ABORTION RATE The estimated annual number of abortions per 1000 women of reproductive age (defined as age 15-44).
ABORTION RATIO The estimated number of abortions per 100 live births in a given year.
ABSOLUTE BENEFIT INCREASE ABI: the absolute arithmetic difference in event rates, |EER-CER|.
ABSOLUTE RISK INCREASE ARI : the absolute difference in rates of bad events, when the experimental treatment harms more patients than the control treatment; calculated as for ABI.
ABSENCE ’refers to a practitioner’s time away from work, either voluntarily or resulting from other another party’s action, including suspension/exclusion from work.
ABSOLUTE RISK REDUCTION ARR: the absolute arithmetic difference in event or outcome rates, |EER-CER|
ACCREDITATION OF RESEARCH PRACTICES. See Primary Care Research Team Assessment. research.
ACCREDITATION OF TRAINING PRACTICES. The established process whereby all Trainers and their practices are assessed every few years to ensure that minimum standards for the structure and process of training registrars exists in their practices.
ACCREDITED PROFESSIONAL DEVELOPMENT (APD) is a RCGP programme developed so that all GPs can demonstrate they are taking part in continuous professional development
ACCURACY The extent to which results of measurements agree with reality as measured by a chosen `gold standard' procedure. Accuracy can be used as comprehensive term for sensitivity and specificity together. See VALIDITY, GOLD STANDARD.
ACME see Alliance for CME (ACME)
ACRONYMS: www.pharma-lexicon.com is A dictionary of over 200,000 medical, pharmaceutical, biomedical & healthcare acronyms and abbreviations.
ACTION VERBS. These are used to specify task and measure the level of a students achievement. They must be both observable and measurable e.g. describe rather than feel, judge rather than understand
ACTIVE ERROR: failures at the level of the frontline operator which are felt almost immediately (see also latent error)
ACTIVITIES OF DAILY LIVING (ADL) SCALE a scale devised to score physical ability/disability; used to measure outcomes of interventions for various! chronic disabling conditions such as arthritis. The scale is based on scores for responses to questions about mobility, self-care, grooming, etc. The COOP/WONCA charts can be used to measure aspects of ADL.
ACUTE Has two meanings depending on relation to health or exposure. 1. Referring to health-recent onset, sometimes loosely used to mean severe, e.g. acute, pain. 2. Referring to exposure-brief, intense, sometimes referring to brief exposure of high intensity. Used about the duration of a health problem it refers to a duration less than 4 weeks. See also EPISODE, CHRONIC.
ACUTE HEALTH SERVICES: Usually refers to short-term hospital based health services.
ADAPTIVE (AKA SINGLE LOOP) LEARNING: Information Flows that enable negative feedback. The negative feedback loops within a system allow it to detect when it veers away from the desired course, and trigger corrective behaviour to bring it back on course. An example is Clinical Audit
ADJUSTED RATES Adjustment is often performed on rates or relative risks, commonly because of differing age distributions in populations that are being compared. Rates may be adjusted using the agespecific health problem frequency of each group and a standard age distribution reference population (direct standardization). An alternative is to use the age distribution of groups and the expected health problem frequency from a reference group to calculate expected total morbidity or mortality (indirect standardization). See STANDARDIZATION.
ADJUSTMENT A summarizing procedure for rates or measures of association in which the effects of differences in composition of the population being compared have been minimized by statistical methods. Age is a variable for which adjustment is most often carried out.
ADMINISTRATIVE CARE (Syn: administrative service) Services which derive from the responsible position accorded to health care providers by the community, e.g. certifying fitness for certain functions (driving, work, sports), unfitness for certain functions, and death, where necessary following a clinical examination. Witnessing of signatures and attestations about character are further examples.
ADULT LEARNING PRINCIPLES: These suggest that adults will learn more effectively if they address problems they already have (i.e. you only wants solutions to the problems you already have); they participate actively in their own learning (i.e. you ask questions); all of this occurs in a manner respectful of they fact that doctors have multiple demands on their lives (i.e. you are busy and do not want your time wasted)
ADVERSE EVENT MONITORING: Recording your failures and mistakes and learning from the process.
