Block 12 - part 1 Flashcards

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1
Q

importance of research informed practice

A

personal experience is biased in various ways, research reports findings for more patients than can hope to see in personal experience, involves application of scientific method, recommendations have been assessed for their clinical and cost effectiveness for the NHS

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2
Q

4 steps of research cycle

A

identify clinical problem, basic research (lab based), applied (clinical research), clinical care

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3
Q

implementation gap

A

gap between scientific understanding and patient care

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4
Q

barriers to implementation of research informed practice

A

characteristics of the recommendations, adopters, organisation and environment

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5
Q

quality improvement

A

facilitates the uptake and continuing use of evidence-based policy and practice, focussing on recurrent problems within system of care to improve performance, professional development and service-user outcomes

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6
Q

what does quality improvement involve

A

Engage participants across organisational levels, foster environment and innovation are viewed as normal, empowering staff to strive for change, provide knowledge and methods to implement change, remove barriers to chaneg

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7
Q

examples of QI initiatives

A

revision of professional roles, introduction of MDTs, change in skill mix or in the setting of service, facilitate audit and benchmarking cycles to identify variations in practice and outcomes that may be targets for QI efforts, network recognition for high-quality practice, promote inter-institutional communication and collabaration (and competition)

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8
Q

what makes a QI initiative effective?

A

passive dissemination of info is generally ineffective at driving change, multifaceted interventions that act of different levels of barrier to change are more likely to acheive improvements in policy and practice,

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9
Q

Quality and outcomes framework (QOF)

A

annual reward and incentive programme detailing GP practice achievement results, enables commisioners to reward excellence across key domains, aims to improve standards of patient care by assessing and benchmarking the quality of care patients receive (against previous years)

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10
Q

aims of national CQUINs 2014-15

A

friends and family test, improvement against NHS safety thermometer, improving dementia and delirium care, improving mental health diagnosis

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11
Q

incidence of falls in the elderly

A

35% of 65-79yo
45% of 80-89yo
55% of 90+

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12
Q

6 possible consequences of falls

A

osteoporotic fractures, head injuries, contusions/lacerations, psychological problem, increase in dependance and disability, impact on carers, institutionalisation

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13
Q

risk factors for falls

A

muscle weakness, Hx of falls, gait deficit, balance deficit, visual deficit, arthritis, impaired ADLs, cognitive impairment, age, medical conditions: stroke, hypotension, PD, depression, epilepsy, dementia

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14
Q

how can falls be prevented/reduce risk

A

increase activity, weekly walk for exercise, strong family networks, multifactorial falls risk assessment, multifactorial intervention, education/info

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15
Q

what doesn’t help reduce falls

A

brisk walking, residential care setting (INCREASES) high intensity strength training (increases injury), educational and behaviural alone

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16
Q

QALY

A

quality adjusted life year, 1 QALY = 1 year in perfect health, e.g. if illness reduced quality of life by 20%, and this affects 10 people, than 2 QALY are lost

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17
Q

How to calculate QALY lost

A

Amount illness reduces quality of life (percentage) x number of people affectes

18
Q

cost of falls

A

£1.3 billion

19
Q

cost of hip fractures

A

£12k per patient, around £720 million per year

20
Q

common fracture in elderly people

A

neck of femur

21
Q

2 types of fractured NOF

A

extracapsular, intracapsular

22
Q

extracapsular

A

bone outside joint capsule breaks - sliding hip screw, intramedullary nail

23
Q

intracapsular

A

bone within joint capsule breaks - internal fixation - screws, nails, plates, rods

24
Q

avascular necrosis

A

death of bone tissue due to lack of blood suply, can lead to tiny breaks in bones and eventual collapse

25
Q

make risk factor for fracture

A

osteoporosis

26
Q

other risk factors for hip fracture

A

low bone mineral density, age, female, low body weight, fam Hx, personal Hx, smoking, ethnicity (low risk in afrocarribbeans), corticosteroid use, medications

27
Q

prevention of hip fracture

A

fall prevention, bone protection - medication, hip protection

28
Q

primary prevention

A

avoidance of disease before any signs or symptoms develop

29
Q

secondary prevention

A

avoidance of progression or later problems, signs or symptoms present

30
Q

primary prevention for stroke

A

no Hx of stroke of TIA

31
Q

secondary prevention of stroke

A

Hx of stroke or TIA

32
Q

prevention paradox

A

majority of people who suffer a stroke are not at a high risk of a stoke, but if whole population changes their health behaviour via PH mechanisms, this would lead to a much greater effect. (majority of cases come from people at low risk becuase because number of people at high risk is small)

33
Q

3 effects of targeting population for prevention

A

large potential benefit to community, low potential benefit to individual, may be low perceived benefit to individual

34
Q

effects of targeting high risk groups for prevention

A

larger potential benefit to individual, smaller effect on population rate of stroke, many of conditions treated are asymptomatic, many treatments have side effects

35
Q

people at highest risk of stroke

A

people who have already had one - 1/5 of people with stroke will have another after 3 months

36
Q

medication used for primary prevention of strokes

A

ischaemic - clopidogrel, statin, antihypertensives, anticoagulant if AF
haemorrhagic - antihypertensives

37
Q

percentage of people who have strokes under 50

A

20%

38
Q

incidence in strokes in men and women

A

men 25 % higher risk, women tend to live longer so incidence higher in women

39
Q

non-modifiable risk factors for stroke

A

age, gender, race (south asians with western lifestyle), family Hx

40
Q

modifiable risk factors for stroke

A

hypertension, diabetes, AF, smoking, hyperlipidaemia, obesity

41
Q

what did the PROGRESS trial show

A

reducing blood pressure after stroke reduces risk of stroke recurrence

42
Q

barriers for initiating medical therapies with no obvius symptoms

A

misinformed, not caring, side effects of tablets, forgetfulness, depression, cognitive impairment