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Yr 3 ALS > Theme C > Flashcards

Theme C Flashcards

1
Q

Audit

A

Systematic critical analysis of the quality of medical care, including diagnostics, treatment, the use of resources and the outcome on patients quality of life. Compared against current standards

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2
Q

5 Stages of audit

A 
1 - Identify current standard
2 - Measure current performace
3 - Compare preformance to standard
4 - Make improvements
5 - Re-evaluate
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3
Q

3 Limitations to audit

A
  • Only as good as national standard
  • Only focuses on one thing at a time
  • Costs/time and resources
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4
Q

How long after noticing a problem must a patient submit a complaint

A

12 months maximum

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5
Q

2 steps of making a complaint

A
  • Directly to NHS direct

- If not happy go to CCG or to the commisioner (NHS England)

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6
Q

PALS

A

Patient advice and liason service in every NHS trust to inform patients about complaints

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7
Q

Medical Indeminity

A

Legal exemption of liability for damages to patients under treatment in the NHS

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8
Q

Most common errors in

  • Primary care
  • Secondary care
A 
Primary = Delayed diagnosis
Secondary = Negligence
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9
Q

3 types of errors

A
  • Knowledge based
  • Rules based
  • Skills based
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10
Q

3 types of violations (3 R’s)

A
  • Routine
  • Reasoned
  • Reckless
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11
Q

National patient safety agency

A

Responsible for handling adverse events - report to them

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12
Q

4 stages of clinical trials process

A 
I = small number healthy volunteers 20-80: test safety, dosage, SE
II = Larger group 100-300 further assess safety
III = 1000-300 look for SE's
IV = After drug has been authorised and marketed, looks at long term use
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13
Q

Benefits of available performance indicators

A
  • Greater openess
  • Focus on improving care
  • Public reassurance
  • Competition will boost performance
  • Facilitate informed patient choice
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14
Q

Cons of available performance indicators

A
  • Negative impact on public trust
  • Case-mix between areas
  • Data manipulation - eg some trusts will only treat patients with good outcomes
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15
Q

Epidemiology of CVD

  • % Deaths
  • Ethnic cultures at +risk
  • Socioeconomic group
A
  • 26% of all deaths CVD
  • South Asians 4x greater risk
  • Afro-Caribbean at greater risk
  • Lower socioeconomic at greater risk
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16
Q

2 measure that take lifestyle/age/sex etc to assess CVD risk

A
  • Framingham cohort charts

- QRISK

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17
Q

Smoking + passive smoking % risk on CVD

A
  • Increased CVD by 50%
  • Passive smoking can increase by 25%
  • Smoking more dangerous in women
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18
Q

How many of the worlds population are obese

A

26%

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19
Q
  • Exercise reduction of CVD risk %

- Exercise guidelines UK

A
  • 20-30% risk reduction

- 150mins mod / 75mins vigorous exercise >2 days week

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20
Q

Alcohol weekly units

A

14 per week M/F

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21
Q

Primary, Secondary and Tertiary prevention CVD

A
  • Primary = Reduce chance of getting CHD eg lifestyle
  • Secondary = Already have CHD reduce MI eg further lifestyle or drugs
  • Tertiary = After MI/stroke prevent further events eg cardiac rehab, CABH, angoplasty
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22
Q

Name a strategy in the UK that looked at reducing CVD disease in local community

A

Cardiovascular disease outcomes strategy 2013 - focused on prevention and risk management

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23
Q

Disease

A

Pathological resulting in an abnormality of structure/function and characterised by symptoms or signs

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24
Q

Different HTN groups and treament protocol

  • Not hypertensive
  • Stage 1
  • Stage 2
A 
- Not hypertensive = <135/85
Monitor
- Stage 1 = >135/85
Treat stage 1 if they are 80+ with other condition*
-Stage 2 = 150/95
Treat everyone regardless of age
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25
Q

When to give DVT prophylaxis

A
  • High risk individuals going in for surgery need assessing for DVT risk
  • Pregnant women who have had previous DVT and assess all obese pregant women
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26
Q

