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YEAR 3 HEALTH AND SOCIETY > GI + SURGERY > Flashcards

GI + SURGERY Flashcards

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1
Q

What is informed consent?

A

The process in which a pt is provided with information about their medical condition, the recommended treatment and the risks and benefits of the treatment, whether there are reasonable alternatives and then given the opportunity to make an informed decision about whether or not to proceed with the treatment

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2
Q

Why is obtaining informed consent important?

A

It respects the pt’s autonomy and right to make decisions about their own health
It’s a professional and legal requirement under the MCA 2005 and GMC
Strengthens doctor patient relationship
Is essential to good decision making

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3
Q

What are the 3 parts to ‘valid consent’?

A

voluntary – the decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family
informed – the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead
capacity – the person must be capable of giving consent, which means they understand the information given to them and can use it to make an informed decision

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4
Q

Whats the role of the physician in obtaining informed consent?

A

To ensure the pt understands the information provided including all the risks and reasonable alternatives
They must also ensure the pt has capacity to make the decision

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5
Q

Whats the role of the pt in obtaining informed consent?

A

The pt has a responsibility to actively participate in the informed consent process including making their preferences known, asking questions and expressing concern. They must be sure they have a clear understanding of the information provided

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6
Q

What are the potential consequences of not obtaining informed consent?

A

Legal issues - dr liable for medical malpractice
Ethical issues
Can damage trust between physician and pt which may result in a breakdown of physician-patient relationship

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7
Q

Outline the ethical principles related to informed consent?

A

Informed consent is grounded in several ethical principles, including respect for patient autonomy, beneficence (doing what is in the patient’s best interest), non-maleficence (avoiding harm), and justice (treating patients fairly and equitably).

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8
Q

How can consent be given?

A

Verbally or in writing
May also give non-verbal consent e.g. holding out an arm for a blood test

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9
Q

When is consent not needed?

A

If pt is incapacitated but needs emergency treatment to save their life
Immediately needs an addditional emergency procedure during an operation and there is a clear medical reason why it would be unsafe to wait to obtain consent
If the pt lacks capacity to consent e.g. under MHA
Pt who need hospital treatment for a severe mental health condition and is competent but refusion - under MHA
Is severely ill and living in unhygienic conditions - National Assistance Act 1948
Infectious disease - Public Health (Control of Disease) Act 1984

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10
Q

What is the WHO operative checklist?

A

A tool used to enhance communication and coordination amongst surgical teams during surgeries
It consists of 3 sections:
- before induction of anaesthesia
- before skin incision
- before the pt leaves the operating room
Each section contains a list of items the surgical team must confirm and check off before proceeding to the next step of surgery e.g. pt identify, necessary equipment, verifying surgical site is marked

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11
Q

What is a culture of safety?

A

shared values, attitudes, beliefs, and behaviors within an organization or healthcare system that prioritize the safety and well-being of patients and employees. It is a commitment to continuously improve safety practices, prevent errors, and reduce harm. In a culture of safety, all members of the organization, from top leadership to front-line staff, are engaged and accountable for creating and maintaining a safe environment.

A culture of safety requires open communication, collaboration, and learning from errors and near-misses. It involves creating a non-punitive environment where individuals feel comfortable reporting safety concerns without fear of retribution. In a culture of safety, safety is viewed as everyone’s responsibility, and safety practices are integrated into daily operations.

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12
Q

Discuss the importance of a culture of safety: minimising complications

A

A culture of safety helps to minimize complications and adverse events in healthcare. When safety is a top priority, healthcare providers are more likely to follow established safety protocols, communicate effectively with each other, and work collaboratively to prevent errors.

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13
Q

Discuss the importance of a culture of safety: learning from errors

A

A culture of safety involves learning from errors and near-misses. When errors occur, it is important to investigate and understand what went wrong and why. By doing so, healthcare providers can identify areas for improvement and make changes to prevent similar errors in the future.

