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Year 2 H+S > Block 9 H+S > Flashcards

Block 9 H+S Flashcards

1
Q

Why is knowing about decision making in medicine important?

A
  • doctors make decisions very often
  • need to know the effect their decision has on patients and their families
  • An understanding of it can help improve medical practice
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2
Q

What is the nature of decisions in medicine?

A
  • They’re complex
  • doctors generally use process of hypothetic-deductive reasoning
  • Research evidence can help inform decision making
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3
Q

What goes into evidence based decisions?

A
  • Evidence from research
  • Patient preferences
  • Clinical expertise
  • Available resources
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4
Q

Why do we need Evidence based decision making?

A
  • Increasing medical knowledge
  • Limited time to read
  • Textbooks etc. often out of date
  • Disparity between diagnostic skills and clinical judgement
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5
Q

What is in the chain of infection?

A
  • host
  • infectious agent
  • reservoir/ environment
  • portal of entry
  • mode of transmission
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6
Q

What are the different types of research studies and when are each appropriate?

A

-Cohort studies- prognosis and cause
-Case control studies- cause
-Randomised control trials- treatments, interventions, benefits/ harm, cost effectiveness
-Qualitative approaches- patient perspectives
Systematic reviews- summary of evidence for a specific question

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7
Q

What is the process of evidence based decision making?

A
  • converting need for information into an answerable question
  • identifying the best evidence to answer that question
  • critically appraise the evidence for validity, impact etc.
  • Integrating the critical appraisal with clinical expertise and patient circumstances
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8
Q

What are the reasons for widespread use of antibiotics?

A
  • Increase in global availability

- Uncontrolled sale in many low/ middle income countries

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9
Q

What are some of the causes of antibiotic resistance?

A
  • Use in livestock for growth promotion
  • Volume of antibiotics prescribed
  • Inappropriate prescribing of antibiotics
  • Missing doses/ not finishing dose
  • Releasing antibiotics into environment when manufacturing
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10
Q

How can we prevent antibiotic resistance?

A
  • Only taking them when prescribed by doctor
  • Completing full prescription
  • Not sharing antibiotics
  • Only prescribing when needed
  • Using more specific antibiotics
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11
Q

What factors influence infection?

A
  • Infectious agents- ability to reproduce, survival, infectivity etc.
  • Mode of transmission
  • Environment
  • Portal of entry- mouth, nose, ears etc.
  • Host factors- nutrition, age, smoking etc.
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12
Q

What are the most important infectious diseases in UK?

A
  • Diptheria
  • Haemophilus influenza
  • Measles
  • Mumps
  • Poliomyelitis
  • Rubella
  • Pneumococcal disease
  • Tetanus
  • Whooping cough
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13
Q

What are the most important infectious diseases in developing countries?

A
  • Pneumonia
  • chronic diarrhoea
  • Malaria
  • HIV
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14
Q

What is surveillance?

A

Systematic collection, collation and analysis of data and dissemination of the results so that appropriate control measures can be taken

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15
Q

What is the purpose of surveillance?

A
  • Early warning system for impending public health emergencies
  • Document the impact of an intervention or track progress towards a goal
  • Monitor and clarify the epidemiology of health problems so can prioritise.
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16
Q

Which infectious diseases are associated with exposure to healthcare?

A

Nosocomial infections:

  • UTI
  • Pneumonia
  • Lower respiratory infections
  • Septicaemia
  • MRSA
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17
Q

How can we reduce risk of nosocomial infections?

A
  • Prevention- handwashing, surveillance, sterilisation of instruments
  • Detection, investigation and control of outbreaks
  • Policies to prevent and control infection
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18
Q

What is global health?

A
  • Health of the global population
  • Improving health and achieving equality in health for all people worldwide
  • Emphasises transnational health issues, determinants and solutions
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19
Q

What is international health?

A

Health defined by geography (poor nations), problems (infections, water, sanitation), instruments and a donor- recipient relationship

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20
Q

What are the major functions of global health?

A

-To provide health-related public goods - research, standards, guidelines
- To manage cross-national externalities through epidemiological surveillance,
information sharing, and coordination
- To mobilise global solidarity for populations facing deprivation and disasters
- To convene stakeholders to reach consensus on key issues, setting priorities,
negotiating rules, facilitating mutual accountability, and advocating for health in other policy-making arenas

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21
Q

What is the motivation for global health?

A
  • Increased awareness of global health disparities

-  Enthusiasm to make a difference across international boundaries

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22
Q

What is the 90/10 gap?

