Tutorial 2

Question 1

% of people consulting GP and % to hospital

Answer 1

20

3

Question 2

Why is the hierarchy of healthcare not completely accurate?

Answer 2

severity of illness does not accurately parallel severity of disease

Question 3

Definition of disease

Answer 3

signs, symptoms, diagnosis, biomedical perspective

Question 4

Illness definition

Answer 4

ICE

Question 5

4 factors affecting uptake of care

Answer 5

lay referral
sources of info eg peers family, TV, leaflet
medical factors - symptoms, visible, worse, duration
non medical - crisis, peer pressure, social class, beliefs, psychological etc

Question 6

5 possible issues from patients point of view for starting treatment

Answer 6

believes himself to be healthy
physically fit 
proud not on tablets 
associations 
will he feel better

Question 7

possible issues from GP’s point of view for starting treatment

Answer 7

more investigations
worried about consequences for his health
info sources to educate yourself

Question 8

3 main aims of providing information

Answer 8

description
explanation
disease control

Question 9

Description (epidemiology)

Answer 9

Describe amount and distribution of disease in human populations

Question 10

Explanation (epidemiology)

Answer 10

natural history
aetiological factors
epidemiological and data from other sources

Question 11

Disease control (epidemiology)

Answer 11

provide bases on which preventative measures, public health practices and therapies developed, implemented, monitored and evaluated

Question 12

What does epidemiology compare and what does this help with?

Answer 12

groups/populations
aetiological clues
scope for prevention
identification of high risk or priority groups

Question 13

General difference between clinical medicine and epidemiology

Answer 13

clinical medicine - individual patient

epidemiology - populations

Question 14

minor illness incidence and prevalence

Answer 14

high incidence but low prevalence

Question 15

Other illness eg chronic incidence and prevalence

Answer 15

low incidence

high prevalence

Question 16

Relative risk

Answer 16

strength of association between associated risk factor and disease under study

Question 17

How to calculate relative risk

Answer 17

incidence in exposed/incidence in unexposed

Question 18

Sources of epidemiological data

Answer 18

mortality data 
reproductive health stats
cancer stats 
accident stats
GP morbidity 
health and household surveys
hospital activity stats
social security stats 
drug misuse database 
expenditure data from NHS

Question 19

Health literacy

Answer 19

having the knowledge, skills, understanding and confidence to use heath information to be active partners in their care and navigate health and social care systems

Question 20

Risk calculators

Answer 20

CHADS2 - AF stroke

bleeding

Question 21

SIGN guidelines

Answer 21

systematic review of literature
help health and social care professionals and patients
reduce variation in care
improve healthcare

Question 22

Descriptive studies

Answer 22

Describe the amount and distribution of a disease in a given population

Question 23

What do descriptive studies give clues about and what do they not?

Answer 23

does not = causation

does - possible risk factors and candidate aetiologies

Question 24

Advantages of descriptive studies

Answer 24

cheap, quick, valuable initial overview of problem

Question 25

When are descriptive studies useful?

Answer 25

identifying emerging public health problems
assessing effectiveness of measures
assess needs for planning
hypotheses about aetiology

Question 26

Cross sectional studies

Answer 26

frequency survery, prevalence study

observations at single point in time

Question 27

Conclusions from a cross sectional study

Answer 27

relationship between disease and variables of interest in a defined population

Question 28

Strength of cross sectional studies

Answer 28

quick results, but cannot do causation

Question 29

Case control studies

Answer 29

compare 2 groups
cases - have disease
controls - do not have disease

Question 30

In a case control study what is data gathered on?

Answer 30

exposure to suspected aetiological factor

Question 31

Cohort studies

Answer 31

baseline data on exposure collected from group of people who do not have the disease and followed until some of them do

Question 32

Trials

Answer 32

experiments used to test ideas about aetiology or evaluate interventions

Question 33

Definitive method for assessing any new treatment

Answer 33

randomised controlled trial

Question 34

6 factors to consider in interpreting results

Answer 34

standardisation 
standardised mortality ratio
quality of data
case definition 
coding and classification
ascertainment

Question 35

Bias

Answer 35

any trend in collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth

Question 36

4 types of bias

Answer 36

selection
information
follow up
systematic error

Question 37

Cofounding factor

Answer 37

associated independently with both disease and exposure under investigation

Question 38

best way possible to prove causation between exposure and disease

Answer 38

demonstrate a weight of evidence in favour of a casual relationship

Question 39

Only absolute criterion for causality

Answer 39

temporality

Question 40

Temporality

Answer 40

The exposure comes before disease

Question 41

AUDITs - could do own or others?

Answer 41

need to set criteria and standards to measure
time consuming and need research
utilise others - guidelines

Question 42

Interventions before repeat audit?

Answer 42

inappropriate prescribed and tell them not to do it again
present audit results to practice
circulate current guideline summary to gps

Question 43

Limitations of audit?

Answer 43

only of those prescribed

misses patients who should have received drug but did not