H&S Flashcards
What is an audit?
The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis & treatment, the use of resources & the resulting outcome & quality of life for the patient
Benefits of an audit?
- to improve pt care by identifying short comings
- opportunity for clinical education
- assess progress against national standards
- financial benefits
- builds relationships between clinicians, clinical teams, managers and patients
Limitations of an audit?
- comparing current best practice
- may not always help
- costs time, money and resources
- measures at fixed intervals, assumes conditional stability
Stages of audit cycle?
- Identify issues
- Obtain or define standards
- Collect data
- Compare performance with standards
- Implement change
- Re-audit
Role of audit in quality improvement?
often the first step in the improvement process, used to identify improvement opportunities
eg: compliance to known standards for high quality patient care
- does not improve care above current well defined standards
Outline complaints service in the NHS
2 step:
1. local resolution
acknowledgement offered within 3 working days, with offer to discuss handling of complaint
2. escalation to independent ombudsman
PALS: confidential advice and support, point of contact and information
PALS can help resolve issues informal with the hospital before an official complaint is made
the right to complain is written in the constitution of the NHS common complaints: safety of clinical practice poor/insufficient information given to patients ineffective clinical practice poor handling of complaints lack of dignity and respect poor attitudes of staff
Define an adverse event
an event, preventable or non-preventable that caused harm to a patient as a result of medical care. Includes never events, events that required life-sustaining intervention and events that cause prolonged hospital stays, permanent harm, or death.
Eg: Primary care: adverse drug reactions: beta-blockers, statins
Secondary care: falls, med errors, malnutrition, incontinence, Hospital acquired pressure injuries/infections
Define a near miss event
an error that occurs in the process of providing medical care that is detected and corrected before a patient is harmed
Define a never event
serious patient safety incidents that should not occur if the available preventative measures have been implemented
How to report an adverse event and why is reporting important?
National Patient Safety Agency: collects information from staff, patients and careers
National Reporting and Learning System: anonymous system run by NPSA
Yellow Card Scheme: adverse drugs reaction, includes non-prescription herbal etc.
online or yellow cards in back of BNF
adverse events are common and have important consequences
- up to 50% are preventable
- important learning opportunities to introduce preventable measures
Give some barriers to learning from an adverse event?
lack of communication
lack of responsibility (especially at top level)
focus on immediate event does not root cause
pride and rigid attitudes of staff
Ethical issues and practical aspects of clinical trials
informed consent is required, must be reviewed by ethics committee (Protection of Trial Subjects)
subjecting some people to risk for the benefits of others: risk-benefit analysis is main job of ethics committee (non-maleficence and beneficence)
creates ethical tension between the interests of current patients and acquiring new knowledge to guide the care of future patients
unknown long term effects
Equity of resources
Ethics of privatisation: If paid money are they taking advantage of pooper populations, will they provide false information to join, removes altruism
End of life issues
Clinical Trial Process and regulatory body
Phase 1: PRE-CLINICAL TESTING: safety and pharmacology in healthy volunteers (20-100)
Phase 2: examine efficacy (dosage regime and delivery) in volunteers with condition
uses lowest number of patients possible to provide significant statistical data (100-500)
most drugs fail here, ineffective? intolerable?
Phase 3: testing in larger population (1000-5000)
reconfirm phase 2 findings in larger population, overall risk/benefit, side effects
Phase 4: Post marketing studies and surveillance
long term effectiveness and safety, cost-benefit analysis
eg: Yellow Card scheme
Regulatory body: COMMISSION ON HUMAN MEDICINES (CHM) - 2005
Advice a patient on reducing or abstaining from smoking
Smoking & CVD: Active smoking and second-hand smoking exposure determine more than 30% of coronary heart disease mortality
In heavy cigarette smokers cessation can reduce CVD risk by up to 40% within 5 years
3 broad options:
- Group therapy
- One to one therapy
- drug therapy
Describe the barriers to rapid diagnosis and Rx of STEMI
- expected and experienced symptoms may differ so delay seeking help (education)
- Time taken to decide if symptoms require hospital treatment (education)
- Personal (encourage discussion of past experiences and to end the stigma
- Geographical, not near a primary PCI centre (more efficient transport, fairer distribution of resources)
- Cultural (use of interpreters)
- Socio-economic (political, ensure sick pay etc, reduce cost of public transport)
- Organisational (ambulance to identify STEMI and go straight to appropriate hospital, reduce waiting times with more staff?
