YEAR 2 EXTRAS FROM BLOCK LEARNING OUTCOMES Flashcards
What does an evidence based decision involve?
evidence from research
clinical experience
available resources
patient preferences
why are evidence based decisions important?
as it gives us a way of dealing with uncertainty, medical knowledge is incomplete, the quanity of medical facts is ever expanding, medical knoqledge is constantly shifting, it ensures patients receive the most appropriate treatment, it improves efficiency of health care services, it reduces variations in practices etc.
outline how to carry out an evidence based decision?
- Creating an answerable PICO question
- Identifying the best evidence to answer that question
- Critically appraising the evidence for validty, impact and applicability
- Intergrating the critical appraisal with clinical expertise and patient’s unique circumstance
- Evaluating effectiveness and efficiency. Seek ways to improve
what are the 3 theories of decision making?
normative, descriptive and prescriptive
what is normative decision making?
what people should do
what is descriptive decision making?
what people do or have done
what is prescriptive decision making?
what people should and can do
what is the hypothetic-deductive model of decision making?
cue acquisition -> hypothesis formation -> cue interpretation -> Hypothesis evaluation.
in which situations would you use the hypothetic deductive model of decision making?
This model is more commonly used in less experienced individuals or for diagnostic problems that are less familiar.
what is the prospect theory of decision making?
Prospect theory assumes that losses and gains are valued differently, and thus individuals make decisions based on perceived gains instead of perceived losses.
aka loss aversion (you would rather have 25 pounds than have 50 and lose 25 even though they ahev the same outcome)
what are the 2 stages of prospect theory?
framing +editing
and evaluation
what is the framing and editing stage of prospect theory?
how you characterise your choices
what s the evaluation stage of prospect theory?
the framed prospects evaluated and the prospect with the highest value is selected.
how do evidence based decisions improve clinical care?
ensure patients recieve the most appropriate treatment
increases the efficiency of health care systems
reduces variations in practice amongst health care professionals
wheree can evidence based information be found
NICE Cochrane library journals databases clinical guidelines Gp update
what are some measures of health outcomes?
mortality safety of care readmissions patient experiences effectiveness of care timeliness of care QUALY morbidity
what are the benefits of using NICE guidelines?
they are evidence based
they take into account cost effectiveness as well as clinical effectiveness
theres a formal process
they aim to ensure all individuals are treated equally
what do NICE do?
produce guidelines and provide advice to clinicians about best practice. They do technology appraisals, make clinical guidelines, produce interventional procedure programmes etc
what is the Cochrane
a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health professionals, patients and policy makers.
what is a case control study?
a type of observational study in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute.
what is a cross-sectional study?
a type of observational study, or descriptive research, that involves analyzing information about a population at a specific point in time
what is a cohort study?
a type of longitudinal study—an approach that follows research participants over a period of time (often many years). Specifically, cohort studies recruit and follow participants who share a common characteristic, such as a particular occupation or demographic similarity.
what are some approaches to smoking cessation?
nicotine gum, patches, nasal spray, inhaler non-nicotine meds e.g. buproprion counseling hypnosis acupuncture behavioural programmes
what is motivational interviewing?
a type of counselling that is collaborative and seeks to call forth the persons own motivation and commitment to change
what is the transtheoretical model of behaviour change?
precontemplation, contemplation, preparation, action, maintenance, and termination.
what is health promotion?
the process of enabling people to increase control over, and improve, their health.
what does Beatties typology do?
it summarises the different approaches to health promotion
e.g. health persuasion, legislative action, personal counselling, community development
what are the 5 aspects of health promotion identified by WHO?
healthy public policy supportive environments community action personal skills reorienting health services from treatment to prevention
what is primary prevention?
prevent onset of disease by health promotion and screening for risk factors
what is secondary prevention?
detection and cure of a disease at an early stage
what is tertiary prevention?
preventing a disease from getting worse and minimising effects by symptoms management, palliative care etc
what are some dilemmas around health promotion?
the opportunity cost - resources are already scarce and people are dying from disease so why should we take money away from treatment
its difficult to determine whats effective and ineffective
who should be responsible for health i.e. the individual, the community, the government?
what is the prevention paradox?
a preventative measure which brings much benefit to the population offers little benefit to each participating individual
if autonomy is sacrosanct, should the right to treatment be?
should smokers be treated
i.e. smoking led to the disease, smoking limits effectiveness of surgery, poor outcome will result in more surgery, expensive when resources are limited
but…
doctors have an ethical obligation to treat on the basis of need, its a slippery slope with self harm/drunk drivers etc, lower SES smoke more than HES
outline the epidemiological transition in the causes of death?
in the mid 19th contrary, communicable disease accounted for 75% of all deaths
in the 20th century this figure fell to 2%
what are determinants of health outcome?
biological social and economic - education/housing/poverty environment - pollution, water lifestyle - diet/smoking health services - access/quality
outline some methods of health promotion for smoking?
health literacy
stigma
taxation increases
smoking availability decreases e.g. cant smoke at restuarants
outline some methods of health promotion for obesity?
health literacy, school dinners, sugar tax
what are the issues with health promotion strategies for tackling obesity?
unhealthy food is tasty
philosophical issues on whether we should be pursuing a happy or healthy life
backlash about views of body image
cultural norms on body image
outline the health belief model?
