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3A GH > PPD/ Public Health > Flashcards

PPD/ Public Health Flashcards

1
Q

what does SBAR stand for?

A

Situation
Background
Assessment
Recommendation

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2
Q

what did the solomon asch psychological experiment involve?

A

participants were asked to identify longest line etc.

Outlined how group social pressure can lead person to conform

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3
Q

what is transformation leadership?

A

work towards common goals, identify needs of subordinates

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4
Q

what is transactional leadership?

A

makes workers do things based on rewards and punishments

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5
Q

what are never events? and where are they published?

A

adverse events that cause harm/death to patients

National Quality data

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6
Q

give some examples of never events

A

retained instrument in surgery

wrong dose of medication

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7
Q

Define health

A

State of physical, mental and social well being. Not merely absence of disease

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8
Q

What are the 3 domains of public health?

A

Health improvement
Health protection
Improving services

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9
Q

4 aspects of health needs assessment

A

Needs assessment
Planning
Implementation
Evaluation

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10
Q

Bradshaw’s ‘needs’

A

Felt need
Expressed need
Normative
Comparative

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11
Q

3 approaches to health needs assessment

A

Epidemiology
Comparative
Corporate

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12
Q

give the layers of maslows hierarchy and some examples of each

A

self-actualisation [achieving full potential, creative activities]

esteem needs [prestige, accomplishment]

belongingness and love needs [intimacy, friends]

safety needs [security, safety]

physiological needs [food, water, warmth, rest]

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13
Q

give structure, process and outcome for Maxwell’s Dimensions of Quality

A

ACCESS: structure = pushchair access, process = sufficient appt.s, outcome = parent and child attend

EQUITY: structure = facilities for hearing impaired Pt, process = longer appt.s, outcome = attendance and pateint satisfaction

APPROPRIATE: structure = hearing test room soundproofed, process = anaemia screeing in city centre, outcome = problems detected

ACCEPTABILITY: clinic at appropriate time, no unacceptable tests, attendence

EFFICIENT: skill mix of examiners, no inefficient tests, cost effective

EFFECTIVE: equipment in good condition, only effective tests, problems identified

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14
Q

describe the 3 categories of The Donabedian model for information about quality of care

A

structure process outcome

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15
Q

what are the 4 domains/tets of medical negligence

A
  1. was there a duty of care?
  2. breach in that duty?
  3. patient harmed?
  4. harm due to breach?
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16
Q

what are the bolam and bolitho rules in medical negligence

A

Bolam: would a reasonable Dr do the same?
Bolitho: the professional opinion relied on must be reasonable and logical

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17
Q

what are the 3 behaviours of health psychiatry and describe each

A

health behaviour [lifestyle/ disease prevention]
illness behaviour [seeking help/ GP]
sick role behaviour [actively getting better]

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18
Q

what are the 5 stages of the transtheoretical model of behaviour change

A 
precomtemplation
contemplation
preparation
action
maintainence/relapse
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19
Q

what are the 2 types of ‘cues to action’ in behaviour change, and give some examples of each

A

internal - symptoms/pain

external - leaflets/ reminders

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20
Q

what 3 things lead to the ‘intention’ in the theory of planned behaviour model of behaviour change?

A

attitude
perceived behaviour control
subjective norm

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21
Q

what makes a communicable disease important [5]

A

highly contagious

expensive to treat

morbidity

mortality

preventable

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22
Q

name some notificable diseases

A 
Acute meningitis
Diphtheria
Food poisoning
Malaria
Measles
Meningococcal septicaemia
Mumps
Rabies
Rubella
Scarlet fever
Tetanus
Tuberculosis
Whooping cough
Yellow fever
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23
Q

define cluster in infectious disease

A

An aggregation of cases

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24
Q

define suspected outbreak in communicable disease

A

more cases than normal in a specific place/group in a period of time

2+ cases with link

SINGLE case of rare/ serious disease

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25
Q

define comfirmed outbreak in communicable disease

A

Link confirmed through epidemiological/ microbiological investigation

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26
Q

define epidemic in communicable disease

A

Occurrence within an area in excess of what is expected for a given time period

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27
Q

define pandemic

A

excessive no of cases for what is expected

over several countries

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28
Q

endemic

A

Persistent level of disease occurrence

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29
Q

hyper-endemic

A

Persistently high level of disease occurrence

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30
Q

who should you contact in the instance of CO poisoning

A

call proper officer [infectious diseases consultant]

