Basic principles HS

Question 1

Diagnosis question =

Answer 1

Cross-sectional analytic study = observational study that analyses data from a
population at a specific period of time

Question 2

Aetiology question =

Answer 2

• Cohort study = longitudinal study that follow a population, often one that has a
  particular exposure – e.g. smoking
• Case-control study = population study in which two existing groups differing in
  outcomes are identified & compared based on basis of some supposed causal
  attribution

Question 3

Prognosis question

Answer 3

cohort

Question 4

Tx question

Answer 4

• RCT / Systematic Review of RCT
• Note: can test for superiority between two variables, or for equivalence
  (i.e. equally as effective)
• Cluster trials is where randomize clusters of patients, e.g. GP surgeries

Question 5

evaluation questiuons

Answer 5

Systemic review/ MA

Question 6

cohort +

Answer 6

• Best information about causation
• Able to examine a range of outcomes
• Good for rare exposure

Question 7

Disadvantages of cohort studies

Answer 7

• Long follow up = expensive & time-consuming
• Bad for rare outcomes
• Bad for long latency periods
• Can have different follow-up for exposed / non-exposed
• Confounders not recognized

Question 8

CCS +

Answer 8

Simple / easy to conduct = don’t require long follow ups
* Best for rare outcomes
* Good for long latent periods

Question 9

disadvantages of a CCS

Answer 9

Inferior to a cohort study
* Bad for rare exposure
* Controls may not represent where sample is from = often requires
several controls per case
* Cases don’t represent full disease spectrum = cured / died
* Recall bias
* Confounders not recognized

Question 10

BIAS

Answer 10

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

Question 11

selectio bias

Answer 11

Error in assigning individuals to groups, leading to differences in
group’s qualities that may influence the outcomes
* To make inferences from results, we require sample to be
representative of population = requires random sampling (or if
smaller group some stratified randomization)

Question 12

ways in which selection bias can arise

Answer 12

• Sampling selected subjects not representative of population
  2. Volunteer volunteer subjects not representative of population
  3. Non-responder responders are not representative of the
  populat

Question 13

recall bias =

Answer 13

• Difference in accuracy of recollection of study participa
• could be due to time, greater recall in those w the disease (issue in CCS)

Question 14

Publication bias

Answer 14

• Failure to publish / include certain studies because they have
  negative results = important in systematic revie

Question 15

hawthorne effect

Answer 15

• Group changing its behavior due to knowledge it is being studi

Question 16

procedure bias

Answer 16

• Subjects in different groups receive different care, other than just the intervention

Question 17

info bias

Answer 17

• Information about participants is incorr

Question 18

methods of randomisation - simple

Answer 18

computer random number generator (may have chance bias)

Question 19

stratified randomisation

Answer 19

– to make sure you have equal numbers of e.g. different severities of illness in each

Question 20

minimisation bias

Answer 20

computer algorithm forms groups to ensure comparability (smaller studies)

Question 21

key principle of randomisation

Answer 21

t must ensure unpredictable assignment to groups

Question 22

concealed randomisation tends to

Answer 22

o yield less impressive results – because without this you over-estimate the effect by
selection bias

Question 23

regression to the mean =

Answer 23

People often get better or worse regardless of intervention = not intervention causing change

Question 24

regression to mean example

Answer 24

If you are measuring something that randomly varies (e.g. BP which is fluctuant) and you’re always
looking at the extremes, a significant proportion of the people who are in the extremes are there by
chance
B. Therefore, when you re-measure the group, on average they will “regress to the mean”
C. In the example of BP = if you measure a group of people with high blood pressure, when you next
measure them, they will improve (decrease BP) on avera

Question 25

precise vs accurate

Answer 25

1. Precise = Narrow CIs 2. Accurate = Close to real value

Question 26

Treatment fidelity

Answer 26

How accurately the intervention is reproduced from a protocol or model

Question 27

randomisation

Answer 27

Purpose is to ensure that any confounding characteristics are equally distributed between the two study groups, avoiding selection bias

Question 28

internal validity

Answer 28

How well study was conducted, taking confounders into account & removing bias

Question 29

Ext validity

Answer 29

Generalizability how well the study can be applied to different scenarios / patients / environment

Question 30

Association

Answer 30

* Two variables are said to be associated when one is found more commonly in the presence of the oth

Question 31

3 types of association

Answer 31

- spurious - indirect - direct

Question 32

Spurious assoc

Answer 32

* An association that has arisen by chance and is not real

Question 33

indirect association vs direct

Answer 33

* The association is due to the presence of another factor (a confounding variable - direct: * A true association not linked by a third (confounding) variab

Question 34

how do we know if an association is causal

Answer 34

bradford hill

Question 35

face validity

Answer 35

does it test what it is meant to

Question 36

content validity

Answer 36

refers to the extent to which a test or measure assesses the full content of a subject or area.

Question 37

criterion validity

Answer 37

concerns the comparison of tests. You may wish to compare a new test to see if it works as well as an old, accepted method. The correlation coefficient is used to test such comparisons

Question 38

concurrent validity

Answer 38

the predictor and criterion data are collected at or about the same time. An example could be testing a new, shorter test of intellectual functioning against a standard measure

Question 39

predictive validity

Answer 39

- validation, the predictor scores are collected first and criterion data are collected at some later/future point. - Here you want to know if the test predicts future outcomes.

Question 40

construct validity

Answer 40

extent to which a test measures the construct it aims to

Question 41

convergent validity

Answer 41

a test has convergent validity if it has high correlation w anothet test that measures the same construct

Question 42

divergent validity

Answer 42

demonstrated by a low correlation with a test that measures a different construtc

Question 43

INITIAL 2 QUESTIONS ON RCT CHECKLISTS

Answer 43

- Did the study ask a clearly focused question - PICO - was the study design app for the question - why was it an RCT

Question 44

Methods of randomisation RCT

Answer 44

Good randomisation is truly random i.e. random computer-generated numbers etc. = this is allocation concealment / unpredictable assignment B. Randomisation methods based on date of presentation to clinic, order of presentation to clinician, letter of name / number in date of birth etc. = not adequate methods of randomisation & do not allow allocation concealment they might allow the allocating clinician to predict / guess what group the patient might be in before deciding to recruit them into the study * Inadequate methods can cause baseline differences of the groups age, gender, co-morbid conditions (if not excluded), severity of condition, lifestyle: must be comparable in ALL respects other than intervention they are receivi

Question 45

What can be done with randomisation to ensure balance

Answer 45

nce, researchers may have to ‘stratify’ randomisation – this means that it you know of a very powerful confounder – say age – you may need first to split participants into ‘young’ and ‘old’ before you randomi

Question 46

what might need to be done for a small sample size

Answer 46

replacement randomisation - equal numbers in each arm

Question 47

* Equipoise=

Answer 47

refers to the situation where the researchers have no preference between the treatments being studied in a t

Question 48

when is equipoise lost

Answer 48

when those designing the trial or recruiting patients into it do have a preference for one treatment over another, it can be considered unethical to recruit patients into the trial as you are offering some patients what you believe to be a “worse option

Question 49

What does blinding prevent

Answer 49

1. Prevents observer bias = form of reactivity in which researcher’s cognitive bias causes them to subconsciously influence the participants of experiment = could influence extra quality of care to these patients 2. Or confirmation bias = see results that aren’t there 3. Expectation bias (Pygmalion effect) = Observers may subconsciously measure or report data in a way that favours the expected study outcome 4. Also prevents placebo effect – or reduces it

Question 50

attrition bias

Answer 50

lost from the study - were these accounted for

Question 51

Intention to treat analysis

Answer 51

used to mitigate impact of attrition bias. All patient analyzed even if didn't complete study = if dropped out either use data before drop out or include this in analysis as a limitation of the study / potential negative of the therapy

Question 52

RCT - follow up

Answer 52

Were all participants followed up / data collected in same way? 1. Same time of day? – sun down phenomenon in dementia, higher levels of cortisol in morning, relation to meal times 2. During same period? – time of year may have impact, e.g. winter = more illnesses 3. Did participants receive the same attention from health workers? – observer / procedural bias 4. Was data collection potentially subjective? – especially relevant if considering placebo effect – treatment group aware = report side effects

Question 53

RCT - sample size

Answer 53

high enough power required to avoid false N - T2 error

Question 54

underpowered study

Answer 54

not enough pts to distinguish real effect of a Tx -> type 2 error

Question 55

how can we ensure we have enough pptd

Answer 55

do a power calc

Question 56

Bradford Hill criteria

Answer 56

1. Strength = effect size 2. Reproducibility = in concordance with other findings 3. Specificity = other likely explanation for results 4. Temporality = effect occurs after cause 5. Biological gradient = greater exposure = greater effect 6. Plausibility = logical mechanism by which effect is achieved SRS-TBP | several rascals stop to be peasants

Question 57

RCT is gold standard for

Answer 57

- cause and effect - However, not ethical to allocate patient to a certain exposure that may be harmful (equipoise) -> cohort

Question 58

cohort studies allow for

Answer 58

startification - reduce risk of confounders

Question 59

selection bias in cohort studies

Answer 59

- selection bias - reduced generalisability -> less EV - . Patient who are more concerned about health more likely to do clinical trial & therefore more likely to get good results B. Only selecting patients with certain outcomes / severity of condition in an attempt to get better results = not representative of full disease spectr

Question 60

Questionnares are subject to

Answer 60

recall and response bias

Question 61

non differential error =

Answer 61

- = random misclassification of exposure equal in both groups - Leads to bias towards null (false negative) and hide true relationships by diluting an existing relationship = type II statistical

Question 62

differential error

Answer 62

- non-random misclassification of exposure proportion misclassified differs between the two groups (normally from recall / observer bias) - Leads to bias in either direction (false negative or positive) i.e. = creating spurious associations (type I statistical error) or obscuring true ones (type 2 error)

