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Block 11 Flashcards

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Sociology 101 flashcards
1
Q

3 factors to be taken into account in reproductive ethics =

A
  1. Parents
  2. Future or existing children
  3. Third parties (e.g. the state)
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2
Q

What autonomy to parents have?

A

Procreative autonomy

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3
Q

Procreative autonomy =

A

Parent’s wishes regarding reproductive choices should be resepected with minimal interference from the state.

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4
Q

What can override procreative autonomy?

A

Interests of future children

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5
Q

ART =

A

Assisted reproduction technologies.

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6
Q

Definition of ART =

A

Any treatment involving in vitro handling of human oocytes or embryos for the achievement of human pregnancy

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7
Q

Arguments for ART

A
  • Procreative autonomy
  • Psychological health of parents
  • Welfare interests
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8
Q

Arguments against ART

A
  • Involves destruction of embryos

- Harmful to parents: disappointment, risk of multiples

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9
Q

What are the restrictions to reduce the number of multiple pregnancies with ART?

A

<40 - 2 embryos

> 40 - 3 embryos

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10
Q

What do we mean by ‘interests of future children’

A

If, as a result of being concieved, a child is likely to suffer serious physical or mental harm, then it would be hard to justify ART in child’s best interests

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11
Q

What Act includes ‘welfare cirterion’

A

Human fertilisation and embryology act

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12
Q

What is a welfare criterion:

A

A woman shall not be provided with ART unless account of future childs welfare has been taken

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13
Q

Criticisms of welfare criterion:

A
  • Fertile couples don’t have to meet this

- Research shows father isn’t needed - ammended

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14
Q

Fertile couples don’t have to meet the welfare criterion, what is the counter argument to this?

A
  • Maybe they should
  • Difference to between positive and negative rights. Don’t have the +ve right to conceive without state if state is helping.
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15
Q

What argument is used against selection of embryos with disabilities?

A

Right to an open future

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16
Q

Right to an open future =

A

Choices should be make to ensure child will have maximally open future.

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17
Q

3rd party interests in ART =

A
  • ART is expensive

- Child may place high burden on state

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18
Q

What does NICE recommended for women between 23-39:

A

Up to 3 IVF cycles funded on NHS

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19
Q

PGD =

A

Pre-implantation genetic diagnosis

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20
Q

Less contentious use of PGD:

A

Screen for genetic abnormalities like CF

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21
Q

More controversial use of PGD:

A

Sex-selection
Desirable traits
Survivor sibilings

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22
Q

MRT =

A

Mitochondrial replacement techniques

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23
Q

Positives of MRT

A

Health benefits to child

Benefits to parents

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24
Q

What act allows termination of pregnancy?

A

The abortion act (1967) - 1990

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25
Q

Abortion is legal if:

A
  • 2 docotrs
  • <24 weeks
  • Risk to mothers life
  • Risk to mother physical or psychological wellbeing
  • Risk of child suffering from serious physical or psychological handicap
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26
Q

GMC on conscious objection:

A

Respected, provisions need to be made. Refer, don’t obstruct. Must in an emergency situation

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27
Q

York IV criteria:

A
  • 28-42
  • 2 yr stable relationship
  • 2 yr unprotected sex
  • BMI 19-29
  • No smoking for 6 months prior
  • No other children
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28
Q

Why are young people particular vulnerable?

A
  • Vulnerable to harm
  • Rely on others for care
  • Communication issues
  • difficulty accessing services
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29
Q

What does the GMC say about young people

A

They are individuals with rights that should be respected. Should listen and take into account what they have to say. Respect their decisions and confidentiality.

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30
Q

Making treatment decisions: children <16

A
  • If child is Gillick competent, can consent
  • If child isn’t competent, someone with parental authority can consent
  • If parent won’t consent to childs best interests, court or treat in an emergency
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31
Q

Those with parental responsibility have a legal obligation to:

A

Act in child’s best interest

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32
Q

Gillick competence refers to what age

A

Children under 16

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33
Q

Gillick competence:

A

The parental right yield to the child’s right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision

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34
Q

Fraser guidelines refer to

A

Contraception/STIs/Sexual health

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35
Q

What are the Fraser guidelines:

A
  • Understand all aspects of advice and implications
  • Cannot be persuaded to tell parents
  • There is risk of physical or mental harm without
  • In patients best interest to recieve advice without parental knowlege
  • Likely child will have sex with/without advice
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36
Q

Young people aged 16-17 consent:

A
  • Assumed competent to consent to treatment
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37
Q

If someone under the age of 18 refuses treatment =

A

Allows treatment is consent from parents or court

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38
Q

Why are parents generally allowed to make treatment decisions for children?

A

Parental autonomy

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39
Q

Parental autonomy =

A

Assumption that parents know children the best (best interests) and will be motivated to act in best interests

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40
Q

Can parental autonomy be overruled?

