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Foundations of Primary Care 2 > Tutorial 2 The Use of Data > Flashcards

Tutorial 2 The Use of Data Flashcards

1
Q

What is the definition of disease?

A

Diagnosis

Bio-medical perspective

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2
Q

What is the definition of the illness?

A

Experience

Patients perspective

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3
Q

What is an example of when disease is present but no illness?

A

Hypertension

This can cause problems when treating (medications)

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4
Q

What are some factors affecting the uptake of care?

A
  1. Concept of lay referral: “granny knows best”
  2. Sources of info: peers, family, internet TV, health pages of newspaper or women’s mag, “What should I do? Booklet, SHOW website, Practice leaflet or website
  3. Medical factors: new symptoms, visible symptoms, increasing severity, duration etc
  4. Non medical factors: crisis, peer pressure “wife sent me”, patient beliefs, expectations, social class, economic, psychological, environmental, cultural, ethnic, age, gender, media etc
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5
Q

What gender and age group visits the GP/practice nurse more?

A 
Female
Older ages (and very young, 4 & under)
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6
Q

What are some possible issues from the patients point of view?

A

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 Ischaemic Heart Disease.

If treatment is proposed, how would he feel better?

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7
Q

What are some possible issues from the GPs point of view?

A

You wish to perform a couple more tests: a Holter Monitor and an Echocardiogram

Assuming they return as confirming AF, you are worried about the consequences for Mr Blackwood’s long term health

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8
Q

What are the three aims of epidemiology?

A

Description: To describe the amount and distribution of disease in human populations.

Explanation: To elucidate the natural history and identify aetiological factors for disease usually by combining epidemiological data with data from other disciplines such as biochemistry, occupational health and genetics.

Disease control: To provide the basis on which preventive measures, public health practices and therapeutic strategies can be developed, implemented, monitored and evaluated for the purposes of disease control.

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9
Q

What does epidemiology compare and why?

A

It compares groups (study populations) in order to detect differences pointing too…..

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10
Q

It compares groups in order to detect differences pointing too…..

A
  1. Aetiological clues (what causes the problem)
  2. The scope for prevention
  3. The identification of high risk or priority groups in society
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11
Q

What does clinical medicine deal with?

A

The individual patient

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12
Q

What does epidemiology deal with?

A

Populations

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13
Q

What may a study population be defined by?

A

Age/sex/location

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14
Q

Numerator/Denominator

A

Numerator: number of events
Denominator: population at risk

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15
Q

What is relative risk?

A

This is the measure of the strength of an association between a suspected risk factor and the disease under study

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16
Q

How is relative risk (RR) calculated?

A

Incidence of disease in exposed group / incidence of disease in unexposed group

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17
Q

Give 6 sources of epidemiological data

A 
Mortality data
Hospital and clinical activity statistics
Reproductive health statistics
Infectious disease statistics
Cancer statistics
General practice morbidity statistics
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18
Q

What is health literacy?

A

Health literacy is about 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

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19
Q

What has the Scottish Government published surrounding health literacy?

A

Making It Easy

20
Q

What is the CHA2DS2-VASc score?

A

Clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrialfibrillation (AF), a common and serious heart arrhythmia associated with thromboembolic stroke

21
Q

What is the score used for?

A

Such a score is used to determine whether or not treatment is required with anticoagulation therapy

22
Q

What does a higher score mean?

A

A high score corresponds to a greater risk of stroke, while a low score corresponds to a lower risk of stroke

23
Q

A score of 1 means…

A

His annual stroke risk is 0.6% per year, and 0.9% of stroke/TIA/systemic embolism

24
Q

What are NOACs?

A

Anticoagulants
These are newer drugs that do not require regular blood test monitoring like Warfarin

Patients will often have heard of them, and the lack of a need for monitoring often appeals to them

25
Q

What are the downfalls of NOACs compared to Warfarin?

A

They are relatively expensive

They are not easily reversed like Warfarin, which can be reversed with Vitamin K in the event of bleeding

26
Q

What can be used to calculate the risk of bleeding?

A

HAS-BLED

Estimates risk of major bleeding for patients an anticoagulation to assess risk-benefit in atrial fibrillation care

Bleeding risk needs to be weighed against the long term consequences of stroke

27
Q

What are descriptive studies?

A

Descriptive studies attempt to describe the amount and distribution of a disease in a given population

28
Q

What is the benefit of descriptive studies?

A

This kind of study does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and candidate aetiologies.

29
Q

What are the advantages and disadvantages of descriptive studies?

A

Such studies are usually cheap, quick and give a valuable initial overview of a problem. They do not provide evidence about the causes of disease. They do not test hypotheses.

30
Q

What framework do descriptive studies follow?

A

The time, place, person framework

31
Q

What are the 3 types of analytical studies?

A
  1. Cross-sectional study
  2. Case control study
  3. Cohort study
32
Q

What is a cross-sectional study?

A

Disease frequency, survey, prevalence study

In cross-sectional studies, observations are made at a single point in time

33
Q

What is the advantage and disadvantage of a cross sectional study?

A

A strength of this method is its ability to provide results quickly; however, it is usually impossible to infer causation

34
Q

What is a case control study?

A

In case control studies, 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)
35
Q

What is the point in a case control study?

A

Data are then gathered on each individual to determine whether or not he or she has been exposed to the suspected aetiological factor(s)

36
Q

What are the results obtained from case control studies expressed as?

A

‘odds ratios’ or ‘relative risks’ (see above)

37
Q

What are cohort studies?

A

In cohort studies, baseline data on exposure are collected from a group of people who do not have the disease under study.

The group is then followed through time until a sufficient number have developed the disease to allow analysis.

38
Q

What do cohort studies allow?

A

Cohort studies allow the calculation of cumulative incidence, allowing for differences in follow up time

39
Q

What are the results of cohort studies normally expressed as?

A

The results are usually expressed as relative risks (see above), with confidence intervals or p values

40
Q

What are trials?

A

Trials are experiments used to test ideas about aetiology or to evaluate interventions

41
Q

What is the definitive method of assessing any new treatment in medicine?

A

Randomised controlled trial

42
Q

Name the 6 factors to consider in interpreting results?

A

Standardisation

Standardised Mortality Ratio

Quality of Data

Case Definition

Coding and Classification

Ascertainment

43
Q

What is bias?

A

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

44
Q

What are the 5 types of bias?

A 
Selection Bias
Information Bias
Follow up Bias
Systematic Error
Publication bias
45
Q

What is a confounding factor?

A

A confounding factor is 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.

In some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration.

46
Q

What are some common confounders?

A

Age, sex and social class

47
Q

What are the criteria for causality?

A

Strength of association

Consistency

Specificity

Temporality

Biological gradient

Biological plausibility

Coherence

Analogy

Experiment

Foundations of Primary Care 2 (4 decks)

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