Health and Society (13) Flashcards
What are the 4 stages of grief?
Numbness
Yearning and Anger
Disorganisation and Despair
Reorganisation
How long does normal grief last?
6 months
What are the 5 processes of grief?
Accept the loss Work through pain and grief Adjust to an environment without the deceased Emotionally relocate the deceased Move on with life
What are the 4 types of childhood attachment?
Secure
Anxious ambivalent/resistant
Anxious avoidant
Disorganised
6 factors affecting grief
Relationship (including directly before death) Unexpectedness and manner of death Age and development of griever Attachment and dependency Social and religious support Individual resilience
4 variations within religion
Born or believe
Social side of church or go for you
Liberal vs Orthodox
Moral values vs Religious belief
What is Byssinosis
An asthma-like disease caused by cotton
What is the most common occupational lung disease?
Occupational asthma
What is a key factor for an occupational asthma diagnosis?
Never had asthma before they start work
What causes pneumoconosis?
What are the two classes?
Coal dust
Simple: Chronic bronchitis (lung function fine, CXR not)
Complicated: Fibrosis (poor CXR and lung function)
What causes silicosis?
What does it predispose? (2)
Fibrous reaction to sand and stone
Predisposes to TB and lung cancer
What is another name for Hypersensitivity Pneumonitis?
Who is it found in?
What does it cause?
What does the CT look like?
Farmer’s Lung
People who keep birds
Patchy CT, fibrosis if not treated
What does acute inhalational injury cause to develop?
Acute pneumonitis
Acute hypoxia, SOB, cough
What is the pathophysiology of benign pleural thickening and pleural plaques?
Asbestos
Thickening: Small exposures causes pleura to thicken
Plaques: Small exposures causes localised thickening and calcification (less effect)
What is the difference in the exposure needed to get asbestosis compared to mesothelioma?
Asbestosis = increased asbestos over many years Mesothelioma = Small exposures
What is the difference between what the 2 asbestos fibres caused?
White = fibrosis and cancer Brown = mesothelioma
What happens in sideriosis?
Fibrosis due to chemicals
No symptoms, horrible CXR
2 ways to get compensation for an occupational lung disease
Disability benefits centre
Civil Litigation through courts
Difference between petrol and diesel
Petrol contains high levels of CO, HC and NOx
Diesel has less CO but more NOx and particulates
Define palliative care
Active, holistic care of patients with advanced progressive illness
Management of pain and symptoms
Psychological, social and spiritual support
Increased QOL of patients and families
Who provides services for:
Palliative medicine
Palliative care
Terminal care
Palliative medicine (medic) Palliative care (non-medic) Terminal care (GP and community)
Define specialist palliative care
Palliative care for patients with complex end of life needs delivered by professionals who have received specialist training
How has palliate care changed across the 20th century?
Early = Hospices introduced and were a safe place Mid = Development of medicine saw death as a failure > medical neglect of the dying Late = Palliative care developed
Do you have to tell the patient about a DNACPR?
No but you should
What are the 4 main palliative care services?
Examples of the professionals involved
Generalist: primary/secondary care, social services, nursing homes
Specialist: palliative care, hospice, nurses
NHS provided: nurses, consultants, in-patient units
Voluntary: macmillan (some NHS), marie curie, hospice
Difference between marie curie and macmillan nurses
Marie curie: Community
Macmillan: Community or hospital
What are the easiest palliative care symptoms to treat?
How?
Stress and anxiety
Talking increases effect of medication and allows the patient to plan their end of life care
What is getting better or worse about CVD?
Obesity, diabetes, exercise worsening
Smoking, cholesterol, deprivation, blood pressure and treatments getting better
What has the largest impact on CVD?
Small risks from common exposures
The risk factors interact
Treatment changes depending on which risks you have and how large these risks are
What calculator is used to calculate CVD risk?
