High Yield Flashcards

Question 1

Q

95% confidence intervals

Answer

A

Range of values that is 95% likely to contain the true value

Question 2

Q

Standard deviation

Answer

A

Value that shows how much variation there is from the mean

Question 3

Q

P Value

Answer

A

Likelihood that the observed result is due to change

P > 0.05 is not statistically significant

Question 4

Q

Odds ratio

Answer

A

Ratio of probability that something will happen, to the probability that it won’t happen

Question 5

Q

Blinding

Answer

A

Patients/clinicians/researchers are prevented from knowing certain information that may lead to conscious or subconscious bias on their part

Question 6

Q

Concealment of allocation

Answer

A

The procedure for protecting the randomisation process

Person randomising the patient does not know what the treatment allocation will be

Prevents selection bias affecting which patients are give which treatment (the bias the randomisation is designed to avoid)

Question 7

Q

Intention to treat analysis

Answer

A

Analysis based on the initial treatment intended from allocation,

Intention to treat (ITT) analysis means all patients who were enrolled and randomly allocated to treatment are included in the analysis and are analysed in the groups to which they were randomized, not the treatment eventually administered.

I.e. “once randomized, always analyzed”

Question 8

Q

Treatment fidelity

Answer

A

How accurately the intervention is reproduced from a manual, protocol or model

Question 9

Q

Number needed to treat

Answer

A

Number of patients that are needed to be treated with the experimental therapy to prevent one negative outcome

E.g. the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial

It is defined as the inverse of the absolute risk reduction.

1/Absolute risk reduction

Question 10

Q

Purpose of randomisation?

Answer

A

To try and ensure that any characteristics of the sample population that may affect the results (confounders) are distributed equally between the 2 study groups, and avoid selection bia

Question 11

Q

Which type of studies are often affected by recall bias?

Answer

A

Case control

Question 12

Q

What is recall bias?

Answer

A

The participant either cannot remember back to when they were exposed or their outcome changes their perception of the exposure

Question 13

Q

Internal validity

Answer

A

Accuracy

How well the study was conducted.

Taking confounders into account and removing bias.

Question 14

Q

External validity

Answer

A

Generalisability

How well it can be applied to different scenarios, patients, environments.

Question 15

Q

Case-control studies are prone to recall bias in general

Answer

A

Cohort studies are prone to selection bias in general

Question 16

Q

List 4 methods that can be used to limit confounding variables.

Answer

A

Restriction:

Limit participants of study that have possible confounders
Means less data available
This method can be difficult with multiple confounders

Matching:

Make comparison groups (with and without the confounder)
Used for things like age and sex in case-control studies

Stratification:

Analyse exposure with sub-groups of the confounder
Adjust for confounding (if there are few variables)
Recombine data
Means sometimes these subgroups have very few participants in them

Multiple variable regression:

Coefficients are established for the confounder groups
Allows for better adjustment

Question 17

Q

Specificity

Answer

A

True negatives (TN)

The probability of a negative, if the patient really is not ill

TN / ( TN + FP)

true negatives / all truly disease-free

Question 18

Q

Sensitivity

Answer

A

True positives

The probability of a positive, if the patient really is ill

TP / (TP + FN)

true positives / all truly diseased

Question 19

Q

Case-control studies are prone to recall bias in general

Answer

A

Cohort studies are prone to selection bias in general

Question 20

Q

Population attributable risk (PAR)

Answer

A

The portion of the incidence of a disease in the population (exposed and non-exposed) that is due to exposure

It is the incidence of a disease in the population that would be eliminated if the cause of exposure was eliminated

