Book Questions IIHMR Delhi

8/13/2019 Book Questions IIHMR Delhi

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QUESTIONS:Q. Define RCT.A. “A study where people are allocated randomly to receiving a particular intervention or not (this couldbe two different treatments or one treatment and a placebo).Q How many groups are formed in RCT trails? A. 2 group i.e. treatment group, control group.Q. why consideration of ethical issues is so important for RCT conduction?A. Because it can have adverse effect on outcome of study.Q. Why informed voluntary consent is necessary for each person in any medical trail?A. So that he may know the possible benefits & adverse effects of treatment and medicine and can actaccordingly.Q. How much loss of follow up is acceptable in RCT?

A. Below 20% is acceptable and above it poses serious threats to validity.Q. Controlled clinical trials are viewed as the ……………..a) Gold standard b) silver standardQ. According to statistical errors, how many types of RCT are being subject to? What are they?A. RCTs are subject to both type I ("false positive") and type II ("false negative") statistical errors. Q. RCTs reduce ………….and ………….in the hierarchy of evidence that influences healthcare policy andpractice.A. Spurious causality, biasQ. Why Data Monitoring Committee need to be established?A. Basically, to assess at regularly scheduled intervals the progress of an RCT, safety data, data quality,and the critical efficacy end points.

Q. Which of the studies are most validating?a) Case-control b) Cross- sectionalc) RCT d) Cohort

Questions1. What are the two of the primary criteria of evaluation in any measurement or observation?

Ans:Whether we are measuring what we intend to measure.Whether the same measurement process yields the same results.

These two concepts are validity and reliability.2. Say you have a piece of wood that is 2 1/2 feet long. You measure it once with the tape measure

- you get a measurement of 2 1/2 feet. Measure it again and you get 2 1/2 feet. Measure itrepeatedly and you consistently get a measurement of 2 1/2 feet. Are the results valid andreliable?Ans: The tape measure yields reliable results. However, the results will be valid if the measure isactually 2 ½ feet long. Measuring this piece of wood with such a "good" tape measure shouldproduce a correct measurement of the wood's length.

3. State if Valid and Reliable



4. What are the three most important factors to assess reliabilityAns: Observer VariationPhysical Variation

Errors related to Technical methods5. What is a good reliability scale?

Ans: the higher the reliability value the more reliable the measure. The general convention inresearch has been prescribed by Nunnally and Bernstein (1994) who state that one should strivefor reliability values of .70 or higher.

6. How do I improve the reliability of my survey instrument?Ans: Reliability values increase as test length increases (see Gulliksen, 1950 for a completediscussion of the relationship between test length and reliability). That is, the more items youhave in your scale to measure the construct of interest the more reliable your scale will become.However, the problem with simply increasing the number of scale items when performing

applied research is that respondents are less likely to participate and answer completely whenconfronted with the prospect of replying to a lengthy questionnaire. Therefore, the bestapproach is to develop a scale that completely measures the construct of interest and yet doesso as economical a manner as is possible.

7. Define validity?(ans is in slides)8. What are the two types of validity? Explain (ans is in slides)

9. Specificity is equal to:a. True positive / (true positive + false positive)b. True negative / (true negative + true positive)c. True positive / (true positive + false negative)d. True Negative / (true positive + false positive)

10. An example of False negative is :a. A diseased person incorrectly identified as healthyb. A healthy person incorrectly identified as diseasedc. A diseased person correctly diagnosed as diseasedd. A healthy person correctly identified as healthy

11. ____________ reflects the diagnostic power of the test (A: Predictive accuracy)12. If a disease has very low prevalence, you typically get poor values for



a. Negative predictive valueb. Positive predictive valuec. Sensitivityd. Specificity

1. Two stage screening willa) Decrease specificity and will reduce sensitivity.b) Increase both sensitivity and specificity.c) Decrease both sensitivity and specificity.d) Increase the specificity and will reduce the sensitivity.

ANS: d)

2. The goal of simultaneous testing is toa) Increase both sensitivity and specificity.b) Increase the specificity and reduce the sensitivityc) Decrease both sensitivity and specificity.d) Decrease the specificity and increase the sensitivity.

ANS: d)

3. Specificity identifies those patientsa) who do not have disease.b) Who are true false as well as true positives.c) Who have disease.

ANS: a)4. Predictive Accuracy reflects

a) Diagnostic power of testb) Sensitivity of testc) Specificity of testd) Validity of test

ANS: a)5. The probability that a patient with positive test result has the disease in question is indicated as

a) Predictive value of negative resultsb) Predictive value of positive resultsc) Sensitivityd) Specificity

ANS: b)6. Those who have disease are told that they do not have disease are known as

a) False positives



b) False negativesc) Both of the aboved) None of the above

ANS: b)7. Lower the sensitivity of a test, larger the number of false negatives.

a) Trueb) False

ANS: a)8. Which of the following is true?

a) False positives burdens the diagnostic facilities.b) False positives discredit to screening programme.

c) None of the above.d) Both of the above.

ANS: d)9. What are the components we consider for evaluating the screening test?

ANS:1. Sensitivity

2. Specificity

3. Predictive value of a positive test

4. Predictive value of a negative test

5. Percentage of false negatives

6. Percentage of false positives

10. What are the difference between sensitivity and specificity?

ANS: SENSITIVITY:

• It is defined as the ability of a test to identify correctly all those who have the disease, that istrue positive.

Sensitivity = a/( a+c) * 100ii SPECIFICITY:

• It is the ability of a test to identify correctly those who do not have disease, that is true negative.

Specificity = d/ (b+ d) * 100



Question 1. All the following are true in a randomized control trial (RCT) except:

1. Baseline characteristics of intervention and control groups should be similar

2. Investigator’s bias is minimized by double blinding

3. The sample size required depends on the hypothesis

4. The drop-outs from the trial should be excluded from the analysis.

Question 2. What are randomized control trials? Explain its types and discussadvantage and disadvantage of RCT.

Question 3. Cause and Effect relationship can be identified through:

1. Surveys2. Correlation3. RCTs4. Case studies

Question 4. Which of the following is considered as gold standard inepidemiological research?

1. Case control2. Cohort3. Cross-sectional4. RCT

Question 5. Discuss different types of trials.Question 6. A randomized controlled trial begins with a random (i.e.

representative) sample from the population of interest. True or False?Question 7. The purpose of using double-blinding in an RCT is to:1. Achieve greater comparability of cases and controls.2. Avoid placebo effects.3. Avoid objective and subjective bias.4. Reduce the effects of sampling variation.5. Reduce the effect of losses to follow-up.Question 8. Randomization in experimental studies ensures that:

1. Assignment to experimental or control groups occurs by chance.



2. Treatment and control groups are alike in all respects, except the treatment.3. Bias is eliminated in the observations.

4. Placebo effects are eliminated.5. The two groups are representative of the population from which they were

drawn.

Question 9. How will you design a RCT study? Explain.Question 10. One of the best way to eliminate bias in epidemiological study can

be done by using :1. RCT2. Cross-sectional study

3. Case-control4. Cohort

Question 11. Write short note on:1. Randomization2. Blinding3. Intention to treat analysis4. Analysis of RCT

Question 12. Bias can be avoided by:1. Incorporation of blinding2. By doing randomization3. Both 1 & 24. None of the above

Question 13. Blinding is difficult:1. Having placebo in the same shape, formula and taste is very costly, and time

consuming.2. Impossible if surgical and medical treatments are compared.3. Both 1 & 24. None of the above

Question 14. What ethical considerations should be kept in mind while conductingRCTs ?



Question 15. Temporal relationship problem can be resolved by using which typeof study:

1. Case-control2. RCT3. Cohort4. Cross-sectional

Questions1. What does Single-blind, double-blind & Triple-blind mean?

“Blinding ” is a procedure in which one or more persons in the research trial are keptunaware of the treatment assignment(s).

Single-blind usually means that the research participant is not told of thetreatment assignment.

Double-blind usually means that the research participant and Doctor/nurse arekept unaware of the treatment assignment.

