2. YEAR 2 EXTRAS FROM BLOCK LEARNING OUTCOMES Flashcards

Question

what is the problem with egalitarianisms view of rationing healthcare resources?

Answer 1

insensitive to factors that are important e.g. patient need

Answer 2

ignores the prognostic differences

Answer 3

the moral imperative to rescue identified individuals in immediate peril, regardless of cost

Answer 4

the clinical commissioning groups are the buyers | providers of care are the sellers

Answer 5

because of the increasing population size, ageing population, multiple morbidities increasing

Answer 6

20,000 -30,000

Answer 7

to treat equals equally and with dignity to meet peoples needs for healthcare as efficienctly as possible by imposing the least sacrifice on others to minimise inequalities in the lifetime health of the population

Answer 8

systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances NICE clinical guidelines are recommendations on how healthcare and other professionals should care for people with specific conditions.

Answer 9

they ensure doctors provide evidence based care, improve cost effectiveness, provide a practical and ethical framework for decision making and enhance the appropriateness of practice

Answer 10

there are conflicting guidelines for patients with multiple morbidities medicien is rapidly developing so guidelines can quickly go out f date failure to understand or agree with responsibility for using the guidelines lack of knowledge that the guidelienes exist

Answer 11

the way in which a life-threatening illness breaks an individual's social/cultural experience by threatening self-identity.

Answer 12

``` loss of control and person power and self esteem loss of independance loss or change of role in family/work loss of financial security loss or change of future plans loss of identity ```

Answer 13

a framework for a coordinated service model that enables patients with long-term conditions and clinicians to work together to determine and shape the support needed to enable them to live well with their condition.

Answer 14

central government decides NHS funding and this is divided amongst the 4 national constituent parts of te NHS. Its allocated by CCGs on the basis of population weighted by need.

Answer 15

requires doctors to maximise benefits of care for the patient regardless of opportunity cost

Answer 16

a need for medical care exists when there is an effect and acceptable treatment or cure demand is when an individual considers they have a need and wishes to recieve care

Answer 17

an effective public health measure where a 20% tax on sugary drinks was used to try to reduce the number of obese adults

Answer 18

an assessment of the future course and outcome of a patients disease, based on knowledge of the course of the disease together with the persons general health, age and sex.

Answer 19

characteristics of the patient that can be used to predict outcomes more accuretaley e.g. demographics, disease specifics and co-morbidities

Answer 20

patient characteristics associated with the development of the disease in the first place.

Answer 21

whether an act is morally right depends only on consequences

Answer 22

``` utrilitarianism rule consequentialism state consequentialism ethical egoism ethical altruism etc ```

Answer 23

the ability to sort through a cluster of features presented by a patient and accurate asian a diagnostic label with the development of an appropriate treatment strategy as an end goal

Answer 24

``` complaints inaccurate diagnoses less recognition of ICE non adherence with care or treatment decreased patient satisfaction ```

Answer 25

The good physician treats the disease, the great physician treats the person who has the disease

Answer 26

``` understanding individuals preferences empathy shared goal setting and decision making active listening open ended questions and reflective conversations involvements of family and friends ```

Answer 27

A consensual relationship in which the patient knowingly seeks the physicians assistance and in which the physician knowingly accepts the person as a patient

Answer 28

paternalistic model where active doctor and passive compliant patient mead and bowers model of patient cent redness

Answer 29

the study of how individuals and companies make decisions to allocate scarce resources

Answer 30

the study of an economy as a whole.

Answer 31

the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness

Answer 32

the phenomenon of unequal and/or unjust distribution of resources and opportunities among members of a given society

Answer 33

“providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status i.e. everyone should have equal opportunity to healthcare

Answer 34

a skill enabling you to better argue to a position you can justify and to evaluate the views and arguments of other people.

Answer 35

is the study of what makes an action wrong or right.

Answer 36

study of the meaning of moral concepts i.e. what does right mean

Answer 37

the study of the means of deciding what is right or wrong aka. Moral theory.

Answer 38

the application of moral theory to real world cases

Answer 39

consequentialism deontoloy virtue utilitarianism

Answer 40

– rightness is judged by desirability of the consequences of that action

Answer 41

actions are right if they conform to a system or rules or regulations

Answer 42

the right act is the one which a virtuous person would perform in the circumstances

Answer 43

the theory of morality that advocates actions that foster happiness or pleasure and oppose actions that cause unhappiness or harm. -

Answer 44

- Beneficience – a practitioner should act in the best interests of the patient - Non-maleficience – a practitioner should ensure no further harm comes to the patient - Autonomy – the competent patient has the right to make their own decisions regarding their own healthcare. This involves acting with understanding, freely from the will of others and in accordance with your own values. - Justice – law/resource management etc

Answer 45

it generally leads to better outcomes as patient is more likely to trust thr doctor and stick to the regimen (consequentialism) its a requirement (deontology) a virtuous person would allow an individual to be self-determinant (virtue) When doctors act in the patients best interests they are activng in ways that will have an overall net benefit for the patient (beneficience). Sometimes the treatment will have side effects (goes against non-maleficence) but its deemed to be in the best interests of the patient because of the net positive effect

Answer 46

It can be difficult to assess best interests when the patient cannot communicate, when youre trying to weigh up conflicted goods. When your own values might disrtort what you think is in the best interest of the patient, when you disagree with the patient etc.

