key concepts Flashcards
1
Q
Gini coefficient
A
statistical representation of nations income distribution (lower = greater equality)
2
Q
what are some domains of public health
A
health protection
improving services
health improvement
addressing the wider determinants of health
3
Q
when can confidentiality be disclosed
A
required by law (notifiable disease)
public is at risk
individual is venerable to exploitation
patient consent
4
Q
criteria for disclosure of confidential info
A
anonymous
kept to necessary minimum
meets current law
patient’s consent
5
Q
5 lifestyle factors promoting mortality
A
smoking obesity sedimentary lifestyle excess alcohol poor diet
6
Q
structural determinants of illness
A
social class material deprivation/poverty unemployment discrimination/racism gender and health
7
Q
what is the biomedical model
A
mind and body are treated separately
8
Q
what are the 3 main notifiable diseases which must be reported to WHO
A
Cholera
yellow fever
plague
9
Q
what is health behaviour
A
aimed to prevent disease
10
Q
what is illness behaviour
A
aimed to seek remedy
11
Q
what is sick role behaviour
A
aimed at getting well
12
Q
what is the health belief model
A
individuals must believe they are susceptible to the condition, believe in the consequences and that taking the action reduces their risk so the benefit outweighs the costs
13
Q
what is the transtheoretical model
A
pre-contemplation, contemplation, preparation, action, maintenance, relapse
14
Q
what is morality
A
concern with the distinction between good and evil or right and wrong
15
Q
what is ethics
A
a system of moral principles and a branch of philosophy which defines what is good for individuals and society
16
Q
Utilitarian/consequentialism (teleological)
A
- An act is evaluated solely in term of its consequences
- Maximising good and minimizing harm
- Types: hedonistic, rule, act, preference
17
Q
Kantianism (deontological)
A
• Features of the act themselves determine worthiness (goodness) of that act
• Following natural laws and rights
• Categorical imperatives - a set of universal moral premises from which the duties are
derived (do not lie; do not kill; …)
18
Q
virtue ethics (deontological)
A
• Focus is on the kind of person who is acting, deemphasizes rules
• Is the person in action expressing good character or not?
• We become virtuous only by practicing virtuous actions
• Integration of reason and emotion
• The Five Focal Virtues:
i Compassion
ii Discernment
iii Trustworthiness
iv Integrity
v Conscientiousness
19
Q
what are the 4 principles
A
autonomy, benevolence, non-maleficence, justice
20
Q
autonomy
A
(self-rule, the obligation to respect the decisions of our patients)
Ø The decision is intentional
Ø The decision is done with understanding
Ø There are no major controlling influences over the decision
21
Q
benevolence
A
providing benefits, balancing the benefits against risks
22
Q
non-maleficence
A
do no harm, reduce or prevent harm
23
Q
justice
A
needs vs benefit, fairness in the distribution of benefits and risks
24
Q
GMC duties of a doctor
A
- Protect and promote the health of patients and the public
- Provide good standard of practice and care
- Recognise and work within the limits of your competence
- Work with colleagues in the ways that best serve patients’ interests
- Treat patients as individuals and respect their dignity
25
measuring daily functioning of older people
toilet use, eating/meal prep, bathing, management of meds/money, dressing/grooming
26
MMSE: mini mental state examination
i orientation, immediate memory
ii short-term memory
iii language functioning
27
acute illness
a disease of short duration that starts quickly and has severe symptoms (often can be cured)
28
chronic illness
a persistent or recurring condition, which may or may not be severe,
often starting gradually with slow changes (can't be cured but can be treated)
29
polypharmacy
the use of multiple medications or administration of more medications
than are clinically indicated
30
what are the key challenges of aging population
• Strains on pension and social security systems
• Increasing demand for health care
• Bigger need for trained health workforce
• Increasing demand for long-term care
• Pervasive ageism (denying older people the rights and opportunities available for other
adults)
31
causes of aging population
* Improvements in sanitation, housing, nutrition & medical interventions
* Life expectancy is rising around the globe
* Substantial falls in fertility (higher age of first pregnancy?)
* Decline in premature mortality
* More people reaching older age while fewer children are born
32
intrinsic vs extrinsic ageing
INTRINSIC AGEING: natural, universal, inevitable
EXTRINSIC AGEING: dependent on external factors (UV ray exposure, smoking, air pollution,
etc.)
