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Phase 2a > Public Health > Flashcards

Public Health Flashcards

1
Q

What is law of tort?

A

a civil wrong other than a breach of a contract of tract e.g. negligence, breach of confidentiality

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2
Q

What is negligence?

A

Where a duty of care existed and it was breached

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3
Q

What is the duty of care?

A

prevent harm to patients - technically only obliged to act in the hospital

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4
Q

What is consent?

A

respecting the patients autonomy otherwise it is assault, it guards against exploitation of patients and prevents battery

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5
Q

What is battery?

A

touching a patient without consent

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6
Q

Who has autonomy?

A

every adult of sane mine

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7
Q

Types of consent?

A

implied, oral, written - must be voluntary, informed and be made by someone with capacity

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8
Q

What does the validity of consent depend on?

A

on the adequacy of explanation given to the patient so they can make an informed decision

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9
Q

Who do you need to tell someone about treatment for consent?

A

how, what, risks, benefits, alternatives

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10
Q

When was the mental health act created?

A

1983 and amended in 2007

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11
Q

What does the mental health act mean?

A

provides compulsory admission, for those cases where their refusal can result in serious injury or death, otherwise competent adults have right to refuse treatment

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12
Q

What is the mental capacity act 2005?

A

for incompetent adults who lack capacity, unconscious, severe learning difficulties or lack necessary understanding that require treatment and cannot make decisions

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13
Q

What is capacity?

A

ability to understand (adults are assumed to have capacity)

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14
Q

What is the order of decision making?

A

previously expressed wishes in a living will, lasting power of attorney, court protection, decision of Dr in patients best interest

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15
Q

When is someone unable to make a decision?

A

can’t understand the relevant info, retain it, weigh up all information or communicate the decision

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16
Q

What is used for consideration of patient’s bets interest?

A

whether the patient could have capacity and when that might occur, the patients past and present wishes and feelings, patients beliefs and values that could influence decision, consultation with carers, family, lasting power of attorney

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17
Q

What is a minor?

A

everyone younger than 18

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18
Q

What is Gillik competence?

A

can the child understand the consequence of the decision, including the social and emotional implications , and if so they can consent, if not, parent must consent in best interest of child

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19
Q

What is the welfare of child ACT 1989?

A

increasing scope for exercise of autonomy to child as they approach the legal minor age

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20
Q

What is confidentiality?

A

respect for autonomy, hippocratic oath, duty to keep confidentiality

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21
Q

When can you breach confidentiality?

A

to another health professional, if patient consents, to a court when required by a judge, if others are in harm or if they can’t drive or for statutory duty, infectious disease, births and deaths

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22
Q

What is compliance?

A

the extent to which patients behaviour coincides with the medical health and advice, assuming that patients should follow doctors orders, it is not patient focus, doctor knows best and does not look at the patients issues

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23
Q

What is adherence?

A

acknowledges the patients belief in the relationship si is more patient centered medicine

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24
Q

What is non adherence?

A

not taking prescribed medicine, stopping medicine without finishing it, can be unintentional (forgetting, unable to pay, difficulty understanding) or intentional (beliefs about the condition and treatment, preference)

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25
Q

What increases compliance?

A

good communication

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26
Q

What is concordance?

A

extension of principles of patient centered medicine, a negotiation between individuals to respect the patients agenda

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27
Q

Barriers to concordance?

A

lack of communication skills, time constraints

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28
Q

What is a law?

A

act of parliament or statues or court decisions

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29
Q

What is the difference between private and public law?

A 
public = criminal and constitutional
private = law of contract, property, family law, welfare law, tort law
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30
Q

What is the BME group?

A

black minority ethnic group - non white descent

minority social groups who share the common experience of discrimination or inequality because of their ethnic origin, language, culture or origin

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31
Q

What are BME’s health like in comparison?

A

worse health generally mainly due to the poorer socio economic position, so are more likely to experience morbidity at a younger age and premature mortality

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32
Q

Why does female genital mutilation occur?

A

purity to prevent females having sex, unable to marry without it being done, reopened at marriage

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33
Q

Complications of female genital mutilation?

A

bleeding, wound infection, death, pain, anxiety, PTSD

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34
Q

Law on female genital mutilation?

A

illegal in the UK, so doctors should be alert for families asking for travel advice to take young girls on holiday if they have FGM in home country, and teachers should be alerted

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35
Q

Problems with professional interpreters, language line and family members translating?

