1
Q
What is an opportunity cost?
A
Benefit that could have been attained if treatment for that was provided
2
Q
What are the main types of economic evaluation?
A
- Cost consequence
- Cost benefit
- Cost effectiveness
- Cost utility
- Cost minimisation
3
Q
What principle does cost consequence apply?
A
Cost 1- Benefit 1 Cost 2 - Benefit 2
4
Q
What is cost benefit?
A
How much more are you willing to pay for a benefit
5
Q
What is cost effectiveness?
A
- Using ICER (Incremental Cost Effectiveness Ratio)
- Difference in cost and benefits between 2 methods
6
Q
What is cost utility?
A
Measured using QALY (Quality adjusted life years)
7
Q
What is cost minimisation?
A
If 2 treatments provided the same benefit, cheaper treatment option is chosen
8
Q
What is marginal benefit?
A
Increase in benefit if there was an increased production by one additional unit
9
Q
What is marginal cost?
A
Increased in cost if there was an increased in production by one additional unit
10
Q
What is equity?
A
Maximisation of benefit for the money eg a poorer person will have more healthcare needs so they should be given care so that they can be at the same level as a wealthy person
11
Q
Which people are QALY usually high?
A
- Lower social class
2. Old people
12
Q
What is the problem with cost effectiveness method?
A
- Measured in natural units so its difficult to compare between multiple outcomes
13
Q
What is the advantage of cost effectiveness method?
A
Measured as part of the clinical try and it is clearly understood
14
Q
What does QALY value of 1,0 and -1 mean?
A
1- Healthy
0 - Dead
-1- Worse off than dead
15
Q
What is measured in QALY?
A
- Length of life
- Quality of life
16
Q
How is the quality of life data obtained?
A
Questionnaires, health state description, published values in literature
17
Q
What does the questionnaire Euro-QoL use?
A
- Mobility
- Anxiety/depression
- Self- care
- Pain/discomfort
- Usual activities
18
Q
What are the problems associated with QALY’s?
A
- Insensitivity of Questionnaire
- End of life treatments
- Discrimination
- Family carer benefits
19
Q
What are the costs due to ill health to the NHS?
A
Direct - Social/healthcare, non-healthcare (OTC, Transport, paid carers, private health care)
Indirect - Lost of productivity, benefits and allowance for sick
20
Q
What are the centres for NICE?
A
- Health technology
- Public health
- Clinical practice
21
Q
Who make up the majority/ least in NICE?
A
- Majority: Clinicians
- Least: Manufacturer
22
Q
Who make up the centre for public health?
A
- Topic experts
- Core members
- Community members
23
Q
Based on what criteria are screening programmes approved by the National Screening Committee?
A
- Natural history of disease
- Appropriate, suitable test/examination
- Approved treatment
- Facilities for diagnosis
- Important health problem
- Agreed policy on who to treat as patients
- Economically balanced
- Continuing process
24
Q
What are the 3 types of distribution systems?
A
- Hierarchial: Bottom nothing top most
- Capitalist: Price determines how goods are distributed
- Free market (Thatcher): No state intervention, prices of goods are determined by open market
25
What is the Keynes Welfare System?
Antithesis of the free market so acknowledges the role of the state to invest.
26
What does the state need to invest in the Keynes Welfare System?
- Financial benefits
- State education
- National health service
- Public housing initiatives
- Employment creation/development
27
What is the Beveridge plan?
Fight against giants of want
1. Ignorance
2. Idleness
3. Squalor
4. Disease
28
When was NHS invented?
1948
29
What was the purpose of NHS?
To provide an equitable distribution of health services accountable to nation to give them a sense of collective purpose and mission to promote the health of the nation
30
What is the concept of justice?
Treating people equally while understanding that there is an existing inequality
31
What are the concepts of justice?
1. Desert
2. Maximising utility
3. Satisfying need
32
What does justice as desert mean?
Treated equally based on how deserving they are
33
What does noble failure mean?
Someone has tried really hard to adapt this good behaviour but failed for whatever reason
34
What does justice as maximising utility mean?
Utilitarianism: Max benefit for most people
35
What does justice as satisfying need mean?
People with least money and most healthcare need are given priority.
36
What is the problem associated with justice as a satisfying need?
Differentiating what is a need and a want
37
What is the fair innings approach?
Someone who has had fair innings will get lower priority compared to someone who has not reached societal norm.
38
What is the problem with fair innings approach?
Old person need is neglected as young person is prioritised
39
What is the estimated cost per QALY approved by NICE?
25K pounds per QALY
40
What are the parties involved in judicial review?
