General Flashcards
4 principles of biomedical ethics
Justice Non-Maleficinece beneficence and Autonomy
Negligence and the bolam principle
Breach in the legal duty of care which can either be passive or an omission and it causes harm through various means such as not acting in the patients best interest or causing intentional harm through non-consensual treatment.
Bolam principle - principle where they establish whether an act by a health care professional breached the duty of care and thus was negligent
- for it to not be negligent an authoritative body of care must support the acts of the HCP even if the HCP wasnt following guidelines
Bolitho test
a take on the bolam principle whereby its a test to assess whether a HCP breached the legal duty of care and thus acted with neglect. This is done first then if it is still deemed unsure bolitho test is used and it is the way this is judged is whether there was any logical thought process to the actions. If the HCPs actions are deemed logical then it can be considered not to be neglect.
Stigma definition
mark of disgrace associated to someone as a result of an outstanding characteristic, circumstance or person.
Process of producing stigma
Labelling - identifying a what is assumed to be ‘abnormal’ characteristic
Stereotyping - presuming negative connotations around someone due to their differences
Othering - grouping those with similar characteristics e.g., diabetics and segregating them from those without it.
Discriminating - negative act towards someone labelled in a specific category
Types of stigma (3)
Felt - shame you feel as a result of stigma
Enacted - active discrimination by others which can lead to felt stigma
Courtesy - shame felt by someone who is with someone being stigmatised
Negative ways to reduce felt stigma (4)
- Passing - not seeking help due to fear of feeling stigma
- Withdrawing - withdrawal from society, not engaging with certain games due to fear your condition may not let you
- Covering - hiding and ignoring your condition, whic could lead to worsening of it
- Resisting - positive response (fighting against)
Equality act date and def
2010 - makes it illegal to discriminate either directly or indirectly against any person with a mental health condition in public services and functions, access to premises, work, education and transport
Implications of stigma for medicine
Fear of stigma - may impact on doctor-patient relationship
Concerns about confidentiality and then further judgement
Treatment may result in stigmas (anticipated stigma)
Health education def
Promoting and giving skills and knowledge to the public to hopefully prevent health damaging behaviours e.g., advice given from health care professional, mass media campaigns and educational bodies
Health protection def
protection of individuals, groups and populations through the effective collaboration of experts in identifying, preventing and mittigating impacts of infectious disease, environmental =, chemical and radiological threats - usually set out in legislation by public health
Primary prevention def and example
Prevention of onset of disease through targetting modifiable risk factors.
Secondary prevention def and example
Cure/identifying disease earlier to aim for better prognosis, if risk factors cannot be reduced
Tertiary def and example
Managing disease to prevent further complications
Beauties typology - try
symtpoms iceburg??
70% of symptoms are hidden due to fear of judgment by the doctor if those symptoms are disclosed however most of these symptoms are the most relevant
5 triggers for seeking healthcare
- Sanctioning
- Time line
- Impacts of hobbies, work, house work
- Impacts on social relations
- Interpersonal crises - death of a chid, family member, divorce
Barriers to health care 5 subcategories and examples
- Logistics
- Cultural differences
- Provisions from the hospital
- Previous bad experiences
- Risk perception
How to reduce barriers in certain ethnic groups
Translators available
Ethical outreach groups
Pamphlets in different languages
Clinician education to look out for ethnic risks
inverse care law??
Better off locations have better medical care than those in poorer locations, even though the poorer locations need it more
Marmot review? And principles implementation
2010
1. Good available employment to all
2. Give every child have the best start to life
3. Maximise control over their own lives
4. Creating and developing healthy sustainable places and communities
Spikes
setting
Perception
Initiation
Knowledge
Strategy and summary
ABCDE
Advance prep
Build relationship
Communicate well
Deal with patient reactions
Encourage and validate emotions
Explain false positive true negative etc.
False pos = shows pos but ach neg
What is positive predictive value
The proportion of those who test positive are actually positive
Tp/ tp+fp
what is negative predictive value
The proportion of those who test negative who are actually negative
Tn/tn+fn
what is sensitivity and what does it test
How good the test is at ruling in disease
Tp/tp+fn
What is specificity and what does it measure
How good a test is at ruling out disease
Tn/tn+fp
What is affected by prevalance
Positive predictive value and negative predictive value as the proportion will increase due to more positive cases
Negative decrease due to less cases
What is prevalance
the number of individuals exiting with the disease in a certain population at a certain time
What is positive likelihood ratio
How much odds of a disease increase when the test is positive
sensitivity (1-specificity)
What is negative likelihood ratio and equation
1-sensitivity/specificty
The odds of a disease decreases when the test is negative
Definition of screening
The systematic application of a test or inquiry to a specific population who may be at risk of a certain disease that wouldn’t likely present to primary care with symptoms in order to establish disease early implement more investigations and treatments
What criteria is used for screening programmes to be established
Wilsons
What is the criteria for the screening programme to be established
- Disease
- is the disease prevalent and impactful
- does the disease have blood markers that can be detected when asymptomatic
- long sojourn time
2.Test
- simple, safe, valid and precise
- cost effective
- benefits outweight harm
- significant cut of point of disease allocation vs no disease
- not harmful
- agreed treatment plan
- Treatment
- cost effective
- benefit from an earlier diagnosis - Programme
- benefits outweigh harm
- cost effective
- regularly reviewed
3 advantages and negatives of screening. Programmes
Advantages
1. Gives relief to those who may be concerned
2. Allows for better prognosis if diagnosed earlier
3. Less invasive procedures and complications = money saved/ can be economical
Disadvantages
1. False positives - lead to heart break and social conflicts
2. False reassurance - if false negative is given
3. Diagnosis of a condition may not necessarily impact on life expectancy (overdiagnosis bias)
What is lead time bias
The perception of having a better prognosis due to living with a diagnosis earlier through early screening, could be weeks or months before clinical apparency and then death = perceived better survival when in fact they had just known longer
What is length bias
The perception of detecting a disease with a longer pre-clinical phase or slower progression which can lead to the overestimation of disease prevalance meaning it looks like more people have the disease just because its around for a longer time
What is selection bias? In terms of screening
Better educated people tend to attend screening then less educated people and thus results will may show the population on average is healthier than it actually is due to lack of attendance of screening programmes
What are the things screened for in the uk
Breast cancer
AAA
Cervical
Prostate
DDH
Antenatal
Bowel
Psa screen knowledge
Prostate specific antigen
Cerivcal screen
Bowel screen
antenatal screen
Aaa screen
DDH screen
Breast screen
