P, PROBABILITY The probability that a test would statistically be as extreme as or more extreme than observed if the null hypothesis were true. The letter P, followed by the abbreviation n.s. (not significant) or by the symbol < (less than) and a decimal number such as 0.05, is a statement of the probability that the difference observed could have occurred by chance, if the groups are really the same.
PACS Picture archiving, communications and storage. NHS Connecting for health information technology strategy
PANDEMIC: An epidemic (see definition) that applies to a vast area such as a country or a continent
PANEL STUDY A study in which a group of people undergo continuous or repeated cross-sectional studies. The group of people have agreed to take part in the study over a specific period of time.
PARADIGM A pattern of thought or conceptualization within which clinicians and scientists work and from which they try to explain and interpret their findings. Paradigms may change due to research and/or philosophy.
PARAMETRIC TEST A statistical test that depends upon the assumption that the data are normally distributed. See NORMAL.
PARITY The status of a woman with regard to the number of deliveries, including still-births but excluding miscarriages. The number of times she has been pregnant is referred to as Gravida, e.g. Gravida 2, Para 1 (expecting her second baby).
PARTICIPANTS in research are patients, users, relatives of the deceased, professional carers or members of the public agreeing to take part in the study
PATIENT A person who receives or contracts for medical advice or services from a health care provider with whom he/she may or may not be registered. 1. Registered patient: a patient who is enrolled with a practice, but may or may not be receiving ongoing health care. 2. Active patient (Syn: attending, regular): a patient who has received services from the practice at least once in the last two years. 3. Inactive patient: a patient who has received no services from the practice within the last two years. 4. Temporary patient (Syn: transient): a patient who receives one or more services, but who is enrolled with, or usually receives health care from another practice. 5. Formerly registered patient: a patient other than a temporary or transient pa2ient, who has been removed from the register either by the practice or by personal choice.
PATIENT CARE ADVISOR (PCA) Someone employed to assist patients with their choice of provider.
PATIENT PARTICIPATION: A process that actively involves patients or users of the service in its planning
PATIENTS AT RISK Patients from the practice population considered to be at greater risk of a specific health problem than other individuals in the same population.
PATIENTS UNMET NEEDS (PUNS) see Learning Diary
PAYMENT BY RESULTS (PbR ) A nationally agreed set of prices for healthcare resource groups, where the latter are commissioned and monitored individually.
PBC Practice Based Commissioning, GP practices hold budgets commission services for patients
PbR Payment by results, system where hospitals get paid for work done
PDC: Potential diagnostics clues
PEER REVIEW A critical study of mutual performance by persons of equal standing. Review of research protocols, manuscripts submitted for publication, abstracts submitted for presentations at scientific meetings, whereby these are judged by colleges in the same field. See MEDICAL AUDIT.
PEER REVIEW: Assessement of your performance by your fellow GPs, or suitably qualified fellow professionals
PEER-REVIEWED PUBLICATIONS: A research article/ report that, prior to publication has been reviewed competitively for it’s quality (originality, importance, scientific reliability) by appropriate professional experts who are independent of the author(s).
PERCEIVED NEED A felt need. It usually refers to need for health care that is felt by the person or community concerned, but which may not be perceived by health professionals.
PERCENTILE The set of divisions that produce exactly 100 equal parts in a series of continuous values, such as children's heights and weights. The 50th percentile indicates the average height and weight of the children in that age group.
PERFORMANCE ASSESSMENT 3 aspects of doctor performance can be assessed patients outcomes, process of care and volume of practice
PERFORMANCE INDICATORS: Standards against which your performance will be measured.
PERFORMANCE PROCEDURES The GMC will restrict a doctors registration if fitness to practice is in doubt in terms of conduct, health or performance. If performance is in doubt then GMC will assess performance regarding attitudes, knowledge, clinical and communicatin skills and clinical records and audit results
PERINATAL MORTALITY The sum of late fetal deaths (Syn: stillborn) and the deaths of liveborn infants aged under 1 week. The perinatal mortality rate refers to the number of deaths per 1000 total births where the birthweight is 500 grammes or more. 1. Stillborn (Syn: fetal death): are babies of 500 grammes or more who are born dead. 2. Neo-natal deaths: deaths occurring in the first 28 days after birth. 3. Infant deaths: liveborn infants surviving less than 1 year.
