H&S (Quizlet) Flashcards

Question

3 examples of complementary and alternative medicine (CAM's)

Answer 1

- Aromatherapy (aromatic oils) - Acupuncture (needles) - Homeopathy (microdoses)

Answer 2

- Interference with work or physical activity - Interference with social relations. - Interpersonal crisis e.g. death in family. - Putting a time limit on symptoms. - Sanctioning - relative/friends tell them to seek help.

Answer 3

- Lack of awareness of symptoms e.g indigestion as MI - Perception and evaluation of symptoms (not severe enough) - Perceived risk. - Confirmation from others - Previous experience. - Psychological factors - Fear of what it might be. - Denial. - Concern about using NHS resources.

Answer 4

Moral based on the consequence of the action

Answer 5

Moral based on the actions adherence to the rules/duties

Answer 6

Right act is one a virtuous person would do, that express the virtues such as compassion and honesty.

Answer 7

A set of values, behaviours and relationships that underpins the trust that the public has in doctors

Answer 8

To protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.

Answer 9

- GMC sets its guidance for what medical graduates need to accomplish in Tomorrow's Doctors. - This is taught by the medical schools. - This is examined formally in various exams taken throughout the course, reflective essays, learning to give feedback and self-reflection, attendance and punctuality, plagiarism.

Answer 10

- More accurate diagnosis. - More accurate data gathering. - Increased adherence with treatment regime. - More effective patient-doctor relationship. - Increased patient-doctor satisfaction.

Answer 11

- Inaccurate diagnosis. - Less recognition of ICE. - Non-adherence to treatment. - Decreased satisfaction with doctor. - More complaints.

Answer 12

- Decisions about research funding. - Pharmaceutical industry - profits. - Ethical issues. - Nature of scientific work - communication.

Answer 13

- Improving a population by controlled breeding. - Encourages good genetics, discourages bad genetics.

Answer 14

- Thinking about the future based on genetics. - Designer babies. - Genetic screening - health insurance, employment, and civil liberties. - Many conditions are polygenic.

Answer 15

Care that is responsive to the wants, needs, and preferences of the patient.

Answer 16

- Explores patients main reasons for visit. +establishes rapport - Seek integrated understanding of patients world - looks at the whole person. - Finds common ground on problem and mutually agrees on management. - Enhances prevention and health promotion. - Enhances the continuing relationship between the patient and the doctor. - Is realistic i.e

Answer 17

Allows a doctor to find the methods of health promotion and preventative care which most appropriately match a patient’s world.

Answer 18

States the rights and responsibilities for patient and doctors when they have a consultation.

Answer 19

- Must want to get well as quickly as possible. - Should seek professional medical advice and cooperate with the doctor. - Allowed to stop normal activities and responsibilities e.g. work. - Regarded as being in need of care and unable to get better alone.

Answer 20

- Apply a high degree of skill and knowledge. - Act for welfare of patient, not self interest. - Be objective and emotionally detached. - Be guided by rules of professional practice.

Answer 21

- Symptom iceberg - Patients do not necessarily act on symptoms and go see the doctor. - Chronic illness and MUS - If cause unknown, patients can't enter sick role due to uncertainty. - People try to label themselves as sick. - Conflict between best interests for the patient and cost to society in allocation of resources.

Answer 22

The process of enabling people to increase control over, and to improve, their health.

Answer 23

* H - Healthy public policy. * A - Action in the community. * R - Re-orientating health services. * P - Personal skills. * S - Supportive environment.

Answer 24

- Individualistic - encouraging individual responsibility and action - Collective/societal - educates groups on preventative health - Governmental - new legalisation to protect/improve health

Answer 25

- Success - Cot death (sudden infant death syndrome) was drastically reduced due to health campaigns "back to sleep" - Easy? - smoking not as easy due to barriers to reduction e.g cool factor, tolerance of society, tax income putting into economy - Hard - obesity hard to solve due barriers e.g desensitisation/victimisation

Answer 26

Aims to prevent onset of disease. * Screening risk factors. * Health protection. * Health education.

Answer 27

* Detect and cure disease at early stage. - E.g. cancer screening.

Answer 28

Minimise the effects or reduce the progression of irreversible disease.

Answer 29

- The process of influencing an individual's attitudes, beliefs, and behaviors related to health - Includes mass media campaigns, such as sexual health and health eating. - For example, 5-a-day TV campaign.

Answer 30

- Opportunistic prevention in consultations. - For example, working with dietician on food.

Answer 31

- Legislation to protect public health. - Includes seat belts, restrictions on smoking in public.

Answer 32

A preventative measure which brings much benefits to the population but offers little to each participating individual. e.g cigarette tax

Answer 33

A combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme.

Answer 34

A process through which people gain greater control over decisions and actions affecting their health.

Answer 35

Taking action in partnership with individuals or groups to empower them to promote and protect their health.

Answer 36

The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.

Answer 37

Differences in people's health linked to social inequalities in their lives.

Answer 38

The unfair and avoidable differences in health status arising from poor governance, corruption or cultural exclusion.

Answer 39

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels

Answer 40

1. Material - stuff you have e.g house, car, food 2. Psychosocial - the stressors/emotional wellbeing 3. Behavioural - eating, smoking, alcohol consumption

Answer 41

* Confirmed social health inequalities are involved in mortality and the extent of this * Shows health inequalities were widening, despite general improvement * Recommended increasing child benefit, introducing minimum wages + improving housing

Answer 42

* Childhood is a period of rapid development and heightened sensitivity to environmental influences. * Father's occupation at birth is a strong indicator of life expectancy.

Answer 43

* Raising National minimum wage. * Increase child benefit. * Increase income support. * Teenage pregnancy strategy. * Supporting families into work and increasing their earnings * Providing free school meals to all infant school children

Answer 44

* Unemployment/part-time work. * Lower pay. * Rising prices of food/necessities * More single parent families. * Freezing or abolition of some benefits * government cuts * More indirect taxation. * economic inflation

Answer 45

* Shows life expectancy has stalled in UK * People living in deprived areas spend most of their (shorter) lives in poor health * Funding cuts have worsened inequalities * urgent health improvement needed in north

Answer 46

The availability of good medical care tends to vary inversely with the need of the population served

Answer 47

Services, research or policies that work to redress inequities by supporting specific vulnerable groups e.g homeless, migrants, sex workers

Answer 48

System of knowledge, experience, belief, attitudes, meanings, signs, and symbols shared by a group of people

Answer 49

Defines the economic and social position of a person in terms of income, wealth, education, and occupation

Answer 50

Process of learning your own group's culture.

Answer 51

Process of taking on another groups culture

Answer 52

* Many people will self treat before seeing a doctor. * Many cultures have strong non-western medical traditions.

Answer 53

* Easily accessible, cheap * own control over treatment. * Dissatisfaction with health care. * Poor doctor-patient relationship. * Desperation. * Perceived effectiveness and safety.

Answer 54

Determining the nature of a disorder by considering the patient's signs and symptoms, medical background, and test results.

Answer 55

Assessment of future course and outcome of patients disease based on knowledge of similar patients together with the pt's health, sex and prognostic factors

Answer 56

* It can help diagnostic and treatment decisions. * It is important for patients to know the likely course of their disease. * Helps discussing opinions of patients

Answer 57

1. Qualitative - which outcomes could happen? 2. Quantitative - How likely are the outcomes to happen? 3. Temporal - over what period will the outcomes happen?

