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Health and society > Block 9 > Flashcards

Block 9 Flashcards

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Sociology 101 flashcards
1
Q

Clinical reasoning =

A

the ability to sort through a cluster of features presented by a patient and accurately add a diagnostic label/treatment strategy

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2
Q

Health literacy =

A

the cognitive and social skills which determine an individuals ability to gain access to, understand and use information in a way to maintain good health

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3
Q

Bad news is…

A

Any news that drastically and negatively alters the patient’s view of his/her future

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4
Q

What does ‘bad news’ depend on?

A

Context:

  • Social life
  • Hobbies
  • Occupation
  • financial circumstances
  • Age
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5
Q

What may clinicians worry about giving bad news?

A
  • Not being prepared for patients emotional reaction
  • Feeling inadequate
  • Embarrassed they may have previously given too optimistic a picture
  • Fears of destroying hopes
  • Uncertainty about patient’s expectations
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6
Q

Distancing strategies that are used in breaking bad news:

A 
Avoidance
False reassurance
Premature reassurance
Normalization
Switching/focusing on something else
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7
Q

2 strategies for breaking bad news:

A

ABCDE

SPIKES

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8
Q

ABCDE =

A 
Advanced preparation
Building relationship
Communicate well
Deal with reactions
Encourage and validate emotions
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9
Q

Ways to advance prep =

A

Location
Turing off distractors
Mentally preparing
Reading notes

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10
Q

Ways to communicate when breaking bad news:

A

Allow silences
Validate feelings
Ask patient to describe their understanding
Allow time for questions

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11
Q

SPIKES =

A 
Setting up
Perception
Invitation
Knowledge
Emotions
Summary and strategy
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12
Q

Ways to prepare patient for bad news =

A

Right setting
Inviting in family members
Find out what patient already knows
Find out what patient wants to know

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13
Q

Ways to disclose bad news =

A

Warning shot
Short chunks
Clarify understanding

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14
Q

Ways to follow-up the disclosure of bad news =

A

Respond to emotions
Answer questions
Plan a follow up

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15
Q

Distress and acute grief can last for

A

up to 6 months

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16
Q

Period of adjustment is between

A

6-12 months

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17
Q

Ways to deal with a patient’s anger =

A
  • Recognise it
  • Don’t dismiss
  • Remain calm
  • Make a plan
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18
Q

lifetime incidence of cancer

A

1:3

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19
Q

Incidence of cancer mortality

A

1:4

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20
Q

How many people in England are diagnosed with cancer each year?

A

> 250,000

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21
Q

How many people in England die from cancer each year

A

> 130,000

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22
Q

Most common cancer for mortality =

A

Lung cancer

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23
Q

Most common cancer in prevalence for women and men

A 
Women = breast
Men = prostate
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24
Q

3rd most common cancer =

A

Colorectal

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25
Q

Most common cancers in young people =

A
  1. Leukemia
  2. Brain: astrocytoma, medulloblastoma
  3. Lymphoma (hodkins and non-hodkins)
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26
Q

Eurocare study was conduted in the

A

1980s

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27
Q

What did the eurocare study find?

A

UK was last in Europe for cancer mortality rates

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28
Q

Potential causes of UKs poor performance in eurocare study:

A 
Difference in data collection
Difference in  stage presentation
Delay in diagnosis
Social class
Access 
Age
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29
Q

What report was a consequence of the Eurocare study?

A

Calman-Hine report

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30
Q

Calman-hine report decided that:

A
  • All patients need uniform access to high quality care
  • Better awareness of early cancer signs
  • More information to cancer patients and their families
  • Psychosocial support
  • Primary care should be central to cancer care
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31
Q

Solutions suggested by the Calman-Hine report:

A
  • 3 levels of care: primary, cancer units, cancer centers

- MDT approach

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32
Q

Functions of the 3 levels of care identifies in the Calman-Hine report

A
  1. Primary care
  2. Cancer units - common, diagnosis, non complex chemo and surgery
  3. Cancer centers - rare, complex chemo, radiotherapy
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33
Q

What does the cancer MDT do?

