CSI Flashcards
why is influenza more dangerous
it preferentially binds to receptors in the lower respiratory tract
what are the 3 membrane glycoproteins on Influenza A
haemagglutinin (HA), neuraminidase (NA) and Matrix-2 (M2)
Influenza B shares which two glycoproteins with A
HA and NA + two others
does influenza C cause lower respiratory tract complications
only rarely
haemagglutin acts as (2)
an attachment factor and membrane fusion
HA binds to
sialic acid (to enter cell)
HA binding to sialic acid on RBCs causes
haemagglutination
Neuraminidase is a
glycoside hydrolase enzyme
neuraminidas allows the virus to be
released from cells (not stuck to sialic acid)
natural mutation over time and happens continuously, in all viruses is called
antigenic drift
genetic reassortment that yields a phenotypic change in viruses is called
antigenic shift
over time, antigenic shift can lead to (2)
loss of immunity<div>vaccine mismatch</div>
antigenic shift only happens in
influenza A
antigenic shift means that immediately, most people have
no immunity
why does antigenic shift only happen in infleunza A
other types of Influenza are not able to infect other animals (whichis essential for allowing reassortment)
what are the most common cold symptoms (3)
- mild cough/sore throat<div>- sneezing</div><div>- post-nasal drip</div>
what are the most common flu symptoms (4)
- cough<div>- fever</div><div>- fatigue</div><div>- headache</div>
what are common symptoms of COVID (3)
- loss of taste/smell<div>- fever</div><div>- cough</div>
what is the most common cold virus
rhinovirus
rhinovirus interacts with which cell membrane protein?
ICAM-1
coronavirus interacts with which cell membrane protein?
ACE2
“What are Zola’s triggers (5)”
“<ol><li>The occurrence of an interpersonal crisis</li><li>Perceived interference with social or personal relations</li><li>Sanctioning by others</li><li>Perceived interference with vocational or physical activity</li><li>Temporalizing (for example setting a deadline, i.e. ““I’ll go to the doctor if my fever is not gone by Monday””)</li></ol>”
“According to Helman’s folk model of illness, what does the patient want to know from their doctor?”
“<ol><li>What has happened? This includes organising the symptoms and signs into a recognisable pattern, and giving it a name or identity</li><li>Why has it happened? This explains the aetiology or cause of the condition</li><li>Why has it happened to me? This tries to relate the illness to aspects of the patient, such as behaviour, diet, body-build, personality or heredity</li><li>Why now? This concerns the timing of the illness and its’ mode of onset (sudden or slow)</li><li>What would happen to me if nothing were done about it? This considers its’ likely course, outcome, prognosis and dangers</li><li>What should I do about it - or to whom should I turn for further help? This considers strategies for treating the condition, including self-medication, consultation with friends or family, or going to see a doctor</li></ol>”
ICE stands for?
Ideas, Concerns, Expectations
in sickle cell haemoglobin, hydrophilic glutamate 6 is replaced by
hydrophobic valine 6
which form of HbS can polymerise
deoxygenated
what are the main symptons of sickle cell disease (3)
- sickle cell crises<div>- increased infection risk</div><div>- anaemia</div>
how might a patient self-manage a sickle crisis
- painkillers<div>- staying warm, warming pads</div><div>- drinking fluids</div>
how does drinking fluids prevent a sickle crisis
keeps blood thin and flowing well
how does staying warm prevent a sickle cell crisis
keeps peripheral blood vessels open
why are patients with sickle cell prescribed antibiotics
functional splenectomy
what are two medical treatments that can be given in an acute sickle crisis
- hydroxycarbamide<div>- blood transfusion</div>
what might you see on the blood test of someone with sickle cell anaemia (2)
- higher reticulocyte count, and thus increased MCV<div>- low Hb</div>
why are bone crises common in sickle cell anaemia
”- smaller blood vessels so easily ‘clogged’ by sickled erythrocytes”
why might visual loss occur in a patient with sickle cell anaemia?
