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Health and society > Block 12 > Flashcards

Block 12 Flashcards

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Sociology 101 flashcards
1
Q

All research studies shld be assessed for:

A

Bias

Applicability

Limits

Value

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2
Q

3 discrete steps of critical appraisal

A
  1. Are the results of the study valid?
  2. What are the results? - statistics e.g. RRR, NNT
  3. Can the results be applied to the specific patient of interests care?
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3
Q

Cons of critical appraisal

A

time-consuming

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4
Q

Pros of critical appraisal

A
  • improves healthcare quality - closes gap btwn. research and practice
  • systematic analysis of validity of results + hence usefulness of research study
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5
Q

Define disability

A

restriction or inability to do something as a result of an impairment

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6
Q

Define impairment

A

A physical loss/functional deficit

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7
Q

impact of disability on a patient’s life

A
  • loss of independence + freedom
  • frustration + anger at having to rely on other ppl
  • anxiety/depression
  • unemployment
  • difficulty accessing buildings
  • limited choice of activites
  • loss of self-esteem + confidence
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8
Q

Occupational therapy role in reducing risk of falls

A
  • assess home for hazards: loose rugs, pets, cluttered home etc.
  • assess whether pt. has fear of falling + help them to break cycle of inactivity tht further increases falls risk
  • assess side effects of any medications on cognitive functioning
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9
Q

Podiatry role in reducing risk of falls

A
  • reccommend appropriate footwear + orthotic devices

- calf + ankle exercises for strengthening

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10
Q

Confounding

A

distortion of the association between the independent and dependent variables because a third variable is independently associated with both

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11
Q

Outline ways to reduce the effect of confounding variables

A
  • randomisation
  • restriction
  • matching
  • stratification
  • linear/logistic regression
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12
Q

Primary prevention of stroke is

A

avoidance of disease before development of any signs or symptoms

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13
Q

Secondary stroke prevention is

A

avoidance of disease progression or later problems e.g. death

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14
Q

Outline some methods for primary prevention of stroke

A
  • stopping smoking
  • reducing alcohol consumption
  • healthier diet
  • increased physical activity
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15
Q

Outline some methods for secondary prevention of stroke

A
  • Antiplatelet meds - Aspirin + Clopidogrel to reduce the risk of stroke recurrence
  • Antihypertensives - manage BP
  • Statins
  • Anticoagulants
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16
Q

What are the effects of targeting high risk groups for prevention?

A

 Larger potential benefit to individual
 Smaller effect on population rate of stroke
 Many of the conditions you treat are asymptomatic
 May of the treatments have side effects

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17
Q

Non-modifiable and modifiable risk factors for stroke:

A

Non-modifable

  • older age
  • male gender
  • race - Asian
  • FHx

Modifable

  • high BP* - most important by far for cerebral haemorrhage
  • diabetes
  • atrial fibrillation
  • smoking
  • hyperlipidemia
  • obesity
  • low physical activity
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18
Q

Outline some risk factors for falls

A

 Muscle weakness
 History of falls
 Gait deficit
 Balance deficit
 Visual deficit
 Arthritis
 Impaired activities of daily living (ADL)
 Cognitive impairment
 Age - >80 years
 Medical conditions - PD, stroke, hypotension, depression, epilepsy, dementia,
arthritis, peripheral neuropathy, dizziness and vertigo

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19
Q

In which care settings are the risk of falls increased?

A

Residential/Care homes

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20
Q

Risk factors for hip fracture

A
  • low BMD
  • long-term corticosteroid use
  • ethnicity
  • being female
  • low body weight
  • psychotropic drugs
  • smoking
  • Fhx of hip fracture
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21
Q

What did the PROGRESS trial show? (Stroke)

A

reducing BP reduces chance of stroke recurrence (secondary prevention)

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22
Q

Implementation gap

A

Gap between scientific understanding and patient care

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23
Q

What does quality improvement involve?

A

 Foster environment where improvement and innovation are viewed as normal
 Empowering staff to strive for change
 Provide knowledge and methods to implement change
 Remove barriers to change
- engages participants across organisational levels
- interactive + iterative i.e builds on knowledge you already have

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24
Q

Give some examples QI initiatives targeting organisations

A
  • Revision of professional roles
  • Introduction of multi-disciplinary teams
  • Changes in skill mix, or in the setting of service delivery
    Financial incentives- CQUIN, QOF
    Guidelines
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25
Q

Outline the QI improvement cycle (PDSA cycle)

A

P - plan

D - do

S - study, analyse data

A - act, evaluate data and decide on nxt step

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26
Q

Give some examples QI initiatives targeting networks

A
  • facilitate auditing + benchmarking cycles to regularly assess current practice + identify variations
  • Network recognition for high-quality practice - talking to colleagues from other departments
  • Promote inter-institutional communication and collaboration, can implement competition to motivate improvement
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27
Q

QI initiatives targeting HCPs

A
  • Educational meetings
  • Local consensus processes to identify or prioritise interventions
  • Educational outreach visits
  • Local opinion leaders
  • Reminders (written, verbal)
  • “Tailored” approaches, such as focus groups or surveys, to identifying specific barrier
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28
Q

What makes a QI initiative effective?