What are the merits of publicly available performance indicators?
- Focusses attention on improving patient care
- Public reassurance about effectiveness and safety
- Competition will boost performance
- Facilitate informed consumer choice
What are the disadvantaged of publicly available performance indicators?
- may have negative impact on public trust
- Case-mix: may not be representative as some places will receive more complex cases = poorer prognosis
- data manipulation: only treating healthy pts, send more complex cases elsewhere
- measured performances will take precedence, those that are not measured will suffer
Risk factors for CVD
Modifiable: smoking, hypercholesteremia, obesity, excess alcohol consumption, poor diet, CKD, diabetes, rheumatoid arthritis
Non-modifiable: male, FHx, ethnic background (south asian)
Explain the difference between primary, secondary and tertiary prevention in CVD
Primary: prevention in those who do not yet have the disease (eg: smoking cessation, diet modification)
Secondary: prevention of MI/Stroke in those who have CVD (detect disease early and prevent it from getting worse, eg: lifestyle modifications, low dose statin)
Tertiary: prevention of further MI/Stroke in patients who have already had a CVD event (eg: cardiac rehab, anti-thrombotic therapy)
Outline a strategy to reduce CVD in the community
- Identification of at risk patients earlier in course of disease (CVD risk)
- many people with HTN, diabetes and CKD are undiagnosed (47%, 25% and 31% respectively)
- Routine appointments to screen for other CV conditions once one diagnosed
- Screen families of those with inherited conditions (familial hypercholesterolemia)
- Focus on high risk (most likely to benefit patient) and population strategy for lower risk (to benefit NHS)
- Example: Smoking cessation programs, posters etc. Opportunistic counselling in GP/Pharmacists. NRT on NHS
Define Risk Ratio
compares the risk of a health event (disease, injury, risk factor, or death) among one group with the risk among another group
Risk of disease (incidence proportion, attack rate) in group of primary interest
divided by
Risk of disease (incidence proportion, attack rate) in comparison group
RR of 1 = identical risk
>1 = greater risk in the exposed group (group at top of division)
<1 = decreased risk for exposed group (group at top of division)
Define Rate Ratio
compares the incidence rates, person-time rates, or mortality rates of two groups.
Rate for group of primary interest
divided by
Rate for comparison group
1 = identical >1 = increased risk <1 = decreased risk
Define Odds Ratio
quantifies the relationship between an exposure with two categories and health outcome
(a/c)/(b/d)
a= cases exposed b= controls exposed c = cases not exposed d = controls not exposed
1 = no relationship
> 1 = greater odds
< 1 = lower odds
define risk difference/attributable risk
the difference between the risk of an outcome in the exposed group and the unexposed group.
Difference between absolute and relative risk
Relative risk = used to compare the risk in two different groups of people.
Absolute risk = your risk of developing the disease over a time period.
Define NNT
NNT = number needed to treat
eg: the number of patients you need to treat to prevent 1 additional bad outcome
eg: if a drug has NNT = 5
you need to treat 5 patients with the drug to prevent 1 bad outcome
Approaches to controlling the spread of TB
Patient based: (contagious up to 2 weeks into treatment)
- stay away from work, school or college until your TB treatment team advises you it’s safe to return
- always cover your mouthwhen coughing, sneezing or laughing
- carefully dispose of any used tissues in a sealed plastic bag
- open windows when possible to ensure a good supply of fresh air in the areas where you spend time
- avoid sleeping in the same room as other people
Friends/Family: should get tested (blood test, x-ray, Mantoux test)
BCG Vaccine: given on NHS to those at risk under 35
- children living in areas with high rates of TB
- people with close family members from countries with high TB rates
- people going to live and work with local peoplefor more than 3 months in an area with high rates of TB
Stigma: educate and encourage patients to seek help, reduce the stigma.
