Public Health Flashcards

Question

Materialist theory

Answer 1

Focuses on the socioeconomic factors, resources, and material conditions that contribute to health disparities.

Answer 2

The Lifecourse theory explains how adverse health events occur more frequently in those individuals who have already had critical periods of ill health in their life.

Answer 3

The psychosocial theory focuses on how individual and social factors, including psychological well-being, social support, and cultural factors, play a significant role in shaping health

Answer 4

Equal treatment for equal need e.g. individuals with pneumonia should all be treated equally

Answer 5

unequal treatment for unequal need e.g. patients with the cold and pneumonia should be treated differently

Answer 6

Equity: What is fair and just Equality: Everyone has equal share

Answer 7

Black Report showed that socioeconomic factors affected health (mortality, life expectancy, chronic illness) Explanations for the inequalities: (hypothesises why) Artefact: data inaccuracies Health or social selection: people in poor health moved down the social hierarchy (less support) Materialist/structuralist: role of income, housing, education, and working conditions Cultural/behavioural: lifestyle choices

Answer 8

systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities.

Answer 9

Need = ability to benefit from an intervention Demand =what people ask for Supply = what we actually provide - Felt need – individual perceptions of variation form normal health - Expressed need – individual seeks helps to overcome variation in normal health (demand) - Normative need – professional defines intervention appropriate for the expressed need - Comparative need – comparison between severity, range of interventions and cost

Answer 10

Epidemiological, Corporate, Comparative

Answer 11

Considers the epidemiology of the condition, current service provision, and the effectiveness and cost-effectiveness of interventions and services - Disease incidence and prevalence - Morbidity & mortality - Life expectancy - Data is from: disease registry, hospital admissions, GP databases, mortality data, primary data collection

Answer 12

Advantages - Uses existing data - Provides data on disease incidence/mortality/morbidity etc - Can evaluate services by trends over time Disadvantages - Quality of data variable - Data collected may not be the data required - Does not consider the felt needs or opinions/experiences of the people affected

Answer 13

- Asking the local population what their health needs are - Use of focus groups, interviews and public meetings - Wide variety of stakeholder e.g. teachers, healthcare professionals, social workers, charity works, local businesses, council workers and politicians

Answer 14

Advantages - Based on the felt and expressed needs of the population in question - Recognises the detailed knowledge and experience of those working with the population - Takes into account wide range of views Disadvantages - Difficult to distinguish ‘need’ from ‘demand’ - Groups may have vested interests "stakeholder bias" - May be influenced by political agendas

Answer 15

- Compare the needs/provision of healthcare in one population with another - Can be spatial (e.g. different towns) or social (e.g. two age groups in the same town)

Answer 16

Advantages: - Quick and cheap if data available - Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance) Disadvantages: - May be difficult to find comparable population - Data may not be available/high quality - May not yield what the most appropriate level (e.g. of provision or utilisation) should be

Answer 17

(down to up) PSLES - Physiological: breathe, food, water, sleep, poo - Safety: employment, health, property - Love/Belonging: family, friends, sex - Esteem: self esteem, confidence, respect - Self-actualisation: (reach full potential) creative, problem solving, morality

Answer 18

Egalitarian, Maximising, Liberatarian

Answer 19

Provide all care that is necessary and required for everyone (A: equal/fair, D: economically restricted)

Answer 20

Based solely on consequences (A: resources allocated to most in need people, D: those with less need get nothing)

Answer 21

Each individual is responsible for their own health (A: patient may be more engaged since its their own responsibility, D: not all diseases are self-inflicted)

Answer 22

assessment of whether a service achieves its objectives

Answer 23

- Structure - what actually is the service, examine the provision of facilities and staff available e.g. how many heart surgeons there are/number of hospital beds - Process – how does the process work, what is done for and to a patient or a population, and how well, eg. time taken from diagnosis to treatment - Outcome – 5 Ds = death, disease, disability, discomfort, dissatisfaction/ QOL, complications, reccurence

Answer 24

Denominator: The total population eligible for a specific process (e.g., all patients diagnosed with a particular condition). Numerator: The subset of this population that received the treatment within the recommended time frame.

