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H&S > YEAR 2 H&S (Quizlet) > Flashcards

YEAR 2 H&S (Quizlet) Flashcards

1
Q

Disadvantages to individuals/society of screening programmes (3)

A
  • False positives results leading to anxiety as well as unnecessary interventions
  • Opportunity cost of the programme for the NHS (and individual)
  • Increased diagnostic activity
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2
Q

How might measuring BMI in school children be used? (4)

A
  • Overweight/Underweight children are identified and parents can take appropriate action
  • Schools take action to tackle obesity
  • Importance of obesity is highlighted in the community
    NHS and/or local authority have information that can be used to plan services to tackle obesity
  • Local obesity figures and performance can be measured
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3
Q

what is screening?

A

Use of a test to assist in identification of a disease or condition among people who do not have symptoms for that disease/condition

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4
Q

what is disease costing?

A

Illuminates total cost of disease, offers no evidence as to relative cost effectiveness of competing interventions that can be used to mitigate its burden on patients and society (so of little use to clinicians and policy makers)

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5
Q

When is indirect standardisation preferable?

A

Only requires that we know the total number of deaths and the age structure of the study population

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6
Q

What is direct standardisation?

A

Required we know the age-specific rates of mortality in all populations under study

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7
Q

What is standardised mortality ratio (SMR)?

A

Ratio between observed number of deaths in a study population to the number of expected deaths

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8
Q

What is standardisation?

A

Way to limit confounding, often used to control for differences in age groups when comparing rates of disease in two populations with different age structures

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9
Q

What is most likely to be higher in hospital compared to GP in terms of diagnostic tests?

A

Positive predictive value

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10
Q

what is a sound argument?

A

Argument is sound if the conclusion follows logically from premises that are in fact true

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11
Q

what is a valid argument?

A

Needs:
Conclusion to follow logically from the premises
It to be impossible for the premises to be true and the conclusion to be false

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12
Q

what is deductive argument?

A

Intended to give logically conclusive support for the conclusion, as opposed to giving the conclusion probable support

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13
Q

what is an inductive arguement?

A
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14
Q

what is a meta-analysis?

A

Statistical technique for quantitatively combining the results of multiple studies that measure the same outcome into a single pooled or summary estimate

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15
Q

Reasons that RCT is less subjected to bias than observational studies? (3)

A
  • RCT groups are likely to be similar with respect to known and unknown determinants of outcome, therefore we can be more confident that any observed differences in outcome are due to the intervention
  • In observational studies, patient and clinician preference rather than randomisation determines whether a patient is allocated to intervention or comparison group
  • In absence of randomisation, greater risk of imbalance in both known and unknown determinants of outcome, so observed differents in outcome might be unrelated to the intervention
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16
Q

Studies being assessed during systematic reviews - two authors discussing disparities (3)

A
  • Good practice because:
    Assessing quality is important because studies with weaker designs will be less valid and can overestimate effects
  • Using two independent reviewers to assess quality makes it less likely that errors will be made
  • Using pre-agreed criteria helps make the process objective and transparent
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17
Q

Things to look out for in search strategy weaknesses (3)

A
  • English-language only
  • Only one database searched
  • Only publicated studies?
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18
Q

Advantages of systematic reviews? (2)

A
  • A rigorous summary of all the research evidence that relates to a specific question
  • By bringing together all the relevant evidence, disadvantages of single studies can be guarded against
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19
Q

what is the argument for fair distribution of healthcare resources - a ‘needs-based’ assessment? (4)

A
  • Health economists identify ‘need’ on ‘capacity benefit’
  • Antibiotics are ‘needed’ for treating bacterial sepsis as patients may benefit
  • Antibiotics are not ‘needed’ for treating a viral infection as patients cannot benefit

Therefore:
Resources should be distributed according to patients’ capacity to benefit

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20
Q

Reason for polio change in policy (oral to injection vaccination) (3)

A
  • Reduced worldwide polio incidence - less risk of infection
  • IPV safer than OPV as it is not a live vaccine
  • Modern IPV is more effective than older types of IPV (but not more effective than OPV)
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21
Q

Other than law, what should inform doctor’s decision to assist someone who needs medical treatment? (2)

A
  • Whether doctor has a moral obligation to assist
  • Whether doctor has a professional obligation to assist
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22
Q

Two main ways causation can be assessed in terms of a negligence claim?

A

Whether the claim satisfies the ‘but for’ test:
Basic rule of causation in common law requires the claimant to show that, ‘but for’ the defendant’s negligence , he/she would not have been injured

Whether the claimant is able to establish on the ‘balance of probabilities’ that the negligent action caused the injury
This requires the claimant to show that the injury was more likely to have occured as a result of their doctor’s negligence than not

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23
Q

For successful negligence claim relating to treatment/diagnosis, 3 things need to be proven…?