- address HIV issues as higher risk
Screening of new entrants to country from areas of high risk: Africa, South Asia, Russia, China, South America
Epidemiology of lung cancer
47,838 new cases of lung cancer 2015-2017 in UK
35,137 deaths from lung cancer 2016-2018 UK
79% of cases are preventable (2015)
1 in 13 UK males and 1 in 15 UK females will be diagnosed with lung cancer in their lifetime.
79% of lung cancer cases in the UK are preventable.
72% of lung cancer cases in the UK are caused by smoking.
5% of lung cancer cases in the UK are caused by ionising radiation.
13% of lung cancer cases in the UK are caused by workplace exposures.
8% of lung cancer cases in the UK are caused by air pollution.
Risk factors of lung cancer
Occupational exposure: Asbestos: Mesothelioma Arsenic Silica: Silicosis (stone masonry, mining, quarrying, sand blasting) Smoking: very rare for someone who has never smoked to get SCLC passive smoking Family History Radon gas exposure
What is consent?
Must be voluntary (no coercion)
Must be informed
Patient must have capacity
Can be given in 3 ways:
- verbal
- non-verbal
- written
Informed consent:
- basic overview of their condition
- likely outcome of their decision
- treatment options, including second opinion
When is consent not required?
Additional procedures
During an operation
Emergency treatment
- to save life if unable to consent
Mental Health Condition
- Under section
Risk to public health
- Rabies, TB
Consent issues with children?
Aged 16 or cover can consent and parents cannot overrule
Under 16 – Gillick competence – to consent
If they refuse, can be overruled by parents or court of protection
If parent refuses to consent, can be overruled by the courts
Only 1 parent needs to give consent
As with adults, consent not required in an emergency
To have capacity a patient must be able to:
UNDERSTAND the information
RETAIN the information
Use the information to make a considered DECISION
COMMUNICATE this decision
What evidence must be proven for an adult be deemed not to have capacity?
Evidence has to show BOTH
Mind/brain impaired or disturbed
Impairment means they cannot make a decision at this time
Must remove all barriers possible and constantly reassess, correct all reversible causes
Why is confidentiality important?
Should be upheld in almost all circumstances to protect the doctor-patient relationship and to ensure that patients are not in fear of seeking medical help
In what situations could you break confidentiality?
General principles:
- protect children
- protect the public (terrorism)
- required by the courts
- provide care in a life-threatening situation (self harm, suicide)
- protect the service provider
What are the 4 medical ethics principles and give examples of each:
Beneficence - acting in best interests (doctors must stay up to date with current best practice in order to act in pt best interest)
Non-Maleficence - Do no harm (offers a threshold for treatment, must do more benefit than good, eg: toxic chemotherapy agents)
Justice - fairness (equal allocation of resources)
Autonomy – patient choice (pt refusing blood products due to cultural or religious beliefs)
What micro-organisms are commonly implicated as causes of food-poisoning?
Rapid onset – staph aureus; bacillus cereus
Intermediate (12hrs) – clostridium perfringens, clostridium botulinum
Several days incubation – campylobacter (overall most common cause), salmonellosis, shigella, E. coli, Viral – parvovirus, calcivirus, Hep A
What actions may be required to control an outbreak of food poisoning?
Identify and isolate the source
Identify and treat affected individuals
Advise on further treatment and prevention of infection (hygiene, isolation ~48hours)
What do you need to do as a doctor if you suspect a case of food poisoning?
Section 11 of Public Health (Control of Disease) Act 1984
It’s a notifiable disease - report to consultant responsible for communicable disease control
Notify a ‘proper officer’ in the local authority
Which organisms are commonly implicated hospital outbreaks?
