HadSoc 1

Question 1

What is clinical governance?

Answer 1

delivering on the legal duty of NHS trusts to put in place systems for monitoring and ensuring that quality of care is provided. Represents a framework through which NHS organsiations are responsible for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

Question 2

What is the health and social care act 2012?

Answer 2

This act has a duty to improve quality. It states that the Secretary of State must exercise the functions of the Secretary of State in relation to the health service, with a view to securing continuous improvement in the quality of services provided to individuals.
o Effectiveness of the services
o Safety of the services
o Quality of the experience undergone by patients
o In regard to the quality standards prepared by NICE

Question 3

How has it been suggested that healthcare is inequitable?

Answer 3

by variations in healthcare, which suggest that not everyone is getting the best care- variations in who receives high quality of care, and access to care
e.g. twice as likely to have foot amputated due to diabetes in you live in SW, compared to SE. More thorough feet check may have meant preventability.

Question 4

what is equity?

Answer 4

everyone with same need gets same care

Question 5

what is an adverse event?

Answer 5

an injury caused by medical management rather than underlying disease, that prolongs hospitilisation, produces a disability, or both.

Question 6

what is a preventable adverse event?

Answer 6

an adverse event that could be prevented given the current state of medical knowledge

Question 7

examples of variations in healthcare?

Answer 7

5-fold variations in asthma admission rates to hospitalts with acute exacerbations across England

14-fold variation rate per 1000 people in provision of hip replacements

Question 8

what is meant by care being inefficient?

Answer 8

the best value for money care is not being provided

Question 9

example of an unavoidable adverse event?

Answer 9

a drug reaction in a patient prescribed drug for 1st time

Question 10

examples of preventable adverse events?

Answer 10

operations on wrong side of body
wrong dose/type of drug
failure to rescue- patient may deteriorate and attention is not given in time
some kinds of infections

Question 11

preventable adverse events in terms of surgery?

Answer 11

leaving behind a foreign object
wrong procedure
wrong site

Question 12

example of a preventable adverse event where medication was given via the wrong site?

Answer 12

vincristine- chemotherapy drug that is administered IV, but between 1975 and 2001, 14 people dies in the UK as drug given intrathecally- as spinal injection

Question 13

why does harm occur in the NHS?

Answer 13

over-reliance on individual responsibility:
all humans make errors, everyone is fallible
most of medicine complex and uncertain
most errors result of system- inadequate training, long hours, lack of checks, ampoules that look the same

personal effort is necessary but not sufficient to deliver safe care

Question 14

how has the WHO said we can address human factors to ensure a systems based approach to promote quality in healthcare?

Answer 14

avoid reliance on memory
make things visible
review and simplify processes
standardise common processes and procedures
routinely use checklists
reduce reliance on vigilance

Question 15

describe a model used to explain why patient safety problems occur

Answer 15

One human factors model is the Swiss
Cheese Model of organisational accidents.
The Swiss Cheese Model hypothesises that in any system there are many levels of defence. Examples of levels of defence would be checking of drugs before administration, a preoperative checklist or
marking a surgical site before an operation. Each of these levels little ‘holes’ in it which are caused by poor design, senior management decision-making,
procedures, lack of training, limited resources etc. These holes are known as ‘latent conditions’.
If latent conditions become aligned over successive levels of defence they create a
window of opportunity for a patient safety incident to occur. Latent conditions also increase the likelihood that healthcare professionals will make ‘active errors- lead directly to a patient being harmed whilst delivering patient care. When a combination of latent
conditions and active errors cause all levels of defences to be breached a patient safety
incident occurs.

Patient safety incident typically due to a series of seemingly minor events all happen consecutively and/or concurrently so on that one day, at that one time, all the ‘holes’ line up and a serious event results

Question 16

types of error in administering healthcare?

Answer 16

1. Slips and lapses
    Error of action
    Person knows what they want to do but action does not turn out as intended
    E.g. wanted to give a baby 0.05mg of a drug but gave 0.5mg instead
2. Mistake
    Error of knowledge or planning
    Action goes as planned but fails to achieve intended outcome because the wrong action was taken
    E.g. perfect administration of migraine treatment, but problem was a brain tumour
3. Violation
    Intentional deviations from protocols, standards, safe operating procedures or other rules
    E.g. not using aseptic technique when inserting a catheter

Question 17

why does violation occur in healthcare causing problems with safety?

