Quiz 2 PHC 216 Past Paper PDF

Quiz2 QUESTION 1 Which one of these follows a predetermined course of action set out in a protocol with which researchers have to comply until a defined endpoint is reached? A. Medical treatment B. Innovative Treatment C. Research D. Clinical treatment QUESTION...

Quiz2 QUESTION 1 Which one of these follows a predetermined course of action set out in a protocol with which researchers have to comply until a defined endpoint is reached? A. Medical treatment B. Innovative Treatment C. Research D. Clinical treatment QUESTION 2 Which of the following is required to become a doctor? A. Able to teach students. B. Understanding atleast five languages. C. Understanding of medical ethics and law. D. Understanding the emotions of everyone. QUESTION 3 When were the Research Ethics Committees established in the NHS? A. In mid 1960s. B. In the mid 1980s. C. In the mid 1920s. D. In the mid 1930s. QUESTION 4 What is the aim of a research? A. To teach students. B. To achieve the best outcome for the individual patient when standard treatment options have no, or only limited, success. C. To understand the chemistry of diseases. D. An increased understanding of the biology of diseases so that preventive as well as diagnostic and therapeutic interventions can be developed. QUESTION 5 What is an important consideration for patients and the healthcare team? A. The degree of digression from usual practice. B. The degree of digression from special practice. C. The degree of agreement from usual practice. D. The degree of agreement from unusual practice. @academic_PHC QUESTION 6 What is required for patients to be aware of, in order for their consent to be considered valid? A. Who will be present? B. Who will be absent? C. They should be aware of their own job. D. They should be aware of their appearance. QUESTION 7 What is an ongoing necessary, process throughout a doctor's career? A. Teaching. B. Education and training. C. Surgeries. D. Learning languages. QUESTION 8 Which one of these factors is to be considered by RECs? A. Display identifiable information about other participants. B. Never store or use subject identifiable information. C. Storage and use of subject identifiable information. D. Display identifiable information to the public. QUESTION 9 Which of the following is one of the responsibilities of doctors who lead multi- disciplinary teams? A. Do not repect the skills of the colleagues. B. Make sure that the team and the organization have the opportunity to learn from mistakes. C. Discourage the team members to co-operate. D. Do not monitor the team's performance. QUESTION 10 Which of the following is the first concern for patient health data? A. Court's welfare B. Patient's welfare C. Doctor's welfare D. Teacher's welfare @academic_PHC QUESTION11 Which one of the following is the primary aim of teaching medical ethics? A. No need for any preparation. B. To develop a video. C. To develop a powerpoint. D. To develop a questioning. QUESTION12 What is the aim of innovative treatment? A. To achieve the best outcome for the individual patient when standard treatment options have no, or only, limited success. B. To increase the understanding of the biology of diseases. C. To increase the understanding of the chemistry of diseases. D. To acquire knowledge rather than to benefits of the participants. @academic_PHC  PHC 216 Final-First Semester 2023 Question 1 Regarding the duties of doctors to monitor quality and performance, when does risk management is assumed to be successful? A. When mistakes are not big enough for consideration B. When mistakes can be reported and analyzed C. When mistakes can be solved and handle D. When mistakes are easy to be handled and managed Question 2 Which of the following is a primary aim of the teaching of medical ethics to students? A. To decrease medical awareness of medical errors B. To improve physicians’ performance in treatment C. To develop a questioning, enquiring, and analytical mind D. To improve patient safety by physicians Question 3 Which one of the following tools has an important role in the promotion of public health, as they can present an emotive, human angle to health stories? A. Scientific papers B. Media C. Public health reports D. Governmental agencies Question 4 Which of the following young person's competency can fluctuate? A. Their history B. Their decision C. Their needs D. Their medical condition Question 5 What should be done when a child refuses care and/or the competency of a child is in doubt? A. Treatment must be withdrawn. B. Parents should be warned. C. Courts must get involved. D. The patient must be dismissed. @academic_PHC 1| Question 6 Which other one from the below cases is considered to be impulsive, rash, and negligent? A. All doctors must work within their competence. B. Embarking on an inherently difficult procedure by a GP C. Embarking on an inherently difficult procedure by an experienced specialist D. Embarking on a simple procedure by an experienced specialist Question 7 Which of the following is the ethical purpose of consent? A. Some interventions can be harmful B. Patients’ views should be respected. C. Consent is the trigger that allows treatment D. Some interventions could be considered assault or battery Question 8 In which of the following circumstances families and those close to the adult are allowed to consent on behalf of an incapacitated adult? A. If they have been working in health care B. If they have been appointed as patient's proxy decision maker C. If they have been appointed as a family member D. If they have been appointed as managers Question 9 When an agreement on treatment cannot be reached in a reasonable period, who should get involved in decision-making? A. Courts B. Parents C. Police D. Hospital Question 10 In which of the following circumstances could informed consent be waived? A. When immediate treatment is necessary to prevent death or permanent impairment B. When the patient is unhappy with the results and wants to understand the process again C. When a patient is above age 18 and able to give proper consent in normal circumstances D. When a patient is found to be competent enough to give proper consent @academic_PHC 2| Question 11 Which one of the following terms refers to students who learn not only from their formal teaching, but also from their experiences of observing and working with practicing doctors? A. Formal curriculum B. National curriculum C. Informal curriculum D. Hidden curriculum Question 12 Which one of the following is a principle for teamwork? A. All team members have a responsibility for ensuring the team’s effective functions. B. Team members should not be supported in their role at any point in time in any situation. C. Policies are shared and aims should be clear for the leader only in the D. All team members are responsible for passing on information about patriations’ to others. Question 13 Which one from below refers to “A pre-determined course of action set out in protocol with which researcher have to comply until a defined endpoint”? A. Research B. Treatment C. Experimental therapy D. Innovative Question 14 Which one of the following is a necessary ongoing process throughout a doctor's career? A. Business development B. Hospital development C. Education and training D. Teaching Question 15 Which of the following best describes off-label drugs? A. They are substitute medicines that meet the patient’s needs after the request. B. They are new drugs that have not been used before in clinical practice for patients. C. Factually unlicensed medicines and lack a body of evidence to support their use. D. They are licensed medicines supported by a body of evidence for legal use. @academic_PHC 3| Question 16 How disagreement or conflict within teams can be minimized? A. By effective communication B. By signing a consent C. Conflict cannot be minimized D. By distributing easy tasks Question 17 What do we mean by health if we define it as an agency? A. The adoption of a changed social role resulting from illness B. A necessary condition for the achievement of goals C. An absence of any abnormal biological functioning D. The individual’s subjective feeling of well-being Question 18 Who must give consent for non-therapeutic circumcision, in the best interest of the child? A. Incompetent Children B. Nurse C. Parents D. Doctor Question 19 Who typically has full responsibility for prescribing medicines for inpatients and outpatient clinics? A. Pharmacist B. Registered nurse C. Consultant D. Physiotherapist Question 20 Who is legally responsible for prescribing medicines? A. The registered nurse who administers patient care B. The front office manager who attends to the patient C. The pharmacist who dispenses medicines D. The doctor who signs a prescription @academic_PHC 4| Question 21 When children must not be discharged from the hospital without a full examination? A. If the diagnostic is very difficult to make B. If the parents, ask for it C. If there are concerns about the wellbeing of the child D. If the condition of the child is not serious. Question 22 On what basis, the confidential medical information of a patient should be shared with the professional providing