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Lifestyle Medicine > Clinical Processes in LM > Flashcards

Clinical Processes in LM Flashcards

1
Q

List the 6 components of a LM history and physical exam

A

1) Vital signs
2) Risk factors
3) Physical exam
4) Lab work and interpretation
5) Diagnosis and management
6) Collaborative care and referrals

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2
Q

List the 8 ‘vital signs’ of LM

A 
Physical activity
Diet
Sleep
Stress
Emotional well-being 
Smoking / tobacco use
Alcohol consumption  
BMI
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3
Q

Of the vital signs in LM which 3 have validated screenings

A

Physical activity
BMI
Alcohol consumption (AUDIT-C)

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4
Q

What 3 questions does the AUDIT-C tool ask and what scores are considered positive?

A

1) how often do you have a drink containing alcohol
2) how many drinks you have on a typical drinking day
3) how often you have =/>6 drinks
Men >4, women >3 (if all in Q 1, less risk. Max 12)

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5
Q

What 2 Qs make up the two-item physical exercise vital sign q-aire?

A

a) How many days a week do you engage in mod-strenuous exercise e.g. brisk walk
b) On average, how many mins do you exercise at that level?
(does not account for strengthening, resistance, flexibility or balance exercise)

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6
Q

What is considered a normal BMI?

A

18.5-24.9

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7
Q

What does the Framingham risk assessment indicate risk for?

A

Risk of MI in the next 10yrs

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8
Q

To which group of pts can the Framingham risk assessment be applied?

A

> 20

without heart disease or diabetes

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9
Q

What does the Framingham risk assessment for MI include?

Why does it exclude those ties DM?

A

Cholesterol, HDL-C, smoking, BP and meds for HTN

results underestimate the risk in those with DM

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10
Q

In the UK what are the healthy cholesterol levels in mmol/L?

A 
Total cholesterol =5
non-HDL =4 (inc LDL and VLDL - carries triglycerides; TC - HDL)
LDL =3
triglycerides <2.3
HDL >1
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11
Q

What is high-sensitivity CRP a marker of?

What risk does it help determine?

A

Chronic inflammation and helps determine risk of MI in those with cardiovascular disease

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12
Q

What is C-peptide measurement used to assess?

A

Assesses endogenous insulin production to identify how well beta cells are functioning to meet demands of insulin production
Helps determine T1DM vs T2DM

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13
Q

What is HOMA-IR blood test?

A

‘homeostatic model assessment for insulin resistance’
estimates insulin sensitivity and beta cell function based on plasma glucose concentrations and fasting plasma insulin or C-peptide measurements

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14
Q

What HbA1c results are consistent with diabetes and pre-diabetes?

A

Diabetes =/>6.5% (>48mmol/mol)
Pre-diabetes 5.7-6.4% (42-47mmol/mol)
Normal <5.7% (<42)

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15
Q

What fasting glucose results are consistent with diabetes and pre-diabetes?

A

Diabetes >/=7.0 mmol/L

Pre-diabetes >/= 5.6mmol/L

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16
Q

What 2-hr post prandial / random (OGTT) results are consistent with diabetes and pre-diabetes? (mmol/L)

A

Diabetes = / >11.1 mmol/L

Pre-diabetes 7.8-11.0 mol/L

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17
Q

Diabetes should be considered in all overweight / obese individuals with risk factors - these include…
(9)

A

Physical inactivity
1st degree relative with T2DM
High risk race (Asian, Black, Latino, Native American Pacific Islander)
Women who deliver >9pound 4.1kg / Gest Diabetes
HTN (>140/90)
PCOS
Prediabetes
Signs of insulin resistance (acanthus nigricans)
History of cardiovascular disease

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18
Q

What 2 questions might you ask to assess emotional well-being as a vital sign?

A

Rank 1 to 5:
a) In most ways my life is close to my ideal
b) I am satisfied with my life
Other options include 12-item or 36-item Short Form
www.rand.org/health/surveys_tools.html

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19
Q

What values are required in the Framingham calculation to assess risk of MI in next 10yrs?
(7)

A 
Age
Gender
Total cholesterol
HDL cholesterol 
Smoking hx 
Systolic BP
HTN meds
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20
Q

What does the Guideline on the Assessment of Cardiovascular Risk assist clinicians with and for whom?

