My notes block 12

Question 1

What has motivated research ethics?

Answer 1

History of research atrocities like Nazi medical experiments

Social, moral and political trends- patient autonomy, related legislation, research ethics codes etc.

Question 2

Before participating in a study what does a patient need to know?

Answer 2

Purpose of the study
What will happen when taking part
Risks and benefits of taking part
What happens if study stops or goes wrong
How confidentiality is respected
Ethics review of trial

Question 3

What does voluntary consent entail?

Answer 3

Not putting pressure on patients
Not threatening patients who don’t want to participate
Not offering inappropriate financial rewards

Question 4

How do you facilitate consent

Answer 4

Information sheets
Presentation of information
Summary of key points
Give opportunity to ask questions
Give at least 24 hours to decide

Question 5

Why is research ethics approval needed for trials?

Answer 5

Needed if it involves humans or human tissues
Needed to protect both participants and researchers from harm
Check integrity of trial and test if it ethical

Question 6

What is the process of critical appraisal?

Answer 6

Form an answerable question- PICO
Search for best evidence
Appraise evidence
Make decision based on evidence, resources and preferences etc.

Question 7

What is a PICO?

Answer 7

P- patient/ population/ problem
I- Intervention
C- Comparison/ Control
O- Outcome

Question 8

What is the best study design to answer different questions?

Answer 8

Diagnosis- cross sectional study
Aetiology- cohort or case control study
Prognosis- cohort study
Treatment- RCT or systematic review
Evaluation- qualitative research

Question 9

What are some benefits of systematic reviews?

Answer 9

Includes lots of research to answer question 
Includes unpublished research
Includes non English research
Increases sample size
Indicates variation amongst studies

Question 10

Appraisals of papers assesses paper for what?

Answer 10

Bias
Applicability
Limits
Values
Whether evidence is useful for a particular patient

Question 11

How do you decide of you can use a papers results?

Answer 11

How similar the study is to your patient
Can local health service provide that treatment
Weigh up benefits and risks

Question 12

What is the waiting list policy in England?

Answer 12

Max waiting time targets and penalties for hospitals or trusts who do not meet the target
Seems to have helped but misprioritisation is evident

Question 13

Why are waiting times important to patients?

Answer 13

Patients condition may deteriorate while waiting
Experience of waiting may be distressing
Family life or work may be affected by waiting
Long waiting times may indicate inefficiency in the healthcare system

Question 14

Theories of NHS waiting lists?

Answer 14

Backlog- implies need for occasional emergency injection of funds
Demand management- deters frivolous use
Allows resources to be fully used
Caused by underfunding and inefficiency

Question 15

What are the criteria for having capacity?

Answer 15

Understands
Retain information
Use or weigh up information
Able to communicate decision

Question 16

What to do when patient lacks capacity?

Answer 16

If they have an advance care plan then use that

If not then make decisions in the patients best interests and be the least restrictive action available

Question 17

What are advance care planning aspects?

Answer 17

Advance decisions to refuse treatment e.g. DNR are legally binding

Advance statement of wishes like where would like to die etc. are not legally binding

Question 18

What are the pros of an advance decision?

Answer 18

Respects patients choice and autonomy
Encourages openness and forward planning
Legal right to refuse treatment
Less anxious about unwanted treatment

Question 19

What are the cons of an advance decisions?

Answer 19

Difficult to verify patient decision hasn’t changed- especially if person now has dementia
Ascertaining circumstances are what patient foresaw
Possibility of coercion when making advance decision
Can patients imagine future situation sufficiently vividly

Question 20

What is confounding?

Answer 20

Happens when a relationship between an exposure and an outcome is distorted by their shared relationship with something else.

E.g. jogging and heart disease, but also joggers eat less pies which also reduce risk of heart disease

Question 21

What are the 4 ways that confounding can be addressed in study design and analysis?

Answer 21

Restriction- limit it so people with the confounder are not involved
Matching- match it so same number of confounder is on both sides of study
Stratification- analyse exposure: outcome association in different sub groups of the confounder. Hard to do if there are many possible confounders
Multiple variable regression- adjust measure of effect at end

Question 22

Why so research informed practice?

Answer 22

Personal experience is biased
Research will give evidence from more patients that it is possible to see in real life
Research uses scientific methods to minimise bias
Recommendations have been assessed for clinical and cost effectiveness in the NHS

Question 23

What are some barriers for uptake of evidence?

Answer 23

Recommendation
Adopters unsure of new knowledge and doubts over credibility
Organisation and environment- time constraints, culture, social influence etc.

Question 24

What are some benefits of a dementia diagnosis?

Answer 24

Know what you're dealing with
Access to treatment
Access to support services
Information/ education
Can plan for the future

Question 25

What so the National CQUINs 2017-9 focus on?

Answer 25

Improving staff health and wellbeing
Reducing impact of serious infections
Improving transitions out of children and young peoples mental health services
Supporting proactive and safe discharge
Preventing ill health by risky behaviour

Question 26

What is quality and outcomes framework?

Answer 26

Annual reward and incentive program for GPs
Compares delivery and quality of care against previous years
Awards excellence and incentives