TERM 1 SUMMARY QUESTIONS Flashcards
what is an outbreak?
a sudden increase in occurrences of a disease in a particular time and place
what is the chain of infection pathway?
microorganism reservoir pathway from reservoir mode of transmission path of entry susceptible host
what is surveillance?
the ongoing and systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event.
what’s the importance of surveillance?
early warning system for public health emergencies
documenting the impact of interventions
monitoring epidemiology of health problems
what is sentinel surveillance?
monitoring the rate of occurrence of specific diseases
what is passive surveillance?
gathers disease data from all potential reporting health care workers continuously to monitor health trends
what is active surveillance?
data collected specifically
how can we control healthcare associated infections?
good hospital hygeine, isolate cases, improve education, good hand hygeine, PPE use, safe use/disposing of sharps, aseptic technique
what is an epidemic?
the rapid spread of infectious diseases to a large number of people in a given population within a short period of time
what turns an epidemic into a pandemic?
if it spreads to other countries and affects a substantial number of people
what’s the role of WHO?
provide leadership on matters critical to health shaping the research agenda setting norms and standards providing technical support monitor the health situation
what was the vaccination act of 1853?
introduction of the smallpox vaccine as free and compulsory
what was the vaccination act of 1898?
the inclusion of the conscientious clause to allow exemption from vaccination
what are the benefits of vaccinations?
they save lives ingredients are safe in small amounts that are used adverse reactions are extremely rare protect the herd protects future generation can eradicate diseases
what are the cons of vaccinations?
can sometimes cause serious/fatal side effects
contain harmful ingredients
mandatory
vaccinations infringe on religious freedom
they contain ingredients that some people consider objectionable or immoral
they’re unnatural
pharmaceutical companies main goal is to make profit
some diseases they target are relatively harmless
what are the 3 main goals of the vaccination policies?
individual immunity
herd immunity
eradication of disease
what is R0?
the basic reproductive number - average number of individuals direction infected by an infectious case in a totally susceptible population
what is R?
the effective reproduction rate - the average number of secondary infections produced by an infective agent
what does R=1 mean?
the disease is endemic and therefore this is the epidemic threshold
why is R usually smaller than R0?
because there is usually <100% susceptibility in a population and we have control measures
how do we calculate the effective reproduction rate (R)?
R= R0 x susceptible population
what is the ‘susceptible population’?
any person not immune, never encountered the infection, unable to mount an immune response and cannot get the vaccine i.e. its contraindicated
how do you work out the herd immunity threshold?
1- susceptible population
what was the expanded programme on immunisation?
established in 1974 to develop and expand immunization programs throughout the world. In 1977, the goal was set to make immunization against diphtheria, pertussis, tetanus, polio, measles and tuberculosis available to every child in the world by 1990.
what is the fucntion of global alliance for vaccines and immunisation?
creating equal access to new and underused vaccines for children living in the world’s poorest countries.
what are some examples of international immunisation programmes?
expanded programme on immunisation
global polio eradication initiative
global alliance for vaccines and immunisation
which groups of people is it important to implement new vaccines programmes into?
the group with the greatest morbidity and mortality
the group with the best chance of developing immunity
what are the msot common cancers in children?
leukaemia, brain and CNS tumours, lymphomas
as a country develops why do diseases switch from communicable to non-communicable?
medical care improvements, ageing population, public health interventions
what is primary prevention?
reducing exposure to a disease to prevent it before it occurs
what is secondary prevention?
aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress
what is tertiary prevention?
aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries ` in order to improve as much as possible their ability to function, their quality of life and their life expectancy.
how many people die of cancer?
1/4
what was the cayman hine report in 1995?
the first comprehensive cancer report to be produced in the UK, and set out principles for cancer care and the clinical organisation for service delivery.
what were the aims of the cayman Hine report? 6
everyone to be able to access uniformly high quality care
education for earlier recognition of symptoms in public and health professionals
giving families/patints clear information about treatment options and outcomes
being patient centred
recognise the psychosocial needs of cancer sufferers
what were the aims of the NHS cancer plan 2000? 4
save more lives
ensure patients get the best treatment
tackling inequalities in health
build for future by investing in the cancer workforce so we never fall behind cancer again
what were the aims of the cancer reforming strategy 2007? 6
prevention - education about lifestyle changes, sunsmart campaign, vaccination
earlier diagnosis - screening and NAEDI
better treatment
reducing cancer inequalities
delivering care locally to the patient - maximises patient convenience
living with and beyond cancer - e.g. psychosocial, financial support. National cancer survivorship initiative
what is the NAEDI?
national awareness and early diagnosis initiative - raising public awareness of signs and symptoms and encouraging people to seek help sooner
what was the NAEDI hypothesis?
delays lead to patients being diagnosed with more advanced diseases and thus experiencing poor survival rates, resulting in potentially avoidable deaths
what is a diagnostic test?
any kind of medical test performed to aid the diagnosis of a disease
what is a true positive?
indicated disease when there is a disease
what is a true negative?
indicated no disease when there is no disease
what is a false positive?
indicated disease when there is no disease
what is a false negative?