A

Provides a preventative tool to firstly help estimate 10-yr and lifetime risk of atherosclerotic CVD and then determine when to start a statin. For men and women 40-79 (Afrian American and non-hispanic Caucasians)

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21
Q

What is different about the 2015 MESA risk score to other CVD risk scores?

A

Again 10-yr CHD risk score for men and women - based on multi-ethnic study (largely caucasian and African American but inc hispanics and Chinese. Includes coronary calcium score

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22
Q

What does Reynold’s risk score consider and in which group of patients?

A

Reynolds: Used to Predict global CVD risk

in: Women
considers: FHx and high sensitivity CRP

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23
Q

Name 2 diabetes risk assessment tools used in America

A

1) The Prediabetes screening test (CDC) https://www.cdc.gov/diabetes/prevention/pdf/prediabetes-screening-test-tag508.pdf
2) American Diabetes Association risk assessment

(Finnish and Australian too)

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24
Q

Waist circumference is considered increased if what measurements for men and women?

A

men >/=40 inches

women >/= 35 inches

25
Q

Normal waist/hip ratios for men and women are…

A

men =/<0.90

women =/<0.85

26
Q

Give the value ranges for:

  • elevated BP
  • stage 1 HTN
  • stage 2 HTN
A

Elevated: 120-129 / <80mmHg
Stage 1: 130-139 / 80-89mmHg
Stage 2: 140 / >90mmHg

27
Q

As a minimum how often should we record pt BP?

A

Every 6-12 months

28
Q

What is Six Sigma?

A

A quality management tool used to streamline quality control to reduce variance.
Expected to lead to 99.99966% defect free results

29
Q

How do statins work?

A

Reduce amount of cholesterol made by the liver and improve LDL excretion

30
Q

What do papers by EH Wagner, JE Jordan, G Flodgren and SA Hetherington have in common?

A

They contain evidence for improved lifestyle outcomes when collaborative and chronic care models are used to combat chronic disease

31
Q

Flodren found that on average patients lost how many kg under joint care by doctor and dietitian compared with 1.2kg dr alone?

A

6.0kg

32
Q

Wagner 2001 on improving chronic care illness found that interdisciplinary team approach achieved what 2 outcomes for pts?

A

higher levels of compliance

improved health outcomes

33
Q

Hetherington 2015 found that healthy eating activities and lifestyle programs are assoc with what 3 outcomes?

A

1) weight reduction
2) improved BP and physical fitness
3) maintained behaviours >5months

34
Q

What is the Ornish Spectrum Program?

A

An Intensive Cardiac Rehab Programme

Comprising physician, RN, exercise physiologist, Health coach, stress management specialist, RD, chef/food services, admin assistant and marketing director

35
Q

What is the Medical Fitness Collaboration?

A

Medically supervised, integrated, outcomes- and accountability-based fitness programs for disease management. Individualised exercise prescriptions

36
Q

What report did the WHO release explaining that healthcare systems need to update practices to care for chronic disease at a societal level?

A

The Innovative Care for Chronic Conditions (ICCC)

  • Micro (pt & family)
  • Meso (healthcare organisation / community)
  • Macro (policy)
37
Q

The Collaborative Care Manager Model created by Agency for Healthcare Research and Quality is a model for what?

A

Showing how pts, experts, residents, nurse pracs and interdisciplinary teams can collaborate in an academic setting to care from chronic conditions

38
Q

The Chronic Care Model by the MacColl Institute and Ed Wagner is helpful in explaining what?

A

the involvement of community and healthcare system in chronic disease care
(Centred on an informed, activated and engaged patient and a prepared, pro-active primary care practice team)

39
Q

What are the 6 key points of focus in the Chronic Care Model guidelines?

A

1) Implementing the Chronic Care Model into local medical practice by creating links with other organisations and groups in the community
2) Healthcare delivery support - leadership top down, comprehensive system change, open and systematic handling of errors
3) Self-management support - pt and family central role, to become experts in own management, improve overall sense of well-being, train staff in behavioural change
4) Delivery system design - EHR, portal for increased ease of comms between / within heath team
5) Decision support - evidence based guidelines, personalise goals and processes to achieve them
6) How to make clinical info systems most effective - ease and timelines of info finding, electronic prompts / reminders, performance feedback, entry of specific tx targets and goals, tracking ability (p82-3)

40
Q

What is Prescription for Health?