its a psychological health behaviour change model developed to explain and predict health related behaviour
percieved seriousness and percieved susceptibility affect a percieved threat
this along with percieved benefits + barriers, self-efficacy and stimulus/cues to action all affect the likelihood in engaging in health promoting behaviour
what is the high-risk prevention approach?
the objective is to target the intervention at those who are at highest risk for the disease and move them to lower risk levels
what are the pros and cons for the high-risk prevention approach?
pros - appropriate for individual so motivates patient, cost effective as not medicating those who dont need it, benefit:risk ratio good
cons - hard to find these high risk groups, limited potential as only targets a small proportion, temporary, labelling issues
what is the population prevention approach?
the objective is to reduce the burden of disease across the entire population. This should shift the curve of risk to the left
what are the pros and cons of the population prevention approach?
pros - large potential as targets everyone
cons - population paradox, poor motivation, benefit: risk ratio low, treating those who dont need it
what are some causes of antimicrobial resistance?
irrational use of antibiotics in humans/animals
insufficieint patient education e.g. not finishing the course, lack of guidelines for treatment and control of infections, lack of scientific information on the rational use of antibiotics, lack of offician government policy on the rational use of antibiotics.
how can we prevent antimicrobial resistance?
: rational use of antimicrobials, regulation on OTC availability of antibiotics, improving hand hygeiene, improving infection prevention and control
what is antibiotic stewardship?
the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.
- educating staff
- reassessing treatment when culture results are available
- using the shortest duration of antibiotics
- prescribing antibiotics with adequate dosages
- only prescribing antibiotics when they are truly needed
outline the chain of infection?
infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
what are Zolas triggers to action?
interference with work interference with social relations interpersonal crisis putting s time limit on symptoms sanctioning
what are some barriers to seeking healthcare?
availability, geographic distance, time, effort, childcare, loss of earnings, transport, previous bad experience, wait times, fear, no outside lay person advice
outline what a medical practitioner has to do if they come across an infectious disease on the notifiable diseases list?
every medical practitioner has a legal duty to notify a proper officer if they suspect a patient has an infectious diseases on the notifiable diseases list
what makes an infectious disease notifiable?
any infection which presents/could present/could have presented significant harm to human health and any contamination which could/has presented significant harm to human health.
what are some examples of infectious diarrhoeal diseases on the notifiable diseases list?
cholera typhoid shigella salmonella campylobacter hep E
what is an outbreak?
an increase in incidence of a disease above expected levels in a particular location or population in a given time period. Another common definition is the occurrence of a disease in two or more epidemiologically linked individuals, such as those with a confirmed common source of infection.
what is…
- universal surveillance?
- sentinel surveillance?
- syndromic surveillance?
- covering an entire population
- collecting data about specific diseases
- gathers info about a particular set of symptoms rather than infectious agents or diseases directly
what is surveillance?
the systemic collection, collation and analysis of data and dissemination of the results so that appropriate control measures can be taken
why is surveillance important?
they serve as an early warning system for public health emergencies
document the impact of an intervention
monitor the epidemiology of health problems
what is the national early warning score NEWS?
a system for scoring the physiological measurements that are routinely recorded at the patient’s bedside. Its purpose is to identify acutely ill patients, including those with sepsis, in hospitals in England.
what are some major global determinants of communicable diseases?
- Poor water sanitation
- Crowding/mass population
- Poor quality shelter
- Hygiene
- Nutrition
- Migration and international travel
what are some major global determinants of non-communicable diseases?
- Smoking
- Alcohol consumption
- Fruit and veg consumption
- Physical activity
- Salt consumption
- Overweight/obesity
- Hypertension
- Family history
- Environment based exposure
- Air pollution]
- UV exposure
- Age, gender, race, ethnicity, social status
- Dental healthcare
- stress
outline how AIDS emerged?
AIDS emerged in the 1980s when, in the US, numbers of cases of opportunistic infections (particularly pneumocystis pneumonia) and unusual tumours (e.g. karposis sarcoma) were reported in previously healthy men who had sex with men.
whats the biggest group of people living with HIV?
those who caught it through heterosexual transmission
since the 2000, there has been a 34% decrease in the prevalence of AIDS… which groups have had the greatest improvements?
sub Saharan Africa
15-24 year olds
cases caused by vertical transmission
what are the main challenges for reducing the prevalence of HIV?
HIV prevention and improving access to treatment
fear/stigma preventing people from seeking help
funding drugs in LIC
achieving long term compliance with therapy
what are some international organisations for AIDS?
UNAIDS - produced Global AIDs strategy 2021-2026 ‘end inequality, end AIDS’
The global fund to fight AIDS, tuberculosis and malaria
WHO
International AIDs society
what are some national organisations for AIDS?
treatment screening for HIV in pregannt HIV action plan AIDS: don't die of ignorance campaign needle exchange schemes for injecting drug users
whats the HIV action plan?
commitment to 0 new transmissions of HIV by 2030
how can you prevent transmission of AIDS?
test for HIV use condoms choose less risky sexual bejaviours limit the number of sexual partners use PrEP dont inject drugs
whats the purpose of the GMC?
to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine
- guidelines
- fitness to practice
- medical students registering to practice
what are some professional values of a doctor?
- competence
- keep skills and knowledge up to date
- establish and maintain good relationships with patients and colleagues
- be honest and trustworthy
- act with integrity
- act within the law
- respect the patients right to privacy and dignity
- treat each patient as an individual
what is medical professionalism?
signifies a set of values, behaviours and relationships that
underpin the trust that the public has in doctors
what is patient centred care?