care? A. Not sharing B. Need to know. C. Open information D. Financial basis Question 23 Which of the following is a cause of poor practice? A. Setting and monitoring clear quality standards B. Hospital regulations for the patients C. Health professionals under stress D. Physicians’ high incomes from the patient Question 24 What is the law regarding taking samples from incapacitated drivers to test for blood alcohol levels in some circumstances? A. The law does not permit the taking of the blood sample. B. The law permits the taking of the blood sample C. The law permits the taking of the blood sample only after a court order. D. The law permits the taking of the blood sample after the consent. Question 25 In which of the following circumstances patients cannot be informed that their treatment is innovative or part of research? A. When a patient lacks mental capacity B. When the subject is aged >18 years C. When a minor is cidered emancipated D. When is a patient at high risk of complication. @academic_PHC 5| Question 26 Which one of the following is the statement referring to “Hidden Curriculum”? A. Students learn from their formal teaching only through available books and journals. B. Students learn from their formal teaching and their experiences of working with practicing doctors. C. Students learn from their conferences and workshops at their medical colleges only. D. Students learn from their colleagues only while doing training in the medical college. Question 27 Legal responsibility of a prescription lies with which of the following? A. No one holds any legal responsibility. B. The doctor who signs it C. The doctor and his team D. The patient and the doctor Question 28 Which one of the following aims to achieve the best outcome for individual patients when the standard treatment gives no or limited success? A. Ethics of the researcher B. Ethics of physician C. Research D. Innovative treatment Question 29 Which of the following refers to the presence of a disturbance in the biological functioning of the body? A. Illness B. Health C. Sickness D. Disease Question 30 Which one of the following is an essential principle to being a good doctor? A. Understanding different languages to communicate with the attendants. B. Understanding management ethics to lead the administrative team. C. Understanding how to chemically engineer new medication for people D. Understanding medical ethics, medical laws, and the ethical practice @academic_PHC 6| Question 31 In the context of ethics and regulations in healthcare, how can we best designate? A. Legal, accurate, electronic, and downsized B. Accurate, clear, factual, and legible C. Legible, contemporaneous, ethical, and electronic D. Clear, short, realistic, and factual Question 32 Which of the following under circumstances, the law does not allow compulsory treatment? A. Mental disorder. B. Some forensic purposes C. Normal Conditions. D. Some investigation under public health legislation Question 33 What is the purpose of the NHS (National Health Service, UK) performance assessment framework and national surveys of patient and user experience? A. Increase service cost for the patient. B. Reduce service costs for the patients. C. Enable quality to be monitored. D. Legal uses of the information Question 34 When should doctors prescribe lifestyle drugs? A. When the drugs are not approved by Food and Drug Administration (FDA) B. When the drugs are not in the best interests of the patient C. When doctors need to form business connections with companies D. When the doctors consider them clinically appropriate for the patient @academic_PHC 7| ESSAY Give 3 types of recordings for which consent to make the recordings is implicit:  Images of internal organs or structures.  Images of pathology slides.  Laparoscopic and endoscopic images.  Recordings or organ functions.  Ultrasound images.  X-rays. What are the main points of Al-Tabari 's code of medical ethics? Write any three. Personal Characters of the Physician: The physician ought to be modest, virtuous, merciful, and to not use liquor. He should:  Wear clean clothes, be dignified, and have well-groomed hair and beard.  Not join the ungodly and scoffers of truth, nor sit at their table.  Select his company from among persons of good reputation.  Be careful of what he says and should not hesitate to ask forgiveness if he makes an error.  Be forgiving and never seek revenge.  Be friendly person and a peacemaker.  Not make jokes or laugh at the improper time or place. Why a young people can competency fluctuate? Give any 3 conditions: A young people's competency can fluctuate because of:  Their medical condition.  Medication.  Time of day.  Their mood. List 3 of the general principles that are applicable to emergency care?  The duty to promote patient autonomy and patient-centered services.  The protection of patient confidentiality, privacy and dignity.  The duty of care both for patients and, in some cases, families.  A recognition of the abilities of others in the healthcare team to work across traditional boundaries.  The obligation to act within one's sphere of competence. @academic_PHC 8|  Mid-term PHC 216 Summar Semester 2024 Question 1 What are doctors' responsibilities with respect to child protection? A. The well-being of the child or children concerned B. Ignoring all the wishes of the child C. Hide the treatment from the parents D. Discharge the child from hospital immediately Question 2 Which of the following are necessary to assure the validity of consent? A. Championship and competition B. Competence, information and voluntariness C. Completeness, respect and precision D. Ambiguousness and secret Question 3 Which do we call the people providing clinical services for a patient, and the administrative and other staff ? A. Healthcare team B. Mastering skills C. Observance of patients' rights D. Devotion to the profession Question 4 Who is entitled to give consent to medical treatment on behalf of children? A. People with parental responsibility B. First and third relatives C. Close neighbours D. Child's friends Question 5 Which of the following can help the doctor to take right decision about patient's conditions particularly under complex situation? A. Consult relatives, carers and any proxy decision makers B. Provide best physical therapy to all patients C. Review the technical notes from literature D. Give the patient who lack capacity to decide Question 6 Which of the following is considered as part of essential nursing care which should be offered to all patients? A. Dehydration and empowerment B. Nutrition and hydration C. Navigation and exploration D. Reading and writing Question 7 Which of the following is one of the Six categories of recordings for which consent to make the recordings is implicit and does not need to be obtained separatel? A. Images of internal organs or structures B. Images of patient face C. Handwriting paper of the patient's wishes D. Patient's financial status Question 8 When will doctors talk to children about their health conditions? A. When children are nervous B. When children are relaxed and comfortable C. When children are uncomfortable and stressful D. When children are unconscious Question 9 Which of the following should be included in health records? A. Health professionals' personal records B. Manger opinion about the patient C. Nurse personal views about patient D. Reasons for seeking healthcare Question 10 What type of communication is crucial when patients are approaching death? A. By conflict management B. By effective communication C. By ineffective communication D. By lack of communication Question 11 When do the courts need to be involved in decisions? A. If the patient is not competent in a general sense B. In some emergency situations C. When agreement on treatment cannot be reached in a reasonable period D. For any surgical operation or related medical procedures Question 12 Who are patient's proxy decision makers? A. People appointed by the patient to make decisions on their behalf B. People appointed by the doctors to decide on treatment C. Patient's capacity and able to take decisions D. The medical staff who serve the patients Question 13 Which of the following conditions are focused on goals of end-of-life care? A. Compassion, sensitivity, and honest communication B. Ineffective communication within the health team C. It is unimportant to recognize when death is approaching D. Health professionals should be sensitive to patients' financial status Question 14 Which concept has been defined as agreement to an action based on knowledge of what that action involves and its likely consequences? A. Consent B. Decision C. Anonymized D. Cognitive development Question 15 What measure do healthcare professionals have to take when disclosing patient photographs or videos for a secondary purpose? A. Anonymize the photo or video B. Disclose patient information C. Secure the information in a public place D. Present it without coding Question 16 What is meant by anonymized information? A. Information from which individuals cannot reasonably be identified B. Information from which individuals can easily be identified C. Personal information used to identify the patients D. General