Year 2 Health and Society 3 2 Flashcards

1
Q

FrontText

A

BackText

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is evidence-based decision making (EBDM)?

A

Process for identifying and using most up-to-date (and relevant) evidence to inform decisions for individual patient problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does EBDM involve? (4 key aspects)

A
  • Patient preferences- Available resources, - Research evidence, - Clinical expertise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is decision making in medicine important?

A
  • Doctors make decisions constantly, - The decisions have effects on patients, families, and society, - Having an understanding of decision making, and the role of evidence, can help improve medical practice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do we need EBDM?

A
  • Limited time to read, - Inadequacy of ‘traditional’ sources of information - textbooks are often out of date, - Disparity between diagnostic skills/clinical judgement (which increase over time) and up-to-date knowledge/clinical performance (which decrease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the different types of research studies and when are they each appropriate? (6 main types)

A
  • Cohort studies - prognosis, cause, - Case-control studies - cause, - Randomised controlled trials - treatment interventions, benefit and harm, cost effectiveness, - Qualitative approaches - patients and/or practitioners perspectives, - Diagnostic and screening studies - identification, - Systematic reviews - summary of evidence for a specific question
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the process of EBDM? (5 steps)

A
  1. Converting the need for information into an answerable question, 2. Identifying the best evidence to answer that question, 3. Critically appraising the evidence for its validity, impact, and applicability, 4. Integrating the critical appraisal with clinical expertise and the patient’s unique circumstances, 5. Evaluating our effectiveness and efficiency in carrying out the previous steps and seeking ways to improve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 4 steps in the approach to smoking cessation?

A
  1. Health education and general information to enhance motivation for quitting (light smokers), 2. Brief advice from a health professional to quit smoking (light smokers), 3. Advice, nicotine replacement, follow-up by a specialist (moderately motivated, medium dependence smokers), 4. Specialised counselling rooms and agencies working with group sessions (high dependence smokers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is antibiotic resistance?

A

Bacteria change so antibiotics no longer work in people who need them to treat infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the reasons for the widespread use of antibiotics? (2 reasons)

A
  • Increase in global availability, - Uncontrolled sale in many low or middle income countries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some of the causes of antibiotic resistance? (5 causes)

A
  • Use in livestock for growth promotion, - Releasing antibiotics into the environment during pharmaceutical manufacturing, - Volume of antibiotics prescribed, - Missing doses when taking antibiotics, - Inappropriate prescribing of antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can antibiotic resistance be prevented? (5 ways)

A
  • Using antibiotics only when prescribed by a doctor, - Completing the full prescription, - Never sharing antibiotics or using leftover prescriptions, - Only prescribing antibiotics when they are needed, - Using the right antibiotics to treat the illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which factors influence infection? (5 main factors)

A
  • Infectious agents - ability to reproduce, survival, ability to spread, infectivity, pathogenicity, - Environment - contamination, other humans, animals, water, - Mode of transmission - droplet, airborne, aerosol, direct consumption, faecal-oral route, blood-borne, sexual contact, zoonosis, - Portal of entry - mouth, nose, ears, genital tract, skin, urinary tract, - Host factors - chronic illness, nutrition, age, immunity, lifestyle (e.g. smoking, drugs, etc.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the most important infectious diseases in the UK? (9 diseases)

A
  • Diphtheria, - Haemophilus influenza, - Measles, - Mumps, - Rubella, - Poliomyelitis, - Pneumococcal disease, - Tetanus, - Whooping cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the most important infectious diseases in developing countries? (4 diseases)

A
  • Pneumonia, - Chronic diarrhoea (due to several causes), - Malaria, - HIV/AIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is surveillance?

A

Systematic collection, collation and analysis of data and dissemination of the results so that appropriate control measures can be taken

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the purpose of surveillance? (3 main points)

A
  • Serve as an early warning system for impending public health emergencies, - Document the impact of an intervention, or track progress towards specific goals, - Monitor and clarify the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which infectious disease are becoming more common in the UK and why?

A

Hospital acquired infections (e.g. MRSA, STIs, mumps)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which infectious diseases are associated with exposure to healthcare?

A
  • Nosocomial infections, - More common examples (60%): UTIs, pneumonia, lower respiratory tract infections (LRTIs), septicaemia, - Less common examples (40%) but more dangerous: chicken pox, TB, legionella, MRSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can be done to reduce the risk of nosocomial infections? (3 main steps)

A
  • Prevention - hand washing, infection control programmes, advisory service, surveillance (mandatory for MRSA), sterilisation and decontamination of instruments, - Detection, investigation and control of outbreaks - screening, barrier nursing/isolation of infected patients, sharps disposal, - Policies and procedures to prevent and control infection - dissemination and implementation of policies, education and training, monitor clinical practice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is global health?

A
  • Health of global population, - Improving health and achieving equality in health for all people worldwide, - Emphasises trans-national health issues, determinants and solutions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is international health?

A

Health defined by geography (nation wealth), problems (e.g. infections, water sanitation), instruments (e.g. infection control aid), and a recipient and donor relationship

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the major functions of global health? (4 key points)

A
  • To provide health-related public goods - research, standards, guidelines, - To manage cross-national externalities through epidemiological surveillance, information sharing, and coordination, - To mobilise global solidarity for populations facing deprivation and disasters, - To convene stakeholders to reach consensus on key issues, setting priorities, negotiating rules, facilitating mutual accountability, and advocating for health in other policy-making arenas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the motivation for global health? (2 key aspects)

A
  • Increased awareness of global health disputes, - Enthusiasm to make a difference across international boundaries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the ‘90/10 gap’ (commission on health research for development - 1990)?

A

Less than 10% of worldwide resources devoted to health research were put towards health in developing countries, where over 90% of all preventable deaths worldwide occurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the solution for the ‘90/10 gap’? (4 steps)

A
  • Regulation of the quality of imported food, medicines, manufactured goods, and inputs, - Getting timely access to information about the global spread of infectious disease, - Procurements of sufficient vaccine and drug supplies in a pandemic, - Ensuring a sufficient corps of well-trained health personnel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What impact has travel and migration had on diseases seen in the UK? (5 impacts)

A
  • Help spread infectious diseases, - Transmission of behaviour and culture increases risk of non-communicable diseases, - May introduce a disease to a new population - widespread and deadly effects, - More in contact with animals - increase in animal diseases (zoonosis), - Migrants may bring diseases to countries that have not been exposed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is WHOs definition of environment, in relation to health?

A
  • All the physical, chemical and biological factors external to a person, and all the related behaviours, - Environmental health consists of preventing or controlling disease, injury, and disability related to the interactions between people and their environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is an outbreak?

A

Sudden increase in occurrences of a disease in a community, which has never experienced the disease before or when causes of the disease occur in numbers greater than expected in a defined area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is an epidemic?

A

Occurrence of a group of illnesses of similar nature and derived from a common source, in excess of what would be normally expected in a community or region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a pandemic?

A

Worldwide epidemic (outbreak -> epidemic -> pandemic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How can we prevent epidemics? (5 steps)

A
  • Insure developing countries against the threat of a pandemic, - Funds and international responders sent to country with outbreak to reduce human suffering, - Development of vaccines, - Fast, early, planned response means less spread, - Monitor disease to prevent future outbreaks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the role of WHO in public health? (6 key aspects)

A
  • Providing leadership on matters critical to health and engaging in partnerships where joint action is needed, - Shaping the research agenda and stimulating the generation, translation, and dissemination of valuable knowledge, - Setting norms and standards and promoting and monitoring their implementation, - Articulating ethical and evidence-based policy options, - Providing technical support, catalysing change, and building sustainable institutional capacity, - Monitoring the health situation and assessing health trends
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What general intervention strategies are possible for HIV/AIDS? (6 strategies)

A
  • Introduction of blood donor and product screening, - Promotion and distribution of condoms at affordable prices , - Peer education for high risk groups e.g. sex workers, - Promotion of safer sexual behaviour at the population level, - Diagnosis and treatment of STDs, - HIV voluntary counselling and testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the determinants of effective outcomes of intervention? (3 main determinants)

A
  • Economics - many developing countries can only spend a few dollars per annum per capita on healthcare, - Priorities - ‘developed world academic’ analyses of cost-effectiveness may not reflect the developing world realities, - Setting - countries where true reductions in incidence and prevalence have occurred (e.g. Uganda) may be characterised by openness in political leadership towards HIV/AIDS and other cultural factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the current problems and issues?

A
  • Africa struggles against debt, trade restrictions and inadequate aid provisions, - Global fund în under-resourced, - US politics are retrogressive and harmful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the public health objectives of vaccination? (7 objectives)

A
  • To reduce mortality and morbidity from vaccine preventable infections, - To prevent outbreaks and epidemics, - To contain an infection in a population, - To reduce the number of infections, - To interrupt transmission to humans, - To generate herd immunity, - To eradicate an infectious agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the 2 most effective developments in healthcare to protect population health?

A
  • Clean drinking water, - Vaccination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What factors influence the utility of immunisation/vaccination as an approach to disease prevention? (9 points)

A
  • Disease burden, - Risk of exposure to the disease, - Age, health status, vaccination history, - Special risk factors, - Reactions to previous vaccine doses, allergies, - Risk of infecting others, - Cost, - Other ways of controlling the disease, - Impact on public perception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is required for a disease to be eradicate using vaccination? (3 requirements)

A
  • Where no other reservoirs of the infection exist in animals or environment, - Where consequences of infection are very high, - Where scientific and political prioritisation exists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Give examples of diseases that have been eradicated

A
  • Smallpox, - Polio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is herd immunity?

A
  • Level of immunity in the population which protects the whole population, - Herd immunity only applies to diseases which are passes from person to person, - Provides indirect protection to unvaccinated as well as direct effect to the vaccinated, - A disease can therefore be eradicated even if some people remain susceptible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is R0?

A
  • Basic reproduction rate, - The average number of individuals directly infected by an infectious case during the infectious period, in a totally susceptible population (number of secondary cases following introduction of infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What factors affect R0? (3 main factors)

A
  • The rate of contacts in the host population, - The probability of infection being transmitted during contact, - The duration of infectiousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is effective reproduction rate (R)?

A

Estimates the average number of secondary cases per infectious case in a population made up of both susceptible and non-susceptible hosts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the equation for effective reproduction rate?

A

R = R0x (x is the fraction of the host population which is susceptible e.g. half population is 0.5), R >1 = number of cases increases, R <1 = number of cases decreases, needs to be maintained for elimination, R =1 = epidemic threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the equation for herd immunity?

A

H = (R0 -1) / R0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is a susceptible population? (4 key points)

A
  • Any person who is not immune to a particular pathogen is said to be susceptible, - A person may be susceptible because they have never encountered the infection or the vaccine against it before, - A person may be susceptible because they are unable to mount an immune response, - A person may be susceptible because vaccination is contraindicated for them
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is WHOs role in vaccination?

A
  • Makes recommendations for countries on vaccination policy, - Supports less able countries with vaccination strategy implementation, - Works through the international health regulations to ensure the maximum security against the international spread of disease with a minimum interference with world traffic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

List some international immunisation programmes

A
  • Expanded programme on immunisation (EPI), - Global polio eradication initiative (GPEI), - Global alliance for vaccines and immunisation (GAVI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How are new vaccination programmes implemented? (who, how and when)

A
  • Who - to protect the vulnerable, contain outbreak, eradicate disease, - How - pilots, phased introduction, global vaccination, - When - greatest impact on disease burden
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is shared decision making and why is it important?

A
  • Conversation between patient and their health care professional to reach a health care choice together, - Important when - there is more than one reasonable option, no one option has a clear advantage, the possible benefits/harms of each option affect patients differently
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the pros of vaccination? (8 points)

A
  • Can save lives, - Ingredients are safe in the amount used, - Adverse reactions are rare, - Herd immunity, - Save children and parents time and money, - Protect future generations, - Eradication of diseases, - Economic benefits for society
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the cons of vaccination? (7 points)

A
  • Can cause serious and sometimes fatal side effects, - Contain harmful ingredients, - Government should not intervene in personal medical choices, - Can contain ingredients some people object to e.g. chicken eggs, - Unnatural, - Pharmaceutical companies main goal is to make profit, - Some diseases that vaccines target are relatively harmless in many cases e.g. rotavirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What factors influence decision making? (6 factors)

A
  • Lifestyle, - Perception of health, - Beliefs about childhood diseases, - Risk perception of the diseases, - Perceptions about vaccine effectiveness and vaccine components , - Trust in institution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the population vs individual interest debate?

A
  • For the individual - protection by ‘herd immunity’ may be safest option as avoids risk of vaccine, - For the community - avoidance of vaccination leads to reduced coverage so diminishes herd immunity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which websites can be used to find out if a person needs travel vaccines?

A
  • NHS fitfortravel, - The National Travel Health Network and Centre (NaTHNaC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are some of the free and private travel vaccines available?

A
  • Free - diphtheria, polio, tetanus, typhoid, hepatitis A, cholera, - Private - hepatitis B, Japanese encephalitis, meningitis, rabies, TB, yellow fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What factors should be consider when deciding to get travel vaccinations? (8 factors)

A
  • The country or countries you’re visiting , - When you’re travelling, - Where you’re staying , - How long you’ll be staying, - Your age and health, - What you’ll be doing during stay , - If you’re working as an aid worker, - If you’re working in a medical setting, - If you’re contact with animals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the 5 common cancers (incidence) in adult men and women in the UK (list in order)?

A
  1. Breast/prostate, 2. Lung, 3. Bowel, 4. Melanoma, 5. Non-Hodgkin lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the 5 most common causes of cancer mortality for adult men and women combined in the UK (list in order)?

A
  1. Lung, 2. Bowel, 3. Prostate/breast, 4. Pancreas, 5. Oesophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the most common cancers in children?

