Health and Society (9 and 10) Flashcards
Define hypothetico-deductive reasoning
Collecting evidence to support or get rid of a hypothesis
Who is evidence-based decision making based upon?
Individual patients
Define background question
What does the question need? e.g.
General knowledge
Question root and disorder e.g. what causes cancer
Define foreground question
How do you create the question?
Specific knowledge about patient management
PICO
5 stages of creating evidence for practise
- Identify need for information
- Identify best evidence
- Critically appraise evidence
- Integrate evidence clinically
- Evaluate and improve
What is PPE?
Personal protective equipment
Common hospital transmitted infection?
Norovirus
Define surveillance
Systemic collection, analysis and publication of data so appropriate measures can be taken
What is the problem with laboratory testing for infectious disease?
It takes a long time but is needed for treatment
2 problems with PHE questionnaires
People might not remember
People might not disclose
Define international health
Defined by geography (north and south)
Donor > Recipient relationship
Define public health
Prevention, equity and scientific approaches to the population e.g. TB DOTS
Define global health
Wider determinants and health of the global population
Interdependence, Trans-national
Define interconnection
Threats and their nature, distribution and consequences
Define interdependence
Distribution of power, responsibility, capacity to respond and disciplines
Give 4 examples of interdependent solution
Regulating quality of imported goods
Information about global infectious disease
Sufficient medication, vaccinations and health professionals for a pandemic
Define development aid
Donor > Recipient
Charity and dependence
Define international cooperation
Independent states > Mutual benefit
Pooled resources and independence
Define global solidarity
Every state has shared responsibility and resources
Interdependence
7 global problems affecting everybody
Global warming, poverty, inequality, food and water security, war, migration, working conditions
5 roles of global health
Research and guidelines Clinical care and prevention Manage cross-national Epidemiological Global solidarity
3 strategic aims of vaccination
2 programmatic aims of vaccination
Strategic: eradication of the agent, elimination of the outbreak, protection of the vulnerable
Programmatic: reduce death and infection rates
What does the vaccination theory determine?
The number of secondary cases caused by each infectious person
In the vaccination theory, what is R?
R = effective reproduction number
Actual average number of secondary cases per primary case in a totally susceptible population
In the vaccination theory, what is Ro?
Ro = basic reproductive number
Average number of individuals directly infected by an infectious case during the infectious period, in a totally susceptible population
What is Ro determined by?
Microorganism and population
What is Ro proportionate to?
Length of time the case remains infectious
Number of contacts the case has with hosts per unit time
Chance of transmitting an infection
How can Ro differ?
Different infections in the same population
Same infection in different populations
How do you calculate the effective reproduction number (R)?
R = Ro x S
What is the relationship between R and Ro?
If the values are equal there is no vaccination (early infection)
If R is smaller, vaccination has taken place
What is the epidemic threshold?
What increases and decreases the number of cases?
R = 1
If R increases the number of cases increase
If R decreases the number of cases decrease (this is what we want!)
In the vaccination theory, what is S?
How is it calculated?
Susceptible proportion of the population
Defined by the threshold at R = 1
1 = Ro x s s* = 1/Ro
In the vaccination theory, what is H?
How is it calculated?
Herd immunity threshold
H = 1 - S*
What should the herd immunity threshold be?
No more than 5% of the population should be susceptible (H = 95%)
Once s greater than 5% then R greater than 1
Define herd immunity
A measure of the immunity to a transmissible infection in the whole population
Measures protection to the un-vaccinated and vaccinated
What do you need to decide before making a vaccination? (6)
If the disease is a public health concern
If immunisation is the most effective strategy
How much disease will be prevented
Negative effects and public perception
Practicality
What the aim of the vaccination is
Define bad news
Any news that drastically and negatively alters the patient’s (or their relatives) view of his or her future
Distancing strategies for breaking bad news (4)
Normalisation, Avoidance, Switching subject, False reassurance
Why is breaking bad news hard? (8)
Fear of negative response Burden of responsibility Uncertainty about patient expectations Fear of destroying hope Not prepared to manage emotions Embarrassment about giving false hope Relative involvement Different cultures, religions and beliefs of patients
Define incidence, outcome and prevalence
Incidence: Number of new cancer cases during a specific period in a defined population
Outcome: Mortality rate, death and survival
Prevalence: Burden of disease (incidence, death and ongoing cases)
What happens to disease frequency over time?
