VLE & SocPop Flashcards

Question

What does the UN Convention on Rights of Persons with Disabilities say about disability?

Answer 1

Establishes that disabled people are not ‘other’, have the same rights and as others Human rights legislation established a universal standard or benchmark which can be applied If a disabled person’s experiences fall short of this universal standard, it is understood as a human rights violation

Answer 2

Equality before the law without discrimination Right to life, liberty and security of the person Equal recognition before the law and legal capacity Freedom from torture Freedom from exploitation, violence and abuse Right to respect physical and mental integrity Freedom of movement and nationality Right to live in the community Freedom of expression and opinion Respect for privacy Respect for home and the family Right to education Right to health Right to work Right to adequate standard of living Right to participate in political and public life Right to participation in cultural life

Answer 3

Requires equal treatment in access to employment, services, regardless of protected characteristics of age, disability, gender reassignment, marriage, civil partnership, race, religion or belief, sex, and sexual orientation Definition of disability: A person is disabled if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities

Answer 4

Disabled people experience social, economic and health inequality: lower levels of participation in all aspects life

Answer 5

11 million disabled people in UK: 16% working age adults, 45% of people over state pension age, 6% children and young people More likely to experience poverty than other people Significantly less likely to be in employment More likely to experience discrimination at work 3 times as likely to not have any qualification Over 1/4 say they don't have choice and control over their daily lives 1/3 report difficulties accessing goods and services More likely to experience poor health outcomes even unrelated to their impairment eg people with learning disabilities

Answer 6

Environmental Social Attitudinal

Answer 7

Systematic reviews: meta-analyses, non meta-analytic reviews Experimental studies: Randomised controlled trials, Controlled trials Observational studies: Cohort studies, Case-controlled studies Descriptive Studies: Cross sectional designs

Answer 8

Identify effective, harmful and ineffective health care Collate empirical evidence that fits pre-specified eligibility criteria to answer a specific research question Done in as reliable a way as possible – systematically Explicit methods selected to minimize bias

Answer 9

Clearly stated objectives with pre-defined eligibility criteria Explicit, reproducible methodology Systematic search which identifies all studies meeting eligibility criteria Assessment of validity of findings of included studies, looking for bias Systematic presentation and synthesis of findings of included studies

Answer 10

Results of individual studies combined to produce overall statistic More precise estimates of the effects of health care than those derived from individual studies included in a review Subject to biases that arise from the study selection process, may produce mathematically precise but clinically misleading result

Answer 11

General term for all attempts to synthesize the results and conclusions of two or more publications on a given topic

Answer 12

When a review strives to comprehensively identify and track down all the literature on a given topic (systematic literature review)

Answer 13

Clinicians need to be evidence-based: making judicious use of the evidence, ensuring practice is up-to-date Busy clinicians need quick and effective ways of identifying what works best for their patient Refine unmanageable amounts of information Added power brought by synthesising the results of a number of smaller studies

Answer 14

Identify whether what we’re doing makes a difference Causes of health problems Know whether we can predict problems and intervene early Know whether we can prevent problems Best ways of diagnosing/identifying problems Extent of a particular problem How people feel about health interventions or reasons for behaving as they do How expensive what we are doing is, value for money

Answer 15

Review of prevention studies e.g. RCTs

Answer 16

Review of treatment studies e.g. RCTs

Answer 17

Diagnostic/screening studies comparing a new diagnostic method with a gold standard RCTs examining the effectiveness of a screening programme

