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1
Q

Maxwell’s dimensions of the quality of health care

A

Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity

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2
Q

Benefits of teaching diversity

A

better outcomes for patients
more satisfying patient encounters

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3
Q

Negligence (4)

A

was there a duty of care?
was there a breach in that duty?
was the patient harmed?
was the harm due to the breach in care?

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4
Q

Negligence -> Bolam test

A

would a group of reasonable doctors do the same?

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5
Q

Negligence -> Bolitho test

A

would that be reasonable?
(defines the ‘reasonable’ part of Bolam -> logical basis)

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6
Q

Determinants of health (8)

A

PROGRESS
Place of residence
Race
Occupation
Gender
Religion
Education
Socio-economic
Social capital

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7
Q

Transtheoretical model - smoking

A

5 stages of change
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

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8
Q

Advantages and disadvantages of the trans theoretical model

A

+ acknowledges differing stages of readiness, allows relapse
- people may skip stages, doesn’t take cultural views into account

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9
Q

Theory of planned behaviour change

A

the best predictor of behaviour is ‘intention’ e.g. I intend to give up smoking

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10
Q

Motivational interviewing

A

attempts initiating behaviour change by resolving ambivalence

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11
Q

epidemiology

A

the study of the frequency, determinants and distributions of diseases and health related states in populations in order to prevent and control disease

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12
Q

domestic abuse

A

any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between current or former partners or family members in a person > 16

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13
Q

child abuse

A

same as domestic abuse but <16yo (any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between current or former partners or family members in a person)

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14
Q

toxic triangle for child abuse

A
  • parents mental health issues
  • alcohol and drug abuse
  • domestic abuse
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15
Q

effect of abuse on health

A

physical trauma, psychological trauma, somatic problems

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16
Q

role of doctor in dealing with domestic abuse

A

display helpline posters, give contact cards
- ensure records are kept
- vocally acknowledge it is not acceptable, be non-judgemental
- refer when appropriate
- break confidentiality if their health is in danger
- don’t speak about abuse when family members are present

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17
Q

DASH assessment

A

determines whether a patient is low, medium, or high risk in abuse

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18
Q

DASH low, medium and high risk

A

serious harm unlikely

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19
Q

DASH medium risk

A

serious harm likely without change in circumstances -> give domestic abuse helpline contact details

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20
Q

DASH high risk

A

risk of imminent harm
-> refer for Marac (multi-agency risk assessment conference) / IDVAS (independent domestic violence advocacy service)

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21
Q

health behaviour

A

a behaviour aimed to prevent diseases (e.g. healthy eating)

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22
Q

sick role behaviour

A

any activity aimed at getting well (e.g. taking medications)

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23
Q

illness behaviour

A

a behaviour aimed to seek remedy (e.g. going to the doctor)

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24
Q

health belief model

A

chance of an action being carried out is associated with persons belief that it will work + cues to action

