Term
| long term physical and mental benefits of exercise? |
|
Definition
reduces risk of CVS disease and HTN
decreases resting HR so heart doesn't have to work as hard
increases bone density
lower BP and improve cholesterol |
|
|
Term
| what are the wider determinants of health and how they affect clinical practice |
|
Definition
described as causes of the causes and can sometimes be out of our control eg
gender and genetic make up
socioeconomic status and health: low status linked with low health outcomes
education: can lower alcohol and drug abuse and teenage pregnancy
physical environment: safe drinking water? clean air etc
social environment: support from family etc |
|
|
Term
| what are health inequalities? |
|
Definition
differences between people or groups due to social, geopgraphical, biological or other factors.
these differences result in people who are worst off experiencing poorer health and shorter life.
examples: local economy, natural environment like green spaces, built environment like cycle routes and parks, activites such as play provision |
|
|
Term
how to calculate mortality rate?
take all the deaths that occurred in a time period and divide it by the total population in that period. it can be multiplied by 100 to give % or per 1000 of the population |
|
Definition
number of deaths/total population x 1000
gives mortality rate per 1000 of the population |
|
|
Term
| what is the difference between effectiveness sand efficacy? |
|
Definition
effectiveness is the ability to achieve intended result in the REAL world
efficacy is the ability to achieve results in IDEAL world under optimum conditions |
|
|
Term
|
Definition
| the effectiveness in relation to cost |
|
|
Term
|
Definition
2nd most common cancer in UK
4th most common cause of cancer death in UK
1 in 8 men will be diagnosed with it in lifetime |
|
|
Term
| prostate cancer screening |
|
Definition
up to 15% men with prostate cancer have normal PSA
there is also high false positive
it is neither sensitive nor specific so screening does not exist for prostate cancer.
instead of screening there is an informed choice programme called 'Prostate cancer risk management for healthy men aged 50 or over who ask their GP about PSA testing. it gives men good information pros and cons of PSA and if you decide you want it then this can be arranged free on the NHS |
|
|
Term
the role of Cancer Registry in epidemiology to measure disease in society?
it is called the National Cancer Registration and Analysis Service |
|
Definition
run by public health England
monitor trends and geographical patterns
provide data to office of national statistics
you can see what information they hold on you but this needs to be done through your GP |
|
|
Term
PHE data collect information for safety and quality of public health and healthcare across England
they have information on infectious and non infections, cancer and non cancer, congenital anomaly and rare disease registration.
do they need your permission for this data? |
|
Definition
No
Permission has been granted from Parliament to collect this data without the need to get consent from individuals as there are strict data protection policies in place but patients can opt out if they want to. |
|
|
Term
| opting out of cancer registration how can it be done? |
|
Definition
this is done in writing.
in the last 15 years < 10 people have opted out |
|
|
Term
| infectious disease notification |
|
Definition
HCP fills out a form and sends to proper officer of the local authority in 3 days or if it is urgent they can notify them verbally in 24 hours
they do not have to wait for a lab confirmation. |
|
|
Term
in an urgent notifiable disease how can you contact the proper officer?
this needs to be done within 24 hours. you don't have to wait for lab confirmation |
|
Definition
Phone
Letter
Encrypted mail
Secure fax machine |
|
|
Term
| what do proper officers do with the information you have given them> |
|
Definition
pass it to public health England within 3 days or within 24hours if urgent.
PHE publishes reports every week |
|
|
Term
National Confidential Enquiry into Patient Outcome and Death features
all pts undergoing inpt surgery aged 16 or more between march 1st and 7th 2010 |
|
Definition
national review of peri op care of pts going in for inpt surgery
identifies remediable factors for the care of high risk pts.
found 1 in 10 hospitals did not comply with NICE CG 50
care of pt was good only 48% of the time |
|
|
Term
| peri and post op risks with morbidity and mortality |
|
Definition
obesity: GA risk
significant comorbidities as pts get older |
|
|
Term
| what did national confidential enquiry into Patient outcomes and death find with 20% of elective high risk pts? |
|
Definition
| they had not been seen in pre assessment clinic. their 30 day mortality was 7 times as high |
|
|
Term
| from the post op mortality that occurs in the UK approximately what percentage of the pts are from the high risk category? |
|
Definition
| 80% deaths occur post op in those deemed high risk |
|
|
Term
| steps to reduce post op mortality |
|
Definition
ID high risk group
improve pre op, triage and preparation
improved intra operative care
improved use of post op resources |
|
|
Term
| features of enhanced recovery programmes |
|
Definition
to improve pt outcomes and speed up recovery after surgery
makes sure pt are active participants in their own recovery process and received evidence based care at the right time
elements:
pre-op assessment
reducing physical stress of operation
structure approach to immediate post op care
early mobilisation |
|
|
Term
|
Definition
up to 35% in those up to 65 years
more in those up to and over 75 years.
