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3A REVISION > PUBLIC HEALTH/PPD > Flashcards

PUBLIC HEALTH/PPD Flashcards

1
Q

What is the population perspective?

A

Think in terms of groups rather than individuals

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2
Q

3 ways of gathering information

A

Data
Surveys
Studies

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3
Q

What does information relate to in a population?

A

Demography
Sociology
Epidemiology

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4
Q

Give some determinants of health? (4)

A

Genes - age, sex
Environment - physical and socioeconomic
Lifestyle
Healthcare - resource allocation

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5
Q

More specific/wider determinants of health? (7)

A 
Agriculture and food production
Education
Work environment/unemployed
Housing
Water/sanitation
Diet, smoking
Healthcare seeking behaviour
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6
Q

Define equity vs equality?

A

Equity is what is fair and just - give people in more need more help
Equality is concerned with equal shares - give everyone the same

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7
Q

What is horizontal equity?

A

Equal treatment for equal need - people with pneumonia given same treatment

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8
Q

What is vertical equity?

A

Unequal treatment for unequal need - areas with poorer health may need more money spending on health

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9
Q

Different forms of health equity? (5)

A 
Equal expenditure/supply
Equal access
Equal utilisation
Equal health care outcomes
Equal health
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10
Q

2 dimensions of health equity?

A

Spatial - geographical

Social - age, gender, class, ethnicity

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11
Q

How is health equity assessed?

A

Assess inequality
Decide if inequitable
Measure utilisation, health status, supply

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12
Q

3 domains of public health practice?

A

Health improvement
Health protection
Improving services

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13
Q

What is health improvement?

A

Concerned with social interventions aimed at preventing disease, promoting health, reducing inequalities

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14
Q

What is health protection?

A

Concerned with measures to control infectious disease risks and environmental hazards

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15
Q

What is improving services?

A

Concerned with the organisation and delivery of safe high quality services for care

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16
Q

Examples of health improvement?

A 
Tackling inequalities
Education
Housing
Employment
Lifestyle
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17
Q

Examples of health protection?

A

Infectious disease control
Chemicals/poisons
Emergency response
Environmental hazards

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18
Q

Examples of improving services?

A

Clinical effectiveness
Efficiency
Audit and evaluation
Clinical governance

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19
Q

Types of health improvement interventions? (2)

A

Health service or public health interventions

Non health interventions which have an impact on public health

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20
Q

How may interventions be delivered? (3)

A

Individual level
Community level
Population level

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21
Q

Example of individual, community and population interventions?

A

Individual - referring individual to smoking cessation nurse
Community - new park or cycle paths to promote exercise, smoking cessation posters in a GP
Population - minimum alcohol pricing, sugar tax

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22
Q

What is the needs assessment and planning cycle?

A

Needs assessment - planning - implementation - evaluation

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23
Q

2 main ways health of patients can be improved?

A

Treating individual patients

Influencing the services available to patients

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24
Q

What is need?

A

Ability to benefit from an intervention

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25
Q

What is demand?

A

What people ask for

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26
Q

What is supply?

A

What is provided

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27
Q

What is health needs assessment?

A

Systematic method for reviewing the health issues facing a population
Leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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28
Q

What is health need?

A

Need for health - general, measured using morbidity and mortality

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29
Q

What is health care need?

A

Need for health care - more specific, ability to benefit from health care
Depends on potential of a treatment to remedy problems

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30
Q

For who/what may a health needs assessment be carried out for? (3)

A

Population or sub group
A condition
An intervention

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31
Q

Who defines need? (5)

A

Individual, family, community, professionals, society

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32
Q

What are Bradshaw’s 4 types of need?

A

Felt need
Expressed need
Normative need
Comparative need

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33
Q

What is felt need?

A

Individual perceptions of variation from normal health

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34
Q

What is expressed need?

A

Individual seeks help to overcome variation in normal health (demand)

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35
Q

What is normative need?

A

Professional defines intervention appropriate for the expressed need

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36
Q

What is comparative need?

A

Comparison between severity, range of interventions and cost

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37
Q

3 types of approaches to health needs assessment?

A

Epidemiological
Comparative
Corporate

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38
Q

What is the epidemiological approach to health needs assessment? (6)

A

Define issue, assess the size (incidence/prevalence)
Assess services available for the issue
Assess evidence base - effectiveness, cost effectiveness
Assess models of care, including quality and outcome measures
Assess for any unmet need or un needed services
Make recommendations

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39
Q

Problems with epidemiological approach?

A

Required data may not be available or of bad quality
Evidence base may be inadequate
Does not consider felt needs of people affected

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40
Q

What is the comparative approach to health needs assessment?

A

Compares the services received by a population with others
Spatial, social
May examine health status, service provision, service utilisation, health outcomes (mortality, morbidity, QOL)

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41
Q

Problems with comparative approach?

A

Neither may be giving most appropriate care!
Data may not be available/of variable quality
May be difficult to find comparable population

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42
Q

What is the corporate approach to health needs assessment?

A

Collect the views of the “stake holders” e.g. The patients/service users, GPs, other health professionals, commissioners, politicians – ask them what they think is needed

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43
Q

Problems with corporate approach?

A

May be difficult to distinguish need from demand
Groups may have vested interests
May be influenced by political agendas, dominant personalities

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44
Q

Example of an intervention that is supplied, but not needed or demanded?