Triple-blind means when the research participant, doctor and the researcher

all are unaware about the treatment assignment.

2. What is a Placebo?

A placebo is an inactive pill, liquid, or powder that has no treatment value. In clinicaltrials, experimental treatments are often compared with placebos to assess theexperimental treatment's effectiveness. In some studies, the participants in the controlgroup will receive a placebo instead of an active drug or experimental treatment.Placebos are used only when no standard treatment exists.

3. What is a protocol & what does it describe?

A protocol is a study plan on which all clinical trials are based. The plan is carefullydesigned to safeguard the health of the participants as well as answer specific researchquestions.



A protocol describes what types of people may participate in the trial; theschedule of tests, procedures, medications, and dosages; and the length of the study.

While in a clinical trial, participants following a protocol are seen regularly by theresearch staff to monitor their health and to determine the safety and effectiveness oftheir treatment.

4. Who can participate in a clinical trial?

The factors that allow someone to participate in a clinical trial are called "inclusion criteria" and those that disallow someone from participating are called "exclusion

criteria." Using inclusion and exclusion criteria is an important principle of medicalresearch that helps to produce reliable results. These criteria are based on such factorsas age, gender, the type and stage of a disease, previous treatment history, and othermedical conditions.Before joining a clinical trial, a participant must qualify for the study. Some researchstudies seek participants with illnesses or conditions to be studied in the clinical trial,while others need healthy participants. It is important to note that inclusion andexclusion criteria are not used to reject people personally. Instead, the criteria are usedto identify appropriate participants and keep them safe. The criteria help ensure that

researchers will be able to answer the questions they plan to study.

5. What are the benefits & risks of participating in a clinical trial?

Benefits : Well-designed and well-executed clinical trials provide the best approach for eligibleparticipants to:

Play an active role in their health care decisions. Gain access to new research treatments before they are widely available. Obtain expert medical care at leading health care facilities during the trial. Help others by contributing to medical research.

Risks : Clinical trials entail risks, which may include:

There may be unacceptable worsening of the illness or condition if the participant israndomly assigned to a control group and/or receives a placebo.

There may be unpleasant, serious or even life-threatening side effects to experimentaltreatment.



The experimental treatment may not be effective for the participant. The protocol may require more of their time and attention than would a non-protocol

treatment, including trips to the study site, more treatments, hospital stays or complexdosage requirements.

6. What are the phases of clinical trial?

PHASE 0 TRIALS :Phase 0 trials are first-in-human trials . also known ashuman microdosing studies and are designed to speed up the development of promising drugsor imaging agents by establishing very early on whether the drug or agent behaves in humansubjects as was expected from preclinical studies. Distinctive features of Phase 0 trials include

the administration of single subtherapeutic doses of the study drug to a small number ofsubjects (10 to 15) to gather preliminary data on the agent's pharmacodynamics (what the drugdoes to the body) and pharmacokinetics (what the body does to the drugs).

A Phase 0 study gives no data on safety or efficacy, being by definition a dose too low to causeany therapeutic effect. Drug development companies carry out Phase 0 studies to rank drugcandidates in order to decide which has the best pharmacokinetic parameters in humans totake forward into further development. They enable go/no-go decisions to be based on relevanthuman models instead of relying on sometimes inconsistent animal data.

PHASE I TRIALS: These studies include the initial introduction of new drugs usually in healthy

human volunteers to determine how the human body metabolizes the drug and what theassociated side effects are with increasing doses. Generally, less than 100 volunteersparticipate in this type of study.

PHASE II TRIALS: These are controlled clinical studies conducted to evaluate the effectiveness ofa drug or device for a particular symptom or symptoms in patients with the disease or conditionunder study and to determine the common adverse effects and risks. These types of studiesgenerally involve no more than several hundred participants.

PHASE III TRIALS: These are larger controlled and uncontrolled studies conducted afterpreliminary evidence suggests effectiveness of an investigational drug or device. These studiesgenerally involve several hundred to thousands of participants to gather additional informationabout effectiveness and safety and adequate basis for physician labeling.

PHASE IV TRIALS: These studies are commonly referred to as “post-marketing” studies becausethey are generally conducted concurrent or after marketing approval to obtain additionalinformation about risks, benefits, and optimal use of a drug or device. These studies could



include, but would not be limited to, studying different doses of a drug that were not doneduring Phase II trials, or use of a drug/device in other patient populations.

7. What are the different kinds of phase I trial?

There are different kinds of phase I trial:SAD :- (Single ascending dose )studies are those in which small groups of subjects aregiven a single dose of the drug while they are observed and tested for a period of time.Typically, a small number of participants, usually three, are entered sequentially at aparticular dose. If they do not exhibit any adverse side effects, and the pharmacokineticdata is roughly in line with predicted safe values, the dose is escalated, and a new groupof subjects is then given a higher dose. If unacceptable toxicity is observed in any of thethree participants, an additional number of participants, usually three, are treated at thesame dose. This is continued until pre-calculated pharmacokinetic safety levels arereached, or intolerable side effects start showing up (at which point the drug is said tohave reached the maximum tolerated dose (MTD)). If an additional unacceptable toxicityis observed, then the dose escalation is terminated and that dose, or perhaps theprevious dose, is declared to be the maximally tolerated dose. This particular designassumes that the maximally tolerated dose occurs when approximately one-third of theparticipants experience unacceptable toxicity. Variations of this design exist, but mostare similar.

MAD :- (Multiple ascending dose) studies are conducted to better understand thepharmacokinetics and pharmacodynamics of multiple doses of the drug. In these studies,a group of patients receives multiple low doses of the drug, while samples (of blood, andother fluids) are collected at various time points and analyzed to acquire information onhow the drug is processed within the body. The dose is subsequently escalated forfurther groups, up to a predetermined level.

Food effect :- A short trial designed to investigate any differences in absorption of thedrug by the body, caused by eating before the drug is given. These studies are usuallyrun as a crossover study, with volunteers being given two identical doses of the drugwhile fasted, and after being fed.

8. How the patient’s rights are reserved?

Patient’s rights are reserved by –a) Informed consentb) Scientific reviewc) Institutional review boards (IRBs)



d) Data safety and monitoring boards (DSMBs)

Informed Consent :• Purpose

• Procedures

• Potential risks and benefits

• Individual rights

• Scientific review

• Institutional review boards (IRBs) are required by federal law for trials that are:

--Federally funded--Subject to FDA regulation

Data and safety monitoring boards :• Ensure that risks are minimized

• Ensure data integrity

• Stop a trial if safety concerns arise or objectives have been met.

MultipleChoiceQuestions1. All of the following must be determined prior to initiating a clinical trial EXCEPT:

a. The number of patients needed to evaluate protocol sample sizeb. The required laboratory tests and X-raysc. The study design, i.e. randomized or single-arm triald. The degree to which the trial outcomes are mete. The eligibility criteria

2. What is the definition of an Adverse Event?a. Any sign or symptom during the course of a clinical trialb. Any event which the PI decides to report during the course of a clinical trialc. Administration of the wrong dose of study agentd. Patient participating in a clinical trial withdraws from study

3. For what purpose does the IRB review the informed consent?

a. Protect the Institution



b. Protect the subjectc. Provide the Institution with information about proposed research trialsd. Protect the Sponsor

4. Which one of the following characterizes phase II drug testing?

a. It uses a s ingle dose of drug determined from the Phase I experience.b. It always treats divergent pathologies in a single trial.c. It is the first human clinical experience with a new agent.d. It always leads to a new drug approval from FDA

5. The following must be done prior to the first patient being entered on a clinical trialEXCEPT:

a. Approval by an Institutional Review Board (IRB)b. A written protocolc. A written consentd. Pharmacy process to obtain drug suppliese. Data analysis

6. The trials of which Phase are of Therapeutic Confirmatory type?a. Phase Ib. Phase IIc. Phase IIId. Phase IV

7. Who Is responsible for Clinical trials in India?

Concepts in EpidemiologyQ. Define endemic, Pandemic and epidemic withexamples?Q. What is incidence and prevalence?Q. What are the components of an epidemiological triad?Q. Define cumulative incidence?Q. Uses of epidemiology?