A

Less than 10% of worldwide resources devoted to health research were put towards health in developing countries, where over 90% of all preventable deaths worldwide occurred

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23
Q

What is the solution for this gap?

A
  • Regulation of the quality of imported food, medicines, manufactured goods, and inputs
  •  Getting timely access to information about the global spread of infectious diseases
  •  Procurement of sufficient vaccine and drug supplies in a pandemic
  • Ensuring a sufficient corps of well-trained health personnel
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24
Q

What impact has travel and migration had on diseases seen in the UK?

A
  •  Help spread infectious diseases
  •  Transmission of behaviour and culture increases risk of non-communicable diseases
  •  May introduce a diseases to a new population - Widespread and deadly effects
  •  More in contact with animals - Increase in animal diseases (zoonosis)
  •  Migrants may bring diseases to countries that have not been exposed
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25
Q

What is WHOs definition of environment, in relation to health?

A

- All the physical, chemical and biological factors external to a person, and all the related behaviours
- Environmental health consists of preventing or controlling disease, injury, and disability related to the interactions between people and their environment

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26
Q

What is an outbreak?

A

Sudden increase in occurrences of a disease in a community, which has never experienced the disease before or when causes of the disease occur in numbers greater than expected in a defined area

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27
Q

What is an epidemic?

A

Occurrence of a group of illnesses of similar nature and derived from a common source, in excess of what would be normally expected in a community or region

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28
Q

What is a pandemic?

A
  • Worldwide epidemic

-  Outbreak -> epidemic -> pandemic

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29
Q

How can we prevent epidemics?

A

-Insure poor countries against the threat of a pandemic
- Funds and international responders sent to country with outbreak to reduce human
suffering
- Development of vaccines
- Fast, early, planned response means less spread
- Monitor disease to prevent future outbreaks

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30
Q

What is the role of WHO in public health?

A

-Providing leadership on matters critical to health and engaging in partnerships where joint action is needed
- Shaping the research agenda and stimulating the generation, translation, and dissemination of valuable knowledge
- Setting norms and standards and promoting and monitoring their implementation
- Articulating ethical and evidence-based policy options
- Providing technical support, catalysing change, and building sustainable institutional
capacity
- Monitoring the health situation and assessing health trends

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31
Q

What are the determinants of effective outcomes of intervention?

A

-Econonics - Many developing countries can only spend a few dollars per annum per capita on healthcare
- Priorities - ‘Developed world academic’ analyses of cost-effectiveness may not reflect the developing world realities
- Setting - Countries where true reductions in incidence and prevalence have occurred (e.g. uganda) may be characterised by openness in political leadership towards HIV/AIDS and other cultural factors

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32
Q

What are the public health objectives of vaccination?

A

-To reduce mortality and morbidity from vaccine preventable infections
- To prevent outbreaks and epidemics
- To contain an infection in a population
- To reduce the number of infections
- To interrupt transmission to humans
 To generate herd immunity
- To eradicate an infectious agent

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33
Q

What factors influence the utility of immunisation/vaccination as an approach to disease prevention?

A
  • Disease burden
     Risk of exposure to the disease
    - Age, health status, vaccination history
    - Special risk factors
    - Reactions to previous vaccine doses, allergies
    - Risk of infecting others
     Cost
    - Are there other ways to control the disease?
    - impact on public perception
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34
Q

What is required for a disease to be eradicated using vaccination?

A

-Where no other reservoirs of the infection exist in animals or environment
- Where consequences of infection are very high
- Where scientific and political prioritisation exists

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35
Q

Give examples of diseases that have been eradicated?

A
  • Smallpox

- Polio

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36
Q

What is herd immunity?

A

- Level of immunity in the population which protects the whole population
- Herd immunity only applies to diseases which are passes from person to person
- Provides indirect protection to unvaccinated as well as direct effect to the vaccinated
- A disease can therefore be eradicated even if some people remain susceptible

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37
Q

What is R0?

A

-Basic reproduction rate
- The average number of individuals directly infected by an infectious case during the
infectious period, in a totally susceptible population (number of secondary cases following introduction of infection)

38
Q

What factors affect R0?

A

-The rate of contacts in the host population
- The probability of infection being transmitted during contact
- The duration of infectiousness

39
Q

What is the effective reproduction rate?

A

Estimates the average number of secondary cases per infectious case in a population made up of both susceptible and non-susceptible hosts

40
Q

What is the equation for effective reproduction rate?

