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D TO REVISE - PHASE 3A > TO REVISE PUBLIC HEALTH > Flashcards

TO REVISE PUBLIC HEALTH Flashcards

1
Q

PREVENTION + SCREENING
What are the Wilson + Junger criteria for screening?

A

CONDITION
-important
- known natural history
- identifiable latent/pre-clinical phase

THE SCREENING TEST
- suitable (sensitive, specific, inexpensive)
- acceptable

ORGANISATION AND COSTS
- facilities
- costs and benefits
- ongoing process

THE TREATMENT
- effective
- agreed policy on whom to treat

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2
Q

STUDY DESIGN
What are the advantages of a cross-sectional study?

A
  • Relatively cheap + quick.
  • Provide data on prevalence at a single point in time.
  • Good for surveillance + public health planning.
  • Large sample size.
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3
Q

STUDY DESIGN
What are the disadvantages of a cross-sectional study?

A
  • Risk of reverse causality.
  • Cannot measure incidence as no time reference.
  • Risk of recall bias + non-response.
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4
Q

STUDY DESIGN
What are the advantages of a case control study?

A
  • Quicker than cohort of intervention studies as it’s retrospective.
  • Inexpensive, good for rare outcomes (e.g. cancer).
  • Can investigate multiple exposures.
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5
Q

STUDY DESIGN
What are the disadvantages of a case control study?

A
  • Retrospective nature only shows an association (not causation).
  • Difficulty finding controls to match with cases.
  • Unreliable due to recall bias.
  • Prone to selection + information bias.
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6
Q

STUDY DESIGN
What are the advantages of a cohort study?

A
  • Prospective so can show causation.
  • Lower chance of selection + recall bias.
  • Absolute, relative + attributable risks can be determined.
  • Good for common + multiple outcomes.
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7
Q

STUDY DESIGN
What are the disadvantages of a cohort study?

A
  • Loss to follow-up, requires a control group to establish causation.
  • Takes a long time, need a large sample size.
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8
Q

STUDY DESIGN
What are the advantages of a randomised control trial?

A
  • Can infer causality (gold standard).
  • Randomisation allows confounding factors to be equally distributed + biases minimised (helped by blinding).
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9
Q

STUDY DESIGN
What are the disadvantages of a randomised control trial?

A
  • Is it ethical to withhold a treatment that is strongly believed to be effective?
  • Time consuming, expensive.
  • Volunteer bias – specific inclusion/exclusion criteria may mean the study population is different from typical pts (e.g. excluding very elderly pts).
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10
Q

EPIDEMIOLOGY
Define bias.

A

A systematic deviation from the true estimation of the association between exposure + outcome.
I.e. systematic error > distortion of the true underlying association.

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11
Q

EPIDEMIOLOGY
What is confounding?
What is the effect of confounding on a study?

A

Where a factor is associated with the exposure of interest + independently influences the outcome but does not lie on the causal pathway.
- May affect the validity of a study.

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12
Q

EPIDEMIOLOGY
What is the Bradford-Hill criteria for assessing causality?

A
  • Strength of association (the magnitude of the RR).
  • Dose response (the higher the exposure, the higher the risk of disease).
  • Consistency (similar results from different researches using various study designs).
  • Temporality (does exposure precede outcome?)
  • Reversibility (experiment) – removal of exposure reduces risk of disease).
  • Biological plausibility (biological mechanisms explaining the link).
  • Coherence (logical consistency with other information).
  • Analogy (similarly with other established cause-effect relationships).
  • Specificity (relationship specific to outcome of interest).
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13
Q

EPIDEMIOLOGY
If association is not causal, how could it be explained?

A
  • Bias.
  • Chance.
  • Confounding.
  • Reverse causality.
  • A true causal association.
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14
Q

HEALTH DETERMINANTS ETC.
Define allostasis.

A

The stability through change, or homeostasis, of our physiological systems to adapt rapidly to change in environment.

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15
Q

HEALTH DETERMINANTS ETC.
Define public health.

A

Defined as the science + art of preventing disease, prolonging life + promoting health through organised efforts of society.
- Population perspective – thinks in terms of groups, not individuals.

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16
Q

HEALTH DETERMINANTS ETC.
What are the determinants of health?

A

PROGRESS

Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socioeconomic status
Social capital

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17
Q

HEALTH DETERMINANTS ETC.
What are the 3 domains of public health?

A
  • Health improvement.
  • Health protection.
  • Improving services.
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18
Q

HEALTH DETERMINANTS ETC.
What are the different forms of health equity?