A

Yes - e.g. Charlie Guard

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41
Q

Arguments for compulsory immunisation:

A
  • Harm principle

- Bring about public good

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42
Q

Arguments against compulsory immunisation:

A
  • Parental autonomy

- Risk harm (side effects)

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43
Q

Who described the harm principle?

A

Mill

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44
Q

The harm principle (Mill) =

A

The harm principle holds that the actions of individuals should only be limited to prevent harm to other individuals.

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45
Q

How does the harm principle relate to childhood immunisations?

A
  • Prevents harm to others

- Prevents more harm than it will cause

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46
Q

What does, as present, the BMA recommend in regards to compulsory immunisation?

A

Inform and educate patients

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47
Q

Confidentiality and children =

A

Doctors owe children obligation of confidentiality. This isn’t absolute

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48
Q

When should you share info in regards to child’s sexual health?

A
  • Young person too young/immature to understand
  • Disparity in age/power
  • Position of trust - teacher, healthcare worker
  • Threat, force, pressure
  • Drugs or alcohol
  • Partner known to police/child protection
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49
Q

Medicalisation =

A

Process by which human conditions and problems come to be defined and treated as medical condition

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50
Q

Childbirth is becoming increasingly

A

Medicalised

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51
Q

Tokophobia =

A

Psychological condition characterised by extreme fear of childbirth or pregnancy

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52
Q

Are all vaginal deliveries natural?

A

No

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53
Q

‘Normal’ labour occurs with

A
  • Spontaneous onset and vaginal delivery
  • Low obstetric risk
  • Sequential nature
  • Progressive cervical dilation and effacement
  • Progressive urterine contractions which are regular
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54
Q

‘Normal’ labour occurs without

A

Induction
Instrumental assistance
Surgical assistance
Epidural/spinal/general anaesthesia

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55
Q

Social model of birth =

A

Aim for increased choice and greater control of own labout.

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56
Q

Birth rate/trends

A

Declining
Older mothers
More single parents
More mothers in work

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57
Q

C-section rate

A

25% of births

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58
Q

Name a mode for the active management of labour:

A

O’Driscoll’s model

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59
Q

O’Driscolls model for active management of labour:

A
  • Diagnosis at 2cm
  • ARM (artificial rupture of membranes)
  • 2 hrly vaginal exam
  • Syntocinon if slower than 1cm/hr
  • Personal nurse
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60
Q

What did O’discolls model do?

A

Increased rate of spontaneous vaginal births

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61
Q

What was the most important factor in O’Driscolls model?

A

Personal nurse

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62
Q

What influences a woman’s ‘choice’ in birth?

A
  • Media
  • Stories from family/friends
  • Fear of unknown
  • Fear for safety of body or baby
  • Perception of the birth process
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63
Q

Examples of high risk pregnancies =

A 
	Psychiatric disorders
	Multiple pregnancies
	Prev PPH
	Borderline DMI
	HIV/AIDS
	Groups B Strep
	Blood disorders: sickle cell, thalassemia
	High Bp
	Lupus
	Maternal age >35, teenage
	Thyroid disease
	Diabetes (type 1, 2 and gestational)
	Alcohol/smoking/substance abuse
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64
Q

Fergurson reflex =

A

Fetal ejection reflex. Neuroendocrine reflex comprising the self-sustaining cycle of uterine contractions

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65
Q

Fergurson reflex is initiated by

A

Pressure at the cervix or vaginal wall

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66
Q

3 things highlighted in Maternity matters (2007) -

A
  • Continuity of care
  • More choice
  • Improve access to care
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67
Q

How many infants, children and adolescents die every year in England and Wales?

A

> 5000

68
Q

What group of children have the highest mortality?

A

Infants, before the 1st year

69
Q

What group of children have the 2nd highest mortality?

A

Adolescents (15-19)

70
Q

What kind of conditions dominate in infancy?

A

Perinatal conditions

Congenital

71
Q

> 50% of deaths in adolscents occur because of

A

External causes

72
Q

External causes of adolescent deaths =

A

Trauma
Accidents
Suicide

73
Q

Deaths in infancy most likely related to

A

Preterm births

74
Q

Injury in boys is what % more likely than females?

A

> 70%

75
Q

What % of external deaths in adolescents does road traffic accidents account for?

A

50%

76
Q

Non-intentional causes of child death:

A

Drowning
Falls
Fire related
Suffocation, strangulation

77
Q

Examples of ‘intentional’ causes of child deaths:

A

Homicide
Physical assaults (shaking)
Abuse, neglect

78
Q

Patterns of suicide and deliberate self harm in children =

A

Rare in <10s
Higher in older boys
Ligature, jumping, poisioning

79
Q

How many deaths a year does suicide count for in older adolescent boys?