A

Leukaemias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the most common causes of cancer mortality in children?

A

Brain, CNS and intracranial tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How do the patterns of cancer in the UK differ from that seen in a developing country?

A

Mortality is higher in UK (29%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the role of legal and lifestyle changes in reducing incidence and mortality of cancer? (3 main points)

A
  • Prevention - legal and lifestyle changes, vaccinations, - Screening - early detection and diagnosis, - Disease management - improving treatments and quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is meant by difficult (bad) news?

A

Bad/difficult news is defined as any news that drastically and negatively alters the patient’s (or their relatives) view of his or her future

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What factors can affect the impact of news on a patient? (7 factors)

A
  • Institutionalised beliefs, - Personality types, - Gender, - Culture/race, - Religion, - Patients knowledge, - Relatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What anxieties might health care professionals have about breaking bad news? (5 points)

A
  • Uncertainty about the patient’s expectations, - Fear of destroying the patient’s hope, - Fear of their own inadequacy in the face of controlling disease, - Not feeling prepared to manage the patients anticipated emotional reactions, - Embarrassment at having previously painted too optimistic a picture for the patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the ABCDE method of breaking bad news?

A

A - Advanced preparation, B - Building a relationship, C - Communicate well, D - Deal with patient reactions, E - Encourage and validate emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the SPIKES method of breaking bad news?

A

S - Setting up , P - Perception, I - Invitation, K - Knowledge, E - Emotions, S - Strategy and summary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What emotions may a patient feel when they receive difficult news? (5 main emotions)

A
  • Grief, - Distress, - Denial, - Anger, - Agitation/restlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How can cancer change partner relationships? (6 changes)

A
  • Change in roles, - Change in responsibilities, - Change in physical needs, - Change in emotional needs, - Change in sexuality and intimacy, - Change in future plans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What were the conclusions and consequences of the Eurocare-II report?

A
  • Despite limitations of the methodology, cancer survival in the UK in the 1980-90s was one of the worst in Europe, - Expert advisory group formed to the chief medial officer in 1995 which generated the calman-hine report
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What were the conclusions and consequences of the Calman-Hine report (1995)? (6 points)

A

(The Calman-Hine report examined cancer services in the UK, and proposed a restructuring of cancer services to achieve more equitable level of access to high levels of expertise throughout the country.), , - All patients to have access to a uniformly high quality of care, - Public and professional education to recognise early symptoms of cancer, - Patients, families and carers should be given clear information about treatment options and outcomes, - The development of cancer services should be patient-centred, - Primary care to be central to cancer care, - The psychosocial needs of cancer sufferers and carers to be recognised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the Calman-Hine solutions?

A

There should be 3 levels of care:, - Primary care, - Cancer units serving district general hospitals - treat common cancers, diagnostic procedures, common surgery, non-complex chemo, - Cancer centres (populations in excess of 1 million) - treat rare cancers, radiotherapy, complex chemo, , Key to managing patients would be the MDT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is a national service framework? (3 main points)

A
  • Set national standards and define service models for a service or care group, - Put in place programmes to support implementation, - Establish performance measures against which progress within agreed timescales would be measured
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the main aims of the NHS cancer plan (2000)?

A
  • Save more lives, - Ensure people with cancer get the right professional support, care and treatments, - Tackle the inequalities in health e.g. unskilled workers are 2x more likely to die from cancer as professionals, - Build for the future - investment in cancer workforce, strong research, preparation for the genetics revolution, , NHS plan followed by several improving outcomes guidance (NICE) which relate to the organisation of services for a particular cancer., , - 2000 manual of cancer - >300 standards relating to the delivery of cancer treatment including provisions of chemotherapy, radiotherapy, etc., - 2004 manual of cancer (manual of quality measures) - >900 new measures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the 6 key areas for action in the cancer reform strategy (2007)?

A
  • Prevention - smoking, obesity, alcohol, etc., - Screening - diagnosing cancer earlier, - Ensuring better treatment - reduced waiting times, increase in radiotherapy capacity, new cancer drugs be referred to NICE, chemotherapy audits, - Living with and beyond cancer - National cancer survivorship initiative, - Reducing cancer inequalities, - Delivering care in the most appropriate setting - locally where possible, services should be centralised where necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which cancers are screened for?

A
  • Cervical, - Breast, - Bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the national cancer survivorship initiative?

A

Partnership with cancer charities, clinicians and patients, considered a range of approaches to improving services and support available for cancer survivors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What were the main outcomes from ‘Improving outcomes: A strategy for cancer (2011)’? (4 outcomes)

A
  • Prevention and early diagnosis - focus on lifestyle factors, screening, diagnostic tests, - Quality of life and patient experience - patient experience surveys, more 1:1 support roles, risky stratified pathway of care, following assessment and care planning, - Better treatments - cancer drugs fund, reducing variation in radiotherapy, reaffirmed MDTs and national audits, - Reducing inequalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are some of the inequalities experiences amongst cancer patients? (5 examples)

A
  • White cancer patients report a more positive experience than other ethnic groups, - Younger people are the least positive about their experience, particularly around understanding completely what was wrong with them, - Men are generally more positive about their care than women, particularly around staff and staff working together, - Non-heterosexual patients reported less positive experience, especially in relation to communication and being treated with respect and dignity, - People with rarer forms of cancer in general reported a poorer experience of their treatment and care then people with more common forms of cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the outcomes from the independent cancer Taskforce (2015)? (6 outcomes)

A
  • Spearhead a radical upgrade in prevention and public health, - Drive a national ambition to achieve earlier diagnosis, - Establish patient experiences being on a par with clinical effectiveness and safety, - Transform our approach to support people living with and beyond cancer, - Make the necessary investments required to deliver a modern high-quality service, - Overhaul process for commissioning, accountability and provision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is body image?

A
  • Perceptions, thoughts, and behaviours related to one’s appearance, - The body is a bearer of values and a means of representing our identity to others - it shows who we are to others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is biographical distribution?

A
  • Chronic illness leads to a loss of confidence in the body, - From this follows a loss of confidence in social interaction or self-identify
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Give examples of diseases/symptoms/treatments/side-effects which affect body image (6 examples)

A
  • Scars, - Prosthetic device - e.g. leg, - Mastectomy, - Impact on sexuality - function, pain, appearance, - Stoma, - Hair loss, - Weight loss/weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the importance of hair?

A
  • An important site for individual and group identity, - A way of ‘doing gender’ - a symbol of felinity? hair loss not so bad for men, - Stigma - patients have some choices as to whether they will be stigmatised, - Patient control of their status as sick - can be managed through ‘normal’ appearance (wigs, beanies, scarves)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the functions of the clinical record? (4 points)

A
  • Support patient care, - Improve future patient care, - Social purposes at the request of patients, - Medico-legal document
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What should be recorded in a clinical record? (7 key aspects)

A
  • Presenting symptoms and reasons for seeking health care, - Relevant clinical findings, - Diagnosis and important differentials, - Options for care and treatment, - Risk and benefits of care and treatment, - Decisions about care and treatment, - Action taken and outcomes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the differences between paper and electronic records?

A
  • Paper - continuous, portable, writer identified, legibility issues, must be dated and signed, - Electronic - problem orientated, searchable, structured, safer prescribing, clinical decision support software
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the use of records in audit, research and management?

A
  • Support clinical audit, - Facilitates clinical governance, - Facilitates risk management, - Support clinical research
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is duty of care?

A

Legal obligation which is imposed on an individual requiring adherence to a standard of reasonable care while performing any acts that could foreseeable harm others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is negligence?

A
  • Negligence is a failure to exercise the care that a reasonably prudent person would exercise in like circumstances, - You have to make decisions that adheres to your duty of care as a doctor and could not be considered negligent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the 4 ethical principles?

A
  • Beneficence - duty to do good, - Non-maleficence - duty to cause no harm, - Autonomy - patient has the right to make their own decision, Justice - fair, equitable treatment for all
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the ethical theories? (3 main theories)

A
  • Consequentialism/utilitarianism - the correct moral response is related to the outcome or consequence of the act, - Deontology - places value on the intentions of the individual and focuses on rules, obligations and duties, - Virtue ethics - right living is derived from the moral character of the agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How do you evaluate an argument? (2 steps)

A
  1. Get clear on the logical form of the argument, 2. Query - valid and sound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Why might an argument be invalid? (4 reasons)

A
  • Different premises may express different concepts, - Confusing necessary with sufficient, and vice-versa, - Insensitive to the way in which claims are qualified, - Argument begs the question
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Why might an argument be unsound? (3 reasons)

A
  • Argument is invalid, - Argument is valid but one or more premise is false - makes a false/controversial moral/empirical claim, - An unsound argument doesn’t mean there will be an unsound conclusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What should be avoided in arguments? (5 points)

A
  • Straw man fallacy - simply ignoring the person’s actual position and substituting it for a distorted, exaggerated or misrepresented version of that position, - Ab hominem - directed against a person rather than the position they are maintaining, - Appealing to emotion, - Begging the question, - Argument from fallacy - conclusion must be false because the premises are false (not necessarily)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is a moral argument?

A
  • Seek to support a moral claim of some kind, - Argument need not succeed but to be an argument it must at least provide supporting reasons for the claim in question
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is a deductive argument?

A
  • Purely logic, - “This means this, therefore this means this”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is an inductive argument?

A

Making an argument based on observation, more probable conclusions (seeing is believing but you may not have seen everything)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What are MDTs in cancer care and why are they needed?

A
  • Modern management of cancer - involves many disciplines, surgical and non-surgical, oncology, - Allied health professionals e.g. nurses, physiotherapists, speech therapists, etc., - Delivery of cancer care is often fragmented over several hospital sites - need to streamline and co-ordinate various components of care, - Probably better outcomes for patients managed in MDTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Who is in a cancer MDT (core and extended)?

A

Core (medical staff):, - Physicians, - Surgeons, - Oncologist, - Radiologist, - Histopathologist, - Specialist nurses, - MDT coordinator, , Extended:, - Physiotherapist, - Dietician, - Palliative care, - Chaplin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What are the functions of MDTs in cancer care? (6 key functions)

A
  • Discuss every new diagnosis of cancer within their site, - Decide on a management plan for every patient, - Inform primary care of that plan, - Designate a key worker for that patient, - Develop referral, diagnosis and treatment guidelines for their tumour sites, - Audit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is sensitivity?

A
  • True positives, - Measures the proportion of positives that are correctly identified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is the equation for sensitivity?

A

Sensitivity = true positives / (true positives + false negatives)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is specificity?

A
  • True negatives, - Measures the proportion of negatives that are correctly identified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the equation for specificity?

A

Specificity = true negatives / (true negatives + false positives)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is a diagnostic test?

A

Any kind of medical test performed to aid in the diagnosis or detection of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the uses of diagnostic tests? (4 uses)

A
  • Diagnosis, - Monitoring, - Screening, - Prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

How is sensitivity and specificity important in informing diagnosis?

A

The importance of a diagnostic accuracy testing is directly proportional to the tests potential to cause patient consequences and harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What does true positive mean?

A

Test indicates disease when there is disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What does true negative mean?

A

Test indicates no disease when there is no disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What does false positive mean?

A

Test indicates disease when there is no disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What does false negative mean?

A

Test indicates no disease when there is disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is positive predictive value?

A

The probability that subjects with a positive screening test truly have the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is negative predictive value?

A

The probability that subject with a negative screening test truly don’t have the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is the likelihood ratio?

A

The likelihood that a given test result would be expected in a patient with the target disorder compared to the likelihood that the same result would be expected in a patient without the target disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is screening?

A

Systematic application of a test or inquiry, to identify individuals at sufficient risk of a specific disorder to warrant further investigation or direct preventive action, amongst persons who have not sought medical attention on account of symptoms of that disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the purpose of screening? (3 purposes)

A
  • Opportunities for primary prevention are limited, - Opportunities for treatment are limited, - Screening gives potential for early and more effective treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is commonly screened for? (8 examples)

A
  • Cancer - colorectal cancer, breast cancer, cervical cancer, - PPD test - tuberculosis, - Prenatal tests - foetal abnormalities, - Newborn bloodspot test - PKU, cystic fibrosis, etc., - Ophthalmoscopy or digital photography and image grading - diabetic retinopathy, - Ultrasound scan - abdominal aortic aneurysm, - Screening for metabolic syndrome, - Screening for potential hearing loss in newborns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What are the limitations of screening?

A
  • Cost and use of medical resources on a majority of people who do not need treatment, - Adverse effects of screening procedure - stress, anxiety, discomfort, radiation exposure, - Stress and anxiety caused by a false positive result, - Unnecessary investigation and treatment of false positive results, - Stress and anxiety caused by prolonging knowledge of an illness without any improvement in outcome, - A false sense of security caused by false negatives, which may delay final diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What are the pros and cons of good screening?

A

Pros - early detection of disease means the risk of death or illness can be reduced for some people, , Cons - Some people get tests, diagnosis ad treatment with no benefit; some people get ill or die despite a negative screening test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What areas should be evaluated when deciding what should be screened for? (4 areas)

A
  • Condition - important? epidemiology, natural history of condition, detectable risk factor, latent period, cost-effective, - Test - simple, safe, precise, validated, cut-off agreed, acceptable, - Treatment - effective evidence based treatment, - Programme - RCT evidence of reduction in mortality or morbidity, benefit outweigh harm, opportunity cost, quality assurance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is sojourn time?

A
  • The duration of a disease before clinical symptoms become apparent but during which it is detectable by a screening test, - Its clinical relevance is that it represents the duration of the temporal window of opportunity for early detection, - Length of sojourn time = short - rapidly progressing disease, poorer prognosis, - Length of sojourn time = long - better prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is length bias?

