Block 12 H + S Flashcards

Question

How can hip fractures be prevented?

Answer 1

- Fall prevention | -  Bone protection - Medication, hip protection

Answer 2

Avoidance of disease before any signs or symptoms develop

Answer 3

Avoidance of progression or later problems, signs or symptoms present

Answer 4

- Primary - No history of stroke or TIA | -  Secondary - After either of these have occurred

Answer 5

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

Answer 6

-Large potential benefit to community - Low potential benefit to individual - May be low perceived benefit to individual

Answer 7

-Larger potential benefit to individual - Smaller effect on population rate of stroke - Many of the conditions you treat are asymptomatic - May of the treatments have side effects

Answer 8

-People who have already had one - Secondary prevention reduces risk in these people - 1/5 people with stroke have another after 3 months

Answer 9

- Ischaemic - Clipidogrel, statin, anti-hypertensive, anticoagulant if AF -  Haemorrhagic - Anti-hypertensives

Answer 10

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

Answer 11

-Age - Gender - Race - South Asians with western lifestyle - Family history - Rare congenital (in young people - CADASIL)

Answer 12

``` -High blood pressure - Biggest risk factor - Diabetes  -Atrial fibrillation  -Smoking  -Hyperlipidaemia  -Obesity ```

Answer 13

Reducing blood pressure after stroke reduces risk of stroke recurrence

Answer 14

``` -Misinformed  -Not caring  -Side effects of tablets - Forgetfulness  -Depression - Cognitive impairment ```

Answer 15

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

Answer 16

Restriction - Limit the participants of your study who have possible cofounders  Means that you have less data and difficult with multiple confounders - Matching - You create a comparison group that is matched on the possible confounder, make case and control group as similar as possible on the confounder and then ask about exposure status  Used for strong confounders like age and sex  Stratification - Analyse exposure:outcome association in different subgroups of the confounder, recombine data and use a weighted average of the strata - Limitations - To take into account all confounders would require lots of strata and you may run out of data to fill all possible options in your strata - Multiple variable regression - You can adjust for the effects of multiple confounders, try and produce a linear model between the outcome and the different exposures  Allows for adjustment of estimates for confounding

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

Small numbers in particular age groups

Answer 22

- There is a limitless demand for health, people can always 'be more healthy' which created high demand -  Limited resources - Supply of money, staff etc is finite

Answer 23

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

Answer 24

-Average waiting time (mean or median) - Proportion who waited longer than 'x number of days'  -Average wait of people currently on the list

Answer 25

-The backlog - Implies a need for occasional emergency injection of funds - Demand management - Waiting acts as a 'price' to deter frivolous use - Allows NHS resources to be fully employed - Don't want lots of spare capacity as this is a waste - Waiting lists are caused by underfunding and ineffieciency

Answer 26

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

Answer 27

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

Answer 28

-No inpatients waiting longer than 3 months - Outpatients reduces, significant increased expenditure alongside this, however funding has now remained constant meaning NHS is struggling despite increased demand

Answer 29

-Sacrifice of professional autonomy - Managers pressurising doctors, may be forced to treat less urgent due to waiting time - Unmeasured performance sufferers - Things that don't have a target may suffer - Adverse behavioural responses e.g. emergency patients waiting in ambulances not emergency rooms, not classed as being in A&E until they are through the doors so essentially cheating - Data manipulation and fraud

Answer 30

``` -Clinical urgency - Clinical severity - Potential health gain - Productivity and economic loss - Equity waiting e.g. poverty - Length of time waiting ```

Answer 31

- Social impact - Difficult to have conversations, isolation, intimacy issues, problems at work -  Psychological impact - Anger, low confidence, frustration, depression, embarrassment -  Practical issues - Doorbells, phones, theatre and cinema, TV, alarms

Answer 32

- Aphasia (dysphasia) - Difficulty in the generation of speech and sometimes also in its comprehension -  Dysarthria - Difficult or unclear articulation of speech that is otherwise linguistically normal (due to weakness of muscles used to speak) -  Dyspraxia - Affects movement and coordination, cannot move muscles in the correct order and sequence to make the sounds needed for clear speech.

Answer 33

- Not being able to express yourself clearly can be very isolating -  Depression -  Frustration -  May not be able to participate in activities they used to enjoy -  Tiring - Communicating may require a lot of effort

Answer 34

- Determination of fitness to drive and other similarly dangerous activities -  Determination of intent for alleged criminal actions

Answer 35

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

Answer 36

- Complementary - Non-mainstream practice is used together with conventional medicine -  Alternative - Non-mainstream practice is used instead of conventional medicine

Answer 37

- Acupuncture - Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes - Chiropractic - Spinal manipulation aims to treat 'vertebral subluxations' which are claimed to put pressure on nerves - Herbal medicine - Medicines with active ingredients made from plant parts - Homeopathy - Based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself - Osteopathy - Moving, stretching and massaging a person's muscles and joints

Answer 38

-Self-healing is triggered - Longer-term effects may be due to physiological (re-)learning and behavioural/life- style changes integral to treatments - Each therapy has its own mechanism(s) - Mostly poorly understood

Answer 39

-Regulatory issues - Financial concerns in NHS - Tribalism - Different medical specialties 'hold on' to their patch - Inertia - Resistance to change - Mixed evidence of effectiveness - Not all are properly evidence-based

Answer 40

