Block 4 Flashcards
Define disability
A person is disabled if s/he has a physical or mental impairment
And the impairment has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities
What are the key features of medical models of disability?
Disability is intrinsic to the individual
Restrictions experiences by disabled people are attributed to their individual characteristics
Interventions/services tend to focus on changing or curing the individual with the deficit
Medical professional’s role is central in treatment
Defined and controlled by medicine
What are the criticisms of the medical model of disability?
Individualised the issue of disability when it is a public issue
Promotes view that disability is a medical issue and healthcare professionals have knowledge and power
Promotes a negative image
May seem as a ‘personal tragedy’
Disabled people’s movement has challenged this view by raising the personal experience of disabled people as the primary source of knowledge
Identifying disability as a public issue needing socio-political responses
What are the key features of the social model of disability?
Is a result of disabled people’s movements
Shifts focus from the individual and intrinsic, to social and extrinsic
Problem faced by individual not caused by their impairments but by the way society is organised
Makes a distinction between impairment and disability
Disability not seen as an inevitable consequence of living with impairment
Emphasises the need to adjust the context/environment within which disabled people live (i.e. remove the barriers)
Identifies disability as social oppression that is linked with a strategy for social and political change
Emphasises rights of disabled people to normal life
What is the distinction between impairments and disability?
Impairments:
Bodily, mental or intellectual limitation or condition
Disability:
The loss of or limitation of opportunities to take part in society on an equal basis with others due to social and environmental barriers
What is the interaction/integrated model of disability (biopsychosocial approach)?
Disability results from complex interactions between impairments and the social and cultural contexts.
This model is adopted by WHO’s ICF (International Classification of Functioning) and UNCRPD (United Nations Convention of the Rights of Persons with Disabilities)
What is the International classification of functioning (ICF)?
WHO framework for measuring health and disability at both individual and population levels.
What are the aims of the ICF?
- Addresses difference of emphasis implicit in the medical and social models
- Establishes a common language for describing health and health-related states to improve communication between different users
- Provides an international coding system for classifying coding and functioning
Why is a human rights approach to disability considered appropriate?
Establishes that disabled people are not ‘other’ – they have the same rights as others (non-disabled people)
Legislation establishes a universal standard/benchmark which can be applied
If a disabled person’s experiences fall short of this standard, it is considered to be a human rights violation
What tools are used to promote human rights of disabled people?
(2 examples)
1. International:
UNCRPD
Identifies various civil, cultural, economic, political and social rights
2. National:
UK Equalities Act
Requires equal treatment in access of employment, private and public services regardless of the protected characteristics (includes disability)
Why is human rights and equality legislation for disabled people needed?
Disabled people experience social, economic and health inequality
Lower levels of participation in all aspects of life
In what way do disabled people live in more disadvantaged circumstances than non-disabled people do?
Housing:
Move likely to experience poverty
Employment:
Less likely to be in employment
More likely to experience discrimination at work
Education:
More likely not to have qualifications
Health:
More likely to experience poor health outcomes
Accessing goods/services:
1/3 report difficulties
More than ¼ report they do not frequently have choice and control over their daily lives
How is the disadvantages of disabled people relevant for doctors?
Disability effects everyone
Need to think about disability and how it can influence treatment/services provided
Understanding disabilities can help people manage impairments and conditions better
Helps doctors recognise environmental, social and attitudinal barrier to participation and QoL
Doctors have to operate within the context of international legislation
Define systematic review
A literature review that focuses on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question.
Results from similar randomised trials are collated but the combination of trials needs to be done systematically (most reliable way as possible).
Methods used include steps to minimize bias in all parts of the process.
Define Meta-analysis
The results of the individual studies combined to produce an overall statistic; can be done without a systematic review by combining the results from more than one trial.
Will be subject to any biases that arise from the study selection process and may produce mathematically precise but clinically misleading results.
Where would you search when undertaking a systematic review?
1. Cochrane library
Database of systematic reviews on the effectiveness of healthcare interventions
2. Medline
Online database of citations and abstracts from health and medical journals but not just reviews
What does PICO stand for and what is it used for?
Used to define a search in a systematic review.
