Block 31 H&S Flashcards
(222 cards)
1
Q
What are its aims?
NHS long term plan?
A
- The NHS long term plan aims to prevent strokes, heart attacks and dementia over the next 10 years
- specifially looks at detection and management of high risk conditions like AF and hypertension
2
Q
NHS LTP - AF?
A
- 90% of patients w AF who are deemed to be high risk to be anticoagulated by 2029
3
Q
NHS LTP - hypertension?
A
- 80% of the expected number of people with high blood pressure diagnosed by 2029
4
Q
NHS LTP - CVD?
A
- 75% of ppl aged 40 to 74 should receieve a CVD risk assessment and cholesterol reading in the last 5 years by 2029
5
Q
NHS england
strategies for reducing CV disease in the local community?
A
- raising public awareness of CVD risk factors
- * implementing NHS England’s RightCare CVD prevention pathway
- using existing data to make the case for action
6
Q
major risk factors contributing to incidence of CVD?
A
- hypertension
- high LDL cholesterol
- diabetes
- smoking
- obesity
- unhealthy diet
- physical inactivity
7
Q
CV diease and lifestyle changes?
A
- lifestyle changes significantly impact cardiovascular health
- Implementing healthy habits, such as regular physical activity, a balanced diet, smoking cessation, stress management, and adequate sleep, can significantly reduce the risk of CVDs and improve overall cardiovascular well-being.
8
Q
smoking cessation and CV health - evidence?
A
- observational study by Duncan et al showed smoking cessation was associated with sig lower CV disease within 5 years relative to current smokers
- Smoking cessation has the propensity to mitigate cardiovascular diseases and complications especially when achieved on a timely scale.
9
Q
primary prevention =
A
- Primary prevention refers to the steps taken by an individual to prevent the onset of the disease.
- This is achieved by maintaining a healthy lifestyle choice such as diet and exercise.
10
Q
secondary prevention?
A
- This is achieved by maintaining a healthy lifestyle choice such as diet and exercise.
- SP = preventative measures in patienst with a diagnosis of CV disease
- Secondary prevention focuses on reducing the impact of the disease by early diagnosis prior to any critical and permanent damage.
11
Q
what does secondary prevention involve?
A
- secondary prevention includes early diagnosis which requires identifying RF so patients can be treated earlier
- e.g. treating dyslipdemias and HTN to prevent complications
12
Q
Three
merits of publically available performance indicators?
A
- allows patients to be more informed about the services they are accessing
- KPIs contribute to quality assurance of e.g. screening programmes
- allows for clinical auits - performsnce can be measured against set standards so that improvements can be made
13
Q
limitations of publically available performance indicators?
A
- can create additional stress for patients and their families
- due to understaffing and pressures some KPI which are set by the DOH are not able to be met such as the 4 hour A&E which puts extra pressure on staff
14
Q
ethnicity and CVD?
A
- people from the White Gypsy or Irish Traveller, Bangladeshi and Pakistani communities have the poorest health outcomes across a range of indicators
- rates of infant and maternal mortality, cardiovascular disease (CVD) and diabetes are higher among Black and South Asian groups than white groups
15
Q
Ethnic minorities faced more ? during the pandemic?
A
- ethnic minority groups experienced higher infection and mortality rates than the white population during the pandemic
- this inequality is thought to be due to many factors such as deprivation, environment, health related behaviours - SES is a key determinant of health status
16
Q
amongst ethnic minority groups, structural racism can?
A
reinforce inequalities, for example, in housing, employment and the criminal justice system, which in turn can have a negative impact on health.
17
Q
which ethnic group has the highest risk of death from heart disease?
A
- South Asian people have the highest risk of death from heart disease of any ethnic group, a 50% higher risk than the population of England and Wales.
- SA people develop heart disease at a younger age
18
Q
Death from ischaemic heart disease was highest for?
A
men and women in the Bangladeshi, Pakistani and Indian ethnic groups, compared to other ethnic groups
19
Q
women that are at higher risk of CVD?
A
- women with lower levels of education and living in more deprived areas of the UK are at greater risk of CHD - largely due to smoking, obesity and physical activity
20
Q
Women are ? as likely to die from CHD?
A
2X
21
Q
Women are more likely to receive?
A
- women are 50% more likely to receive the wrong intial diagnosis for a heart attack
- poor aftercare following a heart attack
22
Q
RF for heart disease in women?