PERINATAL PERIOD From 27th week of pregnancy to 7 days after birth.
PERIODIC MEDICAL EXAMINATION Assessment of health status conducted at predetermined intervals. It usually follows a formal protocol with structured questions, themes to be discussed and laboratory tests to be undertaken.
PERPECTIVES ON TEACHING. An interrelated set of beliefs and intentions that gives direction and justification to our actions. Most educators hold one or two perpectives as their dominant view on teachong and may only marginally identify with oneor two others. There are 5 main perpectives Transmission, Developmental, Aprrenticeship, Nurturing and Social reform
PERSONAL DEVELOPMENT PLANS PDPs: see Personal Learning Plan
PERSONAL HEALTH CARE Those services to individuals that are performed on a one-to-one basis by a health care worker, i.e. a general practitioner, for the purpose of maintaining or restoring health.
PERSONAL LEARNING PLAN (PLP) is designed to reinforce the adult pattern of self-directed learning which is characterised by the learner: -identifying their own educational needs, formulating a plan to address those needs, reflecting on learning achieved or affirmed, and further needs identified.
PERSONALITY TESTS include the California personality inventory, Rotter's "locus of control" scale, Cattell's 16PF, Eysenck's personality index, Minnesota multi-phasic personality inventory, Myers Briggs type indicator, state-trait anxiety inventory, and psychiatric interviews. In the California personality inventory measure, eight subscales have emerged consistently as predictors of success in medical training: "dominance," "tolerance," "sociability," "self acceptance," "well being," "responsibility," "achievement via conformance," and "achievement via independence. Rotter's locus of control is a personality test that assesses the extent to which people feel that outcomes in their lives are contingent on their own behaviour ("internals") in comparison with the influence of factors such as "fate" and "chance" ("externals"). Recent developments in personality theory have suggested that five factors underlie normal personality and that these can be found in previously reported measures of personality.These factors, known as the "Big 5" or five factor model of personality, are "emotional stability-neuroticism" (high scores relate to anxiety, depression), "extroversion" (high scores relate to being outgoing, sociable), "openness to experience" (high scores relate to being creative, artistic), "agreeableness" (high scores relate to being cooperative, trusting), and "conscientiousness" (high scores relate to being methodical, organised, motivated by achievement). Some of the subscales of the California personality inventory, especially the achievement subscales, may relate to conscientiousness in the Big 5. The Big 5 offers a theoretical framework for the study of personality in medical selection and training. Conscientiousness has been shown in previous research to be related to success in a variety of occupational settings, and extraversion has been correlated with success in jobs that involve a social dimension (for example, sales).
PERSON-TIME A measurement combining persons and time, used as denominator in instantaneous incidence rates, e.g. patient-years. It is the sum of individual units of time over which the persons in the study population have been exposed to the condition of interest.
PHRONESIS: Aristotle’s ‘practical wisdom’
PHYSICIAN (Syn: medical practitioner, doctor) Professional person qualified by medical education and authorized by law to practice medicine.
PHYSICIAN OF FIRST CONTACT The first physician seen by a patient during an episode of illness or injury, or for preventive and/or health education matters.
PILOT STUDY A small study, usually of a convenient sample, to test preliminary measurement decisions and identify unanticipated problems in fielding the instruments in a study.
PLACEMENT PROVIDER in relation to professional performance refers to the Trust or general practice where the placement will take place. The lead practitioner providing the placement will be the ‘clinical supervisor’.
PLAN-DO-STUDY-ACT CYCLE (PDSA), a process for continuous quality improvement. Each cycle consists of a plan of action, measurement or testing, evaluation and a change of process that will lead to a desired improvement. Cycles re repeated every 2-12 weeks to achieve improvement.
PMETB Postgraduate Medical Education Training Board
POPULATION AT RISK 'The number of persons at risk of the health problem under consideration, but can also refer to the practice population.
