My notes block 12 Flashcards
What has motivated research ethics?
History of research atrocities like Nazi medical experiments
Social, moral and political trends- patient autonomy, related legislation, research ethics codes etc.
Before participating in a study what does a patient need to know?
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
What does voluntary consent entail?
Not putting pressure on patients
Not threatening patients who don’t want to participate
Not offering inappropriate financial rewards
How do you facilitate consent
Information sheets Presentation of information Summary of key points Give opportunity to ask questions Give at least 24 hours to decide
Why is research ethics approval needed for trials?
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
What is the process of critical appraisal?
Form an answerable question- PICO
Search for best evidence
Appraise evidence
Make decision based on evidence, resources and preferences etc.
What is a PICO?
P- patient/ population/ problem
I- Intervention
C- Comparison/ Control
O- Outcome
What is the best study design to answer different questions?
Diagnosis- cross sectional study Aetiology- cohort or case control study Prognosis- cohort study Treatment- RCT or systematic review Evaluation- qualitative research
What are some benefits of systematic reviews?
Includes lots of research to answer question Includes unpublished research Includes non English research Increases sample size Indicates variation amongst studies
Appraisals of papers assesses paper for what?
Bias Applicability Limits Values Whether evidence is useful for a particular patient
How do you decide of you can use a papers results?
How similar the study is to your patient
Can local health service provide that treatment
Weigh up benefits and risks
What is the waiting list policy in England?
Max waiting time targets and penalties for hospitals or trusts who do not meet the target
Seems to have helped but misprioritisation is evident
Why are waiting times important to patients?
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
Theories of NHS waiting lists?
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
What are the criteria for having capacity?
Understands
Retain information
Use or weigh up information
Able to communicate decision
What to do when patient lacks capacity?
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
What are advance care planning aspects?
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
What are the pros of an advance decision?
Respects patients choice and autonomy
Encourages openness and forward planning
Legal right to refuse treatment
Less anxious about unwanted treatment
What are the cons of an advance decisions?
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
What is confounding?
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
What are the 4 ways that confounding can be addressed in study design and analysis?
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
Why so research informed practice?
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
What are some barriers for uptake of evidence?
Recommendation
Adopters unsure of new knowledge and doubts over credibility
Organisation and environment- time constraints, culture, social influence etc.
What are some benefits of a dementia diagnosis?
Know what you're dealing with Access to treatment Access to support services Information/ education Can plan for the future
What so the National CQUINs 2017-9 focus on?
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
What is quality and outcomes framework?
Annual reward and incentive program for GPs
Compares delivery and quality of care against previous years
Awards excellence and incentives
