C3 Flashcards

Question

Which measures, measure association?

Answer 1

- Risk difference - Number needed to treat - Number needed to harm - Risk ratio - Relative risk reduction - Odds ratio - Hazard ratio

Answer 2

- Attributable fraction among the exposed. - Attributable fraction among the population. - Attributable fraction among the unexposed.

Answer 3

- Clinical endpoint. - Virulence. - Infectivity. - Mortality rate. - Morbidity. - Case fatality rate. - Specificity and sensitivity. - Likelihood ratios. - Pre and post-test probability.

Answer 4

Autonomy – the autonomous individual freely acts in accordance with a self-chosen plan. Beneficence – the prima facie moral obligation of all doctors. Best interests are not limited to best medical interests but also encompasses medical, emotional and all other welfare issues. Non-maleficence – do not cause harm. - Bolam test – a Dr is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular art. Justice – Treat all patients fairly with equity.

Answer 5

Bolam principle: a principle that establishes whether an act or omission by a HCP breached the duty of care, and thus they were negligent. Defined not negligent if there is an established body of professionals supports the act, even if the practice was not standard care (e.g. guidelines). Bolitho test; - Adaptation of the bolam principle. - States courts can’t just accept what professionals say, must consider if is logical first.

Answer 6

- Adaptation of the bolam principle. | - States courts can’t just accept what professionals say, must consider if is logical first.

Answer 7

Stigma: mark of disgrace associated with a particular circumstance, quality, or person. Processes of producing stigma: Labelling, Stereotyping, Othering, Stigmatisation Types of stigma; - Felt: shame you feel as a result of stigma, may be due to your condition. Can result in pt. not disclosing information (passing), very relevant to health conditions like addiction=may act as a barrier to health-seeking advice. - Withdrawing: can worsen health conditions. Covering and hiding it can exacerbate sense of stigma --> worsen health conditions, may also prevent friends/family from noticing,. - Enacted:discrimination by others. - Courtesy: felt by someone who is with someone else who is being stigmatised.

Answer 8

Distinguishing differences between people It's an example of a process of producing stigma.

Answer 9

Making assumptions based on those differences

Answer 10

Separates person, e.g. diabetes, diabetics It's an example of a process of producing stigma.

Answer 11

To set some mark of disgrace or infamy upon It's an example of a process of producing stigma.

Answer 12

Felt stigma (internal stigma or self-stigmatization) refers to the shame and expectation of discrimination that prevents people from talking about their experiences and stops them seeking help.

Answer 13

Enacted stigma (external stigma, discrimination) refers to the experience of unfair treatment by others

Answer 14

Felt by someone who is with someone else who is being stigmatised

Answer 15

Felt stigma (internal stigma or self-stigmatization) refers to the shame and expectation of discrimination that prevents people from talking about their experiences and stops them seeking help. Enacted stigma (external stigma, discrimination) refers to the experience of unfair treatment by others

Answer 16

Can result in pt. not disclosing information (passing), very relevant to health conditions like addiction, this may act as a barrier to health-seeking advice. Withdrawing - can worsen health conditions. Covering - hiding it can exacerbate sense of stigma thus worsen health conditions, may also prevent friends/family from noticing,.

Answer 17

Makes it illegal to discriminate directly or indirectly against people with mental health problems in public services and functions, access to premises, work, education and transport

Answer 18

- Detained in hospital for ASSESSMENT and treatment - Up to 28 days - Can't renew but can transfer to section 3 - Patient CANNOT refuse treatment

Answer 19

- Detained in hospital for TREATMENT - Up to 6 months - Can be renewed - 6m-6m-12m - Patient cannot refuse treatment

Answer 20

- Emergency situations - Detained for ASSESSMENT - Only needs recommendation of one doctor - Up to 72 hours - Patient can refuse treatment

Answer 21

- Doctors holding power - Detained from leaving hospital - Must already be in hospital for treatment - Up to 72 hours, not renewable - Patients can refuse treatment

Answer 22

- Nurses holding power - Detained from leaving hospital - Must already be in hospital for treatment - Up to 6 hours, not renewable - Patients can refuse treatment

Answer 23

Article 2 - right to life (authorities must make every protection to protect your life, if death under section = coroner's report) Article 3 - Prohibition of torture and inhumane or degrading treatment If patient disagrees with treatment, independent psychiatrist agrees then not breaking article 3. Restraint is not torture unless done other than for protection Article 5 - right to liberty and security. Limited liberty if section Right to education - if a child is detained, they must get education

Answer 24

- Right to detain a person if the person is at right to self or others - Right to restrain with reasonable force (no more than necessary) - If patient cannot consent: done in best interests - Treatment must be body recommended

Answer 25

Representation of a health threat depends on - Patient interpretation: symptom perception, social messages - Coping mechanisms - Appraisal: is coping effective These all determine the emotional response to a health threat

Answer 26

- Identity: symptoms, signs, labels and diagnosis - Cause: perceived causes - Consequences: perceived physical, social, economical etc - Timeline: perceived timescale - Control or cure Patient may not match the clinician

Answer 27

Illness perception questionnaire

Answer 28

Problem focused: seeking new information, practical support, learning new skills, new interests, actively participating in treatment Emotion focused: sharing feelings, expressing anger in appropriate ways, acknowledging loss, emotional support Unhelpful: denial, reoccupation with minor issues, blaming

Answer 29

BIOLOGICAL - Genetic vulnerability - Brain damage - Physical disability - Sensory impairment SOCIAL - small circle of friends - limited opportunities for social interaction - decreased finance, employment - decrease support - at risk of exploitation - poor housing - limited choices PSYCHOLOGICAL - coping strategies - low self-esteem - lack of assertiveness - feeling helpless

Answer 30

``` Access to family advocacy Family support and info groups Disability support groups Skills training and emotional support Respite care Formal carers assessment ```

Answer 31

- Stress and worry - Social isolation - Guilty for taking time for self - Financial stresses - Physical health problems - demanding role - Depression - feeling hopeless - Frustration and anger - may not have had a choice about being a carer - Low self-esteem - Emotion strain - especially if patient attempts suicide - Patients with mental health are unpredictable and therefore challenging to care for - Stigma from others on behalf of patient - many try to cope alone - Reduced specialist mental health respite

Answer 32

- M>F - Men choose more lethal methods - hanging, guns - Women tend to choose poisoning and self-cutting - Males have higher success rate - 4500 per year - Incidence 19 per 100,000 men and 5 per 100,00 women - Increased in whites and Asians - Highest in 15-44 years, although elderly also at risk RFs - Previous self harm - Single/widow/divorced/separated - Prisoners - Vets/doctors/pharmacists/farmers - Immigrants/refugees - Recent life crisis - Victim of abuse - Mental illness - Chronic physical illness

Answer 33

- F>M - 1-4% of adults - 10% of 15-16 year old girls - Highest in adolescents and college students - Increased in South Asians RFs - Borderline personality disorder (70% self harm) - MH: depression, bipolar, schizophrenia, drug and alcohol misuse - Domestic violence - Eating disorder - Armed force veterans - Prisoners - Asylum seekers - Victim of abuse - Gay/lesbian/bisexual

Answer 34

Community psychiatric nurse (CPN) - facilitates treatment plan and monitors progress Social worker - housing and benefits, make the most of available services Clinical psychologist - delivers CBT Psychiatrist - diagnoses and develops care plan OT - maintain own skills and develop new ones. Back to work. Keep up motivation Pharmacist - advice on meds Admin staff - first point of call, arrange appointments Counsellor - taking treatment and developing coping strategies.

Answer 35

Symptoms - large variation between patient's Patient decision time - Shorter in men than women (women tend to be atypical) - STEMI has shorter time as more severe presentation - Increase education to decrease time Symptom recognition: men more likely to realise MI More likely to use ambulance if - Educated about MI - Increase symptoms severity - STEMI - Increased age - Increased distance to hospital Hospital: - Prehospital ECG, and meds decreases time to treat - Incorrect level of triage - Busy ER

Answer 36

Outcome indicator: - Describes the effects of healthcare on the status of the population - e.g. proportion with surgical site infection Process indicator: - Measures what is actually done in the giving and receiving of care. - e.g. number of patients receiving the correct antibiotics

Answer 37

Patient choice Patient's want the information Increased transparency and openness Managers more likely to focus on quality than cost Ensures accountability of staff/ providers of care Identify areas for concern and improvements

Answer 38

Only focussing on measured activity Lose sight of long term outcomes Avoiding new approaches in fear of worse outcome Altering behaviour to gain advantage - Decreased access to care in high risk patients - e.g. number treatment with antibiotics in first hour will cause overtreatment of non-cases Cost of producing information - resource demanding Patients may not use info

Answer 39