Answer 47

valid if the conclusion follows logically from the premises.

Answer 48

if the conclusion follows logically from the premises AND the premises are infact true

Answer 49

– irrelevantly attacking the person instead of addressing someones argument e.g. not listening to a woman who stands against abortion because you know she had abortions herself

Answer 50

agreeing with a particular view because the person who said it occupies a place of authority

Answer 51

when an arguments premises assume the truth of the conclusion rather than supporting it e.g. tom wants to convince james chocolate is healthy so his argument is that cjocolate grows on trees so it must be healthy even though there is no proof that something is good for you just because it grows on trees

Answer 52

misrepresenting someones argument to make it easier to attack e.g. telling someone who wants to legalise cannabis that we should not because legalising drugs is dangerous even though the original argument was about cannabis specifically, not just drugs generally.`

Answer 53

– the ability of a test to correctly identify patients with a disease (true positives / all diseased individuals)

Answer 54

the ability of a test to correctly identify people without the disease (true positives / all non-diseased individuals)

Answer 55

fewer false negative results so its used to rule out conditions

Answer 56

reduces false positives so usually used to rule in conditions

Answer 57

proportion of positive tests that are correct (true positives / test positives)

Answer 58

proportion of negative tests that are correct (true negatives / test negatives)

Answer 59

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

Answer 60

- The condition sought should be an important health problem - There should be an accepted treatment for patients with recognized disease - Facilities for diagnosis and treatment should be available - There should be a recognizable latent or early symptomatic stage - There should be a suitable test or examination - The test should be acceptable to the population - The natural history of the condition, includng development from latent to declared disease should be adequately understood - There should be an agreed policy on whom to treat as patients - The cost of case-finding should be economically balanced in relation to possible expenditure on medical care as a whole - Case finding should be a continuing process and not a once and for all project

Answer 61

effective it needs to be able to recognize a high proportion of disease in its preclinical state, be safe, be cost effective, lead to demonstrated improved health outcomes and be widely available.

Answer 62

fear, stigma, moving address so not getting updates, language barriers, people thinking they need symptoms first, not knowing how to book an appointment, embarrassment, lack of transport, misconceptions, childcare to worry about

Answer 63

People worry about coughing and sneezing, worry about their incontinence worsening as they age, worry about smelling of urine, worry about a sex life, limit their choice of clothing and have a desire for normality People may also feel a loss of dependency, loss of control and may develop problems with their body image.

Answer 64

an identifying mark or characteristic that can be a specific diagnostic sign of a disease

Answer 65

: labelling -> stereotyping -> othering -> stigmatisation -> discrimination

Answer 66

keeping stigmatised conditions hidden except to close friends and family

Answer 67

when a stigmatising conition cannot be hidden

Answer 68

a sense of fear and shame due to one’s condition

Answer 69

discrimination by others

Answer 70

absorbing the social views of being lower status and the impact on personal beleifs and behaviours

Answer 71

passing oneself off without acknowledging symptoms e.g. hiding yourself – can come at a very high psychological cost

Answer 72

not disclosing e.g. wearing cream to hide eczema

Answer 73

socially acknowledging a symptom but withdrawing from generally expected social interactions and relationships e.g. social isolation is common amongst incontinence sufferers leaving them with feelings of hopelessness, sadness, and shame. The stigma attached to this condition is often worse than the actual symptoms.

Answer 74

Fear of stigma may act as a barrier to seek medical care Concerns about confidentiality In some cultures stigma attached to HIV contributes to lack of medical care

Answer 75

Those on dialysis have lower levels of physical activity, diminished health questionnaire results compared with the general population. it takes a long time out of the day may be difficult to get to the dialysis unit can limit freedom of movement

Answer 76

represent the potential benefits that an individual misses out on when choosing one alternative over another

Answer 77

tax finance, national insurance and user charges

Answer 78

when someone is denied/not offered an intervention that everyone agrees would do them good and they would like to have

Answer 79

Its not the role of the doctors to decide who is more deserving of a treatment The patient may have little/no control over their smoking habits Even if patients did have control they are no less deserving Decision should be made on ground of clinical need They may not be aware that they have contributed to their own ill health They have paid taxes

Answer 80

the principle of not divulging or disclosing information about patients to others

Answer 81

allows patients to trust clinicians, allows them to have autonomy, prevents patient harm, is virtuous, is a human rights act and a GMC requirement.

