HaDSoc

Question 1

What is clinical governance?

Answer 1

A system through which the NHS organisations are accountable for continuously improving the quality of their services and high standards

• accepts clinical excellence to flourish
• obligation for accountability

Question 2

What is the swiss cheese model of accident causation?

Answer 2

There are holes in the layers and if they line up it allows accidents to slip through
The more layers the less chance of hazards lining up, need to put safety measures in place to plug the holes

• The layers are barriers, defences and safeguards
• some holes are due to active failures, others due to latent conditions eg organisation and management

Question 3

State maxwells dimensions of quality

Answer 3

1. Acceptability - does the care promote satisfaction
2. Effective - curing pts
3. Access
4. Relevance - does the population need the service
5. Efficiency - cost effective, no waste
6. Equitable - everyone with the same needs gets the same care

Question 4

What is an adverse event? Give examples of preventable and unpreventable adverse events

Answer 4

Adverse events are injury caused by management (not underlying disease) that prolongs hospitalisation, produces disability or both
Non preventable: side effects of chemotherapy
Preventable: wrong dose or medication given, some types of infections

Question 5

What are some NHS quality improvement mechanisms?

Answer 5

1. Standard setting - NICE set quality standards based on best available evidence
2. Commissioning - CGCs responsible for budget for their area
3. Financial incentives - used to both reward and penalise
4. Disclosure - all trusts have to publish quality accounts which are available to the public
5. Regulation, registration and inspection - CGC can inspect at any time without warning
6. Clinical audit and quality improvement - identifying quality of care then trying to improve it

Question 6

What are some of the critiques of evidence based practice?

Answer 6

• it is impossible to collate and maintain so much data
• RCTs can be limited on ethical grounds
• what works for a population may not work for an individual

Question 7

Why are some possible explanations as to why lower class is strongly associated with ill health?
(as outlined in the black report)

Answer 7

• may be artefact due to measurement problems
• may actually be that ill health causes lower class
• cultural explanation, low classes engage more in damaging behaviour such as smoking
• materialist explanation, low income means less money to spend on health

Question 8

What us the symptom iceberg?

Answer 8

Only a small proportion of illness actually gets presented to GPs

• 1/3 seek advice
• 1/3 self medicate
• 1/3 do nothing

Question 9

What are lay beliefs?

What is lay referral?

Answer 9

How people understand and make sense of health and illness
Lay referral is the chain of advice the sick person gets from other lay people prior to/ instead of seeking help from professionals

Question 10

What are the principles of health promotion?

Answer 10

• Empowering: allows individual power to change
• Participatory: involves everyone
• Holistic: physical, mental, social
• Intersectoral: collabs relevant sectors
• Equitable: guided by justice
• Sustainable: about continuing change
• Multistrategy

Question 11

What are primary, secondary and tertiary health promotions?

Answer 11

Primary - aims to prevent onset of disease such as smoking cessation
Secondary - aims to detect and treat disease early such as screening
Tertiary - aims to minimise the effects of established disease such as renal transplantation

Question 12

What is the sociological theory on chronic illness?

Answer 12

The work of chronic illness is

• everyday life work eg coping and normalisation
• emotional work eg protecting emotional wellbeing of others and self
• biographical work eg maintaining of sense of self and value

Question 13

Why is it important to measure health?

Answer 13

• indicates the need of health care
• allows targeting of resources
• assesses effectiveness of interventions

Question 14

What are the criteria screening?

Answer 14

Disease: must be an important problem, needs to be fully understood, detectable. detection must lead to benefit.

The Test: simple, safe, precise, valid

Treatment: effective treatment must be available, treatment must be advantageous

Question 15

What are the critiques of screening?

Answer 15

• programmes are complex
• evaluation can be difficult
• idea of victim blaming
• false positives, false negatives

Question 16

What is sensitivity and specificity?

How are they calculated?

Answer 16

Sensitivity is the proportion of people with the disease who test positive - calculated by number of people with the disease who test positive / total people with the disease

Specificity is the proportion of people without the disease who test negative - calculated by number of people without the disease who tested negative / total people with no disease

Question 17

What is positive predicted value?

How is it calculated?

Answer 17

The proportion of people who test positive who actually have the disease
Calculated by number of people who tested positive and have the disease / total number who tested positive

• PPV is strongly influenced by prevalence, a low prevalence condition will have a low PPV

Question 18

What is prevalence?

Answer 18

The total number who have the disease irrespective of how they test.
Total number of people with disease / total number of people

Question 19

What is negative predicted value?

How is it calculated?

Answer 19

The proportion of people who test negative who actually dont have the disease
Calculated by the number of people who test negative and dont have the disease / total number who test negative

Question 20

What are the issues with a false positive and false negative result?

Answer 20

False positive: go through the anxieties of testing when they dont actually have the disease, lower uptake in the future

False negative: the disease goes un-diagnosed, they are falsely reassured and may present late

Question 21

What is lead time bias?

Answer 21

Screening programmes detect slow progressing disease best - early diagnosis falsely appears to prolong survival

Patients live the same amount of time but just know they have the disease for longer

Question 22

What are the 3 core principles of the NHS?

Answer 22

Universal, comprehensive, free at point of entry

Question 23

What are the 5 Ds of rationing in the NHS?

Answer 23

Deterrent - reduce demands via prescription charges
Delay - waiting lists modulate excess demands
Deflection - GPs deflect demand from secondary care
Dilution - fewer tests, cheaper drugs
Denial - reduce services eg IVF and sterilisation reversal

Question 24

What are the principles for resource allocation?

Answer 24

Scarcity - some sacrifice is inevitable
Efficiency - need to get the most out of a resource
Equity - allocating on basis of need
Effectiveness - the extend to which a desired outcome is achieved
Utility - the value an individual item places of health state
Opportunity cost - once you have used a resource in one way you can no longer have it in another way

Question 25

``` What is: Cost minimisation analysis Cost effectiveness analysis Cost benefit analysis Cost utility analysis ```

Answer 25

All ways of measuring resource implications Cost minimisation analysis - when outcomes are similar so focus on cost of intervention Cost effectiveness analysis - looking at whether the extra benefit is worth the cost Cost utility analysis - focusses on quality og health outcomes (eg QALY)

Question 26

What is a QALY?

Answer 26

Quality adjusted life year Incorporates both quantity and quality of life 1 QALY = 1 year of full health 1 QALY can also be 2 years of 50% health

Question 27

How do you calculate cost per QALY?

Answer 27

Calculate number of QALYs gained (eg number of years x percentage of health) Then do cost of treatment / number of QALYs gained

Question 28

What are some criticisms of QALYs?

Answer 28

- not everyone has the same perception of quality of life - problem for older patient because they have less years to live so QALYs will be less regardless of effectiveness of treatment - not necessarily an acceptable form of rationing

Question 29

Why might patients want to use complementary therapies?

Answer 29

- persistent symptoms - adverse reactions to conventional treatments - may feel they receive more time and attention

Question 30

What is the general doctors perspective of complementary therapies?

Answer 30

- some believe there is a benefit but a lot are sceptical - may delay or cause miss of a diagnosis - may facilitate refusal of conventional treatments - may waste money