Case Study Flashcards
1) Kayleigh attends her GP to discuss contraception. She wishes to use the combined pill, but heard that there was a study done that showed there were dangers associated with the pill.
You wish to discuss risk with her. What two different types of risk would be appropriate to discuss? Which is the most relevant for Kayleigh to take into account here?
Actual risk and relative risk – with Actual risk being the most important.
How might you communicate risk to her?
Verbally, using fractions, or perhaps by using illustrations.
2) What kinds of studies might have been performed to generate data that you are able to present to Kayleigh about treatments or illnesses?
Descriptive Studies Cross Sectional Studies Cohort Studies Case-Control Studies Randomised controlled trials (RCTs)
What one word that can affect the outcome of studies describes the tendency to select preferentially from a group.
Bias
If it turned out that one group also smoked more than the others, what kind of factor would smoking be?
A confounding Factor
You are unsure if you and your colleagues are prescribing the Contraceptive Pill according to national guidelines. What action might you take?
You might perform an audit.
What headings might you use to structure an audit according to the Royal College of General Practitioners (RCGP) audit guidelines?
Reason for the audit
Criteria or criterion to be measured Standard(s) set
Preparation and planning
Results and date of collection one
Description of change(s) implemented
Results and date of data collection two
Reflections
What model describes the stages Brenda has gone through in her smoking cessation?
Precontemplation -> smokes regularly
Contemplation -> considering giving up
Preparation -> making definite plans
Action -> actively not smoking
Maintanence -> non-smoker
Regression -> starts smoking again
OR
Maintaining healthier lifestyle
Define Health Promotion
1) Any planned activity designed to enhance health or prevent disease
2) The process of enabling people to increase control over, and to improve, their
health. Applied to a wide range of approaches to improving health of people,
communities and populations.
3) An over-arching principle/activity which enhances health and includes disease
preventing health education and health protection. It is usually planned but may be opportunistic, e.g. in a GP consultation.
(There are a number of ways of describing Health Promotion; all are correct and acceptable.)
What are the three theories of Health Promotion?
Educational - Provides knowledge and education to enable necessary skills to rate informed choices re health – may be one –to-one group workshop e.g. smoking, diet, diabetes
Socioeconomic – ‘Makes healthy choice the easy choice.’ National policies e.g. re unemployment, redistribute income.
Psychological - Complex relationship between behaviour, knowledge, attitudes and beliefs. Activities start from an individual attitude to health and readiness to change. Emphasis on whether individual is ready to change. (e.g. smoking, alcohol).
Following further consultation with his advisers, he decides that the government will fund group sessions on smoking cessation.
What type of health promoting activity does this demonstrate?
Health education-an activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.
To which criteria would they refer when advising him about the appropriateness of a lung cancer screening programme. List the criteria.
Wilson and Jungner’s criteria
Illness – important, natural history understood, clinically detectable pre- symptomatic stage
Test – easy, acceptable, cost effective, sensitive and specific
Treatment – acceptable, cost effective, better if early
Steve works at B&Q moving stock. He frequently has some aches and pains, but one day was moving a bathroom suite and developed a sharp pain in his lower back, with some difficulty bending and twisting.
What is the likely diagnosis.
What is the prognosis?
Mechanical Low Back Pain
Generally good with some initial rest, painkillers and mobilisation with or without physio.
He comes to you for assessment, telling you he has bought over the counter medicines which make it bearable.
However, he does not think he is fit for work .
(he has mechanical back pain)
What might you provide for him?
Different analgesia
A Med 3 Fit Note, which may contain details about altered duties, adaptations, altered hours etc.
Possibly referral to Physiotherapy.
Steve comes back one month later. One of your colleagues signed him off for a further two weeks and he tells you he has just been at home. He does not look as distressed as when you last saw him.
What role could he be said to be adopting?
Is it always a negative role?
The Sick Role
Not necessarily negative. We live in a society that cares for it’s infirm and allows time to recover. On the individual, however, there is an expectation that they will endeavour to get well and return to their previous role.
By 2050, how much is the population aged over 80 years set to rise when compared to 2000. (This is the same rate rise as the number of older people unable to look after themselves).
Four fold (4x)
What is defined by “the co-existence of two or more long-term conditions in an individual”?
Multimorbidity – Note, this is the norm rather than the exception in Primary Care patients.
