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Health and Society > General > Flashcards

General Flashcards

1
Q

What is the sick role?

A

The rights and responsibilities for patients and doctors when they have a consultation. It is the behavior expected of a person who is physically ill, mentally ill, or injured

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2
Q

What are patients expected to do in the sick role?

A

Must want to get well as quickly as possible

Should seek prompts medical advice and cooperate

Allowed to shed normal activities and responsibilities, e.g., work

Regarded as in need of care and unable to get better on their own

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3
Q

Criticism of the sick role

A

Symptom iceberg - patient’s do not necessarily come to the dr for help

Patients with chronic illness and MUS find it difficult to enter the sick role

People try to label themselves as sick

Conflict between best interests of patient and cost to society of the allocation of resources

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4
Q

What are the two agendas of sickness?

A

Disease - the pathology/ what is wrong with the body

Illness - the patient experience of disease

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5
Q

Legislation that supports carers

A

Employment act

Carers and disability act

Carers act

Equality act

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6
Q

Financial support available for carers

A

Carer’s allowance

Disability living allowance

Attendance allowance

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7
Q

Sources that should be used when making a clinical decision

A

Patient preference

Available resources

Research evidence

Clinical expertise

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8
Q

Why is evidence based decision making important

A

Deals with uncertainty

Medical knowledge is incomplete/shifting

Patients will receive most appropriate treatment

Constant need for innovation/improvement

Improving efficiency of healthcare services

Reduces practice variation

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9
Q

Why does medicine used guidelines

A

Allows practice to be more evidence based

Enables care to be more consistent across the country

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10
Q

Aspects of research cycle

A

Identify a clinical problem

Basic research - laboratory based

Applied (clinical) research

Clinical care

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11
Q

Roles of post mortem examination

A

Relatives cannot register death until a medical identification of death is classified

Information recorded on certificate underpins national mortality data

Importance in monitoring population health - epidemiological research

Informs authorities of need for intervention and allows targeting of that

Research - tissue pathology allows development of understanding of natural Hx, potential tests for investigation of disease presence, ID drug targets

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12
Q

Reasons a death should be referred to a coroner

A

Cannot readily be certified as being due to natural causes

The deceased was not seen by a doctor within the 14 days prior

Element of suspicious circumstances

History of violence

Death linked to an accident

Question of self-neglect or neglect by others

Death occurred or illness arisen during/shortly after being detained in custody

Detained under MHA

Death is linked with an abortion

May have been contributed to by actions of the deceased himself

Hx of drug or solvent abuse, self-injury or overdose

Receiving war pension/industrial disability pension unless death shown to be unrelated

Due to industrial disease or related to deceased’s employment

During an operation/before full recovery from anaesthetic/related to anaesthetic (24 hours)

Related to a medical procedure or treatment

Due to lack of medical care

Unusual or disturbing features to the case

Occurs within 24 hours of admission

May be wise to report death where there is an allegation of medical mismanagement

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13
Q

Aims of an audit

A

Clinical education

Encourages teamwork

Improve service/care

Gain financial incentives

Fulfils contractual obligations

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14
Q

Stages of an audit

A

Set standards - NICE/local guidelines

Measure current performance

Compare vs standards - how are we doing

ID barriers/steps to improve - how can we/what’s stopping us getting better?

Make changes - implement plan

Re-audit - did the plan work?

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15
Q

Factors that influence the rate of infection

A

Infectious agents - pathogenicity, ability to spread

Environment - animals, water, population

Mode of transmission - airborne, faecal-oral, droplets, aerosol

Portal of entry - mouth, nose, GIT

Host factors - chronic illness, nutrition, age

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16
Q

Nosocomial infections

A 
MRSA
Catheter-associated UTI
Pneumonia
C diff 
Surgical wounds
Septicaemia
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17
Q

Reducing nosocomial infections

A

Prevention - handwashing, infection control programmes, advisory service, surveillance, sterilisation

Detection, investigation and control of outbreaks

Policies and procedures to prevent and control infection - education and training

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18
Q

What is antibiotic resistance

A

Bacterial change so antibiotic no longer work in people who need them to treat infections

