PPS Year 1 Flashcards
Describe key ethical theories and apply these theories to clinical cases
Virtue Ethics - inherent ‘goodness’ of doctors’ actions are based of performers’ moral stance. An action is only right if it is an action that a virtuous person would carry out in the same circumstances.
Consequentialism - that states the morality of an action is dependent purely on its consequence
Deontology - This ideology states that the correct course of action is dependent on what your duties and obligations are. It means that the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.
Utilitarianism
- Utilitarianism says the best action is one that brings about the best increase in utility (benefit). The utility is generally considered on a broad scale, often taking into consideration wider society and not just the patient in question.
What are the 4 Principles and 4 Quadrants?
Beneficence - act in best interest of the patient
Autonomy - patient choose and get preference
Non-maleficence - do not cause undue harm
Justice - wider context in society, offering something reasonable in scope of financial situation
Medical Intentions - what is clinically bets for patient
Patient Preferences (autonomy) - patient has a choice in treatment they receive
Quality of Life - best outcome in the long term spectrum of health
Contextual Factors - patients should be viewed holistically (biopsychosocial)
Why do we conduct ethical analysis?
Pros:
- Professional legal obligation
- iMPROVES patient care
Cons:
- Poor resources and for ethical analysis
- Very time consuming and resource heavy
Discuss the importance of the law to medical practice?
Medical Act 1983:
- decide which doctors are qualified to work in the UK
- oversee UK medical education and training
- set the standards doctors need to follow throughout their careers
- where necessary, take action to prevent a doctor from putting the safety of patients, or the public’s confidence in doctors, at risk
Parliament will discuss ethical debates in relation to medical profession. i.e Organ donation, abortion or paternalism (bad)
How does the law operate and relate to the medical profession?
Criminal Action vs Civil Action
Criminal A
- gross negligence
- manslaughter
Civil A
- Case law (can be changed)
- Breach of contract
Statue Law → written law by acts of parliament
Common Law → Based on the case
What to prove?
Dr has duty of care
Duty of care breached
Dr caused harm
What are the 4 Professional, GMC recognised domains, describe them?
Knowledge, Skills and Performance
- apply relevant and appropriate clinical knowledge
- reflect on learning
- good record keeping of activities
Safety and Quality
- follow regulations
- maintain safety of patients and colleagues
- appropriate response to risk and mitigation
Communication, Partnership and Teamwork
- cooperation
- respect tea,
- to resolve conflicts appropriately
Maintaining Trust
- confidentiality
- no cheating
- admit mistakes
- don’t pursue relationships using your position
Describe the importance of consent and confidentiality from an ethical perspective
Consent
- a continuous dialogue between patient and professional
- voluntarily agreed to treatment, exams, sharing private information
Why do we do this?
- rapport is built (autonomy)
- trust in the patient as focus (beneficence)
- comfortable (non-maleficence)
- retain and maintain dignity
Adequate vs Informed Consent
Adequate - quick (occurs during exams, BP, HR, RR)
Informed (PARQCC)
- Understand procedure
- Understand alternatives
- Understand risks
- Asks questions
- Consent and Confidentiality
What do you understand about competency?
Ethics and reasons why?
The patient must be able to:
- understand and relay information
- retain information
- weight up information
- communicate the final decision
- MUST BE voluntary
Why?
- legal right
- respect autonomy
- patient rapport
Virtue - morally good
Deontology - respected
Conseqetionalism - bets outcome
The dilemma in Confidentiliaty - what occurs for assessment of competency?
> 16 (or equal) Are able to operate within bounds of confidentiality
<16 - must have a Gillick or Frasers competency test to determine their ability
Mothers have PR
Fathers don’t unless married at conception or birth.
Not Required: emergency, abuse, abandonment
Breaches either Justifiable or Statutory
Gillick and Fraser Competency Tests
- used in scenarios where the child wants to seek treatment or actions that they desire to be their choice and don’t desire/require their parents to decide.
- Should be on the basis of assessment from a medical professional
- testing their understanding of process, consequences and rationale.
- they must be unpressured in the decision-making process
- one decision on the basis of Gillick competence may not carry to another
- refusal of life saving treatment is able to be altered even if competent
-
What to do when done wrong and what is Defensive Medicine?
