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Year 3 > Block 31 H&S > Flashcards

Block 31 H&S Flashcards

1
Q

NHS long term plan?

A
  • The NHS long term plan aims to prevent strokes, heart attacks and dementia over the next 10 years
  • specifially looks at detection and management of high risk conditions like AF and hypertension
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2
Q

NHS LTP - AF?

A
  • 90% of patients w AF who are deemed to be high risk to be anticoagulated by 2029
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3
Q

NHS LTP - hypertension?

A
  • 80% of the expected number of people with high blood pressure diagnosed by 2029
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4
Q

NHS LTP - CVD?

A
  • 75% of ppl aged 40 to 74 should receieve a CVD risk assessment and cholesterol reading in the last 5 years by 2029
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5
Q

NHS england

strategies for reducing CV disease in the local community?

A
  • raising public awareness of CVD risk factors
  • * implementing NHS England’s RightCare CVD prevention pathway
  • using existing data to make the case for action
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6
Q

major risk factors contributing to incidence of CVD?

A
  • hypertension
  • high LDL cholesterol
  • diabetes
  • smoking
  • obesity
  • unhealthy diet
  • physical inactivity
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7
Q

CV diease and lifestyle changes?

A
  • lifestyle changes significantly impact cardiovascular health
  • Implementing healthy habits, such as regular physical activity, a balanced diet, smoking cessation, stress management, and adequate sleep, can significantly reduce the risk of CVDs and improve overall cardiovascular well-being.
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8
Q

smoking cessation and CV health - evidence?

A
  • observational study by Duncan et al showed smoking cessation was associated with sig lower CV disease within 5 years relative to current smokers
  • Smoking cessation has the propensity to mitigate cardiovascular diseases and complications especially when achieved on a timely scale.
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9
Q

primary prevention =

A
  • Primary prevention refers to the steps taken by an individual to prevent the onset of the disease.
  • This is achieved by maintaining a healthy lifestyle choice such as diet and exercise.
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10
Q

secondary prevention?

A
  • This is achieved by maintaining a healthy lifestyle choice such as diet and exercise.
  • SP = preventative measures in patienst with a diagnosis of CV disease
  • Secondary prevention focuses on reducing the impact of the disease by early diagnosis prior to any critical and permanent damage.
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11
Q

what does secondary prevention involve?

A
  • secondary prevention includes early diagnosis which requires identifying RF so patients can be treated earlier
  • e.g. treating dyslipdemias and HTN to prevent complications
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12
Q

Three

merits of publically available performance indicators?

A
  • allows patients to be more informed about the services they are accessing
  • KPIs contribute to quality assurance of e.g. screening programmes
  • allows for clinical auits - performsnce can be measured against set standards so that improvements can be made
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13
Q

limitations of publically available performance indicators?

A
  • can create additional stress for patients and their families
  • due to understaffing and pressures some KPI which are set by the DOH are not able to be met such as the 4 hour A&E which puts extra pressure on staff
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14
Q

ethnicity and CVD?

A
  • people from the White Gypsy or Irish Traveller, Bangladeshi and Pakistani communities have the poorest health outcomes across a range of indicators
  • rates of infant and maternal mortality, cardiovascular disease (CVD) and diabetes are higher among Black and South Asian groups than white groups
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15
Q

Ethnic minorities faced more ? during the pandemic?

A
  • ethnic minority groups experienced higher infection and mortality rates than the white population during the pandemic
  • this inequality is thought to be due to many factors such as deprivation, environment, health related behaviours - SES is a key determinant of health status
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16
Q

amongst ethnic minority groups, structural racism can?

A

reinforce inequalities, for example, in housing, employment and the criminal justice system, which in turn can have a negative impact on health.

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17
Q

which ethnic group has the highest risk of death from heart disease?

A
  • South Asian people have the highest risk of death from heart disease of any ethnic group, a 50% higher risk than the population of England and Wales.
  • SA people develop heart disease at a younger age
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18
Q

Death from ischaemic heart disease was highest for?

A

men and women in the Bangladeshi, Pakistani and Indian ethnic groups, compared to other ethnic groups

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19
Q

women that are at higher risk of CVD?

A
  • women with lower levels of education and living in more deprived areas of the UK are at greater risk of CHD - largely due to smoking, obesity and physical activity
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20
Q

Women are ? as likely to die from CHD?