``` 1/5 men and 1/7 women will die from CHD More common in males Increase South Asians. Increased in northern England Increased with age ``` RFs - Smoking - Lower socioeconomic group - Poor diet - high LDL - Alcohol - Physical wellbeing: work stress, decreased social support, depression and anxiety - Hypertension - Diabetes - Hypercholesterolaemia - FHx - 1st degree relative in men under 55 in women under 65 - Obesity

Answer 40

``` Apo-B/Apo-A1 protein (genetic) Current smoker Psychosocial e/g stresses Abdominal obesity Hypertension Daily fruit and veg intake Exercise Diabetes Alcohol ```

Answer 41

Patients at a high risk of complications from hypertension - Older age, men >55, women >65 - Diabetes - Renal disease/proteinuria - LV hypertrophy - Established vascular disease - CHD - Stroke - Peripheral vascular disease For high risk patients aim for 130/80 Others aim for 140/90

Answer 42

Cardioprotective diet - 5 a day - reduced refined sugars - 2 portions of fish a week - whole grain carbs Physical activity - 150 minutes of moderate or 75 minutes of high intensity Lose weight Reduce alcohol consumption Smoking cessation Decreased salt consumption

Answer 43

``` Decreased lung and other cancers Decreased CVD risk Decreased risk of COPD and respiratory symptoms Decreased risk of infertility Increased life span ``` ``` 20 minutes: decreased HR and BP 12 hours: CO levels drop to normal 2-12 weeks: increase circulation and lung function 1-9 months: decreased cough and SOB 1 year: half risk of CHD 5 years: risk of stroke that of non-smoker 10 years: half risk of lung cancer 15 years: risk of CHD that of non-smoker ```

Answer 44

``` 15% of total cancer patients 31% of female cancer patients Most common cancer in the UK Increased in women Increases with age Highest in Caucasians - western Europe FHx - BRCA gene defect Most common cause of cancer in 15-49 years Most are detected in stage I or II Incidence has been increasing ``` RFs (separate flashcard)

Answer 45

COCD Alcohol Increased adult height Ionising radiation HRT Raised BMI post-menopause (protective pre-menopause) History of Hodgkin's lymphoma, melanoma, lung, bowel, uterus Ca Benign breast disease Digoxin Diabetes Smoking Increased birth weight Increased dietary fat Increased bone mineral density Decreased age at menarche Decreased parity Increased age at menopause Increased age at first giving birth

Answer 46

- Breastfeeding - Hysterectomy / oophorectomy premenopausal - Physical activity - Regular aspirin / NSAIDs - Osteoporosis - Coeliac disease

Answer 47

Condition - Condition should be an important health problem - Recognisable latent or early symptomatic stage - Natural history of condition should be understood Test: - Simple, safe, precise and acceptable to perform - Agreed policy on what happens to a patient with positive result Treatment: - Effective and more effective if given earlier - Agreed policy on who to treat Programme: - RCT evidence that it is effective at reducing morbidity/mortality - Benefit outweighs harm - Cost of screening should be balanced against medical care as a whole - Facilities for diagnosis and treatment should be available

Answer 48

Proportion of patients with the condition who have a positive test result True positives / true positives + false negatives

Answer 49

Proportion of patients without the condition who have a negative test result True negative / true negatives + false positives

Answer 50

Chance that the patient has the condition if the diagnostic test is positive True positive / true positive and false positive

Answer 51

Chance that the patient does not have the condition if the diagnostic test is negative True negative / true negative + false negative

Answer 52

Frequency of screening Ages at which it should be performed Defined mechanisms for referral and treatment Information systems that can: - Send out invitations - Recall for repeat screening - Follow patients with abnormality - Monitor and evaluate the program

Answer 53

50-70 (trial extension from 47 to 73) Every 3 years Mammography

Answer 54

Benefit: - Allows for less aggressive treatment to be used (early stages) - Increases prognosis - Decreased mortality Risks: - Pain - Complications from treatment - Anxiety (false positives) - Does not detect 20% of cancers (false reassurance) - Overdiagnosis and overtreatment

Answer 55

A disease that is picked up by screening that would not otherwise have come to attention in that person's lifetime

Answer 56

Unnecessary medical interventions - Either due to over diagnosis - OR extensive treatment for a disease which only requires limited treatment.

Answer 57

Employment and income: - financial hardship - may have to give up work due to illness/ appointments Social engagement: - harder to participate in social events and maintain friendships - decreased energy and mobility Change in family dynamics Emotional distress Uncertain about unwanted changes to self and life Feelings - shock, disbelief, fear, anxiety, guilt, sadness Depression and anxiety Fertility - can cause infertility Change in relationships with family and friends Inability to perform social roles Changes to sex drive Changes to body image Feelings of guilt and self-blame

Answer 58

``` Older age Lower educational level Non-white ethnicity Non-recognition of symptom seriousness Decreased social support Presentation type - no breast lump No pain Presence of co-existing morbidity Fear of cancer diagnosis Competing life priorities Embarrassment around breast exam ```

Answer 59

Members of ethnic minorities can often delay in help seeking Blacks and Hispanics have more advanced breast cancer when detected and have poorer survival rates Less likely to have mammogram if single, decreased education and unemployed Increased set backs - unemployment, trouble returning to work, struggle with interpersonal relationships Differences in knowledge and beliefs regarding cause, symptoms, curability and consequences Differences in trust in physicians Some cultures RE male examination worries. Some cultures stress importance towards families and putting others first

Answer 60

BRCA1 and 2 gene Can calculate carrier probability using: BOADICEA or Manchester Scoring system Refer if: - 1 1st degree under 40 - 1 1st degree male - 1 1st degree with bilateral cancer - 3 2nd degree or 2 1st degree with breast cancer at any age - 1 1st or 2nd degree with breast and ovarian cancer Only do genetic screening if mutation risk 10-20%

Answer 61

Risk reducing mastectomy Risk reducing oophorectomy Chemoprevention- tamoxifen or raloxifene

Answer 62

Examination of a patient after death Carried out by a pathologist to establish the cause of death or determine effects of treatment

Answer 63

Independent official with legal responsibility for the medical-legal investigation of certain deaths including: sudden, unexplained, unnatural or violent in nature

Answer 64

Sudden deaths from unknown causes Any case where cause of death unknown Any vehicle, boat, train or plane accident Any suspicious circumstances Suicide If not been seen or treated in last 14 days Any death within 24 hours of admission Due to possible negligence, misconduct or malpractice Any death caused by a treatment or anaesthesia Any infant death or stillbirth Death due a crime Detained under Mental Health Act 1983 or under police custody Death linked with occupational hazard e.g. mesothelioma, bladder cancer Due to fall or fracture

Answer 65

Controlled by Human Tissue Authority - Examined with microscope - Complex abnormality requiring detailed examination - Sample may need preparation prior to examination - Preparation can take weeks

Answer 66

Provides valuable information on cause of deat Provides vital info for future treatment/research. Gives relatives information which may impact on their health. Data can improve and assess medical care and research - cause and prevention of disease. Assists in education of doctors and students. Provides accurate mortality and morbidity stats to improve public health.

Answer 67

- Full extensive attempts at reversible causes of cardiorespiratory arrest Body temp, endocrine, metabolic and biochemical abnormalities One of the following criteria is met: - Meets criteria for not attempting CPR - Attempts of CPR failed - Life sustaining treatment has been withdrawn Observe individual for minimum 5 minutes Primary care - No mechanical cardiac function: absent central pulse on palpation, absent heart sounds on auscultation Hospital: one of - Asystole on ECG - Absence of pulsatile flow on arterial monitoring - Absence of contractile activity using echo Check reflexes to light, corneal reflexes, and motor response to supra orbital pressure

Answer 68

Allows relatives to register the death Provides a permanent legal record of death Allows relatives to arrange a funeral and settle estate Provides national statistics regarding cause of death and trends in disease Given to the next of kin to deliver to the Registrar of Births, deaths and marriages within 5 days who decides if it needs reporting to the coroner

Answer 69

Doctors Nurses Suitably trained ambulance clinicians A doctor's legal duty is to notify the cause of death, not the fact the death has taken place

Answer 70

Unresponsive patient with temperature over 35 degrees with no drug or alcohol use - No spontaneous movement - No respiratory effort - No heart sounds or palpable pulse - Absence of corneal reflexes - Pupils fixed and dilated

Answer 71

``` Old age Organ failure e.g. renal/heart/liver Mode of dying e.g. cardiac arrest or shock Diabetes Any abbreviations ```

Answer 72

3rd most common cancer in the UK 2nd most common cancer in males and females in the UK 13% of total cancer cases Increases with age Increased in males Higher in Caucasians FHx - yes 87% non small cell lung cancer 13% small cell lung cancer Most diagnosed in stage 4

Answer 73

