past papers Flashcards
ones I struggled with
Kaplan mier curves
construct survival tables from which survival curves can be plotted.
This method takes into account censoring of patients at the end of the study period or because they have been lost to follow up.
Test: log rank test for overall survival
Issues:
1. comparisons of survival proportions at different time points can be misleading and need to be interpreted with due regard to the overall mortality experience.
2.Particular care needs to taken when interpreting survival curves towards the end of study periods if only a few patients are still being observed as even a single death can substantially alter the appearance of the curve.
other (cox regression, hazard function, instantaneous risk of experiencing the event of interest at a certain time point, HF similar to RR)
sustainable development
’meeting our needs today without compromising the ability of others to meet their
needs tomorrow’
Financial / economic
Social
Environmental
labelling
Labelling occurs when individual attributes and characteristics are identified by others and given a negative label.
primary and secondary deviance
social norms
Individuals try and match behaviour to what they consider normal group behaviour
Group norms based on perception on peer behaviour
Mismatch between perception and actual group behaviour
Use in PH:
People perceive their peers to behave in a less healthy and socially responsible manner than their actual behaviour and if this dissonance is communicated to individuals, they will adopt a more healthier lifestyle.
How to use:
1. Prepare: identify health issue, population
2. Baseline data collection:
3. Analysis: baseline data to show that perceived and actual behaviour different
4. Intervention: design comms to show this dissonance, information on baseline
5. Follow up: post intervention data collection
6. Evaluation: assess change
Evidence:
US campus to show that most students don’t drink
Later UK most don’t do drugs
LMIC evidence that shows most don’t do FGM -> less
issues:
Personal attitude Vs group, group + individual may match bad behaviour, protective norms (muslims don’t drink)
efficacy vs effectiveness
efficacy: ideal conditions,
careful monitoring, adherence
RCT
control: sometimes placebo
-> how much an ideal effect is
effectiveness: real world
pragmatic
control: Usual care
don’t monitor adherence
sample size for prevalence
number to include in sample
make inference for WHOLE population
will depend on prevalence
larger sample smaller CI
choose by:
-expedience
- size of CI willing to accept
population sampling
representative sampling
probability
- simple (may cluster)
- systematic
- stratified (certain groups can be included)
- cluster
non probability
- convenience
- quota
- snowball
Information governance
the necessary safeguards for an appropriate use of patient
and personal information
strategic planning
systematic, formally documented process for deciding what is the handful of key decisions that an organisation, viewed as a corporate whole must get right in order to thrive over the next few years.
The process results in the production of a corporate strategic plan
Aspects of a good indicator (x7)
Uses timely and reliable data;
Does not create perverse incentives or gaming behaviour;
Has been shown to be valid;
Is meaningful;
Is part of a wider and balanced set of indicators;
Is able to detect issues that need investigation;
Can be communicated to other
prescribing measures to see utilisation of drug
- Item based
- number prescribed,
- not good for chronic conditions - cost
- actual Vs net ingredient - volume based
- Defined daily dose: assumed average maintenance dose per day for a drug used for its main indication in adults.
- Average daily qauntity
need a denominator for taking into account sex, age
hazard ratio
Hazard ratios – the ratio of the hazard of an event in one group of
observations divided by the hazard in another.
Measure the strength of the relationship between a predictor variable and
outcome (in this study suicide)
HR = 1 – the risk is the same in both group (i.e. no difference in risk)
HR >1 – adverse effect / risk of outcome is increased
HR <1 – protective effect / risk of outcome decreased
Assumes that the hazard is constant over time
Factors / predictor variables that can be used can be binary, categorical or
continuous
