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Health and Society (Year 3) > Cardiorespiratory > Flashcards

Cardiorespiratory Flashcards

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Sociology 101 flashcards
1
Q

what is relative risk?

A

indicates strength of association between risk factor and event

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2
Q

what is population attributable risk?

A

takes into account RR associated with a brisk factor, as well as prevalence of this risk factor in the population.
oi.e. RF a and RF b have same RR for MI, compared to not having this RF
oMORE PEOPLE in the population have RF a than RF b -> RF a has a ↑er population attributable risk

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3
Q

describe the prinicples of number needed to harm/treat/benefit?

A

oInterventions have both NNtharm/treat
oNeed to think about: comparison, time period, baseline risk
oWhen calculating NNT Harm -> ROUND ↓DOWN↓
oWhen calculating NNT Treat/benefit ->ROUND ↑UP↑
oIn 2° prevention absolute risk difference is larger ->NNT ↓er than in 1° prevention -> fewer people need to take meds for one to benefit
oLonger time period -> ↑ risk therefore ↓NNT, when compared to shorter time period

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4
Q

what are the key aspects of TB control

A

•Effective surveillance to monitor disease + outbreaks
•Prompt ID + treatment
•Ensure people COMPLETE treatment (compliance an issue)
•Targeted prevention – BCG
•Screening for ↑ risk groups (CXR) entering the UK.
•Focus on key populations
oMigrants
oDeprived urban communities

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5
Q

what are the potential opportunities for controlling the spread of TB?

A

•↑ awareness amongst those working with high risk groups:
oHousing support
oMigrants (especially Russia + eastern Europe)
oPrisons + substance misuse projects
•ID + Educate high-risk groups: Symptoms, how it’s spread, TB is treatable + curable, common HIV co-infection
•Public info made available: online, leaflets in various languages etc.
•Interpreters for non-English speaking patients

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6
Q

what is the goal of vaccination?

A

↓mortality + morbidity from vaccine-preventable infections.

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7
Q

what are the strategic aims of vaccination?

A

selective protection of the vulnerable, elimination (herd immunity), eradication

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8
Q

what are the programmatic aims of the BCG vaccination?

A

prevent deaths, infxn, transmission (2° cases), clinical cases
o In neonates (0-4 weeks) who will be at high-risk (high incidence area, ≥1 parent/grandparent born in high-incidence country, FH in last 5 years)
oRoutine vaccination not recommended for 10-14 yrs
oID unvaccinated who are ↑risk before 16 years, who would have qualified for neonatal BCG. Offer Mantoux tesing + BCG if –ve
o Healthcare professionals who have patient/specimen contact.Those who hav FH
o Those who are in contact with someone who has active TB -> TEST + VACCINATE

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9
Q

what is DOT?

A

directly observed treatments

TB control

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10
Q

what are the 5 components of directly observed treatment?

A

oGovernment commitment (political will + centralised system of TB monitoring_
oCase detection by sputum smear
oStandardised treatment regimen, observed by healthcare worker for at least 2 months
oStable + reliable drug supply
oStandardised recording + reporting system

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11
Q

what is a patient pathway?

A
  • A patient-pathway describes the ‘best’ route from 1st contact with services ->stages of investigation/treatment ->definitive treatments ->discharge from NHS + social services.
  • Useful to guide clinicians and to inform patients what is to happen next.
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12
Q

what are the ways for people to access services?

A
  • GP
  • Self-referral (A&E, online)
  • Social services/local authority
  • Emergency – ambulance
  • Educational institution – welfare
  • Dental practitioner
  • Charity?/Community programmes
  • Lay-referral
  • Pharmacists
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13
Q

what are zola’s triggers to health seeking?

A
  • Interference with work/physical activity
  • Interference with social relations
  • Assigning arbitrary time limit
  • Interpersonal crisis (deaths, divorces etc.)
  • Sanctioning
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14
Q

what are the barriers to health seeking?

A

-Inverse care law (poor areas=less provision)
-Geographical distance – transport costs, time
-Previous bad experience (staff, waiting times)
-Childcare(availability + costs)
Psychological factors (refusal to believe, worried, lack of education)
-Context of event (Xmas, birthdays, weddings)
-Perception/Evaluation of symptoms as harmless

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15
Q

what are the ways to overcome barriers to health seeking?

A

•Quality improvement – ID barriers, think about changes, implement change, audit. (PDSA cycles)
oThinks about the system from a user’s perspective
•Community outreach programmes - ↑ provision in the community, rather than centralised provision which may be ↑difficult to access.
•Transport - Volunteer drivers, Discounted hospital buses,

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16
Q

what was the keogh report?

