SocPop Flashcards
(132 cards)
1
Q
In what 3 ways can ‘normality’ be decided?
A
Statistical basis
Optimal health
Social (normative) basis
2
Q
Outline the statistical basis of normality
A
Normal is the usual or average
Normal (Gaussian) distribution - 95% of population should be within 2 standard deviations of the mean
3
Q
Outline the optimal health basis of normality
A
Normal value is determined by what is required for optimal health
e.g. BMI
It is a change from the person’s normal values that is most reliable
4
Q
Outline the social normality basis of normality
A
Normality is what society finds acceptable or desirable
Influenced by culture and time - wide variety across cultures etc.
5
Q
Define disease
A
A pathological process confirmed by signs and investigations
Deviation from the biological norm
6
Q
Define illness
A
A subjective experience or ‘feelings’
Personal
May be experienced in the absence of pathology
7
Q
Define sickness
A
A social role adopted or assigned to people perceived to be ill
8
Q
What is health?
WHO
A
A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
9
Q
Discuss the medical model of health
A
Health is the absence of disease
Causes of ill health can be identified by signs and symptoms and diagnosis
10
Q
List some limitations to the medical model of health
A
Doesn’t take into account multi-causal factors that influence biological functioning
Doesn’t explain chronic/long term condition - not as simple as ‘curing’
Places the power in the medical profession rather than individuals
11
Q
Discuss the social model of health
A
Ill health and disease are caused by social and psychological factors
Income Place in society Gender Employment Education
12
Q
List some benefits of adopting a social model of health
A
Takes into account lay beliefs
Places people at the center and recognises autonomy
Recognises that a person can have a disease and still consider themselves healthy
13
Q
What charge can be brought against Drs if they undertake a procedure without informed, valid consent?
A
Battery
14
Q
Is a written consent form proof of valid consent?
A
No - it is only supporting evidence.
A signed consent form is not valid consent if the patient lacked capacity, lacked information, or didn’t give information voluntarily
15
Q
What are the 2 types of consent?
A
Implicit
Explicit - written, verbal
16
Q
What documents are available to guide Drs on consent?
A
GMC guidance on consent
DoH reference guide to consent
17
Q
What 3 things does valid consent require?
A
Competence/capacity
Information
Voluntariness
18
Q
How is a person’s capacity assessed when it comes to decision making?
A
It must be based on their ability to make a specific decision at the time it needs to be made
19
Q
A person is unable to make a decision if they cannot do one or more of the following:
(Capacity)
A
Understand the information given to them
Retain the information long enough to make the decision
Weigh up the information
Communicate their decision (by any means)
20
Q
Why is information an important part of consent?
What should be considered when giving information?
A
Because it is a legal requirement of consent
Patients needs, wishes, existing knowledge, complexity of treatment and associated risks
21
Q
Describe the voluntary aspect of consent
A
Consent should be given without coercion
Patients should be free of any outside influence when making their decisions
Explicit/implicit coercion
Patient/Dr relationship
Family pressure
22
Q
Who should take consent?
A
Should be yourself or delegate to someone who:
- is trained and qualified
- has knowledge of investigation, treatment, and risks
- acts in accordance with GMC guidance
23
Q
List some potential obstacles to informed consent
A
Poor information/time pressure during information provision
Being rushed into making a decision
Being pressured into making a decision by 3rd parties
24
Q
What does the GMC say about consent in emergency situations?
A
You can treat a patient without consent (if they are unable to consent) provided treatment is immediately necessary to save life or prevent serious deterioration
25
What are the 4 principles of person-centred care?
Care is personalised
Care is coordinated
Care in enabling
Person is treated with dignity, compassion and respect
26
Personalised care involves.....
A whole person approach
Putting the patient's needs and preferences, as they define them, first
Tailoring therapeutic plans and services to a patient's needs and desires
Seeing the patient as a person
27
Enabling care involves.....
Shared decision making
Recognising the patient's strengths in self-management
Supporting self-management
Patient and public involvement in the design and delivery of services
28
Coordinated care involves.....
Coordination across episodes over time
Integration between health and social services
Across primary, secondary and tertiary care
Through transitions e.g. child to adult
29
Which legal outline tells doctors to work in a person-centred way?
What does it outline?
GMC Duties of a Doctor 2013
Make the care of your patient your first concern
Treat patients as individuals and respect their dignity
Work in partnership with patients
30
What does the GMC guidance outline in terms of professional values and person centred care?