A
  • Discuss new diagnosis
  • Management plan
  • Inform primary care
  • Designate key worker
  • Develop guidelines
  • Audit
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34
Q

First every comprehensive strategy to tackle cancer provision was:

A

NHS cancer plan (2000)

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35
Q

6 key areas for action in the cancer reform strategy (2007):

A
  1. Prevention
  2. Early diagnosis
  3. Better treatment
  4. Life after cancer
  5. Reduce inequalities
  6. Provide care in right setting
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36
Q

Name something which helps with life after cancer

A

National survivorship initiative

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37
Q

NAEDI hypothesis decribes =

A

Why people present late/avoidable cancer deaths

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38
Q

Why might people present late with cancer:

A
  • Lack of awareness
  • Negative perception
  • Age, sex, SES, past experience, co-morbidities
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39
Q

Medical functions of the clinical record:

A
  • Aide memory for effective communication
  • Support Hx and examination
  • Clarity of diagnosis
  • Continuity of care
  • Treatment is followed
  • Explanation for patient
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40
Q

Non-medical functions of clinical records =

A 
Audit
Financial planning
Resource usage
Research
Legal - provide info to third party, act as evidence 
Medical education
41
Q

What should you record on a clinical record?

A

Presenting symptoms and reason for seeking care
Relevant clinical findings
Diagnosis and differentials
Options for care and treatment
Safety netting and discussions with patient about risks vs benefits of treatment
Investigations ordered
Decisions made

42
Q

How should you record on a clinical record?

A

Professionally
Comprehensively
Contemporaneously

43
Q

When can info be removed from a clinical record?

A

Valueless

Duplicated

44
Q

Even if a patient requests it, when can info not be removed from a patient record?

A

Will later harm patient

Medically relevant

45
Q

What can a computerised system have that a paper based one doesnt?

A

Clinical decision support tools

46
Q

What is included in a ‘summary care record’

A

Name, address, DOB, NHS number
Mediations
Allergies

47
Q

When can you break confidentiality?

A

Required by law
Health and social care act
Court order
Public interest

48
Q

What act sets out that data should be processed lawfully, fairly, for adequate reason, up to date and not longer than necessary?

A

Data protection act

49
Q

What are the Caldicott principles of data protection?

A
  1. Justify purpose of collection
  2. Don’t share identifaible info
  3. Share minimum info
  4. Access on need to know basis
  5. Everyone with access should know their responsibilities
  6. Understand and comply with law
50
Q

The body is:

A

Physical

Social

51
Q

Discourses for bodies examples

A
  • Good/bad bodies
  • Particular bodies reflex disordered lifestyle
  • Use of self-destructive language for autoimmune diseases
52
Q

Why is the body social?

A

Seen as an external reflection of peoples attitudes, values and lifestyles

53
Q

The civilized body (Elias) =

A

Markers for an adult citizen is that the body is under control

  1. Hide natural functions
  2. Control emotions
  3. Separate space between bodies
54
Q

How is the civilized body disrupted in disease?

A
  • Cannot hide natural functions (leaky bodies)
  • May not control emotions
  • Personal space: physical care
55
Q

Male body image…

A

Language of power, neutral
Function
What the body can do

56
Q

Female body image…

A

Negative
Language of control
Apperance
Social currency

57
Q

Biographical distribution:

A

A reorganisation of life context

58
Q

Ex am ‘age appropriate body’ going wrong in disease

A

Arthritis in young person

59
Q

Body image impacts our

A

Perception of ourself
Confidence
The way we see our role
Interactions with other

60
Q

Body image problem is a

A

existence of a marked discrepancy between the actual or perceived appearance/function and an individuals expressed ideal. Leading to interference with routine, occupational, social or relationship functioning.

61
Q

Physcial impact of breast cancer =

A 
Loss of breast
Asymmetry
Difficulties with bra/clothing
Scarring
Hair loss
Weight gain
Menopausal symptoms
62
Q

Psychological impacts of breast cancer =

A 
Loss anxiety greif
Loss of confidence
Lack of trust in body
Depression
Feeling incomplete
Change of identity
Reminder of cancer
63
Q

Social impacts of breast cancer =

A 
Change in role
Sexuality
Intimacy
Forming new relationships
Employment, leisure
Social isolation
64
Q

Concerns of people with a stoma =

A 
work
intimacy
new relationships
leaky
smell
sex
65
Q

Why is hair important?