This can be expressed as a value or percentage

Question 21

Q

Allocative efficiency

Answer

A

Investing in worthwhile interventions

Question 22

Q

Technical efficiency

Answer

A

Investing in the interventions that make the best use of scarce resources

Question 23

Q

SPIKES

Answer

A

Setting
Perception
Invitation
Knowledge
Empathy
Summary

Question 24

Q

Kubler-Ross model of grief

Answer

A

Denial
Anger
Bargaining
Depression
Acceptance

Question 25

Q

Bowlby model of grief

Answer

A

Numbing
Yearning/searching
Disorganisation
Reorganisation

Question 26

Q

Most common cancers in men

Answer

A

Lung
Bowel
Prostate
Bladder
Stomach

Question 27

Q

Most common cancers in women

Answer

A

Breast
Lung
Bowel
Bladder
Stomach

Question 28

Q

Most common cancers in children

Answer

A

Leukemia
Brain
Lymphoma
Soft tissue sarcoma

Question 29

Q

Type I error

Answer

A

False positive

Question 30

Q

Type II error

Answer

A

False negative

Question 31

Q

Standardised mortality ratio (SMR)

Answer

A

Ratio between the observed number of deaths (O) in a study population to the number of expected deaths (E)

SMR = O/E

Question 32

Q

Direct standardisation?

Answer

A

Required we know the age-specific rates of mortality in all populations under study

Question 33

Q

Indirect standardisation?

Answer

A

Only requires that we know the total number of deaths and the age structure of the study population

Question 34

Q

When is indirect standardisation preferable?

Answer

A

Small numbers in particular age groups

Question 35

Q

Likelihood ratio

Answer

A

The likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that the same result would be expected in a patient without the target disorder

Question 36

Q

Length bias

Answer

A

Overestimation of survival duration among screening-detected cases by the relative excess of slowly progressing cases

Question 37

Q

Consequences of length bias?

Answer

A

 Diseases with a longer sojourn time are ‘easier to catch’ in the screening net.

 On average, individuals with disease detected through screening ‘automatically; have a better prognosis than people who present with symptoms/signs.

 If we simply compare individuals who choose to by screened with those who don’t we will get a distorted picture.

Question 38

Q

Lead time bias

Answer

A

Overestimation of survival duration among screen-detected cases (relative to those detected by signs + symptoms) when survival is measured from diagnosis

Question 39

Q

Consequences of lead time bias?

Answer

A

 Survival is inevitably longer following diagnosis through screening because of the ‘extra’ lead time

 Because of this the appropriate measure of effectiveness is deaths prevented, not surviva

Question 40

Q

Over-diagnosis bias?

Answer

A

 Overestimation of survival duration among screen-detected cases caused by inclusion of pseudodisease - subclinical disease that would not become overt before the patient dies of other causes.

 Occurs when screen-detected cancers are either non-growing or so slow-growing that they never would cause medical problems

Question 41

Q

Statutes (laws) that oblige doctors to disclose information

Answer

A

 Public Health Act 1984
 Road Traffic Act 1988
 Prevention of terrorism act 1989

Question 42

Q

3 different types of errors

Answer

A

 Knowledge based - Such as forming wrong intentions or plans as a result of inadequate knowledge/experience

 Rule based - Encounter relatively familiar problem but apply wrong rule, either misapplication of a good rule or application of a bad rule.

 Skills based - Attention slips and memory lapses, involve the unintended deviation of actions from what may have been a good plan. We are all prone to these types of errors, mainly due to interruption and distractions.

Question 43

Q

Latent error

Answer

A

 Develop over time until they combine with other factors or active failures to cause an adverse event

 Long lived and often can be identified and removed before they cause an adverse event

Question 44

Q

What are violations?

Answer

A

 Deliberate deviation from some regulated code of practice or procedure

 They occur because people intentionally break the rules

Question 45

Q

List 4 types of violations

Answer

A

 Routine - Regularly performed shortcuts due to system, process or task being poorly designed or actions. May become tacitly accepted practice over time

 Reasoned - Occasional reasoned deviation from a protocol or procedure which we believe we have good reason for making (e.g. time constraints), may be in patient’s best interests

 Reckless - Deliberate deviations from a protocol/code of conduct and include acts where opportunity for harm is foreseeable and ignored, although harm may never be intended

 Malicious - Deliberate deviations from a protocol/code of conduct, where the intention is to cause harm

Question 46

Q

What is a near miss?

Answer

A

A situation in which events arise during clinical care but fail to develop further

Question 47

Q

Swiss cheese model of accident causation

Answer

A

Although many layers of defence lie between hazards and accidents, there are flaws in each layer that, if aligned, can allow the accident to occur.