Answer 82

if information is shared with other people without the consent of the patient in question.

Answer 83

if demanded by court statue, if the disclosure is in the public interest, if the patient lacks capacity and disclosure is in their best interest, if it's necessary to prevent harm e.g. if a patent has a serious communicable disease such as an STD

Answer 84

healthcare must be safe (minimisies risk and harm to patient) effective (based on scientific knowledge and evidence-based guidelines) timely (reduce delays) efficient (maximise resource use) equitable (fair and based on need only) patient centred (respectful of and responsive to individual patients).

Answer 85

an unintended event resulting from clinical care that causes patient harm

Answer 86

a situation in which events arising during clinical care fail to develop further, whether or not as a result of compensating action, thus preventing injury to a patient

Answer 87

an unintended event occurs resulting from clinical care but the patients doesn’t experience harm

Answer 88

serious incidents that are entirely preventable because guidance or safety reccomendations provide strong systemtic protective barriers and are available at a national level and should have been implemented by all health care providers. E.g. wrong site surgery

Answer 89

standardised mortality ratio reports on never events and serious incidents inspections and monitoring by care quality commissioners hospital episode statistics

Answer 90

the ratio of the number of deaths in hospital within a given time period, to the number that might be expected if the hospital had the same death rates as some reference population

Answer 91

egulates all health and social care services in England. The commission ensures the quality and safety of care in hospitals, dentists, ambulances, and care homes, and the care given in people's own homes.

Answer 92

errors or violations committed by people in direct contact with a patient

Answer 93

unintentional mistake that may be due to deficiencies in knowledge, rules, or skills

Answer 94

intentional mistakes but not usually with the intention of causing harm e.g. because of time pressure, actions that have become normal

Answer 95

those that develop over time and lay dormant until they combine with other factors e.g. active failures to cause an adverse event

Answer 96

when individuals cover up errors for fear of retribution

Answer 97

deviance from correct or proper behaviour or rule becomes normalized

Answer 98

unfamiliarity with a task, inexperience, shortage of time, inadequate checking, poor procedures

Answer 99

this acknowledges the universal nature of human fallibility, the inevitability of error and that these errors are not necessarily because of incompetence. Its about designing a workplace to minimise the likelihood of errors and their consequences. This can be done by avoiding reliance on memory, make things visibly, review and simplify processes, standardize common procedures, use checklists etc

Answer 100

- Increase doctor and nurse to patient ratio - Improve teamwork and communication - Open reporting and learning from incidents - Standardise approaches to high risk patients - Promote safer prescribing - Promote hand hygeiene

Answer 101

1. Report it on the incident reporting system 2. Assess the seriousness 3. Analyse why it occurred 4. Duty of candour – be open and honest with the affected patient and apologise 5. Learn from the event and put in place actions to reduce the risk of repeat

Answer 102

under 1 | followed by 15-19 year olds

Answer 103

accidental injury, cancer and intentional self-harm (including suicide), followed by neurological, cardiovascular and respiratory disorders.

Answer 104

preterm birth complications, birth asphyxia, pneumonia, congenital abnormalities.

Answer 105

- Reduce the risk of preterm and low birth weight babies by promoting maternal health - Socioeconomic improvements - Improve recognition and management of serious illness across the health service - Implement policies for common causes of death from accidents and injuries - Improve the management of chronic diseases

Answer 106

- Screening for infectious diseases – HIV, syphilis, hepatitis B - asap - Screening for sickle cell and thalassaemia and other haemoglobin disorders– before 10/40 - Foetal anomaly screening programme – downs, Edwards, pautaus syndromes - 11-14/40 - 11 physical conditions – 20/40 (anencephalcy, open spina bifida, cleft lip, diaphragmatic hernia, gastrochisis, exomphalos, serious cardiac abnormalities, bilateral renal agenesis, lethal skeletal dysplasia)

Answer 107

Newborn physical examination – within 72 hrs of both (cataracts, heart murmurs, developmental dyaplasia od the hips, testes) - Newborn hearing screen – in the first 4-5 weeks - Newborn blood spot screening – 5 days old (sikle cell, cystic fibrosis, congenital hypothyroidism, inherited metabolic diseases, severe combined immunodeficiency).

