PA20298 evidence based medicine

Question 0

What types of trials happen in drug development?

Answer 0

Pre clinical trials during research
Phase I,II and III clinical trials
Post marketing evaluation trials

Question 1

Are chance, bias and confounding CAUSAL of a certain event?

Answer 1

No they are not causal.
If non of these were present, then ONE VARIABLE IS CAUSAL OF THE OTHER VARIABLE. If one or more of these factors are present, we cannot be sure if one variable causes what happens to the other variable.

Question 2

What are randomised controlled trials (RCT) distinguishing feature?

Answer 2

Study subjects are RANDOMLY allocated to receive one or other of the alternative treatments under study. I.e group 1 may receive a new treatment whilst group 2 receive old treatment or a placebo.
The 2 groups of subjects are followed up in exactly the same way, the only difference between them is the care they receive.

Question 3

What is the most important advantage of proper randomisation being done in randomised controlled trials?

Answer 3

It minimises allocation bias.

Question 4

What are inclusion and exclusion criteria?

Answer 4

A way of establishing precision in your cohort/ case control study.
They define the population that will be included in your study.
Criteria that must be met for people to be included/ excluded in your study.
It is important to ensure that no group of people is included or excluded for a non scientific reason.
They effect the extent to which the results of a study can be generalised to the whole population.

Question 5

What is inclusion criteria?

Answer 5

The criteria for including a patient in the study. What characteristics must a patient have to be included in the study?
.

Question 6

What happens if inclusion criteria is too narrow?

Answer 6

if the criteria are too narrow, subject recruitment may be difficult

Question 7

What happens if the inclusion criteria are too broad?

Answer 7

if the criteria are too broad this may reduce the level of control in the study design, as it increases the chance that the groups may differ/be effected by some other variable.
If the groups differ in any way other than the treatment, a confound has been Introduced, that could lead to incorrect conclusions..

Question 8

What do Randomised control trials need to consider?

Answer 8

Carefully selected and specified indications (valid reasons to use a certain treatment)
Consider use of a homogeneous population (consider inclusion and exclusion criteria)
Short term therapy- cant have people coming back for checkups 20 years later, want a quick answer.
Can use randomised controlled trials to detect side effects of a treatment.

Question 9

What is pharmacoepidemiology?

Answer 9

The principles of chronic disease epidemiology applied to the area of clinical pharmacology.

Question 10

What happens with non-experimental/ observational studies?

Answer 10

an observational study draws conclusions on the possible effect of a treatment on subjects, where the assignment of subjects into treated and non treated control groups is outside often control of the investigator. These are NOT EXPERIMENTS!
There is no control over exposures assigned so the only source of discretion is the selection of the subjects.
Confounding will occur, as less control over the population picked for the study.
No risk to patients

Question 11

What are cohort studies?

Answer 11

This study identifies a group of people and follows them over a period of time to see how their exposures effect their outcomes. Cohort studies are normally used to look at the effects of suspected risk factors that cannot be controlled experimentally, for example the effect of smoking on lung cancer.
It is a type of observational study.
A cohort is a group of people who share a COMMON CHARACTERISTIC. The comparison group may be e rest of the population or a group who have not been exposed to the treatment, I.e the control group.

Question 12

Advantages and disadvantages of cohort studies?

Answer 12

Advantages;
Efficient for rare exposures 
Multiple effects can be studied
Less prone to bias
Can calculate incidence rate, relative risks, and absolute risks

Disadvantages:
Can have difficulties with loss of follow up
May have problems with BIAS

Question 13

What are case control studies?

Answer 13

An epidemiology study
Often used to identify risk factors for a medical condition
Compares a group of patients who have the condition with a group of patients who don’t, and looks back in time to see how the characteristics of the two groups differ.
Case control studies are often used to identify factors that may contribute to a medical condition by comparing subjects who have the condition/ disease with patients that don’t but are otherwise similar (the controls)

Question 14

In case control studies, what do the case subjects have? What do the control subjects have?

Answer 14

Cases- have disease of interest
Controls- are free from the disease of interest

You’re comparing the differences before treatment, in risk factors, protective factors, etiologic agent (causal agent/microorganism)

Question 15

Advantages of case control studies?

Answer 15

Evaluation of rare diseases.
Diseases with long latent (inactive) periods
Relatively quick to conduct
Relatively cheap
Allows study of multiple exposures (to a drug/ treatment)
No risks to subjects
Useful in early stages when identifying potential risk factors of disease.