A

agenda, bias, not confidential, family members may have poor english, limited interpretation

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36
Q

Issues of diagnosing those with limited english?

A

vocab is different, description of symptoms may be different, undiagnosed disease, unmedicated disease, limited knowledge of disease

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37
Q

What is the largest minority group in the EU?

A

the roma slovak community, they move from city to city, have short term tenancy arrangements with landlords, high prevalence of hep B in slovakia

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38
Q

How can doctors reduce inequality?

A

advocacy, activism, education, research, provide best and flexible services for all, especially those who are vulnerable

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39
Q

What is population attributable risk?

A

the proportion of the incidence of a disease in the exposed and non exposed population that is due to exposure

the disease incidence in the population that would be eliminated if the exposure was eliminated

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40
Q

What health and social problems are worse in unequally rich countries?

A

physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence and teenage pregnancies

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41
Q

Risk factors of heart disease?

A

smoking, diabetes, hypertension, obesity, alcohol, age, cholesterol, exercise, psychosocial

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42
Q

What accounts for the biggest differences in socioeconomic?

A

smoking

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43
Q

what are the 3 physiological views on differences in socioeconomic background?

A

absolutists = all about poverty and absolute measures of socioeconomic deprivation
relativists = think about the relative differences and the larger the differences in society the poorer the outcomes for those worse off
spirit level = think health and social problems are worse in unequal rich countries

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44
Q

Which type of behaviour/personality is a risk factor for CHD?

A

type A - competitive, hostile, impatient

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45
Q

How can personality/behavior be assessed?

A

questionnaires, self report, structured clinical interview, assess non verbal, answer content, speech, psychomotor

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46
Q

Psychosocial factors that cause CHD?

A

mental health problems, low control and high demand at work, shift work, lower rank at work, lack of social support

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47
Q

How can depression be measured?

A

MMPI, beck depression inventory, general health questionnair, spielbergers state anxiety intervention

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48
Q

primary prevention strategies to prevent STIs?

A

raise awareness, vaccinations, one to one risk reduction discussions (15-20mins structured discussion, based on CBT), pre and post exposure prophylaxis

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49
Q

secondary prevention strategies to prevemt STIs?

A

easy access to STI/HIV tests/treatments, partner notification, targetted screening, antenatal screening for HIV and pyphilis, national chlamydia screening programme

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50
Q

tertiary prevention for STIs?

A

anti retrovirals for HIV, prophylactic antibiotic for PCP, acyclovir for suppression of genital herpes

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51
Q

What is the STI/HIV transition model?

A 
R=BCD
reproduction rate
infectivity rate
partners over time
duration of infection
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52
Q

What is partner notification?

A

a public health activity that aims to control infection by identifying key individuals and sexual networks, warn the unsuspecting and attempt to break the chain of infection

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53
Q

Why trace partners for STIs?

A

break the chain of transmission, prevent reinfection of the index patient, prevent complications of untreated infection

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54
Q

How are partners traced for STIs?

A

patient referral, provider referral from phone, test, letter, internet sites, visit, conditional or contract referral

emphasis on the patients choice and confidentiality

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55
Q

Partner notification challenges?

A

hard to reach client group (from phoneless, homeless, floor sleepers, social exclusion, criminal activities, chaotic life, health care is low priority)

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56
Q

How to increase partner notification?

A

MDT with public health, PCT, infectious diseases, GUM and drug and alcohol advisory, partner notification undertaken by specialist community outreach nurse and drug worked, GUM health adviser provided notification training and support and coordinated notification management

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57
Q

When is peak time for gonorrhea diagnosis?

A

18-28

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58
Q

Where do adults get chlamydia and gonorrhea?

A

urethra, endocervical canal, rectum, pharynx, conjunctiva

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59
Q

Where can neonates get STI?

A

conjunctiva

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60
Q

Symptoms of chlamydia and gonorrhea in males?

A

dysuria and urethral discharge, complications are epididymoorchitis, reactive arthritis

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61
Q

Female complications of STIs?

A

pelvic inflammatory disease, tubal factor infertility, ectopic pregnancy, chronic pelvic pain, neonatal transmission, opthalmia neonatorum, atypical pneumonia with chlamydia, Fitz high curtis syndrome (peri hepatitis)

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62
Q

Diagnosis of chlamydia?