``` -Patient choice - Preventative healthcare agenda  -Commissioning changes - Personal budgets - Growing evidence base ```

Answer 41

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

Answer 42

-Back, neck and shoulder problems - Joint, posture and muscle problems - Leg pain and sciatica - Sports injuries

Answer 43

``` -MSK patients - Fertility/pregnancy - Has become much more popular - Neurological pain - Depression - Eczema - Chronic pain ```

Answer 44

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

Answer 45

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

Answer 46

-Is the effect too small and not clinically relevant - NSAIDs are commonly given for chronic back pain - NSAID vs placebo and acupuncture vs placebo have similar effect for pain reduction

Answer 47

-Low back pain - Consider manual therapy, do not offer acupuncture - Osteoarthritis - Manipulation and stretching should be considered as an adjunct to core treatments, do not offer acupuncture - Headache/migraine - Consider a course of up to 10 sessions of acupuncture over 5-8 weeks

Answer 48

- Lack of insight - Person suffers from some disability but seems unaware of the existence of their disability -  Cognitive impairment - e.g. Dementia -  Presence of psychosis - Severe depressive symptoms -  Learning disability

Answer 49

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

Answer 50

-Using a different form of communication - Providing information in a more accessible form - Treating a medical condition affecting the person's capacity - Having a structured programme to improve a person's capacity

Answer 51

Mental capacity act (MCA) 2005

Answer 52

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

Answer 53

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

Answer 54

- Patient noticing changes - Forgetfulness, difficulty with names and finding the right word, embarrassment in social situations -  Family or friends noticing changes - Repetitive, forgets social arrangements, skills deteriorating, withdrawing -  Delirium - Acute confusion with fluctuating level of consciousness, agitation, hallucinations etc -  Social crisis - E.g. death of a spouse reveals cognitive dysfunction and impairment

Answer 55

- Denial (with or without insight) - Patient attributes all problems to old age, often accompanied by anger at the suggestion that there is anything wrong -  Grief reaction - Similar reaction to receiving diagnosis of any serious illness -  Acceptance/positive coping strategies - Need to reconsider the future

Answer 56

- Insight and stage of illness - Ability to remember and process information -  Type of dementia -  Previous personality, relationship, and support

Answer 57

- Confirmation of something they have long suspected -  Fear -  Anger -  Grief

Answer 58

-Understanding of illness - Patients reaction -Nature of relationship with patient and what else is happening

Answer 59

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

Answer 60

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

Answer 61

-More vulnerable - May struggle to discuss their feelings and experiences or remember what happened to them - Can be hard to detect abuse

Answer 62

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

Answer 63

-Extends patients autonomy to apply in situations where they don't have capacity as defined under the MCA 2005. - A valid AD that refuses treatment should always be followed - ADs allow patients to refuse future treatment but not to demand treatments

Answer 64

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

Answer 65

Advanced directive for bipolar disorder

Answer 66

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

Answer 67

-Difficult to verify if the patient's opinion has changed since making AD - Difficult to ascertain whether the current circumstances are what the patient foresaw when making AD - Possibility of coercion on behalf of the patient - Possible wrong diagnosis - Can patients imagine future situations sufficiently vividly to make their current decisions adequately informed?

Answer 68

-Nazi medical experiments (Nuremberg trials) - Willowbrook study - Injected vulnerable children with Hep B to develop vaccine - Tuskegee sphilis study - African-american men given syphilis but not given antibiotics, researchers wanted to see disease progression -Alder Hey - Retaining childrens organs without consent - Wakefield - MMR scandal (autism)

Answer 69

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

Answer 70

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

Answer 71

-Usefulness - Valid, good method, hasn't been done before, strong justification - Necessity - Does it need to be done this way? - Risks - Risks should be as low as possible, sometimes balance minimal risk with benefits - Consent - Valid (competent, voluntary, informed), deception is sometimes needed e.g. psychological studies - Confidentiality - Respect patients information - Fairness - Who benefits? Will it favour particular population group? - Approval - From research ethics committee

Answer 72

Voluntary, informed, patient is competent

Answer 73

-Not putting pressure on patients or volunteers - Not offering inappropriate (financial) inducements - Not threatening/imposing sanctions if they don't take part

Answer 74

``` -Information sheets - Presentation of information - No jargon, easy to understand  -Summary of key points - Opportunity to ask questions - Time to decide - At least 24 hours ```

Answer 75

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

Answer 76

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

Answer 77

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

Answer 78

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

Answer 79

- Research involves humans -  Research involves confidential information -  Research involves biological material (embryos, stem cells, etc)

Answer 80

-NHS Research ethics committees - Higher Education Institution (HEI) research ethics committees  -Gene therapy advisory committee - Social care research ethics committee  -Ministry of defence research ethics committee

Answer 81

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

Block 12 H + S Flashcards

(107 cards)