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PMHP > the key points to learn > Flashcards

the key points to learn Flashcards

1
Q

components of consent

A 
capacity
informed
voluntary
not coerced
not manipulated
valid
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2
Q

valid consent components

A

current
specific
in date

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3
Q

capacity

A 
to act
reasoned decision
communicate decision
understand decision
retain memory
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4
Q

clinical negligence

A 
duty of care
duty was breached
caused/materially contributed to damage
damage was reasonably foreseeable and had negative consequences and effects
= on balance of probability
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5
Q

how long can you sue for?

A

3yrs to sue - from moment you first knew something was wrong

- children until 21

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6
Q

how long should you keep records for?

A

min 11yrs

children until 25

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7
Q

epidemiology

A

study of pops to determine the freq and distribution of disease

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8
Q

roles of epidemiology

A 
monitor infectious diseases
monitor non-infectious diseases
study NH of diseases
investigate RFs of diseases
health needs assessment
development of preventive programmes
evaluation of interventions
health service planning
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9
Q

incidence

A

number of new individuals who contract a disease during a particular period of time

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10
Q

where are incidence estimates obtained from?

A

longitudinal studies/derived from registers

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11
Q

limitations of DMF

A

teeth ext for reasons other than caries
influenced by access e.g. IP surface
diff in differentiating FS from Rxs - underestimate caries
influenced by past disease activity
threshold criteria of disease can vary (must specify)
cannot be used for root caries

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12
Q

types of epidemiological study

A

descriptive (observational)
analytic (observational)
intervention/experimental

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13
Q

descriptive (observational) study

A

measures of disease freq - incidence, prevalence

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14
Q

analytic (observational) study

A

case control

cohort

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15
Q

intervention/experimental study

A

RCT

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16
Q

prevalence

A

number of existing cases

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17
Q

where are prevalence estimates obtained from?

A

CS studies/derived from registers

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18
Q

advantages of sampling

A

reduced number of individuals to be sampled
reduced cost
higher response rate
higher quality of info collected

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19
Q

types of sampling

A 
simple random sample
systematic
stratified
cluster
multi-stage
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20
Q

errors in sampling

A 
sampling/selection bias
response/info bias
measurement error
observer variation
 - intra - you
 - inter
loss to follow up
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21
Q

public health definition

A

the science and practice of preventing diseases, promoting health and improving QOL through the organised efforts of society

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22
Q

aims of public health

A

tackle inequalities

improve reach of services

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23
Q

dimensions of HC quality

A 
person-centred
safe
efficient
equitable
effective
timely
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24
Q

Kerr report

A

inverse care law

reactive (should be anticipatory)

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25
Q

criteria for a public health problem

A

prevalence of condition
impact of condition on individual level
impact on wider society e.g. £
condition preventable and effective txs are available

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26
Q

main roles of public health

A 
epidemiology
health needs assessment
preventing disease and health improvement
addressing health inequalities
policy development
development and implementation of local health strategies
service development - clinical pathways
pt safety
improving governance systems and QI
evaluating health services
teaching and training
research
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27
Q

protected characteristics

A 
Equality Act 2010
age
disability
gender
gender reassignment
pregnancy and maternity
marriage and civil partnership
religion and belief
sexual orientation
race/ethnicity

reasonable adjustments

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28
Q

evidence levels from high to low

A 
SRs and meta-analyses
RCTs
cohort
case-control
CS
ecological studies
case series and case reports
ideas, editorials and opinions
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29
Q

design elements of RCTs

A

inclusion/exclusion criteria
comparison/control group
randomisation
blinding/masking

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30
Q

allocation concealment (selection bias)

A

technique to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until moment of assignment
prevents researchers from influencing which participants are assigned to a given intervention group

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31
Q

advantage of RCTs

A

provide strongest and most direct epidemiologic evidence for causality. Gold standard

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32
Q

disadvantages of RCTs

A

more difficult to design and conduct than observational studies
- ethical issues
- feasibility
- £
still some risk of bias and generalisability often limited
not suitable for all research Qs

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33
Q

CIs VofND

A

diff = 0 ratio = 1

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34
Q

CIs

A

quantify level of uncertainty
tells us the range of values that a true pop tx effect is likely to lie
overlaps/contains VofND - insufficient evidence for a diff

