Phase 2 a public health Phase 2 a

Phase 2 a public health

Phase 2 a public health Phase 2 a Revision Session Hannah Jauncey and Claire Walker 24/04/17 The Peer Teaching Society is not liable for false or misleading information…

Incidence and prevalence • Incidence: number of new cases of a disease/ condition in a population per unit time (usually per year). • Prevalence: number of existing cases of a disease/ condition in a population at a given point in time. The Peer Teaching Society is not liable for false or misleading information…

Stages of change model • Anyone know what the * represents? http: //www. its-possible. ca/wpcontent/uploads/2012/12/stages-ofchange. png The Peer Teaching Society is not liable for false or misleading information…

Prevention • Primary Prevention – Aims to prevent the onset of disease and involves interventions that are applied before any evidence of disease is present • Secondary Prevention – Detection of disease in earliest stages before symptoms are present and intervening to slow, stop or reverse disease progression • Tertiary Prevention – Interventions designed to arrest the progress of established disease and minimise its negative consequences. The Peer Teaching Society is not liable for false or misleading information…

Bias • Bias – a systematic deviation from the true estimation of the association between exposure and outcome. • 1. Selection Bias – systematic error in selection/allocation of study participants • 2. Information (measurement) Bias – systematic error in measurement/classification of exposure or outcome. The Peer Teaching Society is not liable for false or misleading information…

Screening: A process which identifies apparently well individuals who may be at increased risk of developing a condition in the early stages of a condition so that intervention can alter the disease course → reduce morbidity and mortality. https: //www. betternoi. com/Better/includes/the mes/Better. NOI/images/er-screening. png The Peer Teaching Society is not liable for false or misleading information…

Examples of screening programs? • • Bowel Breast Cervical cancer AAA Fetal anomaly screening programme (FASP) Diabetic eye screening Newborn and infant physical examination (NIPE) Newborn heel prick test The Peer Teaching Society is not liable for false or misleading information…

Screening principles • Important condition • Population for screening identified (eg: women between 25 -55) • Cost effective • Natural history of disease must be known • Early/ latent stage recognizable • Suitable test (safe, acceptable to public, appropriate for condition). • Effective+ acceptable treatment • Continuous process (not a one off event) The Peer Teaching Society is not liable for false or misleading information…

True positives/ negatives • True positive: result is positive and they actually have the disease. • True negative: result is negative and they actually don’t have the disease. https: //lh 6. ggpht. com/c. Cy. Xg 9 Dqs 3 w 0 b. UN 8 Jjm. Jv. RQ 1 t. Gs 1 ZAW 6 q. Dp 9 WXzpln Qo 6 MWw. JVl. TEVw. Xc. Epp. Yz. Vy. Zg=w 300 The Peer Teaching Society is not liable for false or misleading information…

False positives/ negatives • False positive: result is positive but they actually don’t have the disease. • False negative: result is negative but they do have the disease. https: //lh 6. ggpht. com/c. Cy. Xg 9 Dqs 3 w 0 b. UN 8 Jjm. Jv. RQ 1 t. Gs 1 ZAW 6 q. Dp 9 WXzpln Qo 6 MWw. JVl. TEVw. Xc. Epp. Yz. Vy. Zg=w 300 The Peer Teaching Society is not liable for false or misleading information…

Sensitivity, specificity, PPV and NPV definitions: • Sensitivity: ability of a test to correctly identify those with the disease. • Specificity: ability of test to correctly exclude those who don’t have the disease. • PPV: proportion of the positive results that are true positives. • NPV: proportion of the negative results that are true negatives. The Peer Teaching Society is not liable for false or misleading information…

The table In terms of the letters a, b, c, d write down the calculations for sensitivity, specificity, PPV and NPV: • Sensitivity= a/ (a+c) • Specificity= d/ (b+d) • PPV= a/ (a+ b) • NPV= d/ (c+d) http: //2. bp. blogspot. com/-6 j 4 js. Ij. VLDI/Tjm 4 oh. Cagr. I/AAAAABo/JLKMEPPe 5 Wc/s 1600/senspec. gif The Peer Teaching Society is not liable for false or misleading information…

Limitations of screening • False positives: unnecessary worry/ stress to those who don’t have the disease • Negative results: people feel they have a license to take risks. • Over detection of sub-clinical (“harmless”) cases • “Harm” from screening: (eg: radiation exposure from mammography). The Peer Teaching Society is not liable for false or misleading information…

Limitations of screening • What are the limitations of using PSA as a screening test for prostate cancer? • What is the limitation of using a D-dimer to detect PE? Is it a sensitive/ specific test? http: //laboratorytests. net/wp-content/uploads/2016/05/d-dimer. jpg The Peer Teaching Society is not liable for false or misleading information…

Risk • Absolute risk: risk of developing a disease (eg: lung cancer) over a time period. Eg: risk of lung cancer is 45/ 300 in smokers and 5/700 in non smokers. • Relative risk: risk of getting a disease (eg: lung cancer) in exposed group (eg: smokers) compared to an unexposed group (eg: nonsmokers). It’s a ratio so has NO UNITS. Eg: 45/300 divided by 5/700 = 21. 4 x the risk of lung cancer in smokers compared to non smokers. • Attributable risk (AR) aka ARR (absolute risk reduction): rate of disease in exposed that may be attributed to exposure. Ie: incidence in exposed minus incidence in unexposed. Eg: 45/300 – 5/700. The Peer Teaching Society is not liable for false or misleading information…

