Block 34 H&S Flashcards
1
Q
Who manages the blood transfusion service?
A
- the blood transfusion service is managed and co-ordinated by NHS blood and transplant - national organisation resp for blood donation, collection, testing, processing and dist
2
Q
What is the NHSBTS ?
A
- NHSBT is a special health authority in England that oversees the provision of blood and organ donation and transplantation services.
- It operates under the oversight of the Department of Health and Social Care (DHSC) and reports to the NHS England and NHS Improvement
3
Q
Blood donation centers?
A
- NHSBT operates a network of fixed and mobile blood donation centers across England.
- These centers provide facilities for voluntary blood donors to donate blood, plasma, and platelets.
4
Q
Labs in the NHSBT?
A
- Donated blood undergoes testing for infectious diseases, blood group typing, and compatibility testing at specialized laboratories operated by NHSBT.
- Processing facilities prepare blood components such as red blood cells, platelets, and plasma for distribution to hospitals.
5
Q
hospital blood banks?
A
- NHSBT supplies blood and blood products to hospitals across England through its regional distribution network.
- Hospital blood banks receive and store blood products from NHSBT and provide them to patients as needed for transfusion.
- They also perform compatibility testing for patients and monitor transfusion reactions.
6
Q
NHSBT specialised services?
A
- NHSBT provides specialized services for patients with specific transfusion needs, such as neonatal and pediatric transfusions, immunoglobulin therapy, and rare blood product provision.
7
Q
using blood products safely?
A
- blood compatibility - ABO and Rh typing as well as crossmatching
- following protocols
- coumentation
- education - risks and signs of complications
- adversr reaction management
- post-transfusion monitoring
8
Q
Aim of the NHS diabetes prrevention programme 2016?
A
Aim of the programme is to reduce the incidence of type 2 diabetes and its associated complications
9
Q
NHS DPP identifies?
A
It identifies patients high risk of developing type 2 diabetes and enrolling them into a programme over a 9 months period
10
Q
Three
NHS DPP is focused on?
A
The programme focused on achieving weight loss, increasing physical activity and improving diet
11
Q
Where is the nHS DPP available?
A
only England
12
Q
Who is eligible for the NHS DPP?
A
Individual above 18 of age and with HbA1c in the non-diabetic hyperglycaemia(42-47mmol/mol) is eligible for this programme
13
Q
confidence interval =
A
range of values that most likely contains the true value of the population
14
Q
which 3 factors determine the width of a confidence interval?
A
- variation within the population
- sample size
- confidence level
15
Q
Mean
a sample with little variation means a sample taken
A
the sample taken will have a mean similar to that of the population
16
Q
more variation ->
A
wider CI
17
Q
Larger sample size ->
A
a larger sample size has more variation so it decreases the CI
18
Q
A 95% confidence interval means that…
A
- in 95 out of 100 samples the value will fall between the upper and lower values specified by the CI
19
Q
CI graph
A
95% is the general consensus
20
Q
risk of disease =
A
number of people who have the disease/ all exposed
21
Q
risk of disease in non exposed =
A
number of people who developed the disease in the unexposed group/ total unexposed
22
Q
Attributable risk =
A
- added risk of developing an outcome based on exposure
- difference in risk between the exposed group and unexposed gr
23
Q
AR equation
A
24
Q
attributable fraction =
A
- percent of an outcome that could possibly be prevented if a risk factor was to be removed
- a.k.a as attributable risk percentage
25
if the attributable fraction for smoking and lung cancer is 70% this means that
70% of lung cancers are related to smoking
26
equation for AF?
risk in exposed - risk in unexposed
/
risk in exposed
27
alt equation for AF that can be helpful for observational studies =
(RR-1)/ RR x 100
28
normal dist?
- bell shaped curve
- is a probability distribution
- continoud and symmetric around the central value - mean
29
Normal dist - mean, median, mode?
all placed at the center
30
variance =
- shape of the curve
- refers to spread of distribution
- often expressed as the SD
31
# Equation
SD =
sq route of variance
32
what follows normal dist?
- BP
- birth weight of babies
33
Increasing mean vs increasing variance?
- increasing variance makes the graph flatter and wider
- changing the mean moves the curve to the left or to the right but doesn't change the shape
34
% of values that fall within 1 SD of the mean?
68%
35
probability of values that fall within 2 SDs of the mean?
95%
36
% that fall within 3 SD of the mean?
99
37
Sensitivity =
- how good a test is at finding disease
- proportion of affected indiv correctly identified by the test
38
Sensitivity equation =
true positives/ all affected
39
tests with high sensitivity help us rule ? disease
OUT
SnOUT
40
Highly sensitive tests are useful for...
screening tests
41
specificity related to how well the test...
identifies disease free individuals
42
specificity =
prop of unaffected indiv corretcly identified by the test
43
Sp equation =
true negatives/ all affected
all affected means the true negatives and the false positives
44
risk ratio is the
- measure used to compare the risk of an event occuring between 2 groups - often an exposed and unexposed grs
45
risk ratio is also known as the
relative risk
46
relative risk is used to assess the
strength of association between an exposure and outcome
47
RR is usually used t interpret results of which study type?
cohort studies
48
RR equation
- number of people with disease in the exposed group/ all exposed
- number of people in the unexposed gr w disease/ all unexposed
divide these 2 values
49
RR of 1 means that
- there is no association between disease and exposure
50
RR > 1 means that
there is an increased risk of disease occuring with exposure
51
Risk ration <1 means that
there is reduced chance of disease occuring w exposure
52
Which is preferred between RR and OR?
RR preferred as its based on probability
53
for rare diseases where prev is low, the odds ratio can
approximate the risk ratio
54
RR = 5 means that
there is a 5x inc risj
55
RRR=
proportion of risk reduced when comparing the exposed and the unexposed group
56
equation for the RRR?
1 - risk ratio
57
Absolute risk reduction =
difference in risk between the unexposed and the exposed group
58
Equation for ARR?
- Like relative risk but you minus instead of dividing the risk in each group
- so the risk in the unexposed - the exposed group
59
odds ratio is the
- odds of exposure in people who have the condition vs the odds of exposure in the controls
60
Odds interpretation?
- same as RR but also look at the confidence interval
- CI should be above 1 for statistical significance
61
odds ratio equation =
disease in exposed group/ disease in unexposed gr
--------------------------------------------------------------------
exposed free of disease/ those without disease and without exposure
A/ C divided by C/ D
62
When are risk and odds ratios used?
- RR: cohort
- OR: case control studies
63
Rare disease rule?
risk ratio can be used in place of odds ratio fir case control studies
64
What needs to occur for OR to be considered stat sig?
CI needs to be above 1
65
What is a positive likelihood ratio?