A

2X

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21
Q

Women are more likely to receive?

A
  • women are 50% more likely to receive the wrong intial diagnosis for a heart attack
  • poor aftercare following a heart attack
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22
Q

RF for heart disease in women?

A
  • risk factors for heart disease often more deadly for women - Smoking increases women’s heart attack risk up to twice as much as men’s,
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23
Q

barriers to rapid diagnosis and treatment for a MI?

A
  • atypical presentation e.g. elderly with comorbitiies or women
  • -> lack of knowkedge - health literacy
  • can present like indigestion -> GP
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24
Q

Barriers to accessing care for MI - time to arrive at hospital?

A
  • distance
  • access to transport
  • availibility of ambulances
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25
Q

time for correct diagnosis and treatment - MI?

A

availability of proper treatment, staff shortages, waiting lists

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26
Q

methods of reducing delay for an MI?

A
  • patient education on atypical presentations
  • early ECG/ troponin on arrival
  • early diagnsosis for STEMI for PPCI/ fibrinolysis
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27
Q

Causes of asthmatic attacks?

A
  • allergies
  • acid reflux
  • high humidity weather
  • breathing in cold dry air
  • fragrances
  • stress
  • paint fumes
  • pets
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28
Q

social triggers for asthma attacks?

A
  • smoking and secondhand smoke can trigger an asthma attack
  • air pollution
  • cockroaches
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29
Q
A
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30
Q

occupational triggers for asthma?

A
  • dust
  • chemicals - pains, varnishes, adhesives, cleaning supplies
  • fumes
  • metals - platinum, chromium
  • animal fur
  • resp irritatnts like chlorine gas
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31
Q

management of chronic asthma (BTS guidelines)

A
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32
Q

Who should be considered for prophylaxis of DVT?

A
  • all patients should undergo a risk assessment to identify their risk of VTE and bleeding on admission to hospital
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33
Q

Mechanical thromboprophylaxis?

A
  • anti-embolism stockings - should not be offered to patients admitted with acute stroke or those w PAD, peripheral neuropathy or severe leg oedema
  • intermittent pneumatic compression
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34
Q

pharmacological thromboprophylaxis?

A
  • LMWH
  • DOACs
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35
Q

approaches to controlling spread of TB?

A
  • BCG vaccines - high risk groups
  • good ventilation
  • practicing good hygeine
  • isolating TB patients and contact tracing
  • early diagnosis
  • supporting adherence to treatment - DOT
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36
Q

How many new cases of lung cancer a year?

A
  • almost 50k new cases and 35k deaths / year
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37
Q

how many lung cancer cases are preventable?

A

80%

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38
Q

10 year survival for lung cancer?

A

10%

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39
Q

lung cancer is the ? most common cancer in the UK

A

3RD

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40
Q

rates of lung cancer in the last decade?

A
  • rates have increased in females in the last decade but decreased in males
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41
Q

RF for lung cancer?

A
  • smoking
  • ionising radiation exposure
  • radon gas
  • asbestos exposure - and other substances like arsenic, chromium, nickel
  • FHx
  • air pollution
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42
Q

NHS stop smoking services?

A
  • can self refer by completeing an online form or by calling the stop smoking service
  • 1:1 and group stop smoking sessions
  • at the first session, discussion of stop smoking aids like NR products including patches and bupropiun
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43
Q

NHS community pharmacies for smoking cessation?

A
  • supports ppts who started a stop smoking programme in hospital to continue their journey in community pharmacy
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44
Q

smoking support for someone who declines referral to NHS stop smoking services?

A
  • Informed about sources of information and support forsmoking cessation.
  • Offered practical advice.
  • Advised to stop abruptly.
  • Offered drug treatment to reduce withdrawal symptoms.
  • These include nicotine replacement therapy (NRT), varenicline or bupropion
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45
Q

harm reduction approaches for those not wanting to stop smoking?

A
  • cutting down smoking with or without NRT
  • temporary abstinence from smoking
  • NRT may be used as long as necessary to prevent relapse
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46
Q

barriers to rapid diagnosis of MI?

A
  • A social “wait and see” approach to chest pain
  • Attendance of GP and not immediately attending A&E
  • GP surgeries not open at the weekend and so pts that might not want to
    attend A&E wait until Monday
  • troponin levels may not rise until 12 hrs after symptoms
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47
Q

Methods to reduce the delay in treatment of suspected ACS?