``` Smoking Low BMI Past cancer (breast, Hodgkin's lymphoma) Asbestos Radon Silica dust HIV Air pollution Ionising radiation Hx of pneumonia, TB, silicosis, COPD Production of coal/coke Organ transplant recipients Diet high in red meet or total fats ```

Answer 74

MS Coeliac Parkinson's

Answer 75

Bring together staff with necessary knowledge and skills to ensure high quality diagnosis, treatment and care - Considers patients as whole, not just disease - Takes into account patients views, preferences and circumstances - Makes recommendations not decisions - Final decision is patient and clinician

Answer 76

Effective MDT should result in: - Treatment and care considered by field experts - Offered opportunity to enter clinical trials - Continuity of care - Good communication between 1y, 2y and 3y care - Good data collection - Improved equality - Better adherence to local and national guidelines - Promotion of good working relationships between staff - Optimisation of resources

Answer 77

- Shock - Depression or anxiety esp if due to prolonged recovery, long lasting disability - Alteration in body image - scar - Alterations in body function - stoma - Change in daily routine - Problems with self care and ADLs - Impact on relationships - Feelings of embarrassment - sex life - Rejection from partner - Altered sleep habits due to fear or leakage, pain or discomfort - Self- conscious - Modification of diet - Employability and insurance issues

Answer 78

``` Fatigue 2y cancer Weight gain Diabetes Ulcers in mouth Anaemia Memory loss Decreased libido Decreased hair Infertility Neuropathy Osteoporosis Renal, liver, lung, cardiac damage Pain Premature aging Early menopause ```

Answer 79

``` Fear of recurrence Grief Loss of libido Loss of physical dependence Loss of fertility Depression Body image and self-esteem (hair loss) Relationship strain Worry of outside world (increased infection risk) Decreased energy Anxiety Fear of losing job - missing for illness and medical appointments Requiring assistance with ADLs Emotional stresses Financial stresses - decreased work, cost of travelling Feelings of isolation ```

Answer 80

- Policy approaches: global, national and local - Healthcare delivery: access to care, quality of care, drugs and technologies - Heath communication: media - Determinants: cultural and social norms, health inequalities, - Identify groups that are high risk - Assess levels of major preventable causes of CVD Focus on - Education - Schools - Work - Environmental change - Policy change

Answer 81

- Media emphasising importance of lifestyle behaviours and risk factors - Public education campaigns to make aware of guidelines for primary and secondary prevention - Ongoing education of public in CPR - Guide for prevention, diagnosis and treatment made available - Limit food advertising to youth - TV shows for children should promote physical activity - Teaching in schools - Compulsory physical education in schools - healthy school meals - CPR teaching

Answer 82

- Supermarkets selling fruit and veg at reasonable price - restaurants offering dishes which meet nutritional guidelines - Low fat/calorie snacks - healthy food at check outs - Support of physical education programmes - Smoke free areas

Answer 83

- Increase unit price for tobacco - Removal of tobacco advertising - NHS treatment for smoking cessation - 5 a day - 30 mins exercise per day - Change for life - No smoking indoors - Alcohol recommended limits

Answer 84

1a - meta-analysis of RCTs 1b - evidence from at least one RCT 2a - evidence from at least one well designed controlled study 2b - evidence from at least 1 other type of well designed studies 3 - well designed non-experimental descriptive studies 4 - evidence from expert committee reports or opinions

Answer 85

High levels of evidence for - PUVA + UVB in psoriasis but is associated with increased cancer risk - Systemic steroids in eczema (no evidence as to which is the best steroid) - Little evidence for methotrexate used in psoriasis - Ciclosporin is the best systemic drug for psoriasis

Answer 86

Increased risk of skin cancer Skin burn - cells and blood vessels are damaged Heat exhaustion - core temp > 40, sickness, headaches, excessive sweating, feeling faint Heat stroke - core temp > 40, body cells begin to break down and body functions stop working, organ failure Vomiting, confusion, hyperventilation, decreased consciousness Repeated damage leads to premature skin ageing - Decreased elasticity, dry wrinkled and discoloured Damage to eyes

Answer 87

GP Community mental health team (CMHT) Early intervention service (EIS) Crisis resolution team Home based treatment (HBT) Assertive outreach team (AOT) Day hospitals In patient units Improving Access to Psychological therapies (IAPT) Support groups and charities - Mind, Rethink, SANE, AA, The Samaritans

Answer 88

Bulk of treatment done by GP If referral required usually to community mental health team Can refer to early intervention service for psychosis Some patients can present to A&E instead They will be assessed by a psychiatrist and then referred Screen and diagnose MH problems

Answer 89

MDT: psychiatrist, mental health social workers, CPNs, psychologists Co-ordinates patient care Monitors patients in the community Initial assessment by psychiatrist then holistic care plan

Answer 90

Used to improve short and long term outcomes of schizophrenia and other psychotic disorders Exclusively PSYCHOSIS at first presentation - Preventative measures - Earlier detection of untreated cases - Intensive treatment and support in early stages of disease

Answer 91

24/7 Acts as gateway to various psychiatric services e.g. admission Most common referrals comes form GP, A+E and CMHT Rapid assessment to determine if admission of home based therapy (HBT)

Answer 92

Short term intensive home based care MDT as per CMHT Visits up to 3x per day with gradual decreased

Answer 93

For revolving door patients Reluctant to seek help therefore present at times of crisis Often have most complex mental health and social problems Specialist MDT dedicated to engaging them in treatment and providing support.

Answer 94

If they cannot be safely managed in community - Patient is danger to self or others - Requires specialist care or supervised treatment - Patient lacking social structure - Carer can no longer cope / needs respite Most are involuntary / informal

Answer 95

Usually a CPN or social worker Co-ordinates and administers treatments Has knowledge of local services and encourages and allows access Liase with GP and other agencies Assists with planning and monitoring of care