- blocked blood vessels in the eye<div>- leads to shoddy blood vessel formation to bypass blockage</div><div>- shoddy vessels break causing retinal haemorrhage and in some cases retinal detachment</div>
are patients with sickle cell at higher risk of stroke
yes
why might a person with sickle cell anaemia take vitamin B12 and folate
manage anaemia and rapid RBC turnover
why are target cells found on the blood film of someone with sickle cell anaemia
loss of spleen function so altered RBCs not removed from circulation
ischaemic stroke is caused by
blood clots
why does sickle cell anaemia cause gallstones
buildup of bilirubin from RBC destruction
why might Howell-Jolly bodies be seen on the blood film of a patient with sickle cell anaemia
functional splenectomy
why might cardiac hypertrophy be seen in sickle cell anaemia
need to pump more blood to compensate for anaemia
what kind of anaemia is SCA
normocytic with high reticulocyte count
Which complication associated with sickle cell disease is most associated with significant memory impairment?
stroke
What is the most common central nervous system disorder associated with sickle cell disease?
Depression
what are healthcare associated infections
infections that patients get while receiving treatment for medical or surgical conditions
what is a central line-associated bloodstream infection
a serious HAI that occurs when germs (e.g., bacteria) enter the bloodstream through the central line (a long flexible tube placed in a large vein that empties out near the heart).
what are 5 common HAIs
<ol> <li>Catheter-associated urinary tract infections</li> <li>Surgical site infections</li> <li>Bloodstream infections</li> <li>Pneumonia</li> <li><em>Clostridium difficile</em></li></ol>
what are the three main types of risk factors for HAIs
medical procedures and antibiotic use, organizational factors, and patient characteristics
what can help to reduce rates of HAIs
proper education and training of health care workers
many HAIs are
preventable
the traditional epidemiologic triad model holds that infectious diseases result from
the interaction of agent, host, and environment
The reservoir of an infectious agent is the
habitat in which the agent normally lives, grows, and multiplies
is the reservoir necessarily the source from which an agent is transferred to a host
no; for example the reservoir of <em>Clostridium botulinum</em> is soil, but the source of most botulism infections is improperly canned food containing <em>C. botulinum</em> spores.
Asymptomatic or passive or healthy carriers are
those who never experience symptoms despite being infected
Incubatory carriers are
those who can transmit the agent during the incubation period before clinical illness begins
Reservoirs include (3)
humans, animals, and the environment
Chronic carriers are
those who continue to harbor a pathogen such as hepatitis B virus or<em>Salmonella</em>Typhi, the causative agent of typhoid fever, for months or even years after their initial infection.
Carriers commonly transmit disease because
they do not realize they are infected, and consequently take no special precautions to prevent transmission
Symptomatic persons who are aware of their illness, on the other hand, may be less likely to transmit infection because (3)
they are either too sick to be out and about, take precautions to reduce transmission, or receive treatment that limits the disease
The term <strong>zoonosis</strong> refers to
an infectious disease that is transmissible under natural conditions from vertebrate animals to humans
The portal of exit usually corresponds to
the site where the pathogen is localized
what is direct transmission
an infectious agent is transferred from a reservoir to a susceptible host by <b>direct contact</b> or<b> droplet spread</b>
direct contact occurs through
skin-to-skin contact, kissing, and sexual intercourse, and also contact with soil or vegetation harboring infectious organisms
<strong>Droplet spread</strong> refers to
spray with relatively large, short-range aerosols produced by sneezing, coughing, or even talking
<strong>Indirect transmission</strong> refers to the transfer of an infectious agent from a reservoir to a host by (3)
suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).
<strong>Airborne transmission</strong> occurs when
infectious agents are carried by dust or droplet nuclei suspended in air.
droplet nuclei may remain suspended in the air for
long periods of time
<strong>Vehicles</strong> that may indirectly transmit an infectious agent include (4)
food, water, biologic products (blood), and fomites (inanimate objects such as handkerchiefs, bedding, or surgical scalpels).
what is a fomite
inanimate objects such as handkerchiefs, bedding, or surgical scalpels that can spread an infectious agent
<strong>Vectors</strong> such as mosquitoes, fleas, and ticks
carry an infectious agent through purely mechanical means or support growth or changes in the agent.
