Session 1

Question 1

What is the term used to describe a situation whereby what is best for an individual patient may not be best for the wider community?

Answer 1

Paradox of the Commons.

Question 2

What can assessing the population tell you about disease and medicine?

Answer 2

• Population based observational studies investigate the causes of disease (e.g. vCJD)
• Population based interventions to treat and prevent disease (e.g. TB outbreak).
• Population based intervention trials to evaluate drugs and interventions (e.g. Thalidomide).

Question 3

What does epidemiology tell us about causation?

Answer 3

That association does not necessarily mean causation. Epidemiology takes a stochastic approach to causation (i.e. there may be a probability/likelihood) rather than a deterministic view of medicine (i.e. association leads to inevitability).

Question 4

What is a definition of Stochastic causation?

Answer 4

An assessment of hypothesis by systematic observations to give a likelihood of future events. For example; probability, likelihood. KEY is that association does not necessarily mean causation.

Question 5

What is a definition of deterministic causation?

Answer 5

Validation of a hypothesis by systematic observations to predict with certainty future events. This refers to the idea of inevitability.

Question 6

How can an epidemiology (population perspective) help make savings in the NHS?

Answer 6

This is the idea of linking into the wider picture and that, for example, using a more expensive drug that is only 5% more effective than a cheaper drug is not beneficial for the population. These small savings could be used elsewhere within the NHS.

Question 7

What are some questions that are key to critical appraisal?

Answer 7

• Is the data BIAS?
• Could the data be down to CHANCE?
• Were there any CONFOUNDING FACTORS?
  Others;
• Was the sample representative?
• Have they used a stratified sample?

Question 8

How can studying the population be useful in terms of disease prevalence?

Answer 8

Studying the local population will give the NHS an idea of disease frequencies and subsequently allow for better planned healthcare that will facilitate the local community.

Question 9

What are some ways of assessing data using averages?

Answer 9

Mean, Median, Mode, Range. Also consider standard deviation. Some of them are distorted by extreme figures which can be a disadvantage and some do not use all of the data (e.g. median).

Question 10

Why is population based evidence important?

Answer 10

It seeks to make a link between association and causality.

Question 11

Name some possible problems with data.

Answer 11

• Unrepresentative of the population.
• Inadequate sample size.
• Appropriate methodology?

Question 12

Why is it important for a doctor to have a perspective beyond that of an individual patient and have consideration for the wider population?

Answer 12

It is important to accept that the overall goal of medicine is to achieve improvements in the health of the general public.
e.g. link to the antibiotics argument.