information about socioeconomic status Question 17 When consent cannot be obtained in an emergency, should doctors provide treatment? A. Immediately necessary to preserve life B. Delay the necessary treatment C. Tertiary and complementary treatment is provided D. Wait for federal approval Question 18 Which of the following is considered as one of the general principles regarding provision of care for patients at the end of life? A. Patients must be afforded dignity and privacy B. Dignity and privacy are afforded to co-patients only C. Dignity and privacy are not necessary principles D. The physician is the one who decide Question 19 Give 2 types of recordings for which consent to make the recordings is implicit. *Images of pathology slides *Images of internal organs or structures *Laparoscopic and endoscopie images *Recordings or organ functions *Ultrasound images. x-rays Question 20 Why a young people can competency fluctuate? Give any two conditions A young people's competency can fluctuate because of : *Their medical condition *Medication *Time of day *Their mood @Gevinshi  Final PHC 216 Second Semester-2024 Question 1 Which of the following consent is given orally, in writing, or via other means of communication available to the patient? A. Capacity consent B. Express consent C. Immediate consent D. Exhibit consent Question 2 Which concept reflects a situation where a young patient who is competent to make his or her own decisions may nevertheless choose to allow parents to make decisions on his or her behalf? A. Ability to choose B. Inability to show up C. Ability to respect D. Ability to disrespect Question 3 Which of the following is central to the partnership between doctor and patient, with each having a role in decisions about treatment or care? A. Relaxation B. Consent C. Consideration D. Competence Question 4 Which of the following secondary uses of patient information as a disclosure for purposes not associated with providing healthcare? A. Complaints B. Employment C. Public health D. Teaching 1 | @academic_PHC Question 5 Which of the following conditions are focused on goals of end-of-life care? A. Compassion, sensitivity, and honest communication B. Ineffective communication within the health team C. It is unimportant to recognize when death is approaching D. Health professionals should be sensitive to patients' financial status Question 6 Who is entitled to give consent to medical treatment on behalf of children? A. People with parental responsibility B. First and third relatives C. Close neighbours D. Child’s friends Question 7 Which of the following is one of the Six categories of recordings for which consent to make the recordings is implicit and does not need to be obtained separately? A. Images of internal organs or structures B. Images of patient face C. Handwriting paper of the patient’s wishes D. Patient’s financial status Question 8 What measure do healthcare professionals have to take when disclosing patient photographs or videos for a secondary purpose? A. Anonymize the photo or video B. Disclose patient information C. It can be undisclosed to medical students D. Present it without coding Question 9 Which of the following care planning is defined as “A process of discussion between an individual and their care providers irrespective of discipline”? A. Advance care planning B. Emergency planning C. First Aid planning D. Fee planning 2 | @academic_PHC Question 10 What are doctors’ responsibilities with respect to child protection? A. The well-being of the child or children concerned B. Performing the wishes of the child C. Explaining the treatment to the parents D. Offer luxury activities Question 11 When do the courts need to be involved in decisions? A. If the patient is not competent in a general sense B. In some emergency situations C. When agreement on treatment cannot be reached in a reasonable period D. For any surgical operation or related medical procedures Question 12 Which concept has been defined as agreement to an action based on knowledge of what that action involves and its likely consequences? A. Consent B. Conduct C. Anonymized D. Cognitive development Question 13 Under which condition should doctors prescribe medication? A. Sufficient knowledge and experience B. Sufficient knowledge and limited experience C. Extraordinary experience D. Limited knowledge is enough for prescribing Question 14 Which of the following is considered unethical practice where doctors are advised to avoid it? A. Consulting their colleagues in other healthcare establishments B. Forming connections with pharmaceutical companies C. Telling the patients about the side effects of the medication D. Considering mental health of their patients 3 | @academic_PHC Question 15 Why should the prescribing doctor communicate with the GP if he/she is not the patient’s GP? A. To avoid higher cost of treatment B. To avoid conflict with existing treatment C. To suggest innovative treatment D. To offer free treatment Question 16 Who is the one held legally responsible for shared prescribing? A. Third-party consultant B. Chief medical officer C. Hospital advisory committee D. Doctor who signs the prescription Question 17 Which of the following is considered an important guidance applied to inpatients who are discharged from the hospital? A. Being given sufficient drugs from hospital pharmacy for at least 7 days. B. Being given medication supply for at least 3 months C. Discharged patients should revisit the hospital every 2 days D. The patients should be discharged without medications Question 18 Which types of requests from patients that doctors are not obliged to comply with? A. Request to choose efficient medication B. Request to double-check the prescribed medications C. Request to read side effects of prescribed drugs D. Request to prescribe drugs for relatives in another country Question 19 What do we call the research combined with trying to improve patient treatment? A. Non-clinical research B. Theoretical and hypothetical studies C. Non-therapeutic research D. Therapeutic or clinical research 4 | @academic_PHC Question 20 Which term is considered as a means of assessing whether clinical performance conforms to good clinical practice? A. Ecology B. Clinical pharmacy C. Audit D. Validity Question 21 Which of the below-mentioned aspects is regarded as one of the key principles applicable to research and innovative treatment? A. Confidentiality of participants B. Participant’s private matters C. Leisure time D. Community trade affairs Question 22 Which of the following has to be considered if there is a possible risk to research participants? A. Information about risk must be given in a balanced way, without bias B. Giving participants deep technical information about operation of research instrument C. Discussion of the hospital budget related affairs with participants D. Getting approval from the participants about who will lead the medical team Question 23 Which of the following has to be used carefully while asking people to participate in research to avoid encouraging people to act against their own better judgment and to avoid inducement? A. Financial incentives or payments B. Use of recent technologies C. Getting international medical support D. Public-private partnership Question 24 Which statement reflects a general principle applicable to emergency care? A. Share of new information with partners overseas B. Looking for expensive treatment options that are highly efficient C. Protection of patient confidentiality, privacy and dignity D. Safeguarding non-financial items from climatic effects 5 | @academic_PHC Question 25 Who among the following has the right to refuse emergency care? A. Incapacitated children B. Unconscious patients C. Adult patient with capacity. D. Incapacitated adult Question 26 What is the primary aim of the teaching of medical ethics? A. To develop within students a questioning, enquiring and analytical mind. B. To develop an effective approach for cost-benefit analysis C. To develop a means for advanced medical procedures D. To provide baseline data for medical services cost estimation Question 27 What type of teaching refers to students’ learning from their experiences of observing and working with practicing doctors? A. Blended learning B. Online instruction C. Official learning D. The hidden Curriculum. Question 28 Which of the below-mentioned statements indicate important aspects needed for leading teams effectively? A. Discourage innovation B. Giving strict and tough orders for achieving work C. Respecting the skills and contributions of colleagues. D. Offering part-time work Question 29 What do we call the transfer of a patient to a private hospital or doctor for getting specialized treatment or assessment? A. Public healthcare B. Referrals for private treatment C. Private patient’s affairs D. Reversed medical process 6 | @academic_PHC Question 30 Which of the following is considered a priority in triage? A. Treatment of urgent cases B. Treatment of class 2 cases C. Treating those who are likely to live the shortest D. Provision of healthy settlement Question 31 Which of the following involves providing support for healthcare staff who acknowledge their own mistakes and