Joint British Societies for CVD Prevention
Explain the relationship between strength and impact using smoking and CVD as an example
If everyone stopped smoking, more deaths would be prevented from CVD than it would for lung cancer
This is because smoking increases the risk of lung cancer by 30 and CVD by 2 (compared to the normal population)
So if 1 non-smoker has lung cancer, multiplied by 30 = 30 people
But as CVD is more common in non-smokers (absolute risk of CVD in non-smokers 100x higher than lung cancer), 100 people have it, multiply by 2 = 200 people
So if you stop all smoking, 29 lung cancer deaths prevented, 100 CVD deaths prevented
Define population attributable risk proportion
Relationship between the prevalence (how common the exposure is) and the relative risk (how strong the risk relationship is)
What does the risk difference measure?
Attributable risk
Measures the impact of an exposure in a population
Give an example of attributable risk using smoking and exercise as an example
Smoking and exercise both double the risk of CVD but reducing exercise has a bigger impact because its more common
Define prevention paradox
Preventative measure which brings large benefits to the community and a large public health impact but little benefits to the individual
4 advantages and 4 disadvantages of decreasing the risk of people with a high risk
Adv: Individual, motivated, cost effective, benefit greater than risk
Disad: Hard to screen, temporary as often palliative, limited potential
1 advantage and 3 disadvantages of population prevention
Adv: large potential
Disad: Reduced individual benefit, poor motivation, reduced benefit:risk
How does population prevention work?
You shift the curve
4 things treatment thresholds are based upon?
Cost to individual (1 more tablet)
Cost to population (10000 more)
Absolute harms (people harmed)
Absolute benefits (people benefit)
What is decision analysis based upon? (5)
A normative theory of decision making (based upon societal norms)
- Subjective (interpretation)
- Expected (future events)
- Utility (desirability/value attached to a decision)
- Theory (explanation to predict what will happen)
3 characteristics of decision analysis?
Logical and rational decision processes
Option which maximises utility
Decision maker is rational
2 types of evidence which decision analysis uses?
RCT evidence for effectiveness and prognosis
Patient and health economics evidence
What is the purpose of decision analysis?
A systematic, quantitative way of making appropriate decisions in healthcare by dividing and understanding the task to improve communication and decisions
What are the 5 stages of decision analysis?
- Structure the problem as a decision tree
- Assess the probability (chance) of every choice branch
- Numerically assess the utility of every outcome state
- Identify option that maximises expected utlity
- Sensitivity analysis to explore effect of varying judgements
- How do you structure the problem as a decision tree?
Decision (square) > Chance (circle) > Outcome (triangle)
e.g. AF > Treatment > Affected by treatment? > Stroke? > Affected by stroke?
- How do you assess the probability of every choice branch
Example: Given Aspirin to treat AF
50 had a stroke, 950 didn’t
Probability of stroke is 0.050
Probability of no stroke is 0.950
- How do you numerically assess the utility of every outcome state
Use utility data e.g. QALY or EQ-5D questionnaire ranking mobility, self-care, pain, activities, psychology
Multiply utility with probability to calculate expected utility values for each branch
- How do you identify the option which maximises utility?
Start at the right of the branch and work backwards
Multiply the expected utility value by the probability for each section of the branch and add the values together
The value which increases health status and maximuses utility is the option which is used
- When do you do a sensitivity analysis to explore the effect of varying judgements?
If the numbers in the analysis are uncertain (e.g. small trial)
What does a sensitivity analysis calculate?
It calculates the effect of uncertainty on the decision
What 2 things can decisions be?
Probability sensitive
Preference sensitive
Define probability sensitive
Example
Sensitive to changes in the chance of different outcomes occurring
(e.g. person lost weight and reduces stroke risk)
Give an example of preference sensitive
e.g. side effects aren’t an issue for that person and you’ve taken them into account
5 benefits of decision analysis
- Makes all assumptions in a decision explicit
- Allows examination of the process of decision making
- Integrates resarch evidence
- Insight gained (more important than numbers)
- Individual, population decisions and cost effectiveness
6 disadvantages of decision analysis
2 for probability estimates, 4 for utility measures
Probability estimates:
- Required data may not exist
- Subjective estimates are subject to bias
Utility measures
- Individuals state of health is subjective
- Different techniques > different values
- Reductionist approach
- Subject to presentation framing effects (e.g. survival or death)