A
- risk factors for heart disease often more deadly for women - Smoking increases women’s heart attack risk up to twice as much as men’s,
23
Q
barriers to rapid diagnosis and treatment for a MI?
A
- atypical presentation e.g. elderly with comorbitiies or women
- -> lack of knowkedge - health literacy
- can present like indigestion -> GP
24
Q
Barriers to accessing care for MI - time to arrive at hospital?
A
- distance
- access to transport
- availibility of ambulances
25
time for correct diagnosis and treatment - MI?
availability of proper treatment, staff shortages, waiting lists
26
methods of reducing delay for an MI?
* patient education on atypical presentations
* early ECG/ troponin on arrival
* early diagnsosis for STEMI for PPCI/ fibrinolysis
27
Causes of asthmatic attacks?
* allergies
* acid reflux
* high humidity weather
* breathing in cold dry air
* fragrances
* stress
* paint fumes
* pets
28
social triggers for asthma attacks?
* smoking and secondhand smoke can trigger an asthma attack
* air pollution
* cockroaches
29
30
occupational triggers for asthma?
* dust
* chemicals - pains, varnishes, adhesives, cleaning supplies
* fumes
* metals - platinum, chromium
* animal fur
* resp irritatnts like chlorine gas
31
management of chronic asthma (BTS guidelines)
32
Who should be considered for prophylaxis of DVT?
* all patients should undergo a risk assessment to identify their risk of VTE and bleeding on admission to hospital
33
Mechanical thromboprophylaxis?
* anti-embolism stockings - should not be offered to patients admitted with acute stroke or those w PAD, peripheral neuropathy or severe leg oedema
* intermittent pneumatic compression
34
pharmacological thromboprophylaxis?
* LMWH
* DOACs
35
approaches to controlling spread of TB?
* BCG vaccines - high risk groups
* good ventilation
* practicing good hygeine
* isolating TB patients and contact tracing
* early diagnosis
* supporting adherence to treatment - DOT
36
How many new cases of lung cancer a year?
* almost 50k new cases and 35k deaths / year
37
how many lung cancer cases are preventable?
80%
38
10 year survival for lung cancer?
10%
39
lung cancer is the ? most common cancer in the UK
3RD
40
rates of lung cancer in the last decade?
* rates have increased in females in the last decade but decreased in males
41
RF for lung cancer?
* smoking
* ionising radiation exposure
* radon gas
* asbestos exposure - and other substances like arsenic, chromium, nickel
* FHx
* air pollution
42
NHS stop smoking services?
* can self refer by completeing an online form or by calling the stop smoking service
* 1:1 and group stop smoking sessions
* at the first session, discussion of stop smoking aids like NR products including patches and bupropiun
43
NHS community pharmacies for smoking cessation?
* supports ppts who started a stop smoking programme in hospital to continue their journey in community pharmacy
44
smoking support for someone who declines referral to NHS stop smoking services?
* Informed about sources of information and support for smoking cessation.
* Offered practical advice.
* Advised to stop abruptly.
* Offered drug treatment to reduce withdrawal symptoms.
* These include nicotine replacement therapy (NRT), varenicline or bupropion
45
harm reduction approaches for those not wanting to stop smoking?
* cutting down smoking with or without NRT
* temporary abstinence from smoking
* NRT may be used as long as necessary to prevent relapse
46
barriers to rapid diagnosis of MI?
- A social “wait and see” approach to chest pain
- Attendance of GP and not immediately attending A&E
- GP surgeries not open at the weekend and so pts that might not want to
attend A&E wait until Monday
- troponin levels may not rise until 12 hrs after symptoms
47
Methods to reduce the delay in treatment of suspected ACS?
- Increased awareness of symptoms and advise to seek medical attention
immediately if symptoms are experienced
- NICE guidelines on early diagnosis of NSTEMI and UA
- Fast-tracking admitting system in A&E
- Rapid response ambulances
48
Pros of publicly available performance indicators?
- Provide information/statistics about healthcare providers
- Informs patients and encourages choice
- Transparency, honest and open (increase trust in health providers as a result)
- quantitative - clear numerical value
49
Cons of publicly available performance indicators?
- Relationship with quality of care not demonstrated
- Even if all treatment was uniform there would always be random variation in mortality rates across hospitals
- dependent on non hosp care
- No evidence that publishing these influences pts (does influence clinicians and managers however)
50
CHD - ethnicities at highest risk?