A
  1. Causation
  2. Duty: a duty of care existed between doctor and patient
  3. Breach: the doctor’s practice fellow below the standard of care expected
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24
Q

what is the legal situation regarding doctor’s duty of care to patient’s when not at work? (3)

A
  • Outside hospital/doctor’s surgery a doctor does not normally owe a duty of care if he did not attempt to help
  • Doctors are not legally obliged to act as ‘Good Samaritans’
  • However, if doctor states they are a doctor or starts to act is if they are a doctor, then they will have taken on a duty of care to that patient
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25
Q

what is the legal duty of care?

A

Legal obligation on one party to take care to prevent harm suffered by another

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26
Q

what are the caring role adverse effects on mental/physical wellbeing? (4)

A
  • Physically exhausted from having to help with ADLs - lead directly to injuries eg bad back or decreasing immunity
  • Increased risk of depression due to continual demands of being a carer and feeling isolated
  • Less time to attend to own health needs
  • Added poverty can impact on medical and physical health
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27
Q

what is a dosset box?

A

Multi-compartment medicine compliance aid - lots of compartments for each day, so patient knows what to take

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28
Q

what are the roles of the district nursing team caring for the elderly?

A

1) Assess whether patient/family need any nursing support
2) Assess whether a community occupational therapy assessment is necessary
3) Assess medication compliance/need for Dosset box
4) Discuss patient’s nursing needs at MDT meetings
5) Administer immunisations

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29
Q

what are the role of social services caring for the elderly?

A

Give information on how to access help/support

1) Assess whether patient needs any help with ADLs - eg carers
2) Assess whether they are eligible for any financial support

Possibility/signs of neglect
Assess whether any need for modifications

30
Q

what are the benefits of visiting a patient at home, that might not be gathered in surgery?

A
  1. Whether patient is caring for themselves
  2. Whether patient is caring for one or more others
  3. Patient’s socio-economic status
    Where patient keeps medication and how they go about taking it
  4. Information relating to cleanliness/personal hygiene needs (whether fresh food in fridge, etc.)
  5. Environmental factors that might make a difference to health care needs (eg steep stairs, lack of wheel chair ramps)
  6. Any signs/indication of elderly abuse
  7. Support from informal carers
    Mobility related to ADLs (able to go upstairs to toilet/bed, make coffee/tea)
  8. Cold, damp causing respiratory symptoms
31
Q

what are the strategies for dealing with anger from patients? (4)

A
  • Recognise/Acknowledge emotion
  • Remain calm
  • Do not dismiss it
  • Apologise and express sympathy
32
Q

what are some distancing strategies doctors might use?

A

To avoid stress of breaking bad news, doctors may normalise the consequences of a diagnosis or falsely reassure the patient

33
Q

Define bad news

A

News that negatively alters the patient’s (or relative’s) view of the future

34
Q

define the null hypothesis

A

No difference between two trialled items/methods
Eg the effect of both drugs on symptoms is the same

35
Q

what is tertiary prevention?

A

Reducing the consequences of outcomes that have occured
Rehabilitation is generally a form of tertiary prevention - for example a fracture has occured, but effective rehabilitation may be key to maintaining mobility despite fracture

36
Q

what is secondary prevention?

A

Limiting the severity of outcomes that occur once a disease has begun

37
Q

what is primary prevention?

A

Stopping a disease state from ever starting

38
Q

what is lead time bias? (2)

A
  • Explains why survival following diagnosis is not a good measure of the effect of screening
  • Early detection through screening inevitably increases the period of time a person ‘survives’ with a diagnosis - all patients apparently gain the ‘lead time’ by which screening brings forward diagnosis
39
Q

what is length bias? (2)

A
  • Occurs when length of intervals are analysed by selevting intervels that occupy randomly chosen points in time or space
  • Explains why cancers detected on screening may, on average, be more slowly progressive
40
Q

what is the purpose of randomisation?

A

To try and ensure any characteristics of the sample population that may affect the results (confounders) are distribute equally between the study groups
Also avoids selection bias

41
Q

what is meant by the number needed to treat? (calculation)

A

Number of patients that are needed to be treated with the experimental therapy to prevent one negative outcome

1/ARR (absolute risk reduction)

42
Q

what is treatment fidelity?

A

How accurately the intervention is reproduced from a manual, protocol or model

43
Q

what is meant by the intention to treat analysis?

A

Analysis based on initial treatment intended from allocation, not the treatment eventually adminstered (eg if a patient dropped out or changed treatment)

44
Q

what is meant by concealment of allocation?

A

Procedure for protecting the randomisation process; person randomising patients does not know what the next treatment allocation will be

Prevents selection bias affecting which patients are given which treatment (bias randomisation is designed to avoid)

45
Q

what is meant by blinding?

A

Where some of the participants (patients, clinicians, researchers) are prevented from knowing certain information that may lead to conscious or unconscious bias on their part

46
Q

what is odds ratio?

A

Ratio of probability that something will happen, to the probability that it won’t happen

47
Q

what is the P value?

A

Likelihood that the observed result is due to chance
P > 0.05 is not statistically significant

48
Q

what is standard deviation?