A

pt safetyPublished hospital standardised mortality rates (SMRs) -> WRONG APPROACH

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17
Q

describe the need for publicly available performance indicators?

A
  • Public scandals ↑ pressure for outcomes to be published and used.
  • Other public sectors (schools, police) make this info. available -> right to access it?
  • Expectation to collect outcome data + publish it ->arrival of coded computerised clinical databases means that data is there to be used.
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18
Q

what are the advantages of publicly available performance indicators?

A
  • ↑ information about healthcare providers
  • Informs patient, ↑ + encourage choice – Caveat emptor
  • Transparency, honest + open ->↑ trust in health providers
  • May ID outliers – can learn from hospital with ↓↓↓mortality, to improve those with ↑↑↑mortality.
  • Quantitative – clear numerical figure
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19
Q

what are the disadvantages of publicly available performance indicators?

A

Hospital SMRs are NOT FIT FOR PURPOSE
•Only work when considered alongside avoidable deaths (PRISM study -> 5.2% avoidable deaths + no correlation, r=0.03, between SMR + avoidable deaths)
•Dependent on non-hosp care (i.e. prehosp/variation in planned place of death (i.e. hospice)
•Data vagaries (unexplicable change in definition/coding)
•Choice of case mix adjustment model ->leads to varying results dependent on which you use
•Relationship with quality of care (validity) not demonstrated
•Even if all treatment/care was uniform, there would ALWAYS be random variation in mortality rates across hospitals, as each patient is unique!
•Must be adjusted for confounders (i.e. age) as older people ↑ likely to die, therefore hospital serving an older population -> ↑ SMR…
•No evidence that publishing these influences patients, lots of evidence showing that it influences clinicians + managers.
•Incentivising targets may be a pervert practice – i.e. people avoid complex cases, to ↓SMR

20
Q

describe primary CHD prevention?

A

before onset of disease, stopping it developing in first instance
i.e. smoking cessation, healthy eating, exercise

21
Q

describe secondary CHD prevention?

A

With disease, preventing progression or any adverse events once disease is developed
antiplatelet therapy post-MI, statins, hypertension treatment

22
Q

describe tertiary CHD prevention?

A

limiting the impact that adverse events have on health

i.e with cardiac rehab, CABG/PCI

23
Q

what is the prevention paradox?

A

A preventive measure that brings large benefits to the community offers little to each participating individual

24
Q

describe the prevention paradox in heart disease?

A
  • Most heart disease is occurring amongst people who are not at high risk
  • But way more people are at moderate/low risk than are at high risk
  • If we target ALL (including this group) with a population strategy then more people are at lower risk -> greatest population benefit.
25
Q

describe the population strategy of prevention?

A

lower the exposure of WHOLE population.
•PROS: Large potential to prevent more deaths.
•CONS: Small individual benefit, poor motivation (why should I make this change if I’m already @ risk?), low benefit:risk (must be safe to do!)

26
Q

what risk factors for heart disease have the greatest population attributable risk?

A 
ApoB/ApoA-1 - 49%
smoking. - 36%
diabetes - 10%
hypertension - 18%
abdominal obesity - 20%
psychosocial - 33%
fruit and veg daily - 14%
exercise - 12%
alcohol - 7%
27
Q

describe the 10 year CVD risk prediction chart?

A
  • These are based on DATA from the Framingham Study, a cohort study looking at RFs + outcomes.
  • 10,000 subjects analysed for BP, diabetic status, smoking status + outcomes measured.
  • Found numerous factors were associated with ↑ risk of CHD, CVA, HF and peripheral vascular disease.
28
Q

describe the role of risk calculators in CHD?

A
  • Illustrates visually to patient – RED = BAD
  • Informs the clinician as to who to treat
  • Emphasises what’s important in terms of modifiable risk factors (i.e. more important to stop smoking than to eat extra fruit + veg)
29
Q

what is strategic planning?

A
  • Where are we now? Baseline data, how many people have the disease? How many at risk? WHO is affected?
  • Where do we want to go? We want less. How much? Is that realistic? Will we have balance ↓ across demographic/socioeconomic classes? Where we draw the line, between treating ‘well people’ for a disease they don’t have?
  • How to get there? -> Evidence base should inform us what’s effective – diet? Exercise? Medication?
  • How will we know if we’re there? Measures of…death? Cashed prescriptions? + NSFs
30
Q

what are national service frameworks?

A

• Policies set by NHS to define care standards for major diseases (Cancer, CHD, COPD, DM etc.) or for specific patient groups (elderly, palliative care)
• TWO main roles:
1) Set formal quality requirements, based on best evidence for/against treatments/services
2) Offer strategies/support to help organisations attain these

31
Q

who would be involved in developing a national service framework strategy?

