Cardiorespiratory Outcomes Flashcards
What is a “patient pathway”?
The “best” route that a patient takes from their 1st contact with an NHS member of staff (usually GP), through referral, completion of treatment.
It also covers the period from entry into a hospital or a Treatment Centre, until the patient leaves
What are Zola’s Triggers to health-seeking? 5 points
- Interference with work / physical activity
- Interference with social relations
- Assigning arbitrary time limit
- Interpersonal crises (death, divorce)
- Sanctioning
State some barriers to health seeking? 6 points
- Inverse care law
- Geographical distance
- Previous bad experience
- Childcare issues
- Psychological factors (denial, worry, lack of education)
- Perception of symptoms as harmless
How can doctors reduce delay in patients getting help for their conditions? 3 points
- Community outreach programmes (Vs. central provision which is difficult to access)
- Transport (volunteer drivers)
- Quality improvement projects (Help think about system from user’s perspective)
What is the Inverse Care Law?
Availability of good medical care varies inversely with the need of the population served
What are the positives of making Performance Indicators publicly available? 4 points
- Increases information about healthcare provider
- Informs patient and encourages choice (Caveat Emptor)
- Transparency increases trust with provider
- Quantitative, with clear numerical figures
What are the negatives of making Performance Indicators publicly available? 5 points
- No evidence patients actually use this information more so than clinicians
- Does not always give the full picture
- Can be subject to random variation
- Not always actionable
- Must be adjusted for confounding factors
Why do South Asians have the highest rates of CVD?
- Genetic susceptibility
- Inverse care law
- Lifestyle: Increased smoking, low fruit / veg consumption, low exercise levels
- Language barriers
- Reliance on folk medicine
What six risk factors are associated with CVD?
Hypertension Smoking Hypercholesterolaemia Diabetes Inactivity Overweight / Obesity
Give examples of two online aids used to calculate CVD risk?
QRISK2
JBS3
Discuss the Joint British Societies (JBS) 10-year CVD risk prediction chart
- Is widely accepted
- Based on Framingham cohort study data of 10,000 patients
- Found many factors are associated with increased risk of CHD, CVD, HF, PVD etc.
What is the role of risk calculators?
- Visual representation to patients (i.e. red = bad, green = good)
- Informs clinicians on who to treat
What is the BP target for patients under and over the age of 80?
Under 80: 140/90
Over 80: 150/90
What is the BP target for diabetics with and without end-organ damage?
With end-organ: 130/80
With no end-organ: 140/80
What medications can precipitate an asthma attack?
NSAIDs
Beta-blockers
What patient groups should be considered for VTE prophylaxis?
Previous VTE, thrombophilia, malignancy, post-operative setting, trauma, indwelling central catheter, Chronic medical conditions, paresis, increasing age, obesity, oestrogen containing contraceptives, HRT, varicose veins, pregnancy and up to 6 weeks postnatal, first-degree relative with a Hx of VTE, admission to intensive care
What are some examples of mechanical VTE prophylaxis?
Compression stockings
Intermittent pneumatic compression devices
What are some examples of pharmacological VTE prophylaxis?
- LMWH drugs (i.e. -parin drugs)
- Factor Xa inhibitors (i.e. -xaban drugs)
- Fondaparinux (antithrombin III inhibitor)
- UFH
Discuss what avenues can be used to control the spread of Tuberculosis? 7 points
- BCG vaccine: Attenuated live bovine vaccine offered to young children
- TB screening: For people at high risk of contracting TB “case finding”
- Contact investigation: For people who have had high exposure to a TB patient
- TB prophylaxis: 3 months of RIP for 6 months of IP, to stop progression of latent -> active TB
- DOT: for prisoners, homeless and those with poor compliance
- DR-TB / XDR-TB: Categorisation of TB allows guidance on ways to treat specific strains
- TB education: DoH, NHS Choices, Public health england should develop strategies
Define “Primary prevention”
Preventative strategies before onset of disease, stopping it developing in first instance
Define “Secondary prevention”
Preventing progression or any adverse events once disease is developed
Define “Tertiary prevention”
Limiting the impact that adverse events have on health
Define “Prevention paradox”
A preventive measure that brings large benefits to the community offers little to each participating individual’
What is the most common and second most common cancer in women?
Breast cancer
Lung cancer
What is the most common and second most common cancer in men?
Prostate cancer
Lung cancer
What are the most common risk factors associated with lung cancer?
Smoking
Asbestos, silica, diesel
Air pollution
Old age
What is “Relative survival”?
Estimated number of patients expected to survive, calculated from mortality data
What is “Observed survival”?
Actual number of patients alive after a specified time post-diagnosis
What is “Net cancer specific survival”?
Probability of surviving illness in absence of other illness
What is “Crude Probability of death”?
Probability of death from illness in presence of other illness
