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Modern medicine - Coggle Diagram

- - - - science: observe how penicillin attacked bacteria
      - individuals: Florey & Chain built on the work of Fleming. All looking for solutions to the same problem
      - attitudes:wanted to find solutions for simple injuries
      - institutions: US government funding research for 5 years, helping develop practices for mass production
      - technology: mass production, storing drugs in vast quantities
    - - 1943: Penicillin first used by British army in North Africa
      - 1944: Enough penicillin available to treat all D-Day landing casualities
      - 1942: US government gave $80M to 4 drug companies to find a way to mass produce penicillin
      - 1945: US army using 2M doses a month
      - December 1941: US enters the war
      - Post WW2: penicillin for civilian use
      - June 1941: Florey travels to the US to get investments of penicillin - little interest
  - - - Run specialist clinics
      - More advanced education
      - Often have nurses and pharmacies attached
      - GP's offer a wider range of care
    - - By Jan 1948 90% of members enrolled
      - Bevan used personality to win over many medical professionals
      - BMA did a survey in late 1946, where 54% of members said they wouldn't co-operate with NHS
      - Gained support from medical consultants by promising them a salary and allowing them to treat private patients in NHS buildings
      - An ex-miner from South Wales, who was a trade-union leader with the reputation of being out-spoken
      - He was willing to talk to doctors about lesser issues
      - Aneurin Bevan
      - In May 1948 opposition crumbled and NHS was created in July 1948 with 90% of doctors enrolled
    - - New drugs are expensive
      - Complex treatments are expensive especially with tech
      - Improvements in medicine mean people expect more treatments
      - Increase staff costs because of rigorous training
      - People live longer so are more likely to need treatment
    - - Hospitals
        
        Many hospitals desperately needed updating
        
        1960: plans introduced to ensure hospitals were evenly spread throughout the country
        
        Government had 1143 voluntary hospitals and 1545 city hospitals under it's control
        
        In he beginning hospital didn't change massively because post-war Britain didn't have the money to spend on health care
      - GP's
        
        Access improved as NHS went one but provisions didn't improve short term
        
        1960's Government introduced changes to NHS
        
        wait time increased and appointment time decreased
        
        1966: A GP's charter was established and incentives were given to keep up to date with medical developments
        
        However because of NHS more people visited GP's
        
        Government had to run NHS, not just fund it. This lead to improved quality of care
        
        1950's GP surgeries were in need of modernisation as well as GP's themselves - A study in 1950 showed that 25% of GP's were unsatisfactory
    - - Dentist & optician appointments
      - Ambulance and emergency treatment
      - Health care for pregnant women & children
      - Health care for elderly people
      - The right to see a GP to be refereed to hospital
    - - Financial pressure
        
        As early as 1952 prescription charges were introduced
        
        Other charges have been implemented such as eye tests and dentist appointments - Free eye-tests were re-introduced in Wales in 2007
        
        NHS is no longer completely free
        
        As life-expectancy increases, greater pressure is put on the NHS
        
        From very beginning finance has put big pressure on NHS
      - quality of care
        
        Some people are refused costly treatments
        
        Since 1999 NICE (National Institute of Health and Clinical Excellence) has provided guidelines and recommendations for effective healthcare
        
        Lack of money means long wait list for many operations
      - New diseases
        
        Became a huge problem in late 1900's because of outbreak of "super bugs" (MRSA) occasionally killing patients
        
        The Care Quality Commission does regular inspections and forces hospitals to change if necessary
        
        Protecting patients from contracting new diseases became major aspect of hospital work
    - - 2.Bombing raids in WW2 lead to many causalities needing treatment, prompting it's creation
      - 3.Beveridge report identified disease as a problem to fight after WW2
      - 1 Government became concerned about inequalities in healthcare system
  - - - smaller cheaper machines: Processes such as dialysis, where the blood of a patient's kidney failure is "washed" by a machine have become widely available as they are small and portable
      - robotics: Better prosthetic limbs, bombing injuries from Afghanistan and Iraq
      - advanced x-rays: doctor can use x-rays to target and shrink tumours in radiotherapy
    - - laparoscopic (key hole) surgery: Using tiny cameras & narrow surgical equipment, surgeons can operate through a small incision, some distance from the body. Causes less trauma
      - robotic surgery: surgeon can use computers to control instruments inside the body, allowing more precise surgery. Operations can be performed on a tiny scale, with precision (eg. brain surgery)
      - microsurgery: The first kidney transplant was performed between identical twins in USA in 1956. Was able to happen because of microsurgery, attaching blood vessels & nerve endings
- - - - If it's not very advanced doctors will give a PET - CT scan, so a small amount of radioactive material injected to identify cancerous cells
      - Patients can have a bronchoscopy, to collect a sample of cells for testing
      - If a doctor spots a potential cancer they can of one of two things
      - Doctors can then identify the cancer, how advance it is and the right treatment plan to attack cancer
      - Patients are given a CT scan to create a detailed image of the body. May be injected with a dye before to show the lungs clearly
  - - - As it wasn't the choice of the child to be exposed the Gov stepped in to protect their health
      - 2007 - age to buy cigarettes increased from 16-18 to reduce no. teenagers smoking
      - 2015 - ban extended to cars because of the harmful effects of second-hand inhalation especially for children.
      - Increased tax on tobacco products to discourage people buying them
      - 2007 - smoking ban introduced in public places and workplaces
    - - Gov created many campaigns to advocate dangers of smoking
      - These included the dangers for pregnant women, the amount of chemicals in cigarettes and showing health impacts through statistics
      - Cigarette companies were banned from sponsoring sporting events
      - Education to discourage smoking introduced in schools
      - 2005 - complete ban of cigarette adverts
      - Gov research showed that tobacco products should be removed from displays to discourage young people form buying them
      - 1965 - begin of a ban of cigarette advertisement
- - - - Step 2: "Homes for heroes" Homes were funded by government for people who fought in WW1. As a result 0.25M houses built
      - Step 3: "Slum clearance" in 1930 a five year plan introduced to eliminate slums. Slum dwellers were rehoused & slums were destroyed. New flat buildings were built. Poorest still lived in slums
      - Step 1: Back to back housing banned banned in 1909 as were a major contributor to ill-health
    - - At least 4,000 people died because of respitory illness, making it worst epidemic since flu in 1919
      - In 1956 a clean air act was introduced to set up smoke-less zones in cities & even control fuels being burned in home
      - In 1952 London suffered a terrible smog
      - By 1971 the amount of smoke in the atmosphere had gone down 65%
  - - - Blood would last longer if it was refridgerated
    - - Rous and Turner discovered that adding citrate glucose blood could be stored for much longer
      - Army soldiers could use public blood donations to help wounded soldiers
    - - Donor no longer had to be present and more transfusions could take place
      - Blood had to be used quickly after it was collected because it deteriorates quickly
      - In 1915 Richard Lewisohn found that adding sodium citrate to blood stopped it from clotting
    - - In 1917 the first blood bank was established for the expected causalities in the battle of Cambrai
    - - He found blood groups A, B, O & AB (which was added in 1902)
      - Landsteiner showed that blood transfusions had to be done with people of the same blood group or else they would die
      - Blood groups were discovered in 1901 by Landsteiner
      - This didn't solve the problem that the donor still had to be present during transfusion
- - - - science
        