POPULATION BASED Pertaining to a general population defined by geographical, political or other boundaries. This population is the denominator.
POPULATION, PRACTICE The total number of registered patients in a practice. In health care systems without registration of patient (i.e. patient lists) it is the estimated number of persons served by the practice. See also REGISTERED POPULATION.
POSTER DISPLAYS – information about the service displayed on posters which are exhibited at conferences or workshops or used locally to advertise your work
POSTERIOR (POST-TEST) ODDS: The odds of disease conditional upon another event having occurred (such as the development of a symptom)
POSTNEONATAL MORTALITY RATE The number of infant deaths between 28 days and one year in a given year per 1000 live births that year. It is an important rate to monitor in developing countries where older infants frequently die of infections and malnutrition.
POST-TEST PROBABILITY: the proportion of patients with that particular test result who have the target disorder (post-test odds/[1 + post-test odds]).
POWER CALCULATIONS (see statistical power) . Power is defined as the probability of detecting a diffeence between patient groups sgould it exist in the population. For a clinical trial a minimum of 80% power is required (=8-% chance of detecting a difference)
PPDP see Practice Professional Development Plans
PRACTICALS AND LABORATORY WORK. A set of experiments or tasks guided and directed by the teacher
Practice population may be further described:1. Rural: a practice population where the majority are not located in a town with a population larger than 2000. 2. Semi-urban: a practice population where the majority is located in a town or city with a population between 2000 and 50 000. 3. Urban: a practice population where the majority is located in a town or city with a population of 50 000 or more.
PRACTICE PROFESSIONAL DEVELOPMENT PLANS (PPDP). A scheme that will replace PGEA with a formal learning plan (see personal learning plan). ‘The Wessex Way’ a published text with practical tools to help formulate ideas and put them into practice has proformas on www.medirect.com/professional-development/
PRACTICE REGISTER (Syn: patient list) The list of all registered patients in the practice. See REGISTER.
PRACTICE SITES 1. Private office (Syn: surgery or consulting rooms): the premises in which a physician conducts his practice. More than one practitioner and paramedical services may be accommodated in these premises. 2. Residential office (Syn: residential surgery rooms): an office which is located in a physician's ; home. 3. Satellite office (Syn: satellite or branch surgery or rooms): an office located at a distance from the main practice site. Staffing and the provision of health services is the responsibility of the main practice administration. 4. Health centre: a centre which emphasizes both total medical care and preventive personal health services. Staffing is varied and may include a group of family physicians/general practitioners, a multidisciplinary team, ancillary staff, specialist, and other health care providers. The centre may be owned by private physicians, government or public agencies. 5. Polyclinic: a clinic with a medical staff largely comprised of GPs and/or specialists, often working independently, rather than as a team. It can be attached to a hospital. 6. Day hospital: a health care facility, providing day health care and monitoring facilities, with medical and paramedical services available.
PRACTICE The professional work of a medical practitioner. Also used to describe organizational structure, the geographical area or the population which is served by one or more medical practitioners.
PRACTITIONER WITH SPECIALIST INTERESTS (PWSIs) A GP, more or other non-consultant clinician who has undertaken additional specialist training for certain conditions to assess and treat patients who would normally be seen in the first instance by a consultant or at outpatients.
PRCTA see Primary Care Research Team Assessment
PRECISION (Syn: accuracy) The extent to which a measure is capable of detecting small differences. 1. The quality of being sharply defined. This can be indicated by the number of significant digits in the measurement or the standard deviation of a series of measurements. 2. In statistics, precision is defined as the inverse of variance of measurements or estimate.
PRECURSOR An early indicator of a health problem preceding pathological onset of a disease; sometimes detectable by screening.
PREDICTIVE VALUE In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e. has the disease) is referred to as the `predictive value of a positive test'. The predictive value of a negative test is the probability that a person with a negative test does not have the disease. The predictive value of a screening test is determined by the sensitivity and specificity of the test, and by the prevalence of the condition for which the test is used. This explains why the predictive value of the same test is very different in general practice and in hospital.