Travel advice for DVT

  • Low risk
  • Medium risk (history DT, recent surgery, pregnant, obese)
  • High risk (previous DVT + additional risk eg cancer/recent surgery)
A
  • Low risk = keep moving/hydrated, dont smoke
  • Medium risk = compression stockings
  • High risk = hydration/compression/enoxaparin before and after flight
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27
Q

4 strategies to control TB spread

A
  • Surveillance and recognition
  • Ensure completion of treatment + compliance
  • Improve access to healthcare
  • Screen new entrants to country coming from high risk areas
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28
Q

3 approaches to stopping smoking

A
  • One:one councelling from nurse/gp with written info
  • Group sessions run by health care professionals
  • Nicotine replacement therapy (doubles chances of successful quitting)
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29
Q

How to deal with community outbreak

A
  • Identify and isolate source
  • Identify and treat those infected
  • Advice to prevent further infection
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30
Q

How to deal with hospital outbreak

A
  • Rapid isolation
  • Rapid identification/notification of outbreak
  • Monitor cleaning regimes and protocol
  • Good communication with staff/visitors and outside bodies
  • Suspend admission until 72hrs no new cases and disease free
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31
Q

Section 11 public health control of disease 1984 act

A

Doctors role to notify local authority during infective outbreak

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32
Q

Limit of MDT

A

Can only advice, decision is left to consultant and patient

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33
Q

4 Strategies for reducing patient risk of liver disease

acohol, hepatitis, drugs, fat

A
  • Alcohol reduction - public awareness, education and detox
  • Hepatitis vaccinations, sterile needle use
  • Paracetamol trading laws and prescribing with care
  • Exercise and diet to reduce fatty liver
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34
Q

Screening

A

Application of test to identify individuals at risk of a disorder to warrant investigation or direct peventative action. Amongst people who have not sought medical attention about related symptoms

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35
Q

How to assess cost effectiveness

A

Cost-effectiveness analysis looks at numbers of years saved

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36
Q

RF Breast cancer and overall % prevelance

A
  • Oestrogen, low socioeconomic group, radiation, alcohol

- 9% will develop

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37
Q

Breast cancer screening for

  • Average risk (general pop)
  • Moderate (FHx same side)
  • High (BRCA/TP53)
A
  • Average = 50-70yrs mammo every 3yrs
  • Moderate = Anual screening from 40-60 then normal^
  • High = Annual MRI/mammo 30-60 then normal^
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38
Q

Bowel cancer screening

A
  • One off flex sigmoidoscopy 55
  • 60-74 offered FOB every 2 yrs
  • 75 can ask for every 2yrs
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39
Q

Cervical screening

A

Smear every 3yrs 25-49 then after every 5yrs

-Vaccine 12-13yrs

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40
Q

Other national screening programmes-

A
  • Downs
  • Diabetic retinopathy
  • Newborn bloodspot
  • Chlamy4 thdia
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41
Q

4 themes of pyschological impact of breast cancer diagnosis

A
  • Worry of death
  • Reactions of family members
  • Views of society
  • Worries about the future
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42
Q

Rate of diagnosis is corrolated negatively with what factor

A

Socioeconomic class (single mum cant get time off work)

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43
Q

Health visitor

A

Monitors child health and development and helps postnatal depression

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44
Q

Practice counceller

A

Sees mild/moderate health problems - active listening

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45
Q

Primary care mental health worker

A

Sign-posts correct services and can do some short term input - CBT

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46
Q

IAPT workers

A

Trained to deliver packages of care - CBT

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47
Q

Registered mental health nurse

A

Hospital based - care and support

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48
Q

Psychotherapist

A

CBT - psychodynamic therapies, family therapy, psychotherapy

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49
Q

Clinical Psychologist

A

Giver regular sessions and pyschotherapies, perform psychometric testing

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50
Q

Key worker

A

1 in a team, often nurse or social worker gets to know client and what they need

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51
Q

Depression vs Bipolar

  • F:M
  • Prevalance
  • Lifetime risk
A 
Depression
-2:1
-2-9%
-10-20%
Bipolar
-Equal
-0.3%
-1%
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52
Q