C. Diff Norovirus/Rotavirus E. Coli Klebsiella MRSA/Staph. Aureus
What can be done to prevent hospital outbreaks of infection?
Decreasing risk of outbreaks in hospitals:
Decrease source of infectious agents – hygiene, prompt discharges, treat potential sources in patients
Prevent modes of transmission – contact (direct & indirect e.g. stethoscopes), droplet, airborne – personal protective equipment, hygiene,
Sterilise/disposable equipment, isolation, barrier nursing
Identify susceptible hosts & protect them
Name some notifiable diseases?
Acute encephalitis Acute infectious hepatitis Acute meningitis COVID-19 Infectious bloody diarrhoea Legionnaires’ disease
Describe the DPP Trail:
The Diabetes Prevention Programme (DPP) trial
Primary Goal:
Prevent or delay the development of T2DM in patents with Impaired Glucose Tolerance (IGT).
Secondary Goal
Reduce Cardiovascular disease events.
Reduce Cardiovascular disease risk factors.
Reduce Atherosclerosis.
Findings
Intensive lifestyle modification reduced development of diabetes by 58%.
Metformin reduced development of diabetes by 31%.
LIFESTYLE modification is MORE EFFECTIVE than METFORMIN
Complications of Diabetes and screening programs to reduce these:
Microvascular – retinopathy, nephropathy, neuropathy
Macrovascular – peripheral, coronary, cerebrovascular disease
Others: Impaired wound healing; mild immunocompromise increasing infection
Screening programmes: For retinopathy, podiatry, clinics monitor renal function, HbA1c, lipids, BP
Risk factors for obesity:
There are many factors that contribute to weight gain and its increasing prevalence in society:
• Genes - tendency to gain weight and store fat.
• behaviour - not adopting healthy habits.
• Environment - one that encourages consumption of fatty foods, large portions and inactivity.
• Social Structure - low income leads to high calorie/fat diets as healthier foods are more expensive; developing countries have low Obesity rates as they have limited availability of food, little public transport and engage in moderate to heavy manual labour.
• Modernisation - has lead to an abundance of food, and more convenience foods, and decreased need for physical activity and manual labour.
• urbanization - convenience has lead to large cities meaning less distance to travel, less open areas for exercise and less pastimes requiring physical activity
Examples of how to tackle obesity:
Implementation of easy access exercise schemes and cheaper/free access to gyms and sports clubs.
Establish regular meals and encourage healthier foods for long term weight management
Reduce dietary fat, avoid fried foods, buy lean meats, use semi-skimmed milk and low fat alternatives.
Educate about what constitutes a ‘balanced diet’ (including ‘5-a-day’ fruit and veg).
Encourage patents to observe food labeling and make healthier decisions when buying foods.
Promote healthy eating in the young through school dinners and healthy packed-lunches.
What is the national obesity forum?
Established to raise awareness of the growing impact of obesity on our patients and NHS. Here are their aims:
• Create recognition of obesity as a serious medical problem.
• Provide education of obesity management.
• Provide guidelines for obesity management in primary care.
• Provide a network for support and an information resource.
• Convince the government to give obesity a high priority.
• Highlight the health inequalities of obesity.
Associated co-morbidities of obesity:
Arthritis (OA and RA) Cancers Carpal Tunnel Syndrome Gout Surgical Complications Type 2 Diabetes End Stage Renal Disease Gallbladder and Liver Disease Sleep Apnoea Urinary Stress Incontinence Cardiovascular Disease Chronic Venous Insufficiency DVT/PE Stroke Hypertension Mental health (depression etc)
Describe factors that increase organ donation rates:
Use of opt out More transplant centres Higher percentage university education Higher percentage roman Catholics Economic reimbursement for hospitals High number of RTAs
Types of Transplant:
Deceased - anonymous
Living pooled/paired - when a donor wants to give a relative but their blood groups are mismatched then are paired with another couple in the same situation to get the best kidney for each party. Operations must happen at the same time.