A
  • Equal expenditure.
  • Equal access.
  • Equal utilisation.
  • Equal healthcare outcome.
    (All for equal need).
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19
Q

HEALTH DETERMINANTS ETC.
What are the 2 main factors affecting health equity.
Give an example of each.

A
  • SPATIAL INEQUITY (geographical) – infant mortality rates high in places like Africa but healthcare spending is low in these areas (health inequality + inequity).
  • SOCIAL INEQUITY (age, gender, ethnicity, socioeconomic status etc) – socioeconomic inequity as angina Sx higher in more deprived areas but coronary artery revascularisations in those with angina Sx higher in more affluent areas in Sheffield.
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20
Q

HEALTH DETERMINANTS ETC.
How is health equity examined?

A
  • Supply/access/utilisation of healthcare.
  • Healthcare outcomes.
  • Health status.
  • Resource allocation (health services or others like education, housing).
  • Wider determinants of health.
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21
Q

HEALTH DETERMINANTS ETC.
How is health equity assessed?

A
  • Typically assess inequality, then decide if inequitable (inequalities need to be explained + equality ≠ equitable).
  • Health care systems – equity often defined in terms of equal access for equal need (NHS) but measurement usually of utilisation, health status or supply.
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22
Q

HEALTH PSYCHOLOGY
What is the main theory for explaining why people undertake health damaging behaviours?

A

Unrealistic optimism.
- Individuals continue practicing health damaging behaviours due to inaccurate perceptions of risk + susceptibility.
- They’re aware of risks but don’t think it would happen to them.

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23
Q

HEALTH PSYCHOLOGY
In terms of unrealistic optimism, what are a person’s perceptions of risk influenced by mainly?

A
  • Lack of personal experiences with the problem.
  • Belief that it’s preventable by personal action.
  • Belief that it’s not happened by now so it’s not likely to.
  • Belief that the problem is infrequent.
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24
Q

HEALTH PSYCHOLOGY
What other factors can influence a person’s perceptions of risk?

A
  • Stress.
  • Health beliefs.
  • Cultural variability.
  • Situational rationality.
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25
Q

HEALTH PSYCHOLOGY
What factors can affect compliance?

A
  • Side effects of medications.
  • Patient perception of risk.
  • Socioeconomic status.
  • Treatment for an asymptomatic condition (e.g. continuing Abx).
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26
Q

HEALTH PSYCHOLOGY
What is the NICE guidance on behaviour change?

A
  • Planning interventions.
  • Assessing the social context.
  • Education + training.
  • Individual, community + population-level interventions.
  • Evaluating effectiveness + assessing cost-effectiveness.
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27
Q

HEALTH BELIEF MODEL
What is the Health Belief Model?

A

Behaviour change model that states individuals will change if they –

  • PERCEIVED SUSCEPTIBILITY - Believe they are susceptible to the condition.
  • SEVERITY - Believe that it has serious consequences.
  • PERCEIVED BENEFITS - Believe that taking action reduces susceptibility.
  • PERCEIVED BARRIERS - Believe that benefits of taking action outweigh costs.
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28
Q

HEALTH BELIEF MODEL
What can be added to the model to give more information about likelihood of action?
Give examples.

A

Cues to action.
- They can be internal or external + are not always necessary for behaviour change.
- Internal = increase pain, decrease ADLs.
- External = reminders in post, GP advice.

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29
Q

HEALTH BELIEF MODEL
What are the pros of this model?

A
  • Can be applied to a wide variety of health behaviours.
  • Cues to action are unique component to the model.
  • Long standing model.
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30
Q

HEALTH BELIEF MODEL
What are the cons of this model?

A
  • Does not differentiate between first time + repeat behaviour.
  • Does not consider the influence of emotions + behaviour.
  • Cues to action often missing.
  • Alternative factors may predict health behaviour such as self-efficacy or outcome expectancy (whether they feel they will be healthier as a result).
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31
Q

THEORY OF PLANNED BEHAVIOUR
What is intention determined by in this model?

A

ASP

  • ATTITUDE = a person’s attitude to the behaviour (I don’t think smoking is good).
  • SUBJECTIVE NORMS = the perceived social pressure to undertake the behaviour (most people who are important to me want me to give up smoking).
  • PERCEIVED BEHAVIOURAL CONTROL = a person’s ability to perform the behaviour (I CAN give up smoking).
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32
Q

THEORY OF PLANNED BEHAVIOUR
What are the 5 points to bridging the intention-behaviour gap?

