SocPop Flashcards

Question

Why is surveillance useful?

Answer 1

Early detection of outbreaks Monitoring Trends Early warning of changes in incidence Guidance to public health programmes (identify high risk groups to receive neonatal BCG to prevent childhood TB).

Answer 2

``` Notification of Infectious Disease Primary Care - Remote health advice (NHS 111) - GP in and out of hours - RCPG consultations for influenza-like-illness - COVER (immunisation data) Secondary Care - Emergency department syndromic surveillance to monitor ED attendances and triage severity ratio. ```

Answer 3

Enables prompt investigation, risk assessment and response to cases of infectious disease and contamination that present risk to human health Registered medical practitioners have a statutory duty to notify the health protection team od suspected cases of certain infectious diseases. Complete a notification form immediately on diagnosis of a suspected disease, do not wait for lab confirmation. Send the form within 3 days, or notify verbally within 24hrs 32 notifiable disease, not including HIV as it has a separate mandatory surveillance system.

Answer 4

Agent : Host : Environment Triad Agent - Virus - Bacteria - Fungus - Protozoa Host - Age - Gender - Socioeconomic Status - Ethnicity - Lifestyle factors - Immunological Status (immunisation, previous exposure, immunosuppression) - Level of inherent resistance Environmental - Climate and temperature - Physical surroundings - Crowding - Sanitation - Availability of health services

Answer 5

Statutory responsibility to take notifications of infectious disease and manage outbreaks/chemical or environmental incidents

Answer 6

Lead and co-ordinate the NHS response to large/significant outbreaks

Answer 7

Support the role of NHS England and work with larger outbreaks/commission community and acute trust providers to support smaller outbreak responses

Answer 8

Support outbreak investigation and management, through taking samples and organising treatment and prophylaxis

Answer 9

Provide microbiological advice regarding single cases of communicable disease/outbreaks. In a hospital incident the Director of Infection Prevention and Control (often a microbiologist) leads the outbreak management.

Answer 10

Environmental HEalth Officers support the investigation of certain communicable disease cases/outbreaks which may have an environmental source, e.g. GI infections, Legionella. They organise food questionnaires and stool samples in an outbreak of GI disease, as well as inspection of food premises/kitchens which may be implicated. They can prosecute where necessary. The Director of Public Health (and teams) in the Local Authority has the statutory responsibility to ensure there are plans in place to protect the health of the population and will support the outbreak response.

Answer 11

``` PHE NHS England CCG Primary Care/Community Provider Trusts Acute Hospital Trust Local Authorities - Environmental Health Officer ```

Answer 12

Touching (Scabies) Kissing (oral infection) Sexual (Chlamydia, Gonorrhoea, syphilis, HIV, HepB) Droplet Spread (measles, mumps, flu, meningococcal) Vertical Transmission - Transplacental/during childbirth (toxoplasmosis, rubella, CMV, HSV, HIV, Hep B, HepC) Faeco-Oral (campylobacter, salmonella, E.coli, Hep A)

Answer 13

Vehicle Borne (flu) - inanimate objects, food/water, biological products e.g blood, tissues Vector Borne (malaria) - an insect or living carrier which carries disease from an infected individual to a susceptible individual Airborne - aerosols e.g TB and dust, fungi and respiratory viruses.

Answer 14

The progress of a disease process in an individual over time without intervention

Answer 15

``` Exposure Subclinical (unapparent pathological) changes Onset of symptoms Clinical illness (or not) Recovery or Death ```

Answer 16

The time interval between initial contact with an infectious agent and the appearance of the first sign or symptom of the diseases.

Answer 17

Time between becoming infected and becoming infectious

Answer 18

The time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to man or from an infected person to an animal.

Answer 19

Irregular pattern of disease, occasional cases at irregular intervals (Bat to human)

Answer 20

Persistent, low or moderate level of disease (Wuhan province)

Answer 21

A higher persistent level of disease (3 Provinces)

Answer 22

Occurrence exceeds the expected level for a given population and/or in a given geographical area and/or in a given time period (cases have a possible but unconfirmed link)

Answer 23

Occurrence exceeds expected level for a given population and/or in a given geographical area and/or in a given time period.

Answer 24

A localised epidemic, and is also practically defined as two or more linked cases, or a single case or serious disease e.g rabies, diphtheria, botulism, polio

Answer 25

Epidemic occurring worldwide or over a very wide area, crossing international boundaries, and usually affecting a large number of people.

Answer 26

Control the Source (Mink Culling) Interrupt transmission (Close borders, Wash hands) Protect susceptible by immunisation of chemoprophylaxis

Answer 27

Confirm (verify diagnosis) Immediate control Convene an Outbreak Control Team Review epidemiological (time, place and person) and microbiological information Case Finding Definitive control measures Descriptive epidemiology (epidemic curves) Analytical study (case control or cohort) Declare outbreak over (lessons learnt, prevention measures in place, ongoing monitoring) Communication throughout

Answer 28

A dodgy burger van All cases appear to occur within one incubation period, suggesting that cases did not arise from person-to-person spread. The fact the outbreak was short in duration suggests a single, brief exposure that didn't persist over time

Answer 29

COVID-19 Begins like an infection form a single case but then develops into a full-blown epidemic with secondary cases infecting new people who, in turn, serve as sources for other cases. Produces successively taller peaks on an epidemic curve, initially separated by one incubation period, but peaks tend to merge into waves with increasing numbers. The epidemic continues until the remaining numbers of susceptible individuals decline or until intervention measures take place.

Answer 30

The London Cholera Outbreak As with the point source outbreak, a group of people are exposed to a single noxious influence. But the exposure continues over a longer time (e.g a contaminated water supply that doesn't get fixed, so the outbreak persists for longer. The relatively abrupt beginning of the outbreak suggests that many people were exposed simultaneously rather than case to case transmission. The lack of cases following an incubation period after termination to exposure suggests this.

Answer 31

COVID-19 Traveller from China to Italy A single case (returning traveller) infects other people, and cases arise after an incubation period (point source with secondary transmission) Outbreak waves when the infected people no longer transmit the infection to other susceptible people, perhaps because of control measures (isolation or quarantine)

Answer 32

Point Propagated Continuous Mixed

Answer 33

Vaccination (Individual protection vs Herd immunity) Post-exposure chemoprophylaxis (individual protection < Elimination of transmission Exclusion from school/work (not allow to return until clear samples or 48 hours after N+V) Use of Part 2A order legislation (Require investigation and detention of an individual who poses a risk to the public)

Answer 34

Any person who is moving or has moved across an international border or within a state away from their habitual place of residence, regardless of: legal status, whether the movement is voluntary, what the causes are, or the length of stay.

Answer 35

Persons who are outside their country of origin for reasons of feared persecution, conflict, generalised violence, or other circumstances that have seriously disturbed public order and, as a result, require international protection.

Answer 36

A person who has fled their country but whose claim has not yet been finally decided on by the country in which they have submitted it.

Answer 37

A person who is to be engages, is engaged or has been engaged in a remunerated activity in a state which they are not a citizen.

Answer 38

Everyone in England is entitled to free pharmacy care, regardless of immigration status Asylum seekers and refugees are entitled to free secondary care, others are charged. Understanding these terms can help HCPs advocate for their patients.

Answer 39

