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Foundations 3 > HES > Flashcards

HES Flashcards

1
Q

What is an opportunity cost?

A

Benefit that could have been attained if treatment for that was provided

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2
Q

What are the main types of economic evaluation?

A
  1. Cost consequence
  2. Cost benefit
  3. Cost effectiveness
  4. Cost utility
  5. Cost minimisation
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3
Q

What principle does cost consequence apply?

A

Cost 1- Benefit 1 Cost 2 - Benefit 2

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4
Q

What is cost benefit?

A

How much more are you willing to pay for a benefit

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5
Q

What is cost effectiveness?

A
  • Using ICER (Incremental Cost Effectiveness Ratio)

- Difference in cost and benefits between 2 methods

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6
Q

What is cost utility?

A

Measured using QALY (Quality adjusted life years)

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7
Q

What is cost minimisation?

A

If 2 treatments provided the same benefit, cheaper treatment option is chosen

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8
Q

What is marginal benefit?

A

Increase in benefit if there was an increased production by one additional unit

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9
Q

What is marginal cost?

A

Increased in cost if there was an increased in production by one additional unit

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10
Q

What is equity?

A

Maximisation of benefit for the money eg a poorer person will have more healthcare needs so they should be given care so that they can be at the same level as a wealthy person

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11
Q

Which people are QALY usually high?

A
  1. Lower social class

2. Old people

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12
Q

What is the problem with cost effectiveness method?

A
  • Measured in natural units so its difficult to compare between multiple outcomes
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13
Q

What is the advantage of cost effectiveness method?

A

Measured as part of the clinical try and it is clearly understood

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14
Q

What does QALY value of 1,0 and -1 mean?

A

1- Healthy
0 - Dead
-1- Worse off than dead

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15
Q

What is measured in QALY?

A
  • Length of life

- Quality of life

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16
Q

How is the quality of life data obtained?

A

Questionnaires, health state description, published values in literature

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17
Q

What does the questionnaire Euro-QoL use?

A
  • Mobility
  • Anxiety/depression
  • Self- care
  • Pain/discomfort
  • Usual activities
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18
Q

What are the problems associated with QALY’s?

A
  • Insensitivity of Questionnaire
  • End of life treatments
  • Discrimination
  • Family carer benefits
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19
Q

What are the costs due to ill health to the NHS?

A

Direct - Social/healthcare, non-healthcare (OTC, Transport, paid carers, private health care)
Indirect - Lost of productivity, benefits and allowance for sick

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20
Q

What are the centres for NICE?

A
  • Health technology
  • Public health
  • Clinical practice
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21
Q

Who make up the majority/ least in NICE?

A
  • Majority: Clinicians

- Least: Manufacturer

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22
Q

Who make up the centre for public health?

A
  • Topic experts
  • Core members
  • Community members
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23
Q

Based on what criteria are screening programmes approved by the National Screening Committee?

A
  • Natural history of disease
  • Appropriate, suitable test/examination
  • Approved treatment
  • Facilities for diagnosis
  • Important health problem
  • Agreed policy on who to treat as patients
  • Economically balanced
  • Continuing process
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24
Q

What are the 3 types of distribution systems?

A
  • Hierarchial: Bottom nothing top most
  • Capitalist: Price determines how goods are distributed
  • Free market (Thatcher): No state intervention, prices of goods are determined by open market
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25
Q

What is the Keynes Welfare System?

A

Antithesis of the free market so acknowledges the role of the state to invest.

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26
Q

What does the state need to invest in the Keynes Welfare System?

A
  • Financial benefits
  • State education
  • National health service
  • Public housing initiatives
  • Employment creation/development
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27
Q

What is the Beveridge plan?

A

Fight against giants of want

  1. Ignorance
  2. Idleness
  3. Squalor
  4. Disease
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28
Q

When was NHS invented?

A

1948

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29
Q

What was the purpose of NHS?

A

To provide an equitable distribution of health services accountable to nation to give them a sense of collective purpose and mission to promote the health of the nation

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30
Q

What is the concept of justice?

A

Treating people equally while understanding that there is an existing inequality

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31
Q

What are the concepts of justice?

A
  1. Desert
  2. Maximising utility
  3. Satisfying need
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32
Q

What does justice as desert mean?

A

Treated equally based on how deserving they are

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33
Q

What does noble failure mean?