A

PPAIR –
- PERCEIVED CONTROL (something an individual feels they are capable of doing).
- PREPATORY ACTIONS (dividing task into sub-goals increases self-efficacy + satisfaction at the point of completion).
- ANTICIPATED REGRET (reflecting on feelings once failed, related to sustained intentions).
- IMPLEMENTATION OF INTENTIONS (biggest one, “if-then” plans – if I need to take my meds in the morning then I will place them here to remind me).
- RELEVANCE TO SELF (can they relate to the behaviour).

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33
Q

THEORY OF PLANNED BEHAVIOUR
What are the pros of this model?

A
  • Can be applied to a wide variety of health behaviours.
  • Useful for predicting intention.
  • Takes into account importance of social pressures.
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34
Q

THEORY OF PLANNED BEHAVIOUR
What are the cons of this model?

A
  • Lack of temporal element + direction or causality, no sense of how long behaviour change may take.
  • ‘Rational choice model’ so doesn’t take into account emotions.
  • Assumes attitudes, subjective norms + perceived behavioural control can be measured.
  • Relies on self-reported behaviour.
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35
Q

TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What are the 5 stages?

A

PC PAM(R)
- PRECONTEMPLATION = no intention of stopping.
- CONTEMPATION - beginning to consider stopping, probably at some ill-defined time in the future.
- PREPARATION = getting ready to quit in near future, set stop date, go to Dr, throw away items (28d).
- ACTION = engaged in stopping behaviour on stop date (6m).
- MAINTENANCE = continues + engaged with abstinent behaviour (6m).
- RELAPSE can occur at any stage of the model.

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36
Q

TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What are the pros of this model?

A
  • Acknowledges individual stages of readiness (tailored interventions).
  • Accounts for relapse/allows patient to move backwards in the stages.
  • Gives temporal element (idea of timeframe/progression, albeit arbitrary).
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37
Q

TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What are the cons of this model?

A
  • Not all people move through every stage.
  • Change might operate on a continuum rather than discreet changes.
  • Does not take into account values, habits, culture, social, economic factors.
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38
Q

HEALTH PSYCHOLOGY
What are some other factors to consider that might influence behaviour change?

A
  • Impact of personality traits on health behaviour (everyone responds differently).
  • Assessment of risk perception.
  • Impact of past behaviour/habit.
  • Automatic influences on health behaviour.
  • Predictors of maintenance of health behaviours.
  • Social environment.
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39
Q

HEALTH PSYCHOLOGY
What do NICE mention about interventions for behaviour change?

A
  • Should work in partnership with individuals, communities, organisations + populations.
  • Population-level interventions may affect individuals + communities + vice versa.
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40
Q

HEALTH NEEDS AX
What is the essence of a HNA?

A
  • Before a health intervention is done, a HNA must be done.
  • It’s a systematic method for reviewing the health issues facing a population, leading to agreed priorities + resource allocation that will improve health + reduce inequalities.
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41
Q

HEALTH NEEDS AX
What is the planning cycle in a HNA and how is this relevant to Doctors?

A
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42
Q

HEALTH NEEDS AX
Define need.

A

ability to benefit from an intervention.

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43
Q

HEALTH NEEDS AX
What are the 4 sociological perspectives of need?

A

FENC

  • Felt need = individual perceptions of variation from normal health.
  • Expressed need = individual seeks help to overcome variation in normal health (demand).
  • Normative need = professional defines intervention appropriate for the expressed need.
  • Comparative need = comparison between severity, range of interventions + cost.
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44
Q

HEALTH NEEDS AX
What are the 3 types of HNA?

A
  • Epidemiological.
  • Comparative.
  • Corporate.
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45
Q

HEALTH NEEDS AX
Epidemiological HNA: what is the methodology?

A
  • Defines the problem.
  • Size of problem (incidence/prevalence).
  • Services available (prevention, treatment, care).
  • Evidence base (effectiveness + cost-effectiveness).
  • Models of care (including quality + outcome measures).
  • Existing services (unmet need, services not needed).
  • Recommendations.
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46
Q

HEALTH NEEDS AX
Epidemiological HNA: what are the pros?

A
  • Uses existing data.
  • Provides data on disease incidence, mortality, morbidity.
  • Can evaluate services by trends over time.
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47
Q

HEALTH NEEDS AX
Epidemiological HNA: what are the cons?

A
  • Required data may not be available + variable data quality.
  • Evidence base may be inadequate.
  • Does not consider felt needs of people affected.
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48
Q

HEALTH NEEDS AX
Comparative HNA: what are the pros?

A
  • Quick + cheap if data available.
  • Indicates whether health or services provision is better/worse than comparable areas (gives a measure of relative performance).
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49
Q

HEALTH NEEDS AX
Comparative HNA: what are the cons?

