Block 9 + 10 Flashcards
EBDM involves
Patient preferences
Available resources
Research evidence
Clinician expertise
Major functions of global health
- Provide global standards, guidelines + research
- Coordinated epidemiological surveillance + information sharing
- Global solidarity for countries facing disaster + deprivation
- Invest and advocate for health policies + key issues
Define global health
Health of global population
90/10 gap
- less than 10% of worldwide resources for health research were put towards developing countries
- despite this being where more than 90% of all preventable deaths worldwide occurred
How to reduce 90/10 gap
- Highlight factors critical to health e.g. good sanitation
- Work together health policies + standards e.g. infection control programmes
- Provide technical support + resources
- Share important knowledge about health research + infection control
- Monitor incidence + progression of health outcomes
General intervention strategies to manage HIV/AIDs
- peer education abt high risk groups e.g. sex workers
- promotion + distribution of condoms at affordable prices
- Voluntary HIV counselling + testing
- promotion of safer sexual behaviours -> getting tested regularly
Public health objectives of vaccination
- reduce mortality + morbidity from vaccine preventable diseases
- prevent outbreaks + epidemics
- generate herd immunity
- eradicate infectious agent
Burden of disease
sum of mortality + morbidity measured by DALYs
DALYs
Disability adjusted life years
1 DALY = loss of 1 year in good health due to premature death/disease/disability
Factors driving decreased communicable disease burden in higher income countries
- better sanitation
- vaccination programmes
- improved education
- improved standards of healthcare
Factors increasing risk of global pandemics
- Global travel - easier spread
- Urbanisation - more overcrowding
- Weak health systems -> poor surveillance + detection
- Climate change
- increased human-animal contact
Climate change impacts on global health
- food production destabilised by drought
- increased temperatures -> easier for vector-borne diseases to circulate e.g. malaria
- rising water lvls increases risk of flooding + spread of water borne diseases
- increased pollution -> more allergies + asthma
R0 is proportionate to
- length of time case remains
- number of ppl. infected person comes into contact with who are susceptible to disease per unit time
- chance of transmission during encounter w infected case to susceptible host
Features of a good screening programme
easy to administer
cause minimal discomfort
be widely available
high test coverage
high sensitivity
high PPV
detect high proportion of disease in preclinical state
be reliable
be affordable
be valid
Why is DM in medicine important?
Doctors make decisions constantly
The decisions have effects on patients, families, and society
Having an understanding of decision making, and the role of evidence, can help improve medical practice
Cohort studies are good for investigating
prognosis
cause
Case control studies are are good for investigating
cause
RCTs are good for investigating
Treatment interventions
benefits and harm
cost effectiveness
Qualitative approaches are good for investigating…
Patients and/or practitioners perspectives
Diagnostic and screening studies are good for
identification
Systematic reviews are good for generating a
Summary of evidence for a specific question
Duty of Care
a legal obligation to provide care that conforms to the standard reasonably expected of a competent doctor
Negligence
failure to exercise the care that a reasonably prudent person would exercise in like circumstances
Functions of the clinical record
Support patient care
Improve future patient care
Social purposes at the request of patients
Medico-legal document
HIV intervention strategies
- Blood donor + product screening
- Promotion + distribution of condoms
- Peer education for high risk groups (sex workers)
- Promotion of safer sexual behaviour
- Diagnosis + treatment STDs
- HIV voluntary counselling and testing
Current problems w HIV interventions
- lack of Global funds from(WHO,UNAIDS etc.) to provide resources
- Political problems hinder outcomes prostitutes are illegal and
condom distribution not carried out
Type I error
rejecting the null hypothesis when it is trrue
Type II error
accepting the null hypothesis when it is false
Power
probability of detecting a statistically significant difference
1 - the probability of a type II error
Precision
quantifies a tests ability to produce the same measurements with repeated tests
Number needed to treat (NNT)
measure that indicates how many patients would require an intervention to reduce the expected number of outcomes by one
1 / Absolute risk reduction
risk ratio is > 1
RATE OF EVENT INCREASED IN EXPERIMENTAL GROUP
risk ratio is < 1
rate of an event is decreased compared to controls
SELECTION BIAS
non-random assignment of patients to a study group
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
Publication bias
Failure to publish results from valid studies, often as they showed a negative or uninteresting result
Late-look bias
gathering information at an inappropriate time
Specificity
proportion of patients without the condition who have a negative test result
Sensitivity
Proportion of patients with the condition who have a positive test result
Standard deviation
= square root of the variance
Usual outcome measure of cohort study
relative risk
Impacts of chronic dialysis on patient
Regular hospital admissions
Restriction of leisure time
May have to give up job
Increased dependence on dialysis
Uncertainness about the future
Fatigue
Limitation of liquids and foods
Disrupts family and friend relationships
Depression
Lower self-esteem
Pros of screening
Early detection of disease means the risk of death or illness can be reduced for some people
LENGTH BIAS
Overestimation of survival duration among screening-detected cases by the relative excess of slowly progressing cases
What factors can affect the impact of news on a patient?
