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Flashcards in Principles and Philosophy Deck (39)
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1
Q

3 goals of Evidence Infromed Practice

A

the best care
based on the best available evidence
for the good of the patient

2
Q

4 Pillars of EIP

A
  • critical mass of high quality - research evidence trumps authority or experience
  • Clinical research can help predict the probability of a particular clinical outcome and the average response
  • research focused on patient centered outcomes trumps bench science or research on biological changes in patience
  • research evidence must be interpreted thru the lens of experience and integrated with patient preference
3
Q

5 A’s of EIP

A
Ask
Acquire/Access
Appraise
Apply
Self Asses
4
Q

Hippocrates

A
4th centruy BC
father of medicine
separted religion from medicine
believed medicine was a calling and treated all people equal
not to differentiate by class or riches
5
Q

Galen

A

1st to document details of his surgeries and treatments

forwarded the humours theory of hippocrates (black bile, yellow bile, blood and phlegm)

6
Q

Dark ages of Medicine

A

same time as the fall of the Roman Empire

  • self treatment was advocated with books explaining process
  • religion began to return to healing as the driving force resulting in exhaltation of saints and Miracle Healers
7
Q

St Rouche

A

plague

8
Q

St Dymphna

A

mental illness

9
Q

Phillip von Hohenheim

A

father of modern toxicology

10
Q

Andreas Versalius

A

1st to significantly counter and disagree with Galens treatises
authored the Fabric of the Human Body…first major anatomy textbook

11
Q

The Barber Pole

A

red is blood (letting) white is bandages, and the blue is for veins

12
Q

William Hervey

A

accurately described blood flow and the hearts role

brought an end to the 4 humours theory in the 1600’s

13
Q

Jenner

A

created small pox vaccine from cow pox, this was the 1st vaccine

14
Q

William Thomas Green Morton

A

first to use Ester as an anesthetic

15
Q

Anestetics

A

credited with making surgery a survivable experience

heralded the age of surgery as a modern concept

16
Q

James Lind

A

nutritional cures (Vitamin C for scurvy)

17
Q

Rene Laennec

A

created the stethescope

18
Q

Robert Koch

A

discovered anthrax and Tuberculosis microorganisms

Koch’s postulate

19
Q

Kochs Postulate

A
  • the causative agent must be present in every case of the disease and must not be present in healthy animals
  • the pathagen must be isolated from the diseased host animal and must be grown in pure culture
  • the same disease must be produced when microbes from the pure culture are inoculated into healthy, susceptible animals
  • the same pathagen must be recoverable once again from this artificially infected animal and must be able to be grown in pure culture
20
Q

Louis Pasteur

A

began to articulate the germ theory

21
Q

Wilhelm Conrad Roentgen

A

used Crooke’s tube to create the 1st x ray

22
Q

Gerhard Domagk

A

inventor of sulfa drugs, the first anitbiotics

followed shortly after was the discovery of pnnicillin

23
Q

Health Insurrance

A

financing relies on resource pooling
-process of collecting small amounts of money from many to redisribute those resources to the sick populations to cover costs of their illnesses

24
Q

“The Bet” of health insurrance (8)

A

individuals gett ill at a reasonably predictable rate
the ilnneses populations suffer can be reasonably predicted
rational customers do not want to get sick
resultant expenses can be predicted
cost administering can be predicted
the profit of the system can be estimated
the revenue needed to offset the cost, related to the support structure can be prosectively calculated
revenue from all can be pooled to cover costs of the few

25
Q

Cost of Health Care

A

$2,809 Billion per year
$8,952 per capita
17.9% of GDP

26
Q

The percentage of US population not insured at all

A

15.4%

27
Q

Reasons for not being insured

A

Cost of insurance and recently loosing employment

28
Q

Year of first group health insurance plan

A

1847

29
Q

Year of Incorperation of Blue Cross and Blue Shield

A

1932

30
Q

Unions in the 40s and 50s

A

to drive employment increase unions used health insurance as “fringe benefits”

31
Q

Major Governemtn insurance Plans

A

Medicare
Medicaid
Tricare
Veterans Administration

32
Q

Primary Elements of Health Care Financing

A

Cost
Quality
Access

33
Q

Cost (managed care)

A

compensation lower; all products and technologies purchased at substantial discount due to volume and purchase power

34
Q

Quality (managed care)

A

standardized practices using evidence and procedural requirements augmented with substantial peer and case oversight, review and control

35
Q

Access (managed care)

A

patients and physicians practice in pre-established locations and facilities that have control over technology, equipment and theraputic options

36
Q

Types of Managed Care Structures

A

Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point-of-Service Organization (POS)

37
Q

Consequences of Managed Care

A

Patient autonomy is reduced- care is provided through a pre-chosen network or organization
Physician Autonomy is reduced - strict case management, centralized review of the appropriateness of provider practices
Selective Contracting - payers negotiate prices and contract selectively with local providers
Patients experience “Gatekeepers” - must see primary physician who need to prescribe any specialty services
Provider compensation is controlled and often reduced

38
Q

Potential Problems of Managed Care

A

Dumping
Creaming
Skimping
Lower Quality

39
Q

Medicare

A

established in 1965

to ensure that insurance was available to retired folks