HBS 21-26

Question 1

CAM

Answer 1

Complimentary and alternative medicine

Question 2

Complementary medicine vs Alternative

Answer 2

Complimentary: Used with conventional
Alternative: Used instead of conventional

Question 3

4 most popular CAMS

Answer 3

chiropractic manipulation, herbal medicine, massage, homeopathy.

Question 4

Perceptions of CAM

Answer 4

Traditional, Holistic, Natural, Life as energy, Patient led

Question 5

Placebo

Answer 5

Any biologically inert therapy that derives benefit.

Question 6

Placebo effect

Answer 6

Tendency to mimic a drug in effect and adherence with changes to physiological and behavioral state, as well as habituation, dependency and withdrawal.

Question 7

Non-interactive placebo theory

Answer 7

Placebo effects stem from characteristics of the medication (color, size, brand price, strength), health professional (higher the professionalism, higher the placebo), or patient.

Question 8

Interactive placebo theory

Answer 8

Placebo effects stem from experimenter bias (if a doctor does not know the placebo is given, the effect is greater), reporting errors (do they actually think they are better or do they just report it?), learning theory (does a white coat elicit a response), or anxiety reduction theory (does feeling less anxiety because of care given make them feel better?).

Question 9

Physiological placebo theory

Answer 9

Placebo can create withdrawal and dependency. So maybe placebos activate the body’s release of opiates.

Question 10

Patient expectation placebo theory

Answer 10

Patient expects to improve. This impacts their behavior, reporting bias, symptom representation and increase susceptibility to learning theory.

Question 11

Nocebo

Answer 11

Negative expectations can result in negative outcomes and this effect. Patient is more likely to report negative side effects if told about them.

Question 12

Adherence

Answer 12

The extent to which a persons behavior (taking medication and lifestyle) is in accordance to the recommendations of a health care professional.

Question 13

Subjective measurements of adherence

Answer 13

Patient’s self-report, patient’s diary, clinician’s estimate.

Question 14

Objective measurements of adherence

Answer 14

Direct monitoring, tablet counting, physiological markers, prescription redemption records, fluid level tests.

Question 15

Condition related factors to non-adherence

Answer 15

Chronic vs acute, severity of symptoms, rate of progression, availability of treatments.

Question 16

Therapy related factors to non-adherence

Answer 16

Price, efficacy, complexity, duration, difficulty, side-effects of treatment.

Question 17

Health system factors to non-adherence

Answer 17

Extent of education, poor medication access, patient-provider relationship.

Question 18

Social/economic factors to non-adherence

Answer 18

Price, illiteracy, stigma, accessibility

Question 19

Patient related factors to non-adherence

Answer 19

Unintentional and deliberate:

Illness perception: is it curable, are the symptoms manageable, is it hereditary?

Question 20

Conformity

Answer 20

Yielding to real or imaginary social pressure.

Question 21

Conformity experiments:

Answer 21

Asch experiments

Question 22

Asch experiments

Answer 22

Confederates given the wrong verbal answer to basic questions had a tendency to compel the participant to also give the wrong answer.

Question 23

Conformity in healthcare:

Answer 23

Not speaking up when there is an error. Fear of whistleblowing. Mistakes and bad practice go unchanged.

Question 24

Obedience

Answer 24

Form of compliance that occurs when people follow direct commands. Obedience increases with transfer of liability, when command comes from authority figure with high prestige.

Question 25

Obedience experiment:

Answer 25

Milgram experiment using shock voltage.

Question 26

Bystander effect

Answer 26

People are less likely to provide help when within a group because responsibility is diffused.

Question 27

Obedience in healthcare:

Answer 27

Orders may be followed that are inappropriate, incomplete, or inappropriate. Rules, which exist to ensure safety, may be broken.

Question 28

Dimensions of quality healthcare:

Answer 28

SET PEE: ``` Safety Efficacy Timelines Patient-centeredness Efficiency Equity ```

Question 29

Patient Safety

Answer 29

The freedom from accidental injury or harm due to medical care or accidental error.

Question 30

Common medical errors

Answer 30

``` Adverse drug events Surgical injuries Wrong-site surgery Restraint-related injury Falls Burns Pressure ulcers Mistaken patient identities ```

Question 31

Adverse healthcare event

Answer 31

An event or omission that arises during healthcare, leading to physical or psychological harm of the patient. This can include medical errors, misdiagnosis, poor monitoring.

Question 32

Rasmussen's 3 levels of performance

Answer 32

1. Knowledge based: Novel situations requiring stored knowledge. 2. Rule based: Familiar problems solved by stored rules. 3. Skill based: Stored patterns.