Health care that is closely congruent with and responsive to patients’ wants, needs and preferences.
why is patient centred care important?
- enhances prevention
- health promortion
- better relationship between patient and doctor
- more accurate diagnoses
- increased adherence with treatment regimes
- increased patient satisfaction
what are the obligations of the patient in the sick role?
- is exmpted from normal social role of responsibilities
- cannot get well by an act of decision/will - not responsible
- is obligated to and will try to get we’ll
- obligated to seek help
outline Mead and Bower’s model of patient cnetredness?
- recognise the patient as a person not a disease
- biopsychosocial perspective
- share power and responsibility
- therapeutic alliance
- doctor as a person
what is medical paternalism?
when a physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient
what did Darwin notice in survival of the fittest?
- individual members of a species vary in their characteristics
- this variation is inherited
- not all species survive to reproduce
what is eugenics?
the study or belief in the possibility of improving the qualities of the human species e.g. encouraging reproduction by persons presumed to have inheritable desirable characteristics
what is the Index of Multiple Deprivation?
what are its domains?
The Index of Multiple Deprivation is a relative measure of deprivation
The domains are: Income; Employment; Education; Skills and Training; Health and Disability; Crime; Barriers to Housing Services; Living Environment
what are some social determinants of health?
income educaton oxxupation social class gender ethnicity sexuality disability food insecurity access to healthcare childhood
what did the black report 1980 show?
the extent to which illness and death where unevenly distributed across the British population
it concluded that these health inequalities where caused by social inequalities.
the report recommended increasing child benefits, improving housing and agreeing on a minimum wage
what is evidence for societal inequalities generating health inequalities?
the best recorded improvements in health where in WW2 when Britian was most equal
as inequality increased, health improvements slowed down
the most unequal societies have the worst health
what are the key findings of the marmot review?
The more deprived the area, the shorter the life expectancy.
Child poverty has increased
There is a housing crisis and a rise in homelessness; people have insufficient money to lead a healthy life; and there are more ignored communities with poor conditions and little reason for hope.
an increase in the north/south health gap, where the largest decreases were seen in the most deprived 10% of neighbourhoods in the North East, and the largest increases in the least deprived 10% of neighbourhoods in London.
what is the materialist model of health?
Poverty exposes people to health hazards. Disadvantaged people are more likely to live in areas where they are exposed to harm such as air-pollution and damp housing.
what is the cultural behavioural model of health?
that culture determines or frames behavioural choices, including decisions affecting health, i.e., engaging in higher risk lifestyles that may include drinking, smoking, or an unhealthy diet
what is the social selection model of health?
health determines socioeconomic position, rather than the reverse. Thus, healthier persons will move towards better socioeconomic positions, compared to less healthier, leading to inequalities
what are some risks of blood transfusions?
giving wrong blood type
infections
what are some arguments against the market for blood?
it represses altruism - people should be giving out of their own kindness
erodes the sense of community
sanctions profits in hospitals
redistributes blood from poor to rich
commercialisation may increase infection risk
what are some arguments for the market for blood?
supply can be increased by removing obstacles to donors
financial rewards
saves more lives
how could we increase the supply of organs?
opt out donor scheme transplant coordinators in hospitals use of nudges financial incentives interventions e.g. DVLA ask when you get your driving license
what are over the counter medicines?
all general sale medicines and pharmacy medicines
they can access them with limited or no healthcare involvement i.e. can be purchased without a prescription
what re the 3 categories of licensed medicinal products?
prescription only
pharmacy
general sales list
what is MHRA?
medicines and healthcare products regulatory agency
what do MHRA do?
ensure medicines, devices and blood components meet applicable standards of safety/quality/efficacy
ensure the supply chain is safe and secure
help educate public and healthcare professionals about risks and benefits of meds leading to safer and more effective use
whats the criteria for a learning disability?
lower intellectual ability (usually defined as an IQ of less than 70),
significant impairment of social or adaptive functioning
onset in childhood.
whats the difference between a learning difficulty and a learning disability?
a learning difficulty is a condition which creates an obstacle to learning but does not affect the overall IQ of the individual like a learning disability does
how do we measure IQ?
mental age/chronological age x 100
what are 3 ways of measuring intelligence?
stanford binet scale
IQ
Wechser adult intelligence scale
what are some consequences of learning disabilities?
significant physical health needs
life expectancy reduces
weather by indifference
significant increase in prevalence of mental disorders
what are the definitions for impairment, disability and handicap in the medical model of disability?
impairment - abnormality of structure or function
disability - functional consequence of an impairment
handicap - social consequence of the impairment
what is WHOs definitions for impairment, disability and handicap?
impairment - any loss or abnormality of psychological, physiological or anatomical structure/function
disability - any restriction or lack of ability to perform an activity in the manner considered normal for a human being
handicap - a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal for that individual
outline the disability discrimination act?
gives new rights to people who have a disability
it places a duty on employers and service providers to make reasonable adjustments for people with disabilities to help them overcome barriers with employment and using services
what is disability defined by the equality act 2010?
you’re disabled if you have a physical or mental impairment that has substantial and long term negative effects on your ability to do normal daily activities
what is discrimination by perception in terms of disability?
being discriminated against because someone thinks you have a disability
what is discrimination by association in terms of disability?
you are discriminated against for being connected to someone with a disability
what is the Barthel test?
measure performance in activities of daily living (ADL)
what is SF-36
a survey that measures health status and QOL
what is a health assessment questionnaire?