Minorities and lower socioeconomic group relationship to factors affecting psychiatric treatment

A
  • More likely to be diagnosed
  • Worse outcome from treatment
  • More likely to disengage
  • Language barriers
  • Substance misuse more indicated
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53
Q

What is the largest cause of diability in the UK

A

Mental health - 105Billion per year

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54
Q

When is treatment without consent appropriate

A

Lack of capacity

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55
Q

4 instances where a person can be sectioned

A
  • Needs to be assessed or treated urgently
  • Health would get worse without treatment
  • Safety at risk (patient ro someone else)
  • Regular hospital monitoring is needed
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56
Q

Section 3 limitation

A

Cannot be employed unless treatment is available

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57
Q

What section can use only one doctor and approved mental health professional and how long does it last

A

Section 4 = 72hrs

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58
Q

What other section is 72hrs and is it renewable

A 
Section 5 (holding power)
-No
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59
Q

Community treatment orders

A
  • After section 3 release
  • Supervised treatment if broken
  • Can be returned to the hospital for up to 72hrs
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60
Q

Coping

  • Problem focused
  • Emotion focused
  • Unhelpful
A
  • Problem: Seeking info, practical support, actively participating in treatment
  • Emotion: Sharing feelings and concerns, giving up unrealistic hopes, being angry, finding religion
  • Unhelpful: hoping/praying the illness will leave, dispear, denial, preoccupation
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61
Q

What is the IPQ and what does it measure

A

Illness perception questionarre, derived from Leventhals self regulatory model.
-Looks at illness identity

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62
Q

Primary prevention for mental wellbeing (3 examples)

A
  • Mindfullness/relaxation
  • Exercise and no substance abuse
  • Encourage positive relationships
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63
Q

5 aims of NHS 5 year forward mental health view

A 
1 - 7 day NHS service (esp crisis)
2 - Intergrate mental and physical services
3 - Focus on children and youth
4 - Creating a culture to end stigma
5 - Encourage online program use
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64
Q

3 Requirements for consent

A
  • informed
  • volunatary
  • with capacity
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65
Q

5 instances were consent is not required

A
  • Emergancy - life saving
  • Additional procedures (eg during operation new found tumor removal)
  • Mental health act
  • Risk to public health
  • Severely ill living in unhygienic conditions (national assistance act)
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66
Q

Who does MC act effect

A

All those above 18

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67
Q

5 key principles of MCA

A
  • Capacity is presumed
  • Supported to make their own decisions
  • Right to make unwise decisions
  • Best interest when lacking capacity
  • Desicions should be least restrictive option
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68
Q

2 questions concerning capacity

A
  • Is there a disturbance in the functioning of the brain?

- Is that enough to cause lack of capacity for this decision

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69
Q

Advanced desicion - when is it not considered

A

legally binding directive when someone loses capacity

-MH act allows for detainment regardless

70
Q

When can consent be breached (3)

A
  • Demanded by court
  • Lack capacity
  • Prevent harm
71
Q

What do doctors need to do about issues regarding confidentiality

A

Document in notes

72
Q

3 forms of carers financial assistance

A
  • Carers allowance
  • Disability living allowance - if diasabiled themselves
  • Attendance allowance - for severly disabled who need help with self care
73
Q

Care act 2004

A

Carers have the right to an assessment of their own needs

74
Q

Give examples of each of the following for dementia care:

  • Community care
  • Residential care
  • Respite
A
  • Primary care/crisis/support with daily living
  • Ordinary housing with intensive support/nursed accomodation
  • Day centres or help with care at home
75
Q

5 services offered by CAMHS

A
  • Art therapy
  • Child/adolescent pyschotherapy
  • CBT
  • Meds
  • Family therapy
76
Q

5 prevention programmes used in CAMHS

A
  • Parenting groups
  • Home visits
  • Anxiety/depression programmes
  • Youth offending programmes
  • School programmes
77
Q

Procedure if child discloses to you

A
  • Do not promise confidentiality
  • Tell them it wasnt their fault
  • Tell appropriate agency (police/NSPCC/social services)
  • Within 48hrs confirm in writing any referral made
  • Document all concerns in notes
  • Common assessment framework may be used after referral
78
Q