Answer 25

▪ Link between health service and health outcome can be difficult to confirm ▪ Time lag between service and outcome may be long ▪ Large sample sizes may be needed ▪ Data may not be available or have a problem with it (CART = completeness, accuracy, relevance, timeliness)

Answer 26

(3Es and 3As) - Effectiveness - Efficiency - Equity - Acceptability - Accessibility - Appropriateness

Answer 27

Ties Maxwell’s dimensions and Donbedian approach together Eg. structure + accessibility = pushchair access process + effectiveness = only efficient tests included

Answer 28

The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.

Answer 29

Number of new cases in a population in period of time Incidence = (number of new cases) / (number of people x time period)

Answer 30

Number of existing cases in a population at a point in time Prevalence = (Incidence) x (disease duration)

Answer 31

Rate of disease in the exposed that may be attributed to exposure incidence in exposed minus incidence in unexposed. Example: - Incidence of cancer in smokers, 1/1000 person-years - Incidence of cancer in non-smokers, 0.05/1000 person-years -- Attributable risk = 0.95/1000 person-years (difference) -- Relative risk = 20 (ratio, no units)

Answer 32

Ratio of risk of disease in the exposed relative to the risk in the unexposed, has no units (is a ratio) RR = (incidence in exposed/ incidence in unexposed) Relative Risk Reduction = (1 - Relative Risk)

Answer 33

Absolute risk aka incidence (eg. 4 per 1000 people per year): Likelihood of a particular event occurring in a specific population over a defined period, has units Absolute Risk Reduction (ARR) = (Incidence in Placebo - Incidence in Treatment) Numbers needed to treat = (1/ARR)

Answer 34

68.3% of values lie within 1 SD of the mean 95.4% of values lie within 2 SD of the mean 99.7% of values lie within 3 SD of the mean

Answer 35

a systemic deviation from the true estimation of the associated between exposure and outcome (it is an example of a systematic error) Selection Information: Report/Recall/Measurement/Observer Attrition Allocation Publication Lead time Length time

Answer 36

error in selection and allocation of participants

Answer 37

* Measurement (e.g. different equipment used to measure the outcome in the different groups) * Observer (e.g. the researcher knows which participants are cases and which are controls and subconsciously reports/measures the exposure or outcome differently depending on which group they are in)- expectation bias/Pygmalion effect * Recall (e.g. events that happened in the past are not remembered and reported accurately) * Reporting (e.g. respondents report inaccurate information because they are embarrassed or feel judged)

Answer 38

participants are removed from the study after withdrawing from it or becoming uncontactable.

Answer 39

different participants in different groups (no equal spread)

Answer 40

Trials with negative results are less likely to be published

Answer 41

When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time, even if screening has no effect on outcome

Answer 42

Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method

Answer 43

Situation where a factor is associated with the exposure of interest and independently influences the outcome but does not lie on the causal pathway e.g. lack of exercise causes weight gain but there are many confounding variables that also effect weight gain Stratification can reduce this (analysing data after separating participants into subgroups according to confounders of interest)

Answer 44

SDCTRBCAS - Strength - The strength of the association - Dose-response – does a higher exposure produce higher incidence? - Consistency – similar results in different studies and populations - Temporality – does the exposure precede the outcome - Reversibility – removing exposure reduced risk of disease - Biological plausibility – does it make sense biologically - Coherence – logical consistency with lab information e.g. incidence of lung cancer with increased smoking is consistent with lab evidence that tobacco is carcinogenic - Analogy – similarity with other established cause-effect relationships in the past e.g. thalidomide in pregnancy, not other teratogenic drugs show similar effects - Specificity – Relationship is specific to the outcome of interest e.g. introducing helmets reduced head injuries specifically, it wasn’t that there has been an overall lower injury rate

Answer 45

This refers to the situation when an association between an exposure and an outcome could be due to the outcome causing the exposure rather than the exposure causing the outcome. Reverse causality – Stress could have caused HTN rather than HTN causing stress

Answer 46

Person-time is a measure of time at risk – i.e. time from entry to a study to (i) disease onset, (ii) loss to follow-up or (iii) end of study.

Answer 47

Primordial prevention -prevent risk developing Primary prevention – Prevent problem when risks exist, trying to stop yourself getting a disease Secondary prevention – trying to detect a disease early and prevent it from getting worse Tertiary prevention – trying to improve your quality of life and reduce the symptoms of a disease you already have Quaternary prevention - prevent over treatment

Answer 48

are a preventative measure delivered on a population wide basis and seeks to shift the risk factor distribution curve

Answer 49

seeks to identify individuals that are above a chosen cut off and treat them.