Question 48

Q

Main causes of individual vs system errors?

Answer

A

Individual error - Errors of individuals, blames individual for forgetfulness, inattention or moral weakness

System error - Conditions under which an individual works, tries to build defences to eliminate errors or mitigate their effect

Question 49

Q

List 3 antenatal screening tests that identify major abnormalities

Answer

A

 Alpha fetoprotein - Raised in neural tube defects and some GI abnormalities

 Downs test - Alpha fetoprotein and HCG

 Ultrasound - Growth check, cardiac abnormalities, diaphragmatic hernia

Question 50

Q

Neonatal tests

Answer

A

Blood spot test - PKU, cystic fibrosis, sickle cell disease, congenital hypothyroidism

Physical examination

Question 51

Q

4 types of neglect

Answer

A

 Physical neglect
 Educational neglect
 Emotional neglect
 Medical neglect

Question 52

Q

Which act says 16 year old has full capacity?

Answer

A

The family law reform act 1969

Question 53

Q

What is Gillick competency?

Answer

A

Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge

Question 54

Q

What are the Fraser guidelines?

Answer

A

Doctor can give contraceptive advice and treatment to a person under 16 if she is mature and intelligent, likely to continue to have sex, and if the treatment if in her best interests

Question 55

Q

Effects of targeting population for prevention?

Answer

A

 Large potential benefit to community

 Low potential benefit to individual

 May be low perceived benefit to individual

Question 56

Q

Effects of targeting high risk groups for prevention?

Answer

A

 Larger potential benefit to individual

 Smaller effect on population rate of stroke

 Many of the conditions you treat are asymptomatic

 May of the treatments have side effects

Question 57

Q

What did the PROGRESS trial show?

Answer

A

Reducing blood pressure after stroke reduces risk of stroke recurrence

Question 58

Q

Occupational causes of asthma

Answer

A

Bakers
Welders
Paint sprayers
Laboratory workers

Question 59

Q

Occupational causes of COPD

Answer

A

Coal mining
Agriculture
Construction
Dock workers
Brick making

Question 60

Q

Simple coal worker’s pneumoconiosis

Answer

A

 After around 10 years coal mining, small nodules are present

 Shouldn’t cause major impairment in lung function

 Some coal workers have symptoms of chronic bronchitis (cough)

Question 61

Q

Pneumoconiosis

Answer

A

Occupational restrictive lung disease caused by inhalation of dust (coal dust, silica, asbestos)

Question 62

Q

Silicosis

Answer

A

Occupational lung disease caused by inhalation of crystalline silica dust, and is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lung.

It is a type of pneumoconiosis.

Question 63

Q

2 types of asbestos fibres

Answer

A

Serpentine - Curly, white asbestos (relatively harmless), cleared with mucociliary escalator

Amphiboles - Short, sharp, blue/brown asbestos (have malignant potential)

Question 64

Q

What are preference sensitive and probability sensitive decisions?

Answer

A

Preference sensitive - The person might feel strongly about the side effects of the treatment

Probability sensitive - Sensitive to changes in the chance of different outcomes

Answer 65

A

 Computerised
 Paper based
 Reminder systems
 Developed to aid with particular decisions

Answer 66

A

 Reminder systems - Screening, vaccination, testing, medication use

 Decision systems (diagnosis and treatment) - Model individual patient data against
epidemiological data

 Prescribing - Advice on drug and dosage, highlights potential drug interactions

 Condition management - Assists monitoring patients

Answer 67

A

Geographic allocation of funding by weighted capitation

Resourcing determined by population weighted by need

Answer 68

A

Evidence of social class equality in the use of primary care and social class inequality in the use of secondary care

Answer 69

A

Target resources to those activities that give the greatest health gain for the money spent as this will maximise population health gain

Informing these choices required estimation of value of what is given up when a patient is treated (opportunity cost) and the value of what is gained in terms of improvements in the health of patients

Answer 70

A

Older people have had a long life already, therefor fairer to divert resources to younger people

Elderly also have a disproportionate share of the available resources allocated to them

