PPD/ Public Health Flashcards
(155 cards)
1
Q
what does SBAR stand for?
A
Situation
Background
Assessment
Recommendation
2
Q
what did the solomon asch psychological experiment involve?
A
participants were asked to identify longest line etc.
Outlined how group social pressure can lead person to conform
3
Q
what is transformation leadership?
A
work towards common goals, identify needs of subordinates
4
Q
what is transactional leadership?
A
makes workers do things based on rewards and punishments
5
Q
what are never events? and where are they published?
A
adverse events that cause harm/death to patients
National Quality data
6
Q
give some examples of never events
A
retained instrument in surgery
wrong dose of medication
7
Q
Define health
A
State of physical, mental and social well being. Not merely absence of disease
8
Q
What are the 3 domains of public health?
A
Health improvement
Health protection
Improving services
9
Q
4 aspects of health needs assessment
A
Needs assessment
Planning
Implementation
Evaluation
10
Q
Bradshaw’s ‘needs’
A
Felt need
Expressed need
Normative
Comparative
11
Q
3 approaches to health needs assessment
A
Epidemiology
Comparative
Corporate
12
Q
give the layers of maslows hierarchy and some examples of each
A
self-actualisation [achieving full potential, creative activities]
esteem needs [prestige, accomplishment]
belongingness and love needs [intimacy, friends]
safety needs [security, safety]
physiological needs [food, water, warmth, rest]
13
Q
give structure, process and outcome for Maxwell’s Dimensions of Quality
A
ACCESS: structure = pushchair access, process = sufficient appt.s, outcome = parent and child attend
EQUITY: structure = facilities for hearing impaired Pt, process = longer appt.s, outcome = attendance and pateint satisfaction
APPROPRIATE: structure = hearing test room soundproofed, process = anaemia screeing in city centre, outcome = problems detected
ACCEPTABILITY: clinic at appropriate time, no unacceptable tests, attendence
EFFICIENT: skill mix of examiners, no inefficient tests, cost effective
EFFECTIVE: equipment in good condition, only effective tests, problems identified
14
Q
describe the 3 categories of The Donabedian model for information about quality of care
A
structure process outcome
15
Q
what are the 4 domains/tets of medical negligence
A
- was there a duty of care?
- breach in that duty?
- patient harmed?
- harm due to breach?
16
Q
what are the bolam and bolitho rules in medical negligence
A
Bolam: would a reasonable Dr do the same?
Bolitho: the professional opinion relied on must be reasonable and logical
17
Q
what are the 3 behaviours of health psychiatry and describe each
A
health behaviour [lifestyle/ disease prevention]
illness behaviour [seeking help/ GP]
sick role behaviour [actively getting better]
18
Q
what are the 5 stages of the transtheoretical model of behaviour change
A
precomtemplation contemplation preparation action maintainence/relapse
19
Q
what are the 2 types of ‘cues to action’ in behaviour change, and give some examples of each
A
internal - symptoms/pain
external - leaflets/ reminders
20
Q
what 3 things lead to the ‘intention’ in the theory of planned behaviour model of behaviour change?
A
attitude
perceived behaviour control
subjective norm
21
Q
what makes a communicable disease important [5]
A
highly contagious
expensive to treat
morbidity
mortality
preventable
22
Q
name some notificable diseases
A
Acute meningitis Diphtheria Food poisoning Malaria Measles Meningococcal septicaemia Mumps Rabies Rubella Scarlet fever Tetanus Tuberculosis Whooping cough Yellow fever
23
Q
define cluster in infectious disease
A
An aggregation of cases
24
Q
define suspected outbreak in communicable disease
A
more cases than normal in a specific place/group in a period of time
2+ cases with link
SINGLE case of rare/ serious disease
25
define comfirmed outbreak in communicable disease
Link confirmed through epidemiological/ microbiological investigation
26
define epidemic in communicable disease
Occurrence within an area in excess of what is expected for a given time period
27
define pandemic
excessive no of cases for what is expected
| over several countries
28
endemic
Persistent level of disease occurrence
29
hyper-endemic
Persistently high level of disease occurrence
30
who should you contact in the instance of CO poisoning
call proper officer [infectious diseases consultant]
31
communicable disease action for MRSA on a ward
no action, someone else's responsibility
32
describe egalitarianism
all people are equal and deserve equal rights and opportunities
'everyone should have everything'
33
describe utilitarianism
maximising utility, e.g. limited resources
34
describe libertarianism
everyone is responsible for their own health, minimal intervention
35
rule of rescue
this is an exemption to utilitarianism. It allows the spending of lots of resources in order to save a life
36
what is human rights article 2
right to life
37
what is human rights article 3
prohibits torture, and "inhuman or degrading treatment or punishment".