Q. What are Death rates and its disadvantage?

Q. Define Infant, Maternal, Child mortality rates?Design and Management of Disease Surveillance in Hospitaland community situation :SHORT QUESTIONS

What is disease surveillance?Ans: It is the ongoing systematic collection, analysis andinterpretation of health data essential to the planning,implementation and evaluation of public health practice as well astimely dissemination of these data to those who need to know.(Centers for Disease Control and Prevention)

Why is disease surveillance necessary?Ans: It is necessary because of the following:-

Predicting or detecting disease outbreaks for containment ( What ?) Identifying high-risk populations ( Who? ) Identifying areas requiring special attention and where systemperformance is poor ( Where ?) Determining the frequency of occurrence of a disease in thecommunity and magnitude of the problem ( When ?how many? )

Identifying underlying causes / risk factors of the disease ( Why ?) Guiding response activities, including immunization ( How the

disease can be prevented, controlled or eliminated ?) .

What are the characteristics of an effectivesurveillance system?



Ans: An effective surveillance system has the followingattributes:-SimplicityAcceptabilityFlexibilitySensitivityData qualityHigh predictive value positive (PVP)

TimelinessStabilityRepresentativeness

What are the components of a surveillance system?Ans: Components of a surveillance system are:-Collection of data

Compilation of dataAnalysis and InterpretationTake actionProvide feedback

What are the criteria for selecting and prioritizing healthproblems for surveillance?Ans: Criteria for disease selection :- -Does the disease have a high disease impact? -Does it have a significant epidemic potential? -Is it a specific target of a national, regional, or internationalcontrol program?



-Will the information collect lead to significant public healthaction?

What do you mean by standard case definition?Ans: A standard case definition is an agreed set of criteria, usuallyclinical, used to decide if a person has a particular disease.Use of standard definitions ensures that every case is detectedand reported in the same way, regardless of where or when it

occurred or who identified it.Case definitions for surveillance must be standardized.Elements of case definition:-

• Criteria for time, place, and person• Clinical and laboratory diagnosis• Epidemiological features of disease• Degree of certainty regarding diagnosis

• High sensitivity and specificityStandard case definition example: GiardiasisClinical descriptionAn illness caused by the protozoan Giardia lamblia (aka G.intestinalis or G. duodenalis ) and characterized by gastrointestinalsymptoms such as diarrhea, abdominal cramps, bloating, weightloss, or malabsorption.

Laboratory criteria for diagnosisLaboratory-confirmed giardiasis shall be defined as the detectionof Giardia organisms in stool, intestinal fluid, tissue samples,biopsy specimens or other biological sample.



Why capturing hospital data is important for disease

surveillance?Ans: Public sector hospitals cater to large population and thuscapture crucial data on many diseases. Hospital is able to notify and report sudden increase in number ofcases of a disease . Corrective action can be taken to prevent the spread of theoutbreak and control it.

Both inpatient and outpatient data needs to be included.

How is data collected?Ans: Types of data collection system:-

1. Vital Record systems2. Existing data sets3. Surveys4. Notifications5. Registries

What rules are used for collecting data?Ans: Following are some of the rules which are used for collectingdata:-

Zero reporting. Avoid double counting. Count only those cases which have been diagnosed by the healthpersonnel. Count current cases only. Report the occurrence of any unusual clustering of cases or anydeath immediately by telephone, fax, email, special messenger



etc. This verbal report must be followed by a written case basedreport.

What are the different types of surveillance?Ans: The different types of surveillance are -

Active Surveillance Passive Surveillance Sentinel Surveillance

Classification of hospital based surveillance?Ans: Following is the classification of hospital based surveillance:- Presumptive or probable surveillance: Diagnosis made on thetypical history and clinical examination by a medical officer. Laboratory Confirmed : Clinical diagnosis with positive laboratoryidentification. Syndromic : Diagnosis made on basis of clinical pattern byparamedical personnel and members of the community.

LONG QUESTION What are the steps in planning of disease surveillance in

the community?Ans: Following are the steps in planning of disease surveillance inthe community:-

Establish objectives Develop case definitions Develop data collection system



Develop data collection instrument Field test methods Develop data analysis approach Determine dissemination mechanism Determine evaluation method

MCQ/TRUE AND FALSE

To be effective, public health surveillance systems must involve public healthagencies, healthcare providers, and the public.

True False

When an unusual disease case occurs, the public health agency has two weeksto investigate and implement control measures if needed to prevent spread.

True False

Describing and monitoring health events and trends through surveillancesystems can allow us to:

a. Detect sudden changes in disease occurrence and distribution.

b. Follow long-term trends and patterns of disease.

c. Interpret current disease situations.

d. Identify changes in agents and host factors.

e. Use appropriate data to direct vaccine production, treatment, and other preventionand control measures.

f. All of the above.



There are many sources of data for surveillance purposes. Some of the mainones are:

a. Mortality reports

b. Environmental data

c. Drug and biologics utilization

d. Population-based surveys

e. All of the above

There are two forms of surveillance, passive and impassive.

True False

Every reportable disease has an official case definition that is used to determinewhether a case should be “counted” in the surveillance system.

True False

The only purpose of sharing surveillance information is to inform those who needto know.

True False

q-1 what do you understand by food borne diseases?Ans; Food borne diseases- Covers illnesses acquired through consumption of contaminated food-food poisoningq-2 write a note on prevention for foodborne diseases?1. Keep Clean –

Wash hands before handling food and often during preparationWash hands after going to toiletWash n sanities all surfaces n equipment for food preparation-protect kitchen from insects, pets

2. Separate raw and cooked food -Separate raw meat, poultry n seafood from other foodsUse separate utensils for handling raw foodsStore food in containers to avoid contact between raw and cooked foods

3. Cook Thoroughly –esp. Meat , poultry , eggs and SeafoodBring soups n stews to boiling (ensure>70degree temp)Reheat cooked food thoroughly

4. Keep food at safe temperature - Don't leave cooked food at room temp.>2 hoursPrompt refrigeration of cooked n perishable food



Keep cooked food piping hot (>60 de.) prior to servingDon’t store food too long even in refrigeratorDon’t thaw frozen food at room temperature

5. Use safe water and raw materials-

Use safe water or treat to make it safeSelect fresh and wholesome fruitsChoose foods processed for safety - pasteurized milkWash fruits n vegetables if eaten rawDon’t use food beyond expiry date6. Choose restaurants carefullyQues 3-write about waterborne diseases?Diseases caused by ingestion of water contaminated by human or animal excrement, which contain pathogenic microorganismsInclude cholera, typhoid, amoebic and bacillary dysentery and other diarrheal diseasesIn addition, water-borne disease can be caused by the pollution of water with chemicals that have an adverse effect on healthQues-4 write about the Strategies for National Vector Control Program?Ans; The basic approach for vector borne diseases control involves a strategy directed against the parasite and vector and to enlist theinvolvement of community in practicing various preventive measures

Disease management

Insecticide resistance

Involvement of NGOs /private sector/community

Quality assurance on laboratory diagnosis

Long lasting insecticide treated nets

Improve quality and efficiency of services at primary, secondary and tertiary levels

Environmental management

Monitoring and evaluation

Collaboration with National Malaria Institute of malaria research and medical colleges

Inter-sectoral collaboration

Ques-write about vector borne diseases?vector-borne diseases are infections transmitted by the bite of infected arthropod species, such as mosquitoes, ticks, triatomine bugs,sandflies, and blackflies

Evaluation of efficacy of therapeutic intervention .Question 1 .Define these: A. PotencyB. Efficacy.Question 2 . What is the difference between efficiency & effectiveness ? explain with example.

Question 3 : Evaluation & PURPOSE OF EVALUATION?Question 4 : Define therapeutic intervention? With example.What are the type of intervention recommended by WHO to prevent malaria & dengue?