Listen to patients, respect their views
Discuss diagnosis, prognosis, treatment, care
Share information with patients so they can make a decision
Maximise patient's opportunities and ability to make decisions
Respect patient's decisions
31
List 5 ethical principles and values to consider when providing person centred care, and through all practice
Respect
Autonomy
Dignity
Care
Consequences
32
Define respect
Due regard for the feelings, wishes, or rights of others
Recognising the moral value of a person as an autonomous being
33
Define autonomy
Individual autonomy is an idea that is generally understood to refer to the capacity to be one's own person, to live one's life according to reasons and motives that are taken as one's own and not the product of manipulative or distorting external forces
34
Define dignity
A state, quality or manner worthy of esteem or respect; and (by extension) self-respect. Dignity in care, therefore, means the kind of care, in any setting, which supports and promotes, and does not undermine, a person’s self-respect regardless of any difference. Or, as one person receiving care put it more briefly, 'Being treated like I was somebody
35
Define care
Beneficence
Best interests
An ethic of care
Treat the condition, care for the person
36
# Define consequences
-in terms of patient centred care
Best overall outcome (totalitarianism)
Likely to lead to better outcomes, fewer complaints, less risk of litigation, increased trust in the medical profession
37
Outline the Calgary Cambridge guide to consultations
Five tasks
- commencing the consultation
- gathering information
- physical examination
- explanation and planning
- closing the consultation
Two functions
- building the relationship
- providing structure
38
What is ethics?
How one ought to act
39
What are facts?
Claims about the world that have been, or can be in principle, verified by empirical methods
40
What are values?
Claims about, or expressions of, things like preferences, attitudes, emotions, aesthetic appreciation
41
What are thick concepts?
Claims that have both factual and evaluative content
42
What are the 3 most popular moral theories in healthcare?
Consequentialism/utilitarianism
Deontology
Virtue ethics
43
What is consequentialism?
What is a drawback to it?
Theories that assess the moral values of anything in terms of that thing's outcomes or impact upon the world
The theory only bases its worth on outcomes, not the process
44
What is utilitarianism?
Aims for the best balance between benefit and harm
This makes for the most effective use of resources
45
Consequentialist theories need provide/defend:
An account of the relevant good
An account and method of quantification (who counts?)
An explanation of how rightness is to be determined
46
What is deontology?
Rules govern actions and we have a duty to abide by them regardless of cost
"The right is prior to the good"
Has less emphasis on outcomes (consequentialism)
47
Which moral theory seeks to respect autonomy?
Deontology
48
What are virtue ethics?
Focuses on the character of the person, not their actions
A right act is the action a virtuous person would do in the same circumstances
Not 'what should I do' but 'what kind of person should I be?'
49
What are the 3 P's of ethical reasoning in clinical practice?
Why is this important
Principles
Particulars - contents, facts
Perspectives
USE THIS WHEN ANALYSING ETHICAL QUESTIONS
50
What is the Refern Report?
Investigation following the retention of organs from deceased children in Alder Hey Hospital, kept without knowledge or consent of parents
51
Outline the Human Tissue Act 2004
Is this the same for the whole of the UK?
HTAct regulates the removal, storage and use of human tissue in England, Wales and Northern Ireland
Human Tissue (Scotland) Act (2006) applies in Scotland
52
What are the 3 principle functions of the HTAct (2004)?
To issues Codes of Practice
To issue licences and inspect establishment
To approve living organ and bone marrow donations
53
Which codes of practice from the HTAct (2004) are relevant to medical education?
Code A
Code C - anatomical examination
Code E
54
What are the four principles the HTAct (2004) is founded on?
Consent
Dignity
Quality
Honesty and openness
55
Which section of the HTAct makes it an offence to undertake scheduled activities without appropriate consent?
Section 5
56
What does the HTAct outline about donation of bodies?
Donation of whole bodies for anatomical examination needs appropriate valid consent
Providing the death has been properly certified and registered
57
Describe 'appropriate consent' in terms of body donation for anatomical examination
Can only be given by the individuals who choose to donate their body
Nobody else can give this consent
Must be written consent (section 3) signed in the presence of one witness
Or contained within a will of the concerned person
58
What 3 things can a donated body be used for?
Anatomical examination - teaching to healthcare professionals
Research - scientific studies
Education and training - training of healthcare professionals e.g. surgical techniques
59
Describe consent for deceased donations of tissue
Relatives can give consent for donation of tissue
60
Describe criminal law
Offences against (usually) individuals brought about on behalf of the Crown
Standard of proof = beyond reasonable doubt
Remedy = punishment
61
Describe civil law
Protects rights of individuals against each other/state
Claimant sues defendent
Standard of proof = balance of probabilities
Remedy = damages or injunction
62
What are the 3 elements of any negligence action under civil law?