A

Identity
A way of doing gender
Demasculating

66
Q

3 different vaccine strategies:

A
  1. Protect vulnerable
  2. Elimination
  3. Eradication
67
Q

Who are ‘vulnerable’ and should be vaccinated

A
  • Increased risk of exposure (IDUs, health workers)

- Increased risks of consequences

68
Q

Elimination vs eradication

A 
Elimination = reducing transmission R<1
Eradication = no infection, animal or environmental reservoirs.
69
Q

Example of vaccines given to vulnerable people

A

Meningitis B
Pneumococcal
Influenza

70
Q

Examples of vaccines for elimination

A

Mumps
Tetanus
Diptheria

71
Q

Examples for vaccines for eradication

A

Smallpox

Polio

72
Q

Examples of passive immunity:

A

Mother to child
Placental, breast milk
IV-Ig

73
Q

Active immunity example:

A

Infection

Vaccine

74
Q

R0 =

A

Basic reproductive number.

Number of 2ndry cases per 1mary case in a totally susceptible population

75
Q

R0 is a factor of the

A

Microorganism

Population

76
Q

R0 is proportionate to:

A

Length of time cases infectious
Number of contacts: population density, travel etc
Chance of transmitting infection during encounter with susceptible host (virulence factors)

77
Q

R0 can differ in

A

Different pathogens

Different populations

78
Q

R =

A

Effective productive number. Actual number of secondary cases per primary cas observed in a population

79
Q

R0 is usually (smaller/larger) than R

A

Larger

80
Q

Equation R =

A

R = R0 x s

81
Q

s =

A

Population susceptible

82
Q

R > 1

A

Number of cases increasing

83
Q

Epidemic threshold is when

A

r = 1

84
Q

R < 1

A

Number of cases decreasing

85
Q

For elimination, R must be

A

< 1

86
Q

S* =

A

critial population susceptible.

S* = 1/R0

87
Q

H =

A

Herd immunity threshold

H = 1 = S*

88
Q

If H = 95%. What does this mean?

A

Only 5% of population can be susceptible for R = 1.

S>5% then R>1

89
Q

What is the only way to effectively eliminate an infection?

A

Herd immunity - <100% efficacy, <100% uptake, contraindications

90
Q

What should you consider when deciding is a disease should be vaccinated against?

A
  • Is it a public health issue?
  • Is this the best way of dealing with it?
  • Side effects, risks
  • public acceptance
  • Costs, resources, will is fit in with vaccine schedule
91
Q

Communicable disease =

A

An illness due to an agent that arises through transmission of that agent from infected person/animal/reservoir to a susceptible host directly or indirectly.

92
Q

How are communicable diseases controlled?

A
  • Survellience from PHE
  • Outbreak tracing
  • Prevention: vaccine, food laws
  • Shutting down/appropriate control
93
Q

Outbreak vs epidemic vs pandemic

A

Outbreak - localised area
Epidemic - large area, threshold depends on microorganism
Pandemic - very large area, crosses international border, large population

94
Q

Factors that increase risk of health-care associated infection:

A
  • Reduced immunity/co-morbidities
  • Extremes in age
  • Virulence factors of hospital pathogens
  • Antimicrobial resistance
  • Breach of defence mechanisms: ventilators, catheters etc.
95
Q

Policies and procedures to reduce HCAIs:

A
  • Sharp disposal
  • Sterilise instruments
  • Isolation, barrier nursing
  • Screening patients
  • Don;t over prescribe antibiotics
  • Vaccinate workers
96
Q

An argument is sound when -

A

Premises are true

Conclusion logically follows premise

97
Q

Deductive vs inductive reasoning

A 
Deductive = arguing from logic
Inductive = arguing from experience
98
Q

Consequentilaism vs deontology vs virtue ethics

A

Consequentiliasm = Morally right if has a good outcome
Deontology = actions themselves are morally right or wrong, duty
Virtue ethics = depends on persons character

Health and society (6 decks)

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