A

Value that shows how much variation there is from the mean

49
Q

what is 95% confidence intervals?

A

Range of values that is 95% likely to contain the true value

50
Q

what are the disadvantages of case control studies? (2)

A
  • Often affected by recall bias - participant cannot remember when they were exposed, or their outcome changes their perception of the exposure
  • Or affected by selection bias - where control group has other factors that may influence their exposure
51
Q

what are the disadvantages of cohort studies? (3)

A
  • Often large, difficult to follow up large groups of patients, especially with something such as monitoring diet
  • Hard to conduct if length of time from exposure to outcome is very long (eg for some cancers) or if exposure you’re observing is rare
  • Need to look out for confounders
52
Q

what are case control studies?

A

Find a sample that already has a certain outcome, follow them back to find out if they were exposed to a certain exposure

53
Q

what are cohort studies?

A

Find a sample that has been exposed to a certain exposure and follow that sample to observe the outcome; working forward in time

54
Q

what are observational studies?

A

Cohort and Case-Control
- they do not intervene, only observe

55
Q

what is meant by external validity?

A

Generalisability, how well it can be applied to different scenarios, patients and environment

56
Q

what is internal validity?

A

Accuracy, how well the study was conducted, taking confounders into account and removing bias

57
Q

How to evaluate evidence and use it? - RCT, Observational and Systematic Review (4)

A
  • Are my patients similar to those tested?
    I- f the trial was held abroad, can it be applied in my setting?
  • Are those interventions feasible in my clinical setting?
  • Will the benefits outweigh harm in my patient?
58
Q

how to evaluate systematic review results? (2)

A

Same as RCT and Observational +:
- Can you interpret the results in a Forest plot?
- Plot of meta-analysis results that easily shows variation between studies

59
Q

how to evaluate RCT and Observational study results? (2)

A
  • How large was the treatment effect? (relative risk, absolute, reduction, NNT or outcome difference on a continuous scale (PEFR, BMI))
  • How precise was the treatment effect (confidence intervals)?
60
Q

how to appraise validity in a systematic review? (5)

A
  • Is this a systematic review of RCTs? - anything less than RCT is inadequate
  • What was the search strategy? - Studies with negative results or foreign languages are unlikely to be included
  • How was validity of individual studies assessed?
  • Are the results consistent from study to study?
61
Q

how to appraise validity in observational studies? (5)

A
  • Can you identify the main hypothesis and how does this match what you’re looking for?
  • Is it an appropriate study design for the hypothesis?
  • How was exposure and outcome measured and could there be bias?
  • Was the assessment of outcome blind to exposure status?
  • Were confounding factors identified and were they accounted for?
62
Q

how to praise validity in RCTs? (6)

A
  • Was assignment of patients randomised?
  • Were the groups similar at the start?
  • Aside from intervention, were the groups treated equally?
  • Were all entered patients accounted for?
  • Were all patients analysed in groups that were originally placed?
  • Were the patients and clinicians kept blind (very important with a subjective outcome)?
63
Q

Question to ask when critically appraising evidence - Harm/Aetiology?

A

Were there clearly defined groups of patients, similar in all important ways other than exposure to the treatment or other cause?

64
Q

Question to ask when critically appraising evidence - Prognosis?

A

Was a defined representative sample of patients assembed at a common (usually early) stage in the course of their disease?

65
Q

Question to ask when critically appraising evidence - Diagnosis?

A

Was there an independent blind comparison with a reference (or ‘gold’) standard of diagnosis?

66
Q

Question to ask when critically appraising evidence - Therapy?

A

Was assignment of patients to treatments randomised?

67
Q

what is the process of evidence-based decision making in medicine? (5)

A

1) Convert need for info into answerable question
2) Identify best evidence with which to answer question
3) Critically appraise the evidence for its validity, impact and applicability
4) Integrate critical appraisal with clinical expertise and patient’s unique circumstances
5) Evaluate our effectiveness and efficiency in carrying out steps 1-4 and seek ways to improve

68
Q

Definition of bias (2)

A

Systematic introduction of error that can distort the results in a non-random way

Case-control studies are prone to recall bias, cohort studies are prone to selection bias

69
Q

what is gate theory (pain)? (2)

A
  • Pain is carried in A delta/C fibres - gate theory implies impulsies carried in other (A beta) fibres can inhibit pain impulses - closing the gate
  • How rubbing a painful spot, or using a TENS machine works to reduce pain
70
Q

how do you assess pain in a clinical interview? (6)

A
  1. Take a full history of the problem
  2. Explore effects on lifestyle (work, leisure, hobbies)
  3. Explore effects on interpersonal relations (children, friends, partner - sex)
  4. Explore effects on self-perception
  5. Find if anything relieves or exacerbates it
  6. Explore the patient’s coping strategies
71
Q

how can you measure pain? (5)

A
  1. McGill pain questionnaire
  2. Self-report questionnaire
  3. Visual analogue scale (VAS)
  4. Pain diary
  5. Clinical interview

H&S (7 decks)

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