A

Someone has tried really hard to adapt this good behaviour but failed for whatever reason

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34
Q

What does justice as maximising utility mean?

A

Utilitarianism: Max benefit for most people

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35
Q

What does justice as satisfying need mean?

A

People with least money and most healthcare need are given priority.

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36
Q

What is the problem associated with justice as a satisfying need?

A

Differentiating what is a need and a want

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37
Q

What is the fair innings approach?

A

Someone who has had fair innings will get lower priority compared to someone who has not reached societal norm.

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38
Q

What is the problem with fair innings approach?

A

Old person need is neglected as young person is prioritised

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39
Q

What is the estimated cost per QALY approved by NICE?

A

25K pounds per QALY

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40
Q

What are the parties involved in judicial review?

A
  • Government: Secretary of State
  • Parliament: Sovereign to satisfy legal need
  • Judiciary: Acts to check on government
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41
Q

ART 2

A

Right to life

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42
Q

ART 3

A

Against inhuman and degrading treatment

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43
Q

ART 8

A

Right to privacy

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44
Q

ART 12

A

Right to found a family

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45
Q

ART 13

A

Prohibition against dicrimination

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46
Q

What are the 9 protected characteristics by single equality act 2010?

A
  • Gender
  • Age
  • Race
  • Religion/belief
  • Sexual orientation
  • Gender reassignment
  • Disability
  • Maternity/pregnancy
  • Marriage/civil partnership
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47
Q

If patient is unable to decide for themselves, who can be given the right to based on Mental Capacity Act 2005?

A
  • Patient nominee
  • Court
  • Doctor
  • Previous wishes of patient
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48
Q

In what ways are autonomy given to the patient?

A
  • Advanced directives
  • Substituted decision making
  • Court of protection
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49
Q

What is the concept of liberalism in terms of safeguarding patients rights?

A
  • Purpose to support and not restrict/control patient
  • Assuming patient has capacity
  • All practical steps are taken to help
  • Unwise decisions are not equated to incapacity
  • Least restrictive option is chosen
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50
Q

What is lack of capacity?

A

Inability to make decision for self either due to impairment or disturbance to function or mind or brain.. This could either be temporary or permanent

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51
Q

What is the test for capacity?

A
  • Understand
  • Retain
  • Weigh info
  • Communicate decision
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52
Q

Why do you review capacity?

A
  • It is decision specific
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53
Q

What can cause temporary incapacity?

A
  • Alcohol
  • Unconscious
  • Drugs
  • Accident
  • Concussion
  • Pain/medication
  • Hypoglycaemia
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54
Q

What are Advance Refusals?

A

Decision can be made at any point to refuse certain treatments in the future

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55
Q

What should the doctor do if they suspect presence of an advanced refusal?

A

Must make reasonable efforts to find out what it says time permitting but can act in emergencies

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56
Q

What is the lasting powers of attorney?

A
  • Patient can have a substituted person to make decisions for them
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57
Q

What are the criteria for lasting powers of attorney?

A
  • > 18 years old
  • Registered and certified by an independent person
  • Donor could place restriction on powers
  • Donee cannot appoint successor
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58
Q

What is the court of protection?

A

New court to deal with all areas for decision making for the incapacitated and has all the powers of the high court.

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59
Q

What powers does the court of protection have?

A
  • One off declarations
  • Substituted decisions
  • Appoint deputies
  • Call for reports
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60
Q

What is eugenics?

A

Set of practices and beliefs that aims to improve genetic quality of life

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61
Q

How were the weak left behind?

A
  • Sterilisation
  • Birth control
  • Marital regulation
  • Segregation of the unfit
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62
Q

What is the tragedy charity model?

A
  • Depicts people as victims of circumstances who deserve pitu
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63
Q

Who uses the tragedy charity model?

A

Charities

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64
Q

What should the funds raised for disabled by charities used for?

A
  • empower disabled people

- full integration into the society as equals

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65
Q

What is the key aim of the medical model for disability?

A

Disability results from a person’s individual limitations and not associated with social and geographical environemtns

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66
Q

What is the difference between impairment, disability and handicap?

A

Impairment: Physical or physiological impairment
Disability: Inability to perform a normal task due to a restriction
Handicap: Any disadvantage that limits the person from fulfilment of a role

67
Q

What are the main points of the social model?

