Exam 2 Supplemental material questions

Question 1

palliative vs hospice care

Answer 1

Palliative care is focused on improving quality of life for people with serious illness ⇒ for any age and wants to manage symptoms effectively involving multiple types of doctors and other care providers that work together so care reflects the sick persons goals and values
- Hospice is a specific type of palliative care in the last months to weeks of life

Question 2

what does palliative care include

Answer 2

• home, assisted living, nursing home, hospital, palliative care clinics
• Advanced care planning, hospice, and bereavement support
• Time for family, communication about what to expect, management of physical and mental symptoms (pain, depression, anxiety, fatigue, shortness of breath, constipation, nausea, loss of appetite, difficulty sleeping), etc

Question 3

who can get palliative care?

Answer 3

anyone with a serious illness

Question 4

child life specialist

Answer 4

help children understand hospitalization, illness, and procedures

Question 5

responsibilities of a child life specialist

Answer 5

distract during invasive procedures, friend, be fun, be positive, emotional issues, collaborate, play with them, get special entertainment, art projects, pet therapy, music therapy, socialize, celebrate life, work with family, etc
- preparation, teaching doll, medical equipment, etc.

Question 6

who is likely to provide care to a family member

Answer 6

women are usually the caregiver

Question 7

what support is available for caregivers?

Answer 7

finding relaxation, time with friends, take time for themself, support groups, resources in the community, speak with your physician, caregiver support programs (reimbursement), home modifications, options and waiver programs for a home health aid (60+ and income), call local offices or state department for aging, accept help, etc.

Question 8

how does advanced planning help the one receiving care as well as the caregiver?

Answer 8

have medical desire conversations early because we don’t know what will happen ⇒ advance directive/living will, durable power of attorney for healthcare, POLST, etc.
- This avoids unnecessary intervention and trauma, it also makes it easier for the caregiver to not have to worry about things in the middle of the crisis

Question 9

is dare effective and why?

Answer 9

No it fails to substantially reduce drug use among peoples peers ⇒ likely because teens were good at catching and dismissing clear exaggerations about the detrimental health effects of relatively harmless drugs like marijuana which discredits overall efforts

Question 10

what is relevant about DARE now that recreational marijuana is being approved

Answer 10

With marijuana legalization, we will likely need to shift to education and rehabilitation programs
- Best way to discourage drug use is to dispute the idea that drug use makes someone an independent risk taker
- Kids should know that studies exist and make up their own mind
- Scaremongering doesn’t really work
- Honesty is likely the best policy

Question 11

what is true of statements about drugs to teens?

Answer 11

We need to use credible statements that tell it how it is and not exaggerate or teens will pick up on it and dismiss anything related to the education
- Some anti drug messages lead to even more drugs ⇒ foster curiosity
- Some of the approaches normalize drug use

Question 12

what health behavior is the focus of research in the Dubner and Levitt article? How did they frame things successfully?

Answer 12

poor hand hygiene by doctors and other hospital staff ⇒ perception deficit and arrogance
- agar plated everyone’s hands and showed the amount of bacteria on them ⇒ this was placed as the screensaver for all of the computers which fixed the hand washing problem

Question 13

what does habits trump medicine mean?

Answer 13

good choices involving food and lifestyle are more effective preventatively than treatments done by medicine ⇒ food and exercise is more effective than drugs are

Question 14

what forms of social support are there for health issues?

Answer 14

• Support groups meeting face to face
• Diabetes screening centers to public transportation sites
• Caregivers and healthcare professionals
• Online support groups

Question 15

how did Frakt induce the placebo effect?

Answer 15

He told the nurse to tell him he was giving him Demerol in his IV when he had a kidney
stone because he knew he would believe it if the nurse said it => placebo ≠ treatment absence

Question 16

what were Frakts observations about placebo?

Answer 16

He felt his pain subside even though the nurse didn’t actually give him dermol

Question 17

What does a placebo-controlled study tell us about a given treatment and about the placebo effect according to Frakt?