A
  • R = R0x (x is the fraction of the host population which is susceptible e.g. half population is 0.5)
  •  R>1 - number of cases increases
  •  R<1 - Number of cases decreases, needs to be maintained for elimination
  •  R=1 - Epidemic threshold
41
Q

What is the equation for herd immunity?

A

H(R0-1)/ R0

42
Q

What is WHO’s role in vaccination?

A

-Makes recommendations for countries on vaccination policy
- Supports less able countries with vaccination strategy implementation
- Works through the international health regulations to ensure the maximum security
against the international spread of disease with a minimum interference with world traffic

43
Q

List some international immunisation programs?

A

-Expanded programme on Immunisation (EPI)
- Global Polio Eradication Initiative (GPEI)
- Global Alliance for Vaccines and Immunisation (GAVI)

44
Q

How are new vaccination programmes implemented- who, how and when?

A

-Who - To protect vulnerable, contain outbreak, eradicate disease
- How - Pilots, phased introduction, global vaccination
- When - Greatest impact on disease burden

45
Q

What is shared decision making and why is it important?

A
  • Conversation between patient and their health care professional to reach a health care choice together.
  •  Important when - There is more than one reasonable option, no one option has a clear advantage, the possible benefits/harms of each option affect patients differently
46
Q

What are the pros of vaccination?

A 
- Can save life
- Ingredients are safe in the amount used
- Adverse reactions are rare
- Herd immunity
- Save children and parents time and money
- Protect future generations
- Eradication of diseases
- Economic benefits for society
47
Q

What are the cons of vaccination?

A
  • Can cause serious and sometimes fatal side effects
    - Contain harmful ingredients
     -Government should not intervene in personal medical choices
     -Can contain ingredients some people object to e.g. chicken eggs
     -Unnatural
     -Pharmaceutical companies main goal is to make profit
     -Some diseases that vaccines target are relatively harmless in many cases e.g.
    rotavirus
48
Q

What factors influence decision making?

A 
-Lifestyle
- Perception of health
 -Beliefs about childhood diseases
- Risk perception of the diseases
- Perceptions about vaccine effectiveness and vaccine components
-Trust in institution
49
Q

What is the population vs individual interest debate?

A
  •  For the individual - Protection by ‘herd immunity’ may be safest option as avoids risk of vaccine
  •  For the community - Avoidance of vaccination leads to reduced coverage so diminishes herd immunity
50
Q

Which websites can be used to find out if a person needs travel vaccines?

A

-NHS fitfortravel

- The National Travel Health Network and Centre (NaTHNaC)

51
Q

What are some of the free and private travel lectures available?

A

-Free - Diptheria, polio, tetanus, typhoid, hepatitis A, cholera
- Private - Hepatitis B, japanese encephalitis, meningitis, rabies, TB, yellow fever

52
Q

What factors should be considered when deciding to get a travel vaccination?

A 
-The country or countries you're visiting
- When you're travelling
- Where you're staying
- How long you'll be staying
- Your age and health
- What you'll be doing during your stay
- If you're working as an aid worker
- If you're working in a medical setting
- If you're in contact with animals
53
Q

What are the 5 most common cancers in adult men and women in the UK?

A
  1. Breast/prostate
  2. Lung
  3. Bowel
  4. Melanoma
  5. Non-Hodgkin Lymphoma
54
Q

What are the 5 most common causes of cancer mortality for adult men and women combined in the UK?

A
  1. Lung
  2. Bowel
  3. Prostate/breast
  4. Pancreas
  5. Oesophagus
55
Q

What is the role of legal and lifestyle changes in reducing incidence and mortality of
cancer?

A

- Prevention - Legal and lifestyle changes, vaccinations
- Screening - Early detection and diagnosis
- Disease management - Improving treatments and quality of life

56
Q

What is meant by difficult or bad news?

A

Bad/difficult news is defined as any news that drastically and negatively alters the patient’s (or their relatives) view of his or her future

57
Q

What factors can affect the impact of news on a patient?

A

Institutionalised beliefs, personality types, gender, culture/race, religion, patients knowledge, relatives

58
Q

What anxieties might healthcare professionals have about breaking bad news?

A

-Uncertainty about the patient’s expectations
 -Fear of destroying the patient’s hope
- Fear of their own inadequacy in the face of controlling disease
- Not feeling prepared to manage the patients anticipated emotional reactions
- Embarrassment at having previously painted too optimistic a picture for the patient

59
Q

What is the ABCDE method of breaking bad news?

A 
A - Advanced preparation
 B - Building a relationship
 C - Communicate well
 D - Deal with patient reactions
 E - Encourage and validate emotions
60
Q

What is the SPIKES method of breaking bad news?

