PDS

Question 1

Audit cycle

Answer 1

Topic identification – importance
Standard setting – using guidelines
Data collection – what date is to be collected and whether it will be retrospective or prospective
Data analysis
Change implementation

Question 2

Affordability

Answer 2

Some households may have less access to funds through the previous allocation of funds to some unnecessary expenditures such as smoking and alcohol
This may lead to a reduced capacity to be have disposable income to pay for some aspects that could lead to a healthy lifestyle:
Some forms of exercise
Healthy diet

Question 3

Optimal allocation

Answer 3

Involves deciding what to fund and what not to fund

Question 4

Equity

Answer 4

Fairness of how resources are allocated

Question 5

Efficency

Answer 5

Maximising benefits in the face of budgets

Question 6

Effectiveness

Answer 6

Measured by clinical improvements such as increasing survival or improving QoL

Question 7

Cost effectiveness analysis

Answer 7

Most common approach used in clinical practise. Increments per surviver compared against previous treatment

Question 8

Negatives with cost effectiveness analysis

Answer 8

Public health programmes are likely to have multiple components and therefore multiple potentially beneficial (or harmful) outcomes
CEA only focuses on a single outcome dimension
It ignores all other effects and if some of these are important then it is possible that the conclusions drawn will be wrong
Can not compare interventions if the single simple outcome is not common across interventions

Question 9

Cost utility analysis

Answer 9

Measures, then values the impact of an intervention in terms of improvements in BOTH quantity AND quality of life

Often reported as quality adjusted life years (QALYs)
Allows comparisons to be made across all areas of a health intervention. Reported as cost per QALY gained

Question 10

QALY

Answer 10

QALYs take into account not only length of life, but also the quality of the life years. Calculated by the increased life span and the QoL improvement a treatment offers

Question 11

Cost benefit analysis

Answer 11

Values all costs and benefits in monetary units. If benefits exceed costs, the evaluation would recommend investing in the programme and vice versa

Favoured approach by economists working in other areas such as environment, development, and transport for economic evaluation

Question 12

Negatives of cost benefit analysis

Answer 12

Often just report costs so may ignore benefits or problems with treatment. Difficult to implement into the NHS due to not valuing health via monetary perspective

Question 13

Incidence

Answer 13

Number of new cases in a given population in a given time period, usually per year or per quarter

Question 14

Prevelance

Answer 14

Number of people in the population in a given time period who are living with the condition

Question 15

Susceptible population

Answer 15

Those with no immunity (either through vaccination or acquired). Some populations may be more susceptible than others:

Pregnant women
The very young or very old
Immunocompromised
IVDU

Question 16

Transmission of infectious diseases

Answer 16

Person to person by inhalation of infected airborne droplets or particles (eg influenza, TB)
Contact with bodily fluids (eg ebola)
Directly from person to person by sexual contact (eg syphilis, HIV)
By ingestion of contaminated food or water (eg salmonella, hepatitis A)
Indirectly through surface or other contamination (eg hepatitis C from contaminated needles, HIV from blood products)
Through an intermediate animal host or vector (eg malaria)

Question 17

Risk of communicable disease linked to

Answer 17

Severity of the disease, susceptibility of the population and transmission of the disease

Question 18

Primary prevention of a disease

Answer 18

Stopping cases occurring i.e. vaccination, food hygiene, sanitation and education

Question 19

Secondary prevention

Answer 19

Controlling the infectious outbreak once it has begun. Ie contact tracing, closing of restaurant, needle exchanges, treatment of case in isolation esp if infectious

Question 20

Notifable disease

Answer 20

Encephalitis, meningitis (meningococcal) and hepatitis 
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning - Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Mumps, measles, rubella
Rabies
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Tetanus, TB, smallpox
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever

Question 21

Surveillance in public health

Answer 21

Microbiology laboratory reports
Infectious disease notifications from doctors
Immunisation information
Ad hoc reports from schools, hospital, EHOs

Question 22

Control of spread:

Answer 22

Reporting of cases or outbreaks - initiates action
Treatment of cases
Isolation / exclusion from work
Contact tracing – advice, prophylaxis, vaccination
Infection control during healthcare