A

Routine C section for women with previous C sections

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45
Q

Example of an intervention that is supplied and needed, but not demanded?

A

Cervical smears/screening

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46
Q

Example of an intervention that is supplied and demanded, but not needed?

A

Prescription of antibiotics for viral URTIs

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47
Q

Example of an intervention that is needed and demanded, but not supplied?

A

NHS drug rehabilitation

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48
Q

Intervention that is demanded, but not needed or supplied?

A

Treatment for mild illnesses - cough, pain with no underlying sinister cause

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49
Q

Intervention that is needed but not demanded or supplied?

A

NHS rehab for drug addicts (may or may not be demanded)

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50
Q

Intervention that is needed, demanded and supplied?

A

Insulin for diabetes

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51
Q

3 ways of defining health?

A

Biomedical - ABSENCE OF DISEASE
Psychosocial - STRESS AND FUNCTION
Lay - FELT AND EXPRESSED NEED

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52
Q

Define evaluation?

A

The assessment of whether a service achieves its objectives

…by systematically and objectively determining the relevance, effectiveness and impact of activities

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53
Q

Examples of health evaluation? (4)

A

Single intervention - e.g. RCT of a cancer drug
Evaluation of public health interventions - e..g epidemiological studies of health after smoking ban
Health economic evaluation - cost effectiveness of an intervention
Health technology assessment - systematic review, economic evaluation, mathematical modelling

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54
Q

4 things that can be evaluated

A

Projects
Processes
Programmes
Services

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55
Q

Donabedian framework for health service evaluation?

A

Structure
Process
(OUTPUT)
Outcome

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56
Q

How is structure evaluated?

A

What is there - buildings, staff, equipment

i.e. no. of ICU beds or vascular surgeons per 1000 people

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57
Q

How is process/output evaluated?

A

What is done - number of patients seen in A+E, the process they go through in A+E, number of procedures performed

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58
Q

How is outcome evaluated?

A

Classification of health outcomes

Mortality, morbidity, quality of life, patient satisfaction

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59
Q

5 Ds classification of outcome?

A 
Death
Disease
Disability
Discomfort
Dissatisfaction
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60
Q

What is PROM?

A

Patient reported outcome measures - questionnaire i.e. oxford hip score

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61
Q

What are some issues with evaluating health outcomes? (4)

A

Link between service provided and outcome may be influenced by many factors
Time lag between service provided and outcome
Large sample size may be needed
Data may be unavailable/bad quality

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62
Q

How is data quality assessed?

A 
Completeness
Accuracy
Relevance
Timeliness 
(CART)
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63
Q

What are maxwell’s dimensions of quality of healthcare? (6)

A 
Effectiveness
Efficiency
Equity
Acceptability
Accessibility
Appropriateness
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64
Q

2 methods of evaluation?

A

Qualitative

Quantitative

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65
Q

Qualitative methods of evaluation? (4)

A

Observation - participant and non participant
Interviews
Focus groups
Document review

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66
Q

Quantitative methods of evaluation? (4)

A

Routinely collected data
Review of records
Surveys
Epidemiological studies

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67
Q

General steps of evaluating health services? (5)

A 
Define what the service is
What are the aims of the service
FRAMEWORK (structure, process, outcome)
Methodology (qual/quant)
Results and recommendations
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68
Q

What is epidemiology?

A

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

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69
Q

What is incidence?

A

NEW cases in a population during a specific time period

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70
Q

What is prevalence?

A

EXISTING cases at a specific point in time

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71
Q

How to work out relative risk?

A

Risk of one group/risk of another i.e. risk of lung cancer in smokers 15%, risk in non smokers 0.7%, 15/0.7 = 21.4
So 21 times more likely to develop lung cancer if a smoker

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72
Q

How to work out attributable risk?

A

i. e. amount of lung cancer specifically due to smoking so take away naturally occurring cases
0. 15-0.07 = 0.143

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73
Q

How to work out number needed to treat?

A

Number needed to treat to prevent one death from lung cancer = 1/attributable risk

1/0.143 = 6.99 = 7 people need to stop smoking to prevent one death

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74
Q

What is sensitivity?

A

% correctly identified WITH DISEASE

100% = correctly identifies everyone with the disease but may cause false positives

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75
Q

What is specificity?

A

% correctly identified WITHOUT DISEASE

100% = correctly excluded everyone without the disease but may miss people who do have it

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76
Q

What is the positive predictive value?

A

% of those with a positive test who actually have the disease

true positive / (true positive + false positive)

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77
Q

What is the negative predictive value?

A

% of those with a negative test who are actually disease free

true negative / (true negative + false negative)

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78
Q

What is absolute, relative and attributable risk?

A

Absolute - actual numbers involved i.e. how many deaths per 1000
Relative - ratio of risk of disease in the exposed to the risk in the unexposed
Attributable - rate of disease in the exposed that may be attributed to the exposure

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79
Q

What can association be due to? (5)

A 
Bias
Chance
Confounding
Reverse causality
True association! (causal)
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80
Q

What is bias?

A

Systematic deviation from the true estimation of the association between exposure and outcome

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81
Q

Main groups of bias?

A

Selection bias
Information bias
Publication bias

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82
Q

What is selection bias?