A
  • Increased awareness of symptoms and advise to seek medical attention
    immediately if symptoms are experienced
  • NICE guidelines on early diagnosis of NSTEMI and UA
  • Fast-tracking admitting system in A&E
  • Rapid response ambulances
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48
Q

Pros of publicly available performance indicators?

A
  • Provide information/statistics about healthcare providers
  • Informs patients and encourages choice
  • Transparency, honest and open (increase trust in health providers as a result)
  • quantitative - clear numerical value
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49
Q

Cons of publicly available performance indicators?

A
  • Relationship with quality of care not demonstrated
  • Even if all treatment was uniform there would always be random variation in mortality rates across hospitals
  • dependent on non hosp care
  • No evidence that publishing these influences pts (does influence clinicians and managers however)
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50
Q

CHD - ethnicities at highest risk?

A
  • SA have 50% higher risk of CHD
  • Bangladeshi have the highest rates > Pakistani > indian
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51
Q

who has the lowest risk of CHD?

A

Black individuals of West African and African origin in the UK have half the risk of the european population

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52
Q

reasons for the difference in IHD rate between ethnicities?

A
  • differences in HC access
  • increased diabetes prev in SA populations
  • genetic susceptibility
  • Increased smoking prevalence in ethnic
    minority populations
  • Oestrogen may have protective effect
    regarding IHD
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53
Q

Modifiable RF for CVD?

A
  • Hypertension
  • Smoking
  • Diabetes mellitus
  • Hypercholesterolaemia
  • Obesity
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54
Q

Non mod IDH RF?

A
  • Age
  • Sex (M>F)
  • FHx
  • Ethnicity
  • Socio-economic position (lower>higher
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55
Q

change in smoking rates?

A
  • overall decreasing numbers but higher
    teenage female smoker
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56
Q

poor diet/ obesity rates?

A

Poor diet/obesity - thought to be responsible for 25-50%
of CVD deaths per year - prevalence increasingly rapidly worldwide

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57
Q

NICE physical activity guidance?

A

Physical activity- at least 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous intensity aerobic activity

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58
Q

NICE - alcohol guidance?

A

Alcohol intake - no more than 14 units per week - some of the days should be alcohol free

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59
Q

e.g. of PP

A

Smoking cessation, healthy eating, exercisE

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60
Q

e.g. of SP?

A

Antiplatelet therapy, statins, antihypertensives

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61
Q

e.g. of Tertiary prevention?

A
    • limiting the impact that adverse event has on health
  • CABG/PCI/Thrombolysis, cardiac rehabilitation
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62
Q

prevention paradox?

A

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

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63
Q

JBS risk tables show the absolute 10 year risk for?

A
  • new angina
  • non fatal MI
  • death from stroke
  • death from CAD
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64
Q

two?

Outline a strategy to reduce cardiovascular disease in the local community?

A
  • Annual calculations of the QRISK2 score
  • Educating members of the public at a younger age, to instil healthy lifestyle habits
  • Prescription of 20mg atorvastatin to pts with a QRISK2 score greater than 10%
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65
Q

Community based method of reducing CVD in the local community?

A

exercise groups, healthy cooking classes, regular BP and cholesterol screenings

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66
Q

Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening health conditions such as:

A
  • Heart disease
  • ACS
  • CVA
  • Cardiac failure
  • Peripheral arterial disease
  • Aortic aneurysms
  • Kidney disease
  • Vascular dementia
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67
Q

BP targe for <80 yrs?

A
  • Clinic BP <140/90 mmHg
  • ABPM/HBPM <135/85 mmHg
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68
Q

> 80 yrs BP target?

A
  • =/>80yrs - Clinic BP <150/90 mmHg
  • ABPM/HBPM <145/85 mmHg
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69
Q

DM pts w/ established atherosclerosis and patients with chronic renal failure aim for

A

<130/80 mmHg

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70
Q

major precipitants of asthmatic attacks?

A
  • pollen, animal fur
  • infections
  • smoke, pollution
  • meds
  • emotions - stress/ laughter
  • mould/ damp
  • exercise
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71
Q

sudden changes in ? can precipitate an asthma attack?

A

Sudden changes in temperature, cold air, wind, thunderstorms, heat and humidity

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72
Q

occupational allergens?

