LEAPS Final Flashcards
What are the 4 main principles of medical ethics?
- Autonomy – self determination, informed consent, advanced care planning, competence, refusal of treatment
- Beneficence – best interest of patient
- Non-maleficence
- Justice – access to care, existing inequalities (i.e. rural), global considerations (war, drug patents, IP, water etc)
Virtue Ethics
- trust
- compassion
- capacity for self-reflection
- justice integrity
- temperament
- honest
etc
Elements of informed consent
Valid consent must:
- Be freely given - no pressure, failure to provide sufficient time
- involve disclosure - by doctor of sufficient into, including material risk
- be specific for the proposed procedures
- be competent to consent
- have an understating of proposed procedure/treatment
Confidentiality principles and exceptions
Confidentiality required else patient might withhold important info which would hinder doctor’s efforts.
Based on autonomy, respect for others and trust.
EXCEPTIONS:
- Ethical:
- Serious risk to patient or another person
- where required by law
- where part of approved research
- where there are overwhelming societal interests - Legal:
- Poses a serious threat to a third party (non-maleficence to them)
- infectious and STD’s
- suspected child abuse, injuries and serious offences
- health professionals’ access to patient records if they are part of the healthcare team (consent is implied)
- judicial proceedings etc
List 4 sustainable development goals that are different to MDGs.
- Clean water and Sanitation
- Affordable and clean energy
- Decent work and economic growth
- life on land
- life below the water
Elements of evidence based practice
- evidence conducted with sound research methods
- clinical expertise
- patient circumstances, wishes and values
Steps to practicing evidence based medicine
- Formulate clinical question
- Track down best evidence
- Appraising the evidence
- Apply the evidence
- Evaluating your performance
Well built clinical question
PICO
- Patient
- Intervention
- Comparison
- Outcome
What are the types of clinical questions? And which types of studies would be most helpful for the above types of questions?
- Diagnostic:
- prospective, blind comparison to a gold standard - Therapy - RCT
- RCT>cohort>case control>case series - Prognosis - Cohort Study
- Cohort>case control>case series - Aetiology/harm - RCT
- RCT>cohort>case control> case series - Prevention - RCT
- RCT>cohort>case control>case series - Clinical Exam
- prospective, blind comparison to a gold standard - Cost
- economic analysis
What is the hierarchy of evidence?
- Systematic reviews and met-analyses
- Evidence based synopses
- RCT
- Cohort/non-randomized trials
- Case control/Case series
- Case study/reports
Why is inequality making us sick? Use racial discrimination as an example
Racism impacts pregnancy outcomes even once socioeconomic factors have been accounted for.
In America, black women with college education or higher have infant mortality rates almost 3x higher than white women with the same level of education. This rate is actually higher than white women who have not even completed high school.
Use rural Australia to illustrate the concept of determinants of health
- fewer doctors, fewer or no specialists
- limited access to medical equipment/pharms
- higher risk occupations
What are the main features of the following study designs:
- RCT
- cohort study
- case-conrtolled study
- case reports/case series
- ecological/correlational studies
RCT:
- people are allocated at random (by chance alone) to receive one of several clinical interventions
- The control may be a standard practice, a placebo (“sugar pill”), or no intervention at all.
- compared
Cohort:
- starts with cohort who don’t have disease
- groups them according to whether they are exposed to a potential cause of disease
- whole cohort followed over time
- compare groups
Case-controlled:
- starts with group who has disease and group who doesn’t
- The exposure status to a potential cause of disease is determined for both cases and controls.
- Then the occurrence of the possible cause of the disease could be calculated for both the cases and controls.
Define:
- prevalence
- incidence
- morbidity rate
- mortality rate
- case-fatality rate
- attack rate
Prevalence:
Measures the amount of a disease in a population at a given point in time
Incidence:
Number of new cases (of an illness, disease or event) occurring during a given period
Morbidity rate:
The frequency with which a disease appears in a population.
Case-fatality rate:
the proportion of deaths within a designated population of “cases” (people with a medical condition), over the course of the disease.
Attack-rate:
biostatistical measure of frequency of morbidity, or speed of spread, in an at risk population
Calculate:
- prevalence
- incidence
Prevalence = No. of people with disease at time T / Total number of people in population
Incidence = No. of people who develop disease in given time period / Average no. of people in the population at risk for developing that disease in that time period
What is the relationship between prevalence and incidence?
The prevalence of a disease is related to both the incidence of the disease and how long people live after developing it (survival).
What are the leading causes of burden of disease?
The six leading specific causes of burden in Australia in 2011 were:
- coronary heart disease,
- other musculoskeletal conditions
- back pain & problems,
- chronic obstructive pulmonary disease,
- lung cancer and
- dementia.
What are the 4 dimensions to emotions in mental health?
Thoughts, feelings, bodily sensations, impulses.
What is mental health? What is mental illness?
a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
Mental illness: Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”
What are some of the health effects due to mental illness? Use anxiety to describe the short terms
effects (bodily effects) and the long-term effects
Anxiety:
Short term:
- throat troubles
- tense muscles
- active spleen
- skin reactions
- liver reactions - increase blood sugar
Long Term:
- digestion problems
- weakened immune system
- sleep problems
- cardiovascular problems
- weaker respiratory functions
What is the GAD-7?
