Quizlet H&S Flashcards

Question

Cancer reform strategy: 4 key drivers for delivery

Answer 1

- Using info to drive qualitiy and choice - Stronger commissioning - Funding world class cancer care - Planning for future

Answer 2

- Cover prevention, screening, diagnosis, treatment + organisation of cancer services through cancer networks: - Model to implement - Bring together health service commissioners + providers, voluntary sector and local authorities - Each network serve 1-2 million people

Answer 3

- Strategic planning - Implementation of national policies - Delivery of improvements in care of patients with cancer - Provide resources to enable network audits and research - Provide channel of communication across the network

Answer 4

- Theory to provide aid to identified victims of illness/accident - Public = more sympathetic to needs of a named person who is dying than an anonymous person - Not captured by QALYs as it aims to provide to all individuals in need - Opposes certain rationing methods - making it unsustainable - Contestable

Answer 5

- Condition = important problem, risk factors known, primary prevention in place - Test = simple, safe, precise and acceptable - Treatment = effective and acceptable, policies on treatment in place - Program = RCT evidence of effectiveness, benefit to outweigh harm - Examples = Chlamydia, Down's, foetal anomalies, newborn bloodspot and hearing, sickle cell, etc.

Answer 6

Setting Perception Invitation Knowledge Empathy Summary

Answer 7

Advance preparation Build relationship Communicate well Deal with patient/family Encourage emotions

Answer 8

Denial Anger Bargaining Depression Acceptance

Answer 9

1. Numbing 2. Yearning/searching 3. Disorganisation 4. Reorganisation

Answer 10

- Active surveillance and investigation - report outbreaks and epidemiology - Reducing infection risk - minimise use and time of use of catheters, tubes, cannulae (use aseptic techniques) - Reduce resevoirs of infection properly cleaned healthcare environment - High standards of hygiene - hand-washing, disinfection protocols - Pruduent use of antibiotics - preference to narrow-spectrum antibiotics

Answer 11

- Reminders - screening, vaccination, testing, medication reviews, risk factor analysis - Diagnosis - match signs/symptoms, highlight abnormal results, match patient with epidemiological studies - Prescribing - which drug, dosage, interactions - Disease management - remind about interacting conditions, NICE guideline support

Answer 12

- GP support - define which cohorts of patients need recalling for medication and disease reviews, screening, etc. (a reminder systems) - Ottawa Ankle Rules - applied as a decision aid for excluding fractures of the mid-ankle and foot (diagnostic decision support)

Answer 13

Investing in worthwhile interventions

Answer 14

Investing the interventions that make the best of scarce resources

Answer 15

- S-F-36 - EQ-5D health surveys - QALYs

Answer 16

- Cost minimisation - Cost-utility - Cost-benefit - Cost-effectiveness

Answer 17

- Only effective if all alternatives produce an equivalent effect - Choose lowest-cost intervention - Only analysis of cost is required

Answer 18

- Combines multiple outcomes into a single measure (eg QALY) - Allows comparisons

Answer 19

- Links costs and outcomes and expresses them both in monetary units - Big problems in attaching a cost to well-being or even life itself

Answer 20

- Includes both cost and a single outcome measure - Allows comparison between interventions - Useful when same condition is examined with a signle primary outcome - Limited use when an intervention has many potential benefits

Answer 21

- A year of healthy life expectancy = 1, a year of unhealthy life = <1. - Williams 1985 if death = 0, possible for QALYs to be negative - Efficient healthcare intervention has a low cost-per QALY - QALYs are ageist, elderly have lower life expectancy, fewer available - QALYs for same treatments - if offered to younger patient

Answer 22

- Life-saving - Financial benefits - Medical, nursing, social worker contact - Relief from loneliness - Further social involvement

Answer 23

- Depression and dependence on hospital personnel - Time consumption impact on social life (travel, clinics) - Limitation of movement - Restriction of fluid intake and diet - Reduction in income - Space required (CAPD)

Answer 24

- Requires transport and delivery - Trained personnel - Space in house - Disposal arrangements

Answer 25

- Distress - Embarrassment - Inconvenience - Self-esteem issues

Answer 26

- Association with morbidity - Depression - Institutionalisation

Answer 27

- Non-compliance with immunosuppressants - Organ rejection - Patient continuing to drink alcohol/take drugs