What 4 areas of development do family contribute to (VSSS)

A
  • Values
  • Skills
  • Socialisation
  • Security
79
Q

Children and family act 2014/Children act 1989

A

Assesses if a child is in need and supports parents

80
Q

Reasons people with sensory impairements may not access mental health services-

A
  • Excluded from outreach and media programmes
  • Limited understanding mental health
  • Communication barriers
  • High risk social exclusion
  • Delivery of programme may not work eg deaf-CBT
81
Q

Reasons for drug addiction

A
  • Personality types
  • Learned behaviour - parents/family
  • Low socioeconomic class
  • Drugs become group norm (emotional aesthetic)*
  • Glamourous image*
  • Childhood abuse*
  • Occupation-stress
  • Poor policing

*Pyschodynamic theories

82
Q

7 catagories of dependance syndrome

A
  • Salience (takes priority)
  • Compulsion (despite - consequence)
  • Tolerance
  • Withdrawal
  • Narrowing of reportoire
  • Reinstated after abstinence
83
Q

Primary/secondary/tertiary harm prevention - alcohol

A 
Primary = education
Secondary = CAGE/Audit identify high risk groups
Tertiary = Treatment alcoholism, alcohol tax, fortify food
84
Q

Primary/secondary/tertiary harm prevention - drugs

A 
Primary = Education
Secondary = HEP vaccine, needle exchange, methadone
Tertiary = Better access to treatment centres and relapse support
85
Q

3 types of drinkers (HHD)

A
  • Hazardous
  • Harmful
  • Dependant
86
Q

4 strategies of alcohol harm reduction england

A
  • Better public communication
  • Prevent/tackle alcohols harm to health
  • Reduce alcohol related crime
  • Work with alcohol industry
87
Q

6 steps cycle of change

A
  • Pre-contemplation - not considering change
  • Contemplation - on the fence
  • Preperation - testing the wters
  • Action - new behaviours 3-6mnths
  • Maintance - continued commitment 6mnth-5yrs
  • Relapse - resume old behaviours
88
Q
  • Haemodyalysis
  • CAPD
  • APD
A
  • Haemo = 3 days per week 4h each
  • CAPD = fluid change 30-40mins 4x per day (2h)
  • APD = overnight sluid change while sleeping
89
Q

Which transplants are considered most urgent

A

Liver and heart

90
Q

What 2 things are the basis for transplant allocation

A
  • Tissue match

- Points (length of time on list and physiological age)

91
Q

Factors that affect choice of transplant

A
  • Compliance
  • Organ abuse likelyness
  • Type of organ
  • Transport time - ischeamia
92
Q

What does Human tissue act 2004 cover

A

-Removal
-Storage
-Use
Human tissue - inc cells

93
Q

5 offences under Human tissue act

A
  • Removing, storing, using tissue without consent
  • Using or storing tissue for a purpose not originally specified
  • Trafficking tissue
  • Analysing DNA without consent (theft)
  • Carrying out these activities without licencing from HTA
94
Q

UK organ donation approach

A

Opt in: via

  • Making wishes known to relatives
  • Registering donor register
  • Carry donor card
95
Q

2 types/examples of opt out systems

A
  • Soft opt out: Spain, relatives can change the desicion

- Hard opt out: Austria, relatives views dont matter

96
Q

Arguments FOR and AGAINTS opt out

A

FOR

  • Save lives at no cost to individual
  • UK Law - corpses arent property
  • Stigma might encorouge less opting out
  • Still a choice
  • Peopl may want to opt in at the moment but dont have access

AGAINST

  • Religion = forfeit access afterlife
  • Upsetting to family
  • Stigma may be attached to opting out
  • Shifts from altrustic giving organs to taking them
97
Q

What is the basis for organ donation in the UK

98
Q

Reasons against a “market” donation system - people pay for their organs, others sell them.