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31
Q

communicable disease action for MRSA on a ward

A

no action, someone else’s responsibility

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32
Q

describe egalitarianism

A

all people are equal and deserve equal rights and opportunities
‘everyone should have everything’

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33
Q

describe utilitarianism

A

maximising utility, e.g. limited resources

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34
Q

describe libertarianism

A

everyone is responsible for their own health, minimal intervention

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35
Q

rule of rescue

A

this is an exemption to utilitarianism. It allows the spending of lots of resources in order to save a life

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36
Q

what is human rights article 2

A

right to life

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37
Q

what is human rights article 3

A

prohibits torture, and “inhuman or degrading treatment or punishment”.

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38
Q

what is human rights article 8

A

right to privacy/family life

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39
Q

what is human rights article 12

A

right to marry and procreate

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40
Q

what is human rights article 14

A

protection from discrimination

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41
Q

define equality and equity

A

equality - everyone is the same

equity - unequal needs = unequal shares, people deserve different levels of care due to different level of needs

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42
Q

what is horizontal equity

A

equal shares for equal needs

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43
Q

what is vertical equity

A

more needs = more shares e.g. if you earn more you pay more tax

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44
Q

types/categoriesof intervention

A

individual
community
ecological/population

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45
Q

what is the Quality and Outcomes Framework

A

annual reward and incentive programme detailing GP practice achievement results. It rewards practices for the provision of quality care and helps standardise improvement in the delivery of primary medical services

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46
Q

name the 8 models/theories of behaviour change

A
  1. theory of planned behaviour
  2. health belief model
  3. transtheoretical model
  4. nudging/ choice architecture
  5. social norms theory
  6. motivational interviewing
  7. social marketing
  8. financial incentives
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47
Q

cons of the health belief model?

A

doesn’t cover outcome expectancy or effect of emotions on behaviour

doesnt differentiate 1st time /repeat behaviour

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48
Q

describe some health behaviours in which the health beleif model is successful

A

breast self screen
vaccination
cancer screening
medication adherence

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49
Q

what is the most important factor for addressing behaviour change in the health belief model?

A

perceived barriers

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50
Q

what are the 4 factors that influence behaviour change in the health belief model?

A

perceived susceptibility
perceived severity
perceived benefits
percieved barriers

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51
Q

the theory of planned behaviour proposes the best predictor of behaviour is what?

A

intention

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52
Q

what are the 5 barriers between intention and behaviour change in the theory of planned behaviour model?

A 
perceived control
anticipated regret
preparatory actions
implementation intentions
relevance to self
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53
Q

5 transition points in life when behaviour change can occur

A 
leaving school
entering workforce
becoming a parent
becoming unemployed
retirement and bereavement
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54
Q

what is motivational interviewing?

a behaviour change it works for and one it doesnt

A

a councelling approach for initiating behaviour change by resolving ambivalence
NO for smoking, YES for problem drinking

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55
Q

describe nudge theory

A

nudge the environment to make the best option the easiest e.g. putting fruit by till queue!

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56
Q

advantages of the transtheoretical model

A

had different stages so can tailor intervention to individual

accounts for relapse

temporal element

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57
Q

disdvanatges of the transtheoretical model

A

not everyone moves step to step [may skip/go backwards]

change may operate on a continuum, not discrete stages

doesnt take into account social/ economic/ values

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58
Q

pros of theory of planned behaviour

A

takes into account social norms/ social pressures and perceived control

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59
Q

describe the hypothetico-deductive model for clinical reasoning

A

info from patient gathered + used to construct hypothesis

hytpothesis tested out / further hypothesis constructed

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60
Q

con of Hypothetic-deductive approach to clinical decision making

A

uncertainty

subject to error at every step

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61
Q

describe the stages of the pragmatism model for clinical reasoning

A

symptoms -> exclude serious illness -> treat Sx -> review

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62
Q

give some examples of intuitive [system 1] vs Analytic [system 2] clinical reasoning

A 
intuitive vs analytical :
emotion vs logic
past experience vs evidence
immediate action vs delayed action
unconscious vs conscious
error prone vs reliable
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63
Q

define “utility” in clinical reasoning

A

Utility = probability of outcome x value of outcome

64
Q

define conditional probability

A

Chances of something given that you have some additional information

65
Q

define anchoring bias

A

Undue emphasis is given to an early salient feature in a consultation.