Question 63

cohort - accurate outcome measure

Answer 63

If outcome measurement reporting is universally poor (non-differential error) = will lead to bias towards the null (type II error) B. If outcome measurement reporting is more accurate in one group (differential error) = may get a spurious positive relationship - T1 error

Question 64

confounding =

Answer 64

“Distortion (or potential for distortion) of association between outcome and exposure, by a third factor which has an association with both exposure & outcom

Question 65

if confounding variables have not been taken into account during design or analysis

Answer 65

, association between exposure and outcome could be biased = can stratify, or (more often) do Multi-Variable Regression

Question 66

cohort - follow up

Answer 66

- was it long enough for exposure to manifest - those lost may have had diff outcomes

Question 67

cohort - incomplete follow up

Answer 67

Allows selection bias -> May reduce power of the study even if it is non-differential between the study group

Question 68

cohort: insufficient length of FU

Answer 68

May mean that relevant outcomes are not observed and associations not detected – leading to: A. Bias towards the null B. Underestimation of outcome & exposure associati

Question 69

systematic review benefits

Answer 69

- speed - ethics - is it defensible to conduct a controlled trial if the answer is already available in trials alr done - 3. Increase total sample size improved power = improving certainty & preci 5. Permit sub groups analysis

Question 70

systematic reviews give an indication of

Answer 70

- any heterogeneity in findings * I2 = represents the heterogeneity between studies - larger value suggests greater risk findings due to chance

Question 71

steps of a SR

Answer 71

- clear question - protocol before searching - search strategy - conclude results in a subjective way

Question 72

publication bias

Answer 72

e * Not including abstracts / grey literature introduces publication

Question 73

Cross sectional study

Answer 73

- Observational study - Source population is examined to see what proportion has the outcome of interest, or has been exposed to the risk factor of interest, or both. - Looks at individuals within a population at a single point in time

Question 74

prevalence study =

Answer 74

cross sectional

Question 75

when are cross sectional studies useful

Answer 75

- Less reliable for determining the prevalence of very rare conditions with a short duration but can often provide useful estimates of disease burden for a particular population. - Descriptive technique rather than analytical, so they cannot be used to estimate the relationship between cause and effect - Most suitable to investigate diagnosis

Question 76

pyramid of evidence

Answer 76

Question 77

absolute risk =

Answer 77

- Chance of an event occurring” * Is affected by condition prevalence - max risk = 1

Question 78

relative risk

Answer 78

* “Risk of an event occurring in an exposed group versus the population (non-exposed group)” = Risk in Experiment Group ÷ Risk in Control * RR of 1 = number difference between the groups: <1 = less likely / >1 = more likely

Question 79

which type of risk does not consider prev of the condition

Answer 79

relative risk

Question 80

RRR

Answer 80

* “(Experimental Event Rate – Control Event Rate) ÷ Control Event Rate” * (EER-CER)/CER (Event Rate = Absolute Risk )

Question 81

ABSOLUTE RISK REDUCTIO

Answer 81

n – a.k.a. risk difference / attributable risk: * “Risk without treatment – Risk with treatment

Question 82

NNT -

Answer 82

Number of patients who need to be treated to prevent one additional adverse outcome in a given time

Question 83

NNT EQUATION

Answer 83

= 1 ÷ Absolute Risk Reduction = ROUND UP to full number!

Question 84

NNH

Answer 84

- Number of patients need to be exposed to a particular risk-factor in order for one additional patient to be harmed in a given time” * i.e. the number of patients that need to be treated for one to get a side effect

Question 85

NNH equation

Answer 85

- 1 ÷ (Incidence in Treated – Incidence in Untreated) * (i.e. 1 ÷ Absolute Risk Increase) = ROUND DOWN to full number!

Question 86

when is odds ratio sed

Answer 86

case controls

Question 87

odds ratio =

Answer 87

- “Number of people who develop an outcome to the number of people who don’t - approximates RR if the outcome is rare

Question 88

RR is used in

Answer 88

cohorts

Question 89

hazard ratios =

Answer 89

- “The ratio of hazard rates in two groups” * e.g. if = 2, hazard occurs twice as much in given exposure group

Question 90

PAR

Answer 90

- how much disease prev would change if a RF was removed - Some exposures dramatically increase individual risk, but have little impact on population risk – i.e. rare exposures

Question 91

95% CI =

Answer 91

- Range of values that is 95% likely to contain the true value * The result is the true result for the sample – the confidence intervals contain the true result for the entire population within them

Question 92

Width of 95% CI

Answer 92

Width represents uncertainty to value (i.e. the precision), if crosses line of no effect (i.e. RR =1), this represents ‘no difference’ between the groups

Question 93

p value =

Answer 93

Likelihood that the observed result is due to chance if is > 0.05 then say the results are statistically insignificant

Question 94

null vs alt hypothesis

Answer 94

- null: no difference between parameters - alt: there is a difference

Question 95

power

Answer 95

e probability of correctly rejecting the null hypothesis (power is increased by increasing sample size)

Question 96

Precision is basically

Answer 96

width of CI

Question 97

* If the 95% CI’s for RR includes

Answer 97

* If the 95% CI’s for RR includes 1 = p value by definition is over 0.05 so results aren’t statistically significant

Question 98

p value of ? indicates stat signficance

Answer 98

under 0.05

Question 99

T1 error

Answer 99

- * Null hypothesis is incorrectly rejected = false positive - not affected by sample size

Question 100

T2 error

Answer 100

- Null hypothesis is incorrectly accepted = false negative * Decreased by smaller sample size

Question 101

Pearsons correlation coefficient

Answer 101

Pearson’s Correlation Coefficient indicates how closely the points lie to a line drawn through the plot

Question 102

PCC values

Answer 102

- R = 1 shows strong positive correlation b) R = -1 shows a strong negative correlation c) R = 0 no correlat

Question 103

standard deviation

Answer 103

* Expresses by how much the members of a group differ from the mean value for the gro

Question 104

1 SD from mean =

Answer 104

68.3% of values

Question 105

2 SD from mean

Answer 105

95.4% of values

Question 106

3 SD from mean =

Answer 106

99.7%

Question 107

margin of error

Answer 107

* We use the idea of a ‘margin of error’ when we talk about how our sample results relate to people not in the sample i.e. ‘the population’ * That margin has to get bigger in relation to factors that would inevitably increase the variation between samples

Question 108

standard error of the mean

Answer 108

* The measure of possible variation between samples is called the standard error * = Standard Deviation / Square Root: (Number of Patients)

Question 109

parametric tests

Answer 109

- can be measured, usually normally distributed - Student's t-test paired or unpaired * - Pearson's product-moment coefficient -> correlation

Question 110

Non parametric tests

Answer 110

- MWU - wilcoxon - chi sq - spearman rank

Question 111

students T test - paired vs unpaired

Answer 111

2. Paired data refers to data obtained from a single group of patients, e.g. Measurement before and after an intervention 3. Unpaired data comes from two different groups of patients, e.g. Comparing response to different interventions in tw

Question 112

MNU

Answer 112

Unpaired data

Question 113

Wilcoxon signed rank test

Answer 113

st compares two sets of observations on a single s

Question 114

chi sq =

Answer 114

used to compare proportions or percentages

Question 115

spearman =

Answer 115

correlation

Question 116

phase 1 trial

Answer 116

- small group, assessing safety of drug, pharmacokinetics and pharmacodynamics and side-effects prior to larger studies

Question 117

# 2a vs 2b phase 2 trial

Answer 117

- larger group to assess dosing & efficacy * 2a = assesses optimal dosing * 2b = assesses efficacy

Question 118

phase 3 trial

Answer 118

3 larger group still (thousands) primarily focusing on effectiveness, compare to other drugs & long-term safety

Question 119

Phase 4 trial

Answer 119

after drug or treatment has authorized for prescription, looking at longer term benefits

Question 120

Ethics of clinical trials - Nuremberg code

Answer 120

- Must have informed & voluntary consent - Must avoid all unnecessary suffering - Must only be conducted by qualified people

Question 121

Helsinki Declaration (1964) sai

Answer 121

any researcher had to be subjected to independent ethical comittee review

Question 122

General ethical principles

Answer 122

- In a therapeutic method are risks > benefit? (non-maleficence vs. beneficence) – including whether what is being researched is worthwhile - Not possible without humans = beneficial results can be achieved from no other mean - Maximise confidentiality / privacy D. No equipoise = all patients in a fair group E. Ethical committee approval F. Patients have right to withdraw at any time

Question 123

research ethics approval

Answer 123

- Always required for research involving human participant / human data / human tissue including recently dead, foetal material * Not normally required if not using above, or if is an audi

Question 124

who gives ethical approval for research

Answer 124

- NHS Research Ethics Committees (REC) give this, otherwise university has to approve * Not normally required for research involving NHS staf

Question 125

Importance of ethical committee approval?

Answer 125

A. Protects participants B. Protects researchers / minimise potential for claims C. Protects reputations of institutions D. Condition for grants / funding E. Legal requirement for some research involving patient lacking mental capacity

Question 126

Consent procedure in research

Answer 126

- voluntary & informed - not pressured - no financial incentive - have time to decide - aware they can withdraw

Question 126

how is approval for research from NHS REC obtaineda

Answer 126

application done online via IRAS

Question 126

Biomedical ethics - autonony

Answer 126

the autonomous individual freely acts in accordance with a self-chosen plan

Question 127

beneficence

Answer 127

acting in best interests of pts

Question 128

Non-maleficence

Answer 128

- do not cause harm

Question 129

justice

Answer 129

treat all patients fairly (with equity)

Question 130

nelignence

Answer 130

- A breach in the legal duty of care which results in damage ● Often passive, or an omission

Question 131

when is negligence criminal

Answer 131

- non consensual Tx - not acting in pts best interests

Question 132

bolam principle

Answer 132

- Principle that establishes whether an act or omission by a HCP breached the duty of care & thus they were negligent ○ Not negligent if an established body of professionals supports the act, even if the practice was not standard care (e.. guidelines)

Question 133

Bolitho test for negligence

Answer 133

- Adaptation of the Bolam principle - States courts can’t just accept what professionals say, must consider if it is logical first

Question 134

stigma =

Answer 134

Mark of disgrace associated with a particular circumstance, quality, or person.