Question 16

Disadvantages of case control studies?

Answer 16

Inefficient for rare exposures
Difficult to choose an appropriate control group
Prone to BIAS

Question 17

What is bias in studies?

Answer 17

The introduction of systematic error in the study. This may be at the point of study design. It cannot be eliminated at the point of analysis.

Bias may be in terms of;
Selection of study subjects
Exposure (treatment) classification for each patient
Outcome classification

Bias can result in over or underestimated risks

Question 18

Why are randomised controlled trials randomised?

Answer 18

To eliminate confounding (outcome effected due to some other variable)

Question 19

Examples of some confounding factors?

Answer 19

Newer drugs given to iller people, therefore they may appear to have more side effects when it’s really just effects of having the illness
Smokers are more likely to have adverse health outcomes,so the medications they’re taking are more likely to have advers side effects
Older people may be more likely to have more side effects

Question 20

Confounding is a result of certain characteristics in the study population.
It can be dealt with through;
Randomisation of exposure
Stratification 
Restriction
Matching
Statistical adjustment

Answer 20

Confounding is the distortion of a risk estimate due to the mixture of the people in the study population.
A confounder is a risk factor for the disease and is correlated with the exposure independent of disease.

Question 21

What must pharmacists consider when conducting a clinical check?

Answer 21

Patient characteristics
Medication regimen
How treatment will be administered and monitored

Question 22

What does clinical pharmacy generally describe?

Answer 22

Knowledge, skills and attitudes required by a pharmacist to contribute to patient care.
Pharmacists provide care that optimises medication therapy and promotes health, wellness and disease prevention.
Blends a caring orientation with specialised therapeutic knowledge, experience and judgment to ensure optimal patient outcomes.

Question 23

What has pharmaceutical care been defined as?

Answer 23

The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patients quality of life

Question 24

What do clinical pharmacist do before the prescription?

Answer 24

Prescribing advice to doctors Develop prescribing guidelines and tools Medicines reconcilliation/ history taking

Question 25

What do clinical pharmacists do during the prescription?

Answer 25

Clinical check of the prescription Counselling the patient Counter prescribing

Question 26

What do clinical pharmacists do after the prescription?

Answer 26

Monitor the effectiveness (drug and disease) Monitor adverse effects (side effects) Ongoing patient counselling Medicines usage review

Question 27

Why do we need clinical pharmacists?

Answer 27

To improve patient care and increase effectiveness | Reduce adverse drug events such as prescribing errors, interactions, side effects

Question 28

What do the patient factors consist of in a clinical check?

Answer 28

Age and sex Disease states Allergies and intolerances Preferences

Question 29

What are the medication factors of a clinical check?

Answer 29

``` Indication Dose, frequency, check Formulation DRUG INTERACTIONS Monitoring of effectiveness ```

Question 30

What are the essential, advanced and enhanced terms of the NHS contract of a pharmacist?

Answer 30

``` Essential (must do); Dispensing medicines RTS Returning medicines Repeat prescriptions ``` Advanced: (can do) MURs, NMS Enhanced: prescribing, near patient testing

Question 31

What is medicines reconciliation ?

Answer 31

The aim of medicines reconciliation on hospital admission is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission. Details to be recorded include the name of the medicine(s), dosage, frequency, and route of administration. Establishing these details may involve discussion with the patient and/or carers and the use of records from primary care. This does not include medicines review. Pharmacists check and amend prescriptions written by doctors.

Question 32

What does clinical pharmacy underpin in the community pharmacy?

Answer 32

Prescription review Medicines use review RTS Counter prescribing

Question 33

In hospital pharmacy what does clinical pharmacy underpin?

Answer 33

Prescription review Prescribing advice Also; Stock checks/ supple checks; inpatient supplies and to take away medicines for outpatients. Ward visits- patient counselling, medicines reconcilliation Total parenteral nutrition,IV chemotherapy

Question 34

What is a medication safety incident?

Answer 34

Any unintended or unexpected incident resulting from an irregularity in the process of medications use, which could have or did lead to patient harm.

Question 35

What is an adverse drug event (ADE)?

Answer 35

Injury resulting from medical intervention related to a drug. Under this definition, it includes harm caused by the drug (adverse drug reactions and overdoses) and harm from the use of the drug (such as discontinuation from therapy)

Question 36

What is a adverse drug reaction?