Answer 50

“A preventative measure which brings much benefit to the population but offers little to each participating individual” E.g. If all male British doctors wore their car seat belts on every journey throughout their working lives, then for one life saved there would be 400 who never benefit from it.

Answer 51

- Communicable diseases - Commercially provided screening - Population-based - Opportunistic - Pre-employment and occupational medicals Examples: cervical/breast/bowel cancer, AAA, diabetic eye

Answer 52

Wilson & Jungner Purpose of screening: The purpose of screening is to identify apparently well individuals who have (or are at risk of developing) a particular disease so that you can have a real impact on the outcome

Answer 53

The Condition * Important condition * Natural history, risk factors and disease markers understood. * The disease should have a latent, detectable stage. Screening Programme * Screening should be ongoing and not just performed on a ‘one-off’ basis. * Cost-effective The Test *Simple, safe, precise & validated screening test. * The distribution of test values in the target population should be known and a suitable cut-off level defined and agreed. * The test should be acceptable (willing to do it) to the population. * There should be an agreed policy on the further diagnostic investigation of individuals with a positive test result and on the choices available to those individuals. The Treatment * There should be an effective treatment or intervention for patients identified through early detection, with evidence of early treatment leading to better outcomes than late treatment * Agreed policy on who to treat * Facilities should be available

Answer 54

* Exposure of well individuals to distressing or harmful diagnostic tests E.g. colonoscopies for those with positive faecal occult blood tests * Detection and treatment of sub-clinical disease that would never have caused any problems E.g. non-aggressive prostate cancer in elderly men * Preventive interventions that may cause harm to the individual or population E.g. the potential for increased antibiotic resistance if all mothers were screened for group B streptococcus in pregnancy (this is not currently carried out in the UK, in contrast to the USA:

Answer 55

Sensitivity – proportion of people with the disease who are correctly idenitified by screening test (a/a+c)- true positive divide by everyone who actually has the disease (true positive + false negative) Specificity – proportion of people without the disease who are correctly excluded by the screening test (d/b+d) - true negative divide by everyone who actually does not have the disease (true negative + false positive) The likelihood ratio for a negative test result is defined by how much the odds of the disease decrease when a test is negative. This is calculated by: (1-Sensitivity)/Specificity The likelihood ratio of a positive test result/how much the odds of disease increase when the test is positive: Sensitivity/(1-Specificity) 0.95/1-0.2 = 1.1875

Answer 56

Positive predictive value - the proportion of people with a positive test result who actually have the disease (a/a+b) - true positive divide by true positive + false positive Negative predictive value – proportion of people with a negative result who actually do not have the disease (d/c+d) - true negative divide by true negative + false negative IF LOWER DISEASE PREVALENCE: - PPV decreases because there are more false positives relative to true positives - NPV increases because there are more true negatives relative to false negatives. This affects counseling - in lower-risk populations, positive results need more careful interpretation while negative results are more reassuring.

Answer 57

Odds of exposure in cases = 75/25 Odds of exposure in controls = 80/20 Odds ratio: (Odds of exposure in cases) / (Odds of exposure in controls) = (75/25) / (80/20) = 0.75 Statistical Significance = CI does not contain 1 Odds ratio >1 = could be risk factor <1=protective factor =1 =no association

Answer 58

type II error= when an investigator finds no difference, even though a difference exists, ie. incorrectly accepting the null hypothesis. A type I error is when the null hypothesis is true and was wrongly rejected. The greater the p-value, the greater the chance that the null hypothesis will be rejected. With a large p-value of 0.2, there is a greater chance the null hypothesis will be rejected and a significant difference will be found. Therefore, the risk of a type I error is high. The power of the study is the ability of a study to detect a difference if a difference exists. Therefore, the power is 1 minus the probability of making a type 2 error, so is calculated as 1 – p (type 2 error). The power of a study is the ability of a study to reject the null hypothesis when it is false. It is dependent on sample size.

Answer 59

observation (ethnography) in depth interviews focus groups document review

Answer 60

Routinely collected data: e.g. hospital admissions; mortality Review of records Surveys Other special studies: e.g. epidemiological methods

Answer 61

- Human error: communication errors, judgement errors, omissions, violations - Misconduct: Deliberate harm, lack of candour, fraud/theft, inappropriate relationships - Poor performance: poor attitude, rudeness, failure to learn from mistakes - Neglect: care falls below acceptable standard

Answer 62

WHAT IS IT? - A framework for developing, testing and implementing changes leading to improvement. WHEN TO USE IT? - it is safer and more effective to test out improvements on a small scale before wholesale implementation. KEY QUESTIONS: - What are we trying to accomplish? (The aims statement). - How will we know if the change is an improvement? What measures of success will we use? -What changes can we make that will result in improvement? (The change concepts to be tested).