Question 135

Process of producing stigma:

Answer 135

1. Labelling = distinguishing differences between people 2. Stereotyping = making assumptions based on those differences 3. Othering = separates person e.g. diabetes - diabetics 4. Discrimination

Question 136

Types of stigma - felt

Answer 136

shame you feel as a result of stigma, may be due to your condition.p

Question 137

passing stigma =

Answer 137

(not seeking help) → very relevant to health conditions like addiction = may act as a barrier to health-seeking behaviour

Question 138

withdrawing stigma =

Answer 138

→ can worsen health conditions

Question 139

covering stigma =

Answer 139

hiding it can exacerbate sense of stigma = worsen health conditions - may also present friends/ family from noticing

Question 140

enacted stigma

Answer 140

discrimination by others

Question 141

courtesy stigma =

Answer 141

= felt by someone who is with someone else who is being stigmatised.

Question 142

equality act

Answer 142

- 2010 - Makes it illegal to discriminate directly or indirectly against people with MH problems in public services and functions, access to premises, work, education and transport

Question 143

Implications of stigma in medicine

Answer 143

- fear of stigma -> impact on health seeking behaviours - concerns abt confidentiality - TX can lead to stigma e.g. wheelchair

Question 144

health education =

Answer 144

give people knowledge & skill to change potentially health damaging behaviours e.g. advice from health professionals, mass media campaigns

Question 145

health protection=

Answer 145

- a core public health function focused on safeguarding individuals, groups, and populations from various health threats - e,g, managing infectious diseases, addressing envir hazards, responsing to outbreaks

Question 146

primary prevention

Answer 146

prevents onset of disease e..g. addressing cause

Question 147

types of primary prevention

Answer 147

- Universal (whole population) ○ Selective (risk group) ○ Individual (identify high risk individuals eg. genetic mutations)

Question 148

secondary prevention =

Answer 148

= cure/ identify disease earlier e.g. screening

Question 149

tertiary prevention

Answer 149

manage disease

Question 150

beatties typology

Answer 150

- health persuasion - mass media campaign - legislation - personal counselling - community based initiatives

Question 151

symptom iceberg

Answer 151

- 70% of symptoms are never reported ○ The way symptoms are perceived = illness behaviours → this is what influences if someone presents to the doctor or not

Question 152

Zolas triggers for health seeking behaviour

Answer 152

1. Interference with work/ hobbies/ house work 2. Interference with social relations 3. Interpersonal crisis = death of relative/ friend, divorce, loss of child etc 4. Putting a time limit on symptoms = will seek help if not resolved by certain time 5. Sanctioning = told to by someone else

Question 153

Barriers to health seeking - availability

Answer 153

- avail of svcs - cant get appts & geographical avail

Question 154

barriers to health seeking - cultural

Answer 154

- stigmisation of MH in certain cultures - ○ Feel like different class/ culture to doctor → “won’t understand them”

Question 155

barriers to health seeking - prev exp

Answer 155

- bad experiences - ○ Felt stigma ○ Language barrier, no interpreter → reduced rapport with doctor ○ Didn’t get what they wanted e.g. Abx

Question 156

barriers to HSB - logistics

Answer 156

- time - childcare - loss of earnings from work - cant get there e.g. no transport

Question 157

barriers to HSB - risk perception

Answer 157

- Don’t smoke (lung cancer) → “won’t happen to me” ○ Or perceive as risk & scared of finding out results ○ Already had & now having different symptoms so not perceived as risk

Question 158

How to reduce barriers in certain ethnic groups

Answer 158

- availability of interpreters - info leaflets in different languages - Better understanding of the health beliefs of different ethnic groups 5. Targeted advice for different groups based on their risk factors

Question 159

inverse care law

Answer 159

better off areas have better access to care than poorer ones (despite better health) → demonstrated by the Black Report 1980

Question 160

Marmot Review (2010) proposed 5 policies to address health inequalities:

Answer 160

- Give every child the best start in life - Enabling all people to maximise their capabilities and have control over their lives - Ensuring a healthy standard of living for all - Creating fair employment and good work for all - Creating and developing healthy and sustainable places and communities

Question 161

BBB - SPIKES

Answer 161

- setting - comfortable & quiet. Offer other ppl to be there - perception - establish what they know & ICE - invitation - what do they want to know today - Knowledge - slowly give info, allow large pauses, reg check understanding - emotions & empathy - tell truth abt prognosis, if dont know diagnosis -> refer - strategy and summary - make a plan for follow up, future steps, check understanding, ask if any ?

Question 162

BBB - ABCDE

Answer 162

Advanced preparation Build a relationship Communicate well Deal with patient reactions Encourage and validate emotions

Question 163

Screening =

Answer 163

“The systematic application of a test or inquiry, to identify individuals at sufficient risk of a specific disorder to warrant further investigation or direct preventive action, amongst persons who have not sought medical attention on account of symptoms of that disorder

Question 164

wilson criteria for a screening programme - the condition

Answer 164

- Common or severe disease = important health problem b) Epidemiology & natural history well understood: - MUST have a latent stage - long pre-clinical durations

Question 165

wilson criteria for a screening programme -the test

Answer 165

- ) Simple, safe, precise & validated f) Isn’t harmful / acceptable level of harm, i.e. benefit outweighs harm (including of future potential investigation - ) Distribution of test values well known & suitable cut off d) Agreed pathway following positive resu

Question 166

wilson criteria for a screening programme - The Tx

Answer 166

- ) Effective intervention that leads to better outcomes if given earlier b) Cost-effective can be measured in terms of both life saved & QAL

Question 167

wilson criteria for a screening programme - the programme

Answer 167

- c) RCT evidence showing programme effective in ↓ mortality / morbidity d) Benefit > harm e) The programme is continually reviewed by for quality assura

Question 168

too low cut off for screening

Answer 168

end up identifying too many people needing unnecessary further investigations (too many false positives i.e. HIGH SENSITIVITY but LOW SPECIFICITY)

Question 169

Too high screening cut off

Answer 169

= all the people you identify are more likely to have disease, but you will inevitably miss some (low false negative rate i.e. LOW SENSITIVITY but HIGH SPECIFICITY)

Question 170

+ of screening

Answer 170

- Better patient outcomes: a) Better survival / less requirement for radical therapy (e.g. can do breast-conserving, or not need chemo) b) May require less long-term therapy so more cost effective 2. Reassurance for those with negative results

Question 171

- of screening

Answer 171

- longer morbidity if prognosis is unaltered – over-diagnosis 2. Cost of resources 3. False reassurance for those with false-negatives 4. Unnecessary investigations for false-positives / over-treatment of borderline abnormalities (may not have died from condition): a) Waste of resources b) Health implications for patient iatrogenic damage / stress

Question 172

lead time bias

Answer 172

Lead time = time between picking up disease via screening and the disease presenting symptoms * Diagnosed earlier so appears survival is longer but in fact just diagnosed for longer = “artefactual extension of survival"

Question 173

lengh time bias

Answer 173

- More likely do detect a more slowly growing and more treatable cancer, meaning that prognosis is good anyway, so not that much benefit * i.e. detect diseases with a longer sojourn time

Question 174

other bias in screening

Answer 174

selection -Well-educated individuals tend to worry and comply with screening programmes better = individuals often healthier & will therefore have better outcomes

Question 175

why dont we have a PSA screening

Answer 175

- poorly understood, many other things raise PSA - PSA true sensitivity / specificity unknow - Currently active monitoring is about as successful as treating = no benefit of screening - median survival following diagnosis is 15 yrs

Question 176

AAA screeing

Answer 176

> US scan for men > 65 - single scan

Question 177

components of antenatal screening

Answer 177

A. Foetal anomalies B. Maternal pre-existing issues C. Maternal obstetric complications

Question 178

benefits of antenatal screening

Answer 178

- Gives women / parents more information and choice about raising child with Down’s or abortion B. Allows time to prepare if wanting to continue with pregnancy and access support groups to ensure they have support system in place for when baby arrives C. Allows pre-planning and identification of any challenges and adaptations that will be required D. Also provides reassurance to women who are low risk

Question 179

risks of antenatal screening

Answer 179

A. Only a SCREENING TEST hence a negative result does not guarantee child won’t have Down’s i.e. false positives and also false negatives B. Risk of diagnostic testing miscarriage of an otherwise healthy baby could occu

Question 180

CC involves women of which ages

Answer 180

25-64

Question 181

CC invitations

Answer 181

A. 25-49 y/o = every 3 years B. 50-64 y/o = every 5 years C. Annual if HIV

Question 182

exceptions to antenatal screening

Answer 182

- virgins may choose not to be screened - low risk - If women present with symptoms or signs of cancer then they are not screened and referred urgently 3. If previous history of CIN then have more frequent surveillanc

Question 183

when is CC rescheduled

Answer 183

- Currently menstruating 2. Less than 12 weeks post-natal = reschedule 3. Current pelvic infectio

Question 184

FIT testing

Answer 184

- 50 -74 - every 2 years - abn -> colonoscopy

Question 185

BC screening

Answer 185

- mammogram: 50-70 yrs - every 3 years > after 70 can self refer

Question 186

Surveillence programme for DDH

Answer 186

- not a screeninf programme

Question 187

Normative ethics =

Answer 187

- Branch or moral philosophy (ethics) concerned with criteria of what is morally right or wrong, evaluated standards for the rightness and wrongness of actions

Question 188

virtue ethics =

Answer 188

- a branch of normative ethics which treat the concept of moral virtue as central to ethics

Question 189

meta ethics

Answer 189

The nature of ethical terms and concepts and to attempt to understand the underlying assumptions behind moral theories

Question 190

deontology =

Answer 190

An ethical theory that states it is possible to determine the rightness or wrongness of actions by examining actions themselves without focusing on the consequences

Question 191

consequentialism =

Answer 191

- an ethical theory that states it is possible to determine the rightness or wrongness of actions by examining its consequences

Question 192

Consent in kids

Answer 192

● Patient 16+ can consent (or if Gillick competent) : - ○ Parents can refuse (or consent if patient is not competent to consent) ○ If doctor disagrees with parent’s decision (not in best interests) can be taken to court → parents must act in the child’s best interest

Question 193

when can we treat w/o consent

Answer 193

emergency

Question 194

patient under 16 cannot

Answer 194

REFUSE treatment - but can consent!