- Government: Secretary of State
- Parliament: Sovereign to satisfy legal need
- Judiciary: Acts to check on government
41
ART 2
Right to life
42
ART 3
Against inhuman and degrading treatment
43
ART 8
Right to privacy
44
ART 12
Right to found a family
45
ART 13
Prohibition against dicrimination
46
What are the 9 protected characteristics by single equality act 2010?
- Gender
- Age
- Race
- Religion/belief
- Sexual orientation
- Gender reassignment
- Disability
- Maternity/pregnancy
- Marriage/civil partnership
47
If patient is unable to decide for themselves, who can be given the right to based on Mental Capacity Act 2005?
- Patient nominee
- Court
- Doctor
- Previous wishes of patient
48
In what ways are autonomy given to the patient?
- Advanced directives
- Substituted decision making
- Court of protection
49
What is the concept of liberalism in terms of safeguarding patients rights?
- Purpose to support and not restrict/control patient
- Assuming patient has capacity
- All practical steps are taken to help
- Unwise decisions are not equated to incapacity
- Least restrictive option is chosen
50
What is lack of capacity?
Inability to make decision for self either due to impairment or disturbance to function or mind or brain.. This could either be temporary or permanent
51
What is the test for capacity?
- Understand
- Retain
- Weigh info
- Communicate decision
52
Why do you review capacity?
- It is decision specific
53
What can cause temporary incapacity?
- Alcohol
- Unconscious
- Drugs
- Accident
- Concussion
- Pain/medication
- Hypoglycaemia
54
What are Advance Refusals?
Decision can be made at any point to refuse certain treatments in the future
55
What should the doctor do if they suspect presence of an advanced refusal?
Must make reasonable efforts to find out what it says time permitting but can act in emergencies
56
What is the lasting powers of attorney?
- Patient can have a substituted person to make decisions for them
57
What are the criteria for lasting powers of attorney?
- >18 years old
- Registered and certified by an independent person
- Donor could place restriction on powers
- Donee cannot appoint successor
58
What is the court of protection?
New court to deal with all areas for decision making for the incapacitated and has all the powers of the high court.
59
What powers does the court of protection have?
- One off declarations
- Substituted decisions
- Appoint deputies
- Call for reports
60
What is eugenics?
Set of practices and beliefs that aims to improve genetic quality of life
61
How were the weak left behind?
- Sterilisation
- Birth control
- Marital regulation
- Segregation of the unfit
62
What is the tragedy charity model?
- Depicts people as victims of circumstances who deserve pitu
63
Who uses the tragedy charity model?
Charities
64
What should the funds raised for disabled by charities used for?
- empower disabled people
| - full integration into the society as equals
65
What is the key aim of the medical model for disability?
Disability results from a person's individual limitations and not associated with social and geographical environemtns
66
What is the difference between impairment, disability and handicap?
Impairment: Physical or physiological impairment
Disability: Inability to perform a normal task due to a restriction
Handicap: Any disadvantage that limits the person from fulfilment of a role
67
What are the main points of the social model?
- Disability is a consequence of environment, social and attitudinal barriers
- Loss or limitation of opportunities to take part in normal community on an equal level
- Stems from a failure of society to adjusts to needs
- If you remove this barriers and give disabled people equal opportunity, it will improve their lives.
68
What are the criticisms of the social model?
- Disability can be eradicated (cannot be)
| - Unable to understand disabled people do have restrictions so may not be able to perform a task like a normal person
69
What are the main points of the biopsychosocial model?
- Based on the social model but recognises elements of the medical model
- Realises that it cannot solve all the problems of impairment but can change discrimination against it
- Recognise inability of disabled to adapt to the demand of the society
- Stems from failure of society to take the needs of the disabled into account
- Focuses on limitations, capabilities and potential
70
What are the key values of human rights?
- Fairness
- Equality
- Dignity
- Respect
71
What is the definition of learning disability?
- Impairment of intellectual functioning
- Consequences in terms of severe social functioning
- Onset before physical maturity
72
What categories of people do not come into the context of learning disability?
- Develop cognitive impairments in later life
| - Specific impairments such as dyslexia
73
What is the difference between IQ test and adaptive behaviour?
- IQ test is to recognise special education help whereas adaptive behaviour is a measure of ability to perform daily tasks
74
What are the problems associated with IQ test?
- Underperformance due to additional disability
- Narrow range of skills
- Invalid application for learning disability
75
What are the problems with adaptive behaviour test?
- Ignore the extent of support from carer
- Variability in performance
- Cultural difference
- Lack of opportunities
- Core skills change over time
76
What are the 2 types of normalisation?