A

nuclei acid amplification tests (NAAT), high specificity and sensitivity (but not 100% sensitive so negative test does not mean not infection)

female - endocervical swab, self collected vaginal swab, first void urine
male - first void urine

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63
Q

Aim of community screening for chlamydia?

A

reduce complications by reducing the prevalence of the asymptomatic infection (an asymptomatic diagnosis does not mean recent partner change)

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64
Q

Treatment of chlamydia?

A

partner managment, test for other STIs, azithromycin 1g stat or doxycycline 100mgbd for 7 days

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65
Q

Treatment of chlamydia if pregnant?

A

Erythromycin 500mg bd for 14 days

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66
Q

gonorrhea diagnosis?

A

microscopy of gram stained smear of genital secretions looking for gram negative diplococci with cytoplasm of polymorphs, male urethra and female endocervix and urethra, culture on selective medium to confirm, sensitivity testing, NAAT

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67
Q

Treatment of gonorrhea?

A

partner notification, test for other STIs, continuous surveillance of antibotic sensitivity, single dose treatment preferred, with ceftriaxone 500mg IMI with Azithromycin 1g orally stat

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68
Q

Is chlamydia or gonorrhea more associated with a partner change?

A

gonorrhea and it has more clinical manifestations, whereas chlamydia can be asymptomatic

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69
Q

What organism cause syphilis?

A

treponema pallidum subspecies pallidum

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70
Q

What are the stages of syphilis?

A

early - primary, secondary, early latents

late - late latent, CNS, CVS, gummatous

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71
Q

What STIs are gay men more likely to have?

A

HIV and syphilis

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72
Q

Symptoms of primary syphilis?

A

primary chancre normally on genital skin, nipple and mouth
intubation is 9-90days, usually 21-35
dusky macule-papule-indurated clean bases non tender ulcer 50% solitary (genital ulcer is syphilis until proved otherwise)
regional nodes 1-2 weeks after
untreated heals without scarring in 4-8weeks

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73
Q

Symptoms of secondary syphilis?

A

onset 6-8 weeks after infection, may have primary chancre or none, most present with skin rash

mucus membrane lesions, generalised lymphadenopathy, alopecia, hoarseness, bone pain, hepatitis, nephrotic syndrome, deafness, iritis, meningitis, cranial n palsies, constitutional symptoms

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74
Q

What is the transmission of STIs like?

A

early syphilis - 40-60% of contactable partners are infected (transmission decreases in early latency and after 4 years)
chlamydia - 70%
gonorrhea - 50-90% women, 20-60% male

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75
Q

What causes death in syphilis?

A

late benign gummatous, neurosyphilis, cardiovascular

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76
Q

Diagnosis of syphilis?

A

early moist lesions - identify motile spirochetes on went mount using dark ground microscopy
genital ulcer
rash
use serology for diagnosis

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77
Q

Treatment of syphilis?

A

penicillin by injection with efficient follow up and partner notification

78
Q

Why is type 2 diabetes such a public health issue?

A

causes mortality, disability, co morbidity, reduced quality of life, increasing prevalence, inequality in prevalence and outcomes, linked to obesity and climate change policies

79
Q

Risk factors for diabetes?

A

sedentary job, sedentary leisure activities, high calorie diet, low fruit and veg, low fibre, cars, cheap tv watching, expensive fruit and veg, safety of going outside, family eating patterns, age, sex, ethnicity, family history, weight, BMI, waist circumferance, history of gestational diabetes, hypertension, vascular disease, impaired glucose tolerance/fasting glucose

80
Q

Diabetes tests?

A

random capillary blood glucose, random venous blood glucose, fasting venous blood glucose, oral glucose tolerance test

81
Q

Preventing diabetes?

A

exercise, change diet, weight loss, focus on ethnic minorities and socio economically deprived communities, focus on culturally appropriate interventions, educate, peer support, self monitoring, identify those at risk, diagnosing earlier,

82
Q

mechanisms that maintain overweightness?

A

more weight makes it more difficult to exercise due to injurys and stress, low self esteen, guilt, comfort eating, scared of the gym, employment, relationships, social mobility,

83
Q

What is the runaway weight gain train?

A

steep slope = obesogenic enviroment
ineffective breaks = knowledge, prejudice, physiology, social
accelerators = ineffective dieting, psychological impact, low socioeconomic status, mechanical dysfunction, psychological dysfunction

84
Q

How can we diagnose diabetes earlier?