- Contractual
- Statutory (NPSI - Nonspecifable Patient Safety Incident to Patient)
- GMC
Performing tests as safeguarding
Issues:
- violates trust
- expensive
- resource allocation
- ethically injust
What is the Children Act (1989) and Mental Capacity Act (04)
Children Act
Ascertain the wishes and feelings from the child
Physical and emotional needs
Effect on Family
Child’s beliefs and values/past wishes/feelings
Views of parents/other indiduals
Potential harm suffered?
Mental Capacity Act
16/18-year-olds have competence
Protect those who don’t have capacity, It sets out a legal framework for assessing a person’s capacity to make decisions and provides guidance on making decisions on their behalf when they lack capacity.
Outline the scope of support available from occupational health services
OH - provides guidance and advice
- support your training
- the well-being of students, learning and social environment of patient care
- can work as an independent mediators between university and students in order to facilitate best practice for all
Post Exposure Prophylaxis
- Immediate immunisation with antibodies
Annual Flu reports and vaccine
Hep B (very effective)/C (no vaccine)
Discuss the reasons and the process of immunity screening and immunisation
Run Immunity Screening and Immunisation
- protection to vulnerable groups (very young and elderly at risk)
- immunosuppressed
Screen for:
TB
MMR
Hep B
Chicken Pox
These can be transmitted between staff and patients via invasive procedures in a clinical setting.
- Prevents transmission
- Early detection fo disease (better for patients)
Management of Sharps and Splash Injuries
Splash
- body fluid in eyes/ mouth
- RINSE (without swallowing)
Sharps
- scapula, knife, syringe, etc
- WASH with warm water and soap
- milking the limb
- apply waterproof dressing
Then:
- Indetify source (details of patient)
- contact OH
- DO NOT depend on self-assessmet
PEP for HIV best in 1 hour
Understand the importance of mental health for students, the impact on them and patient care and identify the support available
Mental Health in Students at a Low
- Take Breaks
- Interests outside of medicine
- Recognise symptoms early
- Know and understand triggers
Talk and find help through OH, counsellors, tutors, peers, and professional counselling services. GP, NHS mental health services
Triggers:
- too much work
- complaints
- poor relationships
- illness
Describe issues of consent relevant to sexual activity for example chemsex or having sex when under the influence of alcohol
Neither party was able to fully consent and was unaware of either person’s mental state at the time of sexual intercourse.
Tough legally.
Chemists offer OTC Morning After Pill
- pregnancy test
- future contraception
- future condom use
- test for STI
What are addiction and related mental health conditions amongst doctors?
Definition
- The fact or condition of being addicted to a particular substance or activity.
GMC referrals are 50% substance related
1/6 doctors suffer from addiction
1/15 Impacted by dependency
3x more likely to suffer cirrhosis of the liver
The majority do to seek care
and SELF PRESCRIBE (70% in 99)
Explain how to prevent yourself and others from developing a mental health disorder?
Aware of the signs and symptoms of addiction, depression, and anxiety and speak out to the person if situations change.
Change the idea of stigma being perfection and stressful
Medical Schools have changed:
- mental health is openly discussed
- preventive measures in place
- support options are available
Take Breaks
Recognise Symptoms
Relax
Interests outside of MED
Understand the ethical and governance issues involved in medical research
Risk must be justifiable to the patients.
The social context of medical research means it should be shared free of charge.
Scientifically Valid
Fair subject selection
- minimal risk and maximum benefit
Favourable Risk/Benefit Ratio
- uncertainty about the degree of risks and benefits associated with a treatment being tested is implicit in clinical research
Human Tissue Act 04 -
regulate the removal, storage, use and disposal of human bodies, organs and tissue
Applying a patient-centred Approach and What benefits this provides.
- Effective communications
- Non-verbal cues
- Questioning style
- empathetic
- person-centred
- Address holistic care (ICE)
Applying a patient-centred Approach and What benefits this provides.