Answer 58

* Descriptive - What are you doing? * Normative - What should you be doing? * Prescriptive - How can we improve what you are doing?

Answer 59

Seeking evidence to disprove your hypothesis

Answer 60

* Inexperienced clinicians. * Experienced clinicians with a problem they don't recognise.

Answer 61

1) Framing & editing - preliminary analysis of problem 2) Evaluation - framed prospects are evaluated and highest value one is selected

Answer 62

Broad evidence is any factor that can and should influence clinical decision-making, whereas narrow evidence is the results of rigorous clinical trials and observational studies.

Answer 63

Lists the types of study design ranked in order of their perceived ability to provide evidence for use in practice.

Answer 64

Systematic reviews and meta analyses - most rigorous and least biased

Answer 65

- Different studies are sometimes suited to certain evidence e.g case studies for smoking relation to cancer - Doesn't include qualitative (words) research e.g diaries/blogs can be very useful

Answer 66

A procedure for statistically combining the results of many different research studies

Answer 67

* Cochrane database. * Evidence based journals. * Medline/embase

Answer 68

The ability to select and use medication to treat self-recognised illness or symptoms i.e. without medical supervision/ professional healthcare advice.

Answer 69

Voluntary agreement given by a competent patient that has been fully informed.

Answer 70

- Fully informed * Voluntary * Patient with capacity

Answer 71

* Oral * Written * Implied * Expressed

Answer 72

* Potential benefits. * Potential risks. * Alternative treatment options.

Answer 73

- If patient lacks capacity e.g treated under mental health law - Under 18, can be refused if in pt best interest - In an emergency - Public Health Act 1984/Mental Health 1983, detaining patients - To prevent serious harm to others

Answer 74

* Before examination. * Before treatment or care. * Disclosure of confidential information. * Screening. * Teaching. * Research.

Answer 75

* Improves trust between patient and doctor. * Legal requirement. * Respects pt autonomy. * Professional duty. * Avoidance of psychological/physical harm/distress

Answer 76

Practitioners are not negligent if they act in accordance with the practice accepted by a responsible body of medical opinion

Answer 77

If a person touches another person without consent.

Answer 78

- The concept of failure to exercise care. - Needs to show a causal connection between failure to inform and the resultant harm

Answer 79

- Determined by a physician, refers to an assessment of the individual's ability to understand, appreciate, and manipulate information to form rational decisions.

Answer 80

Mental Capacity Act 2005

Answer 81

People who are 16 and over.

Answer 82

The Family Law Reform Act 1969.

Answer 83

Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge.

Answer 84

A disease that does not require treatment to be cured; it will resolve on its own

Answer 85

- vitamins/minerals - coughs/colds/nasal congestion - mild cystitis (bladder infection)

Answer 86

Prescription only medicine that is dispensed from a pharmacy/other licensed place

Answer 87

You can get it from a pharmacy under the supervision of a pharmacist.

Answer 88

General sales list - can be purchased from newsagents/ supermarkets, vending machines etc

Answer 89

Over the counter, can be purchased without prescription.

Answer 90

* Pharmacists can ask customers questions about who it is for, symptoms, etc. * Ensures no "red flags" about how long the patient can use it for. * Duration of a symptom may mean it is not safe to self treat.

Answer 91

Medicines and Healthcare Regulatory Authority - authorise the marketing of drugs

Answer 92

- prevents re-prescribing - prevents interactions - OTC medication can be abused (quite prevalent)

Answer 93

No danger when used correctly without the supervision of a doctor.

Answer 94

Safe to sell without the supervision of a pharmacist.

Answer 95

- danger to human health, even when used correctly - frequent incorrect use - further investigation of side effects required - product is administered parenterally (injection/infusion)

Answer 96

* Minor ailment schemes. * Emergency contraception. * Smoking cessation. * Health education.

Answer 97

* People reluctant to take mild analgesics. * People who "don't think twice" about taking mild analgesics. * People who prefer to let pain "run its course".

Answer 98

* Discrete - Only certain values possible. * Continuous - Any value is possible.

Answer 99

* Multinomial - Categories aren't ordered. * Ordered - Categories exhibit logical order. * Dichotomous - Two categories that oppose.

Answer 100

Data is collected and summarised and described in terms of means, SDs, etc.

Answer 101

Inferences about the nature of individuals are deduced from inference for the group to which they belong.

Answer 102

Using statistical tests to make generalisations about a population.

Answer 103

Categorical e.g. sex.

Answer 104

Categories ordered in value e.g. degree of pain.

Answer 105

* Mean - Average of all observations. * Median - Midpoint of the data set. * Mode - Most frequent observation.

Answer 106

Continuous data with equal intervals e.g. height, age, weight.

Answer 107

* Standard deviation * Interquartile range * Range

Answer 108

An idea expressed in such a way that it can be tested and refuted.

Answer 109

Null hypothesis H0 - there is no difference between two groups. Alternative hypothesis H1 - a difference exists between the two groups

Answer 110

1. State H0/H1 2. Define and evaluate a test statsitic 3. Calculate p value 4. Interpret the results

Answer 111

The measure of probability that the null hypothesis was rejected when in fact the null hypothesis is true.

Answer 112

* P=0.05. (any higher then not statistically signifcant) * Strong evidence against the null hypothesis, can reject the null hypothesis. * Statistically significant.

Answer 113

A measure of the variation of the mean, to asses how much discrepancy is likely in a sample's mean compared with the population mean. = SD/ √number in sample

Answer 114

Random variation that is due to chance

Answer 115

When the p value is less than 0.05 (as strong evidence against it)

Answer 116

When the p value is more than 0.05 (as weak evidence against it. i.e should accept it)

Answer 117

you reject null when it is true

Answer 118

The null hypothesis is accepted when it should have been rejected (null hypothesis is accepted incorrectly)

Answer 119

Lowers p value = more power due to reduced random error

Answer 120

A range of values so defined that there is a specified probability that the value of a parameter lies within it. (e.g a range that we think the mean lies within)

Answer 121

The actual upper and lower boundaries that state the boundaries of the confidence interval.

Answer 122

An international collaborative effort to map and sequence the DNA of the entire human genome.

Answer 123

- All human beings are 99.9% identical at the DNA level = race is a social construct - Enabled detailed understanding/marketising of human ancestry

Answer 124

- Predictive testing - using genetics to identify risk of disease. However can lead to misinterpretation. - Diagnostic testing - when a pt has signs/symptoms of genetic disease

Answer 125

* Disease prevalence varies with ethnicity. * Approaches to best treatment may vary with ethnicity. * Affects behaviour towards others. * Can look at the patient according to their own values.

Answer 126

Refers to organisations and cultures developed through history that maintain racist attitudes, beliefs and practices

Answer 127

Ethnic minorities have extra psychological stressors due to being treated as 'other', leads to increased poor mental health

Answer 128

Judging one culture based on the values of another.

Answer 129

* Primary - Carrier screening. * Secondary - Postnatal screening. * Tertiary - Treatment, preventatives, therapeutics.

Answer 130

* Cost - It would cost a lot of money * Could be seen as racist - Screening certain ethnic groups, impression of ethnic minorities being sicker/bringing in disease. * How do we determine ethnicity so know who to screen?