Question 195

Patient > 16 is considered

Answer 195

competent - can accept and refuse Tx

Question 196

common vs statute law

Answer 196

- Common law Law that arises from a ruling court case, e.g. it sets a precedent 2. Statute law Written l

Question 197

which ways can conset be given

Answer 197

1. . Written 2. Oral 3. Non-verb

Question 198

when is consent not always req

Answer 198

- ● If patient requires emergency treatment and they can’t consent ● Can be detained under Public Health (Control of Disease) Act 1984 in hospital if have infectious disease ● Mental Health Act 19

Question 199

Gillick comp

Answer 199

- Parental rights yield if child reaches sufficient understanding + intelligence. Assessed with Fraser Guidelines = can’t overrule this consent * If Gillick competent (i.e. u16) can ACCEPT treatment but can not REFUSE treatment

Question 200

parental autonomy

Answer 200

* Parent responsibility mother / father (only one needed), legal guardian, local authory - must act in best interest of the child

Question 201

When is a child considered competent according to fraser guidelines

Answer 201

A Understand all aspects of advice + its implications = doesn’t apply if young person lacks capacity consent required from parents B. Cannot persuade them to tell parents or allow you to tell them C. Person is likely to have sex without contraception (upon requesting it) D. Their health is likely to suffer without such advice / treatment – in best interest for them to receive it without parental knowledge

Question 202

if u suspect coercion when prescribing contraception

Answer 202

- Suspicion of coercion, sexual exploitation (e.g. partner much older) * Child protection guidelines followed / involve police * This includes if you know they’re having sex when they don’t have capacity to conse

Question 203

under what age can kids NEVER consent

Answer 203

- If under 13 years of age: * Should inform parents, social services / police as can’t consent at this age = statutory rape (regardless of consent

Question 204

MCA and MHA

Answer 204

MCA cannot be used when MHA applies and VV

Question 205

Two-stage functional test of capacity

Answer 205

- In order to decide whether an individual has the capacity to make a particular decision you must answer two questions: 1. Stage 1: * “Is there an impairment of or disturbance in the functioning of a person’s mind or brain?” If so, 2. Stage 2: * “Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?

Question 206

a person is deemed not to have capacity if unable to

Answer 206

1. Understand information 2. Retain information 3. To use or weigh up that information 4. To communicate decision

Question 207

Principles of MCA act 2005`

Answer 207

1. Presumed to have capacity unless proven otherwise 2. Must take all steps to allow patient to have capacity (e.g. speak in their language, not in jargon, hearing aid, change environment) 3. Unwise decision does not mean patient does not have capacity 4. Make decisions for patient in their best interes

Question 208

when can relatives make decisions for a person that lacks capacity

Answer 208

if they have power of attorney

Question 209

MCA - decisions made for a person must be

Answer 209

- in their best interests - It should also be minimally restrictive of that persons rights / freedom

Question 210

LPA =

Answer 210

this allows the patient to appoint an attorney to act on their behalf if they should lose capacity in the future. There is a formal legal protocol to register an attorn

Question 211

Advanced statement of wishes

Answer 211

es are about expressing preferences – i.e. written statements of wishes. They are not legally binding but the should be taken into account

Question 212

Advanced directives =

Answer 212

- specific decision to refuse treatment (can’t demand treatment) * Trumps best interests every time as is equal to consent * Are beneficial as they extend patient auto

Question 213

Ulysses arrangements =

Answer 213

Ulysses Arrangements used in psychiatry, i.e. when someone has bipolar etc which allow someone to direct how they are treated if they have relapsing / remitting capacity

Question 214

A person cannot refuse ... with an advanced directive

Answer 214

Note: can not refuse basic personal care, such as offer of provision of oral food and drink (can refuse artificial nutrition) / prevention of bed sore

Question 215

DOLS

Answer 215

- Deprivation Of Liberty Safeguards: allow restraint and restriction only if this is in the persons best interest - sets out a process that hosp and care homes must follow

Question 216

conditions to deprive liberty under DOLS

Answer 216

- That the arrangements are in the person’s best interest 2. The person is appointed someone to represent them 3. The person is given a legal right of appeal over the arrangements 4. The arrangements are reviewed and continue for no longer than necessary

Question 217

Safeguarding kids=

Answer 217

- Protecting child from maltreatment 2. Preventing impairment of child’s health / development 3. Ensure child grows up in circumstances consistent with provision of safe & effective care

Question 218

if u suspect a child is in immediate danger ->

Answer 218

If suspect a child is in immediate danger refer to local authority social care (or police if very urgent)

Question 219

Section 17 of childrens act

Answer 219

- Under Section 17 of Children’s Act 1989 = deemed to be in need if, without the provision of services by a local authority, a child is: 1. Unlikely to maintain or achieve satisfactory level of health & development 2. Their health or development is likely to be significantly impaired 3. They are disabled

Question 220

Section 44

Answer 220

* Section 44 = Emergency Protection Order (EPO) can be sent by police, NSPCC & social services: 1. Requires person to produce child to applicant 2. Prevention of removal of child from safe place, e.g. hospital, or ensures removal to safe place 3. Gives parental responsibility of child

Question 221

how long does a section 44 last

Answer 221

8 days - can extend for 7 days only

Question 222

paeds confidentiality

Answer 222

- . Must seek child’s permission before discussing with parent / guardian – BUT obligation NOT ABSOLUTE * If risk of abuse or sexual consent (< 13 y/o) must break confidentiality

Question 223

when can confidentiality be broken

Answer 223

- life threatening situations: self harm, suicide, DVLA - Demanded by Court Statute / CQC / NHS fraud / GMC / Parliament (or certain communicable diseases) - disclosure in public interest to prevent harm - Patient lacks capacity & disclosure is in their best interest

Question 224

Disclosure is in public interest to prevent harm:

Answer 224

A. Communicable disease to partner B. Intention to murder / terrorism prevention C. DVLA informed Insulin, Epilepsy, TIAs if patient won’t D. Knife / gun wounds police must be informed E. Protect children F. Prevent trafficking

Question 225

anonymous - confidentiality

Answer 225

can be used for stats purposes if anonymous

Question 226

deceased - confidentiaity

Answer 226

* Usually allowed to disclose to certain parties unless patient explicitly requested complete confidentiality upon deat

Question 227

BREAKING CONFIDENTIALITY (simplified)

Answer 227

1. Protect children 2. Protect public – e.g. from acts of terrorism 3. Required by courts 4. Prevent or detect a crime 5. Provide care in life-threatening circumstances 6. Protect the service provider in life-threatening circumstances

Question 228

Indepndent MH advocate

Answer 228

- Allocated worker to support patient, allow them to express their views & concerns, & to defend their rights a) Doesn’t advise them, but gives them objective information to facilitate them making a decision b) Accompany & support them at meeting

Question 229

AMHP =

Answer 229

- Usually psychiatrist, although could be social worker, CPN etc. - Is someone with special training in mental health, who makes application for section

Question 230

Section 12 approved dr =

Answer 230

usually psychiatrist, although can be GP, who has been approved under MHA for sectioning patient

Question 231

section 2 of MHA

Answer 231

- Detainment in hospital for assessment, e.g. this is done when diagnosis is unclear, & when a treatment plan needs to be put in place - sig risk to self/ others

Question 232

Who must apply for a section 2

Answer 232

Must be applied for by AMHP & approved by 2 doctors (one must be section 12 approved) = 2 independent

Question 233

duration of a section 2

Answer 233

28 days

Question 234

section 3

Answer 234

- . Power Detention in hospital for treatment. Patient must have a diagnosis for this (can include prior diagnosis), and treatment must be available & expected to improve patient - can be treated with meds

Question 235

section 3 -ation b) If want to administer surgical intervention, ECT etc

Answer 235

SOAD approval

Question 236

Who must apply for a section 3

Answer 236

Must be applied for by AMHP & approved by 2 doctors (one must be section 12 approved) = 2 independendent doctors

Question 237

Duration of a section 3

Answer 237

. Duration 6 months (reviewed after initial 3 months), then renewed for another 6 months, then annually after

Question 238

section 4 =

Answer 238

- Detention in hospital for emergency assessment, when S.12 Doctor can’t be obtained quickly (when they’re present converted to SECTION 3)

Question 239

What cannot be done under a section 4

Answer 239

treatment

Question 240

who can apply for a section 4

Answer 240

Can be applied for by an AMHP (or technically nearest relative). Only requires 1 other qualified doctor to approve

Question 241

duration of a s4

Answer 241

72 hrs

Question 242

Section 5(2)

Answer 242

- doctor holding powers - can be converted to a S.2 / S.3 when AMHP, S.12 Doc and SOAD available - applied for by dr, doesnt need approving

Question 243

duration of section 5(2)

Answer 243

72 hrs

Question 244

section 5(4)