- Effective communications
- Non-verbal cues
- Questioning style
- empathetic
- person-centred
- Address holistic care (ICE)
Possible causes of obesity
- Possible imbalance between energy intake and expenditure
- Genetic factors (obesity far more similar in twins (separated) than non-identical twins together)
1 obese parent = 40%
2 obese parents - 80%
2 Healthy BMI - 7%
Fat cell theory
- Cell number genetically determined
- Large and more cells = obese
- Can increase cells
Obesogenic Enviroment
Cost per Calorie
Advertising
- Diet and exercise play a role (could be behavioural basis (enjoy alcohol))
Describe current evidence-based interventions for preventing and managing obesity
Public Health Recommendations
- Dietary standard
- Balanced diet
- Physical activity
Improved weight loss programmes through GP
ENding promotions of high fat, salt, and sugar products in-store or online
Calorie labelling
Treatment
- Behavioural interventions
(lifestyle interventions or behavioural therapy)
Lose 10.7kg in 30 weeks - Pharmacology
- Surgery
- gastric banding
- Vertical banded gastroplasty
- Gastric bypass
However, the patient loses an average 3.5kg and maintain it for 3 years.
Describe the physical, psychological and social consequences of obesity
The risk of death is massively increased
6x of hypertension 85% increased asthmatic risk 4x arthritis Risk of all cancers Colon cancer (93% increase) 6x depression
High BMI is more predictive of death from Cardiovascular disease (men)
Socially
- unattractive
- employees are less willing to take obese people on
- lower college attendance
Models of eating behaviour
Developmental Model of Eating Behaviour
Exposure
- People show neophobia but this reduces after exposure
Social learning
- Importance of modelling and observation
- Parental feeding styles and practices are important!
Association
- Food as the reward
- Food and control- overt & covert differ
Cognitive Model
Beleifs + Percived Behavioural Norm, Subjective Norm + Attitude - Intention - Behaviour
Weight Concern and Body dissatisfaction
- Food being contrived as attractiveness, control and success
- Body dissatisfaction related to dieting too
Demonstrate the clinical importance of the bio-psycho-social approach
Biopsychosocial Approach
- recognises social patterns, psychological and social factors and a patient-centred approach to the individual.
- the wider focus on healthcare
What are the 3 levels of health and Dahlgren and Whitehead model
Micro - lived experence
Macro - explanations for the social structuring of patterns of health and disease found in Population Health
Health - more than the absence of illness
Dahlgren and Whitehead’s (1991) model of social determinants of health
- differences in disease progress
- effectiveness of treatment
Difference between Felt and Enacted Stigma
Felt Stigma - when your disability makes you feel socially rejected, shame
Enacted stigma - perceived act i.e job interviewer views you poorly
Enacted Stigma
The social stigma that results from the attaching of a disease label
Societal reactions which may produce actual discriminatory experiences
Felt Stigma
Result in an imagined social reaction or internalised sense of blame regarding the health condition which can drastically change a person’s self-identity
Describe the main findings of sociological research that have examined the constituents of lay health beliefs
- Sociological research on lay health perspectives focuses on the socio-cultural meanings that underpin how people comprehend their experience of health and illness.
- This research has shown us that individuals do know what affects their health but are
restricted by the material means through which they can act on this information. - The two key models of lay beliefs are the health as functional capacity and health as
disease candidacy models.
What is ‘health as functional capacity’ model?
The health as the functional capacity model is a conceptualisation of
health as the ability to function ‘normally’ within society. Health is the absence of disease.
This is indicated by: 1) being able to fulfil social and work roles; 2)
not taking time off work as a result of disease, and 3) sustaining a
positive mindset and being able to cope, despite physical illness.
What is the ‘health as disease candidacy’ model?
- The health as disease candidacy model reflects lay
explanations of both the relative risk of disease and the
relative efficacy of preventive health behaviours. - This model is indicated by: 1) a retrospective assessment of
one’s a propensity for disease based on characteristics such as
physical appearance and behaviours; - 2) the idea that the occurrence of the disease is attributed to a
purpose, beyond conventional logic.
Explain the relationship between lay health beliefs and patient compliance with clinical treatment
This in large reflects the willingness of Drs to engage with and not be dismissive of patients’ own health beliefs about disease risk and causality
The consultation process in Dr and patient agree therapeutic decisions that incorporate their respective views but now includes patient support in medicine taking as well as prescribing communication
Sensitivity to cultural differences
Culture relates to social class and generational differences
Describe the key feature of ‘help-seeking’ behaviour
Perception of Symptoms
Accommodation to Symptoms
Breakdown of Accommodation
- Inter-personal crisis
- Perceived interference with work activities
- Percied interference with social activities
- Others (wife)
- Symptoms persist past the time set by the patient
The decision to seek help
- Lay referral system
- GP
- Self-medication
A person’s response to symptoms of illness depends on their cultural values and beliefs concerning health
(what is ‘normal’)
. The decision to seek professional medical help is either promoted or delayed by social factors- lay referral system
- Access to information online has extended the lay referral system
Achieve a critical understanding of the notion of ‘risk’ in the context of health promotion and disease prevention strategies
Risk - bad outcome occurring in relation to some event or behaviour
Risk - social construct, quite different perceptions of what is a health risk by the public and clinicians
Assessments of risk is routinely practised , i.e fall risks, risk of disease.
