PBL Flashcards
One of the secondary outcomes was death from noncardiac causes; 8 occured in the preventative PCI group and 6 in the no preventative PCI group; Hazard ratio= 1.10 95%CI: 0.38 - 3.18. p = 0.86. What does the p value tell us?
Greater than 0.05, therefore the result is not statistically significant and could have arisen by chance. No evidence that preventative PCI increases risk of non cardiac death.
OR
0.86 = 86% chance that hazard ratios as large/larger than 1.10 is preventative PCI has no effect on non cardiac deaths
Why are patients randomised in trials?
Why is the randomisation done after the patients are deemed eligible?
Ensure treatment groups are similar in all aspects apart from treatment intervention AND to reduce bias.
If patients are allocated and then found uneligible, it will affect the number of people in each category in the study - there won’t be equal numbers. ALSO if patients randomised first, may influence decision about eligibity
What is the difference between an intention to treat analysis and an on treatment analysis?
When will they give the same answer?
ITT: people analysed according to group, regardless of whether they actually received treatment.
OT: only includes those in the treatment category that actually underwent treatment.
Would give the same answer if all ‘to treat’ patients were treated.
Why might a trial be stopped early?
If results are so statistically significant that it’d be unethical to continue
What are the 2 main methods for measuring health inequality in the UK?
Give 2 social risk factors for depression.
What does ‘prevalence’ of a disease describe?
1) deprevation at area level
2) individual occupational status
Socioeconomic status, family violence and disharmony, poverty, occupational stress, poor education, social isolation, intergenerational MH problems, substance misuse, poor prenatal nutrition, LGBT
Number of cases of disease in a particular population at a given time.
Define ‘felt’ and ‘enacted’ stigma.
What is the purpose of a ‘joint strategic needs assessment’ and a ‘joint wellbeing health strategy’?
Felt: feeling of shame and discrimination stops people seeking help for MH problem
Enacted: direct discrimination = unfair treatment of others based on their MH condition e.g. stigmatising words/phrases
Both aim to improve health and wellbeing of the community and decrease inequalities for all ages
What is a ‘health and wellbeing board’? Where are they based?
Forum where key leaders from health and care system work together to improve health and wellbeing of their local population and reduce health inequalities. Led by public health teams based in local authorities.
What is public health?
Name the top 4 most common musculoskeletal disorders globally.
What is the focus of the WHO International Classification of Functioning, Disability and Health? What are the key components of health it includes?
Improving service, health protection and health improvement
OA, RA, lower back pain, gout
Integrates medical and social models of disability, recognising the significance of social and physical environments which affect functioning and disability. Key components: body structures, functions, impairments, activities and participation.
How does public health work to reduce the disease burden of musculoskeletal conditions?
What is patient centrerd care?
Developing work safe measures and public education campaigns to reduce prevalance and raising awareness of prevalence of musculoskeletal conditions.
Providing care that is respectful of, and reponsive to an individual patient’s preferences, needs and values, and ensuring that patient’s values guide all clinical decisions. 8 principles: respect for values/needs, coordination and integration of care, info and edu, physical comfort, emotional support and alleviation of fear and anxiety, involvement of family/friends, continuity, care access
Describe 2 challenges that you see when integrating public health into a clinical GP setting and explain why you see these as challenges.
Any 4 from:
1) GP’s asked to include many different questions as part of public health in patient consultation which means consultation isn’t patient centred
2) GPs distracted watching PC screen with checklists of questions they must ask as part of screening process
3) Pts with higher levels of education and health literacy will understand better why the dr has to question them - those with lower levels may feel frustrated and annoyed, thus producing inequity.
4) Perceived interference and intrustion on dr pt relationship be having a predetermined agenda of questions asked which doesn’t fit patient centred care. Dr may see this as lack of autonomy
5) The tension between patient centrerd knowledge and dr led knowledge is a tension between novice vs expert or disqualified knowledge verses legitimised knowledge
Give 4 risk factors associated with being admitted to hospital with asthma.
Describe self-efficacy
What is PAAP, and who would be involved in using it?
Geographical area, ethnicity, poor control of symptoms, lack of shared decision making with professional regarding care, lack of regular medication review, lack of asthma care plan.
An individual’s perception of the degree to which they are capable of performing a given behaviour.
Personal asthma action plan. Patient, health professional who gives it to patient e.g. specialist asthma nurse, hospital doctors etc.
Outline Michie’s Behaviour Change Wheel. What is it used for and what are the compoents? How could Shahid’s GP use it in his consultation with him about his asthma?
A framework for health behaviour change. It’s used as a framework for discussing health behaviour change with patients. To change behaviour in an individual: uses the capability, opportunity and motivation of the individual.
In the case control study of recreational drug use and testes cancer the cases and controls were matched for age - why?
The odds ratio of heroin use and testes cancer is 0.92 with a 95% CI of 0.24 to 3.59. What does the CI mean?
Age is a potential confounder associated with testes cancer risk as younger men are more likely to get it. It is also associated with drug use, so that roughly the same amount of exposure to drugs.
95% CI: we are 95% confident that heroin use may decrease the risk of TC by 76% or may increase it by 3.6 times. There is no evidence that heroin use decreases the risk of TC.
List 3 Bradford Hill Criteria for Causation and explain what they are.
Strength of Association: how big is RR/OR/HR?
Dose response: does RR/OR increase as dose increases?
Time sequence: does disease happen after exposure?
Consistency of findings: similar studies in different populations
Biological plausibility
Coherence of evidence: other types on studies
Reversibility: if stop detrimental action, does disease risk decease?
