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MD1010 > EH1 > Flashcards

EH1 Flashcards

1
Q

Outline the historical origins of the medical profession, and in particular, the legacy of Hippocrates

A
  • Priests of Asklepious
  • Hippocrates: introduced Four Humours (Yellow + black bile, phlegm and blood) -> systematic clinical method + attributing disease to natural causes; introduced an ethical framework to medicine (Hippocratic Oath); taught medicine in medical schools and created a body of work (Hippocratic Corpus)
  • Galen translated Hippocrates’ work into Latin -> further disseminating it
  • Barber surgeons + apothecaries in the Middle Ages -> later became GPs + pharmacists
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2
Q

Discuss the role of a doctor in the light of the WHO definition of health

A
  • WHO definition addresses the biopsychosocial model of health: treat mental and social wellbeing as well as pathological disease or infirmity
  • Doctor must practise patient-centered care and be socially accountable
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3
Q

Describe Evidence Based Medicine

A

Made up of a triad:

  • Individual clinical expertise
  • Best external advice
  • Patient values and expectations

EBM is practised when making clinical decisions about healthcare of patients

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4
Q

What is a systematic review?

A

A research paper that identifies, critically appraises and synthesises all primary research studies on a particular topic. It offers a final conclusion on what all the studies say

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5
Q

Define and describe ‘disease’

A

Disease is a syndrome with clinically identifiable signs and symptoms that has a pathological cause (verified by WHO’s ICD-10)

Disease is linked to the Biomedical Model of Health

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6
Q

What is the Biomedical Model of Health?

A

The Biomedical Model of Health states that any ill-health is a cause of an underlying pathology. Hence is deemed as being ‘sick’ if they have a disease, irrespective of whether it is symptomatic or asymptomatic

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7
Q

Define and describe ‘illness’

A

Illness is the individual’s experience of their symptoms. These symptoms may or may not be due to disease

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8
Q

What is the Psychological (stress) Model of Health?

A

The Psychological Model of Health states that an individual self-identifies between ‘health’ and ‘ill-health’ (idiosyncratic). Argues physical illness is a reaction to stress.

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9
Q

Define and describe ‘sickness’

A

Sickness is what society defines as ‘ill-health’, usually entailing rights (sick leave) and responsibilities (get well soon) on those that are deemed as being sick.

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10
Q

What is the Social Model of Health?

A

The Social Model of Health states that illness is a social construct that is defined by society– i.e. whether a person is still functional in society.

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11
Q

What are some differences between biomedical and social constructs of health?

A
  • Biomedical states that you are sick if you have a disease; social states that you are only sick if you cannot function
  • Biomedical model undermines the role of social determinants of health– focuses more on germ theory
  • Social model may not always define ‘sickness’ as being a disease (e.g. obesity, balding, reduced sex drive, etc.)
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12
Q

Reflect on and describe the impact of different world views on the experience of health and illness

A
  • Cultural can influence views on disease causation; symptoms; treatment and harms
  • Cultural safety (non-judgemental attitudes towards culture) is important in fostering trust in healthcare system
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13
Q

Define Paternalism and critique its impact on healthcare

A

Paternalism is where decisions about a patient’s care is made without any input from the patient. This undermines their autonomy and consequently fosters distrust in the healthcare system. It also misses out on the benefits of partnership.

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14
Q

Describe the patient-centred clincial interview and cite the patient-centred clinical method (patient-centred care)

A

Care that is respectful of and responsive to the individual patient’s Ideas, Concerns and Expectations. Patient values should guide all clinical decisions.

The patient centered interview is an method of addressing the doctor’s agenda (i.e. the disease) as well as the patient’s agenda (i.e. illness)

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15
Q

Discuss the importance of the patient ‘in context’ in providing clinical care

A

Context is important in the BPS model of health. Considering context also eliminates contextual errors, where essential information vital for treating a patient is missed.

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16
Q

Define ethics as it applies to health care

A

Ethics are the standards that medical professionals ought to follow

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17
Q

Describe the four ethical principles

A
  • Autonomy: the patient reserves the right to make decisions about their health
  • Non-maleficence: to do no harm, where harm is from the patient’s perspective
  • Beneficence: to do good and to prevent evil/harm
  • Justice: to treat patients fairly and equally (similar patients get similar treatments)
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18
Q

What is an obligation?

A

An obligation is something you must do (rights place obligations on certain people)

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19
Q

What is a duty?

A

A duty is something you ought to do (morals and ethics place duties on people)

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20
Q

What is a right?

A

A right is a privilege or entitlement that puts an obligation on someone else (can be legally binding or moral)

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21
Q

What are the components of informed consent?

