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Ethics, Legal, Organizational > Ethics, Public Heath, Stats > Flashcards

Ethics, Public Heath, Stats Flashcards

1
Q

Difference between criminal, civil and administrative law

A

Criminal - nationwide; fine or jail
Civil - province wide; fine
Administrative - sanctions by regulators, eg college of physicians

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2
Q

Principles of the Canada health act

A

Public administration
Comprehensiveness
Universality
Portability
Accessibility

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3
Q

Public administration- the Canada health act

A

Provincial health insurance programs must be not for profit

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4
Q

Comprehensives - the Canada health act

A

Provincial health insurance must cover all medically necessary services

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5
Q

Universality - the Canada health act

A

All eligible residents must receive free health care

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6
Q

Portability - the Canada health act

A

Emergency health services must be paid by their home province when travelling outside of the province

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7
Q

Accessibility - the Canada health act

A

Provincial plans must ensure access to medical services without financial or other barriers

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8
Q

Federal government responsibilities

A

Indigenous peoples
Marine hospitals
Quarantine
Food and drugs
Medical devices

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9
Q

Provincial government responsibilities

A

Hospitals
Charities
Health professional licensing
Provincial health care plans

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10
Q

This outlines the national terms and conditions provincial health systems must meet to get federal payment

A

Canada Health Act

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11
Q

This states that the federal government gives provinces a single grant to split between healthcare, social programs and education at their discretion

A

Canada Health and Social Transfer Act

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12
Q

The Indian Act

A

Banned Indigenous culture and spirituality and gave the federal government complete control over Indian land

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13
Q

Fiduciary duty

A

Legal duty to act in another party’s interest

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14
Q

Competence vs capacity

A

Competence - determined legally by court

Capacity - determined by HCP

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15
Q

The four principles of medical ethics

A

Autonomy
Beneficence
Non-Maleficence
Justice

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16
Q

Autonomy

A

The patient makes their own decision

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17
Q

Beneficence

A

Maximizing patient benefits; working in the patients best interests

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18
Q

Non-maleficence

A

Do no harm

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19
Q

Justice

A

Fair benefits within a community regardless of geography or income

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20
Q

Privileged information

A

Information that cannot be used in court

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21
Q

Reasons to breach confidentiality

A

Child abuse
Fitness to drive
Communicable diseases
Death
Duty to inform/warn

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22
Q

When does duty to warn apply?

A

Imminent risk, identifiable person/group, serious bodily harm or death

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23
Q

Is duty to warn legally mandated?

A

Federally no but it is allowed
Provincially it varies but still allowed

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24
Q

Lock boxes

A

Situations where a patient expressly restricts a physician from disclosing health information to other people including healthcare providers (except where required by law)

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25
Q

Does a physician need to offer all choices for consent to be obtained?

A

Not necessarily. They don’t need to offer an intervention that would have no benefit

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26
Q

Consent vs assent

A

Consent - they have capacity to make a decision and agree

Assent - they lack capacity but still agree

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27
Q

4 requirements of consent

A

Voluntary
Capable
Specific
Informed

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28
Q

Battery vs negligence when it comes to consent

A

Battery - no consent was obtained or consent for the wrong treatment was obtained

Negligence - the consent wasn’t good enough

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29
Q

Exceptions to consent

A

Emergencies - unless prior signed documentation eg jehovas witness

Psych detaining pt

Communicable disease detaining pt

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30
Q

Tort

A

an act or omission that gives rise to injury or harm to another

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31
Q

Medical error

A

Preventable adverse events or an error that may have caused adverse events

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32
Q

Negligence vs medical error

A

Negligence is a legal determination. If a medical error is never brought to court it can’t be negligence

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33
Q

Apology act

A

Apologizing for something does not mean you are admitting to doing it

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34
Q

SPIKES protocol for breaking bad news

A

Setting - quiet alone space
Patient perceptions - do they understand?
Invitation from patient to receive info
Knowledge - provide facts
Empathize
Strategy, summarize

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35
Q

Therapeutic privilege

A

Withholding information because you think it will cause too much distress in your patient
Rarely acceptable now

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36
Q

At what gestational age is abortion illegal in Canada?

