General H&S

Question 1

What is primary prevention?

Answer 1

Takes place before the onset of disease, with the aim of trying to stop the disease from developing in the first place.

Question 2

Give an example of primary prevention for CHD.

Answer 2

Smoking cessation
Healthy eating
Exercise

Question 3

What is secondary prevention?

Answer 3

This takes place when a person already has a disease, with aims of preventing progression of the disease and preventing any adverse effects from happening once the disease has developed.

Question 4

Give an example of secondary prevention for CHD.

Answer 4

Anti-platelet therapy post MI.
Statins.
HTN treatment.

Question 5

What is tertiary prevention?

Answer 5

This involves limiting the impact that adverse events have on health, where goals are to improve quality of life and limiting/ delaying complications.

This is done through treating disease and providing rehabilitation.

Question 6

Give an example of tertiary prevention for CHD.

Answer 6

Cardiac rehab.
CABG.
PCI.

Question 7

State 4 modifiable risk factors for CHD.

Answer 7

1) HTN
2) Smoking (increases risk by 50%)
3) Diabetes
4) Total cholesterol and HDL:LDL ratio.

Question 8

State 5 non-modifiable risk factors for CHD.

Answer 8

1) Age
2) Sex
3) FHx
4) Ethnicity
5) Socio-economic status

Question 9

Describe what is meant by the ‘prevention paradox’.

Answer 9

A preventative measure that brings large benefits to the community by offers little benefit to each participating individual.

Question 10

Give 2 reasons why risk calculators are useful.

Answer 10

They illustrate risk visually to a patient.
Inform clinicians as to who to treat.
They emphasise what is important in terms of modifiable risk factors.

Question 11

What is screening?

Answer 11

-Systematic application of a test…
-To identify individuals at risk of a disorder
which would warrant further investigation or preventative action…
-Amongst persons who have not sought medical attention for symtpoms of that disorder.

Question 12

What is the aim of screening?

Answer 12

To try and catch pathologies early with the intention of trying to stop the disease becoming too catastrophic.

Question 13

What are the 4 main categories which must be considered for a screening test to be successful?

Answer 13

Condition
Test
Treatment
Programme

Question 14

What needs to be considered about the condition that a screening test is going to be used for?

Answer 14

• Needs to be an important health problem (rare with lifelong impacts/ common conditions affecting a lot of people/ killer conditions).
• Epidemiology and natural Hx of condition should be understood
• Detectable risk factors
• Latent period of disease
• Cost-effective primary prevention should have been implemented.

Question 15

What needs to be considered about the test which is going to be used for screening?

Answer 15

• There should be a simple. safe, precise and validated screening test.
• Distribution of test values should be known and a suitable cut off agreed.
• The test should be acceptable.
• There should be an agreed policy on further agreement.

Question 16

What needs to be considered about treatment of a disease being screened for?

Answer 16

• There should be an effective treatment with evidence of early treatment leading to better outcomes.
• There should be agreed policies covering who should be offered treatment.
• Clinical management of the condition should be optimised prior to a screening programme.

Question 17

What must be considered about the programme itself which is being used for screening?

Answer 17

• There must be RCT evidence that the programme is effective in reducing mortality or morbidity.
• There should be evidence that the whole programme is acceptable to professionals and the public.
• The benefit from the programme should outweigh the harm.
• The opportunity cost of the programme should be economically balanced in relation to health care spending.
• There must be a plan for quality assurance and adequate staffing and facilities.

Question 18

State 5 aims for auditing.

Answer 18

1) Clinical education
2) Encouragement of teamwork
3) Improve services/ care
4) Gain financial incentives
5) Fulfil contractual obligations.

Question 19

What is the 5 step approach to an audit?

Answer 19

Prepare for audit
Select criteria
Measure performance
Make improvements
Sustain improvements

Question 20

What is the 6 step approach to an audit?

Answer 20

Set standards
Measure current performance
Compare current performance to standards
Identify barriers or steps to improvement
Make changes
Re-audit

Question 21

What are the 3 processes involved in selecting criteria for an audit?

Answer 21

Structure: resources that are available (current knowledge, skills and attitudes)
Process: What the proposal is (i.e. protocol)
Outcome: refers to health benefits, cost effectiveness or patient satisfaction.

Question 22

State the strengths of auditing.

Answer 22

• Encourages teamwork.
• Can lead to better patient outcomes.
• Allow patients to question the quality of their care and exercise choice.
• Improve professional practice and the general quality of services delivered.
• Allows assessment of performance against national standards.

Question 23

State the weaknesses of auditing.

Answer 23

• Time consuming.
• Lack of generalisability.
• Data is merely a ‘snapshot’ of performance so may not be representative.
• Finding an adequate sample size.
• There may be a rush to find a ‘quick fix’ which may not prove effective.

Question 24

Give 2 contributions of post-mortems in understanding and influencing the care of the living.

Answer 24

1) Correlation of pre and post-mortem diagnostic process

2) Enhanced accuracy of cause of death

Question 25

Name 5 instances when there may be legal requirements for a coroner’s post mortem.

Answer 25

1) A death cannot readily be certified as being due to natural causes.
2) The deceased was not seen by a doctor within 14 days prior to the death.
3) There is an element of suspicious circumstances surrounding the death.
4) There is any history of violence related to the death.
5) The death may be related to a medical procedure or treatment whether invasive or not.
6) The death may be linked to an accident whenever it occurred.
7) There is any question of self-neglect or neglect by others.
8) The death or causative illness occurred during or shortly after detention in police or prison custody.
9) The death was during an operation or before full recovery from the effects of the anaesthetic or was in any way related to the anaesthetic.
10) The death may be due to a lack of medical care.

