Year 4 Flashcards
What 9 conditions are tested for on the neonatal blood spot?
Congenital hypothyroidism, CF, sickle cell disease, PKU, MCADD, MSU, isovaleric acidaemia, glutamic aciduria 1, homocysteineuria, SCID
What blood disorders are tested for at booking?
Anaemia, red call alloantibodies, sickle cell, thalassaemia, and HIV, hepatitis and syphillis screen
What newborn hearing tests are carried out?
Automated otoacoustic emission (AOAE) and automated auditory brainstem response (AABR) if AOAE is abnormal
What conditions are screen for in the foetal abnormality test?
Anencephaly, spina bifida, cleft lip/palate, diaphragmatic hernia, renal agencies, gastrochisiss, exomphalos, cardiac or renal agenesis, Edwards & Patau’s
When its the foetal anomaly screen?
18-20+6 weeks
When is the foetal Down’s screen?
11-13+6 weeks
What might be tested for in Down’s screen and what are the results?
Nuchal translucency (increased), HCG (increased), PAPP-A (decreased), AFP (decreased) unconjugated oestradiol (decreased), inhibit-A (decreased)
What’s included in combined trisomies test?
Nuchal translucency, free HCG, PAPP-A, mother’s age
Who can’t have live attenuated vaccines?
Anyone who is immunocompromised, e.g. cancer treatment, HIV postive, long term steroids, immunosuppressed, bone marrow transplant in last 6 months
When to postpone a vaccine?
Acute illness, pregnancy (unless high risk disease), adverse reaction to previous dose
Examples of live attenuated vaccines?
MMR, BCG, chickenpox, nasal influenzae, rotavirus, oral polio, yellow fever, oral typhoid
What vaccines are given at 8 weeks?
6 in 1, men B, rotavirus
What vaccines are given at 12 weeks?
6 in 1, PCV, rotavirus
what vaccines are given at 16 weeks
6 in 1, men B
What vaccines are given at 1 year?
2 in 1 (Hib and men C), PCV, MMR, men B
What vaccine is given annually from 2-8 years?
Nasal flu vaccine
What vaccine is given at 3 year, 4 months?
4 in 1 (dip, tet, pertussis, polio), MMR
What vaccine is given at 13-14 years?
HPV
What vaccine is given at 14 years?
3 in 1 (dip, tet, polio)
When is the 6 in 1 vaccine given and what is in it?
- 8, 12, and 16 weeks
- Diphtheria, tetanus, pertussis, polio, HiB, & hep B
When is the 2 in 1 vaccines given and what its in it?
- 1 year
- Hib and men C
When is the 4 in 1 vaccine given and what is in it?
- 3 years, 4 months
- Diptheria, tetanus, pertussis, and polio
When is the 3 in 1 vaccine given and what is in it?
- 14 years
- Diptheria, tetanus, and polio
When is the BCG vaccine given?
Offered from birth to high risk babies
Who is most at risk from a burn?
Children <5, people >75, and those with diabetic neuropathy
Causes of burns in under 5s?
50% happen in kitchen: hot water, chip pan, oven door, kettle, iron, the sun
How to prevent burns?
- Health promotion in schools to teach kids about safety
- Advice to parents about safety and accident prevention in the home
- Workplace safety information to employers
How to prevent sunburn?
- Stay out of sun between 11 and 3
- When in sun wear adequate clothing (e.g. hat, t-shit
- Wear high factor suncream and reapply every 2 hours
- Keep close eye on children wearing suncream
How to prevent burns in the kitchen?
- Keep young children out of the kitchen unless supervised
- Use back hobs
- Keep hot things out of reach of children
- Teach older children how to use kettle and oven safely
How to prevent fires?
- Fit smoke alarms in every room and regularly test
- Avoid open fires (or use fireguard)
- Keep doors closed at night to prevent spread
- Store matches away from children
- Teach older children to use matches safely
- Have fire blanket ready in kitchen
- Don’t smoke inside
What is most common cause of death in children?
Accidents
Most common accidents in babies?
Dropped, burned, scalded
Most common accidents in toddlers?
Falls, burns, scalded, accidental poisoning
Most common accidents in older children?
Falls from heigh, RTAs
Personal effects of back pain?
