Block 9 H+S Flashcards

Question

What is WHOs definition of environment, in relation to health?

Answer 1

- All the physical, chemical and biological factors external to a person, and all the related behaviours - Environmental health consists of preventing or controlling disease, injury, and disability related to the interactions between people and their environment

Answer 2

Sudden increase in occurrences of a disease in a community, which has never experienced the disease before or when causes of the disease occur in numbers greater than expected in a defined area

Answer 3

Occurrence of a group of illnesses of similar nature and derived from a common source, in excess of what would be normally expected in a community or region

Answer 4

- Worldwide epidemic | -  Outbreak -> epidemic -> pandemic

Answer 5

-Insure poor countries against the threat of a pandemic - Funds and international responders sent to country with outbreak to reduce human suffering - Development of vaccines - Fast, early, planned response means less spread - Monitor disease to prevent future outbreaks

Answer 6

-Providing leadership on matters critical to health and engaging in partnerships where joint action is needed - Shaping the research agenda and stimulating the generation, translation, and dissemination of valuable knowledge - Setting norms and standards and promoting and monitoring their implementation - Articulating ethical and evidence-based policy options - Providing technical support, catalysing change, and building sustainable institutional capacity - Monitoring the health situation and assessing health trends

Answer 7

-Econonics - Many developing countries can only spend a few dollars per annum per capita on healthcare - Priorities - 'Developed world academic' analyses of cost-effectiveness may not reflect the developing world realities - Setting - Countries where true reductions in incidence and prevalence have occurred (e.g. uganda) may be characterised by openness in political leadership towards HIV/AIDS and other cultural factors

Answer 8

-To reduce mortality and morbidity from vaccine preventable infections - To prevent outbreaks and epidemics - To contain an infection in a population - To reduce the number of infections - To interrupt transmission to humans  To generate herd immunity - To eradicate an infectious agent

Answer 9

- Disease burden  Risk of exposure to the disease - Age, health status, vaccination history - Special risk factors - Reactions to previous vaccine doses, allergies - Risk of infecting others  Cost - Are there other ways to control the disease? - impact on public perception

Answer 10

-Where no other reservoirs of the infection exist in animals or environment - Where consequences of infection are very high - Where scientific and political prioritisation exists

Answer 11

- Smallpox | - Polio

Answer 12

- Level of immunity in the population which protects the whole population - Herd immunity only applies to diseases which are passes from person to person - Provides indirect protection to unvaccinated as well as direct effect to the vaccinated - A disease can therefore be eradicated even if some people remain susceptible

Answer 13

-Basic reproduction rate - The average number of individuals directly infected by an infectious case during the infectious period, in a totally susceptible population (number of secondary cases following introduction of infection)

Answer 14

-The rate of contacts in the host population - The probability of infection being transmitted during contact - The duration of infectiousness

Answer 15

Estimates the average number of secondary cases per infectious case in a population made up of both susceptible and non-susceptible hosts

Answer 16

- R = R0x (x is the fraction of the host population which is susceptible e.g. half population is 0.5) -  R>1 - number of cases increases -  R<1 - Number of cases decreases, needs to be maintained for elimination -  R=1 - Epidemic threshold

Answer 17

H(R0-1)/ R0

Answer 18

-Makes recommendations for countries on vaccination policy - Supports less able countries with vaccination strategy implementation - Works through the international health regulations to ensure the maximum security against the international spread of disease with a minimum interference with world traffic

Answer 19

-Expanded programme on Immunisation (EPI) - Global Polio Eradication Initiative (GPEI) - Global Alliance for Vaccines and Immunisation (GAVI)

Answer 20

-Who - To protect vulnerable, contain outbreak, eradicate disease - How - Pilots, phased introduction, global vaccination - When - Greatest impact on disease burden

Answer 21

- Conversation between patient and their health care professional to reach a health care choice together. -  Important when - There is more than one reasonable option, no one option has a clear advantage, the possible benefits/harms of each option affect patients differently

Answer 22

``` - Can save life - Ingredients are safe in the amount used - Adverse reactions are rare - Herd immunity - Save children and parents time and money - Protect future generations - Eradication of diseases - Economic benefits for society ```

Answer 23

- Can cause serious and sometimes fatal side effects - Contain harmful ingredients  -Government should not intervene in personal medical choices  -Can contain ingredients some people object to e.g. chicken eggs  -Unnatural  -Pharmaceutical companies main goal is to make profit  -Some diseases that vaccines target are relatively harmless in many cases e.g. rotavirus

Answer 24