A
  • Department of Health create the strategy, after IDing need for one
  • Strategic Health Authority implement + manage it
  • Consultation with patients, carers, public, charities, healthcare professionals and industry
32
Q

what factors go into developing a strategy for CHD?

A
  • Look at risk factors and patient pathway (rapid referral, diagnostic testing) and ID areas for improvement.
  • ID what priorities should be • Evidence in support of proposed interventions
  • Should include clear (SMART) goals, which should be quantified and time-related
  • Outline what measures would be used to monitor this
  • Outline HOW this change can be implemented
33
Q

What are the ethnic and gender differences in ischaemic heart disease?

A
  • Incidence ↑ with age
  • M>F
  • FH
  • Social disadvantage
  • South Asia - ↑ mortality of IHD + stroke, c.f Europeans
  • African/Caribbean - ↓ risk of IHD mortality but ↑ stroke, c.f. Europeans
34
Q

what are the reasons for ethnic and gender differences in ischaemic heart disease?

A
  • Difference in access to healthcare, health-seeking behaviour – different ethnicities may hold firm health beliefs, which arise from their native culture, ↓ likely to seek doctor help.
  • Inaccessible due to language barrier
  • Genetic susceptibility
  • Discrimination – Inverse care law
  • ↑diabetes prevalence in S asians
  • Smoking prevalence↑, ↓ F+V consumption, ↓ exercise levels in Bangladeshi population
35
Q

describe why there is gender difference in ischaemic heart disease?

A

• Oestrogen may have protective effect – HRT  ↓ IHD

o May be selection bias as HRT users typically healthier in general, than non-HRT users.

36
Q

how do ethnic and gender differences in ischaemic heart disease affect population health?

A
  • Larger populations of of those at ↑risk -> ↑Average population risk
  • Should be used to target intervention where it is needed most i.e. community education in areas with ↑population of those at risk.
  • Need to address other barriers – to focus on prevention i.e. provision of information, interpreter access
37
Q

describe the changing prevelance and incidence of ischaemic heart disease?

A
  • UK incidence of IHD is falling, in line with most of developed world.
  • Eastern Europe has the reverse pattern!!
  • Continual flux of race/ethnicity in our population, carries with it changing risks for various diseases.
38
Q

what are the modifiable risk factors for CVD?

A
  • HYPERTENSION
  • SMOKING (↑50%)
  • DIABETES
  • TOTAL CHOLESTEROL + HDL:LDL RATIO
39
Q

what are the non-modifiable risk factors for CVD?

A
  • AGE
  • SEX
  • FAMILY HISTORY
  • ETHNICITY
  • SOCIO-ECONOMIC POSTION (?)
40
Q

how has smoking as a risk for CVD changed over time?

A

↓numbers but ↑teenage F smokers

Factor with one of highest population attributable risk

41
Q

how has poor diet/obesity as a risk for CVD changed over time?

A

– thought to be responsible for 25-50% of CVS deaths per year
o Prevalence↑ rapidly worldwide
o Factor with one of highest population attributable risk

42
Q

how has diabetes as a risk factor for CVD changed over time?

A

↑prevalence rapidly across the westernised world

o Also has high population attributable risk

43
Q

how has smoking, cholesterol, population BP fall, deprivation as risk factors for CVD changed over time?

A

All have ↓ recently – accounts for reduction from 70s

44
Q

how can lifestyle modification be negotiated with patients?

A
  • Visual aids + demonstration of how altering lifestyle can ↓ risk
  • JBS2 or QRISK online aids
  • 2 mmHg ↑  7% ↑ in CVD and a 10%↑ in Cerebrovascular disease
  • Inform that diet and exercise are the MOST EFFECTIVE methods of ↓ CVD risk
  • If ↓ risk, less or no need to take medication (i.e. statins)
45
Q

what works in supporting behavioural change?

A
  • BENEFICIAL – Advice from healthcare professionals re: ↓Na+/Cholesterol diet, antismoking interventions (NRT, Buproprion, Varenicline), exercise advice,
  • LIKELY TO HELP - counselling to ↑activity levels, self-help materials, telephone advice service on smoking cessation
  • INEFFECTIVE/HARMFUL – acupuncture in smoking cessation, anxiolytics in smoking cessation

Studies of these influences are bound to be susceptible to confounding factors and also are very heterogeneous, making meaningful meta-analyses DIFFICULT to assess. However trials have showed benefit.

Health and Society (Year 3) (6 decks)

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