P – Population
I – Intervention
C – Comparator
O – Outcome
What is a forest plot used for?
Looks at and collates different study results.
Give the results from individual studies, confidence intervals, outcome effect ratio, and the overall effect
What is a funnel plot used for?
Way of assessing if the results are affected by publication bias.
Publication of results depend on the nature and direction of the journal.
If the plot is symmetric, like an inverted V, this is interpreted as demonstrated that there is probably no publication bias.
If the plot is asymmetric, the interpretation is that publication bias is likely.
What does PRISMA stand for?
P - Preferred
R - Reporting
I -Items
for
S - Systemic Reviews
and
M - Meta
A - Analyses.
Helps authors report their results.
What is critical appraisal?
The assessment of evidence by systematically reviewing its relevance, validity and results to specific situation
Why is critical appraisal important?
Helps establish if the study is valid, the results are reliable and if the results can be adapted to clinical scenarios
What are the limitations of systematic reviews
Synthesis may disguise or oversimplify important distinctions between primary studies with regard to inclusion/exclusion criteria or the nature of an intervention
Reviews of similar topics may appear to reach different conclusions depending on the precise form of the “review question”
Reviews may make it difficult for practitioners to apply the results of studies to the specific characteristics of the situation in which they find themselves (over-generalisation)
The findings from systematic reviews are not always consistent with the findings of large-scale high quality trials
What are the types of bias found in systematic reviews?
Selection bias:
Systematic bias in the way included studies are selected e.g. publication bias
Attrition bias:
Systematic differences between the comparison groups in the loss of participants from the study
Performance bias:
Systematic differences in the care provided to the participants in the comparison groups other than the intervention under investigation
Detection bias:
Systematic differences between the comparison groups in outcome assessment
Define Hazard
Something that might cause harm
Define risk
The likelihood of that harm actually occurring
What are the categories of hazards and examples?
Physical
Ionising radiation, manual handling
Chemical
Aldehydes, anaesthetic agents, antineoplastic drugs, latex
Mechanical
Biological
Infectious agents
Psycho-social/ organisational
Working hours/shift system, bulling, organisational hierarchy, stress
What are the main categories of work-related ill health?
Accidents
Poisoning
Musculoskeletal (most likely work-related disorder to attend the GP)
Mental Health (most commonly self-reported work-related illness)
Give some causes of occupational disease
Occupational asthma:
Bakers (flour, enzymes)
Isocyanates (paint spray, glues and laminates)
Hard/soft wood dust
Rosin
What is a occupational history?
The most effective method for the proper diagnosis of occupational disease
What is a fit note?
Documentation to provide certification for statutory sick pay
Plays a key role in advising patients about work
Helps patients develop a return-to-work plan
Helps return to work via communication with patients and employers
What is the role of occupational health services?
Not a part of the NHS and not a legal obligation for employers
Provide regular health screening in environments in which employees may be at significant high risk to specific health hazard associated with their work
Provides independent and impartial advice to both the employer and employee
Investigating and diagnosing those who are sick or injured due to work
Assisting the return of the sick and injured to work at the earliest opportunity
Matching people with jobs appropriate to their health, fitness and susceptibility status
What is the role of a health and safety executive?
Shaping and reviewing regulations
Producing research and statistics
Enforcing the law
What is the role of the access to work scheme?
Provides different types of help
Special aids and equipment
Adaptions to equipment
Travel to work and travel in work
Communication support at interviews
Support works
Mental Health Support Service
Define over diagnosis
Correct diagnosis of a disease, but the diagnosis is irrelevant because the disease will never cause symptoms within the patient’s lifetime.
Define over-treatment
Unnecessary treatment, which does not improve health.
What are the health advantages of work?
Income
Status
Self esteem
Purpose
Influence
Security.
What are the risks from needle stick injuries?
Hep B - 1 in 3
Hep C - 1 in 30
HIV - 1 in 300
What are some factors that facilitate return to work?
Medical treatment
Changing work factors that may affect health
Patient’s expectations
Managing patients expectations
What is the fit for work scheme?
Help for people that are in work with health conditions and helps with sickness absence