Over the last 2 weeks, how often have you been bothered by the following problems?
- Feeling nervous, anxious, or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it’s hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
What are the types of anxiety?
- Panic Disorder
- Social Phobia
- GAD
- OCD
- PTSD
- agoraphobia
What is the diagnostic criteria for generalised anxiety disorder? (DCM-V)
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.
Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
have 4 strong facts on
burden/prevalence etc of anxiety and again 4 for depression
- 14.4% of Australians had experienced an anxiety disorder in past 12 months
- highest rates in the 35-44 years group
- 12.6% of medical students currently had anxiety
- 4.1% of Australians had experienced a depressive episode in past 12 months
- 8.1% of medical students were depressed
- anxiety and depression were twice as high for females
-
Tell me about measuring psychological stress and the scale used to measure it
K10 = Kessler Psychological Distress scale
This simple checklist aims to measure whether you may have been affected by depression and anxiety during the past four weeks. The higher your score, the more likely you are to be experiencing depression and/or anxiety.
Describe:
- relative risk
- odds ratio
- absolute risk
- population attributable risk
Relative Risk: Cohort Studies
How many times more likely are exposed persons to become diseased, relative to non- exposed persons?
Odds ratio: Case-Control
odds of exposure among cases / odds of exposure among controls
Absolute Risk [Incidence]:
What is the incidence of disease in a group initially free of the condition?
Population-Attributable Risk:
What is the incidence of disease in a population, associated with the prevalence of a risk factor?
In regard to the issue of efficient and equitable resource allocation, discuss Levels of Decision Making / Resource Allocation
Federal government first involved in deciding what proportion of GDP is allocated to health. Government has traditionally also directed how the health care budget will be divided, i.e. hospital vs community care vs treatment vs prevention, however more recently they have tended to shift this onto regional areas so local communities can identify their own health needs.
BUT at the allocation of med resources at the regional level (‘meso-level’), decisions tend to be influenced by politicians, administrators and various committees and hospital managers.
At the micro level – doctors, i.e. their use of time, appointments, diagnostic treatments etc. They inadvertently affect distribution of resources.
Public hospitals generally owned by state health departments and run by boards of management appointed by the state government. A small number of private ones exist, some are state – so they are basically public. Federal government funds (in part?) the public hospital system but the systems are the responsibility of the states.
GP’s and other health care services are also provided by community health services in some states, funded partly by state government and partly by medicare.
Medicare regulates a lot of the health care system (federal).
In regard to the issue of efficient and equitable resource allocation, discuss the Criteria for evaluating health care (and therefore prioritising health resources)
- Equity (Justice)
- Effectiveness
- Efficiency
- Consumer preferences
- Burden of Disease
In regard to the issue of efficient and equitable resource allocation, discuss efficiency
Getting maximum health benefit for scarce health dollars
Outline the factors that influence risk perception
- Trust vs Lack of Trust
- Voluntary/Controllable vs coerces/uncontrollable
- natural vs man made
- chronic vs catastrophic
- not dreaded vs dreaded
- familiar/awareness vs unfamiliar/not aware
- affects adults vs affects children
Outline the leading behavioural and biomedical risk factors in Australia and name some
diseases/conditions that are connected to these risk factors
Behavioural:
- smoking
- excessive alcohol
- drugs
- inadequate fruit/vege intake
- insufficient physical activities
Biomedical:
- obesity
- BP
- abnormal blood lipids
- impared fasting glucose
Non-modifiable:
- age
- gender
What are the three main models that are used to understand and bring about health behaviour change?
o Health Belief Model:
Likelihood of an individual taking action related to a given health problem is based on the interaction between four different types of belief:
1. Perceived susceptibility to a problem (perceived threat)
2. Perceived seriousness of consequences (perceived threat)
3. Perceived benefits (outcome expectations)
4. Perceived barriers (outcome expectations)
o The Theory of Reasoned Action/ Theory of Planned Behaviour
o The Transtheoretical [Stages of Change] Model
In motivational interviewing, what are the 5 As?
ASK
ASSESS - i.e. readiness to change
ADVISE
ASSIST - motivational interviewing, support services etc
ARRANGE - regular follow up visits to monitor maintenance and prevent relapse
What are the critical components of motivation?
- The importance of change for the patient (willingness)
- The confidence to change (ability)
- Whether change is an immediate priority (readiness).
features of motivational interviewing
O - ask open-ended questions
A - Provide affirmation
R - Reflective Listening
S - Summarising statements
- Generate a gap - Develop discrepancy – generate inconsistency between how they see their current situation and how they would like it to be.
- Roll with resistance
- Avoid argumentation
- Can do - Support self-efficacy – build confidence that change is possible
- Express empathy, warmth and genuineness – facilitate engagement an d build rapport.
Skills:
- open ended questions
- affirmation
- reflective listening
- summarizing
- eliciting change talk
Other tools:
- decisional balance (pros and cons)
- SMART goal setting – specific, measurable, achievable, realistic and timely
- Readiness/confidence rulers
What are the stages of change?
a) Pre-contemplation – raise doubt
b) Contemplation – tip the balance
c) Determination – help them determine the best course of action (or preparation/decision making)
d) Action – help them take steps toward plan – ‘Action Plan’
e) Maintenance – prevent relapse
f) Relapse – renew stage of change
