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Year 2 H+S > Block 14 H + S > Flashcards

Block 14 H + S Flashcards

1
Q

What are CDSS?

A

Clinical decision support systems - Designed to aid clinician decision making

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2
Q

What are the different types of CDSS?

A

-Computerised
- Paper based
- Reminder systems
- Developed to aid with particular decisions

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3
Q

What are some examples of CDSS?

A

-Reminder systems - Screening, vaccination, testing, medication use
- Decision systems (diagnosis and treatment) - Model individual patient data against
epidemiological data
- Prescribing - Advice on drug and dosage, highlights potential drug interactions
- Condition management - Assists monitoring patients

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4
Q

What are the effects of computer support on prescribing?

A 
- Reduced time to achieve therapeutic stabilisation
- Reduced risk of toxic drug level
 -Reduced length of hospital stay
- Increased size of initial dose
- Increased serum drug concentration
- No change in adverse effects of drug
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5
Q

Do CDSS work?

A

-Can improve practitioner performance in diagnosis, disease management, prescribing/drug dosing, rates of vaccination, screening etc
- Evidence for effects on patient outcomes not so robust

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6
Q

What are patient decision aids?

A

-Help patient understand probably outcomes of options
- Help patient consider the personal value they place on benefits vs harm
- Support patient in decision making
- Include additional information - On disease, costs, probability of outcomes, peoples
opinions

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7
Q

What is the key issue with patient decision aids?

A

No consensus on what information should be included in a patient decision aid

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8
Q

What improves practice when using decision support?

A
  • Providing decision support as part of the clinician workflow
    - Providing recommendations for management (not just patient assessments)
    - Providing decision support when and where decision making was happening
    - Compuser-based decision support
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9
Q

What are potential barriers to using CDSS?

A

-Earlier negative experience of IT
 -Potential harm to doctor-patient relationship
- Obscured responsibilities (loss of autonomy or reasoning)
- Reminders increase workload

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10
Q

What are potential facilitators of CDSS?

A
  • Self-control of CDSS

-  If clinician can notice help in practice

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11
Q

What are the major causes of food poisoning?

A

-Not cooking food thoroughly (particularly meat)
- Not correctly storing food that needs to be chilled
 -Keeping cooked food unrefrigerated for a long period
- Eating food that has been touched by someone who is ill or has been in contact with
someone with diarrhoea and vomiting
 -Cross-contamination e.g. preparing raw meat on a chopping board then preparing salad

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12
Q

What are some microbial infections that cause food poisoning?

A

-Bacterial - e.g. salmonella, campylobacter, shigella, C. difficile
- Viral - e.g. norovirus, rotavirus
 -Fungal - e.g. aspergillus
 -Protozoal - e.g. cryptosporidia, giardia

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13
Q

What are some toxins that cause food poisoning?

A
  • Bacterial toxins - Clostridium perfringens, s. aureus, clostridium botulinum
  •  Marine biotoxins - Scombroid poisoning, shellfish, ciguatera
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14
Q

What are some chemicals that cause food poisoning?

A
  • Heavy metals
  •  Pesticides
  •  Herbicides
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15
Q

What is the most common cause of food poisoning?

A

Campylobacter

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16
Q

Describe the clinical picture of salmonella infection?

A
  • Transmission - Ingestion of contaminated food, faecal contaminations, person- person, infected animals
  •  Can cause enteric fever or enterocolitis
  •  Incubation period - is 12-72 hours
  •  Symptoms - Vomiting, diarrhoea, fever, headache, chills
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17
Q

Describe the clinical picture of staphylococcus aureus infection?

A
  • Transmission - Contaminated food by skin/nasal flora
  •  Produces enterotoxins
  •  Incubation - 2-4 hours
  •  Symptoms - Rapid onset, projectile vomiting and diarrhoea
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18
Q

Describe the clinical picture of cryptosporidium infection?

A

-Transmission - Animal-human, person-person, contaminated water or land, associated with foreign travel
- Incubation - 2-5 days
- Symptoms - Watery or mucoid diarrhoea, severe illness in immunocompromised

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19
Q

Describe the clinical picture of escherichia coli infection?

A
  • Transmission - Contaminated food, person-person
  •  Incubation - 1-6 days
  •  Symptoms - Haemorrhagic colitis, 5% get haemolytic uraemic syndrome
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20
Q

Describe the clinical picture of norovirus infection?

A
  •  Transmission - Faecal-oral route, environmental contamination, contaminated food and water
  •  Incubation - 24-48 hours
  •  Symptoms - Nausea, projectile vomiting, low-grade fever, diarrhoea
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21
Q

Describe the clinical picture of clostridium perfinges infection?