indicated no disease when there is a disease
what is sensitivity?
measures the proportions of positive that are correctly identified, avoiding false negatives
how do you calculate sensitivity?
true positives/ true positives + false negatives
what is specificity?
measures the proportion of negatives correctly identified, avoiding false positives
how do you calculate specificity?
true negatives / true negatives + false positives
what is a ROC curve?
receiver operating characteristic curve - allowed investigators to compare the performance of 2 or more diagnostic tests
what is a positive predictive value?
the probability that a subject with a positive screening test truly have the disease
how do you calculate the positive predictive value?
true positive / total test positive
what is a negative predictive value?
the probability that subjects with a negative screening test truly dont have the disease
how do you calculate negative predictive value?
true negative /all test negatives
what is a likelihood ratio?
probability that a positive test would be expected in a patient with the disease divided by the probability that a positive test would be expected in a patient without a disease
what’s the aim of screening?
to identify individuals at sufficient risk of a specific disorder to warrant further investigation or direct preventative action, amongst person who have not sought medical attention on account of symptoms of that disorder
what are the limitations of screening?
cost and use of medical resources on a group of people who, majoritively, dont need treatment
adverse effects of the screening procedure itself
stress/anxiety caused by false psiitives
unnecessary intervention in false positives
stress/anxity caused by prolonged knowledge of an illness with no outcome improvement
a false sense of security from false negatives
what are the 10 principles of screening?
the condition should be an important health problem
there should be an accepted treatment plan for positive results
facilities for diagnosis and treatment should be available
there should be a recognisable latent/early symptom stage
there should be a suitable test
test should be acceptable to the population
natural history of condition should be well understood
there should be an agreed policy on who to treat as patients
the cost of case finding should be economically balanced in relation to possible expenditure on medical care
case-finding should be a continuing process
what is the sojourn time?
the duration of a disease before clinical symptoms become apparent but during which is detectable by a screening test (represents window of opportunity for early diagnosis)
what are benefits of paper clinical record?
reduced upfront cost
familiar format
physical form useful in emergencies
what are benefits of electronic clinical records?
scalable storage backups security more efficient less error prone no legibility issues searchable clear audit trail
what is a clinical audit?
a quality improvement process that seeks to improve patient care and outcomes
what’s the function of a clinical record?
a record of the baseline condition, treatments and progress.
It ensures continuity of care.
It allows communication between members of the MDT
It is a legal document that is admissible as evidence in court.
it supports clinical research
what is an adverse event?
an unintended event resulting from clinical care and causing patient harm
what is a near miss?
a situation in which events arise during clinical care but fail to develop further whether or not as a result of compensating action, thus preventing injury to the patient
what is a hospital standardised mortality ratio?
he ratio of the number of deaths in hospital within a given time period, to the number that might be expected if the hospital had the same death rates as some reference population
what is the summary hospital mortality indicator?
the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.
outline the Swiss cheese model of accident causation?
although many layers of defense lie between hazards and accidents, there are flaws in each layer that, if aligned, can allow the accident to occur.
what are active failures?
unsafe acts committed by people in direct contact with the patient
what are latent errors?
they develop over time and lay dormant until combined with other factors/active failures to cause an adverse event
what are violations?
when rules are intentionally broken whether intended to cause harm or has become normalised behaviour or thought to be in the patients best interest
what is normalisation of deviance?
when people within an organization become so insensitive to deviant practice that it no longer feels wrong.
how can you reduce human factor error?
avoid reliance on memory make things visible review and simplify processes routinely use checklosts standardise common procedures
what should you do when you make a medical error?
report it, assess its seriousness, analyse why it happened, be open and honest with the affected patient, apologise, learn from it, put in place actions to reduce risk of repeat
who should you report patient safety incidents to?
the national report and learning system
what did the Peel Committee report in 1970 do?
a political drive to see hospital confinement as inherently safer and preferable for all women so facilities should be made available
are increased C-section rates decreasing maternal and newborn mortality rates?
not once C-sections reached over 10%
what is the medical model of childbirth?
childbirth is potentially pathological so every woman is potentially ar risk when pregannt/in labour
what is the social model of childbirth?
birth is a normal physiological process and midwives are just there to support the capability of the woman’s body
what was the midwives act in 1902?
the enshrinement of the midwifes role as normality of childbirth and referring to doctors as soon as abnormalities occurred
what was the main aim of the midwives act?
to ensure equal access to midwives and doctors for childbearing women of all socioeconomic standing
how many deaths in adolescents occurred from external causes?