Answer 96

``` General adult Old age Child and adolescent Liaison Substance abuse Forensic Learning disability ``` Psychiatry

Answer 97

Social support - those with more are less likely to get depression - Helps to know they are not alone - Someone pushing them towards getting better - Strong family network Decreased socioeconomic group have decreased stability and increased risk of depression High stress job or environment can worsen depression Ethnic minorities are at higher risk of depression - immigration status, decreased income and education level Different populations talk about depression differently and have different help seeking behaviour Services may not be available in native language Less likely to seek help for depression if: elderly, young adult, ethnic minority or decreased social support Financial implications may be barrier to treatment- child care, transport Stigma is different in different populations Different groups have different beliefs and preferences RE treatment e.g. CBT/medication

Answer 98

- Health visitors for all at risk of post natal depression - School based prevention of violence, bullying, offending or re-offending - Screening and brief interventions for alcohol abuse - Promotion of well being at work - Supported employment for those recovering from mental health problems - CBT for those with medically unexplained symptoms - Suicide prevention - Early intervention service - Debt advice - Anti-stigma campaigns - Increased focus or social support - Tackle social and economic inequalities

Answer 99

Public Health White Paper - Tackle substance addiction through minimum alcohol pricing policy - Promote public health interventions to prevent future inequalities - Ensure suicide prevention strategy - Prioritise mental health within smoking cessation - attended to discrimination and stigma around MH (time to change) - Target public mental health interventions for high risk people: cared for children, unemployed and homeless - Promote importance of MH and well being

Answer 100

Hepatitis - Travel to high risk areas - IVDU - Male homosexuality - Healthcare worker - Tattoos and piercings - Blood transfusions ``` Alcohol Medications FHx Obesity Metabolic syndromes Heart failure ```

Answer 101

In high risk areas - wash hands, no salad or ice IVDU - needle exchange programmes Condoms PPE at work. Tattoos and piercings only though registered practices National screening of blood transfusions Recommended alcohol limits: 14/ weeks, 2 free days Promote MH to decrease Paracetamol OD Drs aware of drug interactions Obesity: national health eating, change for life. increase exercise programmes In metabolic syndromes: control diabetes and weight

Answer 102

Not treated daily so can feel tired and nauseous between treatments Gain fluid weight between sessions Must limit fluid intake and diet strictly Pain and discomfort Additional for PD: - Increased risk of peritonitis - Problems with sleep and rest

Answer 103

Difficulty arranging transport Difficulty managing a fixed schedule around other plans Difficulties with going on holiday - need treatment while there Alteration in marital, social and family relationships - may develop carer role Feelings of loss of personal control Increased anxiety and depression Uncertain future, large demands of illness Dependence on machinery, medication and healthcare Loss of freedom (less with PD) Feelings of frustration Decreased quality of life Impaired self and body image Impact on sexual activity Feeling like a burden

Answer 104

COMMON Large range of conditions seen by GP: adjustment reactions, anxiety, depression, schizophrenia, bipolar disorder, addiction 90% of MH problems are managed by GPs GPs only receive 10% of MH funding 30% of GP visits have a mental health component 30% will have sick leave due to MH problems ``` Patients with MH problems have more consultations regarding physical problems Increased use of services Increased cost Decreased appointments available In 10 minute appointments: - Difficult to spot a problem - Run late if more than 1 problem or brought up last - patient dissatisfied if rushed ```

Answer 105

- Primary care to care for common mental health problems - Primary care to contribute to health promotion - Lack of clarity regarding management of complex, chronic and disabling non-psychotic problems - GPs require good understanding of healthcare needs in these patients

Answer 106

- Directed donation - Direct altruistic donation - Non directed altruistic donation - Donor chain

Answer 107

Living organ donation Health person donates organ to a specific person where there is a relationship between them

Answer 108

Living organ donation | Donation to specific individual but no evidence of genetic or emotional relationship between donor and recipient

Answer 109

Living organ donation Health person donates organ to unknown recipient matched by NHSBT

Answer 110

Living organ donation Non directed altruistic donors can donate into paired or pooled scheme Match 2+ donors to recipients and the organ at the end of the chain goes to best matched NHSBT patient on list - Occurs when donor can't donate to friend/relative as they are not a match - Enter a pool, when friend gets a kidney, they donate theirs

Answer 111

Human Tissue Act 2004

Answer 112

Covers England, Wales and Northern Ireland Established the Human Tissue Authority to regulate activities concerning removal, storage, use and disposal of human tissue It governs consent for storage and use of organs taken from living person for transplantation Consent for removal is under Mental Capacity Act 2005 All living donors must be approved by HTA before hand

Answer 113

- No reward has or is to be given - Consent for organ removal for transplant has been given - Independent assessor has conducted separate interviews with donor and recipient and submitted a report to HTA - Report is sent to HTA approvals team

Answer 114

- Has completed HTA training - Does not have any connection to those being interviewed - Cannot be the same person who provides info on risk or the procedure - They must assess whether the requirements have been met - will interview donor and recipient separately as well as together and produce a report.

Answer 115

If the donor is a child If the donor is an adult who lacks capacity In all cases of pooled or paired In all altruistic non directed In cases where HTA have not delegated decision making In these cases decision is made by HTA panel

Answer 116

1. Surgical procedures and medical treatments, long and short term risks 2. Changes of transplant being successful, side effects and complications 3. Right to withdraw consent at any time - until anaesthetic in live - Until time for first incision in deceased 4. Right to be free of coercion or threat - consent under these circumstances will not be accepted by the independent assessor 5. The fact it is an offence to receive reward or payment and penalties involved - fine and up to 3 years imprisonment 6. Donors can seek expenses - Travel costs and loss of earnings In altruistic non-directed or pooled donors - ANONYMITY of donor and recipient and CONFIDENTIALITY must be respected

Answer 117

- Removal, storage and use of organs from the deceased is governed by the Human Tissue Act 2004 - Consent must first be obtained - Trained staff should determine if deceased has given consent by checking Organ Donor Register - If consent established, inform those close to decreased - If no records, speak to spouse/partner - done by transplant coordinator - If deceased wishes unknown, but they have nominated representative, they can consent - Ask for consent from relatives - A family member CANNOT OVERRULE deceased wishes - no legal right - Consent is only required from one person in the hierarchy and should be obtained from the highest ranking - If number 1 does not consent, lower down cannot overrule 1. Spouse/partner 2. Parent/child 3. Brother/sister 4. Grandparent/grandchild 5. Niece/nephew 6. Step mother/father 7. Half brother/sister 8. Friend If a decision is not made quick enough for organs to not deteriorate, can take minimum steps necessary to preserve organs under HT Act May need coroners consent Use least invasive procedure e.g. cold perfusion

Answer 118

Travelling: extra stresses - Hot weather can affect insulin - Have to take all insulin supplies with you - Cost of insurance - Risk of hypo in unusual settings Carrying diabetes ID - stigma and labelling Eating out difficult: choosing food with unknown content issues with driving - need to inform DVLA if multiple hypoes - Car insurance CANNOT be increased due to diabetes Restricted career choice - Blanket ban on armed forces - Difficult to manage with shift work - Subject to individual medical assessment in police, ambulance or fire service - Embarrassment of hypo in community or work - Increased sexual dysfunction - Can alter relationship dynamic - Difficulty making new relationships esp if sexual dysfunction - Increased risk in pregnancy - Increased risks to baby Often diagnosed in school - Stigma/bullying - Disruption to schooling with meds - Having to inject at school - Worry of hypos at school - Reliance on teachers for medication - issues with compliance Anxiety/Grief/Depression/Shame/Guilt

Answer 119

- Admit to single room until at last 2 weeks of treatment - Minimise the number and duration of outpatient clinics - See patients in less busy areas at less busy times - Risk assess for multi-drug resistance - if it is then negative pressure room only - Don't admit to wards with immunocompromised patients - Ideally keep at home - Patients wear surgical mask when leaving the room

Answer 120

``` Only screen close contacts Do not routinely trace social contacts Risk assess - Social contacts in high risk groups - School pupils - Hospital in patient in the same bay for > 8 hours - Flights > 8 hours < 3m ago ``` Inform HPA

Answer 121

Assess new entrants from high burden countries. In places of high TB - mobile X-ray e.g. homeless and drug users - can use simple incentives like food and drink Screen prisoners within 48 hours of arrival

Answer 122

Allocate named TB case manager Health and social care plan and support Offer directly observed therapy if - not adhering - homeless - drug abuse - Multidrug resistant - prison - at patient request - to ill to administer ``` Address fears of stigmatisation Emphasise importance of completing - educate! - Home visits - Education booklet - Random urine tests - Reminder letters - pill counts - Calls/texts as reminders - incentives - Support ```

Answer 123

Opt - in system A person has to register their consent to donate organs in the event of their deathout-out organ donation system Presumes consent for organ donation unless a person has registered an objectification in advance. If an objection has not been registered, family can still be given the opportunity to confirm any unregistered objection as an extra safeguard

Answer 124

- More organs become available. - better supply of organs - get organs from those who would donate but didn't volunteer - Reduces current pressure on relatives consent when they are grieving. - Up to 90% support organ donation but number signed up is much lower. - Still allows those with strong objections to do so - Reduced wastage of organs - Every organ has the chance to save a life

Answer 125

- Doctors can remove organs from every adult that dies unless a person has registered to opt out - Austria - Singapore: however, they automatically opt out Muslims

Answer 126

- Doctors can remove organs from every adult who dies unless they have opted out or relatives tell the doctors not to take organs - Belgium *it is the relatives responsibility to tell the doctors* - Spain: relatives should be consulted

Answer 127

May not have heard about opt out - may object and still have organs removed (not respecting patients wishes) - Creates a pressure to donate - people may feel ashamed of opting out - Can't dictate what happens to peoples bodies when they die (autonomy) - Very sensitive issue and as such should be entirely voluntary - Costly and complicated to implicate - would need to reach every person - Would be better to design a program to increase number of donors - Suggests that bodies belong to state once dead - seen as offensive - Don't get consent, just a lack of consent.

Answer 128

Quality improvement cycle that involves measurement of the effectiveness of healthcare against the agreed and proven standard for high quality and taking action to bring practice in line with these standards to as to improve the quality of care and health outcomes ``` Aims: • Encourage teamwork • Contractual obligation • Financial incentives • Assess current standards against national standards • Improve the standards of care • Educate and train HCWs ```

Answer 129

- Purpose: many are done as a tick box exercise with little understanding as to why - Burden of evidence: perceived needs to collect sufficient data from poor sources to justify conclusions - Time: takes a long time to extract meaningful data from notes and written records - Organisational inertia: external pressure on clinicians to measure, report and improve often results in resistance to change - Lack of support: not enough support from superiors and audit departments - Cultural factors: traditional hierarchies can disempower junior doctors

Answer 130

Wider goal than Audit QI is an umbrella under which audit sits It is used in examining a clinical process and seeking to improve it. There are circumstances where clinical audit may be appropriate - Encourages data collection from a resource that can determine if change is needed - Has a more collaborative working style to investigate problems

Answer 131

Not useful if there are no national agreed criteria and standards e.g. patient safety, patient experience and performance of a service Rarely take into account local differences

Answer 132

Used to check clinical care meets defined quality standards and monitor improvements to address shortfalls identified Most effective for ensuring compliance with specific clinical standards and driving clinical care improvement

Answer 133

Stage 1 - identify current standards e.g. from NICE guidelines Stage 2 - measure current performance e.g. collecting existing information Stage 3 - compare performance vs set standards Stage 4 - identify steps to improve performance & make these improvements Stage 5 - re-evaluate and re-audit

Answer 134

Plan Do Study Act Used to introduce and test potential quality improvements and refine them on a small scale prior to wholesale implementation. Most effective when a procedure, process or system needs changing or a new procedure, process of system needs introducing. Tests changes to assess their impact, ensuring new ideas improve quality before implementation on a wider scale. Making changes can give unexpected results so it is safer to test on a small scale first and allows stakeholders to be involved in proposed changes.

