Block 12 - part 1

Question 1

importance of research informed practice

Answer 1

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

Question 2

4 steps of research cycle

Answer 2

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

Question 3

implementation gap

Answer 3

gap between scientific understanding and patient care

Question 4

barriers to implementation of research informed practice

Answer 4

characteristics of the recommendations, adopters, organisation and environment

Question 5

quality improvement

Answer 5

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

Question 6

what does quality improvement involve

Answer 6

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

Question 7

examples of QI initiatives

Answer 7

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)

Question 8

what makes a QI initiative effective?

Answer 8

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,

Question 9

Quality and outcomes framework (QOF)

Answer 9

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)

Question 10

aims of national CQUINs 2014-15

Answer 10

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

Question 11

incidence of falls in the elderly

Answer 11

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

Question 12

6 possible consequences of falls

Answer 12

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

Question 13

risk factors for falls

Answer 13

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

Question 14

how can falls be prevented/reduce risk

Answer 14

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

Question 15

what doesn’t help reduce falls

Answer 15

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

Question 16

QALY

Answer 16

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

Question 17

How to calculate QALY lost

Answer 17

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

Question 18

cost of falls

Answer 18

£1.3 billion

Question 19

cost of hip fractures

Answer 19

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

Question 20

common fracture in elderly people

Answer 20

neck of femur

Question 21

2 types of fractured NOF

Answer 21

extracapsular, intracapsular

Question 22

extracapsular

Answer 22

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

Question 23

intracapsular

Answer 23

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

Question 24

avascular necrosis

Answer 24

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

Question 25

make risk factor for fracture

Answer 25

osteoporosis

Question 26

other risk factors for hip fracture

Answer 26

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

Question 27

prevention of hip fracture

Answer 27

fall prevention, bone protection - medication, hip protection

Question 28

primary prevention

Answer 28

avoidance of disease before any signs or symptoms develop

Question 29

secondary prevention

Answer 29

avoidance of progression or later problems, signs or symptoms present

Question 30

primary prevention for stroke

Answer 30

no Hx of stroke of TIA

Question 31

secondary prevention of stroke

Answer 31

Hx of stroke or TIA

Question 32

prevention paradox

Answer 32

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)

Question 33

3 effects of targeting population for prevention

Answer 33

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

Question 34

effects of targeting high risk groups for prevention

Answer 34

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

Question 35

people at highest risk of stroke

Answer 35

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

Question 36

medication used for primary prevention of strokes

Answer 36

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

Question 37

percentage of people who have strokes under 50

Answer 37

20%

Question 38

incidence in strokes in men and women

Answer 38

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

Question 39

non-modifiable risk factors for stroke

Answer 39

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

Question 40

modifiable risk factors for stroke

Answer 40

hypertension, diabetes, AF, smoking, hyperlipidaemia, obesity

Question 41

what did the PROGRESS trial show

Answer 41

reducing blood pressure after stroke reduces risk of stroke recurrence

Question 42

barriers for initiating medical therapies with no obvius symptoms

Answer 42

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