A
  • Data may not be available + variable data quality.
  • May be difficult to find a comparable population.
  • May not yield what the most appropriate level (e.g. of provision or utilisation) should be.
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50
Q

HEALTH NEEDS AX
Corporate HNA: what are the pros?

A
  • Based on the felt + expressed needs of the population in question.
  • Recognises the detailed knowledge + experience of those working within the population.
  • Takes into account a wide range of views.
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51
Q

HEALTH NEEDS AX
Corporate HNA: what are the cons?

A
  • Difficult to distinguish need from demand.
  • Groups may have vested interests + may be influenced by political agendas.
  • Dominant personalities may have undue influence.
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52
Q

HEALTH NEEDS AX
Give an example of a service that is demanded but not needed or supplied?

A

Cosmetic surgery.

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53
Q

EVALUATION OF SERVICES
What is meant by evaluation?

A

Evaluation is the assessment of whether a service achieves its objectives.
- Process that attempts to determine as systematically + objectively as possible the relevance, effectiveness + impact of activities in the light of their objectives.

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54
Q

EVALUATION OF SERVICES
What is the Donabedian framework and what do each headings mean?

A
  • Structure – what is there.
  • Process – what is done.
    [Output sometimes included or classified under process].
  • Outcome – classification of health outcomes.
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55
Q

EVALUATION OF SERVICES
Give some structure examples.

A
  • Buildings = locations where screening is provided.
  • Staff = number of vascular surgeons/1000 population.
  • Equipment = number of ICU beds/1000 population.
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56
Q

EVALUATION OF SERVICES
Give some process examples.

A
  • Number of patients seen in A&E.
  • Number of operations performed (may be expressed as a rate).
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57
Q

EVALUATION OF SERVICES
Give some outcome examples.

A

5Ds:
- Death, disease, disability, discomfort, dissatisfaction.
Also:
- Mortality (e.g. 30-day mortality rate).
- Morbidity (e.g. complication rate).
- QOL/patient reported outcome measures (PROMS).
- Patient satisfaction.

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58
Q

EVALUATION OF SERVICES
Give some examples of PROMs used in outcome.

A
  • Oxford hip score.
  • Oxford knee score.
  • Aberdeen varicose vein questionnaire.
  • EQ-5D.
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59
Q

EVALUATION OF SERVICES
What are some issues with health outcome?

A
  • Link (cause + effect) between health service provided + health outcome may be difficult to establish as many other factors may be involved (e.g. case-mix, severity, other confounding factors).
  • Time lag between service provided + outcome may be long (e.g. healthy eating intervention in children + T2DM incidence in adults).
  • Large sample sizes may be needed to detect statistically significant effects.
  • Data may not be available or may be issues with data quality.
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60
Q

EVALUATION OF SERVICES
When considering data quality what should be considered?

A

CART
- Completeness.
- Accuracy.
- Relevance.
- Timeliness.

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61
Q

EVALUATION OF SERVICES
One aspect of evaluation is the quality of health services. What can be used when assessing this?

A

Maxwell’s Dimensions of Quality (3As + 3Es) –
- ACCEPTABILITY (how acceptable is the service to the people needing it?)
- ACCESSABILITY (is the service provided?)
- APPROPRIATENESS (right treatment given to right people at right time?)
- EFFECTIVENESS (does the intervention/service produce the desired effect?)
- EFFICIENCY (is the output maximised for a given input or is the input minimised for a given level of output?)
- EQUITY (are patients being treated fairly?)

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62
Q

EVALUATION OF SERVICES
Give some examples of things to consider under…
i) accessibility.
ii) appropriateness.

A

i) Geographical access, cost to patients, waiting times.
ii) Overuse? Underuse? Misuse?

63
Q

EVALUATION OF SERVICES
What are the 2 types of evaluation methods?

A
  • Qualitative.
  • Quantitative.
64
Q

EVALUATION OF SERVICES
Describe qualitative evaluation methods.

A
  • Consult relevant stakeholders as appropriate (e.g. staff, patients, relatives, carers, policy makers).
  • Methodology = observation (participant vs. non-participant), interviews (unstructured, semi-structured or structured), focus groups, review of documents.
65
Q

EVALUATION OF SERVICES
Describe quantitative evaluation methods.

A
  • Routinely collected data (e.g. hospital admissions, mortality).
  • Review of records (e.g. medical, administrative).
  • Surveys, other special studies (using epidemiological methods).
66
Q

FOOD + BEHAVIOUR
What are some factors promoting excessive energy intake?

A
  • Employment (shift work).
  • Characertistics of food (energy density, portion size).
  • Social aspect (people usually go out for food).
  • Genetics.
  • Advertisements.
67
Q

FOOD + BEHAVIOUR
Define malnutrition.

