The Use of Data Flashcards
What is general practice?
The interface between the public and the medical profession on one hand, and primary and secondary care on the other hand
What is the difference between disease and illness?
Disease = symptoms, signs, diagnosis, biomedical perspective Illness = ideas, concerns, expectations, experience of disease
What factors affect the uptake of care?
Concept of lay referral
Sources of info: peers, family, internet, TV, newspaper, magazines, practice leaflets or website
Medical factors: new symptoms, visible symptoms, increasing severity, duration
Non-medical factors: crisis, peer pressure, ‘wife sent me’, patient beliefs, expectations, social class, economic, physiological, environmental, cultural, ethnic, age, gender, media
How does age/gender affect uptake of care?
Age:
Young children more likely
Then drops and steadily increases with age
Gender:
Females more likely to receive care than men
What are the investigations for AF?
ECG
U+Es
TFTs
FBC
Diagnose a 66yo male with AF, what are some issues from the patients point of view?
Believes himself to be healthy
Is physically fit
Proud not to be using tablets
Both he and his wife associate all illnesses to do with the heart with IHD
Diagnose a 66yo male with AF, what are some issues from the GPs point of view?
Wish to perform a couple more tests - Holter monitor and echocardiogram
If confirm AF, worried about the consequences for patient’s long-term health
Diagnose a 66yo male with AF, what are some topics that might come up in a consultation?
What would you like to cover in this consultation?
Issues that GP brings up
Issues that the patient brings up
In detail, what are the three main aims of epidemiology?
Description: to describe the amount and distribution of disease in human populations
Explanation: to explain the natural history and identify aetiological factors for disease usually by combining epidemiological data with data from other disciplines
Disease control: provide the basis on which preventative measures, public health practices and therapeutic strategies can be developed, implemented, monitored and evaluated for the purposes of disease control
Overall, what are the three main aims of epidemiology?
Description
Explanation
Disease control
Epidemiology compares groups in order to detect differences pointing to what?
Aetiological clues (what causes the problem)
Scope for prevention
Identification of high risk or priority groups in society
What is the difference between clinical medicine and epidemiology?
Clinical medicine = individual patient
Epidemiology = populations
What is the ratio used when talking about people at risk?
Numerator = events Denominator = population at risk
Why is the at risk part important for events/population at risk ratio?
Everyone in the denominator must have the possibility of entering the numerator, and conversely those people in the numerator must have come from the denominator population
What is incidence?
The number of new cases in a disease in a population in a specified period of time
What is prevalence?
The number of people in a population with a specific disease at a single point in time or in a defined period of time
What is an example of an illness which could have a high incidence but a low prevalence?
A cold
What is an example of an illness which could have a low incidence but a high prevalence?
Diabetes
What is relative risk?
A measure of the strength of an association between a suspected risk factor and the disease under study
What is the equation for relative risk (RR)?
RR = incidence of disease in exposed group/incidence of disease in unexposed group
What are some sources of epidemiological data?
Mortality data Hospital activity statistics Reproductive health statistics Cancer statistics Accident statistics General practice morbidity Health and household surveys Social security stats Drug misuse databases Expenditure data from NHS
What is health literacy?
People having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems
How has the Scottish Government tried to help health literacy?
Making it Easy - A healthy literacy action plan for Scotland
What is the CHA2DS2-VASc score?
Clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation (AF)
What does the CHA2DS2-VASc score use to determine the risk of stroke?
Age Sex CHF history Hypertension history Stroke/TIA/thromboemolism history Vascular disease history Diabetes history
What are NOAC’s?
New oral anticoagulants
What are the advantages of NOACs?
Do not require regular blood test monitoring like Warfarin
What are the disadvantages of NOACs?
Relatively expensive
Not easily reversed like Warfarin
What reverses Warfarin?
Vitamin K
What is the scoring system for estimating the risk of major bleeding?
HAS-BLED
What are SIGN guidelines?
Guidelines based on systematic review of scientific literature and are aiming at aiding the translation of new knowledge into action
What are the SIGN guidelines intended to do?
Help health and care professionals and patients understand medical evidence and use it to make decisions about healthcare
Reduce unwarranted variations in practice and make sure patients get the best care available
Improve healthcare across Scotland by focussing on patient-important outcomes
What are different types of studies?
Descriptive studies
Cross-sectional studies
Case control studies
Cohort studies
What are descriptive studies?
