PP number 2

Question 1

what is a systematic review and what are its components?

Answer 1

secondary research; ‘study of studies’; provides quantitative evidence.

explicit search strategy
 clear inclusion/exclusion criteria
 two raters
 quality criteria
 appropriate analysis
 measure of heterogeneity
 sample-size and bias not obscuring effect

Question 2

What is the aim of a meta-analysis? what are its problems?

Answer 2

to derive one overall effect-size from multiple studies

the typical, overall effect may not apply to the
individual
• the review might be conducted badly
• an effect might be missed due to inappropriate pooling of studies/measures
• the results might be inconsistent with large randomized controlled studies

Question 3

2 points highlighted by mortality data.

Answer 3

use in epidemiology

Plan and evaluate health services

Question 4

who signs a death certificate? where does it go? what does part 1 consist of?

Answer 4

The attending doctor
The relatives take the death certificate to the Registrar of Births & Deaths to register the death
Part I of the Cause of Death Statement is for conveying the sequence of events leading to death, and the condition triggering that sequence is called the UNDERLYING CAUSE OF DEATH – this single cause is coded into the mortality data

Question 5

how are screening programmes potentially harmful?

Answer 5

leads to over diagnosis

patients may be treated for diseases which would never have caused harm

Question 6

What is the definition of research?

Answer 6

generates new knowledge (potentially transferable or generalizable) to fill a gap in evidence-base

Question 7

what is the definition of evaluation?

Answer 7

judges the worth of an evidence- based service, technology, medicine, practice, or other intervention in terms of effectiveness and/or efficiency

(e.g. whether it meets its objectives; whether it works; whether there is value-for-money; whether the outputs justify the costs)

Question 8

what is an audit?

Answer 8

compares practice (cyclically) against evidence-based standards, recommends quality improvement

Question 9

What does NICE do?

Answer 9

• PRODUCING evidence based guidance and advice for health, public health and social care practitioners.
• DEVELOPING quality standards and performance metrics for those providing and commissioning health, public health and social care services
• PROVIDING a range of informational services for commissioners, practitioners and managers across the spectrum of health and social care

Question 10

what is a major benefit of population level prevention?

Answer 10

saves money

Question 11

What is the bradford hill criteria? (9)

Syrians Cause Sensational Tension in Bradford which Precipitates Conservative E-Xenophobic Attitudes

Answer 11

examines causal assocciation

 strength
 consistency
 specificity
 temporality
 biological gradient 
 plausibility
 coherence
 experiment
 analogy

Question 12

What is the prevention paradox?

Answer 12

Many people must participate in a prevention programme yet only a few will receive the direct benefit

Question 13

What is a randomised control trial

Answer 13

are ‘prospective’, are mostly ‘analytical’ (vs descriptive), involve ‘intervention’ (vs
observation), and measure ‘efficacy’ (moreso than effectiveness)

Question 14

What are the challenges of RCTs?

Answer 14

are challenged by technical and ethical constraints on intervening, e.g.:
 ‘first, do no harm’
 informed consent
 approval
 randomizing properly
 managing the trial process  acceptability of intervention  non-participation
 monitoring outcomes
 ending a trial early
 consider: ‘allocation concealment’ vs ‘blinding’

Question 15

what is the index of multi deprivation? (7)

Answer 15

Seven (weighted) domains:
 Income deprivation
 Employment deprivation
 Education, skills and training deprivation
 Health deprivation and disability
 Crime
 Barriers to housing and services
 Living environment deprivation

Question 16

What is health promotion?

Answer 16

The process of ENABLING people to INCREASE CONTROL over and improve their health.

It involves the population as a whole in the context of their EVERYDAY LIVES, rather than focusing on people at risk for specific diseases, and is directed towards action on the determinants or causes of health

Question 17

define disability adjusted life years?

Answer 17

Years of potential life lost + years lived with a disability.

Question 18

6 quantitative study designs from descriptive to analytical

Answer 18

case report
case series 
cross-sectional study
(observational)
      
case-control study 
cohort study

clinical trial (randomized, RCT)
(intervention)

Question 19

P-value Vs 95%CI

Answer 19

P=0.1 therefore not statistically significant at the level of 0.05

If the null hypothesis were true, the probability of obtaining these data by chance would be 0.1

(i.e. greater than the arbitrarily set level of 1 in 20),
thus there is insufficient evidence to reject the null hypothesis

Question 20

Vital events (examples of routine data)

Answer 20

birth notification
birth registration
congenital anomaly reporting
abortion notification
Hospital episode statistics (maternity records inc miscarriage and ectopic)
estimated conceptions (excludes miscarriage and illegal termination)
death certificate

Question 21

whats on a death certificate

Answer 21

1 a)disease or condition directly leading to death

b) other disease or condition leading to a)
c) other disease or condition leading to b)

2 other significant conditions contributing to the death but not related to the disease or condition causing it

Question 22

What is the clinical iceberg?

Answer 22

1/3 see a doctor
1/3 self medicate or endure symptoms
1/3 do nothing, have mild symptoms, have no symptoms at all

Question 23

What is the maxwell criteria?

Answer 23

Measure the quality of a service

EEE
Effectiveness (does it work)
Efficiency (is the outcome maximal)
Equity (is it fair)

AAA
Acceptability (is it in the form that we want)
Accessibility (can people get it)
Appropriateness (is it relevant to needs)

Question 24

what is ecological fallacy

Answer 24

bias that occurs from applying conclusions to an individual bases on analytical findings from group data

Question 25

what is the wilson and hunger criteria?

Answer 25

Classic screening criteria 1 programme should respond to a recognised need 2 programme objectives should be defined from the outset 3 there should be a defined target population 4 there should be scientific evidence of the screening programmes effectiveness 5 there should be effective education, testing, clinical services and programme management 6 there should be quality assurance, with mechanisms to minimise potential risks of screening 7 the programme should ensure informed choice, confidentiality and respect for autonomy 8 there should be equity and access to screening for the entire target population 9 programme evaluation should be planned from the outset 10 the overall benefits of screening should outweigh the harm

Question 26

absolute vs relative risk

Answer 26

``` absolute= the probability of an event under study relative = the ratio of the risk of disease among the exposed to the risk amongst the unexposed ```