33
why do women live longer then men?
§ 20% biological – premenopausal women are protected from heart disease by
hormones
§ 80% environmental – men take more lifestyle risks than women
34
consequences of higher life expectancy
* Pensions will have higher pay outs than those currently planned
* Chronic and comorbid conditions will prevail
* Rising inequalities as more affluent groups will use health services for longer
35
chain of infection
• Susceptible host - low immunity, low white cell count, imbalance in normal flora, invasive
procedures
• Causative micro-organism - increase number in hospital, resistant strains
• Reservoir - patients, visitors, stuff, fomites -> where the spread originates
• Portal of entry/exit - respiratory tract, GI tract, GeUri tract, broken skin
36
modes of transmission
i exogenous spread (direct/indirect contact, vector spread, airborne)
ii endogenous spread (self spread)
37
types of handwashing
i Level 1: Routine handwash
ii Level 2: Hygienic hand antisepsis
iii Level 3: Surgical handscrub
38
impact of smoking
* the greatest single cause of illness and premature death in the UK
* 100,000 deaths/year due to smoking
* cancers, COPD, CHD
* a great economic impact of smoking
39
the millennium development goals
1. Eradicate Extreme Poverty & Hunger
2. Achieve Universal Primary Education
3. Promote Gender Equality & Empower Women
4. Reduce Child Mortality
5. Improve Maternal Health
6. Combat HIV/AIDS, Malaria and Other Diseases
7. Ensure Environmental Sustainability
8. Develop a Global Partnership for Development
40
3 leading causes of death in children in developing countries
1. Pneumonia
2. Diarrhoea
3. Malaria
41
sustainability
Being able to meet the needs of today without compromising the ability of future
generations to meet the needs of tomorrow.
42
screening
A process which sorts out apparently well people who probably have a disease
from those who probably do not
43
primary prevention
to prevent a disease from occurring
44
secondary prevention
detection of early disease in order to alter the course of the disease and maximise the chances of a complete recovery
45
tertiary prevention
trying to slow down the progression of the disease
46
sensitivity
the proportion of people with the disease who are correctly identified by the
screening test
(true positives/ TP+FalseNeg)
47
specificity
the proportion of people without the disease who are correctly excluded by the
screening test
(true neg/true neg + false pos)
48
Positive predicted value
the proportion of people with a positive test result who actually have the disease
true pos/true +false pos)
49
negative predictive value
the proportion of people with a negative test result who do not have the disease
true neg/false+true neg)
50
prevalence
the proportion of a population found to have the disease
51
incidence
the number of new cases within a specified time period divided by the size of the population
initially at risk
52
wilson & jugner criteria for screening
THE CONDITION
it should be an serious health problem
the aetiology should be well understood
there should be a detectable early stage
• THE TREATMENT...
there should be an accepted treatment for the disease
facilities for diagnosis and treatment should be available
there can't be an unmanageable extra clinical workload
• THE TEST
a suitable test should be devised for the early stage
the test should be acceptable for the patients
intervals for repeating the test should be determined
• BENEFITS
there should be an agreed policy on whom to treat
the cost should be balanced against the benefits
53
selection bias
people who choose to participate in screening programmes may be
different from those who do not
54
lead time bias
screening merely identifies the disease earlier than before and thus gives
the impression that survival is prolonged
55
length-time bias
diseases with longer period of presentation are more likely to be
detected by screening than the ones with shorter time of presentation.