Duty of care
Breach of the duty
Breaches causes injury or loss
63
What is prevalence?
A measure of how common a disease is
64
How can prevalence be expressed?
Percentage
Number per n people
65
List the 3 types of prevalence
Point prevalence
Period prevalence
Lifetime prevalence
66
Describe point prevalence
Proportion with the condition in a single point in time
67
Describe period prevalence
Proportion with the condition at any point within a specified time period
68
Describe lifetime prevalence
Proportion of population with the condition at any point in their life
69
Outline the use of prevalence and its limitation
Used to gauge the burden of disease
Prevalence can be affected by disease duration. Many people may have disease but not at that point in time, can get missed
70
Define incidence
The rate at which new events occur in a population, over a defined period of time
71
How can incidence be expressed?
Per n people per time period
Per n person-years
72
How do you calculate person-years
Number of people X number of years
73
How do you calculate incidence?
Number of new cases of disease
OVER
Total number of people X years observed
X 1000
74
How do you calculate prevalence?
Number of people with disease
OVER
Total number of people
x100,000
75
What type of disease would have high incidence and high prevalence
Common not brief condition
| e.g. common cold
76
What type of disease would have high incidence and low prevalence
Common very brief condition
| e.g. nose bleed
77
What type of disease would have low incidence and high prevalence
Uncommon long-term condition
| e.g. T2DM
78
What type of disease would have low incidence and low prevalence
Uncommon short-term condition
| e.g. pancreatic cancer
79
List some factors affecting prevalence
Incidence rate
Recovery rate
Death rate
Migration rate
80
What is statistical inference?
Taking a sample of a population to study and from the results of this form a conclusion about the whole population
81
What is a sampling error?
The difference between the sample point estimates and the truth
82
How can you eliminate or reduce sampling errors?
Test the whole population (rarely feasible)
Test a larger sample size
83
What is the standard error?
A numerical value that represents the sampling error
The larger the sample, the smaller the SE will be
84
Where should a 95% confidence interval sit?
It should include all values within 1.96 standard errors of the point of the estimate
85
How do you calculate confidence intervals?
Lower bound = point estimate - (1.96 X S.E.)
Upper bound = point estimate + (1.96 X S.E.)
86
List the 3 steps to working out confidence intervals
Calculate point prevalence
Calculate standard errors (using the square root p formula given)
Calculate CI
PP +/- (1.96 X S.E.)
87
What is demography?
The study of the size, structure, dispersement, and development of human populations
88
Describe a population census
Describes households and people
ONS England in Wales.
Every 10 years
98% of population information
89
What data is collected in UK census?
Demographic - Age, sex
Cultural characteristics -
Ethnicity, religion
Material deprivation - employment, home ownership, car access, lone parents
Health - general, long-term illness, unpaid care
Workplace and journey to work
90
How would you assess the quality of health information (acronym)?
Completeness
Accuracy
Representativeness / relevance
Timeliness
(Accessibility)
91
CART strengths of the UK census
Completeness - 98%
Accuracy - check of forms, coverage and quality surveys
Representative - data available for different levels (groups of 200 people to entire country)
Access - online
92
CART weakness of the UK census
Completeness - low enumeration of some groups
Accuracy - self-reported (Jedi)
Representative - low enumeration of some groups
Timeliness - 10 years, takes time for release
Access - individual returns confidential for 100 years
93
Why is data collected from the UK census of value to health workers?
Population size and structure - establish service needs
Base population - rates of growth
Measures of material deprivation - identify and target inequalities
94
Outline the process of birth registration
By parents (within 42 days)
OR
Birth notification by attendant (midwife) within 36 hours
Goes to the local registrar for births, marriages and deaths
Goes to the ONS - birth statistics
95
Outline 3 measures of fertility
Crude birth rate - live births/1000 people
General fertility rate - live births/1000 women aged 15-44yrs
Total fertility rate - number of children born per woman per lifetime in accordance with current fertility rates
96
What is a limitation of crude birth rate?
Per 1000 people
Includes males, children, and post-menopausal women
97
What is a limitation of the general fertility rate?
Doesn't take into account variation of fertility with age
98
What is a pro of the total fertility rate?
Does take into account differing fertility rates within age groups
99
List 3 things the total fertility rate is affected by
Delay in childbearing to older ages
Lower completed family size
Population structure
100
Outline the process of death registration
Medical certificate of cause of death issued by doctor
OR
Referral to coroner: coroner's certificate
Goes to death registration - local registrar for births, marriages and deaths
Goes to ONS - mortality statistics
101
What is the underlying cause of death?
