the key points to learn Flashcards

Question

criteria for a public health problem

Answer 1

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

Answer 2

``` 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 ```

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

diff = 0 ratio = 1

Answer 10

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

Answer 11

intervention odds/control odds

Answer 12

starting-modified/starting risk x100

Answer 13

starting - modified risk

Answer 14

1/ARD | round up

Answer 15

difference in risk between groups

Answer 16

risk in tx group/risk in placebo group

Answer 17

number of events of interest/total number of observations

Answer 18

number of events of interest/number without the event

Answer 19

broad goals

Answer 20

specific and define what participants achieve at end of intervention

Answer 21

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

Answer 22

``` Specific Measurable Appropriate Realistic Time-related ```

Answer 23

``` 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 ```

Answer 24

efficiency effectiveness economy

Answer 25

assess what has been achieved, did intervention have desired effect

Answer 26

measure impact and whether was worthwhile

Answer 27

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

Answer 28

inform future plans | justify decisions to others

Answer 29

impact - immediate effects process outcome - longer-term

Answer 30

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

Answer 31

1st conference in health promotion

Answer 32

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

Answer 33

directing following guiding

Answer 34

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

Answer 35

description, destination, quantity, origin, transport

Answer 36

segregation storage disposal document

Answer 37

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

Answer 38

``` precontemplation contemplation preparation action maintenance = at all stages possible relapse ```

Answer 39

Ask Advise Act "drip effect"

Answer 40

``` Ask Advise Assess Assist Arrange follow-up ```

Answer 41

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

Answer 42

``` staining PDD reduced sensation infection risk delayed healing halitosis caries black hairy tongue oral cancers ```

Answer 43

``` cancers COPD chest infections skin - wrinkling miscarriage asthma ```

Answer 44

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

Answer 45

emotional attachment habit neurochemical changes (chemical addiction)

Answer 46

stimulate tobacco smoking through vapourised nicotine delivery without burning conventional tobacco

Answer 47

moderately effective ``` harm reduction hand to mouth habit maintained psychosocial aspect of addiction maintained reduction in withdrawal symptoms control of dosage ```

Answer 48

safety gateway theory: uptake of cigs renormalisation of cigs

Answer 49

nausea and vomiting dizziness headache

Answer 50

``` irritability anxiety headaches craving depression disturbed sleep weight gain ```

Answer 51

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

Answer 52

``` 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) ```

Answer 53

``` Acceptability Practicability Effectiveness Affordability Safety (SEs) Equity ```

Answer 54

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

Answer 55

``` capability - physical - psychological opportunity - social - physical motivation - automatic - reflective ```

Answer 56

sources of behaviour intervention fcts policy

Answer 57

``` 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 ```

Answer 58

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

Answer 59

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)

Answer 60

AUDIT FAST CAGE

Answer 61

hazardous harmful dependent

Answer 62

``` Feedback Responsibility Advice Menu of options Empathic Self-efficacy ```

Answer 63

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

Answer 64

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

Answer 65

absolute relative (/) attributable (-)

Answer 66

smoker inhales then exhales

Answer 67

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

Answer 68

carcinogen laden residue that builds up on surfaces

Answer 69

variable which for some reason was left uncontrolled | multiple variables not one exerting influence on outcome of study

Answer 70

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

Answer 71

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

Answer 72

Critical Appraisal Skills Programme

Answer 73

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

Answer 74

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

Answer 75

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

Answer 76

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

Answer 77

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

Answer 78

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

Answer 79

data collection tool to sample whether optimum care is being delivered

Answer 80

human structural clinical

Answer 81

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

Answer 82

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

Answer 83

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

Answer 84

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

Answer 85

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

Answer 86

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

Answer 87

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

Answer 88

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

Answer 89

``` observe gaps in knowledge learning attitudes protocol training ```

Answer 90

``` 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 ```

Answer 91

``` 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 ```

Answer 92

implement changes | repeat audit

Answer 93

what people could benefit from

Answer 94

what people want

Answer 95

what is provided

Answer 96

``` normative felt expressed comparative unmet ```

Answer 97

``` current research agenda medical knowledge £ historical patterns medical influence: prevention or tx? public and political pressure media social and educational influence ``` = not static

Answer 98

``` 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 ```

Answer 99

health protection health promotion healthcare PH

Answer 100

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

Answer 101

cyclical constant process ``` assessment of need options decisions on policy available resources implementation evaluation (review) ```

Answer 102

``` 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 ```

Answer 103

``` setting perception information/invitation knowledge empathy summarise and strategy ```

Answer 104

acknowledgement of alterity

Answer 105

equal outcome

Answer 106

``` direct indirect associative perceived harassment victimisation instruction to discriminate ```

Answer 107

endocrine system hypothalamus increased cortisol

Answer 108

``` demand control support relationships role change ```

Answer 109

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

Answer 110

emotional exhaustion depersonalisation personal accomplishment

Answer 111

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

Answer 112

awareness thinking reaching out fitness

Answer 113

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

Answer 114

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

Answer 115

``` 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 ```

Answer 116

act on our conscience because of our values | values also form our conscience

Answer 117

acting against our value system

Answer 118

in our voluntary actions

Answer 119

others' decisions trouble us

Answer 120

may/may not be

Answer 121

single research source

Answer 122

multiple papers, synthesising together

Answer 123

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

Answer 124

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

Answer 125

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

Answer 126

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

Answer 127

``` 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 ```

Answer 128

≥2 topic expert methodological expert

Answer 129

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

Answer 130

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

Answer 131

using PICO

Answer 132

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

Answer 133

specific | agreed in advance

Answer 134

systematic and thorough | risk of bias

Answer 135

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

Answer 136

PICO | inclusion criteria

Answer 137

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

Answer 138

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

Answer 139

in the review protocol

Answer 140

protocol development | - it should be registered

Answer 141

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

Answer 142

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

Answer 143

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

Answer 144

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

Answer 145

composite scales | component approach

Answer 146

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

Answer 147

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

Answer 148

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

Answer 149

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

Answer 150

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

Answer 151

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

Answer 152

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

Answer 153

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

Answer 154

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

Answer 155

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

Answer 156

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

Answer 157

``` odds ratio risk ratio %/relative risk reduction risk difference or absolute risk reduction NNT ```

Answer 158

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

Answer 159

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

Answer 160

clinical methodological statistical

Answer 161

variation in participants, interventions, outcomes, study design

Answer 162

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

Answer 163

excessive variation in the results of studies | variation in tx effects above that expected by chance

Answer 164

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

Answer 165

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

Answer 166

updates as each trial becomes available | recalculate RR and CI

Answer 167

p <0.1 demonstrates statistically significant heterogeneity | - may not be appropriate to pool data

Answer 168

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

Answer 169

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

Answer 170

``` 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 ```

Answer 171

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

Answer 172

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

Answer 173

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

Answer 174

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?

Answer 175

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

Answer 176

CONSORT EQUATOR COMET

Answer 177

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

Answer 178

enhancing the quality and transparency of health research

Answer 179

core outcome measures in effectiveness trials | - stipulate which outcomes should be used in all clinical trials

Answer 180

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

Answer 181

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

the key points to learn Flashcards

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