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35
Q

odds ratio

A

intervention odds/control odds

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36
Q

relative risk reduction

A

starting-modified/starting risk x100

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37
Q

absolute risk reduction

A

starting - modified risk

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38
Q

NNT

A

1/ARD

round up

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39
Q

ARD

A

difference in risk between groups

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40
Q

risk ratio

A

risk in tx group/risk in placebo group

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41
Q

risk

A

number of events of interest/total number of observations

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42
Q

odds

A

number of events of interest/number without the event

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43
Q

aims

A

broad goals

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44
Q

objectives

A

specific and define what participants achieve at end of intervention

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45
Q

educational objectives

A

knowledge: increase in level of knowledge
affective: change in behaviour/beliefs
behaviours: acquisition of new skills/competencies

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46
Q

SMART objective

A 
Specific
Measurable
Appropriate
Realistic
Time-related
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47
Q

planning framework

A 
identify needs and priorities
set aims and objectives
decide best way to achieve aims
identify resources
plan evaluation methods
set action plan
ACTION - implement your plan and evaluation
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48
Q

what % of budget is often set aside for evaluation?

A

10-15%

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49
Q

3 Es of evaluation

A

efficiency
effectiveness
economy

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50
Q

3 Es of evaluation - efficiency

A

assess what has been achieved, did intervention have desired effect

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51
Q

3 Es of evaluation - effectiveness

A

measure impact and whether was worthwhile

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52
Q

3 Es of evaluation - economy

A

cost-effectiveness and whether time/labour and money were well-spent

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53
Q

purpose of evaluation

A

inform future plans

justify decisions to others

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54
Q

types of evaluation

A

impact - immediate effects
process
outcome - longer-term

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55
Q

research methods used in evaluation

A 
semi-structured interviews
observation
focus groups
self-response surveys
interview-based surveys
telephone interviews
 = use of both qualitative/quantitative useful
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56
Q

what was the ottawa charter?

A

1st conference in health promotion

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57
Q

aspects of the ottawa charter

A 
building healthy public policy
creating supportive env
strengthening community action
developing personal skills
re-orientating health services
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58
Q

concentration for cleaning blood spills

A

10 000ppm

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59
Q

concentration for cleaning other spills

A

1000ppm

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60
Q

consulting styles

A

directing
following
guiding

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61
Q

domestic abuse response

A 
Ask
Validate "you don't deserve to be hit"
Document
Refer
 - Scottish Domestic Abuse Helpline
 - Rape Crisis Scotland
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62
Q

how long should you keep a consignment note for?

A

3yrs

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63
Q

what should the consignment note contain?

A

description, destination, quantity, origin, transport

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64
Q

principles of waste disposal

A

segregation
storage
disposal
document

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65
Q

F supplements for <0.3ppm F ion level in drinking water - <6m

A

nil

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66
Q

F supplements for <0.3ppm F ion level in drinking water - 6m-3yrs

A

0.25mg

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67
Q

F supplements for <0.3ppm F ion level in drinking water - 3-6yrs

A

0.5mg

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68
Q

F supplements for <0.3ppm F ion level in drinking water - 6-16yrs

A

1mg

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69
Q

F supplements for <0.6ppm F ion level in drinking water - <6m

A

nil

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70
Q

F supplements for <0.6ppm F ion level in drinking water - 6m-3yrs

A

nil

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71
Q

F supplements for <0.6ppm F ion level in drinking water - 3-6yrs

A

0.25mg

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72
Q

F supplements for <0.6ppm F ion level in drinking water - 6-16yrs

A

0.5mg

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73
Q

F supplements for >0.6ppm F ion level in drinking water

A

nil

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74
Q

OARS - communicating behaviour change

A 
Open Qs - how are you managing...?
Affirmation - you've managed to keep up
Reflective listening
Summary - advice
ask permission to discuss health behaviour
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75
Q

cycle of behaviour change

A 
precontemplation
contemplation
preparation
action
maintenance
 = at all stages possible relapse
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76
Q

VBA

A

Ask
Advise
Act
“drip effect”

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77
Q

Brief 5As

A 
Ask
Advise
Assess
Assist
Arrange follow-up
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78
Q

how does F work?