Living altruistic donation - when a patient donates to an unknown recipient.
Illegal - payment, abduction & forced donation.
Who regulates organ donation in the UK?
The Human Tissue Act 2004 (HTA 04) Regulates the donation by living people of Solid organs Bone marrow Stem cells
The HTA 04 requires the HTA to approve any transplantation from a living donor whether they are related to the patient or not.
Ethics of transplantation:
All patients needing a transplant are placed on the UK transplant national transplant database
This ensures fair rationing
Points system based on:
Time on the waiting list (favouring patients who have waited longest).
Tissue match and age combined (favouring well-matched transplants for younger patients).
The age difference between donor and patient (favouring closer age matches).
Location of patient relative to the donor (favouring patients who are closer in order to minimise the transportation time of the kidney).
Three other factors relating to blood group match and rareness of the patient’s tissue type.
Describe the Nuremberg Code:
Voluntary consent is required
Should yield results beneficial to society that cannot be acquired by other means
Based on animal experimentation and a knowledge of natural history of the disease
Avoid all unnecessary physical and mental suffering
Should not be performed if there is a reason to believe the intervention is harmful
Risk should not exceed the benefits
Preparations and facilities should be provided to protect subjects from injury, disability, or death
Should be conducted by scientifically qualified people
Subjects should be able to leave whenever they wish
Scientists in charge must be prepared to end the experiment is there is evidence of harm (or likely to be)
Define a screening program?
Application of a test to identify individuals at sufficient risk of a disorder to warrant investigation or direct preventative action, amongst persons who have not sought medical attention on account of symptoms
What conditions must be met for a screening program to be successful?
The condition being screened for should be an important health problem
The natural history of the condition should be well understood
There should be a detectable early stage
Treatment at an early stage should be of more benefit than at a later stage
A suitable test should be devised for the early stage
The test should be acceptable
Intervals for repeating the test should be determined
Adequate health service provision should be made for the extra clinical workload resulting from screening
The risks, both physical and psychological, should be less than the benefits
The costs should be balanced against the benefits
Examples of screening programs?
Cancer
Breast cancer- all women aged 50-71st bday and registered with a GP automatically invited to screen ing every 3 years
Cervical cancer (smear) - all women and people with a cervix, aged 25 - 65 and registered with a GP, 25-49 3 yearly, 49-64 5 yearly and over 65 only 1 if last three were normal
Bowel cancer (FOB): 60 -74 lives in England and is registered to a GP is automatically sent a screening kit every 2 years
Children
Downs syndrome
Sickle cell & thalassaemia
Newborn bloodspots (sickle cell, homocystinuria, congenital hypothyroidism, etc)
Newborn hearing
Infectious diseases in pregnancy screening (HIV, syphilis, Hep B)
Others
Diabetic retinopathy
AAA (USS)
What is lead time and lead time bias?
Lead time = the length of time between a disease found on screening and its usual clinical presentation
lead time bias: a type of selection bias, it effects the perceived survival time due to earlier detection rather than improvement in actual survival
what is length bias?
form of selection bias
it refers to the phenomenon whereby slower less aggressive cancers have a longer pre-clinical time and so are more likely to be picked up by screening programs than those that are more aggressive and fast growing
What is the healthy ‘screenee’ effect?
Those who participate in screening programs are more likely to make good health choices anyway and so this can make screening look more beneficial than actually is, some of the apparent benefit will be due to the different lifestyles adopted
Definition and types of euthanasia?
The act of deliberately ending a persons life to relieve suffering
Assisted suicide: act of deliberating assisting or encouraging another person to commit suicide
Both active euthanasia and assisted suicide are illegal in UK (not so in some US states)
Types of euthanasia
Active – actively ends the life of another
Passive – withholds life-prolonging treatment
Voluntary – where a person who wants to die asks for help
Non-voluntary – where the person is unable to ask for help (e.g. coma) but has previously expressed their wishes
Involuntary – killed against their wishes (murder)
Alternatives
Making an advance decision to refuse life-sustaining treatment – legally binding
Arguments for and against euthanasia?
