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Year 4 H&S > Things I don't know > Flashcards

Things I don't know Flashcards

1
Q

What are the stages of an audit?

A 
identify current standards
measure current performance
compare performance to standards
make improvements
re-evaluate
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2
Q

Why do audits?

A

improve patient care
encourage teamwork
financial benefits
assess progress against national standards

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3
Q

Limitations of audits?

A

only compares service to best current practice
may not always help
costs time, money and resources
if no changes made, then money wasted

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4
Q

What are guidelines?

A

Consensus of best practice based on available evidence, implemented to ensure consistencies in healthcare

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5
Q

How to create a guideline?

A

collect a wide range of clinical and user perspectives
incorporate external reviews
use a time limit

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6
Q

How to implement guidelines?

A 
computer messages
audio-visual aids
electronic publications
educational outreach areas
local opinion leaders
computer decision support systems
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7
Q

How might liver disease priorities vary internationally?

A

available resources
different financial and healthcare priorities
cultural/ societal interpretation
extent of alcohol related disease burden

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8
Q

How to deal with outbreak of food poisoning?

A

identify and isolate source
identify and treat infected individuals
advise on further treatment and prevention e.g. staying off work until 48 hours clear

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9
Q

How to handle diarrhoea outbreak in hospital?

A

rapid isolation of patients with diarrhoea
rapid identification and notification of outbreak
close monitoring of management protocol e.g, cleaning, sanitising, antibiotic regimes etc.
Ensure good communication with staff and patients etc.

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10
Q

Common causes of hospital diarrhoea?

A 
c diff
norovirus
rotavirus
ecoli
klebsiella
staph aureus
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11
Q

Factors leading to higher transplant rates?

A

use of opt out policy
large numbers of transplant centres
high percentage university educated
high percentage Roman Catholics

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12
Q

Factors affecting organ donation rate?

A

proactive donor detection programme
economic reimbursement for hospitals
high number of road traffic accidents

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13
Q

What is the Calman Hine framework?

A

1995

highlighted need to develop strategic cancer networks incorporating primary care, cancer units and cancer centres

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14
Q

What are the aims of strategic cancer networks?

A

reduce cancer incidence
maximise cancer patient survival
enhance quality of life for patients and families
improve patient experience of cancer services
provide high quality service focused on needs of patients and families

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15
Q

What do strategic cancer networks do?

A

develop strategic plans for delivering better care
implement national policies
deliver the improvements in care
provide resources for audits and research
provide a channel for communication between groups across the network

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16
Q

What do cancer units do?

A

diagnose and treat common cancers
diagnose intermediate cancers
refer to specialists
provide drug therapy and other treatments

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17
Q

What do cancer centres do and pros and cons?

A

provide cancer unit services
provide cancer services for large areas
specialist diagnosis and treatment
Good- better and more specialist management
Bad- patients may have to travel long way, increased geographical inequalities

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18
Q

What are partnership groups?

A

combine users of cancer services- professionals and patients

act to improve cancer services by giving opinions and advice on what could be better in future

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19
Q

What do cancer registries do?

A

responsible for collection, analysis and dissemination of cancer data for whole region
collect information of all new diagnoses
submit data to office of national statistics
essential to implemementation of cancer plan through reliable data of incidence, prevalence and survival rates

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20
Q

What does national cancer research network do?

A

supports recruitment of patients for trials and improves speed, quality and integration of research into care services
integrates and supports work from charities

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21
Q

What does national cancer research institute do?

A

promote cooperation between government, charities and industry for benefit of patients, public and scientific community
helps avoid unnecessary effort
maintains a research database that analyses the research being done and informs about decisions for new research

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22
Q

How to stop smoking?

A

one to one counselling
support groups
nicotine replacement therapy
bupropion (zyban)- reduce cravings and reduce withdrawal symptoms
Vareniciline (champix)- blocks nicotine receptors

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23
Q

What are palliative care aims?

A

affirm life and regard dying as normal process
provide relief from pain/ distressing symptoms
integrate spiritual/ psychological aspects
ensure patients live as actively as possible until death
offer support system for families bereavement

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24
Q

What is used to calculate Qrisk?

A 
age
sex
ethnicity
BMI
BP
Cholesterol
Family history
RA
Smoking
Deprivation
CKD
AF
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25
Q

What does NSF- mental health do?