A
  • Healthcare becomes a business
  • Represses altruism
  • Erodes sense of community
  • Redistributes organs from poor:rich
99
Q 
What ABO bloods are in 
-Lowest stock
-Highest stock
and 
-When do stocks generally fall short
A
  • Lowest = O-
  • Highest = A+/O+
  • Winter
100
Q

Why is dialysis not a viable alternative to transplant

A
  • No endocrine function
  • Poor quality of life
  • Expensive
101
Q

PSA - when is it offered

A
  • Anyone over 50 can ask for it

- Over 45 with a family history

102
Q

Problems with PSA as a screening tool

A
  • Overdiagnosis
  • Overtreatment
  • Invasive diagnostic measures may follow
  • Treatment SE
  • False - and false + (anxiety)
103
Q
  • Prediabates fasting glucose + HbA1c

- Diabetes fasting glucose + HbA1c

A
  • PRE: 6.1-6.9 glucose , 42-47 HbA1c

- DIABETES: >=7 glucose , >=48 HbA1c

104
Q

What instances can HbA1c not be used

A

(Increased RBC turnover)

  • Haemoblobinopathies
  • Haemolytic anemia
  • Fe defiency anemia
  • Hyperglycemia (steroids)
  • Kids
  • HIV
  • CKD
105
Q

Targets for Diabetic patients

  • BP
  • HbA1c
  • Total cholesterol
  • Drug treatment used BP
A
  • BP: 140/85 - use ACEi
  • HbA1c: >7%
  • Total cholesterol: >5%
106
Q

Prevention of diabetic complications

A
  • Smoking cessation
  • Glucose control
  • BP
  • Lower lipids
  • Screening eyes and podiatry
107
Q

What is considered in diabetic annual review

A
  • HbA1c
  • BP
  • Lipids
  • BMI
108
Q

Pyschological/social impact of chonic endocrine disease

A
  • Regular medicatio may affect life
  • May impact body image (weight)
  • May impact sex life
  • Shock/disbelief
  • Some may try to hide diagnosis
  • May have effect on mood
  • May have to carry card (addisonian crisis)
109
Q

Modernisation and Urbanisation (effect on obesity)

A
  • Abundance of food/conveniance/no manual labour needed so less exercise
  • More transport links so no need for exercise
110
Q

BMI guidelines

  • Overweight
  • Obesity 1
  • Obesity 2
  • Obesity 3
A

Overweight - 25-29.9
Obese 1 - 30.34.9
Obese 2 - 35-39.9
Obese 3 - 40+

111
Q

Exercise recommendations

A

30mins of moderaye activity 5x weeks

112
Q

Acceptable calorie deficit for weight loss

113
Q

When should medication be considered

A

Only if lifestyle measures have been tried

114
Q

Criteria to get Orlistat

A
  • BMI>28 and known risk factors

- BMI 30+

115
Q

When to consider bariatric surgery

A
  • BMI 40+ or 35-40 with risk factors
  • Fit for surgery
  • Other measures tried
116
Q

4 Public health strategies to tackle obesity

A
  • Increase exercise - make gyms cheaper / more cycle paths
  • Education
  • Legislation on advertising and tax
  • Schools encourage healthy food
117
Q

Impaired glucose tolerance

A

Pre-diabetes, raised glucose levels but not yet at threshold

118
Q

Diabetes prevention programme

  • Goals
  • Secondary goals
  • Findings
A
  • Goal: Prevent or delay diabetes in those with impaired glucose tolerance
  • Secondary: Reduce CVD events, risk factors and atherosclerosis
  • Findings: Lifestyle modification is more effective than Metformin
119
Q

Alloimmunisation

A

Immune response against foreign RBC antigens

120
Q

What 2 factors increase the risk of alloimmunisation

A
  • Repeated transfusions

- Pregnancy

121
Q

Criteria to give blood

A
  • Fit + Healthy between 7.12 and 25 stone
  • Between ages 17-66 (66-70 if given blood before and 70+ if given blood in last 2yrs)
  • No HIV/Hep
  • Had anal sex in last 3mnths
  • Ever been injected with drugs
122
Q

Process of transfusion

A
  • ABO and Rh grroup of patient found
  • Antibody screen looks for Ab that may damage donor blood
  • Crossmatching to donor blood
123
Q