A

reduces demineralisation
makes E more resistant to acid attack
increases remineralisation
can stop bacterial metabolism (at high conc) to produce less acid

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79
Q

OH effects of smoking

A 
staining
PDD
reduced sensation
infection risk
delayed healing
halitosis
caries
black hairy tongue
oral cancers
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80
Q

general effects of smoking

A 
cancers
COPD
chest infections
skin - wrinkling
miscarriage
asthma
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81
Q

nicotine addiction

A

7-10s to hit brain
binds to nicotinic acetylcholine receptor - stimulates dopamine release = satisfaction
drop in nicotine levels = craving and withdrawal

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82
Q

triangle of nicotine addiction

A

emotional attachment
habit
neurochemical changes (chemical addiction)

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83
Q

e-cigs

A

stimulate tobacco smoking through vapourised nicotine delivery without burning conventional tobacco

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84
Q

how effective are e-cigs at helping smokers to quit?

A

moderately effective

harm reduction
hand to mouth habit maintained
psychosocial aspect of addiction maintained
reduction in withdrawal symptoms
control of dosage
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85
Q

disadvantages of e-cigs

A

safety
gateway theory: uptake of cigs
renormalisation of cigs

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86
Q

signs of nicotine poisoning

A

nausea and vomiting
dizziness
headache

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87
Q

nicotine withdrawal

A 
irritability
anxiety
headaches
craving
depression
disturbed sleep
weight gain
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88
Q

champix

A

active ingredient varenicline

  • stimulates nicotinic receptors - relieves craving and withdrawal symptoms
  • also blocks nicotine from acting on nicotinic receptors - prevents rewarding and enjoyable effects of nicotine

= not NRT

89
Q

behaviour change wheel COM-B stages

A 
identify target behaviour(s)
assess underlying reasons
 - COM-B
ways to change/maintain behaviour
 - barriers and facilitators
techniques (BCTs)
implement and evaluate
 - inc feasibility (APEASE)
90
Q

APEASE feasibility

A 
Acceptability
Practicability
Effectiveness
Affordability
Safety (SEs)
Equity
91
Q

chronic heavy drinking oral issues

A 
oral cancer
oral ulceration
glossitis
angular cheilitis
gingivitis - nutritional deficiency
trauma
xerostomia (dehydration)
poor wound healing and OM
erosion
bruxism
92
Q

sources of behaviour

A 
capability
 - physical
 - psychological
opportunity
 - social
 - physical
motivation
 - automatic
 - reflective
93
Q

aspects of the com b behaviour change wheel

A

sources of behaviour
intervention fcts
policy

94
Q

chronic heavy drinking medical issues

A 
GIT
 - acute gastritis
 - liver problems
 - GI bleeding
 - malnutrition
 - cancers
heart
 - arrhythmias
 - cardiomyopathy
 - hypertension
traumatic injuries
skin, muscles, nerves and bones
 - osteoporosis
blood
 - macrocytosis
 - thrombocytopenia
 - leucopenia
Obs-Gyn problems
other
 - poor wound healing, bleeding
 - immune system
 - mental health
95
Q

what do screening tests do?

A

identify people who need more comprehensive assessment for substance misuse disorders
doesn’t make involved diagnosis/assessment

96
Q

oral cancer and alcohol

A

ethanol metabolite acetaldehyde promotes tobacco initiated tumours
damages DNA and alters oncogene production
alcohol facilitates absorption of carcinogenic substances across mucosa
- partly due to thinning (nutritional deficiency)

97
Q

alcohol screening tests

A

AUDIT
FAST
CAGE

98
Q

types of drinking

A

hazardous
harmful
dependent

99
Q

brief motivational interventions

A 
Feedback
Responsibility
Advice
Menu of options
Empathic
Self-efficacy
100
Q

CMO low risk guidelines

A

don’t regularly drink >14 units per week
- spread evenly over ≥3 days
heavy drinking sessions - increased risk of death from long-term illnesses and accidents and injuries
risk of illnesses (inc cancer) increases with any amount you drink on a regular basis
if want to cut down - have several drink free days each week