Answer 17

There is a perceived benefit. Less trouble for the staff, saves time, reduces distractions while doing the round.
Assumed absent or minimal consequences. Do not consider it likely there will be negative
effects for the patient or consequences for themselves. The process or rule may not appear to have value

Question 18

situation of Elaine Bromiley, 2005: human factors contributing to harm occuring with patient care?

Answer 18

Doctors failed to recognise a standard can’t intubate can’t ventilate crisis when Elaine Bromiley was admitted to hospital for routine sinus surgery and during the anaesthetic, she experienced breathing
problems and the anaesthetist was unable to insert a device to secure her airway
Loss of situational awareness – the stress of the situation meant that the consultants
involved became highly focussed on repeated attempts to insert the breathing tube. As
a result of this they lost sight of the bigger picture i.e. how long these attempts had
been taking. This ‘tunnel vision’ meant they had no sense of time passing or the
severity of the situation
• Perception and cognition - actions were not in line with the emergency protocol. In the
pressure of the moment many options were being considered but they were not
necessarily the options that made the most sense in hindsight
• Teamwork – there was no clear leader. The consultants in the room were all providing
help and support but no one person was seen to be in charge throughout. This led to a
breakdown in the decision making process and communication between the three
consultantswww.patientsafetyfirst.nhs.uk 5
• Culture – Nurses who sensed the urgency early on brought the emergency kit to the
room, and then alerted the intensive care unit. They stated that these were available
but did not raise their concerns aloud when they were not utilised. Other nurses who
were aware of what was happening did not know how to broach the subject. The
hierarchy of the team made assertiveness difficult despite the severity of the situation.

Question 19

What is the NHS outcomes framework?

Answer 19

This is intended to provide a national level overview of how well the NHS is performing in order to monitor and improve quality and safety in the NHS.
It specifies national outcome goals and indicators in 5 domains:
preventing people from dying prematurely
enhancing QOL for people with LT conditions
helping people recover from episodes of ill health/injury
ensuring people have a +ve experience of care
treating and caring for people in a safe environment and protecting from avoidable harm

The NHS outcomes framework provides a national overview of how the NHS is performing, holds the Health Secretary and NHS comissioning board accountable for £95bn of public money and acts as a catalyst to change NHS culture and behaviour to drive up quality

Question 20

what is NICE?

Answer 20

National Institute for Health and Care Excellence- sets quality standards based on best available evidence, aims to define what high quality care should look like.
In April 2013 they were established in primary legislation, becoming a Non Departmental Public Body (NDPB) and placing them on a solid statutory footing as set out in the Health and Social Care Act 2012. They then took on responsibility for developing guidance and quality standards in social care, and name changed to reflect this.

Question 21

what is a NICE quality standard?

Answer 21

a set of statements that are:
markers of high quality, clinical and cost-effective patient care across a pathway or clinical area
derived from best available evidence e.g. NICE guidance or NHS evidence accredited sources
and produced collaboratively with NHS and social care, along with their partners and service users

Question 22

example of a NICE quality standard for stoke

Answer 22

11 statements, including:
brain imaging within 1 hr of arrival if indicated
screen for swallowing within 4 hrs
urinary incontinence reassessed after 2 weeks

Question 23

What are clinical comissioning groups?

Answer 23

groups that are authorised to comission healtcare services for their local populations
drive quality through contracts
Supported by Commissioning Support Units which work in partnership with healthcare commissioners, healthcare providers, local authorities and others, to enable excellence in the commissioning and delivery of healthcare services.
Successful comissioning- delivering right outcomes at the right cost

Question 24

How are CCGs held accountable for their progress in delivering outcomes?

Answer 24

The Clinical Commissioning Group Outcomes Indicator Set (CCG OIS) is an integral part of the NHS Commissioning Board’s systematic approach to quality improvement. Its primary aim is to support and enable clinical commissioning groups (CCGs) and health and wellbeing partners to plan for health improvement by providing information for measuring and benchmarking outcomes of services commissioned by CCGs to drive local improvement in quality and outcomes for patients

Question 25

human factors indicated in patient safety incidents?