ADVERSE EVENT; an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error is a preventable adverse event
ADVERSE HEALTH CARE EVENT AHCE: an event or omission arising during clinical care, which causes physical or psychological injury
ADVERSE REACTION, SIDE EFFECT Any undesirable or unwanted consequences of a preventive, diagnostic or appropriate or inappropriate treatment.
AETIOLOGY Knowledge of causes of a health problem.
AFTER HOURS VISIT: a consultation or a home visit conducted after the normal working hours as defined for that practice. Must be clearly stated when it is used in studies.
AGE DEPENDENCY RATIO See DEPENDENCY RATIO.
AGE GROUPS Standard age groups in years: less than 1 year; 1 to 4 years; 5 to 14 years; 15 to 24 years; 25 to 44 years; 45 to 64 years; 65 to 74 years; 75 years and over. Five-yearly cohorts are increasingly used for children and the elderly. Standard division points should be retained (for example: 5-9 years, 10-14 years, 65-69 years, 70-74 years, 75-79 years, 80-84 years and 8S years and over).
AGE STANDARDIZATION (Syn: adjusted rates) A procedure for adjusting rates, e.g. death rates, designed to minimize the effects of differences in age composition when comparing rates for different populations. See STANDARDIZATION.
AGE The age in years of the patient at his/her last birthday.
AGENT (OF A HEALTH PROBLEM) A factor, such as a micro organism, chemical substance or form of radiation, whose presence, excessive presence, or (in deficiency diseases) relative absence is essential for the occurrence of a health problem. A health problem may have a single agent, a number of independent alternative agents (at least one of which must be present) or a complex of two or more factors whose combined presence is essential for the development of the disease. See also CAUSALITY.
AGE-SEX REGISTER: The list of all patients in a practice by age and sex. The primary purpose of this register is to provide a defined population against which rates of observed occurrence in a practice may be calculated. In the absence of a defined practice list only patients regularly attending and who regard themselves as patients of the practice, should provide the defined population.
AGE-SPECIFIC FERTILITY RATE: The number of births occurring during a specified period to women of a specified age group, divided by the number of person-years lived during that period by women of that age group. When an age-specific fertility rate is calculated for a calendar year, the number of births to women of the specified age is usually divided by the mid-year population of women of that age.
AGE-SPECIFIC RATE: a rate for a specified age group. The numerator and denominator refer to the same age group. The rate is often expressed per 100 or per 1000 for a general practice population or 100 000 or 1 000 000 for the total population.
AGING OF THE POPULATION: a demographic term, meaning an increase over time in the proportion of older persons in the population. It does not necessarily imply an increase in life expectancy or that "people are living longer than they used to". The principal determinant of ageing in the population has been a decline in the birth rate: when fewer children are born than in previous years, the result, in the absence of a rise in the death rate at higher ages, has been an increase in the proportion of older persons in the population. In developing societies, however, mortality change is becoming a factor: little further mortality reduction can occur in the first half of life, so reductions are beginning to occur in the third and fourth quarters of life, leading to a rise in the proportion of older persons from this cause.
AGMETS: Advisory Group on Medical Education and Training, this group reports to CMO of the NHS. There is a GP subgroup
AGREEMENT: The extent to which the results of two observations agree under similar conditions, more observers or the same observer repeatedly. The observers should be blinded for each other's assessments. In a two-by-two table the value of agreement is the proportion of results that are assessed as positive by all observers plus the results that are assessed by all as negative divided by the total number of observations. The proportion agreement is not corrected for chance, as the measure kappa.
AGW: Avon, Gloucester and Wiltshire Strategic Health Authority or area.
AHCE: see Adverse Health Care Event
AIMS: Long term ends in general rather than in detail, and without the structural requirements of objectives
AKT – applied knowledge test. This is an external assessment and is mainly knowledge based
ALGORITHM, CLINICAL: (Syn: clinical protocol) An explicit description of steps to be taken in patient care in specified circumstances. This approach makes use of branching logic and of all pertinent data, both about the patient and from epidemiological and other sources, to arrive at decisions that yield maximum benefit and minimum risk.