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19
Q

Causes of antibiotic resistance

A

Use in livestock

Release of antibiotics into the environment during pharmaceutical manufacturing

Volume of antibiotic prescription

Missing doses when taking antibiotics

Inappropriate prescribing of antibiotics

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20
Q

How to prevent antibiotic resistance

A

Use antibiotics only when prescribed

Complete full prescriptions

Never share antibiotics

Never use leftover prescriptions

Only prescribing antibiotic when needed

Using the right antibiotic to treat illness

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21
Q

Features of a dependence syndrome

A

Salience

Compulsion

Tolerance

Withdrawal

Relief after abstinence and reinstatement upon abstinence

Narrowing of repertoire

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22
Q

What makes drugs addictive

A

Pleasure producing potency

Rapid onset of action/ short duration of action

Tolerance

Withdrawal effects

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23
Q

Medical conditions wholly attributable to alcohol misuse

A

Alcoholic liver disease

Alcoholic neuropathy / Korsakoffs

Chronic pancreatitis

Alcoholic cardiomyopathy

Alcoholic gastritis

Alcohol related accidents

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24
Q

Ways to stop smoking

A

Brief advice

Behavioural support - motivational interviewing, CBT, telephone service

NRT - bupropion, varenicline

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25
Q

Health promotion for alcohol/substance misuse

A

Education - PSHE and TV/radio, FRANK education programme

Policy - minimum unit pricing, taxation, stricter licensing laws

Mass media campaigns - Drink await

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26
Q

What is lay referral system

A

People talk to other people before seeking help

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27
Q

Zola’s triggers for help-seeking behaviour

A

Interference with work or physical activity

Interference with social relations

Interpersonal crisis (i.e. death in family)

Putting time limit on symptoms

Sanctioning (relative/friends tell them to seek health care advice)

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28
Q

Barriers to help-seeking behaviour

A

Provision & availability of resources

Transport - cost, car ownership

Disruption to work

Attitudes of staff

Previous bad experience

Inverse care law

Geographical distance from healthcare

Time/effort

Long waiting times

Inability for time off work/children

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29
Q

What is paternalism?

A

Interference with person’s freedom of information and choices in health care

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30
Q

What is Bolams test

A

is a means of assessing clinical negligence in Court

If a Dr/nurse reaches the standard of a responsible body of medical opinion, he is not negligent

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31
Q

What is Bolitho amendment

A

An addition to the Bolam test of the legal standard of care required in negligence actions, which states that a professional’s acts or omissions be assessed to see if (i) they accord with a reasonable body of opinion and (ii) they withstand the logical analysis of the court.

The concept that doctors should behave in a logical way

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32
Q

What is beneficence

A

The principle of beneficence is the obligation of physician to act for the benefit of the patient

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33
Q

What is autonomy

A

is the right of competent adults to make informed decisions about their own medical care.

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34
Q

What is normative ethics

A

study of the means of deciding what is right and wrong

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35
Q

What is meta ethics

A

refers to the nature of ethical terms and concepts and to the attempt to understand the underlying assumptions behind moral theories

is the study of the nature, scope, and meaning of moral judgment

study of moral concepts

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36
Q

What is deontology

A

is an ethical theory that uses rules to distinguish right from wrong

also known as “duty-based ethics”. This ideology states that the correct course of action is dependent on what your duties and obligations are.

It means that the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.

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37
Q

What is applied ethics

A

The use of moral principles and reasoning to solve problems that arise in practical fields, such as health care, law, or management.

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38
Q

Social constructionist regarding disability

A

The concept that there is no such thing as a disabled individual but that society makes people individual

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39
Q

Social model of disability

A

Discrimination against disabled people is due to the organisation of society

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40
Q

Medical model of disability

A

The medical model of disability says people are disabled by their impairments or differences

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41
Q

What is opportunity cost?

A

The loss of other alternatives when one alternative is chosen

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42
Q

What is eugenics

A

Improving a population by controlled breeding

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43
Q

Wordens four tasks of mourning

A

accept the loss

acknowledge the pain of the loss

adjust to a new environment

reinvest in the reality of a new life

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44
Q

What does the Marmot review summarise to address health care inequalities?

A
  1. giving every child the best start in life
  2. enabling all children, young people and adults to maximize their capabilities and have control over their lives
  3. creating fair employment and good work for all
  4. ensuring a healthy standard of living for all
  5. creating and developing sustainable places and communities
  6. strengthening the role and impact of ill-health prevention.
45
Q

Process of stigma

A

Labelling

Stereotyping

Separating

Lose social status

Discrimination

46
Q

What is technical efficiency?

A

Investing in healthcare interventions which make the best use of scarce resources

47
Q

Calculating incidence

A

New case of disease (within a period) / no initially free of disease

48
Q

Calculating prevalence

A

( number of existing cases / total population ) X 1000

49
Q

What is care poverty?

A

the inability to work because you are a carer

50
Q

What is flat curve of medicine?

A

There is an increase in cost and no further improvement on health

51
Q

What is the implementation gap?

A

Gap between scientific understanding and patient care

52
Q

SPIKES for breaking bad news

A 
Setting up and starting
Perception
Invitation
Knowledge
Emotions
Strategy and summary
53
Q

Herd immunity formula

A

1 - (1/R0)

54
Q

What is statistical power?

A

The probability of rejecting a null hypothesis when it is false

55
Q

What is a CDSS?