In health prevention - based on an aggregation of statistical probabilities of a set of actions linked to disease outcome
What is the risk society thesis?
- It is the perspective that the hazardous environmental costs of
industrialisation (e.g., carbon emissions) now outweighs the
benefits and that technological ‘advancement’ is leading the
world to environmental disaster - Through this theory, the risk becomes a category of societal fear,
forcing people to confront the possibility of an uncertain future,
and a present in which the objects of risk are perceived to
penetrate all aspects of modern society. - It is this fear and uncertainty that risk assessment and management strategies are responding to.
- A consequence of the risk society theory is that perception of risk begin to become highly selective – e.g., peanut allergy
- Secondly, the thesis is used as a diversion away from individual
willingness to limit health-risk behaviours; that is, since there are much greater levels of risk embedded within society, changes at the individual level seem pointless.
What is the social construction of risk theory? + Latent and Extra-rational risk.
- The social construction of risk theory acknowledges risk as a
social construct, subjective in nature, and influenced by sociocultural environments. - The premise of the social construction: we create this shared value system in which we attribute meaning to familiar
phenomena, in the midst of a background of social anxieties and uncertainties. - In this way, we routinely engage in risky behaviours (e.g., drinking, smoking, unprotected sex) without consideration or
calculation of the actual risks posed (e.g., liver disease, cancer). - This can be explained by sociological research, which has shown that lay people tend to translate epidemiological
analyses of risk into all-or-nothing messages. - As a result, preventative healthcare strategies face a challenge, since these all-or-nothing interpretations do not
represent culturally-meaning knowledge – hence, the persistence of risky behaviours in the face of such strategies.
Latent risk= to potential risks that are present but not immediately apparent or recognized.
Extra-rational risk= to risks that are driven by factors beyond rational decision-making or traditional risk assessment methods.
Outline the relationship that exists between changing social patterns of consumption, cultural lifestyles, and the increasing levels of obesity in society
CAPBESP
Food Consumption
- Consumes large portion sizes
Individual Activity
- passive entertainment, parental worry (no going gout), less focus on exercise in school
Food Preparation
- longer working hours (less preparation time)
Individual Biology
- slow metabolism
Activity Environment
- greater urbanisation reduces the opportunity for physical activity
Cultural.Social Factors
- rising demand for convenience food
- Processed food is cheaper
- Media influences choice
- Social acceptance of obesity
Individual Psychology
- eat until full
Cultural Shift into having less money and inflation increasing
Working-Class Mothers - cheaper food
Middle-Class Mothers - veg and diversity in meal
Socio-economic factors play the biggest role
- Family meals vs light grazing of food
Outline the social trends in the incidence of chronic illness
- characteristically older age
- Decline in mortality after the 19th Centruy
- Rising Life Expectancy after WW2
- Degenerative disorders have progressively increased as medicine improves.
26 million in the UK have 1 LTC
10 million have 2 LTC
8 million have 3+ LTCs
EQ-5D (Quality of life, health measurement)
QL of LTC is much lower than without but has a relation to social and financial factors.
Identify the ways in which a disease label impacts the everyday social life of a person living with a chronic illness
Crisis Approach (Labelling Theory)
Doctor Labels Impairment/Disability
Focuses on the societal reaction to living with a chronic illness (how other people react to your changing status)
The label is attached and you cannot remove the diagnosis of chronic illness that irreversibly changes the status of the person
Illness is a deviation (primary deviance) from the norm of health.
After labelling, there is a behaviour change in response to changing status (secondary deviance). MS carries social meanings and implications. Changes to conform to these social meanings occur this is the secondary deviance.
The label changes the way the person thinks about themselves and how they act. Altering the person’s self-regard and hence the degree of social participation.