A

Refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

68
Q

SOCIAL EXCLUSION
What are the 3 core principles of the NHS?

A
  • Universal = it meets the needs of everyone.
  • Comprehensive = it’s based on clinical need, not ability to pay.
  • Free = at the point of delivery.
69
Q

SOCIAL EXCLUSION
What is the inverse care law?

A

The availability of medical care tends to vary inversely with the need of the population served.
- I.e. those who need it most, don’t access it as much + vice versa.

70
Q

SOCIAL EXCLUSION
What is meant by social exclusion?

A

The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.

71
Q

DOMESTIC ABUSE
What assessment tool can be used in domestic abuse?

A

Domestic Abuse + Sexual Harassment (DASH) tool.
- Encourages you to gather information about everything that is going on in the situation.
- No score that = high risk but may say something that suddenly makes you think they’re high risk + need intervention.

72
Q

MODELS OF BEHAVIOURAL CHANGE
Give 4 models of behavioural change?

A

Health Belief Model
Theory of Planned Behaviour
Transtheoretical model
motivational interviewing

73
Q

SUBSTANCE MISUSE
What can I offer a newly presenting drug user?

A

Health check
Screening for blood borne viruses
Contraception, smear
Sexual Health Advice
Check general immunisation status
Sign post to additional help
Information on local drugs services, including needle exchange

74
Q

SUBSTANCE MISUSE
What are the 3 levels of Basic Harm Reduction (as applied to drug users).

A

Action to prevent deaths
Action to prevent blood borne virus transmission
Referral where appropriate.

75
Q

ALCOHOLISM
What is ‘hazardous drinking’?

A

Pattern of alcohol use which increases someone’s risk of harm

76
Q

ALCOHOLISM
Describe the aetiology of problem drinking.

A

Individual
> genes / personality / physique
> occupation
> advertising / availability / peer group
Family
> Religion / tradition / culture

77
Q

ALCOHOLISM
What does persistent drinking throughout pregnancy lead to?

A

Foetal Alcohol Syndrome

small, underweight babies; slack muscle tone
mental retardation; behavioural + speech problems
characteristic facial appearance
cardiac, renal + ocular abnormalities

78
Q

ALCOHOLISM
What Public Health measures might be used to reduce alcohol usage?

A

Minimum price per unit of alcohol
Change licensing laws in areas where cirrhosis is the biggest problem
Reduce ‘passive drinking’ effects

79
Q

ALCOHOLISM
What are the 4 questions which make up the CAGE questionnaire?

A

Have you ever thought you needed to CUT DOWN on your drinking?
Have you ever become ANGRY/ANNOYED at people criticising your drinking?
Do you ever feel GUILTY about your drinking?
Have you ever had an EYE-OPENER in the morning to ease your hangover?

80
Q

ALCOHOLISM
How is Alcohol Dependence Syndrome classified?

A

Cluster of 3 of the below symptoms in a 12 month period:

Tolerance: increasing the amount of alcohol to achieve the same effect
Characteristic physiological withdrawal
Difficulty controlling onset, amount + termination of use
Neglect of social + other areas of life
Spending more time obtaining + using alcohol
Continued use, despite negative physical and psychological effects

81
Q

ALCOHOLISM
Wernicke’s Encephalopathy is characterised by a triad of symptoms. Name these symptoms.

A

Acute mental confusion
Ataxia
Ophthalmoplegia

82
Q

HEALTH NEEDS AX
What is felt need?

A

Felt need = individual perceptions of variation from normal health

83
Q

HEALTH NEEDS AX
What is expressed need?

A

Expressed need = individual seeks help to overcome variation in normal health (demand).

84
Q

HEALTH NEEDS AX
What is normative need?

A

Normative need = professional defines intervention appropriate for the expressed need.

85
Q

HEALTH NEEDS AX
What is comparative need?

A

Comparative need = comparison between severity, range of interventions + cost.

86
Q

HEALTH DETERMINANTS ETC.
what is vertical equity?

A

Unequal treatment for unequal need

(e.g. areas with poorer health may need higher expenditure on health services, common cold + pneumonia require different treatment).

87
Q

HEALTH DETERMINANTS ETC.
what is horizontal equity?

A

Equal treatment for equal need

(e.g. pts with same disease should be treated equally).

88
Q

HEALTH PSYCHOLOGY
What is health behaviour role?

A
  • Health behaviour = a behaviour aimed to prevent disease (e.g. healthy eating).
89
Q

HEALTH PSYCHOLOGY
What is the role of illness behaviour?