The portal of entry refers to
the manner in which a pathogen enters a susceptible host
The final link in the chain of infection is
a susceptible host
Susceptibility of a host depends on (3)
genetic or constitutional factors, specific immunity, and nonspecific factors that affect an individual’s ability to resist infection or to limit pathogenicity
public health interventions are aimed at (3)
<ul> <li>Controlling or eliminating agent at source of transmission</li> <li>Protecting portals of entry</li> <li>Increasing host’s defenses</li></ul>
why may high herd immunity levels still lead to outbreaks
in highly immunized populations, the relatively few susceptible persons are often clustered in subgroups defined by socioeconomic or cultural factors. If the pathogen is introduced into one of these subgroups, an outbreak may occur.
what should we consider for a condition
impact on safety, system and resources
“how can we find out a bacteria’s sensitivities?”
“Antibiotic Sensitivity test<div><img></img><br></br></div>”
what are empiric antibiotics
antimicrobials are given to a person before the specific bacterium is known, anticipate likely cause of disease
why might a patient develop diarrhoea after antibiotic therapy
C difficile overgrowth following microbiome damage
what is candour
“<img></img>”
what is empathy
“<img></img>”
what can antibiotic-resistant infections require (3)
extended hospital stays, additional follow-up doctor visits, and costly and toxic alternatives.
name 3 medical advances dependant on antibiotics
organ transplants, cancer therapy, and treatment of chronic diseases like diabetes, asthma, and rheumatoid arthritis
why are rising community antibiotic-resistant infections concerning (3)
put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients in healthcare.
how should we prescribe antibiotics (4)
Always prescribe the right antibiotic, at the right dose, for the right duration, and at the right time.
what are common side effects of antibiotics (5)
rash, dizziness, nausea, diarrhea, and yeast infection
what does penicillin disrupt
creation of the cell wall
how does penicillin work
triggers lysis by preventing peptidoglycan cell wall creation
what is the active part of penicillin
beta-lactam ring
how is MRSA resistant to penicillin
“encodes alternative PBP which beta-lactams can’t bind to”
why is the NDM1 gene plasmid so dangerous
encodes a beta-lactamase that is effective against almost all known beta lactams
how does co-amoxiclav work
amoxicillin and clavuamic acid which blocks beta-lactamase
what is dementia
a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities
is dementia a normal part of ageing
no
what is the most common form of dementia
“Alzheimer’s disease”
does dementia affect consciousness
no
what does dementia affect (8)
memory,<div>thinking,</div><div>orientation,</div><div>comprehension,</div><div>calculation,</div><div>learning capacity,</div><div>language,</div><div>judgement.</div>
what is the impairment in cognitive function typically accompanied by
deteriortion in emotional control and soical behaviour
what are the three stages of dementia
early, middle, and late
what are three common symptoms of early stage dementia
<li>forgetfulness</li>
<li>losing track of the time </li>
<li>becoming lost in familiar places</li>
what are five common symptoms of middle stage dementia
“<li>becoming forgetful of recent events and people’s names</li><li>becoming lost at home</li><li>having increasing difficulty with communication</li><li>needing help with personal care</li><li>experiencing behaviour changes, including wandering and repeated questioning</li>”
whar are five common symptoms of late stage dementia
<li>becoming unaware of the time and place</li>
<li>having difficulty recognizing relatives and friends</li>
<li>having an increasing need for assisted self-care</li>
<li>having difficulty walking</li>
<li>experiencing behaviour changes that may escalate and include aggression</li>
“what are common forms of dementia other than Alzheimer’s (3)”
vascular dementia,<div><br></br><div>dementia with Lewy bodies (abnormal aggregates of protein that develop inside nerve cells),</div><div><br></br></div><div>frontotemporal dementia (degeneration of the frontal lobe of the brain)</div></div>
what is the estimated proportion of the general population aged 60 and over with dementia at a given time?