A

bakers, farmers, carpenters and people involved in manufacturing plastics, foams and flues

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73
Q

Pathophys of asthmatic attacks?

A
  • type 1 hypersen
  • hygiene hypothesis - clean envr - inert particles seen as allergens
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74
Q

Asthma BTS guidelines

A
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75
Q

acute asthma Mx?

A
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76
Q

identify ppts at risk of DVT

A
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77
Q

initial measures of DVT prevention - all ppts?

A
  • Avoid dehydration
  • Encourage early mobilisation
  • Aspirin or antiplatelets should not be considered adequate VTE prophylaxis
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78
Q

DVT prophylaxis for low risk ppts?

A

Only offer mechanical prophylaxis - compression stocking, intermittent pneumatic pressure

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79
Q

high risk DVT prophylaxis?

A
  • Mechanical prophylaxis
  • Pharmacological prophylaxis - LMWH, UFH, DOACs or fondaparinux
  • IVC filters
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80
Q

approaches to controlling spread of TB?

A
  • BCG
  • contact tracing
  • screening
  • hygiene
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81
Q

BCG?

A
  • Provides life-attenuated strain of organism
  • Currently risk-based e.g. only people who live in high-risk countries, high-risk areas or have high-risk occupation receive the vaccine
  • Administration at birth to prevent the development of TB in young children in most countries where TB is prevalent
  • Only given to those who are tuberculin negative
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82
Q

Contact tracing?

A
  • Effective tracing can limit the spread
  • Can help identify infected individuals at an early stage which is difficult without active seeking because TB can lie latent in individuals
    before becoming clinically apparent
  • Doctors must notify pt to public health authority
  • All close family members, close contacts at work and home are screened (sputum examination or Mantoux test)
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83
Q

TB screening?

A
  • New entrant into UK should be screened via clinical exam and CXR
  • Also consider screening in deprived urban areas
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84
Q

TB hygiene?

A
  • Cover mouth when sneezing or coughing
  • Avoid spitting in open air
  • Good household ventilation
  • Limited prolonged contact with people who have TB whilst their sputum remains positive
  • isolation
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85
Q

epidemiology of LC?

A
  • 3rd most common cancer in UK
  • Most common cause of cancer death in the UK (50% of people who die from lung cancer are >75)
  • 9/10 cases occur in people >60
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86
Q

where is it higher

lung cancer incidence?

A

Lung cancer incidence currently higher in high income countries but is set to change as smoking patterns change

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87
Q

lung cancer cases that are preventable?

A

80%

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88
Q

RF for LC?

A
  • Cigarette smoking
  • asbestos
  • envr exposures
  • air pollution
  • prev radiation to chest
  • chronic infections - HIV, TB
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89
Q

environmental exposures in lung cancer?

A

arsenic, chromium, nickel, beryllium silica

90
Q

benefits of smoking cessation?

A
  • skin appearance
  • teeth improvement
  • reduced risk of fire at home
  • improved sense of smell and taste
  • reduced risk of CVD and angina
91
Q

lung cancer risk is ? after stopping smoking for 10 yrs?

92
Q

stopping smoking campaigns?

A
  1. Education in school & to patient
  2. Tobacco TV & printed adverts banned
  3. Taxes higher to deter
  4. Adverts on cigarette packets about risks
  5. Age restriction
  6. Smoking banned in public enclosed
93
Q

causes of occupatinal lung diseases - asbestos?

A

roofers and plumbers

94
Q

causes of occupational lung disease - coal?

95
Q

causes of occupational lung diseases - aspergillus?

A

malt workers, farmer

96
Q

causes of occupational lung diseases - cigarette smoking?

A

bar worker

97
Q

causes of occupational lung diseases - radiation?

A

radiographer

98
Q

silica?

A

metal mining, pottery manufacture

99
Q

JOB AT RISK OF EXPOSURE

arsenic?

A

paint factory

100
Q

implication of occupational lung diseases for patients?

A
  • may need to change job
  • may be entitled to benefits/ compensation - industrial industries disablement benefit
101
Q

who can help w compensation for occupational lung diseases?

A

british lung foundation and department for work and pensions

102
Q

spread of disease - direct?

A
  • droplet - imp if compromised skin barrier
  • vertical - mother to foetus
103
Q

indirect transmission?