Answer 108

annual diabetic eye test to check for early signs of diabetic retinopathy

Answer 109

some test are associated with a 1% chance of miscarriage (particularly amniocentesis and chorionic villus sampling) lots of anxiety with inaccurate tests pain not always diagnostic

Answer 110

increasing C-sections, epidurals, inducement, less home births etc

Answer 111

is a full term pregnancy with spontaneous onset, vertex presentation of the foetus, low obstetric risk throughout pregnancy and labour, regular painful uterine contractions, progressive cervical effacement and dilation, progressive fetal descent, strenuous maternal effort, spontaneous vaginal delivery of the baby, placenta and membranes

Answer 112

- 1680 – Chamberlens midwifery forceps were crested to allow delivery of live foetuses without crushing the skull - 18th century – lying in hospitals for maternity care of poor married women were made. his caused a significant change as it was discovered that women giving birth at hospitals and being seen my obstetricians had a link to puerperal sepsis (due to poor hygeine) so more attended midwiferies. - 1881 – The Midwifes institute fromed - 1902 - Midwives Institute led to the First Midwife's Act- enshrine normality in childbearing as the midwife's role, referring to doctors as soon as abnormality occurs - this ensured a steady income stream for the medical profession. - 20th centuray - political drive to see hospital confinement for all women in labour as it was inherently safer and preferable. This culminated in the report of the Peel Committe in 1970 = lead to development in more maternal units in hospitals

Answer 113

childbirth can only be considered normal in retrospect

Answer 114

Epidurals actually inhibit the Ferguson reflex and induction/augmentation reduce the sensitivity to natural oxytocin. This natural oxytocin can be produced in a calm and safe environment

Answer 115

allows the woman to create her own endogenous opiods - beta endorphins may dampen down contractions to modulate coordination and modulate perception of pain. This helps coordinate contractions. Women who give birth this way often have. euphoric experience after birth, this is lost when medication is given

Answer 116

Since the 1960s, labour length has increased by nearly 2 hours. This has been attributed to epidural use, older mums and bigger babies.

Answer 117

less likely to get an infection or any risks from interventions, more likely to feel relaxed which helps labour progress, less need for pain meds no aftercare for mother, not safe if at risk, insurance don’t cover costs, still may need to be transferred to the hospital ICE, birth can be messy

Answer 118

pain control, access to NICU, staff support, availability of interventions – stresss, fewer birthing positions, fewer support people, may not choose delivery doctor, little privacy

Answer 119

as a doctor you must be able to Recognise patterns/risk factors of of neglect and refer in a timely and appropriate manner to social care you must know what to do if you are concerned about a child and act on these concerns you must be open minded when considering the possible cause of an injury or other signs that may suggest a child is being abused or neglected – don’t overshadow diagnoses by child protection conerns

Answer 120

department for Education (DfE)

Answer 121

everyone who works with children has a responsibility for keeping them safe, sharing information and identifying concerns.

Answer 122

this places a statutory duty on certain agencies to co-operate to safeguard and promote the welfare of children – local authorities, NHS services and trusts, police, probation services and young offenders institutions.

Answer 123

provide therapeutic services to help children move on from abuse, as well as supporting parents and families in caring for their children. We help professionals make the best decisions for children and young people, and support communities to help prevent abuse from happening in the first place.

Answer 124

more digestible ◦ strengthens the bond witih skin to skin contact ◦ antibodies pass from a mother to baby and strengthen their immune system ◦ naturally contains vitamins ◦ free ◦ different tastes from what the mother has eaten = easy acceptance of solid foods ◦ convenient - Breast milk is perfectly designed for your baby ◦ burns calories/shrinks uterus = mums can return to their pre-pregnancy shape and weight faster ◦ studies show it can lower the risk of breast cancer, high bp, diabetes, CVD - Helps reduce risk of infections, D+v, SIDS, obesity, CVD - Lowers mums risk of breast + oarian cancer, osteoporosis, CVD, obesity

Answer 125

doesnt contain vit D latch on pain for the first 7-10 days ◦ time and frequency of feedings can mean a large commitment on the mother ◦ women need to be aware of what they eat and drink ◦ some maternal medical conditions and medications can be unsafe for the child

Answer 126

◦ sterile ◦ contains vitamin D ◦ convenient as either parent can feed the baby so the partner feels more involved ◦ no need to find a priate place to nurse in public formula is less digestible so formula-fed babies tend to need to eat less often ◦ women doesnt need to worry about diet/medication etc

Answer 127

lack of antibodies so cant provide baby protection against infection ◦ requires planning ◦ costly ◦ formula-fed babies have more gas and firmer bowel movements

Answer 128

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes

Answer 129

privacy, confidentiality and security measures that protect the personal health data of users of health services

Answer 130

It safeguards and encourages consumers to speak against insufficiency and flaws in goods and services. If traders and manufacturers practice any illegal trade, this act protects their rights as a consumer.