``` Leadership/Governance Healthcare Financing Health Workforce Medical products and technologies Information and Research Service Delivery Healthcare Seeking Behaviour ```

Answer 40

Conflicting policy goals between ministries responsible for health, immigration, and human resources. Legislation is not migrant inclusive

Answer 41

Eligibility and enrolment in health insurance schemes Cross border health and social insurance schemes Migrant ability to pay when not enrolled in heath insurance schemes

Answer 42

Profession norms involving discriminatory treatment and perceived "deservingness" and cultural competence of staff treating migrant patients (training)

Answer 43

Availability of essential medicines and technologies for migrant patients

Answer 44

Data collection systems disaggregated by migrant status Availability of databases on migrant health

Answer 45

Language skills or interpreter availability Essential health packages for migrants regardless of documentation status Proximity and accessibility of services (mobile units)

Answer 46

Age, gender, culture, education, or language Perceived health needs Existing health knowledge and practices including self treatment Perceived "deservingness" for services Knowledge, information and accessing care Legal status and possession of documents Fear of arrest or deportation Freedom of movement

Answer 47

Perinatal health (worse outcomes) Child health (disrupted immunisation schedule) Adolescent health (stigma, exclusion, bullying) Mental Health (1st gen worst) Communicable diseases (Hep B,C, HIV, Syphilis, TB, leprosy) Non-communicable disease (interruption of care worsens chronic conditions) Tobacco and alcohol use Occupational health due to employment type (injury, weather, pesticide, depression. Malnutrition Anaemia Parasitic infection Effects of conflict exposure Trafficking and modern slavery FGM Effects of detention and torture

Answer 48

Blood feuds and police corruption make living in country of origin too dangerous Extreme poverty means living in unsafe environments and lack of access to healthcare Forced prostitution, kidnapping, trafficking and rape.

Answer 49

Unsanitary conditions on travel A lot of young women are assaulted and raped (and become pregnant) on their way to the UK.

Answer 50

Some areas do not have a specialised service for asylum seekers which leads to difficulties in accessing health care (language barriers) Some practices refuse to register asylum seekers.