A
  • Illness behaviour = a behaviour aimed to seek remedy (e.g. going to Dr/pharmacist).
90
Q

HEALTH PSYCHOLOGY
What is sick role behaviour?

A
  • Sick role behaviour = any activity aimed at getting well (e.g. resting, taking prescribed meds).
91
Q

HEALTH NEEDS AX
Give an example of a service that is supplied + needed but not demanded?

A

Anti-hypertensives (as usually asymptomatic).

92
Q

HEALTH NEEDS AX
Give an example of a service that is supplied but not needed or demanded?

A

> 75 health check by GP as no benefit seen.

93
Q

DEFINITIONS
Define salutogenesis.

A

Favourable physiological changes secondary to experience which promote healing + health.

94
Q

RESOURCE ALLOCATION
What are the 3 ethical theories in context of resource allocation?

A
  • Egalitarianism.
  • Maximising/Utilitarianism.
  • Libertarian.
95
Q

RESOURCE ALLOCATION
What is the concept of egalitarianism?

A
  • Provide all care that is necessary + required to everyone.
96
Q

RESOURCE ALLOCATION
What are the pros/cons of egalitarianism?

A

Pros:
- equal for everyone (supports belief people deserve equal rights/opportunities)

Cons:
- economically restricted,
- tension between egalitarian aspirations + finite resources.

97
Q

RESOURCE ALLOCATION
What is the concept of maximising/utilitarianism?

A
  • Healthcare should be distributed to bring about the best possible outcome (criteria that maximises public utility).
98
Q

RESOURCE ALLOCATION
What are the pros/cons of maximising/utilitarianism?

A

Pros:
- resources allocated to those most likely to receive most benefit.

Cons:
- those with ‘less need’ receive nothing.

99
Q

RESOURCE ALLOCATION
What is the concept of libertarian?

A

Each individual is responsible for their own health, wellbeing + flourishment i.e. incentives for behaviour change, screening participation paid (all paid with savings made from better health outcomes).

100
Q

RESOURCE ALLOCATION
What are the pros/cons of libertarianism?

A

Pros:
- onus on pt therefore may be more engaged.

Cons:
- not all diseases are self-inflicted,
- should people be held accountable for their current/future health?

101
Q

MEDICAL NEGLIGENCE
Define negligence

A

A breach of duty of care which results in damage.
- There is failure to take proper care over something.

102
Q

MEDICAL NEGLIGENCE
What 2 tests can be used to decide if there was a breach in a duty of care?

A
  • Bolam test = would a group of responsible doctors do the same?
  • Bolitho test = would it be reasonable of them to do so?
103
Q

MEDICAL NEGLIGENCE
What are 6 broad factors which contribute to negligence?

A
  • System failure.
  • Human factors.
  • Judgement failure.
  • Neglect.
  • Poor performance.
  • Misconduct.
104
Q

ERROR
Define error?

A

A preventable event that can cause or lead to an unintended outcome.

105
Q

ERROR
What are some different types of human (individual) errors?

A
  • Omission (required action delayed/not taken).
  • Commission (wrong action taken).
  • Sequence (action taken in wrong order).
  • Fixation (regular act so don’t recognise if something goes wrong).
  • Negligence (actions/omissions do not meet standard of an ordinary, skilled person).
106
Q

ERROR
What are 4 broad classifications of errors?

A
  • Intention.
  • Action.
  • Outcome.
  • Context.
107
Q

ERROR
What are 3 types of intention error?

A
  • SKILL-BASED (action made is not what was intended i.e. performing well-known task>little attention>error if distracted).
  • RULE-BASED (incorrect application of a rule/incorrect plan or course of action taken i.e. in emergencies).
  • KNOWLEDGE-BASED (lack of knowledge in a certain situation.
108
Q

ERROR
What are some red flags for errors?

A
  • Anomalies.
  • Broken communication, missing information or confusion.
  • Departures from normal practice.
  • Stress.
109
Q

ERROR
What are the 10 types of basic error?

A
  • Sloth.
  • Fixation + loss of perspective.
  • Communication breakdown.
  • Poor team working.
  • Playing the odds.
  • Bravado + timidity.
  • Ignorance.
  • Mis-triage.
  • Lack of skill.
  • System error.
110
Q

ERROR
Define a never event.

A

A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented.

111
Q

ERROR
What organisations must the hospital trust report never events to?

A
  • National Reporting and Learning Systems (NRLS).
  • CQC.
  • Strategic Executive Information System (StEIS).
112
Q

ERROR
What are the 2 perspectives on error?