5-8%
what are the principal goals for dementia care (5)
<ul><li>early diagnosis in order to promote early and optimal management</li><li>optimizing physical health, cognition, activity and well-being</li><li>identifying and treating accompanying physical illness</li><li>detecting and treating challenging behavioural and psychological symptoms</li><li>providing information and long-term support to carers.</li></ul>
what are known physical risk factors for dementia (7)
- age<div>- lack of exercise</div><div>- smoking</div><div>- alcohol abuse</div><div>- BMI</div><div>- diet</div><div>- BP, cholesterol, BG</div><div><br></br></div>
what are known psychosocial risk factors for dementia (4)
- depression<div>- low educational attainment</div><div>- social isolation</div><div>- cognitive inactivity</div>
what is mild cognitive impairment
- minor problems with cognition<div>- worse than expected for healthy person of same age</div><div>- not severe enough to interfere with daily life (so not dementia)</div>
how many people over 65 have MCI
5-20%
<div>A person with MCI has mild problems with one or more of the following - VALMR (5)</div>
<ul><li>memory - for example, forgetting recent events or repeating the same question</li></ul>
<ul><li>reasoning, planning or problem-solving - for example, struggling with thinking things through</li></ul>
<ul><li>attention - for example, being very easily distracted</li></ul>
<ul><li>language - for example, taking much longer than usual to find the right word for something</li></ul>
<ul><li>visual depth perception - for example, struggling to interpret an object in three dimensions, judge distances or navigate stairs.</li></ul>
In someone with MCI, however, the decline in mental abilities is greater than in
normal ageing
what can cause MCI (7)
”- ‘pre-dementia’<div>- depression</div><div>- anxiety</div><div>- physical illness</div><div>- poor eyesight/hearing</div><div>- vitamin/thyroid deficiency</div><div>- medication side effects</div>”
do people with MCI have an increased risk of developing dementia
yes but not at all guaranteed
how can MCI be treated (5)
- control heart problems, diabetes<div>- prevent stroke</div><div>- stop smoking/drinking</div><div>- exercise and diet</div><div>- mental and social activity</div>
what are the benefits of diagnosing MCI
- identify and support patients at increased risk of dementia
what are four interventions that either prevent occurence or delay onset of dementia/MCI
Physical activity<div>Mediterranean diet</div><div>Not smoking</div><div>Not drinking to excess</div>
what post-diagnostic interventions can be made after a diagnosis of MCI/dementia (4)
Social isolation<div>Cognitive stimulation</div><div>Prompt treatment of infection</div><div>Prompt treatment of depression</div>
what are the three kinds of cognitive intervention
Cognitive Stimulation, Cognitive Training, and Cognitive Rehabilitation
what is cognitive stimulation
Cognitive stimulation comprises involvement in group activities that are designed to increase cognitive and social functioning in a nonspecific manner.
what is cognitive training
Cognitive training is a more specific approach, which teaches theoretically supported strategies and skills to optimize specific cognitive functions.
what is cognitive rehabilitation
Cognitive rehabilitation involves an individualised approach using tailored programs centred on specific activities of daily life. Personally relevant goals are identified, and the therapist, patient and family work together to achieve these goals (e.g., joining a social group)
what is reminsicence therapy
enable or encourage people to think or talk about personally significant eventsthat occurred in the past
what are other potentially helpful interventions for people with dementia/MCI
- music therapy<div>- art therapy</div><div>- improving living environment</div><div>- excercise (as lifestyle change)</div>
what is a MDT
combination of professionals from different clinical disciplines and with specific expertise, that work together to optimise a patient’s care
what is a MDM
meeting between individuals, or representatives of these different groups/specialties, to plan the best care for a patient.