101
Q

single occasion drinking guidelines

A

limit total amount
drink more slowly with food, alternate with water
avoid risky places and activities
make sure you have people you know around you
ensure you can get home safely

102
Q

3 common risk indices

A

absolute
relative (/)
attributable (-)

103
Q

mainstream smoke

A

smoker inhales then exhales

104
Q

sidestream smoke

A

wafts off end of lit cigarette, more dangerous - more carcinogen

105
Q

3rd hand smoke

A

carcinogen laden residue that builds up on surfaces

106
Q

confounding variable

A

variable which for some reason was left uncontrolled

multiple variables not one exerting influence on outcome of study

107
Q

null hypothesis

A

when making definitive statement impossible to prove therefore a false statement can be made (null) which is then disproven

108
Q

p value

A

probability of obtaining results at least as extreme as the results actually observed during the test, assuming that the null hypothesis is correct
- how likely it is to get a result like this if the null hypothesis is true
could you get this result from luck?
<0.05 data is significant

109
Q

CASP

A

Critical Appraisal Skills Programme

110
Q

CASP components

A

A - are the results valid?
B - results?
C - will the results help locally?

111
Q

intention to treat ITT

A

analyse the data as though the switchers were still in the new agent group
more conservative (preferred)
pragmatic - in real life this will happen
drop outs - can input data

112
Q

per protocol

A

analyse data according to tx actually received
efficacy to explain the effects of the intervention itself
both groups need to be treated exactly the same apart from the factor you are investigating

113
Q

care bundle

A

a set of EB interventions that when used together significantly improves outcomes
aims to ensure pts receive optimum care at every contact

114
Q

split mouth design advantages

A

each participant acts as own control - reduce inter-individual variation
both control and intervention exposed to same env

therefore fewer participants required to obtain same study power as parallel group
every participant receives each intervention therefore good for determining preferences

115
Q

split mouth design disadvantages

A

carry across effects “leakage”
selection of pts (need to have matching carious teeth) might limit external validity
statistical analysis more complicated, isn’t usually done
pt can’t be blinded

116
Q

bundle

A

data collection tool to sample whether optimum care is being delivered

117
Q

factors contributing to adverse events

A

human
structural
clinical

118
Q

QI/clinical governance

A

systematic approach to maintaining and improving the quality of pt care within a health system

119
Q

CG components

A 
education and training (CPD)
clinical audit
clinical effectiveness (EBD)
research and development
openness: Duty of Candour
risk management - to pts and practitioners
120
Q

clinical guidelines

A

systematically developed statements which assist in the decision making about appropriate HC for specific clinical conditions

121
Q

aims of clinical guidelines

A

improve quality of HC
provide recommendations for tx and care
be used to develop standards for clinical audit
be used in education and training of HCPs
help pts make informed decisions
improve communication between pt and HCP

122
Q

how much CPD?

A

100 hours verifiable CPD within 5yr cycle and at least 10hrs verifiable every 2yrs

123
Q

CPD highly recommended topics (pt safety)

A

MEs: at least 10hrs per cycle, at least 2hrs pa
disinfection and decon ≥5hrs every cycle
radiography and radiation protection: at least 5hrs per cycle

124
Q

other CPD recommended areas

A

ethical and legal issues
complaints handling
oral cancer: early detection
safeguarding

125
Q

clinical audit definition

A

a QI process that seeks to improve pt care and outcomes through SR of care against explicit criteria and the implementation of change

126
Q

uses of clinical audit

A 
observe gaps in knowledge
learning
attitudes
protocol
training
127
Q

clinical audit stages

A 
select/identify problem/topic
set criteria
observe practice and collect data
analyse data, determine any deviation from standard
identify any areas of change required
make changes
128
Q

SEA

A 
identify event
collect info
set meeting to discuss
meet and undertake structured analysis
implement changes and monitor progress
write up SEA report
seek external feedback
129
Q

2 things to do after audit cycle

A

implement changes

repeat audit

130
Q

need

A

what people could benefit from

131
Q

demand

A

what people want

132
Q

supply

A

what is provided

133
Q

considering need

A 
normative
felt
expressed
comparative
unmet
134
Q

influences on need, supply, demand

A 
current research agenda
medical knowledge
£
historical patterns
medical influence: prevention or tx?
public and political pressure
media
social and educational influence