A

Overestimation of survival duration among screening-detected cases by the relative excess of slowly progressing cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What are the consequences of length bias?

A
  • Diseases with a longer sojourn time are ‘easier to catch’ in the screening net, - On average, individuals with diseases detected through screening ‘automatically’ have a better prognosis than people who present with symptoms/signs, - If we simply compare individuals who choose to be screened with those who don’t we get a distorted picture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What is lead time bias?

A

Overestimation of survival duration among screen-detected cases (relative to those detected by signs and symptoms) when survival is measured from diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What are the consequences of lead time bias?

A
  • Survival is inevitably longer following diagnosis through screening because of the ‘extra’ lead time, - Because of this the appropriate measure of effectiveness is deaths prevented, not survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What is over diagnosis bias?

A
  • Overestimation of survival duration among screen-detected cases caused by inclusion of pseudo disease - subclinical disease that would not become overt before the patient dies of other causes, - Occurs when screen-detected cancers are either non-growing or so slow-growing that they never would cause medical problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is PSA testing and what can cause elevated PSA?

A
  • Prostate-specific antigen (PSA) - protein produced by cells of the prostate gland, - Elevated in - prostate cancer, BPH, prostatitis, UTI, exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What are the advantages of PSA screening?

A
  • Can help detect tumours with no symptoms, - Allows estimation of prostate size and stage, - Helps doctor predict response to treatment, - Can be used to monitor men who are at increased risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What are the disadvantages of PSA screening?

A
  • Early detection may not reduce the chance of dying from prostate cancer, - Over-diagnosis -> over-treatment, - May give false-positive - other conditions can increase PSA, not specific enough, - May give false-negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What are some of the impacts of incontinence on a patient?

A
  • Distress, - Embarrassment, - Inconvenience, - Threat to self esteem, - Loss of personal control, - Desire for normalisation, - Loss of interest in sex, - Difficulty sleeping (especially with nocturia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What impact might chronic dialysis have on a patient?

A
  • Regular hospital admissions, - Restriction of leisure time, - May have to give up job, - Increased dependence on dialysis, - Uncertainness about the future, - Fatigue, - Limitations of liquids and foods, - Disrupts family and friend relationships, - Depression, - Lower self-esteem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What 4 sources are used when making a clinical decision?

A
  • Patient preferences, - Available resources, - Research evidence, - Clinical expertise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is opportunity cost?

A
  • The loss of other alternative when one alternative is chosen, - The amount of money that is alienated by choosing to use it for one project than another
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What is distributive justice?

A

How we distribute resources the are finite in a fair way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

How can you decide ways to distribute healthcare? (5 factors)

A
  • QALY calculation, - Waiting list, - Likelihood of complying with treatment, - Lifestyle choices of patient, - Ability to pay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What is confidentiality?

A

Pledge of agreement to not divulge or disclose information about patients to others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Why is it important to maintain confidentiality? (6 points)

A
  • Improves trust between patient and doctor, - Respects autonomy, - Prevents patient harm, - Virtuous, - Human rights act, - GMC requirements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

When can confidentiality be breached?

A
  • Statute (law), - Consent by patient, - Public best interest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Name some statutes (laws) that oblige doctors to disclose information

A
  • Public Health Act 1984, - Road Traffic Act 1988, - Prevention of Terrorism Act 1989
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Define patient safety

A

Coordinated efforts to prevent harm to patients cause by the process of health care itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is an adverse event/

A

Unintended event resulting from clinical care and causing patient harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is a near miss?

A

A situation in which events or omissions arising during clinical care fail to develop further

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Describe the Swiss cheese model of accident causation

A

Although many layers of defence lie between hazards and accidents, there are flaws in each layer that, if aligned, can allow the accident to occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What are the main causes of error at an individual and a system level?

A
  • Individual error - errors of individuals, blames individual for forgetfulness, inattention or moral weakness, - System error - conditions under which an individual works, tries to build defences to eliminate errors or mitigate their effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What are active failures?

A
  • Unsafe acts committed by people in direct contact with the patient, - Usually short lived, often unpredictable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What is latent error?

A
  • Develop over time until they combine with other factors or active failures to casein adverse event, - Long lived and often can be identified and removed before they cause an adverse event
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What are the different types of errors? (3 types)

A
  • Knowledge based - such as forming wrong intentions or plans as a result of inadequate knowledge/experience, - Rule based - encounter relatively familiar problems but apply wrong rule, either misapplication of a good rule or application of a bad rule, - Skills based - attention slips and memory lapses, involve the unintended deviation of actions from what may have been a good plan; people are prone to these types of errors, mainly due to interruption or distraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What are violations?

A
  • Deliberate deviation from some regulated code of practice or procedure, - They occur because people intentionally break the rules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What are the types of violation? (4 types)

A
  • Routine - regularly performed shortcuts due to system, process or task being poorly designed or actions; may become tacitly accepted practice over time, - Reasoned - occasional reasoned deviation from a protocol or procedure which we believe we have good reason for making (e.g. time constraints), may be in patient’s best interests, - Reckless - deliberate deviations from a protocol/code of conduct and include acts where opportunity for harm is foreseeable and ignored, although harm may never be intended, - Malicious - deliberate deviations from a protocol/code of conduct, where the intention is to cause harm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What systems are in place in the NHS to try and prevent errors occurring? (3 systems)

A
  • National Patient Safety Agency (NPSA) 2001 - coordination of reporting and learning from mistakes that affect patient safety, - National Reporting and Learning System (NRLS) 2004 - national system for anonymous reporting go patient safety incidents, including near misses; all trusts now have local system for reporting, linked to the national system; also has an E-form for reporting incidents anonymously directly to the NPSA, - Medicines and Healthcare Products Regulatory Agency (MHRA) - ensures medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness and that they are used safely; monitoring of medicines and acting on safety concerns; responsible for adverse incident reporting system for medical devices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

How do we know if a hospital is safe?

A
  • Hospital mortality data, - Data on other measures of safety - reports of never events and serious incidents, NHS safety thermometer, patent safety dashboards, - Monitoring and inspections by regulators - care quality commission (CQC), NHS Improvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What situations are associated with an increased risk of error? (6 examples)

A
  • Unfamiliarity with the task, - Inexperience, - Shortage of time , - Inadequate checking, - Poor procedures, - Poor human equipment interface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What should we do when adverse incidents occur? (5 steps)

A
  • Report it - incident reporting systems, - Assess its seriousness, - Analyse why it occurred - root cause analysis, - Be open and honest with the affected patient and apologise - duty of candour, - Learn from the event and put in place action to reduce risk of repeat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Why do children go to A&E?

A
  • Accidental injury, - Asthma, - Respiratory illness, - Infective process, - Rashes, - Appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Why are males more likely to die than females?

A
  • Higher suicide rates, - Violence related incidents, - Road traffic accidents, - Behavioural differences between males and females - more likely to take part in ‘risky’ behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What is the most common cause of external deaths in adolescents?

A

Traffic accidents (>50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Why does poverty increase the chance of getting ill?

A
  • Poor nutrition, - Overcrowding, - Lack of clean water, - Harsh realities that may make putting your health at risk the only way to survive or keep your family safe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Why does poor health increase poverty?

A
  • Reducing a family’s work productivity, - Leading family to sell assets to cover the costs of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What are the implications of chronic illness in children?

A
  • Affects physical, mental and social development, - Repeated absence at school, - Affect on parents and siblings, - Financial effect (family and community), - Can be lifelong
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What conditions are screened for before birth? (3 main tests)

A

Antenatal screening tests identify major abnormalities, - Alpha fetoprotein - raised in neural tube defects and some GI abnormalities, - Downs test - alpha fetoprotein and HCG, - Ultrasound - growth check, cardiac abnormalities, diaphragmatic hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What tests are done neonatally? (2 tests)

A
  • Blood spot test - PKU, cystic fibrosis, sickle cell disease, congenital hypothyroidism, - Physical examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What are the timings for screening and developmental surveillance?

A
  • Antenatal screening (12th week of pregnancy), - Neonatal examination, - New baby review (14 days), - 6-8 week check, - 1 year check, - 2-2.5 year check
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What is the purpose of the 6-8 week postnatal check?

A
  • Take history, - Assess psychological and social situation, - Examination of mother - abdomen, vaginal exam (sometimes), BMI, - Examination of baby - weight, head circumference, appearance and movement, hips, heart, spine, eyes, - Health promotion - immunisations, breast-feeding, reducing risk of SIDS, car safety, - Assessment of parenting and emotional attachment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is looked for in the heart examination at the 6-8 week postnatal check?

A
  • Look for cyanosis, ventricular heave, respiratory distress, tachypnea, - Feel apex beat, - Listen or murmurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What is developmental dysplasia of hip (DDH)?

A

Ball and socket joint of hip doesn’t form properly - too shallow so femoral head is loose and can dislocate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What are the tests for developmental dysplasia of hip (DDH)?

A
  • Barlows test - flex and adduct hip then push hip posteriorly, positive test causes femoral head to slip out of the acetabulum , - Ortolanis test - gently abduct hip, puts dislocated hip back in place
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What are the normal vital signs of a healthy baby?

A
  • Respiratory rate - 30-60 breaths per minute, - Heart rate - 100-160 beats per minute, - Temperature - 37 degrees celsius
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What immunisations should be given in the first year of life?

A
  • 8 weeks - 6-in-1 vaccine (1st dose), rotavirus vaccine (1st dose), MenB vaccine (1st dose), - 12 weeks - 6-in-1 vaccine (2nd dose), pneumococcal (PCV) vaccine, rotavirus vaccine (2nd dose), - 16 weeks - 6-in-1 vaccine (3rd dose), MenB vaccine (2nd dose), - 1 year - Hip/MenC vaccine (1st dose), MMR (1st dose), PCV vaccine (2nd dose), MenB (3rd dose)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What is puerperium?

A
  • Postnatal period, - Period of about 6-8 weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What are the main aims of antenatal care? (6 aims)

A
  • Monitor progress of pregnancy to optimise maternal and foetal health, - Develop a partnership between the other and health professionals, - Exchange information that promotes choice - about lifestyle, location of birth, etc., - Recognise deviations from the norm and refer appropriately, - Increase understanding of public health issues, - Provide opportunities to prepare for birth and parenthood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Which key documents influence antenatal care provisions?

A
  • MBRRACE-UK (mothers and babies - reducing risk through audits and confidential enquiries across the UK), - NICE antenatal care guideline (2008, modified 2014), - Evidence based practice, - Local policy/guidelines for practice, - Midwifery 2020, - National maternity review ‘Better births’
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What were the key themes of the national maternity review ‘Better births’? (7 themes)

A
  • Personalised care, - Continuity of care, - Safer care, - Better postnatal and perinatal mental health care, - Multi-professional working, - Working across boundaries, - A fairer payment system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What tests are done at antenatal visits? (3 main tests)

A
  • Physical examination - weight, BP, urinalysis, - Blood tests - FBC, antibodies, ABO and Rh, HIV, - Psychosocial and emotional support - general wellbeing, work, financial, anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

What are some of the risk factors for adverse outcomes to pregnancy?

A
  • Chronic or acute disease - may be complicated with pregnancy, - Proteinuria - could indicate renal pathology, - Significant increase BP readings - pre-eclampsia, may lead to eclampsia (fits and convulsions), - Significant oedema - hypertensive disorder?, - Uterus large or small for gestational age - lots of conditions affect these, - Malpresentation - cephalic or breach, - Infection - increases risk of miscarriage/stillbirth, - Social or psychological factors - mental health problems can lead to antenatal depression/postnatal depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What are the different forms of pregnancy loss? (4 types)

A
  • Spontaneous miscarriage - loss of pregnancy before 24 completed weeks of pregnancy, - Ectopic pregnancy - fertilised ovum implants outside uterus (embryo grows in Fallopian tube or even abdomen), - Termination of pregnancy, - Stillbirth - born after 24 weeks and does not show any sign of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What is the MBRRACE-UK report (2014)?

A
  • Mother and Babies Reducing Risk through Audits and Confidential Enquiries across the UK, - Looked at standards of care and mortality and morbidity rates, - 2/3 of mothers died from medical and mental health problems, 1.3 from direct causes, - 3/4 of women who died had known mental health problems before they died
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What are common causes of death in the postnatal period? (4 causes)

A
  • Infection, - Haemorrhage, - Thrombosis, - Hypertensive disorders (eclampsia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

What physical health and wellbeing issues might a woman experience in the postnatal period? (9 examples)

A
  • Perineal care - infection, inadequate repair, wound breakdown/non-healing, - Urinary retention , - Dyspareunia - difficult or painful sex, - Headache, - Fatigue, - Backache, - Constipation, - Haemorrhoids, - Breast and nipples - redness, painful, cracked, mastitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

What mental health problems may be experienced in the postnatal period?

A
  • 50-80% ‘The blues’ - very weepy over small things, time-limited, recovers very quickly, if it continues then begins o worry about postnatal depression, - 10-15% Postnatal depression - tiredness, worthlessness, low mood, - 0.2% Puerperal psychosis - severe episodes of mental illness that begins suddenly, mania, depression, confusion, hallucinations, delusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

What was the main outcome of the Peel Committee Report (1970)?

A

Sufficient facilities should be made available for 100% of childbearing women to give birth in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

What are the risks associated with Caesarean section? (3 main risks)

A
  • General anaesthesia, danger of Mendelsohns’ syndrome (aspiration pneumonia), paralytic ileus, - Surgical techniques, quite radical abdominal surgery, risk to other internal organs from surgical trauma, - Childbearing risks for further births
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

What is the medical model of birth?

A
  • Birth seen as a dangerous journey, only normal in retrospect, therefore assume the worst, - Low threshold for intervention (to fix defective bodies)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

What is the social model of birth?