66
Q

define ascertaiment bias

A

Thinking shaped by prior expectation

67
Q

example of anchoring bias

A

Concentrating on the fact that patient with back pain has a manual job -> MSK pain, and putting less weight on his complaint of hesitancy and nocturia -> prostate cancer mets

68
Q

example of ascertainment bias

A

young patient with unsteady gait in a city centre on a Saturday night expected to be drunk, rather than having suffered a stroke

69
Q

define Availability bias

A

Recent experience dominates evidence

70
Q

examples of availability bias

A

Having recently admitted a patient with multiple sclerosis, this diagnosis comes to mind the next time a patient with sensory symptoms is seen

71
Q

define bandwagon effect bias and e.g.

A

“we do it this way here”

continuing to prescribe diclofenac to patients with cardiovascular risk factors, despite its thrombotic risk profile

72
Q

define omission bias and e.g.

A

Tendency to inaction. Events due to disease preferred to iatrogenic.
Not vaccinating child due to risks, without considering risks of disease

73
Q

define sutton’s slip (bias)

A

going for the obvious diagnosis

74
Q

Gambler’s fallacy (bias)

A

thinking a list of many recent diagnoses means this patient cannot have the same diagnosis

75
Q

Search satisficing bias

A

once one diagnosis is found, others are not explored

76
Q

GMC duties of a Dr

A

make care of patient 1st concern

take prompt action if Pt safety, dignity, comfort compromised

honest/ open/ integrity

77
Q

in the swiss cheese model what do the layers of cheese represent?

A

levels of defence that prevent error/ patient safety incident

78
Q

4 categories of why things go wrong in medical negligence

A

human error (wrong drug route)

neglect (mid-staffs)

poor performance (personal/attitude)

misconduct (deliberate harm)

79
Q

if a doctor is found liable of medical negligence, what 3 aspects do the court take into account when deciding on how much patient is reimbursed

A
  1. loss of income
  2. cost of care
  3. pain and suffering
80
Q

define public health

A

the science and art of preventing disease, prolonging life and promoting health through organised efforts of society

81
Q

Which of the following is not a communicable disease of public health importance:
A. Influenza
B. Urinary Tract Escherichia coli Infection
C. Middle Eastern Respiratory Syndrome Corona virus Infection
D. Rabies
E. Rubella

A

B

82
Q

what communicable disease do you not need to notify about

A

Health Care Associated Infections and sexually transmitted diseases

83
Q

HIV. notify?

A

no

84
Q

MRSA on ward. notify?

A

no

85
Q

In the last two days, you have clerked ten patients with acute respiratory distress with no apparent cause. Action?

A

call CCDC

86
Q

An oncology ward nurse contracts chickenpox. Action?

A

call CCDC

87
Q

A case of Infectious Bloody Diarrhoea in a 4 year old. Action?

A

call CCDC

88
Q

Typhoid in a restaurant chef. Action?

A

call CCDC

89
Q

Animal researcher who received hate mail with some white powder develops acute respiratory distress. Action?

A

call CCDC

90
Q

what is communicable disease surveillance

A

continuous monitoring of frequency + distribution of communicable disease + monitoring risk factors

91
Q

what does communicable disease surveillance tell us

A

which disease cause morbidity/mortality
whos at risk
vaccination program working?
allow outbreak identification

92
Q

what info is needed from a notifying Dr in comm disease?