ANSWERS: 1(.A). POTENCY:

is the relationship between the dose of a drug and the therapeutic effect. It refers to the drug'sstrength.

A drug is considered potent when a small amount of the drug achieves the intended effect.(B).EFFICACY:



is the ability of a drug to produce the desired therapeutic effect. Efficacy means that the drug iseffective. When comparing two drugs that work equally, the one with the lower dose has a higherpotency. They have equal efficacy.

ANSWER 2. Difference between efficiency and effectiveness . Efficiency : is the ratio of the output to the inputs of any system. An efficient system or person is

one who achieves higher levels of performance (outcome, output) relative to the inputs(resources, time, money) consumed.

Examples: Worker A moved 16 boxes from the truck to the store in one hour and worker B moved 9boxes in one hour. Worker A is more efficient than worker B. Car T uses 10 gallons to travel 150 miles,car F uses 13 gallons to travel 150 miles. Car T is more fuel efficient than car F.

Effectiveness: Extent to which planned outcomes, goals, or objectives are achieved as a resultof an activity, strategy, intervention or initiative intended to achieve the desired effect, underordinary circumstances (not controlled circumstances such as in laboratory).

Example: A vaccine is effective when it is capable to produce the desired effect (protectionagainst disease) in the population, under ordinary circumstances.

Being effective means achieving organizational goals. Being efficient means achieving goals with littlewasted resources. Effectiveness comes first.

ANSWER 3. Evaluation & purpose of evaluation. Evaluation is a systematic determination of a subject's merit, worth and significance, using

criteria governed by a set of standards . It can assist an organization, program, project or anyother intervention or initiative to assess any aim, realisable concept/proposal, or anyalternative, to help in decision-making; or to ascertain the degree of achievement or value inregard to the aim and objectives and results of any such action that has been completed.

PURPOSE:in addition to gaining insight into prior or existing initiatives , is to enable reflection and assistin the identification of future change.

ANSWER 4: Therapeutic intervention with example :Therapeutic intervention refers to a type of int ervention that is design to heal the person su fferingfrom the cond ition. Usually, therapeutic intervention is performed by professionals and it isdesigned to effect change in a way that restores the health of the person.

Therapeutic interve ntions used to treat malaria and dengue: Preventive chemotherapies are key elements of t he comp rehensive p ackage of malaria

prevention and c ontrol measures reco mmended by WHO.

Preventive measures recommended by WHO:Prior to a s tay in malaria and dengue affected areas:

Evaluate risk in the ports to b e visited and remember that the risk o f being infected withmalaria or dengue varies between different areas within a coun try. Assess the length o fstay in k nown r isk areas, time spent at sea, in por t, on riv ers, etc., and planned s horeleaves b y the cr ew.



Continuous ly monit or the WHO website and sim ilar sources for o fficial advice as the typ esof d iseases expected within certain areas may c hange with th e seasons.

Contact a medical practitioner if in d oub t.

Infor m the crew about the risks and the precautions to be taken as well as actions to betaken if illness o ccurs at sea. Stress that a slight h eadache, fever and flu-like symptomsare always reasons fo r contacting the medical officer.

Evaluate, in c lose co-operation with a medical doctor and based on the vessel’s expectedexposure time in a risk area, if the crew should take an anti malarial drug.

Questions1) Define Evidence-Based Healthcare?

Evidence-based health care is the conscientious use of current bestevidence in making decisions about the care of individual patients or thedelivery of health services. Current best evidence is up-to-dateinformation from relevant, valid research about the effects of differentforms of health care, the potential for harm from exposure to particularagents, the accuracy of diagnostic tests, and the predictive power of

prognostic factors.

2) What are the steps of Evidence- Based Healthcare?1. Constructing a well-built question: translation of uncertainty

to an answerable question2. Finding the Evidence: systematic retrieval of best evidence

available3. Critical Appraisal: testing evidence for validity, clinical

relevance, and applicability4. Making a Decision: application of results in practice5. Evaluating Performance: auditing evidence-based decisions



3) Explain the PICO model with example? PICO(T):

• Patient/population/problem• Intervention• Comparison

• Outcome• Time

PPatient/Problem

IIntervention

CComparison/Con

trol

OOutcome

Who? What? AlternativeIntervention?

What happens?

“How would Idescribe agroup of patients

similar to this

particular patient?”

“Whichtreatment, test

or other

intervention?”

“Compared towhat other

treatment, test, or perhaps compared

to doing nothing”

What is the patient orientedoutcome – better prognosis?Higher rate of cure? Etc.?”

Example :Q - Does hand washing among healthcare workers reduce

hospital acquired infections? • P -Hospital acquired infection .



• I - Hand washing• C - No hand washing; other solution• O - Reduced infection

4) What are the advantages of Evidence Based Healthcare?

• Minimizes the error in patient care• Reduces the cost of treatment• Optimizes the quality of patient care

• Helps in advancement of knowledge and keeping pace withscientific progress

• Provides material for future research

5) Why is Evidence Based Healthcare required?

• Caring for patients creates the need for clinically importantinformation - Diagnosis, Treatment, Prognosis, Intervention

• Inadequate traditional sources:

Outdated (Textbooks)

Frequently wrong (Expert opinions)

Voluminous and variable in validity (Medical Journals)

• Time constraints in clinical practice

• New evidence often changes clinical practice



6) What are the misconceptions and challenges related to EvidenceBased Healthcare?

• 1. Design seamless, coordinated care• 2. Make effective use of IT, including automating patient records• 3. Manage knowledge so that it is delivered into patient care• 4. Coordinate care across patient conditions, services, and settings

over time• 5. Advance the effectiveness of teams• 6. Incorporate measurement of care processes and outcomes into

daily practice

MCQ’s1. Disease is the result of forces within a dynamic system consisting of :

A) AgentB) HostC) EnvironmentD) All of the above

2. The presence of an infectious agent on a body surface, on or in clothes, beddings, toys, surgicalinstruments or dressings, or other articles or substances including water and food.A) InfectionB) ContaminationC) Infestation

D) Disease

3. An insect or any living carrier that transports an infectious agent from an infected individual orits wastes to a susceptible individual or its food or immediate surroundings.A) VectorB) PathogenC) ReservoirD) None of the above



4. The unusual occurrence in a community of disease, specific health related behavior, or otherhealth related events clearly in excess of expected occurrence.

A) EndemicB) SporadicC) EpidemicD) Pandemic

5. The cases occur irregularly, haphazardly from time to time, and generally infrequently.A) EndemicB) SporadicC) EpidemicD) Pandemic

6. The person who comes into and infects a population.A) Primary caseB) Secondary caseC) Index caseD) Both A & C

7. An endemic occurring in animalsA) Epizotic

B) EnzoticC) ZoonosisD) None of the above

8. This is infection by organisms that take the opportunity provided by a defect in host defense toinfect the host and thus cause disease.A) Hospital Acquired InfectionB) Opputunistic InfectionC) Both of the aboveD) None of the above

9. The person, animal, object or substance from which an infectious agent passes or isdisseminated to the host.A) ReservoirB) PathogenC) HostD) Vector.