FOR:
Ethical – people should have autonomy to chose
Pragmatic – argues that practices used in ‘end-of-life’ are essentially the same as euthanasia
such as DNACPR is a form of passive euthanasia
palliative sedation to ease suffering does shorten life
therefore if going on already, better to legalise and regulate
This is therefore acting in the patient beneficence
AGAINST:
Religious – only god has life ending right
Slippery slope – could lead to unintended consequences
people may feel pressured into euthanasia so they aren’t a burden
Research into palliative and terminal medical care may be discouraged
Misdiagnosis may lead to wrongful euthanasia
Ethics – violates do not harm/non-maleficence
Alternative – advances in palliative care should mean no one should have to suffer anyway
Potential barriers to healthcare?
Personal: negative past-experience; stigma; interference with social life
Discussion, counselling, address stigma
Geographical: transport; postcode lottery
More efficient public transport; fairer distribution of services
Cultural: beliefs, behaviours, language
Ensure interpreters are available; appreciate different cultural attitudes
Socio-economic: education; finances; time off work; paid leave
Ensure there is basic paid sick leave; reduce associated costs (transport); prescription costs
Organisational: disabled access, long waiting times
Strategies for efficient reduction of waiting times; out of hours access; better disabled access
Describe primary, secondary and territory healthcare promotion in relation to alcohol?
PRIMARY:
- education to discourage drinking
- increasing alcohol tax/minimum price
SECONDARY:
- Screen for problem drinkers (CAGE/AUDIT)
- identifying and targeting high-risk groups
TERTIARY:
- treatment of alcohol-related problems and alcoholism
- fortification of foods with vitamins
Describe primary, secondary and territory healthcare promotion in relation to drugs?
PRIMARY:
- education about the dangers
- identification of at-risk groups
SECONDARY:
- Hep B immunisation
- Condoms
- needle- exchange
- methadone regimes
TERTIARY:
- better access to treatment centres
- self-help groups
- relapse prevention schemes
Discuss the importance of a culture of safety with examples?
- WHO safety checklist
- mortality and morbidity meetings
why?
- increased safety cultures accompanies the need for assessment tools
- no blame culture, learn from mistakes
- improve pt safety by adding more layers of protection (swiss cheese model)
Common risks associated with all all surgeries?
Pain Infection Kidney Damage Blood Clotting/bleeding Allergic reaction to anaesthesia Death
Psychosocial effects of surgeries, for example stomas
Body Image: what we think of our appearance and what we believe others think
Stomas can cause anxiety, depression, QOL may change/activities of daily living, people may view themselves as unwell or unattractive
- Shock, deal, acknowledgement and acceptance/resolution
MDT in cancer? (eg: Breast)
Purpose of MDT: working out treatment plans, deciding on further tests, collecting and sharing information, making appropriate referrals.
MDT can only recommend, decision is left with consultation with patient.
safe decision making by MDT, expert advice, consensus of ideas
Cancer: lead clinician + lead nurse specialist, radiologists, histopathologists, expert surgeons, oncologists, palliative care physicians, patient representatives.
Eg: Breast Cancer MDT
breast care nurses: councillors who help break bad news and give information and support
radiographers: take X rays
advanced practitioners: radiographers who also report films and/or do ultrasound and biopsies
radiologists: doctors who report films and do ultrasound
surgeons: examination patients in symptomatic clinics and do GA operations
pathologists: examine tissue samples to diagnose disease
oncologists: arrange radiotherapy and chemotherapy
Risk factors for chronic liver disease and measures to address them at an individual and population level?