= not static

135
Q

SDNAP objectives

A 
health needs assessment
1 - examine and describe the pop
2 - identify needs of pop
3 - examine current service provision
4 - identify how gaps can be met
136
Q

DPH

A

health protection
health promotion
healthcare PH

137
Q

7 special HBs and one PH body

A 
PH Scotland
HIS
SAS
NHS National Waiting Times Centre
State Hospitals Board for Scotland
NHS24
NES
NSS
138
Q

stages of HC planning

A

cyclical constant process

assessment of need
options
decisions on policy
available resources
implementation
evaluation (review)
139
Q

OHIP 2018 key domains

A 
focus on prevention
reduce oral health inequalities
meet needs of an ageing pop
more services on high st
improving info for pts
quality assurance and improvement
workforce
finance
140
Q

SPIKES

A 
setting
perception
information/invitation
knowledge
empathy
summarise and strategy
141
Q

diversity

A

acknowledgement of alterity

142
Q

equity

A

equal outcome

143
Q

categories of discrimination

A 
direct
indirect
associative
perceived
harassment
victimisation
instruction to discriminate
144
Q

stress physiology

A

endocrine system
hypothalamus
increased cortisol

145
Q

stress RFs

A 
demand
control
support
relationships
role 
change
146
Q

burnout

A

process where a prev committed professional disengages from their work in response to stress and strain experienced in the job
exhausted
dissatisfaction with themselves
negative indifferent or cynical attitude

147
Q

MBI 3 scales: Maslach Burnout Inventory

A

emotional exhaustion
depersonalisation
personal accomplishment

148
Q

resilience

A

process of adapting well in the face of adversity, trauma, tragedy and threats

149
Q

4 basic ingredients of resilience

A

awareness
thinking
reaching out
fitness

150
Q

complaints stages

A 
frontline resolution (≤5 WDs)
investigation ( ≤20 WDs)
independent external review
 - NHS - SPSO (pt has 12m)
 - private - HIS or DCS - 6m
151
Q

values

A

subcategory of beliefs
determinants of what we are likely to do
hierarchy - can conflict
value clarification

152
Q

criteria of a value

A 
chosen freely
chosen from alternatives
chosen after thoughtful consideration of consequences of alternatives
we prize this choice
we affirm it to others
act upon it
act upon it repeatedly
153
Q

values and conscience intertwined

A

act on our conscience because of our values

values also form our conscience

154
Q

troubled conscience

A

acting against our value system

155
Q

how are values expressed?

A

in our voluntary actions

156
Q

moral distress

A

others’ decisions trouble us

157
Q

are values related to ethics?

A

may/may not be

158
Q

primary sources

A

single research source

159
Q

secondary sources

A

multiple papers, synthesising together

160
Q

SRs

A

literature review that uses systematic methods to collect secondary data, critically appraise research studies and synthesise studies
designed to provide a complete, exhaustive summary of current evidence relative to a research Q
often quicker and cheaper than embarking on a new study

161
Q

key characteristics of a SR

A 
1 - well-formulated Q
2 - comprehensive data search
3 - unbiased selection and abstraction process
4 - assessment of papers
5 - synthesis of data
162
Q

non-systematic reviews

A

typically invited contributions created by experts to provide an overview or broad summary of what is happening in a particular field
nature means they are susceptible to bias
authors may not clearly state the methodology used, and may be selective in presenting evidence to support a particular, pre-existing view

163
Q

SRs vs single studies

A

save readers time
provide reliable evidence
resolve inconsistencies
identify gaps (catalyst for better studies)
identify when Qs have been fully answered
explore differences between studies

164
Q

why are SRs important?