Answer 63

- Sample is taken from study population and split into two groups, one exposed and one not. Incidence of the disease amongst the two groups is compared. - Prospective

Answer 64

- Can follow-up a group with a rare exposure (e.g. a natural disaster) - Good for common and multiple outcomes - Less risk of selection and recall bias

Answer 65

- Takes a long time - Loss to follow up (people drop out) - Need a large sample size

Answer 66

- Groups with and without a disease are selected and past exposures are identified - Retrospective

Answer 67

- Quick - Good at looking at rare diseases and long latency diseases - Multiple exposures

Answer 68

- Selection and information bias - Impractical for rare exposures (difficult to find controls)

Answer 69

Exposure and outcome are measured simultaneous in a population at one particular time ‘snapshot’

Answer 70

- Relatively quick and cheap - Provide data on prevalence at a single point in time - Large sample size - Good for surveillance and public health planning

Answer 71

- Risk of reverse causality - Cannot measure incidence - Risk recall bias and non-response

Answer 72

Two groups – one control and one treatment which allows for comparison in order to assess the effectiveness of an intervention

Answer 73

- Low risk of bias and confounding factors - Causality (gold standard)

Answer 74

- High drop out rate - Ethical issues - Time consuming + expensive - Specific inclusion/exclusion criteria may mean the study population is different from typical patients (e.g. excluding very elderly people)

Answer 75

Investigation finds a certain correlation between two things in a population e.g. there is a high level of CHD in deprived areas.

Answer 76

Qualitative method of combining the results of independent studies which are drawn from the published literature, and synthesizing summaries and conclusions

Answer 77

Review which endeavours to consider all published and unpublished evidence of a specific question THE BEST ONE!

Answer 78

- Never inform their parents for them - Children under 13 can never consent to sex

Answer 79

- Does she understand the advice? - Has the doctor encouraged her telling the parents? - Will she have sex anyway? - Is the mental/physical health going to be effected if you don’t give it - Best interests

Answer 80

- Does a child under 16 have capacity to make own medical decisions? - Clinical judgement made by the doctor; age, capacity, maturity

Answer 81

- High mortality - High morbidity - Highly contagious - Expensive to treat - Effective interventions

Answer 82

a group of cases that might be linked e.g. scabies in a care home

Answer 83

Epidemic = more than expected incidence in a country Pandemic = more than one country Endemic = persistent level of disease occurrence Hyper-endemic = persistently high level of disease occurrence

Answer 84

- Was there a duty of care? - Was there a breach of that duty? - Was the patient harmed? - Was the harm due to the breach of care?

Answer 85

Poor performance: - below acceptable standard - communication, accessibility, taking responsibility Neglect - culture in an organisation - accepting low standards Misconduct - deliberate act, eg. theft. inappropriate relationships, deliberate harm

Answer 86

1. All staff in NHS trusts must have 24/7 access to a rapid review from a critical care outreach team, who they can contact should they have concerns about a patient. 2. All patients, their families, carers, and advocates must also have access to the same 24/7 rapid review from a critical care outreach team, which they can contact via mechanisms advertised around the hospital, and more widely if they are worried about the patient’s condition. 3. The NHS must implement a structured approach to obtain information relating to a patient’s condition directly from patients and their families at least daily. In the first instance, this will cover all inpatients in acute and specialist trusts.

Answer 87

Would a reasonable doctor do the same?

Answer 88

Would that be reasonable?