A

clinical decision support system (CDSS)

Examples:

  • laboratory information systems (LISs) highlighting critical care values or pharmacy information systems (PISs) presenting an alert ordering a new drug and proposing a possible drug-drug interaction
  • drug dosage advice
  • screening alerts
  • reminder systems
56
Q

What is the Gini coefficient

A

is a measure of statistical dispersion intended to represent the income inequality or the wealth inequality within a nation or a social group

measure of inequality

57
Q

What is a decision tree?

A

decision support tool that uses a tree-like model of decisions and their possible consequences, including chance event outcomes, resource costs, and utility

square = decision 
circle = chance
58
Q

What is relative risk

A

The ratio of the probability of developing an outcome in those exposed compared to those not exposed

59
Q

What is a never event

A

Serious incidents that are entirely preventable because of guidance or safety measures

60
Q

Explanations of black report 1980

A

statistical artefact
health or social selection
materialist/structuralist cultural/behavioural health difference
poverty causes poor health

61
Q

Findings of black report 1980

A

The group found that there were differences in mortality rates across the social groups, with those in lower social groups suffering higher rates of mortality. The report also found inequalities in access to health services, particularly preventative services, with low rates of uptake by the working classes

62
Q

Recommendations of the black report

A

increasing child benefit

improving housing

agreeing minimum working conditions with unions.

63
Q

What is the Ulysses arrangement

A

Advanced directive for Bipolar Disorder

64
Q

Bowlbys stages of grief

A

Shock and numbness. · Yearning and searching. · Despair and disorganization. · Re-organization and recovery.

65
Q

ABDCE method of breaking bad news

A 
Advance preparation
Build therapeutic environment/relationship
Communicate well
Deal with pt/family reactions
Encourage and validate emotions
66
Q

Types of stigma

A

Social stigma, which involves the prejudiced attitudes others have around mental illness

Self-perceived stigma, which involves an internalized stigma the person with the mental illness suffers from

Anticipated stigma - expectation bias from others

Experienced stigma

Discrimination - the behavioural result of prejudice

Discredited - stigma known about

Discreditable - stigma not known about

67
Q

Bradford Hill criteria

A 
Strength of association
Consistency
Specificity
Temporality
Biological gradient
Plausibility
Coherence
Experiment
Analogy
68
Q

What is exculpation

A

Confirming the symptoms are not the patients fault

69
Q

Regulated complementary and alternative medicine?

A

Osteopathy

70
Q

What is cost-effective analysis

A

costs and outcomes are combined into a single measure to allow comparison

71
Q

Leventhal model of illness

A

1) how people identify an illness using symptoms and a disease label (identity),
2) beliefs about cause,
3) duration (timeline),
4) personal consequences
5) control

72
Q

Requirements for valid consent

A

Well informed
Voluntary
Has capacity

73
Q

Why is consent required

A

Improve trust between pt and dr
Legal requirement
Respects autonomy
Professional duty

74
Q

When can confidentiality be breached

A

Law
Consent by patient
Public best interest

75
Q

What law allows you to break pt confidentiality if pt has STI/HIV?

A

public health act

76
Q

Summary of Swiss cheese model

A

Many layers of defence lie between hazards and accidents

Flaws in each layer align and allow accidents to occur

77
Q

Causes of human error

A 
Inexperience
Unfamiliarity with task
Shortage of time
Inadequate checking
Poor procedures
Poor human equipment interface
78
Q

Types of violation

A

Routine - regularly performed shortcuts due to the system, process or task being poorly designed

Reasoned - occasional deviation form a protocol or procedure which we believe have good reason for making

Reckless - deliberate deviation from protocol and includes ignoring foreseeable harm even though it may not be intended

Malicious - deliberate deviation from protocol with intention to cause harm

79
Q

How to know if a hospital is safe?

A

Hospital mortality
Data on other measures of safety - reports of never events, safety thermometer
Monitoring and inspection by regulators - CQC, NHS improvement

80
Q

WHOs 5 steps of health promotion

A 
Health public policy
Action in the community 
Re-orientating health services
Personal skills
Supportive environment
81
Q

Define primary, secondary and tertiary health prevention

A

Primary - aims to prevent onset of disease (e.g., screening risk factors)

Secondary - detect and cure/reduce effects of disease at an early stage (e.g., cancer screening)

Tertiary - minimise the effects.reduce the progression of irreversible disease (self-management programs for those with chronic disease)

82
Q

Beattie’s model of health promotion

A

Health persuasion - public health campaigns, recommended alcohol levels, adverts

Personal counselling - one to one, goal setting, tailored support and action plans

Legislative - food labelling, speed limit on road

Community development - working with stakeholders, community campaigning, group fundraising to improve local services

83
Q

Prevention paradox

A

Preventative measure that brings benefit to local population but offers little to each participating individual