1: Scandinavian approach which emphasises the importance for the disabled person to attain adulthood by overcoming ordinary life challenges. Compensatory services available for disabled person to overcome these challenges.
2: US Wolfsenberg: Ease at which disabled people are assigned to a disrespectful label because of the separateness of their appearance, environment or way of life. Specialist services which identify disabled people as different but assigned social roles- Social role valorisation
77
What are the prevention strategies for learning disability?
Pre-conception: Prenatal PKU screening
Prenatal: Folate therapy, reduce alcohol consumption
Perinatal: Optimal obstetric and neonatal care
Postnatal: Health education, reduce accidents, vaccination
78
What are the causes of high mortality in people with learning disability?
- Neurological disorders (epilepsy)
- Disorders associated with the syndrome (dementia)
- Poor lifestyle
- Poor access to healthcare
79
What is the definition of visual impairment?
- Inability to see
| - Inability to see clearly
80
What is visual acuity?
Ability to see detail
81
What does the top and bottom letter mean? 6/6
Top- distance seen
| Bottom - row of letters seen (5,6,9,12,18,24,36,60)
82
What are the definitions of blind and partial sight?
Blind: 3/60
| Partial sight: 6/60 or 6/18 if field reduced
83
What is the certificate given to sight impaired people?
Certificate of vision impairment
84
What are the main causes of sight loss? Give some other examples as well
- Age related macula degeneration
- Glaucoma
- Hereditary retinal disorders
- Diabetes retinopathy
- Cataract
85
What are the 3 types of refractive error? What do they each mean?
- Myopia: Short sighted so cannot see far objects
- Hypermetropia: Long sighted
- Astigmatism: Distorted vision from an irregular curved cornea
86
What are the possible ways to prevent sight loss?
- National Programmes to control or prevent impairment
- To increase number of eye care services integrated within the primary or secondary healthcare team.
- Campaigns to raise awareness
- International partnerships
87
What is trachoma?
Eye disease caused by infection with the bacterium chlamydia trachomatis.
88
What is the typical description of a blind person?
- Female
- Possibly widowed
- Age related macula degeneration
- Also has hearing problems, arthritis, cardiovascular disease, diabetes
- Cannot read, write or recognise faces
- Still retain her independence
89
What does a guide dog do?
- Walk in a straight line on a pavement unless there is an obstacle
- Not to turn corners unless told to do so
- Judge height and width so owners do not bump their head or shoulder
- Deal with traffic
90
What are the help available for visual impaired people?
- Government benefits
- Eye Clinic Liaison Office (eclo)
- Social workers
- Voluntary organisations
- Low vision aids such as magnifiers
91
What are the benefits of registering as visually impaired?
- Disability living allowance
- Reduction in TV license
- TAX
- Reduced fees on public transport
- Parking concessions
92
What are the different categories of deafness and how are they divided?
- Moderate: 40-70dB
- Severe: 71-95dB
- Profound >95dB
93
What are the main causes of deafness?
- Congenital due to genetic defects, infection, conductive malformation, ototoxic drugs (gentamycin)
- Acquired: Drugs, Meniere's, Tumour, Infection, Loud noise, obstruction, trauma
94
What are the basic principles of the medical models of deafness?
- Caused by a developmental deficiency or disease
- To be cured or corrected by medication/surgery
- Individual's adjustment/behaviour would lead to effective cure
- Aim is to teach deaf child to speak
- Responsibility of dead people to make themselves understood
95
What are the main points of the social model of deafness?
- Disability is a socially created problem
- Communication with deaf barrier because people do not want to use sign language and thus leading to isolation for those who are deaf
- Society caused this due to lack of awareness and opportunity
96
What is the cultural model of deafness?
- BSL is their preferred language as see themselves as part of social, cultural and linguistic community
- Do not see themselves as disabled
- Shared social beliefs
- Not experienced a loss of hearing so positive attitude
- Affects mental health because of social disadvantage
97
What are the do's when speaking to a deaf person?
- Speak clearly normal speed
- Minimal background noise
- Talk face to face
- Gain attention by tapping or waving
98
How to use a sign language interpreter?
- Check interpreter qualified
- Send information before meeting
- No background noise
- Deaf person can see interpreter
- Interpreter is neutral and not offer any opinions
- Interpreter need to interpret everything said
- May ask for repetition
- Allow for time for deaf person to respons
99
How to contact deaf person?
- Mobile
- Textphone
- Fax
- E-mail
- Videophone
- Skype
100
What is a text relay?
- Uses minicom to type message to operator who reads to hearing person
101
How does WHO define health?