A

It’s never illegal at any gestational age. 39 weeks - still allowed

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37
Q

Euthanasia vs MAID

A

Euthanasia- ending someone’s life with or without their consent to relieve suffering

MAID - the person specifically requests it

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38
Q

MAID criteria

A

Patient is eligible for publicly funded health services
18 years old
Has capacity and gives consent
Medical condition without cure
Suffering intolerable
Natural death is reasonably foreseeable

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39
Q

MAID process

A

Patient signs and dates request with 2 independent witnesses (not benefiting from the patients death and not involved in their health care)
2 HCPs (physician or NP) have to approve it
10 days must pass from request to MAID (usually)
Express consent immediately prior to MAID
Can withdraw at any time

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40
Q

When do you need to notify a coroner if death occurs?

A

Violence, negligence, misconduct
Pregnancy
Sudden or unexpected
Disease not treated
Cause other than disease
Suspicious
MAID

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41
Q

OCAP principles

A

Principles created for research involving indigenous populations
Ownership: The community owns the info collectively
Control: The community controls all research that impacts them
Access: they can access info and data about themselves
Possession: They are stewards of the data

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42
Q

You’re doing a great job studying!!

A

Keep it up

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43
Q

Implicit bias

A

bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors.

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44
Q

Enfranchisement (Indigenous context)

A

Taking away an individuals Indian status and giving them a Canadian citizenship - In cases where an a indigenous person got a university degree, joined the armed forces or married a non-Indigenous person

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45
Q

Leading cause of death in Canada

A

Cancer
50% of Canadians will get it, 25% will die from it

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46
Q

Impairment vs disability vs handicap

A

Impairment - a deviation from normal function in an organ or system

Disability - a restriction or lack of ability to perform an activity considered normal for a human being

Handicap - a social disadvantage for an individual resulting from an impairment or disability. I.e their disability prevents them from filling a role

An impairment could lead to a disability which could lead to a handicap

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47
Q

Illness vs sickness vs disease

A

Illness - the experience of disease; subjective feeling of being unwell

Sickness - socially defines status of people who are sick, eg. stigma

Disease - the pathological process of a patients illness

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48
Q

Response shift

A

Changing your expectations to match your declining health to maintain satisfaction with life

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49
Q

The four sacred medicines

A

Sweet grass
Tobacco
Cedar
Sage

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50
Q

How does the WHO define health

A

A capacity to respond to challenges

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51
Q

Illness behaviour

A

The pattern of reactions a patient has to their perception of being sick. Eg seeking care, complying with recommendations, taking meds

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52
Q

Population vs public health

A

Population - how we think; why are some people healthier than others?

Public - what we do; promoting physical activity

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53
Q

Social gradient in health

A

There is a steady rise in longevity across income levels. I.e the more you make the longer you live

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54
Q

Social determinants of health

A

The circumstances in which people are born, grow up, live, work and age

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55
Q

Health inequity

A

A disadvantage that is correctable or could have been avoided

Inequalities in health that are unfair and stem from injustice

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56
Q

Three elements of equity

A

Equality
Fairness
Amendability

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57
Q

Equality

A

Equal access to opportunities

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58
Q

Fairness

A

The most qualified person for a job should get it regardless of their race, gender, etc

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59
Q

Amendability

A

Something should be done to fix situations in which inequities arise

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60
Q

Absolute poverty

A

Lacking the resources to meet basic needs for shelter, nutritious food, clothing and education

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61
Q

Health literacy

A

The patients ability to understand health information and to follow guidelines for their treatment

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62
Q

Distal, intermediate and proximal factors

A

Distal - free immunization clinics

Intermediate - accessibility of clinics

Proximal - choosing to get immunized

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63
Q

Determinants vs risk factor

A

Determinants - population based factors

Risk factor - individual based factors

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64
Q

Risk marker/indicator vs risk factor

A

Marker - Associated but not the cause, eg. Increased age associated with disease

Factor - A direct cause; eg smoking is a factor for cancer

65
Q

The health belief model

A

Factors that influence whether a person will participate in preventative measures:
1. motivation to take action (threat of the disease)
2. The cost and effectiveness of the action (benefit minus barriers)
3. A cue triggering change (eg symptoms, raised awareness, etc)

66
Q

What is the single best predictor of behavior?