previous fallers have a 2 out of 3 chance of a fall in the subsequent year |
|
|
Term
| in a #NOF surgery is recommended in 48 hours. what is the mortality from surgery in old people with #NOF? |
|
Definition
|
|
Term
|
Definition
environment
medication
medical conditions
nutrition
lack of exercise |
|
|
Term
percentage of falls leading to injuries?
hip fractures? |
|
Definition
injuries up to 60%
fractures 5%
hip fractures 1% |
|
|
Term
| Abx prophylaxis is not offered in the following procedures |
|
Definition
not recommended routinely for people:-
undergoing dental procedures
also not recommended in procedures to:
upper/lower GI, GU and childbirth
upper/lower resp tract, ENT |
|
|
Term
| reasons for changing Abx prophylaxis against bacterial endocarditis |
|
Definition
| medical and dental procedures are no longer thought to be the main cause of endocarditis and taking Abx carries its own risks |
|
|
Term
| in making NICE guidelines what is the name of the internationally accepted criteria of quality? |
|
Definition
AGREE II
Appraisal of Guidelines for Research and Evaluation II |
|
|
Term
| all NICE guideline commitees include how may lay members? |
|
Definition
|
|
Term
| what is triangulation in terms of evidence? |
|
Definition
| in some topics there is little evidence from scientific studies or the evidence is weak or contradictory. in these cases we look for evidence from other surces to see if it concurs or differs. this is triangulation. |
|
|
Term
|
Definition
1A: meta analysis of RCTs
1B: evidence from at least one RCT
2A: well designed controlled trial which is not randomised
2B: well designed experimental trial
3: from case, correlation and comparative studies
4: from panel of experts |
|
|
Term
| grading of recommendation can be ABC |
|
Definition
A: based on evidence from at least one RCT
B: evidence from non randomised controlled trials
C: evidence from panel of experts |
|
|
Term
| Wilson and Junger criteria |
|
Definition
important public health condition
whose natural history is known
it has a recognised latent or early symptomatic stage
there is a test available
And an agreed policy on who to treat
cost of case finding economically balance with possible expenditure as a whole
the test is acceptable to the population
the rx is acceptable to the population
facilities for rx and diagnosis are available
case finding should be continous |
|
|
Term
draw out this table in your mind naseema.
write down at the top:
disaease present, disease absent.
down the side column:
test positive, test negative
then fill in TP, FN, FP and TN |
|
Definition
disease present, test positive = TP
disease present, |
|
|
Term
|
Definition
proportion of patients without the condition who have a negative result
specificity =
TN/(TN+FP)
draw the table |
|
|
Term
define sensitivity
TP/(TP +FN) |
|
Definition
| proportion of pts with the result who have a positive result |
|
|
Term
| the chance that the pt has the condition if the diagnostic test is positive is AKA? |
|
Definition
positive predictive value
TP/(TP +FP) |
|
|
Term
| the chance that the pt does not have the condition if the diagnostic test is negative is known as the negative predictive value. how is this worked out? |
|
Definition
|
|
Term
| how much the odds of a disease increase when a test is positive is known as? |
|
Definition
the likelihood ratio for a positive test
sensitivity/1-specificity |
|
|
Term
| how would you work out the likelihood ratio for a negative test? |
|
Definition
| 1- sensitivity/specificity |
|
|
Term
| positive and negative predictive values are affected by what? |
|
Definition
prevalence.