Answer 131

the right to safety, to be informed, to choose, to be heard, to satisfaction of basic needs, to redress, to consumer education and to a healthy environment

Answer 132

1. NHS shoyld be funded from taxation 2. NHS should provide a comprehensive service to everybody 3. NHS should be free at the point of delivery

Answer 133

An audit assesses if a certain aspect of health care is attaining a recognized standard. This lets care providers and patients know where their service is doing well, and where there could be improvements. The aim is to achieve quality improvement and improve outcomes for patients.

Answer 134

provides evidence-based guidance and advise for health, public health and social care practitioners - this improves outcomes for people using NHS and other public health and social care services.

Answer 135

helps collect all your data in one place to ensure all your doctors across different hospitals have the right information. It helps healthcare providers keep a track of everything you have been through- which allows them to help you better. They reduce the risk of malpractice, helps maintain communication amongst healthcare personnel, records hospital quality

Answer 136

- Name age and address - Health conditions - Treatments - Medication - Allergies and past reactions to meds - Tests, scans and x-ray results - Any specialist care e.g. maternity or mental health - Lifestyle infor e.g. smoking and drinking - Hospital admission and discharhe information

Answer 137

the deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy.

Answer 138

abortions must be carried out before 24 weeks of prwgnancy and only after under some very limited circumstances e.g. risk to others life or child will be born with a debilitating disease. Only those <13 will have to have an adult with them, otherwise you are not required to tell anyone.

Answer 139

abortion is legal if two registered medical practitioners are of the opinion, formed in good faith: - That the pregnancy has not excedded 24 weeks and the continuance of the pregnancy would involve risks greater than if the pregnancy were terminated - That the termination is necessary to prevent grave permenant injury to the physical/mental health of the pregnant woman - That the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if terminated - That there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

Answer 140

abortion ends the life of the foetus the human foetus has the same moral status as a person and it is wrong to end the life of someone with a moral status of a person so abortion is morally wrong. Life is sacred. You are robbing a child of its future. Life begins at conception. Relaxed abortion laws mean some people may use abortion as contraception. Abortion discriminates against people with disabilities and devalues them. Foetuses feel pain suring the abortion procedure. Abortions cause psychological damage. Abortion promotes a culture in which human life is disposable.

Answer 141

we do not give the same consideration to a foetus as we do a person. Its alve and human but not a person; personhood begins after a foetus becomes viable or after birth, not at conception. A woman has the right to have control over her body. If we forbid abortions, women will still try to do it but in much less safe ways. Women may not have a choice as they may not be able to financially afford a child. Modern abortion procedures are safe

Answer 142

- Procreative autonomy – parents right to have children - It has helped so many patients who would otherwise be unable to conceieve - Its safe - It can help single women and same sex couples - Unused embryos can be donated to other couples or research - Embryos can be used to screen for inherited diseases - Welfare interests - You can screen embryos before embryo transfer so can avoid genetic diseases

Answer 143

- Involves destruction of embryos which may have a moral status - Harmful to those trying to conceieve e.g. causes a lot of psychological distress - Risk of multi pregnancy and slightly higher risk of ectopic pregnancy - Ethical issues – embryos can be used for screening and choosing favourable characteristics - Unnatural - IVF cycles are often unsuccessful - Expensive – may make the child a burden on the parents - Screening embryos has been used for sex selection, choosing embryos with desirable characteristics etx - Treatment for IVF is made available dependant on where you live in the UK i.e. different postcodes are allowed different numbers of cycles for free

Answer 144

dilemmas should be resolved so as to ensure that children will have a maximally open future.

Answer 145

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 for a father

Answer 146

fertile couples don’t have to meet this criterion, so why should infertile couples have to research suggests that it’s not the case that a father is always required for a child to flourish. - law has now changed from father to 'the need for supportive parenting'

Answer 147

used to assess whether a child is mature enough to consent to treatment i.e. if under 16 and wants to receive treatment but don’t want their parents/carers to know. However young people cannot refuse treatment that may lead to their death or severe permenant harm.

Answer 148

apply specifically to advice and treatment about contraception and sexual health - The young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers). - the young person understands the advice being given. - the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment. - it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent. - the young person is very likely to continue having sex with or without contraceptive treatment.

Answer 149

- if the patient consents to it being shared - if disclosure is of overall benefit to a patient who lacks capacity to consent - when disclosure is required by law - when disclosure can be justified in the public interest

Answer 150

Midwives are specialists in normal pregnancy and birth, and their role is to look after a pregnant woman and her baby throughout a phase of antenatal care, during labour and birth, and for up to 28 days after the baby has been born.