A

Systematic error in selection of study participants or allocation of participants to different groups

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83
Q

What is information bias?

A

Systematic error in the measurement or classification of exposure or outcome

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84
Q

Sources of information bias?

A

Observer
Participant - recall bias, reporting bias
Instrument - wrongly calibrated

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85
Q

What is publication bias?

A

Trials with negative results less likely to be published

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86
Q

What is confounding?

A

Situation where a factor is associated with the exposure of interest and independently influences the outcome

When an apparent association between an exposure and an outcome is actually the result of another factor e.g. grey hair associated with back pain, confounder is age

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87
Q

What are the Bradford hill criteria for causation? (evidence for a causal relationship) (6)

A 
Strength of association
Dose response
Consistency between studies
Temporality (exposure preceding outcome)
Reversibility (removal of exposure reduces risk)
Biological plausibility
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88
Q

What is a cohort study?

A

Longitudinal study in similar groups but with different risk factors/treatments i.e. exposed and not exposed, follows up over time

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89
Q

Pros/cons of a cohort study?

A

Pros: Can follow up rare exposure, can identify risk factors, is prospective
Cons: large sample needed, impractical if rare, expensive, people drop out

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90
Q

What is a case control study?

A

Observational study looking at the cause of a disease, compares similar participants with the disease to controls without, looks retrospectively for a cause

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91
Q

Pros/cons of a case control study?

A

Pros: Quick, good for rare outcomes
Cons: difficult to find appropriately matched controls, prone to selection and information bias

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92
Q

What is a cross sectional study?

A

Observational study collecting data from a population at a specific point in time, snapshot of a group

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93
Q

Pros/cons of a cross sectional study?

A

Pros: large sample size, provides prevalence data, quick, repeat studies can show changes over time
Cons: risk of reverse causality (which came first), less likely to include quick recoveries

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94
Q

What is a randomised control trial?

A

Similar participants (selection criteria) are randomly assigned to an intervention or control group to study effect of intervention

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95
Q

Pros/cons of randomised control trial?

A

Pros: low risk of bias and confounding, comparative
Cons: high drop out rate, little incentive for controls (ethical?), time consuming and expensive

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96
Q

What is an ecological study?

A

Looking at disease prevalence correlation with geographical location or over time

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97
Q

What is odds ratio?

A

Measure of association between exposure and outcome

= (Odds of exposure in cases) / (Odds of exposure in controls)

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98
Q

What is the population approach to prevention?

A

Preventative measure delivered on a population wide/subgroup (i.e. all over 60s) basis and seeks to shift the risk factor distribution curve

i.e. dietary salt restriction through legislation and advice to public should shift blood pressure curve

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99
Q

What is the high risk approach to prevention?

A

Seeks to identify individuals above a chosen cut off and treat them

i.e. screening for people with high BP

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100
Q

What is the prevention paradox?

A

A preventive measure which brings much benefit to the population often offers little to each individual

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101
Q

How can prevention be classified?

A

Primary
Secondary
Tertiary

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102
Q

Criteria a screening programme must fulfil? (6)

A

Important disease
Natural history of the disease must be understood e.g. detectable risk factors, disease marker
Simple, safe, precise and validated test
Acceptable to the population
Effective treatment from early detection with better outcomes than late detection
Agreed policy of who should receive treatment
Achievable with facilities, inexpensive

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103
Q

What is primary prevention?

A

Aims to prevent disease before it occurs, for example education about healthy living/not smoking

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104
Q

What is secondary prevention?

A

Aims to reduce the impact of a disease that has already begun to occur, by detecting and treating as soon as possible

i.e. screening to detect early cancer, daily aspirin/clopidogrel after MI

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105
Q

What is tertiary prevention?

A

Aims to soften the impact of an established, ongoing illness to improve QOL

i.e. stroke rehabilitation, support groups

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106
Q

What is screening?

A

A process which sorts out well people who probably have a disease/disease precursor/disease susceptibility from those who probably do not

NOT DIAGNOSTIC

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107
Q

5 types of screening?

A 
Population based screening
Opportunistic screening
Screening for communicable diseases
Pre employment medicals
Commercial screening
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108
Q

What is lead time bias?

A

Early identification does not alter outcome but appears to increase time of survival e.g person knows they have the disease for longer

(e.g. diagnosed earlier)

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109
Q

What is length time bias?

A

Disease that progresses more slowly is more likely to be picked up by screening as the person is around for longer, making it seem like screening prolongs life

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110
Q

What is health psychology?

A

Emphasises the role of psychological factors in the cause, progression and consequences of health and illness

Puts theory into practice by promoting healthy behaviours and preventing illness

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111
Q

3 main categories of health behaviours?

A

Behaviours related to health…
Health behaviour
Illness behaviour
Sick role behaviour

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112
Q

What is health behaviour?

A

A behaviour aimed to prevent disease i.e. eating healthy

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113
Q

What is illness behaviour?

A

A behaviour aimed to seek remedy i.e. going to the doctor

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114
Q

What is sick role behaviour?

A

Any activity aimed at getting well i.e. taking medication

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115
Q

What are health damaging behaviours?

A

Smoking, alcohol or drug abuse, sun exposure, risky sex, risky driving

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116
Q

What are health promoting behaviours?