``` -Lifestyle - Perception of health  -Beliefs about childhood diseases - Risk perception of the diseases - Perceptions about vaccine effectiveness and vaccine components -Trust in institution ```

Answer 25

-  For the individual - Protection by 'herd immunity' may be safest option as avoids risk of vaccine -  For the community - Avoidance of vaccination leads to reduced coverage so diminishes herd immunity

Answer 26

-NHS fitfortravel | - The National Travel Health Network and Centre (NaTHNaC)

Answer 27

-Free - Diptheria, polio, tetanus, typhoid, hepatitis A, cholera - Private - Hepatitis B, japanese encephalitis, meningitis, rabies, TB, yellow fever

Answer 28

``` -The country or countries you're visiting - When you're travelling - Where you're staying - How long you'll be staying - Your age and health - What you'll be doing during your stay - If you're working as an aid worker - If you're working in a medical setting - If you're in contact with animals ```

Answer 29

1. Breast/prostate 2. Lung 3. Bowel 4. Melanoma 5. Non-Hodgkin Lymphoma

Answer 30

1. Lung 2. Bowel 3. Prostate/breast 4. Pancreas 5. Oesophagus

Answer 31

- Prevention - Legal and lifestyle changes, vaccinations - Screening - Early detection and diagnosis - Disease management - Improving treatments and quality of life

Answer 32

Bad/difficult news is defined as any news that drastically and negatively alters the patient's (or their relatives) view of his or her future

Answer 33

Institutionalised beliefs, personality types, gender, culture/race, religion, patients knowledge, relatives

Answer 34

-Uncertainty about the patient's expectations  -Fear of destroying the patient's hope - Fear of their own inadequacy in the face of controlling disease - Not feeling prepared to manage the patients anticipated emotional reactions - Embarrassment at having previously painted too optimistic a picture for the patient

Answer 35

``` A - Advanced preparation  B - Building a relationship  C - Communicate well  D - Deal with patient reactions  E - Encourage and validate emotions ```

Answer 36

```  S - Setting up  P - Perception  I - Invitation  K - Knowledge  E - Emotions  S - Strategy and summary ```

Answer 37

```  -Change in roles  -Change in responsibilities  -Change in physical needs  -Change in emotional needs  -Change in sexuality and intimacy - Change in future plans ```

Answer 38

-Despite limitations of the methodology, cancer survival in the UK in the 1980-90s was one of the worst in Europe - Expert advisory group formed to the chief medial officer in 1995 which generated the calman-hine report

Answer 39

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.  - All patients to have access to a uniformly high quality of care - Public and professional education to recognise early symptoms of cancer -Patients, families and carers should be given clear information about treatment options and outcomes - The development of cancer services should be patient centred - Primary care to be central to cancer care - The psychosocial needs of cancer sufferers and carers to be recognised

Answer 40

There should be 3 levels of care: - Primary care  -Cancer units serving district general hospitals - Treat common cancers, diagnostic procedures, common surgery, non-complex chemo  -Cancer centres (populations in excess of 1 million) - Treat rare cancers, radiotherapy, complex chemo  Key to managing patients would be the MDT

Answer 41

-Set national standards and define service models for a service or care group - Put in place programs to support implementation - Establish performance measures against which progress within agreed timescales would be measured

Answer 42

-Save more lives  -Ensure people with cancer get the right professional support, care and treatments - Tackle the inequalities in health e.g. unskilled workers are 2x more likely to die from cancer as professionals  -Build for the future -Investment in cancer workforce, strong research, preparation for the genetics revolution NHS plan followed by several improving outcomes guidance (NICE) which relate to the organisation of services for a particular cancer.  - 2000 manual of cancer - >300 standards relating to the delivary of cancer treatment including provisions of chemotherapy, radiotherapy etc - 2004 manual of cancer (manual of quality measures) - >900 new measures

Answer 43

- Prevention - Smoking, obesity, alcohol etc - Diagnosing cancer earlier - Screening - Ensuring better treatment - Reduced waiting times, increase in radiotherapy capacity, new cancer drugs be referred to NICE, chemotherapy audits - Living with and beyond cancer - National cancer survivorship initiative -Reducing cancer inequalities - Delivering care in the most appropriate setting - Locally where possible, services should be centralised where necessary