A
  • Person approach = focus on the individual at fault.
  • System approach = focus on the working conditions/organisations at fault.
113
Q

ERROR
What is the concept of the person approach to error?

A
  • Looks at + blames an individual/group of individuals.
  • States errors are the product of unpredictable mental processes (inattention, distraction, negligence).
  • Focusses on the unsafe acts of people on the frontline.
114
Q

ERROR
What are the cons with the person approach to error?

A
  • Anticipation of blame promotes ‘cover up’ + need for a detailed analysis to prevent recurrence (retraining, discipline).
115
Q

ERROR
What is the concept of the system approach to error?

A
  • Adverse events are the products of many causal factors.
  • The whole system has some kind of flaw at fault to blame.
  • Adapt system to prevent recurrence (recognise errors + implement defences).
  • Errors occur due to interaction between active failures + latent conditions.
116
Q

ERROR
How can errors + harm be reduced?

A
  • Simplification + standardisation of clinical processes.
  • Checklists + aide memories (SBAR).
  • Team training.
  • Risk management programmes to remedy latent factors.
  • Mechanisms to improve uptake of evidence-based Tx patterns.
117
Q

ERROR
Explain the concept of the Swiss Cheese model

A
  • An organisations defences against error are modelled as a series of barriers, represented as slices of cheese.
  • The holes in the slices represent weaknesses in individual parts of the system.
  • The holes are continually varying in size + position across the slices.
  • System failure occurs when a hole in each slice momentarily aligns.
118
Q

ERROR
What do the 3 buckets represent in the 3 bucket model?

A

Self, context + task.

119
Q

ERROR
What is the concept of the three bucket model?

A
  • Error evolves due to interaction between personal, environmental + physical factors as well as organisation – this tool can help stratify risk.
120
Q

ERROR
Three bucket model – what comes under self?

A
  • Level of knowledge (newly qualified, senior support available, unaware of current protocols).
  • Level of skill (competence + experience).
  • Level of expertise (confidence, automaticity, expectations/assumptions).
  • Current capacity to do task (fatigue, stressors, illness, life events).
121
Q

ERROR
Three bucket model – what comes under context?

A
  • Equipment (maintenance, availability, usability, power sources).
  • Physical environment (lighting, surfaces, noise, temperature).
  • Workspace (working environment, handovers, layout).
  • Team + support (leadership, trust, briefing + reflection).
  • Organisation + Mx (communication, safety culture + reporting, workload).
122
Q

ERROR
Three bucket model – what comes under task?

A
  • Errors (omission, commission, fixation, sequence).
  • Task complexity (calculations, double checking).
  • Novel task (unfamiliar events, rare events, new ways of working).
123
Q

ETHICS
Define ethics.

A

system of moral principles + a branch of philosophy that defines what is good for individuals + society.

124
Q

ETHICS
Define morality.

A

concerned with the distinction between good + evil or right + wrong.

125
Q

ETHICS
What is the concept of Utilitarianism?

A
  • An act is evaluated solely in terms of its consequences to maximise good + minimise harm.
126
Q

ETHICS
What are the cons of utilitarianism?

A

treats minorities unfairly to promote majority happiness,
how do you define what is good?

127
Q

ETHICS
What is the concept or virtue ethics?

A
  • Focuses on the person who is acting – do they express good character?
  • An act is only virtuous if the person is acting with the genuine intention of doing the right thing – are they integrating reason + emotion.
128
Q

ETHICS
What are the 5 focal virtues that are acquired?

A
  • DISCERNMENT (ability to judge well).
  • CONSCIENTIOUSNESS (being thorough, careful + vigilant).
  • COMPASSION (showing concern for others).
  • TRUSTWORTHINESS (ability to be relied on).
  • INTEGRITY (being honest + having good moral principles).
129
Q

ETHICS
What are the cons of concept or virtue ethics?

A
  • virtues are culture-specific + too broad for practical application,
  • no focus on consequences i.e. compassion may lead to not telling harmful truth = lying.
130
Q

ETHICS
What is the concept of deontology?

A
  • Features of the act determines worthiness.
  • Teaches that acts are right/wrong + people have a duty to act accordingly (treat others how you would like to be treated).
131
Q

ETHICS
What are the cons of deontology?

A

consequences not looked at, duties can conflict.

132
Q

ETHICS
What are categorical imperatives?

A
  • Version of deontology.
  • Categorical imperative is a rule that is true in all circumstances.
  • Act in a way you would be willing it to become universal law.
133
Q

GMC DUTIES AS A DR
What are the 4 domains encompassing duties of a doctor?

A

1) Knowledge, skills + performance.
2) Safety + quality.
3) Communication, partnership + teamwork.
4) Maintaining trust.

