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DPS Flashcards

1
Q

Case-control study

A

Causes or risk factors
Looks back over time to check for common activities/exposures
Compares those with condition to control group and increase in exposure in condition group suggests risk factor

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2
Q

Cohort study

A

Harm or causes
Forward in time. Take group that got exposed to e.g. radiation and get very similar but unexposed group as control. Watch and see what happens (e.g. increased incidence of specific disease)

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3
Q

Qualitative study

A

Experience of the illness

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4
Q

RCT

A

Effectiveness of treatment

Cohort study with randomly allocated groups between control and interventional

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5
Q

Cross-sectional study

A

Looks at prevalance

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6
Q

The 4 A’s of studys

A

Assess (define question)
Access (search using medline etc)
Appraiase (how good study is)
Act (use info, taking into account limitations)

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7
Q

ODDS RATIO (OR)

A

odds of outcome in treatment group/ odds of outcome in placebo

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8
Q

RELATIVE RISK (RR)

A

risk of outcome in treatment group/risk of outcome in placebo group

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9
Q

What is Attachment?

A

emotional relationship that is specific to 2 people, endures over time and in which prolonged separation causes stress and sorrow

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10
Q

What are the phases of attachment?

A

Pre attachment phase (up to 3 months)
• Preference for contact with humans shown by smiling, nestling and gurgling

Indiscriminate attachment (up to 7 months)
•	Strangers can look after them without distress if they’re caring
•	Discriminate between familiar and unfamiliar people

Discriminate attachment (from 7-8 months)
• Requires infant to be able to discriminate between mother and others
• Actively tries to stay close to familiar people and has separation anxiety on separation

Multiple attachment phase (from 9 months)
• Strong additional ties and starts relationships with others
• Fear of stranger weakens but strongest attachment (mother) remains

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11
Q

What is the Psychoanalytic theory of attachment?

A

Babies become attached to their carer as they satisfy the baby’s instincitive needs

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12
Q

What is the behavioural theory of attachment?

A

Babies become attached to carer due to associating them with gratification and physiological needs

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13
Q

What is Bowlby’s theory of attachment?

A

It is the synchrony of action (baby faces) between the mother and the child in the first 36 months that provides attachment.

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14
Q

What are Mirror Neurones?

A

They fire when an action is watched and same neurones fired when the action is performed.

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15
Q

What is Ainsworth’s theory of Individual Variation?

A

An Attachemnt theory that there are 3 forms of attached children:
Anxious-avoidant type
• Distress caused by being alone but no difference if this is mother or other person.
• Play little affected by whether mother is present or absent
• Indifferent and actively ignores or avoids mother on return.

Secure attachment type
• Ignores mother (can be trusted)
• Plays happily regardless of whether mother is there, stranger is there or not.
• Distressed and play reduced if mother leaves
• Actively seeks mother on return and calms and continues play
• Mother and stranger treated differently but stranger can provide some comfort.

Anxious-resistant type
• Cries more than other types
• Difficulty using mother as secure base
• Very distressed when mother leaves. Seeks contact on return but simultaneously resists and shows anger.
• Actively resists strangers attempts to make contact
• Fussy and wary when mother present

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16
Q

What is Piaget’s Theory of child development?

A

Cognitive Development:
Series of fixed stages
Brain not finished developing til late adolescence
Continuous process of assimilation and accommodation

Birth- 2 yrs Sensoriomotor
Turn from reflex driven to goal driven

2- 7 years Preoperational
Develop language
Only aware of immediate environment

7-12 years Concrete operations
Start to differentiate between self and others
Understand more than one dimension of situation
Can only understand problems in the real world

12+ Formal operations
Hypothetical thinking starts

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17
Q

What is Erikson’s theory of Child Development?

A

Social development:
Each stage linked to psychosocial areas
Each stage struggle between 2 conflicting personalities

0-1 yrs Trust v Mistrus

1-2 yrs Autonomy v Shame and Doubt
• Primary social interaction with parents- feeding, holding on, letting go, toilet training. Start of autonomous will

3-5 yrs Initiative v guilt
• Development of conscience
• Enjoys group play
• Identifies with gender

6- puberty Industry v inferiority
• Primary social interaction outside home
• Role models
• Enjoys peer groups of same gender
• Learns from parents, peers + role models

Adolescence Identity v Role Confusion
• Primary relationships with peers/heterosexual relationships
• Identity crisis
• Coherent sense of self develops
• Distancing from family
• Orientated towards present rather than future

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18
Q 
Children in hospital:
Immanent justice (1-7yrs)
A

illness caused by bad behaviour or punishment. Child normally has limited experience of illness and no other obvious explanation. Preschoolers will abandon this with personal experience of the illness

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19
Q

Children in hospital:

Phenomenonism (3-7yrs)

A

cause of illness is spatially and temporally remote phenomenon.

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20
Q

Children in hospital:

Contagion (6-7 yrs)

A

Cause of illness located in people and linked by magic

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21
Q

Children in hospital:

Contamination (Concrete operations 7-12 yrs)

A

cause is external to child and is passed by touching (you’ve got germs)

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22
Q

Children in hospital:

Physiological (Formal operations 12+)

A

illness is malfunction of internal organs. Realise death is permanent.

