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ASBHDS > Revision Summary Notes 2 > Flashcards

Revision Summary Notes 2 Flashcards

1
Q

What broad categories are social determinants of health?

A 
Constitutional factors.
Individual lifestyle factors.
Social and community networks.
Living and working conditions.
General socio-economic, cultural and environmental conditions.
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2
Q

What is proportional universalism?

A

To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage.

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3
Q

What is the inverse care law?

A

The availability of good medical care tends to vary inversely with the need of the population served.

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4
Q

What is the prevention paradox?

A

Interventions that make a difference at population level might not have much effect on the individual.

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5
Q

Why does the prevention paradox occur?

A

Lay beliefs - people don’t see themselves as a candidate for a disease, awareness of anomalies and randomness.

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6
Q

What is the artefact explanation for health inequalities?

A

The existence of health inequalities is due to the way statistics are collected and in particular to problems with the measurement of social class.

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7
Q

What is the social selection explanation for health inequalities?

A

Direction of causation is from health to social position.

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8
Q

What is the behavioural-cultural explanation of health inequalities?

A

Ill health is due to people’s choices, decisions,
knowledge and goals so people from disadvantaged backgrounds tend to engage in more health damaging behaviours and people from advantaged backgrounds tend to engage in more health-promoting behaviours.

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9
Q

What is the materialist explanation for health inequalities?

A

Inequalities in health arise from differential access to material resources eg low income and work environments. There is a lack of choice in exposure to hazards and adverse conditions, with an accumulation of factors across the life-course.

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10
Q

What is primary prevention?

A

Prevent onset of disease or injury by reducing exposure to risk factors eg immunisation.

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11
Q

What is secondary prevention?

A

Detect and treat a disease at an early stage eg cancer screening.

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12
Q

What is tertiary prevention?

A

Minimise the effects of an established disease eg steroids for asthma.

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13
Q

What are the 4 features of test validity?

A

Sensitivity.
Specificity.
Positive predictive value.
Negative predictive value.

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14
Q

What is test sensitivity?

A

Proportion of people with the disease who test positive = detection rate.

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15
Q

What is test specificity?

A

Proportion of people without the disease who test negative.

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16
Q

What is positive predictive value?

A

Probability that someone who has tested positive actually has the disease.

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17
Q

What is negative predictive value?

A

Proportion of people who test negative who actually do not have the disease.

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18
Q

What is the positive predictive value strongly influenced by?

A

Prevalence of the disease.

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19
Q

What is adherence?

A

Extent to which a person’s behaviour corresponds with agreed recommendations form a healthcare provider.

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20
Q

Name 3 factors that can affect adherence.

A 
Gender.
Age.
Ethnicity.
Education.
Social support.
Marital status.
Mood impairment or cognition.
Number of prescribing doctors.
Visiting more than one pharmacy.
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21
Q

What group of patients tend to be more adherent?

A

Higher income, lower medicine expenses.

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22
Q

Give 3 reasons why a patient may not take their medication.

A 
Forgetting to take the medicine.
Affordability.
Concern about safety or effectiveness.
Fear of or experiencing adverse effects.
Confusion over the directions.
No longer feeling unwell or not feeling any different.
Feeling that they cannot manage with the number of medicines they should take and how to coordinate them.
Having dexterity challenges.
Simply being too unwell.
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23
Q

What is concordance?

A

Agreement between the patient and healthcare professional, reached after negotiation that respects the beliefs and wishes of the patient in determining whether, when and how their medicine is taken, and (in which) the privacy of the patient

24
Q

Why does concordance increase adherence?

A

More empowered patient as their feelings have been discussed and respected, an open forum encouraged to discuss any ensuing treatment challenges, and hence there is a greater likelihood of the patient following the prescribed treatment and therefore commit to a more transparent decision-making process within which they have played a role.

25
Q

Why is the term compliance being replaced with adherence?

A

Compliance implies a submissive, uninvolved patient in a paternalistic setting.

26
Q

What is a stereotype?

A

Generalisations we make about specific social groups and members of those groups.

27
Q

What patterns are seen with in-group/out-group attributions of stereotypes?

A

Groups are a source of self-identity and self-esteem.
People focus on negative attributes of other groups and positive attributes of their own.
Negative bias of stereotypes may lead to prejudice.

28
Q

What is stigma?

A

A negatively defined conditions, attribute, trait or behaviour confirming deviant status.

29
Q

What is discreditable stigma?

A

Condition where nothing is seen but there is a stigma if found out eg mental illness.

30
Q

What is discredited stigma?