PREDISPOSING FACTORS Patient characteristics and conditions, which precede a health problem, and which enable a health care encounter.
PREMATURE EARLY DEATH, defined as under 65 or under 75 years of age. High mortality rates of premature death in a population indicate poor health overall.
PRETEST ODDS: the odds that the patienthas the target disorder before the test is carried out (pretest probability/[1 — pretest probability]).
PRETEST PROBABILITY (prevalence): the proportion of patients who have the target disorder, as determined before the test is carried out ([a + c]/[a + b + c + d]) (figure ).
PREVALENCE The number of all events (e.g. patients with a specific health problem) in a defined population at one point in time (POINT PREVALENCE) or during a defined period of time (PERIOD PREVALENCE). Usually expressed per 1000 or 10 000 persons. The period may be I year, 4 years or a lifetime.
PREVENTION Action to prevent occurrence or development of a health problem and/or its complications. Can be divided into three categories: 1. Primary prevention: action taken to avoid or remove the cause of a health problem in an individual or a population before it arises (i.e. immunization). 2. Secondary prevention: action taken to prevent development of a health problem from an early stage in an individual or a population, by shortening its course and duration (i.e. screening for hypertension). 3. Tertiary prevention: action taken to reduce the effect and prevalence of a chronic health problem in an individual or a population by minimizing the functional impairment consequent to the acute or chronic health problem (i.e. prevent complications of diabetes).
PREVENTIVE MEDICINE The application of preventive measures by clinical practitioners. A specialised field of medical practice composed of distinct disciplines that utilize skills focusing on the health of defined populations in order to promote and maintain health and well-being and prevent disease, disability, and premature death.
PREVENTIVE SERVICES These include immunizations, screening tests, risk assessment, education, pre- and post-natal check-ups, well baby care, family planning and other similar services.
PRIMARY CARE The setting within a health care system, usually in the patient’s own community, in which the first contact with a health professional occurs (excluding major trauma).
PRIMARY CARE PHYSICIAN . A physician from whatever discipline working in a primary care setting.
PRIMARY CARE RESEARCH TEAM ASSESSMENT PRCTA A RCGP scheme (similar to the accreditation of training practices) that aims to set minimum standards for practices that want to be active (and funded) in NHS. More information at pcrta@rcgp.org.uk
PRIMARY CARE TEAM A group of health care providers and ancillary staff serving the same population or geographical area, sometimes occupying the same building, working together to provide different, but complementary services, which are directly available on demand.
PRIMARY CARE TRUST (PCT): NHS body responsible for commissioning health services and improving community health within their area.
PRIMARY HEALTH CARE (Syn: first contact care, primary care) WHO (Alma Ata, 1978) defined primary health care as follows: "Primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford. It forms an integral part of the country's health care system, of which it is the nucleus, and of the overall socio-economic development of the community." Primary health care can be delivered by PHC nurses, doctors or health professionals with a shorter medical training (i.e. barefoot doctors).
PRIMARY MEDICAL CARE Throughout the world most primary medical care is delivered by general practitioners/family physicians. In their work they assume responsibility for the patient, beginning at the time of the first encounter and continuing thereafter. This includes overall management and co-ordination of health care, such as the appropriate use of specialists, and other health care resources. Maintenance of continuity is also included.
PRIMARY PREVENTION: Stopping ill health arising in the first place, by, for example, eating a healthy diet and not smoking.
PRIMIS is a support service designed to help primary care organisations improve patient care through the effective use of the clinical computer systems. PRIMIS is funded by the NHS Information authority
PRINCIPAL INVESTIGATOR: The person designated as taking overall responsibility within the team of researchers for the design, conduct and reporting of the study. There can only be one Principal Investigator per project.
PRIOR (PRE-TEST) ODDS: The odds of disease before acquiring additional information (such as identifying a symptom or acquiring a positive test result)
probability of that same event in non-diseased persons.
PROBABILITY The extent to which an event is likely to occur, measured by the ratio of the favourable cases to the total number of cases possible. Expressed as a measure ranging from 0 to 1. See P-VALUE.