A
  • Threshold element: whether a patient is able to understand and give adequate consent
  • Information elements: appropriate disclosure of information + adequate comprehension by patient
  • Consent elements: whether the patient is voluntarily giving consent + if the right person is asking for consent and if consent is given in the right format
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22
Q

Outline the features of professions and why professionalism is important to medicine

A

Features:

  • Competency
  • Integrity
  • Morality
  • Altruism
  • Promotion of the public good

Professionalism is demanded by the public in the social contract

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23
Q

Discuss the responsibilities of a doctor, making reference to the social contract

A

The doctor must be altruistic and place the patient’s interests above all else. The doctor must maintain standards of competence and integrity and must be able to provide advice to society on matters of health

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24
Q

Discuss the importance of maintaining patient confidentiality, especially as a feature of professionalism

A

Patient confidentiality involves following the four ethical principles of medicine (i.e. respecting autonomy, maleficence, beneficence and justice)

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25
Q

Explain the pressures that influence clinical decision making

A
  • External pressures: pressures outside the profession’s control that can only be negotiated (e.g. government policy, societal attitudes)
  • Internal pressures: pressures inside the profession that can be controlled (e.g. incompetence, conflicts of interest)
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26
Q

What are some daily professional pressures faced by doctors?

A

Managing conflicts of interests; respecting patient autonomy; maintaining professional boundaries; acting in the best interest of patients; informed consent; use of social media; confidentiality; etc.

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27
Q

Briefly describe what epidemiology is

A

Epidemiology is the study of the distribution and determinants of health-related issues

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28
Q

What are the two main classifications of epidemiological studies?

A

Quantitative and Qualitative

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29
Q

Give some examples of quantitative, descriptive studies

A

Case studies, case series, cross-sectional surveys

30
Q

What is an observational study?

A

An observational study is one where the researcher simply observes the natural course of action

31
Q

What is an interventional study?

A

An interventional study is one where the researcher intervenes in the natural order of things and studies the resulting effect

32
Q

Describe the pros and cons of observational and interventional studies

A

Observational studies are more reflective of real life; whereas interventional studies are not very reflective of real life. Interventional studies are experimental

33
Q

True or False: Descriptive studies can generate and confirm hypotheses

A

False, descriptive studies can only generate hypotheses. Analytical studies can test hypotheses, but only experimental studies can outright confirm a hypothesis

34
Q

Name the two types of observational, analytical studies

A

Case-control studies and cohort studies

35
Q

What does a case-control study focus on? Is it prospective or retrospective?

A

A case-control study aims to determine whether a disease resulted from an exposure. It is usually retrospective.

Disease (study factor) -> Exposure (outcome of interest)

36
Q

What does a cohort study focus on? Is it prospective or retrospective?

A

A cohort study aims to determine whether a specific exposure can cause disease. It can be retrospective or prospective

Exposure (study factor) -> Disease (outcome of interest)

37
Q

Explain what a Randomised Controlled Trial (RCT) is

A

An RCT is an interventional, prospective cohort study. It involves randomly assigning participants to either the exposure (treatment) or control groups to minimise the effect of confounding factors. Researchers then study whether a specific exposure (or treatment) causes disease or not

38
Q

What is a confounding factor?

A

A confounding factor is a factor that is independently associated with the exposure and outcome.

39
Q

What is confounding?

A

Confounding is the apparent association between an exposure and an outcome that is caused by an entirely separate variable (confounding factor) that was not postulated in the causal pathway

40
Q

Give an example of confounding

A

Soft drink -> T2DM

Obesity is a confounding factor

41
Q

Name the three methods that can minimise confounding

A
  • Restriction: only allowing certain groups to enter the study
  • Matching: matching one person in one study group to a similar person in the other group (aside from the study factor)
  • Randomisation: randomly assigning participants to groups
42
Q

Name three types of bias and give an example for each

A
  • Confounding: an association between exposure and outcome arises due to an entirely separate variable (e.g. study groups with varying levels of access to healthcare)
  • Selection Bias: bias in the selection of participants (e.g. control group not representative of group with cases)
  • Information Bias: information collected differently between two groups leading to error in association (e.g. rumination bias in traumatised patients)
43
Q

How can bias be avoided? What are the different types of this?

A

Blinding:

  • Single blinding: where either the researchers or the study participants are unaware of which study group they have been assigned to
  • Double blinding: where both researchers and study participants are unaware of their group allocation
44
Q

What is random error? How can it be avoided?

A

Random error is error that occurs purely by chance– it can be avoided by increasing the sample size

45
Q

Define incidence and give the formula for cumulative incidence

A

Incidence is the number of new cases arising in a given time period.