ALLIANCE FOR CME (ACME) An international organisation (mostly N American) that aims to educate and support continuing medical education professionals and to promote leadership in the development of CME in order to improve the performance of health care providers and health care outcomes www.acme-assn.org. A source of clear thinking. Annual conference is in January each year.
ALLIED HEALTH PROFESSIONALS are the autonomous clinical practitioners taking responsibility for their clinical practice and post registration education including consolidating skills and undertaking continuing professional development. They include physiotherapists, occupational therapist, podiatrist, dieticians, radiographers, speech and language therapists, prosthetists and orthoptists
ALLOCATION CONCEALED: deemed to have taken adequate measures to conceal allocation to study group assignments from those responsible for assessing patients for entry in the trial (eg, central randomisation; sequentially numbered, opaque, sealed envelopes; sealed envelopes from a closed bag; numbered or coded bottles or containers; drugs prepared by the pharmacy; or other descriptions that contain elements convincing of concealment).
ALLOCATION NOT CONCEALED: deemed to have not taken adequate measures to conceal allocation to study group assignments from those responsible for assessing patients for entry in the trial (eg, no concealment procedure was undertaken, sealed envelopes that were not opaque, or other descriptions that contain elements not convincing of concealment).
ALLOCATION UNCLEAR CONCEALMENT: the authors of the article did not report or provide us with a description of an allocation concealment approach that allowed for classification as concealed or not concealed.
ALSPAC: The Avon Longitudinal Study of Parents and Children (see definition) and the role that a practitioner (amongst others) may have played in causing this event to suggest what might stop it happening again. A number of methods may be adopted, with Root Cause Analysis being one example.
AMBULATORY CARE (Syn: outpatient care) Care provided to patients who are independently mobile. The care may be provided in general practice, in an outpatient department of a hospital or other health service delivery point.
AMEE: see Association for Medical Education in Europe
ANALYSIS: making theoretical use of facts and concepts
ANALYTIC STUDY (Syn: comparative studies) A study designed to examine associations, commonly putative or hypothesized causal relationships. An analytic study is usually concerned with identifying or measuring the effects of risk factors, or is concerned with the health effects of specific exposure(s). Contrast descriptive study, which does not test hypotheses. The common types of analytic studies are CROSS-SECTIONAL, COHORT and CASECONTROL. In an analytic study, individuals in the study population may be classified according to `attributes' that may influence occurrence of health problems. Attributes may include age, race, gender, health problems, genetic, biochemical and physiological characteristics, economic status, occupation, residence and various aspects of the environment or personal behaviour. See also CASE CONTROL STUDY, COHORT STUDY, CROSS-SECTIONAL STUDY.
ANCHORING: being overly influenced by outside suggestions
ANCILLARY STAFF Non-medical personnel working in a practice, including nurse or practice nurse, health visitor, medical social worker, secretary, practice aide, receptionist, administrator, business manager, book-keeper and others.
ANDRAGOGY is the art and science of helping adults learn
ANNOUNCER, a person who dispenses facts (or what are believed to be facts).
ANTICIPATORY CARE Care devoted to anticipating the patients' future problems in trying to prevent them from occurring or diminishing potential damage.
APD: see Accredited Professional development
APPLICATION: making practical use of facts and concepts
APPOINTMENT SYSTEM The system used by a physician to plan and regulate the timing of patient encounters. It may be complete, where no patients other than emergencies are seen except by appointment, or partial, where there is greater flexibility.
APPRAISAL. The regular and formal assessment (by others) of your past performance and plans for future career development.
