Family Medicine General MB.ChB.VI. Flashcards
DEFINE QUALITY OF CARE ACCORDING TO WORLD ORGANISATION FOR FAMILY DOCTORS
Best health outcomes that are possible, give available resources, and that are consistent with patient values and preferences.
EXPLAIN STEPS OF QUALITY IMPROVEMENT CYCLE
STEP 1. Agree on criteria: set realistic target standards re. structure, process, outcomes, etc.
STEP 2. Observe practice: collect data from sources
STEP 3. Evaluate information: compare to target standards
STEP 4. Plan care and implement change: action plan put into practice
INVOLVE ENTIRE TEAM
REPEAT AFTER PERIOD OF TIME
DEFINE PRIMARY PREVENTION
Removing the causal agent of a disease before it can manifest
e.g. provision of clean drinking water, immunisation programs
DEFINE SECONDARY PREVENTION
Identifying subjects at risk before they become symptomatic
e.g. screening by Pap smears, case-finding of hypertension
DEFINE TERTIARY PREVENTION
Limiting complications and disability of a disease
e.g. fundal examination in diabetics
IMPORTANT ASPECTS OF MOTIVATIONAL INTERVIEWING
- collaborative (no confrontation or coercion)
- evocative (evokes patients own goals)
- respectful and supportive
- empathic (attempt to understand and reflect)
- direction (decide together what to discuss and do)
STRUCTURE OF MOTIVATIONAL INTERVIEWING
- establish rapport
- set agenda - ask permission to discuss, or provide options of things to discuss
- assess readiness to change - stages of change or subjective ruler measurement
- explore importance - discuss pros and cons, give critical information
- build confidence - brainstorm, imagine
STAGES OF CHANGE MODEL
- precontemplation - has not considered change
- contemplation - actively thinking about benefits
- preparation - developing a plan of action
- action - change takes place
- maintenance
RELAPSE CAN HAPPEN IN ANY STAGE
HEALTH PROMOTION ACCORDING TO THE OTTAWA CHARTER
- advocate, enable, mediate
- build healthy public policy
- build supportive environments
- empowerment of communities
- develop personal skills (education, empowerment)
- re-orient health services
DEFINE IMPAIRMENT ACCORDING TO ICF
problems with body structure or function (anatomy or physiology)
DEFINE ACTIVITY LIMITATION ACCORDING TO ICF
problems in executing a task or action
DEFINE PARTICIPATION RESTRICTION ACCORDING TO ICF
problems in participating in a life situation
COMPONENTS OF THE ICF
A. functioning and disabilities
- structure, function, impairment
- activity limitations, participation restrictions
B. contextual factors
- environmental facilitators and barriers
- personal factors
REHABILITATION OUTCOME LEVELS
- physiological instability
- physiological medical stability
- physiological maintenance (nutrition, bladder and bowel, breathing, etc)
- home/residential re-integration
- community re-integration
- productive activity (vocational, educational, household, employment etc)
STEPS FOR CORRECT WHEELCHAIR POSITIONING
correct chair width correct chair depth correct foot rest height correct backrest height stable pelvis optimal spinal posture prevent sitting skew prevent unnecessary adduction/abduction of legs
WHEN WOULD YOU USE A SEMI-RECLINING WHEELCHAIR
acute phase only, in acute spinal or head injuries as assist with respiratory assist
WHEELCHAIR FOR CLIENTS WITH POOR SITTING BALANCE
long backrest wheelchair
WHEELCHAIR FOR ACTIVE CLIENTS
short backrest wheelchair - enables more freedom of upper limbs
FACTORS TO EVALUATE IN WHEELCHAIR ASSESSMENT
- clinical picture
- functional picture
- environmental background
MEASUREMENTS FOR WHEELCHAIR FITTING
SEAT WIDTH: measure hip width and add 2 inches
SEAT DEPTH: measure back of hip to back of knee while seated and subtract 1 inch
ARM HEIGHT: seat to elbow when flexed at 90 degrees, adjustable is best
FOOTREST LENGTH: back of knee to back of heel
BACKREST STANDARD: sitting, from seat to collarbone
LONG VS DESK LENGTH ARM RESTS
long is better for regular transfers, desk length allow for comfortable sitting at desks/tables
DEFINE EVIDENCE-BASED HEALTHCARE
conscientious, explicit and judicious use of current best evidence in making decisions with individual patients
CRITICAL READING AID
READER Relevance (to situation) Educational (challenges own knowledge) Applicability Discrimination (scientific quality) Evaluation (should it be taken seriously) Reaction (how can I use it)
FIVE STEPS OF EBHC
- focused answerable questions
- track down best evidence
- critically appraise for validity, importance, usefulness
- apply results to practice
- audit performance
COMPONENTS OF EBHC FOCUSED QUESTION
a. patient or problem
b. intervention
c. alternative intervention
d. outcome comparison
DETERMINING WHETHER YOU CAN APPLY EBM RESULTS TO YOUR PRACTICE
- burden of disease - is it big enough to warrant implementation
- beliefs - is it acceptable to the patient
- bargain - is it worth the resources of the community
- barriers - traditional, resources, etc
FIVE STEP APPROACH TO ETHICAL DILEMMAS
- identify conflicting values
- establish necessary information: medical, legal, ethical, socio-political, preferences and values
- analyse information obtained: balancing process
- formulate solutions, make recommendations, act
- implement policy
SIGNS AND SYMPTOMS ANAPHYLAXIS
shock bronchospasm angioedema urticaria flushing nausea tingling of lips
MANAGEMENT ANAPHYLAXIS
- secure airway
- IM Adrenaline 0,5mg every five minutes
- IV line
- anti-histamine e.g. promethazine 25-50mg
- oxygen and nebulised B2 agonist (salbutamol)
- glucocorticoids - hydrocortisone
BREAKING BAD NEWS
- make sure it is the right patient
- full attention - take phone receiver off, etc
- starting point: what do you know so far?
- “I’m sorry, it’s not good news” - PAUSE
- speak clearly, concisely, avoid medical jargon
- questions
- tell them they can write questions down and come back
- planning and support
- give realistic hope
- schedule follow-up
CHEMOPROPHYLAXIS CONSIDERED IN HIV PATIENTS
- Pneumocystis Jiroveci Pneumonia (co-trimoxazole)
- Measles, Varicella (immunoglobulin)
- TB (INH)
- Diarrhoea (vit A)
CAGE QUESTIONNAIRE
- feel you should CUT DOWN on drinking
- feel ANNOYED by people talking about your drinking
- feel GUILTY about drinking
- need an EYE-OPENER to get rid of hangover
Yes for 2 = consider harmful alcohol use
Yes for 3 = dependent on alcohol
BACTERIAL VAGINOSIS CRITERIA
- grey-white discharge
- positive amine/whiff test (fishy smell with KOH)
- pH >5
- clue cells
BACTERIAL VAGINOSIS TREATMENT
- Metronidazole 2g stat
2. Clotrimazole pessary stat / cream 7 days
MX STI
- syndromic pharmacy mx
- condoms used during tx
- trace partners and treat
- educate re safe sex, STI, HIV
- contraception counseling
- PAP smear
- continue tx to complete course
SYNDROMIC TX STI WOMEN
- cefixime (gonococcus)
- metronidazole (trachoma, gardnerella)
- doxycycline (chlamydia)
If pregnant: amoxicillin replaces doxy