Answer 25

``` Cognition and mental workload Distractions The physical environment Physical demands Teamwork ```

Question 26

What is the QOF?

Answer 26

Introduced in 2004 as part of the General Medical Services Contract, the Quality and Outcomes Framework is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients. Practices aim to deliver high quality care across a range of areas, for which they score points Sets national quality standards with indicators in primary care General Practices score points according to how well they perform against the indicators Practice payments calculated based on points achieved Results published online annually so can make comparisons Example of a financial incentive to reward quality in healthcare

Question 27

What are Best Practice Tariffs?

Answer 27

Best practice tariffs (BPTs) help the NHS to improve quality by reducing unexplained variation and universalising best practice. Standards must be met to get the max amount of money for that practice.

Question 28

What are quality accounts?

Answer 28

way of disclosing information about performance, focus on safety, effectiveness and experience of patients, published annually and are publically available. All trusts required to publish them, so increased info disclosure at organisational and individual level

Question 29

Describe the CQC

Answer 29

Since 2009, all NHS trusts must be registered with the CQC. which can impose conditions of registration if it is not satisfied, can make unannounced visits, can issue warning notices, fines, prosecution, restrictions on activities, closure, and check quality accounts. Independent regulator of all health and social care services in England

Question 30

What is a clinical audit?

Answer 30

process of quality improvement that seeks to improve patient care and outcomes through sytematic review of care against criteria and implementation of change

Question 31

Example of an audit cycle for hand hygiene

Answer 31

Topic: hand hygiene Research evidence: NICE quality standards Criteria and standards: washing hands on entering a ward First evaluation: 50% of drs did this Implement Change: put up a poster at the entry to a ward Second evaluation: 75% of drs did this

Question 32

Component parts of a clinical audit?

Answer 32

Setting standards Measuring current practice- collecting data Compare results with standards Change practice Re-audit to make sure practice has improved

Question 33

Problems of getting evidence into practice?

Answer 33

Drs don't know about it- dissemination ineffective, drs not incentivised to keep up to date- lot of reading, systematic review help with this Drs don't use the evidence- habit, organisational culture, professional judgement- decision made based on that individual pateint in a certain clinical situation Organisational systems cannot support innovation e.g. managers lack clout to invoke changes Commissioning decisions reflect different priorites e.g. if patients say they want something else Resources not available to implement change- financial or human

Question 34

why might an area exhibit inequality in healthcare, but not inequity in access to healthcare?

Answer 34

inequality- things are different, whereas inequity is when these differences are unfair and avoidable, or not accounted for by clinical need. So inequality in areas may respond to the needs of the population e.g. more healthcare services for the elderly pop in 1 particular region compared to another, this wouldn't be inequitable because everyone with the same need is still getting the same care.

Question 35

Describe how health is linked to socioeconomic status in Britain?

Answer 35

This represents the social and economic position of a person in relation to others in society, which can be classified as individual-based e.g. occupation, and geographical area-based. Life expectancy and disability-free life expectancy are both higher in those areas which are less deprived. Age standardised mortality rates, hence accomodating for confounding factor of age, are also higher in lower socioeconomic groups. Rate of still births, perinatal, neonatal and infant deaths are much higher for those people with lower income occupations

Question 36

describe associations in Britain between health and ethnicity

Answer 36

CVD: highest prevalence in men of S.Asian origin, Bangladeshi=worst Cancer: lower % prevalence in BME groups Infant mortality: higher rates in women of Pakistani and Black Caribbean origin Mental Health: people from BME (black and minority ethnicity) groups more likely to be diagnosed with mental illness), highest reported % poor mental health in women of pakistani and black caribbean origin, but smaller differences than diagnosis rates

Question 37

what is health behaviour?

Answer 37

activity undertaken for purpose of maintaining health and preventing illness

Question 38

what is illness behaviour?

Answer 38

activity of ill person to define illness and seek solution

Question 39

what is sick role behaviour?

Answer 39

formal response to symtpoms, inc seeking formal help and action of person as patient

Question 40

why might smoking be more prevalent among manual workers in comaprison to managerial and professional groupings?

Answer 40

higher social class- professional jobs, more likely to have +ve definition of health so incentives to give up smoking more evident for groups who could expect to remain healthy- focus on LT investments so quitting is rational choice for lower social class- manual workers, incentives to quit are less clear as focus on ST- improving immediate environ, smoking=coping, so may be a normalised behaviour, so smoking would be rational choice

Question 41

what can lay beliefs impact on?

Answer 41

health behaviour- difficulty accepting advice e.g. stopping smoking to prevet cervical cancer if contradicts their lay beleifs illness behaviour adherence/non-adherence to tment e.g. asthma: deniers- say they don't have asthma distancers- deny having proper asthma pragmatists- use preventive medication only when bad asthma, so accepted they had asthma, but saw it as a mild acute illness- so not managed as an ongoing chronic condition won't take medication if don't accept asthmatic identity- no drugs and no attendance to asthma clinics, or stigma associated with asthmatic identity

Question 42

what are lay beliefs?

Answer 42

how people understand and make sense of health and illness, constructed with no specialised knowledge from the person but drawn from many different cources e.g. media, family, friends, own experience with a dr, and so they are not simply the result of having less medical knowledge people reluctant to accept knowledge that contradicts their lay beliefs

Question 43

why do we want to measure health?

Answer 43

want indication of need for healthcare- want to know service requirement so as to not waste resources target resources where most needed assess effectiveness of hcare interventions evaluate quality of hcare services use evaluations of effectiveness to get better value for money monitor patients' progress

Question 44

commonly used measures of health?

Answer 44

mortality morbidity patient-based outcomes

Question 45

pros and cons of mortality as measure of health

Answer 45

easily define not always recorded accurately- reason died? not good way of assessing outcomes and care quality, especially as most procedures are not life or death situations

Question 46

pros and cons of morbidity as measure of health

Answer 46

routinely collected e.g. disease registers collection not always reliable/accurate tells us nothing about patient's experiences of condition when looking at clinical outcomes not always easy to use in evaluation

Question 47

what is a patient-based outcome to measure health?

Answer 47

want to assess patient's well-being from their point of view, e.g. HRQoL, health status patient-reported outcome measures (PROMs) are measures of health that come directly from patients and can be used to measure patient-based outcomes, and work by comparing scores before and after tment or over longer-periods

Question 48

why do we want to use patient-based outcomes?

Answer 48

increase in conditions where aim is managing rather than curing e.g. chronic diseases like RA biomedical tests- just 1 part of picture need to focus on patient's concerns- patient-centered care need to pay attention to iatrogenic effects of care e.g. SEs of part. medication, doing more harm than good

Question 49

what can patient-based outcomes be used to do?

Answer 49