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14
Q

Give an example of a tool used to promote a culture of safety?

A

Mortality and morbidity meetings - they provide a forum for healthcare providers to discuss adverse events, near-misses, and other safety concerns so HCP can identify areas for improvement and make changes to prevent similar events in the future.

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15
Q

What are the 2 questions used to decide if an individual has capacity?

A
  1. Is there an impairment of disturbance in the functioning of the person’s mind or brain?
  2. Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?
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16
Q

When is a pt not deemed to have capacity?

A

If they cannot done one or more of:
- Understand the information
- Retain the information
- To use or weigh up that information
- To communicate a decision

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17
Q

What are the principles of capacity?

A

Presumption of capacity.
Support to make a decision.
Ability to make unwise decisions.
Best interest.
Least restrictive.

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18
Q

State the importance of written documentation, both for giving consent and documenting the information given to the patient and their supporters

A

Legal Protection: Written documentation provides legal protection for healthcare providers. Informed consent forms document that the patient has been given all relevant information, and that they have voluntarily agreed to a treatment or procedure. In the event of a lawsuit, these documents can provide evidence that the patient was adequately informed and gave consent.
Evidence of Consent: Written documentation provides evidence that the patient has given consent.
Clear Communication: The consent form provides a written record of the information that was provided to the patient, which can help to avoid misunderstandings and ensure that the patient fully understands the risks and benefits of the treatment or procedure.
Supporter Involvement: Written documentation can also involve the patient’s supporters, such as family members or caregivers. The consent form can document the supporters’ involvement in the decision-making process and ensure that they understand the risks and benefits of the treatment or procedure.
Ethical Obligations: Written documentation is also important to fulfill ethical obligations towards the patient. Healthcare providers have an ethical obligation to provide patients with complete and accurate information, and to obtain informed consent before providing any treatment or procedure.

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19
Q

What are the common risks associated with all surgery?

A

Infection
Haemorrhage and shock
Pain
Scarring
Anesthesia Complications
DVT/PE
Organ Damage
Adverse reaction to Medications:

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20
Q

Identify the psychosocial effects of surgery

A

Anxiety about the surgery
Depression after particularly if they have a long recovery period or face complications
Self-conscious and decreased self-esteem - changes in body image
It can feel like a loss of control
Fear of recurrence
Financial strain e.g. time off work
Social isolation i..e cannot participate in usual social events

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21
Q

Identify the psychosocial effects of a stoma

A

depression, anxiety, changes in body image, low self-esteem, reduced sexual functioning, denial, loneliness, hopelessness, self conscious, isolation from social events due to upkeep of stoma or risk of leakage and stigmatisation.

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22
Q

How can we help with the psychological aspects of stomas?

A

Adequate counselling
Consider including mental health specialists
Good preparation with visual adis before they get a stoma
Introducing pt to those who have already undergone the procedure
Videos based on pt experienced

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23
Q

What is an outbreak?

A

Incident in which 2+ people, thought to have a common exposure, experience a similar illness or proven infection

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24
Q

Which groups of individuals need to take special precautions regarding food poisoning?

A

Young children under 5
Old adults >65
Pregnant women
Immunosuppressive
Food industry workers

These people are allowed exclusion from work due to them posing increased risk of GIT

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25
Q

How should clinicians act to control food poisoning or infective diarrhoea?

A

Notify local food safety authority (Section 11 of Public Health (Control of disease) Act 1984)
Identify cause (person, school, workplace, event, restaurant)
Contact tracing
Barrier nursing - PPE
Isolate pts - Private/side room with dedicated toilet
Increase handwashing and ensure bare below the elbows
Clean equipment and aseptic technique
Prohibit potential reservoirs
Limit transport of pts with infective diarrhoea
Pt’s room, bed and bedside equipment should be cleaned thoroughly
Urine, faeces and soiled linens should be considered potentially infectious and treated as such
Warn visitors of risk
Dedicated pt care equipment e.g. blood pressure cuffs

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26
Q

What is Section 11 of Public Health (Control of disease) Act 1984?