Answer 89

Falling through the holes because there are failed or absent defenses against error happening. These are called LATENT FAILURES. For catastrophic error to occur, holes need to align in each step in the process allowing all defences to be defeated and resulting in an error If layers are set up with all the holes lined up, it is an inherently flawed system that allows a problem at the beginning to progress all the way through to adversely affect the outcome

Answer 90

SELF = Poor knowledge, fatigue, little experience/skill, feeling unwell CONTEXT = distraction, poor handover, lack of team support, equipment TASK = errors, task complexity, new task, process

Answer 91

SFCPPBIMLS - Sloth = inaccurate documenting/not checking results for accuracy - Fixation/loss of perspective = focus on one diagnosis – confirmation bias - Communication breakdown = unclear plan/not listening and explaining well - Poor team working = some individuals out of depth and others underutilised - Playing the odds = choosing the common and dismissing the rare - Bravado/timidity = working beyond competence/not having confidence to object - Ignorance = lack of knowledge (can be conscious or unconscious incompetence) - Mistriage = over or under-estimating the severity of the situation - Lack of skill = not having appropriate skills/training/practice - System error = environmental/technological/equipment failure

Answer 92

- A serious, largely preventable patient safety incident that should not occur if available, preventative measures have been implemented - Examples: wrong site for surgery, wrong drug given, escape of psychiatry patient - Report to: Care Quality Commission and NHS Improvement

Answer 93

- Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment causes, or has the potential to cause, harm or distress.

Answer 94

The availability of good medical care tends to vary inversely with the need for it within a population.

Answer 95

● Law ● Codes of ethics ● Religious or cultural beliefs ● Personal conscience

Answer 96

● Top down deductive, where one specific ethical theory is consistently applied to each problem ● Bottom up inductive, using past medical problems to create guides to practice

Answer 97

a patient should be provided with enough information and support to make their own informed decision about their healthcare, and this decision should be respected

Answer 98

The duty of acting in the patient's best interest to benefit their health

Answer 99

the duty to prevent, reduce and do no harm

Answer 100

This principle relates to the fair and equal distribution and access to healthcare resources.

Answer 101

An act is evaluated solely in terms of its consequences. It acts to maximise good e.g. killing one to save many.

Answer 102

Focuses on adherence to duty, rules, and moral principles rather than on the consequences of actions

Answer 103

These focus on the character of the person, integrating reason and emotion. An action can be virtuous only if it is performed by a person in the right state of mind (i.e. genuinely intending to do the right thing). The five focal virtues are: CDTIC ● Compassion ● Discernment ● Trustworthiness ● Integrity ● Conscientiousness

Answer 104

individual liberty can be justifiably restricted if one's actions harm others

Answer 105

an ethical principle that states that an action can be morally acceptable if it has both good and bad consequences, as long as the bad outcome was not intended

Answer 106

A procedure in law where it is necessary to deprive a patient of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm, lasts 12 months

Answer 107

CONDITIONS TO BE MET (ALL) - >18 - suffering from mental disorder - in hospital or care home - lacks capacity to decide for themselves - whether the person should be instead considered for detention under MHA - restriction would deprive the person of their liberty - restriction would be in the person’s best interests - they do not have a valid advance decision made that would be overriden - if the LPA agrees

Answer 108

MAIN PRINCIPLES (5) - Every adult is assumed to have capacity unless proven otherwise - Don’t treat someone as lacking capacity unless all practicable steps to help him to do so have been taken without success - Don’t treat someone as lacking capacity cuz of an unwise decision - All acts/ decisions/ Tx done under the act must be done in their best interests - Ensure all acts/ decisions made for them are effectively achieved in the least restrictive way possible

Answer 109

ASSESSMENT OF CAPACITY - Is decision and time specific An adult is lacking capacity if: 1. They have an impairment of or disturbance in the functioning of the mind or brain whether permanent or temporary AND 2. They are unable to do any of the following - Understand info for the decision - Retain the info - Use the info to make the decision - Communicate the decision they made

Answer 110

CONSIDER: - Whether the person is likely to regain capacity and the decision can wait - How to encourage and optimise the participation of the person in the decision - The past and present wishes, feelings, beliefs and values of the person and any other relevant factors - Views of other relevant people

Answer 111

- Legal document that lets ppl appoint one or more ppl to help make decisions on their behalf - For when ppl get into accidents or illness (lack mental capacity) - Health and welfare/ property and financial affairs

Answer 112

Advance care planning offers people the opportunity to plan their future care and support, including medical treatment, while they have the capacity to do so.

Answer 113

- Medical decision made by pt with capacity regarding their future wishes for treatment - Only comes into force if the pt subsequently lacks capacity - Can be used to refuse treatment eg. CPR, abx, ventilation, blood transfusion, etc. - Legally binding document as long as it complies with Mental Capacity Act, applies to situation and is valid

Answer 114

ACP: eg. respect form, a process that guarantees the respect of the patient’s values and priorities about future care at the end of life. Not legally binding AD: a set of legal documents helpful to clinicians and family members for making critical decisions on behalf of the patient in case they become incapable to do so. Legally binding.

