General H&S Flashcards
What is primary prevention?
Takes place before the onset of disease, with the aim of trying to stop the disease from developing in the first place.
Give an example of primary prevention for CHD.
Smoking cessation
Healthy eating
Exercise
What is secondary prevention?
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.
Give an example of secondary prevention for CHD.
Anti-platelet therapy post MI.
Statins.
HTN treatment.
What is tertiary prevention?
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.
Give an example of tertiary prevention for CHD.
Cardiac rehab.
CABG.
PCI.
State 4 modifiable risk factors for CHD.
1) HTN
2) Smoking (increases risk by 50%)
3) Diabetes
4) Total cholesterol and HDL:LDL ratio.
State 5 non-modifiable risk factors for CHD.
1) Age
2) Sex
3) FHx
4) Ethnicity
5) Socio-economic status
Describe what is meant by the ‘prevention paradox’.
A preventative measure that brings large benefits to the community by offers little benefit to each participating individual.
Give 2 reasons why risk calculators are useful.
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.
What is screening?
-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.
What is the aim of screening?
To try and catch pathologies early with the intention of trying to stop the disease becoming too catastrophic.
What are the 4 main categories which must be considered for a screening test to be successful?
Condition
Test
Treatment
Programme
What needs to be considered about the condition that a screening test is going to be used for?
- 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.
What needs to be considered about the test which is going to be used for screening?
- 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.
What needs to be considered about treatment of a disease being screened for?
- 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.
What must be considered about the programme itself which is being used for screening?
- 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.
State 5 aims for auditing.
1) Clinical education
2) Encouragement of teamwork
3) Improve services/ care
4) Gain financial incentives
5) Fulfil contractual obligations.
What is the 5 step approach to an audit?
Prepare for audit Select criteria Measure performance Make improvements Sustain improvements
What is the 6 step approach to an audit?
Set standards Measure current performance Compare current performance to standards Identify barriers or steps to improvement Make changes Re-audit
What are the 3 processes involved in selecting criteria for an audit?
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.
State the strengths of auditing.
- 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.
State the weaknesses of auditing.
- 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.
Give 2 contributions of post-mortems in understanding and influencing the care of the living.
1) Correlation of pre and post-mortem diagnostic process
2) Enhanced accuracy of cause of death
Name 5 instances when there may be legal requirements for a coroner’s post mortem.
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.
What is the licensing authority for premises where post-mortems are carried out?
Human tissues authority.
Give 3 aims of the Yorkshire cancer network.
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
Name the 6 aspects of the cancer network which operates in the region of Yorkshire.
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
Describe the role of primary care in a cancer network.
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.
Describe the role of cancer units in a cancer network.
- 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.
Describe 3 roles of the Yorkshire cancer network.
– 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
Describe 3 roles of cancer units with specialist teams.
– 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
Describe 3 roles of the Leeds cancer centre.
– 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
Give 2 roles of the Yorkshire cancer research network.
– 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
What is an adverse event?
an unintended event resulting from clinical care and causing patient harm.
What is a ‘near miss’?
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.
What is a serious incident?
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.
What are never events?
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.
What are active failures?
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.
What is a violation?
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.
What is meant by ‘normalisation of deviants’?
Where doing something wrong becomes ‘the norm’ and therefore becomes the known way of doing something.
What is age discrimination?
Unjustifiable difference in treatment based solely on how old a person is.
What is direct age discrimination?
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.
What is indirect age discrimination?
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.
What is advocacy?
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.
What is statutory advocacy?
This means that a person is legally entitled to an advocate because of their circumstances.
What are the 3 types of professional advocate?
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.
What is self-advocacy?
The action of representing oneself or one’s views or interests.