Risk Factors: chronic alcohol use, Hep B/C, obesity, tattoos, T2 diabetes, injecting
Individual level: directed towards members of target groups, individuals. EG: cutting down alcohol intake or improving medication complience
Population level: policies or programs that shift the distribution of health risk by addressing the underlying social, economic and environmental conditions. EG: advertising laws around alcohol and cigarette advertisement
Epidemiology of Breast Cancer?
Breast Cancer Research Website:
There are around 55,200 new breast cancer cases in the UK every year, that’s around 150 every day (2015-2017).
Breast cancer is the most common cancer in the UK, accounting for 15% of all new cancer cases (2017).
In females in the UK, breast cancer is the most common cancer, with around 54,700 new cases in 2017.
In males in the UK, breast cancer is not among the 20 most common cancers, with around 390 new cases in 2017
Organisation of breast screening organisation?
women 50 - 71 years
3 yearly
high risk women invited to screening earlier
Triple Assessment:
All breast lumps need Clinical Examination, Imaging (mammography and/or ultrasound) and Sampling (core biopsy or fine needle aspiration cytology)
Organisation of Cancer services in UK?
Need for strategic clinical cancer network highlighted in 1995 Calman-Hine Framework
3 tier system produced:
- Primary care: screening, diagnosis, support during treatment and follow up
- Cancer Units: Hospital that diagnose and treat cancers. Diagnose intermediate cancers and refer to specialists. Provide advanced diagnostic procedures and provide common surgeries and non-complex chemotherapy
- Cancer Centres: treat more rates cancers using complex treatments
Advantages of the Strategic Clinical Cancer network?
Accurate studies on epidemiology of different cancers
Commission care in a way to reduce inequalities in care throughout the SCN region
Reduces incidence of cancer
Maximise survival of cancer patients
Enhance quality of life of patients and families
Improve the patient experience of cancer services
Psychosocial impact of a cancer diagnosis on patients and their families?
how does socio-economic background effect this?
4 themes:
- worry of death, interference with work, family responsibilities
- reactions of family members
- views of society: sympathy, isolation, reluctance to disclose information
- worries about the future: side effects of treatment, spread of disease, effect on children
class inequalities:
- single parent, unable to get childcare to attend GP?
- unable to afford time off work?
- cultural differences: religion can play a part in coping with diagnosis
- cultural believes of holistic medicine over conventional therapy
Factors associated with delayed presentation of breast cancer in primary care?
Patients with breast cancer are least likely to delay presentation
Rates are higher in lower socioeconomic classes
Lack of eduction: may not associate signs and symptoms with cancer
May be influenced by previous illness/ friends and family/internet
Fear of diagnosis: worried about the actual diagnosis/ hoping it will go away.
Lack of availability: access to healthcare services/ financial costs.
Masses in elderly are more likely to be ignored.
May have lack of trust in medial healthcare/belief in alternative medicine
Role of Family History in risk of developing breast cancer and options for those effected?
as of Breast Cancer Research website:
one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer = risk doubled
two first-degree relatives have been diagnosed = risk 5 times higher than average
Average population: screened 3 yearly (50-71)
Moderate Risk: yearly screening from age 40 - 60 then 3 yearly
High Risk, BRCA1 and BRCA2, CHEK2: yearly screening from age 30
Steps that can be taken:
lifestyle: healthy weight, not smoking, good diet, reg exercise, limiting alcohol
screening
protective surgeries (removing one or both healthy breasts before onset of cancer)
prophylactic ovary removal (pre-menopause)
Epidemiology of Depression in UK?
Common 15 % F>M 2:1 1 in 6 people in a lifetime 1 in 4 women and 1 in 10 require treatment during their lifetime
How to deal with a violent patient?
Immediate:
- deescalate: calm voice, friendly
- breakaway techniques
- re-evaluate the setting: seclusion room?
- control and restraint
- assess the need for medication
- rapid transquilisation
- admission under MHA
- police may issue OSMAN warning to inform someone they may be at risk from a patient (break confidentiality)
Long term:
- monitoring
- full review of care plan
- communication: police, social services, MAPPA
- Addiction services
