3A notes Flashcards
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need for it within a population
What is incidence?
The number of new cases per unit of time
What is incidence expressed as?
Percentage or per a certain amount of people (e.g. per 1000)
What is prevalence?
The number of existing cases at a particular point in time
How can prevelance be expressed?
As a percentage or per e.g. 10,000
What is the ‘sick role’?
Being ill allows legitimate deviance from social obligation including exempt from social expectations (e.g. work), and blame for being sick
What is latrogenesis?
The unintended adverse effects of a therapeutic intervention
What are the different models for changing health behaviours?
Health belief model
Stages of change model
ect
What is the health belief model?
Patients perceived susceptibility, the perceivved barriers, benefits and self efficacy are all influences on changing behaviours
What are the different stages in the stages of change model?
Pre-contemplation–> Contemplation–> Preparing to change–> Action–> Maintenance–> Stable changed lifestyle/ relapse
What is the nudge theory?
When you change the environment to make the healthy option the easiest option
What is the sensitivity of a test?
The probability of a person with the disease obtaining a positive test result
How do you work out sensitivity?
True positives divided by total number of people with the disease
What is the specificity of a test?
Probability of a person without the disease testing negative
How is specificity calculated?
True negative results divided by total number of people with the disease who are screened
What is the positive predictive value?
The proportion of people with a positive test results who actually have the disease
What is the negative predictive value?
The proportion of people without the disease who are correctly excluded by the screening test
What happens to the positive predictive value as the prevelance increases?
It will increase
What criteria must be filled in order to create a screening test?
- Important issue
- Acceptable treatment
- Facilities available to diagnosis and treatment
- Recognised latent or early stage
- Natural history of disease known
- Suitable test
- Test acceptable to population
- Agreed policy on who to treat
- Cost of findings economically balanced to overall expenditure
What are the arguments for screening?
Prevent suffering
Early identification beneficial
Early treatment cheaper
High patient satisfaction
What are the arguments against screening?
Damage of false positives/ negatives
Adverse effects of screening tool on healthy people
Personal choice compromised
What is primary prevention?
Prevents the disease becoming established
What are some examples of primary prevention?
Immunisations
Reduce risks (e.g. lose weight)
What is secondary prevention?
Detect early disease to slow down or stop its progress
What is an example of secondary prevention?
Screening
What is tertiary prevention?
Reduce the complications or severity of a disease that is already established
What is the prevention paradox?
That a larger number of people at small risk of disease may contribute to more cases of that disease than a smaller number who are individually at greater risk.
What is the primary prevention of CHD?
Lifestyle changes
Management of related conditions
What does SNAP stand for in the management of lifestyle changes?
Smoking
Nutrition
Alcohol
Physical activity
When is secondary prevention needed in CHD?
After recovery from ACCS, or with stable angina
What does secondary prevention of CHD involve?
Aspirin, B-blockers, Ace-i, statins
What psychosocial factors may be risk factors for CHD?
Type A personality
Depression/ anxiety
Work stress
Lack of social support
What is the influenza incubation period?
1-3 days
What are the phases of a pandemic?
Phase 1-3 (animal infections with few human infections)
Phase 4 (sustained human to human transmission)
Phases 5-6 (Widespread human infection)
Post peak
Post pandemic (disease returns to seasonal levels)
What are the different types of transmission?
Direct
Indirect
Airborne
What are the two types of direct transmission?
Direct route (e.g. STIs)
Faecal oral route (e.g. viral gastroenteritis)
What are the two types of indirect transmission?
Vector-borne (e.g. malaria)
Vehicle-borne (e.g. viral gastroenteritis)
What is the recommended alcohol limit for men?
14 units a week
What is the recommended alcohol limit for women?
14 units
How do you work out units of alcohol?
(% alcohol by volume X amount of liquid mm) / 1,000
What screening tool is used to ask about alcohol dependency?
CAGE
What is compliance?
The extent to which a patients behaviour coincides with medical or health advice
What is adherence?
An active choice of patients to follow through with the prescribed treatment while taking responsibility for their own well-being
What is concordance
The extent to which the patient and practitioner agree on the treatment.
What are the four ethical principles?
Autonomy
Non-maleficence
Beneficence
Justice
What is utilitarianism?
When an act is evaluated solely in terms of its consequences
What is deontology?
The theory that the features of the act themselves determine worthiness
What is virtue ethics?
Focus on the character of the person, integrating reason and emotion
What does PICO stand for when asking a research question?
Population
Intervention
Comparison
Outcome
What is horizontal equity?
Equal treatment for equal need
What is vertical equity>
Unequal treatment for unequal need
What is normative need?
What the professional defines is the appropriate intervention to address a patients need
What is included in the Donabedian framework for evaluation of a health service?
Structure
Process
Outcome
What are Maxwell’s dimensions of quality (3A’s, 3E’s)
Accessible
Acceptable
Appropriate
Equity
Efficiency
Effectiveness
What is an example of a health behaviour?
Doing things to stay healthy e.g. diet/exercise
What is an example of an illness behaviour?
Doing things to seek remedy e.g. going to the doctors
What is an example of a sick role behaviour?
Doing things to get better e.g. taking meds