They attempt to describe the amount and distribution of a disease in a given population
Does not provide definitive conclusions about disease causation but may give clues to possible risk factors and candidate aetiologies
Cheap, quick, give valuable initial overview of problem
What is a cross-sectional study?
Observations made at single point in time looking at disease frequency, survey, prevalence study
What is a case control study?
Two groups of people are compared:
A group of individuals who have the disease of interest are identified (cases)
A group of individuals who do not have the disease (controls)
Look at previous exposures to potentially identify risk factors and compare
What are cohort studies?
Baseline data on exposure are collected from a group of people who do not have the disease under study
Group is then followed through time until a sufficient number have developed the disease to allow analysis
Can compare expose and not exposed/diseased and not diseased
What are trials?
Experiments used to test ideas about aetiology or to evaluate interventions
Which type of trial is the definitive method of assessing any new treatment in medicine?
Randomised controlled trial
How does the trial of a new treatment work?
Intervention group receive new treatment, the control group receive a placebo or current standard therapy and the treatment outcomes are compared in the two groups
How does a trial involving disease work?
Two groups at risk of developing a disease: a study group and control group
An alteration is made to intervention group (suspected causative factor removed or neutralised) whilst no alteration is made to control group
Aim is to determine whether modification of factor alters the incidence of the disease
What are factors to consider when interpreting results from trials?
Standardisation Standardised mortality ratio Quality of data Case definition Coding and classification Ascertainment
What is standardisation?
Set of techniques used to remove the effects of differences in confounding variables, when comparing two or more populations
What is standardised mortality ratio?
A standardisation death rate converted into a ratio for easy comparison
A figure below 100 means fewer than expected deaths, and above 100 means more
What does quality of data mean?
Is the data trustworthy?
What is case definition?
Whether an individual has the condition of interest or not
What is coding and classification?
When data is being collected routinely, it is normal to convert disease info to a set of codes to assist in data storage and analysis
What is ascertainment?
Is the data complete - are any subjects missing? Higher incidence rates in countries that look harder for cases of a given disease.
What is bias?
Any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth
What are different types of bias?
Selection bias
Information bias
Follow up bias
Systematic error
What is selection bias?
When the study sample is not truly representative of the whole study population
What is information bias?
Arises from systematic errors in measuring exposure or disease
What is follow up bias?
Arises when one group of subjects is followed up more than another to measure disease incidence or other relevant outcome
What is systematic error?
There is a tendency for measurements to always fall on one side of the true value e.g. instrument calibrated wrongly/user error
What is a confounding factor?
One which is associated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease
What is consistency?
Repeated observation of an association in different populations under different circumstances
What is specificity?
A single exposure leading to a single disease
What is temporality?
The exposure comes before the disease
What is a biological gradient?
Dose-response relationship
As the exposure increases so does the risk of disease
What is biological plausibility?
The association agrees with what is known about the biology of the disease
What is coherence?
The association does not conflict with what is known about the biology of the disease
What is analogy?
Another exposure-disease relationship exists what can act as a model for the one under investigation
What are the criteria for causality?
Strength of association Consistency Specificity Temporality Biological gradient Biological plausability Coherence Analogy Experiment
What is the only absolute criterion for causality?
Temporality
What could you discuss with a patient after a differential diagnosis?
Use of QOF data to illustrate relevance and practice of epidemiology
SIGN guidelines/NICE/local
Study design
Screening programmes
You are a GP and want to know if your practise is doing it’s best for patients with a condition (AUDIT).
What questions would you ask?
What do you want to assess?
How could you do this?
How would you compare your figures with neighbouring practices?
How would you compare your figures with regional and national figures?
List possible suggestions for disparities between figures
You are on GP placement, you want to ensure that these antiviral treatments are being prescribed appropriately. You decide to do an audit. You need to set criteria and standards, how would you do this?
Could define own: time consuming/needs more research
Could utilise others if available: guidelines based on systematic review of evidence e.g. NICE guidelines
What does NICE provide for doing audits?
Produce audit toolkits for their guidelines with criteria and standards defined
What is an audit?
A process used by health professionals to assess, evaluate and improve care of patients in a systematic way
Audit measures current practice against a defined/desired standard
What are the stages in the audit cycle?
Stage 1 - preparation Stage 2 - select criteria Stage 3 - measuring level of performance Stage 4 - making improvements Stage 5 - maintaining improvements
What could be limitations of an audit?
Misses patients who should have received drug but didn’t