A

raise awareness of diabetes and symptoms in community and in health professionals, use blood tests to screen before symptoms develop

85
Q

Why is NHS England putting money into type 2 diabetes prevention?

A

it is preventable, and easy changes reduces the risk, it is feasible

86
Q

How is NHS England investing into type 2 diabetes prevention?

A

healthier you: the nhs diabetes prevention programme with lifestyle education, weight loss support and group physical exercise

87
Q

What are the basis of medical ethics?

A

deontology, consequentialism, virture

88
Q

What is deontology?

A

the duty of care we owe to each other with the formula of universal law and formula of humanity, to tell the truth but not to be told the complete way

89
Q

What is the formula of universal law?

A

could i live this way where everyone acted this way

90
Q

What is the formula of humanity?

A

people are always treated as ends in themselves, never as means to an end

91
Q

What is consequentilism?

A

consequences are what matters and the means are unimportant, but it is hard to know what the consequences will be and actions can be wrong even in consequences are good

92
Q

What is virtue?

A

characteristics that promote human flourishing e.g. compassion, patience, kindness, fidelity, centers ethics on the person and what it means to be human, including the whole persons life

93
Q

What are the principles of medical ethics?

A

autonomy - patient can make own decision
beneficence - seeks to benefit patient
non maleficence - no overall harm, reasonable harm can be justified e.g. side effects
justice - no discrimination and efforts should be directed without reference to likes and dislikes

94
Q

What is the ethical duty of condour?

A

condour is openness, honesty, transparency

spontaneous without compulsion, applies to disclosure of error or uncertainty and decisions influenced by resources

95
Q

What is the duty of candour?

A

longstanding ethical duty, established regulatory duty, recent contractual duty, new statory duty

96
Q

What is the GMC duty of candour?

A

MUST be open and honest with patients if things are going wrong
SHOULD put matters right if went wrong e.g. apology

97
Q

What is whistle blowing?

A

raising concerns about a person, practice or organisation to make the patient a first concern, shouldn’t get int trouble

98
Q

What makes an effective team?

A

6 or 8-12 in team size, team dynamic, feeling like you belong, common purpose, identified team leader,

99
Q

Why is it important to work as a team?

A

improves decision making, reduces medical error, essential in complex medical modern healthcare

100
Q

Difficulties in team work in the NHS?

A

different offices, shifts and rotations, ward based/visiting/based elsewhere, different employers and line managers, part time, full time, other commitments, informal as well as formal contact

101
Q

Aspects of team working linked to patient safety?

A

shared decision making, shared knowledge, successful team communication,

102
Q

Steps to patient safety?

A

build a safety culture, lead and support your staff, integrate your risk management activity, promote reporting, involve and communicate with the patients and public, learn and share safety lessons, implement solutions to prevent harm

103
Q

What is the SBAR checklist?

A

situation, background, assessment, recommendation

104
Q

Human factors for team work?

A

communication, leadership and followship, authority gradient, situational awareness, declaring an emergency, train together

105
Q

Back pain red flags?

A

55, thoracic pain, persistent at night, night sweats, recent unexplained weight loss, saddle anesthesia, sphincter disturbance, trauma, significant past medical history

106
Q

What is classed as chronic back pain?

A

continuous pain for more thna 3 motnhs

107
Q

predictive factors for lower back pain?

A

psychosocial factors, pain intensity, episode duration, previous history

108
Q

How do musculoskeletal disorders affect us?

A

physical pain, psychological burden (loss of independence, chronic pain), economic implication (loss of income, costs of treatment, costs of care), as a society economic burden (from treatment and loss of work), work place productivity (secondary costs to individuals)

109
Q

risk factors of back pain?

A

more common in women, and increases with age, more common in lower social class, probably due to increased manual labour, more obesity, other things to worry about that poor posture, less atcive

110
Q

Treatment of back pain?

A

remember the red flags, treat with exercise

111
Q

What are the most common work related MSK disorders?

A 
back pain
tension neck (10-17% of the population)
112
Q

what is classed as chronic tension neck?

A

> 6 months

113
Q

How does thoracic outlet syndrome present?

A

pain and tingling, wasting of hands, positive Adson’s test

114
Q

What are the different types of thoracic outlet syndrome?