A
  • airborne - aerosol/ droplet
  • vector borne - mechanical/ bio
  • vehicle borne - water/ food
104
Q

epidemic?

A

Occurrence in a community / region of cases of an illness /
health-related behaviour clearly in excess of normally expecte

105
Q

endemic>

A

Persistent, usual, or expected level of disease in a given populatio

106
Q

pandemic?

A

Epidemic over a very wide area, crossing international boundaries

107
Q

surveillance?

A
  • Systematic collection, collation and analysis of data + resultant
    dissemination, so that appropriate measures can be tak
108
Q

notifiable diseases?

109
Q

What is an audit?

A
  • Audit is the systematic critical analysis of the quality of
    medical care, including:
    1. Procedures for diagnosis = including pathways
    2. Procedures for treatment
110
Q

stages of an audit?

A
  • set standards
  • collect data
  • analyze
  • identify steps to improve
  • implement changes
  • re-evaluate - collect for data
111
Q

benefits of audits?

A
  • Clinical education is improved
  • Can improve teamwork
  • Improve patient care
112
Q

What do audits prevent

how do audits improve ppt care?

A
  • identify if meeting NICE guidance
  • improve cost effectiveness
  • prevent near misses becoming accidents
113
Q
  • of audits?
A
  • can be influenced by confounding factors
  • lack of generalisability
  • small sample size can reduce usefuleness of results
114
Q

aims of guidelines?

A
  • improve quality of HC
  • care is up to date
  • helps make informed decisions based on evidence
115
Q

what are guidelines?

A
  • ”Systematically developed statements that are a consensus of best practice based on the available
    evidence
116
Q

Good guidelines should be?

A
  • valid
  • reproducible
  • cost effective
  • clinically applicable - clear target population
  • clear- easily understood
117
Q

Primary care audit for CVD?

A

CVD prevent

118
Q

NHS funding?

A
  • general taxation
  • NI contributions
119
Q

How is social care funded?

A
  • sep from healthcare
  • managed by LAs
120
Q

in addition to public funding, the NHS is also funded by?

A
  • prescriptions
  • dentistry
  • parking charges
121
Q

NHS: government funding goes to?

A
  • NHSE
  • NHS improvement
  • they are resp for delivering the NHSLTP
122
Q

Role of NHS england?

A
  • oversees commissioning of NHS services
  • allocate funds to CCGs
123
Q

How have we moved away from CCGs?

A
  • CCGs were clinically led grs that decicided on local healthcare needs and allocate funds to diff services
  • have now been merged into ICS
124
Q

intergrated care systems?

A
  • partnerships between hospitals, GPs, community services
  • Since july 2022
  • 42 have been establishes
125
Q

separation of intergrated care systems?

A
  • neighbourhoods
  • places
126
Q

ICS: neighbourhoods?

A
  • GP surgeries coming together as PCNs
127
Q

ICS - places?

A
  • LA area collaborations between H&SC organisations including charity
128
Q

health and social care act?

A
  • 2022
  • gives ICS power and resp
129
Q

Intergrated care partnership?

A

each ICS has a comittee responses for strategy in that area

130
Q

integrated care board?

A

statutory NHS organisation responsible for meeting population health needs and managing budget for services

131
Q

NNT?

A
  • the number of people with a specific condition who need to be treated for a specified period of time in order to prevent one beneficial outcome (NNT to benefit) or adverse outcome (NNT to harm)
132
Q

NNT equation?

A
  • 1/ Abs risk reduction
  • always round UP
133
Q

What are the publicly available performance indicators?

A
  • Performance league tables are a technique for displaying comparative rankings of performance indicator scores of several similar providers = set standard
    of acceptable performance for surgical procedures
  • If any apparent large variations DOH investigates
  • e.g. for cardiac surgery mortality or ppt reported measures like satisfaction
134
Q

why are there publicly avail perf indicators?

A
  • Readily available info in other areas (e.g. schools, police etc.) = why shouldn’t we measure outcomes, as this is the measure of quality
  • There is often a lack of evidence base behind practice should back up what we do with numbers
  • The realization that there is a wide variation in practiced standard / public evidence of deficiency in quality of
135
Q

pros of publicly available perf indicators?

A
  • Allows quantification of quality in an easily categorised & measurable way (e.g. deaths in surgery)
    2. Should drive improvements in quality = can identify outliers & therefore allow for this to be improved upon
    3. Should identify areas for improvement
    4. Give patient trust in doctor & allow patient more choice = transparent, honest & open
136
Q

limitations of publicly available perf indicators?

