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Medicine, Year 3, Health and Society > GI and Surgery Outcomes > Flashcards

GI and Surgery Outcomes Flashcards

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1
Q

What is the definition of consent?

A

The properly informed decision of a competent patient, freely given

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2
Q

What are some reasons for consent? 8 points

A
  1. An ethical requirement
  2. A professional requirement
  3. A legal requirement
  4. Demonstrates respect for autonomy
  5. Avoidance of harm to patient
  6. Upholds trust between doctor and patient
  7. It avoids battery
  8. It avoids negligence
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3
Q

What things must be present when assessing for Mental Capacity?

A
  • Understand the information
  • Retain the information
  • Weigh up that information in the decision-making process
  • Communicate their decision back
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4
Q

What are the five assumptions of the Mental Capacity Act?

A
  1. People have the capacity to make a decision themselves, unless proven otherwise
  2. Wherever possible, help people make their own decision
  3. Patients are allowed to make unwise decisions
  4. If a patient doesn’t have capacity, a decision must be in their best interests
  5. If a patient doesn’t have capacity, it must also be the least restrictive
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5
Q

What is the two-stage test when assessing capacity?

A
  1. Does the patient have an impairment of the mind or brain, as a result of illness / alcohol / drug use?
  2. Does this impairment mean they are unable to make a specific decision when they need to?
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6
Q

From what age does the MCA act apply?

A

> 16 years of age

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7
Q

What are some clinical reasons for having a Medical Record? 6 points

A
  1. Helps clinicians structure their thoughts when making decisions about patient’s care
  2. Helps clinicians reflect back on previous consultations
  3. Makes info available to others involved in their care
  4. Holds information from external parties i.e. test results, referrals, etc.
  5. Allows information to be transferred when changing practice
  6. Assess clinical care of entire population
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8
Q

What are some non-clinical reasons for having a Medical Record? 3 points

A
  1. Medico-legal evidence
  2. Provides information for third parties
  3. Supports claims + benefits
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9
Q

When can you rely only on oral consent?

A
  • For minor routine investigations / treatments, oral or implied consent is enough
  • If not possible to get written consent, i.e. in emergency / pain / distress, can rely on oral consent but must be recorded in their record
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10
Q

List common risks associated with all surgeries

A

General anaesthesia complications, Pulmonary embolism, Infection, Leaks, Heart attack, Haemorrhage, Bowel obstruction, Spleen injuries, Incisional hernia, Anastomotic stricture, Adhesions, Death

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11
Q

What are some psychosocial effects of stomas? 8 points

A
  • Fear of leakage of stomal contents and/or public exposure
  • Adjustment to change in body image perceived by themselves and others
  • Changes to intimate relationships with partner and children
  • Social isolation; may feel isolated and withdrawn from society
  • Stigma; Fear of discussing stomas in everyday conversation
  • Helplessness caused by loss of control
  • Uncertainty about the future; Possible stoma reversal? Permanency?
  • Depression and anxiety
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12
Q

What are the physical aspects of stomas on patient’s self-image? 5 points

A
  • Heavy/dragging sensation from a pouch filling up
  • Skin problems caused by leakage onto the skin or adhesives being changed too often or infection
  • Flatulence creating uncomfortable noise
  • Odour from the content of the pouch
  • Parastomal hernia formation
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13
Q

Which organism is associated food poisoning and cooked rice?

A

Bacillus cereus

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14
Q

Which organism is associated food poisoning and foreign travel / swimming / camping?

A

Cryptosporidium (Protozoa)

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15
Q

Which organism is associated food poisoning and semi-closed environments i.e. hospitals, ships, schools?

A

Norovirus (RNA virus)

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16
Q

Which organism is associated food poisoning and food contaminated with skin/nasal flora?

A

Staph aureus (Gram positive cocci)

17
Q

Which organism is associated food poisoning and haemolytic uraemia?

A

E.Coli 0157:h7

18
Q

Which organism is associated food poisoning and slow-cooking and unrefridgerated food?

A

Clostridium perfringens

19
Q

What is the most common reported cause of infectious intestinal disease?

A

Campylobacter jejuni

20
Q

Which organism is associated food poisoning and food contaminated with animals / human faeces?

A

Salmonella (Gram negative)

21
Q

Give an example of a Legislation used to protect individuals from unsafe food consumption?

A

Food Safety Act (1990)

22
Q

Define “food poisoning” outbreak?