Why is this important?
Changes over time
Aetiological hypothesis and health care planning
What are the 3 population pyramids?
Expanding
Stationary
Contracting
What is the 10 year survival rate like for melanoma?
Nearly 100%
Define childhood cancer
Below 14 years
Are genetics a big cause of cancer?
Yes in children
No in adults (more common to pre-dispose)
Define primary, secondary and tertiary prevention
Primary: Reducing exposure
Secondary: Identification of pre-clinical disease
Tertiary: Modifies outcomes based on the population
Handwritten/Computerised records: how do you know who has seen it?
Handwritten: date and sign, known writer
Computerised: audit trail
What is the difference between what a GP, Community and Hospital clinical record shows?
GP includes information
Community includes work load
Hospital includes imaging
What is the problem with hospital record
30% are not where they’re meant to be
What do community record involve?
Prisons, Occupational health, Private sector
Explain what an SCR is
Summary Care Record
Name, address, DOB, NHS number, Medication and Allergies
Can opt out
How does the clinical record: 1 - Support clinical audit (3) 2 - Facilitate clinical governance (5) 3 - Facilitate risk management (3) 4 - Support clinical research (3)
1 - learning and development, targets, analyse clinical processes
2 - audit trail, patient safety, complaints, review, quality improvement
3 - prescription alerts, allergy pop-ups, continuity of care
4 - identify suitable patients, records participation, primary epidemiological research
Define body
What is it shaped by?
Natural and physical allowing us to do everything we would want and a product of our social environment
Shaped by discourses
Define the civilised body
Separation of the mind and body
e.g. controlling emotions and hiding natural functions (eating and sleeping)
What does our body image represent?
Our identity
Define a clinically significant body image problem
Marked discrepancy between the actual/perceived appearance/function of a body attribute and the individuals ideal
2 highest areas of cancer incidence in the UK
London and midlands
What is the European report on cancer care policies called?
When was it commissioned?
Eurocare Report
1990
Define cancer network
Model for NHS cancer plan
Bringing together every resource
What does the Calman-Hine Report state?
When was it commissioned?
1995
All patients have access to good quality, standardised patient-centred care from an MDT
Recognition of early signs
Importance of psycho-social needs and patient education
What is the difference between a cancer unit and cancer centre?
Cancer unit: smaller, diagnostic and common treatment
Cancer centre: larger, rarer and complex treatment
Function of an MDT
Decide on a management plan, designate a key worker and inform the patient and primary care of that plan
Coordinate care and support the patient
What does the NHS Cancer Plan state?
When was it commissioned?
2000
Focus on prevention and screening
Tackle inequalities and support networks
Invest in research
What legislation followed the NHS Cancer Plan?
NICE Improving Outcomes Guidance
Increasing the standard and quality of care
What are the 6 stages of the Cancer Reform Strategy?
When was it commissioned?
2007
- Prevention
- Diagnosing cancer earlier (screening and diagnosis)
- Improving treatment
- Living with and beyond cancer
- Reducing cancer inequalities
- Delivering care in an appropriate setting
What ages are you screened for cervical, breast and bowel cancer?
Cervical: 25-49 (3 yrs) 50-64 (5yrs)
Breast: 47-73 (5 times)
Bowel: 50-75
5 methods to improve cancer diagnosis
National awareness and early diagnostic initiative
National & significant event audit for cancer diagnosis
NAEDI hypothesis (preventing avoidable deaths by late presentation)
Diagnostic interval delays
Awareness campaigns
6 ways to ensure better treatment and care
Reduce waiting times Increase capacity and training New treatments Local care and centralised services Diagnostic tests in GP's Shift from inpatient to outpatient
What was the role of the National Cancer Suvivorship Initiative?
When did it end?
Ended in 2013
Partnership with charities, clinicians and patients to improve services and support
What does the Improving Outcomes Strategy state?
When was it commissioned?
Commissioned in 2011
Prevention, screening and early diagnosis
Improve patient experience and QOL
Better treatments
Reduce inequalities (race, age, gender, disability, LGBT)
What was commissioned from 2015-2020?
What does it focus on?