limitations? A. Reducing clinical errors. B. Reducing cost of treatment C. Reducing ambiguity in health research D. Reducing technical barriers Question 32 What sort of risks are associated with the shortage of staff and other resources? A. Reduction in the capacity of the health system. B. Reduction in overseas support C. Dominance of the private sector D. Cultural dimension of education Question 33 Which statement is true about Islamic morality? A. It governs part of social life B. It determines non-religious affairs C. It governs the entire cycle of life. D. It governs the metaphysics Question 34 Which of the following is true about the Islamic perspective on saving life? A. Islam gives importance to saving lives. B. Islam doesn’t give importance to saving lives C. Saving life is a personal decision D. Saving life is a controversial issue 7 | @academic_PHC ESSAY Give two types of recordings for which consent to make the recordings is implicit: ▪ Images of internal organs or structures ▪ Images of pathology slides ▪ Laparoscopic and endoscopic images ▪ Recordings or organ functions ▪ Ultrasound images ▪ X-rays Give two examples of the general principles that should be taken into account when considering the medical treatment of a patient lacking capacity to consent? ▪ Liberty ▪ Decision-making freedom ▪ Dignity ▪ Having their views taken into account ▪ Bodily integrity ▪ Confidentiality ▪ Having their health needs met ▪ Being free from unfair discrimination ▪ Having the views of people close to them taken into account What is meant by the term “research”? Research is the attempt to derive generalizable new knowledge by addressing clearly defined questions using systematic and rigorous methods. Identify two of the principles for teamwork? ▪ Good communication and mutual respect are key ▪ All shared policies and aims should be clear to all members ▪ It should be clear who is ultimately accountable for decision making ▪ Team members should be supported in their role. 8 | @academic_PHC Chapter 13 1. Who is responsible for prescribing medication if drugs are included in a hospital clinical trial hospital consultant 2. which health professional in hospital facility has full responsibility for prescribing for inpatients and for specific treatments administered in hospital outpatient clinic hospital consultant 3. which one of the following is extent to which a patient's behavior matches agreed recommendations from the prescriber? Medicines adherence 4. If patients decided not to take a particular medicine, what should doctors do? Doctors should record the discussion and any information presented to the patient in the medical record and the decision should be reviewed on a regular basis 5. For which of the following cases, doctors must resist pressure from patients while prescribing drugs? For prescribing larger doses 6. which one of the following defined in the Concise Oxford Dictionary as pharmaceutical product characterized as improving quality of life rather than alleviating or curing disease? lifestyle drug 7. In which of the following conditions lifestyle drugs could be prescribed? Doctor consider them clinically appropriate for the patient 8. For the minimum how many days drugs should be prescribed and dispensed by hospital pharmacy to outpatient? 14 days 9. in Scotland which one of the following is responsible for providing advice to health boards about new and existing technologies? Health Improvement Scotland (HIS) 10. which is ultimately responsible for prescribing decisions? Doctors 11. what is a good example of patients expectation affecting prescribing? the inappropriate use of antibiotics 12. How should doctors respond to patients requests medication? Doctors should prescribe medication only when they have sufficient Knowledge and experience to be satisfied that it is appropriate for the patient 13. which one of the following are drawn up by multi-disciplinary groups and signed by a senior doctor and a senior pharmacies and must meet certain legal requirements? Patient group directions (PGDs)  14. How many days patient should be prescribed and dispensed when he/she from hospital? At least 7 days period 15. Which of the following hospitality can be accepted from pharmaceutical companies? Nothing 16. Which of the following are commonly Known as Placebos? Dummy pills 17. Which of the following standards of practice doctors should be familiar with? Doctors should follow GMC advice 18. which of the following is major part of medical practice? prescribing medicines 19. What information should doctors discuss with their patients when they prescribe medicines? Interactions with other medicines 20. Which of the following is a key challenge that doctors face when prescribing for children? Lack of drugs that are licensed for use in age group 21. GMC guidance emphasizes that decisions to prescribe off label drugs should be based on which of the following? Sufficient evidence 22. Which one of the following has full responsibility for prescribing to inpatients and hospital outpatient clinics? Hospital consultants 23. Which of the following is a not common prescribing error? Incorrect name on prescription 24. Who should prescribe and dispense medications for a discharged patient? Hospital pharmacy ‫ﻧﻘﺎﻁ ﻣﻤﻜﻦ ﺍﺗﺠﻲ ﻣﻘﺎﻟﻲ ﺃﻭ ﺍﺧﺘﻴﺎﺭﻱ‬  Common prescribing errors, The four most common errors were : 1. a failure to warn about or recognize drug side effects 2. errors in medication or prescribing 3. a problem associated with an injection 4. incorrect or inappropriate medication. - Prescribing from a Distance if Doctors: o ​have sole responsibility for a patient o ​are working on behalf of another doctor who does o ​are working where a doctor has prior Knowledge of a patient's condition and has the authority to access his or her medical record o Then the GMC advises that doctors must:  o ​Established the patient's current medical conditions and history and concurrent or recent use of other medications including non-prescription medicines o ​Carry out an adequate assessment of the patient's condition o ​Identify the likely cause of the patient's condition o ​Ensure that there is sufficient justification to prescribe the medicines or treatment proposed and discuss other treatment options with the patient where appropriate o ​Ensure that the treatment and/or medicines are not contraindicated for the patient o ​Make a clear, accurate and legible record of all medicines -The types of situation in which a conflict of interest could arise in relation to prescribing:  ​ Gifts or hospitality from pharmaceutical companies  ​payments for meeting pharmaceutical representative  ​Financial involvement of doctors in external health-related services  ​participation in market research  ​ownership of pharmacies -A patient has to get all the right information they can understand. It boils down to:  ​any common adsense side effects:  ​potentially serious side effects  ​what to do in the event of a side effect  ​interactions with other medicines  ​the dosage and administration of the medicine ‫ ﺍﻟﻤﺼﻄﻠﺤﺎﺕ‬:  Medicines adherence is defined as the extent to which a patient's behavior matches agreed recommendations from the prescriber.  'Concordance' describes the process of discussion and negotiation that should take place between a doctor and patient regarding their medication.  Older people receive more prescriptions than any other age group.  prescribing for older people the high prevalence of drug errors that occur amongst this age group.  The aim of concordance is to involve patients in decisions about prescribed medicines and to reach an agreement that takes into account the beliefs and wishes of the patient in determining whether, when and how medicines are to be taken.  most medicines used in the UK are licensed for adults only, in pediatric care doctors are often forced to prescribe drugs o ff-label or prescribe unlicensed  medicines.  Religious law in several faiths forbids the consumption of certain products used in the manufacture of some medicines, for example, alcohol or animal derivatives.  Over-medication and coven administration of medication to patients with capacity is unethical.  (ABPI) =The Association of the British Pharmaceutical Industry.  (CAM)= complementary and alternative medicine  Placebos are commonly referred to as dummy pills or treatments which, unknown to the patient, have no active pharmacological or physiological properties or at least have none specific to the condition for which they are prescribed  prescribing off-label is typically done when there is no suitably licensed an alternative.  Prescribing off-label and unlicensed drugs = can carry additional risks.  Prescribing drugs off-label is relatively common and often necessary in certain specialties, such as pediatrics.  national Institute for Health and Clinical Excellence (NICE) Chapter 14-15 1. In how many categories research is divided from the 1960s to 2000 Two 2. In which type of treatment doctors can prescribe unlicensed medicines and drugs to be used outside the terms of their license but take on greater responsibilities when doing so? Innovative treatment 3. Which one from below refers to "A pre-determined course of action set out in protocol with which researcher have to comply until defined endpoint"? Research 4. Which of the following aims to acquire knowledge rather than benefit participants? Research 5. What are the primary considerations to be taken for the individual participants while conducting research and innovative treatment?  