- tells us how much more likely a positive result is in those with the condition
66
positive likelhihood ratio is the odds of a disease being present when
an indiv tests positive
67
PLR formula?
sensitivity/ 1 - specificity
68
Negative LR =
- can tell us how much more likely a negative test result is in those without the condition compared to those w
69
NLR is the odds of...
disease not being present when an indiv tests negative
we want a low NLR for a good test
70
NLR formula?
1 - sensitivity/ specificity
71
What does a LR of 1 indicate
- test is not useful
- result is unable to distinguish between those w disease and those without
72
LR test of <1 indicates that
- the test for a disease is useful in ruling out disease as a negative result is more likely to occur in those without the disease
- negative LR -> ruling out
73
LR >10 indicates that
- the test is useful in ruling in disease as a positive result is more likely to occur in those w the disease
- positive LR -> ruling in
74
A LR of between 1 and 10 is
not useful. Can't rule in or out disease
75
what do predictive values look at?
- ratio of patients correctly diagnosed to the apparent test results
76
PPV is the ratio that
- someone who has tested positive actually has the disease
77
PPV equation =
number of true positives/ all positives
x100 to get the %
78
NPV is the
chance of not having the disease when the test is negative
79
NPV equation
number of true negatives/ all negatives
80
prev =
total number of indiv in a population who have a disease at a specific period of time, given as a percentage
81
as prevalence rises,
- PPV rises
- NPV rises
as bc the prev is going up, more ppl have the disease and so are more likely to test positive
82
RCT design?
- ppt randomly allocated to intervention or control gr
- practical or ethical problems may limit use
83
cohort studie mechanism?
- observational and prospective
- ppts selected according to exposure and then followed up to see how many develop the disease or outcome
84
usual outcome measure in cohort studies?
relative risk
85
CCS are
observational and retrospective
86
what happens in CCS?
- patients with a condition - cases are identified
- they are matched with controls
- data is collected on past exposure looking for a cause of the condition
87
CCS usually use the
odds ratio
88
benefits of CCS?
- inexpensive, produce quick results
- useful for studying rare conditions
89
- of CCs?
prone to confounding
90
Cross sectional studies provide a
snapshot - sometimes called prevalence studies
91
CSS -
provide weak evidence for cause and effecr
92
bias definition =
- where one outcome is systematically favoured
93
selection bias?
- error in assigning people to groups which leads to differences between groups
94
recall bias =
- differences in recall
- particularly in case control studies
95
Example of recall bias?
E.g. a patient with lung cancer may search their memories more thoroughly for a history of asbestos exposure than someone in the control group
96
Publication bias =
- failure to publish results from valid studies as they showed a negative of uninteresting results
- e.g. meta analyses where negative results may be excluded
97
expectation bias =
- Only a problem in non-blinded trials.
- Observers may subconsciously measure or report data in a way that favours the expected study outcome.
98
Hawthorne effect?
Describes a group changing it's behaviour due to the knowledge that it is being studied
99
lead time bias =
Occurs when two tests for a disease are compared, the new test diagnoses the disease earlier, but there is no effect on the outcome of the disease
100
length time bias?
- overestimation of survival due to excess of cases detected that are slowly proressing
101
lead vs length time bias?
- Lead-time bias is due to early detection. Remember the "d" in lead is for early detection.
- Length-time bias is due to slow cases being detected more often simply because they are slowly progressing. Remember the "g" in length is for slowly progressing.
102
validity =
accuracy of results
103
Reliability =
Reliability is used in statistics to imply consistency of a measure.
104
case control vs cohort in terms of retro and prospective?
cohort: either pro or retro
CCS: retro
105
What is the most appropriate design for diagnosis?
cross sectional = observational study that analyses data from a
population at a specific period of time
106
studies looking for aetiology?
- cohort
- CCS
107
cohort study =
ongitudinal study that follow a population, often one that has a
particular exposure – e.g. smoking
108
case control study =
= population study in which two existing groups differing in
outcomes are identified & compared based on basis of some supposed causal
attribution
109
prognosis studies ?
cohort
110
which study to use for treatment?
RCT/systmatic reviews
111
Evaluation studies?
SR/ MAs
112
Advantages of a cohort study?
- Best information about causation
* Able to examine a range of outcomes
* Good for rare exposure
113
Disadvantages of a cohort study?
- Long follow up = expensive & time-consuming
- Bad for long latency periods
* Can have different follow-up for exposed / non-exposed
* Confounders not recognized
114
advantages of CCS?
- Simple / easy to conduct = don’t require long follow ups
* Best for rare outcomes
* Good for long latent periods
115
Disadvantages of CCS?
- bad for rare exposure
- inferior to cohort
- recall bias
- confounding
116
selection bias =
* Error in assigning individuals to groups, leading to differences in
group’s qualities that may influence the outcomes
* To make inferences from results, we require sample to be
representative of population = requires random sampling (or if
smaller group some stratified randomization)
117
Reasons for selection bias?
- Sampling -> selected subjects not rep of population
- volunteer - volunteers not rep of population
- non responder - responders not rep of population
118
randomisation?
- ensures unpredictable assigment to groups
- Purpose is to ensure that any confounding
characteristics are equally distributed between
the two study groups, avoiding selection bias
119
simple randomisation?
computer random number generator (may have chance bias)
120
stratified randomisation =
to make sure you have equal numbers of e.g. different severities of illness in each patient group
121
when something is precise the CI is?
narrow
122
internal validity =
How well study was conducted, taking
confounders into account & removing bias
123
external validity =
Generalizability -> how well the study can be applied to diff scenarios/ patients/ environment
124
what is face validity?
general impression of a test. A test has face validity if it appears to test what it is mean to.
125
content validity =
- refers to extent to which a test or measure assesses the full content of a subect area
126
criterion validity =
- comparisons of tests
- uses correlation coefficient
127
construct validity =
extent to which a test measures the construct it aims to
128
what does blinding prevent?
- prevents observer bias
- confirmatio bias
- expectation bias
129
observer bias =
form of reactivity in which researcher’s cognitive bias causes them to subconsciously influence the participants of experiment = could influence
extra quality of care to these patients
130
expectation bias =
= Observers may subconsciously measure or report data in a way that favours the expected study outcome
131
managing attrition bias?
- ITTA = All patient analyzed even if didn't complete study = if dropped out either use data before drop out or include this in analysis as a limitation of the study / potential
132
Bradford Hill criteria to assess for causation?
- Strength = effect size
- Reproducibility = in concordance with other findings
- Specificity = other likely explanation for results
- Temporality = effect occurs after cause
- Biological gradient = greater exposure = greater effect
- Plausibility = logical mechanism by which effect is achieved
133
what is the gold standard for cause and effect?