Answer 18

Review of aetiological studies e.g. cohort or case-controlled studies

Answer 19

Review of prognostic studies e.g. cohort or case-controlled studies

Answer 20

Review of experiential studies e.g. qualitative

Answer 21

Review of prevalence studies e.g. cross-sectional studies

Answer 22

Review of cost-effectiveness studies e.g. RCTs

Answer 23

``` Prevention/Treatment/therapy Causation Diagnosis/Prognosis Cost/cost-effectiveness Prevalence ```

Answer 24

Population; Intervention; Comparator; Outome [PICO]

Answer 25

Narrative about participants, intervention, setting, outcomes, study types, whether intervention appears to do good or harm

Answer 26

Present results separately for each individual outcome from individual studies Combine the results in a meta-analysis

Answer 27

Effect measures for continuous data in meta analysis e.g. weight; blood pressure mean t1 – mean t2 weighted by individual variances for each study

Answer 28

Data from different standardised scales eg Edinburgh postnatal depression scale; General Health questionnaire Mean t1 – mean t2 / pooled SD

Answer 29

Effect measures for binary/dichotomous data (disease/no disease) RR= p exposed / p non-exposed

Answer 30

0. 2/0.3 = Small ES 0. 5 = Medium ES 0. 8 upwards = Large ES

Answer 31

Disguise/oversimplify distinctions between primary studies with regard to inclusion/exclusion criteria or the nature of an intervention Reviews of similar topics may reach different conclusions depending on the form of the review question Make it difficult for practitioners to apply results of studies to specific characteristics of the situation in which they find themselves Findings from systematic reviews not always consistent with findings of large-scale high quality trials

Answer 32

Selection bias: bias in the way included studies selected e.g publication bias Attrition bias: differences between comparison groups in loss of participants from the study Performance bias: differences in care provided to participants in comparison groups other than the intervention under investigation Detection bias: differences between comparison groups in outcome assessment

Answer 33

Way of assessing whether results of a review have been influenced by publication bias Symmetric interpreted as probably no publication bias Asymmetric interpretation is that publication bias is likely

Answer 34

Is the study valid?: clearly focused question? include right sort of study Are the results reliable?: all relevant studies identified? quality of included studies appraised? If results combined – was this done appropriately? How are results presented – what is the result? How precise are the results? Can I generalise from this study to my workplace?: Can they be applied to local population? Were all important outcomes considered? Should policy or practice change as a result?

Answer 35

Duty: As a citizen: a moral duty to assist someone in need Benefit (consequentialism): May save someone's life or prevent further harm Virtue ethics: Compassionate response to someone in need

Answer 36

Duty: Professional duty of care, General moral duty to assist is greater because of your professional standing Benefit (consequentialism): A doctor is more likely to be able to benefit a person because of their particular knowledge or skill Virtue ethics: Compassion is expected in a good doctor

Answer 37

In UK, no general legal obligation to assist in an emergency situation Doctor not under legal obligation to assist unless there is an established professional duty of care: E.g. in a hospital setting General practitioners may have contractual obligation to provide treatment in emergency during core hours within their practice area If a doctor identifies themself as such and offers assistance in that capacity a legal duty of care is established Unlikely that a legal claim in negligence would be successful unless the standard of care fell below what would be expected of a doctor in that situation Important not to go beyond your clinical competence

Answer 38

You must offer help if emergencies arise in clinical settings or in the community, taking account of: your own safety, your competence, and the availability of other options for care

Answer 39

NHS Litigation Authority provides indemnity to employees in respect of clinical negligence claims Most doctors employed by NHS covered for duties listed in their contract by Hospital & Community Health Services indemnity scheme

Answer 40

Disciplinary issues (by employer) Referrals to the General Medical Council GP contractors, locum GPs and salaried GPs Does not apply to: stopping at accidents/good Samaritan acts not listed in contract, clinical trials not covered under legislation, work for any other agency on a contractual basis, work for voluntary/charitable bodies, work overseas

Answer 41

Medical Protection Society/Medical Defence Unions provide indemnity for Good Samaritan Acts in all jurisdictions

Answer 42

``` Clinical competence Clinical negligence Communication Consent Case notes ```

Answer 43

Treating acquaintances, friends and family | Wherever possible you must avoid prescribing foryourself or anyone with whom you have a close personal relationship

Answer 44

Relationship of trust between doctor and patient Greater understanding of the person and the context by doctor Leads to a better standard of care Reduced burden on NHS

Answer 45

Emotional involvement may lead to lack of objectivity Assessment at home not as good as clinical setting so standard of care may be lower Impaired relationship with own GP Confidentiality Doctor may not wish to explore sensitive topics Patient may feel unable to refuse treatment/seek alternatives

