FPC2 Tutorial 2 The Use of Data

Question 1

Why is data important in medicine?

Answer 1

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

Question 2

What is general practice an interface between?

Answer 2

General practice is at the interface between the public on the one hand, and secondary (hospital) care on the other hand

Question 3

severity of illness does not accurately parallel severity of __________

Answer 3

severity of illness does not accurately parallel severity of disease

Question 4

What are the definitions of:

illness

disease

Answer 4

Disease – symptoms, signs – diagnosis. Bio-medical perspective

Illness – ideas, concerns, expectations – experience. Patients perspective

Question 5

What are the 2 different kinds of factors affecting the uptake of care?

Answer 5

medical factors

non medical factors

Question 6

What are some medical factors affecting the uptake of care?

Answer 6

new symptoms, visible symptoms, increasing severity, duration etc

Question 7

What are some non medical factors affecting the uptake of care?

Answer 7

crisis, peer pressure “wife sent me”, patient beliefs, expectations, social class, economic, psychological, environmental, cultural, ethnic, age, gender, media etc

Question 8

How does age/gender contact rates of a GP change?

Answer 8

Question 9

What are some possible issues from the patient’s point of view to do with treatment?

Answer 9

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?

Question 10

What are the 3 main aims of epidemiology?

Answer 10

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.

Question 11

What does epidemiology compare and what does it detect?

Answer 11

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

Question 12

Difference between clinical medicine and epidemiology?

Answer 12

Clinical medicine deals with the individual patient

Epidemiology deals with populations

Question 13

What is the difference between incidence and prevalence?

Answer 13

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

Question 14

What are some examples showing different incidences and prevelance?

Answer 14

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

Question 15

What is relative risk and how is it calculated?

Answer 15

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

Question 16

Some pictures showing how risk can be communicated

Answer 16

Question 17

What are some sources of epidemiological data?

Answer 17

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

Question 18

What is health literacy?

Answer 18

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

Question 19

What is the CHA2DS2-VASc score?

Answer 19

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

Question 20

What are NOAC’s?

(novel oral anticoagulants)

Answer 20

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

Question 21

Is bleeding risk important to calculate?

Answer 21

yes - there is tools for this also

Question 22

What are SIGN guidlines?

Answer 22

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

Question 23

What are the different types of studies which can be carried out?

Answer 23

Descriptive studies

Cross-Sectional

case control studies

Cohort Studies

Question 24

What are descriptive studies?

Answer 24

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

Question 25

What are cross-sectional studies?

Answer 25

disease frequency, survey, prevalence study

in cross-sectional studies, observations are made at a single point in time

Question 26

What are case control studies?

Answer 26

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)

Question 27

What is a cohort study?

Answer 27

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

Question 28

What are trials?

Answer 28

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

Question 29

What are important factors to consider when interpreting results?

Answer 29

Standardisation

Standardised Mortality Ratio

Quality of Data

Case Definition

Coding and Classification

Ascertainment

Question 30

What is bias and what different tpes of bias are there?

Answer 30

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

Question 31

is it difficult to prove causation between an exposure and disease?

Answer 31

It is difficult to prove causation between an exposure and disease

Question 32

A number of criteria have been devised to help investigators assess the available evidence, known as the criteria for causality, what is this criteria?

Answer 32

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

Question 33

How are audit criteria and standards set?

Answer 33

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

Question 34

when assessing data what else is important to consider?

Answer 34

confounding factors

Question 35

whata re confounding factors and examples of them?

Answer 35

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

Question 36

What are sources of data?

Answer 36

Peers, family, internet TV, health pages of newspaper or women’s mag, “What should I do? Booklet, SHOW website, Practice leaflet or website