Block 1

Question 1

What do you understand by ‘taking a population perspective’?

Answer 1

A population perspective complements the focus on the individual. Sometimes the interests of the individual and population conflict

Question 2

In what ways may an understanding of health in populations influence the practice of a doctor?

Answer 2

Understand what causes disease, know what works in terms of treatment and improve health

Question 3

Can you give a definition of 􏰁health􏰂? Positively Negatively and Functionally

Answer 3

Health can be defined:
Negatively, as the absence of illness
Functionally, as the ability to cope with everyday activities,
Positively, as fitness and well-being.

Question 4

What is incidence?

Answer 4

Incidence - The number of new cases of a disease, divided by the total population at risk by the time interval.

Question 5

What are major causes of death/illness among children and adults􏰄

Answer 5

UK =􏰀 Circulatory disease, cancer and respiratory disease in adults. Infection and poisoning and cancer in children.
Developing world 􏰀= Cholera, malnutrition, malaria, diarrhea, problems with pregnancy and neonatal death, infection, AIDS.

Question 6

What factors led to changes in life expectancy in the developed world over the last century?

Answer 6

Creation of safe water and sewage disposal systems,
The control of disease-bearing insects and rodents,
Immunization programs
Improved nutrition.

Question 7

What is a population pyramid?

Answer 7

Two back-to-back bar graphs, one showing the number of males and one showing females in a particular population in five-year age groups. Males are conventionally shown on the left and females on the right, and they may be measured by raw number or as a percentage of the total population.

Question 8

Typical population distribution for UK?

Answer 8

UK: Rectangular
Narrow base = relatively few children and young people
Lack of change in size between consecutive age groups = very few people die until they reach old age.
Typical of a MEDC - low birth and death rates and a long life expectancy, contraception is widely used, good public hygiene and health care.

Question 9

Typical population distribution for LEDC

Answer 9

LEDC = Triangular / pyramid
Wide base = large number of children
Rapid narrowing = many people die between each age band.
High birth rate, a high death rate and a short life expectancy.
Typical of LEDC - little access to or incentive to use birth control, poor hygiene (often due to a lack of clean water) and little access to health services.

Question 10

Do you know how the following measures are calculated: stillbirth rate

Answer 10

This is the number of infants stillborn with a gestational age of at least 24 weeks per 1000 total births.

Question 11

Do you know how the following measures are calculated: neonatal mortality,

Answer 11

Number of deaths within the first 28 days per 1000 births

Question 12

Do you know how the following measures are calculated: perinatal mortality

Answer 12

Number of deaths after the first 28 days but within the first year of life per 1000 births.

Question 13

Do you know how the following measures are calculated: infant mortality

Answer 13

Number of deaths within 1 year of life per 1000 births. Includes neonatal mortality

Question 14

How do fertility and infant, maternal and adult mortality differ between the developed and developing world?

Answer 14

Fertility is higher in the developing world. Mortality would be higher in the developing world for adults, children and maternal indicators

Question 15

How is EBDM (Evidence Based Decision Making) implemented?

Answer 15

Evidence based clinical guidelines
Summaries of evidence provided for practitioners
Access to reviews of research evidence
Practitioners evaluating research for themselves

Question 16

What are the forms of information doctors have to bring together to carry out their work?

Answer 16

Evidence from research
Clinical experience
Available resources
Patient preferences

Question 17

What is meant by the term 􏰁evidence􏰂?

Answer 17

Evidence is an observation, fact or organized body of information offered to support of justify inferences or beliefs in a demonstration of some proposition or matter at issue.

Question 18

Why is EBDM important?

Answer 18

Way of dealing with uncertainty inherent in medical practice
Medical knowledge is incomplete
Quantity of medical facts ever expanding and impossible to fully master
Medical knowledge is constantly shifting 􏰀 knowledge revised in the light of new evidence e.g. peptic ulcer disease
Constant need for innovation and improvement
Seen as a way of improving clinical care by ensuring that patients receive the most appropriate treatment, proven by research
Improving efficiency of health care services

Question 19

Can you give some examples of aspects of medical practice that are affected by uncertainty?

Answer 19

Diagnosis and treatment, hormone replacement therapy, mammograms, cancer treatment.

Question 20

How is the NHS organised

Answer 20

Taxpayers: Pay for it
Department Of Health: Sets policy, strategy and standards
28 Strategic Health Authorities:􏰀 Manage performance
302 Primary Care Trusts: Fund and commission services
318 Hospital NHS Trusts: Give secondary and tertiary care
Patients and Public

Question 21

What is the role of Primary Care Trusts?