A
  • misleading - may have higher death rate due to more complex cases
  • could lead to ppts w good prognosis going to good hosp
  • ppt could lose faith in docs
  • individualistic culture of blame
137
Q

adverse event?

A
  • unintended event from clinical care and causing ppt harm
138
Q

never event?

A
  • “Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented
  • e.g. wrong site surgery
139
Q

near miss event?

A

Unplanned event that has the potential to cause harm but does not actually lead to injury or damage

140
Q

human factors?

A

mistakes and purp breaking rules

141
Q

systems factors means there were?

A

poor defence against errors

142
Q

how are adverse events and near misses prevented?

A
  • report on national reporting and learning system
  • root cause analysis
143
Q

most common erros?

A
  • prescribing - wrong dose, wrong drug
  • yellow card system - for reporting of side effects
  • communication failures
144
Q

duty of candour?

A
  1. Must tell patient when something has gone wrong
  2. Must apologize & offer appropriate resolution
  3. Must explain the potential short & long-t
145
Q

swiss cheese model?

A

many events have to align for an adverse event to occu

146
Q

active failures in the SCM are split by?

A
  • unintentional errors
  • intentional errors
147
Q

unintentional errors - knowledge based?

A

wrong plan formed due to inadequate knowledge / experience (e.g. junior doctor misdiagnosis

148
Q

unintentional errors - rule based?

A

: Misapplication of ‘good rule’ / guideline (i.e. applying guideline for 10y/o to neonat

149
Q

unintentional errors - skill based?

A
  • Attention / memory lapse = unintended deviation from good action / pl
  • common
150
Q

intentional errors?

A

A. Routine: Normalisation of bad practice
B. Situational: Context-dependent (i.e. shortcuts when overwhelmed / understaffed)
C. Reasoned: Deliberate deviation from protocol thought to be in best interest at time
D. Malicious: Deliberate act intended to ha

151
Q

swiss cheese model?

152
Q

Steps to ppt safety?

A
  • building a safe culture
  • lead and support staff - don’t create indiv blame culture
  • promote reporting
  • implement solutions to prevent harm
153
Q

mental consequences of obesity?

A
  • insulin resistance and T2D
  • dyslipidemia
  • HTN
  • CVD
154
Q

mechanical consq of obesity?

A
  • osteoarthiris
  • reduced mobility
  • sleep apnoea
  • GI issues - GBD, fatty liver, GORD
155
Q

mental consq of obesity?

A
  • depression and anx
  • low self esteem
  • EDs
156
Q

Tier 3 obesity services?

A
  • specialist weight management services psychologists, doctors, nurses
  • comprehensive assessment - obesity related health risks, dietary habits
  • personalised Tx plans
  • Pharmacological management
157
Q

Tier 4 obesity services?

A
  • specialist obesity clinics
  • evaluation for elibility of bariatric surgery
  • bariatric surgery procedures
  • MDT - surgeons, physicians, dietitians, psychologists, and other healthcare professionals to ensure holistic care throughout the bariatric surgery process
159
Q

cardiac rehab involves?

A
  • Helps u recover and get back to as full a life as possible after a heart attack, heart surgery or following a diagnosis such as heart failure
  • individualised exercise, education and support programme built around your personal circumstances and needs.
160
Q

Cardiac rehab - resources?

A
  • cardiac rehab - video calls, websites, telephone support
161
Q

cardiac rehab -RF?

A
  • risk factors - eating healthy, stopping smoking, building exercise
  • exercise sessions - tailored to need and ability
162
Q

Cardiac rehab - info and support?

A
  • information and education sessions - eating healthy, abt medications, smokingc cessation etc
  • peer support - meet people in the same situation
  • emotional support and wellbeing
163
Q

what can cardiac rehab help w?

A
  • recovering from surgery, procedure or heart attack
  • reducing risk of further heart probs
  • improving MH
  • making lifestyle changes
164
Q

women w CHD have ? outcomes?

A
  • women w CHD have worse outcomes than males
  • Women tend to present with coronary artery disease later in life
165
Q

how do women w CHD present?

A
  • Women experience longer delays in access to hospital care and are less likely than men to have invasive diagnostic procedures
  • fewer women present with classical symptoms of chest pain
166
Q

why are women’s symptoms often not recognised?