Basically a self-fulfilling prophecy
Restriction of activities + social role Negative labelling (enacted stigma) -- NEGATIVE SOCIAL VIEWS INFLUENCE Low self Esteem (felt stigma) Isolation and Withdrawn Lack of confidence and skills
CYCLIC
Biological Disruption
- over time chronic illness cause one to lose their self-identity ina s struggle to maintain normality.
- the uncertainty of the nature of pre-existing relationships within familiar environments such as home or work
- relationships challenges as you are left to renegotiate the meaning they can place on certain relationships who offer care)
This is known as coping but obviously differs for each person.
Be aware of the issues around accurately determining cause of death
When anaphylaxis is involved it begins to muddle the cause of death:
- cardio-respiratory arrest
- intubation required ASAP
But unknown factors could be related to asthma or COPD
Identify the different layers of the clinical iceberg of a condition
Death (routine mortality stats - ONS)
Inpatient (routine admissions stats - NHS)
Primary Care (GP data, RCOGP)
Prevalence of Symptoms (Public Health - national surveys)
Asymptomatic (Census ONS)
Describe the key design features of clinical trials (random allocation, control group, blinding) and explain why they are important
Random Allocation - eliminates allocation bias, minimises confounding and facilitates blinding
Placebo/Control groups - ensure blinding, minimises assessor and response bias, minimises dropouts
Sampling minimised selection bias or sampling bias.
Blinding - enables comparison and assessors to be non-bias (reduces response bias) and fishing
Single Blinding of Assessors
- Removes/minimises selection and assessor biases
Blinding of Participants
- Removes selection bias, response bias
Observational Studies vs Experimental Studies
Observational Studies (observing no interference)
- Cross-sectional study
- Case-control study
- Control longitudinal study
Experimental Studies (interference)
- Clinical Trial Study
- Randomized controlled trial
Discuss the pros and cons of Randomised Controlled Trials
Pros:
- reflects causal relationships OR random error BUT not due to bias
- elimination of bias
- facilitates blinding
Cons:
- expensive in large samples
- loss of participants over time
Parallel Group Design vs Cross Over Design
Parallel Group - both groups undergo 1 interference thus parallel
1 Control group and 1 intervention group
Crossover Groups - both groups undergo the control and 1 interference
Pros:
- fewer patients required
- more comparisons derived
Cons:
- disease may to be stable
- not useful for Long Term effects
- could be more drop outs
Discuss definitions of:
Stress Stressors Stress Responses Strain Acute Chronic Traumatic Non-traumatic
Stress - situation the average person would approve as threatening and exceeding their ability to cope)
Stressors - external events that may cause stress
Stress Reponses - behavioural, emotional, cognitive, physiological response to stress
Strain - effect of stress on a person
Acute = rat Chonric = less libdo
Traumatic Stress - real physical threat or injury or death
Non - Tramatic Stress -threat to social self, self identity, confidence, bereavement
describe the general adaptation syndrome (GAS) and cons
Response to stress
- Alarm - flight/fight
- Resistance - defence or adapt as body deals with stress
- Exhaustion - physiological resources are low, disease and death are more likely
Disadvantages:
- assumes stress of equal magnitude
- assumes automatic response to external stressor
- respond similar to some stresors
- cognitive knowledge of information (convict escaped, patient A hear B did not. A is more scared when loud noises)
Life events model of stress including strengths and weaknesses of these models
Life Change Model
Life Change Model
- accumulation of life events is too much
- Starts to impact health
- events given numerical value and added up
- if results are high then this predisposes them to conditions
Strengths
- quantitiave
- all along the same gradient in weight
- takes individual note of events rather
- accounts for accumulation stress
Weaknesses
- all same magnitude
- people respond the same to similar stressors
- not all events are bad (divorce)
- assumes no recall bias
Transactional model of stress including strengths and weaknesses of these models
Stress viewed a dynmaic series of transactions between individual and environment
- stress is a perception of events
- appraise stressor
- adopt coping strategy
- re-appraise enlight of strategy
Primary Appraisal
- assessment of the stressor itself and the demands it makes
- how important is it? Cost? Benefits? (assessment of stressor)
Secondary Appraisal
- internal appraisal (perceived individual resources to cope)
- individual assessment of perceived resources required to cope
Re-appraisal - evaluate how well coping strategies work