A

A provision in UK law that gives local authorities in England and Wales the power to take action to control the spread of infectious diseases.
Under Section 11, if a medical practitioner or any other person has reason to believe that a patient is suffering from an infectious disease that could be a threat to public health, they are required to notify the local authority.
The local authority then has the power to take necessary steps to prevent or control the spread of the disease, including isolating patients, closing premises, and disinfecting areas where the disease is suspected to have spread.
It gives the power to require information, to order medical examination if someone’s suspected to be infected, the power to take specimens, the power to detain to prevent spread and the power to disinfect anything suspected to be contaminated

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27
Q

What are common organisms that cause hospital outbreaks of infective diarrhoea?

A

C.diff
Norovirus
Rotavirus
E.coli
MRSA

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28
Q

How are infective diarrhoea outbreaks prevented in hospitals?

A

Proper hand hygiene
Isolation
PPE
Environmental cleaning
Education on signs and symptoms

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29
Q

What is the Food Safety Act (1990)?

A

A UK law that sets out the framework for food safety and hygiene
It defines food and the responsibilities of the enforcement authorities

Offences:
Sale of food rendered injurious to health, unfit for consumption, not of quality demanded by purchaser
Display of food with label falsely describing food or likely to mislead as to a nature/quality

30
Q

What are the risk factors for liver disease?

A

Heavy alcohol consumption
Viral Hepatitis A, B, C, D, E
Obesity/high fat diet/high cholesterol
Genetics
Medications e.g. paracetamol OD, steroids
Medical conditions: Biliary disease (PBC, PSC) or Vascular disease

31
Q

How can we reduce the risk of liver disease at an individual level?

A

Not engaging in dangerous activities e.g. unsafe sex, sharing needle, IVDU
Lose weight
Cut down on alcohol
Up to date on vaccines

32
Q

How can we reduce the risk of liver disease at a population level?

A

Education in school, media or by doctors on healthy diets, importance of exercise, dangers of alcohol and drug use
Provide needle banks for safe drug use
Regulations to improve food safety and reduce exposure to toxins e.g. aflatoxins
Screening
Free condoms
Reducing risk from drugs e.g. better mental health treatment and blister packs for paracetemol
Tax and restrictions on alcohol and sugar
Vaccinations for healthcare workers and travellers
Safe work environment to reduce needle stick injury
Careful screening of blood transfusion
Better mental health awareness

33
Q

What is screening?

A

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

34
Q

Who is responsible for making recommendations on screening programmes in the UK?

A

UK National Screening Committee

35
Q

What are the principles of screening?

A

The condition should be an important health problem
There should be an accepted treatment for patients with recognised disease
Facilities for diagnosis and treatment should be available
There should be a recognisable latent or early symptomatic stage
There should be a suitable test/examination
The natural history of the condition should be adequately understood
There should be an agreed policy on whom to treat as patients
It should be cost effective
Case-finding should be a continuing process and not a ‘once and for all’ project

36
Q

What are the current national screening programmes in the uk?

A

Breast cancer - mammogram women 50-70 every 3 years and women >70 at self-referral
Cervical cancer - women 25-49 every 3 years and women 50-64 every 5 years
Bowel cancer - m+f 60-74 every 2 years after this at self-referral
AAA - men one off 65
Diabetic eye screening - annually from the age of 12
Newborn blood spot screening, hearing and physical examination
Screening in pregnancy

37
Q

Outline the epidemiology of breast cancer?

A

1 in 7 women!
56,000 new cases each year
11,500 deaths a year
76% survival for 10 or more years
Most common cancer in the UK

38
Q

What are the advantages of screening?

