Theme C Flashcards
In terms of their impact on public health, what are the most important infectious diseases in the Uk
Diphtheria, Haemophilus Influenzae, measles, mumps, poliomyelitis, rubella, pneumococcal disease, tetanus and pertussis.
What are most important infectious diseases in developing/ tropical countries?
pneumonia, chronic diarrhoeal diseases, malaria, HIV/AIDS
What are the public health objectives of vaccination?
to protect individuals from specific diseases
to protect populations
second most effective intervention to protect population health
to protect selected high risk groups
to contain an infection in a population
to eradicate an infectious agent
herd immunity
What is herd immunity?
when a significant proportion of the population is vaccinated to afford protection to the percentage that is not immune.
What is effective reproductive number and what equation does it form a part of?
when it equals <1 then a disease is on its way to being eradicated when it equals 1 we call this the epidemic threshold. When it equals more than 1 the number of cases are increasing. R=Ro x S. Ro= average number of secondary infections produced by an infectious agent
S= portion of population that is susceptible. Ro is influenced by infectivity, duration of infectiousness and population density.
What factors influence the utility of vaccination/immunisation?
risk of exposure to the disease age,health status, vaccination history special risk factors reactions to previous vaccine doses/allergies risk of infecting others cost
5 most common cancers in the UK.
men: lung, bowel, prostate, bladder, stomach
women: breast, lung, bowel, bladder, stomach.
What are the commonest cancers in childhood?
leukaemia, brain, lymphoma, soft tissue sarcoma, neuroblastoma
Who do we need to control/monitor antibiotic prescribing?
antibiotic resistance, expense and drain on resources and side effects.
What policies exist in both primary care and hospital settings?
active surveillance and investigation
reporting of outbreaks
reducing the infection risk from use of catheters, cannulas, instruments etc. reducing time of use and using very good antiseptic techniques when applying. Reducing reservoirs of infection by maintaining very high standards of hygiene in the clinical environment
compliance with handwashing and disinfection protocols
prudent use of antibiotics
local guidelines in place reflect local resistance patterns
educate patients about adherence to proper dose and timings
management and organisation
research and development
What are the main intervention strategies possible for the prevention of HIV/AIDS in Africa and the developed world?
low price and availability of condoms
education for high risk groups e.g. sex workers
population level sex education
introduction of blood donor and product screening
diagnosis and treatment of STDs
HIV counselling and testing
What are the determinants of effective outcomes of interventions?
economy- low-income countries often cannot spend more than a few dollars per capita per annum on healthcare
priorities- cost-effectiveness analyses created by the developed world may not reflect the realities of life in a developing country
setting- countries that have shown success in combatting HIV/AIDS may reflect cultural and political openness to discuss problems and will be difficult to reproduce
what is screening?
The systematic application of a test to a population susceptible to a specific disorder that may need further investigation or warrant preventative treatment but has not sought medical treatment for their symptoms or lack thereof. It is the testing of apparently healthy people to see if they have markers of increased risk for the target condition. It helps to identify disease early to prevent adverse consequences.
Criteria for a screening test.
viable, effective and appropriate.
Condition- must be an important health problem, must have a known and understood epidemiology and natural history with latent phase that can be detected via a risk factor.
Test- simple, safe, validated and precise, distribution of values known and a cut-off agreed, agreed policy on further management
Treatment- effective, with best application early on, clinical management of a condition must be optimised prior to screening.
Program- must be supported by RCT evidence that it reduces mortality and morbidity, must be acceptable for professionals and population, benefit outweighs harm and opportunity costs must be balanced
define specificity
In a healthy population free of disease, how often is the test right? This is shown by working out the proportion of true negatives out of all those who are actually disease free.
define sensitivity
In a diseased population with a condition, how often is the test right or how good is it at telling who has disease? This is shown by working out the proportion of true positives out of all those with actual disease.
define positive predictive value
On obtaining a positive test result, how likely it that the person has disease- this is affected by prevalence of disease in a population e.g. if the test is conducted in those with many risk factors then its is more likely they will have disease.
define negative predictive value
On obtaining a negative result how likely is it that person is truly free from disease? This value decreases as prevalence increase.
How can adverse events be reduced?
needs to be a shift from a blame culture to one of openness, reporting, justice, flexibility and learning.
What systems are in place in the NHS to try and stop adverse events from occurring?
National patient safety agency- coordination of reporting and learning from mistakes that affect patent safety
National reporting and learning system- rolled out in 2004, anonymous national system for the reporting of mistakes and near misses online, each local trust is connected to the national system.
Medicines and Healthcare- Products Regulatory Agency (MHRA) – Ensures medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness and that they are used safely. Monitoring of medicines and acting on safety concerns. Responsible for adverse incident reporting system for medical devices.
What is quality in healthcare?
the extent to which health services for individuals and populations increase the likelihood of beneficial or desired health outcomes and are consistent with current professional knowledge.
What is a national service framework?
plans that aim to improve service quality and reduce variation in outcome of care by setting out clear standards for particular services or care groups.
How is quality inspected in the NHS?
Commission for Health Improvement (CHI)
National Care Standards Commission – Due to merge with CHI in 2004
Quality assurance and inspection mechanisms for social care
The Audit Commission
National Audit Office
National clinical audits of services
Assuring the quality of individual practice (GMC)
barriers to research evidence in clinical practice
simply disseminating research evidence in accessible formats to Dr may be effective for relatively simple interventions but not for more complex problems which involve change that is interlinked. Impossible to read the amount of articles daily to maintain knowledge, poor learning, adult learning, norms not applied to wards, performance influenced by external stimuli, marketing and organisational failures. Need to implement educational outreach and courses and conferences to ensure use of reach evidence, audit and feedback, reminders and computers.
Define intention to treat analysis
analysis based on the intended treatment from allocation not the treatment eventually administered e.g. if patient drops out. Analysed in the treatment group they were originally allocated.
Define number needed to treat
number of patients needed to treat with the experimental outcome to prevent one negative outcome- how many do you need to treat to create a clinically significant outcome? 1/ absolute risk reduction