10. The disease evoking power of a micro-organism in a given hostA) Pathogenecity



B) VirulenceC) InfectivityD) Survival

Differentiate giving example between :-1. Epidemic & Endemic2. Contamination & Infestation3. Erradication & Elimination4. Incidence & Prevalence5. Carrier & case6. Vector & Reservoir

Define with diagram

1. Iceberg Concept of Disease.2. Epidemiological Triad.3. Chain of infection.

A 37 year old women with low back pain for the past 4 week wants to know if you recommendsurgery. You prefer to base your treatment recommendations on research evidence wheneverpossible .In the strongest study you can find , investigation reviewed the medical records of 40consecutive men with low back pain under care at their clinic – 22 had been referred forsurgery,and the other 18 patients had remained under medical care without surgery. The studycompared rates of disabling pain after 2 month s. All of the surgically treated patient and 10 ofthe medically treated patients were still being seen in the clinic thoroughout this time. Rates ofpain relief were slightly higher in the surgically treated patients.For each of the following statements, circle the one reason that best representthe corresponding threat to validity ( yellow color is answers)Q1. Because there are relatively few patients in the study it may give a misleading impression of theactual effectiveness of surgery

a. Selection Biasb. Measurement bias

c. Confoundingd. Chancee. Extremely Validity ( genreralizability)

Q2. The results of the this study may not apply to your patient , a women because all the patients inthe study were men

a. Selection Biasb. Measurement biasc. Confoundingd. Chance



e. Extremely Validity ( genreralizability)

Q3. Fewer patients who did not have surgery remained under care at the clinic two months after

surgerya. Selection Biasb. Measurement biasc. Confoundingd. Chancee. Extremely Validity ( genreralizability)

Q4. The patients who were refered for the surgery were youngest and fitter than those who remainedunder medical care

a. Selection Biasb. Measurement biasc. Confoundingd. Chancee. Extremely Validity ( genreralizability)

Q5. Compared with the patients who had surgery moght have been less likely to report whatever painthey had and the treating physicians might have been less inclined to record pain the thbe medicalrecord

a. Selection Biasb. Measurement bias

c. Confoundingd. Chancee. Extremely Validity ( genreralizability)

Q6 Patient without other medical conditions were both more likely to recover and more likely to bereferred for the surgery

a. Selection Biasb. Measurement biasc. Confoundingd. Chancee. Extremely Validity ( genreralizability)

Q7 Histamine is a mediator of inflammation in patients with allergic rhinitis ( hay fever) . Based on thisfact which of the following is true

a. Drugs that block the effect of histamines will relieve symptomsb. Fall in histamine levels in the nose is a reliable marker of clinical successc. Anti-histamines may be effective and their effects on symptoms ( eg itchy nose, sneezing and

congestion ) should be studied in the patients with allergic rhinitisd. Other mediators are not importante. If laboratory studies of disease are convincing , clinical research is unnecessary



Q8. Which of the following statement about the sample of population in incorrecta. Sample of population may have characteristics that differ from the population even though

correct population procedures were followedb. Sample of population is the only feasibly way of studying the populationc. When population are correctly sampled , extremely validity is ensuredd. Sample of population should be selected in a way that every member of population has an equal

chance of being chosen

Q9. You are making a treatment decision with a 72 year old man with colon cancer. You are aware ofseveral good study that have shown that a certain drug combination prolongs the life of patients withcolon cancer however all the patient in these studies were much younger, Which of below statementis correct

a. Given these studies the decision about this treatment is a matter of personal judgmentb.

Relying on these studies for your patient is called internal validity

c. The results in these studies are affected by chance but not bias

Q10. A study was done to determine whether regular exercise lowers the risk of coronary heartdisease . An exercise program was offered to employees of factory and the rates of subsequentcoronary events were compared in employees who volunteered for the program and those who didnot volunteer . The development of CHD was determined by means of regular voluntary checkupincluding a careful history and electrocardiogram and a review of routine healt records. Surprisinglythe member of exercise group developed a higher rate of CHD even though fewer of them smokedcigarette. This result is least likely to be explained by which of the following

a. The volunteers where at a higher risk of developing CHD than those not volunteering before thestudy began

b. The volunteer did not actually increase the exercise and the amount of excerice was same in thetwo gropes

c. Volunteers got more check ups and the silent myocardial infarctions were therefore more likelyto have been indentified in the exercise group

Q11. Venticular premature depolarization are associated with an increased risk of sudden death froma fatal arrhythmia, especially in people in other evidence of heart disease. You have read there is anew drug for Venticular premature depolarization. What is the most important thing you will like toknow about the drug before prescribing it to the patient

a. The drugs mechanism of action

b. How well the drug prevents Venticular premature depolarization in people using the drugcompared to those who do not use the drug

c. The rate of sudden death in similar people who do and do not take the drug

Question 1.1.2-1.15 are based on the following clinical scenariosBecause reports suggested that estrogens increase the risk of clotting, a study compared the frequencyof oral contraceptives use among the women admitted to the hospital with thrombophlebitis and agroup of women admitted due to other reasons. Medical records were reviewed for indication of oralcontraceptives use in two groups . Women with thrombophlebitis were found to have using oralcontraceptives more frequently than women admitted for other reasons



For each of the following statement, select the one response that represents thecorresponding threat to validity .

Q12 Women with thrombophlebitis may have reported the use of contraceptives more completelythat women without thrombophlebitis because they remembered hearing of the associationa. Selection Biasb. Measurement Biasc. Confoundingd. Chancee. External Validity ( generalizability )

Q13. Doctors mamay have questioned women with thrombophlebitis more carefully aboutcontraceptive use than those without thrombophlebitis ( and recorded the information more carefullyin medical records) because they were aware that estrogen causes clotting

a. Selection Biasb. Measurement Biasc. Confoundingd. Chancee. External Validity ( generalizability )

Q14. Number of women in the study was smalla. Selection Biasb. Measurement Biasc. Confoundingd. Chancee. External Validity ( generalizability )

Q15. Women with thrombophlebitis were admitted to the hospital by doctors working in differentneighborhood than the physicians of those that did not have thrombophlebitis

a. Selection Biasb. Measurement Biasc. Confoundingd. Chancee. External Validity ( generalizability )

Q .Short not1. Define clinical epidemiology.2. Difference in specificity and sensitivity.3. Enlist steps of clinical epidemiology

1. In which five year plan Medical Certification of Cause of Death (MCCD) was initiated ?



a. 2nd Five Year Planb. 3 rd Five Year Planc. 4 th Five Year Pland. 5 th Five Year Plan

Ans. 3 rd Five Year Plan2. In the International Death Certificate, Which of the following is True ?

a. Part 1 of the certificate deals with immediate and also the underlying causeb. Part 1 of the certificate deals with immediate cause onlyc. Part 2 of the certificate deals with underlying caused. Other morbid conditions not related to the cause of death are not included

Ans. Part 1 of the certificate deals with immediate and also the underlying cause3. The following people can sign a Medical Certificate of Cause of Death ?

a. a dentist involved in care of the patient. b. registered medical practitionerc. a senior nurse involved in the care of the patient in his/her final illnessd. a Coroner

Ans. registered medical practitioner

4. Death and birth certificates comes under which registration system ?

a. Statistics Registration System b. Civil Registration Systemc. Sample Registration System

Ans. Civil Registration System

5. Underlying cause means ?

a. Most recent cause

b. Next oldest conditionc. Initiating condition

Ans. Initiating condition

6. IDSP is funded bya) WHO

b) World band



c) CDCd) UNICEF

Ans. World Bank

7. NFHS 3 was conducted in which year :a) 1992-93

b) 1998-99c) 2000-01d) 2005-06

Ans. 2005-06

Short Notes:-

1. What do you understand by “ Immediate cause of death” ?

Ans1. Immediate cause of death - “Most Recent Cause ”. The final act in a series of provocations leading to a particular result or event, directly producing such result withoutthe intervention of any further provocation.

For example, if an individual who was driving while intoxicated crashed his or her car andwas killed, the immediate cause of death was the crash. The proximate cause, however, wasthe individual's state of intoxication.

2. What do you understand by Mechanism of Death? Explain with a suitable example.

Ans2. Mechanism Of Death - The specific physiological change in the body that brought aboutthe ending of life

Example: If the cause of death was a shooting, the mechanism could be loss of blood

(exsanguinations) or cessation of brain function.Example: If the cause of death was massive trauma from a car accident, the mechanismcould be pulmonary arrest (lungs stopped working)

3. What do you understand by “ Underlying cause of Death”?



Ans3. Underlying cause of Death - The disease or injury that initiated the train of events leadingdirectly to death, or the circumstances of the accident or violence which produced the fatalinjury.