ARR and NNT: how many people need to be treated for one person to benefit? How do you calculate NNT? NNT= 1/ ARR Remember if you get an NNT of 6. 99 round it up because you can’t have 6. 99 of a person! The Peer Teaching Society is not liable for false or misleading information…

Never events • Definition: a serious, largely avoidable patient safety event which should not occur if the available preventative measures have been implemented. https: //jkrouwer. files. wordpre ss. com/2008/05/img 36. jpg The Peer Teaching Society is not liable for false or misleading information…

Never event examples… • • Wrong site surgery/ foreign object retained. Wrong drug dose/ route. ABO incompatibility. Mental health: escape of transfer patient. http: //www. pizaazz. com/wp-content/uploads/2010/03/didntusechecklist 300 x 297. jpg The Peer Teaching Society is not liable for false or misleading information…

Human error Error: an unintended outcome. Neglect: falling below the acceptable standard of care. Types of error: • Errors of commission: doing something. • Errors of omission: not doing something. Examples: • Sloth error: being lazy, not checking. • Communication break down. • Lack of skill. • Lack of knowledge. http: //katerawlings. com/wpcontent/uploads/2011/11/9870 human_error_happens. jpg The Peer Teaching Society is not liable for false or misleading information…

Swiss Cheese model • Each layer represents processes which have been put in place to prevent errors happening. • Holes are where processes can fail. • When the holes in the cheese line up an error can occur. • Latent errors: first 3 layers. • Active error: unsafe act. http: //patientsafetyed. duhs. duke. edu/_images/module_e/sw_aligned. gif The Peer Teaching Society is not liable for false or misleading information…

Negligence Breach of legal duty of care owed which results in harm to that patient. 1. Was there a duty of care? 2. Was that duty of care breached? 3. Did the patient come to harm? 4. Was the harm due to the breach in duty of care? http: //images. clipartpanda. com/negligence-clipart-spanish-lawyersmalpractice. jpg The Peer Teaching Society is not liable for false or misleading information…

2 tests of negligence? • Bolam: would a group of reasonable doctors have done the same? • Bolitho: would it have been reasonable of them to do so? The Peer Teaching Society is not liable for false or misleading information…

Patient Compliance Factors affecting patient compliance: 1. Socioeconomic – related factors eg. long distance from treatment setting 2. Health system – related factors eg. supply of medication 3. Condition – related factors eg. memory impairment 4. Therapy – related factors eg. complex treatment regimens 5. Patient – related factors eg. disbelief/denial of diagnosis The Peer Teaching Society is not liable for false or misleading information…

Coronary Artery Disease – Risk Factors Traditional Risk Factors • Increased Age • Male Gender • Family History • Smoking • Obesity • Hypertension • Hyperlipidaemia • Diabetes Mellitus Sedentary Lifestyle Psychosocial Wellbeing Alcohol Consumption Genetic Factors Plasma Lipoprotein(a) concentration • Coagulation Factors • C-Reactive Protein • NSAIDs • • • Other. The. Risk Factors Peer Teaching Society is not liable for false or misleading information…

Substance Misuse Interventions Principles of treatment: • Minimise harm eg. decrease risk of blood-borne virus infection/transmission • Substitute prescribing eg. methadone or buprenorphine for opioid addiction • Psychosocial interventions • Residential treatment • Self-help groups The Peer Teaching Society is not liable for false or misleading information…

Meningitis and Immunization • Meningitis usually refers to a serious infection of the meninges and bacterial meningitis is fatal unless treated. • Meningitis B vaccine – 3 doses given at 8 weeks, 16 weeks and 1 year of age • 5 in 1 vaccine - 8, 12 and 16 weeks of age • Pneumococcal vaccine - 3 doses given at 8 weeks, 16 weeks and 1 year of age • Hib/Men C vaccine – one dose at 1 year of age • Meningitis ACWY vaccine (protects against meningococcal groups A, C, W and Y) – one dose at 14 years (as a replacement for 12 week Men C vaccine) The Peer Teaching Society is not liable for false or misleading information…

Pandemic Influenza • Endemic – disease permanently present within a population in a particular geographical area and /or normal prevalence of the disease • Epidemic - an increase in the prevalence of a disease above the number usually observed in the population in a particular area • Pandemic – an epidemic which occurs in several countries or continents • 3 Influenza pandemics occurred in the 20 th centaury. During a pandemic, most people will have limited immunity to the virus due to the absence of previous exposure. The Peer Teaching Society is not liable for false or misleading information…

Confidentiality What are the 3 times you can break confidentiality? • If they are a risk to the public (they intend to commit a crime). Ie: benefits to society/ an individual outweigh the benefits of maintaining confidentiality. • If they have given consent. • If it is required by law: notifiable diseases (eg: ebola), a judge orders you to do so (eg: as part of a GMC investigation). In these scenarios you must always try to get their consent but you don’t need it. The Peer Teaching Society is not liable for false or misleading information…

Please refer to the Phase 2 a curriculum for the topics we were unable to cover during this teaching session. The Peer Teaching Society is not liable for false or misleading information…