A 
 S - Setting up
 P - Perception
 I - Invitation
 K - Knowledge
 E - Emotions
 S - Strategy and summary
61
Q

How can cancer change partner relationships?

A 
 -Change in roles
 -Change in responsibilities
 -Change in physical needs
 -Change in emotional needs
 -Change in sexuality and intimacy
- Change in future plans
62
Q

What were the conclusions and consequences of the Eurocare-II report?

A

-Despite limitations of the methodology, cancer survival in the UK in the 1980-90s was one of the worst in Europe
- Expert advisory group formed to the chief medial officer in 1995 which generated the calman-hine report

63
Q

What were the conclusions and consequences of the Calman-Hine report 1995?

A

Examined cancer services in the UK, and proposed a restructuring of cancer services to achieve a more equitable level of access to high levels of expertise throughout the country.

- All patients to have access to a uniformly high quality of care
- Public and professional education to recognise early symptoms of cancer
-Patients, families and carers should be given clear information about treatment options and outcomes
- The development of cancer services should be patient centred
- Primary care to be central to cancer care
- The psychosocial needs of cancer sufferers and carers to be recognised

64
Q

What are Calman-Hine solutions?

A

There should be 3 levels of care:
- Primary care
 -Cancer units serving district general hospitals - Treat common cancers, diagnostic procedures, common surgery, non-complex chemo
 -Cancer centres (populations in excess of 1 million) - Treat rare cancers, radiotherapy, complex chemo
 Key to managing patients would be the MDT

65
Q

What is a national service framework?

A

-Set national standards and define service models for a service or care group
- Put in place programs to support implementation
- Establish performance measures against which progress within agreed timescales
would be measured

66
Q

What are the main aims of the NHS cancer plan (2000)?

A

-Save more lives
 -Ensure people with cancer get the right professional support, care and treatments
- Tackle the inequalities in health e.g. unskilled workers are 2x more likely to die from
cancer as professionals
 -Build for the future -Investment in cancer workforce, strong research, preparation
for the genetics revolution

NHS plan followed by several improving outcomes guidance (NICE) which relate to the organisation of services for a particular cancer.

- 2000 manual of cancer - >300 standards relating to the delivary of cancer treatment including provisions of chemotherapy, radiotherapy etc
- 2004 manual of cancer (manual of quality measures) - >900 new measures

67
Q

What are the 6 key areas for action in the cancer reform strategy (2007)?

A
  • Prevention - Smoking, obesity, alcohol etc
    - Diagnosing cancer earlier - Screening
    - Ensuring better treatment - Reduced waiting times, increase in radiotherapy
    capacity, new cancer drugs be referred to NICE, chemotherapy audits
    - Living with and beyond cancer - National cancer survivorship initiative
    -Reducing cancer inequalities
    - Delivering care in the most appropriate setting - Locally where possible, services
    should be centralised where necessary
68
Q

What is the national cancer survivorship initiative?

A

 Partnership with cancer charities, clinicians and patients, considered a range of approaches to improving services and support available for cancer survivors

69
Q

What were the main outcomes from ‘Improving outcomes: A strategy for cancer (2011)’?

A

-Prevention and early diagnosis - Focus on lifestyle factors, screening, diagnostic tests
- Quality of life and patient experience - Patient experience surveys, more 1-1 support
roles, risk stratified pathway of care, following assessment and care planning
 -Better treatments - Cancer drugs fund, reducing variation in radiotherapy,
reaffirmed MDTs and national audits
 -Reducing inequalities

70
Q

What are some of the inequalities experiences amongst cancer patients?

A

-White cancer patients report a more positive experience than other ethnic groups
 -Younger people are the least positive about their experience, particularly around
understanding completely what was wrong with them
- Men are generally more positive about their care than women, particularly around
staff and staff working together
- Non-heterosexual patients reported less positive experience, especially in relation to
communication and being treated with respect and dignity
- People with rarer forms of cancer in general reported a poorer experience of their
treatment and care than people with more common forms of cancer

71
Q

What are the outcomes from the independent cancer taskforce (2015)?

A

-Spearhead a radical upgrade in prevention and public health
 -Drive a national ambition to achieve earlier diagnosis
 -Establish patient experience as being on a par with clinical effectiveness and safety
 -Transform our approach to support people living with and beyond cancer
- Make the necessary investments required to deliver a modern high-quality service
- Overhaul process for commissioning, accountability and provision

72
Q

What is body image?