A
  • Transmission - Contaminated cooked meat and poultry
  •  Incubation - 8-22 hours
  •  Symptoms - Diarrhoea, abdominal pain
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22
Q

Describe the clinical picture of campylobacter infection?

A
  • Transmission - Raw/undercooked meat, unpasteurised milk, bird-pecked milk, untreated water, domestic pets with diarrhoea, person-person
  •  Incubation - 2-5 days
  •  Symptoms - Fever, headache, malaise, nausea, diarrhoa, vomiting is uncommon
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23
Q

How can food poisoning be prevented?

A 
-Isolation
- Hand hygiene
- Protection e.g. gloves, gowns, masks
- Environmental cleaning
- Respiratory hygiene and cough etiquette
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24
Q

What is ‘safe food’?

A

Food that will not cause harm to a person who consumes the food when it is prepared, stored and/or eaten according to its intended use

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25
Q

What are concerns with food?

A 
-Food borne illness
- Nutritional adequacy
- Environmental contaminants
- Pesticides
- Naturally occurring contaminants
- Food additives
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26
Q

What does the public health act state about food poisoning?

A

Allows exclusions from work of people that pose increased risk of GI infection spread - Children in nursery/pre-school, people who work with food, health and social care staff, people with doubtful personal hygiene

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27
Q

What are some of the offences under the food safety act (1990)?

A
  • The sale of food that has been rendered injurious to health, is unfit for human consumption or is so contaminated that it would not be reasonable to expect it to be used for human consumption
  •  The sale of any food which is not of the nature or substance or quality demanded by the purchaser
  •  The display of food for sale with a label which falsely describes the food, or is likely to mislead as to the nature or substance or quality of the food
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28
Q

What is hazard analysis critical control point?

A

-Analysis of the potential food hazards in a food business (e.g. microbiological, chemical & foreign matter contamination).
- Identification of the points in the operations where such hazards could occur.
- Deciding which of the identified points are critical to food safety (critical points).
- Identifying and implementing effective control and monitoring procedures at the
critical points.
- Reviewing the hazards and critical points at periodic intervals and particularly when
any change occurs to the operation

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29
Q

What is an outbreak?

A

Incident in which two or more people, thought to have a common exposure, experience a similar illness or proven infection

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30
Q

What are the objectives in food poisoning outbreaks?

A

-Reduce the number of primary and secondary cases
- Reduce the harm consequent on the episode
- Prevent further outbreaks

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31
Q

What are the investigations done in food poisoning outbreaks?

A
  • Preliminary phase - Is there an outbreak? Confirming the diagnosis. What is the nature and extent of the outbreak?
  •  Immediate steps - Who is ill? How many? Case finding. What is the cause? Is proper care being arranged? What immediate action can be taken?
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32
Q

What are outbreak outliers?

A
  • Outliers are cases at the very beginning and end that may not appear to be related
  • First check to make certain they are not due to a coding or data entry error.
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33
Q

What might outbreak outliers represent?

A

-Baseline level of illness
- Outbreak source
- A case exposed earlier than the others
- An unrelated case
- A case exposed later than the others
- A case with a longer incubation period

34
Q

How can analytical epidemiological studies be useful to identify probably food source of outbreak?

A
  • Compare food history of ill and well persons
  •  Point source outbreak - Cohort study
  •  Common source of outbreak - Case-control study
35
Q

Which GI cancers are prevalent in which populations?

A

-Oesophageal - Middle east and china
- Gastric - Russia
- Colon - Western world e.g. US, UK

36
Q

What is the evidence base for ‘5 a day’?

A
  • Evidence from observational epidemiology that average fruit/veg intake of less than 200g associated with increased risk of cancer, but possibly little additional benefit beyond 400g/day
  •  Very little evidence that 5 a day have impact on cancer
37
Q

Describe the relationship between beta carotene and cancer?

A

-Beta carotene found in fruit/vegetables
- Cohort studies indicated protective relationship against cancer
- However RCT showed beta carotene increased risk of cancer
 -Cohort groups had reduced risk due to confounding factors e.g. increased exercise,
reduced smoking etc

38
Q

What are the problems with measuring diet?

A

-Random error - Diet varies and difficulties in measurement, people don’t eat the same things everyday and out individual consumptions vary significantly
- Homogeneity of exposure - If you only do your studies in the same types of populations they are likely to have similar environments and hence diets, so you are not able to apply results to the population
- Bias
- Confounding

39
Q

What are the different measures of diet?