A

> 60

80
Q

Examples of injuries in childhood:

A 
Falls
Head injuries
Road traffic collisions (pedestrians, unrestrained children)
Drowning
Swallowed foreign body
81
Q

50% of poisioning occurs in

A

<5s

82
Q

Almost all posionings occur

A

In child home

83
Q

Types of posioning =

A

Non-medicinal: cosmetics, cleaning

Medicinal = analgestics, cough medicine, antibiotics, vitamins

84
Q

Common illnesses in children =

A 
Congenital: chromosomal, cardio
Infection
Respiratory
Trauma
Malignancy
Neurological
85
Q

Which malignancies account for 2/3rds of all childhood cancers?

A

Leukemia
Brain
Lymphoma

86
Q

CNS disease in childhood =

A
  • Result of perinatal asphyxia
  • Epilepst
  • Cerebral palsey
  • Neurodevelomental disorders
87
Q

Examples of chronic illness in children:

A 
CF
Diabetes
Epilepsy
Psychiatic
Neurodisability
IBD
Obestiry
Asthma
88
Q

Most common chronic illness in children

A

Asthma

89
Q

Implications of childhood chronic illness:

A
  • Childs physical, mental and social health
  • Development
  • Missed school
  • Siblings
  • Parents
  • Finances
  • Lifelong
90
Q

In the UK, how many babies died before 1

A

> 3,000

91
Q

In the UK, how many children died >1

A

> 2,000

92
Q

After infancy, what is the most frequent cause of child death

A

Accidents

93
Q

Prevalence of childhood asthma in UK

A

1 in 11

94
Q

Most common type of meningitis

A

Viral

95
Q

Most common cause of bacterial meningitis

A

Strep.pneumoniae

96
Q

Common causes of childhood death in low income countries

A 
Infection
Diarrhoae
Pneumonia
Malaria
HIV/AIDS
97
Q

Common causes of childhood death in high income contries =

A 
Congential 
Preterm birth
Accidents
Posioning
CNS disorders, cancer
98
Q

Talking to vs talking with children =

A

Talking to = implies as exclusive approach, child feels left out. Less likely to comply, conveys message child doesn’t own their body and makes them less likely to own their problems in later life.

With = inclusive approach which implies discussion. Encourages responsibility, compliance and ownership of problem in later life. Values child

99
Q

When talking with children you should talk at a level appropriate for their

A

Stage of development

100
Q

What can be used to assess very young children?

A

Behaviour and play

101
Q

Things that may affect communication with children

A

Hearing problems
Sight issues
Speech
Comprehension

102
Q

Why might a child be anxious?

A 
New school
Domestic situation
New home
Recent illness
Bereavement 
Being told off etc.
103
Q

Good listening and clear talking can be summed up with:

A
  1. Is language appropriate?
  2. What is body language conveying
  3. Eye contact, turn-taking, listening, validating child, talking TO child
104
Q

What questions should be used when talking with children?

A

Open

105
Q

What kind of questions should be avoided with children?

A

Why questions

106
Q

WHO definition of adolescence =

A

10-19

107
Q

Children’s Act (1989)

A

States that children must be kept informed about what happens to them and participate in decisions about their future

108
Q

Adverse event/patient safety event =

A

Unintended event resulting from clinical care than causes patient harm

109
Q

Near-miss =

A

Situation in which events or omissions arise during clinical care and don’t go any further, resulting in no harm to patients

110
Q

% of hospital admissions which experience a AE

A

10%

111
Q

Examples of AEs

A 
Wrong site surgery
Med error
Side effects
Failure to treat
Wrong diagnosis
Falls
Pressure sores 
Nosocomial infections
112
Q

Most common adverse event in hospital =

A

Falls

113
Q

Most common NEs in hospitals =

A

Wrong site surgery, retained foreign objects

114
Q

Serious incidents =

A

Events where potential for learning so great, or consequences so significant that resources should be spent to investigate and act

115
Q

Never events =

A

Subset of serious incidents that should never occur if the proper guidance and safety recommendations are put into place

116
Q

How many adverse events occur each year in NHS hospitals?

A

850,000

117
Q

How many patients lodged a new clinical negligence claim last year?

A

11,000

118
Q

NHS England paid out how much in clinical negligence?

A

£1.6 billion

119
Q

How do people assess ‘safety of hospital’

A

Mortality data
Safety event data: AEs, SIs
Monitoring and inspections

120
Q

Who inspects hospitals?

A

CQC

NHS improvement

121
Q

Why can’t we just compare 2 hospitals?

A

Different age
Different complexity of cases
Different location etc.

122
Q

SMR stands for

A

Standardised mortality ratio

123
Q

Standardised mortality ratio -

A

Ratio between observed number of deaths in a study population and number of deaths that would be expected based on age/sex-specific rates in standard population and population size. High SMR = high number of excess deaths.