A

Helps drive up equality and remove the unacceptable variations in provision of healthcare
Set national standards and define service models for promoting and treating mental illness
Put in place programmes to support local delivery of services
Establish milestones and performance indicators which progress can be measure against

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26
Q

What are the standards of NSF-MH?

A 
mental health promotion
primary care and access to services
caring about carers
preventing suicide
round the clock care and crisis for those with severe mental illness
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27
Q

What are the every child matters key outcomes?

A 
healthy- physical/ mental/ lifestyle
safe- from harm and neglect
enjoy and achieve most out of life
contribute to society and community
economic wellbeing and reach full potential
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28
Q

What is the purpose of MDT’s for child safety?

A

children to get help when they need it
professionals take timely action to protect children
professionals ensure children are listened to and respected
agencies and professionals work together to assess needs and risk and develop effective plans
agencies and professionals share information
professionals are confident and competent
agencies work with members of the community

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29
Q

What are the effects of falls?

A 
Head injury
neck of femur fracture
wrist fracture
back injury
long lie- pressure sores, hypothermia, rhabdomyolysis, AKI
Psychological- loss of confidence, immobility, isolation
effect of ADL's
death
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30
Q

What are the risk factors for falls?

A

Medical- Parkinson’s, stroke, arthritis etc
Pharmaceutical- poly pharmacy, sedatives, antihypertensives
Environmental- poor lighting, rugs, poorly fitting footwear

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31
Q

How to decrease falls risk?

A 
strength and balance training
cleaning glasses
staff monitoring in nursing homes
home safety assessment and modifications
podiatry services and walking aids
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32
Q

What are the benefits of registering as blind with local authority?

A 
blue badge parking permit
leisure centre concessions
bus and rail ticket concessions
tv licence concession
career and employment advice
disability living allowance, incapacity benefit etc.
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33
Q

Why do only 1/3rd of blind people register as blind?

A

not in contact with specialist eye services
unaware of registration and benefits
professionals may not recommend as worried about emotional impact
do not want to be labelled as blind due to stigma

34
Q

What are the principles of NSF for older people?

A

make sure older people not unfairly discriminated against
person centred care of elderly patient
intermediate care and integrate services for faster recovery
make sure older people get specialist care if needed and maximum benefit from hospital stay
reduce incidence of stroke
reduce incidence of falls and better treatment and rehab
promote good mental health
health promotion to extend healthy life expectancy

35
Q

What are technology appraisals?

A

NICE assesses clinical evidence and cost effectiveness to decide to provide new healthcare technology or not

36
Q

What is the process of technology appraisals?

A

topic selection
trial data submission
review data for clinical and cost effectiveness
call for contributions from interested parties
fund- if issued as mandatory then ccg’s must fund service if required

37
Q

How is cost effectiveness calculated?

A

cost difference between old and new treatment / QALY difference

38
Q

What are the quality standards for long term conditions?

A 
person centred
early recognition/ diagnosis/ treatment
emergency/ acute treatment
early specialist rehab
vocational rehab
personal care/ support
palliative care
family/ carer support
care during admission
39
Q

What are the quality standards for dementia?

A

People should receive:
care from specialist dementia staff
memory assessment and dementia diagnosing service
written information about diagnosis and treatment
personalised care plan with named coordinator to discuss individual needs
opportunity to discuss advance care plans and LPA while still have capacity
assessment and management of non cognitive symptoms
access to special dementia liaison services when accessing inpatient care
assessment of palliative care in later stages
carers receive assessment of emotional and social needs and receive support
carers have access to respite

40
Q

What are the quality standards for stroke?

A

Patients with suspected stroke should be:
screened with validated tool and sent to acute stroke unit
receive brain imaging within 1 hour
admitted directly to stroke unit and assessed for thrombolysis
have swallowing assessed within 4 hours
are assessed by specialist rehab team within 24 hours
receive ongoing rehab in specialist rehab unit
offered minimum of 45 minutes of therapy thats required
assessed for cause and receive treatment plan if still incontinent after 2 weeks
screened within 6 weeks for mood disturbance or cognitive impairment
carers given training

41
Q

Advantages and disadvantages of releasing performance data?

