2nd year Flashcards
1
Q
what does Wilsons criteria for screening describe as cost considerations
A
costs of case findings economically balanced in relation to possible expenditures on medical care as a whole
2
Q
what do macmillan nurses specialise in
A
cancer and palliative care - provide support and information to people with cancer as well as their families, friends and carers
3
Q
what framework do descriptive studies follow
A
time, place, person
4
Q
what are some causes of disability
A
congenital injury alchohol/ drugs malnutrition/ obesity mental illness
5
Q
what is information bias
A
arises from systematic error in measuring exposure or disease
6
Q
what does the public body/ joint working act 2014 say
A
“improve the quality and consistency of services for pateitns, carers, device users and their families; to provide seals, joined up, quality health and social care services in order to care for people in their homes or a homely setting where it is safe to do so- and to ensure resources are used effectively and efficiently to deliver services that meet increasing number of people with longer term and often complex needs”
7
Q
when is the population of older people (>60) supposed to exceed younger
A
2050
8
Q
what may be some impacts of long term conditions (individual, family, community)
A
individual - self pity, apathy , denial
family - financial, emotional, physical
community - isolation
9
Q
what percent of GP appointments, outpatient appointments and inpatient bed days do long term conditions make up
A
- 50%
- 64%
- 70%
10
Q
what is the difference in definitions of disease and illness
A
disease - symptoms, signs for diagnosis (bio-med)
illness - ideas, concerns & expectations from experience (patients experience)
11
Q
list 4 types of bias
A
selection bias
information bias
follow up bias
systematic error
12
Q
what are the 3 components of the WHO international classification of functioning, disability, health
A
body and structural impairment (organ level) activity limitation (personal level) participation restrictions (social/ environment level)
13
Q
list some common confounding factors
A
age, sex, social class
14
Q
list some burdens of treatment
A
- changing behaviour of others to adhere to lifestyle modifications
- monitoring and managing symptoms at home
- complex treatment regimes & polypharmacy
- complex admin systems
- uncoordinated health and social care
15
Q
what is a challenge of expanding PHCT
A
teamworking
16
Q
what are SIGN guideline intended to do
A
- help health/ social care proffessionals and patients understand medical evidence and use it to make decisions about healthcare
- reduce variations in practice
- allow all patients to get the best care, regardless on where they live
- improve healthcare across scotland
17
Q
what political pressures influence the PHCT
A
reduce cost of treatments
provide more treatments closer to where patient lives
18
Q
how many people in the UK are carers
A
6.5 million
19
Q
what do changes to the PHCT affect it
A
- which professionals are part of it
- which professionals work alongside it
- working relationships between different groups
20
Q
when interpreting results of trials, why would you consider standardisation
A
techniques used to remove/ adjust the effects of differences in age or other confounding variables when comparing 2 or more populations eg age:sex
21
Q
what is relative risk a measure of
A
the strength of an association between a suspected risk factor and the disease under study
22
Q
what changes in population are expected from 2004-2031 (age category related)
A
<16 - decrease by 15% 16-29 - decrease by 12% 30-49 - decrease by 17% \+50 - increase by 28% \+65 - rise by 58% \+75 by 75%
23
Q
what responsibilities does the doctor have towards disabled people
A
neutral attitude, listen and learn form patient, empathise
assess disability , organise a multi- disciplinary care team, rehabilitation
24
Q
what is the explanation aim of epidemiology
A
elucidate the natural history and identify etiological factors for a disease, usually by combining epidemiological data with data from other disciplines such as biochemistry, occupational health and genetics
25
what are the medical aspects of an anticipatory care plan
```
assessment of capacity/ competence
home care package
wishes re DNA CPR
scottish palliative care guidelines
communication which has occurred with other professionals
details of ' just- in - case' medications
electronic care summary
current aids and appliances
```
26
what is the description aim of epidemiology
describe amount and distribution of disease in human populations
27
what are the 4 components of Wilsons criteria for screening
1 - knowledge of disease
2 - knowledge of test
3 - treatment for disease
4 - cost considerations
28
what is the absolute criteria for causation
temporality - exposure before disease
29
who makes up the integrated joint board
same number of representatives form NHS (non- executive directors) and local authorities (councillors)
representatives - carer, GP, nurse, secondary care practitioner, service user, 3rd sector, financial officer, chief officer, chief social worker
30
what roles may a practice nurse have within a practice
```
ECGs
minor/ complex wound management e.g leg ulcers
travel health advice and vaccinations
child immunisation
family planning/ women health
sexual health screening
smoking cessation
```
31
what ways are trials developed to deal with confounding factors
- randomised
- restrict eligibility criteria
- match subjects in different groups for likely confounding factors
- results stratified according to confounding factors
- results adjusted to take account of suspected confounding factors
32
list some sources of epidemiological data
```
mortality data
reproductive health statistics
cancer statistics
hospital activity statistics
drug database
general practice morbidity
health and household surveys
social security
accident statistics
expeniture data from NHS
```
33
list some of the criteria for causality