56
what is an error
any preventable event that may cause or lead to patient harm
57
medical error
• leads to one of two outcomes:
adverse event: an incident which results in harm to a patient
near miss: an event which has the potential to cause harm but fails to develop
further, thereby avoiding harm
58
types of human error
• ERRORS OF OMISSION (required action delayed/not taken)
• ERRORS OF COMMISSION (wrong action is taken)
• ERRORS OF NEGLIGENCE (the actions or omissions do not meet the standard of an ordinary,
skilled person professing)
59
skill based errors
when performing a routine task that is well learnt (automatic)
ii little attention given, thus if distracted - slips of action / memory lapses
60
rule/knowledge based errors
an incorrect plan or course of action is chosen (no experience)
mistakes more likely when the tasks are more complex
61
violations
• deliberate deviations from practices, procedures and standards or rules
• types:
routine (cutting the corners)
necessary (to get the job done - sometimes unavoidable)
optimising (personal gain, selfish)
62
information processing limitations
* automaticity
* cognitive interference
* selective attention
* cognitive bias
* transferring our expectations from familiar situations to similar new ones
63
approaches to managing errors
• The person approach - individual - errors are the products of wayward mental processes of
individual people in the system
• The system approach - organisational - adverse events are product of many causal factors
(Swiss-cheese theory) - the whole system is to blame
64
benefits of teamworking
* improving the service delivery
* improving the decision-making
* reducing the error
65
teamworking obstacles
* organisational (different offices/shifts/rotation posts)
* location (ward based/ visiting/ based elsewhere)
* management (different employers/sub-teams)
* other commitments of the team members
66
SBAR checklist (when reporting a case)
S - situation
B - background
A - assessment
R - recommendation
67
mental health WHO definition
Mental health is a state of well-being in which the individual realises his or her own
abilities, can cope with the normal stresses of life, can work productively and fruitfully and
is bale to make a contribution to his or her community.
68
what are the 2 types of stress
* DISTRESS - a negative stress which is damaging and harmful
| * EUSTRESS - a positive stress which is beneficial and motivating
69
types of stressors
* acute - noise, danger, infections, injuries, hunger, ...
| * chronic - health, home, finances, work, family, friends,
70
fight or flight model
• an automatic response to external acute stressors
• elicits a physiological presponse
i hypothalamus: symphathetic system + andrenocorticosteroid system
ii both adrenal medulla (Ad, NA) and adrenal cortex (cortisol) activated
iii activation of various organs and inhibition of the others: ForF response
71
general adaption syndrome
* ALARM - when threat /stressor identified
* ADAPTATION/RESISTANCE - defensive countermeasures engaged
* EXHAUSTION - the body begins to run out of defences
72
5 signs of stress
* BIOCHEMICAL - endorphin and cortisol levels altered
* PSYSIOLOGICAL - shallow breathing, raised BP, more HCL produced
* BEHAVIOURAL - over-eating, anorexia, insomnia, more alcohol or smoking
* COGNITIVE - negative thoughts, no concentration, worse memory, tension
headaches
• EMOTIONAL - mood swings, irritability, aggression, boredom, apathy,
tearfulness
73
energy compensation
* The adjustment of energy intake following the ingestion of a particular food
* Energy compensation is lower with liquids than solids
74
satiation
what brings an eating episode to an end
75
satiety
inter-meal period
76
4 main STI's
1. Chlamydia
2. Gonorrhoea
3. Syphilis
4. Trichomoniasis
77
complementary and alternative medicine
• A broad domain of healing resources that encompasses all health systems, modalities and
practices and their accompanying theories and beliefs
• It is those healing resources other than those intrinsic to the politically dominant health
system of a particular society or culture in a given historical period
78
types of economic evaluation
• Cost-effectiveness analysis (outcomes measured in natural units: incremental cost per life
year gained)
• Cost-utility analysis (outcomes measured in quality adjusted life years: incremental cost
per QALY gained)
• Cost-benefit analysis (outcomes are measured in monetary units: net monetary benefit)
79
equity
fair distribution of goods and services based on individual need
80
modifiable risk factor
things that we can change e.g. smoking
81
non-modifiable risk factor
things we cant change e.g. sex, age, genetics
82
nutrition security
exists when all people at all times consume food of sufficient quantity and quality in terms of variety, diversity, nutrient content and safety to meet their dietary needs and food preferences for an active and healthy life, coupled with a sanitary environment, adequate health, education and care
83
evidence based medicine
is the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research alongside patient values, preferences, beliefs
84
impairment
any loss or abnormality of psychological, physiological or anatomical structure or function.
85
disability
any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being
86
handicap
a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal
87
asylum seeker
Person who has departed their country of origin and officially applied for asylum in another country but is awaiting a decision on their request for refugee status
88
refugee
a person who ‘owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country
89
duty of candour
Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress. This means that healthcare professionals must:
• tell the patient when something has gone wrong.
• apologise to the patient
• offer an appropriate remedy or support to put matters right
• explain fully to the patient the short and long term effects of what has happened
90
probity
being honest and trustworthy, and acting with integrity