124
Q

Why are HSMRs not fit for purpose =

A
  • People die in hospital
  • Not a measure of avoidable deaths
  • Doesn’t relate to quality of care
  • Depends on hospice/when hospital discharges patients etc.
125
Q

What % of hospital deaths are avoidable?

A

3%

126
Q

Name a model for why there is harm

A

Swiss cheese model

127
Q

What is the swiss cheese model?

A

Need a lot of things to go wrong for things to actually go wrong! Lots of layers where things have helped to make adverse event occur

128
Q

Active failure =

A

Unsafe acts committed by people in direct contact with patient.

129
Q

2 types of active failure and their subsets

A
  • Error: knowledge, rules, skills

- Violations: routine, situational, reasoned, malicious

130
Q

What is very important for causing error (more important than active failures?)

A

Latent conditions

131
Q

Latent errors develop

A

Over time and combine with active failures

132
Q

2 types of bad culture for patient safety

A
  • Blame culture

- Normalisation of deviance

133
Q

Elements of a safety culture:

A 
Leadership
Teamwork
EBDM
Communication
Learning
Patient centered
134
Q

What was long recognised in the aviation industry but is now only being acknowledge in health care?

A

Human factors/the inevitability of human error

135
Q

What should we do with human error?

A

Design it out

136
Q

Situations associated with increased risk of error =

A
  • Unfamiliarity with the task
  • Inexperience
  • Shortage of time
  • Inadequate checking
  • Poor procedures
  • Poor human equipment interface
137
Q

Duty of candour

A

Need to tell patient about wrror

138
Q

NHS resolution is a

A

National safety and learning service

139
Q

What should be avoided to reduce human error?

A

Reliance on memory

Reliance on vigilence

140
Q

What should be done to reduce human error?

A

Make things visible
Streamline, standardise, simplify
Checklists

141
Q

Ex of designing error out

A

Surgical checklists

142
Q

What to do if adverse event occurs =

A 
Report 
Assess seriousness
Root cause analysis
Apologise and explain to patient
Learn from event
143
Q

Examples of ‘dangerous healthcare’

A
  • Mid-staffordshire
  • Bristol royal infirmity
  • Individual doctors: Rodney Ledward, Richard Neale
144
Q

Mid-Stafforshire =

A

Between 400-1,200 patients died as a result of poor care between 2005-2009 at Stafford Hospital

145
Q

What report came our of the Mid-Staffordshire case?

A

Francis report

146
Q

Bristol royal infirmity =

A

High death rates in paediatric cardiac surgery due to:

  • Old boys culutre
  • Lack of leadership
  • Lax approach to safety
  • Secrecy amongst doctors
147
Q

What % of hospital deaths are avoidable

A

3%

148
Q

When is a patient’s death judged to be ‘avoidable’

A

Problem with care which contributed to death

149
Q

Avoidable deaths can be due to acts of

A

Omission
Commission
Complications

150
Q

Omission =

A

Failure to treat according to the evidence

151
Q

Commission =

A

Incorrect treatment or management

152
Q

Complication =

A

Unintended harm due to care

153
Q

What % of hospital admissions are avoidable death?

A

<0.1%

154
Q

Examples of scheme to improve patient safety:

A

TArgeted efforts to reduce MRSA and C.diff infection: reporting, fines.
Introduction of never events

155
Q

Why might increased number or errors be good?

A

Means there is increased reporting - can learn

156
Q

PROMs =

A

Patient-reported outcome measures: QoL before and after procedure

157
Q

What is a patient’s responsibility in healthcare?

A

Informed, make a decision.

158
Q

Medical practice has 3 deficiencies internationally which effect quality of care:

A
  1. Medical practice has a weak evidence base
  2. Large variations in training and practice
  3. Difficult to measure outcomes
159
Q

The basis of healthcare reform what be at what level?

A

Organisational/structural

160
Q

SHMI =

A

Summary hospital-level mortality indicatior

161
Q

Summary hospital-level mortality indicatior

A

 Actual mortality rates within 30 days of discharge compared to expected mortality given hospitals characteristics

162
Q

SHMI in york?

A

100 deaths per month (small)

163
Q

HES =

A

Hospital episode statistics

164
Q

What are hospital episode statistics, what do they include?

A

Detailed dataset including diagnoses, consultant responsible, referring GP, procedures given, duration of stay and discharge/death

165
Q

CQC =

A

Care quality commission

166
Q

What does the CQC do?

A

Regulated all health and social care providers.
Licences
Unannounced visits

167
Q

Name some agencies involved in consumer protections:

A 
CQC
NHS improvement
Public health england
GMC
Royal collages 
NICE 
Department of health and NHS England

Health and society (6 decks)

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