in contrast likelihood ratios are not prevalent dependent. |
|
|
Term
| what plot is used to demonstrate publication bias in meta analyses? |
|
Definition
funnel plot
symmetrical inverted funnel shape indicates publication bias is unlikely |
|
|
Term
| what does a symmetrical inverted funnel plot suggest? |
|
Definition
| that publication bias is unlikely. |
|
|
Term
| what does an asymmetrical funnel plot indicate? |
|
Definition
a relationship between rx effect and study size
interpretation: either publication bias or systematic difference between smaller and larger studies AKA small study effects |
|
|
Term
| what is the main way to illustrate results from a meta analysis? |
|
Definition
| forest plot aka blobbogram |
|
|
Term
| blobbogram shows a result where the confidence interval crosses the line of no effect. what does this mean? |
|
Definition
| they could have mean values which are beyond this line thus can be insignificant |
|
|
Term
| define SE of the mean (SEM) |
|
Definition
| how accurate the calculated sample mean is from the true population mean |
|
|
Term
|
Definition
SEM = SD/ square root (n)
n = sample size |
|
|
Term
| what happens to the standard error of the mean as the sample size increases? |
|
Definition
|
|
Term
SEM = standard error of mean
SEM = SD/ square root of (n)
n = sample size
95% CI
lower limit = mean - 1.96 x SEM
upper limit = mean + 1.96 x SEM
question
mean height is 183cm
SE is 2cm
work out 95% CI |
|
Definition
lower limit = mean - 1.96 x SEM
183 - (1.96 x 2) =179
upper limit = mean + (1.96 x SEM)
183 + 19.6 x 2 = 187
thus 95% CI 179-187 +/- 2SE |
|
|
Term
| in establishing association and causation which criteria should we used? |
|
Definition
|
|
Term
|
Definition
| one variable is found more commonly in the presence of the other |
|
|
Term
| what are the 3 types of association? |
|
Definition
spurious - association risen by chance and not real
indirect -association due to presence of another factor
direct: true association not linked by confounding |
|
|
Term
| using Bradford hill criteria we have established that there is an association between 2 factors. the next step is to determine if the association is causal. how can we do this? |
|
Definition
strength: more stronger association more likely to be causal
temporality: does exposure precede outcome
specificity: suspected cause associated with specific outcome/disease?
coherence: does association fit with other biological knowledge?
consistency: is the same association found in many studies? |
|
|
Term
|
Definition
first we see if there is an association. there are 3 types. the last one is the direct association and this is what we want.
after we establish association we see if it is causal. we do this by checking the
strength, consistency in other others studies, see if it is coherent with what we know about it biologically already, temporality of study checks if the exposure preceeds the effect and specificity checks if the outcome is specific to this cause and nothing else could be causing it. |
|
|
Term
| the number of people that would require an intervention to reduce the expected number of outcomes by one is AKA? |
|
Definition
NNT
this is calculated as 1/absolute risk reduction and is rounded to the next highest whole number |
|
|
Term
| how to work out the absolute risk reduction? |
|
Definition
the difference between the control event rate and the experimental event rate.
experimental event rate = number of people who had a particular outcome with the intervention / total number who had the intervention
control event rate = number of people who had a particular outcome with the control/ total number of who had the control. |
|
|
Term
| summarise how to work out NNT |
|
Definition
NNT = 1/ARR
ARR - CER-EER
CER - number of people who got a particular outcome with the control/total who were given control
EER = number of people who got a particular outcome from the intervention/ total who were given the intervention |
|
|
Term
| do we want a high or low NNT? |
|
Definition
| we want a low NNT. eg if it were one the for every one person treated one person would benefit |
|
|
Term
NNH - we want this number to be high
why is that? |
|
Definition
NNH indicates how many pts on average need to be exposed to a risk factor in order to cause harm to one person that would not otherwise be harmed.
it is defined as the inverse of attributable risk.
the lower the NNH the worse the risk factor. if it were 1 then it means on average every pt exposed is harmed. this is why we want a high NNH and low NNT |
|
|
Term
| which term is defined as the inverse of attributable risk? |
|
Definition
|
|
Term
| what are the 4 phases of clinical trials |
|
Definition
1 = determine pharmacokinetics/pharmacodynamics on healthy volunteers
2 = assess efficacy and dosage on small number of people affected by disease
3 = effectiveness usually in RCT
4 = post marketing surveillance |
|
|
Term
| what are the 11 screening programs offered by NHS? |
|
Definition
infectious disease in pregnancy
sickle cell and thalassemia
fetal anomaly scan
newborn blood spot at day 5
newborn infant physical examination screening
chlamydia screening
cervical screening
diabetic eye screening
AAA
bowel cancer |
|
|
Term
|
Definition
| ability to produce same measurement with repeated tests |
|
|
Term
|
Definition
| identifying individuals who may be at a higher risk for a disease or condition amongst large populations of healthy people |
|
|
Term
primary prevention examples
definition: taking action to reduce incidence of disease |
|
Definition
legislation to ban use of hazardous products eg asbestos
education and safe habits: eating well exercising
immunization: against infections disease |
|
|
Term
| secondary prevention: aims to reduce impact of disease that has occurred. examples? |
|
Definition
statins to reduce cholesterol
aspirin in those with TIA to prevent strokes |
|
|
Term
tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.
examples include? |
|
Definition
cardiac/stroke rehab programs
support groups |
|
|
Term
| what does the Cochrane collaboration do? |
|
Definition
systematically reviews RCTS.
