Paediatrics & Child Health: Clinical Sciences

Evidence-based clinical practice and epidemiology

Clinical decision-making and characteristics of diagnostic and screening tests

• Cognitive biases, such as confirmation bias and anchoring, framing effect, and commission and omission biases
• Inter-rater agreement and kappa statistic
• Negative predictive value
• Positive predictive value
• Pre-test and post-test probabilities, and likelihood ratios (positive and negative)
• Sensitivity
• Specificity

Clinical study design

• Clinical trials, cohort studies, and case-control studies:
  
  • longitudinal and cross-sectional studies
  • selecting the best design for the research question and context
  • strengths and weaknesses
• Clinical versus statistical significance
• Confounding and other forms of bias
• Ecological studies
• Hypothesis testing
• Power and sample size considerations
• Sampling methods and their importance
• Specific issues for certain study designs, such as RCTs: intention to treat analysis, allocation methods, and blinding

Determinants of health​

• Environmental factors
• Individual characteristics and behaviours
• Socioeconomic

Health economics

• Cost effectiveness, such as incremental cost-effectiveness ratio (ICER)
• Quality of life indices, such as quality-adjusted life years (QALYs)

Measures of treatment efficacy and interpretation of study results

• Analysis methods:
  
  • interpretation of meta-analyses and forest plots:
    
    • adjustment for confounding by logistic and linear regression
    • analysis of variance (ANOVA)
    • chi-squared and t-test
    • multiple comparisons
    • p values and confidence intervals
• Measures of effect:
  
  • hazard ratios
  • number needed to treat or harm
  • odds ratios
  • relative risk difference
  • relative risk reduction
  • relative risks
• Type 1 error and multiple testing
• Type 2 error and study power

Population statistics

• Frequency distributions
• Incidence
• Prevalence
• Standard deviation and standard score
• Standard rates, such as infant mortality rate, under-5 mortality rate, maternal mortality rate, and birth rate

Pharmacology

• Appropriate dose adjustments in disease and pregnancy
• Categories of drug safety in pregnancy and their impact on prescribing
• Common and life-threatening drug interactions, adverse drug reactions, and common presentations and conditions of drug-induced disease
• Common interactions between prescription and non-prescription medications and complementary therapies
• Delivery techniques for specific medicines
• Dose conversions to parenteral or transdermal medications for palliative care
• Effect of age, pregnancy, and lactation on pharmacokinetics
• Factors predisposing to polypharmacy (therapeutic cascade) and reasons for overprescribing
• Factors that increase the risk of medication error
• Factors that may affect adherence
• Genetic basis of variations in drug metabolism
• Impact of organ function on pharmacokinetics and dose modification:
  • impact of liver function on drug clearance
  • impact of renal function on drug clearance
• Impact of patient factors, such as allergy, age, and pregnancy, on prescribing
• Indications for monitoring plasma concentrations or pharmacological effects of specific drugs
• Mechanisms of drug actions at the receptor and intracellular level
• Pharmacological basis of drug interactions
• Pharmacology of essential drug groups
• Pharmacology, mechanism of action, and indications for use of botulinum toxin, oral baclofen, and oral anticholinergics
• Prescribing:
  
  • antibiotics
  • antifungals
  • antivirals (excluding antiretrovirals)
• Principles of dose titration
• Techniques for enhancing medication safety

Pharmacokinetics

• Clearance (CI)
• Half-life (t ½)
• Routes of and factors affecting drug administration, absorption and
  bioavailability, distribution, metabolism, and secretion
• Saturable elimination: first and zero order kinetics
• Steady state concentration
• Therapeutic ratio
• Volume of distribution

Pharmacodynamics

• Pharmacogenetic polymorphisms:
  
  • acetylator polymorphism
  • cytochrome P450 system
  • human leucocyte antigen (HLA)
  • P-glycoprotein
  • thiopurine methyltransferase (TPMT)
• Principles:
  
  • affinity
  • agonists and antagonists
  • efficacy
  • potency
  • specificity

Investigations

• Drug level measurement, in particular for phenobarbitone, aminoglycosides, vancomycin, and other commonly prescribed medications
• Organ function measurement, such as liver function tests (LFTs) and urea electrolytes and creatinine (UEC)

Evidence-based clinical practice and epidemiology

• Approaches to clinical problem solving, including:
  • effect of cognitive biases on decision making
  • intuition and looking for patterns
• Critical appraisal of scientific literature
• Ethics and governance processes in Australia and New Zealand, including good clinical practice requirements and national frameworks for ethics applications
• National Health and Medical Research Council (NHMRC) levels of evidence
• Principles of evidence-based medicine
• Use of risk registers and identification of complications that need to be remediated at a health system level

Health needs of specific patient groups

• Māori and Aboriginal and Torres Strait Islander people
• Patients with disability
• Patients with obesity
• Vulnerable patients

Pharmacology

Prescribing

• Legislation regarding prescribing, and controlled and restricted drugs
• Local and national guidelines and their limitations
• Prescribing medication safely and accurately, and monitoring for efficacy and toxicity
• Regulatory and funding framework in which medicines are made available

Management considerations

• Applying best practice for self-monitoring in established chronic disease such as diabetes, hypertension, and respiratory disease
• Assessing patient use of delivery devices
• Educating and reinforcing patient skills in monitoring and self management
• Engaging patients in decision making, explaining drug therapy and monitoring, and following up verbal information with written information
• Factors that can impact on compliance
• Identifying presence of, or potential for, adverse drug reaction and drug interactions and treating appropriately
• Medication reconciliation
• Monitoring drug levels and effects when appropriate and responding accordingly to results
• Monitoring for development of common adverse drug reactions, including selection of appropriate laboratory investigations such as monitoring of renal or hepatic function
• Strategies to enhance patient adherence and techniques for encouraging self-management of health and chronic disease
• Therapeutic drug monitoring, when and how to use

Quality use of medicines

• Analgesics:
  
  • classes of commonly available analgesics with respect to mode of
    action, pharmacokinetics, potency, and efficacy in various pain
    syndromes
  • common adverse effects and drug interactions for each drug class
  • common pain-scoring tools
  • identifying source or potential sources of pain
  • monitoring efficacy of treatment and adjusting regimen
    appropriately
  • non-drug approaches to pain management
• Antimicrobials:
  
  • complications of antimicrobial therapy including candida and Clostridium difficile
  • factors contributing to antimicrobial resistance and antimicrobial
    preservation
  • intravenous to oral switch
  • microbiology-guided therapy including cessation or de-escalation of
    antibiotic therapy
  • narrow and broad spectrum antimicrobials
  • principles of antibiotic selection
  • prophylactic, empiric, and guided antimicrobial therapy