Answer 51

``` Current and PMH TB Mental health screen Sexual health screen Women asked about FGM and safeguarding Asked for an outline of why they are seeking asylum Refer to GP if any significant issues Blood tests for infectious disease, sickle cell, thalassaemia + FBC Chlamydia Test ```

Answer 52

Persistent Cough? Blood? Significant weight loss? Night sweats? Contact of infected person?

Answer 53

GP discusses positive result with patient in a breaking bad news consultation. Refer to sexual Health Annual cervical smear for female HIV positive Annual flu and pneumococcal vaccination.

Answer 54

Asia and Africa

Answer 55

Spread by body fluids e.g sex, vertical transmission

Answer 56

Refer to hepatology specialist Check levels of virus : if high and liver damaged then may need antivirals Spouse and children need screening and immunisation.

Answer 57

Refer to hepatologist | Needs antiviral treatment as it will progress to cause liver damage

Answer 58

Penicillin

Answer 59

Refer to sickle cell and thalassaemia service If pregnant, screen partner Require annual flu vaccine, pneumococcal vaccine and hepatitis A and B vaccine Manage with regular penicillin and folic acid + pain relief.

Answer 60

Active TB identified by screening questions Positive quantiferon gamma assay blood test indicates active or latent TB Call patient in for GP appointment and explain Arrange CXR and basic blood tests to exclude active TB Refer to hospital TB team For latent TB, they will arrange 3 month TB chemoprophylaxis in community.

Answer 61

Anxiety and/or depression PTSD Paranoid Schizophrenia Bipolar

Answer 62

Applicable to all vulnerable populations with complex needs Understand individual situations as fully as possible Referrals to social services, housing. Signpost to Refugee Centre and organisations that can provide social/financial/legal advice Keep up to date with new agencies (modern slavery unit, black country women's centre)

Answer 63

Confront urgently, vigorously, and persistently, divisive myths and discriminatory rhetoric about migrants Foster cross-sector, complementary decision making that integrates health considerations across policies and services that determine the health of migrants Advocate for and improve the rights of migrants to ensure safe and healthy educational and working conditions that includes freedom of movement with no arbitrary arrest.

Answer 64

1. Make sure patients know they don't need to give a personal address 2. Display a poster declaring your surgery a safe space 3. Never ask to see a passport, visa or identity document. 4. Don't ask for proof of address documents 5. Make sure frontline staff know the rules 6. Check your registration policy.

Answer 65

Providing the same level or kind of service to everyone

Answer 66

Providing services according to need.

Answer 67

When people with the same needs do not have access to the same resources, unequal treatment of equals.

Answer 68

Different geographical areas get access to better healthcare or more opportunities for treatment than others.

Answer 69

When people with greater needs are not provided with greater resources to meet those needs

Answer 70

"The right thing to do" - fairness and social justice Equitable access to medical and health care can contribute to reduction in health inequalities Not addressing inequity could widen health inequalities Duty under the equality act 2010.

Answer 71

1. recent fall in CHD attributed to improved treatment uptake across all social groups 2. Increase in proportion of resources allocated to deprived areas led to a reduction in absolute health inequality 3. 15-20% of life expectancy gap can be influenced by health care interventions. 4. Vital to quality of life

Answer 72

Asylum seekers (access) Homeless people (access) Travellers (access) LGBTQ+ report less satisfaction with GP care Uptake of colorectal cancer screening is lower in most social disadvantaged groups. Low income households less likely to take up immunisation and child health screening.

Answer 73

Limited use of total hip arthroplasty among patients from deprived area and inappropriate high use in affluent areas Inequities in treatment provision at the weekend Bowel cancer patients from disadvantages areas have more emergency admissions Most disadvantaged less likely to survive lung cancer Young women (<70) more likely to receive breast reconstruction than old women after breast cancer Disadvantaged patients more likely to die in hospital Ethnic inequalities in the access to cardiac care and secondary diabetes care Significant levels of untreated ill-health and high number of avoidable deaths.

Answer 74

Improving access for all and reducing inequalities in access to GP services.

Answer 75

``` Lack of funding Services at wrong time/place Costs attached Culturally inappropriate Variable Quality Clinician Biases ```

Answer 76

Health literacy Can't use services due to geographical or physical barriers Community and cultural attitudes and norms

Answer 77

MDT approach Driven by information from health impacts assessments Complex and multi-faceted Action at organisational level

Answer 78

Reduce physical and geographical barriers Address attitudinal or knowledge biases of clinicians Reduce variations in quality of services offered to patients with identical needs (between areas, age, gender, ethnicity, disability) Reduce costs to individual Take account of affordability and indirect costs (day of work, childcare) Ensure health service info on availability and type of service is known with equal clarity Preferences for services in particular locations/times Community and cultural attitudes and norms

Answer 79

People sleeping, about to bed down or actually bedded down in the open air People in buildings or other places not designed for habitation Doesn't include people in hostels or shelters, campsites or other sites used for recreational purposes or organised protest, squatters or travellers

Answer 80

Staying for short periods with different friends or family because you have nowhere settled to stay

Answer 81

People who are homeless but found temporary solutions by staying with family members or friends (sofa surfing), living in squats or other insecure accommodation, cars or night shelters.

Answer 82

Main homelessness duty is owned by a council where the authority is satisfied that the applicant is eligible for assistance unintentionally homeless and falls within a specified priority need group.

Answer 83

Households with dependent children or a pregnant woman Those who are vulnerable in some way (mental illness or physical disability) Those aged 16/17 or aged 18-20 who were previously in care Those who are vulnerable as a result of time spent in care, custody or HM forces Those who are vulnerable as a result of having to flee their home because of violence or threat of violence.

Answer 84

``` Poverty Inequality Housing supply and affordability Unemployment Access to social security ```

Answer 85

``` Poor physical health Mental health Childhood trauma Refugees Time in care or prison Relationship breakdown Bereavement Substance Abuse Experience of violence Abuse Neglect Harassment Hate Crime ```

Answer 86

Structural | Individual

Answer 87

Mixed ethnicity females

Answer 88

Attend A&E 6 times as often as housed people Admitted to hospital 4 times as often Stay twice as long because they are 2 to 3 times sicker when they arrive. More likely to have long term physical health problems More likely to have mental health problems Much higher use of drugs or to be in recovery

Answer 89

``` 2.5x more likely to have asthma 6x more likely to have heart disease TB rates are 34x higher Hep C rates 50x higher Leg ulcers Dental Problems Sepsis Severe malnutrition ```

Answer 90

``` Cannabis (64%) Prescription Drugs (29%) Heroin (27%) Benzodiazepines (18%) Amphetamines (17%) ```

Answer 91

Regular smokers (77%) Do not eat at least two meals a day (35%) Only 1-2 Pieces of fruit and veg per day

Answer 92

Everyone has the right to register with a GP in England Do not need a fixed address, ID and your immigration status doesn't matter This is often unknown or misunderstood by patients and receptionists