Answer 71

A

Treating on the basis of need might mean older people don’t receive lower priority

Years of life saved shouldn’t matter, the quality of life is more important e.g QALYs

Fairness is not the only thing that matters, other things do too e.g equal treatment

Answer 72

A

 Good for rare risk factors

 Can assess multiple risk factors at once

Answer 73

A

 Expensive
 Time consuming - Risk factor may take decades to cause disease
 Confounding factors

Answer 74

A

 Good for rare diseases

 Good for tracing source of an outbreak

Answer 75

A

 Recall bias

 Inferior to cohort

Answer 76

A

 Papers that have not been published (publication bias)

 Papers that are not in English

Answer 77

A

Basic reproduction rate

The average number of individuals directly infected by an infectious case during the
infectious period, in a totally susceptible population (number of secondary cases following introduction of infection)

Answer 78

A

The rate of contacts in the host population

The probability of infection being transmitted during contact

The duration of infectiousness

Answer 79

A

Estimates the average number of secondary cases per infectious case in a population made up of both susceptible and non-susceptible hosts

Answer 80

A

R = R0x (x is the fraction of the host population which is susceptible e.g. half population is 0.5)

R>1 - number of cases increases

R<1 - Number of cases decreases, needs to be maintained for elimination

R=1 - Epidemic threshold

Answer 81

A

H = (R0-1)/ R0

Answer 82

A

Free - Diptheria, polio, tetanus, typhoid, hepatitis A, cholera

Private - Hepatitis B, japanese encephalitis, meningitis, rabies, TB, yellow fever

Answer 83

A

Restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for human being

Answer 84

A

 Better model that says we cope w/ grief/bad things by carrying out loss orientated + restoration orientated behaviours

 Loss orientated – grief work, braking bonds, denial

 Restoration orientated – doing new things new roles + relationships

 These 2 processes occur simultaneously through everyday life experiences

Answer 85

A

Direct action
Seeking information
Doing nothing
Developing way of coping

Answer 86

A

The likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that that same result would be expected in a patient without the target disorder.

Answer 87

A

Chance of testing positive if you have disease/ chance of testing positive if you don’t have disease

Answer 88

A

Chance of testing negative if you have disease/ chance of testing negative if you don’t have disease

Answer 89

A

The larger the LR+ the greater chance you have disease if your test is positive

The smaller the LR- the less chance you have disease if your test is negative

Answer 90

A

Chances of disease before test = the disease prevalence in your population

Answer 91

A

Screening is best at picking up long-lasting and slowly-progressive conditions rather than rapidly-progressing poor prognostic ones

Overestimation of survival duration among screening-detected cases by the relative excess of slowly progressing cases

Consequences:
 Diseases with a longer sojourn time are ‘easier to catch’ in the screening net.
 On average, individuals with disease detected through screening ‘automatically; have a better prognosis than people who present with symptoms/signs.
 If we simply compare individuals who choose to by screened with those who don’t
we will get a distorted picture.

Answer 92

A

Overestimation of survival duration among screen-detected cases (relative to those detected by signs and symptoms) when survival is measured from diagnosis.

Consequences:
 Survival is inevitably longer following diagnosis through screening because of the ‘extra’ lead time
 Because of this the appropriate measure of effectiveness is deaths prevented, not survival

Answer 93

A

 Overestimation of survival duration among screen-detected cases caused by inclusion of pseudodisease - subclinical disease that would not become overt before the patient dies of other causes.

 Occurs when screen-detected cancers are either non-growing or so slow-growing that they never would cause medical problems

Answer 94

A

Average or median waiting time
Average or median wait of those on list
Number on the list (size)
Proportion waiting more than x days
Proportion of those on list waiting more than x days
Time to clear list

Answer 95

A

False positive results leading to anxiety and unnecessary interventions.

Opportunity cost of the programme for NHS (and individual).

Increased diagnostic activity.

Answer 96

A

Overweight (or underweight) children are identified and parents take appropriate action.