A

Better survival and less requirement for radical therapy
May require less long-term therapy
Reassurance for those with negative results
Allows you to make informed decisions about your health
Early detection may improve health outcomes
Early detection can improve treatment outcomes
Allows the pt to take preventative measures
Some deaths from AAA, bowel cancer, breast and cervical cancer can be prevented
Cost-effective compared to cost of treating diseases or complications

39
Q

What are the disadvantages of screening?

A

Overdiagnosis - longer morbidity if diagnosis is unaltered
Cost of resources
False reassurance for false negatives
Unnecessary investigation and treatment for false positive - waste fo resources and may have health implications for pt i.e. complications of investigations
Unnecessary investigations for borderline pos/neg results
False pos and negs
Can lead to difficult decisions
May cause considerable anxiety

40
Q

What happens if the cut-off level for screening is too low?

A

You end up identifying too many people needing unnecessary further investigations
High sensitivity but low specificity - false positives

41
Q

What happens if the cut-off level for screening is too high?

A

All the people you identify are more likely to have the disease but you will inevitably miss some - low sensitivity but high specificity

42
Q

What is lead time bias?

A

When a disease is diagnosed earlier so it appears survival time is longer but in fact it has just been diagnosed for longer

43
Q

How can we prevent lead-time bias?

A

Measure deaths prevented rather than survival

44
Q

What is length-time bias?

A

You are more likely to detect a slow growing, more treatable cancer so prognosis will be good i.e. you are more likely to detect disease with a longer sojourn time

45
Q

How can screening programmes have selection bias?

A

Individuals screened not being representative of the population - well-educated individuals tend to worry and comply with screening better but these individuals tend to be healthier and so will have better outcomes

46
Q

How can screening cause verification bias?

A

Individual with positive screening test results are more likely to undergo confirmatory testing
I..e the individual’s interpretation of the result is affected by their pre-existing beliefs

This can lead to an overestimation of the accuracy of the screening test, because the individual is only focusing on the instances where the screening test and the confirmatory test results agree, while ignoring any instances where they do not agree. In reality, the accuracy of a screening test should be evaluated based on its sensitivity and specificity, which are determined through rigorous scientific studies, and not based on individual experiences or perceptions.

47
Q

What are the main challenges that the breast screening services in the uk face?

A

Capacity - high demand for it so long wait times and delays
Shortage of trained personnel e.g. radiographers
Barriers to access such as low socioeconomic groups or ethnic minorities
False positives
Overdiagnosis

48
Q

How would you assess the effectiveness of the breast screening services in the UK?

A

Screening uptake
Cancer detection rates
False positive rates
Interval cancer rates
Treatment outcomes
Patient and staff satirisation

49
Q

How would you assess the quality of the breast screening services in the UK?

A

Quality indications:
Compliance with national standards and guidelines
Timeliness
Safe
Effectiveness
Patient experience

50
Q

Outline the psychosocial impact on patients and their families of the diagnosis and treatment of breast and other cancers

A

Physical changes - pain, fatigue, scars, stoma
Psychological changes - anxiety, depression, social isolation, fear of recurrence
Social changes - capabilities, family, future plans, realtionship strain, financial burden, work issues
Spiritual changes
Existential changes i.e seeking meaning of life in the face of death

51
Q

How can the socio-cultural background of a pt impact their psychosocial response to a cancer diagnosis?

A

Cultural beliefs - in some cultures cancer may be stigmatised which can lead to feelings of shame and guilt. On other cultures cancer may be viewed as a punishment leading to feelings of despair of hopelessness
Socioeconomic - income, education - may have limited access to healthcare resources and support services which can impact their ability to cope with the emotional and financial burden of cancer
Gender and age - women with breast cancer may exprence body image issues and feel stigmatises, older adults may experience unique challenges e.g. mobility issues or cognitive decline that can impact their ability to manage their cancer treatment

52
Q

What is the evidence on social patterns in delayed diagnosis for cancer in the UK?

A

a study found that individuals from more deprived areas in England were more likely to experience delays in the diagnosis of lung and colorectal cancer.
The study also found that individuals from ethnic minority groups were more likely to experience delays in the diagnosis of lung cancer.