how can we assess memory
cognitive screening test
“what are characteristic features of Alzheimer’s”
- most common type<div>- gradual onset</div>
what are characteristic features of Vascular Dementia
stepwise progression
what are characteristic features of Lewy body dementia
visual hallucinations
what are amyloid plaques
Amyloid precursor protein, which is usually cleaved by alpha-secretase, becomes aberrantly cleaved by beta and gamma secretases. This results in a relative surplus of amyloid-beta (Aβ), the final product in this enzymatic pathway. Aβ peptides aggregate into oligomers and fibrils with beta-sheet pairing and ultimately become deposited in diffuse, insoluble senile plaques
what are neurofibrillary tangles
However, when Tau is hyper-phosphorylated, it oligomerises and aggregates into filamentous neuro-fibrillary tangles (NFTs)
“many drug treatments for Alzheimer’s disease focus on”
replacing acetylcholine lost via death of neurones in the nucleus basalis of Meynert
“what are four cerebral features of Alzheimer’s”
(1) amyloid plaques,<div>(2) neurofibrillary tangles,</div><div>(3) synaptic deterioration and neuronal death</div><div>(4) cerebro-cortical atrophy.</div>
“name 3 regions associated with the limbic system implicated in Alzheimer’s”
- cingulate gyrus<div>- hippocampus</div><div>- thalamus</div>
name 4 people who might be part of an MDT for a MCI patient
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when is the mental health act used instead of the mental capaciy act
“<img></img>”
give five examples of people who may lack capacity
“<img></img>”
does lacking the capacity to make a specific decision mean that you lack capacity to make any decision
“no<div><img></img><br></br></div>”
when should we assume someone does not have the capacity to make a decision
when this is proven
can you have capacity to make an unwise decision
yes
decisions made for people lacking capacity must
be in their best interests and least restrictive of their basic rights and freedoms
people should be provided with
an independant advocate
what test of capacity does the MCA set up
2 stage:<div><div>1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? </div><div><br></br></div> <div>2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.</div></div>
“a person is unable to make a decision if they can’t”
“<img></img>”
“Before deciding a person lacks capacity, it’s important to”
take steps to enable them to try to make the decision themselves
how can we take steps to enable them to try to make the decision themselves?
“<img></img>”
“according to the MCA, how do we decide what’s in a patient’s best interests”
“<img></img>”
“who else should we consult for views about a patient’s best interests”
“<img></img>”
what should we try to find beforemaking a decision or act on behalf of someone who lacks capacity
the least restrictive alternative
Where it appears a deprivation of liberty might happen, the provider of care (usually a hospital or a care home) has to
apply to their local authority
the local authority will grant legal authorisation
if the deprivation of liberty is in the best interests of the individual concerned
what is an advance statement
“a written statement that sets down a person’s preferences, wishes, beliefs and values regarding their future care. It’s not legally binding.”
what might an advance statement contain
“<img></img>”
what is an advance decision
legally binding decision that allows someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may lack capacity to consent to or refuse that treatment.
an advance decision must
be valid and applicable to current circumstances.
<div>If the advance decision refuses life-sustaining treatment, it must</div>
<ul><li>be in writing, signed and witnessed</li><li>state clearly that the decision applies even if life is at risk</li></ul>
what does a lasting power of attorney do
enable another person to make decisions about your health and welfare, or decisions about your property and financial affair
<div>When acting under an LPA, an attorney (the appointed person) must</div>
“<ul><li>make sure the MCA’s statutory principles are followed</li><li>check whether the person has the capacity to make that particular decision for themselves – if they do, a personal welfare LPA can’t be used and the person must make the decision</li></ul>”
In addition to a LPA the Court of Protection will be able to
appoint deputies who can also take decisions on health and welfare and financial matters if the person concerned lacks the capacity to make a decision.
what is the role of the court of protection
“The <a>Court of Protection</a> oversees the operation of the Mental Capacity Act and deals with all issues, including financial and serious healthcare matters, concerning people who lack the mental capacity to make their own decisions.”
“what are 7 typical early symptoms of Alzheimer’s (MCMCMRL)”
<li><b>M</b>emory problems like regularly forgetting recent events, names and faces.</li>
<li>Becoming increasingly <b>R</b>epetitive, e.g. repeating questions after a very short interval or repeating behaviours and routines.</li>
<li>Regularly <b>M</b>isplacing items or putting them in odd places.</li>
<li><b>C</b>onfusion about the date or time of day.</li>
<li>People may be unsure of their whereabouts or get <b>L</b>ost, particularly in unfamiliar places.</li>
<li>Problems <b>C</b>ommunicating or finding the right words.</li>
<li>Some people become low in <b>M</b>ood, anxious or irritable. Others may lose self-confidence or show less interest in what’s happening around them</li>
“what are serious symptoms of late Alzheimer’s (not just early ones getting worse)”