Answer 115

the concurrent use of multiple medications, taking or prescribing more medicines than are clinically required

Answer 116

A method of addressing patient safety, quality improvement, and healthcare delivery through an understanding that the healthcare system is complex and involves multiple interacting components. The system approach seeks to identify and address underlying factors contributing to incidents or inefficiencies, with the aim of improving the overall system for better outcomes.

Answer 117

Focuses on addressing errors, incidents, or issues by looking at individual actions or behaviors and attributing responsibility for mistakes to people involved

Answer 118

The Mental Capacity Act allows patients to be treated for physical disorders which affect their brain function if they refuse treatment. The Mental Health Act allows patients to be treated for established mental health disorders if they refuse treatment.

Answer 119

Used to treat patients in emergency scenarios

Answer 120

“Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/ or nutrients.

Answer 121

- Maternal diet and taste preference development - Role of breastfeeding for taste preference and body weight regulation - Parenting practices - Other important influences: Age of introduction of solid food, types of food exposed to during the weaning period

Answer 122

- High prevalence in children younger than 6 years old - Characterized by feeding aversion, food refusal, food selectivity, fussy eaters, failure to advance to age-appropriate foods, negative mealtime interactions

Answer 123

transmission of certain flavours from the maternal diet via amniotic fluid and then breast milk

Answer 124

1. Availability (affordability) of food 2. Access – economic and physical 3. Utilisation – opportunity to prepare food 4. Stability of the three dimensions over time

Answer 125

➢ Long-term weight loss is challenging – interventions typically demonstrate weight loss, plateau then weight regain ➢ Weight cycling (from repeated diet-relapse) often leads to ‘overshoot’ and may accelerate weight gain – metabolic set point/ defended fat mass ➢ Dieting results in a loss of lean body mass, not just fat mass – implications for metabolic rate and energy expenditure ➢ Chronic dieting may disrupt ‘normal’ appetite responses and increase subjective sensations of hunger ➢ Risk factor for the development of eating disorders in some individuals

Answer 126

nicotine replacement therapy (NRT): - SE nausea & vomiting, headaches and flu-like - combination of patches better varenicline - a nicotinic receptor partial agonist - should be started 1 week before target date to stop - SE nausea, headache, suicidal link? - CI pregnancy and breastfeeding bupropion - a norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist (unlike many antidepressants it has a minimal effect on serotonin) - SE: seizures, - CI: pregnancy and breastfeeding pregnant: - first line = CBT

Answer 127

* pregnancy * sexually transmitted infections, recurrent UTIs * sexually precocious behaviour * anal fissure, bruising * reflex anal dilatation * enuresis and encopresis * behavioural problems, self-harm * recurrent symptoms e.g. headaches, abdominal pain

Answer 128

Physical Health, Psychological Assessment, Functional Assessment, Social Assessment, Home environment

Answer 129

medical assessment (history, exam, nutrition, RESPECT forms) medication review: START/STOPP, compliance, SE, drug interactions START: may provide benefits eg ppi for bleed risk STOPP: risk>benefits DOCTOR/GERIATRICIAN

Answer 130

cognition capacity mood MENTAL HEALTH NURSE

Answer 131

mobility frailty ADLs hearing/vision/swallow SALT + PHYSIO

Answer 132

carers/legal/financial (community team) SOCIAL WORKER

Answer 133

Occupational Health/Physiotherapy housing safety equipment transport OCCU THERAPY

Answer 134

Doctors: medical, psychiatric, functional Nurses: medical, psychiatric, functional Physiotherapy: functional (activity limitations) Occupational Therapy: functional, environmental (house, social support) Social workers: environmental SALT: swallowing

Answer 135

One of: - BMI <18.5 - Unintentional weigt loss >10% in 3-6m - BMI <20 + unintentional weight loss >5% in 3-6 m MDT: "food first" approach, then supplement

Answer 136

Instability Immobility Incontinence Impaired Cognition/Intellect

Answer 137

Cardiac: calcified, stenosed, ischaemic Resp: poor muco-ciliary escalator Immunity: reduced Neuro: poor hearing, vision, memory Gastro: reduced motility MSK: muscle weakness, atrophy, arthritis GU: incontinence, prolapse Renal: excretion problems

Answer 138

- diminished strength + endurance - reduced physiological function - increased vulnerability to develop dependency or death