- SA have 50% higher risk of CHD
- Bangladeshi have the highest rates > Pakistani > indian
51
who has the lowest risk of CHD?
Black individuals of West African and African origin in the UK have half the risk of the european population
52
reasons for the difference in IHD rate between ethnicities?
- differences in HC access
- increased diabetes prev in SA populations
- genetic susceptibility
- Increased smoking prevalence in ethnic
minority populations
- Oestrogen may have protective effect
regarding IHD
53
Modifiable RF for CVD?
- Hypertension
- Smoking
- Diabetes mellitus
- Hypercholesterolaemia
- Obesity
54
Non mod IDH RF?
- Age
- Sex (M>F)
- FHx
- Ethnicity
- Socio-economic position (lower>higher
55
change in smoking rates?
- overall decreasing numbers but higher
teenage female smoker
56
poor diet/ obesity rates?
Poor diet/obesity - thought to be responsible for 25-50%
of CVD deaths per year - prevalence increasingly rapidly worldwide
57
NICE physical activity guidance?
Physical activity- at least 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous intensity aerobic activity
58
NICE - alcohol guidance?
Alcohol intake - no more than 14 units per week - some of the days should be alcohol free
59
e.g. of PP
Smoking cessation, healthy eating, exercisE
60
e.g. of SP?
Antiplatelet therapy, statins, antihypertensives
61
e.g. of Tertiary prevention?
- - limiting the impact that adverse event has on health
- CABG/PCI/Thrombolysis, cardiac rehabilitation
62
prevention paradox?
A preventative measure that brings large benefits to the community offers little to each participating individual
63
JBS risk tables show the absolute 10 year risk for?
- new angina
- non fatal MI
- death from stroke
- death from CAD
64
# two?
Outline a strategy to reduce cardiovascular disease in the local community?
- Annual calculations of the QRISK2 score
- Educating members of the public at a younger age, to instil healthy lifestyle habits
- Prescription of 20mg atorvastatin to pts with a QRISK2 score greater than 10%
65
Community based method of reducing CVD in the local community?
exercise groups, healthy cooking classes, regular BP and cholesterol screenings
66
Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening health conditions such as:
- Heart disease
- ACS
- CVA
- Cardiac failure
- Peripheral arterial disease
- Aortic aneurysms
- Kidney disease
- Vascular dementia
67
BP targe for <80 yrs?
- Clinic BP <140/90 mmHg
- ABPM/HBPM <135/85 mmHg
68
> 80 yrs BP target?
- =/>80yrs - Clinic BP <150/90 mmHg
- ABPM/HBPM <145/85 mmHg
69
DM pts w/ established atherosclerosis and patients with chronic renal failure aim for
<130/80 mmHg
70
major precipitants of asthmatic attacks?
- pollen, animal fur
- infections
- smoke, pollution
- meds
- emotions - stress/ laughter
- mould/ damp
- exercise
71
sudden changes in ? can precipitate an asthma attack?
Sudden changes in temperature, cold air, wind, thunderstorms, heat and humidity
72
occupational allergens?
bakers, farmers, carpenters and people involved in manufacturing plastics, foams and flues
73
Pathophys of asthmatic attacks?
- type 1 hypersen
- hygiene hypothesis - clean envr - inert particles seen as allergens
74
Asthma BTS guidelines
75
acute asthma Mx?
76
identify ppts at risk of DVT
77
initial measures of DVT prevention - all ppts?
- Avoid dehydration
- Encourage early mobilisation
- Aspirin or antiplatelets should not be considered adequate VTE prophylaxis
78
DVT prophylaxis for low risk ppts?
Only offer mechanical prophylaxis - compression stocking, intermittent pneumatic pressure
79
high risk DVT prophylaxis?
- Mechanical prophylaxis
- Pharmacological prophylaxis - LMWH, UFH, DOACs or fondaparinux
- IVC filters
80
approaches to controlling spread of TB?
- BCG
- contact tracing
- screening
- hygiene
81
BCG?
- Provides life-attenuated strain of organism
- Currently risk-based e.g. only people who live in high-risk countries, high-risk areas or have high-risk occupation receive the vaccine
- Administration at birth to prevent the development of TB in young children in most countries where TB is prevalent
- Only given to those who are tuberculin negative
82
Contact tracing?
- Effective tracing can limit the spread
- Can help identify infected individuals at an early stagewhich is difficult without active seeking because TB can lie latent in individuals before becoming clinically apparent
**- Doctors must notify pt to public health authority**
- **All close family members, close contacts at work and home are screened (sputum examination or Mantoux test)**
83
TB screening?