A 
current location
home address
date of onset
occupation/school
travel
medical Hx (immunosuppressed)
93
Q

what are some determinents of health

A

genes
lifestyle
healthcare
environment (social, physical, economical)

94
Q

different forms of health equity

A 
Equal EXPENDITURE for equal need
Equal ACCESS for equal need
Equal UTILISATION for equal need
Equal health care OUTCOME for equal need
Equal HEALTH
95
Q

EXAMPLES of the public health domain “health improvement”

A 
lifestyle
education
housing
employment
inequality
96
Q

example of public health domain “health protection”

A

communicable disease
radiation
chemicals
environmental hazards e.g. flood

97
Q

example of public health domain “improving services”

A 
effectiveness
efficiency
audit
equity
clinical governance
98
Q

explain the difference between secondary and tertiary prevention

A

secondary - reducing risk of disease in those who are at risk
tertiary - reducing morbidity/mortality in those who already have disease

99
Q

Explain the difference between public health interventions delivered at the population (ecological) and individual levels, using one example for each to illustrate your answer.

A

population - ^ alcohol tax

individual - smoking cessation advice form GP

100
Q

Explain the difference between horizontal and vertical equity in relation to health care.

A

horizontal aims for equal shares for equal needs e.g. everyone with pneumonia should recieve same treatment.
vertical works on unequal shares for unequal needs

101
Q

define need, supply and demand in health needs assessment

A

Need - ability to benefit from an intervention
Demand – what people ask for
Supply – what is provided

102
Q

give examples of things that are needed and supplied but not demanded

A

health promotion [alcohol tax]
MMR for some parents
GU contact tracing

103
Q

give examples of things that are Needed but not supplied or demanded

A

some palliative care services

contraceptive services in some countries

104
Q

Needed and Demanded but not supplied

A

waiting lists

drug rehab

105
Q

Supplied and demanded but not needed:

A

antibiotics for sore throat

cosmetic surgery

106
Q

Supplied and demanded and needed

A

operations for cataracts

free contraception

107
Q

define health needs assessment

A

systematic review of population health issues. To find priorities and for resource allocation.

To improve health and reduce inequalities

108
Q

health needs assessment may be carried out for which different domains

A

A population or sub-group
A condition
An intervention

109
Q

describe the epidemiological approach to health needs assessment

A

establishes incidence/ prevalence of problems, looks at existing services, evidence, available services and makes recommendations

110
Q

describe the comparative approach to health needs assessement

A

compares services received by population to other groups

111
Q

describe the corporate approach to health needs assessment

A

takes into account the views of service user, politicians, providers, commissioners, professionals, 3rd sector organisations

112
Q

problems with epidemiological approach to health needs assessment

A

needs info - may not be available or accurate
evidence on subject may be sparce
doesn’t take into account felt needs people affected

113
Q

problems with comparative approach to health needs assessment

A

may be difficult to find comparable group
data may be difficult to obtain or poor quality
may not yield appropriate level of need

114
Q

problems with corporate approach to health needs assessment

A

difficult to distinguish need from demand
vested interests/ political agendas
powerful/influencial groups/people may have undue increased influence

115
Q

initiatives to reduce social isolation of older people

A

dementia cafes
age UK 50+ clubs
silverline telephone helpline
intergenerational housing

116
Q

define refugee

A

someone who has been forced to flee their country of nationality due to fear of persecution, war or violence

117
Q

define asylum seeker

A

someone who has applied to become a refugee and is awaiting their claim to be accepted by the home office

118
Q

if an asylum seeker is granted indefinite leave to remain (full refugee status), who are they allowed to bring with them?

A

one spouse, and any child of that marriage under the age of 18

119
Q

what are asylum seekers entitled to?

what are they NOT allowed

A 
£35/week
school
NHS care
housing
NOT allowed to work or claim benefits
120
Q

FAILED Asylum Seekers entitled to?