A

Birth is seen as a normal physiological process which women are uniquely designed to achieve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

What are some of the cultural issues during pregnancy?

A
  • Unintended pregnancy - delay in seeking prenatal care and having a premature baby, higher levels of stress and depression, - Pregnancy may or may not fit with the mother’s plans, - Social disapproval for pregnancy out of wedlock and teenagers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

What was the outcome of the Midwives’ Act (1902)?

A
  • Established normality in childbearing as the midwife’s role - refer to doctors as soon as abnormality occurs, - This ensures equal access to midwives and doctors for childbearing women of all socioeconomic standing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What are the benefits of institutionalised childbirth? (5 points)

A
  • Standardisation of care, - Access to good facilities to support childbirth, - Availability of populations of childbearing women and infants for the purposes of midwifery and obstetric training, - Faster access to emergency care, - Access of effective obstetric analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

What ar the risks of institutionalised childbirth? (5 points)

A
  • Medicalisation, - Depersonalisation of birth, - Lack of privacy, - Inflexibility of labour and birth practices, - Limitation of resources
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is the role of doctors in welfare?

A
  • You must consider the safety and welfare of children and young people, whether or not you routinely see them as patients, - identifying signs of abuse or neglect early and taking action quickly are important in protecting children and young people, - Know what to do if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect, - Act on any concerns about a child or young person who may be at risk of, or suffering, abuse or neglect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

What are the indicators of a successful breastfeed?

A
  • Baby - audible and visible swallowing, sustained rhythmic suck, relaxed arms and head, moist mouth, regular soaked nappies, - Mother - breast softening, no compression of nipples at end of feed, relaxed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

What problems may occur with breastfeeding?

A
  • Nipple pain, - Engorgement, - Mastitis, - Inverted nipple, - Ankyloglossia (tongue ties), - Sleepy baby
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

What is ‘quality’ in relation to health care?

A

The extent to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Why is there a heavy emphasis on quality management in healthcare?

A

Quality management produces improved quality, reduced costs, increased productivity and an increased market share

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Why is consumer protection necessary? (3 medical practice deficiencies)

A
  • Medicine has a weak evidence base, - Large variations in clinical practice - doctors do give different treatments to patients with similar needs and personal characteristics, - Failure to measure success outcomes in healthcare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

What data are available to improve patient safety? (3 sources)

A
  • Hospital episode statistics (HES) - details referring GP, procedures given, duration of stay and discharge/death, lack of basic national data in primary care, - Patient reported outcome measurements (PROMs) - before procedure and after procedure quality of life measurement slowly developing, - Reference cost data - cost data are poor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

What is the summary hospital level mortality indicator (SHMI)?

A

The ratio between the actual number of patients who die within 30 days of discharge compared with the number that would be expected to die on the basis of average

201
Q

What are the key consumer protection agencies? (3 main ones)

A
  • Care Quality Commission (CQC) - regulates ‘quality’ and financial performance of all health and social care providers, public and private, provides regulatory framework, license all providers of health and social care, - NHS Improvement (formerly ‘Monitor’) - ensures financial obligations are met in terms of balancing income and expenditure, - National Institute for Health and Clinical Excellence (NICE) - set standards for treatment
202
Q

Who enforces the NICE guidelines?

A
  • Royal colleges, - GMC, - Professional audit
203
Q

How can consumer protection be improved?

A
  • Appraisal by peers, - Revalidation by the GMC, - Medical audit as a compulsory part of routine practice and annual job planning, - GP and consultant contracts - increasing transparency in comparative performance in relation to activity, costs, and patient reported outcomes, - Transparency and accountability
204
Q

What is clinical governance?

A

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

205
Q

What are the types of neglect? (4 types)

A
  • Physical neglect, - Educational neglect, - Emotional neglect, - Medical neglect
206
Q

What are the signs of neglect? (7 examples)

A
  • Malnutrition, begging, stealing or hoarding food, - Poor hygiene, matted hair, dirty skin, body odour, - Unattended physical or medical problems, - Frequent lateness or absence from school, - Inappropriate clothing, especially inadequate clothing in winter, - Frequent illness, infections or sores, - Being left unsupervised for long periods
207
Q

What are the 4 types of child abuse?

A
  • Physical abuse - deliberate aggressive actions on the child that inflict pain, - Neglect - failing to provide a child’s needs, - Psychological abuse - behaviours towards children that cause mental anguish or deficits, - Sexual abuse - when someone touches a child in a sexual way or commits a sexual act with him or her
208
Q

Who are the people involved in reproductive ethic debates? (3 main parties)

A
  • Parents - procreative autonomy, parents wishes regarding reproductive choice should be respected, state interference should be minimal, - Future or existing child - parents wishes should not be respected if not in interests of the future or existing child, - Their parties, including the state - use of resources, health care providers objections of cosncience
209
Q

What was the main outcome of the human fertilisation and embryology act (1990)?

A

‘A woman shall not be provided with fertility treatment services unless account has been taken of the welfare of any child who may be born as a result of the treatment (including the need of that child for a father)’

210
Q

What were some of the criticisms of the ‘welfare criterion’? (3 main criticisms)

A
  • Fertile couples don’t have to meet this criterion, - Predicting the welfare of future children is very difficult, - Research suggests not the case that a father is always required for a child to flourish
211
Q

What was the main outcome of the human fertilisation and embryology act (2008)?

A

Continues to talk about a duty to take account the welfare of the child in providing fertility treatment (hence, welfare criterion remains) but replaces reference to ‘the need for a father’ with ‘the need for supportive parents’, thus valuing role of all parents

212
Q

What is the pro-life argument?

A
  • Abortion ends the life of a foetus., - Human foetus has the moral status of a person, - It’s wrong to end the life of a person or something with moral status, - Therefore, abortion/termination of pregnancy is morally wrong
213
Q

What is procreative autonomy?

A
  • To have control over one’s reproductive capabilities, - The freedom to choose whether or not to have children
214
Q

What did the abortion act (1967, amended 1990) state?

A

A person shall not be guilty of an offence under the law relating to abortion when pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith:, - Pregnancy has not exceeded 24 weeks, - Termination is necessary to prevent injury to physical or mental health, - Continuing pregnancy would involve risk to the life of the pregnant woman, - Risk that if the child was born it would suffer from physical or mental abnormalities

215
Q

What are the arguments for assisted reproduction? (4 arguments)

A
  • Procreative autonomy, - Helps get around fertility problems, - More successful than other forms of assisted reproductive technology, - Can help single women and same-sex couples have a child
216
Q

What are the arguments against assisted reproduction? (7 arguments)

A
  • Involves destruction of embryos, - Higher risk of multiple pregnancy with associated risks of mortality and morbidity, - Is ‘unnatural’, - Encourages the mentality which views people as things which can be bought or sold as wanted, - IVF babies are more at risk of birth defects than naturally conceived babies, - Psychological and physical health risk on parents, - ART can be expensive
217
Q

What is pre-implantation genetic diagnosis and what are the associated ethical issues?

A
  • Genetic profiling of embryos prior to implantation 9as a form of embryo profiling), and sometimes even oocytes prior to fertilisation, - Can be sued for avoiding genetic diseases, - Issues - sex selection, saviour siblings - ‘Designer babies’
218
Q

What provisions, if any, should be made for doctors who conscientiously object - what are the 3 views?

A
  • Objections should always be respected - the autonomy of the medical provider is paramount, no-one should be made to do something that goes against their strongly held personal beliefs, - Objections should never be respected - women’s interests should always take priority, sometimes argued that if doctors don’t like this then shouldn’t have chosen medicine as a profession, - Objects can sometimes be respected (the GMC’s position) - it might be possible for women’s interests to be met while at the same time not requiring doctors to do something that would cause them a great deal of distress, e.g. perhaps can refer patients to abortion services or provide patients with information
219
Q

Which act says a 16 year old has full capacity?

A

The Family Law Reform Act of 1969

220
Q

What is Gillick competency?

A

Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge

221
Q

What are Fraser guidelines?

A

Doctor can give contraceptive advice and treatment to a person under 16 if they are mature and intelligent, likely to continue to have sex, and if the treatment is in their best interests

222
Q

What should you do before conducting an intimate examination? (5 steps)

A
  • Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions, - Explain what the examination will involve, - Get consent and record that the patient has given it, - Offer a chaperone, - Give the patient privacy to undress
223
Q

What is the role of the midwife in postnatal care? (7 key points)

A
  • Screening/identification of actual and/or ‘at risk’ patients, - Pregnancy and postnatal period are ‘window of opportunity; to make lifestyle changes - smoking cessation, diet, exercise, - Sign-posting, liaison and referral - mental health services, MDT working, - Health promotion - women and family, - Source of information - bonding, breastfeeding, - Reassurance and support, - Safeguarding - vulnerable adult or child
224
Q

What are the aims from NICE postnatal care up to 9 weeks after birth guidelines (2006, updated 2015)?

A
  • A documented, individualised postnatal care plan for every woman, - Communication, particularly about transfer of care, - Information giving - empower women to take care of their own health and their baby’s health, - Assess the health and wellbeing of the woman and her baby, - Alert women to signs and symptoms of potentially life-threatening conditions, - Encourages breastfeeding - large proportion of postnatal care, - Assess emotional wellbeing, - Parents should be given information regarding assessing baby’s general condition, identifying common health problems and how to contact a healthcare professional or emergency services if needed
225
Q

Who is in the pregnancy MDT? (7 roles)

A
  • Midwives, - GPs, - Obstetrics, - Support workers, - Health visitors, - Maternity care assistants, - Public health practicitioners
226
Q

What is the role of MDT postnatal care and support teams?

A

Postnatal care should be a continuation of the care the woman received during her pregnancy, labour and birth, and involve planning and regularly reviewing the content and timing of care, for individual women and their babies

227
Q

What are some of the barriers to MDT work?

A
  • Separate documentation, - Poor working relationship, - Lack of awareness and appreciation of the roles and responsibilities of others, - Limited time and resources, - Overlapping of roles and duplication of services, - Poor communication, - Lack of information sharing, - Lack of collaboration, - Lack of trust and confidence in the abilities of other agencies, - Increased workload, - Lack of appropriately trained staff
228
Q

What is the importance of research-informed practice? (5 points)

A
  • Personal experience is biased in various ways, - Research reports findings for more patients than we can hope to see in personal experience, - Research involves the application of scientific method - testing of hypotheses, systematic data collection, analysis-designed to minimise bias, - Recommendations have been assessed for their clinical and cost effectiveness for the NHS
229
Q

What is the research cycle?

A
  1. Identify a clinical problem, 2. Basic research - laboratory based, 3. Applied (clinical) research, 4. Clinical care
230
Q

What is the implementation gap?

A

Gap between scientific understanding and patient care

231
Q

What are the barriers to implementation of research-informed practice? (4 barriers)

A
  • Characteristics of the recommendations - easy to follow, compatible with existing norms, need for new skills, complexity of recommendations, - Characteristics of the adopters - knowledge, attitudes, skills and abilities, - Characteristics of the organisation - limitations and constraints, organisational culture, - Characteristics of the environment - social influence
232
Q

What is quality improvement (QI)?

A

Facilitate the uptake and continuing use of evidence-based policy and practice, focusing on recurrent problems within system of care to improve:, - Performance, - Professional development, - Service-user outcomes

233
Q

What does quality improvement involve? (5 aspects)

A
  • Engage participants across organisational levels, - Foster environment where improvement and innovation are viewed as normal, - Empowering staff to strive for change, - Provide knowledge and methods to implement change, - Remove barriers to change
234
Q

Give some examples of quality improvement initiatives

A
  • Revision of professional roles, - Introduction of MDTs, - Change in skill mix, or in the setting of service, - Facilitate audit and benchmarking cycles to identify variations in practice and outcomes that may be targets for QI efforts, - Network recognition for high quality practice, - Promote inter-institutional communication and collaboration (and inter-institutional competition)
235
Q

What makes a quality improvement initiative effective? (3 aspects)

A
  • Passive dissemination of information, such as distribution of educational materials or didactic lectures, is generally ineffective in driving change, - Multifaceted intervention that act of different levels of barriers to change are more likely to achieve improvements in policy and practice, - Key - tailors to the key barriers, no just ‘the usual approach’
236
Q

What is quality and outcomes framework (QOF)?

A
  • Annual reward and incentive programme detailing GP practice achievement results, - Enables commissioners to reward excellence across key domains, - Aims to improve standards of care by assessing and benchmarking the quality of care patients receive - compares delivery and quality of care against previous years
237
Q

Does quality and outcomes framework work?

A
  • Improvements associated with financial incentives seem to be achieved at the expense of small detrimental effects on aspects of care that were not incentivised, - Following the removal of incentives, level of performance across a range of clinical activities generally remain stable
238
Q

What was the aims of national commission for quality and innovation (CQUINs) 2014-15?

A
  • Friends and family test - incentivise high performing providers, - Improvement against the NHS safety thermometer, particularly pressure ulcers, - Improving dementia and delirium care, - Improving diagnosis in mental health
239
Q

What is the incidence of falls in the elderly?

A
  • 35% of 65-79 year olds, - 45% of 80-89 year olds, - 55% of 90+ year olds
240
Q

What are the possible consequences of falls?

A
  • Osteoporotic fractures, - Head injuries, - Contusions, lacerations, - Psychological problem - fear of falling, social isolation, depression, - Increase in dependence and disability , - Impact on carers - time and anxiety, - Institutionalism
241
Q

What are the risk factors for falls?

A
  • Muscle weakness, - History of falls, - Gait deficit, - Balance deficit, - Visual deficit, - Arthritis, - Impaired activities of daily living (AoL), - Cognitive impairment, - Age (>80 years), - Medical conditions - PD, stroke, hypotension, depression, epilepsy, dementia, arthritis, peripheral neuropathy, dizziness and vertigo
242
Q

How can falls be prevented/decrease risk?