- New entrant into UK should be screened via clinical exam and **CXR**
- Also consider screening in deprived urban areas
84
TB hygiene?
- Cover mouth when sneezing or coughing
- Avoid spitting in open air
- Good household ventilation
- Limited prolonged contact with people who have TB whilst their sputum remains positive
- isolation
85
epidemiology of LC?
- 3rd most common cancer in UK
- Most common cause of cancer death in the UK (50% of people who die from lung cancer are >75)
- 9/10 cases occur in people >60
86
# where is it higher
lung cancer incidence?
Lung cancer incidence currently higher in high income countries but is set to change as smoking patterns change
87
lung cancer cases that are preventable?
80%
88
RF for LC?
- Cigarette smoking
- asbestos
- envr exposures
- air pollution
- prev radiation to chest
- chronic infections - HIV, TB
89
environmental exposures in lung cancer?
arsenic, chromium, nickel, beryllium silica
90
benefits of smoking cessation?
- skin appearance
- teeth improvement
- reduced risk of fire at home
- improved sense of smell and taste
- reduced risk of CVD and angina
91
lung cancer risk is ? after stopping smoking for 10 yrs?
halved
92
stopping smoking campaigns?
1. Education in school & to patient
2. Tobacco TV & printed adverts banned
3. Taxes higher to deter
4. Adverts on cigarette packets about risks
5. Age restriction
6. Smoking banned in public enclosed
93
causes of occupatinal lung diseases - asbestos?
roofers and plumbers
94
causes of occupational lung disease - coal?
miners
95
# Who is at risk
causes of occupational lung diseases - aspergillus?
malt workers, farmer
96
causes of occupational lung diseases - cigarette smoking?
bar worker
97
causes of occupational lung diseases - radiation?
radiographer
98
silica?
metal mining, pottery manufacture
99
# JOB AT RISK OF EXPOSURE
arsenic?
paint factory
100
implication of occupational lung diseases for patients?
- may need to change job
- may be entitled to benefits/ compensation - industrial industries disablement benefit
101
who can help w compensation for occupational lung diseases?
british lung foundation and department for work and pensions
102
spread of disease - direct?
- droplet - imp if compromised skin barrier
- vertical - mother to foetus
103
indirect transmission?
- airborne - aerosol/ droplet
- vector borne - mechanical/ bio
- vehicle borne - water/ food
104
epidemic?
Occurrence in a community / region of cases of an illness /
health-related behaviour clearly in excess of normally expecte
105
endemic>
Persistent, usual, or expected level of disease in a given populatio
106
pandemic?
Epidemic over a very wide area, crossing international boundaries
107
surveillance?
* Systematic collection, collation and analysis of data + resultant dissemination, so that appropriate measures can be tak
108
notifiable diseases?
109
What is an audit?
- Audit is the systematic critical analysis of the quality of
medical care, including:
1. Procedures for diagnosis = including pathways
2. Procedures for treatment
110
stages of an audit?
- set standards
- collect data
- analyze
- identify steps to improve
- implement changes
- re-evaluate - collect for data
111
benefits of audits?
* Clinical education is improved
* Can improve teamwork
* Improve patient care
112
# What do audits prevent
how do audits improve ppt care?
- identify if meeting NICE guidance
- improve cost effectiveness
- prevent near misses becoming accidents
113
- of audits?
- can be influenced by confounding factors
- lack of generalisability
- small sample size can reduce usefuleness of results
114
aims of guidelines?
- improve quality of HC
- care is up to date
- helps make informed decisions based on evidence
115
what are guidelines?
- ”Systematically developed statements that are a consensus of best practice based on the available
evidence
116
Good guidelines should be?
- valid
- reproducible
- cost effective
- clinically applicable - clear target population
- clear- easily understood
117
Primary care audit for CVD?
CVD prevent
118
NHS funding?
- general taxation
- NI contributions
119
How is social care funded?
- sep from healthcare
- managed by LAs
120
in addition to public funding, the NHS is also funded by?
- prescriptions
- dentistry
- parking charges
121
NHS: government funding goes to?
- NHSE
- NHS improvement
- they are resp for delivering the NHSLTP
122
Role of NHS england?
- oversees commissioning of NHS services
- allocate funds to CCGs
123
How have we moved away from CCGs?