A

Exercise, healthy eating, vaccinations, compliance with medication

117
Q

What fraction of cancers can be potentially prevented by modifiable risk factors/lifestyle? What are the others due to?

A

1/3

2/3 due to total number of cell renewals in normal cells as part of homeostasis

118
Q

Modifiable risk factors for cancer? (12)

A 
Stop smoking
Healthy BMI
Eat fruit and veg
Less alcohol
Less sun exposure
Eat less processed/red meat
High fibre diet
Exercise/less sedentary
Eat less salt
Minimise chemical/radiation exposure
Minimise certain infections
Breastfeed
119
Q

Most common causes of death in UK? (5)

A 
Cancer
Cardiovascular disease 
Cerebrovascular disease
Dementia
Respiratory disease - flu, pneumonia
120
Q

What % of patients with chronic illnesses are non compliant with medication?

A

50%

May be higher in females, non white groups

121
Q

What is health promotion?

A

The process of enabling people to exert control over the determinants of health, thereby improving health

122
Q

How are interventions carried out at the individual level?

A

Patient centred approach, care responsive to individual needs

123
Q

Name 3 health promotion campaigns

A

Change 4 life (eat well move more)
Stoptober (stop smoking)
Act FAST (stroke)

124
Q

How can preventing individual alcohol consumption affect other levels of intervention?

A

Individual - level of consumption, individual health outcomes, incidence of domestic violence
Community - local alcohol sales, alcohol crime, A+E visits
National - national alcohol statistics, demographic patterns of liver disease

125
Q

Why do people engage in health damaging behaviours?

A

Smoking - stress relief
Alcohol/drugs - social, escapism
Unhealthy food - convenience, social

126
Q

What is unrealistic optimism of health?

A

Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility

127
Q

What is perception of risk influenced by? (4)

A

Lack of personal experience with the problem
Belief that it is preventable by personal action
Belief that if it hasn’t already happened it won’t
Belief that the problem is rare

Also stress, age, socioeconomic and cultural factors

128
Q

What does perception of risk impact on?

A

Adherence - lower risk perception associated with reduced attendance to cardiac rehab, reduced medication compliance

129
Q

NICE guidance on behaviour change? (8)

A
  1. Planning interventions
  2. Assessing the social context
  3. Education and training
  4. Individual-level interventions
  5. Community-level interventions
  6. Population-level interventions
  7. Evaluating effectiveness
  8. Assessing cost-effectiveness
130
Q

5 steps to helping individuals to change their health behaviours?

A 
Work with your patient’s priorities
Aim for easy changes over time
Set and record goals
Plan explicit coping strategies
Review progress regularly
131
Q

Why is behaviour change important?

A

Both individually for mortality and morbidity
Population perspective
Relatively simple way to reduce disease!

132
Q

What is the biggest cause of illness and premature death in the UK?

A

Smoking
kills 100,000 a year in the UK
Due to cancer, COPD, heart disease

133
Q

What is smoking linked to?

A

Poverty
Unemployment
Being single
Male

134
Q

What is QOF?

A

Quality and outcome framework indicators

135
Q

8 models/theories of behaviour change?

A
  1. Health belief model (HBM)
  2. Theory of Planned Behaviour (TPB)
  3. Stages of change /transtheoretical model (TTM)
  4. Social norms theory
  5. Motivational interviewing
  6. Social marketing
  7. Nudging (choice architecture)
  8. Financial incentives
136
Q

What is the health belief model? (4)

A

Individuals will change if they:
Believe they are susceptible to condition
Believe it has serious consequences
Believe taking action reduces susceptibility
Believe benefits outweigh costs- perceived barriers

This motivates them and cues them to action

137
Q

What are cues to action in the health belief model?

A

Can be internal or external

i.e. advice from GP

138
Q

Critique of health behaviour model? (3)

A

Alternative factors may predict health behaviour - self efficacy, outcome expectancy
Does not consider emotions
Does not differentiate between first time or repeat behaviour

139
Q

Most important factor of the health behaviour model for addressing behaviour change?

A

Perceived barriers

140
Q

What is the theory of planned behaviour model?

A

Best predictor of behaviour is intention

Attitudes, subjective norm and perceived behavioural control lead to intentions which lead to behaviour

141
Q

What is intention determined by? (3)

A

A persons attitude to behaviour
Perceived social pressure to undertake behaviour
Persons thoughts that they are able to perform the behaviour

142
Q

5 ways to help people act on their intentions?

A 
Perceived control
Anticipated regret
Preparatory actions
Implementation intentions
Relevance to self
143
Q

Critique of planned behaviour model?

A

Lack of temporal element, direction or causality
Doesn’t take into account emotions
Relies on self reported behaviour

144
Q

What are the 5 stages in the stages of change model (transtheoretical)?

A 
Precontemplation
Contemplation
Preparation
Action
Maintenance
145
Q

Pros and cons of stages of change model?

A

Pros: acknowledges individual stages of readiness, accounts for relapse, temporal
Cons: people might not move through every stage, doesnt take into account external factors

146
Q

What is motivational interviewing?

A

Counselling approach - initiating behaviour by resolving ambivalence

147
Q

What is nudge theory?

A

Change environment to make the best option the easiest - opt out schemes, fruit next to checkouts

148
Q

Typical transition points to initiate behaviour change? (5)

A 
Leaving school
Entering workforce
Becoming a parent
Retirement
Bereavement
149
Q

Common implication of all models?