``` clinically- montior progress of patient assess benefits in relation to cost clinical audit measure health status of populations compare interventions in clinical trial measure of service quality ```

Question 50

How has the NHS outcomes framework made use of PROMs?

Answer 50

identified them as a key source of info about outcomes of planned procedures indicator 3.1 has been renamed and extended to total health gain as assessed by patients, so helping people to recover from episodes of ill health or following injury assessment isn't just based on biomedial tests and a drs opinion

Question 51

why have PROMs been introduced?

Answer 51

improve clinical management of patients- informed, shared decision-making comparison of providers (hospitals)- monitor performance, people not doing well are exposed so they can be made to improve or will not be contracted with to improve quality, so productivity can be increased through demand management, quality improved through patient choice.

Question 52

what happens to data collected from PROMs?

Answer 52

published by health and social care info centre, and can be broken down by provider so can make trust comparisons of interest to comissioners who will contract with an organisation that will carry out procedure to highest quality and of interest to patients who can choose dr to do a part operation, so informs their decision-making

Question 53

challenges of using PROMs?

Answer 53

minimising time and cost of collection, analysis, and date presentation achieve high rates of patient participation provide appropriate output to different audiences e.g. CCGs or patient avoid misuse, must be appropr for situation expand to other areas e.g. LT conditions, emergency conditions, mental health

Question 54

HRQoL is an example of a patient-based outcome, what is its definition?