- RCT
- but it's not ethical to allocate patients to certain exposures that may be harmful
134
questionnaires are subjec to?
recall bias & response bias (a group with a certain condition may be less likely to respond)
135
what is confounding =
“Distortion (or potential for distortion) of association between outcome and exposure, by a third factor which has an association with both exposure &
outcome”
136
# How is confounding controlled for?
if confounding has not been taken into account in a study?
if not, association between exposure and outcome could be biased = can stratify, or (more often) do Multi-Variable Regression
137
inappropriate measurement can lead to
type 1 or type 2 error
138
incomplete follow up can reduce?
power of the study
139
insufficient length of follow up ->
underestimation of outcome and exposure association
140
systematic reviews +
- speed
- ethics - can u justify the ethics or a new trial if trials are already available
- increased sample size -> improved power and precision
141
cross sectional studies?
- observational
- Source population is examined to see what proportion has the outcome of interest, or has been exposed to the risk factor of interest, or both.
- Looks at individuals within a population at a single point in time
142
cross sectional studies are most useful to investigate?
diagnsosi
143
ecological studies?
An observational study
- Data analysed at population/group level rather than individual
- Often used to measure prevalence/incidence of disease particularly when disease is rare
144
evidence pyramid
145
Number needed to treat?
- “Number of patients who need to be treated to prevent one additional adverse outcome in a given time”
146
Equation for NTT?
- 1 - ARR
- round up to full number
147
equation for NHH?
- “Number of patients who need to be treated to prevent one additional adverse outcome in a given time”
- 1+ ARR
- Round down to full number
148
P value
- Likelihood that the observed result is due to chance
- less than 5, statis sig
149
power of study =
* Power of a study is the probability of correctly rejecting the null hypothesis (power is increased by increasing sample size
150
Type 1 error =
- False positive - null hypothesis is incorrectly rejected
- not affected by sample size
151
Type 2 error =
- * Null hypothesis is incorrectly accepted = false negative
* Decreased by smaller sample size
152
Phase 1 of a clinical trial?
- small gr
- assesses safety. pharmacokinetics and pharmacodynamics, side effects before moving on to larger studies
153
phase 2 studies?
- larger gr to assess dosing and efficiacy
154
studying efficacy means its a phase ? trial?
2
155
phase 3 trials?
effectivessness, compare to other drugs and long term side effects
156
phase 4 trials?
after drug or treatment has authorized for prescription, looking at longer term benefits
157
General ethical principles of a trial?
- risk > benefits
- maximise confidentiality
- all ppts in a fair gr
- ethical committee approval
- patients have a right to withdraw at any time
158
what are the 4 ethical principles?
- autonomy
- beneficence
- non-maleficence
- justice
159
autonomy?
the autonomous individual freely acts in accordance with a
self-chosen plan
160
beneficence?
- moral obligation
- acting in the best interest of ppts
161
Non-maleficence?
do not cause harm
162
justice?
treating all ppts fairly (with equity)
163
Bolam test?
a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular act
164
What is negligence?
- A breach in the legal duty of care which results in damage
- Often passive, or an omission
165
when is negligence criminal?
- Non consensual treatment or
- Not acting in patient’s best interests
166
How is the bolam principle applied?
- principle that establishes whether an act or omission by HCP breached the duty of care menaing that they were negligent
167
Bolam principle - not negligent when?
Not negligent if an established body of professionals supports the act, even if the practice was not standard care (e.. guidelines)
168
Process of producing stigma?
1. Labelling = distinguishing differences between people
2. Stereotyping = making assumptions based on those differences
3. Othering = separates person e.g. diabetes - diabetics
4. Discrimination
169
Felt stigma ?
shame you feel as a result of stigma, may be due to your condition.
170
passing stigma?
not seeking help) → very relevant to health conditions like addiction = may act as a barrier to health-seeking behaviour
171
withdrawing stigma?
Withdrawing → can worsen health conditions
172
covering stigma?
Covering → hiding it can exacerbate sense of stigma = worsen health conditions -
may also present friends/ family from noticing
173
enacted stigma?
2. Enacted = discrimination by others.
174
courtesy stigma?
Courtesy = felt by someone who is with someone else who is being
stigmatised
175
equality act 2010?
Makes it illegal to discriminate directly or
indirectly against people with MH problems in public services and functions, access to premises, work, education and transport.
176
implications of stigma in medicine?
- Fear of stigma may act as health-seeking barrier -
doctors judging patients
- Concerns about confidentiality - who will see my records, and will they stigmatise me?
- Treatments can lead to stigma - e.g. people using wheelchairs following amputation
177
health eductation =
= give people knowledge & skill to change potentially health damaging behaviours
e.g. advice from health professionals, mass media campaigns
178
health protection?
- protection of indiv, groups. and populations through effective collaboration of experts in identifying and mitigating infectious diseases
179
health protection is the resp of?
- responsibility of Public Health through legislation to protect public health e.g. not smoking inside, pollution, seat belts
180
Primary disease prevention IS
prevent onset of disease
181
Types of primary prevention?
- Universal (whole population)
- Selective (risk group)
- Individual (identify high risk individuals eg. genetic mutations)
182
secondary prevention =
cure/ identify disease earlier e.g. screening
183
tertiary prevention?
manage disease
184
Beattie's typology?
- health persuasion
- legislation
- personal counselling
- community based
185
health persuasion -
Mass media campaign
186
legislation?
smking ban in public places
187
factors that influence access to care?
- symptom iceberg
- 70% of symptoms are never reported
188
the way synptoms are perceived =
= illness behaviours → this is what influences if someone
presents to the doctor or not
189
Zola's triggers for seeking healthcare - interference?
- interference w work/ hobbies
- inteference w social relations
190
zola's triggers - interpersonal crisis?
death of relative/ friend, divorce, loss of child etc
191
zola's triggers - time limit?
Putting a time limit on symptoms = will seek help if not resolved by
certain time
192
zola's triggers - sanctioning?
Sanctioning = told to by someone else
193
factors influencing access to care?
- provision of services - can 't get appts
- cultural/ family attitudes - depression
- prev bad experience - stigma
- logistics - childcare, tie loss, loss of earnings , transport
194
inverse care law?
- better off areas have better access to care than poor areas (Despite better health)
- demonstrated by the Black report 1980
195
Marmont review (2010) proposed 5 policies to address health inequalities- ensuring?
- Ensuring a healthy standard of living for all
- Give every child the best start in life
196
Marmont review (2010) proposed 5 policies to address health inequalities- enabling?
- Enabling all people to maximise their capabilities and have control over their lives
197
Marmont review (2010) proposed 5 policies to address health inequalities - creating?
- Creating fair employment and good work for all
- Creating and developing healthy and sustainable places and communities
198
BBB - Spikes?
- Setting - comfortable and private room
- offer for other ppl to be there
199
BBB - sPikes
- Discuss events leading up to it → symptoms/
investigations
- Establish what patient knows/ is expecting
- ICE
200
spIkes?