A

An incident where two or more people, though to have a common exposure, experience a similar illness / infection

23
Q

What things can hospitals to do control outbreaks?

A
  • Isolation of patients to cubicles or specific wards
  • Use of extra personal protective equipment
  • Restriction of patient visitors
  • Ensure staff are appropriately immunised
  • Symptomatic staff should be excluded from duty
  • Closure of wards when appropriate
  • Symptomatic patient visitors should alert staff
24
Q

What risk factors can we target to reduce the prevalence of Chronic Liver Disease?

A
  • Target Alcohol
  • Target Obesity
  • Target Viruses
  • Target Drugs
25
Q

How can we target Alcohol on an individual and population level to reduce the prevalence of Chronic Liver Disease? 5 points

A
  1. Public health campaigns
  2. Minimum unit price
  3. Taxation
  4. Licencing restriction
  5. Sale restriction
26
Q

How can we target Obesity on an individual and population level to reduce the prevalence of Chronic Liver Disease? 7 points

A
  1. Public health campaigns
  2. Taxation (sugar tax)
  3. Sale restriction
  4. Reformulation of food
  5. Community food / exercise regimens
  6. Education
  7. Healthy snacks at school / work
27
Q

How can we target Viruses on an individual and population level to reduce the prevalence of Chronic Liver Disease? 6 points

A
  1. Vaccination against HepB / Yellow fever
  2. Screen blood products
  3. Needle exchange programs
  4. Free contraception
  5. Disposable instruments / sharps
  6. Licencing in tattoo parlours
28
Q

How can we target Drugs on an individual and population level to reduce the prevalence of Chronic Liver Disease? 2 points

A
  1. Needle exchange programmes

2. Reduce OTC availability (Paracetamol)

29
Q

What is “screening”?

A

The systematic application of a test / inquiry to identify individuals at sufficient risk of a disorder to warrant further investigation or direct preventative action, amongst persons who have not sought medical attention on account of symptoms of that disorder

30
Q

What criteria must be satisfied for an effective screening programme to be put in place?

A
  1. Condition
    - Must be an important health condition
    - Epidemiology must be well understood, with a detectable risk factor and a latent period
    - Cost-effective primary prevention should already be put in place
  2. Test
    - Must be simple, safe, precise and validated
    - Test values should be known with an agreed cut off
    - Patients need to find the test acceptable
  3. Treatment
    - Treatment with evidence of early administration with good evidence must be available
    - Should be agreed who is offered treatment
    - Pre-existing management of treatment must be optimised
  4. Screening Programme
    - Benefits > harm
    - RCT evidence to show the programme is effective
    - Must be entirely acceptable to doctors and patients
    - Opportunity cost must be balanced
    - Must have adequate resources
31
Q

What is Lead-time bias wrt screening?

A

Lead time is the length of time between the detection of a disease and its usual clinical presentation and diagnosis

Lead-time bias is hence the overestimation of survival duration due to earlier detection before clinical presentation

32
Q

What is Length time bias wrt screening?

A

Length time bias refers to the fact that diseases with a longer sojourn time are easier to catch compared to those with a shorter sojourn time

33
Q

Describe the organisation of breast screening services within the NHS

A

Women aged between 50 and 70 are entitled to breast screening every 3 years (47 and 73 in some areas)

34
Q

If women have a strong FHx or a genetic pre-disposition (BRCA1/2), when are they invited for breast screening?

A

Aged 40

35
Q

The mammogram is taken from what views?

A

Cranio-caudal

Medio-lateral

36
Q

Discuss the psychosocial impact of a breast cancer diagnosis on patients and their families?

A
  • Uncertainty in prognosis
  • Patients may want to get affairs in order
  • Family tension with treatment pathway
  • Devastating physiologically
  • Depression / anxiety
37
Q

What factors are associated with delayed presentation of breast symptoms in primary care? 6 points

A
  1. Patients attribution of their symptoms i.e. Benign? Cancer? Nothing?
  2. Psychological i.e. denial / fear / anxiety
  3. Allocated time slot of thinking about symptoms
  4. Disclosing the discovery to someone else
  5. Source of motivation for attending GP (themselves, someone else i.e. sanctioning)
  6. Reason for attending the GP (breast symptom, something else)
38
Q

What is the Triple Assessment?

A

When recalled women get further assessment:

  1. Clinical history taking
  2. Imaging i.e. US / Mammogram
  3. Pathology i.e. Fine needle cytology / Biopsy

Medicine, Year 3, Health and Society (5 decks)

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