Answer 93

``` Prejudice from HCPs Fear and embarrassment No phone so unable to book Inflexible appointment times No consistent GP Blacklisted from local GPs Appointments too short to address all problems Lack of self-worth Lack of trust in authority Lack of trust in medical professionals Chaotic lives ```

Answer 94

Identify risk of homelessness among people who have poor health, and prevent this Minimise the impact on health from homelessness among people who are already experiencing it. Enable improved health outcomes for people experiencing homelessness so that their poor health is not a barrier to moving on to a home of their own

Answer 95

Some authorities in England have a duty to notify local housing authorities of users they think may be homeless or at risk of homelessness Duty to Refer - Prisons - Youth offending teams - Probation services - Secure training centres - Colleges - Jobcentre Plus - Social service authorities - Emergency departments - Urgent treatment centres - Hospitals in their function of providing inpatient care If threatened with becoming homeless within 56 days, or a service discloses this, the authority is required to ask customer if they would like to be referred to a local housing authority of their choice. Public authority is required to make the referral if its agreed on, to the LHA of the reason for referral.

Answer 96

``` Listen Allow time to discuss issues Ask about housing when clerking Refer to local housing authorities Understand 'drug' slang Timely methadone prescription Understand good pain relief prescribing Promote vaccinations Promote sexual health Arrange for district nurse care in temporary accommodation Be aware of local homelessness and addiction services ```

Answer 97

Infectious LRTI HIV/AIDS Diarrhoeal Disease

Answer 98

Non-communicable IHD Stroke Trachea, bronchus, lung cancer

Answer 99

Disability Adjusted Life Year A single measure to quantify the burden of diseases, injuries and risk factors. Based on years of life lost from premature death and years of life lived in less than full health. DALYs account for the quantity and quality of life lost due to disease/disability. Better measure of disease burden than deaths alone.

Answer 100

``` Poverty War Lack of clean water and food supply Environment Under resourced health care services Lifestyle Illiteracy Political instability International Travel ```

Answer 101

``` Avian flu Bats: COVID-19, Nipah Virus Ebola Marburg virus Borrelia burgdorferi: Lymes Disease Deer Tick Mastomys Rodent: Lassa Fever Hantavirus pulmonary syndrome ```

Answer 102

Spread by direct contact with blood/bodily fluids of someone who has developed symptoms Initial infection is spread by infected fruit bats, may also be monkeys, dogs, or pigs.

Answer 103

Transmission - caused by parasites of the plasmodium genus - most important protozoa infection in the world - 4 human species of malaria (P.falciparum, P.ovale, P.malaria, P.vivax) Global Distribution - P. falciparum dominant in Africa and new guinea - P. vivax predominates in India, Pakistan, Bangladesh - P. ovale and malaria occur mainly in Africa and South America Problem - 300m people contract malaria annually - 1 million die - mostly children <5 years in sub-saharan Africa - 2/3 of reported cases are in Africa, Indian subcontinent, Vietnam and Columbia and Brazil - 10,000 - 30,000 people contract in developed countries through foreign travel - 2,000 cases annually in UK with 10 deaths

Answer 104

Most common infectious disease in the world 1/3 of population infected 2.5 million deaths annually 8.7 million new cases Bulk of infection in south asia (3m) and Africa (2m) 1/3 of patients infected in Africa are co-infected with HIV

Answer 105

Blood fluke - trematode infection where worms live in the host's mesenteric veins for years Caused by 3 major schistomiasis species - S.mansoni (Africa, Middle East, South America) - S.japanicum - S.haematobium (Africa, Middle East, South America) Chronic intestinal and hepatic schistomiasis caused by S.mansoni and S.japanicum Chronic urinary schistomiasis caused by S.haematobium

Answer 106

Type of infection - Viral disease that is transmitted by several species of mosquito - Caused by the yellow fever virus, which belongs to genus flavivirus Problem - Endemic in 10 countries in South America - Endemic in 30 countries in sub-saharan Africa - Great degree of underreporting - WHO estimates 200,000 cases per year - 30,000 deaths per year Route of transmission is mosquito - Aedes aegypti - Haemogogus spp Reservoir - Humans and monkeys

Answer 107

A negotiated, shared agreement between clinician and patient concerning treatment regimes, outcomes and behaviours. A more cooperative relationship than those based on issues of compliance and non-compliance.

Answer 108

The fulfilment by the patient of the HCPs recommended course of treatment.

Answer 109

The extent to which a person's behaviour (taking meds, following a diet, and/or executing lifestyle changes) corresponds with agreed recommendations from a healthcare provider

Answer 110

Patient-centred/demographic Psychological Patient-Prescriber Relationship

Answer 111

Age - Better concordance as patient gets older until disabilities occur - Younger patients' work commitments hamper concordance - Adolescents have poor concordance - rebellious behaviour, disagreement with parents and authorities, want to live normal life like friends Ethnicity, Gender and Education - Equivocal results, except in adolescents with diabetes Marriage - Increases concordance, support from spouse

Answer 112

Patient beliefs and motivations - improved concordance in patients that believe illness poses threat, motivated to take treatment they believe to be effective. - Decreased concordance in patients who believe disease is uncontrollable, fear dependence, fear ineffective, religious beliefs, cultural beliefs Negative attitude towards therapy - depression, anxiety, anger towards illness - adolescents feel stigmatised and different to peers.