Answer 17

Whether the second effect (placebo effect) operates only through belief or if the active part of the treatment does more
- 2 placebos relieve more pain than 1
- Placebo pills with name brands are more effective
- Patients taking cholesterol medications survive longer than those with placebos skilling doses
- Measurements of increased endorphins aka our bodies natural pain relievers are associated with placebos

Question 18

is the placebo effect real according to Burton?

Answer 18

Yes, when there was no medicine we only had placebo effect treatments and those appeared
to work somewhat effectively

Question 19

what are physiological mechanisms uncovered about placebo according to Burton?

Answer 19

Belief in positive thinking and personal self control push us to scientific validity
- The placebo effect reduces pain by triggering endogenous opiate like hormones
aka endorphins ⇒ opioid receptors were engaged
- Dopamine receptors responsiveness is associated with placebo too

Question 20

what was found in the placebo controlled dental surgery Burton looked at?

Answer 20

Those who were told they were getting a powerful analgesic that was actually saline had the same response as those who were actually given morphine

Question 21

what are the placebo and nocibo responses in the Harvard Magazine?

Answer 21

P: sham patients of the acupuncture and pills that were having a placebo effect said they
felt amazing ⇒ acupuncture patients said they felt even better than the anti pain pill ones
N: The other patients said that they felt sluggish from the pills and had swelling and redness from the needles ⇒ each of the procedures were fakes

Question 22

was the sham acupuncture more affective than the pills?

Answer 22

Yes, more “invasive” procedures such as needles are more effective because they feel more realistic

Question 23

what were the IBS study results for patient-provider interactions according to Harvard Magazine?

Answer 23

Methods of placebo administration are as important as the administration itself
- Patients who experienced the greatest relief were those who received the most care
- This showed a dose dependent response

Question 24

what happened in the IBS study follow up with openly labeled placebos according to Harvard Magazine?

Answer 24

Even patients who know they are taking a placebo still report feeling better
- 2x the amount of relief as no treatment groups
- Rituals and drugs have the same effect on the brain

Question 25

what is dose dependent response?

Answer 25

a response dependent on how much of the placebo as well as the time with the (+) doctor that patients have

Question 26

in the Harvard Magazine asthma study what symptoms responded to the placebo?

Answer 26

Only the real treatment yielded improved lung function, but not the sham treatments
When Kaptchuk team measures patients own assessments of improvements, the researchers
found no difference between the real and sham treatments ⇒ contradicted their own
objective physical measures

Question 27

What was the nocebo response in the Sheridan study?

Answer 27

People said they felt more pain when the cream looked expensive

Question 28

what factors influenced the response in Sheridan?

Answer 28

The perceived price of the cream and the level of activation in areas depending on the amount of pain
people said they were feeling

Question 29

are people faking illness if they are healed by a placebo according to radio lab podcast?

Answer 29

No, peoples brains respond to placebo the same as drugs

Question 30

according to radio lab podcast what other forms do placebos take?

Answer 30

hypnosis, confidence, interaction (body language), religion

Question 31

in the Ted Kaptchuk TED-talk how many arms were used in the IBS study and what happened in each?

Answer 31

3-armed study with 262 patients
- 28% in no treatment had relief
- 44% in no engaged physician care had relief
- 62% in placebo + engaged physician care had relief

Question 32

what was done in the migrant study with Ted Kaptchuk TED-talk? What were the results?

Answer 32

headaches were observed of acute episodes
- Gave patients maxalt for aborting headaches or gave them placebos
- Put them in an envelope labeled maxalt, placebo, or maxalt
Results:
- Placebo maxalt ⇒ 30% reduction in pain
- Maxalt labeled placebo ⇒ 38% reduction in pain
- Maxalt labeled maxalt ⇒ 62% reduction in pain

Question 33

what was done in the Ted Kaptchuk TED-talk with Parkinson’s disease? What were the results?

Answer 33

6 patients with parkinsins were taken off of their medications
- Neuroimaged in symptomatic places
- Gave them either their old pill or placebos
Results:
- They had more dopamine in the brain with the placebo than the baseline
- 200% increase in dopamine
- Equivalent to their stable dosage from before being taken off