Summary

Question 1

What are the 3 main ways a disease is detected?

Answer 1

Spontaneous presentation
Opportunistic case finding
Screening

Question 2

Define screening

Answer 2

A systematic attempt to detect an unrecognised condition by the application of tests, examinations or other procedures, which can be applied readily and cheaply to distinguish between an apparently well person who probably have a disease and those who probably do not

Question 3

What are the four categories in the criteria for screening programmes?

Answer 3

Disease
Test
Treatment
Programme

Question 4

For a screening programme to be accepted what does the disease need to be?

Answer 4

Important health problem
Well understood
Early detectable stage
Cost effective interventions must be available

Question 5

For a screening programme to be accepted what does the test need to be?

Answer 5

Simple and safe
Precise and valid
Acceptable to the population

Question 6

What is a true positive result?

Answer 6

When the test correctly identifies the presence of disease

Question 7

What is a false negative result?

Answer 7

Where the test says the patient does not have the disease when in actual fact, they do

Question 8

What is a false positive result?

Answer 8

Where the test says the patient has the disease when really they don’t

Question 9

What is a true negative result?

Answer 9

Where the test correctly says that the disease is not present

Question 10

What is sensitivity?

Answer 10

If the disease is present, what is the chance that the test will pick it up?

Question 11

What is specificity?

Answer 11

If the disease is absent, what is the chance that the test will correctly say it is absent?

Question 12

What is positive predictive value?

Answer 12

If the patient has a positive test, what is the chance of them actually having the disease?

Question 13

What is negative predictive value?

Answer 13

If the patient has a negative test, what is the chance of them actually not having the disease?

Question 14

What are some examples of chronic illness work?

Answer 14

Illness work
Everyday work
Emotional work
Biographical work
Identity work

Question 15

What are some milestones in illness work?

Answer 15

Getting a diagnosis

Symptom management

Question 16

What is biographical disruption?

Answer 16

Loss of the taken for granted life a person expected

Question 17

What is stigma?

Answer 17

A negative trait attributed to a group of persons, giving them ‘deviant status’

Question 18

What is discreditable stigma and what is an example of it?

Answer 18

Nothing seen, but stigmatised if found out

HIV, mental illness

Question 19

What is discredited stigma?

Answer 19

Physically obvious

Question 20

What is enacted stigma?

Answer 20

Experience of real prejudice

Question 21

What is felt stigma?

Answer 21

Fear of prejudice

Question 22

What is the medical definition of disability?

Answer 22

Deviation away from the norm that needs fixing

Question 23

What is the social definition of disability?

Answer 23

Failure of the environment to adjust

Question 24

Define validity in terms of social research questionnaires

Answer 24

The questionnaire measures what it’s supposed to measure

Question 25

Define reliability in terms of social research questionnaires

Answer 25

Measures things consistently Differences in results come from differences between participants (not from understanding or interpretation of questionnaire or results)

Question 26

What are quantitative questionnaires good for?

Answer 26

Comparisons Measuring Describing Finding relationships

Question 27

What are quantitative questionnaires bad for?

Answer 27

Forces people into categories Can't express the way they want May not access all info Not effective at causality

Question 28

What are some examples of qualitative research?

Answer 28

Ethnography (observation) Interviews Focus groups Documentary and media analysis

Question 29

What are qualitative research methods good for?

Answer 29

Perspective Accessing info not revealed by questionnaire Explains relationships

Question 30

What are qualitative research methods bad for?

Answer 30

Finding relationships | Generalises

Question 31

What are some problems with QALYs?

Answer 31

Common conditions disadvantaged Doesn't distribute according to need RCT evidence not perfect

Question 32

What are 4 approaches to the patient professional relationship?

Answer 32

Functional Conflict Interactionist Patient centred

Question 33

What is clinical governance?

Answer 33

Legal responsibility for a framework through which NHS organisations are accountable for continuously improving the quality of service and safeguarding standards of care by creating an environment in which clinical care will flourish

Question 34

What is the audit cycle?

Answer 34

``` Choose topic Standards and criteria 1st evaluation Implement change 2nd evaluation ```

Question 35

What are some examples of latent changes?

Answer 35

Similar packaging for drugs Poor training Short staffed Time pressures

Question 36

What is the Swiss cheese model?

Answer 36

Acts leading to harm to a patient

Question 37

What are some explanations for health inequalities?

Answer 37

Artefact Social selection Behavioural-cultural explanation Materialist

Question 38

What are some factors of the materialist explanation that explain why people from lower socioeconomic groups have worse health outcomes?

Answer 38

Low income Unemployment Poor work environments Poor housing

Question 39

What is an example of a generic patient reported outcome measure?

Answer 39

SF36 | EQ5D

Question 40

What is an example of a specific patient reported outcome measure?

Answer 40

Oxford hip score

Question 41

What are advantages of generic patient reported outcome measures?

Answer 41

Can be used on general pop Can be used if there is no specific measure Can be used to compare Can detect unexpected effects

Question 42

What are disadvantages of generic patient reported outcome measures?

Answer 42

Loss of detail Loss of relevance Not sensitive to change Less acceptable to patients

Question 43

What are advantages of specific patient reported outcome measures?

Answer 43

Relevant More specific to change More acceptable

Question 44

What are disadvantages of specific patient reported outcome measures?

Answer 44

Limited comparison | May not detect unexpected effects

Question 45

What are some of the challenges with responding to patient dissatisfaction?

Answer 45

How to locate responsibility Sometimes their views aren't reasonable How should we view a patients concern about someones FTP How much resource should we divert to satisfy these issues

Question 46

Why is the implementation of EBM difficult?

Answer 46

Dr's don't know the evidence Resources not available to implement change Commissioning decisions reflect different priorities (what the patient wants) Organisational systems cannot support innovation Dr's know about the evidence but don't use it

Question 47

What are the criticisms of the functionalism approach to Dr-patient relationship?

Answer 47

Some patients cant get better Assumes patients are incompetent Assumes rationality and beneficence of medicine Doesn't explain why things go wrong

Question 48

What are the criticisms of the conflict approach to Dr-patient relationships?

Answer 48

Patients aren't always passive Patients can seek to medicalise issues as well as Drs Patients may appear differential in consultation but assert themselves outside of this