Public Health Flashcards
Hospital autopsy
- Less than 10% in the UK - Requires medical certificate of cause of death (MCCD) - Used for audit, teaching, research and governance
Medico-legal autopsy
- > 90% in the UK - Coronial autopsy - death is not due to unlawful action - Forensic autopsy - unlawful (eg: murder)
What percentage of deaths are referred to the coroner?
- About 40% - But they only choose to investigate about 10%
Deaths referred to coroner
Presumed natural - Presumed iatrogenic - Presumed unnatural
Presumed natural death
- Not seen by a doctor in the last 14 days - Unknown cause
Presumed iatrogenic death
Peri/postoperative deaths - Anaesthetic deaths - Abortions - Complications of therapy
Presumed unnatural death
Accidents - Industrial death - Suicide - Unlawful killing - Neglect - Custody deaths
Who carries out an autopsy?
A doctor (pathologist)
Who can refer to autopsy
Doctors - Registrar of BDM (statuatory duty to refer) - Relatives - Police - Anatomical pathology technicians
What 4 questions do coronial autopsies aim to answer?
Who was the deceased? - When did they die? - Where did they die? - How did they come About their death?
Steps of autopsy
External examination - Evisceration - Internal examination
Autopsy external examination
Identification: formal identifiers, gender, age, body habitus, jewellery, body modifications, clothing - Disease and treatment - Injuries
Autopsy evisceration
Y-shaped incision - Open all body cavities - Examine all organs in situ - Remove thoracic and abdominal organs - Remove brain
Autopsy internal examination
Heart and great vessels - Lungs trachea, bronchi - Liver, gallbladder, pancreas - Spleen, thymus and lymph nodes - Genitourinaty tract - Endocrine organs - CNS
How many healthcare associated infections are in England every year? And how many deaths are due to healthcare associated infections
- About 300,000 (9% of patients) - 20,000 deaths
The Health Act 2006 on infection control
Infection control is every health care workers responsibility - the possibility of health care related infections should be considered in all aspects of patient management
What percentage of healthcare workers are estimated to get infected at work?
75%
Bacteria to consider in infection control
MRSA - C.difficile - Multi-drug resistant gram negatives - Glycopeptide resistant enterococci - Group a strep - Mycobacterium tuberculosis
Viruses to consider in infection control
- Influenza - Norovirus - SARS-CoV-2 - HIV - Hep B + C - Varicella Zoster Virus - Viral haemorrhagic fevers
Other things to consider in infection control
Candida auris (a fungus) - Creutzfeldt-Jakob Disease
How do we prevent and control infections?
- Identify risks (both patients/staff and the environment) - Ensure staff are aware of the risks and what to do - Develop strategies to reduce risks - Policy development - Audit
Ways to identify risk of infectous disease
Look at risk factors (eg: going abroad to a particular country) - Screening - Clinical diagnosis - Lab diagnosis
Why is diabetes a public health issue?
Mortality - Disability - Co-morbidity - Reduced quality of life - Preventable but increasing in prevelance
How can we reduce the impact of T2DM?
Identify those at risk - Prevention - Diagnose earlier - Effective management and supporting self-management
Lifestyle and environmental factors that increase risk of diabetes?
Sedentary job and leisure activities - Diet high in calories, low in fruits, vegetables, pulses and wholegrains - Obesogenic environment
Obesogenic environment
Physical: TV remotes, lifts, car culture - Economic: Cheap TV, expensive fruit and veg - Sociocultural environment: Safety fears, family eating patterns