A state of complete physical, mental and social well being and not merely the absence of disease or infirmity
102
What are the key components of healthcare system?
- Continually improve health status of an individual, family and communities
- Defence against health threats
- Protection against financial consequences of ill health
- Equitable access to people centred care
- Assisting people to participate in decision making process regarding their health
103
What is public health?
```
Science and art of
- Preventing disease
- Prolonging life
- Promoting health
through organised efforts
```
104
What is the difference between individual and population healthcare?
- Different needs identified
- Delivered and evaluated
- Doctor advocates for different people
105
What is the healthcare continuum?
Primary prevention - secondary prevention- tertiary prevention - end of life care
106
What factors contribute to the changing healthcare requirements?
- Increase in population size
- Increase in ageing population
- Increase in life expectancy
- Increase prevalence of chronic disease
- Supply/demand
107
What is the new model of healthcare?
- Integration of services
| - Patient centred care
108
What are the radical changes to healthcare provision due to Health and Social Care Act 2012?
- Clinically led commissioning
- Increased patient involvement
- Focus on Public Health
- Focus on quality of healthcare
- Allowing healthcare market competition in the best interests of patients
109
What is NHS 3 key strands to delivering quality care?
- Patient safety
- Clinical effectiveness
- Patient experience
110
What are the 2 overarching quality outcome for public health?
- Increase life expectancy
| - Increase quality of life ( decrease different in quality years and life expectancy)
111
What is the difference between prevention and promotion?
Prevention is more disease focused and uses a medical model whereas promotion is a holistic approach to widen the benefits to the whole population by enabling people to have control over their health
112
What are the 3 approaches to health promotion?
- Medical
- Socioenvironmental
- Behavioural
113
What is the difference between high risk and population approach to health promotion?
- High risk only targets high risk group whereas population targets the whole population
- Large benefits seen among high risk group but small changes seen at individual level for population approach however as a whole, substantial benefit for population approach
114
What consists of in the interventional ladder?
1. Do nothing
2. Provide information
3. Enable choice
4. Disincentives
5. Incentives
6. Change default policy
7. Restrict choice
8. Eliminate choice
115
What are methods of health promotion?
- Health communication via leaflets, adverts
- Health education
- Self help eg alcoholic anonymous
- Organisational change
- Community development
- Policy/legislation
116
What are the role of doctors?
For patients: Lifestyle advice, referral, advocacy, empower patients to manage chronic disease
For healthcare: Participate in public health research, contribute to national reports
117
What is the role of screening?
Identify apparently health people who are at an increased risk of disease
118
How do you calculate sensitivity?
a/(a+c)
119
How do you calculate specificity
b/(b+d)
120
How do you calculate positive predictive test?
a/(a+b)
121
How do you calculate negative predictive test?
c/(c+d)
122
What happens when you screen a low risk population?
High false positive
123
What does sensitivity tell us?
How good a test is at picking up disease
124
What does specificity tell us?
How good a test is at excluding disease
125
What do each population gain/lose from screening?
1. True positive: Disease picked up early so can be treated immediately but if no treatment then is it worth knowing? Will you be labelled
2. False positive: Need to emotionally go through more tests. Hazards of further diagnostic tests and costs
3. False negative: Give them false reassurance and delays diagnosis
4. True negative: Hazard and costs of screening
126
What is the function of a National Screening Committee?
Advise ministers on all aspect of screening policy, evaluate screenings and research evidence
127
What are the non NSC approved screening programmes?
- Prostate cancer
- Chlamydia screening
- Health check every 5 years above 40
128
What are the types of bias that could arise from screening?
1. Volunteer bias
2. Lead time bias
3. Length time
129
What is volunteer bias?
People who do attend screening are more concerned for their health so possibly have better health
130
What is lead time bias?
Disease is diagnosed at an earlier stage (pre-symptomatic) so makes it seem like patient lived longer from point of diagnosis but no change to course of progression of disease
131
What is length time bias?
- Diseases with long pre-clinical phase more likely to be detected and usually has better prognosis because it is less aggressive.
132
What is the definition of tertiary prevention?
- Reduce impairments
- Promote patient's adjustments
- Improve function/minimise impact
- Prevent complication
133
What are the key characteristics of tertiary prevention?
- Patient has an established disease
- Focus on intervention of either improving function or preventing gradual decline
- Intervention begins after acute disease
- Long timescale
134
What are the types of tertiary prevention?
- Clinical
- Collaborative: Physiotherapy, occupational, psychologist
- Social: Minimise disability
135
What are the primary, secondary and tertiary interventions for stroke?