Answer 151

you may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. You must explain to patients if you have a conscientious objection to a particular procedure. You must tell them about their right to see another doctor and make sure they have enough information to exercise that right. In providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs. If it is not practical for a patient to arrange to see another doctor, you must make sure that arrangements are made for another suitably qualified colleague to take over your role. You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress. The investigations or treatment you provide or arrange must be based on the assessment you and your patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options. You must not refuse or delay treatment because you believe that a patient’s actions or lifestyle have contributed to their condition. You must not unfairly discriminate against patients or colleagues by allowing your personal views to affect your professional relationships or the treatment you provide or arrange

Answer 152

encourage patients to stay physically active, have their eyes and hearing tested, be aware about side effects of medications, get enough sleep, , limit alcohol, stand up slowly, use assistive devices if needed and ensure they have everything in place at home that they need e.g. lifts, psychotropic drug withdrawal, podiatry interventions.

Answer 153

Older people living in care homes are three times more likely to fall than older people living in the community.

Answer 154

- Eat a healthy diet – reduce salt intake - Exercise regularly - Don’t smoke - Doont drink too much alcohol - Lower bp if too high - Give aspirin and clopidogrel following a previous stroke if they don’t have AF - Control AF with meds - Lose weight if obese - Come off oral contraception/HRT

Answer 155

the distortion of the relationship between an exposure and outcome due to a shared relationship with another variable.

Answer 156

using randomisation restriction (limit no. of participants in study who have possible confounding variables) matching (create a comparison group that matches the possible confounder) stratification adjustment multivariate analysis (the simultaneous observation and analysis of more than one outcome variable).

Answer 157

a ratio between the observed number of deaths in an study population and the number of deaths would be expected, based on the age- and sex-specific rates in a standard population and the population size of the study population by the same age/sex groups. >1 indicates that more mortality has occurred than would have been expected. A ration < 1.0 indicates less mortality has occurred

Answer 158

adjust for different age distributions in different populations and enable, say, the rates of disease between the populations to be directly compared/ a weighted mean event rate for a study population, using the group/stratum sizes of a reference population as the weighting scheme

Answer 159

there is a limitless demand for health i.e. people can always be healthier, there are limited resources too.

Answer 160

they are a major source of dissatisfaction for patients

Answer 161

allow NHS resources to be fully epmployed i.e. we don’t want loads of spare capacity as this is a waste of resources they also defer frivalous use

Answer 162

- Manage demand e.g. effectively refer patients, effective use of primary care - Manage the queue – patients called from a waiting list in order of clinical priority and within agreed waiting time standards - Manage capacity - Provide leadership

Answer 163

869 million

Answer 164

the ability to make decisions by yourself. It is decision and time specific.

Answer 165

presumption of capacity, the right to be supported to make their own decisions, the right to make eccentric or unwise decisions, healthcare providers must make decisions for those who lack capacity based on their best interests, the healthcare provider making a decision for someone who lacks capacity should choose the least restrictive intervention.

Answer 166

- Understand information relevant to the decision in question - Retain the information - Use the information to make their decision - Communicate a decision

Answer 167

advanced statement of wishes | advanced decision refusing treatment

Answer 168

advanced statement of wishes isnt but advanced decision refusing treatment is

Answer 169

a written statement of your wishes to refuse a certain treatment in a specific situation. It is a way of making sure everyone knows what treatment you do not want to have if you become unable to make your own decisions.

Answer 170

valid if youre aged 18 or over and has capaicyt at the time the decision was made, you specify clearly what treatments you want to refuse, its signed by you and a witness, you hve made the advanced decision by your own accord and you have not done anything that could contradict the advanced decision since you made it

Answer 171

a way of giving someone you trust, your attorney, the legal authority to make decisions on your behalf if you lose the mental capacity to do so in the future, or if you no longer want to make decisions for yourself

Answer 172

- Research involves access to records of personal or sensitive confidential information - Research involves the use of administrative or controlled data - Research involves linking or sharing of personal data or confidential information - Research involves participants over 18 years old than are not considered 'vulnerable adults'

Answer 173

- Research involves participants under 18 years old - Research involves participants over 18 years old that are considered 'vulnerable adults' - Research involves human biological materials, as well as human embryos, foetuses, foetal tissue, reproductive material and stem cells

Answer 174

If research doesn’t involve participants or personal data

Answer 175

In the UK, one in eight men and one in 15 women die from coronary heart disease. CHD kills twice as many women in the UK as breast cancer. Around 24,000 people under the age of 75 in the UK die from CHD each year. CHD death rates are highest in Scotland and the north of England. More people die of ischaemic heart disease globally than any other cause

Answer 176

smoking, cholesterol levels, population bp and deprivation have decreased. Obesity, diabetes and physical inactivity have increased but to a lesser extent so overall CVD deaths are reducing

Answer 177

1 in 13 UK males and 1 in 15 femailes will be diagnosed with lung cancer in their lifetime. 79% of these cases are preventable and 72% are caused by smoking Lung carcinoma make up >90% of primary lung malignancies. It is the leading cause of cancer mortality in men and woman. Over 90% of these cases are >40 years of age

Answer 178

2 billion people infected, about 33% of the global population. Of these, 90-95% aren’t even away they are affected. Lower-middle income countries like Subsaharan Africa have the highest rates Tb rates are slowly decreasing but it is still a huge global problem. The areas with high TB are also areas that tend to have a great burden of HIV A large proprotion of TB cases in the UK are from people who have moved here from other countries

Answer 179

a preventative measure that brings large benefits to the community often offers little to each participating individual.