A

-Food disappearance data
- Household survery - What do you buy and who eats what?
- Individual survery - 24 hour recall, food frequency (very open to bias), diet diary,
biomarkers (very rarely have this)

40
Q

What are the pros and cons of food frequency questionnaires?

A

-Pros - Captures usual diet and less work to code/complete
- Cons - Doesn’t record actual diet as eaten, overestimates fruit and vegetables, poor
measure of energy intake, less flexible

41
Q

What are the pros and cons of diet diaries?

A

-Pros - Records diet as eaten (over limited period), better estimate of energy and absolute intake, more flexible
- Cons - Required effort to complete and expensive to code

42
Q

What are the main dietary associations with cancer?

A

-Oesophageal - Alcohol, obesity
- Stomach - Possible salted preserved foods
- Pancreas - Overweight, obesity
- Hepatic - Aflatoxin contamination
- Colorectal - Preserved and red meat, alcohol, body fat
- Breast - Alcohol, overweight
- Urologic - high calcium

43
Q

What is the trend of alcohol consumption in the UK?

A
  • Per capita consumption in the UK is lower than many European countries
  • However people in the UK start earlier and tend to drink more on single occasions (‘binge drinking’)
  •  Peak of consumption was 2008 - This is linked with affordability
44
Q

What percentage of men and women have an alcohol use disorder?

A

-38% of men and 16% of women (16-64) have an alcohol use disorder (approx 8 million people)
- 21% of men and 9% of women are binge drinkers - Double the recommended daily intake
- 3.6% of the total population are alcohol dependent (1.1 million people)

45
Q

Where is identification and brief advice (IBA) delivered?

A

Delivered in a range of settings - Primary and secondary care but also community settings (pharmacies, community health-oriented events).

46
Q

What specialised treatment is available for alcohol problems?

A

-CBT common
- Behavioural approaches - Behavioural couples therapy, behavioural self-control for
moderation goal
 -Motivational interviewing
- Social behaviour and network therapy (SBNT)

47
Q

Which medical conditions are wholly attributable to alcohol?

A 
-Alcoholic liver disease
- Alcoholic neuropathy
 -Chronic pancreatitis
 -Alcoholic cardiomyopathy
- Alcoholic gastritis
- Alcohol related accidents
- Risk factor for - Colon cancer, mouth and oesophageal cancer etc
48
Q

What are some of the social consequences of alcohol consumption?

A

-Death - Declining since 2008
- Crime and disorder
- Domestic violence - Involved in 73% of cases
- Poor productivity at work
 -Absences/sick leave from work
- Family effects - 5 million families deal with problem drinker, arguments, violence,
debt, relationship problems

49
Q

What are effective, moderately effective and less effective policies for alcohol related health promotion?

A

More effective policies:
- Price increases - Taxation, minimum price
- Restricting availability - Opening times, reducing outlet density, age restrictions

Moderately effective policies:
- Restricting exposures of young people to adverts
- Treatment - Identification and brief advice

Less effective policies:
- Drug and alcohol education
- Mass media campaigns

50
Q

What are the key UK departments involved in alcohol policy?

A
  • Home office (focus on public order)

-  Department of health (focus of public health)

51
Q

What was the ‘alcohol strategy (2012)’?

A

-Minimum unit price policy dropped, multi-buy promotion offers were not banned as suggested
- Local health bodies able to instigate review of licenses
- Double fine for selling alcohol to underage people
- ‘Enforced sobriety’ - 1 year pilots based on US models
- Overview alcohol consumption guidelines for adults
- Alcohol included in NHS health check for adults 40-75

52
Q

What is efficiency?

A
  • Target resources to those activities that give the greatest health gain for the money spent as this will maximise population health gain
  •  Informing these choices required estimation of value of what is given up when a patient is treated (opportunity cost) and the value of what is gained in terms of improvements in the health of patients
53
Q

What is allocative efficiency?

A

Investing in health care interventions that are worthwhile

54
Q

What is technical efficiency?

A

Investing in health care interventions which make the best use of scarce resources

55
Q

What is equity in financing?

A

-Geographic allocation of funding by weighted capitation

- Resourcing determined by population weighted by need

56
Q

What is the class equality/inequality in health care?

A

Evidence of social class equality in the use of primary care and social class inequality in the use of secondary care

57
Q

What is the concept of the ‘margin’?

A

The incremental change in resources (inputs and their cost) committed to an activity that produces an incremental change in effects (improved patient outcomes)

58
Q

Why is the margin important?

A

-Incremental investments in an activity may be associated with diminishing returns
- I.e. successive increase in activity (inputs) yield declining benefits to the patient, or
the more you do, the less they benefit

59
Q

Why do we need economic evaluation?