Answer 244

- nurse holding powers - can be converted to 5(2) when dr available - applied for by nurse doesnt need approving

Question 245

Section 5(4) duration

Answer 245

only 6 hrs

Question 246

section 125 =

Answer 246

A. Power Police can use this to hold you or take you to a place of safety if they think you are suffering from MHD - Does not need any approvals

Question 247

duration of a section 135

Answer 247

36 HRS - CAN BE EXTENDED

Question 248

section 136

Answer 248

A. Power Police can use this to hold you or take you to a place of safety if they think you are suffering from a MHD - does not need any approvals

Question 249

duration of a 136

Answer 249

B. Duration 24 hours + 12 hour

Question 250

section 17

Answer 250

A. Power To leave ward whilst on an inpatient section * : Enforced treatment, whilst living in community = must follow certain conditions - if break these conditions pt recalled

Question 251

HRA

Answer 251

. Right to life: * The European court has held that the article requires hospitals to take measures to ensure steps are in place to secure an individual's right to life = mostly relevant with regards to suicide 2. Prohibition of torture: * Have to justify medical treatment (as side effects / process e.g. ECT) could be classified as torture * Relevant to MHA as could give patient cheaper drug with worse side effects (can’t do this), or give drug instead of psychological therapy 3. Right to liberty & security: * Everyone has right to freedom cannot be taken away without good reason

Question 252

HRA - right to a fair trial

Answer 252

4. Right to a fair trial: * Everyone sectioned has the right to a mental health review tribunal hear

Question 253

limited rights

Answer 253

- authorities can interfere e.g. s it’s not a breach of your right to personal freedom if you’re detained following a criminal conviction or under mental health legislation and the correct procedure was followe

Question 254

Qualified rights

Answer 254

A public authority can sometimes interfere with your rights if it’s in the interest of the wider community or to protect other people’s rights. These rights are qualified The following rights are qualified: A. Article 8 - your right to respect for private and family life B. Article 9 - freedom to manifest your religion or belief C. Article 10 - freedom of expression D. Article 11 - freedom of assemb

Question 255

absolute rights

Answer 255

- can never be restricted - e.g. right to not be tortured or treated in inhumane way - right to hold religious and non-religious beliefs

Question 256

Fertility and LD

Answer 256

- : most people with LD have sexual interests. It is discouraged as they may not be able to provide sufficient care, capacity to consent or refuse sex - Serious issues including sterilisation are dealt with by the Court of Protection when a patient doesn’t have capacity

Question 257

LD - if sterilisation or abortion are being considered then

Answer 257

If sterilization or abortion are being considered as a possible option for a person who is considered to lack capacity, and the person has no-one else to support or represent them, an Independent Mental Capacity Advocate (IMCA) must be appointed

Question 258

Disability Discrimination Act (1995):

Answer 258

- Illegal to discriminate against someone applying for a job because of a disability & employers are expected to make reasonable adjustments to their premises to assist disabled users * Includes: 1. Reasonable adjustment during recruitment 2. Allowing someone with anxiety to have own desk instead of hot desking 3. Installing physical changes, e.g. ramp for wheel-chair access 4. Letting disabled person work somewhere else, e.g. ground floor for wheel chairs, or quieter room 5. Allowing phased returns to work & flexible hour

Question 259

What is an audit

Answer 259

- Audit is the systematic critical analysis of the quality of medical care, including: 1. Procedures for diagnosis = including pathways 2. Procedures for treatment 3. Care of patient

Question 260

How does an audit measure quality

Answer 260

1. Outcomes, e.g. survival 2. QOL for patient 3. Cost-effectiveness

Question 261

stages of an audit

Answer 261

Set standards what should be happening 2. Collect data measure current situation 3. Analyze assess against standards set 4. Identify steps to improve 5. Implement changes 6. Re-evaluate collect more

Question 262

benefits of audits

Answer 262

- 1. Clinical education is improved 2. Can improve teamwork 3. Improve patient care: can identify if pt outcomes met, prevent near misses becoming incidents, ensure pt satisfaction 4. fulfils contractual obligations

Question 263

negatives of audit process

Answer 263

- snapshot - influenced by confounding factors, may not be rep - hard to identify if something is a problem - e.g. hard to know what desired outcomes are

Question 264

what can limit audits

Answer 264

- small sample size - reduced usefulness of results - Can be hard to do as takes time for people to implement change (get used to new way) - cost/ time constraints of making the change

Question 265

clinical audit =

Answer 265

is a way of finding out whether you are doing what you should be doing by asking if you are following guidelines and applying best practice

Question 266

Research =

Answer 266

- evaluates practice or compares alternative practices, with the purpose of contributing to a body of knowledge by asking what you should be doing

Question 267

NICE technology appraisals

Answer 267

- Aim of appraisal is to assess evidence base for: clinical / cost-effectiveness of new / existing technology providing - authoritative source of advice = mandatory for a CCG to fun

Question 268

developing tech appraisals

Answer 268

-1. Topic selection – through consultation with industry, NHS and patient groups topics agreed with Department of Health 2. Data submission – industry required to submit all trial data according to NICE criteria (e.g. use of NICE endorsed questionnaires / tests) 3. Data review – NICE appraisal committee allocates data to an academic center to report on clinical and cost-effectiveness - NICE report - 6. Call for contributions – committee reaches a preliminary conclusion - interested parties are called to contribute e.g. Royal Colleges, patients, healthcare professionals 7. Funding – the reports are finalized and if issued as mandatory, CCGs must fund if service is required 8. Guidance issued: * If issued as mandatory, CCGs must fund service if req

Question 269

Technology appraisals - NICE issue a report based on

Answer 269

- A. Clinical effectiveness industry required to submit all trial data & then NICE reviews B. Cost effectiveness identified with the Incremental Cost Effectiveness Ratio = (cost A – cost B) ÷ (QALYs B – QALYs A) * NICE commissions an independent academic center to undertake this review

Question 270

aims of guidelines

Answer 270

- improve QOH - Provide standards against which HCPs should be assessed * Reduce unacceptable variations 3. Helps to make informed decisions based on evidence 4. Improve communication between patient & HCP = allow patient to make informed decisions

Question 271

assessing efficacy of guidelines

Answer 271

SSRI-AC - Scope & purpose = what intends to do 2. Stakeholder involvement = has it considered preferences of users / target population 3. Rigor of development: * Has it been formed using systematic approach 4. Independence (editorial) = recommendations not due to external influence 5. Applicability = tools / advice on how to implement, and identified barriers to implementation 6. Clarity = does it make clear recommendations

Question 272

good guidelines should be

Answer 272

Question 273

Barriers to use of guidelines

Answer 273

- lack of awareness of how current practice is inappropriate - attitudes - cred of resource - overreliance on trusted sources - time limits and contraints - b) Organisational culture behaviour, pressure to act / follow certain

Question 274

Encouraging people to adopt guidelines

Answer 274

- multifaceted approach - involve pt - educational sessions - audio/ visual aids/ computeer reminders

Question 275

publically available performance indicators

Answer 275

- * Performance league tables are a technique for displaying comparative rankings of performance indicator scores of several similar providers = set standard of acceptable performance for surgical procedures * If any apparent large variations DOH investigates * e.g. for cardiac surgery mortality

Question 276

why do we have publically available performance indicatirs

Answer 276

- 1. Readily available info in other areas (e.g. schools, police etc.) = why shouldn’t we measure outcomes, as this is the measure of quality 2. There is often a lack of evidence base behind practice should back up what we do with numbers 3. The realization that there is a wide variation in practiced standard / public evidence of deficiency in quality of care 4. Internet / increasing public education reducing the previous high level of trust public has in HC

Question 277

advantages of publically available performance indicators

Answer 277

Allows quantification of quality in an easily categorised & measurable way (e.g. deaths in surgery) 2. Should drive improvements in quality = can identify outliers & therefore allow for this to be improved upon 3. Should identify areas for improvement 4. Give patient trust in doctor & allow patient more choice = transparent, honest & open

Question 278

limitation of publically available performance indicators

Answer 278

- Mis-leading, e.g. doctor with high death rate may be because does more complex surgeries = ‘case-mix’ - most hosp deaths not preventable - no proven correlation w care - Could result in bad hospitals getting worse / good getting better patient with good prognosis go to good hospital - 5. Creates an individualistic culture of blame

Question 279

cost effective vs clinically effectiev Tx

Answer 279

- Cost-effective intervention – is ALWAYS clinically effective B. Clinically effective – is not always cost-effective

Question 280

adverse events =

Answer 280

“An unintended event resulting from clinical care and causing patient harm (physical or psychological

Question 281

Never event =

Answer 281

- Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented - wrong site surgery e.g.

