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Year 3 H&S (2), Sammer Sheikh - Coggle Diagram
Year 3 H&S (2)
Audit
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6 stages
- set standards (what should be happening)
- collect data (what is happening)
- identify steps to improve
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- reevaluate (collect more data)
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Studies
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Cohort study
issues with recruitment
selection bias: selection of individuals, groups, or data for analysis in a way that proper randomisation is not achieved, making a sample obtained non-representative of the population intended to be analysed
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longitudinal study that follows research participants over a period of time (usually participants will share a common characteristic)
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disadvantages
long follow up - expensive, time consuming
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validity
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internal validity: how well the study was conducted, taking confounders into account and removing bias
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power: probability that it will correctly lead to the rejection of the null hypothesis when it is false
confounding factor
distortion of association between outcome and exposure, by a third factor which has associations with both exposure and outcome
e.g. when looking at effect of smoking on cancer, age can be a confounding as risk of cancer increases with age as well
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Systematic reviews
summary of all the research on a particular topic, that meets pre-defined eligibility criteria
benefits
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increases total sample size - improved power, certainty and precision
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CAT
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process
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- make decision based on appraisal
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bias
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5 types of bias
selection bias: error in assigning individuals to groups, leading to differenced in groups qualities that may influence outcomes
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publication bias: failure to publish/include certain studies because they have negative reviews - important in systematic reviews
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procedure bias: subjects in different groups receive different care other than just the intervention
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Errors
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events
adverse event: unintended event resulting from clinical care and causing patient harm (physical or psychological)
never event: serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented e.g. wrong site surgery, wrong chemotherapy admin route
near miss event: 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
doctors have a duty to report both adverse and near miss events - report to National Reporting & Learning System (confidential) - run by National Patient Safety Agency (NPSA)
root cause analysis: structures investigation that aims to identify the true cause of a problem and the actions necessary to eliminate it
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Swiss Cheese Model
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- latent failures e.g. management decision, organisational processes
- conditions of work e.g. workload, supervision, communication, equipment, knowledge, ability
- active failures e.g. unsafe acts, omissions, action slips, failures, cognitive failures, memory lapses and mistakes, violations
- lack of barriers / defences
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unintentional errors
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skill-based - attention / memory lapse, unintended deviation from good action / plan (these are common)
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quality
Commissioning for Quality and Innovation organisation (CQUIN) incentivise good quality - pay GP's for vaccinating patients or providing sterioid injections etc.
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