A

-Values both inputs (opportunity costs) and outputs (health outcomes) of any intervention
- Assess if changes in resource allocation are efficient
- Important because increasing healthcare expenditure needs best outcome for the
money e.g NICE

60
Q

How do you measure cost?

A
  • Cost to NHS - NICE perspective, cost of drug, cost of delivery
    - Cost to patient, carers, and society - Lost working days
61
Q

How do you measure benefit?

A

Health gain = Increase in length + QoL

62
Q

What is cost-minimisation analysis?

A

Chooses cheapest option between treatments that have identical outcomes

63
Q

What is cost-effective analysis?

A

-Costs and outcomes are combined into a single measure e.g reduction in blood pressure
- Allows comparison between treatments in the same therapeutic area only

64
Q

What is cost-utility analysis?

A

-Combines multiples outcomes into a single measure (QALY) using QoL instruments e.g EQ5D
- Allows comparisons between alternatives in different therapeutic categories e.g CV and cancer

65
Q

What is cost-benefit analysis?

A

Puts cost and benefit into monetary/numerical terms, e.g. how much is the 3 months gained worth to the patient?

66
Q

When can cost-effectiveness analysis be used?

A
  • If the outcome measures are just clinical
    - If other more generic outcome measures are used use cost utility analysis to get
    QALY (NICE use it)
67
Q

What are the levels of resource allocation decisions?

A

-Macro (societal) level - Regarding health funding v education or funding of certain drugs
- Micro (clinical) level - Individual decisions regarding care of individual patients

68
Q

What are the arguments for and against age-based rationing being applied to macro-level
resource allocation decisions?

A

-For - Treatment and care of elderly people is very costly so ‘cost-effective’ argument might require resources elsewhere
- Against - Most of the elderly burden relates to cost of illness and incapacity rather than age, young person with chronic/serious disease could also cost the same amount

69
Q

Describe the Fair-innings argument (1997)?

A

-Older people have had a long life already, therefor fairer to divert resources to younger people
- Elderly also have a disproportionate share of the available resources allocated to them

70
Q

What are the contradictions to the Fair-innings argument?

A

-Treating on the basis of need might mean older people don’t receive lower priority
- Years of life saved shouldn’t matter, the quality of life is more important e.g QALYs
- Fairness is not the only thing that matters, other things do too e.g equal treatment

71
Q

What are the arguments for and against age-based rationing being applied to micro-level resource allocation decisions?

A
  • For - Age should be relevant because older people are less likely to respond to treatment and have a poorer prognosis in general due to increased complication risk
  •  Against - Age alone is not a good predictor of prognosis/complications hence need case-by-case decisions, decisions based on age may be hidden form of discrimination
72
Q

What is age discrimination?

A

Unjustifiable difference in treatment based solely on age

73
Q

What is the difference between direct and indirect age discrimination?

A

-Direct - Direct difference in treatment based on age, cannot be justified
- Indirect - Neutral provision or practice that has harmful repercussions on a person
based on their age

74
Q

What is the GMS and laws view on age discrimination?

A
  • GMC - must not unfairly discriminate against patients or let views about patient affect decisions
  •  Law - equality act 2010, protects age, race, sex, gender, disability, religion etc
75
Q

How do you calculate QALY?

A

-Assign a utility value (0-1) to a state of health and then multiply by the number of years expected to live in this state
- 0.5 QALY points x 5 yrs = 2.5 QALYs
- 0.8 QALY points x 5 years= 4.0 QALYs

76
Q

What leads to a utilitarian justification?

A

QALYs focus on overall likely outcomes of resource allocations

77
Q

What type of healthcare do you have when the cost per QALY is low/high?

A
  • Low - High priority, efficient health care

-  High - Low priority

78
Q

What are the arguments for QALY-based assessments?

A

-Maximises healthcare based on quality and quantity of life
- Considers individual patient level when informing decisions about whether or not to
proceed with an invasive procedure based on QALys they are likely to gain

79
Q

What are the arguments against QALY-based assessments?

A

-Difficulties in mesuring - How do you measure quality or value or life? Who makes the decisions? Introduces bias
- Can seem unjust - Can favour life years over individual lives

80
Q

What is the relationship between age and QALY?

A

-The older you are the fewer QALYs you will gain due to lower life expectancy + co- morbidities
- Doesn’t aim for ageism but it is still discriminatory (indirect)

81
Q

What body appraises medical technologies in pounds per QALY?

A

NICE

Year 2 H+S (14 decks)

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