A
  • The historic limited interpretation of women’s symptoms based on the traditional approaches such as the Diamond and Forrester risk model results from under-recognition of the sex-specific presentation of IHD and contributes to misdiagnosis and delayed recognition of ischemia
167
Q

women w IHD use more?

A
  • women with IHD use more cardiac resources and incur greater healthcare costs bc of greater symptom burdern and hospitalization
168
Q

subgroups of women who experience worse outcomes?

A
  • Subgroups of women who experience worse outcomes for IHD include younger women (aged <55 years) and those of Black, Latino, and South Asian descent
169
Q

south asian MI risk?

A

upto 30% more likely

170
Q

black people MI risk?

A
  • Black people were at 51% lower risk of myocardial infarction
171
Q

mortality from IHD in both SA men and women?

A
  • mortality from IHD in both South Asian men and women is 1.5 times that of the general population
172
Q

Impact of living w uncertain prognosis?

A
  • depression
  • distress
  • anxiety
  • stress
  • hyperaware of physical changes
  • focusing excessively on the medical details
173
Q

role of HF specialist nurses?

A
  • co-ordinate care for the patient promotoing MDT approach
  • assisting patient with self management
  • accessible to patients and ehtir families - rapid response
  • support and counselling
  • easy access to a profressional who knows the patient and can provide consistent care
174
Q

Referral to MDT/ cardiology?

A
  • severe HF (NYHA class 4)
  • HF that doesn’t respond to tx
  • HF from valvular disease
  • LVEF of <35%
  • women w HFrEF who are plannig a pregnancy
175
Q

occupations at risk of asthma?

176
Q

LC referral guidelines

177
Q

aetiology of LC?

A
  • smoking - 80-90% of cases
  • asbestos exposure - strongly associated with mesothelioma but also linked to adenocarcinoma of the lung
  • radon gas - occurs from uranium
178
Q

2 week referral for LC

A
  • unexplained haemoptysis and aged over 40
  • Patients with evidence of SVCO or stridor require an urgent referral and emergency admission to hospital for further review.
179
Q

occupational and enviromental lung diseases - deaths due to?

A
  • deaths mainly due to PM2.5
  • Deaths are due to IHD/stroke (58%), COPD (18%), lung cancer (6%)
180
Q

pollutants - particulate matter?

A
  • A mix of solid and liquid droplets arising mainly from fuel combustion and traffic
  • This has the greatest impact on peoples’ health
181
Q

pollutants - NO2?

A
  • Arising mainly from road traffic and indoor gas cooking
182
Q

Pollutants - sulphur dioxide?

A
  • Arises mainly from burning fossil fuels
  • Associated with asthma and poor lung function
183
Q

pollutants - ozone?

A
  • Caused by the reaction of sunlight with pollutants from vehicle emissions
  • A major factor associated with asthma
184
Q

most toxic PM?

A
  • particulates are a mix of solid and liquid droplets in the air e.g. soot
  • PM 2.5 are the most toxic and are associated with CR disease and lung cancer
185
Q

indoor air pollution?

A
  • Worldwide smoke fires used for cooking.
  • Biomass fuels produce large amounts of particulate matter
  • contributes to COPD and childhood respiratory infection
186
Q

occupational asthma?

A
  • commonest cause of occupational lung disease in the UK
  • interactionw smoking and atopy
187
Q

Work related asthma?

188
Q

occupational asthma causes

189
Q

identifying occupational asthma?

A
  • ask abt occupation - are symptoms worse at work and are they better when they’re away from work - weekends/ holiday?
  • peak flow diary
  • challenge tests
190
Q

pneumoconiosis?

A
  • lung disease resulting from inhalation of dusts
  • Long latency between exposure and development of disease
191
Q

types of pneumoconiosis?

A
  • Coal workers pneumoconiosis
  • Silicosis
  • Asbestosis
  • Many other rarer causes (eg. Berylliosos, Bagossis etc).
192
Q

silicosis?

A
  • rare
  • looks like sarcoidosis
  • predisposes to TB and LC
  • Upper lobe nodules and lymph node calcification
193
Q

asbestos can cause a range of diseases?

