FLUFF Flashcards
Give 8 steps in the WHO preop checklist to enhance the safety of surgery. (2011, 2012, 2013, 2014)
“<img></img><br></br><div><ul> <li>confirm identity, consent, and procedure</li> <li>Side/site marked</li> <li>Anesthesia equipment check completed</li> <li>Pulse ox check</li> <li>Check allergies</li> <li>Assess airway risk</li> <li>Confirm expected blood loss and availability of blood products</li> <li>Confirm antibiotic prophylaxis administered</li></ul></div>”
4 components of WOMAC
<div>Western Ontario and McMaster Universities Osteoarthritis Index<br></br></div>
<ul> <li>Pain (5 items)</li> <li>Stiffness (2 items)</li> <li>Physical Function (17 items)</li> <li>Index/Global Score (summary of 3 subscales)</li></ul>
<div>4 principles for establishing causality (2012)</div>
“<ul> <li>Consistency</li> <li>Strength of relationship</li> <li>Excluding alternative (no plausible alternatives)</li> <li>Dose Response</li></ul><div><ul> <li>Bradford Hill’s Criteria for Causality</li> </ul><ol> <li>Strength of association: a strong association supports causality</li> <li>Consistency: causality is more likely if multiple studies show a consistent relationship </li> <li>Temporal Relationship: there must be a temporal relationship between exposure and outcome in order for there to be causality</li> <li>Dose Response Relationship (aka biological gradient): If there is a relationship between the degree of exposure and the magnitude of effect then there is more likely to be causality</li> <li>Specificity: if there is a specific outcome related to a specific exposure, causality is more likely</li> <li>Plausibility: whether or not the association is plausible</li> <li>Coherence: the cause and effect relationship should not contradict current substantive knowledge</li> <li>Analogy: existing similar associations would support causality</li> <li>Experiment: causation is more likely if evidence is based on randomized experiments</li> </ol></div>”
<ul><li>Surgeon is conducting an RCT on olecranon fractures. Patient comes into emergency with a fracture that could likely be included. The surgeon is scrubbed in but the OR says they could call for that patient next. Surgeon sends med student to discuss the study and obtain consent. Give 3 problems with this scenario. (2014)</li></ul>
“<ul><ul><li>Med student is not a ““qualified representative”” who is trained in proper procedures to obtain informed consent</li> <li>Medical student is not familiar with the details of the study protocol including required follow up, nor is he/she likely aware of treatment alternatives, risks and benefits to participating, etc</li> <li>This is a rushed consent if they are going to be called for next case. ““For consent to be informed, prospective participants shall be given adequate time and opportunity to assimilate the information provided, pose any questions they ma have, and discuss and consider whether they will participate.””</li> </ul> </ul> <div></div> <div>Government of Canada Research Ethics website (<a>http://www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/chapter3-chapitre3/#toc03-1</a>)</div> <div>"”For consent to be informed, prospective participants shall be given adequate time and opportunity to assimilate the information provided, pose any questions they may have, and discuss and consider whether they will participate. The time required for this initial phase of the consent process will depend on such factors as the magnitude and probability of harms, the complexity of the information conveyed, and the setting where the information is given.””</div> <div>””</div> <div>The information generally required for informed consent includes:</div> <ul> <li>information that the individual is being invited to participate in a research project;</li> <li>a statement of the research purpose in plain language, the identity of the researcher, the identity of the funder or sponsor, the expected duration and nature of participation, a description of research procedures, and an explanation of the responsibilities of the participant;””</li> </ul> <div>"”The approach to recruitment is an important element in assuring voluntariness. In particular, how, when and where participants are approached, and who recruits them are important elements in assuring (or undermining) voluntariness. In considering the voluntariness of consent, REBs and researchers should be cognizant of situations where undue influence, coercion or the offer of incentives may undermine the voluntariness of a participant’s consent to participate in research.””</div>”
<div>List 5 components of determining capacity to provide consent.</div>
“<div>vowels: UEEIOD</div><ul> <li>Does the person <u>understand</u> the conditions for which the specific treatment is being proposed</li> <li>Is the person able to <u>explain</u> the nature of treatment and understand relevant information</li> <li>Is the person <u>aware of possible outcomes </u>of treatment, alternatives or lack of treatment</li> <li>Are the persons’ <u>expectations reasonable</u></li> <li>Is the person able to make a <u>decision</u> and communicate a choice</li> <li>Is the person able to <u>manipulate the information</u> rationally</li></ul>”
<div>List 5 steps in management of a medical error</div>
<div>DDDDP</div>
<div>detect</div>
<div>disclose</div>
<div>document</div>
<div>display empathy</div>
<div>prevent recurrence</div>
<ul> <li>CMPA Website - Disclosing harm from healthcare</li> <ul> <li>Detect the error and address the error</li> <li>Full Disclosure to patients</li> <li>Show empathy and apologize</li> <li>Full Documentation</li> <li>Identify cause and prevent recurrence</li> </ul></ul>
<div>List 5 methods to help eliminate bias in constructing a randomized control trial.</div>
<ul> <li>Centralized random allocation (non tamperable way, aka not envelopes)</li> <li>Blinding of assessors at minimum (triple blinding is best)</li> <li>Predetermined, objective, valid outcome measures</li> <li>Intention to treat analysis</li> <li>Appropriate sample size/power</li> <li>Adequate follow up period to capture outcome (minimum 80% need to reach for high quality study)</li></ul>
<div>RC 2015 - Name 6 risk factors for non-therapeutic opioid abuse</div>
<ul> <li>Personal or family history of substance abuse</li> <li>Nicotine dependency</li> <li>Age < 45 years</li> <li>History of depression or psychiatric diagnosis</li> <li>Lower level of education</li> <li>Pre-injury/Pre-operative opioid use</li></ul>
Canmeds roles?
