H&S Quizlet Important Terms Flashcards
What are case control studies best used for in EBDM?
Aetiology/cause
What are cohort studies best used for in EBDM?
Prognosis
Aetiology/cause
What are RCT studies best used for in EBDM?
Treatment intervention effectiveness
Cost-effectiveness
Benefit and harm
Why is evidence based decision making important?
What are the components of EBDM involve?
Patient preferences
Available resources
Research evidence
Clinical exposure
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
Why is there widespread use of antibiotics?
Uncontrolled sale in low or middle income countries
Increase in global availability
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
What are important infections in developing countries?
Pneumonia
HIV/AVIDs
Chronic diarrhoea
Malaria
What is the role of surveillance?
Early warning system for public health emergencies
Document impact of intervention
Helps to inform public policy and strategy
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
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
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
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Inadequacy of traditional sources like textbooks which may be out of date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
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
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
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
Which diseases have been eradicated by vaccines?
Smallpox
Rinderpest
Polio
Which factors affect reproductive number?
Duration of infectiousness
Probability of infection transmission during contact
Rate of contact in the host population
How to determine herd immunity number?
1- (1/R0)
What is a susceptible population to a disease?
No previous exposure
No vaccination against disease
Immunocompromised so cannot mount immune response against disease
What are vaccination programmes?
Extended programme of Immunisation (EPI)
Global Alliance for Vaccination and Immunisation
What is the role of WHO in vaccination?
Produces vaccination recommendations
Supports strategies for vaccination implementation
Prevents international spread of disease through health regulations
What are the benefits of vaccination?
Protects future generations
Protects immunocompromised groups like infant and elderly
Generates herd immunity
Eradicates disease in populations
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.