- Constant discomfort
- Loss of income
- Loss of independence
- Depression due to social isolation
- Feeling of guilt
- Medication side effects
- Relationship issues
- Decreased social/leisure activity
- Inability to care for family
- Decreased libido
Societal issues of back pain
- 3rd most common cause of sick leave
- 80% of people will experience back pain
Iatrogenic causes of back pain?
- Lack of encouragement to return to work
- Medical mismanagement
- Inappropriate drugs or surgery
- Lack of reassurance from doctor
Iatrogenic causes of back pain?
- Lack of encouragement to return to work
- Medical mismanagement
- Inappropriate drugs or surgery
- Lack of reassurance from doctor
Services to help with returning to work after back pain?
Physio, OT, employment advisors, exercise prescriptions, osteopathy/chiropractors/acupuncture
Physical effects of falls in the elderly?
- Fractured hip
- Head/eye injury
- Forearm injury/wrist fracture
- back/spinal injury
- Long lie
- Loss of ability to do ADLs
- Death
Effects of a long lie?
- Pressure sores
- Hypothermia
- Infection from wounds or aspiration
- Dehydration
- Rhabdomyolysis and AKI
Psychological effects of a fall?
- Loss of confidence
- Immobility
- Isolation
- Depression
- Increased independence
Methods to prevent falls?
- Regular cleaning of glasses
- Home safety assessment and modifications
- Home-based strength and balance programmes
- Walking aids
- Nurse supervision in care home
Medical risks for fall?
- Arthritis
- Postural hypotension
- Gait abnormality
- Parkinson’s
- Muscle weakness
Environmental risks of fall?
- Poor lighting
- Loose rugs/carpets
- New environment
- Cluttered areas
Pharmaceutical risks of fall?
- Polypharmacy
- Antihypertensives
- Sedatives
Sensory/cognitive causes of fall?
- Dementia
- Poor eyesight
- diabetic neuropathy
System (care home) risks of fall?
- Poor staff education
- Poor staff:patient ratio
8 key principles of NSF-elderly?
- Age discrimination
- Patient centred care
- Intermediate care
- Hospital care
- Strokes
- Falls
- Mental health
- Health promotion
Technology appraisal process:
- Topic selection
- Data submission
- Data review
- Call for contributions
- fund
Cost effectiveness measured using?
- Incremental cost effectiveness ratio
- ICER=(cost A - cost B)/(QALYs B - QALYs A)
HIV transmission can be:
- Intentional (deliberately meaning to give HIV)
- Reckless (not deliberate, but careless; fails to inform partner)
- Accidental (unaware of having HIV/condom failure)
Can you inform someone partner they have HIV?
If you believe partner issues high risk then tell them, but inform patient you are going to do so
Why monitor adverse events?
- They are common
- They have important consequences
- 50% are preventable
- We can learn from them to improve care and safety
Who is responsible for handling of adverse events?
National Patient Safety Agency
Where should you report adverse events?
The National Reporting and Learning System
How are adverse events handled?
Root Cause Analysis
Duty of candour in adverse events:
- Explain what has happened and apologise
- Offer solution
- Explain long term implications
Most common adverse events?
- Prescribing error
- Communication failure
- Delay/failure in diagnosis
What are never events, and give an example?
A serious preventable patient safety incident that should not have occurred if all the correct safety procedures were implemented/followed, e.g. wrong-site surgery
What its an adverse event?
An unintended event arising from clinical care that causes patient harm
Barriers to correcting adverse events
- Failure to take responsibility
- Lack of communication
- Focus on immediate event and not root cause
- Poor/rigid staff attitudes
What are types of unintentional adverse event?
- Knowledge based
- Rule based
- Skill based
What is an example of a knowledge based adverse event?
Wrong care plan formulated due to poor knowledge of clinician in that area
What is an example of a rule based adverse event?
Wrong application of a rule/guideline to the clinical scenario, e.g. applying a paediatric treatment pathway to a 2 year old
What is an example of a skill based adverse event?
- Attention/memory lapse
- Deviation from a good plan
- These are common
What are types of intentional adverse events?
- Routine
- Situational
- Reasoned
- Malicious
What is an intentional routine adverse event?
The normalisation of bad practice
What is a situational intention adverse event?
- Depends on clinical situation/scenario
- I.e. cutting corners when short staffed or overwhelmed
What is a reasoned intentional adverse event?
A deliberate deviation from protocol thought to be in best interests at the time
What is a malicious intentional adverse event?