Question 282

near miss events

Answer 282

A situation in which events or omissions, arising during clinical care fail to develop further whether or not as the result of compensating action, thus preventing injury to a patient

Question 283

When do adverse events occur

Answer 283

- when factors at diff levels align e.g. swiss cheese model

Question 284

reporting of advserse events

Answer 284

- drs have a duty to report adverse events and near misses 1. Report on the National Reporting & Learning System = confidential 2. Reporting done to prevent future errors occurs - Root cause analysis

Question 285

RCA

Answer 285

“structured investigation that aims to identify the true cause of a problem and the actions necessary to eliminate it

Question 286

Serious hazard of transfusion

Answer 286

sUK haemovigilance scheme collects anonymised info on adverse events / reactions to blood trans

Question 287

Yellow card scheme

Answer 287

a system: yellow card system = drug reactions and side-effects reported on a yellow card at bac

Question 288

most common Adverse events

Answer 288

- prescribing - wrong dose, drug, route - comm failure - delay/failure in diagnosis

Question 289

duty of candour

Answer 289

1. Must tell patient when something has gone wrong 2. Must apologize & offer appropriate resolution 3. Must explain the potential short & long-term effects

Question 290

Swiss Cheese Model

Answer 290

many events have to align for an adverse event to occur

Question 291

SCM - active failures - knowledge based

Answer 291

-. Knowledge-based: wrong plan formed due to inadequate knowledge / experience (e.g. junior doctor misdiagnosis (unintentional)

Question 292

SCM - active failures - rule based

Answer 292

: Misapplication of ‘good rule’ / guideline (i.e. applying guideline for 10y/o to neonat

Question 293

SCM - active - skill based

Answer 293

- : Attention / memory lapse = unintended deviation from good action / plan * These are commo

Question 294

SCM - routine error

Answer 294

intentional - normalisation bad practice

Question 295

SCM - situational error

Answer 295

intentional - l: Context-dependent (i.e. shortcuts when overwhelmed / understaffe

Question 296

SCM - REASONED ERROR

Answer 296

: Deliberate deviation from protocol thought to be in best interest at ti

Question 297

SCM - malicious error

Answer 297

: Deliberate act intended to ha

Question 298

e.g. of latent errors SCM

Answer 298

e.g. working environment, staff training, staff hou

Question 299

Adverse events - steps to pt safety

Answer 299

- Build safety culture - lead and support staff - intergrate RM activity - promote reporting - involve and comm w patients - implement solutions to prevent harm - learn and share safety systems

Question 300

other aspects of pt safety (3)

Answer 300

1. Fitness to practice 2. Reporting near misses & adverse events learning from these 3. Incentivize good quality Commissioning for Quality and Innovation (CQUIN) paym

Question 301

Measures of quality – Donabedian Model

Answer 301

2. Structure – this is good quality because the right things are present 3. Process – good quality because the right things are done 4. Outcome – good quality because things turn out right

Question 302

2 stage process of complaints

Answer 302

1. local resolution 2. national level

Question 303

local resolution of compliants

Answer 303

* Encouraged to express directly to staff at the time * 1st step is to contact service provider directly e.g. GP or hospital OR contact CC - Complaints should normally be made within 12 months of an incident but this can be extended if there are good reasons for the delay * If unhappy with outcome / decision / process then can escalate

Question 304

PALS

Answer 304

– can offer advice about the process + help resolve issues informally

Question 305

Claims - if patient not satisfied with local resolution

Answer 305

* If individual is not satisfied with the dealing / outcome of this Parliamentary and Health Service Ombudsman = independent of government /NHS

Question 306

Eurocare study

Answer 306

a uniform data collection protocol and statistically analyzes problem. It collects data on the 5 year survival of cancer patients in different countries. The UK had one of the worst survival statistics in Europe

Question 307

EUROCARE

Answer 307

= EUROpean CAncer REgistr

Question 308

reasons for the UK performing so badly in the EuroCare study

Answer 308

1. Differences in data collection 2. UK has an older population 3. Patients present later in the UK 4. Lower social classes don’t access the services 5. Poor access to treatment = delay in diagnostic pathways

Question 309

The results of the eurocare study lead to

Answer 309

creation of the calman hine report

Question 310

Recommendations of the calman hine report

Answer 310

- Concluded unacceptable variation in quality of treatment between hospitals = services were disjointed & outcomes were poor 2. So would be better to centralize treatment to improve quality, with primary care at the center of this 3. Should ensure all patient have equal access to care 4. Public & professionals educated on recognizing early signs 5. Services should be patient centered given clear info on treatment options & outcomes 6. Cancer registration & monitoring of outcomes is essential 7. Psychosocial needs of carers & patient recognized

Question 311

resolutions from the CHR

Answer 311

- resulted in the formation of cancer networks - 3 levels of care - PC - Cancer unit - Cancer center

Question 312

Role of PC in the cancer network

Answer 312

prevention and early diagnosis

Question 313

Cancer unit =

Answer 313

(1 per 250,000) treat common cancer, make diagnosis (non-complex chemo & surger

Question 314

cancer center =

Answer 314

treat rare cancers, radiotherapy, complex chemotherapy & surg

Question 315

reasons for centralising cancer care

Answer 315

1. Not cost effective to have resources for everything everywhere 2. Clinicians become more expert so better outcomes = been shown clinicians with higher vol. have better outcomes especially important as will see more of the rare cancers * Easier to have alliance between providers = share best procedure knowledge, less variation 3. Patient will receive better care for their specific condition = can get more holistic care as can integrate all serv

Question 316

Issues with centralising cancer care

Answer 316

* Some hospitals get neglected with resources & have worse care * Cost to patient of travel

Question 317

What are the Aims of the Strategic Cancer Networks?

Answer 317

- Reduce incidence of cancer. - Maximize survival of cancer patients. - Enhance quality of life of cancer patients and their families. - Improve the patient experience of cancer services. - Provide a high quality service focused on the needs of the patients and carers.

Question 318

What do the Strategic Cancer Networks do?

Answer 318

- Develop strategic plans for delivering better care. - Implement national policies. - Deliver the improvements in care. - Provide a channel for communication between groups across the network. - Provide resources for audits and research.

Question 319

cancer networks

Answer 319

- created to implement the NHS cancer plan - primary aim is to reduce inequalities in cancer care - 34

Question 320

National Cancer Research Network

Answer 320

- created in resp to need to imporve infrastructure within NHS for clinical research in cancer - established in 2001 - Aim = improve the speed, quality and integration of research, ultimately resulting in improved patient car

Question 321

Cancer research institute

Answer 321

- was created to help develop common plans for cancer research - helps avoid duplication of studies - established in 2001

Question 322

Roles of cancer research institute

Answer 322

1. Invest in facilities + resources for research 2. Maintain cancer research database and analyze new research 3. Develop research initiatives 4. Coordinate clinical trials for new dru

Question 323

cancer reform strategy

Answer 323

1. Prevention 2. Early diagnosis overcome barriers preventing presentation to GP (including awareness of symptoms), education of GPs & more screening, new referral guidelines, decision aiding tools 3. Treatment being better reduce waiting times (2 week wait), improve clinical trials, better training 4. Living with & beyond cancer partnership with charities, clinicians and patient to increase support + services for survivors (ended 2013) 5. Inequality reduction 6. Delivering care in most appropriate settings locally for patient convenience when possible, but centralised if this improves quality of care PETLID

Question 324

Cancer registration

Answer 324

- conducted by 4 cancer registries which collect data and submit to ONS - National Cancer Intelligence Network (NCIN) at ONS coordinates this & carries out secondary analysis: * Attempt to identify all new cancers diagnoses & follow these patients up

Question 325

What does cancer registration allow for

Answer 325

Allows comparisons in the incidence of disease & survival in different places and populations groups – and also allows researchers to examine the long term outcome under different treatments or between population groups

Question 326

who is resp for reporting cancer diagnoses

Answer 326

Doctor responsible for reporting this have to inform patient - to ONS

Question 327

Functions of cancer registration

Answer 327

1. Monitoring trends in incidence, survival & variations between areas & social groups 5 year survival 2. Evaluate effectiveness of screening programmes 3. Evaluate quality & outcomes of current care 4. Evaluate impact of environmental & social factors on cancer risk

Question 328

Relative cancer survivals

Answer 328

survival compared with people without the illn

Question 329

observed cancer survival

Answer 329

actual number following observational period

Question 330

net cancer survival

Answer 330

probability of surviving cancer in absence of other illness

Question 331

cruide cancer survival

Answer 331

probability of death from cancer in presence of other causes of death

Question 332

confounding factors and death rates

Answer 332

- can control for it via: - Indirect standardisation: observed/ expected mortality rate > 100% is more than expected - direct standardisation - stratum spec rates * = rate in a specific segment / stratum of the population

Question 333

Psych consq of cancer

Answer 333

- appearance: chemo and hair loss, mastectomy - disruption of assumptove world theory - Family / friends death forces to confront own mortality 2. Worry about leaving people behind, especially children 3. Grief 4. Uncertainty

Question 334

asuumptive world theory

Answer 334

- Benevolence theory = not everything in world is good * That world is meaningful = bad thing happens to good person, so point of being good is shattered * May change biography = who I am – can also directly change identity * The assumption of invulnerability = nothing bad could happen to me * Can’t rely on body anymore * Can control fate = loss of control of fate

Question 335

Global burden of cancer prev

Answer 335

Lung > breast > colorectal > prostate

Question 336

Global causes of cancer death

Answer 336

- Lung > colorectal > breast > prostate * 33,000 deaths per year from lung malignancy (almost all caused by smoking)

Question 337

Uk top 3 cancer

Answer 337

1. Female = breast / Male = prostate 2. Lung 3. Bowel

Question 338

Incidence changes in uk cancer rates

Answer 338

1. Incidence of most increases with age 2. Bladder currently decreasing due to reduced occupational exposure to aniline dyes 3. Lung decreasing overall (still increasing in women) 4. Liver increasing due to alcoholism 5. Melanoma increasing due to holidays abroa

Question 339

childhood cancer rates =

Answer 339

- Peak incidence at 2-5yrs * Leukaemias > brain/CNS > lymphomas * Acute Lymphoblastic Leukaemia most common

Question 340

cancer MDT

Answer 340

STERAMLINES AND CO-ORDINATES CANCER CARE SO IT IS NOT FRAGMENTED

Question 341

members of cancer MDT

Answer 341

A. CORE: Medical staff (physician, oncologist, radiologist, histopathologist), specialist nurse, MDT co-ordinator B. EXTENDED: Physio, dietician, palliative care, chaplain, social worker

Question 342

function of cancer MDT

Answer 342

1. Discuss all new diagnosis 2. Decide on management plan & inform primary care 3. Develop guidelines 4. Designate specialist nurse to patient

Question 343

impairment =

Answer 343

Any loss or abnormality of psychological, physiological or anatomical function

Question 344

disability =

Answer 344

Any restriction or lack of ability, resulting from impairment, within a manner considered normal for a human being

