Surgery

Question 1

What PICO question did the trial address?

Answer 1

Question 2

What is the purpose of randomisation?

Answer 2

To ensure that known and potential prognostic factors are balanced between the treatment groups, i.e. control for confounding and bias in patient allocation.

Question 3

Which technique, commonly used to control for placebo effect and bias in assessment of outcomes, could not be used in this trial?

Answer 3

Blinding of patients and assessors. Because of the obvious identity of the study groups, treatment allocation was not blinded to patients or surgeons. Site investigators were blinded to interim outcome reports until all patients had undergone their final evaluation.

Question 4

What is the name of the technique by which the randomised groups are analysed? Why is this used?

Answer 4

Intention-to-treat analysis. First, it is necessary to preserve the strengths of randomisation. Randomisation ensures that known and potential prognostic factors are balanced between the treatment groups. This balance may be lost if some patients are excluded from the analysis or analysed according to how they self-selected rather than how they were randomised. Second, it estimates the treatment effect in real-world clinical practice where patients often do not adhere to treatments, rather than the treatment’s efficacy when taken correctly.

Question 5

What is an RCT?

Answer 5

A randomised controlled trial is often used to test the efficacy of various types of interventions within a patient population. The study subjects, after assessment of eligibility and recruitment but before the intervention begins, are randomly allocated to receive one or other of the alternative treatments under study.

Question 6

What is the purpose of blinding?

Answer 6

➢ Blinding to treatment type and randomisation of participants aim to reduce bias.

Question 7

What is Confounding?

Answer 7

Confounding: interference by a third variable to distort the association being studied between two other variables, because of a strong relationship with both of the other variables. For example, when looking at BMI and heart disease, age and sex are confounders that need to be accounted for, as these affect both BMI and heart disease.

Question 8

What is the p-value?

Answer 8

Question 9

What are Confidence Intervals?

Answer 9

Question 10

What is Haddon’s Matrix?

Answer 10

Question 11

Why is preventing falls important?
- Incidence?
- Service Utilisation?

Answer 11

Question 12

Complete a Haddon’s Matrix for Falls prevention?

Answer 12

Question 13

What is a Systematic Review?

Answer 13

Question 14

What is a Meta-analysis?

Answer 14

Question 15

Complete a Haddon’s Matrix for the prevention of road traffic accidents?

Answer 15

Question 16

List 2 advantages and 3 disadvantages of case-control studies.

Answer 16

Question 17

Who is the ideal control for a case-control study?

Answer 17

The ideal control is a person (or persons) who would have been enrolled in the study as a case if they had had the disease.

Question 18

What is confounding? How do researchers control for confounding?

Answer 18

Confounding occurs when a third factor influences independently both the disease and exposure and is not a factor on the causal pathway.

Question 19

Why do researchers often match controls for age and sex?

Answer 19

Because both age and sex are often known to influence the disease and exposure, matching by age and sex reduces the possibility of confounding.

Question 20

What are Survivial curves?

Answer 20

**Survival curves: **Regression models are used to quantify the relative contribution of each independent or exposure variable to the outcome of interest e.g. is age more important than sex etc.

Question 21

What is Regression analysis?

Answer 21

Regression analysis is a statistical technique for estimating the relationships among variables. It can be used to control confounding. The goal of regression analysis is to determine the values of parameters for a function that cause the function to best fit a set of data observations that you provide. In linear regression, the function is a linear (straight-line) equation.

Question 22

What is a disadvantage of each of the following study types:
- Cross-sectional?
- Case-control?
- Cohort?
- RCT?

Answer 22

Question 23

What is sensitivity?

Answer 23

Sensitivity is the proportion of people with the disease that have a positive test result (a/a+c).

Question 24

What is Specificity?

Answer 24

Specificity is the proportion of people without disease who have a negative test result (d/b+d).

Question 25

When should you use a highly sensitive test?

Answer 25

A sensitive test rarely misses people with the disease. When a disease is very serious and missing it has severe consequences, a sensitive test should be used. This will result in more false positives though.

Question 26

When should you use a highly specific test?

Answer 26

Highly specific tests are good to ‘rule in’ a diagnosis that may have been suggested by another test (or data) and when the consequences of a positive test are serious for example resulting in a major operation. It is rarely positive in the absence of disease.

Question 27

What is positive predictive value (PPV)?

Answer 27

Positive predictive value is the probability of disease in a patient given a positive test result or post- test probability of a positive test result (a/a+b).

Question 28

What is negative predictive value (NPV)?

Answer 28

Negative predictive value is the probability that disease is absent in a patient given a negative test result (d/c+d).

Question 29

What factors influence the predictive value?

Answer 29

The accuracy of the test (i.e. sensitivity and specificity) and the prevalence of the disease in the population being tested influence predictive value.

Question 30

According to the CanMEDS Physician Competency Framework, list the seven roles that a physician needs to fulfil to effectively meet the health care needs of their patients and the broader community.

Answer 30

Question 31

Define advocacy. Describe the role of a doctor as a health advocate as stated in the CanMEDS Physician Competency Framework.

Answer 31

Advocacy is ‘public support for or recommendation of a particular cause or policy’ ...’from medieval Latin advocatia, from advocare summon, call to one's aid’

Question 32

What actions should you take in the clinical context in order to fulfil your role as an advocate for your patient? This is an example of reactive health advocacy.

Answer 32

Question 33

What are your statutory responsibilities in this situation?

Answer 33

If she has a notifiable STI you need to report it to the WA Health Department using an Infectious Disease Notification Form. If you form a reasonable belief that she has been sexually abused you need to make a mandatory report to the Department of Child Protection.

Question 34

What should you do next to act on these concerns? Once you have gained the support of key stakeholders, what actions could you take at the health service level to minimise such incidents in the future?

Answer 34

Discuss these concerns with key stakeholders. These include, first and foremost, the immediate medical or surgical team that you are working with, specifically the consultant physician or surgeon. Other stakeholders include, but are not limited to, staff in Clinical Quality and Safety, Medical Education, Surgery, ED, Sexual Health/Infectious Diseases. You will need to obtain the support of key stakeholders before being able to proceed with investigating or acting on these concerns.

Question 35

List at least 4 other organisations that you and the group of elders should consider working in partnership with, and explain how their involvement would assist in addressing these issues.

Answer 35

Question 36

How does the regulatory environment of health care compare to advocacy?

Answer 36

Question 37

What advocacy strategies would you consider using and explain why, taking into consideration any unintended and/or adverse effects that could result from using each selected strategy.

Answer 37

Question 38

What are 4 different ways as a junior doctor in which you can assist with mitigating the harmful effects of climate change?

Answer 38

Question 39

What is a clinical audit?

Answer 39

A clinical audit is the systematic peer evaluation of an aspect of patient care. The process, which may be multidisciplinary, involves a cycle of continuous improvement of care based on explicit and measurable indicators of quality. A quick way to think about the clinical audit cycle is the Plan-Do- Study-Act cycle.

Question 40

What is the difference between audit and research?

Answer 40

Research is designed to generate knowledge or what is the best way to do something, while an audit assures that current knowledge, skills and resources are being properly used.

Question 41

What are the nine stages of the audit cycle?

Answer 41

Question 42

List 7 Examples of methods for providing information on quality of clinical care.

Answer 42

Question 43

What are Morbidity and mortality meetings?

Answer 43

Question 44

What are 8 criteria that can be used to help rank potential audit topics in order of priority?

Answer 44

Question 45

What is the difference between Prevalence and Incidence?

Answer 45