Strengths
- Lay referral system is a massive part of medicine
- Personalises healthcare
- Doesn’t maintain similar magnitude
- Indivudal cases
Weaknesses
- doesn’t account for sudden stressors
- people response same wat
- pre-exisitng factors don’t influence appraisal
- response not always dependent on appraisal
Coping Mechanism
Probelm Focused - stressor itself
Behavioural
- attept to control
- escape
- info seeking
- problem solving
Cognitive
- ositive reappraisal
- over-generalising
Emotional Focus - emotional reaction
Behavioural
- seeking support
- alcohol, smoking
- exercise
- distraction
Cognitive
- emotional expression
- repression
- denial
Define work stress and job strain and job decision latitude
Work Stress - objective, subjective factors in work relationships that generaqte stress reactions
Job Strain - high job demands, low job control
High Levels of Work Stress
- associated with sick leave, Cardiovascular disease + Depression and Anxiety
Job Decision Latitude
- authority and skill in your position
Demand - Control - Support Model (DCS) What is it? Pros Cons Draw
Proposes that job stress occurs when:
- High job demand
- Low job control
- Low social support (colleague, bosses)
Pros:
- quantitiative data (correlates psychological well-being and physical health)
Cons:
- social factors treated as e all end all (someone enjopys high demand)
- no mention of perception, cognition or reflection
Explain why an intention-to-treat analysis is used and how it differs from a per-protocol analysis
Intention to Treat
- analysis on the basis of randomisation to preserve non-bias
- likely to underestimate effect of intervention (as includes non-compliance)
- treatment polic rather than specific effect
Per Protocol
- caries out the analysis on the basis of treatment being take (compliance)
- less likely to underestimate effect of intervention
- may be BIAs (no. and determinants of dropouts)
- subsidory analysis
Interpret relative risk and absolute risk differences in treatment effects and how to estimate number needed to treat
Relative RIsk - ratio of absoulte risk of exposed/unexposed
Absolute Risk - a measure of the risk of a certain event occurring
Number Needed to Treat - is the number of patients you need to treat to prevent one additional bad outcome
Risk Ratio (intervention) = Certain Event/TOTAL Risk Ratio (placebo) = Certian Event/TOTAL
Risk Ratio (intervention) -------------------------------------- = Relative Risk Risk Ratio (placebo)
Risk Differences (Absolute) = Risk Ratio (intervention) - RIsk Ratio (placebo) = -/+ Ve
Intervention reduces certain event by - (- Ve)
Intervention increased certain event by (+Ve)
Number Needed to Treat = 1/Absolute Risk
= Patients
Define epidemiology and public health and their objectives
Epidemiology
- the study o the distrubition and determinants of disease frequency in human populations and the application of this study to control health problems
Objectives:
- study the natural history
- identify patterns
- extent of disease
- causes and prevention
Public Health
- the science and art of preventing disease, prolonging life and promoting health through organsied efforts of society
Objectives
- promoting health in population
- focus on prevention tactics and strategies (reduces alcohol consumption)
Recall differences in medicine practiced on individuals in a clinical setting to that practiced at a population level
Public Health:
- Promotes healthier lifetsyle
- Support local authorities
- Collect, orangise, anaylse ad improve on data
- Target and focus on inequalities present in out healthcare system and society
Describe the rate of a health outcome in general terms
Health Outcomes (changes in health status of an individual or group)
- Determines the impact of the process of care or intervention
- must be valid and responsive (well detailed)
Define risk factor, attributable risk, relative risk, confounding and incidence rate?
Risk Factor
- aspect of personal lifestyle/genetics associated with a disease
Attributable Risk
- extra risk due to exposure
Relative Risk
- ratio of absolute rate of exposed/unexposed
Confounding
- associatedwith risk factor without being a consequence or associated with the disease indepently of risk factor
Incidence Rate
- total new occurrences during follow up at risk
Define incidence and prevalence, and explain the difference between these measures
Incidence
- new cases of disease that develop in a certain time interval (Royal College of GP) Primary Care basis
Prevelance
- Current cases
(NHS in hospital, general admission stats)
Identify and describe different types of medical data measured on individuals
VTE - Venous Thrombembolsion (DVT and PE) (1 every 37s in West dies)
Numerical
- weight
- BP S/D
- Prothrombin time
- Age
- No. long distance flights
- No. of cigarettes smoked
Categorical
- Smoker?
- Cancer?
- Anticoagulation medication?