Check they want to receive results today and how much they want to know
201
spiKes?
- slowly siggest bad news
- allows large poauses
- no jargon
- reg check ppt understading
202
spikEs - emotions, empathy?
- Recognise and respond to emotions = empathy
○ Tell truth about prognosis
○ If don’t know diagnosis → refer to someone else
203
spikeS?
- Strategy and summary
- make a plan for follow up
- ask if they have any questions
- tell them what will happen in the future/ if they will be referred
204
BBB - ABCDE?
- Advanced preparation
- Build a relationship
- Communicate well
- Deal with patient reactions
- Encourage and validate emotion
205
Values of sensitivity and specificity ? with disease prev?
do NOT change
206
Identify methods of preventing kidney injury?
- screening of diabetic ppts
- screening of HTN ppts for comps
- appropriate fluid managemenr
- monitor rebal function in elderly
- prevent childhood UTIs
207
Impacts of peritoneal and haemodialysis?
- Disruption to life (takes up large periods of day - isolation and depression, limitation to travel)
- Still heavily symptomatic as is only around 10% of renal function
- Does not replace endocrine functions of kidneys
- Have restrictions on salt and fluid intake
208
Haemodialysis -?
- Requires AV fistula
- 4 hrs 3x a week in dialysis center
- risk of clots, infection
- more expensive
209
haemodialysis +
- 3 days dialysis free
- good for elderly/ frial who may struggle w the tech
210
PD -
- less effective than haemodialysis
- peritonitis
- have to be able to work equipment
- if peritoenum becomes fibrosed, must switch to haemodialysis
211
how are organs allocated?
- Donation after brainstem death = allocated nationally via National Allocation Scheme
- Donation after circulatory death = allocated regionally - one kidneys always offered preferentially to the localtransplant center
212
what is donation based on?
- points system based on compatability, age, time on transplant list, age difference between donor and recepient (want to be close), close in location
213
Matching?
- ABO Blood group
- Major histocompatibility complex - 2 copies of each HLA-type
- HLA-DR homozygosity
- HLA-B homozygosity
- HLA-A homozygosity
214
HTA 2004?
Consent needed for scheduled purposes of removal, storage
+use of human tissue of living/deceased for the following
reasons:
1. Research
2. Transplantation
3. Education
215
Independent assessors?
- interview potential donors and recipients to ensure the requirements of the Human Tissue Act 2004 have been met
- They interview the donor and recipient together and individually
- IA submits a report of their assessment to the Human Tissue Authority (HTA) and the HTA makes the final decision on
whether or not to approve the proposed donation
216
what do independent assessors ensure?
Donors not forced against their will
- No reward has been sought/offered in
- Donor has capacity to make an informed decision
217
conditions for a living donor (IA establishes these)?
- Donor competent and >18
- Risk to donor must be low
- Decision must be fully informed
- Decision must be voluntary and not coerced or incentivized
- Transplant must have good chance of successful outcome
218
costs of dialysis?
£35,000 per pt per year for haemodialysis
- £17,500 per pt per year for peritoneal dialysis
219
cost of transplantation?
£17,000 Transplantation + £5,000 per year immunosuppression (median transplant survival time is 10 years)
220
when does kidney transplant lead to a cost benefit?
Overall kidney transplant leads to cost benefit in the 2nd year and each subsequent year there is a saving of £25,000 and
£241,000 in a 10 year period
221
diabetes diagnostic criteria?
- Fasting plasma glucose >7.0mmol/L
- Random plasma glucose test >11.0mmol/L
- HbA1C of above 48
222
Who can HbA1c not be used in?
- Adolescents and children
- Type 1 diabetes
- Symptoms of diabetes <2 months
- Acutely ill
- Certain meds – e.g. steroids, antipsychotics, etc.
- Acute pancreatic damage
- Pregnancy
- Anaemia
- Chronic liver disease
- Haemoglobinopathies
- Alcoholic
223
why do we not have a screening programme for prostate cancer?
- very variable disease - some never progress so active surveillenace may be needed
- PSA has a lot of false negatives
- difficult to establish cut off for PSA as there's great variation amongst population
224
UKPDS?
- 20 yr trial
- concluded that reducing HbA1C reduces MI, death and macrovascular complications
225
acute complications of diabetes?
- Hypoglycaemia and hypoglycaemic coma
- Hyperosmolar hyperglycaemic state
226
chronic diabetes comps - eyes?
Retinopathy - DM can cause retinopathy cataracts, refractory defects, glaucoma and infection
227
Chronic diabetes comps - nephropathy?
Nephropathy - Leading cause of dialysis and kidney transplantation - urine assessed for microalbuminaemi
228
chronic diabetes comps - neuropathy?
Direct damage by hyperglycaemia and decreased blood flow to the nerves - most common diabetic
complication
229
macrovascular comps of diabetes?
- Cardiovascular disease - 2-3x increased risk, ACS and AMI have higher mortality rates among the diabetuic population
- Cerebrovascular disease
- Peripheral vascular disease
- Hypertension
- Renal artery stenosis
230
prevention of diabetic complications?
- Optimal weight control
- Tight Glycaemic control
- Tight BP control - ACEi/ARB 1st line
- Annual diabetic screening (eye, feet, kidney, CV)
- Feet - effective foot care and education, protective footwear
231
lifestyle modifications to prevent diabetes?
- Smoking cessation
- Reduction in alcohol intake
232
primary/ community diabetes services?
- GP - glycaemic control and annual review
- DSN
- dieticians
- podiatrist
233
Secondary services for diabetes?
- opthalmologists - management of diabetes eye disease
- renal - diabetic nephropathy
- endocrinology -complex cases
- GE - gastroparaesis
234
difference in diabetes services across the UK is affected by?
- Funding
- Prevalence of DM in different areas
- Staffing/resources
235
Jobs you can't do if insulin dependent?
- Armed forces
- Fire/ambulance services
- Prison service
- Airline pilots and Airline Cabin crew/Air traffic control
- Offshore work
236
Understand how pituitary, adrenal and thyroid disease affects individuals clinically and socially
Stigma due to visual appearance e.g. Exophthalmos
- Infertility - impacts relationships
- constant burden of lifelong meds
- Hormone deficiency can manifest as lethargy and malaise - decreased social mobility and interaction
leading to withdrawal
237
Health survey for England estimates that ? are obese?
Healthy Survey for England 2019 estimates 28% of adults in England are obese and 36.2% are overweight butnot obese
238
causes of obesity - high fat?
- To expensive to eat healthy
b. Time constraints to eating healthy
- unhealthy foods advertised
239
obesity causes - lifestyle?
- More jobs where you don’t have to be physically active
b. More automated transport
c. Increased use of lifts
d. Not safe enough on roads for cyclists
240
obesity - less excersie?