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25
health
a state of complete physical, mental and social wellbeing. Not merely the absence of disease or infirmity
26
public health
the science and art of preventing disease, prolonging life and improving health through organised efforts of society
27
equity
what is fair and just
28
equality
having equal shares (not always equitable)
29
horizontal equity
equal treatment for equal need
30
vertical equity
unequal treatment for unequal need (e.g. poor area requires more services than rich area; simple cold vs pneumonia need unequal treatment)
31
inverse care law
availability of health care tends to vary inversely with its need
32
three domains of public health practice
health improvement, health protection, improving services
33
health improvement
societal interventions aimed at preventing disease, promoting health, reducing inequalities
34
health protection
measures to control infections disease and environmental hazards
35
improving services
organisation and delivery of safe, high quality care
36
5 stages of grief
denial; anger; bargaining; depression; acceptance (think haunting of hill house)
37
health needs assessment
a systematic approach for reviewing health issues affecting a population in order to enable agreed priorities and resource allocation to improve health and reduce inequalities -> should be carried out before designing an intervention
38
needs assessment cycle
needs assessment -> planning -> implementation -> evaluation
39
perspectives a health needs assessment are based on: (3)
epidemiological, comparative, coporate
40
epidemiological perspective of health needs assessment
informs health need based on size of problem (incidence, prevalence), services available (prevention, treatment), evidence base (effectiveness, cost-effectiveness) +> uses existing data -> doesn't consider felt need, data quality varies
41
comparative perspective of health needs assessment
compares the services received by a population with others +> indicates if better/worse than comparable areas -> difficult to find comparable population
42
corporate perspective of health needs assessment
asks the local population what their health needs are (focus groups, surveys, etc) +> based on felt and assessed needs -> difficult to distinguish 'need' from 'demand'
43
need
ability to benefit from an intervention
44
demand
what people ask for
45
supply
what is provided
46
supplied but not demanded or needed e.g.
routine C section for people with previous C sections
47
supplied and demanded but not needed e.g.
antibiotics for mild infection
48
health need
ability to benefit from an intervention measured using mortality, morbidit
49
health care need
need for health care / ability to benefit from health care
50
felt need
individual perceptions of variation from normal health
51
expressed need
individual seeks help to overcome variation in normal health (demand)
52
normative need
professional defines intervention for the expressed need
53
comparative need
comparison between severity, range of interventions and cost
54
principles of resource allocation
egalitarian maximising libertarian
55
egalitarian resource allocation
provide all care that is necessary and required for everyone +> equal for all -> economically restricted
56
maximising resource allocation
act evaluated in terms of its consequences - will it be beneficial? +> resources allocated to those most likely to benefit -> those with less need receive nothing
57
libertarian resource allocation
each is responsible for their own health +> promotes patient engagement -> most diseases are not self-inflicted
58
primary prevention
preventing disease occurring -> vaccine (=no disease)
59
secondary prevention
early identification of disease to alter disease course -> screening (=pre-clinical disease)
60
tertiary prevention
limit consequences of established disease (=clinical disease)
61
population approach to prevention
prevention delivered to everyone aimed to shift the risk factor distribution curve (e.g. sugar tax)
62
high risk approach to prevention
seeks to identify individuals above a chosen cut-off and treat them (e.g. screening for people with high BP & treating them)
63
Wilson Jungner criteria for screening INASEP
Important disease Natural history of disease understood (e.g. known disease marker) Acceptable to population (not too invasive) Simple, safe precise test Effective treatment (early detection has better outcomes than late detection) Policy agreed on who to treat
64
sensitivity
ability to detect people with disease (true positive results / true positive + false negative)
65
specificity
excluding those without disease correctly (true negatives / true negatives + false positives)
66
positive predictive value
proportion of people who test positive who actually have the disease (true positives / true positives + false positives)
67
negative predictive value
proportion of people who test negative who don't have the disease (true negative / true negative + false negative)
68
ecological study design
observational; looks at the prevalence of the disease over time (population) > can show prevalence and association but NOT causation
69
cross sectional study
observational; collects data from a population and a specific point in time (snapshot) +> large sample size -> no time reference
70
cohort study
longitudinal study in similar groups but with different risk factors/ treatments. follows up over time to measure who gets disease +> can follow up rare exposure that would be unethical in RCT; causation -> long time; high drop out rate
71
case control study
observational; looks at cause of diseases by comparing similar participants with and without disease. Looks retrospectively for cause +> quick, good for rare disease causes -> hard to find similar control group, prone to selection and information bias
72
RCT
gold; randomised participants, one group gets treatment, other is control +> low risk of bias/confounding, can infer causality -> time consuming, expensive, can be unreliable if population not representative (volunteer bias)
73
odds
probability / 1- probability
74
odds ratio
the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure
75
addiction
craving, tolerance, compulsive drug seeking behaviour, physiological withdrawal state
76
positive conditioning in addiction
increases desire to use drug
77
negative conditioning in addiction
people don't quit due to unpleasant withdrawal
78
physical complications of drug use
injection complications (DVT, abscess, endocarditis, blood borne virus); overdose; side effects (constipation in opiates)
79
social complications of drug use
criminal acts; social exclusion; poverty
80
psychological complications of drug use
guilt; cravings; fear of withdrawal
81
what can you offer a newly presenting drug user?
-screening for blood viruses -health check -contraception/smear -sexual health advice -check immunisation history -info on drug services (e.g. needle exchange service)
82
opiate detoxification drugs
methadone; buprenorphine naltrexone to prevent relapse
83
improving services
organisation and delivery of safe, high quality care
84
Maslow's hierarchy of needs
1. physiological (air, water, food) 2. safety (security of body and resources) 3. love/belonging (friends, family, intimacy) 4. esteem (confidence, achievement, respect) 5. self actualisation (morality, creativity, problem solving)
85
asylum seeker
someone who is applying for refugee status
86
asylum seekers receive
-vouchers to live off -NASS support package -access to NHS BUT not allowed to work & have no choice where they go
87
refugee
someone who has been granted asylum status -> lasts 5y
88
humanitarian protection
failed to get asylum but serious threat of returning -> can stay for 3y
89
health problems for refugees
injury/illness from war/travelling communicable disease lack of health screening and immunisation malnutrition untreated chronic disease mental illness (PTSD, depression, anxiety, post migratory stress)
90
barriers to health for migrants
reluctance of GPs to register them illiteracy communication difficulties lack of permanent site mistrust of professionals
91
alcohol unit calculation
ABV (%) x volume (ml) / 1000
92
drugs for alcohol dependance
acamprosate -> reduces cravings naltrexone -> reduces pleasure gained disulfiram -> causes unpleasant reaction if you drink
93
drugs for alcohol dependance
acamprosate -> reduces cravings naltrexone -> reduces pleasure gained disulfiram -> causes unpleasant reaction if you drink
94
alcohol withdrawal treatment
chlordiazepoxide inpatient regime (lorazepam in hepatic failure) CIWA score carbamazepine -> anti-convulsive

3a (8 decks)

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