Answer 139

- localised damage to skin +- underlying tissue - as a result of pressure/shear - lack mobility, incontinence, pain, malnourishment - managed with moist + hydrocolloid, NO SOAP! - > grade 3 = surgeon

Answer 140

- clocks - familiar objects eg. photos - control noise level - lighting + temperature (bright in morning, dark at night) - involve family - consistent medical team - access to aids medication: haloperidol (lorazepam if parkinsons/lwbd)

Answer 141

- Anaemia - Bacteriuria - Blood group, Rhesus status and anti-red cell antibodies - Down's syndrome - Fetal anomalies - Hepatitis B - HIV - Neural tube defects - Risk factors for pre-eclampsia - Syphilis The following should be offered depending on the history: - Placenta praevia - Psychiatric illness - Sickle cell disease - Tay-Sachs disease - Thalassaemia

Answer 142

- Low levels of blood tryptophan (source of serotonin) - Low serotonin levels in brain and low receptor - HPA dysregulation & elevated blood cortisol levels - Low serotonin and 5HIAA (serotonin metabolite) in the CSF of suicide victims

Answer 143

- Risk assessment (active suicidal plans, access to lethal methods, psychotic, agrees to plan) - Safety plan/ Crisis plan derived - Methods for maintaining safety, and ensuring no access to lethal suicidal methods - Hospitalization is recommended when safety is unpredictable and provides removal from a stressful environment. - If it is not safe to be discharged – advice admission

Answer 144

a study that measures a child's ability to delay gratification in order to receive a larger reward in the future

Answer 145

a psychological experiment that assesses how infants bond with their primary caregiver

Answer 146

Variable penetrance: % of individuals carrying a genetic variant who manifest a disease Age related penetrance: % of individuals who develop a given genetic disease at different ages Variable expressivity: different phenotypes expressed by different people with the same genetic disease

Answer 147

"an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

Answer 148

- To set a path, goal, or vision for the people who are being led. - To motivate people to pursue and eventually achieve the goal Models: Laissez Faire Transactional Transformational Others: - Bureucratic (like military, rules) - Autocratic (like dictatoroship) - Coaching (recognising s+w in members)

Answer 149

- representative of subordinates - guides + inspires - appropriate counselor - creates vision + initiative - creates work environment - resolves conflict - strives for effectiveness

Answer 150

- Collaboration + everyone can participate in decision-making, ideas and discussion - more autonomy and freedom - The democratic leader still has the power of control

Answer 151

PROS - can evaluate own performance - establish goals - encourages growth and promotion - recognises and encourages achievements CONS - some employees prefer not to be involved - quiet team members may not share ideas unless prompted - assigning blame for failure/scapegoating - not effective if working with underqualified or underskilled worders

Answer 152

Leader rely on rewards and punishments to achieve optimal job performance from their subordinates

Answer 153

PROS - performance is rewarded so good behaviour is encouraged - high productivity in repetitive processes - order + structure is clear CONS - limited creativity: very rigid system - punishment can result in low engagement - no longer term motivation + rewards don't work on everyone

Answer 154

- Focuses on inspiring and motivating employees - Leaders act as role models - Idealised influence + inspirational motivation + individualised consideration + intellectual stimulation

Answer 155

PROS - strong motivation factor - encourage personal growth CONS - team dynamics differ - might not be realistic, blindly follow leader - employee favouritism (focusing on those contributing more and neglecting the rest) ** best one for NHS - Empowerment + motivation needed in high pressure environments - Innovation + adaptability encouraged - common long term vision/goal

Answer 156

- Used to working individually - Value autonomy highly - Power imbalance fear - Think its presumptuous to set a vision for an organisation - Science driven, behave tactically rather than strategically

Answer 157

- Implementor: rule follower, conservative - Coordinator: confident, chairperson - Shaper: challenging, likes pressure - Plant: creative - Resource Investigator: over optimistic - Monitor Evaluator: strategic - Team worker: diplomatic - Completer Finisher: anxious

Answer 158

a theory that explains how doctors make decisions and think when diagnosing patients System 1: Fast, intuitive, automatic, and requires minimal effort System 2: Slow, deliberate, conceptual, and systematic eg. if youre deciding between doing an invasive biopsy or blood test and you go ask ask supervisor what to do

Answer 159

evaluation of other cultures according to preconceptions originating in the standards and customs of one's own culture.