50%
why are death rates in infants dropping?
as preterm babies are now more likely to survive due to surfactant replacement and mechanical ventilation
what are men more likely to die of?
suicide
violence crimes
RTC
taking part in more risky behaviour
leading causes of death in under 5s?
preterm birth complications, birth asphyxia/trauma, pneumonia, congenital anomalies, diarrhoea and malaria
why does poverty increase the chance of getting ill?
poor nutrition, overcrowding, lack of clean water
why can poor health lead to poverty?
reduces a family’s work productivity
leads to selling assets to cover treatment costs
after infancy, what is the most frequent cause of death?
injury
what is the leading cause of death in young people?
suicide
what are the aims of the healthy child programme?
help parents develop a strong bond
encourage keeping children safe and healthy
protecting children from serious diseases through screening and immunisation
promoting healthy eating and exercuse
encouraging breast feeding
identifying health problems ASAP
getting children prepared for school
what are 4 social implications of chronic illness?
physical, social and mental toll
repeated absence at school
burden on parents and siblings
finances
how can we reduce the impact of chronic illnesses?
reduce risk of preterm birth and low brith weight by promoting maternal health
improve recognition and management of serious illness across health service
implement policies for common causes of death from accidents/injuries
improve management of chronic conditions an dmental health
what evidence is available to check patient safety?
hospital episode statistics
patient reported outcome measures
summary hospital level mortality indicators
what are some consumer protection agencies?
care quality commission
NHS improvement
National Institute for health and Clinical Excellence
GMC
what do Care Quality Commission do?
monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety
what is medical negligence?
when a healthcare professional deviates from the care standards of their profession and cause injury to the patient
to prove medical negligence what must you show?
Duty - prove a relationship with healthcare professional
Dereliction - show there was fail to follow care standards so patient suffered harm
Direct cause - specific action of them caused this harm directly
Damages - some physical, psychological or financial impacts of this event
what in England decides how much money a region gets for fertility treatment?
CCGs
what is Gillick competence?
Helps decide whether a child (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge.
what are the Fraser guidelines? (definition)
the criteria that need to be met to make it lawful for doctors to provide contraceptive advice/treatment without parental consent
outline the Fraser guidelines?
- the young person will understand the professional’s advice
- the young person cannot be persuaded to inform their parents
- the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
- unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
- the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
what is meant by ‘bad news’?
news that negatively alters the patients/relatives view of the future
what’s it called when doctors avoid the stress of breaking bad news by normalising the consequences of a diagnosis?
distancing
what does ABDCE stand for?
advanced preparation build a relationship communicate well deal with patient reactions encourage and validate emotions
what does SPIKES stand for?
setting up perception invitation knowledge emotions strategy and summary
what are the strategies for dealing with anger?
recognising and acknowledging
remains calm
not dismissing it
apologising and expressing sympathy
what are some immediate manifestations of grief?
denial depression agitation blame bargaining guilt numbness
what information might you gather from visiting a patient at home that you might not have gathered if you saw them in surgery?
whether they are caring for themselves
whether they are caring for anyone else
socio-economic status
where they store and how they take their meds
information relating to cleanliness and personal hygeiene
environmental factors that make a difference to health care needs e.g. steel stairs
indications of elder abuse
support from informal carers
mobility
cold/damp causing respiratory symptoms
what actions can social services take?
information on how to access support
assess with they need any help with activities of daily living
assess whether they are eligible for any financial support
possible signs of neglect
what actions can district nursing team take?
assess whether they need any nursing support
assess whether a community occupational therapy assessment is necessary
assessing medication compliance
discuss patients nursing needs at MDT meeting
administer immunisations
what is a dosset box?
a plastic tray which organises your medicines into separate compartments for different times of the day for each day of the week
how can a local pharmacy help a patient take their meds?
dosset boxes and medication reviews
how can being a carer have adverse effects on mental and physical health?
physical exhaustion from having to help with activities of daily living
increased risk of depression as a result of continual demands of being a carer and feeling isolated
less time to attend own health needs
what is the legal duty of care?
a legal obligation which is imposed on an individual, requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others
what is the legal situation regarding doctors’ duty of care to patients when not at work?
Outside hospital or a doctor’s surgery, a doctor does not normally owe a duty of care if he did not attempt to help. Doctors are not legally obliged to act as ‘good Samaritans’
However, if a doctor states they are a doctor or starts to act as if they are a doctor, then they will have taken on a duty of care to that patient.
in order for a patient to be successful in a negligence claim, what 3 things need to be proven?
duty
causation
breach
to prove causation for a negligence claim, what are the 2 ways in which causation can be assessed?
whether the can satisfies the but for test
whether the claimant is able to establish on the balance of probabilities that the negligent action caused the injury
what is a ‘but for’ test?
The but-for test says that an action is a cause of an injury if, but for the action, the injury wouldn’t have occurred
what is the ‘balance of probabilities’?
a court is satisfied an event occurred if the court considers that, on the evidence, the occurrence of the event was more likely to occur as a result of the doctors negligence than not
what should inform a doctor decision whether to assist someone who needs medical treatment?
law
moral obligation
professional obligation
is a D-dimer test more useful to rule in or out and disease and why?
out because its sensitivity is much better than its specificity
what is the national cancer survivorship initiative?
to ensure that those living with and beyond cancer get the care and support they need to lead as healthy and active a life as possible, for as long as possible
what are the objectives of the SunSmart campaign?
Improve and monitor skin cancer prevention awareness, knowledge, attitudes and behaviour.
Support priority populations to detect skin cancers earlier.
Advocate for strategies that aim to reduce the health and economic burdens of skin cancer.