A

Perceived barriers

67
Q

Theory of planned behaviour

A

Includes everything in the health belief model (motivation, effectiveness and cues to action for the behavior) plus societal views on the behavior and beliefs on self efficacy

Eg quitting smoking
I want to quit
Quitting is an effective way to prevent cancer
My dad just died from lung cancer
Society says smoking is bad
I think I’m able to quit

68
Q

Predisposing, enabling and reinforcing factors example

A

Predisposing - awareness and attitude towards drugs

Enabling - receiving funding for rehab

Reinforcing - feeling better when sober

69
Q

The interacting triad of causal factors

A

Agent (eg. A virus, addictive quality of drugs)

Environment (eg. Poor sanitation, growing up around addicts)

Host (eg. Poor immunity, addictive personality)

70
Q

Aleatory chance vs epistemological chance

A

Aleatory - completely unpredictable

Epistemological - we can’t yet explain due to limits in our current scientific understanding

71
Q

Upstream vs downstream analyses

A

Up - the cause of incidence rates; looking at the population

Down - the cause of causes; patterns of health in individuals

72
Q

Being conscious of similarities and differences between cultural groups and understanding how culture may affect a patients approach to health, illness and healing

A

Cultural awareness

73
Q

Being aware of and understanding how your own culture may shape your approach to patients from other cultures

A

Cultural sensitivity

74
Q

Attitudes, knowledge and skills of practitioners necessary to become effective HCPs for patients from diverse backgrounds

A

Cultural competence

75
Q

Understanding power imbalances and institutional discrimination between people of different cultures and how this may affect patient care

A

Cultural safety

76
Q

The sense that one’s own beliefs, values and way of life is superior than others

A

Ethnocentrism

77
Q

Attempting to be unbiased by ignoring the race and culture of your patient.

A

Cultural blindness

NOT a good thing

78
Q

Distress that occurs when being exposed to something not part of your culture

A

Culture shock

79
Q

When the rules of one culture and contraindicated by the rules of another culture

A

Cultural conflict

80
Q

Imposing values of your culture on another without consideration of their beliefs

A

Cultural imposition
Aka cultural assimilation
Aka colonialism

81
Q

Collectivist vs Individualist cultures

A

Collectivist - family-centered, group decisions. Eg Chinese traditionally have parents live with their adult children

Individualist - values autonomy. Eg. North Americans usually put their parents in an old age home

82
Q

Primordial prevention

A

Actions to modify population health determinants and prevent environmental, economic, social and behavioural factors that increase the risk of disease

Eg. Subsidized fitness programs

83
Q

Primary prevention

A

Preventing the onset of specific diseases via risk reduction

Eg. Smoking cessation

84
Q

Example of active vs passive primary prevention

A

Active - brushing your teeth
Passive - adding fluoride to municipal drinking water

85
Q

Secondary prevention

A

Screening for and treating disease

Eg. Mammograms to detect early breast cancer and preventing it from spreading

86
Q

Tertiary prevention

A

Once a disease has been established, decreasing the impact of the disease. Eg. A cardiac patient losing weight

87
Q

Health protection

A

Actions that help to eliminate the risk of adverse consequences for health attributable to environmental hazards, or unsafe food, water, drugs, etc

88
Q

Health promotion

A

Enhancing health by developing healthy public policies, healthy environments and personal resiliency

89
Q

Health protection vs health promotion

A

Protection - removing negative influences on health

Promotion - adding positive influences on health

90
Q

Aspects of critical appraisal

A

Falsifiability
Logic
Comprehensiveness
Honesty
Replicability
Sufficiency

91
Q

Falsifiability in critical appraisal

A

For a conclusion to be based on evidence it has to be possible to disprove the claim
Eg. God is not falsifiable because you can’t prove he doesn’t exist

92
Q

Comprehensiveness in critical appraisal

A

All available evidence must be considered; you can’t ignore evidence that contradicts you

93
Q

Sufficiency in critical appraisal

A

Evidence must be adequate enough to establish truth
Eg someone’s opinion isn’t sufficient

94
Q

Evidence based medicine

A

Using best evidence derived from research to treat your patients and taking into account their specific circumstances

Includes the science and art of medicine

95
Q

The 5 A’s of evidence based medicine

A

Assess - what’s the patients problem
Ask - make a question
Acquire - look at research
Appraise - is the research legit
Apply - treat the patient that way

96
Q

Ordinal vs interval scale

A

Ordinal - they are ordered but not necessarily evenly spread numbers. Eg on scale 1 to 10 of pain

