GI & surgery Flashcards
Explain the need for informed consent
- Consent: process of getting permission before conducting a healthcare intervention on a person or for disclosing personal information.
- Obtaining informed consent isn’t always required e.g. if patient lacks capacity (child/mentally ill).
- Consent is an ethical and legal obligation.
- Consent is: situation specific/dynamic, recorded, informed, voluntary, patient must have mental capacity to make the decision.
Outline the key aspects of WHO operative checklist
- Aims to decrease errors and adverse events and increase teamwork and communication in surgery.
- 19 item checklist.
- Reduction in morbidity and mortality
- Sign in (before induction of anaesthesia) —> patient identity, consent, procedure, allergies, marked surgical site.
- Time out (before start of surgical intervention) —> team members introduce themselves, confirm patient’s name and procedure, surgical site infection bundle, VTE prophylaxis.
- Sign out (before any member of the team leaves the operating room) —> record name of procedure, instrument/swabs/sharp count, labelled specimens, any equipment problems? Any key concerns for patient recovery and management?
Outline the role of surgical morbidity and mortality meetings (M&M)
- Used to aid to surgical training by taking time during each working week to discuss adverse outcomes.
- Education of all HCPs and hospitals to learn lessons from clinical outcomes and drive improvements in service delivery.
- Ensures quality.
Apply the principles of informed consent
- Decision capacity.
- Documentation.
- Disclosure of risks/benefits and alternatives.
- Competency.
- Voluntary.
Describe the elements necessary for mental capacity to give informed consent
- Disclosure - give all information necessary, including risks and benefits and what will happen if treatment is withdrawn.
- Capacity.
- Voluntariness - no external pressure (no coercion, manipulation, or undue influence).
Check for mental capacity, and recognise when an individual doesn’t have capacity to give consent
- Mental Capacity Act 2005.
- Reasoning for questioning if a person has capacity: behaviours/circumstances, concerns have been raised by family or HCP, previously been diagnosed with a condition causing impairment of mind functioning.
- Assessing capacity: cannot assume capacity or discriminate, document decision with reasons.
- Two-stage test of capacity: Does the person have an impairment or disturbance in functioning of their mind or brain? Does the impairment or disturbance mean that the person is unable to make a specific decision when they need to (offer appropriate support to achieve this).
- Functional test, patient must: understand information, retain information, use and weigh information and communicate their decision.
State the importance of written documentation, both for giving consent and documenting the information given to the patient and their supporters
IMPORTANCE OF DOCUMENTATION
- Shows reasoning for the clinical judgement made.
- Enable other clinicians important in the patients care to understand their situation.
- Shows timeline of patients journey.
- Shows proof of consultation/investigations/management (legal - covers doctors back).
List the exceptional circumstances when you can rely on oral consent, and the need to document this
Exceptional circumstances when consent cannot be given:
- If patient is unconscious and in need of urgency life saving procedure.
- In an emergency you can rely on oral consent.
- Not possible to find out patients wishes.
- Least restrictive of patients future choices.
In the case of minor or routine investigations or treatments, if you are satisfied that the patient understands what you propose to do and why, it is usually enough to have oral or implied consent.
Document this!
List the common risks associated with all surgery
- Anaesthesia complications: grogginess/confusion, N+V, headache, dizziness, fatigue, stroke, MI, brain damage, death, urinary retention, adverse reactions e.g. anaphylaxis.
- VTEs (DVT & PE).
- Post-operative lung infections.
- Wound infections.
- Bleeding/haemorrhage.
- Abdominal wall hernias.
- Pain.
- Neurological problems.
Identify and discuss with patients the psychosocial effects of surgery including stomas
- Negatively impacts body image.
- Leaky bodies - stigma - ‘our bodies shouldn’t leak’.
- Odour associated.
- Not being bake to wear certain clothes/being embarrassed wearing certain clothes.
- Biographical shift - ‘will I be able to live as I used to?’
- Difficult to look in mirror for the first time.
- Concern about self care.
- Impact relationships - not feeling sexually desirable.
- Loss of control over body.
- Social isolation.
- Stigma that stoma is associated with disease.
- Depression/low mood.
Outline the risk factors for chronic liver disease
- Excess alcohol consumption.
- Hepatitis B/C.
- High fat diet.
- Drugs e.g. paracetamol, steroids.
Identify measures to address liver disease risk factors at individual and population level
INDIVIDUAL
- Not engage in dangerous activities e.g. unsafe sex, sharing needles, IVDU.
- Losing weight.
- Cutting down on alcohol.
- Up to date with vaccines.
SOCIETAL
- Education (schools, mass-media, doctors) on healthy diets, exercise and alcohol.
- Provide needle banks for safe drug use. Provision of clean needles.
- Free condoms.
- Better mental health treatment reducing alcohol and drug use.
- Blister packs for paracetamol and restricting amount a person can buy.
- Minimum pricing on alcohol.
- Sugar tax.
- Vaccinations for HCP and people travelling.
- Safe working environment to reduce needle stick injuries.
- Screening of blood transfusions to prevent hepatitis.
Outline the epidemiology or breast cancer
- Most common cancer in UK.
- 1 in 8 women will develop breast cancer in their lives.
- Incidence is greatest in those aged 90+.
- 1% breast cancer cases are in males.
- 98% 5 year survival rate for stage 1.
- 25% 5 year survival rate for stage 4.
Describe the organisation of breast screening services within the NHS
- Women aged 50-70 screened every 3 yrs. Those > 70 self-refer by talking to GP.
- Women < 50 have more dense breast tissue so mammogram is difficult to interpret.
- If genetic mutation —> yearly MRI scans (aged 20 for TP53 and aged 30 for BRCA1/2).
- Mammograms (X-rays) used to screen breast tissue. 2 X-rays of each breast (one from above and one from side) - 4 pictures in total.
- Results posted within 2 weeks.
- Abnormalities require further testing —> magnified mammogram or US of breast.
- Recall done via triple assessment.
CHALLENGES
- Overdiagnosis and overtreatment.
- Exposure to radiation.
- 75% uptake.
- Cost.
- Education about self-examination.
EFFECTIVENESS
- Digital mammography has a high sensitivity (97%) meaning it’s good at ruling breast cancer out. Low sensitivity (64.5%) meaning it’s not good at ruling cancer in.
Outline the evidence on social patterns in delayed diagnosis for breast cancer in the UK
Risk factors associated with delayed presentation:
- Age.
- Low SES.
- Low education level.
- Initial symptoms weren’t a lump.
Describe the factors that are associated with delayed presentation of breast symptoms in primary care
- Lack of knowledge on breast cancer symptoms.
- Embarraed of symptoms.
- Scared to have breasts examined.
- Symptoms are vague.
- Lack of education on self examination.