Answer 28

- Availability of organ - Waiting list + other recipients - Compliance with anti-rejection medication - Likelihood of organ abuse - Likelihood of effective transplantation (match)

Answer 29

True positives/(True positives + false negative) True positives/All truly diseased

Answer 30

High sensitivity = all cases are picked up, there may be false positives Negative result = highly suggestive of freedom from disease Probability of a positive if patient is ill

Answer 31

True negatives/(True negatives + false positives) True negatives/All truly free of disease

Answer 32

- High specificity = all free of disease are labelled free, but there may be false negatives - Positive result is highly suggestive of disease - Specificity is probability of negative, if patient is well

Answer 33

True positives/(True positives + false positives) True positives/All positives

Answer 34

True negatives/(True negatives + false negatives) True negatives/All negatives

Answer 35

- Forgetfulness - Clumsiness - Embarrassment in social situations

Answer 36

Kubler-Ross model of grief (similar)

Answer 37

- Repetitiveness - Forgets social arrangements - Social withdrawal - Delirium - Confusion

Answer 38

Star ratings: - Benefits - focus attention on national priorities, public reassurance, competition boosting performance - Detriments - unmeasured performance suffers, data manipulation, sacrifice of professional autonomy

Answer 39

- Wait for emergency admission - Wait for first cancer investigation - Finances - Cleanliness - Staff satisfaction - Waiting times - Clinical governance - Deaths within 30 days of surgery

Answer 40

- Clinical urgency/severity, potential health gain, productivity and economic loss, space available and length of time waiting

Answer 41

- Environmental Agency - protects England & Wales - Scottish Environment Protection Agency (SEPA) - Scotland

Answer 42

- Decrease in pulmonary functioning - Increased prevalence of respiratory symptoms - Sensitisation to allergens - Respiratory infections (rhinitis, bronchitis, pneumonia) - Occupational asthma

Answer 43

- NO, NO2, SO2, CO - Environmental tobacco smoke - Formaldehyde - Infectious organisms - Particulate matter

Answer 44

Forgetfulness, loss of concentration, not paying attention, moral weakness

Answer 45

Inadequate education, lack of resources, poor quality equipment, unsafe environment

Answer 46

National reporting and learning system (NRLS) - for anonymous reporting, near misses and learning from mistakes Medicine and healthcare-products regulation agency (MHRA) - ensures medicines and equipments meet standards of safety, quality, performance and effectiveness

Answer 47

Forming wrong intentions/plans as a result of inadequate knowledge or experience

Answer 48

Applying the wrong rule at a familiar pattern

Answer 49

Attention slips and memory lapses, due to interruptions and distractions

Answer 50

Regularly performed shortcut due to poor system design, may be accepted over time

Answer 51

Deviation from protocol with good reason, due to time constraints, abnormal conditions and patient's best interests

Answer 52

Deliberate deviation from protocol where harm is foreseeable and ignored, although not intended

Answer 53

Deliberate deviation from protocol with intention to cause harm

Answer 54

Used to specify treatment if a person later loses their capacity to make a decision. Typically end of life decisions in patients suffering from degenerative cognitive impairment (Alzheimer's, dementia, Huntington's, etc.)

Answer 55

- Understand + retain information that is relevant - Patient believes information - Patient can weight information from both sides and arrive at a decision

Answer 56

- Gives legal right to refuse treatment when capacity lost - Respects patient autonomy - Encourages openness and forward-planning - May reduce anxiety of unwanted treatment

Answer 57

- Therapeutic options may change after directive is established - Patient's questionable rationality about future interests - Possibility of coercion or mistaken diagnosis

Answer 58

- Thought to be a catalyst to change - Little evidence to support effectiveness at actually curing disease - BUT - self-healing thought to be triggered by therapies

Answer 59

- Some have own regulatory bodies, practitioners must pass certain tests to prove safety - BUT, most don't have them, or are self-regulatory

Answer 60

- Acupuncture - Chiropractic - Herbal Medicine - Homeopathy - Osteopathy

Answer 61

- Statutory regulation of practitioners - Evidence of clinical effectiveness - Evidence of cost-effectivess - Provision of funds within the NHS

Answer 62

- Adverse effects (media, friends, family) - Bad previous experiences - Child's emotional response to needle - Distrust in public information

