PPS Flashcards
What is allocation theory based on??
egalitarianism
libertarian
maximising
What is egalitarianism
Require all care that is necessary and appropriate to everyone – equal access
What are maximising principles?
Criteria that maximise public utility
What are libertarian principles?
Each is responsible for their own health, well being and fufillment of life plan
What ethical issues does sustainability highlight
autonomy and justice
as those who have to deal with effects less likely to have caused them
what is sustainability?
Sustainability is using environment as we need while preserving for future generations.
What is the rule of rescue?
What is the rule of rescue?
ethical imperative to save an individual life
What is a con of rule to rescue?
resources could be spent better to save more lives rather than just focusing on the one
What are duties of a doctor?
Make care of patient your first concern, take prompt action if you think patient safety, dignity or comfort compromised and be honest and open and act with integrity.
Why do things go wrong?
human error
neglect
poor performance
misconduct
What causes human error?
poor communication or judgement
plus lapses
omissions
violations
What is neglect?
falling below accepted standard
repeat minor mistakes and culture of not caring
care is withheld, nutritional and personal care and medical care not to standard and pt not safeguarded
What is poor performance?
problem of attitude, failure to learn from mistakes and listen to advice
What is misconduct?
deliberate harm
lack of candour
fraud/theft and improper relationship
What is medical negligence?
outcome of court case
civil claim
balance of probabilities
liable not guilty
what are the four tests that must be passed to not be medically negligent?
duty of care - who takes responsibility for the failing
breach in duty (Bolam and Bolitho test)
patient come to harm?
breach cause harm?
what is the Bolam test?
would a group of reasonable doctors do the same?
what is the Bolitho test?
would it be reasonable of them to do so - decided by the court
how does the court decide what costs to award?
loss of income
cost of care
pain and suffering
what is intuitive decision making?
ability to understand something instantly w/o conscious reasoning
often relies on pattern recognition, one part of dual process theory
What is dual process theory?
consist of an implicit (automatic), unconscious process and an explicit (controlled), conscious process.
what is heuristics
cognitive shortcuts
examples: availability (what you know well)
anchoring (suggested reference point, make diagnosis based on that point because its what you know)
representativeness
What are the biases in intuitive thinking?
- over attachment - confirmation bias, premature closure
- failure to consider alternative - search satis
- inheriting thinking
- prevalence perception - availability bias, gamblers fallacy
what is availability bias?
type of mental shortcut that involves basing judgments on info and examples that quickly come to mind
what is gamblers fallacy?
To put it another way, it is the incorrect assumption that if a random outcome occurs more often than expected over a period of time then it is less likely to happen in the future.
example of coin toss
What is analytical thinking?
basis of EBM
good at measuring and calculating odds or values
second part of dual process theory
What are the advantages and disadvantages of analytical decision making?
advantages:
accurate, reliable
disadvantages:
slow, resource intensive and cognitively demanding
How do we reduce the risks of intuition?
decision environment
personal debiasing
structural debiasing
What is personal debiasing??
acknowledgement of bias and personal accountabiloity
What is structural debiasing?
training in dual process theory and structural forcing technique
What is consequentialism/utilitarianism?
act is evaluated solely on consequences
What is virtue ethics
morality of an action is based on the character of the agent, focusing on compassion, discernment, trustworthiness, integrity, and conscientiousness
What is deontology?
concerned with the actions not the consequences
How does the law work with the doctrine of the double effect?
Normally, if you carry out an action knowing that X is a likely consequence of that act then the law regards you as intending to cause X.
what are the five focal virtues?
Compassion Discernment Trustworthiness Integrity Conscientiousness
Give ethical analysis tools
seedhouse ethical grid
Four quadrants approach
What is the seed house ethical grid based on?
moral theory
What are the layers of the grid about generally?
inner - individuals
2nd - duties and motives
3rd consequence
4th external consideration
What are the advantages of the seed house ethical grid?