Question 23

High risk GI infections

Answer 23

Group 1 – Foodhandlers
Group 2 - Healthcare, nursery or other care staff with vulnerable clients
Group 3 - Children < 5 years of age
Group 4 - Others unable to perform good standards of hygiene because of ability or available facilities, e.g. those with learning difficulties, people camping
Group 5 - People living in institutionalised care i.e. care homes etc

Question 24

E Coli O157

Answer 24

1000 cases per year.
50% are in <16yr olds, highest rates in <5yr olds
Faecal-oral transmission (can be via a contaminated surface).Highly transmissible, low infective dose
15% of cases develop HUS

HUS can be fatal due to the shiga toxin produced by e.coli. Leads to thrombocytopenia, haemolytic anaemia and renal failure

Question 25

E.coli 0157 control

Answer 25

Identify the possible source of infection – and so prevent other primary cases
Prevent onward transmission from the case to others – secondary cases
Early identification and notification by clinicians is essential
Public health action requires a multi-agency team (health protection, clinicians and labs, environmental health

Question 26

Violations

Answer 26

A violation is defined as a deviation from safe operating procedures, standards or rules.

Routine violation - cutting corners, a common occurrence and often tolerated

Optimising violation is where actions are taken for personal reasons rather than patient benefit eg motivated by greed/risk taking personality

Necessary violation is where someone knowingly misses out steps in a task in the need to get the job done - eg rushed medicine dispensing

Question 27

Meningitis prophylaxis

Answer 27

Rifampicin BD for 2 days, stat dose of ciprofloxacin

If pregnant IM ceftrixone

Question 28

Hard to reach groups examples

Answer 28

minority ethnic groups and refugees, MH, travellers, homeless people
people with learning disabilities
LGBT, sex workers, HIV patients
the elderly, teenagers
people with physical disabilities (including hearing and visual loss)
victims of domestic abuse

Question 29

Hard to reach groups definitions

Answer 29

Those who are underserved, ‘service-resistant’, or ‘slipping through the net’. Or those who traditionally wouldn’t seek help.

Question 30

PETeR

Answer 30

Policy, education, technology and resources

Question 31

Voluntary vs involuntary prevention measures

Answer 31

Voluntary work best for high socioeconomic class

Compulsory work better for lower socioeconomic class

Question 32

Health protection

Answer 32

Surveillance, control, communication and prevention

Question 33

Contextual

Answer 33

Contextual factors are those that are based on the place itself, and the fact that this will change the health of the population.
Economic environment - house prices, house quality, job access
Social environment - services available (GP, pharmacy, childcare), place stigma
Physical environment - pollution, contaminated land

Question 34

Compositional

Answer 34

Compositional factors are those that are based on the population that live there - their behaviour, attitudes, and how they live.

Risk taking behaviours including smoking, drinking, misuse of drugs
Incomes and wages due to educational attainment
Demographics of a population

Question 35

Diagnostic momentum

Answer 35

This is when a diagnostic label sticks, despite accumulating contrary evidence

Question 36

Anchoring

Answer 36

Too heavy reliance on the first piece of information - incorrect as the first piece of information was the history, and there is no evidence that this alone is what the GP based his diagnosis on

Question 37

Search satisficing

Answer 37

Stopping the search when we find something convenient - there’s no clear evidence that the search was actually stopped, as more information came in following the hypothesis of lung cancer

Question 38

Premature closure of hypothesis - jumping to a conclusion before all the info has been gathered

Answer 38

Jumping to a conclusion before all the info has been gathered

Question 39

Availability bias

Answer 39

Only seeing something because it comes easily to mind - this wasn’t really described in this scenario

Question 40

Run charts

Answer 40

Analyse 16 - 25 data points in time sequence and compare the results to the median line in order to identify special cause variation. Key features include Number of runs, shifts (run length) and trends (run direction).

Question 41

Medical error

Answer 41

The failure to complete a planned action as intended or the use of a wrong plan to achieve an aim

Question 42

Adverse effect

Answer 42

An injury caused by medical management rather than by the underlying disease or condition of the patient