- CCGs were clinically led grs that decicided on local healthcare needs and allocate funds to diff services
- have now been merged into ICS
124
intergrated care systems?
- partnerships between hospitals, GPs, community services
- Since july 2022
- 42 have been establishes
125
separation of intergrated care systems?
- neighbourhoods
- places
126
ICS: neighbourhoods?
- GP surgeries coming together as PCNs
127
ICS - places?
- LA area collaborations between H&SC organisations including charity
128
health and social care act?
- 2022
- gives ICS power and resp
129
Intergrated care partnership?
each ICS has a comittee responses for strategy in that area
130
integrated care board?
statutory NHS organisation responsible for meeting population health needs and managing budget for services
131
NNT?
- the number of people with a specific condition who need to be treated for a specified period of time in order to prevent one beneficial outcome (NNT to benefit) or adverse outcome (NNT to harm)
132
NNT equation?
- 1/ Abs risk reduction
- always round UP
133
What are the publicly available performance indicators?
- Performance league tables are a technique for displaying comparative rankings of performance indicator scores of several similar providers = set standard
of acceptable performance for surgical procedures
* If any apparent large variations DOH investigates
* e.g. for cardiac surgery mortality or ppt reported measures like satisfaction
134
why are there publicly avail perf indicators?
- Readily available info in other areas (e.g. schools, police etc.) = why shouldn’t we measure outcomes, as this is the measure of quality
* There is often a lack of evidence base behind practice should back up what we do with numbers
* The realization that there is a wide variation in practiced standard / public evidence of deficiency in quality of
135
pros of publicly available perf indicators?
- Allows quantification of quality in an easily categorised & measurable way (e.g. deaths in surgery)
2. Should drive improvements in quality = can identify outliers & therefore allow for this to be improved upon
3. Should identify areas for improvement
4. Give patient trust in doctor & allow patient more choice = transparent, honest & open
136
limitations of publicly available perf indicators?
- misleading - may have higher death rate due to more complex cases
- could lead to ppts w good prognosis going to good hosp
- ppt could lose faith in docs
- individualistic culture of blame
137
adverse event?
- unintended event from clinical care and causing ppt harm
138
never event?
- “Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented
- e.g. wrong site surgery
139
near miss event?
Unplanned event that has the potential to cause harm but does not actually lead to injury or damage
140
human factors?
mistakes and purp breaking rules
141
systems factors means there were?
poor defence against errors
142
how are adverse events and near misses prevented?
- report on national reporting and learning system
- root cause analysis
143
most common erros?
- prescribing - wrong dose, wrong drug
- yellow card system - for reporting of side effects
- communication failures
144
duty of candour?
1. Must tell patient when something has gone wrong
2. Must apologize & offer appropriate resolution
3. Must explain the potential short & long-t
145
swiss cheese model?
many events have to align for an adverse event to occu
146
active failures in the SCM are split by?
- unintentional errors
- intentional errors
147
unintentional errors - knowledge based?
wrong plan formed due to inadequate knowledge / experience (e.g. junior doctor misdiagnosis
148
unintentional errors - rule based?
: Misapplication of ‘good rule’ / guideline (i.e. applying guideline for 10y/o to neonat
149
unintentional errors - skill based?
- Attention / memory lapse = unintended deviation from good action / pl
- common
150
intentional errors?
A. Routine: Normalisation of bad practice
B. Situational: Context-dependent (i.e. shortcuts when overwhelmed / understaffed)
C. Reasoned: Deliberate deviation from protocol thought to be in best interest at time
D. Malicious: Deliberate act intended to ha
151
swiss cheese model?
152
Steps to ppt safety?
- building a safe culture
- lead and support staff - don't create indiv blame culture
- promote reporting
- implement solutions to prevent harm
153
mental consequences of obesity?
- insulin resistance and T2D
- dyslipidemia
- HTN
- CVD
154
mechanical consq of obesity?
- osteoarthiris
- reduced mobility
- sleep apnoea
- GI issues - GBD, fatty liver, GORD
155
mental consq of obesity?
- depression and anx
- low self esteem
- EDs
156
Tier 3 obesity services?
- specialist weight management services psychologists, doctors, nurses
- comprehensive assessment - obesity related health risks, dietary habits
- personalised Tx plans
- Pharmacological management
157
Tier 4 obesity services?