134
Q

DIVERSITY EDUCATION
Define culture.

A

a socially transmitted pattern of shared meanings by which people communicate, perpetuate + develop their knowledge + attitudes about life.

135
Q

DIVERSITY EDUCATION
Define stereotypes.

A

generalisations about the ‘typical’ characteristics of members of a group.

136
Q

DIVERSITY EDUCATION
What are some challenges + solutions concerning diversity in healthcare?

A
  • Language barriers (longer appts, interpreters).
  • Fasting + needs for medications (speak to religious leader ?exemption).
  • Health beliefs such as different expectations in Dr/Pt relationship (paternalistic), Jehovah Witnesses’ refusing blood (talk to pts + understand their beliefs, education).
  • Expectations of healthcare system private vs. NHS (education).
  • Taboos (i.e. sexual health in some cultures).
137
Q

DIVERSITY EDUCATION
Define prejudice.

A

attitudes towards another person based solely on their membership of a group.

138
Q

TEACHING SKILLS
What is Peyton’s 4 step procedure for skill training?

A
  • Trainer demonstrates without commentary./
  • Trainer demonstrates with commentary.
  • Learner talks through + trainer does.
  • Learner talks through + does.
139
Q

TEACHING SKILLS
What are some critiques of Peyton’s 4 step procedure?

A
  • Insufficient time for learner to practice.
  • Insufficient feedback.
  • Lack of clarity + thoroughness.
140
Q

TEACHING SKILLS
What is the tripartite model of types of learning?

A
  • Surface.
  • Strategic.
  • Deep approach.
141
Q

TEACHING SKILLS
What is meant by surface?

A
  • Fear of failure.
  • Desire to complete a course.
  • Learning by rote + focus on particular tasks.
142
Q

TEACHING SKILLS
What is meant by strategic?

A
  • Desire to be successful.
  • Leads to a patchy + variable understanding (well organised form of surface learning).
143
Q

TEACHING SKILLS
What is meant by deep approach?

A
  • Intrinsic, vocational interest, person understanding.
  • Making links across materials, search for deeper understanding of the material, look for general principles.
144
Q

TEACHING SKILLS
What are 4 different types of learner?

A
  • Theorist = complex situation, can question ideas, offered challenges.
  • Activist = new experiences, extrovert, likes deep end, leads.
  • Pragmatist = wants feedback, purpose, may like to copy.
  • Reflector = watches others, reviews work, analyses, collects data.
145
Q

TEACHING SKILLS
What is Kolb’s learning cycle?

A
  • Conclusions from experience (theorist).
  • Experience (activist).
  • What can I do differently next time? (pragmatist).
  • Review + reflect on experience (reflector).
146
Q

TEACHING SKILLS
What is the dual process theory?

A
  • Intuitive thinking with its irresistible combination of heuristics + biases, together with analytical thinking, using evidence-based medicine.
147
Q

LEADERSHIP
What are the 5 leadership styles?

A
  • Authoritarian.
  • Participative.
  • Delegative (Laissez-faire).
  • Transactional.
  • Transformational (inspirational).
148
Q

LEADERSHIP
What are the pros/cons of authoritarian leadership?

A

Pros:
- consistent results,
- time spent on crucial decision reduced.

Cons:
- v strict,
- lack of staff creativity/innovation,
- lack of group input.

149
Q

LEADERSHIP
What are the pros/cons of transactional leadership?

A

Pros:
- staff motivation + productivity increased,
- reward system.

Cons:
- innovation/creativity minimised,
- less leaders created,
- seen as coercive.

150
Q

LEADERSHIP
What are the pros/cons of transformational leadership?

A

Pros:
- high value on corporate vision,
- high morale for staff,
- not coercive.

Cons:
- leaders can deceive staff,
- may need consistent motivation/feedback.

151
Q

LEADERSHIP
What leadership model is best suited for healthcare and why?

A
  • Transformational.
  • It places the needs of pts, carers + families at the centre of all work + people can intervene when necessary.
  • I.e. speak up if risk to pt, continually improve system, talk to seniors if lack of skill, knowledge or resources.
152
Q

LEADERSHIP
What are the pros/cons of participative leadership?

A

Pros:
- encourages staff creativity,
- increases staff motivation.

Cons:
- decisions may be time-consuming,
- poor decisions may be made.

153
Q

LEADERSHIP
What are the pros/cons of delegative leadership?

A

Pros:
- environment of independence,
- experienced staff can offer experience.

Cons:
- downplays role of leader,
- leaders avoid leadership,
- staff may abuse.

D TO REVISE - PHASE 3A (9 decks)

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