Answer 44

 Partnership with cancer charities, clinicians and patients, considered a range of approaches to improving services and support available for cancer survivors

Answer 45

-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

Answer 46

-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

Answer 47

-Spearhead a radical upgrade in prevention and public health  -Drive a national ambition to achieve earlier diagnosis  -Establish patient experience as being on a par with clinical effectiveness and safety  -Transform our approach to support people living with and beyond cancer - Make the necessary investments required to deliver a modern high-quality service - Overhaul process for commissioning, accountability and provision

Answer 48

- Perceptions, thoughts, and behaviours related to one’s appearance - The body is a bearer of values and a means of representing our identity to others - It shows who we are to others

Answer 49

- Chronic illness leads to a loss of confidence in the body | -  From this follows a loss of confidence in social interaction or self-identity

Answer 50

``` - Scars - Prosthetic device - leg  -Mastectomy - Impact on sexuality - Function, pain, appearance - Stoma - Hair loss  -Weight loss/weight gain ```

Answer 51

-An important site for individual and group identity - A way of 'doing gender' - A symbol of femininity? Hair loss not so bad for men - Stigma - Patients have some choice as to whether they will be stigmatised - Patient control of their status as sick - Can be managed through 'normal' appearance (wigs, beanies, scarves)

Answer 52

-Support patient care - Improve future patient care - Social purposes at the request of patients - Medico-legal document

Answer 53

-Presenting symptoms and reasons for seeking health care  -Relevant clinical findings - Diagnosis and important differentials - Options for care and treatment - Risk and benefits of care and treatment - Decisions about care and treatment  -Action taken and outcome

Answer 54

- Paper - Continuous, portable, writer identified, legibility issues, must be dated and signed -  Electronic - Problem orientated, searchable, structured, safer prescribing, clinical decision support software

Answer 55

-Support clinical audit  -Facilitates clinical governance  -Facilitates risk management - Support clinical research

Answer 56

Legal obligation which is imposed on an individual requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others

Answer 57

- Negligence is a failure to exercise the care that a reasonably prudent person would exercise in like circumstances -  You have to make decisions that adheres to your duty of care as a doctor and could not be considered negligent

Answer 58

-Beneficence - Duty to do good - Non-maleficence - Duty to not cause harm - Autonomy - Patient has the right to make their own decision  -Justice - Fair, equitable treatment for all

Answer 59

-Consequentialism - The correct moral response is related to the outcome or consequence of the act -Deontology - Places value on the intentions of the individual and focuses on rules, obligations and duties - Virtue ethics - Right living is derived from the moral character of the agent

Answer 60

- Get clear on the logical form of the argument | - Query - Valid and sound

Answer 61

-Different premises may express different concepts  -Confusing necessary with sufficient, and vice-versa - Insensitive to the way in which claims are qualified - Argument begs the question

Answer 62

-Argument is invalid - Argument is valid but one or more premise is false - Makes a false/controversial moral/empirical claim  -An unsound argument doesn't mean there will be an unsound conclusion

Answer 63

-Straw man fallacy - Simply ignoring the person’s actual position and substituting it for a distorted, exaggerated or misrepresented version of that position - Ab hominems - Directed against a person rather than the position they are maintaining - Appealing to emotion - Begging the question  -Argument from fallacy - Conclusion must be false because the premises are false (not necessarily)

Answer 64

-Seek to support a moral claim of some kind - Argument need not succeed but to be an argument it must at least provide some supporting reasons for the claim in question

Answer 65

- Purely logic | - This means this, so this means this

Answer 66

Making an argument based on observation, more probable conclusions (seeing is believing but you may not have seen everything)

Answer 67

-Modern management of cancer - Involved many disciplines, surgical and non- surgical, oncology  -Allied health professionals e.g. nurses, physiotherapists, speech therapists, etc - Delivery of cancer care is often fragmented over several hospital sites - Need to streamline and co-ordinate various components of care - Probably better outcomes for patients managed in MDTs

Answer 68

-Discuss every new diagnosis of cancer within their site - Decide on a management plan for every patient  Inform primary care of that plan - Designate a key worker for that patient - Develop referral, diagnosis and treatment guidelines for their tumour sites - Audit