Answer 46

Make sure conduct justifies patients’ trust & public’s trust in the profession Social media blurred boundaries between public and private life, online information can be easily accessed by others Be aware of limitations of privacy online, regularly review privacy settings for profiles. Patients, your employer & potential employers may be able to access personal information Must not use professional position to pursue sexual or improper emotional relationship with a patient or someone close to them Personal relationships with former patients may also be inappropriate depending on: length of time since professional relationship ended, nature of previous professional relationship, whether patient was vulnerable at the time of professional relationship, whether they are still vulnerable, whether you will be caring for other members of the patient’s family

Answer 47

Medical students have legal restrictions on clinical work they can do, should be aware of often acting in position of a qualified doctor and their activities will affect patients Patients may see students as knowledgeable, consider them to have the same responsibilities and duties as a doctor Basic medical training gives opportunity to learn professional behaviour in supervised environment, safe for patients An opportunity for medical schools to identify types of behaviour that are not safe, to take appropriate action to help students improve their behaviour; if this is not possible, make sure they do not graduate as doctors Students must be aware that behaviour outside clinical environment, including personal lives, may impact fitness to practise. Behaviour at all times must justify the trust the public places in the medical profession

Answer 48

Professional status imposes ethical, professional and legal duties Basis of patient doctor relationship is one of trust and trustworthiness Legal and professional duties based on what we as a society expect of a doctor A doctor may have to weigh personal and professional obligations: e.g. duty to patients and duty to family

Answer 49

``` Income Status: Self esteem Purpose Influence Security ```

Answer 50

State: benefits, taxes, extra healthcare Individuals: loss of income, emotion and physical costs Employers: cost of staff turnover, time spent managing absence, OH

Answer 51

Mental ill health

Answer 52

Students At home Long-term sick Retired

Answer 53

Culture, beliefs and attitudes: Misconceptions about health and work – need to be 100% fit, Poor retention in work of those with disabilities or chronic disease Inadequate systems: Inflexible system of sickness certification – sick note, No pathways of rapid intervention stay in work or return to it Lack of Primary Care involvement: Rehabilitation to work not a performance measure for local health bodies, Configuration of OH services: lack of availability, not available in primary care

Answer 54

``` Fit for work program Likely to be off for 4 weeks/Off for 4 weeks Consent Referral to Fit for Work Service Telephone consultation Return to Work Plan ```

Answer 55

Poorer physical health: More likely to die sooner Poorer mental health More medical care Poorer social integration Loss of self-confidence Less monetary resources Effect on next generation: (e.g. Child deaths from injury correlate with low employment status and worklessness of parents)

Answer 56

Change from industrial society to a service and information society

Answer 57

Manufacturing, Physical, Fixed products, Large firms, Strong Unions, Job for Life, Long Contracts, Full Time, Male Workforce, Women at home, Retire at 65yrs Changed to: Service Industries, Sedentary, Variety of products, Small and Medium Enterprises, Reduced Membership, Portfolio Careers, Mobile Workforce, Part Time, Flexitime, Diverse Workforce, Women at Work, Work beyond 65yrs

Answer 58

``` Mental Health: depression, anxiety Musculoskeletal Skin Respiratory Infection ```

Answer 59

Effects of Work on Health, Health on Work Discipline concerned with the effects of work on health and the influence of pre-existent health problems on the capacity to work

Answer 60

Promotion and maintenance of highest degree of physical, mental and social well-being of workers in all occupations Prevention amongst workers of departures from health caused by working conditions Placing and maintenance of worker in an occupational environment adapted to physiological and psychological capabilities Adaptation of work to man and of each man to his job

Answer 61

Something that might cause harm

Answer 62

The likelihood of harm actually occurring

Answer 63

Identify the hazard Assess the risks (to health) Manage/control the risks

Answer 64

``` Physical Chemical Mechanical (ergonomic) Biological Psycho-social Organisational ```

Answer 65

``` Patients Investigations Therapeutic agents Environment Biological: infectious agents Chemical: Aldehydes, Anaesthetic agents, Antineoplastic drugs, Latex Physical: Ionising radiation, Manual Handling Psycho-social ```

Answer 66

Hep B - 1 in 3 Hep C - 1 in 30 HIV - 1 in 300

Answer 67