Answer 63

- People may think herd immunity = safest option (so child does not risk adverse effects of vaccine) - Reduces coverage and causes loss of herd immunity - Vaccinations are NOT a legal requirement for school entry - preserves individual rights

Answer 64

- BNF - MIMS - Travel Doctor - NHS Choices

Answer 65

Significant portion of the population is vaccinated to provide a degree of protection to the population that is not immune

Answer 66

Greater the proportion of resistant population = less likely a susceptible individual is to be exposed to an infected individual Disease control is attained when the effective reproductive number (R) is less than/equal to 1 90% coverage is required to allow herd immunity from a mumps outbreak

Answer 67

Susceptibility of the population, average number of secondary cases in absence of immunity (Ro)

Answer 68

- No other reservoirs of infectious agent (animals/environment) - Scientific and political prioritisation of specific agent has to exist (money + time more available) - result of infection being serious and common - Examples of eradicated diseases - polio and smallpox

Answer 69

- Certain diseases classed as notifiable and practitioners MUST inform local authority of these diseases - PUBLIC HEALTH ACT 1988 (infectious diseases) + 1984 (control of diseases)

Answer 70

30 notifiable diseases (in back of BNF) HIV not a notifiable disease - practitioners must take steps to ensure any sexual partners of infected patients are informed Examples - meningococcal meningitis, cholera, diphtheria, legionnaire's, MMR, tetanus, TB, whooping cough, yellow fever, etc.

Answer 71

- What we think of our own appearance and how we think others see our bodies Many factors - most important = - youth/old-age - weight/size - what is important is stereotypes that come with attributes

Answer 72

- Positive - plastic surgery for scarring, reconstructive surgery for cleft palate, medication for skin conditions - Negative - drug side-effects (thalidomide), cosmetic surgery problems, or certain reproductive techniques that can cause cleft palate/IUGR - Steroid treatment - weight increase, etc.

Answer 73

Regard management of pain and other symptoms as paramount, along with provision of psychological, social and spiritual support

Answer 74

Achieve best quality of life for patients and families when medical cure is unavailable

Answer 75

Helping patient to cope from pre-diagnosis, through diagnosis, treatment to cure (if treatable), or contiuing illness to death and bereavement

Answer 76

- Primary health care team - Nursing homes - Social services - Specialist nurses - Specialist physicians (trained in palliative care) - Hospices - Marie Curie + Macmillan nurses

Answer 77

Care + support provided especially in terminal stage of cancer often in the home

Answer 78

Care + support from diagnosis, working with other health care professionals

Answer 79

Important to remember that as technology advances a patient is still a person (not a stat) so maintain that death is not always a medical failure

Answer 80

- Mortality + morbidity - Crime + public disorder - Social relationship issues - Occupational issues - Dependence/addiction - Resource consumption in NHS - Acute - accidents, poisoning, violence, suicide - Chronic - all-organ damage

Answer 81

- Hazardous - drink above sensible limits, but not yet harmed - Harmful - drink above sensible limits and experiencing harm - Dependent - drink above sensible limits and experiencing harm and symptoms of dependence (CAGE)

Answer 82

- Alcohol generally found in complement to cannabis, other illicit drugs and mainly tobacco - To the point where increase in price of alcohol, can lead to decreased consumption of all of them

Answer 83

- Pleasure - Affordability - Marketing - Culture, social norms, peer pressure - Emotional and psychological issues

Answer 84

- Provide better communication with public - Prevent + tackle alcohol's harms to health - Reduce alcohol-related crime and disorder - Work with the alcohol industry

Answer 85

- Population-based - price and tax controls, availability controls, advertising controls, education - Problem-based - fines, severe interventions for alcohol-related crime (eg drink-driving), drink-free areas - Controlling continued alcohol abuse - support groups, counselling, AA, medication

Answer 86

- Changes in lifestyle and eating habits - Less time given to preparing food, eat-out more - Changes in food processing (minimal processing favoured) - Extended shelf-lives and pre-preparation - Changes in agricultural practices (intensive farming) - Fish farming changes - Improved reporting and diagnostic techniques

Answer 87

- Notifiable illness under Public Health act 1984 - objectives of surveillance are; 1. prevention + control of contaminated products 2. knowledge of disease-causing agent 3. administrative guidance on how to control the situation

Answer 88

- Public education - Staff training - Food inspectors - Good quality raw materials - Use of fridges - Clean surfaces and clean water - Disposable equipment