A

hyperabduction syndrome - pinches nerves that run under the pec minor muscle when you lift your arm overhead

anterior scalene syndrome - pinches nerves and vessels between the scalene muscles and other structures

costoclavicular syndrome - pinches nerves underneath collarbone

115
Q

What happens in rotator cuff tendinitis?

A

roatator cuff tears and swells, leading to further infringement beneath arch

test using ‘empty/full can jobes’ - elevate extended arm against resistance

116
Q

What is frozen shoulder?

A

adhesive capsulitis, with equal resistriction of active and passive movements in capsular patterns

at risk if diabetic, thyroid, adrenal dysfunction, parkinsons

more common in females

117
Q

What test is used for bicipital tendonitis?

A

the speed test - elbow fully extended, forearm supinated and flexes against resistance

118
Q

What test is used for subacromial impingement?

A

hawkins-kennedy test - flexed arm and rotation

119
Q

What test is used for the AC joint impingement?

A

cross arm adduction (scarf) test

120
Q

What is medial and lateral epicondylitis?

A 
medial = pain against resisted flexion of the wrist
lateral = pain against resisted extension of the wirst

aka olecranon bursitis caused by repetitive bending and straightening of the elbow, in those who continuously lean on their elbows

121
Q

How does carpal tunnel syndrome present?

A

pain/tingling/numbness in the median nerve distribution in the hand

has TINEL’s and PHALEN’s signs

122
Q

Risk factors for carpal tunnel syndrome?

A

pregnancy, obesity, endocrine disease, COCP/NRT, repetitive wrist movements

123
Q

What is tenosynovitis?

A

local tenderness and swelling and pain on resisted movements, seen in manual workers, more common in women

124
Q

What is DeQuervain’s tenosynovitis?

A

local tenderness and swelling of the tendon sheaths (extensor pol brevis and abductor poll longus), pain on resisted movements, see in manual workers and rowers, more common in women

125
Q

What is trigger finger?

A

inflammation and hypertrophy of the retinacular sheath progressively restricting the motion of the flexor tendon

126
Q

What is Depuytren’s?

A

tissue between the skin and the tendons known as the fascia is thickened due to collagen proliferation. Nodules or cords are formed and the elasticity of the fascia is reduced

127
Q

What is hand arm vibration syndrome?

A

when exposed to sufficient vibration, causing finger blanching, pain numbness, tingling, wasting, dexterity, asymmetrical, carpal tunnel syndrome,

128
Q

yellow flags for back pain chronicity?

A

a belief that the back pain is potentially disbling
fear avoidance behaviour
reduced activity levels
expectation of passive treatments rather than active
low mood and social withdrawal
problems or dissatisfaction with work
problems with claims/compensation/time off work
overprotective family and lack of support

129
Q

What is RULA?

A

the rapid upper limb assessment

a tool to analyse event driven postures when work related upper limb disorders are reported

assesses biochemical and postural loading on the whole body with particular attention to the neck, trunk and upper limps

takes little time to complete and the scoring generates an action list which indicates the level of intervention required to reduce the risk of the injury due to physical loading on the operator

130
Q

What is static anthropometrics?

A

measurement of human subjects in rigid, standardized position e.g. static arm length

used in designing a workplace when the body movement is not a major variable e.g. seat breadth, height, head room

131
Q

What is dynamic anthropometrics?

A

measurement of human subjects at work or in motion e.g. functional arm reach curves

132
Q

What is biomechanics?

A

the measurement of the range, strength, endurance, speed and accuracy of human movements

133
Q

What is the problem with static anthropometrics?

A

many factors have variability between groups e.g. average male in USA is 167cm but in vietnam is 152cm

134
Q

What important factors should be considered in work related MSK disorders?

A

task, individual, load, enviroment

135
Q

Why are students at risk of mental health disorders?

A

unrealistic expectations, finance academic stress, alcohol, peer pressure, lack of support

136
Q

Which occupations have high stress levels?

A

managers, nurses, doctors, healthcare professionals

137
Q

Sources of stress for doctors?

A

lack of resources, too much work, poor management, ill patients, complaints, too much responsibility, poor relationship at work, too little time

138
Q

Symptoms of professional burn out?

A

less contact with colleagues, decreased work commitment, do not seek help, decreased productivity, stereotypic thinking, increased minor illnesses, objectification, feeling of failure

139
Q

Personality traits susceptible to psychological difficulties?