A

Need to explore a persons beliefs and reasons why they engage in behaviours before developing a plan for change

150
Q

Features of a communicable disease that would make it a public health concern? (5)

A 
High mortality
High morbidity
Highly contagious
Expensive to treat
Effective interventions
151
Q

Who must report notifiable diseases?

A

Registered medical practitioners

Labs - if results

152
Q

When must you report notifiable diseases?

A

Any case of a notifiable disease, on clinical suspicion don’t need lab confirmation
Any other infection/contamination that could risk human health

153
Q

What must you report about notifiable diseases?

A

Case details - NHS no, DOB, contact
Details of disease
Details of contamination

154
Q

How do you report notifiable diseases?

A

Contact local health protection/public health england

Written, telephone if urgent

155
Q

Name some notifiable diseases (8)

A 
Yellow fever
Whooping cough
TB
Scarlet fever
Measles, Mumps, Rubella
Meningococcal septicaemia
Acute encephalitis/meningitis
Food poisoning
156
Q

What is an epidemic? Pandemic?

A

Epidemic - occurrence of disease in excess of what is expected for a given time period
Pandemic - epidemic widespread over several countries

157
Q

What different factors can contribute to excessive energy intake?

A 
Genetics, early development
Employment - shift work
Media
Fatty food, big portions
Reduced activity
Psychological
158
Q

What is malnutrition?

A

Deficiencies, excesses or imbalances in a persons intake of energy/nutrients
Can be undernutrition or overnutrition

159
Q

Name some chronic conditions requiring nutritional support? (5)

A 
Type 2 diabetes
Coeliac disease
Eating disorders
IBD
Cancer
160
Q

Early influences on feeding behaviour?

A

Maternal diet/taste preference (can detect flavour before birth through amniotic fluid)
Breastfeeding
Parenting practices - age of solid food, types of food

161
Q

What is breastmilk composed of?

A

Colostrum 3 days after birth - protein, protective factors
Mature milk is calorie dense, fatty
Enzymes for digestion, gut protection IgA, white cells and bifidus factor for infection, lactoferrin

162
Q

Impact of breastfeeding on later eating habits? (4)

A

Acceptance of new foods during weaning
Less picky eaters
Eat more fruit and veg
Preferences to flavours they have been exposed to in amniotic fluid/milk

163
Q

Bad parental feeding practices?

A

Tactics such as coercion, persuasion

Using food as an incentive to eat increases liking for the reward and decreases liking for the other food

164
Q

Good parental feeding practices?

A

Modelling healthy eating
Variety of food
Avoid pressure to eat
Not using food as reward

165
Q

What is non organic feeding disorder?

A

High in children before 6
Food aversion, refusal, selectivity, failure to advance to age appropriate food
Often parents use bad feeding practices

166
Q

What is chemical continuity?

A

Transmission of certain flavours from maternal diet via amniotic fluid and breast milk

167
Q

What are the 3 basic forms of dieting?

A

Restriction of total amount
Avoidance of certain types of food
Fasting

168
Q

4 problems with dieting?

A

Risk factor to develop eating disorders
Loss of lean mass
Slows metabolic rate
Disrupt notmal appetite responses - increased feelings of hunger

169
Q

Why is dieting difficult for some people?

A

Unresponsive to internal cues that signal satiety and hunger

Vulnerable to external cues that signal availability of food

170
Q

What is the externality theory of obesity?

A

Normal weight individuals responsive to internal homeostatic cues
Overweight eat according to external cues, time of day, sensory food cues

171
Q

What is restrained eating and disinhibition?

A

Restrained - inhibit food intake, ignore hunger

Disinhibition - inability to maintain control

172
Q

What regulates food consumption?

A

Hunger to increase food intake, satiety to keep it below a max level
Determined by body weight set point
Regulated by social, environmental, psychological factors

173
Q

What is the boundary model of dieting?

A

Self imposed desired intake of food
If exceed this, continue to eat until feel full (more than that of normal eater)
Leads to overeating repeatedly

174
Q

Disinhibitors of diet?

A

High energy preload
Alcohol
Stress, emotion
Large portions

175
Q

What is the goal conflict theory?

A

Dieters experience conflict between enjoying eating and controlling weight

176
Q

What is the portion size effect

A

Consumption of large portion sizes of energy dense food facilitates over consumption

177
Q

Common eye conditions leading to sight loss? (6)

A 
Cataracts
Age related macular degeneration
Glaucoma
Retinitis pigmentosa
Hemianopia
Diabetic retinopathy
178
Q

What are cataracts?

A

Lens inside the eye becomes less transparent, cloudy

Vision appears misty

179
Q

What is age related macular degeneration?

A

Damage to the macular (central part of retina), affects central vision
May be able to be slowed/halted by lasers/drugs

180
Q

What is glaucoma?

A

Group of eye conditions that affect the optic nerve, may be caused by raised pressure or nerve weakness
Damage cannot be reversed
Affects peripheral vision, often leads to blindness

181
Q

What is retinitis pigmentosa?

A

Group of inherited conditions of the retina that lead to gradual progressive vision reduction
Difficulties with peripheral vision, night vision

182
Q

What is hemianopia?