- institutionalised beliefs
- personal types
- gender
- religion
- pts. knowledge
What websites can be used to find out if a person needs travel vaccinations?
NHS fitfortravel
The National Travel Health Network and Centre (NaTHNaC)
Body image is
perceptions, thoughts + behaviours relating to one’s appearance it shows our identity to others
What is meant by the term ‘biographical disruption’?
describes how a patient’s experience of chronic illness can lead to loss of confidence in their body image and consequently a loss of confidence in their social + cultural interactions or self-identity
Give examples of diseases/symptoms/treatments/side-effects which affect body image?
- scars
- prosthetic devices
- mastectomy
- stoma
- hair loss
- weight loss or weight gain
What did the Calman-Hine report of 1995 do?
Examined cancer services in the UK, and proposed a restructuring of cancer services to
achieve a more equitable level of access to high levels of expertise throughout the country.
What were the conclusions of the Calman-Hine report
- all patients shld have access to a uniformly high quality of care (justice)
- public + professional education about the early symptoms of cancer
- pts, families + carers shld be given clear information about all the treatment options + outcomes (autonomy)
- psychosocial needs of cancer sufferers and their carers shld be recognised
- development of cancer care services shld be patient centred (beneficence)
- primary care shld be central to cancer care
What were the Calman-Hine solutions?
There should be 3 levels of care:
- Primary care
- Cancer units => in general hospitals for: treating common cancers, running diagnostic procedures, non-complex chemo + common surgeries
- Cancer centres => treating rare cancers, radiotherapy + complex chemo
***key to managing patients would be MDT
Which cancer care policy set out the first ever comprehensive plan to tackle cancer disease?
NHS cancer plan - 2000
Aims of NHS cancer plan 2000
- To save more lives (i.e reduce burden of disease)
- To ensure people w cancer get the right professional support + care as well as the best treatments (beneficence)
- To tackle the inequalities in health that mean unskilled workers are twice as likely to die from cancer as professionals
- To build for the future through investment in the cancer workforce, through strong research and through preparation for the genetics revolution, so that the NHS never falls behind in cancer care again
Role of cancer networks in NHS cancer plan 2000
Cancer networks -> organisation model of cancer services to implement plan:
- to bring together health service commissioners and providers, the voluntary sector, and local authorities
- Each network will typically serve a population of around 1-2 million people
Role of National Awareness and Early Diagnosis Initiative in cancer care
- raise public awareness of early signs+symptoms of cancer
- encourage ppl to seek help sooner
6 key areas for action highlighted by the Cancer Reform Strategy 2007
- Prevention - reduce risk factors e.g. smoking, obesity
- Diagnosing cancer earlier - screening, public awareness
- Living with cancer and beyond
- Ensuring better treatment
- Reducing cancer inequalities
- Delivering care in the most appropriate setting
What were the main outcomes from ‘Improving outcomes: A strategy for cancer (2011)’?
Prevention and early diagnosis - Focus on lifestyle factors, screening, diagnostic tests
Quality of life and patient experience - Patient experience surveys, more 1-1 support roles, risk stratified pathway of care, following assessment and care planning
Better treatments - Cancer drugs fund, reducing variation in radiotherapy,
reaffirmed MDTs and national audits
Reducing inequalities
Why is cancer survival improving in the UK?
- newer treatments
- faster diagnoses
Inequalities experienced among cancer patients:
White cancer patients report a more positive experience than other ethnic groups
Younger people are the least positive about their experience, particularly around understanding completely what was wrong with them
Men are generally more positive about their care than women, particularly around staff and staff working together
Non-heterosexual patients reported less positive experience, especially in relation to communication and being treated with respect and dignity
People with rarer forms of cancer in general reported a poorer experience of their treatment and care than people with more common forms of cancer
How might doctors deal with angry patients?
- Recognise/acknowledge
- Remain calm
- Do not dismiss it
- Apologise/express sympathy
Types of distancing strategies
- Avoidance
- Normalization
- Premature Reassurance
- False reassurance
- Switching
- Jollying along
ABCDE of breaking bad news?
A - advance preparation
B - build relationship
C - communicate well
D - deal with patient reactions
E - encourage and validate emotions
News is bad if it results in
cognitive, behavioural or emotional deficit in the person receiving the news that persists for some time after the news is received
Briefly explain the stages in the grief response
- Numbness for up to 2 weeks
- Distress + acute grief for 6 months
- Period of adjustment for 6-12 months
How can social services help a patient (in their home)?
Give information about how to access help + support:
- assess whether a patient needs a carer for help with ADLs
- assess whether patient is eligible for financial support
- look for signs of neglect
- assess whether there is a need for any modifications
How can the district nursing team help a patient?
- Assess whether either the patient or family need any nursing support
- Assess whether a community Occupational Therapy assessment is necessary
- Assessing medication compliance/need for Dosset box
- Discuss patients’ nursing needs at MDT meetings
- Administer immunisations
Ethical objections to IVF
- harmful to those trying to conceive as multiple pregnancies can increase risk of mortality + morbidity
- involves destruction of embryos which some argue have a moral status
- “unnatural”