It was one of the first self-report functional status (disability) measures and has become the dominant instrument in many disease areas, including arthritis.
who is more likely to have a neurotic disorder?
females, middle-aged, separated, divorced, living alone
who is more likely to have a psychotic disorder?
males
those who are married
how much earlier do those with severe mental health disorders die, on average, compared to the gen population?
20 years
what social factors seem to contribute to severe mental health disorders?
unhealthy diet lack of physical actvity smoking alcohol abuse obesity diabetes lack of support socially
what are some reasons why as humans we stigmatise?
its a human trait to demarcate ourselves from those seen as different
it reinforces our own identity
what are the stages of discrimination?
labelling stereotyping othering stigmatisation discrimination
what is stereotyping?
when labels are attributed to characteristics
a generalized belief about a particular category of people.
what is othering?
using language and labels to distinguish between them and us
what is stigmatisation?
the disapproval of percievable social characteristics that serve to distinguish them from other members of society
what is discrimination?
when stigmatisation is reinforced through legislation/language/behaviour - i.e. treating someone negatively because of stigma
what is ‘passing’?
when oneself doesnt aknowledge symptoms
what is felt stigma?
The feeling of shame from discrimination that stops people seeking help
what is enacted stigma?
the experience of unfair treatment by others.
what is covering?
the concept of consciously changing the impression one is making to hide an outsider identity
what are the ADLs?
eating bathing dressing ambulating toileting transferring
what is informal care?
unpaid caring by someone who is not medically trained e.g. a neighbour or mum
outline the effects of caring for someone on health?
carers report high levels of physical and mental health problems
high emotional impact of caring
carers not having enough time to look after their own health
may impact their socio-economic status as may have to give up their job
chronic stress
what is the ‘Carer’s allowance’?
a benefit for people who regularly spend >35 hours a week caring for someone with a severe disability and they receive a qualifying disability benefit
its 69.70 a week
whats the eligibility for carers allowance?
must be caring for >35 hours a week be 16 or over earnings must be <110 pounds a week not receiving any overlapping benefits studying <21 hours a week
what is self care?
individuals taking responsibility for their own health and wellbeing
what category of medicines do new medicines tend to be?
prescription only medicines
whats MHRA’s criteria for a POM drug to become a pharmacy drug?
if its not likely to present danger to human health when used correctly without doctor supervision
not frequently used incorrectly
doesnt have substances or cause side efefcts that require further investigation
not by parneterl administration
why was the Wechsler adult intelligence scale created?
because it was felt that the Stanford Binet scale was inappropriate for adults as it relied too much on language ability
what are some causes of learning disabilities?
trauma, toxins, tumours, genetics e.g. tuberous sclerosis or downs syndrome, metabolic e.g. PKU, infections e.g. TORCH
what is active coping?
cognitive and behavioural attempts to deal directly with problems and their effects
what is avoidant coping?
efforts to avoid or disengage from a stressful situation or ones emotion
what is problem focused coping?
attempts to alter the stressful situation itself
what is emotion focused coping?
involves efforts to alter negative affect surrounding the stressful situation
what is support seeking coping?
involvement of other people as resources to seeking solutions to a stressful situation
what is behavioural avoidacen coping?
staying away from the stressful situation
what is cognitive avoidance coping?
wishing the stressful situation did not happen or repressing thoughts about it
what is discreditable stigma?
keeping stigmatised conditions hidden except to close people
what is discredited stigma?
A visible stigma that is hard to conceal e.g. race
what were America’s ugly laws?
illegal for people considered unsightly or disgusting to expose themselves to public view. The last arrest for this was in 1974.
what types of things do informal carers do?
provide practical help e.g. shopping keeps an eye on the recipient provides company provides person care e.g. bathing gives medicine provides physical help
what are some of carer’s unmet needs
information and advice practical and emotional support training in care activities respite care and short term breast transport language issues
what are the aims of the UK immunisation programme?
to protect the population from vaccine preventable diseases and reduce the associated morbidity and mortality.
eradicate disease
herd immunity
what is the expanded programme of immunisation?
Who launched this in 1974 with the aim to make immunisation against diptheria, tetanus, pertussis, polio, measles and BCG available to all children in the world by 1990. Hep B, yellow fever, HiB are now also on this list
what was the vaccination act of 1853?
– smallpox vaccine became free and compulsory
what was the vaccination act of 1898?
– included a conscientious clause to allow exemption from vaccination
what is the global vaccine action plan?
extends vaccination to all people worldwide by 2020, and so save 20 million lives
when did girls start getting vaccinated against HPV cervical cancer?
2008
when did the NHS start vaccinating babies against Men B?
2015
what is the global polio eradication initiative?
an initiative created in 1988, just after the World Health Assembly resolved to eradicate the disease poliomyelitis.
what is the global alliance for vaccines and immunisations?
upports countries to strengthen primary health care through innovative partnerships that address challenges of access to immunisation, including gender-related barriers.
to enable even the poorest countries to provide vaccines to all children
what is an initiate the NHS uses to increase vaccination uptake?
The NHS uses the call-recall system where every child is registered with a local healthcare practitioner and an automates system ensures that all vaccine doses are received
give examples of countries where children must prove their vaccination status before starting school?