A

Loss of right or left half of visual field in both eyes, following stroke
Damage to right posterior brain causes loss of left field of view in both eyes

183
Q

What is diabetic retinopathy?

A

Affects blood vessels supplying the retina, leading cause of blindness in adults under 65
Can be treated with laser if early to stop progression

184
Q

How can communication be improved for blind people?

A

Large print
Audio
Braille
Speech packages

185
Q

What is a disability?

A

A disability is related to anyone who has a physical, sensory or mental impairment which seriously affects their daily activities

186
Q

How would you recognise a visually impaired person?

A 
White walking stick
White symbol cane, guiding cane
Reading braille
Dark glasses
Being guided/guide dog
Feeling the way
Peering closely at something
187
Q

What are some emotional needs (human givens)?

A 
Security
Attention
Intimacy
Status
Part of a wider community
Privacy
Control/autonomy
Meaning and purpose
188
Q

What is the prevalence of loneliness?

A

Half of over 75s live alone
1 in 6 over 65 depressed, 1 in 5 alone for more than 12 hours a day
50% of men over 50

189
Q

Physical consequences of loneliness?

A 
Earlier death
Take more risks
Harder to self regulate
Physical changes = poor health
Cigarette smoking
190
Q

How to recognise loneliness?

A 
If pt is clingy, talkative
Says they're bored
Lives alone, esp. male >50
Recent bereavement or transition
Lack of mobility
Sensory impairment
No family nearby
191
Q

Define social exclusion

A

Dynamic process of being shut out, fully or partially, from any of the social, economic, political or cultural systems which determine the social integration of a person in society

192
Q

5 domains of society?

A 
Material resources
civic activities
basic services
neighbourhood
social relationships
193
Q

Causes of social exclusion?

A 
Poor health
Poverty
Housing issues
Fear of crime
Transport problems
Disrcimination
Lack of information
Lack of social networks
194
Q

Initiatives to help with social exclusion?

A

Age UK
Silverline
Regional clubs - dementia cafes

195
Q

What is domestic abuse?

A

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality

196
Q

Forms of abuse?

A 
Psychological
Physical
Sexual
Financial
Emotional
197
Q

How does domestic abuse impact on health?

A

Traumatic injuries, inc. miscarriage
Chronic illness - headache, pain
Psychological problems - PTSD, depression, substance misuse

198
Q

Indicators of domestic abuse in a presentation?

A

Injury unwitnessed by anyone else
Repeat attendance
Delay in attendance
Multiple minor injuries

199
Q

How does domestic abuse impact children?

A

Affects self esteem, education, relationships, stress response
Predispose to conditions i.e. mental health

200
Q

How to respond to domestic abuse?

A

Display helplines, contacts
Focus on safety
Ask direct qs
Be non judgemental, reassuring
Acknowledge behaviour is not OK
Be open to working with other organisations
DONT discuss it in front of family members

201
Q

What are the risk levels in domestic abuse?

A

Standard - no indication of causing serious harm
Medium - some indicators of serious harm, but unlikely unless change in circumstances
High - indicators of imminent risk of serious harm, could happen at any time

202
Q

Things that increase risk?

A

Victim - new baby/pregnant, isolated
Perpetrator - history of violence, drug use, weapons, accomplices, controlling
Other - sexual abuse, financial issues, death threats, stalking

203
Q

What to do if standard/medium/high risk?

A

Standard/medium - give domestic abuse services contact

High - refer, if very serious don’t need consent and can break confidentiality

204
Q

What is MARAC?

A

Multi agency risk assessment conference for domestic abuse

205
Q

What is the DHR?

A

Domestic homicide review for deaths that appear to have resulted from abuse

206
Q

What is the IDVA?

A

Independent domestic violence advocate - works with high risk women to increase safety

207
Q

What is Maslows hierarchy of needs?

A 
TOP: self actualisation (morality, creativity)
Esteem (confidence, achievement)
Love/belonging (family, sex)
Safety (employment, property)
BOTTOM: Physiological (food, water)
208
Q

Implications of rough sleeping?

A

30 years less life expectancy
4 x more likely to die from unnatural causes
Nearly half have mental health problems - 35x more likely to commit suicide
Half have alcohol/drug issues

209
Q

Causes of homelessness?

A

Relationship breakdown - mental illness, abuse, disputes, bereavement

210
Q

Some health conditions faced by homeless people?

A 
Infection - TB, hepatitis
Poor dental and foot care
Resp problems
Injury - violence, rape
Poor sexual health, no contraception
Serious mental illness
Substance addiction
Malnutrition
211
Q

Needs of homeless children?

A 
Stability and emotional security
Safety
Immunisations
Education
Play
212
Q

Barriers to healthcare faced by homeless? (4)

A

Access - opening times, appointment times, discrimination
Lack of integration of health with housing/social services
Health not a priority
May not know where to access

213
Q

Healthcare issues faced by travellers?

A

Children 2x more likely to die in first year
2.5x higher miscarriage rate
More smoking, asthma, angina, anxiety

214
Q

Barriers to healthcare faced by travellers?

A 
Reluctance ot GPs to visit communities
Illiteracy
Communication difficulties
Transient lifestyle
Mistrust of professionals
215
Q

Interventions to increase healthcare in homeless/travellers?