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23
Q

Why do we age?

A
  1. Wear and tear- body is mechanical robot
  2. Cellular
    - a. Hayflick limit- max no. of cell divisions
    - b. Cross linking- proteins in cells make body stiffer.
    - c. Free radicals- interact and cause damage
    - d. DNA replication/repair malfunction
  3. Rate of living- born with max physiological capacity
  4. Programmed cell death- genetically programmed to die
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24
Q

How do you perpare children for hospitals?

A

Preparing for hospitals- Encourage parents to stay.
Before admission- visits, videos, books.
On admission- show instruments, distraction strategies, short waits before operations.

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25
What is Attribution theory?
There is a causal explanation for events/behaviours e.g. Kelley's covariation theory
26
What is Kelley's covariation theory?
That there are 3 factors that influence behaviour: Consensus- do other people do the same in that situation? Consistency- does behaviour reliably occur in this situation? Distinctiveness- does it only occur in this situation?
27
What is an internal locus of control
relating to Kelley's covariation theory of attribution, event/behaviour are attributed to individual e.g. individual is prime determinant of health state.
28
What is an external locus of control
Relation to Kelley's covariation theory of attribution, event/behaviour are attributed to uncontrollable factors e.g. Luck and chance.
29
What is Fundamental attributional error
overemphasis of personality compared to environmental influences
30
What is Actor-observer attributional bias?
tendency to overestimate importance of environmental influences in explaining own behaviour
31
What is False Consensus?
Tendency to believe own views widely shared
32
What is a self-serving attributional bias?
Tendency for individuals to attribute more .responsibility to themselves for successes rather than failures
33
What is somatisation in terms of attribution theory?
Patients with the wrong attribution of the cause
34
What is an Attitude?
learned response, relatively enduring that influences and modifies our response towards that person or object
35
What are the three aspects of Attitude?
Cognitive- beliefs and preconceived expectations Affective- feelings or emotions aroused by object Behavioural- action towards object
36
What is stigma?
hostile or negative attitude towards distinguishable group with no reinforcing evidence, normally as result of a generalisation
37
Cognitive dissonance
holding 2 opposite beliefs at same time (e.g. I smoke. Smoking is harmful) causes either belief to change, behaviour to change or for a new belief to be made
38
What is a Stereotype?
Perceptions that most members of a category share an attribute.
39
What are the effects of stigma due to a physical deformity?
``` H eightened social anxiety E mbarrassment L ow self esteem D epression S ocial withdrawal I solation ```
40
What is Discredited stigma?
openly visable and involved in all social interactions
41
What is Discredible stigma?
can be hidden
42
What is Felt stigma?
refers to shame and expectation of discrimination
43
What is enacted stigma?
actual experience of being treated differently because of stigma.
44
What is courtesy stigma?
If you are close to someone who is stigmatised and try to conceal it from others.
45
What is Invisible death
In modern society there is less experience of death with NHS institutionalising dying. Means people are more afraid of dying and the process as it is more unknown.
46
What is the role of doctors in dying?
* Symptom control * Facilitating care * Counselling/therapy * Prescribing drugs * Maintaining hope
47
What is the Glaser and Strauss theory of dying?
* Closed awareness- doc knows patient is dying, patient doesn’t * Suspicion- suspect they are dying * Mutual deception- both know but deceive each other. Can happen in treatment from curative to palliative. * Open Awareness- both know whats going on.
48
What are the trajectories of dying?
Gradual slant downward slant peaks and valleys descending plateaus
49
What are the Elizabeth Kubler-Ross 5 stages of dying
``` DABDA Denial Anger Bargaining Depression Acceptance ```
50
What are the pros and cons for the 5 stages of dying?
Critisisms Reinforces ‘good death’ and over sentimentalises the dying process Death and dying industry Over influential Defences Wasn’t a self help guide Wasn’t intended to be sequential Based on own experiences of interviewees
51
What are the Rob Buckman 3 stages of dying?
``` IVC Initial stage (facing threat) -Shock, anger, disbelief etc. Chronic (being ill) -Finishing unfinished business -Depression Final (acceptance) ```
52
What is the Pattison- Living-dying interval (1977)
Interval between crisis of knowledge of death and point of death when we realise life trajectory has changed from our predicted one.
53
What are the Corr (1992) Task based approaches to dying?
``` PSPS Physical-pain control Social- finishing unfinished business Psychological- maintaining independence Spiritual-Life review ```
54
Refugee
Fled country and cannot return for well- founded fear of persecution. Granted indefinite leave to remain and same rights as UK citizen.
55
Asylum seeker
left country and is applying for recognition as a refugee, awaiting a decision.
56
What are the rights to healthcare of refugees, asylum seekers and failed asylum seekers?
Asylum seekers/ refugees allowed same amount healthcare as UK citizen Failed asylum seekers only allowed emergency healthcare
57
What is aggression?
Verbal/physical behaviour that is intended to injure person or damage property.
58
What is the Ethnology Theory, Lorenz (1963)
Agression theory • Ensures members of same species don’t live too close developing resources for future generations • Fights select biggest/strongest to breed