A deliberate act intended to harm
Advantages to releasing performance data?
- Transparency for patients
- Increases patient confidence
- Competition could boost performance
- Focus of improving care
- Public reassurance on safety of care
Disadvantages to releasing performance data?
- May not be representative (e.g. surgeons that do riskier surgeries will look worse)
- Could result in fewer clinicians carrying out important but risky procedures
- Manipulation of data (doctors may only want to treat healthier patients so they look better)
- Case-mix (some areas only receive patients with poor prognoses
What 3 aspects of consent are required?
- Informed
- Voluntary
- Patient must have capacity
How can consent be given?
- Written
- Verbally
- Non-verbally
When its consent not required?
- Additional procedures
- Emergency treatment when patient can’t consent (e.g. unconscious)
- Mental health condition (under MHA 2005)
- Risk to public health with infectious disease (under Public Health (Control of Disease) Act 1984)
- Severely ill and living in unhygienic conditions (under National Assistance Act 1948)
What explained for consent to be informed?
- Overview of condition/procedure
- Likely outcome of decision
- Treatment options, including second opinion
Evidence that a person lacks capacity must show both of the following:
1) Patient has an impairment or disturbance in function of their mind or brain
2) This impairment or disturbance is significant enough to hinder them making a particular decision at this time
Examples of conditions that would reduce patient capacity:
- Schizophrenia
- Bipolar
- Dementia
- Drug intoxication
- Serious LD
- Brain damage
- Delirium
To have capacity, patients must be able to:
1) Understand information
2) Retain the information
3) Use the information to make a decision
4) Communicate their decision
What may and may not be treated without consent if a person lacks capacity and hasn’t made wishes known?
- Mental health conditions and related physical issues (e.g. paracetamol overdose) CAN be treated
- Unrelated physical conditions CAN’T be treated
What is an example of an unwise decision that doesn’t necessarily mean a patient lacks capacity?
Jehovah’s Witness refusing blood transfusion, so long as they’re aware of consequences
Transient conditions that may affect capacity include?
- Shock
- Intoxication
- Delirium
- Panic
-Extreme fatigue
What may be put in place if a person knows their capacity may change?
- An advance directive
Important facts about advanced directives?
- Legally binding
- Can refuse treatment
- cannot be overruled, unless someone needs to be sectioned under the MHA 2005
When can you break confidentiality?
- Protecting children
- Protecting the public (e.g. act of terror, communicable disease)
- Required by courts
- Prevent or detect crime (e.g. Drug Trafficking Act 1986)
- Provide care in life threatening circumstances
- Protect service provider in life threatening circumstances
Why I confidentiality important?
- Legal requirement
- Strengthens doctor-patient relationship
- Reduces fear of health seeking
- Improves autonomy and trust
- Do not harm to patient
Confidentiality and capacity?
- Patients without capacity can’t be assumed to give or withhold consent
- Disclosure to relevant parties (e.g. family) its allowed if it will benefit the patient or is in the interest of justice
Death and consent?
Can disclose information relevant parties unless strictly told not to by patient
What is euthanasia?
The act of deliberately ending someone’s life to relieve suffering
What is assisted suicide?
The act of deliberately aiding or encouraging someone to commit suicide
Example of assisted suicide?
Acquiring strong sedatives for a relative to take to commit suicide
Which is legal out of euthanasia and assisted suicide?
NEITHER
What are the types of euthanasia?
Active, passive, voluntary, non-voluntary, involuntary
Describe active euthanasia?
When someone actively ends the life of another to relieve suffering
What is an example of active euthanasia?
- Injecting drugs that will kill a patient
- Think: Million Dollar Baby
Describe passive euthanasia?
When a person withholds or withdraws life-prolonging treatment
What is an example of passive euthanasia?
Removing ventilation
Describe voluntary euthanasia?
When someone decides they want to die and ask for help
Describe non-voluntary euthanasia?
When someone can’t give consent for euthanasia, os someone decides for them, often because the patient has previously expressed their wishes to die to them
Describe involuntary euthanasia?
Euthanasia when someone doesn’t want to die, essentially murder
Arguments for euthanasia?
- Ethical: people should have choice (autonomy) to decide how and when they want to die
- Pragmatic: argues procedures in end of life care are essentially the same a euthanasia
Pragmatic arguments for euthanasia?
