public health Flashcards
alcohol effect on CNS
potentiate GABA (inhibitory neurotransmitter) inhibits glutamate (excitatory neurotransmitter)
goverement alcohol strategy
- when
- what
2012
prevention- based
minimum pricing licensing law marketing availability lower risk limits (14 units/ week)
AUDIT
- stands for
- short version
- long version
alcohol use disorder identification test
short version - indicates high risk drinking
- how often alc
- how many units/day
- how often 6/8 units +
long version- indicates dependance
- unable to stop drinking
- failed to do what was expected
- needed morning drink
- guilt/remorse
- unable to remember
- someone worried about it
- injury because of it
unit calculation
% x ml /1000
SADQ
severity of dependance questionaire
- withdrawal symptoms, frequency of alc, withdrawal onset speed,
relief drinking
name 2 treatments for alcohol withdrawal
benzodiazepines eg chlordiazepoxide
lorazepam (better for hepatic insufficiency)
name 3 medicines for alcohol relapse prevention
acomprosate - alleviates cravings
disulfiram - makes you v ill (anaphylactic-like) every time you drink alcohol
nalmefene - effect of alc still present but reduced feeling of pleasure/reward
law of tort sections
negligence
battery
breach of confidence
negligence
what are the 3 requirements
1 Duty of care exists
- Obligation to take care to prevent harm being suffered by another
- -Doctors have duty of care for patients
2 Duty of care is breached
– Have they breached the standard of care?
(doctors agree if they would have done the same (Standard of care) – judge decides whether they think this standard of care is fit – or if the practice needs to change
3 Harm results
do doctors have a duty of care to someone outside the hospital
legally, no
unless they stop to help
gmc thinks you do have a duty
battery =
lack of consent
can consent be implied
for some things yes - eg vaccination : arm held out
mental illness and consent
Mental illness- can admit without their consent but cannot treat for other medical conditions without their consent (mental health act)
if patient is not able to give consent eg unconscious, can family/ friends speak for them?
relatives/ friends do NOT make decision on behalf of those unable to give consent unless specifically empowered to do so by the mental capacity act (eg advance decision) (or minor)
what is bolams test
asks if doctors actions meet standard of care by asking medical body (doctors) to assess the actions (eg they would do the same)
how to deem if someone has capacity
1 Understand and retain information about treatment
2 Believes it
3 Weighs it to arrive at an informed choice
when can doctor disclose information without breaching consent
- Patient gives consent (you can tell me wife ..)
- Others involved with patient’s care
- Required by a judge in court
- Police (not always: )
- — Terrorism act
- — Road traffic act
- To coroner
- Statutory duty
- — To public health england, notifiable infectious diseases
- — Register births (inc under infertility treatment) and deaths (inc abortion)
do patients have right to see own health records?
yes
Unless will cause serious harm to mental/ physical health of patient/ physician/ another person
Or if the information is about or provided by another individual
necessity belief
perceptions of personal need for treatment
adherence/compliance
adherence = joint decision
(better term)
compliance = doctors orders
when to wash hands
before and after patients after handling soiled item after toilet before and after aseptic procedure after removing protective clothing inc gloves
seedhouses framework
ethical framework
like sqaures inside each other with X over it
inner grid = autonomy (yours and patients)
truth telling
best interests of patient and family
outer tier = risks, resources available, law, effectiveness
four quadrants framework
this is just like four things- going top left to right to bottom left to right:
medical indications (beneficence, non-maleficence)
patient preferences
quality of life
contextual factors (unintended consequences for other people eg patient family)
legally how do you prioritise two sick people where one is your patient
patient first
