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| Multiple Determinants of Health |
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Definition
Health Care, Behavior, Biology, Environmental, Social/Economic
"Have Big breakfasts - egg sandwiches" |
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| Prevention, clear consistent messages, benefits environment and community, sustained, measurable improvements, evidence (science) based |
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| 3 public health challenges (IOM) |
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Globalization
Scientific and Medical Technology
Demographic changes |
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| in top or bottom 2.5% In a panel of 20 tests one would by chance be abnormal |
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ignoring the exception to the rule
"common things are common" mentality
Avoid by: differential diagnosis every time |
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Letting our proconceptions influence our diagnosis
Avoid by: dont make assumptions
consciously alter persons connotation
"we attribute diseases based on looks" |
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not wanting to believe bad things or do uncomfortable things to the people we love- to objects of "affection"
avoid by: play it by the book, put feelings aside |
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overly influenced by the last or most memorable case-- our brain makes that answer "available"
Avoid by: ask "why" you think that?
Don't be afraid to DO nothing for a little while |
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subconcious
pattern recognition
Strength- can dicern something is wrong
Weakness- not comprehensive |
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| cherry-picking facts to "confirm" our diagnosis, ignore what doesnt fit-- |
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structured analysis, conscious effort
strenths: comprehensive, standardized
weaknesses: impersonal, time/effort intensive |
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| Four Quadrant Approach to Clinical Ethics |
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Definition
Medical Indications Patient Preferences
Quality of Life Contextual Features |
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Term
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Definition
1. Ethical Theory
2. Principles
3. Rules
4. Particular judgements and actions |
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Term
| 4 Principles of Clinical Ethics |
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Definition
1. Autonomy
2. Beneficence
3. Non-maleficence
4. justice |
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Term
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Emphasizes: the action
Actions are right or wrong in and of themselves, emphasizes duty
Problems: competing duties? cold? |
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Definition
Emphasizes: Agent
What would virtuous person do?
The "good"
what is motivation of doer?
Problems: competing virtues, good people make mistakes |
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emphasizes: outcome
ends justify the means
Problems: aren't some things just wrong?
How do you define "good" outcome? |
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intuitive sense of right and wrong
"gut reaction"
Hard to explain/ argue
Problems:How can you resolve conflict? What if your moral compass is totally off? |
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Term
| 3 element types of informed consent |
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Definition
Threshold elements
Information elements
Decision Elements |
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Term
| 2 Threshold elements in informed consent |
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Definition
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Term
| 3 information elements of informed consent |
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Definition
Disclosure
recommendation
understanding |
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Term
| 2 Consent elements of informed consent |
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Definition
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Term
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Definition
supreme court case- 1963
Says attending physician is ultimately responsible |
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Term
| Harris vs. Robert C. groth |
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Definition
Supreme court case 1983
follow up to price v. Neland
Says attending physician is ultimately responsible (for informed consent etc) |
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Term
| 4 Exceptions to informed consent |
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Definition
Emergency
Medical Neglect
Waiver to informed consent
Incompetence (lack of DMC)
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Definition
| Person named by court to make decisions of pts. behalf |
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| Person named in DPA-HC to make decisons for pt |
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| person best able to offer sustituted judgement in absence of DPA-HC |
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What reasonable person would want
drawback: impersonal |
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| Hierarchy of Ethical Decision Making |
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Definition
Autonomy
Substituted Judgement
Best interests |
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Term
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Definition
Type of DNR
valid only at Fletcher Allen
as opposed to COLST
valid in all clinical settings |
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| Exceptions to Confidentiality |
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Definition
Pt threat to harm self
pt threat to harm others
Required by Law
(ex. communicable diseases, bites of rabid animals, child abuse, cancer registry) |
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one's relationship to the divine
manifested in group observance of ritual |
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one's personal understanding of the relationship between oneself, others and the universe
may involve "religion"
include values, goals, priorities |
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| 3 Characteristics of a "profession" |
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Definition
1) self-regulation
2) expert knowledge
3) Fiduciary Responsibility |
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Definition
§ being professional vis-à-vis:
1)Yourself: don’t self-medicate or self-diagnose
2)Family & friends: don’t treat family and friends
3)Staff: be respectful, but accept your authority
4)Health care industry: There is no free lunch! |
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an unequal relationship based on trust, where the focus is on the best interests of the vulnerable party
based on communication and humanism |
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commissions or omissions
would be judged wrong at time it occurred
doesn't necessarily lead to negative consequence
distinct from mal-outcome
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| prevalence of specific allele among individuals in a given population |
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| frequency of specific allele among all alleles in a given population |
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| Assumptions in H-W equilibrium |
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Definition
large population/ random mating
constant allele frequencies |
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Term
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Definition
(p+q)^2= p^2+ 2pq+q^2
2pq= carrier frequency
q^2= frequency of condition |
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| The first family member clinically diagnosed with the condition |
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Definition
No skipped generations
Each child has 50% chance of getting it
transmitted equally to men and women |
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Definition
Affect members of sibship
Parents are heterozygous carriers
carriers have 1 in 4 chance of affected child |
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Definition
| mitotic mutation in fetus |
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Definition
| mitotic mutation in tumor |
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Definition
| chromosomes with small p arm that consits of a stalk and a sattelite that code for ribosomal RNA - form nucleolus of cell |
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Definition
-dark bands
-relatively inactive |
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light bands
actively transcribed |
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Chromosome number is a multiple of 23
-"just like you (eu)" |
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Definition
| -Chromosome number not multiple of 23 |
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Term
| robertsonian translocation |
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Definition
structural abnormality
-two acrocentric chromosomes fuse together
-p arms lost
- result in two long arms (q arms) |
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Definition
refers to the effect on one person
-genetic expression affects multiple organ systems |
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refers to the genetic expression in population
-condition is expressed differently in different people |
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Definition
the propability of an individual expressing a condition given inheritance of the pre-disposing genotype
- happens in cancer |
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| the production of identical phenotypes by a mutation at two or more different loci |
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Definition
populations: different mutant alleles at same locus
individual: the same or similar phenotypes may be caused by different mutation alleles rather than identical alleles at the same loci
carriers by difinition exhibit allelic heterogeneity |
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Term
| two ways of getting declared dead |
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Definition
1) heart-lung death
2) death by neurologic criteria |
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Definition
1976
"even patients who lack DMC have right to refuse life-sustaining treatment" |
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Definition
-states can set "reasonable standards"
-artificial hydration and nutrition is life-sustaining treatment
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1997
The court unanimously rules
Difference between letting die and making die |
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Definition
The right to suicide has no place in constitution
outweighed by "compelling state interest" |
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