Safety and welfare 6. Which of the following aims to achieve the best outcome for the individual patient when standard treatment options have no, or only limited, success? Innovative treatment 7. Which of the following is the aim of research? Acquire knowledge rather than to benefit participants 8. Which of the following is a key concept in research and innovative treatment? Consent 9. When can confidential medical information shared with professional providing care to the patient? On a 'need to know' basis 10. Which of the following is an essential factor to being a good doctor? Understanding of medical ethics and law, and the ethical practice 11. Within, working in multi-disciplinary teams which members have responsibility for ensuring the proper functioning of the team? Inside members 12. During education and training of medical ethics, which of the following tutors must ensure that teaching, both formal and informal, complies with? Good ethical practice 13. What are the Core Ethical Issues of emergency care of patients? Keep the confidentiality, privacy and dignity of patients 14. Which of the following is the most widely known method of comparing treatment options and obtaining an objective answer? Randomized controlled trials 15. Which of the following is correct if a participant wishes to withdraw from a study during research? Participant is voluntary and they can withdraw at any point of time 16. Which of the following process is essential in multiple casualties and may occur both at the scene of disaster and in emergency department? Triage 17. On which of the following basis confidential medical information of patients  should be shared with professionals providing care? Need to know 18. Which skills from below are essential to the ethical practice of medicine? Communication skills 19. which one from the following is a primary goal of the teaching of medical ethics? Develop a questioning, enquiring and analytical mind. 20. Which of the following includes general principles to emergency care? The duty to promote patient autonomy and patient-centered services 21. Multi-disciplinary team leader always makes sure that his team and organization have the opportunity to learn from which of the following? Mistakes 22. Which of the following factors are an ongoing necessity process throughout a doctor's career? Education and training ‫ ﻧﻘﺎﻁ ﻣﻤﻜﻦ ﺍﻧﻬﺎ ﺍﺗﺠﻲ ﻣﻘﺎﻟﻲ ﺃﻭ ﺍﺧﺘﻴﺎﺭﻱ‬:  Research combined with trying to improve patient treatment was termed 'therapeutic' or 'clinical' research.  Research that simply sought knowledge without claiming to benefit its participants was termed 'non-therapeutic'.  The use of medical records for audit by the clinical team managing the patient's care does not require explicit patient consent; implied consent is generally sufficient.  Factors to be considered by RECs include: 1. whether the chief investigator in the trial is competent and has adequate facilities 2. possible hazards to trial participants and precautions taken to deal with them 3. measures for providing information and seeking appropriate consent 4. whether adequate compensation arrangements are in place in case of any harm arising from the trial 5. methods of recruitment and any payments to participants..  6. payments to investigators 7. storage and use of subject identifiable information.  Measures to Improve research practice: 1. The values of responsible research conduct should be instilled in staff at an early stage by all institutions engaged in research. 2. New researchers should receive training in UK legislation as well as the principles of research practice. 3. Regular audit should occur throughout the conduct of a study and a culture of routine self-audit should be developed among research teams. 4. Research should be recorded in logs, which include details of the research 5. The senior academic or consultant who is conducting the research, or in whose name the research is conducted 6. Research projects should be subjected to rigorous scientific evaluation and all but the simplest should undergo external peer review. 7. Consideration should be given to the use of independent third parties to obtain consent to research 8. Journal editors have an important role in ensuring that publication is declined for research that does not meet standards set out by bodies such as the ICMJE. 9. Editors may also check with the named REC that approval was obtained or, if anomalies are apparent, with the university or other employing body of the researcher.  The role of the NRES includes the following: 1. ensuring robust ethical review of research by RECs 2. providing ethical guidance and management support to RECs 3. delivering a quality assurance framework for the research ethics service 4. providing training programmes 5. working with colleagues across the UK to maintain a UK-~ e framework for ethical review 6. working with colleagues in the wider regulatory environment to  streamline the processes for approving research 7. working with colleagues to promote transparency in research.  GMC advice on disclosure in the public Interest for research The GMC sees medical research as a justifiable reason for a public interest disclosure without consent if: 1. it is essential to use identifiable information, or 2. it is not practicable to anonymize the information 3. and not practicable to seek consent. The GMC also lists the factors that must be explained to an REG when it has to decide whether breach of confidentiality in the public interest would be justified : 1. the nature of the information involved 2. the use that will be made of it 3. how many people will have access to it 4. the security arrangements to protect further disclosure 5. the advice of an independent expert advisor 6. the potential for ha rm or distress to patients  The general principles applicable to emergency care include: 1. the duty to promote patient autonomy and patient-centered services 2. the protection of patient confidentiality, privacy, and dignity 3. the duty of care both for patients and, in some cases, families 4. a recognition of the abilities of others in the healthcare team to work across traditional boundaries 5. the obligation to act within one's sphere of competence.  GMC guidelines on the reporting of gunshot and knife wounds The GMC stipulates the following: 1. You should inform the police quickly whenever a person arrives with a gunshot wound or an injury from an attack with a knife, blade, or other sharp instrument. This will enable the police to make an assessment  of risk to the patient and others, and to gather statistical information about gun and knife crime in the area. 2. You should make a professional judgement about whether disclosure of personal information about a patient, including their identity, is justify ed in the public interest  Domestic abuse In the emergency setting 1. While routine enquiry for domestic abuse is not recommended in emergency departments, it is still important that emergency doctors know how to create the opportunity and environment for a patient to disclose domestic abuse, so that self-reported victims can be offered help. 2. Following a disclosure of domestic abuse a healthcare professional should carry out specific enquiries into drug and alcohol use 3. The first priority with a patient who has suffered from domestic abuse would be to treat the physical injuries. 4. While police contact must be offered, the healthcare professional must not put pressure on the patient to make any decisions about disclosure.  Research involving adults with mental capacity in which the patient's awareness of it could itself significantly affect the outcome poses a particular challenge. In each case where it is being argued that specific patient consent need not be sought ‫ ﺍﻟﻤﺼﻄﻠﺤﺎﺕ‬:  Research: new knowledge to restructure or reorganize existing bodies of information to verify extent theory or to apply existing knowledge to a new situation.  System investigation: *activity designed to test hypothesis objective applied to obtain directive and answer an operationally defined question general knowledge include theories.  Innovative theory: occurs when petitioner proposes to use treatment procedure or intervention in clinical non-standard treatment. change from currently accepted.  Medical ethics —-> taught capacity to motivate students and residents to improve quality outcome and patient physician interactions.  Audit: is a means of assessing whether clinical performance conforms to good clinical practice. It is defined by the General Medical Council (GMC) as the 'evaluation of clinical performance against standards or thorough comparative analysis, to inform the management of services'.  Consent: is even more vital when the procedure is not intended to benefit the individual undergoing it, as is the case with research and innovative treatment. ( Consent is a key concept in both research and innovative treatment.)  