- Some procedures e.g. DNACPR and palliative sedation are essentially the same as euthanasia (passive and active respectively) so may as well legalise and regulate it
- This would be acting in patient’s best interests (beneficence)
Arguments against euthanasia?
- Religious: people believe only god has the right to end a life
- Slippery slope: concerns legalising will lead to unwanted side effects
- Medical ethics: possibly violates non-maleficence
Alternatives: is a cure just round the corner? Will advances in palliative medicine and mental health make disease bearable?
Examples of slippery slope arguments for euthanasia?
- Very ill people may feel pressured to end their own life so they aren’t a burden
- Research in palliative care may be discouraged
- Misdiagnosis and prognosis may lead to euthanasia when not required
Medical ethics arguments against euthanasia?
- Violates non-maleficence
- May result in poor attitudes towards terminally ill
- Loss of patient trust (e.g. “doctor just wants to kill me off)
What is an abortion?
An elective procedure to end a pregnancy
What 2 acts are relevant to abortion in the UK?
- Abortion Act 1967
- Human Fertilisation and Embryo Act 1990
When its an abortion legal until?
-24 weeks
- Reduced from 28 to 24 weeks under Human Fertilisation and Embryo Act 1990
When might an abortion be carried out after 24 weeks?
- Necessary to save mother’s life
- Necessary to prevent severe permanent injury to the physical or mental health of the mother
- Substantial risk of severe permanent mental or physical disability that would result in the child being handicapped
How many doctors must sign for an abortion after 24 weeks?
2
Does a patient under 16 need tell her parents about having an abortion?
- Not if 2 doctors agree it is in her best interests and she understands the procedure
- But doctors should try to convince child to tell parents or an adult
Arguments for abortion?
- A woman has the right to choose what happens to her body, including pregnancy (autonomy)
- Banning abortions will cause women to use illegal and dangerous abortionists (beneficence)
- Woman shouldn’t have to bear the emotional stress of carrying a child by rape (Justice)
- Vast majority of abortions occur when foetus is in such an immature state it isn’t alive/wouldn’t survive outside the uterus (non-maleficence)
Arguments against abortions?
- All forms of life, however immature, have a right to life (Justice)
- Abortion is the deliberate ending of another life, similar to murder (non- maleficence)
- Abortions can have complications later in life (e.g. ectopics) (non-maleficence)
What outlines research ethics principles for human experimentation?
The Nuremberg Code
What are 3 research ethics principles?
- Voluntary consent is required from all patients
- Experiment should yield results that are beneficial to society that can’t be gained by other means
- Based on animal experimentation and should be knowledge of natural history of disease
- Must avoid all unnecessary physical or mental suffering
- Should not be performed if intervention is believed to be harmful
- Risk should not exceed humanitarian importance
- Preparations and facilities should be in place to protect subjects from injury, disability or death
- Should be conducted by qualified people
- Subjects can leave whenever they wish
- Those in charge should be prepared end the experiment if harm to subjects becomes likely
When should you break confidentiality regarding young people asking for sex related treatment (e.g. contraception, abortion)?
- If under 13 always inform relevant authorities (this is statutory rape)
- If fear of coercion or exploitation (e.g. much older partner, patient is secretive)
Dr responses to MUS diagnosis?
- Sceptisism
- Pressure on Dr (can’t provide cure etc)
- Assume patient is seeking cure
- Easier to give in to give treatment
- Difficult communication/explanation with patient
Patient responses to MUS?
- Unnecessary tests/radiation exposure
- Patient seeking exculpation and explanation, not necessarily a cure
- Want to feel listened to
- Not disregarded
Measures of QoC?
- Donebedian model
- PROM forms
- Public performance data (e.g. mortality rate)
- Audits
- Complaints
What is primary prevention?
- Occurs before a disease has developed
- Aims to prevent onset of disease
What is an example of primary prevention?
- Tackling modifiable risk factors
- E.g. smoking cessation to prevent onset of CVD
What its secondary prevention?
- Occurs after disease has developed
- Preventing disease progression or any adverse effects of disease
What is an example of secondary prevention?
- Medications to prevent adverse secondary outcomes of a disease
- E.g. statins to prevent MI in CVD
What is tertiary prevention?
- Occurs after an adverse event
- Aims to limit impact that adverse event has on life
What is an example of tertiary prevention?
- Treatment to prevent deterioration following adverse events or further adverse events
- E.g. CABG following MI