- Blood Group Type
Nominal - no natural order (A, AB, B, O-)
Ordinal - natural order (1, 2, 3), (thin to fat)
Historgrams (big up the boys)
Descirbe
Normal Distrubtion
Skewness
Histograms (present data that is direclty comparitable and relative)
- large number of values to plot
- general
If data is not normally distribute use median and quartiles.
If data is normally distribute use means and SD.
If mean > median = Positive skewness
If mean < median = Negative skewness
Mean +/- SD = 68%
Mean +/- 2SD = 95%
What are the 3 equations for Standard Deviation, Variance and Standard Error
CHECK BOOK.(last page)
What are the 3 equations for Standard Deviation, Variance and Standard Error
CHECK BOOK.(last page)
Explain what is meant by hypothesis testing in statistics
Hypothesis testing is an act in statistics whereby an analyst tests an assumption regarding a population parameter
To write a null hypothesis, first start by asking a question. Rephrase that question in a form that assumes no relationship between the variables. In other words, assume a treatment has no effect. Write your hypothesis in a way that reflects this.
Interpret p-values from statistical significance tests
The smaller the p-value, the stronger the evidence that you should reject the null hypothesis. A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. It indicates strong evidence against the null hypothesis, as there is less than a 5% probability the null is correct
Contrast what p-values and confidence intervals represent when comparing treatment effects
● A confidence interval calculated for a measure of treatment effect
shows the range within which the true treatment effect is likely to lie
A p-value is calculated to assess whether trial results are likely to have
occurred simply through chance
Confidence intervals are preferable to p-values, as they tell us the range
of possible effect sizes compatible with the data.
● p-values simply provide a cut-off beyond which we assert that the
findings are ‘statistically significant’
Standard Error what happens to SE as N increases
Becomes smaller as sample size increases.
Explain how the interpretation for a confidence interval differs between ratio and absolute differences
Does the interval contain the value that implies no change / no effect / no association?
- If the confidence interval is for a ratio measure, look to see if the interval contains 1.0
- If the confidence interval is for a measure of absolute change/difference look to see
whether that interval includes zero
- Is the confidence interval wide or narrow?
- If it is narrow then the results are precise
- If its wide then the results are imprecise
- What are the upper and lower limits? (This ties in with clinical implications of any potential
effect)
Explain how the interpretation for a confidence interval differs between ratio and absolute differences
Does the interval contain the value that implies no change / no effect / no association?
- If the confidence interval is for a ratio measure, look to see if the interval contains 1.0
- If the confidence interval is for a measure of absolute change/difference look to see
whether that interval includes zero
- Is the confidence interval wide or narrow?
- If it is narrow then the results are precise
- If its wide then the results are imprecise
- What are the upper and lower limits? (This ties in with clinical implications of any potential
effect)
Management of a Soft Tissue Injury
P—protection of the injured area
R—resting the injured area
I—ice or other cold compress to the injured area
C—compression to the injured area, not tight
E—elevation of the injured area.
Epiderimology of Blood Pressure
Blood Pressure
◦ Higher BP strongly associated with increased risk of CVD
◦ Statistical phenomenon of regression to the mean and accommodation means that BP
lowers with repeated measurements
◦ With complications of HTN, risk of CVD rises seven-fold
◦ Prevalence of HTN increases with age and is more common in men
◦ Risk Factors: ↑BMI, ↑alcohol, ↑salt, ↑diet, ↓potassium, physical inactivity
◦ Low BP Populations: Hunter-gathers, ↓fat, ↓salt, ↓alcohol, ↓BMI, physical activity
◦ Causes of Secondary HTN: Aortic coarctation, renal disease, renal vascular disease,
adrenal disease, pregnancy, drugs
Epidimeology of VTE
VTE
◦ Incidence of ~1/100 per year, strong association with age
◦ Prognosis – 28-day mortality in 10% DVT and 15-20% PE
◦ VTE association with flying may be causal
◦ Not explained by confounding, consistent in different study types, dose-response relationship,
biologically plausible
◦ Relative risk of flying is constant (~4x)
◦ Factors influencing baseline VTE risk: Age, pre-existing illness, recent recovery from surgery/
trauma, pregnancy smoking, obesity, oral contraceptives/HRT, inherited thrombophilia
Epidemeology of Coronary Heart Disease
Coronary Heart Disease
◦ Major global health problem, ~9mil deaths/year worldwide
◦ Major causes: Smoking, HTN, hyperlipidaemia (↑risk with each)
◦ Prevention is mainly achieved by reducing exposure/ altering pathogenesis
◦ Secondary prevention: Smoking cessation, dietary changes, risk-reducing medication
◦ Statins, B-blockers, ACE-inhibitors, anti-platelets (Combo = 70% risk reduction)
◦ Strong evidence that anti-platelets reduce relative risk by ~25%
◦ Not used for low-risk as side effects outweigh benefits
◦ Challenges to control – Strengthen population based strategies, increasing risks of
obesity and T2DM, understanding social/ethical differences, rising epidemic in low
income countries
Define the term `climate crisis’ and explain how the climate crisis is a health crisis
The climate crisis is a health crisis because the changing climate has numerous impacts on human health. For example:
Air quality: As temperatures rise, air pollution worsens, leading to increased rates of respiratory illness such as asthma and bronchitis.