Answer 180

a reduction in disease incidence.

Answer 181

high risk prevention approach | population prevention approach

Answer 182

the objective is to target the intervention at those who are at highest risk for the disease and move them to lower risk levels - really important at the individual level but not so effective at a population level.

Answer 183

- positives - appropriate to the individual, motivated patient and clinician, cost effective(not medicating those who done need it), beneft to risk ratio is good - negatives - screening is difficult (aka finding these groups is hard), limited potential as onyl targeting a small proportion, temporary and labelling

Answer 184

the objective is to reduce the burden of disease across the entire population. This should shift the curve of risk to the left

Answer 185

- positives - large potential as approaches the entire population - negatives - population paradox, poor motivation, benefit:risk ratio is low

Answer 186

- Occupational exposure to unsafe chemicals, dusts and fibres - Smoking - Frequent exposure to second hand smoke - Particulate matter - Formaldehyde - Ozone - Asbestos - Uranium - Arsenic - Cadmium - Chromium - Nickel - Some petroleum products

Answer 187

How much of a disease in the population is attributable to a particular exposure Calculate by: risk in population - risk in unexposed

Answer 188

What proportion of disease in the population is attributable to a particular exposure? Calculate by: (Risk in population - risk in unexposed ) / risk in population

Answer 189

- Mental health concerns – depression, anxiety, subclinical stress, ambivalence aout care, feeling isolated - Physical health concerns – fatigue, sleep problems etc - Secondary strains – finance, work relationship stress, loss of time for self care, reduced QOL - Family challenges – conflict about care, lack of support for caregiver, balancing needs of family members, behavioural isues

Answer 190

Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment

Answer 191

- Improves QOL • provides relief from distressing symptoms • Supprts life and regards death as a normal process • Doesnt quicken or postpone death • Combines psycholgoical 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

Answer 192

- If cardiac or respiratory arrest is an expected part of the dying process and CPR will not be successful in restarting breathing and circulation, discussing, making and recording a decision in advance not to attempt CPR can help to ensure that the patient dies in a dignified and peaceful manner. It may also help the patient achieve their wish of spending their last hours or days at their preferred place of death. A recorded DNACPR decision is not, in itself, legally binding and should be regarded as a clinical assessment and decision, made and recorded in advance, to guide immediate clinical decision-making in the event of a patient’s cardiorespiratory arrest.

Answer 193

A systematic review of injuries following CPR attempts identified rib fractures with a frequency of up to 97% and sternal fractures with a frequency of up to 43% in cases of attempted resuscitation. There is also a risk of internal injuries, with the systematic review noting a frequency of 1–5% of cases sustaining cardiac, pulmonary, or intra-abdominal organ injuries. Even if the heart is initially restarted, fewer than half of those who survive initially will survive to go home from hospital.

Answer 194

1. perceived futility of CPR (CPR is unlikely to restore spontaneous circulation) 2. refusal of CPR by the patient with capacity or through an advance decision to refuse treatment 3. when the burdens of the resuscitation attempt are thought to outweigh the benefits.

Answer 195

designed to aid clinical decision making. They provide clinicians with patient-specific assessments or recommendations to aid clinical decision making. They may be computerised, paper based, reminder services and may be develped to aid with particular decisions.

Answer 196

earlier negative experience of IT ◦ potential harm to doctor-patient relationship ◦ obscured responsibilities i.e. loss of autonomy or reasoning ◦ reminders increase workload

Answer 197

useful to aid clinical decision making, can improve practitioner performance and patient decision aids may improve patient knowledge.

Answer 198

campylobacter, salmonella, E.coli and norovirus

Answer 199

campylobacter, salmonella, E.coli, norovirus, listeria, vibrio cholerae, hep A virus, echinococcus spp

Answer 200

48 hours at least

Answer 201

You muct notify any notifiable diseases, any infection which presents/could present/could have presented significant harm to human health and any contamination which could/has presented significant harm to human health. Notifications should be made based on clinical suspicion! do not wait for labs! All urgent cases should be reported by phone within 24 hours as there is often a critical window of time within which effective public health control measures can be implemented. Routine cases should be notified within writing within 3 days.

