Heath and Society Flashcards
Disadvantages of cohort studies
Expensive
attrition (i.e. people may drop out)
Must consider how long for risk factor to cause disease
Disadvantages for case control
Recall bias
Advantages of case control study
observational study
good for rare diseases
Good for tracing source of an outbreak
What should be considered when critiquing systematic reviews
Inclusion of studies:
Publication bias
Studies not in english
Define sensitivity
the likelihood that a test will pick up someone with disease
A highly specific test will…
Correctly identify a high proportion of people free from disease
Define positive predictive valve
Probability that those with a positive result truly have disease
Define negative predictive value
probability that those with a negative result truly are disease free
What is a 95% confidence value
The range in which the population mean is 95% likely to lie
What is a p value
Probability of results being found if there is no difference in treatments (accept null hypothesis)
Risk ratio
Ratio of the risk of an event between two groups
used in cohort studies
Odds ratio
chance that something will happen : compared to chance that something will not
(used in case control studies)
Define relative risk
One population’s risk compared to another population
Define absolute risk
one population’s risk in its own right
What is intention to treat analysis?
Participants in a trial are analysed within the group they were allocated, even if they didn’t complete the trial
Suggest the criteria for a suitable screening test
Simple, safe, precise and validated
Distribution of test values should be known and suitable cut-off agreed
Benefits outweigh risk of screening
There should be effective treatment with evidence of early detection leading to better outcomes
Formula for positive predictive value
Number of those who truly have disease who screened positive/all those who tested positive
Steps in the NHS complaint system
1) Raise matter verbally or written with practitioner or NHS England or local CCG
2) Parliamentary and Health service ombudsman (who is independent of the NHS and government)
Disadvantages of using mortality rate to measure hospital performance
- Most hospital deaths are not preventable
- Adjusting for risk of death is complex and only partially achieved
- Poor correlation with other measures of quality for example specialist centres treat rarer more complex cases and therefore have higher mortality rates
Who inspects for quality in the NHS?
Care quality commission
National audit office
List ways in which quality of care can be measured
CQC inspection rating A&E performance (and wait times) Mortality rate % of patients waiting less than 18 weeks friends and family rating
Three aspects of Donabedian Quality
Structure
Process
Outcome
Formula for NNT
1/(rx difference)
What are the main aims of the strategic cancer network?
- Reduce incidence of cancer
- Maximise survival of cancer patients
- Enhance quality of life of patients
- Improve the patient experience of cancer services
- Provide high quality service focused on the needs of patients and carers
Outline the role of strategic clinical networks in cancer care
- Develop strategic plans for delivering better care
- Implement national policies
- Provide resources for audits and research
Describe the key steps in an audit cycle
- Identify current standards
- Measure current performance
- Compare performance vs standards
- Make improvements
- re-evaluate
What are the limitations of audit?
- Only compares the service to best current practice
- May not always help
- Costs time, money and resources
- Can only audit where current standards exist
List common complaints
- Safety of clinical practice
- Poor/insufficient information
- Poor handling of complaints
- Discharge and co-ordination of care
- Lack of dignity and respect
- Poor attitudes of staff
What information must a patient be provided with to ensure consent is informed?
- Basic overview of their condition
- Likely outcome of their decision
- Their treatment options, including a second option
List scenarios in which consent is not required
- Emergency treatment - when treatment is essential to save someone’s life but they are physically or mentally incapacitated to consent
- If a patient is being sectioned under the MHA (1983)
- Rx to public health e.g. infectious disease
- Severely ill and in unhygienic conditions - national assistance act
What is the most common form of cancer in the UK?
Breast cancer
4 most common causes of cancer death in the UK
- Lung
- Bowel
- Prostate
- Breast
Discuss the features of the breast cancer screening programme
- Women aged between 50-70 are screened every 3 years using mammography
- Challenges –> accessibility, uptake (cultural/embarrassment), detection rates are low
Discuss features of the AAA screening programme
Men aged 65 years invited for screening (if no AAA detected then one of screen)
Discuss features of the Bowel cancer screening programme
Offered every 2 years to men and women aged between 60-74
An additional one-off bowel scope screening is offered for men and women at the age of 55
Outline the ways in which quality of cancer services can be measured
- Waiting times from GP referral to first cancer treatment
- Hospital discharge rates
- 30 day mortality
- 1-year and 5-year survival rates (however this is problematic as more specialist centres deal with more complex cancers and therefore tend to have lower survival rates)
Most common adverse events in primary and secondary care
Primary = delayed diagnosis Secondary = negligence
How can the cost-effectiveness of screening be assessed?