        The human genome project was a prime example of 'big science'
        
        Thousands of scientists working together to solve one big puzzle
        
        Understanding DNA required lots of collaboration of the scientific community
      - teamwork
        
        Wilkins shared clearer photographs, all work together on the structure of DNA
        
        By sharing notes and working together the structure of DNA was revealed
        
        Crick & Watson made a model of DNA and showed it to Franklin, she edited it based on her x-rays
        
        Rosalind Franklin & Maurice Wilkins photographed DNA in 1951** using imporved x-ray technology
      - technology
        
        Electron microscopes, first developed in 1931 by Ernst Ruska and Max Knoll.
        
        Built a model that was able to magnify more than any light microscope used before
        
        Advances in microscopes and high powered images enabled scientists to identify DNA and start to examine how it's formed
        
        Discovering the shape of DNA and mapping out the human genome was all possible through technology
    - - Not a current treatment - good understanding lead to doctors understanding what caused illness
      - Science was not at the stage where treatment of this nature was widely available for disease
      - Disorders caused by missing information in Genome - scientist could theoretically replace missing piece and treat illness
      - Better understanding of DNA and how each part of the genome affects the body, helped scientists recognise genetic disorders
    - - Early research into genetics
        
        1951 - scientist knew characteristics were passed down from parents, as children look like their parents
        
        Substances in cells passed information from one person to the next
        
        Didn't have scientific proof this was correct
        
        1953- DNA is discovered
        
        1900 - German scientist Mendel theorised genes come in pair (one from mother & one from father) - fundamental law of inheritance
      - Crick & Watson - human gene
        
        Looked at x-rays and built a model of DNA - solved the puzzle of the structure of DNA
        
        Discovered it was shaped as a double helix and could "unzip" to copy itself
        
        Both had a passion for finding out more about human biology
        
        Published their paper in 1953 - Crick suggested they had found a secret life
        
        Crick and Watson both worked at Cambridge University
        
        Understanding DNA meant that they could begin to look at it's structure and identify what caused hereditary disease
      - The science of genetics
        
        Some babies were born with conditions that seemed to originate in the womb
        
        It related how children inherited certain traits from their parents, and how that relates to hereditary diseases
        
        By 1900 scientists realised that not every disease could be contracted from microbes
      - Human genome project
        
        For 10 years 18 teams of scientists worked together to map out the human genome
        
        First draft not completed until 2000
        
        human Genome project launched in *1990 - lead by James Crick
        
        Scientists could now identify mutations in DNA and how they related to diseases
        
        Understanding was vital in order for scientists to be able to understand the cause of genetic disease
        
        Scientists have found a gene sometimes present in women with breast cancer
        
        All information that builds a person is in their DNA
        
        Can't be used to cure disease but can help with prevention plan
        
        Structure had been discovered so now had to be understood
  - - - most people are familiar with eating a healthy balanced diet - plenty of fruit & veg with others in moderation
      - Two important substances are sugar & fat - too much sugar can lead ot type 2 diabetes & too much fat can lead ot heart disease
      - we now regonise that this is partly the truth - but in a very different way than previously suggested
      - Due to the TOTFH medieavel ancestors believed what we ate had a huge impact on you health
    - - Doctors now recognise smoking is connected with all kind of disease: high blood pressure // cancers // heart disease // gum disease // tooth decay
      - Smoking was the biggest cause of preventable disease in the world
      - By 1950s doctors noticed a link in men suffering wiht lung cancer and the link with smoking
      - Causes problems for second-hand inhilation
      - Became popular in 1920's
      - Government introduced laws to make it illegal to smoke in cars when under 18s are present