Question 345

handicap=

Answer 345

A disadvantage (limitation to role) because of a disability

Question 346

social model of disability

Answer 346

Disability is caused by the way society is organised, rather than by a person’s impairment or difference

Question 347

social constructionism

Answer 347

The concept that there is no such thing as a disabled individual but that society makes people individual

Question 348

medical model of disability

Answer 348

People are disabled by their impairments or differences

Question 349

interaction model of disability

Answer 349

- disability derives from the interaction between the individual and society

Question 350

cost effectiveness analysis

Answer 350

Used when the effect (outcome) of the two interventions is expected to vary * The outcome is measured in natural units e.g. BP, cholesterol level, mortality, live years saved * The outcome is one dimensional - addresses quantity or quality, not both

Question 351

Cost utility analysis

Answer 351

- Used when the effect (outcome) of the interventions on health status has two or more dimensions * Measures outcome in terms of quantity and quality. Combines these into a single measure e.g. the QALY = Quality Adjusted Life Year - Can be used to compare interventions with a disease or condition or across different diseases or treatment options

Question 352

cost benefit analysis

Answer 352

Most comprehensive form of evaluation ● Takes a societal perspective ● All costs and outcomes are included ● Measured in monetary units

Question 353

cost minimisation analyssi

Answer 353

- Assumes both options have the same outcome ● Choose the option that costs the least ● Cannot provide answers where effectiveness is different between competing alternatives

Question 354

cost consequene

Answer 354

Measures costs, measures consequences

Question 355

sensitivity analysis

Answer 355

Vary key assumptions and see if it has an impact’

Question 356

normal grief

Answer 356

Numbness - Yearning/pining - Anger - Disorganisation and despair - Reorganisation

Question 357

Acute grief

Answer 357

- Somatic or bodily distress - Preoccupation with image of the deceased - Guilt relating to the deceased or circumstances of the death - Hostile Reactions - Inability to function as one had before the loss

Question 358

Wordens task of mourning

Answer 358

1. Accept the reality of loss 2. Work through the pain of grief 3. Adjust to an environment in which the deceased is missing 4. Emotionally relocate the deceased and move on with life

Question 359

Pathological grief

Answer 359

- Extended grief reaction - Mummification – preservation of deceased person’s thing or room and denial - Major depressive disorder >2 months after loss

Question 360

fair innings argument

Answer 360

- According to this argument, younger persons have stronger claims to life-saving interventions than older persons because they have had fewer opportunities to experience life. - The implication is that saving one year of life for a young person is valued more than saving one year of life for an older person.

Question 361

Leventhal's Model of Illness Representation

Answer 361

1. Identity of Illness 2. Timeline of illness 3. Consequence of illness 4. Cause of illness 5. Control of illness ● Provides framework/checklist to guide understanding of how patients psychologically represent the illness

Question 362

MUS

Answer 362

- Physical symptoms with no organic disease explanation, assumed they’re caused by psychological factors - related to stress, iatrogenic maintenance, childhood exp

Question 363

impact of MUS

Answer 363

- distress - concern abt future - high cost of ix and mx - iatrogenic harm - Lack of legitimacy (can’t enter sick role) - can’t access support groups and experience social isolation

Question 364

Role of the post-mortem examination influencing the care of the living

Answer 364

- Gain more insight into pathological process allows you to see if diagnostic tests / clinical signs correlate with what was actually going on - help w medical research - prevention of pt deaths in the future - understand disease progression

Question 365

10 legal requirements for a post-mortem

Answer 365

1. Sudden / unexpected death 2. Unknown cause of death / unnatural death (accident / suicide / suspicious) 3. History of violence or substance abuse, alcoholism etc. 4. Death may be due to a medical procedure either invasive or not 5. Industrial disease death 6. Death from negligence 7. Death within 24 hours of admission 8. Not seen by doctor for 14 days 9. Patient detained under MHA 10. Receiving war pension / industrial disability pension unless death shown to be unconnecte

Question 366

Role of HM Coroner

Answer 366

- Investigate and ascertain cause of deaths occurring in suspicious circumstances * Body can’t be release until after coroner satisfied with cause of dea

Question 367

consent in a PM examination

Answer 367

1. A coroner’s post mortem / inquest does not need consent i.e. if there is a criminal investigation 2. Hospital post-mortems do need consent Consent otherwise may be from: 1. The deceased before they died 2. A nominated representative 3. A qualifying relations

Question 368

Quality in healthcare can be measured or examined / evaluated using

Answer 368

Donabedian Model of Structure, Process and Outcom

Question 369

Donabedian model - structure

Answer 369

* Refers to the setting in which care is delivered: includes facilities and equipment * Good care structure and adequate settings + facilities should contribute to good care

Question 370

Donabedian model - process

Answer 370

- How is the care provided in terms of Appropriateness, Acceptability, Completeness or Competency (2 A’s / 2 C’s) - * Measuring process equates strongly to quality of care because you are looking at all of the acts of delivering healthcare

Question 371

donabedian - outcome

Answer 371

* Refers to the end point of care such as survival, improvements in function or speed of recovery - However they are open to bias because outcomes can be influenced by MORE THAN JUST HEALTHCARE

Question 372

what should we inform the GMC of

Answer 372

- cautions - do not need to inform of fixed penalty fines

Question 373

Period prevalence =

Answer 373

number of identified cases during a specified period of time / total number of people in that population

Question 374

point prev

Answer 374

the number of cases in the population at this point in time

Question 375

incidence =

Answer 375

the number of new diagnoses per population during a specified period of time

Question 376

relative risk =

Answer 376

experimental - control risk /// Control risk

Question 377

controlled drug prescription - what needs to be stated in words and figures

Answer 377

it is the quantity supplied which needs to be stated in both figures and words, rather than the dosage 56 (fifty six) tablets

Question 378

is the framework that governs the emergency management of patients who refuse treatment

Answer 378

common law

Question 379

SD values

Answer 379

68.3% of values lie within 1 SD of the mean 95.4% of values lie within 2 SD of the mean 99.7% of values lie within 3 SD of the mean

Question 380

Notify the coroner with these deaths: (PHONE the coroner)

Answer 380

Police custody/prisoners Hospital admission (24hrs) Occupational related (asbestosis) Neglect (ill treatment, starvation) unExpected/sudden death

Question 381

healthy volunteers are always recruited for which phase of a trial

Answer 381

always 1

Question 382

testing sig of a correlation

Answer 382

- parametric (normally distributed): Pearson's coefficient - non-parametric: Spearman's coefficient

Question 383

rELATIVE RISK

Answer 383

EXP EVENT RATE - CONTROL EVENT RATE

Question 384

Increasing the sample size increases the

Answer 384

power of the study and decreases type 2 error

Question 385

used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions

Answer 385

chi sq

Question 386

occurs when two tests for a disease are compared, the new test diagnoses the disease earlier, but there is no effect on the outcome of the disease

Answer 386

lead time bias

Question 387

conditions of an advanced care directive

Answer 387

- MUST BE OVER 18 - must be of sound mind - must be specific - can refuse Tx but not demand it

Question 388

best form of obs study

Answer 388

prospective cohort - can establish a temporal relationship

Question 389

This states that you must tell the GMC, without delay, if anywhere in the world, you:

Answer 389

Are found guilty of a criminal offence Are charged with a criminal offence Formally admit to committing a criminal offence (for example, by accepting a caution) Accept the option of paying a penalty notice for an ASBO Receive a cannabis warning Have had your registration restricted, or have been found guilty of an offence, by another medical or other professional regulatory body. Your conduct (including as part of a management team) has directly contributed to an organisation that has entered into a deferred prosecution agreement.

Question 390

GMC Guidelines state that you must notify the police in case of ? wounds

Answer 390

- knife wounds caused by a violent attack - Personal information about the patient should not usually be disclosed in the initial contact with the police, and they will respond even if the patient's identity is not disclosed.

Question 391

following an unsuccessful resuscitation attempt in hospital, an individual should be observed for signs of life for a minimum

Answer 391

of 5 mins

Question 392

Disclosures to prevent an act of terrorism can be made withou

Answer 392

pt consent

Question 393

how should a patient who has dropped outs datae be analaysed in a study

Answer 393

as part of the group they were allocated to regardless of adherence - ITTA

Question 394

When analyzing data on a scatter plot,? may be used to predict how much one variable changes when a second variable is changed

Answer 394

linear regression

Question 395

A graphical display of continuous data where the values have been categorised into a number of categories

Answer 395

HISTOGRAM

Question 396

If GMC requests pts info,

Answer 396

inform the patient then give it - must comply even w/o patient consent

Question 397

Power =

Answer 397

the probability of (correctly) rejecting the null hypothesis when it is false

Question 398

paticular problems in CCS

Answer 398

recall bias

Question 399

HIV - disclosure

Answer 399

give opportunity to inform, if patient does not inform partner then it is your duty to inform

Question 400

MHA vs MCA

Answer 400

The Mental Health Act overrides the Mental Capacity Act and enables people with capacity to be given treatment against their will

Question 401

Graphical representation of the sample minimum, lower quartile, median, upper quartile and sample maximum

Answer 401

bOX PLOT

Question 402

Variance =

Answer 402

square of SD. Variance is a measure of the spread of scores away from the mean.