Answer 135

``` Early aggressive behaviour Lack of parental supervision Substance abuse Drug availability Poverty Care giver who uses drugs Fhx of drug addiction Male Mental health disorder Peer pressure Loneliness, anxiety or depression Child abuse Neglect Poor academic performance ADHD Bullying Deviant peer group Conduct disorder Poor family relationships ```

Answer 136

``` Self-control Parental monitoring Academic competence Anti-drug use policies Strong neighbourhood attachment Consistent discipline in childhood ```

Answer 137

Environmental - risk factors Genetics: development of addiction can be influenced by genetics

Answer 138

Initial use - Motivated by: curiosity, peer pressure, psychodynamic processes - If drug taken repeatedly - casual drug use - More frequently using high doses - intensive drug use - Compulsive drug use = substance has strong motivational properties and appears to govern an individuals behaviour 1. Experimental or circumstantial 2. Casual drug use 3. Intensive drug use 4. Compulsive drug use 5. Addiction

Answer 139

Physical dependency model - after repeated exposure, get withdrawal symptoms. They act as negative reinforcement and cause continued drug use Positive reinforcement model - drug acts a positive reinforce causing a change in behaviour Reinforcement system in the brain - Reinforcers are thought to increase the effect of dopamine - Increased dopamine release

Answer 140

Minimum unit pricing Label alcohol with health warnings Sale of alcohol in shops restricted to certain times Higher tax on alcohol Prohibit alcohol advertising and sponsorship - or limit to purely factual information Regulartion of alcohol packaging and design Train all health and social workers on giving alcohol advice

Answer 141

No more than 14 units per week in men and women | Ideally 2 alcohol free days

Answer 142

``` Precontemplation Contemplation Preparation Action Maintenance Relapse ```

Answer 143

- User is not considering change - Is aware of negative consequences - Is unlikely to take action soon - Need information linking substance with problems - Brief intervention: education about negative consequences Interview approach - express concern - agree to disagree about severity of problem - suggest bringing family member - explore perception of drug abuse problem

Answer 144

User is aware of some pros and cons but feels ambivalent to change - not yet committed to a change - Explore feelings of ambivalence - Seek to increase awareness of continued abuse and benefits of stopping Interview approach - Elicit positives and negatives, help tip the decisional balance - Ask about past abstinence - Consider trial - Self-Motivational statements of intent and commitment

Answer 145

User has decided to change and begins to plan steps towards recovery - Needs to work on strengthening commitment - List options for treatment to choose from Interview approach - Clarify goals and strategies - Acknowledge significance, offer options and advice - help patient decide on achievable action - Consider and lower barriers for change - finances, transport - Have them publicly announce plans for change

Answer 146

User tries new behaviours, not yet stable First active step towards change - help executing the plan - brief interventions can help prevent relapse Interview approach - Source of encouragement and support - Acknowledge negatives and reinforce importance in continuing - Support realistic view of change using small steps - Identify high risk situations and develop coping strategies

Answer 147

Established new behaviours on a long term basis - help with relapse prevention - Support lifestyle changes - Help to practice and use coping strategies - Maintain supportive contact - Anticipate difficulties and recognise the struggle

Answer 148

Recurrence of symptoms and must now cope with consequence and decide what to do next - Help them re-enter the change cycle - Commend any willingness to reconsider positive change - Explore what can be learned from relapse - Express concern about relapse - Support patient so recovery seems achievable

Answer 149

- May not reduce the change of dying from prostate cancer. Some tumours grow very slowly and are unlikely to threaten life. OVERDIAGNOSIS AND OVERTREATMENT - Side effects of overtreatment: surgery, radiotherapy (urinary incontinence, bowel control issues, ED, infection) - May not be useful for those with fast growing as may have mets before detection - False positives and false negatives (anxiety) - Most men with raised PSA do not have prostate cancer - Non specific test as will detect aggressive and slow growing tumours

Answer 150

For monitoring for recurrence

Answer 151

If prostate cancer is suspected A man over 50 can ask for PSA - GP must explain risks and benefits - Give any written info - Answer any questions

Answer 152

Recent urine infection Ejaculated in last 48 hours Exercised heavily in last 48 hours Had a prostate biopsy in the last 6 weeks

Answer 153

Mesothelioma Asbestosis - Construction workers - Home remodellers - Shipyard workers - Workers who mine, mill or manufacture it

Answer 154

Silicosis - Coal miners - Foundry works - Potters - Sand blasters - Tunnel workers

Answer 155

- Woodworkers - wood dust - Spray painter - isocyanates - Solderer - colophony - Metal workers - Cobalt, nickel - Bakers, millers, farmers - Cereal grains

Answer 156

``` 25% at some point 5% annual 1/4 women, 1/10 men More common in women Increased in Blacks, Asians, refugees Increased in 25-44 and elderly ``` RFs - Unemployment - Lower income - Debt - Violence - Stressful life events - Inadequate housing - Poverty - Smoking - Lower education - Genetic FHx - Pregnancy (post natal) - Physical illness causing pain - Dementia - Other mental health problems

Answer 157

- May have unassessed or undiagnosed LD as verbal IQ tests are inaccurate - Few residential or nursing homes can sign to deaf people - Limited access to specialist mental health services - postcode lottery - Difficulties communicating with GPs - Equal prevalence of mental health problems In children higher prevalence due to: - Excess organic problems - Excess emotional, physiological and behavioural disorders - Delays to access which increases duration - Care often poor - Increased stresses - Socially isolated Lack or understanding Little support available

Answer 158

NEWS score to assess those at risk iodinated contrast agents - IV volume expansion if high risk or acute illness with sodium chloride Stop ACEi and ARBs if GFR < 40 Advice from pharmacy if high risk

Answer 159

RIFLE, AKIN, KDIGO Rise of creatinine of greater than 26 in 48 hours 50% rise in creatinine within 7 days Fall in urine output to less than 0.5ml/kg/hr

Answer 160

``` Over 65 Heart failure Liver disease CKD Past AKI Diabetes Fluid intake dependent on carer Hypovolaemia Oliguria Haematological malignancy Sepsis Urological obstruction Iodinated contrast agents Nephrotoxic meds: ACEi, ARBs, NSAIDs, aminoglycosides, diuretics Deteriorating NEWS score ```

Answer 161

Compulsive need to use a habit forming substance This compulsion is accompanied by an increased tolerance and experience of withdrawal symptoms

Answer 162

``` Organ damage Hormone imbalance Cancer Prenatal and fertility issues GI disease HIV/AIDS/hepatitis Depression Anxiety Memory loss Mood swings Paranoia ```

Answer 163

- More work days lost - Increased number of people claiming benefits and not paying taxes - Increased criminal activity - Illegal drugs - funding other types of criminality - Drain on healthcare resources - Drain on economy - High risk of accidents or becoming a victim of crime - Can destroy communities

Answer 164

- Erratic behaviour, physical/verbal abuse - Some can be high functioning but most are poor providers - Financial difficulties - Stealing from family members - Unable to care for children - neglect - Set bad examples to child - Increased divorce rate - Change of relationship with friends and family

Answer 165

Person is obsessed with substance and neglects other areas of their lives Life is unfulfilling + filled with despair Increased morbidity/mortality Worse mental health/increased suicide risk Poor attendance at work, difficult finding work Mood swings Increased probation, arrests, prison time Increased homelessness Secretive behaviour

Answer 166

Being overweight and general health risks Realistic targets for weight loss Distinguishing between weight loss and maintaining weight loss Realistic exercise and healthier eating targets Treatment options Healthy eating in general Medical and surgical options

Answer 167

DO NOT - use restrictive and nutritionally unbalanced diets as they are ineffective in the long term and can be harmful - FOLLOW FADS BE - Flexible - Encourage diet improvement even if no weight loss Diet with 600kcal deficit per day. Can consider 800-1600 kcal per day but less balanced. Swap unhealthy and high energy foods for healthier choices 5 fruit and veg a day Wholegrain varieties of starches Lower sugar milk and dairy - yoghurt, soy Eat beans, pulses, fish, eggs, meat and other protein 2 portions of fish per week Plenty of fluid