Answer 89

Epidemic curves - used to graphically represent an outbreak, good for identifying certain aspects of outbreak: - Pattern of spread - Magnitude - Outliers - Timing - Exposure - Disease incubation period

Answer 90

R = Effective Reproduction Number Ro = Average number of secondary infections produced by a typical infective agent S = Portion of the population that is susceptible (not immune)

Answer 91

Average number of secondary infections produced by a typical infective agent Altered by infectivity of organism, duration of infectiousness and population density

Answer 92

Portion of the population that is susceptible (not immune) Altered by immunity of the population (eg by vaccination or prior exposure)

Answer 93

- R < 1: number of cases decreases - R > 1: number of cases increases so when R=1 (this is called Epidemic threshold)

Answer 94

- To achieve elimination of a disease, R must be less than 1 - Set R as 1 in equation and rearrange it we can make 1 = Ro x S - Rearrange again to make S* = 1/Ro - S* is critical proportion susceptible - Herd Immunity Threshold = 1 = S*

Answer 95

- Surveillance - Preventative measures - Outbreak investigation - Appropriate control measures - Education + training - Monitoring clinical practice

Answer 96

- Expanded programme on immunisation (EPI) - Global polio eradication initiative (GPEI) - Global alliance for vaccines and immunisations (GAVI)

Answer 97

Action of giving birth

Answer 98

- Pail relief - Doctor's attendance - Safety - Cleanliness (contradictory) - Higher status (contradictory) - Care after birth

Answer 99

Suicide - thought to be caused by a mixture of exhaustion and hormonal changes

Answer 100

- Screening - management plans for at-risk mothers - use of mental health teams - psychiatrists in maternity units

Answer 101

Language bias - statistically significant results are more likely to be translated into - English than non-significant results (BUT they are equally important when conducting a systematic review)

Answer 102

- Publication bias - occurs when publication of a study is influenced by its results, hence inclusion of only published studies may overestimate the intervention effect - Shown when drug companies conduct trials of their own drugs - not as good as they hope so they don't publish it

Answer 103

- Measure of disease burden including both quality and quantity of life lived - Used in assessing value for money of a medical intervention

Answer 104

- Based on number of years of life that would be added by intervention - Each year of perfect health = 1, to a value of 0 for death - If extra years are not lived in full health (eg loss of limb) = between 0 and 1

Answer 105

- Good for rationing - Making best of scarce resources

Answer 106

- Difficulty in measuring quality of life (how do you measure QoL of someone else?) - Who should decide on whether someone's QoL will be good/bad? (threat of bias) - Double jeopardy objection (person who needs treatment for something - eg cancer, may lose out due to another illness - eg arthritis that is unrelated) - For terminally ill with major disease - less than a normal patient with minor illness - always left without treatment - Ageism - older people = less QALYs

Answer 107

When deciding on who to provide treatment to (eg who to offer a transplant to) - lifestyle of recipient is taken into account to decide whether or not it may be more beneficial to give it to someone else

Answer 108

Those who behave in ways that contribute to their ill health (eg smoking, taking drugs) are less deserving of treatment Justification looks backward at life of the individual

Answer 109

- Those who engage in behaviours that contribute to their ill-health are more likely to be deterred from such behaviour if they are denied treatment - Justification looks forward at the life of the individual

Answer 110

- Benefits of treating those who do not contribute to their ill health is likely to be more substantial and longer-lasting than others. - Justification looks forward at life of the individual

Answer 111

- Many who engage in behaviour that contributes to ill health may not be responsible for their decisions - may have lacked knowledge it was dangerous. - Therefore unfair to punish someone for something he/she had limited control over - It is unclear whether the threat of non-treatment would deter an individual from behaviour that contributes to ill-health, particularly where there is addiction

Answer 112

- For many reproduction is a fundamental for living a life of value - having a family is one of the most important things - Restrictions on rights to start a family are considered very invasive and abuse of state power - Remember, not being permitted access to assisted reproduction therapy is different from forcibly sterilised by the state

Answer 113

- Deafness is only disabling because of the way society is organised - a couple could raise a child in a way that it means it will not be disabled - We all have fundamental interests in making reproductive choices and this is clearly something parents want strongly so should not prohibited from doing it - Child is likely to have a worthwhile life, no-one is harmed, people should do what they want