Answer 131

* Probability that an event will occur during a specified time. * Only works if a time period is fixed.

Answer 132

* Relative - The ratio of the probability of developing an outcome in those exposed compared to those not exposed (risk ratio). * Absolute - Risk of developing the disease over a time period.

Answer 133

* Risk in exposed ÷ by risk in non-exposed. * A RR of 1 - No difference in risk between the two groups. * A RR of <1 - The event is less likely to occur in the experimental group than is the control group.

Answer 134

Difference in risk between study and control populations. = risk in control - risk in experimental = 0 (risk same in both groups < 0 (risk reduction) > 0 (risk increase)

Answer 135

Pledge of agreement to not divulge or disclose information about patients to others.

Answer 136

* Statute (law). * Consent given by patient. * When in Publics best interest. * to prevent harm to others or to self

Answer 137

* Public Health Act 1984. * Road Traffic Act 1988. * Prevention of terrorism act 1989.

Answer 138

* Descriptive study, observational. * Analyses data from a population at one specific point in time, usually using a survey, to assess frequency/prevalence * Used to generate hypotheses on risk factors

Answer 139

* Can be prospective (looking to future) or retrospective (looking into past). * Subjects with certain exposure followed over time for outcome occurrence (start with exposure, compare outcomes)

Answer 140

- usually large in size = researchers are able to draw confident conclusions regarding the link between risk factors and disease. - can investigate multiple outcomes - allows calculation of useful estimates - reduces risk of survivor bias

Answer 141

- complex, time-consuming and expensive. - Participants may drop out, increasing the risk of attrition bias - large numbers of confounding variables making it difficult to link cause and effect. - does not establish causation, only association - possible selection bias

Answer 142

- Objective - gain access to Dr's notes (BETTER) - Subjective - surveys/interviews people may not be able to remember

Answer 143

systematic differences between people who drop out or stay in a study

Answer 144

- healthy population may not be representative of a real community - individuals may volunteer purely for monetary gain - different groups may vary on socioeconomic factors + lifestyle

Answer 145

- hard to find causal relationships - cannot estimate incidence - Limited information on temporal relationships - potential Bias in sampling

Answer 146

- Can be done in a short period of time - Cheap - Provides prevalence data - Provides trend data - Hypothesis generating - Easy to conduct a survey

Answer 147

An observational style study that looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and the disease/outcome.

Answer 148

- If frequency of exposure is low, case control studies quickly become inefficient - difficulty choosing control group - Particularly prone to bias; especially selection, recall and observer bias. - The temporal sequence between exposure and disease may be difficult to determine

Answer 149

Systematic error due to differences in accuracy or completeness of recall to memory of past events or experiences.

Answer 150

- can study multiple risk factors/exposures - effective in the investigation of diseases that have a long developmental time - allows calculations of multiple useful estimates (incidence rates, relative risk…) - Useful in the study of rare disease

Answer 151

Detailed report of symptoms, signs, diagnosis, treatment, and follow-up of individual patient.

Answer 152

* People get better or worse irrespective of medical intervention. * Hard to distinguish whether medical action or temporal change is responsible.

Answer 153

If a variable is extreme on its first measurement, it will tend to be closer to average on its second.

Answer 154

Everyday tasks and functional activities that are an essential part of life. Can be grouped: - leisure - locomotion - personal - work/domestic

Answer 155

- illness, injury or a congenital condition that either causes or is likely to cause a loss of or a difference to function. - may be functional, physiological or psychological.

Answer 156

Disability is the loss or limitation of opportunities to take part in society on equal a level with others due to either environmental or social barriers.

Answer 157

Disadvantage from impairment that limits/prevents the fulfilment of a role that is normal for that individual.

Answer 158

Healthcare professionals who support the work of physicians pre/during/post treatment to optimise the experience. INc. nurses, technologists, radiographers, therapists, and others.

Answer 159

* Impairment assessment. * Management of condition through various therapies e.g acupuncture

Answer 160

* Functional assessment. * Occupational assessment. * Goal setting * QOL assessment * Advise and arrange adaptations for employment and/or hobbies

Answer 161

* Measures of disability - Barthel Index * Observation. * History taking. * Clinical examination. * Validated questionnaires

Answer 162

* Weight loss * Fatigue * Reduced grip strength * Diminished physical activity * Slowed gait - often closely associated with an increased risk of falls

Answer 163

* Individuals must be an active participant in their own rehab and recovery, showing effort and approp. behaviour * Management must relieve pain and prevent disability.

Answer 164

a model of health that integrates the effects of biological, behavioral, and social factors on health and illness

Answer 165

- bio - impairment and loss of function - psycho - attitudes, illness behaviour, distress - social - occupational demands, cultural attitudes, economic incentives

Answer 166

understanding disease/illness as a biological cause

Answer 167

* Disability due to an underlying disease/disorder * Exclusion from society. * looks at what is wrong with the person and that it requires intervention/treatment

Answer 168

* Industrial revolution - replacing low tech local work * Advances in technology - something can be done * Social Darwinism - survival of the fittest

Answer 169

* Looks at disability as a tragedy. * Doesn't look at the person as normal in society. * Sees disability as a medical problem that doctors have to fix. * Focuses on what they CANT do

Answer 170

Emphasises the social and environmental constraints on a person, that results in discrimination

Answer 171

* Discrimination arises because of the organisation of society. * Society fails to make activities accessible e.g poorly designed buildings/public transport * Doesn't fully appreciate the complexity of different disabled peoples lives. * segregated education

Answer 172

There is no such thing as a disabled individual but that society makes people disabled.

Answer 173

1) body function and structures 2) Activities 3) Participation

Answer 174

Disability Discrimination Act 1995.

Answer 175

A study that compares groups rather than individuals, snapshot descriptive/observational study

Answer 176

- The right to life (Article 2) - Freedom from torture (Article 3) - Right to liberty and security (Article 5) - The right to respect for family and private life (Article 8) - Freedom of thought, conscience and religion (Article 9) - Freedom of expression (Article 10) - The right not to be discriminated against in respect of these rights (Article 14)

Answer 177

Equality Act 2010

Answer 178

* Barthel Index. * SF36. * Functional assessment measure. * Health assessment questionnaire (HAQ) * Nottingham health profile * EQ5D

Answer 179

A person who, without payment, provides help and support to a partner, child, relative, friend, or neighbour who could not manage without their help.

Answer 180

- Cannot work because you are caring. - so reduced lifetime earnings with wider gender equality implications

Answer 181

* Increased physical health problems e.g lack of time for exercise or to see doctors * Increased mental health problems e.g loneliness/seeing friends * Carers often don't have enough time to look after their own health.

Answer 182

They don't take advantage of benefits/resources available e.g - Carers special grant - Carers allowance - Practical and emotional support - Training in care activities e.g lifting - Respite and short term breaks

Answer 183

* Employment Act. * Carers and Disabled Children Act. * Carers Act. * Equality Act.

Answer 184

* Assessment of needs in their own right. * Carers special grants * Made aware of their entitlement in assessment. * Assessments must consider carers' wishes about employment, training, etc.

Answer 185

Funding for respite and short breaks for carers.

