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