Answer 113

Communication Patient trust in prescriber Empathy of prescriber towards patient

Answer 114

Patient centres treatment plan Detailed explanations Understanding illness and therapy. Therapy-related - Oral route of administration is best - Treatment complexity: dosing frequency not quantity - side effects - degree of behaviour change needed Socioeconomic - Time commitment for appointments - 1:10 US seniors cannot afford medication - Social support: Friends and family

Answer 115

Waiting times, problems accessing treatment and quality of consultation all affect availability and accessibility.

Answer 116

Concordance reduces with - fluctuating/absent symptoms e.g HTN - severity: adolescents have better concordance with mild asthma Concordance improves with - Marked improvement of symptoms - Perceived poor health status

Answer 117

Concordance needs to be embraced in the healthcare system in order to improve care. Financial burden from excess urgent care visits, hospitalisation and higher treatment costs.

Answer 118

The period following the onset of puberty, during which a young person develops from a child into an adult.

Answer 119

Expected that adolescence would be a period of good health, but higher rate of mortality during adolescence than in early childhood (1-9 years) Adolescents are learning to manage onset of new conditions and are dealing with long term self-management of existing chronic conditions.

Answer 120

Just before puberty, there is exuberant synaptogenesis - The weaker connections are pruned in several areas of the brain including prefrontal cortex which is responsible for advanced reasoning, understanding cause and effect and impulse management.

Answer 121

Those that potentially expose people to harm, or significant risk of harm, which are associated with poor health or psychosocial outcomes.

Answer 122

Risk taking is a normal part of adolescence Disparity between the limbic system (risk reward) and prefrontal cortex (impulse control) during early-mid adolescence. Limbic system matures more quickly that the frontal love explaining why mid adolescents take more risks than older.

Answer 123

Self-management partially laid down in adolescence Adolescence is a period of transition to self-management with ups and downs along the way Lack of concordance a problem Learn to manage conditions and fit in rather than deliberately destructive behaviour. Young people manage their condition depending on age, sex, family context and socio-economic position Some barriers are similar across conditions, other are condition or treatment specific.

Answer 124

Management regimes are difficult and demanding Self-monitoring is inconvenient and disruptive: social activities take priority Feel like they are being 'controlled' Management regimes make it difficult to 'fit in'

Answer 125

Treated like a person Understanding, giving options and encouragement Don't force

Answer 126

Whether you can access appointment Parents not engaging with healthcare Continuity of care Doctor's attitudes to family

Answer 127

Early diagnosis and prompt referral depends on: - Children and parent recognising symptoms as 'not right' and presenting - Doctors recognising symptoms as being suggestive of something serious. Consulting behaviour depends on way in which disease presents and way symptoms are interpreted by parents and children. First suspect something wrong because of range of medical signs/symptoms and/or feelings that child 'not right' (crankiness, tiredness, quiet, change in behaviour)

Answer 128

'It's a virus', 'growing pains', 'wants to get out of school' Adopt wait and see approach: temporalising of symptomology Consult if symptoms persist or if feeling that child 'not right' doesn't go away.

Answer 129

Fits, fainting, blood in urine, felt lump in tummy Tend to interpret these as needing prompt attention Seek attention promptly

Answer 130

Use of temporalising strategies - Place a time limit on signs/symptoms before taking action or making a referral Use of discrediting strategies - seeing the parent as lacking credibility 'mum too anxious'

Answer 131

Returning repeatedly to see the GP Using private healthcare Visiting A&E

Answer 132

Experiences linked to clinical management and social context of children's lives Key Features - Distressing symptoms - Disruption to identity and relationships - Uncertainty and fear - Strategic Management

Answer 133

Changes to appearance Received to be different or treated differently Forms of care associated with infancy - Bathing - Toileting - Feeding Difficulty maintaining a socially acceptable identity among peers.

Answer 134

Keep pre-illness lifestyle | Re-designation of illness life as new 'normal life'

Answer 135

Trying to gain self control - Strategies for adults are not available for children Older children have more strategies - Taking control (CF: pushed into adulthood) - Risk taking (CF: way of showing condition has not restricted them)

Answer 136

A systematic method of identifying unmet health and healthcare needs of a population and making changes to meet these unmet demands

Answer 137

Provide information to plan, negotiate, and change services for the better and to improve health in other ways

Answer 138

Change services/activities for the better (effectiveness) Improve equity (equal resources for equal need) Target Efficiency (allocate resources to those in need) Set Priorities Gather general intelligence on population health/need Corporate involvement

Answer 139

What people benefit from A need for medical care exists when an individual has an illness or disability for which there is effective and acceptable treatment or care.

Answer 140

What is provided

Answer 141

What people ask for/want

Answer 142

Epidemiological Approach - Epidemiology of health condition and risk factors - Evidence of effectiveness and cost-effectiveness - Description of current services. Comparative - compare service and care between different (but comparable) populations Corporate (stakeholders and views) - Ask experts, users, policy makers and any other stakeholders what the issues are and what changes are needed.