More passive leisure activities, especially due to technology at home
b. Lack of affordable community venues for exercise/expensive gym membership/sports club
c. Lack of attractive outdoor areas for walking/playing for kid
241
physical comps of obesity?
- arthiritis
- HTN
- T2D
- cancer - breast, colon, GB
- gout
- sleep apnea
242
social effects of obesity?-
- low self esteem due to poor body image
- bullied
- stigma
- can't have some surgeries or IVF when obese
243
economic effects of obesity?
- Increased health resources
- New equipment to account for in society
- Reduced productivity
244
strategies to address obesity - indiv?
- Explain risks of developing diabetes and/or IHD
- Education about diet and nutrition
- Implement exercise regimes
- Dietician referral
- Medication
245
population level methods of addressing obesity?
- Education: campaigns and dietary advice
- Parent-focused education for their children
- Schools provide healthy eating options
- Advertise bans on sweets or fast food
during children TV time
246
diabetes prevention programme trial findings?
- Found that early aggressive lifestyle interventions in obese patients with impaired glucose tolerance was more effect at preventing the onset of DM in comparison to placebo or metformin
- There is an association between increasing weight and risk of developing diabetes
247
DPPT - risk of IGT -> diabetes?
Risk of conversion between impaired glucose tolerance and diabetes is around 5% annually and 50% life-time risk
248
Safe blood transfuions?
- Positive pt identification (name, D.O.B and unique ID number)
- Blood samples for pre-transfusion testing
- Collection and delivery of blood components to clinical area without delay
- monitoring ppt for 24 hrs post transfusion
249
who regulates storage of blood?
The Blood Safety and Quality Regulations 2005 enforced by MHRA regulates blood storage and transport
250
# the four things it does
NHS blood and transplanrt service?
- Test Blood, Process and Store it and then distribute it to every NHS trust
- Encourage donors to donate every 12-16 weeks
- Recruit new donors
- Manage the supply of blood and deliver it to hospitals
251
arguments for an opt out system?
- Reduces current pressure on relatives to consent whilst grieving
.- Still enables those with strong objections to deny permission
- QOL is better after transplant than dialysis
252
Against opt out?
- Shouldn’t assume choices for patient = reduces patient autonomy; presumed consent is not consent
2. Patient have right not to donate & just as against human rights to do medical procedure on someone when alive, shouldn’t change right when die
3. Decisions can be based on different groups, e.g. religious, moral etc.
4. Is risking state becoming authoritative = removing patient freedom / autonomy
253
risk of stigmatisation w an opt out system?
decision to opt out may become stigmatised
254
arguments against a blood market?
- Represses altruism
2. Erodes sense of community
3. Redistributes supply from poor to rich. This also increases infection rates, patient often have other medical conditions reduces qualit
- sanctions profits in healthcare
255
arguments for a blood market?
1. Each person has the right to do as they chooses with their own body
2. Will improve supply
4. No different from any other tradeable goo
256
257
advantages of renal transplantation?
* removes burden of life long dialysis
* improves renal clearance - dialysis only provides GFR of around 10ml/min
* improves life expectancy
258
+ of transplantation - renal clearance?
* improves renal clearance - dialysis only provides GFR of around 10ml/min
259
disadvantages of renal transplantation?
* sig perioperative mortality risk - largely cardiovascular mortality or sepsis
* 2% of perioperative mortality
* new onset post transplant diabetes (NODAT) - 10-20%
* assoc w sig inc risk of graft loss and early death
260
disadvantages of renal transplantation - immune related?
* lifelong burden of immunosuppression
* risk opportunistic infections - espec viral, pneumocystitis
* cancer risk - non-melanoma skin cancer, cervical, lymphoma
261
absolute CI for renal transplants?
* active infections
* active cancer - wait 2-5 yrs following cure
* active drug misuse
* uncontrolled major psychiatric disease that would disrupt ability to take meds
* active non-concordance w treatment
* short life expectancy - under 5 yrs
262
organ transplantation is governed by?
* Human Tissues Act 2004
* main change to prev legistlation - facilitated live donor transplantation between unrelated ppl
263
Human tissues act 2004?
- regulates activities concerning the removal, storage, use and disposal of human tissue
- consent is the fundamental principle
264
key points of the HTA?
- Reg storage, removal and use of human tissues
- makes it lawful to take minimum steps to preserve the organs of a deceased person for use in transplantation while steps are taken to determine the wishes of the deceased
265
offences under the HTA?
- removing storring or using human tissue without consent
- storing or using donated tissue for a scheduled purpose for something else
- trafficiking in human tissue for transplant purposes
266
types of transplants from cadaveric donors?
- heart beating - DBD
- non-heart beating - DCD
267
heart beating (DBD) transplant?
* heart beating (DBD) - donation after brain death. Traditionally the more common one
268
non heart beating donation?
* non-heart beating (DCD) - donation after cardiac death, organs no longer perfused at the time of transplantation
269
main diff between heart beating and non heart beating transplants?
* main difference between DBD and DCD is that in DBD the kidneys are still perfused at the time of retrieval but aren't in DCD
* With DCD youre more likely to get delayed graft function which means that the kidneys dont intially work on implantation
270
changes in donation overtime?
* increase in donations from living donors over time up until 2014/2015 and then has tailed off - may be due to increased risk in end stage CKD in live donors
* DBD donors stayed the same
* DCD increased
271
live donors?
* related - blood or emotional relation
* unrelated
* paired or pooled donor - organs exchanged between pairs to overcome incompatibility to obtain best immunological match
* altruistic donor - person donates to anyone
272
how are live donations done?
* in paired or pooled transplants the organs are exchanged between donor-recepient pairs to overcome blood group or HLA incompatibility
273
the independent assessor?
* All donors and organ recipients are required to see an Independent Assessor (lA) who is trained and accredited by the HTA.
* The lA interviews the donor and recipient both separately and together on our behalf and is independent of the healthcare teams who are involved with the medical parts of the process.
274
independent assessor interviews?
* The purpose of the interviews is to ensure that donors are not forced to do something against their wishes, to ensure that no reward has been sought or offered and to ensure that the donor has the capacity to make an informed decision.
* Donors and recipients will be asked to bring along proof of their identity and proof of their relationship.
* It is a criminal offence to carry out a transplant operation between two living people if the conditions of the HT Act are not met.
275
psychological side effects of haemodialysis?
* mental fatigue
* drowsiness
* tiredness
* light headedness
* lack of motivation
276
impacts of haemodialysis on social wellbeing?
* low self esteem
* loneliness
* depression
* anxiety
* repeated hospital trips - impact on work and social life
277
role of the HTA 2004?
* regulates activities concerning the removal, storage, use and disposal of human tissue
* The Human Tissue Act 2004 also created an offence of DNA ‘theft’.