PROBLEM ORIENTED MEDICAL RECORD (Syn: POMR) A medical record in which the patient's history, physical findings, laboratory results, etc. are organized to give a cumulative record of problems. This distinguishes it from. the chronological record where encounters are organised in a time sequence. The record includes information which is subjective (S), objective (O) including significant negative information and an assessment (A) which includes a discussion and conclusion. This is followed by diagnostic and treatment plans (P). This format (SOAP) is applied to each problem the patient presents.
PROBLEM, HEALTH Any concern in relation to the health of a patient as determined by the patient and/or the health care provider. Problems should be recorded at the highest level of specificity determined at the time of an encounter. 1 . New problem: the first presentation of a problem, including the first presentation of a recurrence of a previously resolved problem but excluding the presentation of a problem first assessed by another provider. 2. Continuing problem: a previously assessed problem which requires ongoing care. It includes follow-up for a problem or an initial presentation of a problem previously assessed by another provider.
PROCESS The activities of a health care system or practitioners in the provision of care.
PRODIGY A computerised decision support system. The NHS executive has declared that it will be made available to any GP who wants it.
PRODIGY is a computer based decision and learning support system for GPs offering a series of recommendations for the treatment of a condition. Used during the consultation the GP enters the diagnosisi in response to which PRODIGY can suggest a range of therapy options to prescribe as wellas specifying non-drug advice, patient information leaflet or reommend a referral.
PROFESSIONAL JUDGMENT is a form of knowledge called practical wisdom which is not formally taught and learnt but is acquired largely through experience and informal conversations with respected peers. Wisdom develops through lithe critical reconstruction of practice, I including deliberation, which is distinguished from mere reflection.
PROFESSIONAL SELF REGULATION: The idea that the profession polices itself.
PROGRAMME An organized response to eliminate or reduce one or more problems where the response includes one or more objectives, performance of one or more activities, and expenditures of resources.
PROGRAMME SUPERVISOR in relation to professional performance refers to an individual with experience in postgraduate medical or dental education who will assist a practitioner in compiling a practitioner Improvement Plan (IP) and oversee the programme as a whole, reporting to the responsible director on progress against objectives. While the role of programme supervisor is distinct from that of clinical supervisor, in some cases it may be possible for the same individual to carry out both the role of programme and clinical supervisor.
PROGRAMMED LEARNING. Instructional sequence involving presentation of information alternating with questions on the topic
PROMISING INTERVENTION: one that has both a theoretical basis for efficacy and empirical evidence supporting at least some parts of the theoretical model
PROPORTION A type of ratio in which the numerator is included in the denominator. By definition, a proportion (p) must be in the range 0.0 < p < 1 .0 and is a dimensionless quantity. See RATIO.
PROSPECTIVE AUDIT: the process of collecting data about patient care as it proceeds and then reviewing the standard of care achieved after a set interval
PROSPECTIVE STUDY: Research study which gathers new information over a future period, for example, to observe emerging patterns of disease in a healthy population over a period of time.
PROTOCOL : In research it is plan or set of steps to be followed in a study, investigation or an intervention programme. In clinical practice it is the local clinicians agreement on the care that will be offered.
PROVIDER (Syn: health care provider) A person to whom a patient has access when contacting the health care system. In the majority of instances this will be a professional such as a general practitioner, a nurse, a midwife, a physician assistant, a medical social worker, a physiotherapist, or other allied health personnel. In some cultures, the provider may be a lay person with limited or no medical training but with health care responsibility.
PSQ – the patient satisfaction questionnaire is an assessment tool. This will be carried out at lease twice in a 3 year program.
PSYCHOMETRIC The use of test or scales to measure an attribute of an individual or object.
PUBLIC HEALTH Part of the health care service aimed at protection, promotion and restoration of health in the population through collective and social actions.
PUBLIC LIFE STANDARDS should include - selflessness, integrity, objectivity, accountability, openness, honesty and leadership
published separately. The elements of both these publications have now
PUNS: see learning Diary
P-VALUE `P' comes from probability. The P-VALUE is the theoretical chance to find a difference as actually met in this study (or a greater difference) under the presumption that groups are equal with