Answer 114

- Deafness is disabling, given reality of society, intentionally creating a disadvantaged child - Even if child has a good life, its right to an open future has been violated and its future been constrained due to others - Not be permissible to deliberately deafen a foetus or an infant and this procedure amounts to the same thing

Answer 115

- To be of benefit, must be aimed at detecting a disease that can be cured or for which subsequent impact can be lessened by early intervention - Tests employed should be accurate in order to avoid any undue anxieties from false positives, or missing cases through false negatives - Cost also important

Answer 116

- Alphaferoprotein - raised in neural tube defects, allows more specific focus to those at risk - Down's Test - based on alphaferoprotein and HCG. Levels of these in conjunction with mother's age can be used to calculate risk. - Allowing for more invasive procedures (amniocentesis) - Ultrasound - check growth against estimated time of delivery and identify anomalies, cardiac and diaphragmatic hernia easily identified, smaller defects harder

Answer 117

- Phenylkenonuria (PKU) - aims to prevent brain damage from build-up of toxic phenylketones - Thyroid-stimulating hormone (congenital hypothyroidism) - hormones essential for neuron development - Immunoreactive trypsin (IRT) - cystic fibrosis

Answer 118

- Check for any congenital abnormalities - weight - height - head circumference - plot centiles and hearing

Answer 119

- Heart murmurs - DDH - testicular descent - red reflex - vision/hearing - plot centiles

Answer 120

6-9 month check - hearing distraction, gait 18-24 month check - walking gait, speech, Hb, plot centiles, educational needs 5-6 year school nurse check - vision, hearing, plot centiles

Answer 121

Promotes improvement in quality of both NHS and private and voluntary healthcare in England and Wales

Answer 122

- Set national standards - create implementation strategies with an agreed timescale - to raise quality and reduce variations in service delivery

Answer 123

Concept of an illness affecting a person's day-to-day life so that they can't continue to be within the social norm - due to employment, housing, etc.

Answer 124

- No financial incentive - Time constraints - Perceived lack of liability - What the patient expects

Answer 125

- Clinical uncertainty - Over-confidence in own competence - Information overload

Answer 126

- Practice routine - Disagreement from superiors - Own medical training - Advocacy (eg drug reps)

Answer 127

- Education - courses and conferences - Audit and feedback - Reminders on computers - Mass media influence - Finance budgets

Answer 128

- Theoretical perspectives are useful when considering implementation - All interventions have the potential to help implement research into practice - No single approach is superior, we need all of them

Answer 129

- Muscle weakness - History of falls - Gait, visual, balance deficit - Depth perception or contrast sensitivity deficit - Cataracts - Arthritis - Depression - Cognitive impairment - Impaired ADL - Age > 80 years

Answer 130

- Psychological problems - Fear of falling - Loss of mobility - Social isolation - Depression and dependence - Disability - Institutionalisation - Impact on carers

Answer 131

- Fall prevention (handles, walking stick, home assistance) - Hip protectors - Visual deficit correction - Treatment of osteoporosis (biphosphonates, vit D, Ca, HRT) - Gait training and balance exercises - Medication review (sedatives) - Postural hypotension check

Answer 132

- Treating fracture - inpatient costs - ward stay - remainder surgery - investigations - multiple minor injuries - dealing with the psychological issues (dependency, isolation, depression, carers, etc.)

Answer 133

- When patient falls and is unable to get up to call for help so found a lot later - Serious and can lead to hypothermia, pressure sores, pneumonia and even renal damage due to muscle breakdown

Answer 134

- Urban homelessness - IV drug abus - Neglect of TB control programmes - AIDS epidemic

Answer 135

- Crowded living conditions (easy airborne transmission) - Population with little native resistance

Answer 136

- Incidence in Africa 10 times higher than America - Incidence in Birmingham 20 times higher than rural Hertfordshire

Answer 137

- Vaccinate the population - Develop better diagnostic techniques - Treat with multi-drug therapy to prevent resistance

Answer 138

- Works on Subjective Expected Utility Theory (SEUT) - divides a decision task into its components - Utilises decision trees to structure the task and adds evidence in the form of probabilities to examine risks associated with different options. - Then examines the utility or benefit/detriment achieved of each option and finally suggests the most appropriate decision

Answer 139

- Structure the problem as a decision tree - Assess probability of every choice branch - Assess utility of every outcome state - Identify option which maximises utility by working from right to left, multiplying the utilities by the probabilities