strength of association
consistency (repeated observation)
specificity (single exposure - single disease)
temporality - exposure before disease
biological gradient - agrees with disease biology
coherence - no conflict with disease biology
analogy
experiment
34
what is the role of an occupational therapist
assessment and treatment of physical & psychiatric conditions using specific activity to prevent disability and promote independent function in daily life
35
what are the SIGN guidelines rated on
quality of evidence of alphabetical scale - A is best
36
define a trial
experiments used to test idea about aetiology or to evaluate intervention
37
what are the 5 principles of patient centred care
```
respect
choice and empowerment
patient involved in health policy
access and support
information
```
38
which new proffesional roles affect to PHCT
healthcare assistants
advanced nurse practitioners - triage/ prescribing
extended role of pharmacists
39
what is dietetics
interpretation and communication of nutritional science to enable people to make informed and practical choices about food and lifestyle in health and disease
40
what are the 3 main aims of epidemiology
description , explanation, disease control
41
what is the aim of a randomised control trail
to determine whether modification of the factor (removing/ reducing. increasing exposure) alters the incidence of the disease
42
list some members of the primary healthcare team
```
GP partners
receptionists
community nurses
practice nurses
health visitors
practice manages
nurse practitioners
```
43
what is the definitive method of assessing any new treatment in medicine
randomised controlled trial
44
what does the WHO international classification of functioning, disability, health describe as body and structural impairment
abnormalities of structure, organ or system function (organ level)
45
what is the role of the pharmacist
ensure patients get maximum benefit from their medicines
- advice on prescription
- advice to patient on how to manage
46
when should an anticipatory care plan be done and who by
any time that seems appropriate/ continuous
| anyone with an appropriate relationship
47
what are the legal aspects of an anticipatory care plan
welfare power of attorney
financial power of attorney
guardianship
48
what does a personal reaction to disability depend on
```
nature of disability
information/ education of individual
personality / coping strategies
support network of individual and reaction
time to adapt
additional resources - support groups
```
49
how is a randomised control trail carried out
2 groups at risk of developing disease are assembled - one alteration given to intervention group and none to control group
date on outcomes collected - relative risk calculated
50
list come options for care
- living in own home with support from family
- living in own home with support from carers
- sheltered housing
- residential home (24hr support but no medical cover)
- nursing home
51
what are anticipatory care plans
ACP promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care
52
what is the role of a midwife
provide care during all stages of pregnancy, labour and early post natal period
53
what are responsibilities of dieticians
- work with special dietary needs
- inform public about nutrition
- offer unbiased advice
- evaluate and improve treatments
- educate patients/ clients
54
describe a cross sectional analytical study
observations at a single point in time - conclusion drawn on relationship between diseases and other variables of interest in a defined population
55
why may a patient have issues with going to the GP
believes to be healthy
looks physically fit
proud not using tablets
56
what do descriptive studies attempt to do
describe the amount and distribution of disease in a given population
57
define incidence
the number of new cases of a disease in a population in a specific period of time
tells about trends in causation/ aetiology
can be helpful when planning
58
what is biographical disruptions
process where a long term condition leads to a loss of confidence in the body and then in social interaction or self identity
59
what are advantage and disadvantage of a descriptive study
adv - clues to possible risk factors, cheap, quick
| dis - no evidence of disease causes, don't test hypothesis
60
what is the fastest growing population group in the world
80+ (>65s in the UK)
61
what are the differences in populations in more developed and less developed regions
more - 20% >60 in 2000, 33% in 2050
| less - 8% >60 in 2000, 20% in 2050
62
what is multi- morbidity
the co-existnece of two or more long term conditions in an individual
63
what is an expert patient
someone who completely understands their disease - knowledge/ experience is a good resource and can greatly impact their quality of care/ life and treatment process
64
what are descriptive studies useful in
- identifying emerging public health problems through monitoring and surveillance of disease patterns
- signalling presence of effects worthy of further investigation
- assess effectiveness of measures of prevention and control (screening)
- asess needs for health service planning
- generate hypothesis about disease aetiology
65
what are the personal aspects of an anticipatory care plan
statement of wishes regarding treatment
next of kin
consent to pass on information to relevant others
preferences and priorities regarding treatment
who else to consult/ inform
preferred place of death
religious/ cultural beliefs regarding death
current level of support
66
what is the role of a physiotherapist
help and treat people with physical problems caused by illness, accident or ageing
maximise movement through health promotion, preventative care, treatment and rehab
67
when interpreting results of trials, why would you consider case definition
to decide whether or not individual has the condition - medical terms may change
68
what does the WHO international classification of functioning, disability, health describe as activity limitation