Provides structure and coherence in a field in which it is lacking
Based on Moral theory
Can be used over time at different points in the research
Seems to embrace many of the ideas described elsewhere
Explain the four quadrants approach
- medical indications
- Patient preferences
- Quality of life
- Contextual features - religious, cultural, legal factors
What is the difference between compliance and concordance?
compliance - following medical advice
concordance - pt and professional coming to an agreement on rx
what are barriers to concordance?
Patients may not want to disclose certain things to their doctor.
Patients may want doctors to tell them what to do.
Poor communication from healthcare professionals.
Time, resources or other organizational restraints.
What are ways of improving concordance?
Improving communication. Increased patient involvement. Understand the patient’s perspective. Provide information. Review medications.
What is a neomaterialist epxlanation of inequalities in health?
that economic disadvantages account for the inequalities observed
What are psychosocial explanations for health inequalities?
access to resources including social support and health care are key social determinants for such inequalities in health.
What is standard deviation?
the measure of the average distance of data from the mean
What is standard error?
a measure of how variable the mean will be if you repeat the study
what is confidence interval?
where the true value is likely to lie - it describes the amount of uncertainty associated w a sample estimate of a population parameter
what is social class
measure of occupation,stratificaiton, social position and access to power and resources
What is Maslows triangle of needs?
describes heirarchical levels of human needs
Describe the levels in mallows triangle
physiological - breathing, food etc safety love/belonging esteem self-actualisation - morality, creativity etc
what are the 6 recommendations of the marmot review?
- Give every child the best start in life.
- Enable all children, young people and adults to maximize their capacities and have control over their lives.
- Create fair employment and good work for all.
- Ensure a healthy standard of living for all.
- Create and develop healthy and sustainable places and communities.
- Strengthen the role and impact of ill health prevention
What is clinical significance?
one that is big enough to be worthwhile
sample size should be adequate to detect clinically significant result
what is proportionate universalism
to reduce steepness of social gradient, action must be universal, but with a scale and intensity that is proportionate to the disadvantage
what is sociology?
study of social relations and social processes
what is sociology a measure of ?
social interdependencies
what are risk factors for health inequality?
PROGRESS Place of Residence (rural, urban, etc.) Race or ethnicity Occupation Gender Religion Education Socioeconomic status Social capital or resources
what is health?
a state of complete physical, mental and social wellbeing. Not merely the absence of disease or infirmity
what is article 2 of the human rights act?
right to life
what is article 3 of the human rights act?
right to freedom from inhumane and degrading treatment
what is article 8 of the human rights act?
Right to respect for privacy and family life
what is article 12 of the human rights act?
right to marry and found a family
what is article 14 of the human rights act?
right to freedom from discrimination
What is health improvement?
Social interventions and preventing disease, promoting health and reducing inequalities
what is health protection?
Measures to control infectious disease risk and environmental hazards
What is improving service?S
Organization and delivery of safe high quality services
What are the 5 geriatric giants?
- incontinence
- iatrogenic
- impaired homeostasis
- falls
- confusion
How is diarrhoea in hospitals and nursing homes managed/
SIGHT: Suspect c.diff as a cause of diarrhea, isolate the case, Gloves and aprons must be worn, Hand washing with soap and water, Test stool for toxin. Treat with Metronidazole or vancomycin
What is the rx of suspected c. diff
metronidazole or vancomycin
What is criteria for a pandemic spread?
- A novel virus
- Capable of infecting humans
- Capable of causing human illness
- Large pool of susceptible people
- Ready and sustainable transmission from person to person
What are phases of a pandemic
1-3 (animal infections w few human inf
4 - sustained human-human transmission
5-6 widespread human infection
post peak - possibility of recurrent events
post pandemic - disease returns to seasonal levels
Which strain of influenza causes pandemics and which causes seasonal influenza?
A causes pandemics
B causes seasonal
What is reproduction number r0
mean no. of secondary cases following a single infection
What are the surface antigens of influenza?
haemagglutinin
neuraminidase
Give examples of direct routes of transmission
STIs
faecal oral route
give examples of indirect transmission
vector borne - malaria
vehicle borne - viral gastroenteritis
Give examples of airborne transmission
resp route - TB