Answer 54

quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient

Question 55

what does HRQoL consider about the patient?

Answer 55

``` physical function- mobility, AODL symtoms global judgements of health- look at QoL that could be expected if didn't have that condition psychological well-being social well-being cognitive functioning personal constructs- stigma, life satisfaction, satisfaction with bodily appearance satisfaction with care ```

Question 56

advantages of using qualitative methods to measure HRQoL?

Answer 56

gives access to parts other methods don't reach very appropriate in some cases good for initial look at dimensions of HRQoL- can be used as guidance for developing quantitative tool to measure HRQoL

Question 57

disadvantages of using qualitative methods to measure HRQoL?

Answer 57

not easy to use in evaluation, esp RCTs, not part standardised very resource hungry- need expert training, time

Question 58

what do quantitative methods of measureing HRQoL rely upon?

Answer 58

use of questionnaires known as 'instruments' or 'scales' | should fulfil certain criteria

Question 59

properties of instrument necessary for use of PROMs as quantitative approach to measuring HRQoL (patient based outcome)

Answer 59

Reliabiliy: instrument accurate over time and internally consistent- if patient has no change in health, they should get same score each time on the measure Validity: does it measure what it is intended to measure- measure might be accessing only pain, and neglecting social aspects of illness

Question 60

characteristics of published instruments used to measure HRQoL?

Answer 60

validated, developed in a scientific way ,easy to use, reliability and validity already established can compare across different groups of patients using standardised measures BUT can be used indiscriminately and inappropriately

Question 61

what must be considered when selecting an instrument to measure HRQoL?

Answer 61

is there published work showing established reliability and validity have there been other published studies that have used this instrument successfully is it suitable for area of interest- is pop used appropriate does it adequately reflect patient's concerns in this area is instrument acceptable to patients is it sensitive to change- must consider size of change expected is it easy to administer and analyse

Question 62

examples of generic measures of HRQoL?

Answer 62

short-form 36-item questionnaire | euroQol EQ-5D

Question 63

how does the SF-36 work?

Answer 63

contains 36 items which can be grouped into 8 dimensions: physical functioning, social funcitoning, role functioning- physical and emotional, bodily pain, vitality, general health, mental health responses to questions scored and scores for items within each dimension added together, this score then transformed to give each respondent's score for each dimension (0-100), but NOT allowed to add up dimensions to give overall score- interpretation can be difficult in some cases

Question 64

positives of SF-36?

Answer 64

``` acceptable to people 5-10 mins for completion good internal consistency test retest high responsive to change pop date available so can compare to wider pop outcome ```

Question 65

advantages of generic instruments?

Answer 65

use in broad range of health problems can be used if no disease-specific instrument enable comparisons across tment groups can detect unexpected +ve/-ve effects of an intervention, specific too focused for this can assess health of populations

Question 66

disadvantages of generic instruments?

Answer 66

less detailed loss of relevance- too general? can be less sensitive to changes that occur as a result of an intervention, so change after intervention must be big may be less acceptable to patients- may not know what/why being asked if vague qns

Question 67

what types of specific instruments are there?

Answer 67

disease specific: asthma QOL questionnaire site specific: oxford hip score, shoulder disability questionnaire dimension specific: McGill pain questionnaire

Question 68

advantages of specific instruments?

Answer 68

acceptable to patients- tunes in well to their experience sensitive to change very relevant content

Question 69

disadvantages of specific instruments?

Answer 69

can't use with people that don't have disease comparison is limited may not detect unexpected effects

Question 70

QOL can be measured with generic and specific instruments, what do each do?

Answer 70

Generic: can be used with nay pop, generally cover perceptions of overall health, also qns on social, emotional, physical functioning, pain, self-care Specfic: evaluates a series of health dimensions specific to a disease, site of body or dimension

Question 71

what is stigma?

Answer 71

a -vly defined condition, attribute, trait or behaviour conferring "deviant status"

Question 72

what is discreditable stigma?

Answer 72

nothing seen, i.e. chronic illness not visible on exterior, but if found out.. acute awareness of patient that people would act differently towards them if they knew

Question 73

examples of diseases with discreditable stigma?

Answer 73

HIV | mental illness

Question 74

what is discredited stigma?