changed functional performance and activity by the individual (personal level)
69
what is a care manager
expert in working with individuals to identify their goals and locate the specific support services that enhance well- being (highly trained social workers)
70
when interpreting results of trials, why would you consider ascertainemnt
if data is complete or is subjects are missing
71
what is the disease control aim of epidemiology
provide basis on which preventative measures, public health practices and therapeutic strategies can be developed, implemented, monitored and evaluated for the purposes of disease control
72
what does Wilsons criteria for screening describe as treatment for disease
accepted treatment for patients with recognised disease
facilites for diagnosis and treatment available
agreed policy concerning who to treat as patients
73
what is patient centred care
placing the patient at the centre, ensuring that the healthcare system meets their needs/ preferences defined by themselves
74
how is strength of association measured when determining causality
relative risk or odds ration
75
which groups of people are long term conditions more prevalent in
old and socially deprived
76
what is the integrated joint board model
NHS and local authorities delegate responsibilities for planning and resourcing service provision for delegated adult health and social care service to the IJB
77
what are SIGN guidelines based on
systematic review of the scientific literature and are aimed at aiding the transition of new knowledge into action
78
what factors affect the uptake of care
- concept of lay referral (granny knows best)
- sources of info - peers, family, internet/ TV, NHS, leaflets
- medical - visible symptoms, increasing in severity and duration
- non-medical - peer pressure, patient beliefs, expectations, social class, economic, age, gender, media
79
in case- control analytic studies, what is compared in the 2 groups
average exposure to suspected aetiological factors - clues to factors which elevate/ reduce risk of disease
80
what is the most common relationship for a carer
40% parent
| 1/4 spouse
81
what is selection bias
when study sample is not truly representative of the whole study population about which conclusions are to be drawn
82
what is health literacy about
people having the knowledge, skills, understanding and confidence to use health information, be active in their care and navigate health/ social care systems
83
why is there estiamted to be such a difference in population ages from 2004- 2031
baby boomers born after WWII will be 80 in 20131
| older people are increasingly healthy + preserve fitness
84
what are some health related implications of an ageing population
- increased number of geriatricians & health professionals for elderly
- increased facilities for elderly health care requires
- care of many long term conditions moving to primary care for palliative care
- specific health promotion campaigns aimed at elderly
85
how do health visitors contribute to safeguarding and protecting children
trained in recognising risk factors, triggers of concern and signs of abuse and neglect in children
support families going through formal safeguarding
sometime appear in court
86
what 2 acts give rights for disabled people
disability discrimination act 1995/ 2005
| equality act 2010
87
what does Wilsons criteria for screening describe as knowledge of test
suitable test or examination available
test acceptable to population
case finding should be continous
88
when interpreting results of trials, why would you consider coding and classification
when data collected it is often converted into codes to assist in data storage and analysis - the rules for the codes may change
89
what does the WHO international classification of functioning, disability, health describe as participation restrictions
disadvantage experiences by the individual as a result of impairments and disabilities (social/ environmental level)
90
define bias
any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systemically different from the truth
91
what is the social model of a disability
- society cause
- conditions relating to housing
- social/ political action needed eg. facilities
- societal attitude change eg use of politically correct language
92
what do cohort studies allow
calculation of cumulative incidence, allowing for differences in follow up time
93
list some factors to consider when interpreting results of trials
```
standardisation
standardised mortality ratio
quality of data
case definition
coding and classification
ascertainment
```
94
describe the process of a cohort study
baseline data on exposure from group of people who don't have disease - group followed through time until sufficient number have developed disease
split into subgroups depending on exposure status - compared to determine how incidence relates
95
what is the role of district nurses
visit people in their own homes - provide care and support families
teaching/ supportive role (keep hospital admission minimum)
96
which contract do the majority of GPs have
independent form NHS - responsible for premises and employing their own staff
97
what services to macmillan nurses offer
- pain and symptom control
- emotional support for both patient and family/ carer
- care in variety of setting
- information on cancer treatments and side effects
- advice to other members of caring team
- coordinate care between hospital and home
- advice on other forms of support, incl financial
98
what is the dictionary definition of disability
lacking in one or more physical powers such as the ability to walk or co-cordiante ones movements
99
what handicaps may a long term condition have
affect physical, social and psychological well-being
- constraints on family life
- no functional capacity to work
- unremitting physical discomfort (chronic pain)
100
what are some economic related implications of an ageing population
