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Medicine - Year 2 > Health and Society (13) > Flashcards

Health and Society (13) Flashcards

1
Q

What are the 4 stages of grief?

A

Numbness
Yearning and Anger
Disorganisation and Despair
Reorganisation

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2
Q

How long does normal grief last?

A

6 months

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3
Q

What are the 5 processes of grief?

A 
Accept the loss
Work through pain and grief
Adjust to an environment without the deceased
Emotionally relocate the deceased
Move on with life
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4
Q

What are the 4 types of childhood attachment?

A

Secure
Anxious ambivalent/resistant
Anxious avoidant
Disorganised

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5
Q

6 factors affecting grief

A 
Relationship (including directly before death)
Unexpectedness and manner of death
Age and development of griever
Attachment and dependency
Social and religious support
Individual resilience
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6
Q

4 variations within religion

A

Born or believe
Social side of church or go for you
Liberal vs Orthodox
Moral values vs Religious belief

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7
Q

What is Byssinosis

A

An asthma-like disease caused by cotton

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8
Q

What is the most common occupational lung disease?

A

Occupational asthma

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9
Q

What is a key factor for an occupational asthma diagnosis?

A

Never had asthma before they start work

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10
Q

What causes pneumoconosis?

What are the two classes?

A

Coal dust
Simple: Chronic bronchitis (lung function fine, CXR not)
Complicated: Fibrosis (poor CXR and lung function)

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11
Q

What causes silicosis?

What does it predispose? (2)

A

Fibrous reaction to sand and stone

Predisposes to TB and lung cancer

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12
Q

What is another name for Hypersensitivity Pneumonitis?
Who is it found in?
What does it cause?
What does the CT look like?

A

Farmer’s Lung
People who keep birds
Patchy CT, fibrosis if not treated

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13
Q

What does acute inhalational injury cause to develop?

A

Acute pneumonitis

Acute hypoxia, SOB, cough

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14
Q

What is the pathophysiology of benign pleural thickening and pleural plaques?

A

Asbestos
Thickening: Small exposures causes pleura to thicken
Plaques: Small exposures causes localised thickening and calcification (less effect)

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15
Q

What is the difference in the exposure needed to get asbestosis compared to mesothelioma?

A 
Asbestosis = increased asbestos over many years
Mesothelioma = Small exposures
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16
Q

What is the difference between what the 2 asbestos fibres caused?

A 
White = fibrosis and cancer
Brown = mesothelioma
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17
Q

What happens in sideriosis?

A

Fibrosis due to chemicals

No symptoms, horrible CXR

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18
Q

2 ways to get compensation for an occupational lung disease

A

Disability benefits centre

Civil Litigation through courts

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19
Q

Difference between petrol and diesel

A

Petrol contains high levels of CO, HC and NOx

Diesel has less CO but more NOx and particulates

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20
Q

Define palliative care

A

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

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21
Q

Who provides services for:
Palliative medicine
Palliative care
Terminal care

A 
Palliative medicine (medic)
Palliative care (non-medic)
Terminal care (GP and community)
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22
Q

Define specialist palliative care

A

Palliative care for patients with complex end of life needs delivered by professionals who have received specialist training

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23
Q

How has palliate care changed across the 20th century?

A 
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
24
Q

Do you have to tell the patient about a DNACPR?

A

No but you should

25
Q

What are the 4 main palliative care services?

Examples of the professionals involved

A

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

26
Q

Difference between marie curie and macmillan nurses

A

Marie curie: Community

Macmillan: Community or hospital

27
Q

What are the easiest palliative care symptoms to treat?

How?

A

Stress and anxiety

Talking increases effect of medication and allows the patient to plan their end of life care

28
Q

What is getting better or worse about CVD?

A

Obesity, diabetes, exercise worsening

Smoking, cholesterol, deprivation, blood pressure and treatments getting better

29
Q

What has the largest impact on CVD?

A

Small risks from common exposures
The risk factors interact
Treatment changes depending on which risks you have and how large these risks are

30
Q

What calculator is used to calculate CVD risk?

A

Joint British Societies for CVD Prevention

31
Q

Explain the relationship between strength and impact using smoking and CVD as an example

A

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

32
Q

Define population attributable risk proportion

A

Relationship between the prevalence (how common the exposure is) and the relative risk (how strong the risk relationship is)

33
Q

What does the risk difference measure?

A

Attributable risk

Measures the impact of an exposure in a population

34
Q

Give an example of attributable risk using smoking and exercise as an example

A

Smoking and exercise both double the risk of CVD but reducing exercise has a bigger impact because its more common

35
Q

Define prevention paradox

A

Preventative measure which brings large benefits to the community and a large public health impact but little benefits to the individual

36
Q

4 advantages and 4 disadvantages of decreasing the risk of people with a high risk

A

Adv: Individual, motivated, cost effective, benefit greater than risk
Disad: Hard to screen, temporary as often palliative, limited potential

37
Q

1 advantage and 3 disadvantages of population prevention

A

Adv: large potential
Disad: Reduced individual benefit, poor motivation, reduced benefit:risk

38
Q

How does population prevention work?

A

You shift the curve

39
Q

4 things treatment thresholds are based upon?

A

Cost to individual (1 more tablet)
Cost to population (10000 more)
Absolute harms (people harmed)
Absolute benefits (people benefit)

40
Q

What is decision analysis based upon? (5)

A

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)
41
Q

3 characteristics of decision analysis?

A

Logical and rational decision processes
Option which maximises utility
Decision maker is rational

42
Q

2 types of evidence which decision analysis uses?

A

RCT evidence for effectiveness and prognosis

Patient and health economics evidence

43
Q

What is the purpose of decision analysis?

A

A systematic, quantitative way of making appropriate decisions in healthcare by dividing and understanding the task to improve communication and decisions

44
Q

What are the 5 stages of decision analysis?

A
  1. Structure the problem as a decision tree
  2. Assess the probability (chance) of every choice branch
  3. Numerically assess the utility of every outcome state
  4. Identify option that maximises expected utlity
  5. Sensitivity analysis to explore effect of varying judgements
45
Q
  1. How do you structure the problem as a decision tree?
A

Decision (square) > Chance (circle) > Outcome (triangle)

e.g. AF > Treatment > Affected by treatment? > Stroke? > Affected by stroke?

46
Q
  1. How do you assess the probability of every choice branch
A

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

47
Q
  1. How do you numerically assess the utility of every outcome state
A

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

48
Q
  1. How do you identify the option which maximises utility?
A

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

49
Q
  1. When do you do a sensitivity analysis to explore the effect of varying judgements?
A

If the numbers in the analysis are uncertain (e.g. small trial)

50
Q

What does a sensitivity analysis calculate?

A

It calculates the effect of uncertainty on the decision

51
Q

What 2 things can decisions be?

A

Probability sensitive

Preference sensitive

52
Q

Define probability sensitive

Example

A

Sensitive to changes in the chance of different outcomes occurring
(e.g. person lost weight and reduces stroke risk)

53
Q

Give an example of preference sensitive

A

e.g. side effects aren’t an issue for that person and you’ve taken them into account

54
Q

5 benefits of decision analysis

A
  • 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
55
Q

6 disadvantages of decision analysis

2 for probability estimates, 4 for utility measures

A

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)

Medicine - Year 2 (19 decks)

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