<li>People may have problems walking, be unsteady on their feet, find swallowing food more difficult or have seizures.</li>
<li>People may experience hallucinations, where they see or hear things that are not there. Others may believe things to be true that haven’t actually happened, known as ‘delusions’.</li>
what are specific symptoms of vascular dementia (4) SPMS
<ul> <li>Slower thinking - taking more time to process information and to form thoughts and sentences.</li> <li>Personality changes – people may become low in mood, more emotional or lose interest in what’s happening around them.</li> <li>Movement problems - difficulty walking or changes in the way a person walks.</li> <li>Stability – unsteadiness and falls.</li></ul>
What are specific symptoms to dementia with Lewy Bodies (SMASH U)
<ul> <li>Changes in <b>A</b>lertness and attention, and periods of confusion, that may be unpredictable and change from hour-to-hour or day-to-day.</li> <li><b>M</b>ovement problems - Parkinson’s-type symptoms such as slower movements, stiffness in the arms and legs, and shaking or trembling.</li> <li><b>U</b>nsteadiness and falls.</li> <li>Visual <b>H</b>allucinations – Seeing things that are not really there, e.g. people or animals. These often happen repeatedly and are realistic and well-formed.</li> <li><b>S</b>leep disturbances - Vivid dreams, shouting out or moving while sleeping which can disrupt sleep, and may cause injury.</li> <li>Sense of <b>S</b>mell – Problems detecting smells.</li></ul>
what are 3 types of frontotemporal dementia
behavioural variant frontotemporal dementia<div>semantic dementia<br></br></div><div>progressive non-fluent aphasia<br></br></div>
In behavioural variant frontotemporal dementia, the parts of the frontal lobe that control what may be most affected
social behaviour
In semantic dementia, the parts of the temporal lobe that support what are most affected.
understanding of language and factual knowledge
In progressive non-fluent aphasia, the parts of the frontal lobe that control what are most affected.
speech
what are specific symptoms of frontotemporal dementa (MAILO)
<li><b>I</b>nappropriate behaviour - this might include making inappropriate jokes or showing a lack of tact. Humour or sexual behaviour may change. Some people become impulsive or easily distracted.</li>
<li><b>O</b>bsessions – people might develop unusual beliefs, interests or obsessions.</li>
<li><b>A</b>wareness - do not realise there are changes in their personality or behaviour.<br></br></li>
<li><b>L</b>anguage - decline in language abilities. This might include difficulty speaking or understanding the meaning of words. People may repeat words and phrases or forget what words mean.<br></br></li>
<li><b>M</b>ovement problems - around one in every eight people with behavioural variant FTD also develops movement problems of motor neurone disease. This can include stiff or twitching muscles, muscle weakness and difficulty swallowing.<br></br></li>
what is pre-diabetes
your blood sugars are higher than usual, but not high enough for you to be diagnosed with type 2 diabetes. It also means that you are at high risk of developing type 2 diabetes.
what are other names for pre-diabetes
<ul> <li>borderline diabetes</li> <li>Impaired Fasting Glucose (IFG)</li> <li>Impaired Glucose Tolerance (IGT)</li> <li>Impaired Glucose Regulation (IGR)</li> <li>Non-diabetic hyperglycaemia</li></ul>
“what is the target range HbA1C if you’re at risk of developing T2DM”
below 42mmol/mol
does pre-diabetes mean you will get T2DM
No, but you need ot act to avoid it
what are symptoms of pre-diabetes
“Prediabetes doesn’t have any symptoms. If you start to have any of the <a>symptoms of type 2 diabetes</a> it means you have probably already developed it.”
how many people are at increased risk of T2DM in the UK
12.3 million
how many cases of T2DM can be prevented
3 in 5
what can significantly reduce your risk of T2DM
losing 5% of your body weight
how can T2DM be prevented
- manage weight<div>- healthy diet</div><div>- be more active</div>
what kind of diet increases your risk of T2DM
“ifyour diet is made up of food and drinks withhighfat, high GI (short for <a>glycaemic index</a>) and lowfibre”
what kinds of diet have been linked with a decreased risk of T2DM
<ul> <li>Mediterranean diet</li> <li>Dietary Approaches to Stop Hypertension (DASH) diet</li> <li>vegetarian and vegan diets</li> <li>the Nordicdiet</li> <li>moderately cutting down on carbohydrates.</li></ul>
what is a sedentary lifestyle
spend a lot of time sitting down
do you need to join a gym to become more active
no, you could make small changes so that you are being more active every day. Think about taking phone calls standing up, using stairs instead of the lift, and going for a walk on your lunch break
what is the NHS diabetes prevention programme
The NHS Diabetes Prevention Programme (NHS DPP) is a joint commitment from NHS England, Public Health England and Diabetes UK, to deliver at scale, evidence based behavioural interventions for individuals identified as being at high risk of developing Type 2 diabetes
diabetes currently accounts for what proportion of the NHS budget
10%
what are the long-term aims of the NHS DPP
To reduce the incidence of Type 2 diabetes;<div>•To reduce the incidence of complications associated with diabetes - heart, stroke, kidney, eye and foot problems related to diabetes; and</div><div>•Over the longer term, to reduce health inequalities associated with incidence of diabetes</div>
why might the incidence of diabetes increase when the NHS DPP is first implemented
In the short-term we recognise that a stronger focus on identifying people who are at risk of diabetes is likely to increase incidence of diabetes as more undiagnosed cases are uncovered.