- Estimate the costs in relation to calculated numbers of years saved
- Cost of the screening e.g. mammography
- Prevalence and mortality of the disease being screened
- Rate of complications
- Cost of primary therapy
What to do if a child discloses abuse
Statutory obligation to tell either social services, NSPCC or police
Inform child protection lead
Document all concerns in writing within 48hrs
Effects of dementia on carers
- Frustration and anger
- Neglect of their own personal health problems (nearly 50% have there own long standing illness/disability)
- Loneliness and social isolation
Modes of support available for carers
- Carers have the right to assessment of their own needs (Care act 2014)
- Carers allowance
- Disability living allowance
- Respite care
- Community care services
Negatives of screening programmes
- False positives and negatives can cause unnecessary anxiety/reassurance
- Overdiagnosis and overtreatment
Social patterns of delayed diagnosis in breast cancer
- Rural-urban differences
- Educational attainment
- Those able to self examine
- Female family members encouraging self-examination
- Males may not know the signs and may be embarrassed to present to GP early
Outline gender differences in rates of depression and bipolar in the UK
- Depression, twice common amongst women
- Bipolar, affects men and women equally
Outline primary prevention strategies in the prevention of harm from alcohol
- Eduction to discourage inappropriate alcohol consumption at school
- Increasing alcohol tax/ minimum price per unit
- Drink free areas such as on TFL
Outline secondary prevention strategies in the prevention of harm from alcohol
- Screen for problem drinking (CAGE/AUDIT)
- Identify and targeting high risk groups
- AA counselling
Stages in the cycle of change
- Pre-contemplation
- Contemplation
- Determination
- Action
- relapse
- Maintenance
Role and use of section 4 (MHA)
Detention in hospital for emergency assessment, when AMHP can’t be assembled quickly (when they’re present converted to SECTION 3)
Can’t be used to treat patient
Can be applied for by an AMHP (or technically nearest relative). Only requires 1 other qualified doctor to approve
Discuss merits of publicly available performance indicators
- Focusses attention on improving care
- Public reassurance about safety
- Competition boosts performance
- Facilitates informed consumer choice
Discuss limitations of publicly available performance indicators
- May have negative impact on public trust & professional
- Case-mix: some areas only receive patients with poor prognosis, more complex cases have poorer prognoses.
- Data manipulation: just treat healthier patients/ send them to other hospitals
- Unmeasured performance will suffer
What are the aims of the strategic cancer network?
P- improve Patient experience H - provide High quality service E - Enhance quality of life R- Reduce incidence of cancer M - maximise survival
Discuss steps to improve patient safety
- Build safety culture
- Lead and support staff
- Integrate your rx management activity
- Promote reporting
- Involve and communicate with patients and public
- implement solutions to prevent harm
- Learn and share safety systems
Discuss key aims of the Calman-Hine report
- Should ensure all patient have equal access to care
- Public & professionals educated on recognizing early signs
- Services should be patient centered given clear info on treatment options & outcomes
- Cancer registration & monitoring of outcomes is essential
- Psychosocial needs of carers & patient recognized
Discuss the stages in Leventhal’s Self-Regulatory Model of Illness Behaviour
Stage 1 - Interpretation
Involves perception of symptoms
Stage 2 - Coping
approach coping and avoidance
stage 3 - Appraisal
was my coping effectiveCriteria of the ‘programme’ for a suitable screening programme
There should be evidence from high quality randomised controlled trials that the screening programme is effective in reducing mortality or morbidity
The benefit gained by individuals from the screening programme should outweigh any harms, for example from overdiagnosis, overtreatment, false positives, false reassurance, uncertain findings and complications
The opportunity cost of the screening programme (including testing, diagnosis and treatment, administration, training and quality assurance) should be economically balanced in relation to expenditure on medical care as a whole
Key actions to eliminate TB
- Vaccinations
- Contact tracing
- Surveillance and monitoring
- Tackle TB in underdeveloped locations
- Improve access (especially in lower SE areas)
- Quality treatment and reduce drug resistance
Barriers to change in safety
- Lack of communication
- Lack of responsibility
- Pride/rigid attitude
- Poor monitoring
External validity
it is the extent to which the results of a study can be generalized to and across other situations, people, stimuli, and times
can be affected by selection bias
Internal validity
validity of conclusions drawn within the context of a particular study
Affected by bias and confounders