Answer 140

- Square nodes - decisions, represent choice - Circle nodes - chance, represent uncertainty

Answer 141

- Makes all assumptions explicit - Allows examination of the decision process - Integrates evidence into decisions

Answer 142

- Probabilities are often estimates - Estimates are subjective to overconfidence and bias - Often required data doesn't exist

Answer 143

A preventative measure that brings large benefits to the community offers little to each participating individual

Answer 144

Portion of incidence of a disease in the population (exposed and non-exposed) that is due to exposure Incidence of a disease in the population that would be eliminated if the cause of exposure was eliminated, can be expressed as a value or percentage

Answer 145

A situation in which a measure of the effect of an exposure is distorted because of an association of the exposure with other factors (confounders) that influence the outcome under study

Answer 146

- Limit participants of study that have possible confounders - Means less data and can be difficult with multiple confounders

Answer 147

- Make comparison groups (with and without the confounder) - Used for things like age and sex in case-control studies

Answer 148

- Analyse exposure with sub-groups of the confounder - Adjust for confounding (if there are few variables) - Recombine data - Means sometimes these sub-groups have very few participants in them

Answer 149

- Coefficients are established for the confounder groups - Allows for better adjustment

Answer 150

Waiting times are beneficial to NHS for a number of reasons, including as a way of rationing resources and making we make the best of resources we have

Answer 151

Patient with suspected cancer must be seen within 2 weeks

Answer 152

- Average (or median) waiting time of patients - Average (or median) waiting time for those on waiting lists - Number of people on the list - Proportion of those waiting more than X hours - Proportion of those on waiting list waiting more than X days - Time to clear the list

Answer 153

- More doctors - Day case surgeries - Targets and penalties to practices - Performance and star ratings - Incentives to reduce lists - Other providers of care

Answer 154

- McGill pain questionnaire - Self-report questionnaire - Visual analogue scale (VAS) - Pain diary - Clinical interview

Answer 155

- Take a full history of the problem - Explore effects on lifestyle (work, leisure, hobbies) - Explore effects on interpersonal relations (children, friends, partner - sex) - Explore effects on self-perception - Find if anything relieves or exacerbates it - Explore the patient's coping strategies

Answer 156

- Pain is carried in A delta/C fibres - gate theory implies impulsies carried in other (A beta) fibres can inhibit pain impulses - closing the gate - How rubbing a painful spot, or using a TENS machine works to reduce pain

Answer 157

- Systematic introduction of error that can distort the results in a non-random way - Case-control studies are prone to recall bias, cohort studies are prone to selection bias

Answer 158

1. Convert need for info into answerable question 2. Identify best evidence with which to answer question 3. Critically appraise the evidence for its validity, impact and applicability 4. Integrate critical appraisal with clinical expertise and patient's unique circumstances 5. Evaluate our effectiveness and efficiency in carrying out steps 1-4 and seek ways to improve

Answer 159

Was assignment of patients to treatments randomised?

Answer 160

Was there an independent blind comparison with a reference (or 'gold') standard of diagnosis?

Answer 161

Was a defined representative sample of patients assembed at a common (usually early) stage in the course of their disease?

Answer 162

Were there clearly defined groups of patients, similar in all important ways other than exposure to the treatment or other cause?

Answer 163

- Was assignment of patients randomised? - Were the groups similar at the start? - Aside from intervention, were the groups treated equally? - Were all entered patients accounted for? - Were all patients analysed in groups that were originally placed? - Were the patients and clinicians kept blind (very important with a subjective outcome)?

Answer 164

- Can you identify the main hypothesis and how does this match what you're looking for? - Is it an appropriate study design for the hypothesis? - How was exposure and outcome measured and could there be bias? - Was the assessment of outcome blind to exposure status? - Were confounding factors identified and were they accounted for?

Answer 165

- Is this a systematic review of RCTs? - anything less than RCT is inadequate - What was the search strategy? - Studies with negative results or foreign languages are unlikely to be included - How was validity of individual studies assessed? - Are the results consistent from study to study?

Answer 166

- How large was the treatment effect? (relative risk, absolute, reduction, NNT or outcome difference on a continuous scale (PEFR, BMI)) - How precise was the treatment effect (confidence intervals)?