A
  • Disability is a consequence of environment, social and attitudinal barriers
  • Loss or limitation of opportunities to take part in normal community on an equal level
  • Stems from a failure of society to adjusts to needs
  • If you remove this barriers and give disabled people equal opportunity, it will improve their lives.
68
Q

What are the criticisms of the social model?

A
  • Disability can be eradicated (cannot be)

- Unable to understand disabled people do have restrictions so may not be able to perform a task like a normal person

69
Q

What are the main points of the biopsychosocial model?

A
  • Based on the social model but recognises elements of the medical model
  • Realises that it cannot solve all the problems of impairment but can change discrimination against it
  • Recognise inability of disabled to adapt to the demand of the society
  • Stems from failure of society to take the needs of the disabled into account
  • Focuses on limitations, capabilities and potential
70
Q

What are the key values of human rights?

A
  • Fairness
  • Equality
  • Dignity
  • Respect
71
Q

What is the definition of learning disability?

A
  • Impairment of intellectual functioning
  • Consequences in terms of severe social functioning
  • Onset before physical maturity
72
Q

What categories of people do not come into the context of learning disability?

A
  • Develop cognitive impairments in later life

- Specific impairments such as dyslexia

73
Q

What is the difference between IQ test and adaptive behaviour?

A
  • IQ test is to recognise special education help whereas adaptive behaviour is a measure of ability to perform daily tasks
74
Q

What are the problems associated with IQ test?

A
  • Underperformance due to additional disability
  • Narrow range of skills
  • Invalid application for learning disability
75
Q

What are the problems with adaptive behaviour test?

A
  • Ignore the extent of support from carer
  • Variability in performance
  • Cultural difference
  • Lack of opportunities
  • Core skills change over time
76
Q

What are the 2 types of normalisation?

A

1: Scandinavian approach which emphasises the importance for the disabled person to attain adulthood by overcoming ordinary life challenges. Compensatory services available for disabled person to overcome these challenges.
2: US Wolfsenberg: Ease at which disabled people are assigned to a disrespectful label because of the separateness of their appearance, environment or way of life. Specialist services which identify disabled people as different but assigned social roles- Social role valorisation

77
Q

What are the prevention strategies for learning disability?

A

Pre-conception: Prenatal PKU screening
Prenatal: Folate therapy, reduce alcohol consumption
Perinatal: Optimal obstetric and neonatal care
Postnatal: Health education, reduce accidents, vaccination

78
Q

What are the causes of high mortality in people with learning disability?

A
  • Neurological disorders (epilepsy)
  • Disorders associated with the syndrome (dementia)
  • Poor lifestyle
  • Poor access to healthcare
79
Q

What is the definition of visual impairment?

A
  • Inability to see

- Inability to see clearly

80
Q

What is visual acuity?

A

Ability to see detail

81
Q

What does the top and bottom letter mean? 6/6

A

Top- distance seen

Bottom - row of letters seen (5,6,9,12,18,24,36,60)

82
Q

What are the definitions of blind and partial sight?

A

Blind: 3/60

Partial sight: 6/60 or 6/18 if field reduced

83
Q

What is the certificate given to sight impaired people?

A

Certificate of vision impairment

84
Q

What are the main causes of sight loss? Give some other examples as well

A
  • Age related macula degeneration
  • Glaucoma
  • Hereditary retinal disorders
  • Diabetes retinopathy
  • Cataract
85
Q

What are the 3 types of refractive error? What do they each mean?

A
  • Myopia: Short sighted so cannot see far objects
  • Hypermetropia: Long sighted
  • Astigmatism: Distorted vision from an irregular curved cornea
86
Q

What are the possible ways to prevent sight loss?

A
  • National Programmes to control or prevent impairment
  • To increase number of eye care services integrated within the primary or secondary healthcare team.
  • Campaigns to raise awareness
  • International partnerships
87
Q

What is trachoma?

A

Eye disease caused by infection with the bacterium chlamydia trachomatis.

88
Q

What is the typical description of a blind person?

A
  • Female
  • Possibly widowed
  • Age related macula degeneration
  • Also has hearing problems, arthritis, cardiovascular disease, diabetes
  • Cannot read, write or recognise faces
  • Still retain her independence
89
Q

What does a guide dog do?