Answer 36

A response to a drug which is noxious and unintended and which occurs at doses normally used in man for prophylaxis ( prevention / protective treatment of disease), diagnosis, and therapy of the disease, or for the modification of physiological function.

Question 37

What is a medication error?

Answer 37

Incidents in which there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice, regardless of whether any harm occurred.

Question 38

Types of adverse drug reactions? Types A, B and C

Answer 38

Type A: augmentation ( increased action of) of pharmacological action: it is common and predictable, eg. Decrease in heart rate with beta blockers. They act to decrease blood pressure so this decrease in HR is predictable. Type B: bizarre reaction. Unpredictable, eg an allergic reaction to penicillin. Type C; dose related and time related, related to cumulative dose.

Question 39

Adverse drug reactions types D E and F?

Answer 39

D; time dependent reactions. Occur some time after the drugs been used. E; withdrawal reactions. Eg. Opioid withdrawals F; unexpected failure of therapy; often caused by drug interactions, eg failure of oral comtraceptions in the presence of enzyme inducers

Question 40

How are adverse drug reactions reported?

Answer 40

Reported to the UK medicines healthcare products authority using Yellow Cards Can be reported by healthcare professionals and patients

Question 41

What should ADRs be reported for?

Answer 41

All black triangle drugs Suspected ADRs in children Serious ADRs for established medicines and vaccines Any delayed drug effects

Question 42

What is a prescribing error?

Answer 42

Prescribing decision or prescription writing process that results in unintentional, significant reduction in the probability of treatment being timely and effective or InCREASe the risk of harm when compared with generally accepted practice.

Question 43

What kinds of clinical checking errors exist for dispensing?

Answer 43

``` Inappropriate drug prescribed for patients condition Inappropriate dose/ directions Inappropriate formulation of drug Drug interactions present Drug- disease interaction present ```

Question 44

What types of preparation errors exist for dispensing?

Answer 44

Selecting the wrong drug Selecting the wrong strength Selecting the wrong diluent Drug not completely dissolved

Question 45

Common administrations errors?

Answer 45

Administer medication at wrong time Failing to administer a medicine Administration using the wrong technique / via the wrong route

Question 46

Some common causes of medication errors?

Answer 46

``` Lack of knowledge about patients/ medicines Workload too big Hunger Tiredness Poor communication ```

Question 47

What are clinical guidelines in place for?

Answer 47

Improve reproducibility of practice Produced by expert bodies in specific clinical areas such as the British hypertension society Produced by clinical advisory bodies to produce national guidelines eg. NICE

Question 48

What are integrated care pathways ?

Answer 48

Single document which brings together multidisciplinary responsibilities I.e, role of doctor, role of nurse, role of pharmacist They are PATIENT SPECIFIC THEY'RE WRITTEN FOR A SINGLE CLINICAL CONDITION They're guides only and are not intended to replace individual clinical judgement.

Question 49

What do integrated care pathways include?

Answer 49

Specific treatment objectives Timed treatment objectives Guidance on review of patient Defined monitoring criteria The roles and responsibilities of each professional Are defined within these. (doctors nurses pharmacist)

Question 50

Why do we use integrated care pathways?

Answer 50

``` Local policy Documentation Standardise treatments Define goals of treatment Define roles of the healthcare team Deliver patient focused care ```

Question 51

How do integrated care pathways effect a pharmacist?

Answer 51

Involvement in development and application of the ICP Educational tool for the pharmacist Provide a differential diagnosis Provide a framework for monitoring the patient, the disease and the effectiveness of treatment.

Question 52

What do care plans include?

Answer 52

``` Planned action of care for an individual Expected progress of individual Intended outcome of medication Expected timescale of use of that medication Revise patient care Monitor intended outcome ```

Question 53

What are the columns of a care plan subtitled?

Answer 53

PROBLEM GOAL OR DESIRED OUTCOME COMMENTS ON TREATMENT SELECTED OR ANY FURTHER INTERVENTION REQUIRED MONITORING NEEDS (including biochemistry, patient observations, or disease or medication)

Question 54

Care plans are all about providing cost effectiveness, efficacious, safe, evidence based care

Answer 54

Care plans are only ever as good as the person using them

Question 55

Why do we monitor?

Answer 55

To monitor the severity/ progression of a disease state To monitor the intended/ beneficial effect of a drug or other intervention To monitor the adverse effects of the drug (side effects, interactions) To monitor blood levels of a drug (toxicity, efficacy)

Question 56

We monitor disease and the intervention (the things were doing to help the patient)

Answer 56

As pharmacists we are primarily interested in: How the drug effects the patient (therapeutic and adverse effects) How the patients condition may effect their handling of the drugs

Question 57

When do we monitor?