Schools take action to tackle obesity

The importance of obesity is highlighted in the community
NHS and/or Local Authority have information that can be used to plan services to tackle obesity

Local obesity figures and performance can be monitored

Answer 97

A

Congenital hypothyroidism;

Phenylketonuria;

Medium Chain Acetyl Decarboxylase (MCAD);

Hearing problems;

Cystic fibrosis;

Sickle cell disease;

Answer 98

A

Children as care givers
Orphans
Psychosocial distress
Poverty
Lack of schooling
Reduced access to health care services
Discrimination
Child labour and exploitation
Sexual exploitation
Street children

Answer 99

A

Reduction in the young and middle aged adults rather than children (2 marks)

Infects sexually active people with an approx. 10 year period to death so time to reproduce is not affected (2 marks)

Answer 100

A

Sub-Saharan

Answer 101

A

Act as rationing

Makes best use of resources

Answer 102

A

More doctors/healthcare staff

Day cases

Targets and penalties for missing them

Activity based remuneration for doctors

Activity based remuneration for hospitals

Star ratings

Other service providers (e.g. contracting with private providers; switch to primary care provision)

Answer 103

A

 Established normality in childbearing as the midwife’s role - Refer to doctors as soon as abnormality occurs

 This ensures equal access to midwives and doctors for childbearing women of all socioeconomic standing

Answer 104

A

 Standardisation of care
 Access to good facilities to support childbirth
 Availability of populations of childbearing women and infants for the purposes of
midwifery and obstetric training
 Faster access to emergency care
 Access of effective obstetric analgesia

Answer 105

A

 Medicalisation
 Deposonalisation of birth
 Lack of privacy
 Inflexibility in labour and birth practices
 Limitation of resources

Answer 106

A

Human fertilisation and embryology authority act 2008

Welfare of child needs to be taken into account
Need for ‘supportive parenting’ hence valuing role of all (hetero and homo) parents
Sex selection/social selection of embryos is prohibited

Answer 107

A

Ratio between the observed (O) number of deaths in a study population to the number of expected (E) deaths

SMR = O/E

Answer 108

A

 The patient’s condition may deteriorate while waiting and in some cases the effectiveness of the proposed treatment may be reduced
 Experience of waiting can be extremely distressing in itself
 Patient’s family life may be adversely affected by waiting
 Patient’s employment circumstances may be adversely affected by waiting
 Excessive waiting times may be symptoms of inefficiencies in the healthcare system
and should be addressed as part of good management

Answer 109

A

 There is a limitless demand for health, people can always ‘be more healthy’ which created high demand

 Limited resources - Supply of money, staff etc is finite

Answer 110

A

 The backlog - Implies a need for occasional emergency injection of funds

 Demand management - Waiting acts as a ‘price’ to deter frivolous use

 Allows NHS resources to be fully employed - Don’t want lots of spare capacity as this
is a waste

 Waiting lists are caused by underfunding and ineffieciency

Answer 111

A

 Manage demand - Ensuring each referral represents the most appropriate decision for the care of the individual patient

 Manage the queue - Ensuring waiting lists are well managed and patients are called for treatment in appropriate order

 Manage capacity - Providing efficient and effective services that meet the level of demand from appropriate referrals

 Provide leadership - Ensuring that all parts of the local NHS work together to achieve waiting time improvements in the best interests of patients.

Answer 112

A

 Performance management of Trusts and PCTs based on achievement of target waiting times

 Hospitals receive an overall performance score and managers could lose their jobs if targets missed

Answer 113

A

 No inpatients waiting longer than 3 months

 Outpatients reduces, significant increased expenditure alongside this, however
funding has now remained constant meaning NHS is struggling despite increased demand

Answer 114

A

 Sacrifice of professional autonomy - Managers pressurising doctors, may be forced to treat less urgent due to waiting time.

 Unmeasured performance sufferers - Things that don’t have a target may suffer.

 Adverse behavioural responses e.g. emergency patients waiting in ambulances not emergency rooms, not classed as being in A+E until they are through the doors so
essentially cheating.

 Data manipulation and fraud.