- retirement / pension age increasing
- harder to find employment for younger
- proportionally less people paying into tax and pension funds
- state pension may not be adequate
- increasing cost of 'free personal care for elderly' policy
101
what is the current demographic trend
increase in older people (>60) and declines in young (<15)
102
what percentage of carers say their financial circumstances were affecting their health
45% (30% saw a drop in more than £20,000)
103
what are some political related implications of an ageing population
- decision making/ workforce planning must take into account aging population
- increasing elderly population will influence votes in relation to their concerns
104
list different types of analytical studies
cross sectional
case control
cohort
105
list some allied health professionals
```
physiotherapy
occupational health
diets
podiatry
pharmacy
counselling
```
106
when interpreting results of trials, why would you consider quality of data
care to ensure that the data is trustworthy
107
how are results of case- controlled studies expressed
odds ratios or relative risks
108
what is a confounding factor
a factor which is assoicated independently with both the disease and with the exposure under investigation and so distorts the relationship between the exposure and disease
109
what is systematic error
form of measurement bias where there is a tendency for measurements to always fall on one side of the true value (instrument calibration/ operator differences)
110
what format does a case controlled analytical study take
two groups of people compared - one with the disease (cases) and a group without (controls)
- data gathered to determine if people have been exposed to suspected etiological factors
111
define prevalence
the number of people in a population with a specific disease at a single point in time or in a defined period of time
can by used to assess workload for health service
112
what is the purpose of the public bodies joint working act 2014
created integration authorities to break down barriers to joint working between NHS boards and local authorities, and integrate health and social care budgets (nationally agreed outcomes)
113
what differences in groups does epidemiology detect
aetiological clues
scope for prevention
identification of high risk or priority groups in society
114
what are the differences in life expectancy for people born in 2004 and 2031
2004 - 74.3 (M) , 79.4 (F)
| 2031 - 79.2 (M), 83.7 (F)
115
what percentage of carers receive the disability living allowance for themselves
27%
116
what ratio is used for epidemiology
events / population at risk
| risk 0 everyone in denominator must have potential to enter numerator
117
what is the purpose of descriptive studies
gaining insight into the aetiology of the condition/ planning health services to meet clinical need
118
what does Wilsons criteria for screening describe as knowledge of the disease
condition should be important
must be a recognisable latent or early symptomatic stage
should understand the natural course of the condition
119
what roles may a health visitor have
parenting support on minor illness
advice on feeding, weaning and dental health
physical and developmental checks
support on subjects eg PND
work closely with nursery
lead child services team
refer to specialists eg speech and language
120
list some roles of carers
```
keep an eye on
keep them company
take person out
help deal with financial matters
help deal with care services and benefits
help with personal care
```
121
what are some social related implications of an ageing population
- aging population dependent on families
- demand for home carers/ nursing homes
- role of elderly as grandparents
- housing demands change as elderly people likely to live alone
122
when interpreting results of trials, why would you consider the standardised mortality ratio
figure of standard reference population = 100, standardised death rate is a proportion of 100
123
what is follow up bias
arises when one group of subjects is followed up more assiduously than another when measuring outcome
124
what are long term conditions
persistant conditions that do not lead to early death.
125
what is the legal definition of disability
difficulty can be physical, sensory or mental
| a disability that makes it difficult for them to carry out normal day to day activities, ongoing for more than 12 months
126
what ratio is used for relative risk
incidence of disease in exposed group / incidence of disease in unexposed group
127
list some economic factors that influence the PHCT
- existing premises too small for growing number of GPs
- trend form small traditional GP to larger building developed by private companies
- trend to wider services provided within a practice
128
what is the medical model of a disability
- individual cause
- underlying pathology
- individual level intervention form health profession
- individual changes to behaviour
129
what are benefits of a cross sectional sectional analytic study
provides results quickly (usually impossible to infer causation)
130
list some secondary care services
consultants
diagnostic imaging
operating services
131
list some of the ways PHCT should work as a team
- patient centred care
- agree common objectives/ goals
- agree teamworking conditions including conflict policy
- ensure every member knows their role and the roles of each other
- communicate well
- select a leader with good leadership skills
- joint conferences, education and training
132
what factors other than age affect population
migration, health education, public health improvements (housing/ clean water/ nutrition) ,
133
what is the iceberg of illness
no disease in 50% of GP appointments - some reported, some unreported
134
what is the role of a health visitor
lead and deliver child and family health services form pregnancy to 5 years - assess the support parents need and develop appropriate programs to help give the child the best possible start in life
