FoPC III Flashcards

Question

How can one deal with confounding factors when designing a study?

Answer 1

- Randomization in trials - Restriction of eligibility criteria to only certain study subjects - Matching subjects for likely confounding factors - Stratification of results according to confounding factors - Adjusting results to take account of suspected confounding factors

Answer 2

1. Strength of association (as measured by relative risk or odds ratio) 2. Consistency (Repeated observation of an association in different population under different circumstances) 3. Specificity (a single exposure leading to a single disease) 4. Temporality (the exposure comes before the disease) 5. Biological Gradient (Dose-response relationship; as exposure increases so does the risk of disease) 6. Biological Plausibility (the association agrees with what is known about the disease) 7. Coherence (the association does not conflict with what is known about the biology of disease) 8. Analogy (exposure-disease relationship) 9. Experiment (a suitably controlled experiment to prove the association is casual – uncommon in human populations) NOTE: temporality is the only absolutely necessary criterion

Answer 3

22%; the majority (80%) will live in low or middle income countries

Answer 4

The population has a steady INCREASE, Fertility rate is decreasing and total life expectancy is increasing

Answer 5

- Migration - Health education programs including AIDS and malaria prevention - Improvements in public health related to housing, clean water and nutrition - Increased involvement in aid agencies and charities

Answer 6

The population is aging rapidly – even in lower socioeconomic classes, the fertility rate is decreasing and the life expectancy rate is increasing dramatically

Answer 7

The population is aging and growing, fertility is decreasing and the life expectancy is growing

Answer 8

There is an increasing life expectancy, an increase in the number of people ++65, and an increase in net migration, the young population (0-50) is going to decrease significantly

Answer 9

- Baby Boomers after WW2 are ageing - Mortality rates are improving - There is an increasing emphasis on preserving health and fitness in the older population

Answer 10

- Increasing number of geriatricians and health professionals involved in care of the elderly will be required - Increasing need for facilities for elderly health care - Chronic disease care will be moving from secondary care to primary/community care - Palliative care will be increasing - Increasing specific health promotion campaigns for the elderly

Answer 11

- Increasing dependence on families to take care of ageing relatives - Increasing demand for home carers - Increasing need for providing social activities for the elderly - Changing role of elderly as grandparents, etc. - Changing housing demands as more elderly people become capable of living on their own

Answer 12

- The retirement/pension age is increasing - Finding employment for young people may be harder as elderly people stay in work for longer - Proportionately fewer people will be paying taxes, making pension funds less adequate - Decreasing adequacy of state pension funds - Increasing cost of ‘free personal care for the elderly’ policy

Answer 13

- Current decision making and planning must take into account the ageing population - The elderly population will gain a bigger voice in influencing political decisions

Answer 14

The co-existence of two or more long-term conditions in an individual; it is the norm, rather than the exception, in primary care patients

Answer 15

Older patients may have more than one chronic health conditions making treatments more complex. E.g. treating one condition may make another condition worse

Answer 16

-Promotes discussion in which individuals, their care providers and those close to them, make decisions with respect to their future health or personal and practical aspects of care

Answer 17

-Any time in life that seems appropriate and continuously

Answer 18

Any doctor with an appropriate relationship

Answer 19

- Thinking ahead and make plans | - Be careful; write down everything

Answer 20

Through a Key Information Summary (KIS)

Answer 21

1) Legal Matters a. Welfare Power of Attorney b. Continuing power of attorney c. Guardianship 2) Personal a. Advance statement (statement of values, preferences and priorities, advance decisions to refuse treatments, other people to contact) b. Thinking ahead and making plans 1. Medical a. SPAR b. Home care packages c. Potential Problems d. GSFS e. ePCS f. DNA/CPR g. Just in Case h. Liverpool Care pathway i. DN verification of death