Answer 57

When the drug being used is a cause for a concern eg warfarin The disease state , will the disease effect the drug eg healthy / unhealthy liver Depending on whether it's an acute or chronic disease- acute diseases have intensive monitoring. Patient factors may decide whether monitoring should be done; premature babies, neonates, elderly, obese, malnourished

Question 58

What are clinical laboratory services?

Answer 58

A support service to healthcare at a local level Usually based within a hospital trust These services are purchased by others within the hospital

Question 59

What types of parameters can we monitor?

Answer 59

``` Physiological Biochemical Haematological Serum drug concentrations Microbiological Signs and symptoms ```

Question 60

What types of physiological parameters are there that we can monitor?

Answer 60

Blood pressure due to anti hypertensives Heart rate due to beta blockers / digoxin Heart rhythm due to anti-arrhythmics Respiratory rate due to strong opioids Temperature due to antibiotics

Question 61

What is the value of the optimal blood pressure? Systolic and diastolic?

Answer 61

<120 mmHg systolic | <80 mmHg diastolic

Question 62

What is the value of normal blood pressure? Systolic ? Diastolic ?

Answer 62

<130 mmHg systolic | <85 mmHg diastolic

Question 63

High-normal blood pressure?

Answer 63

130-139 mmHg systolic | 85-89 mmHg diastolic

Question 64

Mild hypertension (grade 1) systolic blood pressure / diastolic blood pressure?

Answer 64

140- 159 mmHg systolic | 90 - 99 mmHg diastolic

Question 65

Medium hypertension blood pressure (grade 2) ?

Answer 65

160- 179 mmHg systolic | 100-109 mmHg diastolic

Question 66

What are the values of blood pressure for severe hypertension (grade 3)?

Answer 66

Over 180 mmHg systolic | Over 110 mmHg diastolic

Question 67

What is stage 1 hypertension?

Answer 67

Clinic blood pressure is 140/190 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher

Question 68

Why is stage 2 hypertension?

Answer 68

Clinic blood pressure is 160/100 mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher.

Question 69

What biological parameters do we monitor?

Answer 69

Creatine and urea: Renal function/ fluid status Liver function tests: indicate type / timescale of damage Cardiac enzymes: a good diagnostic tool for myocardial infarction, troponin in most commonly used C-reactive protein (CRP) : an indicator of course of infection/ inflammation.

Question 70

Tell me about CRP, what is it, what does it measure?

Answer 70

C- reactive protein Indicator of course of infection/ inflammation It is not an absolute measure, it's useful as a trend only. It's a protein found in the blood, and it's levels rise in inflammation.

Question 71

Liver function tests, what are we monitoring for? What do they indicate?

Answer 71

ALT or AST (transaminases) tend to indicate acute damage poss normal in chronic phase of disease. Cholestasis (bile cannot flow from liver to duodenum) may involve ALP, Bilirubin and GGT. ALP is High in infiltrative liver disease.

Question 72

What is creatinine?

Answer 72

It is a BY-PRODUCT of muscle metabolism. It is excreted by the kidneys. The amount of creatinine in the blood is a measure of HOW WELL the kidneys are functioning. Cr

Question 73

What does FBC stand for?

Answer 73

Full blood count | It is a blood test

Question 74

What does an FBC screen for?

Answer 74

Haemoglobin White blood cell count Platelets Red blood cell count

Question 75

What is a folate test/ when is it requested?

Answer 75

To help diagnose the cause of macrocytic anaemia Requested as follow up tests when large red blood cells cells and a decreased heamopoeitic concentration are found during an FBC test. Folate and vitamin B12 are used to help evaluate the nutritional status of a patient with signs of malnutrition.

Question 76

What is an INR test?

Answer 76

Stands for international normalised ratio Measures how THIN the blood is It measures HOW LONG IT TAKES FOR THE BLOOD TO CLOT Used to monitor WARFARIN therapy!!!!! A ratio of how long it takes anticoagulated blood to clot compared to normal blood.

Question 77

What is APTT?

Answer 77

Activated partial thromboplastin time Detects abnormalities in blood clotting Used to monitor therapeutic effect with heparin

Question 78

Why are FBC's done?

Answer 78

After a patient has received chemotherapy to track neutrophils To track the course of infection To identify and determine the side effects to drugs To determine the type/ severity/ progress of anaemia

Question 79

What is an anticoagulant/ anticoagulated blood?

Answer 79

Anticoagulant: a substance that prevents coagulation (CLOTTING) of blood Anticoagulant medicines can be used in thrombotic disorders (formation of blood clots disorder)

Question 80

What is the INR of normal blood? What do INRs higher/ lower than the desired target range indicate?

Answer 80

1.0- 1.5 is normal. People of warfarin treatment (an anticoagulant, blood thinner) will have different target INR ranges to aim for with warfarin treatment. Eg a target range of 2.0 to3.0 with deep vein thrombosis. An INR lower than the desired range means the blood is 'not thin enough' or clots too easily. An INR higher than the desired range means blood is too thin.

Question 81

Does anticoagulated blood have a higher or lower INR?

Answer 81

A Higher INR means the blood is anticoagulated therefore thinner.

Question 82

Typically, a person who is not taking a blood thinning medicine has an INR of around 1.

Answer 82

People who are undergoing blood thinner therapy will have a higher INR.

Question 83

If the INR is out of range it can lead to uncrontrollable bleeding. A value too low may increase your risk of a stroke.

Answer 83

.

Question 84

What characteristics of a drug means we need to monitor drug levels?

Answer 84

Where there is a large degree of inter-patient variability (if we can't predict dose/effect very well). If the drug has a narrow therapeutic index: toxic levels are close to therapeutic levels. If odd pharmacokinetics means dose/response isn't very predictable. (eg zero order)

Question 85

Why should phenytoin be monitored?

Answer 85

First order kinetics at low doses Zero order kinetics at higher doses Narrow therapeutic window Small increases in dose of phenytoin can result in large increases in plasma levels.

Question 86

Why monitor gentamicin?

Answer 86

Excreted by kidneys and toxic to kidneys | Monitor to avoid toxicity; pre dose levels must be less than 1mg/L

Question 87

Why monitor vancomycin?

Answer 87

To confirm therapeutic levels and clearance

Question 88

Why monitor tericoplanin?

Answer 88

Concerned about effectiveness

Question 89

In microbiology testing, what can we take cultures from samples of?

Answer 89