A
  • Increase activity - diversity of physical activity, - Weekly walk for exercise, - Strong family networks, - Multifactorial falls risk assessment, - Multifactorial intervention, - Education and information
243
Q

What doesn’t help reduce falls?

A
  • Brisk walking, - Residential care setting - causes an increase, - High intensity strength training - increases injury and strain, - Educational and behavioural preventions alone - need further methods
244
Q

What is QALY?

A
  • Quality adjusted life year, - 1 QALY = 1 year in perfect health, - e.g. if an illness reduces quality of life by 20% (0.2) and this affects 10 people then 2 QALY are lost
245
Q

What is the cost of falls for the NHS each year?

A

£1.3 billion

246
Q

What is the cost of hip fractures for the NHS each year?

A
  • £12,000 per patient, - Around £720 million per year
247
Q

What is a common fracture in elderly people?

A

Fracture of the neck of femur

248
Q

What are the two types of fracture of the neck of femur?

A
  • Extracapsular - the bone outside the joint capsule breaks; fixed with sliding hip screw, intramedullary nail, - Intracapsular - the bone within the joint capsule breaks; fixed by internal fixation (screws, nails, plates and rods)
249
Q

What is avascular necrosis?

A
  • Death of bone tissue due to lack of blood supply, - Can lead to tiny breaks in the bone and the bone’s eventual collapse
250
Q

What is the main risk factor associated with increased risk of fracture?

A

Osteoporosis

251
Q

What are the risk factors for hip fractures? (10 examples)

A
  • Low bone mineral density (BMD) is associated with increased fracture risk, - Age - every 5 year increase doubles the risk, - Female gender, - Low body weight (correlates with bone density), - Family history of hip fracture, - Prior history of hip fracture, - Smoking, - Ethnicity - people of Afro-caribbean descent have very low fracture risk, - Corticosteroid use, - Medications e.g. psychotropic drugs
252
Q

How can hip fractures be prevented?

A
  • Fall prevention, - Bone protection - medication (bisphosphonates, calcium & vitamin D), hip protection
253
Q

What is primary prevention?

A

Avoidance of disease before any signs or symptoms develop

254
Q

What is secondary prevention?

A

Avoidance of progression or later problems, signs or symptoms present

255
Q

What would be primary and secondary prevention be in relation to stroke?

A
  • Primary - no history of stroke or TIA, - Secondary - after either of these have occurred
256
Q

What is the prevention paradox?

A
  • The majority of people who suffer a stroke are not at high risk of stroke (e.g. 75% have ‘normal’ blood pressure), - But if the whole population changes their health behaviour via public health mechanisms, this would lead to a much greater effect
257
Q

What are the effects of targeting population for prevention?

A
  • Large potential benefit to community, - Low potential benefit to individual, - May be low perceived benefit to individual
258
Q

What are the effects of targeting high risk groups for prevention?

A
  • Larger potential benefit to individual, - Smaller effect in population rate of stroke, - Many of the conditions you treat are asymptomatic, - Many of the treatments have side effects
259
Q

Which group of people are at the highest risk from stroke?

A
  • people who have already had one - secondary prevention reduces risk in these people, - 1/5 people with stroke have another after 3 months
260
Q

What medication is used for secondary prevention of strokes?

A
  • Ischaemic - clopidogrel, statins, anti-hypertensives, anticoagulant if AF, - Haemorrhagic - anti-hypertensives
261
Q

What percentage of people who have strokes are under 50 years old?

A

<20%

262
Q

What is the incidence in strokes in men and women?

A
  • Men are at a 25% higher risk of having stroke and at a younger age compared to women, - However, as women tend to live longer there are more total incidences of stroke in women
263
Q

What are the non-modifiable risk factors for stroke?

A
  • Age, - Gender, - Race - South Asian descent with western lifestyle, - Family history - rare congenital (in young people - CADASIL)
264
Q

What are the modifiable risk factors for strokes? (6 factors)

A
  • High blood pressure - biggest risk factor, - Diabetes, - Atrial fibrillation, - Smoking, - Hyperlipidaemia, - Obesity
265
Q

What did the PROGRESS trial show?

A

Reducing blood pressure after stroke reduces risk of stroke recurrence

266
Q

What are the barriers for initiating medical therapies for conditions with no obvious symptoms? (6 barriers)

A
  • Misinformed , - Not caring, - Side effects of tablets, - Forgetfulness, - Depression, - Cognitive impairment
267
Q

What is a confounding factor?

A
  • Distortion of the relationship between an exposure and outcome due to shared relationship with something else, - Confounders can either increase associated associated between exposure and outcome, or decrease association between exposure and outcome
268
Q

How can we limit confounding factors and what are the effects? (4 strategies)

A
  • Restriction - limit the participants of your study who have possible confounders; means that you have less data and difficult with multiple confounders, - Matching - you create a comparison group that is matched on the possible confounder, make case and control group as similar as possible on the confounder and then ask about exposure status; use for strong confounders like age and sex, - Stratification - analyse exposure-outcome association in different subgroups of the confounder, recombine data and use a weighted average of the strata; limitations - to take into account all confounders would require lots of strata and you may run out of data to fill all possible options n your strata, - Multiple variable regression - you can adjust for the effects of multiple confounders, try and produce a linear model between the outcome and the different exposures; allows for adjustment of estimates for confounding
269
Q

What is standardisation?

A

Way to limit confounding, often used to control for differences in age groups when comparing rates of disease in two populations with different age structures

270
Q

What is standardised mortality ratio (SMR)?

A

Ratio between the observed number of deaths in a study population to the number of expected deaths, , SMR = observed number of deaths / expected number of deaths

271
Q

What is direct standardisation?

A

Required we know the age-specific rates of mortality in all populations under study

272
Q

What is indirect standardisation?

A

Only requires that we know the total number of deaths and the age structure of the study population

273
Q

Why do we have waiting lists?

A
  • There is a limitless demand for health, people can always ‘be more healthy’ which created high demand, - limited resources - supply of money, staff, etc. is finite
274
Q

Why are waiting times important to patients? (5 examples)

A
  • The patient’s condition may deteriorate while waiting and in some cases the effectiveness of the proposed treatment may be reduced, - Experience of waiting can be extremely difficult distressing in itself, - Patient’s family life may be adversely affected by waiting , - Patient’s employment circumstances may be adversely affected by waiting, - Excessive waiting times may be symptoms of inefficiencies in the healthcare system and should be addressed as part of good management
275
Q

How can you measure waiting times? (3 methods)

A
  • Average waiting times (mean or median), - Proportion who waited longer than ‘x number of days’, - Average wait of people currently on the list
276
Q

What are the theories of NHS waiting lists?

A
  • The backlog - implies a need for occasional emergency injection of funds, - Demand management - waiting acts as a ‘price’ to deter frivolous use, - Allows NHS resources to be fully employed - don’t want lots of spare capacity as this is a waste, - Waiting lists are caused by underfunding and inefficiency
277
Q

How can the NHS reduce waiting times? (4 methods)

A
  • Manage demand - ensuring each referral represents the most appropriate decision for the care of the individual patient, - Manage the queue - ensuring waiting lists are well managed and patients are called for treatment in appropriate order, - Manage capacity - providing efficient and effective services that meet the level of demand from appropriate referrals, - Provide leadership - ensuring that all parts of the local NHS work together to achieve waiting time improvements in the best interests of patients
278
Q

What was the 2002-2008 policy ‘targets and terror’?

A
  • Performance management of Trusts and PCTs based on achievement of target waiting times, - Hospitals receive an overall performance score and managers could lose their jobs if targets missed
279
Q

What are the pros of ‘targets and terror’ policy?

A
  • No inpatients waiting longer than 3 months, - Outpatients reduced, significant increased expenditure alongside this, however funding has now remained constant meaning NHS is struggling despite increased demand
280
Q

What were the cons of ‘targets and terror’ policy?

A
  • Sacrifice of professional autonomy - managers pressuring doctors, may be forced to treat les urgent due to waiting times, - unmeasured performance sufferers - things that don’t have a target may suffer, - Adverse behavioural responses - e.g. emergency patients waiting in ambulances not emergency rooms, not classed as being in A&E until they are through the doors so essentially cheating, - Data manipulation and fraud
281
Q

What is possible criteria for priority on a waiting list? (6 examples)

A
  • Clinical urgency, - Clinical severity, - Potential health gain, - Productivity and economic loss, - Equity waiting e.g. poverty, - Length of time waiting
282
Q

What are the social consequences of deafness?

A
  • Social impact - difficult to have conversations, isolation, intimacy issues, problems at work, - Psychological impact - anger, low confidence, frustration, depression, embarrassment, - Practical issues - doorbells, phones, theatre and cinema, TV, alarms
283
Q

How can a stroke affect communication?

A
  • Aphasia (and sometimes dysphasia) - difficulty in the generation of speech and sometimes also in its comprehension, - Dysarthria - difficult or unclear articulation of speech that is otherwise linguistically normal (due to weakness of muscles used to speak), - Dyspraxia - affects movement and coordination, cannot move muscles int he correct order and sequence to make the sounds needed for clear speech
284
Q

What are the social consequences of speech and communication difficulties?

A
  • Not being able to express yourself clearly can be very isolating, - Depression, - Frustrating, - May not be able to participate in activities they used to enjoy, - Tiring - communicating may require a lot of effort
285
Q

What areas can medico-legal implications occur in a person with epilepsy?

A
  • Determination of fitness to drive and other similarly dangerous activities, - Determination of intent for alleged criminal actions
286
Q

What are the rules for whether people can drive with epilepsy?

A
  • Group 1 which applies to cars, motorbikes, and most other small vehicles - need to be seizure free for 12 months, - Group 2 which applies to bigger vehicles such as lorries, heavy goods vehicles and other specialised types of vehicle - unlikely to qualify for group 2 licence, need to be seizure free for 10 years and have not taken epilepsy medicines for 10 years, , NEW RULES relating to whether people can drive if:, - They have only had seizures while they sleep, - They have only had seizures that do not affect their consciousness, - Their doctor changed their dosage or medication, but they have now gone back to the original dosage or medication
287
Q

What are CAMs?

A
  • Complementary - non-mainstream practice is used together with conventional medicine, - Alternative - non-mainstream practice is used instead of conventional medicine
288
Q

What are the 5 big CAMs?

A
  • Acupuncture - fine needles are inserted at certain sites in the body for therapeutic or preventative purposes, - Chiropractic - spinal manipulation aims to treat ‘vertebral subluxations’ which are claimed to put pressure on nerves, - Herbal medicine - medicines with active ingredients made from plant parts, - Homeopathy - based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself, - Osteopathy - moving, stretching and massaging a person’s muscles and joints
289
Q

What is the underlying principle with CAMs?

A
  • Self-healing is triggered, - Longer-term effects may be due to physiological (re-)learning and behavioural/lifestyle changes integral to treatments, - Each therapy has its own mechanism(s) - mostly poorly understood
290
Q

What percentage of CAMs are covered by the NHS?

A

10%

291
Q

What are the barrier to CAMs on the NHS? (5 main barriers)

A
  • Regulatory issues, - Financial concerns in NHS, - Tribalism - different medical specialties ‘hold on’ to their patch, - Inertia - resistance to change, - Mixed evidence of effectiveness - not all are properly evidence-based
292
Q

Why should CAMs be provided by the NHS? (5 arguments)

A
  • Patient choice, - Preventative healthcare agenda, - Commissioning changes, - Personal budgets, - Growing evidence base
293
Q

Which complementary therapy is most used for MSK problems?

A

Osteopathy

294
Q

What is osteopathy used mainly to treat? (5 problems)

A
  • Back pain, - Repetitive strain injury, - Changes to posture in pregnancy, - Postural problems caused by driving or work strain, - The pain of arthritis and sports injuries
295
Q

What do chiropractors mainly treat?

A
  • Back, neck and shoulder problems, - Joint, posture and muscle problems, - Leg pain and sciatica, - Sports injuries
296
Q

What is acupuncture used to treat?

A
  • MSK patients, - Fertility/pregnancy - has become much more popular, - Neurological pain, - Depression, - Eczema, - Chronic pain, - Irritable bowel
297
Q

Why are people using acupuncture?

A

Effectiveness gap - a clinical area where available treatments are not fully effective or satisfactory for various reasons including lack of efficacy, adverse effects and acceptability to patients

298
Q

What is the evidence base for acupuncture?

A
  • Acupuncture correlated with physiological parameters i.e. with decreases in brain flow, - Acupuncture can be seen as having an overall effect vs usual care, - More effective than no treatment or sham treatment for lower back pain (indicate it is more than a placebo) but there are no differences in effectiveness compared with other conventional therapies, - Acupuncture, osteopath, chiropractic shown to be effective when compared to usual care, - As is the case with biomedicine, more and better research is needed
299
Q

What are the criticisms of acupuncture?

A
  • Is the effect too small and not clinically relevant?, - NSAIDs are commonly given for chronic back pain - NSAID vs placebo and acupuncture vs placebo have similar effect for pain reduction
300
Q

What does the NICE guidelines state about acupuncture in lower back pain, osteoarthritis, and headaches?

A
  • Lower back pain - consider manual therapy, do not offer acupuncture, - Osteoarthritis - manipulation and stretching should be considered as an adjunct to core treatments, do not offer acupuncture, - Headache/migraine - consider a course of up to 10 sessions of acupuncture over 5-8 weeks
301
Q

What are the 5 categories for significant impaired decision making ability?