84
Q

Objectives of vaccination

A 
Reduce M+M
Prevent outbreaks and epidemics
Contain infection within population
Generate herd immunity
Eradicate infectious agent
Interrupt transmission to humans 
Reduce no of infections
85
Q

Diseases that have been eradicated with vaccination

A

Small pox

Polio

86
Q

What travel vaccines are not free on NHS

A 
Hep B
Japanese encephalitis
Yellow fever
Meningitis
Rabies
TB
87
Q

What is reproductive rate

A

estimates the average number of secondary cases per infection cases in the population made up of both susceptible and non-susceptible hosts

R=RoX

Ro - average number of individuals directly infected by an infectious agent in a totally susceptible population (basic reproduction rate)

X = fraction of the host population which is susceptible

R=1 is epidemic threshold

88
Q

Adverse effects of screening

A

Cost and use of medical resources

Adverse effects of screening procedure - stress, radiation

False positive results

Unnecessary investigations and treatment of false positives

Stress of prolonging knowledge of illness without any improvement in outcome

False negative - false security

89
Q

What is Sojourn time

A

The duration of a disease in which there are no clinical symptoms but the disease is detectable through screening

90
Q

Cancer reform strategy 6 key areas

A

Prevention - tackle smoking, obesity
Screening - diagnose cancer early
Ensuring better treatment - reduce waiting times, increases radiotherapy capacity
Living with and beyond cancer - national cancer survivorship initiative
Reducing cancer inequalities
Delivering care in the most appropriate settings - e.g., locally

91
Q

Ethical theories

A

Deontology - an ethical theory that uses rules to distinguish right from wrong

Virtue ethics - person rather than action based: it looks at the virtue or moral character of the person carrying out an action, rather than at ethical duties and rules, or the consequences of particular actions.

Consequentialism - Of all the things a person might do at any given moment, the morally right action is the one with the best overall consequences.

92
Q

Deductive arguments

A

Purely logical argument using premises that follow each other

93
Q

Inductive arguments

A

Making an argument based on observation with more probable conclusions

94
Q

Argument valid?

A

Premises follow each other

Argument does not beg question

95
Q

Argument sound?

A

Not if premise is false/opinion/moral claim

96
Q

Fallacies that should be avoided in arguments

A

Straw man fallacy - ignore persons actual position and substituting it for a distorted/exaggerated version of that position

Ad Hominems - directing an argument against a person rather than the point they make

Appealing to emotion

Begging the question

Argument from fallacy - conclusion must be false as premises are false

97
Q

Purpose of cancer registries

A

Establish incidence and survival over time between demographic groups and social groups to reduce inequality

Track efficacy of screening and primary prevention schemes

Allows comparison between regions - evaluates the quality of care

Evaluates the impact on social and environmental factors

98
Q

What is recorded on cancer registry

A

Cancer diagnosis - type, date/location
Cancer treatment - type, date/location
Outcomes - date of death, cause of death

99
Q

What is national cancer research network? (NCRN)

A

Aim to ^ speed, quality and integration of research to improve patient care

Supports prospective cancer trials and trials performed by charities

100
Q

Measures of structure relative to cancer care

A

Facilities

Resources - human and material

Organisation - ie. clinics, consultants, nurses, mammogram scanner, GPs

101
Q

Health promotion strategies for MH

A

Parenting programmes - for children with conduct disorder, prevent PD

HV interventions - for women at ^ risk of PND

School based programmes - prevent violence, bullying, offending and reoffending

Screening and brief intervention - alcohol CAGE

Debt advice

Physical activity campaigns

Anti-stigma campaigns

Promote well being and early depression detection at work

102
Q

Strengths of ICD-10/DSM

A

Standardisation of diagnostic criteria

Allows epidemiological studies, geographical comparisons of prevalence and incidence

Alphanumerical format, allows quick referral and easy addition of categories

103
Q

Limitations of ICD-10/DSM

A

Two different criteria sets - who uses what

Schizophrenia diagnosis relies on many psychotic Sx, which are a common final pathway in other disease

Just groups commonly co-existing Sx patterns, without understanding underlying cause/nature

104
Q

Role of CPN and key worker in MH

A

CPN - talk through problems, offer advice and support, give meds and monitor Fx

Key worker - manage cases and checks in with patients

105
Q

What is health protection?

A

Responsibility of PHE to deal with outbreak situations and monitor the emergence of diseases not previously seen in the UK

106
Q

What is standard error

A

A measure of the accuracy with which a sample represents a population

107
Q

What form of service improvement science technique is best to explore the root cause of a problem,?

A

Fishbone chart

108
Q

Maximum age by which a smoker will need to quit in order that their life-expectancy remains equal to that of a never smoker

A

40

109
Q

What self report impact of urinary incontinence worried most women

A

Coughing or sneezing

Health and Society (4 decks)

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