A

Mutlifaceted interventions that act at different levels of barriers to change:

  • shld be tailored to key barriers
  • patient mediated - encouraged pts. to challenge doctors
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29
Q

What is QOF?

A

Quality outcomes framework

  • annual financial incentive for GP excellence

Compares delivery and quality of care against previous years

30
Q

What are the aims of QOF?

A

Aims to improve standards of care by assessing and benchmarking the quality of care patients receive

31
Q

Outline the evidence for financial incentives

A
  • they offer small improvements but at the expense of another factor tht might not have been measured
  • when incentives are removed performances lvls generally remain stable
32
Q

Barriers to evidence implementation

A

Characteristics of reccomendations

  • may be complex
  • may require new skills

Characteristics of adopters:

  • may not trust credibility of source
  • may already have a trusted/convenient information source
  • may feel as though their are a tsunami of guidelines i.e too many too read

Characteristics of organsations

  • may be limited by time, resources, equipment
  • social influence - if the most influential ppl in the org don’t like the reccomendation may be harder to follow
  • organisational culture - current values, attitudes + behaviour of the organisation
33
Q

What is QI?

A

Quality improvement

  • facilitates the uptake + continuing use of evidence based medicine by focussing on reccurent problems within care systems

aims to improve:
performance - in terms of the systems outcomes for patients

professional development - support clinicians

service-user outcomes

34
Q

Why are waiting times important?

A

Because their a major source of patient dissatisfaction + uncertainty

35
Q

Supply in healthcare will depend on:

A
  • availability of healthcare professionals
  • availability of beds
  • availability of infrastructure
  • capacity of operating theatres
36
Q

Need in healthcare will depend on

A
  • general health status of the population
  • the technology available
  • the more there are new treatments available
37
Q

Outpatient waiting time

A

time between being referred by your GP to a specialist

38
Q

Inpatient waiting time

A

time between specialist assessments and starting specialist’s recommended treatment

39
Q

In the UK outpatient + inpatient waiting time is combined to give

A

referral to treatment waiting time

40
Q

Why is waiting time more important compared to waiting list?

A

because you can have a very long waiting list but if the waiting time is short then patient satisfaction is improved

41
Q

Most common waiting time policy

A

introduction of a maximum waiting time:

  • Sanctions if these aren’t met (Eng, Fin)
  • option to switch to a different healthcare providers if this target isn’t met (Denmark, Netherlands, Portugal)
42
Q

Unintended effects of sanctions for waiting times:

A
  • may mean pts. with less severe problems treated quickly over others just to meet target
  • higher probability of being treated as pt. approached max wait target
  • lower probability of being treated the more the pt. passed the max wait
43
Q

In 2010 NHS constitution introduced target: ‘max wait from GP referral to treatment’ how long was this?

A

18 weeks

  • expectation tht 92%-95% of pts. shld be treated within this target
  • breach of these targets - reduction of up to 5% of revenues for relevant speciality in month breach occurs
  • initial reduction in waiting times but have been rising since pre COVID
44
Q

Which agency in Finland was used to help regulate waiting times

A

Valvira - National Supervisory Agency

had authority to penalise municipalities tht failed to comply
BUT this had a “rubber band” effect - any time supervisory regime was lessened, waiting times increased

45
Q

Outline the basis of Denmark’s policies to reduce waiting times

A

Choice-based policy

if hospital cannot fufil max wait → pt. can choose to receive treatment in another public or private hospital

expected max wait declined significantly aft 2002 and these have been sustained

46
Q

What info can you gather from visiting a pt in their home?

A
  • their socioeconomic status
  • whether they are caring for themselves
  • whether they are a carer for anyone else
  • how they are taking their medication and where they store it
  • mobility and how it affects their ADLs i.e are they able to get up the stairs
  • any cold or damp that may be causing respiratory symptoms
47
Q

Immediate manifestations of grief

A
  • Denial
  • Fluctuating mood/depression
  • Preoccupation
  • Agitation
  • Blame
  • Bargaining
  • Guilt
  • Numbness
48
Q

5 main complementary therapies:

A

 Acupuncture - Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes

 Chiropractic - Spinal manipulation aims to treat ‘vertebral subluxations’ which are claimed to put pressure on nerves

 Herbal medicine - Medicines with active ingredients made from plant parts

 Homeopathy - Based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself

 Osteopathy - Moving, stretching and massaging a person’s muscles and joints

49
Q

MAIN barriers to CAMs on NHS:

A
  • mixed effectiveness => not all are evidence-based
  • regulation issues
  • resistance to change
50
Q

Which complementary therapy is most used for MSK problems?