Question 403

show publication bias in meta aalysis

Answer 403

if asymmetrical - funnel plot

Question 404

phase 2 studies

Answer 404

assess efficacy of drugs

Question 405

DNACPR and consent

Answer 405

Resuscitation is an active treatment and therefore DNACPRs can be put on non-consenting patients. This is supported by case law

Question 406

Advance directive - most cruicial element

Answer 406

refers to a specific treatment in a specific circumstance

Question 407

MA and power

Answer 407

increases power and reduces p value - improves estimates of the size of the effect by combining individual studies that may be low-powered

Question 408

Controlled drug prescriptions -? must be included on the prescription

Answer 408

the address of the patient

Question 409

MHA - use in non psychiatric issues

Answer 409

should not be used to detain patients (including those with mental health conditions) for non-psychiatric issues

Question 410

the probability of detecting a statistically significant difference

Answer 410

power

Question 411

Increasing the sample size increases

Answer 411

power of the study -> decreases t2 error

Question 412

survival plot

Answer 412

The Kaplan-Meier survival plot displays estimates of decreasing survival with time after an event

Question 413

Expectation bias (Pygmalion effect)

Answer 413

observers may subconsciously measure or report data in a way that favours the expected study outcome.

Question 414

Which phase of clinical trials specifically looks at the efficacy of the drug?

Answer 414

Phase IIb

Question 415

power equation

Answer 415

1 - prob of type 2 error

Question 416

As a doctor, if you identify your job role online,

Answer 416

you should also state your name

Question 417

gathering information at an inappropriate time

Answer 417

late look bias

Question 418

Standard error of the mean =

Answer 418

Standard error of the mean = standard deviation / square root (number of patients)

Question 419

Skewed distributions

Answer 419

- alphabetical order: mean - median - mode - '>' for positive, '<' for negative

Question 420

compares two sets of observations on a single sample, e.g. a 'before' and 'after' test on the same population following an intervention

Answer 420

wilcoxon signed rank test

Question 421

? can be used to combine data from more than one study

Answer 421

forest plot

Question 422

larger studies done on actual patients, comparing treatments with currently available treatment

Answer 422

phase 3

Question 423

If the deceased has an unknown cause of death then they should be

Answer 423

ref to coroner

Question 424

chronic disease prev

Answer 424

In chronic disease prevalence is greater than incidence - in acute disease the incidence is greater than the prevalence

Question 425

acute disease prev

Answer 425

incidence > prev

Question 426

Graphical representation using Cartesian coordinates to display values for two variables for a set of data

Answer 426

scatter plot

Question 427

describes a group changing it's behaviour due to the knowledge that it is being studied

Answer 427

hawthorne effect

Question 428

compares ordinal, interval, or ratio scales of unpaired data

Answer 428

mann whitney u

Question 429

did the study address a clearly focused question

Answer 429

- PICO

Question 430

CAR: randomisation

Answer 430

- was there randomisation - was it sufficent - allocation concealment?

Question 431

Were all participants who entered the study accounted for at its conclusion?

Answer 431

- good study not expected to lose more than 20% - attrition bias - was this accounted for? - intention to Tx analysis

Question 432

Full analysis set shows

Answer 432

an ITTA was carried to

Question 433

Apart from the experimental intervention, did each study group receive the same level of care (that is, were they treated equally)?

Answer 433

- was there a clearly defined protocol - were any additional Tx given - were they similar between study groups - were follow up intervals the same for each study gr

Question 434

what helps limit publication bias in an RCT

Answer 434

Having a protocl before study starts

Question 435

cruical element of randomisation

Answer 435

unpredictable assignment to groups

Question 436

as you increase the sample size what happens to CI

Answer 436

narrower

Question 437

why do a SR

Answer 437

- single studies combined - scientific approach to summarising evidence - reduced inaccuracies from bias - more reliable and quicker - provide more statistical power

Question 438

how can we address confoundung

Answer 438

- restricting entry to study - matching - statification - multi variable regression

Question 439

OR and RR table

Answer 439

Question 440

clinical heterogenecity

Answer 440

Clinical heterogeneity means that the forms of treatment being compared in the individual studies varied.

Question 441

statistical heterogenecity

Answer 441

Statistical heterogeneity means that estimates of how effective the treatment was differed between individual studies.

Question 442

explain your understanding of a meta analysis

Answer 442

Meta-analysis means that the results of more than one study are combined (or pooled) together to create an overall average estimate of the effectiveness of a treatment. Done appropriately this can give a more precise estimate of how well a treatment works

Question 443

why can a MA sometimes not be done for certain measures

Answer 443

- Only one study measured the outcome (e.g. return to physical exercise), so there were no data to pool. - High level of statistical heterogeneity (e.g. pain scores), so meta-analysis would have produced a result that was unreliable.

Question 444

MA - forest plot exlanation

Answer 444

- Figure Xrepresents pooled analysis of X RCTs - Results are expressed in terms of whether treatment was associated with an increased or decreased rate - 95% confidence intervals are presented for each study, and these represent a credible margin of error around each study estimate. - A line is plotted on the graph highlighting the relative risk value of one, this is value taken if there is no association between stenting and risk of admission.

Question 445

Discuss why quickly searching a few key terms on MEDLINE is considered inadequate for a systematic review (2 mark)

Answer 445

Complex search strategies are sensitive enough to identify all potential trials * Using one database might result in omission of trials published in a journal not captured within Medline

Question 446

DATASBASES that can be searched to find studies

Answer 446

- cochrane - textbooks - Direct communication with pharmaceutical/device companies - pubmed - embase - clinicaltrials.gov

Question 447

publication bias

Answer 447

* The likelihood of publishing a study based on the nature and strength of the study findings

Question 448

Name two approaches taken by the authors in this study might have introduced publication bias

Answer 448

- The authors excluded non-English language articles. * The authors excluded conference abstracts.

Question 449

Explain how publication bias might impact the meta-analysis findings

Answer 449

Excluding these studies reduces the power of the metaanalysis (due to smaller sample sizes being excluded)

Question 450

) In a systematic review, what condition must be met before individual study results can be combined in a meta-analysis?

Answer 450

Presence of homogeneity or absence of heterogeneity

Question 451

Based on figure 1 and 2, what statistic did the authors use to determine 'non-combinability’?

Answer 451

presented I2 statistic

Question 452

What other statistic could the author uses to quantify 'noncombinability’?

Answer 452

- Cochran’s Q statistic * Metaregression

Question 453

critically discuss recommendation

Answer 453

- which Intv is better/ no decision can be made off this alone - reasoning - no info on pt preference - no cost estimation - no side effect info - which outcomes show stat sig - sample characteristics may not be rep - out of date search

Question 454

who must consent for a surgical procedure

Answer 454

the cons performing it

Question 455

? may verify death in certain circumstances

Answer 455

RN

Question 456

driving and schizophrenia

Answer 456

Patients with schizophrenia must not drive and must notify the DVLA, until stable and well for 3 months and following a suitable psychiatristy report

Question 457

patient who lacks capacity who needs imminent Ix ->

Answer 457

tx under mental capacity. Common law is used if imminent risk of death

Question 458

Any decision about CPR should be

Answer 458

clearly communicated to all those involved in the pts care

Question 459

failure to publish results from valid studies, often as they showed a negative or uninteresting result

Answer 459

publication bias

Question 460

The hazard ratio is typically used when

Answer 460

analysing survival/ time

Question 461

what is heterogeneity

Answer 461

- used in MA to show how different the studies are - high levels of heterogeneity -> studies are not similar enough for a combined analysis

Question 462

A good MA shows..

Answer 462

homogeneity

Question 463

how much the odds of the disease increase when a test is positive

Answer 463

LR+

Question 464

Full plaster cast should not fly (if >2 hours durations) until

Answer 464

48 HRS AFTER CAST APPLIED

Question 465

Equation for relatie risk reduction

Answer 465

RRR = (risk in control group - risk in treatment group) / risk in control group × 100%

Question 466

probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true

Answer 466

p VALUE

Question 467

Comparing paired data ->

Answer 467

wilcoxon signed

Question 468

comparing unpaired ->

Answer 468

man whitney U (unpaired)

Question 469

comparing %/prop

Answer 469

chi sq

Question 470

Sampling bias

Answer 470

subjects not representative of the population

Question 471

commonly employed to compare the means of two groups of subjects

Answer 471

unpaired T test

Question 472

The Mental Health Act overrides the Mental Capacity Act and enables

Answer 472

people with capacity to be given tx against their will

Question 473

selection bias in a SR

Answer 473

Evidence selection bias occurs when a systematic review does not identify all available data on a topic.

Question 474

Ways in which selection bias occurs in a SR

Answer 474

* Evidence selection bias can arise from publication bias, where data from statistically significant studies are more likely to be published than those that are not statistically significant. * Evidence selection bias can arise from poor search strategies * Evidence selection bias can arise from when there is unconscious selection of preferred studies

Question 475

Interpreting a funnel plot

Answer 475

* The outer dashed lines represent 95% confidence intervals of the effect size * The dot represents each individual study * The vertical line represents the overall effect

Question 476

Methods of assessing for publication bias

Answer 476

- funnel plot * Begg -Mazumdar’s test * cumulative meta analysis * Fail safe sample size

Question 477

What further information do the authors need to present in this study before these findings are considered to inform public health interventions

Answer 477

- confounders - heterogeneity - quality of included studies

Question 478

Identify the type of health prevention approach necessary to prevent endometrial cancer in individuals with hypertension (1 mark).

Answer 478

- SP - e.g. routine surveillence, BP medication

Question 479

A technique that facilitates validation of data through cross verification from two or more sources

Answer 479

triangulation

Question 480

A measure of the accuracy with which a sample represents a population

Answer 480

standard eror

Question 481

Which of the following is unlikely to be associated with alcohol consumption?

Answer 481

lung cancer

Question 482

Which modifiable lifestyle risk factor explains the largest proportion of incidence of breast cancer in the UK?

Answer 482

obesity

Question 483

Individuals who stop smoking will, on average, see an increase in their life expectancy. What is the maximum age by which a smoker will need to quit in order that their life-expectancy remains equal to that of a never-smoker?

Answer 483

40

Question 484

What sort of database is CINAHL?

Answer 484

A database of research by health professionals who are not doctors