* It is unlawful to have human tissue with the intention of its DNA being analysed, without the consent of the person from whom the tissue came
278
Offences under the HTA
1) Removing, storing or using human tissue for Scheduled Purposes without appropriate consent.
2) Storing or using human tissue donated for a Scheduled Purpose for another purpose.
3) Trafficking in human tissue for transplantation purposes.
4) Carrying out licensable activities without holding a licence from the HTA (with lower penalties for related lesser offences such as failing to produce records or obstructing the HTA in carrying out its power or responsibilities).
5) Having human tissue, including hair, nail, and gametes, with the intention of its DNA being analysed without the consent of the person from whom the tissue came or of those close to them if they have died.
279
key functions of the HTA?
* establish the Human Tissue Authority (HTA) to regulate activities concerning the removal, storage, use and disposal of human tissue
* make appropriate consent a legal requirement for the removal, storage and use of body parts, organs, tissue and cells (“relevant material”). The Human Tissue Act lists the purposes for which consent is required ( these are called “scheduled purposes”)
* introduce licensing requirements for the removal, storage and use of bodies, organs, tissue and cells
* sets out offences and penalties for breaching the requirements
280
arguments for an opt out system?
* increases number of organ donations -> reducing number of patients dying whilst awaiting an organ transplantation
* families are consulted before the donation occurs
* faith and religious beliefs considered
* argued that opt-out systems overcome many traditional barriers to deceased organ donation – such as perceived religious or socio-cultural preclusions, lack of education or transplant awareness and challenges in communicating with families who are grieving a loved one.
281
arguments against an opt out system?
* insufficient consent - explicit consent not sought before the person dies
* unethical - taking away rights of people
* can be seen as a bodily violation
* implies that bodies belong to the state
* safeguaring issues - as patients haven’t directly said they do want their organs to be donated and those that want to refuse could feel pressured by social norms to comply.
282
Principles guiding organ and tissue donation ?
* should be voluntary and altruistic
* free and consented
* respect for donor and receptient autonomy
* confidentiality and protection of donor's and recipients data
283
Ethical issues in organ donation?
* insufficient donors- shortage of obtainable and useable organs
* use of organs from cadavers, infants and organs
* internet and global transplant tourism
* use of organs from living donors - could lead to manipulation, coercion, emotional suffering, morbidity
* financial payments to encourage donation - organs moving from poor to rich
* organ black market
284
Blood donation ethical issues?
* unacceptable for some e.g. Jehovas witnesses
* absolute safety of the blood cannot be guaranteed
* patient rejection of blood transfusions - autonomy
* coercion. financial gain
* anonymity between donor and recipient
285
Discuss the healthcare resource implications of organ transplantation and blood donation
* reduced need for dialysis which is more expensive long term -> reduced health care spending
* lifelong immunosuppressants required - cost
286
DSN role?
* The DSN educates the patient on how to use the devise and inject safely (this is done using ‘dummy’ injections of sterile water).
287
Prevention of T2D?
*Since obesity is a major contributory factor to the development of type 2 diabetes, ways of preventing/treating obesity
- Lifestyle changes are likely to be the most effective treatments
288
Impacts of obesity?
* Increases the risk of developing a range of serious diseases, including heart disease and cancers.
* Associated with the development of long-term health conditions, placing demands on social care services.
* Significant economic impact on the NHS and wider economy.
289
DSN?
* doctors can work with DSN to provide education and training to patients
* medication manegement - monitoring adherence, assessing for side effects
* patient support
290
podiatrists?
* Doctors can refer patients to podiatrists for regular foot screenings, risk assessments, and preventive interventions.
* patient education
* collaboratiev care to address both medical and podiatric concerns
291
dieticians
* nutritional assessments - provide individualized dietary recommendations for individuals with diabetes, taking into account their medical history, lifestyle, and treatment goals.
* meal planning
* nutrition education
292
doctors and dieticians - collaborative care?
Doctors and dietitians collaborate to integrate nutrition therapy into the overall diabetes management plan
293
endocrinologist?
* endocrinologists - They provide expertise in adjusting insulin therapy, managing electrolyte imbalances, and addressing underlying factors contributing to DKA.
294
DSN?
* diabetic specialist nurses - DSNs play a crucial role in educating patients about diabetes self-management, including insulin administration, blood glucose monitoring, and lifestyle modifications. They also provide support and guidance during hospitalization and after discharge.
295
GP in diabetes management?
* GP - ongoing diabetes management, preventative care, regular monitoring of blood glucose levels
296
the diabetes control and complications trial (DCCT trial)
* landmark clinical trial
* demonstrated the importance of intensive glycemic control in preventing or delaying the development of diabetes-related complications in individuals with type 1 diabetes.
* The DCCT provided robust evidence that maintaining blood glucose levels as close to normal as possible significantly reduces the risk of long-term complications of diabetes, such as retinopathy, nephropathy, and neuropathy.
297
what did the DCCT trial demonstrate?
* The trial demonstrated that achieving lower hemoglobin A1c (HbA1c) levels through intensive insulin therapy was associated with better outcomes.
298
establishment of HbA1c targets?
* DCCT established HbA1c targets for individuals with type 1 diabetes, with the goal of reducing levels to below 7% to minimize the risk of complications.
* This set a benchmark for glycemic control that has since been widely adopted in clinical practice
299
Discuss with patients the dietary recommendations in Type 1 diabetes?
* A diet that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged.
* People with diabetes are advised to avoid sugar-sweetened beverages (including fruit juice).
* carb counting
300
primary care in diabetes Mx?
* services include regular monitoring, diabetic education, lifestyle advice, and medication management
* GPs, practice nurses, dietitians
301
secondary care in diabetes?
* more specialised
* diabetic clinics, endocrinology departments, MDTs - endocrinologists, diabetic specialist nurses, dietitians, podiatrists, and opthalmologists
* Secondary care offers more complex management, including insulin pump therapy, continuous glucose monitoring, and management of diabetic complications.
302
variation in diabetes services?
* urban areas have better accesse to specialised diabetes clinics
* higher levels of deprivation may exp higher level of diabetes - more deprived areas may have fewer resources for diabetes prevention and manageemnt
* variation in primary care capacity
303
what varies between regions?
* The presence of community-based diabetes support groups, educational programs, and lifestyle intervention services can vary between regions, impacting the level of support available to individuals living with diabetes and their families.
304
models of diabetes care - ICP?
* ICPs: collaboration between primary and secondary care providers to ensure seamless and co-ordinated care for individuals with diabetes
305
models of diabetes care - MDT approach?
* MDT approach: aim to address the complex needs of individuals with diabetes through a holistic and collaborative approach.
306
models of care - primary care led model?
* Primary care led model: involve regular monitoring, lifestyle advice, medication management, and coordination of referrals to specialist services as needed.