Answer 186

* Carer's allowance - For people who regularly spend at least 35 hours a week caring for someone with a severe disability who receives a qualifying disability benefit. * Disability living allowance - Many carers not only look after someone but are ill themselves. * Attendance allowance - Benefit for severely disabled people aged 65 or over who need help with personal care.

Answer 187

* Time off for dependents. * Flexible working regulations. ( Work and Families Act 2006)

Answer 188

How we distribute finite resources in a fair way.

Answer 189

- Equality is that people are given the same resources/opportunities e.g hospice nurse spending equal time with pt's whereas - Equity is people are given resources/opportunities based on their individual needs/circumstances e.g community free checkups

Answer 190

- qualified rights can be restricted in order to protect others + in publics best interest (have more exceptions) - limited rights can be lawfully restricted e.g liberty with arrest (limited to fewer exceptions)

Answer 191

right to free speech

Answer 192

right to own property

Answer 193

* QALY (quality adjusted life year) calculation. * Waiting list (higher = more priority) * Likelihood of complying with treatment (more compliant = more priority) * Lifestyle choices of patient (bringing condition upon themself)

Answer 194

Rights are justified claims on others or things to which a person is entitled (and is due them).

Answer 195

- protective boundaries (limits actions of others) - conducive to good (dignity, respect, happiness) - provide minimum standards (represents least we can expect) - Provide security of expectations - knows where one stands; social environment predictable/secure

Answer 196

no exceptions or limits e.g prohibition of torture

Answer 197

Some people are poor because they don't work hard enough, or cause their own needs (e.g. by smoking).

Answer 198

Allocating resources should take into account lifestyle choices patients make.

Answer 199

* People who contribute to ill health are less deserving of resources for treatment than those who don't. * Deterrence - It is more likely to deter people from damaging their health. * You are also more likely to get more benefits from a treatment in people who don't behave inappropiately

Answer 200

* Not everyone purposely engages in high risk behaviour and is not responsible for their actions. * Unfair to punish people - no less deserving * Deemed unacceptable by the GMC to use lifestyle-based approach. * Not the role of doctors to make decisions regarding who is more deserving of treatment * patient may have no or little control over habits and therefore unfair to say they are less deserving of treatment

Answer 201

* Legal rights e.g to vote * Natural moral rights e.g to autonomy * Human rights e.g to life

Answer 202

* The purpose of rights is to promote a certain state of affairs which is seen as good. * If we have a system that recognises rights, it will lead to a much happier society.

Answer 203

* To make it possible for people to directly raise or claim their human rights within complaints and legal systems in the UK. * To bring about a new culture of respect for human rights within British Law, not just about public authorities complying with the law.

Answer 204

Transformation of human condition into opportunities for pharmaceutical intervention.

Answer 205

Harm resulting from the medicalisation of life.

Answer 206

The destruction of traditional ways of dealing with and making sense of death, pain and sickness.

Answer 207

A mark of disgrace associated with a particular circumstance, quality or person that discredits the individual, denying full social acceptance.

Answer 208

* Labelling - Label human difference. * Stereotyping - Differences link to characteristics. * Othering - Separating yourself, 'us and them'. * Stigmatising - Devaluing people based on 'undesirable' attributes. * Discrimination - Acting differently towards people based on attribute/behaviour.

Answer 209

An imbalance between the demands made on us and our personal resources to deal with these demands.

Answer 210

* Primary - Appraisal of event. * Secondary - Appraisal of personal coping skills.

Answer 211

- Emotional - Feeling sad, over-reacting. * Cognitive - Cannot concentrate, sensitive. * Behavioural - Eating, smoking. * Physiological - Heart rate, breathing, perspiration.

Answer 212

* Misinterpretation and amplification of symptoms due to stress and other psychological factors. * Occurs due to tendency to worry, mental illness, illness beliefs.

Answer 213

* Misinterpretation and amplification of symptoms due to stress and other psychological factors. * Occurs due to tendency to worry, mental illness, illness beliefs.

Answer 214

A patient's own implicit common sense beliefs about their illness.

Answer 215

* Identity * Timeline * Consequences * Cause * Control/cure

Answer 216

* Problem-solving - Controlling problem and reconstructing it as manageable, seeking information and support. * Emotion focused - Involves managing emotions and maintaining emotional equilibrium.

Answer 217

- Problem focused - Focuses on problem, unlikely to help reduce stress. - e.g denial, substance abuse, social isolation, avoidance

Answer 218

Physical symptoms not explained by organic disease.

Answer 219

Patient presents with symptoms and doctor tries to treat disease, despite there not being one (iatrogenic harm)

Answer 220

* Uncertainty - no diagnosis or prognosis. * Lack of social support. * Can't enter the sick role. * Strained social and family relations.

Answer 221

* Explanation lies with the patient. * Patients deny a psychological cause. * They want a cure and diagnosis. * They get physical intervention because they demand it. * Doctors should help patients to appreciate psychological factors.

Answer 222

* Alliance with the doctor over problems. * Wants the doctor to recognise they are suffering and it's not their fault. * A convincing explanation that is plausible and credible.

Answer 223

Doctor denies the reality of the disorder and implied it is a stigmatising psychological problem.

Answer 224

Using explanations about blood pressure and serotonin to push antidepressants.

Answer 225

Legitimises patients suffering, exculpation.

Answer 226

- Addiction is mental/behavioural disorder characterised by continued repetition of a behaviour despite adverse consequences, - Dependence is the presence of the symptoms of tolerance/withdrawal

Answer 227

* Salience. * Compulsion. * Tolerance/Withdrawal. * Relief after abstinence.

Answer 228

* Pleasure producing potency. * Rapid onset of action. * Short duration of action. * Tolerance and withdrawal.

Answer 229

* Personality factors. * Social factors. * Withdrawal symptoms.

Answer 230

* Overwhelming desire to take drug. * Almost automatic habit. * Can be triggered by cues many years after abstinence.

Answer 231

We can rarely prove things are true, but can easily prove things are false.

Answer 232

Strength of association gained by hypothesis testing.

Answer 233

Practical importance of treatment effect and whether it has a noticeable effect on everyday life.

Answer 234

Long term illness expected to last 12 months or more.

Answer 235

* Uncertainty - Diagnosis, prognosis, complications, etc. * Involves high levels of self-management. * Can have consequences for employment. * Can be a source of embarrassment or stigma. * Can have impact on social life. * Can impact self-identity and personal relationships.

Answer 236

* Relief. * Access to sick role. * May result in employment rights, welfare benefits. * Accepted as ill by friends and relatives. * Access to information. * Access to support groups.

Answer 237

* Face new set of uncertainties - prognosis, etc. * Stigma. * Possible limitations on paid work. * Worry about being able to fulfil obligations, e.g. look after children. * May have to claim benefits. * Worry about complications. * Worry about being able to deal with medications.

Answer 238

* Social - Employment, finance, etc. * Clinical - Prognosis. * Diagnosis. * Psychosocial - Sense of self and identity.

Answer 239

- Sees chronic illness as disruptive event, disrupting structures of everyday life. - Onset of chronic illness can affect upon a person's sense of self and their identity.

Answer 240

* Biographical distribution based on adult-centred model. * It is a part of themselves since birth. * Older adults will usually maintain the same activities, behaviours, relationships as they did in their earlier years of life.

Answer 241

* Relationship with doctor. * Good experience with doctor in the past. * Drugs best avoided. * Experience of symptoms when they don't take them. * Gender roles.