A

A physically visible characteristic or well known stigma that sets them apart eg physical disability.

31
Q

Give an example of a condition that can be both discreditable and discredited stigma?

A

Epilepsy.

32
Q

What is enacted stigma?

A

The real experience of prejudice, discrimination and disadvantage as a consequence of a condition.

33
Q

What is felt stigma?

A

The fear of enacted stigma which also encompasses a feeling of shame so leads to selective concealment.

34
Q

Give 2 impacts of stereotypes and stigma in a clinical setting.

A

Symptoms may be missed by doctor due to attributes linked to an illness.
Patients reluctant to disclose symptoms.
HCP reluctant to label patient.

35
Q

What 6 things define healthcare quality?

A

Safe, effective, patient-centres, timely, efficient, equitable.

36
Q

What is an adverse event?

A

Injury that is caused by medical management (rather than the underlying disease) and that prolongs the hospitalisation, produces a disability, or both.

37
Q

What is a preventable adverse event?

A

An adverse event that could be prevented given the current state of medical knowledge

38
Q

What is usually at fault in an adverse event?

A

System failures rather than individuals - multiple contributions and not enough or the right defences built in.

39
Q

Name 3 ways healthcare systems can be made safer.

A 
Avoid reliance on memory.
Make things visible.
Review and simplify processes.
Standardize common processes and procedures.
Routinely use checklists.
Decrease the reliance on vigilance.
40
Q

What is first order problem solving?

A

Either:
Do what it takes to continue the patient care test, no more or less. This meets immediate needs and minimises time away from patient care.
OR
Ask for heals from those who are socially close rather than from those who are best equipped to correct the problem. This preserves reputation and minimises difficult encounters.

41
Q

What is second order problem solving?

A

Taking action to prevent the problem recurring. Has positive consequences for workers and organisations if action is successful eg high productivity and greater customer satisfaction.

42
Q

What are active failures?

A

Acts that end directly to the patient being harmed. Occur at the sharp end of practice.

43
Q

Wha are latent failures?

A

Predisposing conditions that make active failures more likely eg poor training, poor design of syringes, too few staff.

44
Q

When designing a system, what do defences need to do?

A

Trap and mitigate the active failure.

45
Q

What is a systems approach?

A

Set of elements (people, processes, information,
organisations, software, hardware etc) that when combined have qualities that are not present in any of the elements themselves.

46
Q

What techniques can be used in systems analysis?

A

Fishbone diagram.
5 whys.
Timelines.

47
Q

What is a systems analysis?

A

Structured approach to the retrospective investigation of adverse events in healthcare focusing on the densification of the underlying (latent) factors causing the problem.

48
Q

What is PDSA?

A

Plan, do, study, act.

49
Q

Give 3 reasons why might someone not speak up if they had concerns about safety.

A

Loss of situational awareness.
Authority gradients.
Too much deference/confidence.
No certainty it will lead to improvements.
Provoke informal hostility or reduce quality of working relations.
Difficult to be sure if something is really a problem.

50
Q

What channels are available for raising concerns?

A

Incident reporting systems.
Raising concerns with seniors.
Raising concerns with regulators.

51
Q

What is consultation in patient and public involvement in the research cycle?

A

Consultation involves asking members of the public for their views about research, and then using those views to inform decision-making. This consultation can be about any aspect of the research process – from identifying topics for research, through to thinking about the implications of the research findings. Having a better understanding of people’s views should lead to better decisions.

52
Q

What are the benefits of consultation for public involvement in the research cycle?

A

Useful when exploring sensitive and difficult issues.

Can get a wide range of views.

53
Q

What are the challenges of consultation for public involvement in the research cycle?

A

Might not get the broad views you were hoping for.

People may have had previous bad experiences of consultation where their views were not listened to.

54
Q

What is collaboration in patient involvement in the research cycle?

A

Collaboration involves an ongoing partnership between you and the members of the public you are working with, where decisions about the research are shared. For example, members of the public might collaborate with the researchers on developing the research grant application, be members of the study advisory group and collaborate with researchers to disseminate the results of a research project.

55
Q

What are the benefits of collaboration for public involvement in the research cycle?

A

Skills and perspectives of public and researchers can complement one another.
Can help with recruitment and informed consent.

56
Q

What are the challenges of collaboration for public involvement in the research cycle?

A

Time consuming and involves additional cost.

Researcher need to be flexible and willing to share control of the research.

57
Q

What is co-production in public involvement in the research cycle?

A

Its application in health and social care research varies, revealing a lack of consensus around the concept. Some argue that co-production in research is just really good PPI

ASBHDS (2 decks)

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