307
models of care - specialist diabetes centers?
* specialist diabetes centers: including advanced treatments, education programs, and support services.
* Specialist diabetes centers may provide outpatient clinics, inpatient care, and access to cutting-edge technologies for diabetes management.
308
UKPDS?
* the UK Prospective Diabetes Study (UKPDS) have shown that tight BP control significantly reduces the risk of cardiovascular events, such as heart attacks, strokes, and heart failure.
* renal function - trials have shown that medications targeting the renin-angiotensin system (e.g., ACE inhibitors, ARBs) can delay the progression of diabetic kidney disease.
309
DCCT trial?
* reduction in microvascular complications: DCCT trial showed delayed onset and slowed progression of these complications
* CV risk reduction - While the evidence for cardiovascular risk reduction with glycemic control is less consistent compared to blood pressure control, some studies suggest that tight glycemic control may reduce the risk of cardiovascular events over the long term
310
DCCT - improved QOL?
* improved QOL - Better glycemic control is associated with improved quality of life, reduced symptoms of hyperglycemia (e.g., polyuria, polydipsia, fatigue), and decreased risk of acute complications,
311
advantages of using BMI?
* inc BMI generally correlates w metabolic and fat mass diseases in population studies
* commonly used
* reasonably reprod and low cost
* adequate screenign metric for most patients
312
Disadvantages of using BMI?
* may not correlate w metabolic and fat mass diseases in an indiv ppt
* does not account for muscle mass
* cut off points don't distinguish between men and women, nor ethnic and racial considerations
* shouldn't be used as a sole measure of obesity
313
obesity - history:
image
314
risks of obesity?
* cold intolerance, dysmenorrhea
* faigue, hair loss, brittle nails
* small inc in gallstones, kidney stones and gout flare
315
exercise prescription (FITTE)
* frequency
* intensity
* time spent
* type
* enjoyment level
316
Meds for obesity?
* Orlistat: lipase inhibitor
* liraglutide: GLP-1 analogue
317
# indications
Bariatric surgery for obesity?
* BMI of >35 with >1 AHC
* BMI of > 40 w or without AHC
318
dietary recommendations for obesity?
* calorie deficit
* portion control
* balanced diet
* limiting energy dense foods - reduce consumption of sugary snacks, fried foors, processed meats, sugary beverages
* inc fiber intake - fruits, veggies, nuts
* limit sugar and saturated fats
* regular meal timings w balanced snacks throughtout the day
* health deating patterns - meditteaenan diet or dietary approaches to stop HTN (DASH)
319
Weight gain occurs when there's an imbalance in?
* energy imbalance - Weight gain occurs when energy intake (calories consumed) exceeds energy expenditure (calories burned
* high calorie food and sedentary lifestyle
320
weight gain - environment?
* obesogenic environment - environment is characterized by an abundance of energy-dense, processed foods high in sugar, fat, and salt, as well as easy access to fast food outlets, vending machines, and convenience stores.
321
SE factors in weight gain?
* SE factors - individuals from lower-income households facing greater barriers to accessing healthy foods, safe recreational spaces, and healthcare service
322
food deserts and weight gain?
* Limited resources, food insecurity, and neighborhood environments characterized by food deserts and limited opportunities for physical activity contribute to higher obesity rates in socioeconomically disadvantaged populations.
323
psychological factors in weight gain?
* psychological factors - stress, depression, anxiety, and emotional eating, can influence eating behaviors and contribute to weight gain.
324
coping mechanisms & weight gain?
* Unhealthy coping mechanisms, such as using food as a reward or comfort, and maladaptive dietary patterns, such as binge eating or night eatin
325
cultural and social norms in weight gain?
* cultural and social norms - Cultural celebrations, social gatherings, and food-centric traditions may promote overeating and contribute to weight gain in Western societies.
326
Why is prev of obesity inc in western society?
* changes in diet - shift towards energy dense, saturated fats and processed carbs
* sedentary lifestyles - desk jobs, screen time, and motorized transportation
* obesogenic envir - fast foods, vending machines, convenience stores
* marketing and advertising of unhealthy foods paticularly to children and adolescents
327
Social implications of obesity?
* stigma -> negative pscyhological effects
* economic burden on society - healthcare costs, reduced productivity
* barriers to accessing opportunities like employment
* healthcare system strain
* productivity loss - absenteeism, disability related limitations
* educational attainment - bulling, exclusion
328
social impacts of obesity - healthcare disparities?
* healthcare disparities - Socioeconomic factors can influence access to healthcare services and resources for managing obesity, leading to disparities in treatment and outcomes among different socioeconomic groups.
329
physical implications of obesity?
* chronic disease risk
* osteoarthiris
* metabolic syndrome
* resp issues e.g. Obst sleep apnoea
* GORD
* depression, anxiety, body image issues, social stigma, and reduced quality of life.
330
economic impacts of obesity - healthcate?
* healthcare costs - increased utilization of medical services, including hospitalizations, doctor visits, medications, and treatments for obesity-related conditions such as diabetes, heart disease, and joint problems
331
economic impacts of obesity?
* Productivity loss
* disability payments
- economic disparities
332
economic disparities and obesity?
* economic disparities - Obesity disproportionately affects socioeconomically disadvantaged populations, exacerbating existing inequalities in access to healthcare, education, employment opportunities, and healthy food options
333
what are the population impacts of obesity?
* public health burden
* reduced life expectancy
* socioeconomic disparities
* interconnected health risks
* childhood obesity epidemic
334
Strategies for reducing obesity - info?
* Providing information and resources on nutrition, physical activity, and weight management through workshops, seminars, educational materials, and online platforms to raise awareness and empower individuals to make healthier choices.
335
strategies for reducing obesity - envir change?
* environmental change - Implementing environmental modifications to promote physical activity and access to healthy foods, such as building walking paths and bike lanes, creating community gardens, improving access to fresh produce through farmers' markets or corner stores, and limiting the availability of unhealthy foods and sugary beverages in schools and public spaces.
336
strategies for reducing obesity - partnerships?
* Building partnerships and collaborations with local stakeholders, including healthcare providers, schools, employers, faith-based organizations, and community leaders, to leverage resources, share best practices, and mobilize support for obesity prevention efforts.
337
Behavioural interventions of obesity?
* self-monitoring of behaviour and progress
* stimulus control
* goal setting
* slowing rate of eating
* ensuring social support
* problem solving
* assertiveness
* cognitive restructuring (modifying thoughts)
* reinforcement of changes
* relapse prevention
* strategies for dealing w weight gain
338
Physical activity in order to manage obesity?
* to avoid obesity people may need to do 45 to 60 minutes of moderate-intensity activity a day, particularly if they do not reduce their energy intake.
* Advise people who have been living with obesity and have lost weight that they may need to do 60 to 90 minutes of activity a day to avoid regaining weight
339
# Indications
surgical interventions for obesity?