``` Blood, Pus, Aspirate, Sputum, Tissues, CSF ```

Question 90

What is evidence based medicine all about?

Answer 90

Efficacy versus effectiveness, Use of current based evidence in making decisions about care of individual patients. Integrates individual clinical expertise with the best available external clinical evidence from systemic research.

Question 91

What is critical appraisal?

Answer 91

A way to assess the methods and results of published research. Balanced assessment of the strengths of research against its weaknesses All research and health professionals should undertake critical appraisal. You're basically making your own assessment of articles/research papers.

Question 92

Why would you critically appraise?

Answer 92

Not all research is reliable Data doesn't always support researchers conclusions Not all research may be relevant Provides framework for interpreting research.

Question 93

What are CASP forms?

Answer 93

Critical appraisal skills programme form Aims to help individuals to develop the skills to find and make sense of research evidence , helping them to put knowledge into practice.

Question 94

What is BIAS?

Answer 94

It is a systemic error in data | Bias consistently pulls the risk estimate away from its true value

Question 95

What is non-differentiential and differential misclasification?

Answer 95

Non differential: misclasification to the same degree for All groups, all groups have the same error rate. Differential: misclasification different between groups (error rate probability differs between groups).

Question 96

What is misclasification bias in epidemiological studies?

Answer 96

Also known as information bias, or observation bias, | It essentially refers to bias arising from a measurement error.

Question 97

What do generisable results mean?

Answer 97

Are the patients in the study like the ones you would expect to receive the treatment? They may be healthier, younger etc... You want your results to be generalisable.

Question 98

What are the 3 E's in pharmacoeconomics?

Answer 98

Effectiveness Equity Efficiency Equity: is there equality of access to healthcare for those with equal need? Is equal treatment being received? Efficiency? Are we using our available resources to the max?

Question 99

What are the benefits of economic evaluation?

Answer 99

Cost-minimisation analysis -simplest form, costs/inputs alone are compared. Cost-effectiveness analysis- compares costs and benefits of interventions to determine their value for money. Most cost effective; greatest effectiveness at the lowest cost. Cost-utility analysis Cost-benefit analysis

Question 100

What is the incremental cost- effectiveness ratio (ICER) for comparing 2 alternatives determined by?