Answer 74

physically visible characteristic or well known stigma which sets them apart

Question 75

examples of discredited stigma?

Answer 75

physical disability | known suicide attempt

Question 76

why might epilepsy be considered as having both discreditable and discredited stigma?

Answer 76

condition may be unknown to others in daily life as no outward symptoms- discreditable, but then may undergo a seizure in a public place- epilepsy has become visible to people, patient then has discredited stigma as feel people are judging them because of what has just happened

Question 77

what is enacted stigma?

Answer 77

real experience of prejudice, discrimination and disadvantage as consequence of condition

Question 78

what is felt stigma?

Answer 78

fear of enacted stigma, pateint's concern about being treated differently, also encompasses a feeling of shame assoc with having condition selective concealment

Question 79

what is biological disruption?

Answer 79

key sociological concept which identifies chronic illness as a major disruptive experience as the pattern a patient though their life would follow is disrupted, so there is a new consciousness of the body and fragility of life, grief for a former life. Accepted more by older people

Question 80

categories of work in chronic illness?

Answer 80

``` illness everyday life emotional biographical identity ```

Question 81

what are illness narratives?

Answer 81

much sociological research based on people's narratives of their illness, which offer a way of making sense, perform certain functions and allow patient to create an understanding of their own condition

Question 82

what is a narrative reconstruction?

Answer 82

process where shattered self is reconstructed in ways that explain illness appearance, so patient is made aware of how they can explain the illness to themselves, and have a desire to create a sense of coherence, stability and order in aftermath of biographical disruption

Question 83

what is illness work?

Answer 83

symptom management, central to coping task is dealing with physical problems which has to occur prior to coping with social relationships, e.g. eating, bathing, interaction between body and identity, with bodily changes promoting changes in self conception

Question 84

what is everyday life work?

Answer 84

coping and strategic management: coping- cognitive processes involved in dealing with illness strategy- actions and processes involved in managing condition and impact Decisions about mobilisation of resources and how to balance demands on others and remain independent, when does help need to be accepted by patient? Must manage daily living: want to keep pre-illness lifestyle and indentity intact, so may pretend nothing is wrong, or may redesignate new life as normal life- so person may signal changes in identity rather than preserve old ones, creating a new identity

Question 85

what is emotional work?

Answer 85

work done by patients to protect emotional well-being of others, so maintaining normal activities becomes deliberately conscious, may disrupt friendships and may strategically withdraw or restrict social terrain, may down play pain, and present as 'cheery self', making it difficult for self and family- know patient in pain and that they are trying to hide it- can't really help if patient won't admit their struggle impact on role e.g. being head of family- breadwinner dependency- feeling of uselessness to self and others, being a burden

Question 86

what is biographical work?

Answer 86

loss of self, former self-image lost with difficulty constructing a new image, so constant struggle to lead valued lives and maintain +ve definitions of self, interaction between body and identity

Question 87

what is identity work?

Answer 87

working to maintain an acceptable identity, illness can affect how people see themselves and how others see them, consequence of actual and imagined reaction of others, illness can become defining part of identity

Question 88

what 4 dilemmas does loss of self give rise to?

Answer 88

scrutinise reactions of others for signs of discreditation foster dependence on others relationships harder to maintain as illness progresses, but increasing needs require more intimate contact inability to 'do' leads to loss of social life

Question 89

what is the medical model of conceptualising disability?

Answer 89

disability as deviation from medical norms, diasadvantages direct consequence of impairment and disabilities, needs medical intervention to cure or help, person responsible for needing to change, rather than society

Question 90

what is the social model of conceptualising disability?

Answer 90

problems product of environment and failure of environment to adjust, disability form of social oppression, political action and social change needed, so society is wrong e.g. wheelchair users- stairs not adjusted for them

Question 91

critiques of medical model for disability?

Answer 91

lack of recognition of social and psychological factors, stereotyping and stigmatizing language

Question 92

critiques of social model for disability?

Answer 92

body left out overly drawn view of society failure to recognise body realities and extent to which these are solvable socially

Question 93

what is evidence-based hcare?

Answer 93

hcare delivered on best available evidence, which is derived from findings of rigorously conducted research. We must do what we believe is likely to work, and our beliefs will be based on the evidence.

Question 94

what is there evidence of in evidence-based hcare?

Answer 94

effectivenss- of drugs, practices or itnerventions, offering best tment for patient cost-effectiveness- as finite resources, so money must be spent where can gain maximum utility.

Question 95

what were practices previously influenced too much by before evidence-based practice introduced?

Answer 95

organsiational and social culture historical practice and precendent clinical fashion professional opinion

Question 96

practical criticisms of evidence-based practice

Answer 96

may be an impossible task to create and maintain sytsematic reviews across all specialities- need to keep up to date and include everything may be challenging and expensive to disseminate and implement findings RCTs seen as gold standard but not always feasible or even necessary/desirable e.g. due to ethical considerations choice of outcomes often very biomedical- definition by pharmaceutical compaines who want to show their tment in best light, so this may limit interventions trialled, and so which are funded required good faith on the part of the pharmaceutical companies

Question 97

philosophical criticisms of evidence-based practice

Answer 97

does not align with (most) doctors' modes of reasoning aggregate, pop-level outcomes don't mean that an intervention will work for an individual, not patient-centered may create unreflective rule followers out of professionals, who just do what they're told irrespective of judgement of patient in front of them might be understood as a means of legitimising rationing, with potential to undermine trust in dr-patient relationship, hcare expenditure cut which may not act in patient's best interest professional responsibilty/autonomy

Question 98

why are systematic reviews useful to clinicians?

Answer 98

offer quality control and increased certainty as appraise and integrate findings up to date, authoritative and generalisable conclusions save clinicians from having to locate and appraise studies for themselves may reduce delay between research discoveries and implementation of tment in clinical practice help prevent biased decisions can be relatively easily converted into guidelines and recommendations

Question 99

strengths of quantitative methods for social science research?

Answer 99