* BMI over 40
* Or between 35-40 with a sig health condition
* lower BMI threshold for South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ppl
340
types of bariatic surgery?
- laparoscopic adjustable gastric banding
- sleeve gastrectomy
- Roux-en gastric bypass
- billiopancreatic diversion
341
Laparoscopic adjustable gastric banding (LAGB)?
* Band is placed around the stomach at the proximal end, creating a small pouch at the top of the stomach.
* Band can be adjusted over time to alter the amount of restriction
* Adjustments made by injecting or withdrawing fluid from a subcutaneous access port
342
What is the safest and least invasive type of bariatic surgery?
LABG
343
LABG - weight loss peaks at?
18 months post-procedure
344
LABG -
* Can make some foods difficult to tolerate
345
LABG - band related complications?
Slippage, erosion, or leakage of the gastric band, which may require surgical revision or removal.
346
LABG - band intolerance?
Some individuals may experience discomfort, pain, or intolerance to the gastric band, leading to inadequate weight loss or complications.
347
sleeve gastrectomy?
* Part of the fundus and body of the stomach are removed – about 75% of the stomach in total
* Stomach volume typically reduced from 2500ml to 200ml
* Permanent fixed reduction
348
what is required after a sleeve gastrectomy?
* Patients require mulitvitamin, and sometimes iron and B12 supplementation for life
349
risks of sleeve gastrectomies?
- acid reflux
- strictures
350
Acid reflux after a sleeve gastrectomy?
* Acid reflux: Increased risk of gastroesophageal reflux disease (GERD) due to changes in stomach anatomy and increased pressure on the lower esophageal sphincter.
351
Roux-en-Y gastric bypass?
* Small stomach pouch created, and the lower stomach, duodenum and first portion of the jejunum are bypassed.
* Smaller stomach restricts intake
* Bypass of first portion of small intestine reduces absorption of nutrients (and therefore calories intake
352
considerations of RYGB?
* Multivitamin supplementation required for life
* dumping syndrome
* nutrional deficiencies - vitamin B12, iron, calcium, folate
353
biliopancreatic diversion?
* Similar to a Roux-en-Y bypass
* Lower portion of stomach removed and duodenum and first part of jejunum are bypassed
* malabs of ADEK vitamins
354
side effect of bilipancreatic diversion?
* Foul-smelling stools and flatulence: Changes in digestion and absorption patterns can lead to unpleasant digestive symptoms.
355
Dumping syndrome?
Dumping syndrome describes a group of symptoms caused by food rapidly emptying or being ‘dumped’ from the stomach into the small intestines. This results in undigested food within the small intestine that the body finds difficult to absorb.
356
Diabetes prevention programme trial found that?
* It demonstrated that lifestyle interventions, such as dietary changes, increased physical activity, and modest weight loss, were more effective than medication in reducing the risk of developing type 2 diabetes among high-risk individuals with impaired glucose tolerance.
* highlighted the crucial role of lifestyle modifications in preventing or delaying the onset of type 2 diabetes
357
NHS diabetes prevention programme?
* recruits patients at high risk of T2DM and refers them to a behaviour change programme
* aims:
* reduce incidence of T2D
* reduce incidence of complications assoc w T2
* to reduce inequalities assoc w incidence of diabetes over the long term
358
predisposing factors for AML?
* radiation
* benzene
* previous chemo
* inherited bone marrow failure conditions
* downs
359
RF for prostate cancer?
* age
* highest in african americans > white americans> asians
* red meat diet
* FHx
* genetic mutation: BRCA-2: 5x higher risk
360
Alpha-1 antitrypsin deficiency is a risk factor for
HCC
361
kidney cancer prev?
* comprises 3% of all cancers in men, 2% in women
* 8th most common cancer in men
* overall mortality 40%
362
RF for kidney cancer?
* age
* sex - male > female
* obesity
* smoking
* HTN
* diet - poor intake of fruit and veg
* radiotherapy for prev testicular/ gynae cancer
363
prev of bladder cancer?
* 4th commonest cancer in men, 11th in women
* overall mortality approx 50%
364
gender affected more by bladder cancer?
* M:F = 5:2
365
RF for bladder cancer?
* SMOKING
* occupation - analine dyes - paint, hair dye, textile and pesticide industries
* hair dyes
* pelvic irradiation
* caucasian males
* dietary factors
366
drugs inc rate of bladder cancer?
phenacetin, cyclophosphamide
367
RF for PC?
* age - 80% OF OVER 80
* Fhx
* ethnic origin -2-3x inc risk in black Africans/ Caribbean
* dietary - lycopenes and selenium protective
368
PC - 98% are ?
adenocarcinomas
369
Prev of incontinence?
* 25% of over 20s have UI, 50% have SUI
370
PSA?
* protein produced by prostate epithelial cells
* PSA is produced by normal prostate tissue, however levels in the blood tend to increase in malignancy.
371
asymptomatic PSA testing?
* PSA testing can be discussed with men over 50, and should be offered to those men over 50 who request it
372
before PSA testing men should not have?
* Active or recent UTI (last 6 weeks)
* Recent ejaculation, anal sex or prostate stimulation
* Engaged vigorous exercise for 48 hours
* Had a urological intervention in the past 6 weeks
373
benefits of PSA testing?
* can detect prostate cancer at early stage -> earlier treatment -> better outcomes
374
- of PSA testing
* PSA testing can result in false positives -> unecessary biopsies, anx for patients
* PSA can be elevated from other conditions such as BPH
375
Which ethnicity has the highest risk of PC?
black men
376
RF for incontinence?
* advancing age
* previous pregnancy and childbirth
* high body mass index
* hysterectomy
* family history
377
overactive bladder/ urge incontinence is due to
detrusor overactivity
378
stress incontinence is due to?
leaking small amounts when coughing or laughing, related to increased intra-abd pressure
379
overflow incontinence?
due to bladder outlet obstruction, e.g. due to prostate enlargement, overflow after retention
380
RF for stress incontinence?
* weakening of pelvic floor muscles:
* Age
* Pregnancy & vaginal delivery
* Constipation
* Obesity
* Family history
381
psychological impact of incontinence?
* shame and embarassment -> social withdrawal
* low self esteem
* anxiety
* social isolation - fear or leakage or odor
* reduced QOL - fear of accidents
* financial burden - purchase of absorbent products
382
physical impacts of incont?
* skin irritation and infection - rash, ulcers
* UTIs
* sleep disturbances due to nocturia
* sexual dysfunction
383
physical impacts of neuropathic bladder disorders?
* incontinence
* retention
* overactivity
* distension
* hydronephrosis
384
PSYCH impacts of neuropathic bladder disorders?
* stress and anxiety
* depression
* self esteem
* social withdrawal