Emergencies types of blood used

  • Immediate
  • 10-15mins time
  • 45mins time
A
  • O-neg
  • Use blood same ABO and Rhd = group compatible
  • Full cross match
124
Q

4 strategies to avoid unnecessary transfusions

A
  • Strict criteria for use blood products
  • Stop drug therapy that increases bleed risk
  • Treat anemia prior to surgery
  • Use fibrinolytics
125
Q

NHSBT

A

NHS blood transfusion service

126
Q

Role of NHSBT

A
  • Collect blood from locations
  • Organise service and recruit doners
  • Transport/storage/processing/distribution
  • Teaching and training
  • Research and development
127
Q

Patient problems MUS

A
  • Needs not met
  • Poor QOL
  • Poor outcome
  • Iatrogenic harm
128
Q

System problems MUS

A
  • Patients continue to return
  • Repeat costs
  • Ineffective use of resources
129
Q

Patients want a convinving explanation but recieve:

R,C,E

A
  • Rejection: Deny symptoms
  • Collusive: Sanctions patients belief about symptoms
  • Empowers: tangible opportunities for management and legitimises patient suffering = alliance
130
Q

Legal requirements for PM

A
  • Sudden death
  • Unkown cause of death
  • Unnaturall death
  • Death from industrial disease
  • death from negligence
  • Death during procedure
  • Death within 24hrs of admission
  • Not seen by doctor in 14 days
  • Patient detained under MHA
131
Q

4 criteria certifying death

A
  • Pupils fixed and dilated
  • No ventilation observed or auscultated 3mins
  • No central pulse 1min
  • No heart sounds on auscultation 3mins
132
Q

Personal requirements for certifying death

A
  • Must have seen patient in 14days prior
  • Must have provided care before death
  • Must be registered medical practitioner
  • Knowledge or belief in cause of death
133
Q

Aims of Calman-Hine Framework 1995

A

Developing cancer networks that inorporate primary care, cancer units and cancer centres

134
Q

What are the aims of strategic cancer networkds

A
  • Reduce cancer incidence
  • Maximise survival
  • Enhance QOL
  • Improve patient experience
  • Provide high quality service for patients and carers
135
Q

What do strategic cancer networkds do

A
  • Develop strategic plans
  • Implement national policies
  • Deliver improvements
  • Provide communication across all networks
  • Provide research for audits
136
Q

Cancer unit vs cancer centre

A
  • Cancer unit = diagnose and treat common cancers and refer to specialists
  • Cancer centre = provide cancer unit services and also specialist diagnostics and treatment for large areas
137
Q

Partnership groups

A
  • Combine users of cancer services
  • Act to improve cancer services by considering opinions and looking at what worked well
  • Design literature for patients
138
Q

Cancer registries

A

Collection and analysis of data for whole assigned region, submit data to national stats

139
Q

National cancer research network

A
  • Supports recruitment of patients for trials
  • Integreates research into care services
  • Integrates and supports work from cancer charities
140
Q

-National cancer research institute

A

Promotes coperation between govenment, charity and industru

-Maintains national research database and informs about new research desicions

141
Q

3 ways in which the quality of cancer services are measured

A
  • Clinical service quality measure (CSQM) provide info about how well service is performing
  • CQC publish data comparing hospitals
  • National audits
142
Q

Social workers role and how they help the MDT

A

Support families and review enviroments including finances, can contribute knowledge from patients home environment so providing context

143
Q

Advocacy

A

Getting support from another person to help you express views and wishes, helps you stand up for your rights and can accompany you to meetings/appointments

144
Q

What can advocate not do (3 things)

A
  • Give their personal opinon
  • Solve problems for you
  • Judge you
145
Q

Stigma

A

Strong feeling of dissaproval that is shared by socety about a certain thing. Does not exist in itself is associated with behaviours

146
Q

Social process of labelling

L,S,O,S,D

A
  • Labelling X
  • Stereotyping (Peaple who are X are..)
  • Othering (Us vs X)
  • Stigmatising (devaluing X based on atrribute
  • Discrimination (Acting differently to X)
147
Q

