# 3 - HaDSoc - Screening + The NHS Flashcards Preview

## ESA4 > 3 - HaDSoc - Screening + The NHS > Flashcards

Flashcards in 3 - HaDSoc - Screening + The NHS Deck (29)
1
Q

What is the purpose of screening?

A
• Detect an unrecognised condition using tests to rapidly distinguish between apparently well people who probably have the disease, and those who probably don’t
• To give a better outcome compared to finding the disease in the usual way
2
Q

What are the 4 Wilson/Younger criteria for having a screening programme?

A

1) Disease/condition
- Severe/freq, early detectable stage
2) Test
- Simple, safe, precise, valid, acceptable to pop, cut-off point
3) Treatment
- Effective, evidence-based, early tx advantageous
4) Programme
- Quality assured, facilities for counselling, diagnosis and treatment available, cost-benefit analysed

3
Q

Regarding screening tests, what is meant by sensitivity?

A

Probability a case will test positive

4
Q

Regarding screening tests, what is meant by specificity?

A

Probability a non-case will test negative

5
Q

Regarding screening tests, what is meant by positive predictive value?

A

Probability someone who tested positive, actually has the disease

6
Q

Regarding screening tests, what is meant by negative predictive value?

A

Probability someone who tested negative, actually doesn’t have the disease

7
Q

How is the sensitivity of a screening test calculated?

A

Number of true positive results /

Number of true positives + false negatives

8
Q

How is the specificity of a screening test calculated?

A

Number of true negative results /

Number of true negatives + false positives

9
Q

How is the positive predictive value of a screening test calculated?

A

Number of true positive results /

Number of true positives + false positives

10
Q

How is the negative predictive value of a screening test calculated?

A

Number of true negative results /

Number of true negatives + false negatives

11
Q

Why is it important for a screening test to have high sensitivity?

A

If it wasn’t sensitive, a larger number of people would receive a false negative result:
- Inappropriate reassurance, may lead to delay of presentation when symptoms appear

12
Q

Why is it important for a screening test to have high specificity?

A

If it wasn’t specific, a larger number of people would receive a false positive result:

• Stress
• Anxiety
• Inconvenience
• Costs
13
Q

What are the critiques of screening?

A
• Alters patient-doctor relationship (doctor turns people into patients, rather than them presenting to dr)
• Hard to define targeted group to screen
• Evaluation is susceptible to lead time bias, length time bias and selection bias
• Harms caused by inevitable false results
• Victim blaming - individual must take responsibility
• Interfering ‘nanny state’ - people are expected to present
• Social norms - judged if you do not present
14
Q

What year was the NHS created, and on which 3 principles was it initially based on?

A

1948

1) Universal
2) Comprehensive
3) Free

15
Q

What main reforms have occurred in the NHS since it was created?

A
• 1980 - ^ management to improve quality
• Commissioning based on needs, quality and cost
• 2012 - Heath + Social care act - power to primary care providers
• Devolution between England, Scotland, Ireland + Wales
• ^ Marketisation
16
Q

Who has the overall accountability for the NHS?

A

Secretary of State for Health

17
Q

Who sets the national standards to shape the direction of the NHS?

A

Department of Health

18
Q

Who authorises CCGs, and commissions specialist and GP services?

A

NHS England

19
Q

Who commissions secondary and community care?

A

CCGs

20
Q

What does CCG stand for?

A

Clinical Commissioning Group

21
Q

What are the 4 managerial roles for doctors?

A
• GP
• Consultant
• Clinical director
• Medical director
22
Q

Who provides clinical and cost-effectiveness information as to whether a treatment should be recommended in the NHS?

A

NICE

23
Q

What type of analysis do NICE use to decide whether or not to recommend an intervention, based on costs and benefits?

A

Cost-utility analysis

- calculates cost per QALY for different interventions, allowing comparison

24
Q

What is a QALY?

A

1 QALY = 1yr perfect health = 2yrs 50% health etc

25
Q

What are the criticisms of using QALYs?

A
• Resources not distributed according to need
• Disadvantage elderly or end-of-life patients
• Don’t assess other factors ie impact on carers/family
26
Q

What are the most common patient complaints?

A
• Poor communication from healthcare professionals
• Poor hygiene
• ‘Hotel’ aspects of care
• Waiting times
• Incompetence
• Culturally inappropriate
27
Q

Define complimentary therapy:

A

Diagnostic and therapeutic medical disciplines that are based on theory which is not taught at medical schools

28
Q

What are the challenges in conducting trials on complimentary therapies?

A
• Funding (big pharmaceuticals won’t fund)
• Difficult to find placebos
• Strong views for/against implicates randomisation
29
Q

Who regulates doctors? Is this authority inside or outside of the profession?

A

GMC

Outside profession