A

Good- focuses attention on improving patient care, public reassurance about effectiveness and safety, competition will boost performance

Bad- unmeasured performance will suffer, opportunity for data manipulation by only choosing healthier patients, case mix- some areas or centres only receive patients with poor prognosis

42
Q

What are 4 pillars of medical ethics?

A

beneficience
non-maleficence
justice
autonomy

43
Q

What is needed for valid consent?

A

valid
informed
patient has capacity

44
Q

What does a patient need to know to be informed?

A

overview of condition
likely outcome of condition
treatment options including second opinion

45
Q

When is consent not required?

A 
additional procedures
mental health act
emergency situation
risk to public health
severely ill and living in unhygienic conditions
46
Q

What does the Nuremberg code about medical ethics state?

A

voluntary consent is required from all participants
should yield results beneficial to society that can’t be got from other means
based on animal experimentation and a knowledge of natural history of disease
avoid all unnecessary mental and physical suffering
should not be performed if prior reason to believe intervention harmful
should be conducted by scientifically qualified people
risk should not exceed humanitarian importance of the problem solved by experiment
subjects should be able to leave whenever they wish
Scientist in charge should be prepared to end the experiment if harm to subjects becomes likely

47
Q

When can you break confidentiality?

A 
Protect children
Protect the public
Required by the courts
Provide care in life threatening situation e.g. suicide/ self harm
protect service provider
DVLA for TIA/ stroke/ epilepsy
Gun and knife wounds reported to police
communicable diseases
48
Q

What are the most common causes of food poisoning and onset times?

A

rapid- staph aureus, bacillus cereus
intermediate (12hrs)- clostridium perfringens, clostridium botulism
Several days- campylobacter, coli, shigella, salmonella, hep a, parvovirus
Most common overall- campylobacter

49
Q

What is the aim of diabetes prevention programme?

A

identify those with impaired glucose tolerance
prevent or delay diabetes onset
reduce cardiovascular risk factors
reduce cardiac risk factors
reduce atherosclerosis
lifestyle reduces onset by 58%, metformin. by 31%

50
Q

What are the causes of obesity?

A

genes and tendency to gain weight
not adopting healthy habits
environment that encourages fatty food and immobility
low income, bad food is cheaper
modernisation and abundance of food
urbanisation and not having to walk far for food

51
Q

How to tackle obesity?

A 
easy access to exercise schemes
reduce dietary fat
education about balanced diet
healthy school dinners
clear food labelling
52
Q

What are the national obesity forum aims?

A

create recognition of obesity as serious medical problem
provide education of obesity management
provide guidelines for obesity management in primary care
provide a network for support and information resources
convince government to give obesity high priority
highlight health inequalities of obesity

53
Q

What is euthanasia?

A

act of deliberately ending a person’s life to relieve suffering

54
Q

What are the types of euthanasia?

A

active- actively ends another’s life
passive- withhold life prolonging treatment
voluntary- where person who wants to die asks for help
Non-voluntary- where person can’t ask for help now but previously expressed their wishes
Involuntary- murder

55
Q

What are the arguments for euthanasia?

A

ethical- should have autonomy to choose
relieves suffering
Pragmatic argument that end of life care such as withdrawing food is the same thing

56
Q

Arguments against euthanasia?

A

religious- only god should end life
slippery slope- could lead to people feeling they should die to avoid being a burden, misdiagnoses
ethics- violates non maleficence
alternative- advances in palliative care mean no one should be suffering anyway so euthanasia not needed

57
Q

What are the barriers to healthcare?

A

personal- negative past experience, stigma
geographical- transport, postcode lottery
cultural- beliefs, language barrier
Socio economic- can’t get time off work, education, finances, prescription costs
Organisational- disabled access, long waiting times, few out of hours appointments

58
Q

What are some common complaints?

A 
safety of clinical practice
poor/ insufficient information
ineffective clinical practice
poor handling of complaints
lack of dignity and respect
poor attitudes of staff
59
Q

What are the reasons complaints are handled badly?

A

failure to acknowledge validity of complaint
failure to apologise
response to complaint does not say what has been done to prevent recurrence
response to complaint contains medical jargon
failure to involve the staff directly involved in complaint in investigation

60
Q

What is the complaints process?