Answer 242

Attitudes are developed and modified based on assessments about beliefs and values.

Answer 243

* Search relevant databases (medline/embase) * Develop complex search strategy. * Include unpublished data.

Answer 244

* Randomisation. * Allocation concealment. * Blinding. * Withdrawals and intention to treat analysis.

Answer 245

The differences in the results, methodology or study populations used in the included studies.

Answer 246

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Answer 247

Not all clinical studies get included in a systematic review due to: - not being published - not written in English - show non-significant results

Answer 248

- A statistical expression of the amount of random sampling error in the results of a survey. - The larger the margin of error, the less confident you can be that the results reflect onto the population. (A way of measuring how effective your survey is)

Answer 249

1. A presumption of Capacity (cant do this), unless proved otherwise 2. Individuals being supported to make their own decisions (i.e find ways to communicate) 3. There is no Unwise decisions (people have own preferences/beliefs) 4. Best Interests 5. Less restrictive option

Answer 250

- Learning disability hotline - Local groups - Short breaks and respite services - Social care support funded by government - Primary care - Secondary care

Answer 251

- Social care support funded by government - practical, professional support for people who need extra support with everyday life. - This might be help with cooking, shopping, personal care or support with managing money or getting a job.

Answer 252

Deaths which could've been avoided, but occurred due to neglect within the health care system, institutional discrimination, and delay in diagnosis and or treatment

Answer 253

A multidisciplinary approach involves drawing appropriately from multiple disciplines to explore problems outside of normal boundaries and reach solutions based on a new understanding of complex situations

Answer 254

- Continuum - The continuum sets out descriptions of different types of care delivery teams functioning and describes how these change as multidisciplinary team working deepens and extends throughout the team. - Common Principles - To be effective, every team needs core principles that to adhere their functions, practice and delivery together. - Commissioning - Focusing on innovative & effective use and distribution of funds to commission services for a multidisciplinary team.

Answer 255

- Team approach - Communication among team members regarding treatment planning - Access of the full therapeutic range for all patients, regardless of geographical remoteness or size of the institution - Provision of care in accordance with the nationally agreed standards - Involvement of patients in decisions about their care - Shared goals and objectives about providing best care

Answer 256

- Pt experience a co-ordinated seamless service that is centred on parental choice and decision. - promotes independence + QOL - Improved information sharing - Health Care Plans based on goals established

Answer 257

1. drug discovery 2. preclinical development/studies e.g non human/animal trials 3. clinical development e.g satisfactory human clinical trial + cost effectiveness 4. post marketing surveillance stage

Answer 258

- the likelihood of finding a statistically significant difference when a true difference exists (True positive result) - or correctly rejects the null hypothesis when it is false

Answer 259

People being treated may be at different periods of a disease

Answer 260

behaviour that goes beyond the limits (transgresses) of society's rules, norms and laws and likely causes harm to others

Answer 261

- 1/20 five to nineteen year olds - mainly boys

Answer 262

- estimated £70k over lifetime through... - educational provision (changing schools), criminal justice processes, policing costs, social work

Answer 263

- a disorder characterised by age-inappropriate and persistent displays of angry, defiant, and irritable behaviours - challenging adult authority

Answer 264

- repeated rule/law breaking - disregarding the well being of others - lacking empathy (with or without prosocial emotions i.e comforting/agreeing with people)

Answer 265

- repeated disregard to social morals and/or laws - failure to respond to punishment - lack empathy - often manipulative, risk taking and charming

Answer 266

- learning difficulties e.g with school or ADL - literacy issues e.g dyslexia - autism - ADHD (cant concentrate)

Answer 267

- depression - anxiety - substance misuse - PTSD - attachment disorder - psychosis spectrum illness e.g schizophrenia

Answer 268

- NICE guidelines - developmental history and illnesses - mental health assessment - Adverse child experiences (ACE's)

Answer 269

- Low activity of the allele of MAOa (breaks down neurotransmitters), - Leads to aggression and a higher risk of conduct disorders in adult life

Answer 270

- Parent management training - helps cares deliver good parenting - Cognitive behaviour therapy - can improve anger management - Multisystemic therapy - based on family therapy, very expensive but very effective

Answer 271

- ICD is international - DSM is American and used more in clinical trials

Answer 272

- PHQ-9 - HADS (used in hospital)

Answer 273

Carried out every 7 years to gauge prevalence of mental disorders

Answer 274

- Hard to categorise and diagnose - Relapsing and remitting nature of mental health conditions - A substantial amount of mental health services are delivered outside the health sector - Huge numbers of people - Sub-groups in the population

Answer 275

the higher a person's income, education or occupation level (socioeconomic status), the healthier they tend to be and vice versa

Answer 276

- 3/4 adults having feelings of worry/anxiety - around 1/2 of patients are cancelling/pausing therapy sessions due to money concerns - 2/3 of therapists report cost of living is deteriorating mental health of their patients

Answer 277

- debt - food insecurity - stress - precarious employment

Answer 278

Stressful or traumatic life experiences that can lead to poor health in adults. e.g - abuse - neglect - domestic violence - parental substance abuse - parental mental disorders - separation or divorce

Answer 279

the subfield of psychology concerned with how psychological factors influence the causes and treatment of physical illness and the maintenance of health

Answer 280

any activity people perform to maintain or improve their health, regardless of their perceived health status or whether the behavior actually achieves that goal

Answer 281

- Regular exercise - Eating a balanced diet - Obtaining necessary vaccinations (inoculation)

Answer 282

- Smoking - Poor nutrition - Lack of exercise - Alcohol and drug use - Risky sexual behaviour - Transmission, misconceptions, and prevention of AIDS

Answer 283

- attending Screenings/health checks - vaccination - safe sex - good exercise/diet

Answer 284

How a person perceives causal explanations for events/behaviour (how people explain causes for their behaviour) e.g internal or external or controllable or uncontrollable

Answer 285

People differ to the degree in which they can control their lives e.g - internal vs external - behavioural control (action taken) - cognitive control (external expect others to help and vice versa)

Answer 286

- internal - one controls own's life e.g more likely to manage their own symptoms + use coping strategies - external - outside forces dictate one's life e.g belief symptoms are due to luck/chance, more likely to look for others for help

Answer 287

common sense of self regulation model based on emotional reactions to health

Answer 288

- provides framework to guide understanding of how patients view their illness - can correct inaccuracies that may affect management of their condition and decision making

Answer 289

- previous experience - outcome expectancy (desirable?) - self efficacy expectancy (that one can perform the behaviour properly)

Answer 290

1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance 6. Relapse

Answer 291

model for explaining and predicting how beliefs may influence behaviours

Answer 292

- Perceived severity - view problem as severe - Perceived benefits - consider likelihood of effective treatment as high - Perceived susceptibility - Perceived threat to sickness or disease - Self efficacy - believe they can change - Perceived barriers - identify few barriers to adherence

Answer 293

- A psychological theory that explains how individuals respond to threats and engage in protective behaviours. - Influenced by two key factors: threat appraisal and coping appraisal.