Answer 21

Cover roughly 170,000 people each.
Improve health of community, secure provision of high quality services in primary, secondary and tertiary care.
Integrate health and social care locally (work with local authorities).
Contract services from 􏰅independent contractors􏰆 such as GPs, dentists and community pharmacists.
Responsible for examination of premises and investigation of complaints & for screening, communicable disease control and emergency planning services are provided.

Question 22

What is the role of Strategic Health Authorities?

Answer 22

Below DOH, came in to existence 2002 – covers around 1.5million people.
Provides strategic leadership for health and healthcare, ensures commitment to national goals and standards as well as securing service improvement.
Ensure service response effectively meet and improve health status.
Account to Sec. Of State For Health for the performance of the NHS in their area.
Troubleshoot and resolve conflict between local NHS bodies that threatens the delivery of NHS objectives.
Work with all NHS bodies and other local stakeholders to improve local heath, reduce inequalities and build in capacity for improvement to local health services.
Monitor and manage performance of commissioning and delivery of healthcare in their area to ensure that local populations have access to a choice of services which are of high quality.
Work with other local government authorities.

Question 23

What is the role of Foundation Hospitals?

Answer 23

A hospital trust free of direct governance from the department of health.
Has considerable freedom of budget.
Responsible for providing a service to a 􏰅reasonable level of demand􏰆.

Question 24

What is the role of Acute and Community NHS Trusts?

Answer 24

Have considerable levels of freedom.
Contribute to plans for improvement and modernisation.
Have the power to set their own wages and make financial decisions over staff, equipment, buildings etc (must be consistent with local priorities).
Include acute examples such as hospitals and ambulance services and community examples such as care trusts (deliver integrated health and social care).

Question 25

What is the role of the Health Development Agency?

Answer 25

Aims to reduce inequalities in healthcare and to promote public health.
Now merged with NICE.

Question 26

What is the role of NICE?

Answer 26

Provides guidance to the NHS based on clinical evidence and cost effectiveness. 
Produces two types of guidance: 
Technology appraisals (look at clinical cost effectiveness of a new or existing treatment 􏰀 Usually takes around 1 year) 
Clinical guidelines covering everything from self care to care by primary care, hospitals and specialist services. Also includes recommendations for the use of new expensive drugs.

Question 27

What is the role of the Healthcare Commission (formerly Commission for Healthcare Inspection and Audit)?

Answer 27

Independent body setup to inspect the quality of NHS services and make public reports.
Assess local clinical governance. Looks at local implementation of national frameworks & the implementation of NICE guidelines.
Commission has the power for rapid investigation in the event of failing services. Performs regular checks and looks for improvement at subsequent visits.

Question 28

What user charges are there in the NHS?

Answer 28

Prescription charges, dental care, ophthalmic care and treatment after RTAs

Question 29

Where does most of the finance for the NHS come from?

Answer 29

General taxation (85%)
National insurance contributions (10%)
User charges (5%)

Question 30

Healthcare financing in USA?

Answer 30

Medicare and Medicaid 􏰀 Available to very poorest only

Question 31

Healthcare financing in Italy?

Answer 31

Mostly state provided but 􏰇50 charge for operations etc

Question 32

Healthcare financing in France?

Answer 32

Not free at the point of delivery: every patient must pay for his treatment and is later refunded to a certain extent.
Some treatment is totally refunded, other less so. Every medical treatment has a recommended price.
Those who adhere to this = 􏰅conventionné􏰈􏰆, those who do not = 􏰅non-conventionné􏰈􏰆.
The latter can charge what they like but the former can include 􏰅private􏰆 establishments

Question 33

Main functions of GMC?

Answer 33

Controls the UK medical register.
Sets standards in undergraduate education, clinical practice and behaviour.
Responsible for audits of UK medical schools and for the continuing professional development of practicing doctors.
Continuing revalidation of doctors.

Question 34

Who are the responsibility of the GMC?

Answer 34

All medical students and doctors.

Question 35

What sanctions can the GMC apply?

Answer 35

Warning, conditions of license, suspension and removal from register

Question 36

what is prevalence?

Answer 36

The total number of individuals, who have an attribute or disease at a particular time or during a particular period, divided by the total population at risk.􏰃