Answer 22

1. GPs, District Nurses ad hoc arrangements 2. No discussion w/ patient or family on condition, outlook, anticipated problems, place of care 3. Patient problems with pain, sickness, constipation and anxiety continue 4. Patient makes a crisis call OOHs – there is no plan of care and no drugs in the home 5. Patient is admitted to hospital after calling 999 6. Patient dies in hospital after failed CPR 7. Family is given minimal support grief 8. There is no reflection by the profession team on care

Answer 23

1. Patient is on the GP register and is discussed at team meetings 2. Social and financial support and information is given to the patient and carers 3. There are usual GP and DN proactive support visits and phone calls to the patient 4. Assessment of symptoms, partnerships with specialists and customized care are provided to the patient 5. Care is continuously assessed, including respite and psychosocial needs 6. The preferred place of care is noted and organized 7. Care plan and medications are issued for patient use at home 8. An end of life pathway is created with the patient 9. Patient dies in the preferred place; family bereavement is met with support 10. Staff reflect on patient’s death, audit gaps improve care and the whole MDT learns more about good patient practice

Answer 24

A sector of health care that focuses with the effects of health on work and work on health. It attempts to maximize people’s opportunity to benefit from healthy and rewarding work while not putting themselves or others at unreasonable risk

Answer 25

Something with the potential to cause harm

Answer 26

The likelihood of something causing harm

Answer 27

Something that increases the risk of harm occurring

Answer 28

Something that has the potential to decrease harm

Answer 29

Something that influences the likelihood that something will cause harm

Answer 30

1. Demands of the job; Physical/intellectual 2. Environment (office, shop, factory) and its Associated Risk Factors 3. Temporal (shift work, early starts) 4. Travel 5. Organizational (lone working, customers, etc.) 6. Layout (ergonomic, work equipment, etc.)

Answer 31

``` Stamina Mobility (walking/bending/sitting) Agility (dexterity/posture/co-ordination) Rationale (mental state/mood) Treatment (duration, side effects) Intellectual (cognitive abilities) Essential for Job Sensory Aspects ```

Answer 32

The ability of a patient to do their job effectively (safety, performance, attendance, any pre-existing conditions) -This may include assessment of fitness for specific jobs (especially Pilots, Offshore Workers, Fire-fighters, armed forces, seafarers, and HGC/PCV drivers

Answer 33

Construction, agriculture, waste/recycling (Note: roughly 1 in 2000 employees report a non-fatal work injury)

Answer 34

8000 Occupational Cancer Deaths in the UK, 4000 cases of COPD due to exposure, Occupational Asthma accounts for 15% of all adult asthma The problem of Occupational Health is worse in developing nations The majority of Occupational Health complaints are: stress, depression/anxiety and MSK disorders It should be preventable

Answer 35

Act places a duty on employers “so far as is reasonably practicable to protect the health, safety and welfare.” of their employees, visitors and the public

Answer 36

1. Identify Hazards; requires knowledge of link between exposure and disease 2. Determine who might be harmed and how 3. Evaluate risks and decide on precautions 4. Record findings and implement controls 5. Review and update when necessary

Answer 37

SUBSTITUION – find a less hazardous procedure, a less hazardous agent or a less hazardous formulation ENGINEERING CONTROLS – general ventilation, local exhaust ventilation, enclosures, silences, isolation/separation ADMINISTRATIVE CONTROLS – permit to work systems, access controls, information/instruction/training, task rotation, equipment purchasing, maintenance PERSONAL PROTECTIVE EQUIPMENT – hard hats, ear defenders, goggles, breathing apparatus, gloves, coveralls, body armour, safety boots

Answer 38

It Is the LEAST effective control due to: maintenance, storage, replacement, training, usage, compatibility, ‘one size fits none’ and inappropriate selection

Answer 39

1. Diagnosis – occupational history, clinical examination, clinical tests, workplace visit 2. Investigation – workplace monitoring, biological monitoring 3. Treatment 4. Modifying Work Procedures – modified hours, duties, adjustments under the equality Act, redeployment 5. Modify Workplace (unnecessary if employee does not become reaffected) 6. Health Surveillance 7. RIDDOR (Reporting of injuries, diseases and dangerous occurrences 8. Regulations) reportable condition?

Answer 40

1. Inequalities in health within and between countries 2. Crisis in ‘Western’ Healthcare 3. Managing expectations and facilitating behavioral changes 4. Population, demographics and consumption 5. Material inequalities 6. Effective use of limited resources 7. Politics/human rights/ gender issues

Answer 41

Climate Change leading to: - Severe food shortages - Extreme heat leading to more CVS and respiratory disease, infections and allergies - Natural disasters leading to drought/famine, more waterborne disease, infections - Human migration

Answer 42