Answer 294

the perceptions of vulnerability and severity (threat appraisal) should outweigh the awards associated with the response

Answer 295

- The Transtheoretical Model/Stages of Change - the Health Belief Model - the Theory of Planned Behavior. - protection motivation theory

Answer 296

assumes that individuals act rationally, according to their attitudes, subjective norms, and perceived behavioural control

Answer 297

- work problems - money problems - debts - relationships - moving house - diagnosis of physical illness

Answer 298

- Reduces stigmatisation of mental illness - Allows people to assume the sick role - Physical expression of distress, thus reduces internal emotional conflict.

Answer 299

- primary = appraisal of the event - secondary = appraisal of personal coping abilities or resources available

Answer 300

- Emotional responses - feeling on edge, sad, irritable, tearful, overreacts (emotional dysregulation) - Cognitive responses - difficulty concentrating and switching off, sensitive to criticism, self critical, difficulty making decisions (cerebral processes) - Behavioural responses - comfort eating/loss of appetite, drinking/smoking, hyperactivity/underactivity, disturbed sleep - Physiological response - physical symptoms e.g activation of SNS

Answer 301

- relapses - poor control of chronic illness - increased morbidity

Answer 302

- poor compliance with medication - increased alcohol intake - increased smoking - reduced exercise

Answer 303

- problem solving e.g seeking information/support, developing action plan - emotion focused coping e.g managing emotions, supportive friendships, resigned acceptance

Answer 304

- small genetic effects - Cognitive processes e.g over worriers/thinkers - childhood factors e.g physical illness used (unconsciously) as a method of obtaining support (insecure attachment) - Previous neglect/abuse re wiring the brain

Answer 305

Behaviours to avoid the 'stigma' or inability to accept physical/mental disease

Answer 306

- General population - 20% - Primary - 10 to 33% presenting complaint diagnosed as MUS

Answer 307

- social instability/support, alcohol free network, family history of dependence - severity and chronicity of addiction

Answer 308

stigma association

Answer 309

- Expressing empathy through reflective learning - Develop discrepancy through client’s goals and their current behaviour - Avoid argument and direct confrontation - Adjust to client resistance rather than opposing it directly - Support self-efficacy and optimism

Answer 310

Physical, psychological, cognitive and spiritual responses to a loss

Answer 311

- Affective - e.g depression, anxiety, anhedonia. anger - Cognitive - e.g preoccupation of thoughts of deceased, helplessness - Behavioural e.g agitation, crying, social withdrawal - Psychological somatic - e.g appetite loss, energy loss, sleep disturbance - Immunological/endocrine - e.g susceptibility, disease, mortality

Answer 312

- grief is not linear and doesnt follow a specific pattern - you can feel each state more than once - theres no over/end date or point - people may feel more than these 5 stages

Answer 313

- to know that they are going to be cared for - to know that they didnt cause the death - to feel important and involved - someone to listen to feelings + questions

Answer 314

- the way grief is expressed - treatment/disposal of body - time allotted to mourning

Answer 315

A cluster of symptoms such as anxious and depressive thoughts, painful memories, dreams of and preoccupation with the deceased.

Answer 316

A physical or mental impairment that has a substantial and long term negative effect on your ability to do normal daily activities

Answer 317

- a significantly reduced ability to understand new or complex information - a significantly reduced ability to cope independently - significant impairment in intelligence - which started before adulthood, with a lasting effect on development

Answer 318

- discrimination - social exclusion - poverty - insufficient support for carers - premature mortality

Answer 319

- Profound and multiple learning disability - Have more than one disability, the most significant of which is a profound intellectual disability. - These individuals all have great difficulty communicating, often requiring those who know them well to interpret their responses and intent.

Answer 320

T - Time - offering double appointments, early morning quieter app. E - Environment - visiting a home/operating nurses meeting in normal clothes A - Attitude - treating everyone with dignity and respect C - Communication - using accessible information that they can understand H - Help - Listening to others e.g family/staff/supporters advice

Answer 321

- reasonable adjustments - hospital passports - annual health checks - intensive interaction/sensory stories

Answer 322

- visual impairment - obesity - epilepsy - constipation - ataxic/gait disorders

Answer 323

1. Is there impairment/disturbance of functioning of brain? 2. If so, is it sufficient to effect their capacity to make a normal decision?

Answer 324

U - Understand info given to them R - Retain info long enough to make a decision W - Weigh up the info C - communicate their decision

Answer 325

- improve care for people with LD - reduce health inequalities - prevents early deaths

Answer 326

- physical check up including height, weight, BP, HR - Urine/blood tests - discuss how to keep healthy - ask about common problems e.g constipation, dysphagia, eyesight etc - medication review to prevent over medicalisation - vaccinations - ask about feelings - create health action plan

Answer 327

- Cognitive - Problems of knowledge: faulty info - Emotional - Problems of attitude: stereotypes lead to fear/anxiety - Behavioural - Problems of discrimination

Answer 328

- self stigma is - the disgrace people assign themselves because of public stigma, impacts their self esteem. - felt stigma - the shame and expectation of discrimination that prevents people from talking about their experiences and stops them seeking help.

Answer 329

refers to the experience of unfair treatment by others

Answer 330

people being impacted by being associated with a stigmatised person

Answer 331

- Individual Stigma e.g self stigma - Public/social Stigma e.g media representations - Structural Stigma e.g black lives matter (more likely to enter MH services through police/criminal justice system)

Answer 332

an individual's characteristic style of behaving, thinking, and feeling

Answer 333

- Psychoanalytic - unconscious motives + childhood experiences - Humanistic - Subjective human experience + perspective (focuses on optimism) - Trait - extroversion/introversion, 3 factor theory, 16 personality factors - Social-cognitive - influenced by social learning theory, environment and conditioning, internal/external locus of control

Answer 334

realisation of personal potential, becoming everything one is capable of

Answer 335

1. Conscious - contact with outside world 2. Preconscious - things just below that you can bring to consciousness 3. Unconscious

Answer 336

Suggests that personality can be described and understood based on three fundamental dimensions or factors: - extraversion > introversion - neuroticism > emotional stability - psychoticism > impulse control

Answer 337

C - conscientiousness A - agreeableness N - neuroticism (poor emotional stability) O - openness to new experience E- extraversion

Answer 338

- does not comment on personality development (changing) - poor predictor of future behaviour

Answer 339

- MMPI - Minnesota Multiphasic Personality Inventory - 16PF Questionnaire - NEO personality inventory - measures the "Big Five" personality traits

Answer 340

A diverse category of psychiatric disorders characterised by long term behaviour that deviates markedly from the expectations of cultural norms.

Answer 341

A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

Answer 342

a disorder that affects a person's thoughts (cognition), emotions, and social behaviours

Answer 343

- emergence of medical sciences (traditionally seen as religion/witchcraft) - rise of psychiatry + neurology (who started to treat + use talking therapies) - new pharmacology - psychoanalysis

Answer 344

Shared origins, culture and traditions that are maintained between generations, ultimately leading to a sense of identity and group

Answer 345

A group of human beings distinguished by physical traits, blood types, genetic code patterns or genetically inherited characteristics.