Primary - Smoking/alcohol
Secondary - FAST, TIA management
Tertiary - Rehabilitation
136
How is the process of stroke rehabilitation? What programme is this?
- Early in the hospital: Mobilisation and functional positioning
- Community: Early discharge and long term rehabilitation
National Stroke Strategy
137
What are the facets of rehabilitation?
- Aerobic training
- Arm re-education
- Orthoses
- Positioning
- Self management
- Task training
- Splinting
- Assessment
138
What are the phases in cardiac rehabilitation?
I: Counselling/assessment
II: Post discharge support
III: Structured exercise programme
IV: Long term maintenance
139
What are the components in the tertiary prevention shopping list?
- Rehabilitation
- CBT
- Medication Adherence strategies
- Mental health relapse prevention
- Dietary advice
- Routine review
- Self management plans
- Community support groups
140
What is palliative, supportive and end of life care?
- Palliative care: Relief their suffering and support them through tough times
- Supportive: Support patient and their family members to cope with the condition and treatment from pre-diagnosis to bereavement services
- End of life care is a mixture of palliative and supportive care so that their needs are identified and met through that last phase.
141
What are the components of holistic approach to palliative care?
- Physical
- Psychological
- Social
- Spiritual
142
What are the trajectories of death?
1. Sudden - Car accident
2. Well then sudden decline- terminal disease
3. Better then decline then better - Organ failure
4. Slow decline- Old age
143
What is the difference between spectacular and subtacular?
1. Spectacular- Sudden traumatic loss of life, high priority in A&E
2. Subtacular- Management of chronic disease, neglected in A&E
144
What are the concerns over care?
- Poor communication
- Lack of recognition of expert family
- Lack of continuity of care
145
What are the End of Life Care Policies in present?
- Gold Standard Framework
- Liverpool Care pathway no longer used
- NHS EOL strategy 2008
146
What are the criteria to initiate a Liverpool Care Pathway based on recommendations given?
- Senior clinician
- Cannot do it out of hours
- Urgent call to nurse/midwifery for advice
147
What is an Advanced Statement and Advanced Refusal?
- Advanced Statement is to formalise what patient/family wish to happen to them later in their disease. It is not legally binding
- Advanced Refusal is formalising what patient/family do not wish to happen and it is legally binding
148
How can patients play a distinct role in their healthcare?
- Understanding cause of disease and factors that influence it
- Self diagnosis and treating minor self-limiting condition
- Selecting most appropriate treatment for acute conditions
- Managing treatment and taking medications
- Monitoring symptoms and effects of it
- Being aware of safety issues
- Adopting healthy behaviour
149
What is health literacy?
Ability to make sound health decisions in the context of everyday life
150
What are the objectives of health literacy?
- Provide information and education
- Encourage appropriate and effective use of healthcare
- Tackle health inequalitites
151
What is self-efficacy?
Patient's belief that they have the capacity to learn a perform a specific behaviour, confidence and ability is the key.
152
What are some patient empowerment techniques?
- Coaching
- Prompt cards
- Diaries
153
What is the function of Healthwatch?
Ensure patient involvement in NHS planning
154
Define carer
Designated person who provides long term help to a disabled person usually a family member of their immediate family but now extends to social care worker
155
What do family carers receive from the government?
Carer's Allowance or manage social security payments such as Attendance allowance
156
Who are care providers?
- Family
- NHS
- Local authorities
- Charities
- Private sector
157
What are the problems with staff care?
- Abuse/neglect
- System of abuse in contracting system which forces down expenditure leading to poor pay, difficulty recruiting staff and unfilled vacancies.
158
What are the problems associated with the term carer?
- Families see it as ordinary obligations and activities of family life
- Support is reciprocal
- Carer suggests disabled person is in permanent need of attention
159
What is the impact of care by spouse/partners?
- Feeling exposed and vulnerable
- Changes in employment and income
- Change in relationship and family responsibilities
- 24 hour on call
- Stress greatest in the early stages and towards end of life.
160
What is the impact on family life for caring for a disabled child?
- Single parents, poverty
- More time consuming and costly
- Disproportionate effects on those with low income
- Stigmatisation
- Burden
- Family are diverse and capable of adaptation to unforeseen events
161
What is occupational health?
Discipline that focuses on effects of work on health and influence of pre-existing health problems on the capacity to work
162
What are the core services provided by occupational health team?
- Prevention
- Timely intervention
- Rehabilitation
- Health assessment
- Promotion of well being
- Teach and train staff to support health and well being
163
What consists of pre-work assessment?
- Health status
- Job requirement
- Functional assessment
- Restrictions
- Adaptiations
Foundations 3
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