- specialist obesity clinics
- evaluation for elibility of bariatric surgery
- bariatric surgery procedures
- MDT - surgeons, physicians, dietitians, psychologists, and other healthcare professionals to ensure holistic care throughout the bariatric surgery process
158
159
cardiac rehab involves?
* Helps u recover and get back to as full a life as possible after a heart attack, heart surgery or following a diagnosis such as heart failure
* individualised exercise, education and support programme built around your personal circumstances and needs.
160
Cardiac rehab - resources?
* cardiac rehab - video calls, websites, telephone support
161
cardiac rehab -RF?
* risk factors - eating healthy, stopping smoking, building exercise
* exercise sessions - tailored to need and ability
162
Cardiac rehab - info and support?
* information and education sessions - eating healthy, abt medications, smokingc cessation etc
* peer support - meet people in the same situation
* emotional support and wellbeing
163
what can cardiac rehab help w?
* recovering from surgery, procedure or heart attack
* reducing risk of further heart probs
* improving MH
* making lifestyle changes
164
women w CHD have ? outcomes?
* women w CHD have worse outcomes than males
* Women tend to present with coronary artery disease later in life
165
how do women w CHD present?
* Women experience longer delays in access to hospital care and are less likely than men to have invasive diagnostic procedures
* fewer women present with classical symptoms of chest pain
166
why are women's symptoms often not recognised?
* The historic limited interpretation of women’s symptoms based on the traditional approaches such as the Diamond and Forrester risk model results from under-recognition of the sex-specific presentation of IHD and contributes to misdiagnosis and delayed recognition of ischemia
167
women w IHD use more?
* women with IHD use more cardiac resources and incur greater healthcare costs bc of greater symptom burdern and hospitalization
168
subgroups of women who experience worse outcomes?
* Subgroups of women who experience worse outcomes for IHD include younger women (aged <55 years) and those of Black, Latino, and South Asian descent
169
south asian MI risk?
upto 30% more likely
170
black people MI risk?
* Black people were at 51% lower risk of myocardial infarction
171
mortality from IHD in both SA men and women?
* mortality from IHD in both South Asian men and women is 1.5 times that of the general population
172
Impact of living w uncertain prognosis?
* depression
* distress
* anxiety
* stress
* hyperaware of physical changes
* focusing excessively on the medical details
173
role of HF specialist nurses?
* co-ordinate care for the patient promotoing MDT approach
* assisting patient with self management
* accessible to patients and ehtir families - rapid response
* support and counselling
* easy access to a profressional who knows the patient and can provide consistent care
174
Referral to MDT/ cardiology?
* severe HF (NYHA class 4)
* HF that doesn't respond to tx
* HF from valvular disease
* LVEF of <35%
* women w HFrEF who are plannig a pregnancy
175
occupations at risk of asthma?
176
LC referral guidelines
177
aetiology of LC?
* smoking - 80-90% of cases
* asbestos exposure - strongly associated with mesothelioma but also linked to adenocarcinoma of the lung
* radon gas - occurs from uranium
178
2 week referral for LC
* unexplained haemoptysis and aged over 40
* Patients with evidence of SVCO or stridor require an urgent referral and emergency admission to hospital for further review.
179
occupational and enviromental lung diseases - deaths due to?
* deaths mainly due to PM2.5
* Deaths are due to IHD/stroke (58%), COPD (18%), lung cancer (6%)
180
pollutants - particulate matter?
* A mix of solid and liquid droplets arising mainly from fuel combustion and traffic
* This has the greatest impact on peoples’ health
181
pollutants - NO2?
* Arising mainly from road traffic and indoor gas cooking
182
Pollutants - sulphur dioxide?
* Arises mainly from burning fossil fuels
* Associated with asthma and poor lung function
183
pollutants - ozone?
* Caused by the reaction of sunlight with pollutants from vehicle emissions
* A major factor associated with asthma
184
most toxic PM?
* particulates are a mix of solid and liquid droplets in the air e.g. soot
* PM 2.5 are the most toxic and are associated with CR disease and lung cancer
185
indoor air pollution?
* Worldwide smoke fires used for cooking.
* Biomass fuels produce large amounts of particulate matter
* contributes to COPD and childhood respiratory infection
186
occupational asthma?
* commonest cause of occupational lung disease in the UK
* interactionw smoking and atopy
187
Work related asthma?
188
occupational asthma causes
189
identifying occupational asthma?
* ask abt occupation - are symptoms worse at work and are they better when they're away from work - weekends/ holiday?