Answer 168

Overweight BMI >25 Obese BMI > 30 Morbidly obese BMI > 40

Answer 169

``` Discrimination Lower wages Lower quality of life Transport difficulties - planes, trains, buses Difficulty buying clothes More likely to commit suicide More likely to divorce Fewer friends Depression and anxiety Body dissatisfaction ```

Answer 170

Increased risk of: - heart disease - stroke - diabetes - hypertension - high cholesterol - asthma - sleep apnoea - gallstones - kidney stones - infertility - OA - fatty liver disease - cancer: leukaemia, breast, colon Increased morbidity and mortality life expectancy reduced by more than 9 years

Answer 171

``` Lost days of work High employer insurance premiums Lower wages and income Large costs on the health care systems Increased social services having to provide care ```

Answer 172

``` Surgeon Radiologist Histopathologist Oncologist - clinical and medical Haematologist Palliative care specialist GP Physicians of appropriate speciality Clinical nurse specialist Ward nurses MDT coordinator Admin/managerial ```

Answer 173

Structure: - Membership and attendance - Technology (Availability and use) - Physical environment of the meeting room - Preparation for MDTs - Organisation and admin during the meeting Clinical decision making: - Team working - patient centred care Team governance: - Leadership - Data collection, analysis and audit Professional development and education of team members

Answer 174

- Improved clinical decision making - More coordinated patient care - Improvement to overall quality of care - Evidence based treatment decisions - Increased number of patients being considered for trials - Improved timeliness of tests and treatments - Improved survival rates - Increase proportion of patients staged (cancer)

Answer 175

62% of UK adults are overweight or obese 65% men, 58% women 25% of them are obese - Prevalence is similar among men and women - More men are overweight - More women are obese - Women are more likely to have extremely high BMI values

Answer 176

BIOLOGY - Influence of genetics and ill health: - Prader-Willi, Hypothyroidism, Cushing's ACTIVITY ENVIRONMENT - Influence of environment on the individuals activity behaviour - e.g. decision to cycle to work influenced by road safety, cycle shelters, showers PHYSICAL ACTIVITY - Type, frequency, intensity SOCIETAL INFLUENCES - Impact of media, education, peer pressure, culture INDIVIDUAL PSYCHOLOGY - Drive for particular foods - Consumption patterns - Physical activity patterns or preferences FOOD ENVIRONMENT - Availability and quality of fruit and veg near home - Demand for convenience - Lack of perceived time FOOD CONSUMPTION - Tendency to graze - Parental control

Answer 177

- Frequent large meals - Food high in refined grains, red meat, unhealthy fats, sugary drinks - Increased television - Increased use of cars - Busier lifestyles - Longer commutes - snacking - Increased advertising - Sleep issues - Increased stresses and boredom - Decreased cost of fats and sugars

Answer 178

Key organisation in the control of communicable disease

Answer 179

Public Health Act 1984 (control of diseases) & 1988 (infectious diseases) Aims to reduce the spread of communicable disease - Act on clinical suspicions, do not wait for definitive diagnosis - Legal requirement to notify Health Protection Agency (HPA) - Notify Consultant in Communicable Disease Control

Answer 180

Treat patient Minimise chances of other getting same infection - Chemoprophylaxis after meningitis to contacts Reduce infectiousness of the bug = antibiotics Contain infectivity - Isolate in side room - Exclusion from certain activities e.g. work or school - Hand washing - Personal protective equipment - Managing blood and body fluids adequately - Education of patients - Cough etiquette IMMUNISATION

Answer 181

- Notification of infectious disease - Prevents sale of infected articles - Prevents infected people from using public transport - Cleaning and disinfection of premises - Excluding people from work and school - Offering immunisation - Compulsory exclusion - Remove to hospital and detain there - Obtaining information from households and schools to prevent spread of disease

Answer 182

- Polio - Acute encephalitis - Anthrax - Cholera - Diphtheria - Dysentery - FOOD POISONING - Malaria - MEASLES - MENINGITIS - MUMPS - Plague - Rabies - RUBELLA - SCARLET FEVER - SMALLPOX - TETANUS - TB - Typhoid fever - VIRAL HEPATITS - Viral haemorrhagic fever - WHOOPING COUGH - YELLOW FEVER **HIV is not a notifiable disease but practitioners should make sure that any sexual partners have been notified

Answer 183

Activities aimed at stopping a disease from developing in the first place

Answer 184

Activities aimed at stopping adverse events once a disease has happened

Answer 185

Limiting the impact that adverse effects have on health

Answer 186

Primary - Smoking cessation in someone without heart disease - Weight loss in someone without heart disease or diabetes Secondary - Antiplatelet therapy post MI - Statins for those post MI or stroke Tertiary - Beta blockers in heart failure - Cardiac rehabilitation program post MI

Answer 187

A preventative measure that brings a large benefit to the community offers little to each participating individual Most heart disease occurs in people who are not high risk. It is easy to identify those at high risk If you improve chances for people at low risk then stands to gain more as a population.

Answer 188

Probability that an even occurs in a given time

Answer 189

Joint British Societies Risk Prediction chart Uses UK GP data rather than Framingham data QRISK 2 - Overestimates low risk - Underestimates high risk - Does not take into account socioeconomic position and ethnicity

Answer 190

``` Age Sex Postcode Smoking Diabetes Angina or MI in first degree relative < 60 CKD stage 4 or 5 AF On BP treatment RA Cholesterol BMI ```

Answer 191

DPPT In overweight people with raised fasting glucose - Allocated to either: intensive lifestyle changes OR standard lifestyle recommendations + metformin OR placebo - Incidence of diabetes was lower in the intensive lifestyle changes group - Lifestyle is better than metformin for preventing T2DM Intensive lifestyle was minimum 150 minutes of exercise + 16 lesson curriculum + 7% weight loss

Answer 192

Degree in which patient is overweight Change in weight Duration patient is overweight Increasing BMI

Answer 193

``` Informal Tier Tier 1 Tier 2 Tier 3 Tier 4 ```

Answer 194

Professionals Any tier 1 person can refer to a PRIMARY MENTAL HEALTH WORKER They are not mental health specialists but have regular contact with children and young people Offer advice and treatment for less severe problems, promote good mental health, facilitate early identification of problems and refer - Teaching assistants - Teachers - Paediatricians - GP - Social worker - Health visitor - School worker - Public health nurses - Voluntary workers

Answer 195

Bridge between tier 1 and 2 - provides consultation and advice to the professional in tier 1 - Assess the child - Carry out short term work with the family - up to 4 session - Co work with referring professions - Refer onto other agencies .e.g. social service and education and support services - Refer up tiers 2, 3, 4

Answer 196

Everyone that specialises in child mental health Specialist CAMHS clinicians working in community setting Offer consultations to support severe or complex needs - Psychologist - Nurse - OT - Social worker - Psychiatrist - Psychologist - CPNs - Creative therapists

Answer 197

Teams depend on locality and requirements Very specialist teams ``` Family therapy LD Attention problems Looked after children Eating disorder Autism Adoption support Paediatric liaison Self-harm Psychosis Bereavement Palliative care ```

Answer 198

``` Inpatient units For young people with - psychosis - severe eating disorders - severe OCD - severe depression ```

Answer 199

Recommendations All patients need to have access to a high quality of care Public and professional education into the early signs of cancer Patients, families and carers to be given clear information about the treatment and outcomes Cancer care should be patient centred Primary care is the central focus of cancer care Psychological aspects need to be recognised Cancer registration and monitoring

Answer 200

Qualified nurses with specialist training who work in the community

Answer 201

1. Select topic 2. Review literature 3. Set standards 4. Design audit 5. Collect data 6. Analyse data 7. Feedback findings 8. Change practice 9. Set/review standards 10. Reaudit

Answer 202

Also referred to as risk ratio It is the probability of an event occurring e.g. developing a disease in an exposed group vs non exposed group RR = probability when exposed / probability when not exposed Used in RCTs and cohorts

Answer 203

Risk of developing the disease over a period of time Number of events in a group/ number of people within the group

Answer 204

Absolute risk in control - (absolute risk in treatment / absolute risk in control) RRR = 1 - relative risk

Answer 205

Absolute risk in the control group - absolute risk in the treatment group

Answer 206

1 / absolute risk reduction Needs to be expressed as a whole number NNT BENEFIT = round up NNT HARM = round down Extending the time period in which the risk is expressed will decrease the number needed to treat

Answer 207

Needs to have a time period e.g. within 10 years Look at the nature of the outcome Decide if looking at something that is getting better or work (NNT benefit or harm)

Answer 208

Difference in the rate of a condition between an exposed and unexposed population. Also called risk difference of risk rate difference. Incidence in exposed - incidence in unexposed

Answer 209

Reduction in incidence that would be observed if the population were entirely unexposed in comparison to its current exposure pattern.