Achieving World Class Cancer Outcomes
Independent cancer taskforce focusing n prevention, early diagnosis, technology patient experience and support
How common are adverse events from vaccinations?
Rare
2 things which can affect a vaccines effectiveness?
Order in which a vaccination is given
Gender
3 things rubella can cause in pregnant women
Miscarriage, Stillbirth and Congenital defects
5 parental objections to vaccination
Disease is not serious (it is, people forget)
Disease is uncommon (bc of vaccinations)
Vaccine ineffective (none 100% but they do work)
Vaccine unsafe (testing)
Better methods (no evidence)
What % of vaccination coverage do you need to prevent an outbreak?
90%
What do you need to be confidence about with diagnostic tests?
If the patient is above a threshold to treat or below a threshold to withdraw treatment
Has the patient passed the threshold where intervention is needed?
How do you calculate sensitivity
Define sensitivity
Number of true positives / All those with the disease
The TRUE POSITIVE RATE
Correctly classifies the people WITH disease
How do you calculate specificity
Define specificity
Number of true negatives / All those without disease
The TRUE NEGATIVE RATE
Correctly classifies the people WITHOUT disease
How do you calculate positive predictive value
Define PPV
Number true positives / All those who test positive
If your test is positive, what are the chances you’re ill?
How do you calculate negative predictive value
Define NPV
Number true negatives / All those who test negative
If your test is negative, what are the chances you’re NOT ill?
What does it mean for sensitivity and specificity if tests have a high threshold?
Reduced sensitivity as you will diagnose some people who have the disease incorrectly
Increased specificity as people without disease will be diagnosed correctly
What does it mean for sensitivity and specificity if tests have a low threshold?
Increased sensitivity as you will diagnose people with the disease correctly
Reduced specificity as some people without the disease will be diagnosed incorrectly
Which of the 4 values change depending on prevalence
Sensitivity and specificity DO NOT change
If prevalence is increased, increased NPV and reduced PPV (test is more likely to be wrong when positive and right when negative)
3 ways which prevalence changes
Between primary and secondary care
Age
Country
Define likelihood ratio
Assesses how the chances of disease change after a test
How do you calculate the likelihood ratio for a positive AND negative test result?
Chance test positive if disease /
Chance test positive if well
Chance test negative if disease /
Chance test negative if well
How do you calculate chance?
e. g. true or false positive / all those who test positive
e. g. true or false negative / all those who test negative
What does it mean if you have a larger / smaller likelihood ratio?
Larger: GREATER chance you have the disease if you test POSITIVE
Smaller: LESS chance you have the disease if you test NEGATIVE
How do you calculate the chances of the disease after the test?
Chance of disease before x Likelihood ratio
Define screening
Systemic application of a test to identify individuals at sufficient risk of disorders to warrant further investigation / preventative action in individuals who have not sought medical attention on account of symptoms of that disorder
When is screening used?
When more definite tests are more dangerous
What type of prevention is screening?
Secondary
What are the 4 things you need to appraise when looking into a screening tecnhique
- Condition
- Test
- Treatment
- Programme
5 factors about the condition
Important health problem (difficult)
Understanding of history and epidemiology
Detectable risk factor
Latent period
Cost effective primary intervention in place
4 (5) factors about the test
Simple, safe, precise, validated and acceptable
Known distribution of test values
Suitable cut-off agreed
Agreed policy on further management
4 factors about the treatment
Effective treatment
Evidence that early treatment = better outcome
Agreed policy on who is offered treatment
Current clinical management is effective
5 factors about the programme
RCT evidence that the programme will reduce morbidity and mortality
Evidence that it is acceptable
Benefit outweighs harm
Opportunity cost balanced
Plan for quality assurance and continuation of programme
Explain over-diagnosis
Most cancers are slow growing and would never have caused medical problems but people now have to live with the consequences of the treatment
Define length bias
What is the problem with this?
Screening detects slow progressing tumours
Individuals detected through screening have an automatically better prognosis
Define selection bias
People who opt into screening are more health aware
Define lead time bias
2 ways to overcome this
Screening makes the disease live longer not the person
Survival needs to be significant
Measure deaths prevented not survival
What is good about good screening?
Early detection decreases cancer mortality
What is bad about good screening?
Some people have no benefit
Some people get the disease despite a negative screening result
