Block 15 - part 1 Flashcards
CDSS
clinical decision support systems - designed to aid clinician decision making
4 different types of CDSS
computerised, paper based, reminder systems, developed to aid with particular decisions
examples of CDSS
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 interactions
condition management
effects of computer support on prescribing
reduced time to achieve therapeutic stabilisation, reduced risk of toxic drug level, reduced length of hospital stay, increased size iof initial dose, increased serum drug conc. no change in adverse effects of drug
do CDSS work?
can improve practitioner performance in diagnosis, disease management, prescribing/drug dosing, rates of vaccinations, screening but evidence for pt outcomes not so cobust
patient decision aids
help pt understand probable outcomes of options, help pt consider personal value they place on benefits vs harm, support pt in decision making, include additional info
key issue with pt decision aids
no consensus on what info should be included
what improves practice when using decision support
providing decision support as part of the clinician workflow, providing recommendations for management, providing decision support when and were decision making happening, computer-based decision support
potential barriers to using CDSS
earlier negative experience of IT, potential harm to Dr-pt relationship, obscured responsibilities - loss of autonomy, reminders increase workload
potential facilitators of CDSS
self control of CDSS, if clinician can notice help in practice
food poisoning
diarrhoea and vomiting with or without pain
major causes of food poisoning
not cooking food thoroughly, not storing chilled food properly, keeping cooked food unrefridgerated for long periods of time, eating food that has been touched by someone who is ill or has been in contact with someon with diarrhoea and vomiting, cross contamination
bacterial infections which cause food poisoning
salmonella, campylobacter, shigella, C. difficile
viral infections which cause food poisoning
norovirus, rotavirus
fungal infections which cause food poisoning
aspergillus
protozoal infections which cause food poisoning
cryptosporidia, giardia
bacterial toxins which cause food poisoning
clostridium perfringens, s.aureus, clostridium botulinum
marine biotoxins which cause food poisoning
scombroid poisoning, shellfish, ciguatera
chemicals which cause food poisoning
heavy metals, pesticides, herbicides
most common cause of food poisoning
campylobacter
clinical picture of salmonella infection
transmission - ingestion of contaminated food, faecal contaminations, person-person infected animals
can cause enteric fever or enterocolitis, incubation period is 12-72 hours, symptoms - diarrhoea, vomiting, fever, headache, chills
clinical picture of staph aureus infection
transmission contaminated food by skin/nasal flora, produced enterotoxins, incubation 2-4 hours, rapid onset, projectile vomiting and diarrhoea
clinical picture of crytosporidium infection
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 immunocomprimised
clinical piture of e.coli infection
contaminated food, person-person, 1-6 days incubation, symptoms - haemorragic colitis, haemolytic uraemic syndrome in 5%
clinical picture of norovirus infection
faecal-oral route, environmental contamination, contaminated food and water, incubation 24-48 hours, symptoms nausea, projectile vomiting, low grade fever, diarrhoea
clinical picture of campylobacter infection
raw/undercooked meat, unpasteurised mild, bird-pecked milk, untreated water, domestic pets with diarrhoea, person-person, incubation 2-5 days, fever, headache, malaise, nausea, diarrhoea, vomiting=uncommon
prevention of food poisoning
isolation, hand hygiene, protection (gloves gowns masks), environmental cleaning, respiratory hygiene and cough etiquette
‘safe food’
food that will not cause harm to a person who consumes it when it is prepared, stored, and/or eaten according to its intended use
concerns with food
food bourne illness, nutritional adequacy, environmentl contaminants, pesticides, naturally occuring contaminents, food additives
public health act statement on food poisoning
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
offences under the food safety act 1990
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,
sale of any food which is not of the nature or substance or quality demanded by the purchaser,
sale of food for sale with a label that falsely describes the food, or is likely to mislead as to the nature or substance or quality of food
hazard analysis critical control point
analysis of potential food hazards in a food business, identification of points in operations where such hazards could occur, deciding which of the identified points are critical to food safety, 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
outbreak
incident in which 2 or more people thought to have a common exposure experience a similar illness or proven infection
objectives in food poisoning outbreakds
reduce number of primary and secondary cases, reduce harm consequent on the episode, prevent further outbreaks`
investigations in food poisoning outbreaks
preliminary phase, immediate steps
preliminary phase investigations in food poisoning outbreaks
is there an outbreak? confirming diagnosis, what is nature and extent of outbreak?
immediate steps investigations in food poisoning outbreaks
who is ill? how many? case finding. what is the cause? is proper care being arranged? what immediate action can be taken?
outbreak outliers
cases at the very beginning and end that may not appear to be related, first check to make certain they are not due to coding or data entry error
what might outbreak outliers represent?
baseline level of illness, outbreak source, case exposed earlier than the others, unrelated case, case exposed later than the others, case with longer incubation period
how can analytical epidemiological studies be useful to identify probable food source of outbreak
compare food history of ill and well persons, point source outbreak - cohort study, common source of outbreak - case-control study