Interval - the difference between numbers is constant. Eg temperature

97
Q

Criteria for inferring a causal relationship

A

Chronological - the exposure came before the disease

Strength of association - all those with the disease were exposed

Intensity/duration - the longer the exposure the higher the likelihood of disease

Specificity of association- the exposure consistently only relates to this disease

Consistency - different populations show the exposure causing the disease

Coherent/plausible findings - is there an explanation

Cessation of exposure - If the exposure is removed does the disease incidence decline

98
Q

Random vs systematic error

A

Random - an error due to chance

Systematic - an error due to bias

99
Q

A challenge in interpreting a study due to the effects of two processes not being distinguished from each other

A

Confounding

100
Q

Types of experimental studies

A

RCTs
Non-randomized experiments

101
Q

Types of observational studies

A

Cohort
Case-control
Cross-sectional
Descriptive

102
Q

Cohort vs case control

A

Cohort - sampling based on an exposure

Case-control - sampling based on an outcome

103
Q

Quasi-experimental studies

A

Allocation to groups is not fully random

Eg. Comparing people living in one town to another town

104
Q

Equation for measuring RCT intervention effectiveness

A

The change in the intervention group minus the change in the control group

105
Q

Efficacy vs effectiveness

A

Efficacy - the impact of a treatment based on optimal experiment conditions

Effectiveness - the impact of a treatment in the real world

106
Q

N of 1 trial

A

The same patients receives both interventions one after the other to see what one works better

107
Q

Phase 1 intervention study

A

New treatment is tested in a small group for the first time to determine safe dosage and side effects

108
Q

Phase 2 intervention study

A

The treatment is given to a larger group at the recommended dosage to determine safety

109
Q

Phase 3 intervention study

A

A series of randomized trials for a new treatment

110
Q

Phase 4 intervention study

A

After the treatment becomes available, data continues to be collected about the safety of a drug

Post-marketing surveillance
No formal RCT

111
Q

 Descriptive studies

A

Using descriptive statistics to summarize results - percentages, mean, or median value.

112
Q

How do you descriptive studies differ from analytic studies

A

Analytic studies test a hypothesis while descriptive studies just describe what’s happening

113
Q

Cross-sectional studies

A

Studies that use a single time reference for the data collected.

Example, if patients seen in the past two weeks were stressed or not

114
Q

The main disadvantage of cross-sectional studies

A

You cannot show temporal sequence, rather that there is an association between the variables in that timeframe

115
Q

Ecological studies

A

Studies that measure variables at the level of populations rather than individuals

116
Q

The ecological fallacy

A

Drawing conclusions about individuals based on population data

117
Q

Cohort study

A

Following a cohort of people without the disease and then seeing if they get the disease based on if they were exposed not exposed to something

118
Q

How can you get the incidence of disease for exposed and unexposed patients and the relative risk in a 2 x 2 table?

A

Incidence of exposed = exposed with disease present / number of people exposed overall

Incidence of unexposed = unexposed with disease present / number of people unexposed overall

Relative risk/risk ratio = incidence of exposed / incidence of unexposed

119
Q

How to interpret relative risk

A

RR of 1 = people exposed are no more or less likely to get the disease as those not exposed

RR > 1 = exposed increased risk of disease

RR <1 = exposed decreases risk of disease

120
Q

Advantages and disadvantages of cohort studies

A

Advantage - temporal making it more likely causation

Disadvantage – takes a long time to complete and is expensive

121
Q

Case-control studies

A

Studies that pair a group of patients with a disease to an otherwise similar group of people without the disease to see if there was any difference in an exposure

122
Q

Infant mortality rate equation

A

Number of deaths of infants <1 in a given year divided by number of births that same year x 1000

123
Q

Perinatal mortality rate equation

A

deaths of >28 WGA until 1 week after birth divided by (deaths of >28 WGA and live births) x 1000

124
Q

Neonatal mortality rate

A

Deaths of infants <28 days old divided by live births in the same year x1000

125
Q

Crude mortality rate equation

A

Number of deaths in a year divided by the population at a certain point in that time frame x 1000

126
Q

Standardized mortality ratio

A

The ratio of deaths in a population compared to the expected number of deaths if the population had the same structure as a reference population

SMR 100 means the deaths are the expected level
SMR 110 means the death rate is 10% higher than expected

