FPC2 Tutorial 2 The Use of Data Flashcards
Why is data important in medicine?
knowledge of data and how to present it to patients is a key skill in a world where the management of a patient is now centred around the patient, with the patient understanding what is happening to them and being involved in making decisions
It is impossible to provide good person centred care without being able to communicate risk and data to patients
What is general practice an interface between?
General practice is at the interface between the public on the one hand, and secondary (hospital) care on the other hand
severity of illness does not accurately parallel severity of __________
severity of illness does not accurately parallel severity of disease
What are the definitions of:
illness
disease
Disease – symptoms, signs – diagnosis. Bio-medical perspective
Illness – ideas, concerns, expectations – experience. Patients perspective
What are the 2 different kinds of factors affecting the uptake of care?
medical factors
non medical factors
What are some medical factors affecting the uptake of care?
new symptoms, visible symptoms, increasing severity, duration etc
What are some non medical factors affecting the uptake of care?
crisis, peer pressure “wife sent me”, patient beliefs, expectations, social class, economic, psychological, environmental, cultural, ethnic, age, gender, media etc
How does age/gender contact rates of a GP change?
What are some possible issues from the patient’s point of view to do with treatment?
Believes himself to be healthy
Is physically fit
Proud not to be using tablets
Both he and his wife associate all illnesses to do with the Heart with Ischaemic Heart Disease
If treatment is proposed, how would he feel better?
What are the 3 main aims of epidemiology?
Description - To describe the amount and distribution of disease in human populations.
Explanation - To elucidate the natural history and identify aetiological factors for disease usually by combining epidemiological data with data from other disciplines such as biochemistry, occupational health and genetics.
Disease control - To provide the basis on which preventive measures, public health practices and therapeutic strategies can be developed, implemented, monitored and evaluated for the purposes of disease control.
What does epidemiology compare and what does it detect?
It compares groups (study populations) in order to detect differences pointing to:
Aetiological clues (what causes the problem)
The scope for prevention
The identification of high risk or priority groups in society
Difference between clinical medicine and epidemiology?
Clinical medicine deals with the individual patient
Epidemiology deals with populations
What is the difference between incidence and prevalence?
Incidence - is the number of new cases of a disease in a population in a specified period of time
Prevalence - is the number of people in a population with a specific disease at a single point in time or in a defined period of time
What are some examples showing different incidences and prevelance?
Minor illnesses might have a high incidence but low prevalence e.g. a cold
Other illnesses might be chronic with low incidence but high prevalence i.e. diabetes
What is relative risk and how is it calculated?
This is the measure of the strength of an association between a suspected risk factor and the disease under study
Relative risk (RR) = incidence of disease in exposed group
incidence of disease in unexposed group
Some pictures showing how risk can be communicated
What are some sources of epidemiological data?
Include, but not restricted to:
Mortality data
Hospital and clinical activity statistics
Reproductive health statistics
Infectious disease statistics
Cancer statistics
Accident statistics
General practice morbidity statistics
Health and household surveys
Labour force surveys
Social security statistics
Drug misuse databases
Expenditure data from NHS
What is health literacy?
Health literacy is about people having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems
Health literacy is being increasingly recognised as a significant health concern around the world
The Scottish Government has now published Making it Easy - A Health Literacy Action Plan for Scotland
What is the CHA2DS2-VASc score?
the CHA2DS2-VASc score, are clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation (AF), a common and serious heart arrhythmia associated with thromboembolic stroke. Such a score is used to determine whether or not treatment is required with anticoagulation therapy or antiplatelet therapy
What are NOAC’s?
(novel oral anticoagulants)
These are newer drugs that do not require regular blood test monitoring like Warfarin
They are relatively expensive – see the table attached for the additional costs and the benefits gained
Patients will often have heard of them, and the lack of a need for monitoring often appeals to them
They are not easily reversed like Warfarin, which can be reversed with Vitamin K in the event of bleeding
used in the prevention of stroke for people with non-valvular AF
Is bleeding risk important to calculate?
yes - there is tools for this also
What are SIGN guidlines?
The guidelines are based on a systematic review of the scientific literature and are aimed at aiding the translation of new knowledge into action. The guidelines are intended to:
Help health and social care professionals and patients understand medical evidence and use it to make decisions about healthcare
Reduce unwarranted variations in practice and make sure patients get the best care available, no matter where they live
Improve healthcare across Scotland by focusing on patient-important outcomes
What are the different types of studies which can be carried out?
Descriptive studies
Cross-Sectional
case control studies
Cohort Studies
What are descriptive studies?
Descriptive studies attempt to describe the amount and distribution of a disease in a given population
This kind of study does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and candidate aetiologies
Such studies are usually cheap, quick and give a valuable initial overview of a problem
What are cross-sectional studies?
disease frequency, survey, prevalence study
in cross-sectional studies, observations are made at a single point in time
What are case control studies?
two groups of people are compared:
a group of individuals who have the disease of interest are identified (cases)
a group of individuals who do not have the disease (controls)
What is a cohort study?
In cohort studies, baseline data on exposure are collected from a group of people who do not have the disease under study
The group is then followed through time until a sufficient number have developed the disease to allow analysis
What are trials?
Trials are experiments used to test ideas about aetiology or to evaluate interventions
The “randomised controlled trial” is the definitive method of assessing any new treatment in medicine
What are important factors to consider when interpreting results?
Standardisation
Standardised Mortality Ratio
Quality of Data
Case Definition
Coding and Classification
Ascertainment
What is bias and what different tpes of bias are there?
Bias is any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth
Selection Bias
Information Bias
Follow up Bias
Systematic Error
Publication bias
is it difficult to prove causation between an exposure and disease?
It is difficult to prove causation between an exposure and disease
A number of criteria have been devised to help investigators assess the available evidence, known as the criteria for causality, what is this criteria?
Strength of association - As measured by relative risk or odds ratio
Consistency - Repeated observation of an association in different populations under different circumstances.
Specificity - A single exposure leading to a single disease
Temporality - The exposure comes before the disease.
Biological gradient - Dose-response relationship. As the exposure increases so does the risk of disease
Biological plausibility - The association agrees with what is known about the biology of the disease
Coherence - The association does not conflict with what is known about the biology of the disease
Analogy - Another exposure-disease relationship exists which can act as a model for the one under investigation. For example, it is known that certain drugs can cross the placenta and cause birth defects - it might be possible for viruses to do the same
Experiment - A suitably controlled experiment to prove the association as causal - very uncommon in human populations
How are audit criteria and standards set?
Need to set criteria and standards to measure
Could define own but it is time consuming and needs more research
Could utilise others if available - Guidelines based on systematic review of evidence
when assessing data what else is important to consider?
confounding factors
whata re confounding factors and examples of them?
A confounding factor is one which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease. In some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration.
Age, sex and social class are common confounders
What are sources of data?
Peers, family, internet TV, health pages of newspaper or women’s mag, “What should I do? Booklet, SHOW website, Practice leaflet or website