Randomized controlled trials (RCTs): are the most widely known method of comparing treatment options and obtaining an objective answer.  Triage: is essential when there are multiple casualties and may occur both at the scene of a disaster and in the emergency department. Chapter 18-19 1. Which of the following is essential factor to being a good doctor? Understanding of medical ethics and law, and the ethical practice 2. What is the education and training process for doctors? An ongoing process 3. When should confidential medical information be shared with professional providing care to the patient? On a “need to know” basis 4. What is the Hidden curriculum? Medical students learn from their experiences of observing and working with practicing doctors 5. For consent to be valid in the context of teaching, which of the following do patients need to be aware? Who will be present 6. What is the primary aim of the teaching of medical ethics? To develop within students a questioning, enquiring and analytical mind 7. Which of the following is essentially required from healthcare workers to increase patients’ satisfaction and good clinical outcomes? Cooperation in teams 8. What is the process of education and training throughout doctor’s career? An ongoing process 9. Which of the following is priority of the working in multi-disciplinary teams? Performance and collaboration of the team work 10. Medical students develop their clinical skills through steadily increasing involvement with patients. Which of the following should be done? With the knowledge and consent of the patients concerned 11. Which of the following is priority in working in multi-disciplinary? Safe and good quality care for the patient 12. Which one of the following is sometimes criticised for bring insufficiently practical? Teaching of medical ethics 13. What is an important part of medical training? Help medical students develop the skills required to assist people during some of the most difficult times of there life ‫ﻧﻘﺎﻁ ﻣﻤﻜﻦ ﺍﻧﻬﺎ ﺍﺗﺠﻲ ﻣﻘﺎﻟﻲ ﺃﻭ ﺍﺧﺘﻴﺎﺭﻱ‬:  Handling requests for work observation in clinical settings The following points should be considered where requests for work observation are received.  Observers should be present during consultations only if patients have given their express consent, ideally in writing.  Only those students who are aged 16 or over should be allowed into clinical areas for work observation.  Doctors must emphasis the importance of patient confidentiality to observers before they begin the placement  It is good practice to obtain a signed confidentiality agreement from the observer before the placement goes ahead.  Work observation should take place outside the observer's immediate locality wherever possible.  The BMA recommends that doctors confirm that work observers are covered in their insurance policy.  The RCS recommends that, when considering live surgery for the education of clinicians, the three principles listed below should be adhered to in order to ensure the best patient care.  Professionalism and a fundamental duty of care to the patient must be the sole motivation for all clinical decisions undertaken during live surgery.  Assessment, consent and follow up of the patient must pay particular attention to the issues surrounding live transmission of the procedure.   The surgeon and surgical team must be willing and prepared to stop interaction with the audience and/or transmission of the operation as necessary  It has long been recognized that students learn not only from their formal teaching, but also from their experiences o f observing and working with practicing doctors. This aspect of teaching has been referred to as the 'hidden curriculum  The following are common ethical dilemmas faced by medical students  the proper form by which students should be introduced to patients  the sharing of confidential patient information with clinical firms  inexperience in carrying out procedures  carrying out intimate examinations on patients while under an aesthetic  conflicts between medical education and patient care  witnessing poor practice  how to respond when senior colleagues have impaired judgement  physical or verbal assault from patients  disclosure from patients that they have been subjected to abuse  Principles for teamwork  Good communication and mutual respect are key.  All shared policies and aims should be clear to all team members.  It should be clear who is ultimately accountable for decision making but there should be opportunities for all team members to contribute their knowledge and expertise.  All team members have a responsibility ty for ensuring the team's effective functioning.  Team members should be supported in their role.  The General Medical Council (GMC) highlights the importance of team working emphasizing that, in providing a good standard of care   Doctors who have a managerial role also have responsibility for the welfare and safety of patients, even when their contractual duties are non-clinical.  Delegation involves professionals asking other staff to carry out procedures or provide care.  Investigations or treatment should be arranged on the basis of clinical judgement and if specialist assessment is needed, the patient should be referred to an appropriate service.  Integrated care pathways: are structured multi- disciplinary care plans which set out the essential steps in the care of patients with a specific clinical problem.  Brattish Medical Association recommendations for undergraduate medical education In its detail ed recommendations, the BMA stressed that medical undergraduates should:  have well-developed skills of thinking and reasoning  have skills for personal development and self-criticism  be taught and understand the ethical principles underpinning medical practice  know their limitations and when to call for help  have good communication skills  develop attitudes appropriate to the practice of medicine  be given support at all levels  have interactive teaching to encourage them to reflect on, and critically evaluate , their own work  be encouraged to define educational objectives to meet their personal learning needs  have teachers who are kind and thoughtful towards them  have access to a confidential advice and counselling service separate from any academic support.  Objectives of teaching medical ethics and law In the British Medical Association's view, teaching should ensure that students develop:  an ability to identify the morally relevant issues, values, and principles at stake in particular dilemmas  the skills to analyse these in order to reach a morally justified decision about how to proceed  an awareness of their legal and professional obligations to patients, employers and the community  the competence to communicate well with patients and professional colleagues  an understanding of the generally complementary nature of ethics and law  an overview of the implications for medical practice of ethical principles and law  skills in communicating ethical concepts in a professional environment  an attitude of respect for patients' rights as an integral part of medical ethics and law. Chapter 20 1. Which criteria should be included for any screening program? Benefits must outweigh the harms 2. Which of the following is one of the public health practice goals? The primarily concerned with the health status of populations 3. Which of the following is an ethical consideration for setting public health priorities? Scientific and medical functioning 4. Which of the following is a contemporary public health threats?  Obesity 5. Which of the following could define Health as the absence of disease? An absence of any abnormal biological functioning 6. Which of the following is an ethical consideration for setting public health priorities? The need for proportionality 7. Which of the following is concerned with protecting the health of entire populations? Public health 8. When can doctors prescribe unlicensed medicines and drugs to be used outside the terms of their license? When a course of treatment is innovative or there is little evidence to support its use 9. Which of the following defined Health as a social description? Notions of health have an important social dimension that cannot easily be reduced to biological functioning 10. Which of the following is a form of rationing or allocation of scarce resources under critical or emergency circumstances where decisions about who should receive treatment must be made immediately because more individuals have life threatening conditions than can be treated at once? Triage 11. which one of the following is a focus of medical ethics? relationship between a doctor and a patient 12. which one of the following is the goal of health interventions? the restoration or maintenance of the subjective experience of well-being 13. which one of the diseases was first identified in the 1920s? Creutzfeldt-Jakop disease (CJD) 14. which one of the diseases through to be caused by the build up in the brain of an abnormal form of a naturally occurring 'prion' protein? Transmissible spongiform encephalopathies (TSEs) 15. which one of the following is clearly a core function of public health? Health promotion ‫ ﻧﻘﺎﻁ ﻣﻤﻜﻦ ﺍﻧﻬﺎ ﺍﺗﺠﻲ ﻣﻘﺎﻟﻲ ﺃﻭ ﺍﺧﺘﻴﺎﺭﻱ‬:  Contemporary public health threats These include :  tobacco, drug, and alcohol misuse  obesity  mental illnesses, such as depression and anxiety  cancer  dementia and other forms of age-related cognitive impairment  climate change  10 key areas in which social factors have a clear impact on health outcomes. 