``` Education Carbon Reduction Strategies Reduction of Waste New Technologies Increasing global interdependence in health care with sharing of resources including skilled workers ```

Answer 43

1. Organisational/Management - Safety Culture - Managerial leadership - Communication 2. Work Environment - Work environment and hazards 3. Workgroup/ Team - Teamwork structure/process - Team leadership 4. Individual Worker - Cognitive skills (situation awareness, decision making) - Personal Resources (stress, fatigue)

Answer 44

- the universal nature of human fallibility | - the inevitability of error

Answer 45

- minimise the likelihood of error | - minimise the consequences of inevitable error

Answer 46

1. Situation Awareness 2. Decision Making 3. Communication 4. Team Work 5. Leadership 6. Managing Stress 7. Coping With Fatigue (Some Dudes Can Tinkle Like My Corgi)

Answer 47

Knowing and understanding what is going on around you by: Gathering Information, Interpreting Information, anticipating future states

Answer 48

1. Good briefing 2. Minimising distractions and interruption 3. Updating 4. Monitoring 5. Speaking up 6. Time management 7. Maintaining fitness for work

Answer 49

The process of reaching a judgement or choosing a course of action to meet the needs of a given situation

Answer 50

1. Situation assessment 2. Generation and consideration of multiple options 3. Selection and implementation of the most appropriate option 4. Review of outcome

Answer 51

1. Rule based 2. Comparison of options (choice) 3. Recognition (primed based on experience) 4. Creative

Answer 52

Type 1. Intuitive = contextual, where most errors will occur | Type 2. Analytical

Answer 53

 Be aware of when decision making may be most at risk (e.g. stressful situations, fatigue, etc.)  Story Telling  Metacognition (higher cognitive function)  Relfection  Seek feedback on decision making

Answer 54

1. What must be communicated? 2. How might the information be communicated? 3. Why is the communication taking place? 4. Who are you communicating with?

Answer 55

Language, culture, motivation, expectations past experiences, prejudice, status, emotions/moods, deafness, voice level

Answer 56

Noise, interference or distractions, separation in location/time, lack of visual cues (e.g. body language, etc.)

Answer 57

1. Active Listening 2. Approach (passive vs. assertive vs. aggressive) 3. Speaking Up (challenging the behavior of others, even if it breaks the hierarchy)

Answer 58

a. Verbal communication (content, Use ‘I’ statements, offer solutions, obtain feedback, repetition) b. Non-verbal communication (maintain eye contact, posture, inflections and tone of voice, timing)

Answer 59

1. More than one person 2. Common goal 3. Timing 4. Co-ordination 5. May involve people with different expertise (e.g. Multi disciplinary Team)

Answer 60

- individuals have the ability to perform their given tasks effectively - team workers support one another - Teammates solve conflicts - Exchanging of vital information - Co-ordination of team activities

Answer 61

- use of authority where necessary - maintenance of standards - planning and prioritizing - mgmt of workload and resources

Answer 62

The adverse reaction people have to excessive pressure or other types of demand placed on them

Answer 63

1. identify the cause of stress 2. Recognize the symptoms and effects 3. Implement coping strategies