4. What is the value of Death Certificate ? What are the usages of Death certificate?

Ans.4. Value of Death Certificate - One of the most important documents we need to settle theaffairs of our loved one is a death certificate. The death certificate is the official legalrecord of death. It includes information about the person who died and about their cause ofdeath. Insurance companies, the Social Security Administration, and other agencies mayrequest certified copies of the death certificate as proof of death. Certified copies are

printed on special paper that cannot be easily duplicated.

Usages of death certificate :-

Claiming life insurance benefits Claiming pensions Settling estates Government programs, pensions, welfare funds, and many other services will require

the notice of a death certificate as well.

5. What are the different source of hospital data and use of these data?

Ans.5. Source of hospital data :

1) Out Patient Department and clinics2) Medical Record Department3) Pathology Laboratories.4) Autopsy services5) Hospital patient information system.6) Other clinical departments of hospital.

Uses:1) Resource management:

Drug management, Human resource management.2) To study disease resulting from hospitalization.

3) To study the natural history of disease.4) To study attributes related to disease.5) To determine disease morbidity.6) To facilitate comparative studies of hospitals.7) To study administrative planning.

6. What are the problems encountered by ICD?

Ans.6.



Size of the Classification No formal training No user-friendly software to guide No abridged Classification of Diseases based on Indian condition & requirement No Online Help-line system

QUESTIONS:Q. Define RCT.A. “A study where people are allocated randomly to receiving a particular intervention or not (this couldbe two different treatments or one treatment and a placebo).Q How many groups are formed in RCT trails? A. 2 group i.e. treatment group, control group.Q. why consideration of ethical issues is so important for RCT conduction?A. Because it can have adverse effect on outcome of study.Q. Why informed voluntary consent is necessary for each person in any medical trail?A. So that he may know the possible benefits & adverse effects of treatment and medicine and can actaccordingly.Q. How much loss of follow up is acceptable in RCT?A. Below 20% is acceptable and above it poses serious threats to validity.Q. Controlled clinical trials are viewed as the ……………..a) Gold standard b) silver standardQ. According to statistical errors, how many types of RCT are being subject to? What are they?A. RCTs are subject to both type I ("false positive") and type II ("false negative") statistical errors. Q. RCTs reduce ………….and ………….in the hierarchy of evidence that influences healthcare policy and

practice.A. Spurious causality, biasQ. Why Data Monitoring Committee need to be established?A. Basically, to assess at regularly scheduled intervals the progress of an RCT, safety data, data quality,and the critical efficacy end points.Q. Which of the studies are most validating?a) Case-control b) Cross- sectionalc) RCT d) Cohort

Questions13. What are the two of the primary criteria of evaluation in any measurement or observation?

Ans:Whether we are measuring what we intend to measure.Whether the same measurement process yields the same results.These two concepts are validity and reliability.

14. Say you have a piece of wood that is 2 1/2 feet long. You measure it once with the tape measure- you get a measurement of 2 1/2 feet. Measure it again and you get 2 1/2 feet. Measure it



repeatedly and you consistently get a measurement of 2 1/2 feet. Are the results valid andreliable?Ans: The tape measure yields reliable results. However, the results will be valid if the measure isactually 2 ½ feet long. Measuring this piece of wood with such a "good" tape measure shouldproduce a correct measurement of the wood's length.

15. State if Valid and Reliable

16. What are the three most important factors to assess reliabilityAns: Observer VariationPhysical VariationErrors related to Technical methods

17. What is a good reliability scale?Ans: the higher the reliability value the more reliable the measure. The general convention in

research has been prescribed by Nunnally and Bernstein (1994) who state that one should strivefor reliability values of .70 or higher.

18. How do I improve the reliability of my survey instrument?Ans: Reliability values increase as test length increases (see Gulliksen, 1950 for a completediscussion of the relationship between test length and reliability). That is, the more items youhave in your scale to measure the construct of interest the more reliable your scale will become.However, the problem with simply increasing the number of scale items when performingapplied research is that respondents are less likely to participate and answer completely whenconfronted with the prospect of replying to a lengthy questionnaire. Therefore, the bestapproach is to develop a scale that completely measures the construct of interest and yet doesso as economical a manner as is possible.

19. Define validity?(ans is in slides)20. What are the two types of validity? Explain (ans is in slides)

21. Specificity is equal to:e. True positive / (true positive + false positive)f. True negative / (true negative + true positive)g. True positive / (true positive + false negative)h. True Negative / (true positive + false positive)



22. An example of False negative is :e. A diseased person incorrectly identified as healthyf. A healthy person incorrectly identified as diseasedg. A diseased person correctly diagnosed as diseasedh. A healthy person correctly identified as healthy

23. ____________ reflects the diagnostic power of the test (A: Predictive accuracy)24. If a disease has very low prevalence, you typically get poor values for

e. Negative predictive valuef. Positive predictive valueg. Sensitivityh. Specificity

Short notes and multiple choice questions on outbreakinvestigation.(By Nuzhat Fatema, Roopal Chandrakar, Sonal Agarwal)

Questions:Q1) What is an outbreak? Differentiate between outbreak and epidemic. What are the

identification signs of an outbreak? Mention the importance of outbreak investigation.Q2) Mention in brief the steps of outbreak investigation.Q3) Write short notes on:

1) What is the difference between outbreak and epidemic?2) What are the warning signs of an impending outbreak?3) What are the step wise actions to be taken during the outbreak?4) How the outbreak is confirmed?5) What is case fatality rate?6) What is attack rate?7) How the collected data during the outbreak, is analyzed?

8) How the ecological factors responsible for outbreak, are analyzed?9) What are the sub steps of further investigation of population at risk of outbreak?10) Explain in detail the procedure of report writing?

Multiple choice questions:1) What is an emerging disease?

a) a disease that is always present in a population b) a disease that occurs only occasionally and at unpredictable intervalsc) a global outbreak of disease



d) a disease with clinically distinct symptoms whose incidence has increased, particularly over the last two decades

2) What is a sporadic disease?

a) a disease that is always present in a population b) a disease that occurs only occasionally and at unpredictable intervals c) a disease with clinically distinct symptoms whose incidence has increased,

particularly over the last two decadesd) a global outbreak of disease

3) What is an epidemic disease?

a) a disease that occurs suddenly and spreads rapidly to many people b) a disease that occurs only occasionally and at unpredictable intervalsc) a global outbreak of diseased) a disease with clinically distinct symptoms whose incidence has increased,

particularly over the last two decades

4) Most common way(s) that a local health department uncovers outbreaks is/are bya) receiving calls from affected residents

b) receiving calls from health care providersc) reviewing all case reports received each week to detect common featuresd) performing descriptive analysis of surveillance data each weeke) both (a) and (b)

5) In an ongoing outbreak of a disease with no known source and mode of transmission, the primary reason for an investigation relates to:

a) prevention and control b) training of staffc) learning more about the diseased) being responsive to the concerns of the communitye) legal responsibility

6) For an investigation of an outbreak, what is the logical order of the activities listed below?1. Analyze data by time, place, and person2. Conduct a case-control study3. Generate hypotheses4. Conduct active surveillance for additional cases5. Verify the diagnosis6. Confirm that the number of cases exceeds the expected number



7. Coordinate who will talk to the press about the investigationa) 1-2-3-4-5-6-7

b) 5-6-4-1-2-3-7c) 6-5-1-3-2-4-7d) 7-6-5-4-1-3-2e) 5-6-1-3-2-4-7

7) If you were a state employee, the first step in the investigation of an outbreak ofmeningococcal meningitis 200 miles away might include:

a) talking with someone knowledgeable about meningococcal meningitis b) talking with someone knowledgeable about field investigationsc) talking with a couple of the initial case-patientsd) discussing the feasibility of mass vaccinatione) all of the above

8) The appropriate role for an epidemiologist from the CDC in the investigation of a localoutbreak of botulism (possibly food borne)

a) is to lead the investigation in consultation with CDC experts b) is to provide consultation to the local staff who will conduct the investigationc) is to lend a hand to the local staffd) is whatever is negotiated in advance with the local health department

