H&S Quizlet Important Terms Flashcards by Sumaya L

What are case control studies best used for in EBDM?

Aetiology/cause

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What are cohort studies best used for in EBDM?

Prognosis
Aetiology/cause

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What are RCT studies best used for in EBDM?

Treatment intervention effectiveness
Cost-effectiveness
Benefit and harm

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Why is evidence based decision making important?

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What are the components of EBDM involve?

Patient preferences
Available resources
Research evidence
Clinical exposure

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What is the process of EBDM?

—>Converting the need for information into answerable question using PICO
—>Identifying best evidence
—>Critically appraising the evidence for validity and applicability
—>Integrating the critical appraisal, taking into account patient situation and clinical expertise
—>Evaluating the effectiveness and efficiency of carrying it out

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Why is there widespread use of antibiotics?

Uncontrolled sale in low or middle income countries
Increase in global availability

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How can antibiotic resistance be prevented?

—>Completing antibiotic course
—>Only using antibiotics when prescribed
—>Only using antibiotics when needed
—>Not taking leftover prescription
—>Using the right type of antibiotic to treat the illness

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What are important infections in developing countries?

Pneumonia
HIV/AVIDs
Chronic diarrhoea
Malaria

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What is the role of surveillance?

Early warning system for public health emergencies
Document impact of intervention
Helps to inform public policy and strategy

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How can nosocomial infection be reduced?

Prevention through hand-washing and infection control

Detection and outbreak control through screening

Policies and procedures implemented to prevent infection such as education and training

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What is the impact of travel and migration on disease in UK?

Increased human-zoonoses contact

Migrants may introduce diseases into the country which there is no previous exposure to, which can have widespread and deadly effects

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How can epidemics be reduced?

Developing vaccines

Monitor diseases to prevent outbreak

Fast and early planned response

Provide funding and international responders to countries suffering an outbreak

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Why is evidence based medicine important?

Inadequacy of traditional sources like textbooks which may be out of date

Disparity between clinical judgement + diagnostic skills which increase over time and up-to-date knowledge affecting clinical performance which decreases over time.

Variation in clinical practise

Limited time to read

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What is the role of WHO in public health?

Leadership and engaging in partnerships for joint action

Setting norms and standards for implementation

Assessing health trends

Shapes the research agenda

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Which factors affect vaccine uptake?

Disease burden

Risk of disease exposure to population

Reactions to previous vaccines

Alternative measures available to prevent disease

Age, health status and vaccination history

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What are the requirements for disease eradication by vaccines?

No other reservoirs of infection exist in animals/environment

Consequences of infection are high

There is scientific/political prioritisation

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Which diseases have been eradicated by vaccines?

Smallpox
Rinderpest
Polio

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Which factors affect reproductive number?

Duration of infectiousness

Probability of infection transmission during contact

Rate of contact in the host population

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How to determine herd immunity number?

1- (1/R0)

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What is a susceptible population to a disease?

No previous exposure

No vaccination against disease

Immunocompromised so cannot mount immune response against disease

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What are vaccination programmes?

Extended programme of Immunisation (EPI)

Global Alliance for Vaccination and Immunisation

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What is the role of WHO in vaccination?

Produces vaccination recommendations

Supports strategies for vaccination implementation

Prevents international spread of disease through health regulations

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What are the benefits of vaccination?

Protects future generations

Protects immunocompromised groups like infant and elderly

Generates herd immunity

Eradicates disease in populations

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What are the arguments against vaccination?

Potential serious/fatal side effects Contains harmful ingredients Parents and individuals have right to autonomy and governments should not interfere Contains ingredients people may object to, like animal products Some vaccinations for diseases do not cause severe harm

What influences patient decision making?

Helath status and health beliefs Lifestyle factors Trust in institution/healthcare system Risk perception

Sources for travel vaccine information?

NHS fit-for-travel National Travel Health Network and Centre

What is the most common childhood cancer?

Leukaemia

What is the most common cause of childhood mortality from cancer?

Brain and CNS tumours

What is the ABCDE framework for bad news?

ADVANCED preparation BUILDING a relationship COMMUNICATE well DEAL with patient reaction ENCOURAGE and validate emotions

What is the SPIKES framework for bad news?

SETTING up PERCEPTION INVITATION KNOWLEDGE EMOTION/EMPATHY STRATEGY and summary

What was the outcome of the Eurocare report?

UK had the worst cancer mortality in Europe

What was the outcome of the Eurocare report?

UK had the worst cancer mortality in Europe

How does cancer affect relationships?

Change in emotional and physical needs Role and responsibilities Future planning Sexual intimacy and relationship

What were the findings of the Calman-Hine report?

All patients should have access to uniform high quality care Education of early symptoms of cancer Cancer centres should be patient orientated Primary care should be the centre for cancer delivery

What were the Calman-Hine solutions?

Levels of cancer care should be: Primary care Secondary care in general district hospitals for diagnosis and radiotherapy and chemotherapy Specialist cancer centres for rare cancers or complex chemotherapy

Which cancers have screening?

