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Flashcards in Tutorial 2 Deck (43):
1

% of people consulting GP and % to hospital

20
3

2

Why is the hierarchy of healthcare not completely accurate?

severity of illness does not accurately parallel severity of disease

3

Definition of disease

signs, symptoms, diagnosis, biomedical perspective

4

Illness definition

ICE

5

4 factors affecting uptake of care

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

6

5 possible issues from patients point of view for starting treatment

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

7

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

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

8

3 main aims of providing information

description
explanation
disease control

9

Description (epidemiology)

Describe amount and distribution of disease in human populations

10

Explanation (epidemiology)

natural history
aetiological factors
epidemiological and data from other sources

11

Disease control (epidemiology)

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

12

What does epidemiology compare and what does this help with?

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

13

General difference between clinical medicine and epidemiology

clinical medicine - individual patient
epidemiology - populations

14

minor illness incidence and prevalence

high incidence but low prevalence

15

Other illness eg chronic incidence and prevalence

low incidence
high prevalence

16

Relative risk

strength of association between associated risk factor and disease under study

17

How to calculate relative risk

incidence in exposed/incidence in unexposed

18

Sources of epidemiological data

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

19

Health literacy

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

20

Risk calculators

CHADS2 - AF stroke
bleeding

21

SIGN guidelines

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

22

Descriptive studies

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

23

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

does not = causation
does - possible risk factors and candidate aetiologies

24

Advantages of descriptive studies

cheap, quick, valuable initial overview of problem

25

When are descriptive studies useful?

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

26

Cross sectional studies

frequency survery, prevalence study
observations at single point in time

27

Conclusions from a cross sectional study

relationship between disease and variables of interest in a defined population

28

Strength of cross sectional studies

quick results, but cannot do causation

29

Case control studies

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

30

In a case control study what is data gathered on?

exposure to suspected aetiological factor

31

Cohort studies

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

32

Trials

experiments used to test ideas about aetiology or evaluate interventions

33

Definitive method for assessing any new treatment

randomised controlled trial

34

6 factors to consider in interpreting results

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

35

Bias

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

36

4 types of bias

selection
information
follow up
systematic error

37

Cofounding factor

associated independently with both disease and exposure under investigation

38

best way possible to prove causation between exposure and disease

demonstrate a weight of evidence in favour of a casual relationship

39

Only absolute criterion for causality

temporality

40

Temporality

The exposure comes before disease

41

AUDITs - could do own or others?

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

42

Interventions before repeat audit?

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

43

Limitations of audit?

only of those prescribed
misses patients who should have received drug but did not