A
  • Walk in a straight line on a pavement unless there is an obstacle
  • Not to turn corners unless told to do so
  • Judge height and width so owners do not bump their head or shoulder
  • Deal with traffic
90
Q

What are the help available for visual impaired people?

A
  • Government benefits
  • Eye Clinic Liaison Office (eclo)
  • Social workers
  • Voluntary organisations
  • Low vision aids such as magnifiers
91
Q

What are the benefits of registering as visually impaired?

A
  • Disability living allowance
  • Reduction in TV license
  • TAX
  • Reduced fees on public transport
  • Parking concessions
92
Q

What are the different categories of deafness and how are they divided?

A
  • Moderate: 40-70dB
  • Severe: 71-95dB
  • Profound >95dB
93
Q

What are the main causes of deafness?

A
  • Congenital due to genetic defects, infection, conductive malformation, ototoxic drugs (gentamycin)
  • Acquired: Drugs, Meniere’s, Tumour, Infection, Loud noise, obstruction, trauma
94
Q

What are the basic principles of the medical models of deafness?

A
  • Caused by a developmental deficiency or disease
  • To be cured or corrected by medication/surgery
  • Individual’s adjustment/behaviour would lead to effective cure
  • Aim is to teach deaf child to speak
  • Responsibility of dead people to make themselves understood
95
Q

What are the main points of the social model of deafness?

A
  • Disability is a socially created problem
  • Communication with deaf barrier because people do not want to use sign language and thus leading to isolation for those who are deaf
  • Society caused this due to lack of awareness and opportunity
96
Q

What is the cultural model of deafness?

A
  • BSL is their preferred language as see themselves as part of social, cultural and linguistic community
  • Do not see themselves as disabled
  • Shared social beliefs
  • Not experienced a loss of hearing so positive attitude
  • Affects mental health because of social disadvantage
97
Q

What are the do’s when speaking to a deaf person?

A
  • Speak clearly normal speed
  • Minimal background noise
  • Talk face to face
  • Gain attention by tapping or waving
98
Q

How to use a sign language interpreter?

A
  • Check interpreter qualified
  • Send information before meeting
  • No background noise
  • Deaf person can see interpreter
  • Interpreter is neutral and not offer any opinions
  • Interpreter need to interpret everything said
  • May ask for repetition
  • Allow for time for deaf person to respons
99
Q

How to contact deaf person?

A
  • Mobile
  • Textphone
  • Fax
  • E-mail
  • Videophone
  • Skype
100
Q

What is a text relay?

A
  • Uses minicom to type message to operator who reads to hearing person
101
Q

How does WHO define health?

A

A state of complete physical, mental and social well being and not merely the absence of disease or infirmity

102
Q

What are the key components of healthcare system?

A
  • Continually improve health status of an individual, family and communities
  • Defence against health threats
  • Protection against financial consequences of ill health
  • Equitable access to people centred care
  • Assisting people to participate in decision making process regarding their health
103
Q

What is public health?

A 
Science and art of 
- Preventing disease
- Prolonging life
- Promoting health
through organised efforts
104
Q

What is the difference between individual and population healthcare?

A
  • Different needs identified
  • Delivered and evaluated
  • Doctor advocates for different people
105
Q

What is the healthcare continuum?

A

Primary prevention - secondary prevention- tertiary prevention - end of life care

106
Q

What factors contribute to the changing healthcare requirements?

A
  • Increase in population size
  • Increase in ageing population
  • Increase in life expectancy
  • Increase prevalence of chronic disease
  • Supply/demand
107
Q

What is the new model of healthcare?

A
  • Integration of services

- Patient centred care

108
Q

What are the radical changes to healthcare provision due to Health and Social Care Act 2012?

A
  • Clinically led commissioning
  • Increased patient involvement
  • Focus on Public Health
  • Focus on quality of healthcare
  • Allowing healthcare market competition in the best interests of patients
109
Q

What is NHS 3 key strands to delivering quality care?

A
  • Patient safety
  • Clinical effectiveness
  • Patient experience
110
Q

What are the 2 overarching quality outcome for public health?

A
  • Increase life expectancy

- Increase quality of life ( decrease different in quality years and life expectancy)

111
Q

What is the difference between prevention and promotion?

A

Prevention is more disease focused and uses a medical model whereas promotion is a holistic approach to widen the benefits to the whole population by enabling people to have control over their health

112
Q

What are the 3 approaches to health promotion?