1. The social gradient the lower an individual is in the social hierarchy, the poorer his or her health outcomes. 2. Stress: anxiety, insecurity, low self-esteem, social isolation and lack of control over work and home life have a powerful impact on health. 3. Early life: many of the foundations of adult health are laid down in early childhood. 4. Social exclusion: the longer people live in disadvantage, the more likely they are to develop a range of health problems. 5. Work: people who have more control over their work have better health. 6. Unemployment higher rates of unemployment are linked to illness and reduced life expectancy. 7. Social support: friendship, good relationships and strong social networks improve health. 8. Addiction: alcoholism, illicit drug use and cigarette  smoking are all associated with social and economic disadvantage. 9. Food: a healthy diet and a secure food supply are necessary for good health. 10. Transport: cycling , walking and the use of public transport provide exercise and social contact. They also reduce accidents and improve air quality. ‫ﻻ ﻳﻨﺒﻐﻲ ﻓﻬﻢ ﺍﻟﺤﻖ ﻓﻲ ﺍﻟﺼﺤﺔ‬ ‫ﻋﻠﻰ ﺍﻧﻪ ﺣﻖ ﺍﻟﺘﻤﺘﻊ ﺑﺎﻟﺼﺤﺔ ﻭ‬  The right to health is not to be understood as a right to be healthy. ‫ﻳﺘﻀﻤﻦ ﺍﻟﺤﻖ ﻓﻲ ﺍﻟﺼﺤﺔ‬ ‫ﺍﻟﺤﺮﻳﺎﺕ ﻭ ﺍﻻﺳﺘﺤﻘﺎﻗﺎﺕ ﻋﻠﻰ‬ The right to health contains both freedoms and entitlements. ‫ ﺗﺤﺘﻮﻱ ﺗﺸﺮﻳﻌﺎﺕ ﺍﻟﺼﺤﺔ ﺍﻟﻌﻤﻮﻣﻴﺔ‬ Public health legislation contains a number of powers designed to ‫ﻋﺒﻰ ﻋﺪﺩ ﻣﻦ ﺍﻟﺼﻼﺣﻴﺎﺕ ﺍﻟﻤﺼﻤﻤﺔ‬ control the spread of infectious diseases. This includes the power to ‫ﻟﻠﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺍﻧﺘﺸﺎﺭ ﺍﻻﻣﺮﺍﺽ‬ subject individuals to compulsory medical examination ‫ﺍﻟﻤﻌﺪﻳﺔ ﻭ ﻫﺬﺍ ﻳﺘﻀﻤﻦ ﺳﻠﻄﺔ‬ ‫ﺇﺧﻀﺎﻉ ﺍﻻﻓﺮﺍﺩ ﻟﻠﻔﺤﺺ ﺍﻻﺟﺒﺎﺭﻱ‬  If a registered medical practitioner believes or suspects that a person he or she is attending has a notifiable disease, he or she must send to the proper officer a certificate stating:  the name, age and sex of the patient and the address of the premises where the patient is residing  the disease or poisoning from which the patient is, or is suspected to be, suffering and the date, or approximate date, of its onset  if the premises are a hospital, the day on which the patient was admitted, the address of the premises from which the patient came, and whether or not, in the opinion of the person giving the certificate, the disease or poisoning from which the patient is, or is suspected to be, suffering was contracted in the hospital  key determinants of obesity:  primary appetite control in the brain  the force of dietary habit  levels of physical activity  psychological difficulties in making lifestyle choices.   priorities during a severe emergency are likely to include:  limiting social disruption  ensuring maintenance of healthcare systems  ensuring integrity of social infrastructure  limiting economic losses.  Tobacco control regulation -Control measures include: - comprehensive ban on advertising and promotion of tobacco products including the sponsorship of sporting events - restrictions on broadcasting smoking on television and radio to protect young people - age restrictions on the sale of tobacco to young people - enforced labelling depicting written health warnings, the disclosure of ingredients, a ban on misleading descriptors like 'light' or 'mild' and images illustrating the negative health consequences of smoking - duty imposed on purchasing and importing tobacco goods - ban on smoking in indoor workplaces and indoor public places.  Ethical considerations engaged In rationing decisions These include: o Need o welfare maximization o clinical effectiveness o relative cost-effectiveness o equity o individual rights o patient choice o communication and public involvement ‫ﺗﻌﺘﻤﺪ ﺍﻟﻘﺮﺍﺭﺍﺕ ﺍﻟﻤﺘﻌﻠﻘﺔ ﺑﻔﻌﺎﻟﻴﺔ‬ ‫ﺍﻟﺘﺪﺧﻞ ﺑﺸﻜﻞ ﺣﺼﺮﻱ ﻋﻠﻰ ﺍﻟﻌﻼﺝ‬ o transparency and rationality of decision making. ‫ﺍﻟﺴﺮﻳﺮﻱ ﺍﻟﻤﻌﺎﻳﻴﺮ ) ﺍﻟﺠﺴﺪﻳﺔ ﻭ‬ ‫ﺍﻟﻨﻔﺴﻴﺔ ( ﺍﻟﺘﻲ ﻻ ﺗﺘﺄﺛﺮ ﺑﻘﻀﺎﻳﺎ ﺍﻟﺘﻜﻠﻔﺔ‬  Decisions relating to an intervention's effectiveness are based  exclusively on clinical criteria (both physical and psychological), unaffected by issues of cost.  Methods for public Involvement: 1. Public consultations: these are an increasing feature of Government activity and are used to ensure stakeholders have an opportunity to have their voices heard in decision-making processes. 2. Health panels: these are standing panels of local people who are seen to be representative of the local population. 3. Citizens' juries: these are made up of local people who sit on a jury for a specified time and debate a variety of health topics presented by health practitioners. 4. Focus groups: these tend to comprise groups of between 6 and 12 local people and are run by a facilitator who promotes discussion on a variety of local health topics. 5. Interviews: individuals are selected either at random, or because they are particularly representative, and their views are sought on a variety of issues. 6. Questionnaires: these enable the gathering of structured information from a variety of target populations. 7. Experimental methods: these are used by professional researchers such as psychologists and economists to elicit and quantify public prefere ‫ﺍﻟﻤﺼﻄﻠﺤﺎﺕ‬:  Public health is primarily concerned with the health status of populations.  Triage is a form of rationing or allocation of scarce resources under critical or emergency circumstances where decisions about who should receive treatment must be made immediately because more individuals have life-threatening conditions than can be treated at  once.  Quasi-mandatory programs: under this approach, individuals are required to be vaccinated unless they qualify for an exemption. if they refuse, they are subject to possible penalties  Incentive-based programs: in some countries, parents can be offered certain benefits if their child has appropriate vaccinations or payment for ensuring a child completes a vaccination program Chapter 21 1. What is the fundamental obligation of all doctors in improving quality and reducing risk? Patient is the first concern 2. Which of the following is a type of procedure that helps to address cases of poor practice of health professional? Open discussion of errors that averted 3. When does the risk management assume to succeed? Mistake can be reported and analyzed 4. What is the main duty of doctor to monitor quality and performance? Aware of main causes of error 5. What is the first duty that doctors must ensure for patients? Protect patients from any kinds of harm 6. Which of the following scenarios that cause harm for patients? GP fails to diagnose the patients’ condition 7. Which of the following is an indicator of poor clinical performance? Errors or delays in diagnosis 8. Mistakes have profound effects on patient trust, which of the following is an example of that effect? Stress and lost resources 9. Which of the following is an example of, “risks imposed by cost constraints”?  Shortage of staff 10. What is the goal of stander of practice for health care professional? Doctors should recognize their limitations 11. Which among the following condition do not contribute to risk while performing duty in healthcare settings? Casual approach 12. When problems are identified, What is the first step to be taken before contact the GMC? local procedures 13. which one of the following affect the doctor-patient relationship and are significant cause of stress to all parties? Clinical errors 14. which one of the following is often criticized as inefficient costly and an inappropriate way of dealing with a medical mistake? Clinical negligence system 15. Regarding patient safety and quality of care, which of the following causes suffering, stress and lost resources, especially if litigation results? Errors ‫ﻧﻘﺎﻁ ﻣﻤﻜﻦ ﺃﻧﻬﺎ ﺍﺗﺠﻲ ﻣﻘﺎﻟﻲ ﺃﻭ ﺍﺧﺘﻴﺎﺭﻱ‬  Write down the doctors’ duties to monitor quality and performance?  Doctors need to be aware of the main causes of error  Identifying poor performance can be complex and its causes multi- factorial   Successful risk management depends on developing a culture in which mistakes and errors can be openly reported and analysed.  Systems managers have a duty to take all reasonable steps to avoid situations of foreseeable risk or the repetition of errors.  There must also be appropriate support in place for health professionals who are still learning  When problems are identified, local procedures should be the first avenue to be tried, followed by a formal audit or investigation if problems cannot be resolved  List the General principles that Doctors should follow to reduce error and improve quality of services?  