A
  • Benign asbestos related pleural plaques
  • Asbestos related pleural effusions
  • Diffuse pleural thickening
  • Mesothelioma
  • Lung fibrosis (asbestosis)
  • Lung cancer
194
Q

Mesothelioma?

A
  • almost always caused by occupational exposure
  • long latency
  • rising prev in UK despite being banned in the 70s
  • incurable
195
Q

occupational lung cancer?

A
  • Estimated to cause 10% of lung cancers in men
  • Asbestos estimated to cause 60% of these but unclear whether has to cause fibrosis (asbestosis) first or direct effect
196
Q

other causes of occupational lung cancer?

A
  • Also arsenic,chromium, coal gas, coke production, cadmium, chloromethyl ethers, silica, radon, soot
197
Q

Role

the health and safety executive?

A
  • independent regulator that aims to prevent work related death, injury and ill-health
  • produce guidance
198
Q

organisations with responsibility for the environment and health?

A
  • Deparment for environment, food and rural affairs
  • PHE - air pollution
199
Q

occupational lung diseases?

200
Q

Jobs at risk of sillicosis?

A
  • mining
  • slate works
  • foundries
  • potteries
201
Q

high incidence TB countries?

A
  • india
  • indonesia
  • pakistan
  • china
202
Q

RF for TB?

A
  • Place of birth
  • HIV
  • Prison inmates/staff,
  • nursing homes
  • homeless shelters,
  • health care workers,
  • substance abuse,
  • immigrant centres & migrant workers camps
203
Q

medical factors inc TB risk?

A
  • under nutrition
  • smoking
  • cancer
  • HIV
  • taking illicit drugs
  • alcoholism
204
Q

social factors increasing risk of TB?

A

Single/widowed men, immigration, incarceration, homelessness

205
Q

contact tracing in TB?

A
  • idenficiation of contacts of TB positive individuals
  • national target is for 90% of people with infectious TB to have at least 5 contacts traced
  • pre-entry screening programme for testing of active pulmonary TB in migrants from high incidence countries who apply for visas which reduces importation of active TB
206
Q

Benefit over mantoux

INF-gamma tests?

A
  • quantiferon TB gold - used in place of TB testing for previous infection
  • not confounded by prior BCG vaccine
  • main role is screening for latent disease
207
Q

what does the INF-G test measure?

A
  • measures cell mediated immune response by looking at INF-g released by T cells in response to TB antigens
208
Q

TB drugs?

A

*Isoniazid
*Rifampin
*Pyrazinamide
*Ethambutol

RIPE

209
Q

other tests for TB patients?

A
  • Testing for HIV
  • hep B and C serologic tests if risks present
210
Q

tests to do when TB Tx is initiated?

A
  • AST
  • ALT
  • bilirubin
  • ALP
  • serum creatinine
  • platelet count
  • Visual acuity and color vision tests (when EMB used)
211
Q

Approaches to controlling spread of TB
?

A
  • improve vaccination uptake
  • address TB in under-served populations
  • improve access to services and ensure early diagnosis
  • quarentine
  • DOT - directly observed treatment when non-compliance suspected e.g. homeless, alcoholics
212
Q

MDT TB teams should provide data to TB control boards on:

A

screening uptake, referrals and the number of active TB cases identified.

213
Q

TB control boards should?

A
  • control boards should develop TB prevention and control programmes working with commissioners, Public Health England and NHS England
  • TB control boards should be responsible for developing a TB prevention and control programme based on the national strategy and evidence‑based models.
214
Q

roles of the TB control boards?

A
  • TB control boards should plan, oversee, support and monitor local TB control, including clinical and public health services and workforce planning.
215
Q

CF screening?

A

heel prick blood test

216
Q

advanced care plainning?

A
  • process of discussion between and indiv and their care providers
  • facilitates and enables individuals to think abt the care that they would like to receive
  • allows them to choose where they want to die
217
Q

Benefits of ACP?

A
  • patient centered
  • prevents over-treatment when the patient lacks capacity
218
Q

Indicator of deterioration?

A

SPICT tool - indicators of deteriation for each disease

219
Q

EoL care plan:

A

ensures best quality of care during the patients last days

220
Q

advanced care planning leads to

221
Q

most common cause of liver failure in the UK?

A

Paracetamol overdose

222
Q

when is prev higher than indicence?

A

In chronic disease prevalence is greater than incidence - in acute disease the incidence is greater than the prevalence

Year 3 (45 decks)

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