Answer 210

Increase availability of heathier food in public service venues Improve availability of healthy food - subsidise Provide incentives for food retailers to locate healthier products in prime areas Small portion sizes in public service venues Limit advertisement of unhealthy goods Discourage consumption of sweet drinks Increase support for breastfeeding Increase school PE requirements Compulsory PE Enhance infrastructure to encourage walking and cycling Improve safety in areas where people could be physically active e.g. schools Healthy school dinners Clear food labelling Increased education - change for life Weight loss advice Promote physical activity in the workplace Raise awareness of complications Teaching in schools about healthy diets and exercise

Answer 211

Started in 2000 with NHS cancer plan Brings together all the key players in research to identify where research is most needed Partnership of UK cancer research funders to promote collaboration Support advancement of areas lacking in research NHS supported clinical trials Comprised of 7 government partners and 14 charities

Answer 212

Maintains database of cancer research in UK Organising annual NCRI cancer conference Developing a plan to network UK cancer registries and encourage epidemiological research Revitalise UK radiotherapy research Development of the national Cancer Research Network Setting up a network of experimental cancer medicine centres Publish reports on key areas Establish the National Cancer Intelligence Network

Answer 213

Foster research aimed at: - Better prevention leading to lower cancer risk for the individual - Earlier diagnosis - Better, cost effective treatments with more people cured - Less inequality in outcomes for patients - Improvements in health and quality of life for people who survive cancer

Answer 214

Aims to improve speed, quality and integration of research to improve patient care - Increase funding for trials - Provides researchers with practical support - Increases participation in clinical research, raising the number of patients entering trials - Engages with stakeholders - Ensures research is translated into benefits for patients,

Answer 215

Adults: - Diabetic eye disease - Retinography - Breast cancer - Mammography - Colorectal cancer - Fecal occult blood - Cervical cancer - Smear test - AAA - Ultrasound Antenatal: - Down's, Edwards', Patau's syndrome - Infectious diseases: HepB, HIV, syphilis - Inherited conditions: sickle cell, thalassaemia, other haemoglobin disorders - Ultrasound for abnormalities: spina bifida ``` Neonatal (48 and 72 hours): - Newborn hearing Newborn bloodspot: - Phenylketonuria (PKU) - Congenital hypothyroidism (TSH) - Sickle cell disease - Cystic fibrosis (immunoreactive trypsinogen) ```

Answer 216

Everyone over 12 with diabetes receives it annually During pregnancy - at first antenatal clinic and at 28 weeks

Answer 217

Mammography Women aged 50-70: 3 yearly Trail extension: 47-73

Answer 218

Faecal occult blood Every 2 years from 60-74

Answer 219

Cervical Smear Every 3 years from 25-50, every 5 years 50-64 Tests for HPV and cell changes

Answer 220

Men aged 65 are offered US scan If normal, never tested again If small-medium then regular monitoring

Answer 221

Requires a judgement between balance of helping and harming Early detection is necessary for screening but in itself does not provide benefit Population screening is about programmes not tests

Answer 222

AAA - a person that dies during surgical repair of AAA detected through screening Down's - loss of normal foetal following investigation of a high risk screening test Colorectal cancer - healthy individual who suffers from perforation of bowel during colonoscopy following screening Patients receiving additional tests due to false positives on screening e.g. biopsy

Answer 223

If you succeed in early detection of a disease then you increase the time between diagnosis and death - even if treatment is useless - Care not to count this extra time as benefit - Need to use number of events prevented rather than survival time.

Answer 224

Patients who participate in screening often make other health conscious choices. Different lifestyles between those who take up screening and those who don't.

Answer 225

Screening tends to detect disease which progresses more slowly The screening detected disease will have better outcomes as they have less aggressive disease It appears as if the cancers detected by screening have better outcome

Answer 226

Provides statutory framework to empower vulnerable people who are not able to make their own decisions. It makes it clear who can make decisions, in which situations and how they should go about this. It applies to those aged 16 and over.

Answer 227

Assessment of mental capacity is specific for each individual decision at any given time 1. Presumption of capacity: every adult has the right to make their own decisions and must be presumed to have capacity unless proven otherwise 2. The right for individuals to be supported to make their decisions. People must be given all appropriate help before anyone concludes they cannot make decisions. 3. Individuals retain the right to make an unwise decision 4. Best interests anything done for or on behalf of people without capacity must be in their best interests 5. Least restrictive intervention possible

Answer 228

To have capacity a person must: - Be able to understand information provided - Be able to retain this information - Be able to weigh up pros and cons - Be able to communicate this decision

Answer 229

Restraint is only permitted if it is deemed reasonable to prevent harm Needs to be proportionate to likelihood and seriousness of harm

Answer 230

Gives the person the right to make decisions about healthcare treatment in the future for times when they no longer have capacity. - Replaced advanced directives - Only over 18s - Must currently have capacity - Any treatment can be refused except for those to keep a person comfortable - food, water, warmth, shelter - Can express which treatments you would like but cannot demand - It carries the same weight as a person with capacity so best interests does not apply - Can be verbal unless about life-sustaining treatment which must be written and signed by patient and a witness, plus a statement that it is still to apply if life is at risk - Becomes invalid if the decision is withdrawn while still has capacity - Must apply to the specific circumstance in question

Answer 231

Can appoint an attorney to act on their behalf if they lose capacity in the future Lets them make financial, property, health and welfare decisions Attorney must be over 18 Only comes into force once a person loses capacity Must be registered with the Office of Public Guardian

Answer 232

Appointed if someone without capacity has no one to speak for them Makes representations about patients wishes Can challenge the decision maker MUST be involved if: - Serious medical treatment - Stay of more than 28 days in hospital or 8 weeks in care home - Change to accommodation

Answer 233

Provides legal protection for vulnerable adults who are not detained under Mental Health Act 1983 but are restricted in freedom due to an inability ot consent to care or accept treatment Anyone over 18 with - mental disorder or disability of the mind e.g. dementia or profound LD - Lack of capacity to give informed consent If a person lacks capacity, must apply to a supervisory body for authorisation of deprivation of liberty

Answer 234

Provides a national overview of NHS performance Supports the secretary of state in holding NHS England to account for improving outcomes and acts to aim to encourage a change in health inequalities. 5 domains: - Preventing people dying prematurely - Enhancing quality of life for people with long term conditions - Helping people to recover from periods of ill health or following injury - Ensuring people have a positive experience of care - Treating and caring for people in a safe environment and protecting them from avoidable harms

Answer 235

NHS Outcomes framework - One year survival from all cancers - 5 year survival from all cancers - One year survival from breast, lung, colorectal cancers - 5 year survival from breast, lung, colorectal cancers - 5 year survival from all cancers in children Cancer Patient Experience Survey CCG Outcomes Indicator Set PROMs

Answer 236

Drives local improvement and sets priorities - Under 75 mortality from cancer - 1 and 5 year survival from all cancers - Record of stage of cancer at diagnosis - Percentage of cancers detected at stage 1 and 2 - Mortality from breast cancer in females - Patient experience and survivorship

Answer 237

CPES National assessment of patient satisfaction with their cancer treatment. In 2014 - asked 110,000 patients, 64% response Positives - Given enough information - Offered a range of treatment options - Treated with respect and dignity Negatives - GP and nurses in GP could do more - Not enough care form health and social services post discharge

Answer 238

- 4 in the UK - Responsible for registering all cancer that occur in their population - Prime aim to establish incidence and survival - Identify all new cases and follow them through to death - Allows comparison of incidence in different regions - Allows researchers to examine long term outcome provides inform on cancer epidemiology

Answer 239

Criteria for causation - minimal conditions necessary to provide adequate evidence of a causal relationship between incidence and possible consequence 1. Strength - larger = more likely to be causal 2. Consistency (reproducibility) 3. Specificity - causation likely if a very specific population and disease with no other likely explanation 4. Temporality - effect after cause 5. Biological gradient - greater exposure = greater incidence of effect 6. Plausibility 7. Coherence - between epidemiological findings and lab findings 8. Experiment 9. Analogy

Answer 240

Alcohol Obesity Viral hepatitis Metabolic syndrome Healthcare workers IVDU Unprotected sex with multiple partners Working with toxic chemicals Certain medications

Answer 241

Hep B vaccine Antenatal testing for Hep B and C Test in prisons Needle exchange programs Free barrier contraception

Answer 242

Alcohol cession Low sodium diet Healthy diet Avoid infections - immunise for hepatitis, influenza, pneumonia Care RE over the counter drugs Weight loss

Answer 243

3 levels of care - Primary care ``` - Cancer UNITs for populations of 250,000 Treat common cancers Diagnostic procedures Common surgery Non-complex chemotherapy ``` - Cancer CENTRES for populations of 1,000,000 Treat rare cancers Radiotherapy Complex chemotherapy Palliative care runs alongside all 3 levels

Answer 244

Established in 2000 28 cancer networks in the UK Work in local areas with clinicians, patients, managers to deliver the National Cancer Strategy to improve performance of cancer services Becomes known as Strategic Clinical Networks from 2013 - Now wider than cancers - One per region - Seeks to reduce inequalities in care

Answer 245

4 aims: - Save more lives - Ensure people with cancer get the right professional support and care as well as the best treatments - Tack inequalities in health - Build for the future through investment in the cancer workforce: strong research and preparation for a genetic revolution

Answer 246

12 – 72 hours: Eggs Peaks in LATE SUMMER

Answer 247

12 – 48 hours: Food or animal contact Strains: O157H7, HUS

Answer 248

1 -6 hours: Rice The fastest incubation time except heavy metals.