A

Osteopathy

51
Q

What is osteopathy mainly used to treat?

A

 Back pain

 Repetitive strain injury

 Changes to posture in pregnancy

 Postural problems caused by driving or work strain

 The pain of arthritis and sports injuries

52
Q

What does the NICE guidelines state about acupuncture in lower back pain, osteoarthritis, and headaches?

A

SUMMARY: for low back pain + osteoarthritis do not offer acupuncture but for headaches + migraines can consider course

 Low back pain - Consider manual therapy, do not offer acupuncture

 Osteoarthritis - Manipulation and stretching should be considered as an adjunct to core treatments, do not offer acupuncture
 Headache/migraine - Consider a course of up to 10 sessions of acupuncture over 5-8
weeks

53
Q

What are the criticisms of the evidence for acupuncture?

A
  • effect is too small and not clinically relevant

- similar effects in pain reduction are seen when comparing NSAIDs vs placebo vs acupuncture for chronic back pain

54
Q

What is the evidence for acupuncture?

A
  • acupuncture correlated with physiological measurements i.e with decreases in brain flow
  • acupuncture showed effectiveness compared to sham or no treatment for low back pain indicating it has more than placebo effect
  • acupuncture showed no difference in effectiveness when compared to conventional therapies
  • acupuncture shows an overall effect compared to usual care
55
Q

Effectiveness gap

A

clinical area where available treatments are are not fully effective or satisfactory for various reasons including lack of efficacy, adverse effects and acceptability to patients

56
Q

Things that might impair decision making abilitiies (think capacity, there are 5 main categories)

A
  • cognitive impairment e.g. dementia
  • lack of insight => Person suffers from some disability but seems unaware of the existence of their disability
  • presence of psychosis
  • severe depressive symptoms
  • learning disability
57
Q

Why is it important to support patients in DM?

A
  • respects patient autonomy
  • professional requirement of GMC
  • legal requirement of Mental Capacity Act 2005
  • patient are generally happier if they can make their own decisions
  • improves doctor-pt relationship
58
Q

How might doctors assist patients in decision making?

A

 Using a different form of communication

 Providing information in a more accessible form

 Treating a medical condition affecting the person’s capacity

 Having a structured programme to improve a person’s capacity

59
Q

According to the Mental Capacity Act 2005 when can does a person lack capacity?

A

A person LACKS CAPACITY IF unable to:

 Understand information that may be relevant to the decision, including the consequence
 Retain information, even for a short time
 Use or weigh information to make decisions
 Communicate decision

60
Q

What determines the response of a carer to a dementia diagnosis?

A
  • nature of the carer-patient relationship
  • how the patient reacts
  • their understanding of the illness
61
Q

What are the pros of advanced directives?

A
  • respects patient autonomy
  • encourages forward planning
  • pts will be less anxious about unwanted treatments
  • may lessen healthcare costs as patient will opt for less aggressive treatment
62
Q

What are the cons of advances directives?

A

 Difficult to verify if the patient’s opinion has changed since making AD

 Difficult to ascertain whether the current circumstances are what the patient
foresaw when making AD

 Possibility of coercion on behalf of the patient

 Possible wrong diagnosis

 Can patients imagine future situations sufficiently vividly to make their current decisions adequately informed?

63
Q

Numremberg code 1947

A

early code for research ethics principles:

  • need for voluntary consent
  • avoidance of all unnecessary physical/mental suffering+injury
  • conducted only by scientifically qualified ppl
64
Q

List some basic research ethics principles that should be considered

A
  • fairness - who will it favour
  • risks - shld be minimal
  • confidentiality - respects pt’s information
  • consent - valid, informed, voluntary + competent
  • usefulness
  • has sought + gained approval from ethics committee
65
Q

3 things needed for consent to be valid

A
  • voluntary
  • informed
  • patient competent
66
Q

What might a doctor do to facilitate gaining valid consent from a patient?

A
  • presentation of information in a way tht’s easy to understand
  • summary of keys points
  • opportunity to ask questions
  • time to decide
67
Q

How might we increase confidentiality levels?

A
  • encrypt identifiable info
  • securely store info
  • limit access to identifiable info
  • properly dispose/destroy i
68
Q

What is an ethics committee

A

body of ppl responsible for ensuring medical experiments + human research is carried out in an ethical manner in accordance with international + national law

69
Q

Why does research need ethics approval?

A
  • to protect participants
  • to protect researches
  • many publishes won’t accept research if it is no ethically approved
  • researches won’t be covered if claim against them made
  • won’t be eligible for financial support
70
Q

Examples of research ethics committees

A
  • NHS research committee
  • MOD => Ministry of Defence research committee
  • HEI => higher education institution research comittee
  • Social care research committee
71
Q

According to the Human Tissues Act 2004, when would you not need consent for use of human tissue from living patients?

A
  • when the human tissue will be anonymous to the researches

- when the research has ethics approval

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