A

Homeless - homeless assessment and support service with specialists
Travellers - specialist health visitor since 1985, caused gradual acceptance of health care

216
Q

What is a refugee?

A

owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his nationality, and is unable, or owing to such fear, unwilling to avail himself of the protection of that country

217
Q

What is an asylum seeker?

A

Someone who has submitted an application to be recognised as a refugee and is waiting for their claim to be decided by the home office

218
Q

What is refugee status?

A

Indefinite leave to remain (ILR) :when a person is granted full refugee status and given permanent residence in the UK.
They have all the rights of a UK citizen.
They are eligible for family reunion- one spouse, and any child of that marriage under the age of 18
Usually reapply in 5 years

219
Q

Rights of asylum seekers?

A

£35 a week, housing, NHS care
If under 18 - social services, school
NOT allowed to work or other benefits
FAILED asylum seekers - no money, housing etc

220
Q

Barriers to healthcare in asylum seekers? (4)

A

Lack of knowledge where to go/how NHS works
Communication/language/culture barriers
Move around a lot
Health not a priority

221
Q

Health problems faced by asylum seekers?

A

Mental from previous experiences - separation, poverty, war/threat, detention
Physical health - malnutrition, abuse, infestations, blood borne diseases, untreated chronic disease or congenital, no immunisations etc

222
Q

What does asylum seeker health care service provide? (7)

A 
Rapid access
Screening
Catch up imms programmes
Appropriate referrals
Education
Mental health expertise
Supporting evidence for hearings
223
Q

What is humanitarian protection?

A

Failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3years then reapply

224
Q

Example of sloth? Opposite?

A

Not bothering to check results/information for accuracy, incomplete evaluation or documentation

Conscientiousness

225
Q

Example of fixation and loss of perspective? Opposite?

A

Unshakeable focus on a diagnosis, overlooking other signs, can’t see bigger picture

Open minded, situational awareness

226
Q

Example of communication breakdown? Opposite?

A

Unclear instructions or plans, not listening to others

Effective communication

227
Q

Example of poor team working? Opposite?

A

Team members working independently, poor direction, not using people’s skills

Good team working

228
Q

Example of playing the odds? Opposite?

A

Choosing the common, dismissing the rare condition

Probability assessment

229
Q

Example of bravado? Opposite?

A

Working beyond your competence, show of confidence to hide deficiency

Humility

230
Q

Example of ignorance? Opposite?

A

Lack of knowledge, unconscious incompetence

Self awareness

231
Q

Example of mis-triage? Opposite?

A

Over/underestimating the seriousness of a situation

Prioritisation

232
Q

Example of lack of skill? Opposite?

A

Lack of appropriate skills, teaching, or practice

Effective technical skills

233
Q

Example of system error? Opposite?

A

Environmental, technology, equipment or organisation mistake, inadequate safeguards

Good system design

234
Q

Define culture?

A

Socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop knowledge and attitudes about life
Distinguishes between groups of people

235
Q

What is ethnocentrism?

A

Tendency to evaluate other groups according to the values and standards of one’s own group, especially thinking you are superior

236
Q

What are the goals of diversity education?

A
  1. understand how culture influences our thoughts, perceptions, values, bias
  2. understand the nature of individual cultural identity as dynamic
  3. respectful curiosity attitude
237
Q

What is individual culture based on?

A

Heritage - country, language
Individual circumstances - gender, age
Personal choice - lifestyle

238
Q

What is a stereotype?

A

Generalisations about the typical characteristics of members of a group

239
Q

What is prejudice?

A

Attitudes towards another person solely on their membership of a group

240
Q

What is discrimination?

A

Actual positive or negative actions towards the objects of prejudice

241
Q

Challenges of cultural distance?

A 
Takes effort
Assumptions more likely to be wrong
Lack of rapport
Language barrier
Different expectations
242
Q

How to overcome challenges of cultural distance?

A

Flexibility - capacity to adapt, accommodate, modify
Inquisitive - eager to learn
Intellectual integrity - examining own thoughts
Be open minded
Reflect

243
Q

What are never events?

A

Adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability

244
Q

Why are never events a problem? (5)

A 
Cause harm/death to patients
Show gaps in provision of care
Affect NHS reputation
Financial penalties
Prompt visits by CQC etc
245
Q

Examples of never events? (5)

A

Surgery - wrong site, retained object
Medication - wrong preparation, route or overdose
Maternity - PPH death
Suicide in mental health care
General - falls from window, entrapment in bed rails, misidentification

246
Q

What is the biggest cause of medical errors?

A

Miscommunication - ignoring team members, no clear leader

247
Q

What is the swiss cheese model?

A

Accident/injury occurs errors in from organisational factors (i.e. cost cutting), unsafe supervision (deficient training), preconditions for unsafe acts (mental fatigue) and unsafe acts (wrong surgical site) all lining up in some patients

248
Q

Interventions for patient safety?

A

Checklists

SBAR (situation background assessment recommendation)

249
Q

What is the conformity problem?

A

People migrate to working in ways that they know to be wrong if there is great beneftit (eg saving time) and unlikely consequences
Become normalised, and if someone takes longer to be safe they are criticised

250
Q

What is transformational leadership?

A

Concerned with values, ethics, standards and long term goals

Inspires with possibilities and raises confidence to work together for a common purpose

251
Q

What is transactional leadership?