Extreme weather events: Climate change is causing more frequent and severe weather events, such as hurricanes, floods, and wildfires, which can cause injuries, displacement, and loss of life.
Food and water insecurity: Changes in rainfall patterns and rising temperatures can lead to crop failures, water scarcity, and malnutrition.
Spread of disease: Climate change is increasing the range and activity of disease-carrying insects such as mosquitoes and ticks, leading to the spread of diseases such as Lyme disease, dengue fever, and malaria.
Mental health: The stress and trauma caused by climate change-related disasters and displacement can lead to mental health issues such as depression and anxiety.
Outline the importance of sustainable health care and its basic principles
Reduce environmental impact: Sustainable healthcare seeks to reduce the environmental impact of healthcare activities, such as energy use, waste generation, and water consumption. This can be achieved through the use of renewable energy, waste reduction and recycling, and the use of environmentally friendly materials.
Promote social equity: Sustainable healthcare aims to promote social equity by ensuring that all individuals have access to quality healthcare regardless of their socio-economic status. This can be achieved through policies that reduce healthcare disparities and improve access to healthcare services for marginalized populations.
Enhance public health: Sustainable healthcare seeks to enhance public health by promoting prevention and healthy lifestyles, reducing exposure to environmental toxins, and improving healthcare quality.
Promote economic viability: Sustainable healthcare aims to promote economic viability by reducing healthcare costs and improving the efficiency of healthcare delivery.
Foster collaboration: Sustainable healthcare recognizes that addressing complex health and environmental challenges requires collaboration across sectors and disciplines. Therefore, it seeks to foster collaboration between healthcare providers, policymakers, researchers, and community stakeholders.
Describe specific examples of sustainable medical care practice which can contribute to the achievement of net zero health care
Energy efficiency: Healthcare facilities can reduce their energy use and carbon emissions by adopting energy-efficient practices such as using LED lighting, implementing HVAC systems that reduce energy consumption, and upgrading to energy-efficient medical equipment.
Renewable energy: Healthcare facilities can transition to renewable energy sources such as solar, wind, and geothermal to reduce their reliance on fossil fuels and reduce their carbon footprint.
Waste reduction: Healthcare facilities can reduce their waste by implementing recycling programs and composting food waste. Medical equipment and devices can be reused or recycled instead of being disposed of after a single use.
Sustainable transportation: Healthcare providers can use public transportation, walk, or bike to work instead of driving to reduce their carbon footprint. Additionally, healthcare facilities can encourage their patients and visitors to use public transportation or carpool to reduce the number of cars on the road.
Sustainable food practices: Healthcare facilities can promote sustainable food practices by serving locally sourced, organic, and plant-based food options, which have a lower carbon footprint compared to meat-based products.
Green building design: Healthcare facilities can adopt green building practices such as green roofs, rainwater harvesting, and natural ventilation systems, which can reduce energy consumption and improve indoor air quality.
Changing patterns of illness
1900’s and before - infectious diseases or war were the main cause
of death (acute conditions such as TB and pneumonia)
1960s - degenerative diseases main cause of death (chronic
conditions)
1990s - new infectious disease main cause of premature death
Today : contageous diseases and infections contribute
minimally to illness and death in the Western World
most deaths are caused by heart disease, cancer and
strokes, diseases which studies suggest are a by-
product of lifestyle
WHO (2004) - 65% of the world’s population live in countries where
overweight and obesity kills more people than underweight