A

6-yr initiative that evaluated 27 evidenced-based strategies to improve delivery and effectiveness of health behaviour change services in primary care

41
Q

What 4 health risk behaviours were targeted by the Prescription for Health initiative?

A

Tobacco use
Risky alcohol use
Unhealthy diet
Lack of physical activity

42
Q

What did Prescription for Health research find?

A

That substantial practice redesign was required to occur alongside public health and community resources (note the toolkit which resulted is now outdated!)

43
Q

What can the Electronic Preventive Services Selector (ePSS) be used for?

A

To help support / direct decision making regarding screening, counselling and preventive services by pt demographics at the point of consultation (e.g. 30, female, sexually active -> cervical screening)

44
Q

What does a Plan-Do-Study-Act cycle help with?

A

Heathcare service quality improvement (p84)

45
Q

What 2 questions should be during a Root Cause Analysis?

A

WHY? (3-5times to get to root of the incident)

SO WHAT? What is the consequence of something not going as planned (p85-6)

46
Q

Resting energy expenditure accounts for what % of overall daily energy expenditure?

A

60-75%

physical exercise only accounts for 15-30%; thermic 10%

47
Q

The physical activity 2-item screening tool measures which element of physical fitness?

A

cardiovascular fitness only

doesn’t account for strength/resistance/balance/flexibilty

48
Q

What tool may be used to assess vital sign ‘Stress’? Roughly how does the scoring work?

A

Perceived Stress Scale (Cohen)

Score 1-4 (Never to Very Often) - 6 Qs negatively phrased, 4 Qs positively phrased (inverse scoring)

49
Q

What 3 Qs are used to assess the vital sign ‘Sleep’?

A

a) how many hrs sleep do you get on an average week night?
b) how many hrs sleep do you get on an average weekend night?
c) how well do you feel you sleep? (perceived quality)

50
Q

What are the 2 Qs used to assess the vital sign Tobacco use?

A

1) Do you use tobacco

2) if yes, how much and for how many years

51
Q

What is considered normal weight re BMI in asian population?

A

BMI 18.5-22.9

over weight 23-27.4; Obese 27.5-32.4

52
Q

Reduction in BP by 5mmHg reduces mortality risk with the following by how much:

  • stroke
  • CHD
A

Stroke 14%

CHD 9%

53
Q

Risk of overall heart disease is very low when total cholesterol is less than what/

A

3.88

54
Q

Raised triglycerides are often assoc with what 2 features?

hint: cholesterol and body comp related

A

increased girth

Low HDL

55
Q

What 6 screening/diagnostic blood tests (or groups of blood tests) are relevant to lifestyle-related diseases?

A

1) metabolic panel (UEs, LFTs, sugars/HbA1c, Proteins)
2) FBC
3) Fasting lipids (TC, LDL, HDL, Tri, hsCRP)
4) C-peptide and HOMA-IR (insulin prod & resistance)
5) Vit D
6) TFTs

56
Q

What figures are diagnostic of diabetes:

  • HbA1c
  • Fasting glucose
  • 2-hr post prandial / random glucose
A

DIABETES

HbA1c >6.5% (>48mmol/mol UK)
Fasting glucose >7.0mmol/L
2-hr post-prandial/random >11.0mmol/L

57
Q

What figures are associated with pre-diabetes:

  • HbA1c
  • Fasting glucose
  • 2-hr post prandial / random glucose
A

PRE-DIABETES:

HbA1c 5.7 - 6.4% (42-47mmol/mol)
Fasting glucose 5.6 - 6.9mmol/L
2-hr post-prandial/random 7.8 - 11mmol/L

58
Q

What can Human Services referrals offer pts?

A

Nutrition programs
Social Services
Advice on disability benefits etc

59
Q

What can State/Area Agency of Aging offer?

A 
housing
food
employment
health care
counselling

Lifestyle Medicine (11 decks)

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