Jim comes to you with arthritis in his hands, and has tried some Diclofenac (a non-steroidal anti-inflammatory drug –NSAID) which his friend gave him. He found it a great help and asks you for some. What issues would you raise with him?
Would you refuse to prescribe it?
He has Ischaemic Heart Disease, and Diclofenac can have a detrimental effect on this and Blood Pressure. He is also likely to be taking an Anti-Hypertensive, perhaps affecting renal function, again a negative with Diclofenac. Finally, Diclofenac could irritate his stomach, particularly if he is using Aspirin.
It would depend on Jim’s thought’s about risk. If you present the risks to him appropriately in a way that he can understand he may still decide that he is willing to accept that level of risk. Both you and he would have to weigh it against his severity of symptoms and how they affect his life. Some patients find topical preparations helpful and this would carry less risk of interaction. Finding ways of tailoring treatments to individual patient needs is one of the skills of generalism.
Brenda’s condition has continued to deteriorate over the years and she now has very severe COPD with recurrent infections and is housebound. She has been referred for oxygen therapy, but there remain few treatment options to improve her condition. She is often admitted to hospital at the weekends and discharged quickly within 24 hours on oral antibiotics.
What kind of plan might help to avoid these predictable admissions?
An Anticipatory Care Plan
What does an anticipatory care plan promote?
“Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care”
In Brenda’s case what might an anticipatory care plan include?
Legal details – power of attorney etc
Contact details for close friends and carers.
A strategy for managing illness without admissions – perhaps a home supply of antibiotics.
Advance statements.
A resuscitation status.
Details for the out of hours team – treatment plans etc.
Thinking of Sustainability relating to Travel, what modifications could the NHS or it’s staff make to improve Environmental Sustainability.
Teleconferencing and videoconferencing Switch to local food suppliers for hospitals
Car pooling ( where more than one person occupies the same vehicle, sharing costs and taking it in turn to be driver)
Car sharing (where people hire cars for short periods of time)
Fuel efficient vehicles eg hybrids
Health services to have their own fleet of vehicles eg NHSG mini buses
Reduce the number of free car parking spaces
Reward multiple vehicle occupancy, lower carbon emission vehicles and bikes
Pool of fleet vehicles, could be electric
Health boards to consider reimbursement for travel at higher rate for use of low carbon options, public transport
Have an institutional travel plan e.g. providing facilities for cyclists, measure carbon emissions
Liaise with Councils to promote bus links
Brenda becomes more debilitated and requires help at home. Who might coordinate this?
A care manager; they would provide advice regarding care packages available and costs of care. They could help link with sheltered housing or nursing homes if needed.
Brenda develops pneumonia, and during an admission to hospital it is noticed that she has a mass on a Chest X-ray. Further tests show that this is a lung cancer, and has spread to her bones, liver and adrenal glands. A decision is made with Brenda that there are no acceptable treatment options for her cancer. Brenda becomes gravely unwell and is unfit to be discharged to her own home. Her friend Jill visits on the ward, and after discussing the situation with her husband Jim, they offer to allow Brenda to stay in their spare room downstairs.
Name five members from the Primary Health Care Team or other Community Professionals who might be involved in Brenda’s care after discharge, and what might be their roles?
GP – coordination of care and medication
District Nurse – administering medication and tending wounds/bedsores.
OT –assessing the environment around Brenda and provision of aids– e.g. air bed, transfer and toileting aids
Macmillan Nurse – liaising with palliative medicine department and providing support for the Brenda and her carers.
Care Manager (Social Work) – coordination the provision of carers and financial aid for Brenda
Pharmacist – assisting with the provision of medication for Brenda
Receptionist – coordinating care and messages between members of the team and being a first point of contact for Brenda or Jill
What ‘Scale’ might Brenda’s GP use to assess and monitor changes in her condition?
The Palliative Performance Scale
What factors constitute “A Good Death” in Western Culture?
A Pain-free death
Open acknowledgement of the imminence of death
Death at home surrounded by family and friends
An ‘aware’ death, in which personal conflicts and unfinished business are resolved Death as personal growth
Death according to personal preference and in a manner that resonates with the person’s individuality
Name five of the ten emotions that might be experienced following a bereavement?
Shock Anger Denial Bargaining Relief Sadness Fear Guilt Anxiety Distress