Answer 249

2 – 4 hours, a close second. Skin

Answer 250

Protozoa that resides in the GI tract. Resists chlorination with it’s tough oocytes. Bad one if immunocompromised!

Answer 251

24-hour incubation period RNA virus that is highly infective and causes D+V. Most common cause of viral gastroenteritis and plagues semi-closed environments.

Answer 252

12-24 hour incubation period The reason you should refrigerate things properly! Vegetative cells develop (toxic spores) which cause GAS GANGRENE

Answer 253

* The big papa – the most common reported cause of food poisoning. * Incubation period is 48 - 96 hours (2-4 days) * GI tract of poultry and uncooked meat.

Answer 254

Campylobacter: - 48-96 hours, 2-4 days - Meat - Profuse (bloody) diarrhoea , severe abdo pain - Most common reported cause of food poisoning UK Salmonella: - 12-48 hours - Poultry, eggs - Diarrhoea, abdo pain Norovirus: - 24 hour RNA virus - Gastroenteritis Staph Aureus: - 2-4 hours - Skin C. perfringens: - 12-24 hours - Cooked meats develop vegetative cells that produce toxic spore which cause gas gangrene B. cereus: - 1-6 hours - Cooked rice

Answer 255

* Preliminary phase: Establish the nature of the outbreak; who, what, where… How!? Make sure potential sources are removed and people are safe. Start making contacts who can help – those affected or people in the right place. * Data collection and descriptive epidemiology: Gather more data and analyse (who, what, where, etc – use questionnaires (though chance of bias). Take food histories, even though the method is flawed (people forget, people lie etc) * Investigate the environment

Answer 256

A cohort study (follow those with a known exposure)

Answer 257

Case – control study; have a group of affected and unaffected people. Look back to figure out where the problem was

Answer 258

Allows the exclusion of people from a public place if they have “dubious” hygiene (lol) 1) Inadequate hand washing and personal hygiene 2) Children at nursery – don’t spread the pox 3) Anybody involved in food prep 4) Healthcare workers working with vulnerable people – very young, very old, pregnant women, immunocompromised patients.

Answer 259

1) Protect the health of the people 2) Protect the rights of the people (don’t get ripped off) 3) Protect the practice of fair trade (support our farmers!)

Answer 260

* Defines what food it – substance that we consume, doesn’t necessarily have to be of calorific value (chewing gum counts) and drink counts too. * Defines who the authorities are and what are their responsibilities are.

Answer 261

* Selling food that is injurious to health * False advertising – food has to be at the quality demanded by the user, they can’t be mislead * Selling food that is unfit for consumption

Answer 262

* Report it to the consultant in charge and to the local authority. * Wash hands, aseptic tekkerz, barrier nursing, use of side rooms, isolate cases, restrict ward visiting hours, lift cases that are 72 hours symptom free, bare below the elbow etc…

Answer 263

1) Improve care of the patient and therefore outcomes 2) Make recommendations for the best available care using best evidence available 3) Help train professionals 4) To set the standards that clinicians can be compared against 5) Help inform patients (they can google things…) 6) Help facilitate communication between patient and doctor (better relationship)

Answer 264

1) Scope and purpose – has the aim of the study been defined? Have targets and goals been set? Has a population been defined? 2) Stakeholder involvement: Have service users and providers been involved? Get their opinion on things! 3) Rigour of development: Has the best evidence available been sought? Have you even bothered to set selection criteria? Well please tell you at least got somebody else to appraise the study and methods? Was it an external review? 4) Clarity of presentation 5) Applicability of the study: Will it have an effect? Will there be barriers to uptake? Can it be done!? Do you even have the resources or man power to put it into practice!? 6) Editorial independence – Did you do the whole study without bias? Were any conflicts in research declared honestly!? No funding bodies played a part?

Answer 265

* Sensitivity – number of +ve results/number of people who really have the condition * Specificity – number of -ve results/number of people who DON’T have the condition * PPV – number of true +ve results/ ALL positives * NPV – number of true -ve results/ALL negatives * LR+ - sensitivity/(1-specicifity) * LR- : (1-sensitivity)/specificity PPV increases and NPV decreases with PREVALENCE

Answer 266

* PPV of a PSA test is only 30% * Condition isn’t overly understood in the progression and PSA can be raised by confounders * Test is invasive and may provide false positive * Treatment can’t guarantee a better outcome – “watchful waiting” * No research to say whether it would improve survival

Answer 267

* Lead time bias: survival appears longer, but really isn’t * Length bias: slow progressing conditions more likely to be detected: apparent increased incidence * Selection bias: People who opt in for screening are likely to be healthier and less likely to be unhealthy.

Answer 268

Out-pt. clinics. Day hospitals: Non-residential units, require pt. to have supportive home environment to return to. Can also be used to slowly discharge pt. back to community. Assertive outreach teams: Effectively high level CMHTs for challenging pt. (pose real threat of harm & does not want to engage with mental health services). In-pt. units: Admitted when high risk (Self or others), grossly disturbed behaviour., or period of assessment needed (diagnosis/treatment efficacy) for severe psychiatric disorder. Early intervention services: Works with young people over the age of 14 (-35) to deal with first episode of psychosis as evidence earlier treatment improves prognosis. Team workers have much smaller case loads than the CMHT so can provide far more intensive input. Crisis resolution + home team (CRHT): Team that can support you at home during a mental health crisis=When your mental health is ‘at breaking point’, e.g suicidal ideations, mania, psychotic episodes, severe panic attacks. - Team is available 24/7. - Act as final arbitrators for inpatient admission. - Can provide intensive & flexible home support to prevent admission=give short but intensive input. - Respond to psychiatric emergencies.

Answer 269

- Systematic assessment of patients health and social needs - Formation of agreed plan to address needs - Allocation of care coordinates to keep in touch with patients

Answer 270

Psychiatrist: - Prescribe medication - May be involved in administering psychotherapy Community psychiatric nurse (CPN): - Visit patient at home - See pt. in out-patient departments - Can help coordinate the care for patients - Can administer medications and monitor effects Social worker: - Allow patients to talk through their needs and consider social care implication Includes ensuring patient rights under MHA are considered Occupational therapist (OT): - Help to improve ADLs - Identify what patients can’t do, what support they need etc. to allow them to become independent and regain skills Clinical psychologist: - Person giving psychotherapies - Note: counselling can be given by counsellors with less training Primary mental health worker: - Assess and sign-post patients - Can also provide them with short-term therapy (not-trained) Team manager: - Usually a senior nurse or social worker - Don’t see patients themselves - Are responsible for running team

Answer 271

- Wrong site surgery - Wrong implant/prosthesis - Retained foreign object post procedure - Mis-selection of a strong potassium solution - Administration of medication by the wrong route - Overdose of insulin due to abbreviations or incorrect device - Overdose of methotrexate for non-cancer treatment - Mis-selection of high strength midazolam during conscious sedation - Failure to install functional collapsible shower or curtain rails - Falls from poorly restricted windows - Chest or neck entrapment in bed rails - Transfusion or transplantation of ABO-incompatible blood components or organs - Misplaced naso- or oro-gastric tubes - Scalding of patients - Unintentional connection of a patient requiring oxygen to an air flowmeter

Answer 272

Cost effectiveness analysis: requires all comparisons to have the same outcome Cost utility analysis: measures all outcomes on one scale a combination of quantity and quality of life Cost benefit analysis: measures outcomes in money Cost minimisation analysis: assumes same outcome, measures costs Cost consequence analysis: measures costs, measures consequences Discounting: ‘A bird in the hand is worth two in the bush’ Sensitivity analysis: ‘Vary key assumptions and see if it has an impact’

Answer 273

Quality standards: models of a high quality service -> something to aim for Indicators: evidence-based indicators of practice quality -> e.g. QoF indicators, incentive scheme for General Practice

C3 Flashcards

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