2018 in the British Journal of General Practice

53
Q

What explanations are there for why some groups present with more advanced cancer at time of diagnosis?

A

Individual level:
- lack of knowledge about symptoms and importance of early detection
- fear and anxiety about diagnosis and treatment
- cultural and language barriers prevention people from seeking help
- beliefs in cancer and its causes which cna impact a pt decision to seek care

Social determinants of health:
- lower income groups more likely to present with advanced cancer due to barriers of healthcare access, transport or childcare
- individuals from certain ethnic minorities are more likely to present with advanced cancer due to systemic racism, lack of access to healthcare, cultural or language barriers
- geirgraphy - people living in rural or remote areas are less likely to have access to screening programmes and treatment

Others:
- lack of trust in healthcare system
- stigma surrounding cancer
- fear of cancer diagnosis or treatmet

54
Q

What are factors that predict successful coping response to cancer diagnosis?

A

Few unresolved concerns
Good social support
Active coping - seeking support, engaging in positive thinking etc
Personality traits - optimistic, resilient, strong sense of self-efficacy
Knowledge and understanding so they feel empowered to make informed decisions
Good relationships with staff
Satisfaction with information
Spirituality and religious beliefs as a source of strength

55
Q

What is problem-focused coping?

A

This coping style involves taking active steps to address the problem or stressor causing the distress. Examples may include seeking information, making decisions, and taking action to manage the cancer.

56
Q

What is emotion-focused coping?

A

This coping style involves managing the emotional response to the stressor rather than trying to change the stressor itself. Examples may include seeking support from family or friends, practicing relaxation techniques, and engaging in activities that provide a sense of comfort.

57
Q

What is avoidance-focused coping?

A

This coping style involves avoiding or denying the stressor or problem. Examples may include avoiding conversations about the cancer, denying the severity of the illness, or engaging in activities to distract from the stressor.

58
Q

What is meaning-focused coping?

A

This coping style involves finding meaning and purpose in the cancer experience. Examples may include finding ways to give back to others, developing a new appreciation for life, or finding spiritual or religious meaning in the experience.

59
Q

What is fatalism?

A

When pt believes the events are predetermined and that their actions have little to no effect on the outcome e.g. cancer is inevitable and there is nothing that can be done to treat or prevent it
This can lead to a sense of hopelessness and may discourage individuals from seeking medical care or engaging in preventative behaviours

60
Q

What are some causes of practitioner delay in cancer diagnosis?

A

Younger patient
Atypical symptoms
Misdiagnosis
Inadequate examination
Inappropriate tests
Failing to follow-up negative/inconclusive tests

61
Q

What are the genes that increase the risk of breast and ovarian cancer?

A

BRCA1 and BRCA2

62
Q

What are the options for preventing breast cancer in pt with a FHx?

A

Genetic testing in 1st degree family members
Consider mastectomy and oophorectomy
Advice (lifestyle, contraception, HRT)
Mammogram and breast MRI every year starting at age 25
Education on symptoms and signs of cancer (e.g. breast checking)

63
Q

Whats the incubation time for salmonella?

A

12-72 hrs

64
Q

Whats the incubation time for E.coli?

A

12-48 hours

65
Q

Whats the incubation time for campylobacter?

A

48-72 hours

66
Q

Whats the incubation time for bacillus cereus?

A

1-6 hours

67
Q

Whats the incubation time for staph aureus?

A

2-4 hours

68
Q

Whats the most common cause of infectious gastroenteritis?

A

Norovirus

69
Q

Whats the most common bacterial cause of gastroenteritis?

A

Campylobacter

70
Q

What are common causes of gastroenteritis in developing countries?

A

Shigella
Vibrio cholera
Enterotoxigenic E.coli

(Due to poor sanitation)

YEAR 3 HEALTH AND SOCIETY (14 decks)

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