Surgery Flashcards
What PICO question did the trial address?
What is the purpose of randomisation?
To ensure that known and potential prognostic factors are balanced between the treatment groups, i.e. control for confounding and bias in patient allocation.
Which technique, commonly used to control for placebo effect and bias in assessment of outcomes, could not be used in this trial?
Blinding of patients and assessors. Because of the obvious identity of the study groups, treatment allocation was not blinded to patients or surgeons. Site investigators were blinded to interim outcome reports until all patients had undergone their final evaluation.
What is the name of the technique by which the randomised groups are analysed? Why is this used?
Intention-to-treat analysis. First, it is necessary to preserve the strengths of randomisation. Randomisation ensures that known and potential prognostic factors are balanced between the treatment groups. This balance may be lost if some patients are excluded from the analysis or analysed according to how they self-selected rather than how they were randomised. Second, it estimates the treatment effect in real-world clinical practice where patients often do not adhere to treatments, rather than the treatment’s efficacy when taken correctly.
What is an RCT?
A randomised controlled trial is often used to test the efficacy of various types of interventions within a patient population. The study subjects, after assessment of eligibility and recruitment but before the intervention begins, are randomly allocated to receive one or other of the alternative treatments under study.
What is the purpose of blinding?
➢ Blinding to treatment type and randomisation of participants aim to reduce bias.
What is Confounding?
Confounding: interference by a third variable to distort the association being studied between two other variables, because of a strong relationship with both of the other variables. For example, when looking at BMI and heart disease, age and sex are confounders that need to be accounted for, as these affect both BMI and heart disease.
What is the p-value?
What are Confidence Intervals?
What is Haddon’s Matrix?
Why is preventing falls important?
- Incidence?
- Service Utilisation?
Complete a Haddon’s Matrix for Falls prevention?
What is a Systematic Review?
What is a Meta-analysis?
Complete a Haddon’s Matrix for the prevention of road traffic accidents?
List 2 advantages and 3 disadvantages of case-control studies.
Who is the ideal control for a case-control study?
The ideal control is a person (or persons) who would have been enrolled in the study as a case if they had had the disease.
What is confounding? How do researchers control for confounding?
Confounding occurs when a third factor influences independently both the disease and exposure and is not a factor on the causal pathway.
What is Regression analysis?
Regression analysis is a statistical technique for estimating the relationships among variables. It can be used to control confounding. The goal of regression analysis is to determine the values of parameters for a function that cause the function to best fit a set of data observations that you provide. In linear regression, the function is a linear (straight-line) equation.
What is a disadvantage of each of the following study types:
- Cross-sectional?
- Case-control?
- Cohort?
- RCT?
What is sensitivity?
Sensitivity is the proportion of people with the disease that have a positive test result (a/a+c).
What is Specificity?
Specificity is the proportion of people without disease who have a negative test result (d/b+d).
What is positive predictive value (PPV)?
Positive predictive value is the probability of disease in a patient given a positive test result or post- test probability of a positive test result (a/a+b).
What is negative predictive value (NPV)?
Negative predictive value is the probability that disease is absent in a patient given a negative test result (d/c+d).
According to the CanMEDS Physician Competency Framework, list the seven roles that a physician needs to fulfil to effectively meet the health care needs of their patients and the broader community.
What actions should you take in the clinical context in order to fulfil your role as an advocate for your patient? This is an example of reactive health advocacy.
What are your statutory responsibilities in this situation?
If she has a notifiable STI you need to report it to the WA Health Department using an Infectious Disease Notification Form. If you form a reasonable belief that she has been sexually abused you need to make a mandatory report to the Department of Child Protection.
What should you do next to act on these concerns?
Once you have gained the support of key stakeholders, what actions could you take at the health service level to minimise such incidents in the future?
Discuss these concerns with key stakeholders. These include, first and foremost, the immediate medical or surgical team that you are working with, specifically the consultant physician or surgeon. Other stakeholders include, but are not limited to, staff in Clinical Quality and Safety, Medical Education, Surgery, ED, Sexual Health/Infectious Diseases. You will need to obtain the support of key stakeholders before being able to proceed with investigating or acting on these concerns.
List at least 4 other organisations that you and the group of elders should consider working in partnership with, and explain how their involvement would assist in addressing these issues.
How does the regulatory environment of health care compare to advocacy?
What advocacy strategies would you consider using and explain why, taking into consideration any unintended and/or adverse effects that could result from using each selected strategy.
What are 4 different ways as a junior doctor in which you can assist with mitigating the harmful effects of climate change?
What is a clinical audit?
A clinical audit is the systematic peer evaluation of an aspect of patient care. The process, which may be multidisciplinary, involves a cycle of continuous improvement of care based on explicit and measurable indicators of quality. A quick way to think about the clinical audit cycle is the Plan-Do- Study-Act cycle.
What are the nine stages of the audit cycle?
List 7 Examples of methods for providing information on quality of clinical care.
What are Morbidity and mortality meetings?
What are 8 criteria that can be used to help rank potential audit topics in order of priority?
What is the difference between Prevalence and Incidence?
