Summary Flashcards
What are the 3 main ways a disease is detected?
Spontaneous presentation
Opportunistic case finding
Screening
Define screening
A systematic attempt to detect an unrecognised condition by the application of tests, examinations or other procedures, which can be applied readily and cheaply to distinguish between an apparently well person who probably have a disease and those who probably do not
What are the four categories in the criteria for screening programmes?
Disease
Test
Treatment
Programme
For a screening programme to be accepted what does the disease need to be?
Important health problem
Well understood
Early detectable stage
Cost effective interventions must be available
For a screening programme to be accepted what does the test need to be?
Simple and safe
Precise and valid
Acceptable to the population
What is a true positive result?
When the test correctly identifies the presence of disease
What is a false negative result?
Where the test says the patient does not have the disease when in actual fact, they do
What is a false positive result?
Where the test says the patient has the disease when really they don’t
What is a true negative result?
Where the test correctly says that the disease is not present
What is sensitivity?
If the disease is present, what is the chance that the test will pick it up?
What is specificity?
If the disease is absent, what is the chance that the test will correctly say it is absent?
What is positive predictive value?
If the patient has a positive test, what is the chance of them actually having the disease?
What is negative predictive value?
If the patient has a negative test, what is the chance of them actually not having the disease?
What are some examples of chronic illness work?
Illness work Everyday work Emotional work Biographical work Identity work
What are some milestones in illness work?
Getting a diagnosis
Symptom management
What is biographical disruption?
Loss of the taken for granted life a person expected
What is stigma?
A negative trait attributed to a group of persons, giving them ‘deviant status’
What is discreditable stigma and what is an example of it?
Nothing seen, but stigmatised if found out
HIV, mental illness
What is discredited stigma?
Physically obvious
What is enacted stigma?
Experience of real prejudice
What is felt stigma?
Fear of prejudice
What is the medical definition of disability?
Deviation away from the norm that needs fixing
What is the social definition of disability?
Failure of the environment to adjust
Define validity in terms of social research questionnaires
The questionnaire measures what it’s supposed to measure
Define reliability in terms of social research questionnaires
Measures things consistently
Differences in results come from differences between participants (not from understanding or interpretation of questionnaire or results)
What are quantitative questionnaires good for?
Comparisons
Measuring
Describing
Finding relationships
What are quantitative questionnaires bad for?
Forces people into categories
Can’t express the way they want
May not access all info
Not effective at causality
What are some examples of qualitative research?
Ethnography (observation)
Interviews
Focus groups
Documentary and media analysis
What are qualitative research methods good for?
Perspective
Accessing info not revealed by questionnaire
Explains relationships
What are qualitative research methods bad for?
Finding relationships
Generalises
What are some problems with QALYs?
Common conditions disadvantaged
Doesn’t distribute according to need
RCT evidence not perfect
What are 4 approaches to the patient professional relationship?
Functional
Conflict
Interactionist
Patient centred
What is clinical governance?
Legal responsibility for a framework through which NHS organisations are accountable for continuously improving the quality of service and safeguarding standards of care by creating an environment in which clinical care will flourish
What is the audit cycle?
Choose topic Standards and criteria 1st evaluation Implement change 2nd evaluation
What are some examples of latent changes?
Similar packaging for drugs
Poor training
Short staffed
Time pressures
What is the Swiss cheese model?
Acts leading to harm to a patient
What are some explanations for health inequalities?
Artefact
Social selection
Behavioural-cultural explanation
Materialist
What are some factors of the materialist explanation that explain why people from lower socioeconomic groups have worse health outcomes?
Low income
Unemployment
Poor work environments
Poor housing
What is an example of a generic patient reported outcome measure?
SF36
EQ5D
What is an example of a specific patient reported outcome measure?
Oxford hip score
What are advantages of generic patient reported outcome measures?
Can be used on general pop
Can be used if there is no specific measure
Can be used to compare
Can detect unexpected effects
What are disadvantages of generic patient reported outcome measures?
Loss of detail
Loss of relevance
Not sensitive to change
Less acceptable to patients
What are advantages of specific patient reported outcome measures?
Relevant
More specific to change
More acceptable
What are disadvantages of specific patient reported outcome measures?
Limited comparison
May not detect unexpected effects
What are some of the challenges with responding to patient dissatisfaction?
How to locate responsibility
Sometimes their views aren’t reasonable
How should we view a patients concern about someones FTP
How much resource should we divert to satisfy these issues
Why is the implementation of EBM difficult?
Dr’s don’t know the evidence
Resources not available to implement change
Commissioning decisions reflect different priorities (what the patient wants)
Organisational systems cannot support innovation
Dr’s know about the evidence but don’t use it
What are the criticisms of the functionalism approach to Dr-patient relationship?
Some patients cant get better
Assumes patients are incompetent
Assumes rationality and beneficence of medicine
Doesn’t explain why things go wrong
What are the criticisms of the conflict approach to Dr-patient relationships?
Patients aren’t always passive
Patients can seek to medicalise issues as well as Drs
Patients may appear differential in consultation but assert themselves outside of this