``` research produced is reliable and repeatable good at describing measuring finding relationships between things allowing comparisons ```

Question 100

weaknesses of quantitative methods for social science research?

Answer 100

may not access all important info may force people into inappropriate categories don't allow people to express things in the way they want may not be effective in establishing causality

Question 101

what is quantitative research?

Answer 101

Quantitative research is a collection of numerical data, which begins as a hypothesis and conclusions can be drawn by deduction, about relationships between variables, sometimes causal.

Question 102

when might questionnaires be used in quantitative research?

Answer 102

measure of exposure to RFs, effect of lifestyle and dietary factors on cancer knowledge and attitudes e.g. sexual health satisfaction with health services

Question 103

what must a questionnaire design be?

Answer 103

VALID:measure what it is supposed to RELIABLE: measure things consisitently, so differences in results come from differences between people, not from inconsistencies in how items understood or responses interpreted

Question 104

Quantitative research designs?

Answer 104

experimental study designs-RCTs case-control cohort cross-sectional surveys secondary analysis: official statistics- census other national surveys e.g. by universities local and regional surveys- e.g. by local councils

Question 105

what are qualitative methods for social science research good for?

Answer 105

understand perspective of those in a situation access info not revealed by quantitative approach, and people may be more willing to answer qns by talking than filling in a questionnaire explaining relationships between variables e.g. why and how ethnicity promotes or discourages smoking cessation

Question 106

what are weaknesses of qualitative methods for social science research?

Answer 106

finding consistent relationships between variables generalisability- cannot infer propensity of those views from a small sample that may not be statistically representative time/cost

Question 107

what does qualitative research achieve?

Answer 107

understand perspective emphasises meaning, experience and views of responders analysis emphasises researcher's interpretations, not measurement can provide insight into people's behaviour look at hows and whys of an association

Question 108

4 research methods used in qualitative research?

Answer 108

observation and ethonography interviews focus groups documents

Question 109

advantages of ethongraphy and observation?

Answer 109

can gain access to a person's behaviour, which they may provide a biased account of or be unaware of, and which may not be commented on by interviewees as they don't think it's worth it, and the context within which they occur- study human behaviour in natural context e.g. observing hospital

Question 110

problems of observation?

Answer 110

labour intensive, can take a long period of time for research to occur so commonly combined with formal interviews and other data sources in ethnographic studies

Question 111

good points about focus groups?

