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Health and society > Block 13 > Flashcards

Block 13 Flashcards

1
Q

Evidence based decision is based on…

A

Clinical expertise
Research
Patient preference
Available resources

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2
Q

What is decision analysis?

A

Decision analysis is a systematic, explicit, quantitative way of make decisions in health care that can lead to both enhanced communication about clinical controversies and better decisions

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3
Q

Normative decision making

A

What we should do

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4
Q

Decriptive decision making

A

What we are doing

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5
Q

Prescriptive decision making

A

How we can improve

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6
Q

Decision analysis is based on

A

Based on a normative theory of decision making: subjective expected utility theory (SEUT)

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7
Q

Normative =

A

Based on social norms, shared interpretations/understanding

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8
Q

Subjective =

A

Subject to interpretation

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9
Q

Expected =

A

Future events

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10
Q

Utility =

A

desirability or value attaches to a decision outcome

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11
Q

Evidence in decision trees come from

A
  1. Probabilities

2. Utility or cost associated

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12
Q

Info in decision tree should come from

A

Good quality research/best available evidence

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13
Q

5 stages of decision analysis:

A
  1. Structure into decision tree
  2. Assign probability
  3. Assign utility
  4. Calculate value
  5. Sensitivity analysis
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14
Q

Square node =

A

Decision node, choice between actions

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15
Q

Circle node =

A

Chance node/uncertainty or potential outcome

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16
Q

Each branch is decision tree must =

A

100%

1

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17
Q

Ways to assess utility

A

Utility measures
QALYs
VAS

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18
Q

Name a utility measure

A

EQ-5D

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19
Q

EQ-5D

A

People with a particular health state fill in questionnaire

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20
Q

5 domains of EQ-5D:

A
  1. Mobility
  2. Independence
  3. ADLS
  4. Pain, discomfot
  5. Worried/sad/happy
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21
Q

VAS =

A

Visual analogue scale

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22
Q

QALY =

A

Quality adjusted life year

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23
Q

Health states can be measured against what?

A

QALYs

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24
Q

Value of each branch =

A

utility x probability

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25
Q

In a decision tree sensitivity analysis, a decision can be:

A
  1. Preference sensitive

2. Probability sensitive

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26
Q

Benefits of DA

A
  • Makes all assumptions in a decision explicit
  • Allows examination of the process of making a decision
  • Integrates research evidence into the decision process
  • Gain insight during process
  • Can be used for: individual, population level, cost-effectiveness analysis
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27
Q

Limitations of probability estimates in DA

A
  • Required data dets of estimate probability may not exist

- Subjective probability estimates are subject to bias

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28
Q

Limitations of utility measures in DA

A
  • Individuals may be asked to rate a state of health they haven’t experienced
  • Different techniques = different numbers
  • Subject to presentation framing effects (e.g. survival/death)
  • Reductionist – e.g. ‘affected’ vs ‘unaffected’ reduces a complex issue into 2 options.
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29
Q

Colin Murray Parkes states the

A

4 stages of grief

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30
Q

4 stages of grief (Colin Murray Parkes)

A
  1. Numbness
  2. Yearning/pining and anger
  3. Disorganised and despair
  4. Reorganisation
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31
Q

Who decribed some of the symptomology of acute grief?

A

Lindemann

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32
Q

Lindemann acute grief:

A
  • Somatic/bodily distress
  • Preoccupation with the image of the deceased
  • Guilt re: the deceased or circumstances of death
  • Hostile reactions
  • Inability to function as one has before the loss
  • Development of traits of the deceased in their own behaviour
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33
Q

Grief symptomology can be split into what domains?

A

Emotional
Somatic
Cognitive
Depression-like

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34
Q

Emotional symptoms of grief:

A 
Sadness
Anger
Guilt 
Anxiety
Loneliness
Helplessness
Shock
Yearning
Numbness
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35
Q

Somatic symptoms of grief:

A 
Sensations from stomach, chest, throat
Sensitivity to noise
Breathlessness
Weakness
Lack of energy
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36
Q

Cognitive symptoms of grief:

A

Disbelief
Preoccupation
Sense of presence
Hallucination

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37
Q

Who described the tasks of mourning?

A

Worden

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38
Q

What did worden believe grief was?

A

An active process

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39
Q

Tasks of mourning:

A
  • Accept the reality of loss
  • Work through the pain of grief
  • Adjust to an environment in which the deceased is missing
  • Emotionally relocate the deceased and move on with life
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40
Q

Pathological grief is grief which is

A

Extended (>6 months)

41
Q

What can happen in complicated grief?

A

Mummification

denial

42
Q

Mummification -

A

Preserving aspects of the deceased’s life pathologically

43
Q

Impact of close death:

A

Loss of presence (function, emotional, role in life)
May change persons role
Forced to confront own mortality
Traumatic undermining of world view

44
Q

What effects grief severity?

A
  1. Closeness of relationships, meaningfulness of relationship, nature of relationship.
  2. Expectedness and manner of death
  3. Age and developmental stage of griever
  4. Individual resilience: neuroticism, introversion, childhood trauma, parenting, attachment and dependency
  5. Religious belief
  6. Social support
45
Q

Which attachment style might lead to complex grief?