Answer 346

Black and african caribbean more likely: - to be diagnosed schizophrenia/psychosis - to be regarded as violent - to be hospitalised via police - were more affected by pandemic

Answer 347

A model that explains how individuals of marginalised groups experience discrimination (environment not genetic) and how it can produce both negative and positive physical and mental health outcomes for stigmatized group members

Answer 348

- constructions of masculinity/feminity (internal/external) - cultural and social causation - environment - minority stress model - medical systems (racism, lack of diversity, disparity in treatment)

Answer 349

the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect especially in the experiences of marginalized individuals or groups

Answer 350

the tendency to make strong emotional bonds to particular individuals, usually seen in children seeking protection/care

Answer 351

- way to pass boredom - staff offer cigs - elevated smoking rates amongst staff

Answer 352

belief that rehabilitation doesn't work

Answer 353

- dont have access to conventional cessation services - not encouraged to do so by MH workers

Answer 354

- Embarrassment depending on approach - Lack of language to describe emotions/sensations/body parts - Assumptions of gender -What is “normal”? - Assumptions of another’s experience - easy to be distracted by own experiences

Answer 355

- LGBTQ+ - type of penetration? - be aware of cultural norms - be open and comfortable - is there violence/payment involved? (be non judgemental)

Answer 356

Process by which some natural aspects of human life come to be considered/treated as medical problems, whereas before they weren't considered pathological. e.g pregnancy, childbirth, death, ageing, sexual desire and sadness, menopause, menstruation, sleep, stress

Answer 357

- Hyperkinesis (ADHD) - Happened because children were not conforming to social expectations, but also because of pharmaceutical developments in psychoactive drugs

Answer 358

- Clinical - unnecessary/harmful medical treatments e.g side effects from drugs - Social - people becoming over reliant on health care - Cultural/structural - medicine undermines peoples capacity to cope with life, such as pain suffering and death

Answer 359

- In the past, childbirth was a domestic event, attended by mainly females + 1 midwife at home, now less private - Recently the credibility and traditional knowledge of midwives were reduced + Homebirth is considered more hazardous - healthy and normal physiological phenomena - Active management of labour

Answer 360

Women subjected to hourly internal examinations and progress in labour measured by cervical dilatation

Answer 361

- process of gradual physical decline, used to be managed by families/communities - medicalisation of conditions such as pre-diabetes, prehypertension, overactive bladder, sarcopenia (low muscle mass) and borderline-high risk cholesterol - gives the idea that ageing is wrong, fearful and requires treatment. There is a huge budget for this.

Answer 362

- Sexuality is not a fixed, natural category but rather a socially constructed concept that has been used to regulate and control individuals and groups. - biological basis of sexuality = anything that deviated from "normal" was underpinned with a biologically driven pathology, which could be rooted out, diagnosed and "cured" or contained.

Answer 363

conversion therapies

Answer 364

a condition in society where it is assumed that everyone is heterosexual

Answer 365

An ideology that indirectly promotes heterosexuality as the preferred sexual orientation

Answer 366

discrimination or bias against persons because they are not heterosexual

Answer 367

ensuring trans people feel safe to access healthcare regardless of setting

Answer 368

everyone regardless of their sexual orientation, gender or sex characteristics to be able to live safe, happy and healthy lives where they can be themselves without fear of discrimination

Answer 369

- More humane treatment (palliative care) - Gives the patient the feel of validation of their felt state (e.g associating low mood with MH disorders) - life changing treatments - release someone from social obligations (sick role)

Answer 370

- overuse of unnecessary medical technologies - Experts tend to dominate health care - Dislocation of responsibility (i.e. with cases of PTSD rising)

Answer 371

A systematic review is an appraisal and synthesis of primary research papers using a rigorous and clearly documented methodology in both the search strategy and the selection of studies in order to minimise bias in results.

Answer 372

1 - review question 2 - define eligibility criteria + method 3 - search for studies 4 - apply eligibility criteria 5 - collect data + appraise quality 6 - analysis + synthesis 7 - Conclusions

Answer 373

- focuses on the Population, Intervention, Comparison, Outcomes and Study design of a (usually quantitative) article. - used to identify components of clinical evidence for systematic reviews in evidence based medicine - endorsed by the Cochrane Collaboration

Answer 374

P – Population: Problem interested in, population/person characteristics I – Intervention: Treat/diagnose/observe/… C – Comparator(s): Placebo/no treatment/alternative O – Outcomes: Morbidity/death/complications/… S – Study design: RCT/cohort studies/historical cohort studies/…

Answer 375

- identify all relevant studies using pre specified selection/eligibility criteria - check for unpublished data - does it meet all of PICOS

Answer 376

- collate, combine + summarise findings of individual studies found in all the systematic reviews. *can be narrative or quantitative (meta-analysis)

Answer 377

A graphical display to present the results of a meta-analysis

Answer 378

- illustrate the length of the confidence interval. - The longer the line, the wider the confidence interval and hence, the less reliable the study results

Answer 379

- The vertical line is the line of no effect. - - The position at which there is no clear difference between the intervention and control groups

Answer 380

Pooled estimate is the probability of an event occurring in the treatment group vs. it occurring in a control group across ALL studies. * a narrower diamond = more precise estimate

Answer 381

- If the outcome of interest is adverse (i.e. mortality), the results to the left of the vertical line favour the intervention over the control. - If the outcome of interest is desirable (i.e. remission), the results to the right of the vertical line favour the intervention over the control.

Answer 382

- The overall (combined) result is not statistically significant. - The overall outcome rate in the intervention group is the same as in the control group

Answer 383

- indicates the influence an individual study has on the pooled result. - In general, the bigger the sample size and narrower the CI, the higher the % weight, larger the box and greater the influence the study has on the pooled result

Answer 384

- the number of participants in the group who achieve a stated end-point divided by the number of patients who do not. - measure of strength of association between a risk factor and outcome in a case control study

Answer 385

- number of participants in the group who achieved the end stated end-point, divided by the total number of patients in the group - a measure of the strength of association. It is usually used in cohort studies

Answer 386

- the probability that the confidence interval also contains the true odds ratio. - If the study was repeated and the range calculated each time, the true values are expected to lie within these ranges on 95% of occasions. - The higher the confidence level, the more certain that the interval contains the true odds ratio

Answer 387

- statements that include recommendations intended to optimise patient care. - informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options

Answer 388

- WHO - Royal college of physicians - NICE - SIGN

Answer 389

- Reduce post-code lottery - allow for equity. NICE guidelines were founded to reduce variation in the quality and availability of NHS care and treatments - To make sure practice is evidence based

Answer 390

- Lack of knowledge of the guideline - Out of date guideline in rapidly developing area of therapy - Conflicting guidelines (i.e. for patients with multi-morbidities) - Failure to understand/agree on responsibility for using the guidelines

Answer 391

- Systematic - Formal and transparent. Open for scrutiny - Relevant clinical questions are addressed - Best evidence available is used to answer the each question

Answer 392

- not comprehensive - not reliable - not objective

Answer 393

- many systematic reviews - expert opinion

Answer 394

- value for money e.g cost effectiveness - social value e.g equality + pt preferences

Answer 395

- sets out a precise/logical sequence of activities to be adhered to in the management of a specific clinical condition. - often developed for specific local situations.

Answer 396

- Clear framework - Increased autonomy - Ensures consensus - Accountability - Identify training needs

Answer 397

- May stifle individual care management - May reduce need for qualified staff - Requires regular review - Compliance - May resist clinical discretion

Answer 398

- Based on systematic reviews - Developed by competent multi-disciplinary panel of experts and representatives from key affected groups - Considers important patient subgroups and patient preferences - Is based on an explicit and transparent process - Provides ratings of quality of evidence used and the strength of the recommendations

Answer 399

- Cost effective relative to other analytical studies such as cohort studies. - Case-control studies are retrospective, and cases are identified at the beginning of the study; therefore there is no long follow up period (as compared to cohort studies). - Efficient for the study of diseases with long latency periods. - Efficient for the study of rare diseases. - Good for examining multiple exposures.