A
  • Medical
  • Socioenvironmental
  • Behavioural
113
Q

What is the difference between high risk and population approach to health promotion?

A
  • High risk only targets high risk group whereas population targets the whole population
  • Large benefits seen among high risk group but small changes seen at individual level for population approach however as a whole, substantial benefit for population approach
114
Q

What consists of in the interventional ladder?

A
  1. Do nothing
  2. Provide information
  3. Enable choice
  4. Disincentives
  5. Incentives
  6. Change default policy
  7. Restrict choice
  8. Eliminate choice
115
Q

What are methods of health promotion?

A
  • Health communication via leaflets, adverts
  • Health education
  • Self help eg alcoholic anonymous
  • Organisational change
  • Community development
  • Policy/legislation
116
Q

What are the role of doctors?

A

For patients: Lifestyle advice, referral, advocacy, empower patients to manage chronic disease
For healthcare: Participate in public health research, contribute to national reports

117
Q

What is the role of screening?

A

Identify apparently health people who are at an increased risk of disease

118
Q

How do you calculate sensitivity?

A

a/(a+c)

119
Q

How do you calculate specificity

A

b/(b+d)

120
Q

How do you calculate positive predictive test?

A

a/(a+b)

121
Q

How do you calculate negative predictive test?

A

c/(c+d)

122
Q

What happens when you screen a low risk population?

A

High false positive

123
Q

What does sensitivity tell us?

A

How good a test is at picking up disease

124
Q

What does specificity tell us?

A

How good a test is at excluding disease

125
Q

What do each population gain/lose from screening?

A
  1. True positive: Disease picked up early so can be treated immediately but if no treatment then is it worth knowing? Will you be labelled
  2. False positive: Need to emotionally go through more tests. Hazards of further diagnostic tests and costs
  3. False negative: Give them false reassurance and delays diagnosis
  4. True negative: Hazard and costs of screening
126
Q

What is the function of a National Screening Committee?

A

Advise ministers on all aspect of screening policy, evaluate screenings and research evidence

127
Q

What are the non NSC approved screening programmes?

A
  • Prostate cancer
  • Chlamydia screening
  • Health check every 5 years above 40
128
Q

What are the types of bias that could arise from screening?

A
  1. Volunteer bias
  2. Lead time bias
  3. Length time
129
Q

What is volunteer bias?

A

People who do attend screening are more concerned for their health so possibly have better health

130
Q

What is lead time bias?

A

Disease is diagnosed at an earlier stage (pre-symptomatic) so makes it seem like patient lived longer from point of diagnosis but no change to course of progression of disease

131
Q

What is length time bias?

A
  • Diseases with long pre-clinical phase more likely to be detected and usually has better prognosis because it is less aggressive.
132
Q

What is the definition of tertiary prevention?

A
  • Reduce impairments
  • Promote patient’s adjustments
  • Improve function/minimise impact
  • Prevent complication
133
Q

What are the key characteristics of tertiary prevention?

A
  • Patient has an established disease
  • Focus on intervention of either improving function or preventing gradual decline
  • Intervention begins after acute disease
  • Long timescale
134
Q

What are the types of tertiary prevention?

A
  • Clinical
  • Collaborative: Physiotherapy, occupational, psychologist
  • Social: Minimise disability
135
Q

What are the primary, secondary and tertiary interventions for stroke?

A

Primary - Smoking/alcohol
Secondary - FAST, TIA management
Tertiary - Rehabilitation

136
Q

How is the process of stroke rehabilitation? What programme is this?

A
  • Early in the hospital: Mobilisation and functional positioning
  • Community: Early discharge and long term rehabilitation
    National Stroke Strategy
137
Q

What are the facets of rehabilitation?

A
  • Aerobic training
  • Arm re-education
  • Orthoses
  • Positioning
  • Self management
  • Task training
  • Splinting
  • Assessment
138
Q

What are the phases in cardiac rehabilitation?

A

I: Counselling/assessment
II: Post discharge support
III: Structured exercise programme
IV: Long term maintenance

139
Q

What are the components in the tertiary prevention shopping list?

A
  • Rehabilitation
  • CBT
  • Medication Adherence strategies
  • Mental health relapse prevention
  • Dietary advice
  • Routine review
  • Self management plans
  • Community support groups
140
Q

What is palliative, supportive and end of life care?