Answer 64

- job demands - Lack of control - Relationships - Change - Home/Work interface - Uncertainty

Answer 65

- Increase resources and positive mediators - provide necessary training and experience - Avoid working too far outside of the comfort zone - Maintain a good standard of fitness - Identify personal workplace stressors - Be aware of the symptoms of stress - Look at coping mechanisms - Take advantage of stress management offered in the workplace - Prepare for new roles - Look after yourself when not at work

Answer 66

the state of tiredness that is associated with long hours of work, prolonged periods without sleep, or requirements to work at times out of synch with the body’s biological or circadian rhythms

Answer 67

``` COMMUNICATION = difficulty finding and delivering the correct information = speech less expressive SOCIAL = withdrawn =more acceptance of errors =less tolerant of others =neglect of small tasks =less likely to converse =increasing irritability =Increasingly distracted by discomfort THINKING = less able for innovative thinking and decision making =Decreased ability to cope with unforeseen circumstances =Decreased ability to adjust plans =Tendancy to rigid thinking MOTOR SKILLS = less co-ordination =Poor timing ```

Answer 68

1, Will the test detect the condition at an early pre-clinical stage? 2. is the disease an important public health problem? 3. Is the natural history of the disease adequately understood? 4. Is a test available for the condition? Is the test sensitive (low false negatives) 5. Is the test specific? (low false positives) 6. Is the test safe? 7. Is the test acceptable to the public and professionals involved 8. is the cost of the test reasonable? 9 Does the overall cost-benefit analysis make it worthwhile? 10. Is there effective treatment for the test being screened? 11. Is the treatment safe? 12. Is the treatment considered acceptable by the public, patients and medical professionals? 13. Are facilities available for diagnosis and treatment?

Answer 69

- Two groups of people are compared: one group has the disease process being studied (case) and the other group does not have the disease (control) - data is collected on both groups to determine what aetiological factors may be attributed to the disease in question.

Answer 70

- Baseline data on exposure is collected in a group of people without the specific disease being studied - The group is followed through time until a sufficient number of subjects have developed the disease, allowing analysis

Answer 71

- Mortality data - Hospital activity statistics - General practice morbidity/disease registers - Health and household surveys/population census data - Social security stats - NHS expenditure data

Answer 72

- Does he work with chemical irritants? - How much exposure does he have to these irritants, incl. intensity and duration? - Do his symptoms improve when he is away from work? - Is PPE use encouraged in the workplace? - Does he comply with PPE use? - Does the company enforce PPE use? - Do other colleagues have similar symptoms? - Does he have any hobbies, pets, etc. that could be the cause? - Does he use any creams or topical gels which he may be allergic to?

Answer 73

- anxiety re. travel - depression and loneliness from being away from family - Stress caused by shift patterns - Pressure to maintain standard of living - Difficulty adjusting to family life when onshore - Abuse of drugs and alcohol - Missing foreign culture and feels ethnic isolation - anxiety about job security

Answer 74

1. Pre-contemplation e.g. I currently smoke and do not intend to stop 2. Contemplation e.g. I currently smoke and am thinking about giving up 3. Preparation e.g. I have booked an appointment with my GP about nicotine patches 4. Action e.g. I stopped smoking one week ago 5. Relapse e.g. I had stopped smoking but have had a couple because work has been so stressful 6. Maintenance e.g. I no longer smoke and have not done so for 18 months

Answer 75

1. Lack of knowledge about health issues 2. Lack of knowledge about NHS 3. Fear and distrust 4. Racism 5. Bias and athnocentrism 6. Aterotyping 7. Ritualistic behaviours 8. Language barriers 9. Presence of third party (translator) in the room 10. Deifferences in perceptions and expectations 11. Examination taboos 12. Gender differences between doctor and patient 13. Religious beliefs 14. Difficulties using the language line

Answer 76

- Increased number of geriatricians and allied health professionals - increased wards/health care facilities for elderly health care - increased prevalence of long term chronic conditions - necessity of health care promotions aimed at the elderly