Answer 400

A bias introduced in hospital based control studies due to the varying rates of hospital admission

Answer 401

a qualitative variable e.g mild, moderate, Severe

Answer 402

the socially constructed roles and characteristics by which a culture defines male and female

Answer 403

a condition present at birth due to unusual combinations of male and female chromosomes, hormones, and anatomy; possessing biological sexual characteristics of both sexes

Answer 404

sexual preference

Answer 405

The GMC highlights the principle of acting in a child's best interests, even if it conflicts with parental preferences. Also... - Effective communication - confidentiality - safeguarding child welfare

Answer 406

a means to ensure the fair distribution of resources that are scarce. e.g COVID: - Ventilators - PPE - Dialysis - Testing resources - Vaccines

Answer 407

- Considerable advances in medical technology (Often very expensive + poor cost:benefit ratio) - Demographic trends (ageing/greying population) - Budgetary restrictions on the NHS - Public expectations (expect more)

Answer 408

- Time of health professionals - Availability of operating theatres, dialysis machines, ICU beds...

Answer 409

- 42 Integrated care boards are the main commissioning organisations - doctors are the primary rationing agents

Answer 410

- Hippocratic looks at maximising the benefits of care for the individual patient in your care - Economic (societal perspective) considers both costs and benefits of treatment choices (including doing nothing) and also comparing the competing needs of other patients

Answer 411

- Rationing by ability to pay - Rationing by "need" or ability to benefit - Rationing by social values

Answer 412

- Demand exceeding supply leads to price increases. Goods and services are distributed according to ability to pay. - Causes exclusion of the poorest and discourages others from using healthcare e.g healthcare in USA

Answer 413

Resources are targeted at cost effective interventions e.g healthcare in UK where access to services is based on clinical need, not an individual ability to pay

Answer 414

Rather than rationing on the basis of need as defined by cost per quality adjusted life year (QALY) (NICE approach), use a basis of cost per QALY by social values (i.e. age)

Answer 415

if an individual is able to benefit from an intervention

Answer 416

- They are the explicit device for rationing healthcare. - They aim to maximise benefits from constrained healthcare budgets, using QALY.

Answer 417

- Demand of care exists when an individual considers that he has a need and wishes to receive care - utilization occurs when an individual actually received care

Answer 418

- Before the NHS, healthcare was simply rationed by price. - Since then, care is constrained by non-price rationing, mostly waiting time, due to constraints in: * Staffing levels * Equipment * Training * Perceived appropriate care

Answer 419

A measure of how many years of high-quality life a person lives. Used by medical economists in justification of healthcare decisions (typically rationing) where 1 QALY = 1 year of perfect health.

Answer 420

- To treat equally and with dignity - To meet people's needs for healthcare as efficiently as possible (imposing the least sacrifice on others) - To minimise inequalities in the lifetime health of the population

Answer 421

one that supports and encourages healthy behaviors and choices through - physical environment (clean, safe, encourages activity) - social environment (supportive and inclusive) - policy environment (healthy gov. policies) - access to healthcare - Availability of healthy resources

Answer 422

- Active transportation e.g walking/cycling - Access to healthy/sustainable food - creation and preservation of green space (improves air quality, good for MH) - renewable energy ( improves air quality)

Answer 423

- 2 modal curves - used when there are 2 DIFFERENT population

Answer 424

- mean and standard deviation - mean, median and mode are exactly the same - distribution is symmetrical about the mean

Answer 425

the range of test values expected for healthy individuals.

Answer 426

- Asymmetrical distribution where the long tail is on the positive (right) side of the peak and the distribution is concentrated on the negative (left) side. - mean > median > mode

Answer 427

- Asymmetrical distribution where the long tail is on the negative (left) side of the peak and the distribution is concentrated on the positive (right) side. - mean < median < mode

Answer 428

Bradford Hill Criteria

Answer 429

1. Strength of association - Stronger the association between a risk factor and outcome, more likelier the relationship to be causal 2. Consistency of findings - Same findings being observed among different populations, in different study designs or different times (over and over and over) 3. Specificity of association - 1:1 relationship between cause and outcome 4. Temporal sequence of association - Exposure must precede outcome 5. Biological gradient/dose response relationship - Change in disease rates should follow from corresponding changes in exposure (dose-response) i.e greater exposure = greater effect 6. Biological plausibility - Presence of a potential biological mechanism that helps ascertain causality 7. Coherence - Does the relationship agree with the current knowledge of the natural history/biology of the disease? (i.e match between epidemiology and laboratory) 8. Experimental evidence - Does removal of the exposure alter frequency of the outcome 9. Analogy - use of similarities between observed association and any other associations i.e when one causal agent is known, the standards of evidence are lowered for a second causal agent that is similar in some way

Answer 430

- Chance (random error) - Bias (systematic error) - Confounding (when both factors are not directly associated but linked by a 3rd factor)

Answer 431

- a group of buyers and sellers of a particular good or service - in the NHS , Buyers (commissioning groups - ICB's) and sellers (providers of care)

Answer 432

- stops altruism (generosity) - erodes the sense of community - sanctions profits in services - subjects services to market rules/regulations - commercialisation may increase infection risks - increases blood supply from poor, unskilled, unemployed

Answer 433

- no different from any other tradeable product - supply can be increased by removing obstacles to donors - offering financial rewards of gifts

Answer 434

- From 2020 in England, replaced opt in donor cards with opt out scheme (assumed consent) - intervention/adverts on DVLA website to encourage people to join

Answer 435

- would increase supply - illegal 'transplant tourism' occurs and is risky for donor + recipient - illegal black markets of organs is dangerous

Answer 436

- Comorbidity is the co-existence of other conditions with an index condition that is the specific focus of attention, whereas - Multimorbidity is the co existence of several conditions where none are considered an index condition that is the specific focus of attention

Answer 437

The co existence of two or more chronic conditions, each one of which is either: - a physical non communicable disease thats chronic - a mental health condition thats chronic - an infectious disease thats chronic

Answer 438

- Estimates are between 23-27% - higher prevalence in women (30& compared to 24% in males) - people living in most deprived areas develop MM 10 years earlier that those in least deprived

Answer 439

- more unscheduled hospital appointments - reduced functional ability and QOL - Polypharmacy (multiple meds) - Fragmented care (multiple specialists)

Answer 440

- leading restricted lives - experiencing social isolation - being discredited - burdening others

Answer 441

* Loss of control and personal power – Self-esteem * Loss of independence * Loss or change of Role – family, work * Loss of financial security * Loss or change of hopes and dreams * Loss of identity

Answer 442

- informed shared decision making - help with health promotion activities - informs clinical practice

Answer 443

- Research evidence of effectiveness and safety - Your clinical expertise - Availability (e.g. is the drug licensed? Is it affordable by the NHS?) - Patient preferences

Answer 444

- Mortality rate - Weight change - BMI change - Quality of life measures (e.g. SF-36, QALY)