A

local resolution first with hospital and GP and raising matter with practitioner, or local CCG, then escalation with parliament and health service ombudsman

61
Q

What is PALS?

A

patient advice and liaison service
give impartial advice on complaints procedure
offers confidential advice and support on healthcare related matters
provide point of contact for patients and families
give information on health related questions, complaints procedure and external support groups

62
Q

What are adverse events?

A

Unintended event resulting from clinical care and causing physical or psychological patient harm

63
Q

Give some GP and hospital examples of adverse events?

A 
prescribing errors
documentation error
diagnosis delays
consent, communication, confidentiality errors
procedure errors
patient accident
64
Q

What is a near miss?

A

events or omissions arising during clinical care but not developing far enough to cause harm to patient

65
Q

What is a never event?

A

serious patient safety incidents that should never occur if available preventative measures have been implemented.
e.g. wrong site surgery

66
Q

Who are adverse events reported to?

A

NPSA- national patient safety agency which collects information from staff, patients and carers and ensures solutions produced to prevent harm where risks identified
NRLS- national reporting and learning system, an anonymous system run by NPSA
Yellow card system run by MHRA for drug reactions

67
Q

Why do we monitor adverse events?

A

they are common- 1 in 10 hospital admissions they occur
they are preventable
to learn from them
opportunity to introduce preventative measures

68
Q

What are the barriers to learning from adverse events?

A

lack of communication
lack of responsibility and scape goat culture
focus on immediate event not root cause
pride and rigid attitudes of staff

69
Q

What are the 2 types of post mortem?

A

hospital- where cause of death unknown/ interesting and doctor wants to do one or when family unsure of cause and request one. Need family consent
Coroner- when death is sudden or suspicious- mandatory

70
Q

Why are deaths referred to the coroner?

A 
sudden death
unknown cause of death
unnatural death- suicide, murder
death from industrial disease
death during surgery
death within 24 hours of admission
patient in custody
patient detained under MHA
not seen by doctor in 28 days
71
Q

What happens after deaths referred to coroner?

A

if cause if obvious e.g. has cancer but saw gp 5 weeks ago then they sign death certificate
or if death sudden or suspicious then do post mortem and then may go to inquest if still not sure of cause and if suspicious or not

72
Q

What are the benefits of post mortem?

A

gain deeper insight into pathological processes
learn how to prevent future patient death
help with teaching or medical research
further understand long term effects of drug therapy
study and monitor levels of chemicals absorbed from environment

73
Q

What is the childhood vaccine schedule?

A

8 weeks- 6 in 1 (hib, hep b, diphtheria, tetanus, pertussis, polio), rotavirus, men b
12 weeks- 6 in 1, rotavirus, pneumococcal
16 weeks- 6 in 1, men b,
1 year- hib/ men c, MMR, men b, pneumococcal
preschool- 4 in 1 (pertussis, diphtheria, tetanus, polio), MMR
13- hpv
14- 3 in 1 (polio, tetanus, diphtheria), menACWY

74
Q

What are Wilson’s screening criteria?

A

condition is an important health problem
natural history of the disease is well understood
should be a recognised symptomatic or latent period
test should be easy to perform and interpret and acceptable to patients
should be an accepted treatment
treatment should be more effective id started early
should be a policy on who should be treated
diagnosis and treatment should be cost effective
case finding should be a continuous process

75
Q

What does an argument need to be?

A

Logical
Valid
Sound

76
Q

What makes an argument valid?

A

conclusion must follow on logically from the premises

77
Q

What makes an argument sound?

A

must be valid- conclusion follow on from premises and all premises must be true

78
Q

What is opportunity cost?

A

benefits foregone by particular use of resources

79
Q

What is cost minimisation analysis?

A

not a full form of economic evaluation, assume equal health effects and choose least cost option

80
Q

What is cost effectiveness analysis?

A

efforts measured in terms of single most appropriate unidimensional natural unit e.g. cost per baby with down’s syndrome detected in downs screening but cost per life saved in kidney transplant. So difficult to compare different things as measuring different outcomes.

81
Q

What is cost utility analysis?

A

multidimensional effects, compares quality of life years gained. Uses QALY’s for effectiveness.
Able to compare different interventions

Year 4 H&S (1 decks)

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