Answer 202

the study of the distribution and determinants of health-related states and events in specified populations

Answer 203

as an increase in incidence of a disease above expected levels in a particular location or population in a given time period. Another common definition is the occurrence of a disease in two or more epidemiologically linked individuals, such as those with a confirmed common source of infection.

Answer 204

Conduct outbreak surveillance and detection. • Confirm the diagnosis, and assess the public health impact. • Convene an outbreak control team, and establish communication. • Establish a case definition and mechanisms for case ascertainment. • Conduct thorough descriptive epidemiological and preliminary investigations. • Where relevant, conduct contact tracing and environmental investigations. • If necessary, undertake an analytical study to identify the cause of the outbreak. • Communicate the findings. • Implement and evaluate control strategies.

Answer 205

Different cancers are prevalent in different populations and regions of the world e.g. oesophageal in Middle and East China, gastric in Russia and colon in the Western world. The fact that we see striking variations in cancer incidence across the world clearly indicated environmental influence. Migrant studies showed that lifetime cancer risk in Japenese migrants who moved to hawaii ncreased compared with japanese men who stayed in japan. Evidence from observational epidemiology that average fruit/veg intake of less than 200g was associated with increased risk of cancer. The average portion size of fruit is 80g so the '5 a day' was introduced.

Answer 206

Alcohol consumption has increased since the 1960s and reached a peak in 2008 when it was most affordable.

Answer 207

3.3 million deaths (6%)

Answer 208

People with higher socioeconomic status indicators tend to drink more frequently than others but lower SES groups tend to drink larger quantities of alcohol.

Answer 209

flavoured alcoholic beverages

Answer 210

we drink to celebrate but also as a coping mechanism | we tend to start consuming alcohol at a younger age and have a greater tendancy to binge drink.

Answer 211

38% of men | 16% of women

Answer 212

There is at least 1 hiospital alcohol health worker per trust

Answer 213

alcohol related harms, hospital admissions, deaths, public disorder, workplace inefficiency, absences and sick leave, family issues e.g. arguments/violence/debt

Answer 214

mass media campaigns, restricting exposure of young people to adverts, increasing price and taxation, charging per unit, restricting availability, enforced sobriety for jobs and not selling multi pack alcohol.

Answer 215

removing 2 for 1 bargains on unhealthy food sugar tax Shops will be encouraged to promote healthier choices and offer more discounts on food like fruit and vegetables.

Answer 216

the relationship between cause and effect

Answer 217

a group of nine principles that can be useful in establishing epidemiologic evidence of a causal relationship between a presumed cause and an observed effect

Answer 218

1. Strength : A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal. 2. Consistency (reproducibility): Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect. 3. Specificity: Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation. The more specific an association between a factor and an effect is, the bigger the probability of a causal relationship. 4. Temporality: The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay). 5. Biological gradient (dose-response): Greater exposure should generally lead to greater incidence of the effect. However, in some cases, the mere presence of the factor can trigger the effect. In other cases, an inverse proportion is observed: greater exposure leads to lower incidence. 6. plausibility: A plausible mechanism between cause and effect is helpful (but Hill noted that knowledge of the mechanism is limited by current knowledge). 7. Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect. However, Hill noted that "... lack of such [laboratory] evidence cannot nullify the epidemiological effect on associations". 8. Experiment: "Occasionally it is possible to appeal to experimental evidence". 9. Analogy: The use of analogies or similarities between the observed association and any other associations

Answer 219

confounding | reverse causality

Answer 220

a risk factor is associated with an outcome which leads to the development of another risk factor which is incorrectly associated with the outcome e.g. low BMI as a risk for lung cancer but really high BMI caused lung cancer which caused weight loss or alcohol decreased with associated with angina but really the angina caused the person to decrease their alcohol intake.

Answer 221

* persons or doubtful personal hygiene or with unsatisfactory toilet handwashing or drying facilities * children in nursery or pre-school groups * people whose work involves food prep or handling of ready to eat foods * health and social care staff who have contact with highly susceptible patients

Answer 222

Define food and the enforcement authorities and their responsibilities. It came into force on 1st January 1991 and provides the framework for all its food legislation.

Answer 223

* 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 consmption * the sale of any food which is not of the nature or substance or quality demanded by the purhcased * 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 food

Answer 224

breast prostate lung colorectal

Answer 225

lung, head and neck - smoking prevalence is greater

Answer 226

malignant Melanoma - afford sun exposure

Answer 227

because of medical care improvements, an ageing population and Public Health interventions e.g. vaccination or clean water

Answer 228

alcohol very hot drinks obesity salted fish

Answer 229

salt and salt preserved foods

Answer 230

obesity red meat processed meat

Answer 231

alcohol and obesity after menopause

Answer 232

with a decision tree