Answer 143

Strengths - Systematic and objective approach - size of problem, what works, current services Weaknesses - Lack of existing local epidemiological data - Lack of evidence for certain interventions - Carrying out new epidemiological work is costly and time consuming

Answer 144

Strengths - Usually quick to achieve - Inexpensive Weakness - Problems of finding a sufficiently similar locality for an accurate comparison

Answer 145

Strengths - Making the needs assessment responsive to local concerns - Fostering "local ownership" Weaknesses - Determines demands rather than needs - Stakeholders may be influenced by political agendas

Answer 146

``` Purchaser Providers Professionals Patients/service users Press GP Politicians Opinion Leaders ```

Answer 147

Plan, Do, Study, Act Plan 1. Problem identification and desired outcome 2. Identify most likely causes through data 3. Identify potential solutions and date needed for evaluation Do 4. Implement solution and collect data for evaluation Study 5. Analyse data and develop conclusions Act 6. Recommend further study and/or action

Answer 148

Ask - ask and record patients' smoking status, smoker, ex-smoker or never-smoked Advise - advise patients on the best ways to stop, most effective way is with a combination of stop smoking meds and support Act - Offer all patients who smoke a referral to an effective stop smoking intervention and offering stop smoking meds if appropriate.

Answer 149

Identify - identify and record alcohol risk using AUDIT-C Advise - advise patients who drink above the low-risk level, but are not dependent, about harms and benefits of cutting down Refer - those who are identified as possibly alcohol dependent for specialist assessment and support.

Answer 150

Low risk (0-4) - explain score: low risk of harm - Give advice on low risk levels - Congratulate patient Increasing or higher risk (5-10) - Explain their alcohol use ay be increasing their risk of ill health - Provide brief advice to reduce - Give information leaflet Possible Dependence (11-12) - Explain cause for concern - Offer a referral to specialist assessment and support and, if they agree, make an active referral.

Answer 151

A quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.

Answer 152

Designed to derive generalisable new knowledge Designed to test a hypothesis Addresses clearly defined questions, aims and objectives Study design may involve allocation patients to intervention groups Normally requires research ethics committee review

Answer 153

Designed and conducted to produce information to inform delivery of best care Designed to answer 'does this service reach a predetermined standard'? Measures against a standard No allocation to intervention Does not typically require research ethics committee review

Answer 154

Designed and conducted solely to define or judge current care Designed to answer 'what standard does this service achieve'? Measures without reference to a standards No allocation to intervention Doesn't require research ethics committee review

Answer 155

Health and Social Care Act 2008 CQC - essential standards of quality and safety Revalidation for medical staff Professional standards for individual disciplines NHS standard contract Local trusts quality accounts Monitor compliance framework Monitoring or current practice alongside guidance High volume/High cost procedures Response to serious incidence, risk issue or complaint Trust/departmental/speciality/local priorities Re-audits Quality improvement

Answer 156

Stage 1: Preparation and Planning - Select topic - identify standards - Create Audit Team - Agree methodology - Develop tool - Sample size and selection - Carry out pilot test - Follow local NHS procedures. Stage 2: Measuring Performance - Information governance issues - Ensuring data quality - Recording - need for evidence trail - Analysing and presenting results Stage 3: Implementing Change - Present and discuss results - Discuss issues and recommendations - Set realistic goals and timescales - Develop an action plan - SMART actions Stage 4: Sustaining improvement including re-audit - Complete action plan and evaluate progress - Review and implement the actions - Discuss areas of concern following data collection/results/feedback - Re-audit - Is a full re-audit required - Targeted audit focusing on key aspects from audit - Spin-off audits on areas that have been highlighted as areas of concern - Can be a starting point for a service evaluation and research

Answer 157

Keep health risks from alcohol to a low level it is safest to not drink more than 14 units a week on a regular basis If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over 3 or more days. If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.

Answer 158

Limiting the total amount of alcohol you drink on any single occasion Drinking more slowly, with food, and alternating with water Planning ahead to avoid problems such as transport home.

Answer 159

The safest approach is to not drink alcohol at all, to keep risks to baby to a minimum Drinking in pregnancy can lead to long-term harm to the baby with the more you drink the greater the risk

Answer 160

Children and their parents and carers are advised that an alcohol-free childhood is the healthiest and best option. However, if children drink alcohol it should not be until at least 15. If young people aged 15 to 17 consume alcohol, it should always be with the guidance of a parent or carer or in a supervised environment.

Answer 161

The presence of an attribute that discredits its possessor

Answer 162

Attributes, behaviours or pathological states that set people apart from others, that mark them as less unacceptable or inferior beings in some way.

Answer 163

Enacted Felt Discreditable Discrediting

Answer 164

Real experience of negative attitudes and discrimination

Answer 165

Fear that prejudice or discrimination may occur

Answer 166

Attribute, condition or impairment not immediately obvious or known by many e.g mastectomy

Answer 167

Obvious and visible attribute, condition or impairment

Answer 168

``` Epilepsy Hearing and visual impairment HIV and AIDS Mental Illness Psoriasis Physical Impairment Some cancers (lung) Alcohol Dependence Obesity ```

Answer 169

Felt | Discreditable

Answer 170

Enacted | Discrediting

Answer 171

Passive (Absorb or accept) Normalisation (New normal) Withdrawal (limit engagement) Active (seek support, challenge stigma)

Answer 172

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence. Cognitive, language, motor, and social abilities

Answer 173

Learning Disability (UK health and social services) Learning Difficulties (UK Education) Mental Retardation (Worldwide, USA WHO) Developmental Disability Intellectual Disability (current RCPsych term) Intellectual Development Disorder (DSM-5)

Answer 174

Ranges from mild to severe - Mild (IQ 69-50) - Moderate (IQ 49-35) - Severe (IQ 34-0) ``` Expressive Language Comprehension Non-Verbal Communication Self-Care Independent Living Academic Work Adult Work Mobility Social Development Associated Deficits ```