A
  • Palliative care: Relief their suffering and support them through tough times
  • Supportive: Support patient and their family members to cope with the condition and treatment from pre-diagnosis to bereavement services
  • End of life care is a mixture of palliative and supportive care so that their needs are identified and met through that last phase.
141
Q

What are the components of holistic approach to palliative care?

A
  • Physical
  • Psychological
  • Social
  • Spiritual
142
Q

What are the trajectories of death?

A
  1. Sudden - Car accident
  2. Well then sudden decline- terminal disease
  3. Better then decline then better - Organ failure
  4. Slow decline- Old age
143
Q

What is the difference between spectacular and subtacular?

A
  1. Spectacular- Sudden traumatic loss of life, high priority in A&E
  2. Subtacular- Management of chronic disease, neglected in A&E
144
Q

What are the concerns over care?

A
  • Poor communication
  • Lack of recognition of expert family
  • Lack of continuity of care
145
Q

What are the End of Life Care Policies in present?

A
  • Gold Standard Framework
  • Liverpool Care pathway no longer used
  • NHS EOL strategy 2008
146
Q

What are the criteria to initiate a Liverpool Care Pathway based on recommendations given?

A
  • Senior clinician
  • Cannot do it out of hours
  • Urgent call to nurse/midwifery for advice
147
Q

What is an Advanced Statement and Advanced Refusal?

A
  • Advanced Statement is to formalise what patient/family wish to happen to them later in their disease. It is not legally binding
  • Advanced Refusal is formalising what patient/family do not wish to happen and it is legally binding
148
Q

How can patients play a distinct role in their healthcare?

A
  • Understanding cause of disease and factors that influence it
  • Self diagnosis and treating minor self-limiting condition
  • Selecting most appropriate treatment for acute conditions
  • Managing treatment and taking medications
  • Monitoring symptoms and effects of it
  • Being aware of safety issues
  • Adopting healthy behaviour
149
Q

What is health literacy?

A

Ability to make sound health decisions in the context of everyday life

150
Q

What are the objectives of health literacy?

A
  • Provide information and education
  • Encourage appropriate and effective use of healthcare
  • Tackle health inequalitites
151
Q

What is self-efficacy?

A

Patient’s belief that they have the capacity to learn a perform a specific behaviour, confidence and ability is the key.

152
Q

What are some patient empowerment techniques?

A
  • Coaching
  • Prompt cards
  • Diaries
153
Q

What is the function of Healthwatch?

A

Ensure patient involvement in NHS planning

154
Q

Define carer

A

Designated person who provides long term help to a disabled person usually a family member of their immediate family but now extends to social care worker

155
Q

What do family carers receive from the government?

A

Carer’s Allowance or manage social security payments such as Attendance allowance

156
Q

Who are care providers?

A
  • Family
  • NHS
  • Local authorities
  • Charities
  • Private sector
157
Q

What are the problems with staff care?

A
  • Abuse/neglect
  • System of abuse in contracting system which forces down expenditure leading to poor pay, difficulty recruiting staff and unfilled vacancies.
158
Q

What are the problems associated with the term carer?

A
  • Families see it as ordinary obligations and activities of family life
  • Support is reciprocal
  • Carer suggests disabled person is in permanent need of attention
159
Q

What is the impact of care by spouse/partners?

A
  • Feeling exposed and vulnerable
  • Changes in employment and income
  • Change in relationship and family responsibilities
  • 24 hour on call
  • Stress greatest in the early stages and towards end of life.
160
Q

What is the impact on family life for caring for a disabled child?

A
  • Single parents, poverty
  • More time consuming and costly
  • Disproportionate effects on those with low income
  • Stigmatisation
  • Burden
  • Family are diverse and capable of adaptation to unforeseen events
161
Q

What is occupational health?

A

Discipline that focuses on effects of work on health and influence of pre-existing health problems on the capacity to work

162
Q

What are the core services provided by occupational health team?

A
  • Prevention
  • Timely intervention
  • Rehabilitation
  • Health assessment
  • Promotion of well being
  • Teach and train staff to support health and well being
163
Q

What consists of pre-work assessment?

A
  • Health status
  • Job requirement
  • Functional assessment
  • Restrictions
  • Adaptiations

Foundations 3 (8 decks)

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