Answer 115

A

 Clinical urgency
 Clinical severity
 Potential health gain
 Productivity and economic loss
 Equity waiting e.g. poverty
 Length of time waiting

Answer 116

A

 Social impact - Difficult to have conversations, isolation, intimacy issues, problems at work

 Psychological impact - Anger, low confidence, frustration, depression, embarrassment

 Practical issues - Doorbells, phones, theatre and cinema, TV, alarms

Answer 117

A

 Group 1 which applies to cars, motorbikes, and most other small vehicles - Need to be seizure free for 12 months

 Group 2 which applies to bigger vehicles such as lorries, heavy goods vehicles and other specialised types of vehicle - Unlikely to qualify for group 2 licence, need to be seizure free for 10 years and have not taken epilepsy medicines for 10 years

Answer 118

A

 They have only had seizures while they sleep
 They have only had seizures that do not affect their consciousness
 Their doctor changed their dosage or medication, but they have now gone back to
the original dosage or medication

Answer 119

A

Oestropathy - moving, sketching, massaging muscles and joints.

Answer 120

A

 Low back pain - Consider manual therapy, do not offer acupuncture

 Osteoarthritis - Manipulation and stretching should be considered as an adjunct to
core treatments, do not offer acupuncture

 Headache/migraine - Consider a course of up to 10 sessions of acupuncture over 5-8
weeks

Answer 121

A

 Understand information that may be relevant to the decision, including the consequence

 Retain information, even for a short time

 Use or weigh information to make decisions

 Communicate decision

Answer 122

A

The null hypothesis is REJECTED when it is true

i.e. Showing a difference between two groups when it doesn’t exist, a false positive. This is determined against a preset significance level (termed alpha).

As the significance level is determined in advance the chance of making a type I error is not affected by sample size. It is however increased if the number of end-points are increased. For example if a study has 20 end-points it is likely one of these will be reached, just by chance.

Answer 123

A

The null hypothesis is ACCEPTED when it is false.

i.e. Failing to spot a difference when one really exists, a false negative.

The probability of making a type II error is termed beta. It is determined by both sample size and alpha

Answer 124

A

Probability of an event in a given time period.

Answer 125

A

Risk ratio = Risk exposed/ Risk unexposed

Risk ratio = Risk of CVD smoker/Risk of CVD non smoker

Cohort studies

Answer 126

A

The risk of disease will increase as the exposure prevalence or relative risk increases

Answer 127

A

 Smoking (90%)
 Radon
 Asbestos
 Environmental tobacco exposure
 Genetics
 Other lung diseases
 Prior radiation in chest area

Answer 128

A

 Small cell (13%)

 Non-small cell (87%)

Adenocarcinoma (>40%),
Squamous cell carcinoma (20%),
Large cell carcinoma (2%)

 Mesotheloma

Answer 129

A

A preventive measure that brings large benefits to the community offers little to each participating individual

Answer 130

A

 Restriction - Limit the participants of your study who have possible cofounders
 Means that you have less data and difficult with multiple confounders

 Matching - You create a comparison group that is matched on the possible confounder, make case and control group as similar as possible on the confounder and then ask about exposure status
 Used for strong confounders like age and sex

 Stratification - Analyse exposure:outcome association in different subgroups of the confounder, recombine data and use a weighted average of the strata
 Limitations - To take into account all confounders would require lots of strata and you may run out of data to fill all possible options in your strata

 Multiple variable regression - You can adjust for the effects of multiple confounders, try and produce a linear model between the outcome and the different exposures
 Allows for adjustment of estimates for confounding

Answer 131

A

 NHS Research ethics committees
 Higher Education Institution (HEI) research ethics committees
 Gene therapy advisory committee
 Social care research ethics committee
 Ministry of defence research ethics committee

Answer 132

A

Examined cancer services in the UK, and proposed a restructuring of cancer services to achieve a more equitable level of access to high levels of expertise throughout the country.

Answer 133

A

Precontemplation
- No recognition of need/or interest in change

Contemplation
- Thinking about changing

Preparation
- Planning the change

Action
- Adopt new habits

Maintenance
- Active practice of new healthier behaviour

Answer 134

A

The larger the LR+ the greater chance you have disease if your test is positive

The smaller the LR- the less chance you have disease if your test is negative

Answer 135

A

QALY

Standard gamble – Assesses utility for a health state by asking how high a risk of death would accept to improve it.