A
  • Lack of insight - person suffers from some disability but seem unaware of the existence of their disability, - Cognitive impairment - e.g. dementia, - Presence of psychosis, - Severe depressive symptoms, - Learning disability
302
Q

Why is it important to support patients decision making? (5 reasons)

A
  • Patients generally happier if they can make decisions, - Enables patients to have self-determination, autonomy, - Likely to facilitate other positive goods - good doctor-patient relationship, - A professional requirement (GMC), - A legal requirement - Mental capacity act (2005)
303
Q

How might doctors assist patients in making decisions? (4 methods)

A
  • Using a different form of communication, - Providing information in a more accessible form, - Treating a medical condition affecting the person’s capacity, - Having a structured programme to improve a person’s capacity
304
Q

Which act are capacity determinants governed by?

A

Mental capacity act (2005)

305
Q

According to the mental capacity act, when does a person lack capacity?

A

A person lacks capacity if they are unable to:, - Understand information that may be relevant to the decision, including the consequence, - Retain information, even for a short time, - Use or weigh information to make decisions, - Communicate decision

306
Q

What are the 5 key principles of the mental capacity act?

A
  • Presumption of capacity - a person must be assumed to have capacity until proven otherwise; assumption can be over-ridden if shown to lack capacity for that decision at that time, - Right to be supported to make their own decisions - use different forms of communication, provide information in different formats, treat a condition that is impacting capacity thus restoring capacity, - Right to make eccentric or unwise decisions - a person is not to be treated as unable to make a decision merely because it is an unwise one, - Best interests - a decision made under the MCA for someone lacking capacity must be done in their best interests, - Least restrictive intervention - before the decision is made you should explore other less restrictive options
307
Q

How many people in the UK have dementia?

A

Approximately 850,000 people

308
Q

How might dementia first present?

A
  • Patient noticing changes - forgetfulness, difficulty with names and finding the right word, embarrassment in social situations, - Family or friends noticing changes - repetitive, forgets social arrangements, skills deteriorating, withdrawing, - Delirium - acute confusion with fluctuating level of consciousness, agitation, hallucinations, etc., - Social crisis - e.g. death of a spouse reveals cognitive dysfunction and impairment
309
Q

What is the impact of diagnosis of dementia on a patient?

A
  • Denial (with or without insight) - patient attributes all problems to old age, often accompanied by anger at the suggestion that there is anything wrong, - Grief reaction - similar reaction to receiving diagnosis of any serious illness, - Acceptance/positive coping strategies - need to reconsider the future
310
Q

What determines the response of the patient to the diagnosis of dementia?

A
  • Insight and stage of illness - ability to remember and process information, - Type fo dementia, - Previous personality, relationship, and support
311
Q

What is the impact of diagnosis on the carers?

A
  • Confirmation of something they have long suspected, - Fear, - Anger, - Grief
312
Q

What determines the response of the carer to the diagnosis?

A
  • understanding of illness, - Patient’s reaction, - Nature of the relationship with the patient and what else is happening
313
Q

What are the benefits of diagnosis?

A
  • Know what it is that you are dealing with, - Access to treatments, - Access to support services, - Information/education, - Planning for the future - financial affairs, etc., - Assess and manage risks - e.g. driving, etc.
314
Q

Describe the effect of dementia on the patient, spouse/partner, children and carers

A
  • Patient - loss of self-esteem, may find communication difficult, loss of independence and autonomy, change in social roles and relationships, impact on ADLs, - Partner - relationship becomes skewed, practical, emotional, financial, strained relationship with family/friends, - Child - role reversal, competing demands, conflict between family members, effect on young children, previous relationship, - Carers - stress, physical care, poor sleep, constant vigilance, loss of support, unable to take time off sick
315
Q

How much of the cost of dementia is paid by people with dementia and their families?

A

2/3 = £17.4 billion

316
Q

What percentage of carers don’t receive enough support?

A

43%

317
Q

Why are people with dementia at high risk of elder abuse? (3 main reasons)

A
  • More vulnerable, - May struggle to discuss their feelings and experiences or remember what happened to them, - Can be hard to detect abuse
318
Q

What are examples of advanced care planning?

A
  • Advanced statement of wishes - wishes and preferences about treatment/care they would like (NOT legally binding hence can use best interests judgement), - Advanced decisions/directives - a decision to refuse treatment (LEGALLY BINDING so should always be followed)
319
Q

What are advanced directives?

A
  • Extends patient autonomy to apply in situations where they don’t have capacity as defined under the MCA 2005, - A valid AD that refuses treatment should always be followed, - ADs allow patients refuse treatment but not to demand treatments
320
Q

What are advanced directives valid and applicable?

A
  • Patient is 18+ - note MCA is for 16+ but only 18+ can refuse treatment, - Patient lacks capacity at the time of treatment but had capacity at time of making AD, - Properly informed patient and statement is clear and applicable to current situations, - ADs can be used to refuse life-saving treatments but cannot be used to refuse basic care e.g. food/water
321
Q

What is Ulysses arrangement?

A

Advanced directive for bipolar disorder

322
Q

What are the pros of advanced directives?

A
  • Respect patient autonomy, - Encourages forward planning, - Patient will be less anxious about unwanted treatment, - May lower healthcare costs as people opt out for less aggressive treatments
323
Q

What are the cons of advanced directives?

A
  • Difficulty to verify if the patient’s opinion has changed since making AD, - Difficult to ascertain whether the current current circumstances are what the patient foresaw when making AD, - Possibility of coercion on behalf of the patient, - Possible wrong diagnosis, - Can patients imagine future situations sufficiently and vividly enough to make their current decisions adequately informed?
324
Q

What are some of the research atrocities in history?

A
  • Nazi medical experiments (Nuremberg trials), - Willowbrook study - injected vulnerable children with Hep B to develop vaccine, - Tuskegee syphilis study - African-American men given syphilis but not given antibiotics, researchers wanted to see disease progression, - Alder Hey - retaining children organs without consent, - Wakefield - MMR scandal (autism claim)
325
Q

What is the Nuremberg Code (1947)?

A

The Nuremberg code resulted from the Nuremberg trials. It was an early code for research ethics principles, including:, - Need for voluntary consent, - Avoid all unnecessary physical and mental suffering and injury, - Conducted only by scientifically qualified persons

326
Q

What is the Helsinki declaration (1964)?

A

Includes requirement that any human research is subject to independent ethical review and oversight by properly convened committee

327
Q

What are some research ethics principles? (6 examples)

A
  • Usefulness - valid, good method, hasn’t been done before, strong justification, - Necessity - does it need to be done this way?, - Risks - risks should be as low as possible, sometimes balance minimal risk with benefits, - Consent - valid (competent, voluntary, informed), deception is sometimes needed e.g. psychological studies, - Confidentiality - respect patients information, - Fairness - who benefits? will it favour particular population group?, - Approval - from research ethics committee
328
Q

What is valid consent?

A

Voluntary, informed, patient is competent

329
Q

What does voluntary consent mean?

A
  • Not putting pressure on patients or volunteers, - Not offering inappropriate (financial) inducements, - Not threatening/imposing sanctions if they don’t take part
330
Q

What should patients be given to facilitate consent?

A
  • Information sheets, - Presentation of information - no jargon, easy to understand, - Summary of key points, - Opportunity to ask questions, - Time to decide - at least 24 hours
331
Q

What is confidentiality and why it is important?

A
  • Confidentiality is the state of keeping or being kept secret or private , - It is important for patient trust and for ensuring valid results, - All patient information is confidential
332
Q

How can we increase the level of confidentiality?

A
  • Limit access to identifiable information, - Securely store data documents, - Assign security codes to computerised records, - Properly dispose, destroy or delete study data/documents, - Encrypt identifiable data
333
Q

What is an ethics committee?

A

Body responsible for ensuring that medical experimentation and human research are carried out in an ethical manner in accordance with national and international law

334
Q

Why do we need ethics approval? (5 reasons)

A
  • To protect participants, - Make sure no harm to researchers, - Researcher will not be covered is a claim regarding the research is made against them, - Many publications will not accept research that was not ethically approved, - Funders will not provide financial support without ethical approval
335
Q

When is ethics approval needed? (3 examples)

A
  • Research involves humans, - Research involves confidential information, - Research involves biological material (embryos, stem cells, etc.)
336
Q

What are some of the types of research ethics committees?

A
  • NHS research ethics committees, - Higher education institution (HEI) research ethics committees, - Gene therapy advisory committee, - Social care research ethics committee, - Ministry of defence research ethics committee
337
Q

What does the human tissue act (2004) state about research?

A
  • Consent for storage and use of tissue for ‘scheduled purposes’ is required for tissues from living or deceased persons, - These purposes include research in connection with disorders, or the functioning of the human body, - However, consent is not required to use tissue obtained from living patients if the tissue is anonymous to the researcher and the project has research ethics approval
338
Q

What percentage of deaths does CHD cause in the UK?

A
  • 29% men, - 28% women
339
Q

Why are the death rates falling from CHD?

A
  • Risk factors improved - fewer smokers, cholesterol better controlled, HTN controlled, - Treatments - medical interventions improved for various cardiac conditions
340
Q

What is the effect of health inequalities on CHD?

A

Lower social class at higher risk - health behaviours

341
Q

What are the non-modifiable risk factors for CHD?

A
  • Elevated blood cholesterol, - High LDL, low HDL, - High BP, - Diabetes, - Smoking, - Obesity, - Excessive alcohol, - Inactivity, - Excessive stress
342
Q

What is risk?

A

The probability of an event in a given time period

343
Q

What is the equation for risk ratio?

A

Risk ratio = risk for exposed / risk for non-exposed

344
Q

What is the equation for risk difference?

A

Risk difference = Risk for exposed - Risk for non-exposed

345
Q

What is odds ratio?

A

A ratio of the odds of an event in an exposed group to the odds of the same event in a group that is not exposed

346
Q

What is the equation for odds ratio?

A

OR = ad/bc, , a = disease with exposure (case), b = no disease with exposure (control), c = disease with no exposure (case), d = no disease with no exposure (control)

347
Q

What is population attributable risk?

A

The risk of disease will increase as the exposure prevalence or relative risk increases

348
Q

What is the leading cause for cancer mortality?

A

Lung cancer

349
Q

What are the main risk factors associated with lung cancer?

A
  • Smoking, - Radon, - Asbestos, - Environmental tobacco exposure, - Genetics, - Other lung diseases, - Prior radiation in chest area
350
Q

What percentage of lung cancer cases are cause by smoking?

A

90%

351
Q

What is the second leading cause of lung cancer after smoking?

A

Radon

352
Q

What are the different types of lung cancer?

A
  • Small cell (13%), - Non-small cell (87%) - adenocarcinoma (>40%), squamous cell carcinoma (20%), large cell carcinoma (2%), - Mesothelioma
353
Q

How many people in the world are infected with TB?

A

1/4 of the world population = approx. 2 billion people

354
Q

How many deaths per year does TB cause (million)?

A

1.5 million people (in 2020 according to WHO)

355
Q

What are the factors associated with recent increases in the prevalence of TB? (4 main factors)

A
  • Urban homelessness, - IV drug use, - Growing neglect of TB control programmes, - AIDS epidemic
356
Q

What time of year does TB incidence peak?

A

Spring/summer

357
Q

What can be done to address rising rates of TB?

A
  • Put more people on ART, - New vaccine , - Improved drugs , - Diagnose better
358
Q

What is the prevention paradox?

A

A preventative measure that brings large benefits to the community offers little to each participating individual

359
Q

What are the pros of ‘high risk’ approaches to health promotion?

A
  • Appropriate to individual, - Motivated subject, - Motivated clinician, - Cost-effective resource use, - benefit for risk is high
360
Q

What are the cons of ‘high risk’ approaches to health promotion?

A
  • Screening is difficult, - palliative and temporary, - Limited potential as not many people, - Labelling
361
Q

What are the pros of ‘population’ approaches to health promotion?

A

Large potential as targeting many people

362
Q

What are the cons of ‘population’ approaches to health promotion?

A
  • Population paradox - small perceived individual benefit, - Poor motivation can cause compliance issues, - Benefit for risk is low
363
Q

What are some examples of occupational lung disease?

A
  • Occupational asthma, - COPD, - Pneumoconiosis, - Toxic pneumonitis, - Hypersensitivity pneumonitis, - Benign pleural disease, - Infections including TB, - Malignancy of lung and pleura
364
Q

How have occupational health risks changed over time?

A
  • Better environmental control an health and safety - e.g. from mid 20th century with coal mining, etc., - Depends on health of the population and local industry, - Diagnosis of occupational lung disease (e.g. occupational asthma) has improved, - Biological factors - predisposing/protective factors
365
Q

What is occupational asthma?

A

Like other types of asthma, it is characterised by airway inflammation, reversible airways obstruction, and bronchospasm, but it is caused by something in the workplace environment

366
Q

Give some examples of occupations that are at a higher risk for occupational asthma

A
  • Bakers, - Welders, - Paint sprayers, - Laboratory workers
367
Q

What history would you expect from a patient with occupational asthma?

A
  • Symptoms worse at work and better away from work e.g. weekends and holidays, - Peak flow falls at work and improves away from work
368
Q

Give some occupational causes of COPD

A
  • Coal mining, - Agricultural jobs, - Contraction workers, - Dock workers, - Brick making
369
Q

What is pneumoconiosis?

A

Occupational restrictive lung disease caused bye inhalation of dust (coal dust, silica, asbestos)

370
Q

What is simple coal workers pneumoconiosis?

A
  • After around 10 years of coal mining, small nodules are present, - Shouldn’t cause major impairment in lung function, - Some coal workers have symptoms of chronic bronchitis (cough)
371
Q

What are possible complications with coal workers pneumoconiosis?

A
  • Occurs in coal workers especially fi the coal they work with is heavily contaminated with silicates, - Very serious - scarred, fibrotic tissue distorts the remaining lung (gross obstruction and restriction)
372
Q

What is silicosis?