38
what is human rights article 8
right to privacy/family life
39
what is human rights article 12
right to marry and procreate
40
what is human rights article 14
protection from discrimination
41
define equality and equity
equality - everyone is the same
| equity - unequal needs = unequal shares, people deserve different levels of care due to different level of needs
42
what is horizontal equity
equal shares for equal needs
43
what is vertical equity
more needs = more shares e.g. if you earn more you pay more tax
44
types/categoriesof intervention
individual
community
ecological/population
45
what is the Quality and Outcomes Framework
annual reward and incentive programme detailing GP practice achievement results. It rewards practices for the provision of quality care and helps standardise improvement in the delivery of primary medical services
46
name the 8 models/theories of behaviour change
1. theory of planned behaviour
2. health belief model
3. transtheoretical model
4. nudging/ choice architecture
5. social norms theory
6. motivational interviewing
7. social marketing
8. financial incentives
47
cons of the health belief model?
doesn't cover outcome expectancy or effect of emotions on behaviour
doesnt differentiate 1st time /repeat behaviour
48
describe some health behaviours in which the health beleif model is successful
breast self screen
vaccination
cancer screening
medication adherence
49
what is the most important factor for addressing behaviour change in the health belief model?
perceived barriers
50
what are the 4 factors that influence behaviour change in the health belief model?
perceived susceptibility
perceived severity
perceived benefits
percieved barriers
51
the theory of planned behaviour proposes the best predictor of behaviour is what?
intention
52
what are the 5 barriers between intention and behaviour change in the theory of planned behaviour model?
```
perceived control
anticipated regret
preparatory actions
implementation intentions
relevance to self
```
53
5 transition points in life when behaviour change can occur
```
leaving school
entering workforce
becoming a parent
becoming unemployed
retirement and bereavement
```
54
what is motivational interviewing?
| a behaviour change it works for and one it doesnt
a councelling approach for initiating behaviour change by resolving ambivalence
NO for smoking, YES for problem drinking
55
describe nudge theory
nudge the environment to make the best option the easiest e.g. putting fruit by till queue!
56
advantages of the transtheoretical model
had different stages so can tailor intervention to individual
accounts for relapse
temporal element
57
disdvanatges of the transtheoretical model
not everyone moves step to step [may skip/go backwards]
change may operate on a continuum, not discrete stages
doesnt take into account social/ economic/ values
58
pros of theory of planned behaviour
takes into account social norms/ social pressures and perceived control
59
describe the hypothetico-deductive model for clinical reasoning
info from patient gathered + used to construct hypothesis
hytpothesis tested out / further hypothesis constructed
60
con of Hypothetic-deductive approach to clinical decision making
uncertainty
| subject to error at every step
61
describe the stages of the pragmatism model for clinical reasoning
symptoms -> exclude serious illness -> treat Sx -> review
62
give some examples of intuitive [system 1] vs Analytic [system 2] clinical reasoning
```
intuitive vs analytical :
emotion vs logic
past experience vs evidence
immediate action vs delayed action
unconscious vs conscious
error prone vs reliable
```
63
define "utility" in clinical reasoning
Utility = probability of outcome x value of outcome
64
define conditional probability
Chances of something given that you have some additional information
65
define anchoring bias
Undue emphasis is given to an early salient feature in a consultation.
66
define ascertaiment bias
Thinking shaped by prior expectation
67
example of anchoring bias
Concentrating on the fact that patient with back pain has a manual job -> MSK pain, and putting less weight on his complaint of hesitancy and nocturia -> prostate cancer mets
68
example of ascertainment bias
young patient with unsteady gait in a city centre on a Saturday night expected to be drunk, rather than having suffered a stroke
69
define Availability bias
Recent experience dominates evidence
70
examples of availability bias
Having recently admitted a patient with multiple sclerosis, this diagnosis comes to mind the next time a patient with sensory symptoms is seen
71
define bandwagon effect bias and e.g.
"we do it this way here"
| continuing to prescribe diclofenac to patients with cardiovascular risk factors, despite its thrombotic risk profile
72
define omission bias and e.g.
Tendency to inaction. Events due to disease preferred to iatrogenic.