Time-trade off – Utility assessed by asking how much time (life expectancy) would give up to improve it

Answer 136

A

Used in cohort studies

Risk in the exposed group DIVIDED BY risk in control group

Answer 137

A

Comparing patients who already have the condition with patient who do not.

Used in case controls.

Odds of having being exposed to a risk factor DIVIDED BY odds in the control group

Answer 138

A

To manage confounding, limiting participant of study who have possible confounders.

Means you have less data

Answer 139

A

Creating a comparison group that is matched on possible confounder.

Used for strong confounders like age and sex

Answer 140

A

Analyse exposure:outcome association in different subgroups. e.g. CHD in pie eaters v non-pie eaters

Answer 141

A

Restriction
Matching
Stratification
Multiple variable regression
Standardisation

Answer 142

A

Adjusting for the effects of multiple confounders, producing a linear model between outcome and different exposures

Answer 143

A

To limit confounding, usually for age.

Comparing 2 groups in age subgroups

Answer 144

A

Comparing how many deaths you would expect to how many there actually were.

SMR > 100% = higher death than average.

This is an example of indirect standardisation

Answer 145

A

Take a weighted average of stratum specific rates, comparing between 2 groups

Answer 146

A

Risk in exposure / Risk in unexposed

RR = a/a+c divided by c/c+d

Answer 147

A

Risk of disease will increase as the exposure prevalence or relative risk increases

Answer 148

A

In general, absolute risk reduction is the difference between one treatment comparison group’s event rate (EER) and another comparison group’s event rate (CER).

The difference is usually calculated with respect to two treatments A and B, with A typically a drug and B a placebo.

ARR = c/(c+d) - a/(a+b)

Answer 149

A

The proportion of people with the target disorder in the population at risk at a specific time (point prevalence) or time interval (period prevalence)

For example, the prevalence of rheumatoid arthritis in the UK is 1%

Answer 150

A

C. The probability of obtaining a result at least as extreme, assuming that the null hypothesis is true

The p value is the probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true. It is therefore equal to the chance of making a type I error (see below).

Answer 151

A

A type II error occurs when the sample size in a study is too small to allow for a difference to be detected.

A type II error can be prevented by recruiting a larger sample size.

Answer 152

A

A type I error occurs when the investigators conclude that there is a difference in a study when in reality there is none. Investigators usually set an arbitrary value such as 0.01 or 0.05.

This means that the investigators accept that there is a 1% or 5% chance that any difference detected is due to chance.

Answer 153

A

A lead-time bias is introduced in a study when a disease is detected an earlier stage and this gives the impression that the survival time from the detection point has increased. In reality, the increase in survival time is because the disease is detected earlier and the time of death remains unchanged.

Answer 154

A

In the analysis stage of an experiment, confounding can be controlled for by stratification.

NOT RANDOMISATION

Answer 155

A

 National Patient Safety Agency (NPSA) - 2001. coordination of reporting and learning from mistakes that affect patient safety.

 National Reporting And Learning System (NRLS) - 2004. National system for anonymous reporting of patient safety incidents, including near misses. All trusts now have a local system for reporting, linked to the national system. Also has a E- form for reporting incidents anonymously directly to the NPSA.

 Medicines and Healthcare - Products Regulatory Agency (MHRA) - Ensures medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness and that they are used safely. Monitoring of medicines and acting on safety concerns. Responsible for adverse incident reporting system for medical devices.