US and France
outline the NHS vaccination schedule uk?
8 weeks – 6 in 1 (diptheria, tetanus, pertussis, polio, Hib and Hep B), men B and rotavirus
12 weeks – 6 in 1, rotavirus, pneumococcal
16 weeks – 6 in 1, men B
1 year – HiB, menC, pneumococcal, MMR and Men B
3 years 4 months – 4 in 1 (diptheria, tetanus, pertussis and polio), MMR
12-13 years – HPV
14 years – 3 in 1 (tetanus, diptheria, polio)
65 – pneumococcal disease once and annual influenza
70 years – shingles
From 28 weeks of pregnancy – pertussis and flue vaccines in season
argue ethically the use of mandatory vaccinations?
maximises vaccine uptake, limits autonomy, allows protection from herd immunity, could cause indirect discrimination, less harm,
what are some pros of vaccination?
- They save lives
- Ingredients are safe at the small amounts used
- Adverse reactions to vaccines are extremely rare
- Vaccines protect the herd
- Vaccines protect future generations
- They have eradicated some diseases
what are some cons of vaccination?
- Rarely, but can, cause some serious/potentially fatal side effects
- Contain harmful ingredients
- Mandatory vaccines infringe upon constitutionally protected religious freedom
- Contain ingredients some people consider immoral
- Pharmaceutical companies main objective is to make profit so should they be trusted
- Some diseases that vaccines protect us against are relatively harmless.
what is R0?
the basic reproduction number and is the average number of individuals directly infected by an infectious case during this infectious period in a totally susceptible population.
what is R?
effective reproduction rate and is the average number of secondary infections produced by an infective agent
what is R=0?
the epidemic threshold
how do you calculate R?
R= R0 x susceptible population
how do you calculate herd immunity threshold?
1- susceptible population
what proportion of people will develop cancer in their lifetime?
1/3
which cancer types account for more than half of all cancers?
lung, large bowel, breast and prostate
how many cancer deaths is smoking responsible for?
25%
why is incidence of cancer increasing?
because we have an ageing population
what are the main risk factors for cancer?
poor diet, smoking, hypertension, obesity, alcohol and drug use
what is a risk factor?
something that increases an individuals chances of developing that disease
what are the key aspects of the NHS long term plan ambitions for cancer?
are that by 2028 55000 more people will survive cancer for 5 years + each year and 75% of people with cancer will be diagnosed by stage 1 or 2.
what are the 4 pillars to WHOs approach to cancer?
early detection, diagnosis, treatment, and palliative care.
what are 2 ways we can detect cancer earlier?
early diagnosis (detecting symptomatic patients asap) and screening (identifying cancer before symptoms appear).
what was the calman hine report?
This examined cancer services in the UK and proposed a restructuring of cancer services to achieve a more equitable level of access to high levels of expertise throughout the country. It included education to recognise early cancer symptoms, allowing all patients access to uniformly high wuality care, patient centred approaches, recognisig the psychosocial needs of cancer sufferers and carers.
what is the NHS cancer plan?
The first time the government created a programme to link prevention, diagnosis, treatment care and research. It aims to save more lives, ensuring people get the right professional support and best treatments, to tackle inequalities in health, to build for the future through investment in thr cancer workforce so we never fall behind it again
what is the cancer reforming strategy?
The areas for action are prevention, diagnosing earlier, ensuring better treatment, living with and beyond cancer, reducing cancer inequalities, delivering care in the most appropriate setting
what is the national awareness and early diagnosis initiative?
Coordinates a priogramme of activity to support local interventions to raise public awareness of signs and symptoms of early cancer and encourage people to seek help sooner
what are the key aims of the independent cancer task force 2015?
Radical upgrade in prevention, drving a national ambition for earlier diagnosis, being patient centred, living with and beyond cancer etc
what is body image?
is the mental picture you have of your own body and how you see yourself when you look in a mirror.
what is negligence?
a substandard care that has been provided by a medical professional to a patient, which has directly caused injury or harm.
what do you need to prove medical negligence?
- The negligent person had a duty to the individual (duty)
- The negligent persns actions or lack of actions was not something a prudent person would’ve done (breach of care/dereliction)
- The damages to the victim were directly caused by the negligence itself (causation)
- Actual harm or injury occurred (damages)
within what time period must a claim for negligence be out?
within 6 years of the breach
how should you reduce the risk of negligence?
always act in the best interests of the clinet, warn them of all potential risks, keep the workspace safe, properly train staff, provide proper supervision when needed, don’t provide advice outside of your purview, never share confidential information and take out indemnity insurance.
what are the 2 standard test for proving causation
but for test
balance of probabilities
what is the but for test?
a requirement for the claimant to show that ‘but for’ the defendants negligence the patient would not have been injured
what is the balance of probabilities in proving causation?
the court must be satisfied that on the evidence, the occurrence of an event was more likely than not
what is a deductive argument?
an argument intended to give logically conclusive support for the conclusion as opposed to give the conclusion probable support
If the arguer believes that the truth of the premises definitely establishes the truth of the conclusion, then the argument is deductive
what is an inductive argument?
If the arguer believes that the truth of the premises provides only good reasons to believe the conclusion is probably true, then the argument is inductive.
what is a valid argument?
if the conclusion follows logically from the premises
what makes a sound argument?
if the conclusion follows logically from premises that are in fact true
whats a partial evaluation outcome description?
a study that looks at one programme and only looks at the outcome
whats a partial evaluation cost description?
a study that looks at one programme and only looks at costs
whats a partial evaluataion (effectiveness analysis?