Not vaccinating child due to risks, without considering risks of disease
73
define sutton's slip (bias)
going for the obvious diagnosis
74
Gambler’s fallacy (bias)
thinking a list of many recent diagnoses means this patient cannot have the same diagnosis
75
Search satisficing bias
once one diagnosis is found, others are not explored
76
GMC duties of a Dr
make care of patient 1st concern
take prompt action if Pt safety, dignity, comfort compromised
honest/ open/ integrity
77
in the swiss cheese model what do the layers of cheese represent?
levels of defence that prevent error/ patient safety incident
78
4 categories of why things go wrong in medical negligence
human error (wrong drug route)
neglect (mid-staffs)
poor performance (personal/attitude)
misconduct (deliberate harm)
79
if a doctor is found liable of medical negligence, what 3 aspects do the court take into account when deciding on how much patient is reimbursed
1. loss of income
2. cost of care
3. pain and suffering
80
define public health
the science and art of preventing disease, prolonging life and promoting health through organised efforts of society
81
Which of the following is not a communicable disease of public health importance:
A. Influenza
B. Urinary Tract Escherichia coli Infection
C. Middle Eastern Respiratory Syndrome Corona virus Infection
D. Rabies
E. Rubella
B
82
what communicable disease do you not need to notify about
Health Care Associated Infections and sexually transmitted diseases
83
HIV. notify?
no
84
MRSA on ward. notify?
no
85
In the last two days, you have clerked ten patients with acute respiratory distress with no apparent cause. Action?
call CCDC
86
An oncology ward nurse contracts chickenpox. Action?
call CCDC
87
A case of Infectious Bloody Diarrhoea in a 4 year old. Action?
call CCDC
88
Typhoid in a restaurant chef. Action?
call CCDC
89
Animal researcher who received hate mail with some white powder develops acute respiratory distress. Action?
call CCDC
90
what is communicable disease surveillance
continuous monitoring of frequency + distribution of communicable disease + monitoring risk factors
91
what does communicable disease surveillance tell us
which disease cause morbidity/mortality
whos at risk
vaccination program working?
allow outbreak identification
92
what info is needed from a notifying Dr in comm disease?
```
current location
home address
date of onset
occupation/school
travel
medical Hx (immunosuppressed)
```
93
what are some determinents of health
genes
lifestyle
healthcare
environment (social, physical, economical)
94
different forms of health equity
```
Equal EXPENDITURE for equal need
Equal ACCESS for equal need
Equal UTILISATION for equal need
Equal health care OUTCOME for equal need
Equal HEALTH
```
95
EXAMPLES of the public health domain "health improvement"
```
lifestyle
education
housing
employment
inequality
```
96
example of public health domain "health protection"
communicable disease
radiation
chemicals
environmental hazards e.g. flood
97
example of public health domain "improving services"
```
effectiveness
efficiency
audit
equity
clinical governance
```
98
explain the difference between secondary and tertiary prevention
secondary - reducing risk of disease in those who are at risk
tertiary - reducing morbidity/mortality in those who already have disease
99
Explain the difference between public health interventions delivered at the population (ecological) and individual levels, using one example for each to illustrate your answer.
population - ^ alcohol tax
| individual - smoking cessation advice form GP
100
Explain the difference between horizontal and vertical equity in relation to health care.
horizontal aims for equal shares for equal needs e.g. everyone with pneumonia should recieve same treatment.
vertical works on unequal shares for unequal needs
101
define need, supply and demand in health needs assessment
Need - ability to benefit from an intervention
Demand – what people ask for
Supply – what is provided
102
give examples of things that are needed and supplied but not demanded
health promotion [alcohol tax]
MMR for some parents
GU contact tracing
103
give examples of things that are Needed but not supplied or demanded
some palliative care services
| contraceptive services in some countries
104
Needed and Demanded but not supplied
waiting lists
| drug rehab
105
Supplied and demanded but not needed:
antibiotics for sore throat
| cosmetic surgery
106
Supplied and demanded and needed
operations for cataracts
| free contraception
107
define health needs assessment
systematic review of population health issues. To find priorities and for resource allocation.
To improve health and reduce inequalities
108
health needs assessment may be carried out for which different domains
A population or sub-group
A condition
An intervention
109
describe the epidemiological approach to health needs assessment
establishes incidence/ prevalence of problems, looks at existing services, evidence, available services and makes recommendations
110
describe the comparative approach to health needs assessement
compares services received by population to other groups
111
describe the corporate approach to health needs assessment
takes into account the views of service user, politicians, providers, commissioners, professionals, 3rd sector organisations
112
problems with epidemiological approach to health needs assessment
needs info - may not be available or accurate
evidence on subject may be sparce
doesn't take into account felt needs people affected
113
problems with comparative approach to health needs assessment
may be difficult to find comparable group
data may be difficult to obtain or poor quality
may not yield appropriate level of need
114
problems with corporate approach to health needs assessment
difficult to distinguish need from demand
vested interests/ political agendas
powerful/influencial groups/people may have undue increased influence
115
initiatives to reduce social isolation of older people
dementia cafes
age UK 50+ clubs
silverline telephone helpline
intergenerational housing
116
define refugee
someone who has been forced to flee their country of nationality due to fear of persecution, war or violence
117
define asylum seeker
someone who has applied to become a refugee and is awaiting their claim to be accepted by the home office
118
if an asylum seeker is granted indefinite leave to remain (full refugee status), who are they allowed to bring with them?
one spouse, and any child of that marriage under the age of 18
119
what are asylum seekers entitled to?
| what are they NOT allowed
```
£35/week
school
NHS care
housing
NOT allowed to work or claim benefits
```
120
FAILED Asylum Seekers entitled to?