A

Are NOT entitled to any money
Are NOT housed
Are NOT entitled to full NHS care

121
Q

barriers to health services for asylum seekers

A

language
unaware of where to go for help
health not a priority

122
Q

examples of self-actualisation in maslows hierarchy of needs

A

achieving full potential
morality
creativity
spontaneity

123
Q

examples of self-esteem in maslows hierarchy of needs

A

confidence
achievement
respect from others

124
Q

give examples of safety in maslows hierarchy of needs

A

employment
health
property
money

125
Q

health problems faced by homeless people

A 
STIs
alcohol/drug abuse
respiratory
TB
poor nutrition
injuries form violence
mental health
126
Q

barriers to healthcare for homeless people

A

perceived or actual discrimination
other priorities
appt procedures [ringing up to book/giving address]

127
Q

alcohol recommended units

A

<14 units/week

128
Q

features of fetal alcohol syndrome

A 
low birth weight
low muscle tone
Mental retardation
behavioural problems
speech problems
Cardiac/ renal/ ocular abnormalities
facial - smooth philtrum, epicanthic folds, thin upper lip,  low nasal bridge, short palpebral fissures
129
Q

medications used when reducing alcohol intake

A

disulfiram [sensitises]
acamprosate [reduces withdrawal]
naltrexone [also for opiates]

130
Q

criteria for alcohol dependence syndrome

A 
3 or more (in 12 months):
^tolerance
physiological withdrawal
difficultly controlling use and amount
neglect of other areas/social
spending more time obtaining/using
continue despite -ve effects
131
Q

triad of wernickes

A

confusion
ataxia
opthalmoplegia

132
Q

treatment of wernickes

A

IM thiamine (vit B1) [pabrinex]

133
Q

define Delirium Tremens

A

short lived (3-5 days) confusional state due to reduced alcohol intake in alcohol dependent individual/ long history of use.

134
Q

treatment of delirium tremens

A

fluids, benzodiazepine

135
Q

symptoms of delirium tremens

A 
confusion
reduced consciousness
seizures
hallucinations
tremor
136
Q

what is principlism

A

practical approach for ethical decision-making - focuses on autonomy, beneficence, non-maleficence, and justice.

137
Q

consequentialism

A

the consequences of an action determine the right/wrongness of it

138
Q

define deontology

A

ethical principle that focuses of duty and rules and doing the right thing because its the right thing to do, regardless of consequences

139
Q

define virtue ethics

A

ethical principle that emphasizes the moral character of the person, rather than the rules or consequences

140
Q

give 3 reasons that the need for rationing in health care has increased

A

switch from acute to chronic long term illness

medicalisation of physiological events

^choice of, AND ^cost of treatments

141
Q

WHAT IS THE maximising principle in resource allocation

A

maximise public utility/ rationing

142
Q

what are the 4 layer of millers pyramid of clinical competence?

A

does
shows
knows how
knows

143
Q

acid fast bacilli on sputum smear often indicates…

A

TB

144
Q

list some types of error

A 
sloth
poor team work
loss of persective/ fixation
mistriage
communication breakdown
ignorance
bravado
syste error
145
Q

the 3 bucket model for error - what are the 3 buckets?

A

self
context
task

146
Q

advantages and disadvantages of RCT

A

low bias risk, low confounding risk

expensive, time consuming

147
Q

how do you calculate attributable risk of lung cancer due to smoking

A

risk in smokers - risk in non smokers

[taking away the ‘naturally occurring’ risk]

148
Q

how do you calculate number needed to treat?

what does a number needed to treat of 7 for smoking and lung cancer mean?

A

1/ attributable risk

7 people would need to stop smoking to stop 1 person getting cancer

149
Q

define lead time bias

A

early identification appears to ^survival because Pt knows they have it for longer

150
Q

define length time bias

A

diseases with slow progress are more likely to be picked up by screening, so screening appears to prolong life

151
Q

what is the standard error

A

the standard error is the standard deviation of all the sample means. larger sample = lower standard error

152
Q

what is the p value

what dies it mean if p value <0.05

A

the probability of an event occurring given that the null hypothesis is true

means you can reject null hypothesis

153
Q

what is the confidence interval

A

range that contains true mean?

if you did test 100 times, 95 of them are likely to contain the true value for the population, 5 wont

154
Q

if people on pill have 50% increased risk of cancer, and the absolute risk in the population is 10%. What is the absolute risk for people on the pill?
and attributable risk?

A

15%

5%

155
Q

calculate NNT

A

1/absolute risk reduction

3A GH (8 decks)

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