Types of stigma

  • Discreditable
  • Discrediting
  • Felt
  • Enacted
  • Courtesy
A
  • Discreditable: keep stigma hidden (eg HIV)
  • Discrediting: Cannot be hidden (wheelchair)
  • Felt: By person (eg shame at STI clinica)
  • Enacted: By others (eg shizophrenic gets off from bus)
  • Courtesy: Felt by someone with patient open to stigma (eg spouse of alzhiemers patient)
148
Q

Internalising

A

Absorbing social views of being lower status and the impact on personal belied and behaviour

149
Q

4 methods of coping with stigma (P,C,W,R)

A 
Passing = Pretending to be normal (+Pyschological toll)
Covering = Not disclosing (blin wearing sunglasses)
Withdrawal = acknowledging symptom but withdrawing from society (+ psychological cost)
Resistance = Contesting against stigma related outcomes
150
Q

Sensitivity

  • Definition
  • Formula
A

Tests with high sensitivity correctly classify a high proportion of people who really have disease

All those with the disease (true +ive + false -)

151
Q

Specificity

  • definition
  • formula
A

Tests with high specificity correctly classify people who dont have the disease

All those without disease (true -ive + false +)

152
Q

Positive predictive value

  • definition
  • formula
A

Chances of having disease if test is positive

Everyone with + test (true +ive + false +)

153
Q

Negtaive predictive value

  • definition
  • formula
A

Chance of NOT having the disease if test is negative

Everyone with a - test (true -ive + fals -)

154
Q

Which measures of test performance are usually affected by prevalance and which are not

A 
AFFECTED = +/- predictive value
CONSTANTS = Specificity/sensitivity
155
Q

How do -/+ predictive values change with prevalance

A

As prevalance ↑

+ predictive value ↑
-predictive value ↓

and vice versa

156
Q

likelyhood ratios

-definition

A

looks at how likely you have/have not got disease if your test is +/-

  • The larger the +LR the more likely you have the disease with + test
  • The smaller the -LR the less chance you have the disease with a -test.
157
Q

+ LR formula

A

1 - Specificity

158
Q
  • LR formula
A

1 - Sensitivity

159
Q

Work out chance of disease with LR’s

A

Chance of disease before test x LR = chance of disease after test

160
Q

Soujorn time

A

Duration of disease before symptoms are apparent yet can still be picked up by screening

  • shorter = rapidly progressing disease
  • longer = milder/less dangerous disease course
161
Q

Lead time bias

A

Point detected by screening is far beyond its usual clinical presentation - faslely “prolonging” survival. Screening is not the cause for their long survival.

162
Q

Length time bias

A

A form of selection bias
Patients with long soujorn time (slowly progressing) disease more likely to be detected in screening. These people have a better prognosis anyway, screening is not the reason why.

163
Q

Risk Ratio

  • Definition
  • formula
A

Probability that an event will occur during a specific time

Number of whole groups

164
Q

Relative risk

  • Definition
  • formula
A

Ratio of developing an outcome in those exposed to an event vs those not exposed

Ratio = Risk in exposed
———————
Risk in non-exposed

165
Q

Risk ratio = 1

-Meaning

A

There is no difference in risk between 2 groups (top and bottom are same)

166
Q

Odds ratio
(O = Outcome)
-Definition
-Formula

A

The odds that an outcome will occur given a particular exposure, compared to odds of it occuring without exposure

Odds in non-exposed

167
Q

NNT

  • definition
  • calculation
A

Number of patients who need to be treated to prevent one additional bad outcome

NNT = 1/ARR (absolute risk reduction)

168
Q

NNH

  • definition
  • calculation
A

How many people need to be exposed over time to a specific risk factor to cause harm to an avg of one person who otherwise wouldnt have been harmed

NNH = 1/Attributable risk

169
Q

3 WHO checklists for theatre

A
  • Before induction
  • Before knife to skin
  • Before departure of theatre
170
Q

Who is required for the WHO

A

Nurse + Anaesthetist (+ surgeron for last 2)

Yr 3 ALS (10 decks)

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