- a study that looks at 2 programmes comparitively but only looks at the outcomes
whats a partial evaluation cost analysis?
a study that looks at 2 programmes comparitively but only looks at the costs
whats a partial evaluation cost-outcome description?
a study that looks at one programme but examines both the costs and consequences.
whats a full economic evaluation?
a study that looks at two programmes comparatively looking at both inputs and outputs
what are some costs considered in economic evaluation?
operating costs to healthcare sector e.g. staff time, power, premises
costs to patients and families e.g. travel, anxiety
costs burned to outside the healthcare sector e.g. social services
costs to wider society e.g. productivity loss whilst in treatment
what are some outcomes considered in economic evaluation?
health service cost savings
savings to patients and families e.g. reduced input of time caring for them
society e.g. productivity gains
changes in quality of life for patients and family
what are the 4 types of economic evaluation?
cost minimisation analayss
cost effectiveness analysis
cost benefit analysis
cost utility analysis
what is a cost minimisation analysis?
a method of comparing the costs of alternative interventions (including the costs of managing any consequences of the intervention), which are known, or assumed, to have an equivalent medical effect. choosing the least costly option
whats the issue with cost minimisation analysis?
t assumes health effects to be equal in each alternative so its only appropriate when prior evidence suggests there is no difference in outcomes between the alternatives - this is unusual to see
what is the cost effectiveness analysis?
It compares an intervention to another intervention (or the status quo) by estimating how much it costs to gain a unit of a health outcome, like a life year gained or a death prevented.
what are advantages and disadvantages of cost evaluation analysis ?
- straightforward and simple to carry out
- easily understood as we use clinical units e.g. number of patients stopped smoking/ life years gained
• narrow, uni-dimensional measures of effect so we are only able to compare alternatives measured in the same units
whats the threshold value for NICE for QUALY?
30,000 for 1 QUALY
what is cost utility analysis?
CUA measures health effects in terms of both quantity (life years) and quality of life. These are combined into a single measure of health: quality-adjusted life years (QALYs)
what are advantages and disadvantages to cost utility analysis?
- enables us to make comparators between interventions that would be measured using different clinical outcomes
- enables a global health budget to be allocated more efficiently across different clinical areas
• is heavily reliant on the QUALY - this gets a lot of criticisms e.g. insensitive to mental health outcomes which makes these patients disadvantages for healthcare resources
what is a cost benefit analysis?
a way to compare the costs and benefits of an intervention, where both are expressed in monetary units
what are the advantages and disadvantages of cost benefit analysis?
- allows comparison across programmes with different health outcomes and with non-health care interventions e.g. road safety
- can be used to allocate a global budget
- allows us to maximise the amount of output from fixed resources
- how do we value a life?
- ethical problems - reluctance to place monitorial values on life
- how do we value a health outcome?
- how do we measure and value other societal costs e.g. time?
whats the preferred choice for economic evaluation and is used by NICE?
cost utility analysis (cost measured in pounds and outcomes measured in QUALYs)
what are some common hospital acquired infections?
c.diff MRSA CPE legionella pneumphila norovirus hospital acquired pneumonia catheter associated UTI
what is a DALY?
a disability adjusted life year
- the loss of the equivalent of one year of full health
why are there global differences in healthcare?
inequalities in GDP funding on healthcare
differences in workforce
differences in burden of disease
unequal efefcts of climate change e.g. flooding, air pollution etc
inequalities in health research
what do Preston curves dhow?
plots GDP per capita by life expectancy
whats the definition for immunisation?
Process of acquiring active or passive immunity - different to vaccination
who are vaccines monitored by for adverse side effects?
MHRA
why is PSA testing not carried out in the UK as screening for prostate cancer?
because it has such a low sensitivity
prostate cancer, BPH, prostatitis, ageing, being a cyclist can all increase PSA
what are the most common cancers for ages 0-14?
leukaemia, brain, non-hodgkins and kidney
what are the most common cancers for ages 15-49?
testis, melanoma skin, breast, colorectal and ovary
what are the most common cancers for ages 50-80+?
breast, prostate, lung, colorectal
outline the relation with ethnicity and cancer incidence?
Asian, Chinese and mixed ethnic groups have a lower risk of getting cancer compared to white ethnic groups
what is a gold standard test?
the best available diagnostic test for determining if the individual does or does not have a disease
how do you calculate likelihood ratio?
sensitivity / 100 - specificity
negative = 100- sensitivity / specificity
what are adults screened for?
cervical cancer breast cancer screening diabetic eye sreening bowel cancer screening abdominal aortic aneurysm screening
compare hand written and computerised clinical records?
hand written are continuous, portable but must be dated and signs, have legibility issues
computerised carry an audit trail, are searchable, structured, provide clinical decision support and have better security
outline the cycle of falls?
Fall 2. Fear of falling 3. Reduced physical activity 4. Deconditioning 5. Functional decline 6. Imparied activities of daily living 7. Social isolation 8. Reduced quality of life 9. Depression 10. Increased risk of fall 11. Institutionalization
what is a fall?
An unexpected event in which the participant comes to rest on the ground, floor or lower level
what percentage of over 65s fall annually?
30%
how many over 80s fall one a year?
50%
what are some causes of falls in the elderly?