A
  • Occupational lung disease caused by inhalation of crystalline silica dust, and is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lung, - It is a type of pneumoconiosis
373
Q

What is siderosis?

A
  • Deposition of iron in tissue, - Iron has no effect on lungs - no associated fibrosis or narrowed airways
374
Q

What is acute pneumonitis?

A
  • Acute inhalation of a substance that causes symptoms immediately, - Can be caused by chlorine, ammonia, organic chemicals, metallic compounds, - Form of acute respiratory distress syndrome
375
Q

What is hypersensitive pneumonitis?

A
  • Type 3 hypersensitivity reaction (immune complex deposition), - It is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dust
376
Q

What are some causes of hypersensitive pneumonitis?

A
  • Bird fancier’s lung - due to feathers and bird droppings, - Farmer’s lung - due to mouldy hay (moulds and bacteria), - Metalworking fluids HP - due to mist from metalworking fluids (non-TB mycobacterium)
377
Q

What percentage of lung cancers in men are related to occupation?

A

10%

378
Q

What is asbestos?

A
  • A natural occurring silicate mineral, - Used a lot in the 1950s-60s as a building material - fire retardant and could be used as cement, - In the 1960s it was found to cause malignant mesothelioma (pleural tumour) - only a small amount of asbestos was found to cause this
379
Q

What are the 2 types of asbestos fibres?

A
  • Serpentine - curly, white asbestos (relatively harmless), cleared with mucociliary escalator, - Amphiboles - short, sharp, blue/brown asbestos (have malignant potential)
380
Q

What is mesothelioma?

A
  • Cancer of the mesothelium almost inevitably caused by occupational exposure asbestos, - Latency period of around 40 years
381
Q

Where are claims submitted for compensation for occupational illness in the UK?

A

Disability benefits centre of benefits agency (DSS)

382
Q

What is decision analysis?

A

Systematic and quantitative way of making healthcare decisions e.g. when presented with two options

383
Q

What does decision analysis assume?

A
  • Decision process is logical and rational, - A rational decision maker will choose the option to maximise utility (the desirability or value attached to a decision outcome)
384
Q

What are the stages ind decision analysis? (4-5 stages)

A
  1. Structure the problem as a decision tree - identifying choice, information (what is and is not known) and preferences, 2. Assess the probability (chance) of every choice branch, 3. Assess (numerically) the utility of nervy outcome, 4. Identify the option that maximises unexpected utility, 5. (Possibly) Conduct a sensitive analysis to explore effect of varying judgements
385
Q

What do squares and circles mean on decision trees?

A
  • Squares - indicated decision, represents choice between actions, - Circles - indicated chance (probability), represents uncertainty, potential outcomes of each decision
386
Q

How do you calculate expected utility?

A

Expected utility = utility value x probability

387
Q

What is sensitive analysis?

A

Sensitive analysis explores what would happen if the probabilities or utility values were slightly different to the ones you are using - calculate effect of uncertainty on decision

388
Q

What are preference sensitive and probability sensitive decisions?

A
  • Preference sensitive - the person might feel strongly about the side effects of the treatment, - Probability sensitive - sensitive to changes int he chance of different outcomes
389
Q

What are the benefits of using decision analysis to make decisions? (5 benefits)

A
  • Makes all assumptions in a decision explicit, - Allows examination of the process of making a decision, - Integrates research evidence into the decision process, - insight gained during process may be more important then the generated numbers, - Can be used for individual decisions, population levels decisions and for cost-effectiveness analysis
390
Q

What are the negatives of using decision analysis to make decisions?

A
  • Probability estimates - required data sets to estimate probability may not exist; subjective probability estimates are subject to bias, - Utility measures - individual may be asked to rate a state of health they have not experienced; different techniques will result in different numbers; subject to presentation framing effects; the approach is reductionist
391
Q

What is the ICF model of disability?

A

Functioning and disability are multi-dimensional concepts relating to:, - Body functions and structures - physiological functions and anatomical parts of the body, including cardiac and respiratory systems, - Activities, - Participation of people in life, - Environmental factors

392
Q

What is palliative care?

A
  • Active holistic care of patients with advanced progressive illness, - It aims to treat or manage pain and other physical symptoms and will also help with any psychological, social or spiritual needs
393
Q

What are the goals of palliative care? (8 goals)

A
  • Improves quality of life, - Provides relief from pain and other distressing symptoms, - Supports life and regards death as a normal process, - Doesn’t quicken or postpone death, - Combines psychological and spiritual aspects of care, - Offers a support system to help people live as actively as possible until death, - Offers a support system to help the family cope during a person’s illness and in bereavement, - Uses an MDT approach to address the needs of the person who is ill and their families
394
Q

Who is general palliative care given to?

A

Core aspect of care for all patients and their families with advanced disease by all health professionals

395
Q

Who is specialised palliative care for?

A

Patients (and carers) with unresolved symptoms and complex psychosocial issues, with complex end-of-life and bereavement issues

396
Q

Who provides specialised palliative care?

A
  • NHS - community/hospital clinic nurse specialist, some consultants, some inpatient units, macmillan, - Voluntary - hospice services, inpatient beds, independent charities (Marie Curie, Sue Ryder), macmillan
397
Q

What is end of life care?

A
  • Branch of palliative care - caring for people who are nearing the end of life, - ‘End of life care pathway’ - last 48 hours of life
398
Q

What are some of the challenges for the future of palliative care?

A
  • Inequality of service provision and standards, - Funding, - Training, recruitment and retention, - Maintaining a sense of humanity and compassion - due to increasing technologies and treatment options for management of disease
399
Q

What is ‘total pain’?

A

Recognises pain as being physical, psychological, social and spiritual

400
Q

What are the different types of nurses involved in palliative care? (4 main types)

A
  • District nurse - primary health care team, community based, generic palliative care skills, ‘hands on’ nursing skills, - Practice nurse - primary health care team, practice based, generic palliative care skills, ‘hands on’, - Marie Curie nurse - community based, arranged by district nurse, specialist palliative care skills, ‘hands on’, - Macmillan nurse - community or hospital based, specialist palliative care advice, support, resource
401
Q

Where is the preferred place of death?

A
  • Most people wish to die at home, - Few people wish to die in hospital, - Most people die in hospital, - Hard to plan because you don’t know when it will happen
402
Q

What percentage of admission notes document the CPR decisions?

A

10%

403
Q

What percentage of in-hospital CPR is not appropriate?

A

40-50%

404
Q

What is DNACPR?

A

Do Not Attempt CPR - decision made and recorded in advance, applies to those present if a person subsequently suffers sudden cardiac arrest or dies

405
Q

What are Bowlby’s 4 stages of grief?

A
  • Numbness, - Yearning/pining and anger, - Disorganisation and despair, - Reorganisation
406
Q

What are the symptoms of grief?

A
  • Sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, numbness, - Somatic sensations - stomach, chest, throat, sensitivity to noise, depersonalisation, breathlessness, muscle weakness, lack of energy, dry mouth, - Concentration impairment, preoccupation with the deceased, hallucinations, disbelief, - Sleep and appetite disturbance, absent-mindedness, social withdrawal, dreams of deceased, avoidance of reminders, searching and calling out, sighing, overactivity, crying
407
Q

What is Warden’s tasks of mourning? (4 tasks)

A
  1. Accepting the reality of the loss e.g. come to terms with the person being ‘gone’, 2. Work through the pain of grief, 3. Adjust to an environment in which the deceased is missing, 4. Emotionally relocate the deceased and move on with life
408
Q

What factors affect the severity of grief? (6 factors)

A
  • Closeness of relationship, - Meaningfulness of relationship, - Nature of relationship prior to death, - Expectedness and manner of death, - Age and developmental stage of griever, - Social support
409
Q

What is spirituality?

A

Umbrella term that includes religious/faith frameworks, but it also includes the meaning of life, purpose, sense of personhood

410
Q

How can religious beliefs impact on bereavement?

A
  • Belief in an afterlife - the continuing existence of the loved one and possibility of meeting up again, - Continued attachment - prayer as means of continuing connection with the deceased, - Defence against fear of personal death/extinction, - Religious funeral rituals that aid and progress the grief process, - Religious funeral rituals that recruit social support
411
Q

What is pathological grief?

A
  • Extended grief reactions - getting stuck in one of the phases (normally each phase is about 6 months), - Can be in denial for an extended period of time - exhibit mummification (not changing things in dead persons room for example), - Major depressive disorders >2 months after loss
412
Q

What is the myth of the neutral therapist?

A
  • Idea that psychotherapists will ‘leak’ their personal views regardless of their intention, - This will come across in their questioning/direction of questioning
413
Q

What are CDSS?

A

Clinical decision support system - designed to aid clinician decision making

414
Q

What are the different types of CDSS?

A
  • Computerised, - Paper based, - Reminder systems, - Developed to aid with particular decisions
415
Q

What are some examples of CDSS? (4 examples)

A
  • Reminder systems - screening, vaccination, testing, medication use, - Decision systems (diagnosis and treatment) - model individual patient data against epidemiological data, - Prescribing - advice on drug and dosage, highlights potential drug interaction, - Condition management - Assists monitoring patients
416
Q

What are the effects of computer support on prescribing? (6 main effects)

A
  • Reduced time to achieve therapeutic stabilisation, - Reduced risk of toxic drug level, - Reduced length of hospital stay, - Increased size of initial dose, - Increased serum drug concentration, - No change in adverse effects of drug
417
Q

Do CDSS work?

A
  • Can improve practitioner performance in diagnosis, disease management, prescribing/drug dosing, rates of vaccination, screening, etc., - Evidence for effects on patient outcomes not so robust
418
Q

What are patient decision aids?

A
  • Help patient understand probable outcomes of options, - Help patient consider the personal value they place on benefits vs harm, - Support patient in decision making, - Include additional information - on disease, costs, probability of outcomes, peoples opinions
419
Q

What is the key issue with patient decisions aids?

A

No consensus on what information should be included in a patient decision aid

420
Q

What improves practice when using decision support? (4 examples)

A
  • Providing decisions support as part of the clinician workflow, - Providing recommendations for management (not just patient assessments), - Providing decision support when and where decision making was happening, - Computer-based decision support
421
Q

What are potential barriers to using CDSS? (4 examples)

A
  • Earlier negative experience of IT, - Potential harm to doctor-patient relationship, - Obscured responsibilities (loss of autonomy or reasoning), - Reminders increase workload
422
Q

What are potential facilitators of CDSS?

A
  • Self-control of CDSS, - If clinical can notice help in practice
423
Q

What is food poisoning?

A

Diarrhoea and vomiting with or without pain

424
Q

What are the major causes of food poisoning?

A
  • Not cooking food thoroughly (particularly meat), - Not correctly storing food that needs to be chilled, - Keeping cooked food unrefrigerated for a long period, - Eating food that has been touched by someone who is ill or has been in contact with someone with diarrhoea or vomiting, - Cross-contamination e.g. preparing raw meat on a chopping board then preparing salad on the same board
425
Q

What are some microbial infections that cause food poisoning?

A
  • Bacterial - salmonella, campylobacter, shigella, C. difficile, - Viral - norovirus, rotavirus, - Fungal - aspergillus, - Protozoal - cryptosporidia, giardia
426
Q

What are some toxins that cause food poisoning?

A
  • Bacterial toxins - clostridium perfringens, s. aureus, clostridium botulinum, - Marine biotoxins - scombroid poisoning, shellfish, ciguatera
427
Q

What are some chemicals that cause food poisoning?

A
  • Heavy metals, - Pesticides, - Herbicides
428
Q

What is the most common cause of food poisoning?

A

Campylobacter

429
Q

Describe the clinical picture of salmonella infection (transmission, incubation, symptoms)

A
  • Transmission - ingestion of contaminated food, faecal contaminations, person-person, infected animals, - Can cause enteric fever or enterocolitis, - Incubation period is 12-72 hours, - Symptoms - vomiting, diarrhoea, fever, headache, chills
430
Q

Describe the clinical picture of staphylococcus aureus infection (transmission, incubation, symptoms)

A
  • transmission - contaminated food by skin/nasal flora, - Produces enterotoxins, - Incubation - 24 hours, - Symptoms - rapid onset, projectile vomiting and diarrhoea
431
Q

Describe the clinical picture of cryptosporidium infection (transmission, incubation, symptoms)

A
  • Transmission - animal-human, person-person, contaminated water or land, associated with foreign travel, - Incubation - 2-5 days, - Symptoms - watery or mucoid diarrhoea, severe illness in immunocompromised
432
Q

Describe the clinical pictures of escherichia coli infection (transmission, incubation, symptoms)

A
  • Transmission - contaminated food, person-person, - Incubation - 1-6 days, - Symptoms - haemorrhagic colitis, 5% get haemolytic uraemic syndrome
433
Q

Describe the clinical picture of norovirus infection (transmission, incubation, symptoms)

A
  • Transmission - faecal-oral route, environmental contamination, contaminated food and water, - Incubation - 24-48 hours, - Symptoms - nausea, projectile vomiting, low-grade fever, diarrhoea
434
Q

Describe the clinical picture of clostridium perfringens infection (transmission, incubation, symptoms)

A
  • Transmission - contaminated cooked meat and poultry , - Incubation - 8-22 hours, - Symptoms - diarrhoea, abdominal pain
435
Q

Describe the clinical picture of campylobacter infection (transmission, incubation, symptoms)

A
  • Transmission - raw/undercooked meat, unpasteurised milk, bird-pecked milk, untreated water, domestic pets with diarrhoea, person-person, - Incubation - 2-5 days, - Symptoms - fever, headache, malaise, nausea, diarrhoea, vomiting is uncommon
436
Q

How can food poisoning be prevented?