``` Working Hours/Shift Systems Organisational Hierarchy Bullying Under-stimulation/Over-stimulation Commuting Stress ```

Answer 68

Demands: Workload Vs Capacity, Domestic/ family Control: Pace and organisation of work Support: Colleagues, managers, human resources and occupational health, Outside – specialist agencies, health professionals, family and friends

Answer 69

1 in 6 adults will currently have a mental health condition | Further 1 in 6 will have poor mental health: Poor sleep, Worry, Fatigue, Irritability

Answer 70

``` Fear of re injury High physical demands of job Low expectation of return to work Low job satisfaction Low support Lack of adjustments Poor communication ```

Answer 71

``` Sphincter disturbance Gait disturbance Saddle anaesthesia Age under 20 or over 50 Non mechanical pain Thoracic pain History of cancer, HIV, steroids Unwell, weight loss Widespread neuro abnormality Structural deformity ```

Answer 72

``` Shoulder pain Epicondylitis Tenosynovitis Non-specific diffuse forearm pain Carpal Tunnel Syndrome: prolonged and extreme wrist flexion, forceful and repetitive wrist movement, direct pressure on the carpal tunnel, use of hand-held vibrating tools ```

Answer 73

Improved ergonomics of tool design, equipment and work layout to improve posture, reduce forces and repetition Job rotation to reduce time at a repetitive task New employee to work at a slower rate initially Rest breaks to allow recovery time Redeployment if the above measures aren’t effective Rehabilitation of affected worker: Reduce hours, Reduce work-rate

Answer 74

Bakers: Flour and enzymes Isocyanates: Paint sprayers, Polyurethane foam, Glues and laminates Animal handlers Wood workers

Answer 75

Coincidental / Inter-current Made worse by Work Caused by Work History, Examination, Investigations

Answer 76

Mesothelioma

Answer 77

GP is rarely involved with determining fitness to start work | Normally Employer’s responsibility (with advice from their Occupational Health Adviser)

Answer 78

Return to work should be one of key clinical outcomes by which success of treatment is measured Needs to be an integral part of the case management plan After only six weeks sickness absence, almost one in five people will eventually leave paid employment

Answer 79

Sickness absence self-certification Up to 7 days | Beyond 7 days: Medical Certificate Now called fit note

Answer 80

Provide certification for statutory sick pay Play a key role in advising patients about return to work Help patients develop a return-to-work plan Facilitate return to work through communication with patients and employers

Answer 81

Nature of the medical condition Appropriate clinical guidelines for management of the condition Work factors that might aggravate health problems Patient’s expectation and needs in relation to work

Answer 82

What can they not do? Amended duties: activities to be avoided Altered hours: changes to the times or duration of work A phased return to work: a gradual increase in work duties or hours Workplace adaptations: changing aspects of the workplace

Answer 83

Without medication/prosthesis or other aid | If without them he would be substantially impaired, he is disabled

Answer 84

Make ‘reasonable adjustments’ to avoid being put at a disadvantage compared to non-disabled people in the workplace: Hours, Equipment

Answer 85

Not part of the NHS No legal obligation for employers to provide an Occupational Health Service Management of Health and Safety at Work Regs 1999: appoint competent persons to fulfill their statutory responsibilities

Answer 86

``` Ionising radiation Lead Asbestos Compressed Air Diving ```

Answer 87

Providing independent and impartial advice to both employer and employee Investigating and diagnosing those who are sick or injured due to their work Assisting return of sick and injured to work at the earliest opportunity Matching people with jobs appropriate to their health, fitness and susceptibility status

Answer 88

Shaping and reviewing regulations Producing research and statistics Enforcing the law

Answer 89

``` Special aids and equipment Adaptations to equipment Travel to work Travel in work Communication support at interviews Wide variety of support workers Mental Health Support Service ```

Answer 90

Bodily inviolability: Links to legal concept of battery Freedom from interference: Free choice, implications for restraint Self determination: Implies life goals, higher and lower order desires