Answer 167

- Same as RCT and Observational +: - Can you interpret the results in a Forest plot? - Plot of meta-analysis results that easily shows variation between studies

Answer 168

- Are my patients similar to those tested? - If the trial was held abroad, can it be applied in my setting? - Are those interventions feasible in my clinical setting? - Will the benefits outweigh harm in my patient?

Answer 169

Accuracy, how well the study was conducted, taking confounders into account and removing bias

Answer 170

Generalisability, how well it can be applied to different scenarios, patients and environment

Answer 171

Cohort and Case-Control - they do not intervene, only observe

Answer 172

Find a sample that has been exposed to a certain exposure and follow that sample to observe the outcome; working forward in time

Answer 173

Find a sample that already has a certain outcome, follow them back to find out if they were exposed to a certain exposure

Answer 174

- Often large, difficult to follow up large groups of patients, especially with something such as monitoring diet - Hard to conduct if length of time from exposure to outcome is very long (eg for some cancers) or if exposure you're observing is rare - Need to look out for confounders

Answer 175

- Often affected by recall bias - participant cannot remember when they were exposed, or their outcome changes their perception of the exposure - Or affected by selection bias - where control group has other factors that may influence their exposure

Answer 176

Range of values that is 95% likely to contain the true value

Answer 177

Value that shows how much variation there is from the mean

Answer 178

- Likelihood that the observed result is due to chance - P > 0.05 is not statistically significant

Answer 179

Ratio of probability that something will happen, to the probability that it won't happen

Answer 180

- Where some of the participants (patients, clinicians, researchers) are prevented from knowing certain information that may lead to conscious or unconscious bias on their part

Answer 181

- Procedure for protecting the randomisation process; person randomising patients does not know what the next treatment allocation will be - Prevents selection bias affecting which patients are given which treatment (bias randomisation is designed to avoid)

Answer 182

Analysis based on initial treatment intended from allocation, not the treatment eventually adminstered (eg if a patient dropped out or changed treatment)

Answer 183

How accurately the intervention is reproduced from a manual, protocol or model

Answer 184

Number of patients that are needed to be treated with the experimental therapy to prevent one negative outcome 1/ARR (absolute risk reduction)

Answer 185

- To try and ensure any characteristics of the sample population that may affect the results (confounders) are distribute equally between the study groups - Avoids selection bias

Answer 186

- Occurs when length of intervals are analysed by selecting intervals that occupy randomly chosen points in time or space - Explains why cancers detected on screening may, on average, be more slowly progressive

Answer 187

- Explains why survival following diagnosis is not a good measure of the effect of screening - Early detection through screening inevitably increases the period of time a person 'survives' with a diagnosis - all patients apparently gain the 'lead time' by which screening brings forward diagnosis

Answer 188

Stopping a disease state from ever starting

Answer 189

Limiting the severity of outcomes that occur once a disease has begun

Answer 190

- Reducing the consequences of outcomes that have occured - Rehabilitation is generally a form of tertiary prevention - for example a fracture has occured, but effective rehabilitation may be key to maintaining mobility despite fracture

Answer 191

- No difference between two trialled items/methods - Eg the effect of both drugs on symptoms is the same

Answer 192

News that negatively alters the patient's (or relative's) view of the future

Answer 193

To avoid stress of breaking bad news, doctors may normalise the consequences of a diagnosis or falsely reassure the patient

Answer 194

- Recognise/Acknowledge emotion - Remain calm - Do not dismiss it - Apologise and express sympathy

Answer 195

- Whether patient is caring for themselves - Whether patient is caring for one or more others - Patient's socio-economic status - Where patient keeps medication and how they go about taking it - Information relating to cleanliness/personal hygiene needs (whether fresh food in fridge, etc.) - Environmental factors that might make a difference to health care needs (eg steep stairs, lack of wheel chair ramps) - Any signs/indication of elderly abuse - Support from informal carers - Mobility related to ADLs (able to go upstairs to toilet/bed, make coffee/tea) - Cold, damp causing respiratory symptoms

Answer 196

- Give information on how to access help/support 1) Assess whether patient needs any help with ADLs - eg carers 2) Assess whether they are eligible for any financial support - Possibility/signs of neglect Assess whether any need for modifications

