Block 15 - part 1

Question 1

CDSS

Answer 1

clinical decision support systems - designed to aid clinician decision making

Question 2

4 different types of CDSS

Answer 2

computerised, paper based, reminder systems, developed to aid with particular decisions

Question 3

examples of CDSS

Answer 3

reminder systems: screening, vaccination, testing, medication use
decision systems (diagnosis and treatment) - model individual patient data against epidemiological data
prescribing - advice on drug and dosage - highlights interactions
condition management

Question 4

effects of computer support on prescribing

Answer 4

reduced time to achieve therapeutic stabilisation, reduced risk of toxic drug level, reduced length of hospital stay, increased size iof initial dose, increased serum drug conc. no change in adverse effects of drug

Question 5

do CDSS work?

Answer 5

can improve practitioner performance in diagnosis, disease management, prescribing/drug dosing, rates of vaccinations, screening but evidence for pt outcomes not so cobust

Question 6

patient decision aids

Answer 6

help pt understand probable outcomes of options, help pt consider personal value they place on benefits vs harm, support pt in decision making, include additional info

Question 7

key issue with pt decision aids

Answer 7

no consensus on what info should be included

Question 8

what improves practice when using decision support

Answer 8

providing decision support as part of the clinician workflow, providing recommendations for management, providing decision support when and were decision making happening, computer-based decision support

Question 9

potential barriers to using CDSS

Answer 9

earlier negative experience of IT, potential harm to Dr-pt relationship, obscured responsibilities - loss of autonomy, reminders increase workload

Question 10

potential facilitators of CDSS

Answer 10

self control of CDSS, if clinician can notice help in practice

Question 11

food poisoning

Answer 11

diarrhoea and vomiting with or without pain

Question 12

major causes of food poisoning

Answer 12

not cooking food thoroughly, not storing chilled food properly, keeping cooked food unrefridgerated for long periods of time, eating food that has been touched by someone who is ill or has been in contact with someon with diarrhoea and vomiting, cross contamination

Question 13

bacterial infections which cause food poisoning

Answer 13

salmonella, campylobacter, shigella, C. difficile

Question 14

viral infections which cause food poisoning

Answer 14

norovirus, rotavirus

Question 15

fungal infections which cause food poisoning

Answer 15

aspergillus

Question 16

protozoal infections which cause food poisoning

Answer 16

cryptosporidia, giardia

Question 17

bacterial toxins which cause food poisoning

Answer 17

clostridium perfringens, s.aureus, clostridium botulinum

Question 18

marine biotoxins which cause food poisoning

Answer 18

scombroid poisoning, shellfish, ciguatera

Question 19

chemicals which cause food poisoning

Answer 19

heavy metals, pesticides, herbicides

Question 20

most common cause of food poisoning

Answer 20

campylobacter

Question 21

clinical picture of salmonella infection

Answer 21

transmission - ingestion of contaminated food, faecal contaminations, person-person infected animals
can cause enteric fever or enterocolitis, incubation period is 12-72 hours, symptoms - diarrhoea, vomiting, fever, headache, chills

Question 22

clinical picture of staph aureus infection

Answer 22

transmission contaminated food by skin/nasal flora, produced enterotoxins, incubation 2-4 hours, rapid onset, projectile vomiting and diarrhoea

Question 23

clinical picture of crytosporidium infection

Answer 23

transmission - animal-human, person-person, contaminated water or land, associated with foreign travel, incubation 2-5 days, symptoms - watery or mucoid diarrhoea, severe illness in immunocomprimised

Question 24

clinical piture of e.coli infection

Answer 24

contaminated food, person-person, 1-6 days incubation, symptoms - haemorragic colitis, haemolytic uraemic syndrome in 5%

Question 25

clinical picture of norovirus infection

Answer 25

faecal-oral route, environmental contamination, contaminated food and water, incubation 24-48 hours, symptoms nausea, projectile vomiting, low grade fever, diarrhoea

Question 26

clinical picture of campylobacter infection

Answer 26

raw/undercooked meat, unpasteurised mild, bird-pecked milk, untreated water, domestic pets with diarrhoea, person-person, incubation 2-5 days, fever, headache, malaise, nausea, diarrhoea, vomiting=uncommon

Question 27

prevention of food poisoning

Answer 27

isolation, hand hygiene, protection (gloves gowns masks), environmental cleaning, respiratory hygiene and cough etiquette

Question 28

‘safe food’

Answer 28

food that will not cause harm to a person who consumes it when it is prepared, stored, and/or eaten according to its intended use

Question 29

concerns with food

Answer 29

food bourne illness, nutritional adequacy, environmentl contaminants, pesticides, naturally occuring contaminents, food additives

Question 30

public health act statement on food poisoning

Answer 30

allows exclusions from work of people that pose increased risk of GI infection spread - children in nursery/pre school, people who work with food, health and social care staff, people with doubtful personal hygiene

Question 31

offences under the food safety act 1990

Answer 31

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 consumption,

sale of any food which is not of the nature or substance or quality demanded by the purchaser,

sale of food for sale with a label that falsely describes the food, or is likely to mislead as to the nature or substance or quality of food

Question 32

hazard analysis critical control point

Answer 32

analysis of potential food hazards in a food business, identification of points in operations where such hazards could occur, deciding which of the identified points are critical to food safety, identifying and implementing effective control and monitoring procedures at the critical points, reviewing the hazards and critical points at periodic intervals and particularly when any change occurs to the operation

Question 33

outbreak

Answer 33

incident in which 2 or more people thought to have a common exposure experience a similar illness or proven infection

Question 34

objectives in food poisoning outbreakds

Answer 34

reduce number of primary and secondary cases, reduce harm consequent on the episode, prevent further outbreaks`

Question 35

investigations in food poisoning outbreaks

Answer 35

preliminary phase, immediate steps

Question 36

preliminary phase investigations in food poisoning outbreaks

Answer 36

is there an outbreak? confirming diagnosis, what is nature and extent of outbreak?

Question 37

immediate steps investigations in food poisoning outbreaks

Answer 37

who is ill? how many? case finding. what is the cause? is proper care being arranged? what immediate action can be taken?

Question 38

outbreak outliers

Answer 38

cases at the very beginning and end that may not appear to be related, first check to make certain they are not due to coding or data entry error

Question 39

what might outbreak outliers represent?

Answer 39

baseline level of illness, outbreak source, case exposed earlier than the others, unrelated case, case exposed later than the others, case with longer incubation period

Question 40

how can analytical epidemiological studies be useful to identify probable food source of outbreak

Answer 40

compare food history of ill and well persons, point source outbreak - cohort study, common source of outbreak - case-control study