THERE ARE 6 TYPES OF COCHRANE REVIEWS |
|
|
Term
| what kind of reviews does the Cochrane database do? |
|
Definition
intervention
diagnostic tests
methodology
qualitative
prognosis
overviews of systematic reviews |
|
|
Term
name a campaign to help notice sepsis in children?
lead by Melissa Mead |
|
Definition
the SPOT SEPSIS campaign
it is called 'just ask could it be sepsis?' |
|
|
Term
|
Definition
stay active
NSAIDs
behavioural therapy
back schools
trigger point injections |
|
|
Term
| how much does back pain account for of health related absences from work? |
|
Definition
|
|
Term
| major complications accounting for maternal death |
|
Definition
bleeding
infections
high BP
birth complications
unsafe abortion |
|
|
Term
| define maternal mortality? |
|
Definition
| death of a pregnant women or within 42 days of delivery, miscarriage, TOP or ectopic if the death is related to pregnancy or its rx |
|
|
Term
| two ways maternal mortality rate information can be attained? |
|
Definition
Office of National Statistics
MBRRACE-UK
mother and babies: reducing risk through audits and confidential enquiries |
|
|
Term
| maternal death can be due to direct and indirect causes. definition |
|
Definition
direct: related to obstetric complications during pregnancy, labour or puerperium
indirect: associated with a disorder, the effect of which is exacerbated by pregnancy |
|
|
Term
| cause of maternal death in UK versus worldwide |
|
Definition
UK: thrombosis and thromboembolism
worldwide: PPH |
|
|
Term
|
Definition
death of baby before or during birth after 24weeks gestation.
the WHO definition is 28 weeks |
|
|
Term
| death of baby within 28 days is AKA? |
|
Definition
|
|
Term
| perinatal mortality definition? |
|
Definition
| still births plus early neonatal deaths under 7 days |
|
|
Term
|
Definition
| no of stillbirths per 1000 total births |
|
|
Term
| definition of low birth weight? |
|
Definition
|
|
Term
| in the UK who published the latest report on causes of perinatal death? |
|
Definition
| centre for maternal and child enquiries (CMACE) |
|
|
Term
what is the aim of MBRRACE?
they handle the epidemiology of maternal deaths. deaths should be reported to them |
|
Definition
| to provide robust information to support the delivery of safe, equitable, high quality maternal, infant and new born health services. |
|
|
Term
what is the aim of MBRRACE?
they handle the epidemiology of maternal deaths. deaths should be reported to them |
|
Definition
| to provide robust information to support the delivery of safe, equitable, high quality maternal, infant and new born health services. |
|
|
Term
| statins can help lower bad cholesterol and would benefit high risk people like those who have had an MI. so we selectively give those people statins is an example of what time of resource efficiency? |
|
Definition
|
|
Term
| when a resource is scarce it is important to evaluate how well they are being used to achieve a desired outcome. what is this also known as? |
|
Definition
|
|
Term
| define financial and economical costs |
|
Definition
financial = actual monetary spend
economical = finance plus time, energy and effort e.g. going to ED and waiting 4 hours to be seen by doctor is an economic cost to the pt. |
|
|
Term
|
Definition
| what is lost when an alternative service is not provided because resources are directed elsewhere. eg you get your first pay check, you can go on holiday or buy a car. you choose to go on holiday. the true opportunity cost of going on holiday was the forgone benefits of purchasing new car |
|
|
Term
| what analysis can be used if the health outcomes of two or > competing interventions are similar? |
|
Definition
|
|
Term
| cost utility uses QUALYS. this measures health related benefits of competing intervention but it does not measure non health related impacts. what analysis can be done to measure the non health impacts of the competing interventions? |
|
Definition
| cost-consequence analysis |
|
|
Term
cost benefit analysis is used when your interested in monetary costs
T/F? |
|
Definition
|
|