A 
reduce large quantities of information into manageable portions
formulate policy and develop guidelines
efficient use of resources
increased power/precision
limit bias and improve accuracy
165
Q

authors for SRs

A

≥2
topic expert
methodological expert

166
Q

study protocol for SRs

A

in advance set out what they plan to do methodologically (so you don’t deviate from procedures during it)

167
Q

the process for SRs

A 
authors
study protocol
specific Q
search strategy
inclusion/exclusion criteria
critical appraisal
synthesis
168
Q

SRs specific Q

A

using PICO

169
Q

SRs search strategy

A

comprehensive and repeatable
multiple electronic databases
published and unpublished literature
- research studies that haven’t been published - hard to find
look quite a long way back not just really recent ones
ideally without language restrictions

170
Q

SRs inclusion/exclusion criteria

A

specific

agreed in advance

171
Q

SRs critical appraisal

A

systematic and thorough

risk of bias

172
Q

SRs synthesis

A

qualitative (narrative) synthesis
quantitative pooling of data in meta-analysis
- relative precision and quality of the included studies

173
Q

SRs well-formulated Q

A

PICO

inclusion criteria

174
Q

how reliable are SRs?

A

depends
- methodological quality of the included studies
- quality of the SR itself
- how well was the review conducted?
- AMSTAR2/ROBIS - checklists to assess how well SR
has been done

175
Q

Cochrane

A

evidence tool to enhance healthcare knowledge and decision making
for anyone interested in using high quality info to make health decisions
global independent network
gathers and summarises the best evidence from research - informed choices
does not accept commercial or conflicted funding

176
Q

SR - where should all of the steps be described?

A

in the review protocol

177
Q

what is the first step in the SR process?

A

protocol development

- it should be registered

178
Q

declaration of helsinki

A

every clinical trial must be registered in a publically accessible database before recruitment of the first subject

179
Q

reporting bias SRs

A

statistically significant ‘positive’ results are:

  • more likely to get published - publication bias
  • more likely to be published rapidly - time lag bias
  • more likely to be published in english - language bias
  • more likely to be cited by others - citation bias
180
Q

unbiased selection and abstraction process SRs

A

selection of relevant papers
data extraction to a predefined data extraction form
conducted independently by at least 2 reviewers - done in duplicate
- if don’t agree can get a 3rd to adjudicate
clear description of reasons for exclusion
adequate description of inc studies
details of studies funding sources

181
Q

assessment of papers

A

how well studies have been designed and conducted (methodologically)
independently by at least 2 reviewers
- if don’t agree can get a 3rd to adjudicate
results of assessment should be reflected in analysis

182
Q

‘quality’ assessment tools

A

composite scales

component approach

183
Q

‘quality’ assessment tools - composite scales

A

assign numerical value to individual items to provide overall estimate of quality
problematic - can get same score for different reasons

184
Q

‘quality’ assessment tools - component approach

A

assess relevant methodological aspects individually e.g. randomisation, blinding, drop outs
preferred

185
Q

risk of bias assessment

A

bias determines extent to which results of studies can be believed
a study conducted to the highest possible standards can still have risk of bias
direction of bias: causes overestimation or underestimation of tx effect
magnitude of bias

186
Q

study risk of bias table

A

each author does independently then come together to compare
judge each category as low/unclear/high risk and include comment re support for judgement

random sequence generation (selection bias)
allocation concealment (selection bias)
blinding - outcome assessors
blinding - participants
incomplete outcome data (attrition bias)
selective reporting (reporting bias)
other bias

can form a summary table and a summary graph

187
Q

SR synthesis of data

A

appropriate pooling
- qualitative (narrative)
- quantitative (MA) - inappropriate when data are sparse
or when heterogeneity exists
clear presentation of individual studies inc in the review

188
Q

MA potential advantages

A

an increase in power
an improvement in precision
the ability to answer Qs not posed by individual studies

189
Q

MAs have potential to mislead and should only be undertaken when:

A

minimal differences in characteristics across studies
same outcome measure
data in each study are available - data needs to be extractable

190
Q

SRs - why use risk of bias?

A

in practice, impossible to measure the amount of bias in a study
so do risk of bias assessment

191
Q

dealing with risk of bias

A

variation in risk of bias may be an explanation for heterogeneity between results of different studies - sensitivity analyses
a significant risk of bias in included studies should give rise to cautious conclusions in a SR
- you want them to be a low risk of bias

192
Q

what is a MA?

