General Medicine Flashcards
What is the difference between a systematic review and a meta-analysis?
- A systematic review is a summary of the medical literature that has used explicit strategies to perform a comprehensive literature search and critical appraisal of individual studies. A systematic review may or may not include a meta-analysis.
- A meta-analysis is a systematic review that uses statistical analysis to combine or integrate the results of several independent clinical trials to synthesise and summarise the results. Trials must be considered by the analyst to be combinable (homogenous). Trials that are very different (heterogeneous) cannot usually be combined and a meta-analysis cannot be done.
What are 7 advantages of using systematic reviews and meta-analyses to answer clinical questions?
What are 5 limitations of using systematic reviews and meta-analyses to answer clinical questions?
What is primary, secondary and tertiary prevention?
➢ Primary prevention are activities used to prevent a given health problem e.g. immunisation.
➢ Secondary prevention measures are those that identify and treat asymptomatic patients who have already developed risk factors or preclinical disease but in whom the condition is not clinically apparent for example, treating hypertension & hyperlipidaemia.
➢ Tertiary prevention involves the care of patients with established disease, with attempts made to restore to highest function, minimize the negative effects of disease, and prevent disease-related complications.
- What is an MCCD?
- What criteria must be met in order for you to complete a patient’s death certificate?
- Must you sight the body before signing an MCCD?
What types of deaths must be reported to the coroner? (9)
What types of deaths must be reported to the Chief Health Officer? (3)
Why is it important to complete death certificates correctly? (4)
Using the example above, what is the disease or condition directly leading to death and what are the antecedent causes?
Disease or condition directly leading to death – SARS-CoV-2.
Antecedent causes –colectomy, due to colon cancer, due to primary adenocarcinoma of the sigmoid colon.
How would the measurement of the case-fatality rate in Western Australia for SARS-CoV-2 change if it was not included in the death certificate?
Under what circumstances should you NOT sign a cremation certificate? (4)
According to the CDNA SONG, “A COVID-19 death is defined for surveillance purposes as a death in
a confirmed or probable COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g. trauma).” It is plausible that COVID-19 hastened his death.
This would not be considered a COVID-19 death and not be included on the death certificate as there is a very clear alternative cause of death (sub arachnoid haemorrhage) and it is very unlikely COVID-19 contributed to the death.
Why was this study conducted?
Correct cause of death is important for database use (research/policy planning etc) and various studies have noted that it is not well completed. The authors also noted at their morbidity and mortality meetings that there were errors noting the correct cause of death.
When developing measurable standards for assessing a health service practice or component, the SMART acronym can be used. What does it stand for?
What are the:
- Advantages (2)
- Disadvantages (2)
- Application (2)
of a Retrospective Audit type?
What are the:
- Advantages (2)
- Disadvantages (2)
- Application (1)
of a Prospective Audit type?
What criteria do the Pharmaceutical Benefits Advisory Committee use to make recommendations? (5)
Does Australia set an incremental cost-effectiveness ratio (ICER) threshold? What is the UK’s ICER threshold?
How does the cost effectiveness of treating hepatitis C with direct anti-viral agents compare with preventing hepatitis C with needle syringe programs?
Preventing hepatitis C with needle syringe programs is likely more cost effective at A$416-8750 per QALY gained compared to treating hepatitis C with DAAs at an ICER of $5078 ($2847–5295) per QALY gained.
What is cost-effectiveness?
What are 5 Type of economic analysis?
The term “cost-effectiveness” is often used to cover all types of economic analyses; it is also a more specific type of economic analysis too.
Types of economic analysis:
1. Cost minimisation
2. Cost effectiveness
3. Cost utility
4. Cost benefit
5. Cost consequences
What is:
- QALY?
- DALY?
- HYE?
What are Opportunity costs?
When critically appraising the internal validity of an economic analysis, you need to be aware of the assumptions on which the results are based. List 4 of these?
Why does polypharmacy exist? (7)
It is very important for specialists and GPs to maintain good communication so that each are aware of patients’ medication and if any are changed. My Health Record is another way to share information safely about patients between health professionals though, though at this stage it is not widely used as it could be.
What are 2 reasons why elderly patients are at particular risk of complications from polypharmacy.
List 6 adverse effects of polypharmacy in the elderly.
Identify strategies to reduce polypharmacy.
Why are adverse drug reactions monitored?
What is the difference between a population-based and high-risk prevention strategy?
A population approach attempts to remove the underlying cause that makes the disease common. In this way, it has the potential to positively affect the population as a whole. A high-risk approach just targets the high-risk population.
What are the advantages of using a population strategy (3) or high-risk strategy (5) for preventive activities?
What are the disadvantages of using a population strategy (5) or high-risk strategy (4) for preventive activities?
What is triangulation in qualitative research?
Triangulation is the use of a combination of research methods to generate data which allows ‘cross- checking’ and improved validity of results. Independent analysis of the data by more than one researcher also improves validity.
Why is compliance with medication important? (5)
What are 11 reasons for non-compliance in patients?
How can patients be supported to be compliant with taking medication? (7)
What are the CAGE Questions?
What is the main difference between the CAGE and Alcohol Use and Disorders Identification Test (AUDIT) questionnaires?
CAGE is designed to detect severe forms of alcohol disorders (lifetime alcohol use and dependence) but does not perform well to detect hazardous drinking (i.e. drinking which confers risk of hazardous or psychological harm but has not yet caused significant alcohol-related problems.) The AUDIT questionnaire is sensitive enough to detect hazardous as well as harmful drinking.
Are brief interventions by doctors cost-effective? Give Examples (12).
Brief interventions by GPs have been shown to be cost-effective in reducing alcohol problems (see example below on evaluating interventions to reduce alcohol problems).
What factors contribute towards residents of rural and remote communities experiencing
poorer health outcomes than metropolitan residents?
What sorts of issues do Indigenous Australians living in metropolitan regions face that might influence their health status? (6)
What health conditions are common in refugee patients?
List 7 roles for GPs in the care of refugee patients.
What content should GPs include in their health assessment of refugees?
- Hx? (5)
- Exam? (5)
- Ixs?
- Mx?
List the infectious diseases commonly included in a “health assessment for refugees and other humanitarian entrants”. Which of these are notifiable infections? (6)
Infectious diseases to be tested for (most of which are notifiable) include:
1. Tuberculosis
2. Malaria
3. Blood borne viruses
4. Schistosomiasis
5. Helminth infection
6. STIs.
What sorts of health providers or community organisations may be helpful to support your Somali patient?
List some potential barriers to good health in refugee patients.