Answer 111

can be quick method for establishing parameters, or for accessing group-based, collective understanding of an issue may encourage people to participate

Question 112

bad point about focus groups?

Answer 112

quieter people may not get involved some topics may be too sensitive to discuss not so useful for individual experience need for good facilitator to manage group dynamics, can be difficult to arrange

Question 113

what factors determine the approach and study design used in social science research methods?

Answer 113

topic under investigation and research qn research team's preference/expertise time and money funders and/or audience

Question 114

what is meant by a system's based approach of managing quality and safety in hcare?

Answer 114

Systems-based approaches to quality and safety suggest that when things go wrong in complex systems such as healthcare, it is due to multiple errors occurring (the swiss cheese model) rather than the fault of individuals. The errors committed by individuals are the “active errors” but these are usually at the end of a long chain of other types of errors. Latent errors are built into systems, and include such things as understaffing, error-tolerant cultures, team conflict, poor management, etc, and these are the issues that really demand to be tackled in a systems-based approach. Systems-based approaches require learning from other high risk, low error industries, and having organisational cultures that discourage latent errors, having reporting systems that promote “no-blame” learning.

Question 115

what is the social selection explanation for health inequality?

Answer 115

This explanation argues that the direction of causation is from health to social position, rather than vice versa. Sick individuals move down the social hierarchy, while healthy individuals move up. Therefore chronically ill and disabled people are more likely to be disadvantaged.

Question 116

what is the behavioural-cultural explanation for health inequality?

Answer 116

This explanation argues that ill health is due to people’s choices/decisions, knowledge and goals. It would suggest that people from disadvantaged backgrounds tend to engage in more health-damaging behaviours, while people from advantaged backgrounds tend to engage in more health-promoting behaviours

Question 117

Why might a woman with heavy menstrual bleeding not seek hcare advice based on her lay beliefs?

Answer 117

Some women may feel that their heavy menstrual bleeding is not interfering with their ability to carry out their normal roles or activities (functional definition of health). They may not feel it constitutes a medical problem and/or may not think there is anything a doctor could do to help. It may be normalized as ‘just part of being a woman’.

Question 118

Why can delay and decay make evaluating health promotion interventions difficult?

Answer 118

Decay and delay can cause problems in evaluating the effectiveness of health promotion interventions. ‘Delay’ refers to when an intervention might take a long time to have an effect, while ‘decay’ refers to when an intervention might have an initial effect but this wears off rapidly. The timing of an evaluation can therefore influence the outcome.

Question 119

What is the International Classification of Impairments, Disabilities or Handicaps (ICIDH)?

Answer 119

Attempts to classify consequences of disease. 3 concepts: impairment- abnormality in structure or functioning of body disability- performance of activities handicap- broader social and psychological consequences of living with impairment and disability 1 state may or may not lead to another- not an inevitable progression also no necessary relationship between severity of impairment and severity of resulting disability or handicap e.g. RA: very stiff joints, but good control, so can walk well.

Question 120

problems with international classification of impairments, disabilities or handicaps?

Answer 120

many features of medical mode, not social of disability? problematic use of word handicap- derogotory term implies problems are intrinsic or inevitable

Question 121

what is the international classification of functions, disability and health (ICF) ?

Answer 121

ICF is the WHO’s framework for measuring health and disability at both individual and population levels. It is endorsed for use as the international standard to describe and measure health and disability and attempts to integrate medical and social models., and recognise significance of wider environment.

Question 122

key components of international classification of functions, disability and health?

Answer 122

body structures and functions, and impairments of/to activities undertaken by individual, and difficulties in doing them participation in life situations, which may become restricted All, and relationships between, affected by personal and environmental contextual factors

Question 123

why is optimum self-management in chronic disease difficult to achieve?

Answer 123

poor adhenerence rates to tment reduced QOL poor psychological well-being

Question 124

what is the expert patient's programme?

Answer 124

provide courses to help patients living with LT conditions. Aims to reduce hosp admissions and is patient centered. Patients can share good coping techniques with others. BUT responsibility for care placed on very ill patients, real agency and understanding, little evidence of efficiency savings