59
What is Freuds psychoanalytic theory?
* Aggression is basic drive. | * Form of energy that persists until goal complete
60
Frustration- Aggression Hypothesis (Dollard 1939)
Frustration is goals being thwarted. Leads to behaviour intending to injure obstacle Frustration: Always leads in aggression Aggression: Always stems from frustration
61
Social Learning Theory (Bandura 1973)
Aggression is learned form of social behaviour No innate aggressive drives Starts in childhood- rewards for tantrums
62
What are the Social/environment factors that influence aggression?
1. Frustration leads to aggression 2. Direct Provocation- Reciprocity (easier against ugly people) 3. Exposure to media violence (bobo doll experiments) 4. Being in a group- mob mentality 5. Heightened arousal- increased vigour of current response 6. Hot, humid weather 7. Pain- Berkowitz- rats attack nearby rat if shocked and will continue if interrupted
63
What is Transsexualism
* Linked at psychiatric disorder * Cross-dressing not for sexual arousal * Real life test before surgery
64
What is Transvestism?
* Cross dressing to gain membership of opposite sex | * Not related to sexual orientation
65
What are the 3 components of sexuality?
1. Gender identity, 2. sexual responsiveness, 3. maintenance of emotional relationships
66
Name some Problems of desire
Loss of desire Sexual aversion Lack of sexual enjoyment
67
What are histrionic patients?
Need attention | Constantly seeking reassurance
68
What are dependant patients?
* Require large amounts of attention that doesn’t reassure them * Urgent calls and want special consideration
69
What are narcissistic patients?
Self love and overly self important | Feel contempt for doctors inadequacies
70
What are suspicious patients?
* Chronic, deeply ingrained suspicion that people are unreliable and want to cause harm * Bear grudges
71
What is a help-rejecting complainer?
Communicate though list of complaints | Blame others
72
What are manipulative patients?
Use lying to communicate Malinger to gain external objectives e.g. analgesia drugs History of using violence or threats of self-harm to control docs.
73
What is somatisation?
The physical manifestation of psychological disorders Present as somatic symptoms Difficult to know when to stop investigating
74
What is hypochondriacal disorder?
Over emphasise minor symptoms to a major disease
75
What is conversion disorder?
Alteration or loss of physical function linked to psychological factors such as stressors Unconscious psychological conflict
76
What is body dysmorphic disorder?
Preoccupation with minor defect e.g. nose, skin etc. | Causes impairment in social or occupational areas
77
What is factitious disorder?
• Admitted with plausible account of illness but is lying • Intentional production of physical/psychological signs • To assume sick role Different to malingering which is to gain external incentives e.g. drugs
78
What are the differences between medical power and medical dominance?
Medical power is the ability to enforce power even if they resist Medical dominance is Legitimised control that doctors have over patients
79
What are the French and Raven (1959) 5 bases of Power?
``` LERRC Legitimate-power given by society Expert-qualifications and knowledge Referent-ability to pursuade others Reward-give patients benefits Coercive- can select patients or refuse treatment until weight loss ```
80
What is medicialisation?
The treatment of non-medical problems as medical e.g. over-reliance on technology in pregnancy
81
What is the doctors role?
1. apply high level of knowledge and skill 2. Act for patients welfare rather than for own gain 3. Objective and emotionally detached 4. Guided by rules of GMC
82
What are the doctors rights?
1. Probe and examine 2. Granted autonomy 3. Position of power relative to patient
83
What are some sick label advantages?
``` Free prescriptions Socially acceptable explanation for deviant behaviour Sympathy + gets to drop roles Sick pay Insurance pay Helps person cope ```
84
What are some sick label disadvantages?
May not get all advantages May be denied certain activities e.g. driving May have automatic medical follow up Change in primary label to ill person May not be able to get insurance, mortgage etc
85
What are some effects of institutionalisation?
stress/anxiety, depersonalisation. Patients become apathetic with inability to undertake simplest tasks.
86
What are the methods of adaptation to institutionalisation?
1. Situation withdrawal- only thinks of themselves 2. Playing it cool- is different role depending on situation 3. Intransigent line- won’t co-operate 4. Colonisation- inside more desirable than outside 5. Conversion- tries to be good patient
87
What are the criteria for being negligent in law?
* Doc must own defendant duty of care * Doc must be in breach of that duty of care * Breach MUST cause patient harm
88
What is a duty of care?
in cases where positive acts of individual cause physical damage, the existence of such a duty of care can be assumed
89
What is negligence?
Negligence is falling below standard of care of a reasonable doctor. Can’t be negligent if 2 doctors (a body) deems it accepted practice (Bolam test)
90
What is the but for test?
BUT FOR test- if not for docs negligence wouldn’t have suffered harm.
91
What is gross negligence manslaughter?
1. Must owe duty of care 2. Must breach duty of care badly enough to warrant criminal culpability 3. Breach must cause patients death
92
What are the two types of negligence?
Treatment/Diagnosis- poor clinical practice Consent- Not enough info about risk/side effects and they wouldn’t have consented had all the info been presented to them.

charlies medicine (9 decks)

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