“<ul> <li>PALS CC</li><li>Professional</li> <li>Advocate</li> <li>Scholar</li> <li>Medical Expert</li> <li>Communicator</li> <li>Leader</li> <li>Collaborator</li> </ul> <div></div> <ul> <li><img></img></li></ul>”
RC 2010 - principles of medial ethics
<ol> <li>Non-maleficence - do no harm</li> <li>Respect for Autonomy</li> <li>Beneficence (benefit the patient)</li> <li>Justice (fairness)</li></ol>
RC 2011 - 16 y/o F Jehovah witness trauma patient who has lost enough blood to require a blood transfusion. You explain her that she needs blood. She gets agitated when you say this and refuses. Although she is in shock, she seems competent. What ethical principles are in conflict with each other when dealing with this situation?
“<ul> <li>respect for autonomy (pt’s desire as a competent minor to make her own decisions about her body)</li> <li>Beneficence (desire to save her life with blood products)</li> <li>Non-maleficence (concern about ostracizing her from her family/religious community, and potentially affecting her eternal soul, according to her beliefs, if you provide blood products against her will.)</li></ul>”
RC 2013 - Which of the following are not important when evaluating an outcome instrument? <ol> <li>Content</li> <li>Cost effectiveness</li> <li>Methodology</li> <li>Clinical utility</li></ol>
“B<div><br></br><div><div>Outcome Instruments: Rationale for Their Use (JBJS 2009) Schemitsh is a co-author</div><div><br></br></div> <div>"”Terwee et al. proposed a checklist of quality criteria to evaluate the methodological soundness of patient reported outcome instruments. These criteria include: content validity, internal consistency, criterion validity, construct validity, reproducibility (agreement and reliability), responsiveness, floor and ceiling effects, and interpretability.””</div> <div></div> <div>"”The most important feature of outcome instruments is their ability to test whether treatment is effective in improving symptoms or function from a patient’s point of view””</div></div></div>”
<ul> <li>RC 2008 - What is ethical principle of “do no harm”</li> </ul>
<ol> <li>nonmalefecince</li> <li>beneficence</li> <li>autonomy</li> <li>justice</li></ol>
A<div><ul> <li>Non-maleficence –> first, do not harm</li> <li>Beneficence - actions that promote wellbeing of others, serves best interest of patient</li> <li>Autonomy - right of individuals to self-determine, make informed choices about personal matters</li> <li>Justice - moral obligation to act on basis of fair adjudication</li></ul></div>
RC 2008 - A patient’s right to know his diagnosis is grounded in the principle of: <ol> <li>Beneficence</li> <li>Justice</li> <li>Truthfulness</li> <li>Autonomy</li></ol>
D<div><ul> <li>Non-maleficence –> first, do not harm</li> <li>Beneficence - actions that promote wellbeing of others, serves best interest of patient</li> <li>Autonomy - right of individuals to self-determine, make informed choices about personal matters</li> <li>Justice - moral obligation to act on basis of fair adjudication</li></ul></div>
RC 2016, 2013 - When plotting a survivorship curve using the Kaplan Meier survivorship analysis, the number of failed is divided by: <ol> <li>Initial number of procedures</li> <li>Total number still being followed</li> <li>Number that have already failed</li> <li>Number that were lost of follow</li></ol>
B
RC 2013 - Very serious question. Patient has been “Malingering” and “making unreasonable requests”. In regard to ending this relationship the physician should do all the following except: <ol> <li>talk with the patient and explain the situation</li> <li>Provide written notice to the patient</li> <li>Stop seeing the patient once they receive written notice</li> <li>Make alternative recommendations for another physician to treat the patient.</li></ol>
“C.<div><ul> <li>Consider the circumstances, and if you think it is appropriate, inform the patient in person of the decision to terminate. There may be circumstances, such as when you are concerned for your safety, where such a meeting would not be advisable. If you do have a discussion with the patient, you should clearly document it in the patient’s medical record and send a confirming letter, if your College requires it.</li> <li>If you do not think a face-to-face meeting is advisable, send a letter (your College may require that it be registered) to the patient. Keep a copy of the letter in the patient’s medical record.</li> <li>Whether you meet with the patient in person and/or send a letter, you will want to:</li> <li>Notify the patient clearly of your decision to end the doctor-patient relationship. You also need to decide what, if anything, you will tell the patient about the reasons for the termination. The Colleges appear to differ on the best course of action. When making this decision, you should take into consideration issues such as your personal safety and the patient’s particular circumstances.</li> <li>Provide the patient with reasonable notice of the date on which medical services will terminate. Tailor the notice period to each situation taking into consideration such things as the patient’s circumstances, the availability of alternative physician resources in the community, and whether the patient poses any threat.</li> <li>Advise the patient to obtain a new physician and, if possible, provide advice to the patient on possible steps to do so.</li> <li>Advise the patient of the need to transfer copies of medical records to the new physician. You should also request the necessary consent to make the transfer. Consider any Privacy Commission or College guidelines that might apply to the transfer of patient records.</li> <li>Inform the patient you will provide only urgent or emergent care in the interim.</li> <li>Provide any specific information or instructions concerning the patient’s particular medical condition (e.g., information about outstanding laboratory results and where they will be sent, information about renewal of prescriptions, or other specific medical advice) to ensure the continuity of care in the circumstances.</li> <li>Inform your staff members about the termination and instruct them on how to transfer copies of the medical records. You should be as helpful as possible in ensuring the transfer to the new treating physician is done promptly.</li></ul></div>”