CI= no. of new cases/no. of people at risk

46
Q

Define prevalence and give the formula for point prevalence

A

Prevalence is the number of existing cases at a given time

PP= total no. of cases/total population

47
Q

Why is age distribution important to consider?

A

Age can be a confounding factor; hence, comparing two populations with different age structures may be inaccurate without considering age distribution

48
Q

What is absolute risk? What is it the same as?

A

Absolute risk is the same as cumulative incidence. It is the actual risk (%) of developing a disease over a certain time period.

49
Q

What is excess risk and how is it calculated?

A

Excess risk is the risk difference of absolute risk– how higher the risk of getting disease in those that are exposed is vs. those that aren’t exposed.

Excess risk = AR(exposed)% - AR(non-exposed)%

50
Q

What is absolute risk reduction?

A

Absolute risk reduction is the opposite of excess risk: the percentage of risk reduced by something.

ARR= CI0 - CIe

51
Q

What is relative risk and how is it calculated?

A

Relative risk (or risk ratio) estimates the magnitude of association between exposure and disease

RR= incidence of D+ in E+/incidence of D+ in E-

52
Q

A study found that the relative risk between disease and exposure was 3 (>1). What can be concluded?

A

It can be concluded that the risk of disease increased as a result of exposure.

This risk of disease is 3 times more likely in those exposed than those not exposed.

53
Q

A study found that the relative risk between disease and exposure was 0.25 (<1). What can be concluded?

A

It can be concluded that the risk of disease decreased as a result of exposure.

This risk of disease is 25% less likely in those exposed than those not exposed; there was was relative risk reduction of 75%.

54
Q

A study found that the relative risk between disease and exposure was 1. What can be concluded?

A

Disease is unlikely to be related to exposure as risk in both exposed and non-exposed groups is identical.

55
Q

Why is the odds ratio used in case-control studies?

A

The odds ratio is used in case-control studies as it difficult to determine cumulative incidence. This is because participants for the case group are essentially ‘cherry-picked’ from the general population.

56
Q

How do you calculate the odds ratio?

A

OR= odds that a case (D+) was exposed/ odds that a control (D-) was exposed

57
Q

A case-control study had an odds ratio of 2:1 (2). What can be concluded?

A

It can be concluded that exposure increases the likelihood of disease two-fold.

58
Q

A case-control study had an odds ratio of 1:3 (0.333). What can be concluded?

A

It can be concluded that exposure decreases the likelihood of disease three-fold.

59
Q

A case-control study had an odds ratio of 1:1 (1). What can be concluded?

A

It can be concluded that the odds of exposure in both groups is identical; hence, exposure is unlikely to lead to disease.

60
Q

What is the Number needed to Treat (NNT)?

A

NNT is the number of people that need to be treated to prevent one additional person getting the outcome (disease).

61
Q

How is NNT calculated?

A

NNT is the reciprocal of absolute risk reduction

NNT= 1/absolute risk reduction
ARR=CI0-CIe

62
Q

Drug A has a NNT of 100. Drug B has a NNT of 200. Which one is more desirable?

A

Drug A, as only 100 people need to be treated to yield a benefit.

63
Q

What is the P-value?

A

The P-value gives the probability of study findings being due to chance

64
Q

What does an odds ratio of 1 indicate?

A

An OR of 1 indicates that there is no true difference between the study groups. This is also known as the null hypothesis.

65
Q

What P-value is required for a finding to be considered as statistically significant?

A

A P-value that is =< 0.05 (5%). In this case, the null hypothesis may be rejected as the data are statistically significant.

66
Q

Explain what the 95% Confidence Interval is. How can the 95% CI be statistically insignificant?

A

The 95% CI is a range that has a 95% certainty of containing the true value.

If the 95% CI contains the OR of 1 (e.g. 0.85-1.3), it is considered as statistically insignificant.

67
Q

What is the main purpose of qualitative research methods?

A

Qualitative studies seek to understand the perspectives of individuals and explore the behaviour and factors that influence it

68
Q

What are the two main advantages of keeping the social contract for the medical profession?

A

The medical profession is allowed professional autonomy and self-regulation

69
Q

Outline benefits of self-regulation to the medical profession and some benefits for the public

A

Benefits for the profession: individuals can practise without supervision; no government intervention; allows profession to express its own views; prestige and public trust

Benefits for the public: more efficient and less costly than government regulation; specialised standards for specialised skills

70
Q

Describe a descriptive study

A

A descriptive study describes patterns of disease occurrence in relation to persons, place and time

71
Q

Describe an analytical study

A

An analytical study describes or measures health effects of risk factors or exposures (association between exposure and disease)

MD1010 (4 decks)

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