9) The primary distinction between the terms “outbreak” and “epidemic” is:a) “outbreak” does not imply that the cases are all related

b) “outbreak” implies a grouping of cases but not necessarily more than expectedc) “outbreak” is limited to fewer than 20 cases, epidemic to more than 20d) “outbreak” does not generate as much anxiety among the public

10) Why should an investigator who has no clinical background nonetheless talk to a patient ortwo as an early step in the outbreak investigation?

a) To verify the clinical findings as part of verifying the diagnosis b) To verify the laboratory findings as part of verifying the diagnosisc) To learn more about the clinical manifestations of the diseased) To develop hypotheses about the cause of the outbreake) Both (c) and (d)

11. Common methods of identifying additional cases (expanding surveillance) as part of anoutbreak investigation include

a) sending a letter to physicians b) telephoning the infection control nurse at the local hospitalc) advising the public through newspapers, TV, and radio to contact the local

health department



d) asking case-patients who they were with at the time of exposure (if known)e) all of the above

12. The ultimate purpose for characterizing an outbreak by time, place, and person is to:

a) identify errors and miscodes in the data b) provide a comprehensive description of an outbreak by portraying its time course,

geographic extent, and populations most affected by the diseasec) ensure that all true cases are captured by the surveillance systemd) generate hypotheses

13) Reasonable ways of generating hypotheses in an outbreak investigation include

a) asking the local health officer what he/she thinks is the cause b) asking the case-patients what they think is the causec) reviewing a textbook about the disease under investigationd) postulating explanations for the patterns seen in the descriptive epidemiologye) focusing on the patients who do not fit the general patterns seen in the descriptive

epidemiology

14) For a federal investigator, which of the following communication modes should be used firstto announce the findings of an outbreak investigation?

a) Written report for local authorities b) Written report for state newsletterc) Written report for the Morbidity and Mortality Weekly Reportd) Oral report for the local authoritiese) Press conference to explain findings the public

15) Infectious disease outbreak investigation includes both epidemiological and laboratorycomponent.

a) True

a) False

QuestionsQ1 what is biostatistics? How is it different from statistics?



Q2 what is hospital data? What are the different types of hospital data analysis?Q3 what are the elements of hospital data analysis.Q4 Mention the uses of hospital data analysis.

Q5 why capturing hospital data is important for disease surveillance?Q6 briefly describe hospital based surveillance.Q7 Mention the roles of various personnel involved in establishing surveillance at hospital levels.Q8 what are the limitations of hospital data?True and false

1. Routine Reporting from the hospital to DSU needs to be done once in a month.2. The L form reporting in the hospital is done by the laboratory technical staff based on the

number of samples tested and those found positive.



Answers

Ans1

When the data analyzed are derived from the biological science and medicine, the term biostatistics isused to distinguish this particular application of statistical tools and concepts. While Statistics is a field ofstudy concerned with

• collection, organization, summarization and analysis of data.• drawing of inferences about a body of data when only a part of the data is observed

Ans2 Hospital medical records contain immense amounts of information on patients. Hospital accountingrecords contain a wealth of data on the facility’s business activities.Hospital data analysis is of two types

Quantitative analysisQualitative analysisAns3

Elements of hospital data analysis

• Collection• Analysis

• Interpretation

• Dissemination

Ans 4uses of hospital data analysis

• Monitoring trends of diseases• Can use to measure outcomes of care (death, complications, hospital readmission)• Can use to examine disparities in care based on gender, or payer status• Can use to examine market share for certain diagnoses, procedures

• Identifying epidemics• Evaluate public policy, cost and interventions• Utilization of health care services (resource utilization)

• Identifying new diseases and infections.• Projecting future needs

Ans 5 Public sector hospitals cater to large population and thus capture crucial data on many diseases.

Hospital is able to notify and report sudden increase in number of cases of a disease .

Corrective action can be taken to prevent the spread of the outbreak and control it.

Both inpatient and outpatient data needs to be included.

Ans6• Presumptive or probable surveillance: Diagnosis made on the typical history and clinical

examination by a medical officer.

• Laboratory Confirmed : Clinical diagnosis with positive laboratory identification.



– Severity of disease – Associated conditions – Admission policies

2. Hospital records are not designed for research. They may be- – Incomplete, illegible, or missing – Variable in diagnostic quality

3. Population(s) at risk (denominator) is (are) generally not defined.

TRUE AND FALSE1 FALSE ( IT IS DONE ONCE IN A WEEK)2 TRUEQ.1:- Describe three uses of Life Table.Q.2:- Describe the different columns of a life table.Q.3:- What are the Strengths and weaknesses of a Life Table.Q.4:- Describe the inferences that are derived from Life Table.Q.5:- Describe the different types of Life Table.Q.6:- Life Table is also known as ---------------- table.Q.7:- Life table consists of --------- no. of columns.Q.1. Simultaneously two (or more) tests are conducted in

1. Serial testing 2. Sequential testing3. Both of the option (1,2) 4. Parallel testing

Answer : 4

Q.2. the performance of a diagnostic testing strategies can be evaluated by using which measures1. Validity 2. Both of the two options (1,3)3. Predictive value 4. Neither of the two optionsAnswer : 2

Q.3. Differentiate between serial testing and parallel testing.• In serial testing two or more tests are run consecutively to confirm a diagnosis. Also

known as Sequential Testing (Two-Stage Screening) whereas In parallel testing two (ormore) tests are conducted in parallel i.e. all at once also known as Simultaneous Testing

• Serial testing strategy maximizes specificity and positive predictive value but lowers

sensitivity and the negative predictive value whereas Parallel testing strategy generallyincrease the sensitivity and the negative predictive value for a given disease above thoseof each individual test

Q.4. Define serial testing. Describe the steps of events which are followed in interpreting results.Serial testing is in which two or more tests are run consecutively to confirm a diagnosis.Herediagnosis requires all test to be positive.



4. Reduce the effects of sampling variation.5. Reduce the effect of losses to follow-up.

Question 8. Randomization in experimental studies ensures that:6. Assignment to experimental or control groups occurs by chance.7. Treatment and control groups are alike in all respects, except the treatment.8. Bias is eliminated in the observations.9. Placebo effects are eliminated.10. The two groups are representative of the population from which they were

drawn.

Question 9. How will you design a RCT study? Explain.

Question 10. One of the best way to eliminate bias in epidemiological study can be done by using :5. RCT6. Cross-sectional study7. Case-control8. Cohort

Question 11. Write short note on:5. Randomization

6. Blinding7. Intention to treat analysis8. Analysis of RCT

Question 12. Bias can be avoided by:5. Incorporation of blinding6. By doing randomization7. Both 1 & 28. None of the above

Question 13. Blinding is difficult:5. Having placebo in the same shape, formula and taste is very costly, and time

consuming.6. Impossible if surgical and medical treatments are compared.7. Both 1 & 28. None of the above



Question 14. What ethical considerations should be kept in mind while conductingRCTs ?

Question 15. Temporal relationship problem can be resolved by using which typeof study:5. Case-control6. RCT7. Cohort8. Cross-sectional

QUESTIONS AND ANSWERSTopic: Writing Reports, communication strategyfor publ ic information for outbreak of epidemics

By: col maan singh gahlot PG/12/42Dr. Megha sood PG/12/50Dr. Ridhima Joshi PG/12/74

Q1.What is an outbreak? Ans 1. A disease outbreak is the occurrence of cases of disease

in excess of what would normally be expected in a definedcommunity, geographical area or season. An outbreak may occurin a restricted geographical area, or may extend over severalcountries. It may last for a few days or weeks, or for several years. Q2. What is the difference between official, preliminaryand daily report?



Ans 2. Official report- may be sent too late for action orresponse usually meant for documentation & futurereferencePreliminary report-usually meant as first response & to getmore response-to launch control measures-sent asap(usually within the first few hours)Daily report- in major outbreaks- for communication

Q3. What are the important points to be avoided during

writing a report? Ans 3.

the inclusion of careless, inaccurate, or conflictingdata the inclusion of outdated or irrelevant data facts and opinions that are not separated unsupported conclusions and recommendations

careless presentation and proof-reading Too much emphasis on appearance and not enoughon content.