127
Q

Potential years of life lost

A

Some diseases that kill younger are worse than diseases that kill older in terms on potential years of life lost. Eg. Suicides are often in younger people so have a higher rate of potential years of life lost compared to heart disease

128
Q

Quality adjusted life years

A

The idea that not every year of life is worth the same amount. If a treatment prolonged your life by 10 years but you had severe disability after the treatment, you would give them a year value less than the 10 years

129
Q

The standard gamble

A

Asking someone with a disability if they could get a surgery that would either completely cure them or kill them, what percentage mortality rate would they accept to gamble the cure

130
Q

The time trade off

A

How many years of life expectancy would you give up to have years without disability

131
Q

Reliability

A

Reliable - something is consistent, not necessarily right.

132
Q

Validity

A

Is the test measuring what we are intending to measure

133
Q

Sensitivity

A

How well the test detects disease. The probability that a person with the disease will test positive

True positive divided by (True positive + false negative)

134
Q

Specificity

A

How well a test identifies those who don’t have the disease

True negative divided by (true negative + false positive)

135
Q

Positive predictive value

A

What portion of patients with a positive test actually have the condition

True positives divided by all positive test results

136
Q

Negative predictive value

A

What portion of patients with a negative test actually do not have the condition

True negatives divided by all negative test results

137
Q

Ruling in and ruling out a disease based on test sensitivity and specificity

A

Think SNNOUT and SPPIN

SNNOUT - a negative test with high sensitivity rules out a disease

SPPIN - a positive test with high specificity rules in a disease

138
Q

Positive likelihood ratio

A

How much more likely someone with a disease is to have a positive test as someone without the disease

Sensitivity divided by (1-specificity)

How much a positive test increases the odds of having the disease

139
Q

Negative likelihood ratio

A

How much more likely someone without a disease is to have a negative test as someone with the disease

(1 - Sensitivity) divided by specificity

How much a negative test decreases the odds of having the disease

140
Q

Likelihood ratio cut off values for ruling in or out a disease

A

<0.2 for negative likelihood ratio rule out the disease

> 5 for positive likelihood ratio rule in the disease

141
Q

Attributable risk

A

Incidence in the exposed group - incidence in the unexposed group

142
Q

Exposed attributable fraction

A

(Incidence of exposed - incidence of unexposed) divided by incidence of exposed

143
Q

Number needed to treat

A

The number of people with a condition who must follow a treatment regimen in order for one person to get the desired outcome

144
Q

Calculating number needed to treat example

A

A medication cures 35% of people but 20% of people are cured spontaneously. The difference is 15%. 1/0.15 = 7

You need to treat 7 people for 1 person to benefit

145
Q

Passive surveillance

A

The surveillance agency waits for info to come to them. Eg. Death certificates, notifiable diseases etc

146
Q

Active surveillance

A

Surveillance agencies seek data. Eg sending out surveys to physicians about cases of a specific disease

147
Q

Continuous source

A

A prolonged source of a disease, eg. Contaminated drinking water. The cases will not grow exponentially like they would if it was spread person to person

148
Q

Intermittent exposure

A

People are getting a disease at certain time intervals. Suggests it’s not transmitted person to person

149
Q

Propagated spread

A

One person infects another who then infects a few people and then all of them infect a few people and it grows exponentially

150
Q

Cost minimization analysis

A

Picking the cheaper option. Eg choosing generic drug over brand name

151
Q

Cost benefit analysis

A

Seeing if by spending money it actually saves money in the long run

152
Q

Cost effectiveness analysis

A

Assesses the benefit of the outcome (not monetary value) compared to the cost

153
Q

Cost utility analysis

A

The same as cost effectiveness but includes a standardized scale to compare across different populations

154
Q

Length bias

A

Slowly progressing diseases are picked up more on screening tests and have longer survival rates

155
Q

Lead-time bias

A

Screening leads to an earlier diagnosis so it looks like the patient lives longer but it’s possible they would’ve died at the same time regardless of knowing they had the disease

156
Q

Systemic matters

A

Policies involving the health system overall.

Eg should government pay for health care

157
Q

Programmatic matters

A

Policies that involve health care programs and how resources should be allocated

158
Q

Organizational matters

A

Policies that involve how resources can be used productively in organizations

159
Q

Instrumental matters

A

Policies that concern management of organization, eg electronic health records

Ethics, Legal, Organizational (1 decks)

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