk difference?

A

The difference in risk between exposed subjects and non-exposed subjects.

(d1/n1) - (d0/n0)

60
Q

What is the calculation for the risk ratio?

A

RR = risk in exposed ÷ risk in non-exposed

d1/n1) ÷ (d0/n0

61
Q

Black report 1980

A
  • Reasons for inequalities in health
  • Confirmed social health inequalities are involved in mortality
  • Shows health inequalities were widening
62
Q

4 explanations of socioeconomic inequalities in the black report.

A
  • A statistical artefact
  • Natural selection - People’s health drives their social class, healthy people are more likely to get promoted, while unhealthy people are more likely to lose their jobs
  • Result of differences in health behaviour
  • Poverty causes poor health
63
Q

Autonomy

A

Does it show respect for the patient and their right to make decisions?

64
Q

Non-maleficence

A

Does it harm the patient?

65
Q

Justice

A

Are there consequences in the wider community?

66
Q

Beneficence

A

Does it benefit the patient?

67
Q

Family Law Reform Act 1969

A

Governs consent to treatment of 16/17 year olds

  • However 16/17 year olds cannot refuse medical treatment.
68
Q

What is the regulatory role of the GMC?

A

Protect, promote, maintain health and safety of the public by ensuring proper standards in the practice of medicine.

69
Q

Define clinical significance

A

Practical importance of treatment effect, whether it has a noticeable effect on everyday life.

70
Q

Disease vs Illness?

A

Disease: Discrete pathological processes within the body w/ clinical signs.

Illness: Sufferer’s subjective experience.

71
Q

Leventhal’s 5 dimensions to illness cognition

A 
Identity
Consequences
Cause
Control/Cure
Timeline
72
Q

Measures for assessment of disability

A

Barthel index

SF36

Functional assessment measure (FAD)

EQ5P

HAD

73
Q

What types of bias are there in RCTs?

A

Selection bias.

Performance bias.

Ascertainment bias - systematic distortion of the results of a RCT as result of knowledge of the group assignment.

74
Q

95% confidence interval

A

95% chance that the true value lies somewhere within the confidence interval.

75
Q

Define validity.

A

Internal validity (accuracy): extent to which results of a study rules out confounding variables, systematic error and bias to show cause and effect

External validity (generalisability): how well the study can be applied to different populations, scenarios and environments.

76
Q

Incidence

A

New cases of disease within a period / number initially free of disease.

77
Q

Prevalence

A

No. of people with disease at particular point in time / the total population

Changes are people die, recover or emigrate.

78
Q

Malingering

A

Fraudulent simulation or exaggeration of symptoms for financial or other gain.

79
Q

Conversion disorder

A

Loss of motor/sensory function, no consciously undertaken.

80
Q

Somatisation

A

Multiple physical symptoms with refusal to accept negative test results.

Symptoms not disease (unlike hypochondria)

81
Q

Hypochondrial disorder

A

Persistent belief of disease, refusal to accept negative test results.

Disease not symptoms (unlike somatisation)

82
Q

Factitious disorder

A

Intentional production of physical or psychological symptoms.

83
Q

Impairment

A

Loss or abnormality of psychological physiological or anatomical structure or function.

84
Q

Labelling

A

The recognising and naming of a difference of an individual.

85
Q

Stigma

A

A mark of disgrace associated w/ a particular circumstance, quality or person.

86
Q

What is economics about?

A

How people allocate scarce resources amongst competing activities.

87
Q

Give 3 aspects of opportunity cost decisions.

A

Time - spending time on 1 person denies another.

Overspending budget cuts another elsewhere.

Good medical practice means you must be aware of the cost of the care you deliver to patients.

C (6 decks)

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