make care of patients their first concern  protect and promote the health of patients and the public  provide a good standard of practice and care  keep their knowledge and skills up to date throughout their working life  recognize and work within the limits of their professional competence  work with colleagues in ways that best serve patients' interests  observe and keep up to date with the laws and statutory codes of practice that affect their work  take part in regular and systematic medical and clinical audit and respond appropriately to the outcomes of any review, assessment, or appraisal of performance  be willing to take action if they have reason to think patient safety is compromised by inadequate premises, equipment, resources, policies or systems  be aware of the performance of colleagues and be willing to address problems identified  when the GMC investigates a case, it decides on one of four outcomes:  the case is concluded without the doctor being given specific advice  a warning may be issued to the doctor  a formal agreement is set up between the doctor and the GMC, under which the doctor accepts various undertakings, and the agreement is published online in the list of registered doctors   the case may be referred for a public hearing before a fitness to practice panel, which can set conditions on the doctor's registration for up to 3 years, suspend the doctor's registration for up to a year or erase the doctor's name from the medical register so that the doctor cannot practice. Chapter 15 Medical Ethics in Arab and Islamic Medicine 1. which one of the following is necessary to unravel the secrets of nature? Basic Biological and medical Research 2. which one of the following is complicated research process and is time- consuming? Development New Drug 3. what is an indispensable part of biomedical research and pharmaceutical product safety testing? The appropriate and responsible use of animals 4. which one of the following is a study of diseases that are inherited and caused by fault in a person's genetic code? Study of Genetic Disorders 5. When to make an accurate and rapid diagnosis? If the treatment is to be effective 6. which one of the following is Islam places great emphasis? sanctity of life and the reality of death 7. What does Draize's test involve? Applying 0.5mL or 0.5g of a substance to an animal's eye or skin 8. which one of the following is the Islam categorically opposed and regards it as an act murder? mercy killing 9. What is the only condition Islam allows to abort a viable fetus? When to save the life of the mother 10. which one of the following is written by Ishaq ibn Ali al-Ruhani?  Adeb al-tabib or The Ethics of the physician ‫ﻧﻘﺎﻁ ﻳﻤﻜﻦ ﺍﺗﺠﻲ ﻣﻘﺎﻟﻲ ﺃﻭ ﺍﺧﺘﻴﺎﺭﻱ‬  Personal Characters of the Physician: The physician ought to be modest, virtuous, merciful, and to not use liquor. He should: 1. Wear clean clothes, be dignified, and have well-groomed hair and beard 2. Not join the ungodly and scoffers of truth, nor sit at their table 3. Select his company from among persons of good reputation 4. Be careful of what he says and should not hesitate to ask forgiveness if he makes an error 5. Be forgiving and never seek revenge 6. Be friendly person and a peacemaker 7. Not make jokes or laugh at the improper time or place  Preparations of Natural Products Used in Medical Research and Treatment. Animals can produce useful medical substances in their blood or milk, like antibodies, vaccines, and hormones that are important for diagnostic tests, medical treatments, and basic research.  Around 70% of serious adverse effects that occur in humans are identified at the animal testing stage. Therefore, animal testing is extremely beneficial in minimizing the risks to humans in clinical trials.  Toxicity Testing. A wide range of chemicals and medicines used in day-to-day life, such as those in household products, in farming, and industry, need to be tested for their safe use in humans as well as in animals. Such preliminary testing is essential for avoiding pollution and associated health hazards, as well as for proper maintenance of the environment.  In Biology and Medical Education. Animals are used in schools and colleges to contribute to the understanding of basic anatomy and physiology of man and other species.  Each class of product may undergo different types of preclinical tests. For instance, drugs may undergo the following:  Pharmacodynamics: The study of the physiological effects of drugs within/on the body, the mechanisms of drug action and the relationship between drug concentration and effect.  Pharmacokinetics: The determination of the fate of substances  administered to a living organism.  ADME: Assessments of drug’s absorption, distribution, metabolism, and excretion, and describe the disposition of a pharmaceutical compound within an organism.  Toxicity testing through animal testing and in vitro studies. Data obtained allows researchers to estimate a safe starting dose of the drug for clinical trials in humans.  The basic reason for animal trials is to determine two issues before any new compound is introduced into a human: safety and efficacy  The Development of Arab-Islamic Ethics Obligations Toward His Colleagues  The physician should speak well of his colleagues  He should not honor himself by shaming others  If another physician has been called to treat his patient, he should not criticize his colleague even if the diagnosis and the recommendations of the latter differ from his own  He has the obligation of explaining the consequences of each method of treatment, since it is his duty to counsel the patient as best he can  He must warn his patient that combining different types of therapy may be dangerous because the actions of different drugs may be incompatible and injurious  In the first series of experiments acute, subacute, and chronic studies are performed and data is collected. These include the following:  Acute Studies: Short-term, acute studies are usually performed in one or more rodent species with the aim to assess the dose range for lethality of a test substance.  Subchronic Studies: These studies are long term (generally 3–6 months) and are conducted using multiple doses  Chronic Studies: The next stage of toxicity study is the chronic testing. As for subchronic studies, this study is conducted in multiple species, in both sexes, and for a duration that approaches the life-span of the animal.  Reproductive and developmental toxicity tests can be conducted as follows:  One-Generation Reproduction Toxicity: A one-generation reproductive toxicity study in rats or mice is used to evaluate toxic effects on male and  female reproduction  Two-Generation Reproduction Toxicity: A two-generation reproductive toxicity study continues dosing with the test substance to the first- generation offspring.  Carcinogenesis is a long and multistep process that includes three main stages; initiation (selection of a mutated cell), promotion (selective proliferation of the initiated cell) and progression as a consequence of an imbalance between cell proliferation and cell death (e.g., apoptosis).  Phase I subjects may be patients who have not improved from standard treatments. About 70% of experimental drugs pass this phase of testing. There are different kinds of Phase I trials: - Single ascending dose(SAD) studies involve a single dose of the drug that is given to small groups of volunteers while they are observed and tested for a predetermined period. - Multiple ascending dose(MAD) studies are conducted to assess the pharmacokinetics and pharmacodynamics of multiple doses of the drug - Food Effect: A short trial is conducted to study differences in absorption of the drug by the body, caused by eating before the drug is given  Phase II studies test the efficacy of a drug or device. This second phase of testing can last from several months to 2 years, and involves up to several hundred patients.  Phase III studies are randomized controlled multicenter trials and consist of hundreds or thousands of people.  Phase IV studies can result in a drug or device being taken off the market or, alternatively, restrictions on its use could be imposed depending on the new findings.  Obligation Toward The Community The physician should speak no evil of reputable men of the community or be critical of any one's religious beliefs  Obligations Toward His Assistants If his subordinate makes a mistake, the physician should not rebuke him in front of others, but correct him privately and cordially ‫ﺍﻟﻤﺼﻄﻠﺤﺎﺕ‬:  Developmental Neurotoxicity. Developmental Neurotoxicity Study involves the daily oral feeding of a test substance to female rats (preferred species) from the  time of mating through lactation.  Chronic Toxicity Test: these studies are generally conducted in both sexes of two laboratory animal species, one of which is a nonrodent species.  Toxicokinetic Study: Toxicokinetic (TK) studies are conducted to characterize the absorption, distribution, metabolism, and elimination (ADME) of xenobiotic materials and to quantify the influence of exposure on those properties.  Carcinogenicity Test: The term carcinogen denotes a substance or a mixture of substances that induces tumors (benign or malignant)  Repeated Dose/Organ Toxicity: Repeated dose toxicity testing using oral administration of a test substance in rodents for 28 and 90 days is used to evaluate chronic toxic effects  A clinical trial broadly refers to any testing done on human beings for the sake of determining the safety and efficacy values of a treatment for the sick or for preventing disease.