Answer 100

Difference in treatment costs divided by difference in effectiveness

Question 101

What is cost-utility analysis? What's QALY?

Answer 101

Improvements in health care status are measured in terms of utility Most common measure of utility is e QALY QALY= quality adjusted life year This is a measure of disease burden, including both the quality and quantity of life lived. It is used to asses the value for money of a medical intervention The QALY is based on the number of years of life that would be added by the intervention,

Question 102

What do values 1, 0 and between 1-0 indicate in QALYS?

Answer 102

``` 1= a year in FULL HEALTH 0= death 0-1 = illness or disability to varying diseases. ```

Question 103

QALYS can facilitate comparisons across health car programmes in terms of health gain per unit of expenditure.

Answer 103

Improvements in health status are measured in terms of utility The most common measure of utility is the QALY QALYS determine health gain per unit of expenditure

Question 104

Disadvantage of QALYS?

Answer 104

They're racist, sexist, ageist, difficult to interpret...

Question 105

``` What do the following abbreviations HR RR U & E's CRP ```

Answer 105

.

Question 106

What is a systemic review?

Answer 106

A review of the important systems of the body. Usually the review starts with the systems relevant to the presenting complaint and then the other major systems of the body. The findings of the systems review will be documented in the medical notes. Only positive data (e.g. shortness of breath on exertion) or important negative data (e.g. non-smoker) tends to be recorded. Sometimes the absence of symptoms is denoted by the symbol ∘ne.g. ∘dyspnoea,

Question 107

What does GU in patients medical notes stand for?

Answer 107

Genitourinary Things like • Frequency/dysuria/nocturia/polyuria/oliguria/haematuria • Incontience/urgency/hesitancy/poor flow Menstrual problems Will be recorded under here.

Question 108

What does JVP in the physicAl examination part of patient medical notes stand for?

Answer 108

• Jugular venous pressure (JVP) | useful in the differentiation of different forms of heart and lung disease

Question 109

What is chest percussion?

Answer 109

Percussion is an assessment technique which produces sounds by the examiner tapping on the patient's chest wall, Creating motion, audible sounds and palpable vibrations. Percussion helps to determine whether the underlying tissues are filled with air, fluid, or solid material.

Question 110

What is the Glasgow Coma Scale?

Answer 110

The Glasgow Coma Scale or GCS is a neurological recording of the conscious state of a patient. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale). GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, and doctors as being applicable to all acute medical and trauma patients.

Question 111

What does gait mean on patients medical notes?

Answer 111

Human gait is the way locomotion is achieved using human limbs.

Question 112

What do the triangle symbols in the diagnosis section of the medical notes indicate?

Answer 112

In this section the doctor will record his/her diagnosis. The abbreviations Dx or Δ are used to indicate a definitive diagnosis. (doctor is sure of this diagnosis) Sometimes there may be a number of potential diagnoses, each known as a differential diagnosis, indicated by the abbreviation DD or ΔΔ. The medical team will then conduct a number of different investigations to establish the definitive diagnosis.

Question 113

In progress reports (follow ups) in patients medical notes, what is the SOAPS criteria?

Answer 113

S ​= Subjective ​1) Subjective data i.e. the patient’s symptoms O ​= Objective​ 2) Objective data i.e. physical signs and results of any ​ investigations A ​= Assessment ​3) Interpretation of data from physical examination and ​ Investigations P ​= Plans​ 4) Immediate plans. ​5) Therapy

Question 114

What is pharmacoepidemiology?

Answer 114

The study of the use of and the effects of drugs in large numbers of people.

Question 115

What knowledge is required to judge whether a medicine is safe and effective for use in patients?

Answer 115

Clinical trials assessing the effectiveness of medicines Pharmacoepidemiological studies assessing the risk of medicines use Pharmacoeconomic studies determining the cost-effectiveness of medicines

Question 116

What are the three stages of medicines reconciliation?

Answer 116

Medication history: create a list, collect the info Check and verify the list against current prescription Communicating

Question 117

What sources of information are used to get information on the medication/ drug history of the patient?

Answer 117

GP prescribing record Carer/ family Repeat slips

Question 118

What are the limitations of the ways you can collect a patients medication history?

Answer 118

The patient may not actually be taking the medicines on the prescriptions/ what the doctor tells you their on, it's down to the patient to take them/ tell you the truth. A repeat slip would not include all the information on any non regular medicines.

Question 119

What does C&S stand for?

Answer 119

Culture and sensitivity