Answer 197

1) Assess whether patient/family need any nursing support 2) Assess whether a community occupational therapy assessment is necessary 3) Assess medication compliance/need for Dosset box 4) Discuss patient's nursing needs at MDT meetings 5) Administer immunisations

Answer 198

Multi-compartment medicine compliance aid - lots of compartments for each day, so patient knows what to take

Answer 199

- Physically exhausted from having to help with ADLs - lead directly to injuries eg bad back or decreasing immunity - Increased risk of depression due to continual demands of being a carer and feeling isolated - Less time to attend to own health needs - Added poverty can impact on medical and physical health

Answer 200

Legal obligation on one party to take care to prevent harm suffered by another

Answer 201

Outside hospital/doctor's surgery a doctor does not normally owe a duty of care if he did not attempt to help Doctors are not legally obliged to act as 'Good Samaritans' However, if doctor states they are a doctor or starts to act is if they are a doctor, then they will have taken on a duty of care to that patient

Answer 202

- Causation - Duty: a duty of care existed between doctor and patient - Breach: the doctor's practice fellow below the standard of care expected

Answer 203

- Whether the claim satisfies the 'but for' test: Basic rule of causation in common law requires the claimant to show that, 'but for' the defendant's negligence , he/she would not have been injured - Whether the claimant is able to establish on the 'balance of probabilities' that the negligent action caused the injury This requires the claimant to show that the injury was more likely to have occured as a result of their doctor's negligence than not

Answer 204

- Whether doctor has a moral obligation to assist - Whether doctor has a professional obligation to assist

Answer 205

- Reduced worldwide polio incidence - less risk of infection - IPV safer than OPV as it is not a live vaccine - Modern IPV is more effective than older types of IPV (but not more effective than OPV)

Answer 206

- Health economists identify 'need' on 'capacity benefit' - Antibiotics are 'needed' for treating bacterial sepsis as patients may benefit - Antibiotics are not 'needed' for treating a viral infection as patients cannot benefit Therefore: Resources should be distributed according to patients' capacity to benefit

Answer 207

- A rigorous summary of all the research evidence that relates to a specific question - By bringing together all the relevant evidence, disadvantages of single studies can be guarded against

Answer 208

- English-language only - Only one database searched - Only publicated studies?

Answer 209

Good practice because: - Assessing quality is important because studies with weaker designs will be less valid and can overestimate effects - Using two independent reviewers to assess quality makes it less likely that errors will be made - Using pre-agreed criteria helps make the process objective and transparent

Answer 210

- RCT groups are likely to be similar with respect to known and unknown determinants of outcome, therefore we can be more confident that any observed differences in outcome are due to the intervention - In observational studies, patient and clinician preference rather than randomisation determines whether a patient is allocated to intervention or comparison group - In absence of randomisation, greater risk of imbalance in both known and unknown determinants of outcome, so observed differents in outcome might be unrelated to the intervention

Answer 211

Statistical technique for quantitatively combining the results of multiple studies that measure the same outcome into a single pooled or summary estimate

Answer 212

Intended to give logically conclusive support for the conclusion, as opposed to giving the conclusion probable support

Answer 213

Needs: - Conclusion to follow logically from the premises - It to be impossible for the premises to be true and the conclusion to be false

Answer 214

Argument is sound if the conclusion follows logically from premises that are in fact true

Answer 215

Positive predictive value

Answer 216

Way to limit confounding, often used to control for differences in age groups when comparing rates of disease in two populations with different age structures

Answer 217

Ratio between observed number of deaths in a study population to the number of expected deaths

Answer 218

Required we know the age-specific rates of mortality in all populations under study

Answer 219

Only requires that we know the total number of deaths and the age structure of the study population

Answer 220

Small numbers in particular age groups

Answer 221

- Illuminates total cost of disease, offers no evidence as to relative cost effectiveness of competing interventions that can be used to mitigate its burden on patients and society (so of little use to clinicians and policy makers)

Answer 222

- Use of a test to assist in identification of a disease or condition among people who do not have symptoms for that disease/condition

Answer 223

- Overweight/Underweight children are identified and parents can take appropriate action - Schools take action to tackle obesity Importance of obesity is highlighted in the community - NHS and/or local authority have information that can be used to plan services to tackle obesity - Local obesity figures and performance can be measured

Answer 224

- False positives results leading to anxiety as well as unnecessary interventions - Opportunity cost of the programme for the NHS (and individual) Increased diagnostic activity