A

Leader offers something in return for something i.e. increased pay for more work

252
Q

Mechanisms underlying inhumane behaviour? (3)

A

Conformity - unwillingness to rebel against common view
Pressing situational factors - emergency
Bystander effect - ambiguity

253
Q

Why have healthcare resource needs increased?

A

Shift from acute illness to chronic
Normal physiological events medicalised
Increase in number and cost of drugs

254
Q

What are allocation theories based on?

A

Egalitarian principles
Maximising principles
Libertarian principles

255
Q

What is the egalitarian principle of allocation?

A

NHS was founded on the requirement to provide all care that is necessary and appropriate to everyone - equal access

But now finite resources

256
Q

What is the maximising principle of allocation?

A

Criteria that maximise public utility

257
Q

What is the libertarian principle to allocation? Example?

A

Each is responsible for their own health, well being and life fulfilment
i.e. german incentive schemes for participation in screening etc
What about those unable to pay healthcare!

258
Q

What is the solidarity principle of health allocation?

A

Contribution according to level of income, benefits according to need

259
Q

What is sustainable medical practice?

A

a sustainable process is one that “meets the needs of the present without compromising the ability of future generations to meet their own needs.”

260
Q

What is health?

A

Health is the state of complete physical, mental and social wellbeing and not merely the absence of disease or informity

261
Q

4 rights (from human rights act) that are frequently engaged in healthcare?

A

Art 2 – the right to life (limited)
Art 3 – the right to be free from inhuman and degrading treatment (absolute)
Art 8 – the right to respect for privacy and family life. (qualified)
Article 12 – right to marry and found a family

262
Q

What are absolute rights in the human rights act?

A

Art 3 - protection from inhuman treatment
Art 4 - prohibition of slavery
Art 7 - protection from retrospective criminal penalties

263
Q

What are qualified/limited rights?

A

Rights are limited under explicit and finite circumstances i.e. respect to privacy qualified to protect health

264
Q

Is there a right to medical treatment?

A

Article 2 - There is a positive obligation upon the State; to take appropriate steps to safeguard life

But cannot impose an impossible or disproportionate burden on the authorities.

265
Q

Difference between novice and expert decision making?

A

Novices use analysis
Experts use intuition

Hinges on pattern recognition

266
Q

What is intuitive decision making?

A

Ability to understand something instantly without conscious reasoning

Fast and strong but prone to bias

267
Q

Biases in intuitive thinking?

A

Error of over attachment
Error due to failure to consider alternative
Error due to diagnosis momentum
Errors in prevalence estimation

Use debiasing techniques - acknowledge it, rethink, checklists, group decision making

268
Q

What is analytical decision making?

A

Not good at estimating odds or values but good at measuring or calculating things - evidence based medicine

Accurate but slow, resource intensive

269
Q

What is the dual process theory?

A

Intuitive thinking with analytical thinking - may come up with different diagnoses from both

270
Q

GMC duties of a doctor?

A

Knowledge, skills and performance
Safety and quality
Maintaining trust

271
Q

Examples of human error?

A

Communication
Judgment
Omissions/lapses

272
Q

Examples of misconduct?

A

Deliberate harm
Lack of honesty
Fraud/theft
Improper relationships

273
Q

Bolam test for breach in duty?

A

Would a group of reasonable doctors do the same?

274
Q

Bolitho test for breach in duty?

A

Would it be reaosnable of them to do the same?

275
Q

How to determine medical negligence?

A

1) Was there a duty of care
2) Was there a breach in the duty of care?
3) Did the patient come to harm?
4) Did the breach cause the harm?

276
Q

What is the 3 buckets model?

A

Each bucket contains diffrent sources of risk - the more full each one is the greater the risk
Self/Context/Task

Self - fatigue, lack of skill
Context - distraction, equipment failure
Task - complex, long

277
Q

What is Peyton’s 4 step procedure for skills teaching?

A

Trainer runs through without commentary
Trainer talks through and does
Learner talks through and trainer does
Learner talks through and does

278
Q

2 types of small group dynamics?

A

Group taught by teacher

Teacher facilitates communication

279
Q

4 distinct learning styles?

A

Activist
Theorist
Pragmatist
Reflector

280
Q

4 teaching styles?

A

Facilitator
Conductor
Enabler
Dominator

281
Q

What is consequentialism?

A

The end justifies the means - the right action is the one that gives the best outcome

282
Q

Types of consequentialism?

A

Utilitarianism
Egoism
Altruism

283
Q

What is utilitarianism?

A

Best course is the one that promotes most happiness/absence of pain for all - lesser of two evils

284
Q

What is egoism?

A

Best course is what’s best for you (may not be best for others)

285
Q

What is altruism?

A

The best course is what is best for others (may not be best for you)

286
Q

What is deontology?

A

Duty based - there are fundamental duties and rules to be followed, and acts are seen as wrong if they violate these no matter what the consequence

287
Q

What are the 4 principles of ethics?

A

Autonomy - patient choice
Beneficence - patients best interest
Non maleficence - do no harm
Justice - equity, avoid discrimination

288
Q

What is dynamism?

A

situations are always dynamic/changing and what is best at one time may not be appropriate at a later stage

3A REVISION (17 decks)

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