A
  • Isolation, - Hand hygiene, - Protection e.g. gloves, gowns, masks, - Environmental cleaning, - Respiratory hygiene and cough etiquette
437
Q

What is ‘safe food’?

A

Food that will not cause harm to a person who consumes the food when it is prepared, stored and/or eaten according to its intended use

438
Q

What are concerns with food?

A
  • Food borne illness, - Nutritional adequacy, - Environmental contaminants, - Pesticides, - Naturally occurring contaminants, - Food additives
439
Q

What does the public health act state about food poisoning?

A

Allows exclusions from work of people that pose increased risk of GI infection spread - children in nursery/pre-school, people who work with food, health and social care staff, people with doubtful hygiene

440
Q

What are some of the offences under the food safety act (1990)? (3 examples)

A
  • The sale of food that has been rendered injurious to health, is unfit for human consumption or is so contaminated that it would not be reasonable to expect it to be used for human consumption, - The sale of food which is not of the nature or substance or quality demanded by the purchaser, - The display of food for sale with a label which falsely describes the food, or is likely to mislead as to the nature or substance or quality of the food
441
Q

What is hazard analysis critical control point?

A
  • Analysis of the potential food hazards in a food business (e.g. microbiological, chemical & foreign matter contamination), - Identification of the points in the operations where such hazards could occur, - Deciding which of the identified points are critical to food safety (critical points), - Identifying and implementing effective control and monitoring procedures at the critical points, - Reviewing the hazards and critical points at periodic intervals and particularly when any change occurs to the operation
442
Q

What are the objectives in food poisoning outbreaks? (3 objectives)

A
  • Reduce the number of primary and secondary cases, - Reduce the harm consequent on the episode, - Prevent further outbreaks
443
Q

What are the investigations done in food poisoning outbreaks?

A
  • Preliminary phase - is there an outbreak? confirming the diagnosis, what is the nature and extent of the outbreak?, - Immediate steps - who is ill? how many? case finding; what is the cause? is proper care being arranged? what immediate action can be taken?
444
Q

What are outbreak outliers?

A
  • Outliers are cases at the very beginning and end that may not appear to be related, - First check to make certain they are not due to a coding or data entry error
445
Q

What might outbreak outliers represent? (6 examples)

A
  • Baseline level of illness, - Outbreak source, - A case exposed earlier than the others, - An unrelated case, - A case expose later than the others, - A case with a longer incubation period
446
Q

How can analytical epidemiological studies be useful to identify probable food source of outbreak?

A
  • Compare food history of ill and well persons, - Point source outbreak - cohort study, - Common source of outbreak - case-control study
447
Q

Which GI cancers are prevalent in which populations?

A
  • Oesophageal - Middle East and Chine, - Gastric - Russia, - Colon - ‘Western’ countries, e.g. USA, UK
448
Q

What dietary intake increase the risk of colorectal cancer?

A

Fat intake

449
Q

What is the evidence base for ‘5-a-day’?

A
  • Evidence from observational epidemiology that average fruit/veg intake of less than 200g associated with increased risk of cancer, but possibly little additional benefit beyond 400g/day, - Very little evidence that ‘5-a-day’ have impact on cancer
450
Q

Describe the relationship between beta carotene and cancer

A
  • Beta carotene found in fruit/vegetables, - Cohort studies indicated protective relationship against cancer, - However RCT showed beta carotene increased risk of cancer, - Cohort groups had reduced risk due to confounding factors, e.g. increased exercise, reduced smoking, etc.
451
Q

What are the problems with measuring diet?

A
  • Random error - diet varies and difficulties in measurement, people don’t eat the same things everyday and individual consumptions vary significantly, - Homogeneity of exposure - if you only do your studies in the same types of populations they are likely to have similar environments and hence diets, so you are not able to apply results to the population, - Bias, - Confounding
452
Q

What are the different measures of diet?

A
  • Food disappearance data, - Household survey - what do you buy and who eats what?, - Individual surgery - 24 hour recall, food frequency (very open to bias), diet diary, biomarkers (very rarely have this)
453
Q

What are the pros and cons of food frequency qeustionnaires?

A
  • Pros - captures usual diet and less work to code/complete, - Cons - don’t record actual diet as eaten, overestimates fruit and vegetables, poor measure of energy intake, less flexible
454
Q

What are the pros and cons of diet diaries?

A
  • Pros - records diet as eaten (over limited period), better estimate of energy and absolute intake, more flexible, - Cons - required effort to complete and expensive to code
455
Q

What are the main dietary associations with cancer? (7 examples)

A
  • Oesophageal - alcohol, obesity, - Stomach - possibly salted preserved foods, - Pancreas - overweight, obesity, - Hepatic - aflatoxin contamination, - Colorectal - preserved and red meat, alcohol, body fat, - Breast - alcohol, overweight, - Urologic - high calcium
456
Q

What is the trend of alcohol consumption in the UK?

A
  • Per capita consumption in the UK is lower than many European countries, - however people in the UK start earlier and tend to drink more on single occasions (‘binge drinking’), - Peak of consumption was 2008 - this is linked with affordability
457
Q

What percentage of men and women have an alcohol use disorder?

A
  • 38% of men and 16% of women (16-64) have an alcohol use disorder (approximately 8 million people), - 21% of en and 9% of women are binge drinkers - double the recommended daily intake, - 3.6% of the total population are alcohol dependent (1.1 million people)
458
Q

Where is identification and brief advice (IBA) delivered?

A

Delivered in a range of setting - primary and secondary care but also community setting (pharmacies, community health-oriented events)

459
Q

What specialised treatment is available for alcohol problems? (4 examples)

A
  • CBT - common, - Behavioural approaches - behavioural couples therapy, behavioural self-control for moderation goal, - Motivational interviewing, - Social behaviour and network therapy (SBNT)
460
Q

Which medical conditions are wholly attributable to alcohol?

A
  • Alcoholic liver disease, - Alcoholic neuropathy, - Chronic pancreatitis, - Alcoholic cardiomyopathy , - Alcoholic gastritis, - Alcohol related accidents, - Risk factor for - colon cancer, mouth and oesophageal cancer, etc.
461
Q

What are some of the social consequences of alcohol consumption?

A
  • Death - declining since 2008, - Crime and disorder, - Domestic violence - involved in 73% of cases, - Poor productivity at work, - Absences/sick leave from work, - Family effects - 5 million families deal with problem drinker, arguments, violence, debt, relationship problems
462
Q

What are effective, moderately effective and less effective policies for alcohol related health promotion?

A

More effective policies:, - Price increases - taxation, minimum price, - Restricting availability - opening times, reducing outlet density, age restrictions, , Moderatley effective policies:, - Restricting exposure of young people to adverts, - Treatment - identification and brief advice, , Less effective policies:, - Drug and alcohol education, - Mass media campaigns

463
Q

What are the key UK departments involved in alcohol policy? (2 main departments)

A
  • Home office (focus on public disorder), - Department of health (focus on public health)
464
Q

What was the ‘alcohol strategy (2021)’?

A
  • Minimum unit price policy dropped, multi-buy promotion offers were not banned as suggested, - Local health bodies able to instigate review of licenses, - Double fine for selling alcohol to underage people, - ‘Enforced sobriety’ - 1 year pilots based on US models, - Overview alcohol consumption guidelines for adults, - Alcohol included in NHS health check for adults 40-75
465
Q

What is efficiency?

A
  • Target resources to those activities that give the greatest health gain for the money spent as this will maximise population health gain for the money spent as this will maximise population health gain, - Informing these choices required estimation of value of what is given up when a patient is treated (opportunity cost) and the value of what is gained in terms of improvements in the health of patients
466
Q

What is allocative efficiency?

A

Investing in healthcare are interventions that are worthwhile

467
Q

What is technical efficiency?

A

Investing in health care interventions which make the best use of scarce resources

468
Q

What is equity in financing?

A
  • Geographic allocation of funding by weighted capitation, - Resourcing determined by population weighted by need
469
Q

What is the class equality/inequality in health care?

A

Evidence of social class equality in the use of primary care and social class inequality in the use of secondary care

470
Q

What is the concept of the ‘margin’?

A

The incremental change in resources (inputs and their cost) committed to an activity that produces an incremental change in effects (improved patient outcomes)

471
Q

Why is the margin important?

A
  • Incremental investments in an activity may be associated with diminishing returns, - i.e. successive increase in activity (inputs) yield declining benefits to the patient, or the more you do, the less they benefit
472
Q

Why do we need economic evaluation?

A
  • Values both inputs (opportunity costs) and outputs (health outcomes) of any intervention, - Assess if changes in resource allocation are efficient, - Important because increasing healthcare expenditure needs best outcome for the money e.g. NICE
473
Q

How do you measure cost?

A
  • Cost to NHS - NICE perspective, cost of drug, cost of delivery, - Cost to patient, carers, and society - lost working days
474
Q

How do you measure benefit?

A

Health gain = increase in length + QoL

475
Q

What is cost-minimisation analysis?

A

Chooses cheapest option between treatments that have identical outcomes

476
Q

What is cost-effective analysis?

A
  • Costs and outcomes are combined into a single measures e.g. reduction in blood pressure, - Allows comparison between treatments in the same therapeutic area only
477
Q

What is cost-utility analysis?

A
  • Combines multiple outcomes into a single measure (QALY) using QoL instruments e.g. EQ5D, - Allows comparisons between alternatives in different therapeutic categories e.g. CV and cancer
478
Q

What is cost-benefit analysis?

A

Puts cost and benefit into monetary/numerical terms, e.g. how much is the 3 months gained worth to the patient?

479
Q

When can cost-effectiveness analysis be used?

A
  • If the outcome measures are just clinical, - If other more generic outcome measures are used, use cost analysis to get QALY (NICE use it)
480
Q

What are the levels of resource allocation decisions?

A
  • Macro (societal) level - regarding health funding vs education or funding of certain drugs, - Micro (clinical) level - individual decisions regarding care of individual patients
481
Q

What are the arguments for and against age-based rationing being applied to macro-level resource allocation decisions?

A
  • For - treatment and care of elderly people is very costly so ‘cost-effective’ argument might require resources elsewhere, - Against - most of the elderly burden relates to cost of illness and incapacity rather than age, young person with chronic/serious disease could also cost the same amount
482
Q

Describe the Fair-innings argument (1997)

A
  • Older people had a long life already, therefore fairer to divert resources to younger people, - Elderly also have a disproportionate share of the available resources allocated to them
483
Q

What are the contraindications to the Fair-innings argument?

A
  • treating on the basis of need might mean older people don’t receive lower priority, - Years of life saves shouldn’t matter, the quality of life is more important e.g. QALYs, - Fairness is not the only thing that matters, other things do too e.g. equals treatment
484
Q

What are the arguments for and against age-based rationing being applied to micro-level resource allocation decisions?

A
  • For - age should be relevant because older people are less likely to respond to treatment and have a poorer prognosis in general due to increased complication risk, - Against - age alone is not a good predictor of prognosis/complications hence need case-by-case decisions, decisions based on age may be hidden form of discrimination
485
Q

What is age discrimination?

A

Unjustifiable difference in treatment based solely on age

486
Q

What is the difference between direct and indirect age discrimination?

A
  • Direct - direct difference in treatment based on age, cannot be justified, - Indirect - neutral provision or practice that has harmful repercussions on a person based on their age
487
Q

What is the GMC and laws view on age discrimination?

A
  • GMC - must not unfairly discriminate against patients or let views about patient affects decisions, - Law - equality act 2010, protects age, race, sex, gender, disability, religion, etc.
488
Q

How do calculate QALY?

A
  • Assign a utility value (0-1) to a state of health and then multiply by the number of years expected to live in this state, , EXAMPLE:, 0.5 QALY points x 5 years = 2.5 QALYs, 0.8 QALY points x 5 years = 4.0 QALYs
489
Q

What leads to utilitarian justification?

A

QALYs focus on overall likely outcomes of resource allocations

490
Q

What type of healthcare do you have when the cost per QALY is low/high?

A
  • Low - high priority, efficient health care, - High - low priority
491
Q

What are the arguments for QALY-based assessments?

A
  • Maximises healthcare based on quality and quantity of life, - Considers individual patient level when informing decisions about whether or not to proceed with an invasive procedure based on QALYs they are likely to gain
492
Q

What are the arguments against QALY-based assessments?

A
  • Difficulties in measuring - how do you measure quality or value or life? who makes the decisions? introduces bias, - Can seem unjust - can favour life years over individual lives
493
Q

What is relationship between age and QALY?

A
  • The older you are the fewer QALYs you will gain due to lower life expectancy & co-morbidities, - Doesn’t aim for ageism but it is still discriminatory (indirect)
494
Q

What body appraises medical technologies in pounds per QALY?

A

NICE

495
Q

What is PICO?

A

Population, Intervention, Comparison, Outcome

496
Q

What are the 3 discrete steps in critical appraisal?

A
  • Are the results of the study valid?, - What are the results?, - Can I apply the results to this patient’s care?
497
Q

What is study validity and what should you look for?

A

Study validity is the believability or credibility of the results, - Do these results represent an unbiased estimate of the treatment effects?, - Have they been influenced in some systematic fashion to lead to a false conclusion?

498
Q

What are the different types of results?

A
  • Therapy - look at relative risk reduction, absolute risk reduction, odds ratio, number needed to treat, confidence intervals, - Diagnosis - look at sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, - Prognosis - look at how likely the outcomes are over time and how precise the prognostic estimates are (relative risk or odds ratio), - Harm/aetiology - look at relative risk, odds ratio, number needed to harm
499
Q

How should you apply the results of a critical appraisal?

A
  • How similar are the patients to the study to your patient?, - Can the local healths service provide the intervention/diagnostic test?, - What are the benefits and costs?