Physiology : show reflexes, muscle weakness, stiff joints, decreased step height
Environment : Poor lighting, loose rugs, footwear, clothing
Pathology : stroke, parkinson disease, incontinence, arrhythmia
Drugs : polypharmacy, psychotropics
what are some risk factors for falls in the elderly?
History of falls 2-3x higher and fear of falling Age and frailty. Gender - female Living alone. Sedentary behavior Ethnicity -caucasian On more than 4 medications Nutritional deficiency - VIt D Foot problems Visual problems
whats the biggest cause of disability in the UK?
stroke
what is the CHADS2 VASc score?
the score for risk of stroke/ method to predict thromboembolic risk in atrial fibrillation
congestive heart failure, hypertension, age >75, diabetes, prior TIA or stroke, vascular disease, age 65/74, sex category
what are some symptoms of dementia?
Day to day memory (2) thinking and concentrating (3) Problem solving and planning (4) Language and communication (5) Visual perception (6) Changes in mood
how can air pollution affect people throughout their lifetime?
pregnancy - low birth weight
children - asthma slower lung development
adults - asthma, CHD, stroke, lung cancer, COPD, diabetes
elderly - asthma, accelerated decline in lung function, diabetes, dementia, heat failure, strokes
what is pneumoconiosis?
lung disease resulting from inhalation of dusts
e.g. silicosis or asbestosis
what is an EQ-5D score? what does it measure?
records the patient’s self-rated health on a vertical visual analogue scale
1) mobility (2) Looking after self (3) doing usual activities (4) having pain or discomfort (5) Feeling worried, sad or unhappy (6) Overall rating 0 worst health 100 best health
what are some barriers to changing diet in respect to risk of bowel cancer?
Press give the impression that everything causes cancer so ppl don’t care anymore - oversaturation of information
Influencing behavior : diet changing from meat centric to fruit and veg centric. Means that the whole world organization needs to change ( farms ect. )
Intervention is difficult : low socio economic ppl find it harder to buy more expensive healthy alternatives
what are patient decision aids?
Interventions designed to help people make specific and deliberate choices by providing information on the options and outcomes relevant to the persons health status
- Help give an understanding of probable outcomes of options
- Consider the personal value of benefits Vs harms by helping clarify preferences
- Gets patients to feel supported
- Move through the steps in making a decision
- Participate in deciding about their healthcare
how much does alcohol cost the NHS per annum?
3.5 billion
what are 2 screenings test for alcohol harm assessment?
alcohol use disorders identification test
fast alcohol screening test
outline the FRAMES brief intervention strategy for alcohol use?
F
Feedback: From the screening score (alcohol harms assessments) and the meaning of this in relation to risk. Encourage them to ask questions and for the need for the patient to make informed decisions. They may be uncertain about addressing the issue, if they chose to stop make sure that they are encouraged to take ownership of that decision
R
Responsible: Offer straight forward and accurate
A
Advice: On modifying alcohol use. If uncertain agree to return to the patient with accurate information and provide a leaflet or access to NHS website addresses and numbers
M
Menu: Of options to Choose from, forster their involvement
E
Empathetic: respectful and non-judgemental. Express optimism that they can modify their own alcohol use
S
Self efficacy: Promote this and their ability to succeed
whats the front line medication for management of alcohol withdrawal?
benzodiazepines
what is Wernicke-Korsakoff syndrome?
Complication of thiamine deficiency and neurotoxicity from alcohol
present with…
- Altered mental state and mild memory impairment
- Oculomotor abnormality ( nystagmus, ocular palsies )
- Cerebella dysfunction ( ataxia )
what is economic evaluation?
Deals with inputs and outputs ( costs and consequences )
Concerned with choices
Aim to make these choices explicit
what do HACCP do?
Analysis of hazards. Identification of points where hazards may occur. Deciding which point are critical to food safety. Implementing control and monitoring procedures. Reviewing hazards at critical points at intervals especially when there has been a change in operation.
what do HACCP do?
Analysis of hazards. Identification of points where hazards may occur. Deciding which point are critical to food safety. Implementing control and monitoring procedures. Reviewing hazards at critical points at intervals especially when there has been a change in operation.
what’s the most common bacterial cause of food poisoning in the UK?
campylobacter
what’s the most common cause of infective gastroenteritis in the UK?
norovirus
how is salmonella transmitted?
ingestion of contaminated food, mainly of animal origin
or faecal contamination
why have the number of cases of salmonella decreased since 2001?
EU surveillance began and control measures in poultry were implemented.
how is staph aureus transmitted?
ingested toxin or bacteria (previously cooked food can be contaminated with someones skin or nasal flora)
how is cryptosporidium transmitted?
animal to human e.g. farms
person to person
recreational exposure to contaminated water or land
consumption of contaminated water or food with faces
what is cryptosporidiums reservoir?
GI tract or man and animals
how long is staphylcoccus incubation time in terms of food poisoning?
2-4 hrs
how long is shigella incubation time in terms of food poisoning?
1-3 days
how long is giardias incubation time in terms of food poisoning?
up to 1 month
how long is hep As incubation time in terms of food poisoning?
up to 1 month
how long is cryptosporidiums incubation time in terms of food poisoning?
2-5 days
how long is noroviruses incubation time in terms of food poisoning?
24-48 hours
why can norovirus occur at any age?
because immunity is not long lasting
how is norovirus transmitted?
faecal oral route
environmental contamination
how long is clostridium perfringens incubation time in terms of food poisoning?