46
Q

Impact of religious belief of bereavement:

A
  • Belief in afterlife: continuing existence of the loved one and possibility of meeting up again, continued attachment (prayer means of continuing connection).
  • Defence against fear of personal death/extinction
  • Religious funeral rituals aid and progress the grief response
  • Religious funeral rituals that recruit social support
47
Q

Palliative care =

A

The active, hollistic care of patients with advances, life-limiting, progressive illness

48
Q

Palliative care aims to =

A

Improve QOL: pain, other symptoms, psychologial, social, spiritual support

49
Q

2 types of palliative care services:

A
  1. General

2. Specialist

50
Q

General palliative care is done by

A 
All health professionals:
Primary health team
Nursing home
Secondary care
Social services
51
Q

What is included in general palliative care?

A
  1. Holistic needs assessment
  2. Provision of basic symptom control
  3. Referral if needed
52
Q

Supportive care =

A

Happens before diagnosis, after diagnosis, during treatment, palliative care, bereavement

53
Q

Terminal care =

A

Treatment, care and support for people nearing end of life

54
Q

When is specialist palliative care provided?

A

• Patients and carers with unresolved symptoms and complex psychosocial issues with complex end-of-life and bereavement issues

55
Q

What does complex mean in the context of palliative care?

A

Cannot be dealt with by general professionals

56
Q

Who provides specialist care?

A

Specialist nurses
Specialist consultants
Hospice
Chaplain etc.

57
Q

Where does the funding for palliative care come from

A

NHS

Voluntary and charity sector

58
Q

What does the NHS provide for PC?

A
  • Doctors, nurses
  • Some in patient beds
  • Community clinical nurse specialist
59
Q

Macmillian funding =

A

Part NHS

Part charity

60
Q

What does the voluntary sector provide for PC?

A

Hospice
most inpatient beds
Marie curie nurses, macmillian nurses

61
Q

District nurse =

A

Based in community
Generalist
Hands on

62
Q

Practice nurse =

A

Based in practice
Generalist
Hands on

63
Q

Marie curie nurse =

A

Community
Specialist
Hands on

64
Q

Macmillian nurse

A

Community or hospital
Specialist
Advice, support, resource

65
Q

Most people would prefer to die where

66
Q

Challenges for the future of PC:

A
  • How do we maintain sense of humanity and compassion
  • Attitude to death as not being a medical failure
  • Inequality between cancer and other probelms for referal
  • Recruitment and training
67
Q

Highest cause of world-wide mortality:

A

Cardiovascular disease

68
Q

What % of all CVD deaths are in low and middle income countries

69
Q

What % of deaths is attributable to CVD

70
Q

CVD rates change in one country depending on

A

Social gradient/socioeconomic status

71
Q

Ethnicity with highest levels of CVD

A

Bangladeshi men

Pakistani men

72
Q

Ethnicity with lower levels of CVD

A

Carribean

West africa

73
Q

What might higher rates of CVD in Bangladeshi men be linked to?

A

Higher rates of smoking

74
Q

What experience is important for CVD

A

Experiences in early life

75
Q

Non-modifiable RF for CVD

A 
Age
Male
FHx
ACE mutation
Social deprivation
76
Q

Modifiable RF for CVD

A 
Hyperlipidemia
Hyperchlesterolemia
Hypertension
Smoking
Diabetes
Lack of exercise
Coagulation factors
Homocyteinaemia
Obesity Gout 
Drugs
77
Q

Most important/RF which are targets in CVD

A

Hypercholesterolemia
Smoking
Hypertension

78
Q

Risk =

A

Probability of an event occuring in a given time period

79
Q

Risk ratio =

A

The ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group.

80
Q

Risk ratio is the same as

A

Relative risk

81
Q

ABCD method of calculating risk what is RR

A

a/(a+b) / c/(c+d)

82
Q

Odds ratio

A

Odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.

83
Q

ABCD method, what is OR?

84
Q

Risk difference is the same as

A

Attributable risk

85
Q

Risk difference equation

A

Risk in exposed - risk in unexposed

86
Q

Why is size not everything in risk?

A

Small risk from a common exposure may have a big impact

87
Q

What is a better measure of the impact of an exposure on a population?

A

Risk difference

88
Q

What is used in epidemiology to measure and assess the public health impact of exposures in populations.

A

Population attributable risk

89
Q

Population attibutable risk =

A

The fraction of all cases of a particular disease/adverse condition in a population that is attributable to a specific exposure.

90
Q

PAR depends on

A

Prevalence of exposure

RR/relationship between risk and exposure

91
Q

PAR is higher with

A

Higher prevalence of exposure

Higher RR

92
Q

What is the prevention paradox

A

 A preventative measure that brings large benefits to the community offers little to each participating individual.

93
Q

Most CVD occur in people at what risk?

A

Low/moderate

94
Q

2 strategies to reducing risk:

A

High risk strategy

Population strategy

95
Q

Which strategy is needed to have a large effect?

A

Population strategy

96
Q

Benefits of high risk strategy

A
  • Appropriate to individual
  • Motivated subject
  • Motivated clinician
  • Cost-effective resource use
97
Q

Cons of high risk strategy

A
  • Screening difficult
  • Palliative and temporary
  • Limited potential
  • Labelling
98
Q

Pros of population strategy

A

large potential

99
Q

Cons of population strategy

A
  • Population paradox – small individual benefit
  • Poor motivation
  • Benefit:Risk (LOW)

Health and society (6 decks)

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