A

perfectionism, self criticism, low flexibility, high discipline

140
Q

What are traits of emotional resilient?

A

self aware, in control of life, practice acceptance, balanced view of the world

141
Q

What neurological diseases can be prevented with a vaccine?

A

polio, tetanus, measles, meningococcus, TB, H.influenze

142
Q

What is obesity?

A

a high amount of body fat in relation to lean body mass (BMI 30 or more)

143
Q

morbiditys associated with obesity?

A

hypertenision, dyslipidaemia, type 2 diabetes, CHD, stroke, gall bladder disease, osteoathritis, sleep apnoea, respiratory problems, cancer

144
Q

Factors contributing to weight maintenance?

A

energy intake, type of food intake, appetite, mood, activity, metabolic rate, genes, drugs

145
Q

Causes of obesity?

A

americanisation of diet and society, increased car usage, longer working hours, over consumption of food, grazing replacing meal times, replacement of water with sugary drinks

146
Q

What makes up an adults energy expenditure?

A

exercise and non exercise activity thermogensis

147
Q

what is non exercise activity thermogensis?

A

spontaneous physical activity (fidgeting), so there are marked individual differences in contribution to daily expenditure

148
Q

How can you asses the intra abdominal adiposity?

A

measure waist circumference as it is strongly correlated

149
Q

What is metabolic syndrome?

A 
high waist circumference plus 2 of:
triglycerides >1.7mmol/L
HDL cholesterol 130/85
FPG >5.6mmol/L
diabetes
150
Q

What effect does adipocytes have on the body?

A

inflammation, atheroscleoris, thrombosis, type 2 diabetes, atherogenic dyslipidaemia, hypertension

caused by increased in hormones

151
Q

How can patients be assisted for successful weight loss?

A

assessing weight history, assess motivation, choose weight management strategies, set appropriate targets, behavioural approaches, prescribing issues

patients views and reasons for weight gain, beliefs on food and exercise, socioeconomic influences, previous success, readiness to change, confidence to make changes

152
Q

What is the multi component intervention for weight loss?

A

activity - set goals
individual diet advice
behavioural strategies
positive feedback

153
Q

factors contributing to losing weight?

A

medication (orlistat, incretin mimetics (GLP1 agonists 9 reducing effect of glucose)), dietry counselling, support, diabetes managment, encouragement, activity, hypo advice, hard work

154
Q

How do GLP-1 agonists help lose weight?

A

it is secreted on ingestion of food to enhance glucose dependent insulin secretion, help regulate gastric emptying, decrease glucagon reducing hepatic glucose output, decrease postprandial glucagon secretion and promotes satiety and reduces appetite

155
Q

How to maintain weight?

A

low calorie, low fat diet, eat breakfast every day, eat same amount on week days, weekends and holidays, highly active, less depression excess eating and binging, self montioring

156
Q

When does end of life care occur?

A

from the diagnosis of a poor prognosis or a deterioration of a chronic disease (around 1-2 years)

157
Q

What does end of life care aim to do?

A

increase QoL, give support and palliative care to patient and family, manage pain with psychological, social and practical support, control symptoms but avoid too much investigation and treatment

158
Q

What must be prepared for end of life care?

A

focus on patient and family, educate family on last hours to reduce fear, ensure preemptive medications are available, explore a preferred place of care

159
Q

What are the 5 priorities of care for a dying person?

A

individual care plan, needs of the family, the dying person, sensitive communication, decisions regularly reviews

160
Q

How is death verified?

A

no heart sound or pulse, no breath sounds, no response to painful stimuli, pupils fixed and dilated

161
Q

What is palliative care?

A

improving the QoL of patients and families who face life threatening illnesses by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to end of life bereavement

162
Q

who are involved in specialist palliative care?

A

consultants, clinical nurse specialists, hospital nurses, specialist social workers, dieticiens, physio

163
Q

who are general care providers?

A

Gps, hospital doctors, district nurses, nursing home staff, copd nurses

164
Q

how is lung cancer palliative care different from copd palliative care?

A

lung cancer patients receive visits from district nurses, they are more likely to know they might die and get more support from the specialists, less likely to suffer depression and less likely to visit ICU and have a better activities than COPD patients

165
Q

Difficulties in palliative care for COPD patients?