A

the process of using statistical methods to combine the results of different studies
aim - integrate findings, pool data - identify the overall trend of results
optional part of a SR
calculates a tx effect based on pooled data from a group of studies
estimates a common tx effect across studies
improves the precision of a point estimate by using all available data - getting more participants

193
Q

different types of data

A

dichotomous (binary)
continuous

= whatever type - calculate a single summary statistic to represent the effect found in each study - usually 95% CIs

194
Q

choice of summary statistic for dichotomous data

A 
odds ratio
risk ratio
%/relative risk reduction
risk difference or absolute risk reduction
NNT
195
Q

choice of summary statistic for continuous data

A

weighted mean difference: when all outcomes are using the same scale
standardised mean difference: for when all the studies are assessing the exact same outcome but do it in a variety of ways

196
Q

weighting studies

A

more weight given to studies which give us more info:

  • more participants
  • more events (e.g. prevalence of disease)
  • lower variance
  • may not be able to tell from plot whether variation is lower
197
Q

types of heterogeneity

A

clinical
methodological
statistical

198
Q

clinical heterogeneity

A

variation in participants, interventions, outcomes, study design

199
Q

methodological heterogeneity

A

variation in methods used in studies e.g. quality of allocation concealment

200
Q

statistical heterogeneity

A

excessive variation in the results of studies

variation in tx effects above that expected by chance

201
Q

identifying heterogeneity visually

A

if studies are estimating the same thing we would expect CIs to overlap to a large extent
statistical heterogeneity may appear in forest plots as poor overlap of CIs
- if CIs don’t overlap - can say there is a lot of
heterogeneity
look for outliers

202
Q

interpretation of forest plot

A

if the CI crosses the line of no effect, this is equivalent to saying that there is insufficient evidence for a difference in the effects of the 2 interventions

203
Q

cumulative meta-analysis

A

updates as each trial becomes available

recalculate RR and CI

204
Q

chi squared test of heterogeneity

A

p <0.1 demonstrates statistically significant heterogeneity

- may not be appropriate to pool data

205
Q

I squared statistic

A

% variation due to heterogeneity rather than chance
<50% acceptable
represents level of statistical heterogeneity

206
Q

sensitivity analysis

A

does result change according to small variations in data and methods

  • choice of tx effects of method for pooling
  • inclusion/exclusion of dubious data
  • inclusion/exclusion of trials

should set out plans in protocol if going to include/exclude some data from meta-analysis
- study quality/reasons that make it different to others - see if it makes a difference

a common sensitivity analysis is to repeat the analysis taking out lower quality trials

207
Q

Cochrane GRADE

A 
Grading of
Recommendations
Assessment
Development and
Evaluation
evaluates the quality of the body of evidence (MA)
high, mod, low, v low
e.g. certainty, heterogeneity, risk of bias
208
Q

subgroup analysis

A

where it is suspected in advance that certain features may alter the effect of an intervention
e.g. gender, age groups, specific disease subtypes (mild/mod/severe)
need to predefine subgroups before you start - can’t do it when you see the results

209
Q

fixed effects

A

assumes that the studies are so similar that they are effectively different parts of one large study
assumes that the ‘true’ answer for each study is the same

210
Q

random effects

A

assumes that the studies are slightly different
assumes that the ‘true’ answer for each study will be slightly different from the ‘true’ answer of the others
wider CI
more conservative - prefer it unless really good reason to believe fixed effects

211
Q

5 factors that can lower quality

A

high or unclear risk of bias
inconsistency between studies (heterogeneity)
indirectness (PICO)
imprecision - numbers and CIs
publication bias - likely that negative/null results not published?

212
Q

summary of findings table

A 
summary of key findings from a SR
presents:
 - quality of evidence
 - magnitude of the effect
 - reasons behind judgements
format:
 - PICO
 - outcomes
 - results
213
Q

improving reporting standards

A

CONSORT
EQUATOR
COMET

214
Q

CONSORT

A

evidence-based minimum set of recommendations for reporting RCTs
shown to improve quality of reporting

215
Q

EQUATOR

A

enhancing the quality and transparency of health research

216
Q

COMET

A

core outcome measures in effectiveness trials

- stipulate which outcomes should be used in all clinical trials

217
Q

disadvantage of cochrane reviews

A

don’t incorporate human factors e.g. seeking HC, tx compliance, if they don’t change their behaviour etc

218
Q

registered trials

A

Trials registries - gov
international committee of medical journal editors (ICMJE)
declaration of helsinki

PMHP (1 decks)

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