Answer 175

Assessment by Educational or Clinical Psychologist Tests include Wechsler Adult Intelligence Scale IV Performance on testing can be affected by various factors (motivation, mental illness, fatigue, drugs, alcohol) Impacts of culture, language, ASD can skew the result

Answer 176

``` Communication Self-care Home living Social Skills Community Use Self-direction Health and Safety Functional Academics Leisure Work ``` Assesses individual needs to provide for self.

Answer 177

``` Normal IQ: 100 +- 15 Borderline IQ: 70-84 Mild Learning Difficulty: 50-69 (developmental age 9-12) Moderate LD: 35-49 (dev age 6-9) Severe LD: 20-34 (dev age 3-6) ```

Answer 178

``` Mild LD - 2% general population - 75% of people with a LD Moderate LD - 0.5% general population - 20% people with a LD Severe - 5% people with a LD Profound - <0.05% population - <1% people with a LD ```

Answer 179

Genetic Factors Antenatal Factors Perinatal Factors

Answer 180

Chromosomal abnormalities present at conception - Trisomy 21 (Down's) - Fragile X Syndrome - 5p Syndrome - Sex chromosome disorders - Prader Willi Syndrome Primary disorder with secondary neurological damage - Defective protein metabolism (PKU) - Endocrine disorders (congenital hypothyroidism) - Neurocutaneous disorders (tuberous sclerosis)

Answer 181

``` Iodine deficiency Neural tube defects Autoimmune (rhesus) Infectious diseases (TORCH, measles, HIV, Syphilis) Drugs, alcohol and toxins ```

Answer 182

``` Trauma (forceps) Hypoxia Hypoglycaemia Cerebral Thrombosis Premature/Low birth weight babies are particularly at risk ```

Answer 183

Assumption of capacity LD is an impairment of the mind and as such can interfere with decision making abilities Capacity is purpose and time specific Capacity may fluctuate

Answer 184

Understand information related to decision Retain information for long enough to - Use and weigh up information to make decision - Communicate the decision by any means

Answer 185

Can the decision wait? Not making assumptions based on disability or other factors Consult family, carers, any substitute decision makers Involve the person, consider what you know about them Refer to IMCA for serious medical treatment Actions proportionate to need Decision maker is responsible

Answer 186

Deprivation of Liberty Safeguards - Introduced as an amendment to the 1983 MHS. - For those who lack mental capacity and are deprived of liberty in care or in hospital but not subject to mental health legislation.

Answer 187

When an emergency arises in a clinical setting and it is not possible to find out a patient's wishes. Can treat providing the treatment is immediately necessary to save their life or prevent serious deterioration of their condition. Least restrictive of the patient's future choices.

Answer 188

Higher rates of problems in PWLD - Dementia 10-25% - Psychosis 1-6% - Autism 30% Presentation - Depression (less self harm) - Mania (flight of ideas) - Psychosis (-ve symptoms more than +ve) - Anxiety (baseline anxiety, ASD related, LD related) - Dementia (mood/personality issues prior to memory and skill decline)

Answer 189

Different domains that are used when assessing patients with a learning disability Axis I - Severity of learning disability Axis II - Associated medical conditions Axis III - Psychiatric disorders (inc ASD) Axis IV - Assessment of psychosocial disability Axis V - Abnormal psychosocial situations

Answer 190

On Average 18 years lower life expectancy for females with LD (14 for males) By 2021 PWLD aged over 60 expected to increase by 36% 2010-12 inquiry into deaths of PWLD - 22% died before 50 - 42% felt to be premature - 43% unexpected

Answer 191

Introduced in 2008-09 following formal investigation into health inequalities Allow for reasonable adjustment of needs Detection of unmet, unrecognised and potentially treatable health conditions.

Answer 192

``` Epilepsy - increased with level of LD - 20x higher in PWLD Sensory impairment - Visual 20-30% - Hearing 10-40% Mental illness (20-40% higher) Obesity (up to 68%) Dysphagia - 5% community - 36% hospital - 60% if cerebral palsy Other eating disorders - PICA - Atypical anorexia - Autistic food fads GORD (60-90% H.Pylori) Constipation (up to 69% of LD population) Dental health (86%) ```

Answer 193

Notifying the death and review into the circumstances leading to the death of PWLD aged 4-74 Stages roll-out of LeDeR Help reduce premature mortality and health inequalities Reviews of deaths lead to reflective learning

Answer 194

PWLD have higher mortality rates and rates of preventable death - 58x more likely to die before 50 - 3x higher mortality rate in those with moderate to severe LD - 4x more likely to die from preventable death - 26% hospitalised compared to 14% of general population - Suffer more Accidents

Answer 195

``` Clinician - Educational needs - Diagnostic overshadowing - Personal communication skills - Legislation awareness (MCA etc) Service - Accessibility - Flexibility of appointments - Clinical Environment - User friendly information Patient - Cognitive ability - Communication - Poor 'Health Literacy' - Phobia / anxiety (autism) - Sensory impairment - Late presentation Carer - Health awareness (training issue for paid carers) - Own cognitive abilities - Poor 'Health literacy' ```

Answer 196

An approach that improves quality of life of patients and families facing the problems associated with life-threatening illness - Early identification - Impeccable assessment - Treatment of pain and other problems, physical, psychosocial and spiritual

Answer 197

A life-limiting illness is an illness that cannot be cured and that you are likely to die from Also known as life-threatening, terminal, progressive or advanced

Answer 198

Managing pain and other distressing symptoms Psychological Social Physical Spiritual Support for patient and family

Answer 199

Involves treatment, care and support for people who are nearing the end of their life. For people who are thought to be in the last year of life, but can be difficult to predict.

Answer 200

Early Identification - Early recognition and appropriate discussion - Prognostication is difficult Impeccable assessment - Person centred approach (what matters, main concerns, what can't you do, goals) Treatment of pain and other problems, physical, psychosocial and spiritual

Answer 201

That the amount of pain a person is in is associated with physical, psychological, social and spiritual causes.

Answer 202