Question 26

What is the licensing authority for premises where post-mortems are carried out?

Answer 26

Human tissues authority.

Question 27

Give 3 aims of the Yorkshire cancer network.

Answer 27

1) Reduce incidence of cancer
2) Maximise survival opportunities of cancer patients
3) Enhance quality of life for all patients and their families at all stages of the patient pathway
4) Improve patient experience of cancer services
5) High quality service provision focused on the needs of the patients and carers

Question 28

Name the 6 aspects of the cancer network which operates in the region of Yorkshire.

Answer 28

1) Pre-hospital (GPs)
2) Cancer units
3) Cancer units with specialist teams
4) Leeds Cancer centre
5) Yorkshire cancer network
6) Yorkshire cancer research network

Question 29

Describe the role of primary care in a cancer network.

Answer 29

1) Promotion of behaviour to reduce the risk of cancer.
2) Encourage compliance with national screening.
3) Prompt better public understanding of signs and symptoms that require urgent attention
4) Identification of people who may have cancer and arrange urgent investigation.

Question 30

Describe the role of cancer units in a cancer network.

Answer 30

• Diagnose and treat common cancers.
• Diagnose intermediate cancers before referral to specialist teams for treatment.
• Provide majority of treatment, drug therapy and palliative care services.

Question 31

Describe 3 roles of the Yorkshire cancer network.

Answer 31

– Development of strategic plans
– Implementation of national policies
– Delivery of improvements in the care of patients with cancer.
– Co-ordinate and support ‘Network’ activities in relation to the pathway of patients within a specific tumour site
– Provide a channel for communication across partners within the Network
– Provide resources to enable Network audits and research

Question 32

Describe 3 roles of cancer units with specialist teams.

Answer 32

– Specialist cancer teams can be developed to serve certain areas
– They should form a specialist network with similar teams
– These teams should have the same status and work to the same standards as the equivalent teams in the cancer centre

Question 33

Describe 3 roles of the Leeds cancer centre.

Answer 33

– Provide all the cancer unit services for Leeds residents
– In addition will supply more specialised cancer services, some will be for Leeds residents only and some will be provided for the whole network
– Services for rare cancers can also be developed

Question 34

Give 2 roles of the Yorkshire cancer research network.

Answer 34

– Increase patient accrual to accredited NCRN (national cancer research network) clinical trials
– Infrastructure provided to aid cancer research is distributed across the network to ensure wide-ranging and inclusive involvement

Question 35

What is an adverse event?

Answer 35

an unintended event resulting from clinical care and causing patient harm.

Question 36

What is a ‘near miss’?

Answer 36

A situation in which events or omissions arising during clinical care fail to develop further, whether or not as a result of compensating action, thus preventing injury to a patient.

Essentially, when something could have happened and nearly did happen, but the adverse event didn’t actually occur.

Question 37

What is a serious incident?

Answer 37

An event where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant that they warrant using resources to investigate and act.

Question 38

What are never events?

Answer 38

These are serious incidents that are entirely preventable because guidance or safety recommendations providing strong systematic protective barriers are available at national level and should have been implemented by all healthcare providers.

Question 39

What are active failures?

Answer 39

These are unusafe acts which are committed by people in direct contact with the patient. They can be knowledge based, rule based or skills based. They often happen as a result of occurrences upstream which are known as contributory factors.

Question 40

What is a violation?

Answer 40

This is when somebody does something consciously which they know is against rules. There may be a justifiable reason for this action, or the action may have been purposefully malicious. Violations can be categorised as: routine, situational, reasoned or malicious.

Question 41

What is meant by ‘normalisation of deviants’?

Answer 41

Where doing something wrong becomes ‘the norm’ and therefore becomes the known way of doing something.

Question 42

What is age discrimination?

Answer 42

Unjustifiable difference in treatment based solely on how old a person is.

Question 43

What is direct age discrimination?

Answer 43

Occurs when a direct difference of treatment based on age cannot be justified. A direct difference of treatment is a situation in which a patient is, was or could be treated in a less favourable manner than another person in a comparable situation, based on his or her age.

Question 44

What is indirect age discrimination?

Answer 44

When a seemingly neutral provision, measure or practice has harmful repercussions on a person or group of persons. A service where the aim is to not discriminate against those older people, but nevertheless does discriminate against older people. This may be because the service is more difficult for older people to access.

Question 45

What is advocacy?

Answer 45

This means getting support from another person to help you express your views and wishes and to help you to stand up for your rights. There are 3 types of advocacy; self-advocacy, individual advocacy and systems advocacy.

Question 46

What is statutory advocacy?

Answer 46

This means that a person is legally entitled to an advocate because of their circumstances.

Question 47

What are the 3 types of professional advocate?

Answer 47

1) An independent mental health advocate (IMHA): Support people who are being assessed or receiving treatment under the MHA 1983.
2) An independent mental capacity advocate (IMCA): Support people who lack capacity to make certain decisions and are provided under the MCA 2005.
3) A social care advocate: Support people under the care act of 2014.

Question 48

What is self-advocacy?

Answer 48

The action of representing oneself or one’s views or interests.