Clinical Processes Flashcards
What is the only formally validated LM vital sign?
PAVS
Physical activity vital sign
Dietary assessment options?
- 3 day diet history
- Report typical day of eating
- How many servings of veg? (or how. many servings of UPF, or animal-based food)
- photograph meals
- Lifestyle Assessment Short Form
–> over last 2/4, how often fast food, sugary drinks, UPF; how many servings of whole fruit/veg; how often meat
- Starting the conversation
- 8 item simplified food freq - Mediterranean Diet Adherence Screener
- (ASA-24) Automated Self Admin 24 hour
- (DSQ) Dietary History Questionnaire
Validated dietary assessments
What are some in-depth follow up tools for physical activity?
STAR-Q (sedentary time & activity reporting Q)
IPAQ Long Form
What are some brief assessment tools for Sleep?
- Single Item Sleep Quality Scale
- Global Sleep Assessment Quest
- STOP-BANG Quest
In-depth follow up:
1. Pittsburgh Sleep Quality Index
What are some brief assessment tools for Stress?
- PHQ-2
Patient health quest 2
‘in last 2 weeks, how often littlei nerest, feeling low’ - Perceived Stress Scale
- GAD-2
- Satisfaction with Life Scale
- Loma Linda Social Relationship quest
- social support
What are some in-depth follow up tools for Stress?
PHQ-9
PSS-10
GAD-7
SWLS
What are some validated assessment tools for substance use?
NIDA quick screen
- freq of alco, tobac, precription
TAPS-1
AUDIT-C
NIDA-Modified ASSIST
TAPS-2
Physical exam components?
BMI
Waist circumference
(< 102 cm men; 88cm women)
- mid lowest rib and iliac crest
Waist-to-hip ratio
(<= 0.9 men, 0.85 women)
% Body fat
(calipers, BIA, Densitometry. BodPod, DEXA)
< 25% men; < 30% women
Pulse
- endurance training and yoga can lower pulse
BP
- elevated (120-129 and <80)
- stage 1 HTN (130-139 OR 80-89)
- stage 2 HTN (140+ OR 90+)
Measures of fitness
Cardioresp (step testing)
Muscular endurance (squats, pushups, sit ups)
Muscular strength (grip, or refer)
Flexibility (sit and reach)
Body compisition (calipers)
Lifestyle guidelines for cardiovascular disease?
- AHA
Calories out > calories in
- 150 min mod; 75 min vig / wk
Healthy dietary pattern
- min proc’d, added sugar, salt, etoh
Avoid tobacco - USPSTF
- Statin for prim prevention in 40-75yo who have
>=1 risk factors AND
>= 10% ten-yr risk of CV event
AHA Guidelines for hyperlipidemia
Limit saturated fat <6% daily cal
Minimise trans fats
Limit red meat, dairy, fried
AHA and USPSTF guidelines for hypertension
- AHA
DASH
- plant based
- limit red meat, sodium, sweets - USPSTF
- screen BP in >18y/o
- get BP outside of office for diag
CDC
Guidelines for CVD, HTN, Hyperlipidemia
- fruit and veg
- high fiber
- low sat/trans fats
- limit salt and sugar
- alcohol <2 men and <1 wom
- reg physical activity
- Don’t smoke
ACLM
Guidelines for CVD, HTN, Hyperlipidemia
To reverse coronary artery disease
low fat
WFPB
leafy greens
min high fat plant food (nuts, seeds, avocado, oils)
min caffeine, salt
REVERSES plaque build up!
DIABETES
Guidelines
- ADA
Plate method
- 1/2 veg, 1/4 non starch veg, 1/4 lean protein - CDC
Eat well
Stay active - USPSTF
Screen for prediabetes / T2DM in ppl 35-70 who are overweight / obese - ACLM
- low fat, WFPB to min insulin resistance
- remission, rather than mgmt
OBESITY
Guidelines
- USPSTF
- refer BMI>30 for intensive tx - ACC / AHA / The Obesity Society
- refer if BMI>25 + CV risk factors OR if BMI>30
- indiv/group based
- caloric restriction, physical activity
- behavioural strategies - ACLM
- WFPB
WEIGHT LOSS
Guidelines
- Reduce calories
- eating 3500 cal less per week will lose 1lb weight per week
- women 12-1500 cal / day
- men 15-1800 cal / day
(No specific dietary pattern is superior)
- NREE should be increased
- Refer to bariatric surgery
BMI >= 40
BMI >= 35 with one comorbid
BMI >=30 with poorly controlled diabetes
+ Motivation to lose weight
What is TEE?
Total energy expenditure
Sum of:
- Resting EE (REE) - 60%
- Thermic effect of feeding (TEF) 5-10
- Non-resting EE (NREE) 30-40%
WHO classifies processed meat as a ? and red meat as a ?
Carcinogen
Probable carcinogen
CAD
Intensive lifestyle changes
VS
Lipid-lowering drugs
Lifestyle Heart Trial (5yr RCT)
Reduction in LDL
Reduction in angina episodes
Regression of atherosclerosis
Stable CAD
Exercise
VS
PCI
12 month RCT
Higher ischaemic threshold
16% increase O2 uptake
Less health expenses
Remission of T2DM
? Intensive weight mgmt within routine primary care
(DiRECT 12 month RCT)
46% achieved remission to a non-diabetic state and wewre off diabetic drugs
Incidence of T2DM
Lifestyle
VS
Metformin
Diabetes Prevention Program
(2.8 yr RCT)
Lifestyle intervention more effective at an average f/u of 2.8 yrs
Statin
VS
Dietary
For lowering cholesterol
3 month RCT
No difference
Medication
VS
Exercise
on Mortality outcomes
Meta-analysis
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