Where is this used?
The disease or injury which initiated the train of morbid events leading directly to death
OR
the circumstances of the accident or violence which produced the fatal injury
Used in mortality statistics
102
Using this example, what is 1a, 1b and 1c on the medical death certificate?
A patient with primary squamous cell carcinoma of the lung died from an intracerebral haemorrhage, which was caused by cerebral metastases from the primary
1a - intracerebral haemorrhage
1b - cerebral mets
1c - squamous cells carcinoma
103
What are the 5 main broad disease groups?
Cancer
CV diseases
RS diseases
Mental and behavioural disorders
CNS diseases
104
What was the highest cause of death in England and Wales in 2015 out of the 5 main broad disease groups?
Dementia and Alzheimer's disease
105
List 2 strengths of mortality data
Complete coverage in UK (births as well)
Important information on health of the population
106
List 3 weakness of mortality data
Accuracy - underlying cause subject to diagnostic uncertainty, variable quality
Ethnicity not collected
Derivation of socio-economic status - posthumous inflation of status
107
Give 3 uses of population estimates and projections
Used for planning services and resource allocation
To understand what has been happening to the population
To make sense of present activity
To predict what is going to change
108
Give 2 strengths of population estimates
More up to date than census
More accurate than projections
109
Give 3 weaknesses of population estimates
Less reliable with time from census
Poor information on migration
Says nothing about the future
110
How is the population estimate calculated
Census baseline + births - deaths +/- migration
Estimation of population size between census
111
What is a population projection
Forecast future population size and structure
112
What is a strength of population projections
Can be used for longer term planning
113
Give 2 weaknesses of population projections
Less accurate the further ahead
Unforseen changes of past trends can invalidate projections
114
Which 3 places can morbidity data be found?
Cancer registration system
NHS data
Notification of infectious diseases
115
Describe the cancer registration system
What are its uses?
NAtional Cancer registration and Analysis Services: Public health England
Cancer diagnosis triggers registration
Uses:
- monitoring cancer rates
- evaluation and improvement of cancer treatment
- evaluation of screening programmes
- aiding cancer research
116
List 2 strengths of cancer registration
Detailed information updated over time
Record linkage to cancer deaths (ONS)
117
List 2 weakness of cancer registration
Expensive
Access is difficult due to confidentiality
118
Give 2 sources of NHS data on morbidity
Hospital episode statistics
Quality and outcomes framework
119
What data does hospital episode statistics collect?
All admissions, out-patient and A&E visits to NHS hospitals in England
personal information (e.g. age, gender)
clinical information - diagnoses and operations
administrative data (e.g. date of admission, discharge)
geographical information - where treated & lives
120
Who uses information from hospital episodes statistics and what do they do with it?
Commissioning organisations
Provider organisations
Researchers
Look at:
Trends in NHS hospital activity
Supports local service planning
Health trends over time
Fair access to healthcare
121
What are the 2 main data coding systems in HES?
ICD-10 - conditions treated or ivestigated
OPCS-4 - details of operations
122
Give 3 strengths of hospital episode statistics
Completeness - covers all hospital activity
Accuracy - standard codes used
Representative - routine national data
123
Give 1 weakness of hospital episode statistics
Accessibility - to individual data
124
What information does quality and outcomes framework (QOF) data collect?
Primary care data from GP surgeries
Works on a point system , higher score leads to higher GP income
125
Does QOF lead to improvement of health?
Improves information recording
Has a focus on process-based indicators, clinical outcomes are unclear
126
List the CART strengths of QOF
Completeness - almost 100% from GPs
Representative - all population, surgery, CCG, national levels
Timeliness - annually
Access - QOF online
127
List the CART weaknesses of QOF
Completeness - some GPs not involved
Accuracy - not sure about individual GPs
Representative - only aggregated data, no sex or age breakdown
Access - aggregated data only
128
How many notifiable diseases are there in England and Wales?
31
129
What what a Dr do if they suspect a notifiable disease?
Notify local health protection team (part of public health England)
PHE collates and produces trends each week
130
What would a lab do if they identified a notifiable organism?
Notify public health England
PHE collates and produces trends each week
131
Give 3 strengths of notification of infectious diseases
Timeliness - weekly report
Representative - routine national data
Linked to other data to improve accuracy
132
Give 2 weaknesses of notification of infectious diseases
Poor/variable completeness of some diseases e.g. food poisoning
Accuracy - ?limited. Asked to notify 'suspected' cases. Increasing link with lab reports