Are NOT entitled to any money
Are NOT housed
Are NOT entitled to full NHS care
121
barriers to health services for asylum seekers
language
unaware of where to go for help
health not a priority
122
examples of self-actualisation in maslows hierarchy of needs
achieving full potential
morality
creativity
spontaneity
123
examples of self-esteem in maslows hierarchy of needs
confidence
achievement
respect from others
124
give examples of safety in maslows hierarchy of needs
employment
health
property
money
125
health problems faced by homeless people
```
STIs
alcohol/drug abuse
respiratory
TB
poor nutrition
injuries form violence
mental health
```
126
barriers to healthcare for homeless people
perceived or actual discrimination
other priorities
appt procedures [ringing up to book/giving address]
127
alcohol recommended units
<14 units/week
128
features of fetal alcohol syndrome
```
low birth weight
low muscle tone
Mental retardation
behavioural problems
speech problems
Cardiac/ renal/ ocular abnormalities
facial - smooth philtrum, epicanthic folds, thin upper lip, low nasal bridge, short palpebral fissures
```
129
medications used when reducing alcohol intake
disulfiram [sensitises]
acamprosate [reduces withdrawal]
naltrexone [also for opiates]
130
criteria for alcohol dependence syndrome
```
3 or more (in 12 months):
^tolerance
physiological withdrawal
difficultly controlling use and amount
neglect of other areas/social
spending more time obtaining/using
continue despite -ve effects
```
131
triad of wernickes
confusion
ataxia
opthalmoplegia
132
treatment of wernickes
IM thiamine (vit B1) [pabrinex]
133
define Delirium Tremens
short lived (3-5 days) confusional state due to reduced alcohol intake in alcohol dependent individual/ long history of use.
134
treatment of delirium tremens
fluids, benzodiazepine
135
symptoms of delirium tremens
```
confusion
reduced consciousness
seizures
hallucinations
tremor
```
136
what is principlism
practical approach for ethical decision-making - focuses on autonomy, beneficence, non-maleficence, and justice.
137
consequentialism
the consequences of an action determine the right/wrongness of it
138
define deontology
ethical principle that focuses of duty and rules and doing the right thing because its the right thing to do, regardless of consequences
139
define virtue ethics
ethical principle that emphasizes the moral character of the person, rather than the rules or consequences
140
give 3 reasons that the need for rationing in health care has increased
switch from acute to chronic long term illness
medicalisation of physiological events
^choice of, AND ^cost of treatments
141
WHAT IS THE maximising principle in resource allocation
maximise public utility/ rationing
142
what are the 4 layer of millers pyramid of clinical competence?
does
shows
knows how
knows
143
acid fast bacilli on sputum smear often indicates...
TB
144
list some types of error
```
sloth
poor team work
loss of persective/ fixation
mistriage
communication breakdown
ignorance
bravado
syste error
```
145
the 3 bucket model for error - what are the 3 buckets?
self
context
task
146
advantages and disadvantages of RCT
low bias risk, low confounding risk
| expensive, time consuming
147
how do you calculate attributable risk of lung cancer due to smoking
risk in smokers - risk in non smokers
[taking away the 'naturally occurring' risk]
148
how do you calculate number needed to treat?
| what does a number needed to treat of 7 for smoking and lung cancer mean?
1/ attributable risk
7 people would need to stop smoking to stop 1 person getting cancer
149
define lead time bias
early identification appears to ^survival because Pt knows they have it for longer
150
define length time bias
diseases with slow progress are more likely to be picked up by screening, so screening appears to prolong life
151
what is the standard error
the standard error is the standard deviation of all the sample means. larger sample = lower standard error
152
what is the p value
what dies it mean if p value <0.05
the probability of an event occurring given that the null hypothesis is true
means you can reject null hypothesis
153
what is the confidence interval
range that contains true mean?
if you did test 100 times, 95 of them are likely to contain the true value for the population, 5 wont
154
if people on pill have 50% increased risk of cancer, and the absolute risk in the population is 10%. What is the absolute risk for people on the pill?
and attributable risk?
15%
5%
155
calculate NNT
1/absolute risk reduction