A

- Perceptions, thoughts, and behaviours related to one’s appearance
- The body is a bearer of values and a means of representing our identity to others - It
shows who we are to others

73
Q

What is biographical distribution?

A
  • Chronic illness leads to a loss of confidence in the body

-  From this follows a loss of confidence in social interaction or self-identity

74
Q

Give examples of diseases/symptoms/treatments/side-effects which affect body image?

A 
- Scars
- Prosthetic device - leg
 -Mastectomy
- Impact on sexuality - Function, pain, appearance
- Stoma
- Hair loss
 -Weight loss/weight gain
75
Q

What is the important of hair?

A

-An important site for individual and group identity
- A way of ‘doing gender’ - A symbol of femininity? Hair loss not so bad for men
- Stigma - Patients have some choice as to whether they will be stigmatised
- Patient control of their status as sick - Can be managed through ‘normal’ appearance
(wigs, beanies, scarves)

76
Q

What are the functions of a clinical record?

A

-Support patient care
- Improve future patient care
- Social purposes at the request of patients
- Medico-legal document

77
Q

What should be recorded in a clinical record?

A

-Presenting symptoms and reasons for seeking health care
 -Relevant clinical findings
- Diagnosis and important differentials
- Options for care and treatment
- Risk and benefits of care and treatment
- Decisions about care and treatment
 -Action taken and outcome

78
Q

What are the differences between paper and electronic records?

A
  • Paper - Continuous, portable, writer identified, legibility issues, must be dated and signed
  •  Electronic - Problem orientated, searchable, structured, safer prescribing, clinical decision support software
79
Q

What is the use of records in audit, research and management?

A

-Support clinical audit
 -Facilitates clinical governance
 -Facilitates risk management
- Support clinical research

80
Q

What is duty of care?

A

Legal obligation which is imposed on an individual requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others

81
Q

What is negligence?

A
  • Negligence is a failure to exercise the care that a reasonably prudent person would exercise in like circumstances
  •  You have to make decisions that adheres to your duty of care as a doctor and could not be considered negligent
82
Q

What are the 4 ethical principles?

A

-Beneficence - Duty to do good
- Non-maleficence - Duty to not cause harm
- Autonomy - Patient has the right to make their own decision
 -Justice - Fair, equitable treatment for all

83
Q

What are the ethical theories?

A

-Consequentialism - The correct moral response is related to the outcome or consequence of the act
-Deontology - Places value on the intentions of the individual and focuses on rules, obligations and duties
- Virtue ethics - Right living is derived from the moral character of the agent

84
Q

How do you evaluate an argument?

A
  • Get clear on the logical form of the argument

- Query - Valid and sound

85
Q

Why might an argument be invalid?

A

-Different premises may express different concepts
 -Confusing necessary with sufficient, and vice-versa
- Insensitive to the way in which claims are qualified
- Argument begs the question

86
Q

Why might an argument be unsound?

A

-Argument is invalid
- Argument is valid but one or more premise is false - Makes a false/controversial
moral/empirical claim
 -An unsound argument doesn’t mean there will be an unsound conclusion

87
Q

What should be avoided in arguments?

A

-Straw man fallacy - Simply ignoring the person’s actual position and substituting it for a distorted, exaggerated or misrepresented version of that position
- Ab hominems - Directed against a person rather than the position they are maintaining
- Appealing to emotion
- Begging the question
 -Argument from fallacy - Conclusion must be false because the premises are false
(not necessarily)

88
Q

What is a moral argument?

A

-Seek to support a moral claim of some kind
- Argument need not succeed but to be an argument it must at least provide some
supporting reasons for the claim in question

89
Q

What is a deductive argument?

A
  • Purely logic

- This means this, so this means this

90
Q

What is an inductive argument?

A

Making an argument based on observation, more probable conclusions (seeing is believing but you may not have seen everything)

91
Q

What are MDTs in cancer care and why are they needed?

A

-Modern management of cancer - Involved many disciplines, surgical and non- surgical, oncology
 -Allied health professionals e.g. nurses, physiotherapists, speech therapists, etc
- Delivery of cancer care is often fragmented over several hospital sites - Need to
streamline and co-ordinate various components of care
- Probably better outcomes for patients managed in MDTs

92
Q

What are the functions of MDT in cancer care?

A

-Discuss every new diagnosis of cancer within their site
- Decide on a management plan for every patient
 Inform primary care of that plan
- Designate a key worker for that patient
- Develop referral, diagnosis and treatment guidelines for their tumour sites
- Audit

Year 2 H+S (14 decks)

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