* peak flow diary
* challenge tests
190
pneumoconiosis?
* lung disease resulting from inhalation of dusts
- Long latency between exposure and development of disease
191
types of pneumoconiosis?
* Coal workers pneumoconiosis
* Silicosis
* Asbestosis
* Many other rarer causes (eg. Berylliosos, Bagossis etc).
192
silicosis?
* rare
* looks like sarcoidosis
* predisposes to TB and LC
* Upper lobe nodules and lymph node calcification
193
asbestos can cause a range of diseases?
* Benign asbestos related pleural plaques
* Asbestos related pleural effusions
* Diffuse pleural thickening
* Mesothelioma
* Lung fibrosis (asbestosis)
* Lung cancer
194
Mesothelioma?
* almost always caused by occupational exposure
* long latency
* rising prev in UK despite being banned in the 70s
* incurable
195
occupational lung cancer?
* Estimated to cause 10% of lung cancers in men
* Asbestos estimated to cause 60% of these but unclear whether has to cause fibrosis (asbestosis) first or direct effect
196
other causes of occupational lung cancer?
* Also arsenic,chromium, coal gas, coke production, cadmium, chloromethyl ethers, silica, radon, soot
197
# Role
the health and safety executive?
* independent regulator that aims to prevent work related death, injury and ill-health
* produce guidance
198
organisations with responsibility for the environment and health?
* Deparment for environment, food and rural affairs
* PHE - air pollution
199
occupational lung diseases?
200
Jobs at risk of sillicosis?
- mining
- slate works
- foundries
- potteries
201
high incidence TB countries?
- india
- indonesia
- pakistan
- china
202
RF for TB?
- Place of birth
- HIV
- Prison inmates/staff,
- nursing homes
- homeless shelters,
- health care workers,
- substance abuse,
- immigrant centres & migrant workers camps
203
medical factors inc TB risk?
- under nutrition
- smoking
- cancer
- HIV
- taking illicit drugs
- alcoholism
204
social factors increasing risk of TB?
Single/widowed men, immigration, incarceration, homelessness
205
contact tracing in TB?
* idenficiation of contacts of TB positive individuals
* national target is for 90% of people with infectious TB to have at least 5 contacts traced
* pre-entry screening programme for testing of active pulmonary TB in migrants from high incidence countries who apply for visas which reduces importation of active TB
206
# Benefit over mantoux
INF-gamma tests?
* quantiferon TB gold - used in place of TB testing for previous infection
* not confounded by prior BCG vaccine
* main role is screening for latent disease
207
what does the INF-G test measure?
* measures cell mediated immune response by looking at INF-g released by T cells in response to TB antigens
208
TB drugs?
*Isoniazid
*Rifampin
*Pyrazinamide
*Ethambutol
RIPE
209
other tests for TB patients?
* Testing for HIV
* hep B and C serologic tests if risks present
210
tests to do when TB Tx is initiated?
* AST
* ALT
* bilirubin
* ALP
* serum creatinine
* platelet count
* Visual acuity and color vision tests (when EMB used)
211
Approaches to controlling spread of TB
?
* improve vaccination uptake
* address TB in under-served populations
* improve access to services and ensure early diagnosis
* quarentine
* DOT - directly observed treatment when non-compliance suspected e.g. homeless, alcoholics
212
MDT TB teams should provide data to TB control boards on:
screening uptake, referrals and the number of active TB cases identified.
213
TB control boards should?
* control boards should develop TB prevention and control programmes working with commissioners, Public Health England and NHS England
* **TB control boards should be responsible for developing a TB prevention and control programme** based on the national strategy and evidence‑based models.
214
roles of the TB control boards?
* TB control boards should plan, oversee, support and monitor local TB control, including clinical and public health services and workforce planning.
215
CF screening?
heel prick blood test
216
advanced care plainning?
- process of discussion between and indiv and their care providers
- facilitates and enables individuals to think abt the care that they would like to receive
- allows them to choose where they want to die
217
Benefits of ACP?
* patient centered
* prevents over-treatment when the patient lacks capacity
218
Indicator of deterioration?
SPICT tool - indicators of deteriation for each disease
219
EoL care plan:
ensures best quality of care during the patients last days
220
advanced care planning leads to
221
most common cause of liver failure in the UK?
Paracetamol overdose
222
when is prev higher than indicence?
In chronic disease prevalence is greater than incidence - in acute disease the incidence is greater than the prevalence