what are the three core goals of the NHS DPP
achieving a healthy weight<div>•achievement of dietary recommendations</div><div>•achievement of CMO physical activity recommendations</div>
what does the NHS DPP programme consist of
at least 13 sessions, with at least 16 hours face to face contact time, spread across a minimum of 9 months, with each session lasting between 1 and 2 hours. People will be supported to set and achieve goals and make positive changes to their lifestyle in order to reduce their risk of developing Type 2 diabetes. Sessions will be delivered predominantly in face to face groups
who is eligible for the NHS DPP programme
Individuals eligible for inclusion have ‘non-diabetic hyperglycaemia’ (NDH), defined as having an HbA1c 42 – 47 mmol/mol (6.0 – 6.4%) or a fasting plasma glucose (FPG) of 5.5 – 6.9 mmol/l. The blood result indicating NDH must be within the last 12 months to be eligible for referral and only the most recent blood reading can be used. Only individuals aged 18 years or over are eligible for the intervention
what are the referral routes into the NHS DPP programme
•Those who have already been identified as having an appropriately elevated risk level (HbA1c or FPG) in the past and who have been included on a register of patients with high HbA1c or FPG;<div><br></br></div><div> •The NHS Health Check programme, which is currently available for individuals between 40 and 74. NHS Health Checks includes a diabetes filter, those identified to be at high risk through stage 1 of the filter are offered a blood test to confirm risk;</div><div><br></br></div><div>and •Those who are identified with non-diabetic hyperglycemia through opportunistic assessment as part of routine clinical care.</div>
in T2DM, what contributes to progressive failure in the function of β-cells
β-cell resistance to the incretin ‘glucagon-like peptide 1’ (GLP1)
in T2DM, what contributes to the excessive glucose production by the liver
increased glucagon levels and enhanced hepatic sensitivity to glucagon
Insulin resistance in adipocytes results in
accelerated lipolysis and increased plasma free fatty acid (FFA) levels, both of which aggravate the insulin resistance in muscle and the liver and contribute to β-cell failure
In T2DM, what in the kidney contributes to the maintenance of hyperglycaemia
Increased renal glucose reabsorption by the sodium/glucose co-transporter 2 (SGLT2) and the increased threshold for glucose spillage in the urine
what contributes to weight gain in T2DM
Resistance to the appetite-suppressive effects of a number of hormones, as well as low brain dopamine and increased brain serotonin levels, which exacerbates the underlying resistance.
What two other factors cause hyperglycaemia in T2DM
- inflammation<div>- vascular insulin resistance</div>
what are symptoms of T2DM
<ul><li>peeing more than usual, particularly at night</li><li>feeling thirsty all the time</li><li>feeling very tired</li><li>losing weight without trying to</li><li>itching around your penis or vagina, or repeatedly getting thrush</li><li>cuts or wounds taking longer to heal</li><li>blurred vision</li></ul>
what are 4 risk factors for T2DM
<ul><li>are over 40 (or 25 for south Asian people)</li><li>have a close relative with diabetes (such as a parent, brother or sister)</li><li>are overweight or obese</li><li>are of Asian, African-Caribbean or black African origin (even if you were born in the UK)</li></ul>
Impaired insulin secretion in T2DM is caused by pancreatic β-cell dysfunctioning owing to (3)
lipotoxicity, glucotoxicity and resistance toincretins (intestinal hormones that stimulate insulinsecretion).