12-18 hrs
how is clostridium perfringens transmitted?
contaminated cooked meat and poultry
inadequate temperature control during cooling and storage
how is campylobacter transmitted?
raw/undercooked meat esp poultry unpasteurised milk untreated water domestic pets with diarrhoea person to person if hygiene is poor
how long is e.coli incubation time in terms of food poisoning?
1-6 days
how is e.coli transmitted?
contaminated and undercooked food stuff - beef products and milk
person to person
contact with infected animals
what are the 5 types of pathogenic e.coli?
Shiga toxin-producing E. coli aka enterohemorrhagic E
Enterotoxigenic E. coli (ETEC)
Enteropathogenic E. coli (EPEC)
Enteroaggregative E. coli (EAEC)
Enteroinvasive E. coli (EIEC)
what does enteropathogenic e.coli cause?
infantile diarrhoea
what does enteroaggregative e.coli cause?
travellers diarrhoea
what does enterotoxigenic e.coli cause?
travellers diarrhoea
what does enteroinvasive e.coli cause?
bacillary dysentrey (same as shigellosis)
what does enterohaemorrhagic e.coli cause?
they make a Shiga toxin/ verotoxin which colonises the small intestine
also known as e.coli 0157 H7
for which e.coli strain is there a vaccine
enterotoxigenic e.coli
what is meant by the ‘10/90 gap’?
only 10 per cent of global health research is devoted to conditions that account for 90 per cent of the global disease burden
outline the impact of travel and migration on disease seen in the UK?
travellers can contract a disease and not have any symptoms until they return home and have already exposed others
travelling to a new area may introduce a disease to a new population
how does WHO define environment, in relation to health?
all the physical, chemical and biological factors external to a person, and all the related behaviours
what are some changes that may occur to trigger an epidemic?
increased virulence
introduction into a novel setting
changes in host susceptibility
what are some ways we can control an epidemic?
insure poor countries against the threat of a pandemic
funds and international responders sent to a country with an outbreak
develop vaccines
fast, early, planned responses to stop spread
monitor diseases to prevent future outbreaks
what are some factors that affect transmission of communicable diseases?
population density sanitation vaccination deprivation poverty access to healthcare travel
use the chain of infection to describe how we can manage MRSA infections?
- Eradication of MRSA e.g. antibiotics
- Destroy reservoir e.g. cleaning or isolation
- Stopping path of exit from reservoir e.g. PPE
- Stopping mode of transmission e.g. disposing PPE properly and hand hygeine
- Stopping path of entry into human e.g.hand washing or bare below the elbow
- Protecting susceptible host e.g. skin care like covering open wounds in which MRSA could enter
what are the top 3 causes of death in UK?
COVID-19
dementia
IHD
whats an endemic infection?
one that is constantly present in a given geographical area
what is a point source epidemic?
when everyone who is infected catches the infection at the same time from a common source - cases will peak and then fall as there is no further exposure.
what is a propagated epidemic?
where transmission is prolonged by person-to-person spread and it stops when there are no more susceptible people.
what is a continuous epidemic?
when people are continuously exposed to the source of infection
whats the only disesse which has been eradicated? is it extinct?
small pox
not extinct as governments of Russa and the US retain samples of the virus under secure conditions
what is the difference between elimination, eradication and extinction of a disease?
elimination - reduction to zero of incience
eradication - permenant reduction to 0 worldwide
extinction - specific infectious agent no longer exists in nature or in the laboratory
who must medical practitioners notify when they come across a notifiable disease?
local authority proper officer
where is most malaria found?
sub sahran africa
how can we prevent malaria?
nsecticide-impregnated bed nets
• personal protective measures e.g. covering the body and using a strong insect reprelling
• spraying walls of dwellings with long-lasting insecticides and praying areas of the environment where larvae are present
what causes the most deaths out of all communicable disease?
pneumonia
whats the epidemiological triad?
host, agent and environment
what is the latent period?
time between infection and becoming infectious
what is an incubation period?
time between infection and becoming symptomatic
what is active immunity?
involves the production of specific antibodies either after natural exposure to disease or atificial inoculation by vaccines.
what is passive immunity?
provided by administration or transfer of antibodies = temporary protection and is usually used when individuals are at high risk of developing disease
what are the advantages and disadvantages of live vaccines?
strong immune response, single dose often results in life long immunity, frequency of adverse reactions decreases with number of doses
potential to revert t virulence and cause disease, poor stability, contraindicated in immunocompromised
what are the advantages and disadvantages of killed vaccines?
good stability, unable to cause disease, can be given to immunocompromised
need several doses, shorter immunity, local reactions more common, frequency of adverse reactions increases with number of doses
whats an…
overall survival rate?
event-free survival rate?n
net survival rate?
- Overall -> the percentage of people who are alive a certain amount of time after their diagnosis or start of treatment
- Event-free -> the length of time after primary treatment for a cancer ends that the patient remains free of certain complications or events that the treatment was intended to prevent or delay.
- Net -> how many more will die if they are diagnosed with cancer compared to what we wouldve expected otherwise
whats the most common cancer in the UK?
breast cancer
whats the definition of screening?
Screening is defined as a systematic application of a test or inquiry to identify people at sufficient risk of a specific disorder, to warrant further investigation amongst those who have not sought medical attention on account of symptoms of that disorder