Q4. Elaborate the steps involved in report writing. Ans 4. 1) Letter of transmittal:

This is a letter to the person who commissioned thereport, in which you effectively hand over your work tothat person. Include: a salutation (eg. Dear Ms Podolinsky) the purpose of the letter (eg. Here is the final versionof the report on ‘Underwater Welding’ which wascommissioned by your organisation.) the main finding of the report any important considerations



an acknowledgement of any significant help an expression of pleasure or gratitude (eg. Thank youfor giving us the opportunity to work on this report.)

2) Title page: This must contain: the report title which clearly states the purpose of thereport full details of the person(s) for whom the report wasprepared

full details of the person(s) who prepared the report the date of the presentation of the report

3) Abbreviations and/or glossary If necessary, you should provide an alphabetical list ofthe abbreviations you have used in the report,especially if they may not be familiar to all readers ofthe report.

If you have used a lot of technical terms, you shouldalso provide a glossary (an alphabetical list of theterms, with brief explanations of their meanings).

4) Table of Contents usually only if the report is longer than, say, tenpages) This is a list of the headings and appendices of thereport. Depending on the complexity and length of the report,you could list tables, figures and appendicesseparately. Make sure the correct page numbers are shownopposite the contents. Up-to-date word processing packages can generate atable of contents for you.



5) Acknowledgements (if appropriate): This is a shortparagraph thanking any person or organization whichgave you help in collecting data or preparing the report6) Abstract (Summary or Executive Summary)

An abstract is quite different from an introduction. It isa summary of the report, in which you include onesentence (or so) for every main section of your report.For example, you can include: the context of the research

the purpose of the report the major findings (you may need several sentenceshere) the conclusions the main recommendations

Write the abstract after you have written the report.7) Introduction

Give enough background information to provide acontext for the report. State the purpose of the report. Clarify key terms and indicate the scope of the report(i.e. what the report will cover).

8)Body• The CONTENT of the body depends on the purpose of

the report, and whether it is a report of primary orsecondary research. A report of primary research (based on your ownobservations and experiments) would include: LITERATURE REVIEW (what other people have writtenabout this topic). The literature review should leadtowards your research question.



and objectives should include reinforcing vigilanceand aiding the recovery process.

B. What communication functions or roles should a planinclude?

A communication plan should describe the variouscommunication roles, or functions, required to achievethe plan’s objectives Functions and associated responsibilities may include: Communication Leadership:

Political liaison: Message Development and material production: Management of Approvals Listening Media Relations Website Management: Partner Communication Coordination

Communication evaluationC. Protocols, Procedures, Templates and Contacts Contact lists protocol for the first announcement established system for the distribution of publicinformation Protocols for various high and low technology optionsfor message dissemination Procedures for effective listening in order to determineaudience concerns, knowledge, attitudes, andbehaviors during the outbreak Potential protocols on the joint announcement of newdevelopments, public health recommendations to limitrisk, and other key updates Designation of organization spokespersons



Specific protocols and arrangements to addresscommon outbreak communication challenges Processes and procedures for communicationevaluation during the outbreak Update, simulation and training schedules to promotereadiness.

Q8. Listening plays a very important role in outbreakcommunication. Explain.

Ans 8. Listening Understanding the public’s risk perceptions, viewsand concerns is critical to effectivecommunication and the broader emergencymanagement function it supports. Without knowing how people understand andperceive a given risk and what their existing

beliefs and practices are, decisions and requiredbehavior changes necessary to protect healthmay not occur and societal or economicdisruption may be more severe.

Q9. Broaden your views as to how can we train our teamduring outbreaks?

Ans 9. Training programs on risk communication Training exercises such as table top simulations andguided discussions involving both communication staffand outbreak or emergency response managementstaff. Gaining experience of dealing with the press andmedia Plans should be reviewed periodically



Senior management should endorse the emergencycommunication plan and other outbreakcommunication planning activities Ensure readiness by establishing a riskcommunications training program, includingsimulations and exercises to test the emergencypublic communication plan and its components

Q10. Write down a communication plan for outbreak of

dengue in Delhi. Ans 10. Same as Q7. With focus on dengue in Delhi

Q11. Which of the following is not essential in writing areport for outbreak?a. Title pageb. Introduction

c. Bodyd. Bibliography Ans 11. Bibliography

Q12.Fill in the blank An appendix contains material which is too detailed, technical, orcomplex to include in the body of the report (for example,specifications, a questionnaire, or a long complex table of figures),

but which is referred to in the report Ans 12. AppendixQUESTIONS ON EVIDENCE BASED POLICY

Q1. “Evidence based policy is a public policy informed by rigorously established objective evidence”What is the meaning of Public Policy in the above statement?

Q2. RCT is (a) ______________________ standard for a clinical trial and are used to test the (b) ___________________ and/or (c) ______________________________ of various types of medicalintervention within a patient populationAnswer: (a) Gold, (b) Efficacy and (c) Effectiveness



Q14. What is the need for evidence in policy making?

DRAFT QUESTIONSQues1. Fill in the blanks.

a) Two types of Observational studies are _____________ andAnalytical studies.

b) Descriptive studies basically question time, ____________,andperson studies.

c) Hypothesis can be accepted or rejected using the techniques of _______________ Epidemiology.

Ques 2. State true or false.a) Time distribution has three kinds of distributions short term,periodic and long term. T/F b) During observational studies Intervention of investigation isdone by the observer when observing individuals. T/Fc) Retrospective studies look forward in time to study events.

T/Fd) An epidemic is an example of short term distribution of diseasein time distribution. T/Fe) Descriptive Epidemiology provides data regarding diseasemagnitude and etiology. T/F

Ques 3- Discuss the following types of research designs in terms ofcomponents, strengths, and limitations in determining cause-effectrelationships:

a. Cross-sectionalb. Case-control

Ques 4- . Define the following terms briefly:a. Reliability and validityb. Person, time, place variables



Ques 5- What is the difference between clinical and epidemiologicapproaches in describing disease?

Ques 6- Distinguish between descriptive and analytic epidemiology.

Ques 7- What are different tests for analysis and discuss significance

test?

QUESTIONS – SCREENINGQ1. Screening is the testing of apparently healthy populations.TRUE/FALSE

Q2. Which one of the following is Criteria for Use Of a Screening test1. Significant burden of disease in the population2. The disease should be an important public health problem3. Preclinical stage is detectable and preventable4. All of above

Q3. In natural history of disease the sequence of following events isA. Clinical stage B. pre-exposure stage C. resolution stage D. pre –

clinical stage

1. ABCD2. BDAC3. ADBC4. CDAB

Q4. In preclinical stage



1. Factors present leading to problem development2. Exposure to causative agent: no symptoms present

3. Symptoms present4. Problem resolved. Returned to health or chronic state or

death

Q5.Mass screening involves screening of:1. High risk group2. Whole population3. None of above4. Both 1& 2

Q6. Uses of screening is :1. Case detection-2. Control of disease-3. Research purpose-4. All of above

Q7. Three Characteristics of Screening test :

Q8. Screening, in and of itself, does not diagnose disease.TRUE/FALSE

Q9.Which one of following is NOT true:1. Sensitivity detect true positive cases2. Specificity detect true negative cases3. Sensitivity detect true negative cases4. Both 1&2

Q10.Which one of following is true1. Screening is more expensive than diagnostic test2. Diagnostic test is more accurate than screening3. Diagnostic test is not basis for treatment4. Both 1&3

Solutions



1. TRUE

2. 4

3. 2

4. 2

5. 2

6. 4

7. CCEPTIBILITY , REPEATABILITY, VALIDITY

8. TRUE

9. 3

10. 2



CHAPTER 2

UNDERSTANDING

AND

ANALYZING

THE EXTERNAL ENVIRONMENT

Minakshi Gautam Assistant Professor

IIHMR, Delhi

Book Questions IIHMR Delhi

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