``` Physical Pain - Physical causes - Other symptoms - Adverse effects of treatment - Co-morbidities Psychological Pain - Anger - Anxiety - Depression - Fear of suffering - Past experience of illness Spiritual Pain - Hopelessness - Finding meaning - Loss of faith - Fear of the unknown - Anger at fate/anger at higher power Social Pain - Dependency - Worry about future of family - Financial concerns - Job loss - Loss of role and social status ```

Answer 203

Allow for shared decision making Prevent unnecessary interventions Ensure dying persons expressed wished are considered Avoid misunderstanding and unnecessary distress.

Answer 204

Improves end of life care | Improves bereavement experience of those important to them

Answer 205

1. Each person seen as an individual 2. Each person gets fair access to care 3. Maximising comfort and wellbeing 4. Care is coordinated 5. All staff are prepared to care 6. Each community is prepared to help

Answer 206

1. Dying in Pain (83%) 2. Dying Alone (67%) 3. Being told they are dying (62%) 4. Dying in hospital (59%) 5. Going bankrupt (41%) 6. Divorce/end of relationship (39%) 7. Losing their job (38%)

Answer 207

``` We want to save lives Acceptance only when interventions fail Pressure to provide medically futile treatment (patient/family/society) Tendency to shy away from dying Feeling of failure Lack of experience Lack of training Inadequate communication skills ```

Answer 208

``` Signs getting worse day by day or hour by hour Reduced mobility/bedbound Extreme tiredness and weakness Little interest in food or drink Difficulty swallowing oral meds Sleepiness and drowsiness Reduced urine output Changes in breathing New incontinence Increased restlessness Confusion +/- agitation No reversible cause for deterioration. ```

Answer 209

Australian-modified Karnofsky Performance Scale (0-100) - 0 = death - 50 = Considerable assistance and frequent medical care - 100 = normal with no complaints or evidence of disease ECOG Performance Status Scale (Grade 0-5) - 0 = fully active, able to carry on all pre-disease performance without restriction - 3 = Capable of limited self-care, confined to bed or chair more than 50% waking time - 5 = dead

Answer 210

``` Phase 1: Stable Phase 2: Unstable Phase 3: Deteriorating Phase 4: Terminal Phase 5: Bereavement ```

Answer 211

The 'surprise' question Would you be surprised in the patient died in the next... - 12 months - 6 months - 1 month - Few Days - Few hours

Answer 212

The earlier the better Ascertain patients level of involvement in decision and amount of information Leads to advanced care planning and patients wishes - Place of care and death - what's important - ascertain and address concerns/questions - Escalation of care and DNAR discussion. Important to communicate whilst patient has capacity

Answer 213

The earlier the better Needs to be shared with all involved in patient care (discuss with patient) Regular reviews Made available to all HCPs - avoid repetition Patient held documentation

Answer 214

``` Symptom control Appropriate medication only - correct dose and route Stop inappropriate interventions Rationalise medications Consider anticipatory drugs ```

Answer 215

Prescribing jobs in case a situation arises - Pain = Morphine s/c - N+V = Levomepromazine s/c - Agitation = Midazolam s/c - Secretions = hyoscine butylbromide s/c Requires an authorisation to administer form

Answer 216

The probability that a hazard will give rise to harm

Answer 217

Reduction of risk in the intervention group relative to the risk in the control group

Answer 218

The difference between risk in the intervention and control group

Answer 219

The number of patients who need to be treated to prevent on additional adverse outcome

Answer 220

(Control group event rate - Experimental group event rate) / control group event rate *100 for % RRR=(CER-EER)/CER*100

Answer 221

ARR = control event rate - Experimental event rate ARR = CER - EER

Answer 222

NNT = 1 / Absolute risk reduction OR NNT = 1 / (CER - EER)

Answer 223

Using relative risk to point out the benefits but absolute risk for the harms

Answer 224

Use bigger denominators to make it look impressive (5/10 vs 500/1000)

Answer 225

Use the bigger percentage to make your point (chance of winning is 10%, chance of losing is 90%)

Answer 226

Using smiley faces on a decision aid, groups of faces, red for negatives, DNR vs Allow natural death

Answer 227

AR = number of events in treated or control group / number of people in that group AR = Events/n

Answer 228

RR = incidence in exposed / incidence in control group RR = Experimental / Control

Answer 229

Use a 2x2 table of Treatment and control on the left vertical, Event vs No Event on the horizontal Treatment + Event = A Treatment + No Event = B Control + Event = C Control + No Event = D Event No Event Treatment A B Control C D OR = (A*D)/(B*C)

Answer 230

Use a 2x2 table of Treatment and control on the left vertical, Event vs No Event on the horizontal Treatment + Event = A Treatment + No Event = B Control + Event = C Control + No Event = D Event No Event Treatment A B Control C D Relative Risk = [A/(A+B)] / [C/(C+D)]