Health and Society Flashcards
Why do we have waiting lists?
There is a limitless demand for healthcare but limited resources, i.e. finite supply of staff and money
What are the theories about NHS waiting lists
The backlog - implies a need for occasional emergency injection of funds
Demand management - waiting acts as price to deter frivolous use
Don’t want lots of spare capacity as this is a waste
Waiting lists are caused by underfunding and inefficiency
How can the NHS reduce waiting times
Manage demand - appropriate referrals
Manage the queue
Manage capacity - efficient and effective services
provide leadership
What are some social consequences of deafness
Social impact - difficult to have conversations, isolation and intimacy issues
Psychological impact - anger, low confidence, frustration and depression
Practical issues - doorbells, phones etc.
What are the 5 big CAM’s
Acupuncture Chiropractic Herbal medicine Homeopathy osteopathy
What are the 5 categories for significant impaired decision making ability
Lack of insight Cognitive impairment e.g. dementia Presence of psychosis Severe depressive symptoms Learning disability
Why do we need evidence based decision making
Limited time to read
Inadequacy of traditional sources of information - text books out of date
Medical knowledge is constantly changing
Disparity between diagnostic skills and clinical judgement
What are some of the causes of antibiotic resistance
Use in livestock for growth promotion Releasing of antibiotics into environment Volume of antibiotics prescribed Missing doses Inappropriate prescribing of antibiotics
How can antibiotic resistance be prevented
Using antibiotics only when prescribed by a doctor
Completing the full prescription
Never sharing antibiotics or using leftover prescriptions
Only prescribing antibiotics when they are needed
Using the right antibiotics to treat illness
What is the purpose of surveillance
Serve as an early warning system for impending public health emergencies
Document the impact of an intervention
Monitor and clarify the epidemiology of health problems
What can be done to reduce nosocomial infections
Hand washing, infection control programmes, surveillance
Detection, investigation and control of outbreaks e.g. barrier nursing, isolate infected patients
Policies and procedures to prevent infection
Change catheters etc.
What are the functions of global health
To provide heath related public goods e.g, research, standard and guidelines
To manage cross-national externalities through epidemiological surveillance
to mobilise global solidarity for populations facing disaster
To convene stakeholders to reach consensus on key issues
Summarise the key points of the Calman-Hine report
- Public and professional education to recognise early symptoms of cancer
- uniformly high standard of care
- Patients, family and carers given clear information of treatment prognosis etc..
- Primary care to be central to cancer care
- The psychosocial needs of cancer sufferers and carers to be recognised
Public health objectives of vaccination
- To protect individuals from specific disease
- To protect populations
- to protect selected high risk groups
- To eradicate an infectious agent
What is the basic reproductive number
Average number of secondary infections produced by a typical infective agent in a totally susceptible population
What are the main elements of the national cancer plan for the NHS
- To save more lives
- To ensure people with cancer get the right support and care as well as the best treatments
- To tackle inequalities in health
- To build for the future through investment in cancer workforce
- To ensure the NHS never falls behind in cancer care again
Why do we have multidisciplinary teams
- Modern management of complex disease e.g. cancer requires many disciplines i.e. surgical and medical oncology
- Allied health professionals play a role e.g. nurses, physiotherapists, speech therapists..
- Delivery of cancer care is often fragmented over several hospital sites - therefore MDT helps to streamline and co-ordinate care
- probably better outcomes for patients
Function of MDTs
- To discuss every new diagnosis
- To decide on a management plan for every patient
- Inform primary care of that plan
- To designate a key worker
- develop referral
- Audit
What are the features of a condition that are required to introduce a screening programme
- An important health problem
- There must be a detectable risk factor
- Epidemiology and natural history of condition should be known
- Cost effective primary prevention implemented
What are the features of a screening test that are required to introduce a screening programme
- There should be a simple, safe, precise and validated test
- Distribution of test values known and cut-off agreed
- The test should be acceptable
- Agreed policy on further management
What are the key features of treatment for a condition that are required to introduce a screening programme
There should be an effective treatment with evidence of early treatment leading to better outcomes
Agreed policies on covering who should be offered treatment
What are the features of a screening programme required in order to introduce said screening programme
- There must be RCT evidence that the programme is effective in reducing mortality or morbidity
- There should be evidence that the whole programme is acceptable to professionals and public
- The benefit from the programme should outweigh the harm
- the opportunity cost of the programme should be economically balanced in relation to heath care spending
- Quality assurance and adequate staffing services
With regard to a diagnostic test, which term is used to describe the proportion of healthy individuals identified by a test
Specificity
Formula for the herd immunity threshold
H=1-S*
Negative effects of vaccination programme
Risk from vaccine
Programme errors
Interference with existing vaccines
What is an appropriate measure of effectiveness of a test
Deaths prevented
What is a P value
probability that any particular outcome would have arisen by chance
P value of 0.05 = statistically significant
Advantages of RTC
Allows for vigorous evaluation of single variable
Potentially eradicates bias
Allows meta-analysis
Factors affecting validity of RCTs
- Allocation i.e. randomisation etc
- Blinding
- In tention to treat analysis
- Bias in data collection
- Sample size
- Presentation of results
- Applicability to local Population
Define number needed to treat
How many people need to have intervention to prevent 1 unwanted outcome
= 1/absolute risk reduction