APPRENTICESHIP LEARNING IN POSTGRADUATE TRAINING includes Learning by doing Experience of seeing patients, Building up personal knowledge and experience, Discussing patients, Managing patients, Having errors corrected, Making teaching points during service, Listening to experts' explanations,"Picking things up" , Charismatic influences, Learning clinical methods from practice, Being questioned about thought and actions about patients, Teaching by doing , Using knowledge and skill Bite-size learning from "bits and pieces" Retrieving and applying knowledge stored in memory, Learning from supervision, Receiving feedback, Presentation and summarising , Observing experts working,Learning from role models, Learning from team interactions, Hearing consultants thinking aloud ,Thinking about practice and patients
ASSESSMENT & SUPPORT CENTRE. In the consultation document Supporting doctors & Protecting Patients (1999) the NHS would use these centres to provide impartial support to a doctor and local employer or HA by advising on the action to be taken and provide to the doctor being assessed a supportive environment while he or she is undergoing assessment
ASSESSMENT (Syn: evaluation, examination or opinion) 1. Clinical assessment:General or complete assessment: a standardized procedure to determine the physical, mental, and social well-being of the patient with appropriate investigations, including a complete record of findings and advice to the patient. Specific or partial assessment: includes a history and detailed examination which relates to a specific diagnosis or problem with appropriate investigations, and including a complete record of findings, and advice for the patient. Functional assessment: the measurement, both objectively and/or subjectively, over a stated period of time of a person's ability to perform and adapt to his/her environment. 2. Educational assessment: Obtaining information concerning a student's progress and level of attainment. See also MONITORING and EVALUATION. Formative assessment: measures the progress of gains made by the student and informs him/her about the amount still to be learnt before educational objectives are achieved. Summative assessment: measures the achievement of the student at the end -of an educational programme, usually for the purposes of awarding a certificate or diploma or to enable progress to the next stage. 3. Qualitative assessment: The thorough study and analysis of a known or suspected problem in quality of medical practice, designed to define causes and necessary action to correct the problem.
ASSESSMENT: see Formative, Summative, & Self-Assessment
ASSESSMENT refers to a formal, structured and methodologically sound process conducted to review concerns about a practitioner’s performance. Assessment undertaken by NCAS aims to clarify the areas of concern, gain a better understanding of why the issues have arisen, and make recommendations for the referring body and the practitioner, based on robust evidence.
ASSESSMENTS – WPBA (work place based assessment)
ASSIST: database Avon Surveillance System for Infections Transmitted Sexually –specialised software for collecting data on sexually transmitted infections.
ASSOCIATION (Syn: correlation, statistical dependence, relationship) Relationship between two or more persons, events, characteristics or other variables. A statistical association is present if the probability of occurrence of an event or characteristic or the quantity of a variable, depends upon the occurrence of one or more other events, the presence of one or more other characteristics or the quantity of one or more other variables. The presence of a statistical association does not necessarily imply a causal relationship. (For further statistical and epidemiological use of the term see Last, 1988).
ASSOCIATION FOR MEDICAL EDUCATION IN EUROPE (AMEE) email p.m.lilley@dundee.ac.uk for details
ASSOCIATION OF PRACTICES (Syn: group practice) Practices of physicians who share premises and/or staff, during regular office hours, but they do not share patients, e.g. list of patients. See GROUP PRACTICE.
ATTITUDES States of readiness or predisposition; feeling for or against something which predisposes to particular responses. They involve emotions (feelings) and knowledge (or beliefs) about the object and emanate in behaviour. They are not inherited but learnt and, though relatively stable, are modifiable by education.
ATTRIBUTE A qualitative characteristic of an individual or item.
AUDIT An examination or review that establishes the extent to which a health problem, process or performance conforms to agreed standards or criteria. An audit is a process that involves a survey, discussion, action to improve care, and a repeat survey to demonstrate improvement in care.It is finding out if we are doing what we ought to do (see research).See also MEDICAL AUDIT.
AUTHORSHIP The Vancouver guidelines from the International Committee of Medical Journal Authors (www.icmje.org/index.html#authorship) suggest all persons designated as authors should qualify for authorship, and all those who qualify should be listed. Authorship credit should be based only on 1. Substantial contributions to conception and design or acquisition of data or analysis and interpretation of data 2. Drafting the article or revising it critically for important intellectual content and 3. Final approval of the version to be published. Conditions 1,2 and 3 must all be met
AVAILABILITY HEURISTIC: Focusing excessive attention on a particular fact or event rather than the big picture simply because it is more visible or fresher in your mind
AVON LONGITUDINAL STUDY OF PARENTS AND CHILDREN (ALSPAC): A research study that follows about 14,000 Bristol children born in 1991/92 throughout their childhood and beyond to find out what affects their development, health and disease.
AXIS The direction or reference within a classification system. The ICPC is biaxial, with its primary axis representing body systems (chapters) and the other axis representing components (reasons for encounters, process and diagnosis).