A

unpredictable illness trajectory, difficulties in prognostication, patients have poor understanding and poor access to palliative care, there is a stigma against smoking

166
Q

Challenges of the aging population?

A

strains on pension and social security, increasing demand for health care, bigger need for trained health workforce, increasing demand for long term care, pervasive ageism that denies older people the rights and opportunities available for other adults

167
Q

Causes of population aging?

A

improvement in sanitation, housing, nutrition, medical interventions, falls in fertility, decline in premature mortality, more people reaching an older age while fewer children are being bron

168
Q

Physical changes in age?

A

loss of skin elasticity, loss of hair and hair colouring, decrease in size and weight, loss of joint flexibility, increased susceptibility to illness, decline in learning ability, less efficient memory, affected sight, hearing, taste and smell.

169
Q

How to prevent recurrent hospital admissions for patients?

A

supporting discharged patients, supporting chronic disease management in the community, providing alternative in acute care in community

170
Q

Roles of GP?

A

prevent unnecessary loss of function, prevent and treat problems which adversely affect QoL in old age, supplement the existing system of informal care and prevent its breakdown, give older people a good death as well as a good life

171
Q

Documents created for patient safety?

A

organisation with a memory 2000
building a safer NHS 2001
Bristol enquiry
improving safety of patients in England 2003

172
Q

What is a human error and examples?

A

failure of a planned action or a sequence of mental and physical actions to be completed as intended or the use of a wrong plan to achieve an outcome

errors of omission - action is delayed or not taken
errors of commission - where the wrong action is taken
professional negligence - actions or omissions do not measure up to the standard of an ordinary, skilled person

173
Q

What errors are made in medication prescribing?

A

ordering, transcribing, dispensing, administering

so must be storage, labeling and segregation of high alert medication

174
Q

What human factors can lead to error?

A

load theory - how much a brain can process

situational awareness - what else is happening

175
Q

What is confirmational bias?

A

the tendancy to look for confirming evidence to suppory a diagnosis rather than diagnosing

176
Q

What is anchoring?

A

locking onto salient features in a presentation too early

177
Q

What is diagnosis momentum?

A

giving a diagnostic label too early

178
Q

What is the difference between a latent and an active failure?

A

latent - not in the practitioners control e.g. organisation of procedures, allocation of resources

active - direct contact with the patient (sharp end)

179
Q

What are never events?

A

serious, largely preventable patient safety incidents that should not occur if the available preventable measures are there, they are intolerable and inexcusable

180
Q

What is an organisational system failure?

A

involving management, protocols and knowledge

181
Q

What are technical failures?

A

external factors

182
Q

What is an adverse event?

A

an incident which results in harm to the patient which is not a direct result of their illness

183
Q

What is a near miss?

A

an event that arises during care and has the potential to cause harm but failures to develop further, avoiding harm

184
Q

What is the difference between a skill and knowledge based error?

A

skill = it is a well known task, that is given little attention, so can be distracted and have a slip

knowledge = incorrect action due to inexperience and insufficient information

185
Q

What are violations and the different types?

A

deliberate deviations from practices, procedures, standards and rules which could be routine cut corners, necessary to get the job done or optimizing for self benefit

186
Q

What limits information processing?

A

automacity, cognitive interference, selective attention, cognitive bias, positive and negative transfer from previous experiences

187
Q

Examples of strategies to reduce error and harm?

A

simplification and standardization of clinical processes, checklists, aide memoires, information technology, team training, risk management programmes, mechanisms to improve uptake of evidence based treatment patterns

188
Q

What are the 2 approaches to managing error?

A

the person approach = error is a product of wayward mental processes and focuses on the unsafe acts of people on the front line

the system approach = only occasionally necessary to cause adverse events

189
Q

What are the benefits of work?

A

obtaining adequate economic resources, part of society, meet psychosocial needs, an individuals identity, social role and social status, the main drive of social gradient in physical and mental health and mortality

190
Q

What causes work related illnesses?

A

MSK, stress, depression, respiratory

191
Q

Safety issues for work?

A

have to be safe to do tasks, personal and co worker safety, strict criteria for safety critical job, physical requirements, medical contraindications, so try and match individual to work and task

192
Q

What is involved in an occupational health physician?

A

regulation, legal, rehabilitation, well being and lifestyle, obligations to employer, medical examination at employers request

Phase 2a (15 decks)

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