Cervical Breast Bowel Abdominal Aortic aneurysm

What are the aims of the NHS cancer plan?

Invest in cancer workforce Tackle inequalities Ensure people with cancer receive the right treatment and care

What is the importance of clinical records in audit and management?

Facilitates risk management and clinical governance Supports clinical research and audit

What is duty of care?

Legal obligation to provide a standard reasonable care to a patient

What are the ethical principles?

Beneficence Non-maleficience Autonomy Justice

What are the ethical theories?

Consequentialism: ends justify the means Deontology: acting in accordance with a set of duties Virtue ethics: acting in a way you expect a virtuous person to act

What are the functions of MDTs in cancer care?

Management plan for patient Designates a key worker for the case Informs the primary care plan for the patient

What are diagnostic tests used for?

Screening Prognosis Monitoring

Why is screening performed?

Potential for early and more effective treatment Opportunities for primary prevention are limited Treatment opportunities for the disease are limited

What are the drawbacks of screening?

Harmful exposure to radiation False positives may cause distress and lead to unnecessary treatment False negatives provide false sense of assurance and delay treatment of disease

What are 4 sources for making clinical decisions?

Patient preferences Available resources Research evidence Clinical expertise

When can confidentiality be broken?

Public interest By law Patient consent is given

What are considerations for deciding healthcare distribution?

QALY calculation Likelihood of treatment compliance Lifestyle choices of patient Waiting list

What are the laws to break patient confidentiality?

Prevention of Terrorism 1989 Public Health Act 1983 Road Traffic Act 1988

What are the types of medical errors?

Knowledge based errors Rule based errors from rule misapplication Skills based errors from memory slip or distraction

What are the types of rule violations?

Reasoned violations Routine violation Malicious/reckless violation

What are the systems in place to prevent error?

MHRA: Medicines Health and Regulatory Agency National Reporting and Learning agency for safety incidents (2004) National Patient safety agency for reporting and learning mistakes of patient safety (2001)

What are the benefits of institutionalised childbirth?

Standardised care Access to facilities for managing complications of birth Access to stronger analgesics like epidurals for birth

What are the drawbacks of institutionalised childbirth?

Medicalisation Depersonalisation during birth Inflexibility with procedures for birth by hospitals Lack of privacy

What are the drawbacks of institutionalised childbirth?

Medicalisation Depersonalisation during birth Inflexibility with procedures for birth by hospitals Lack of privacy

Why is consumer protection important?

Large variation in clinical practise Medicine has a weak evidence base Failure to measure success outcomes in healthcare

What are the consumer protection agencies?

NICE sets standards Care quality commissions NHS quality improvement

What are the Fraser guidelines?

Doctors can provide contraceptive advice to those under age 16 if treatment is in their best interest sand they are likely to have sex regardless.

What is the role of midwives?

Identifying at risk patients Providing reassurance and support Health promotion and sign-posting

Why is research-based medical practise important?

Personal experience is biased Research findings include a large population of patients Recommendations are assessed for clinical and cost-effectiveness

Which Act states that 16 year olds have full capacity?

Family Law reform Act 1969

What are the requirements of indirect standardisation?

General age structure of population Total number of deaths in population

Why are waiting times important?

Indicates inefficient healthcare system Impacts employment and family life Causes distress and condition may deteriorate further

What is the priority on waiting list?

Clinical urgency and severity Time waiting Potential health gain

What are the barriers to the use of complementary medicines on the NHS?

Allocating financial budget Regulatory issues with allocation Mixed evidence of effectiveness

What are the types of CAMS?

Acupuncture Chiropractors Herbal medicine Homeopathy Osteopathy

What is the evidence base for acupuncture?

Shows evidence of effectivitiy compared to placebo and is used for headaches or migraines, however not to the extent as conventional therapy Provides psychological benefits to patients

What is the legislation for mental capacity?

Mental Capacity Act 2005

What are the ethical principles for research?

Usefulness Necessity Confidentiality Risks Consent from participants Approval from an ethics committee

When is an ethics approval committee required?

Research involving: Humans Confidential information Biological materials

What are the Research ethics committees?

NHS research ethics committee Gene therapy advisory committee Ministry of defence research ethics committee

What are the benefits of high risk strategies?

Tailored to individual Clinican and patient is motivated High cost-effectiveness and risk ratio

What are the drawbacks of high risk strategies?

Most cases of disease are from low risk Limited potenital Difficulty identifying people at risk

What are the drawbacks of high risk strategies?

Most cases of disease are from low risk Limited potenital Difficulty identifying people at risk

What is pneumonitis?

Acute reaction to inhalation of a substance that leads to acute respiratory distress syndrome

What are the goals of palliative care?

Pain management Improve quality of life Support patients and their families

What are the future challenges of palliative care?

Funding Inequality of service provision and standards Maintaining humanity and compassion

Bowlby’s stages of grief?

Numbness Yearning and anger Disorganisation and despair Reorginasaiotn

What is the biggest cause of adult disability?

Stroke.