Answer 156

A

 Hospital mortality data

 Data on other measures of safety - Reports of never events and serious incidents,
NHS safety thermometer, patient safety dashboards

 Monitoring and inspections by regulators - Care quality commission (CQC), NHS
Improvement

Answer 157

A

Reminder systems - screening, vaccinations, testing
Decision systems for dx and tx
Prescribing - advice on drug/dosage + highlights potential interactions
Condition management

Answer 158

A

 Reduced time to achieve therapeutic stabilisation
 Reduced risk of toxic drug level
 Reduced length of hospital stay
 Increased size of initial dose
 Increased serum drug concentration
 No change in adverse effects of drug

Answer 159

A

 Transmission - Contaminated food by skin/nasal flora
 Produces enterotoxins
 Incubation - 2-4 hours
 Symptoms - Rapid onset, projectile vomiting and diarrhoea

Answer 160

A

 Transmission - Ingestion of contaminated food, faecal contaminations, person- person, infected animals
 Can cause enteric fever or enterocolitis
 Incubation period - is 12-72 hours
 Symptoms - Vomiting, diarrhoea, fever, headache, chills

Answer 161

A

 Transmission - Animal-human, person-person, contaminated water or land, associated with foreign travel
 Incubation - 2-5 days
 Symptoms - Watery or mucoid diarrhoea, severe illness in immunocompromised

Answer 162

A

 Transmission - Contaminated food, person-person
 Incubation - 1-6 days
 Symptoms - Haemorrhagic colitis, 5% get haemolytic uraemic syndrome

Answer 163

A

Incident in which two or more people, thought to have a common exposure, experience a similar illness or proven infection

Answer 164

A

 Baseline level of illness
 Outbreak source
 A case exposed earlier than the others
 An unrelated case
 A case exposed later than the others
 A case with a longer incubation period

Answer 165

A

 Compare food history of ill and well persons
 Point source outbreak - Cohort study
 Common source of outbreak - Case-control study

Answer 166

A

 Oesophageal - Alcohol, obesity
 Stomach - Possible salted preserved foods
 Pancreas - Overweight, obesity
 Hepatic - Aflatoxin contamination
 Colorectal - Preserved and red meat, alcohol, body fat
 Breast - Alcohol, overweight
 Urologic - high calcium

Answer 167

A

 Therapy - Look at relative risk reduction, absolute risk reduction, odds ratio, number needed to treat, confidence intervals

 Diagnosis - Look at sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios

 Prognosis - Look at how likely the outcomes are over time and how precise the prognostic estimates are (relative risk or odds ratios)

 Harm/aetiology - Look at relative risk, odds ratio, number needed to harm

Answer 168

A

Tackle health inequalities including poverty

Improving access to services/information

Focus on early intervention/Sure Start

Promote physical mental and emotional wellbeing

Promote healthy lifestyles

Setting standards

Answer 169

A

Accidents are a major cause of death in children

They cause twice as many deaths in children as cancer and leukaemia

Cause 6 times as many childhood deaths as murder (homicide)

The incident rate of childhood accidents has not fallen in recent decades as quickly as, for example, diphtheria and pneumonia

Answer 170

A

 For - Age should be relevant because older people are less likely to respond to treatment and have a poorer prognosis in general due to increased complication risk

 Against - Age alone is not a good predictor of prognosis/complications hence need case-by-case decisions, decisions based on age may be hidden form of discrimination

Answer 171

A

Equality Act 2010

Answer 172

A

Clinical - efficacy and effectiveness

Economic - efficiency

Answer 173

A

A systematic review is a rigorous summary of all the research evidence that relates to a specific question.(1 mark)

By bringing together all the relevant evidence disadvantages of single studies can be guarded against.(1 mark)

Answer 174

A

They have only looked at publications in English
They have only searched one database – e.g. Medline
Relevant publications might be published in non English language journals.
Not all relevant articles may be indexed in Medline.
A thorough search will reduce the risk that studies that might influence the results of the review will be missed
Trial reports that are translated for publication in English language journals tend to have bigger effect sizes (i.e. so English-language only searches tend to overstate the effect of an intervention).

Answer 175

A

 Appraisal by peers

 Revalidation by the GMC

 Medical audit as a compulsory part of routine practice and annual job planning

 GP and consultant contracts - Increasing transparency in comparative performance
in relation to activity, costs, and patient reported outcomes

 Transparency and accountability

Answer 176

A

What are the different consumer protection agencies?

Answer 177

A

 Ischaemic - Clipidogrel, statin, anti-hypertensive, anticoagulant if AF

 Haemorrhagic - Anti-hypertensives

Answer 178

A