Answer 77

- increased dependence on families/carers - demand for home carers and nujrsing homes will increase - increased emphasis of social activities for elderly within the community - role of elderly as grandparents likely to change - housing requirements will change as more elderly live on their own

Answer 78

- poor mental health due to stress re. parents health - decreased financial stability as more time must be dedicated to the parent - Less time for hobboes - lack of privacy - house adaptations to make it more compliant with elderly needs - satisfaction from role - development of better relationship between parent and child

Answer 79

- Benefits for carer (attendance allowance) - Day care cantre - elderly food deliveries - Physiotherapy/OT assessment and support - Medication reviews - additional help from other family members - disabled badge scheme - home carers - assisted living home - psychological support

Answer 80

1. District Nurse/Practice nurse – monitors bloods, BP, assesses DM control, etc. 2. Home Carer – assists with practical tasks such as bathing, dressing, etc. 3. Pharmacist – ensures drug safety, prepares dossett box 4. Social worker – provides social care for the patient 5. OT – ensures patient has adaptations to living environement 6. Physiotherapist – maintains mobility and QOL, walking aids 7. GMED/NHS 24 – provides around the clock help for medical enquiries 8. Nurse practitioner – GP supported prescribing, home visits, assessments of patient 9. Dietician – advice on diet to minimise further health deterioration 10. Practice Staff – create appointments 11. Physicians assistant – GP supported medical assistance and care

Answer 81

- listen to the patient and his carers - Set the scene - Check if the patient wants other family present - Find out what the patient understands about their illness - Share information using a common language - Review and summarise information frequently - Allow opportunities for questions - Agree on follow up and support

Answer 82

1. SHOCK – news is unexpected, patient may be tearful and anxious 2. ANGER – may be angry about lifestyle choices, may be angry with healthcare professionals for not being able to provide a cure 3. DENIAL – will not acknowledge the reality of the illness 4. BARGAINING – if I change something in my life I can get better 5. RELIEF – finally happy to know what is wrong so they can deal with it accordingly 6. SADNESS/DEPRESSION- low mood 7. FEAR/ANXIETY – worried about dying, pain, what will happen to family, etc. 8. GUILT – not able to provide for family anymore, worried they caused their health problems 9. DISTRESS –unable to cope with bad news

Answer 83

- will not survive within the next 6-12 months - breathless at rest - FEV1 <30% - spends >50% of the day in bed - long term O2 therapy - >3 acute hospital admissions in the last 6 months

Answer 84

- patient is on the GP practice’s palliative care register and is discussed at team practice meetings - patient receives information on social and financial support - GP and district nurse support visits and phone calls - Assessment of symptoms and partnership with specialists to customise care needs - total care is assessed including respite and pshyc. Needs - care plan and medication issued to home - preferred place of care noted and organised - End of life pathway is used - patient dies in preferred location - bereavement services offered to the family - staff reflect on patient care

Answer 85

- increased use of tele/video conferencing - Switch to local food suppliers - Car pooling - Car sharing - Use of fuel efficient vehicles - Shuttle buses/fleet - reduce the number of free parking spaces - encourage use of public transport - reward multiple vehicle occupancy - combine clinics for patients with multiple conditions

Answer 86

A process of systematic stereotyping and discrimination against people just because they are old.

Answer 87

4 fold greater

Answer 88

- Increases in the proportions of older persons (≥60 years) are being accompanied by declines in the proportions of the young (<15 years) - The demographic transition from high to low levels of fertility and mortality is increasing the older population.

Answer 89

Migration Health education Programmes (AIDS, Malaria prevention) Improvements in public health Nutrition Aid Agencies and charities working in developing nations

Answer 90

The pace of population ageing is much faster in developing countries than in developed countries, developing countries will have less time to adjust to the consequences of population ageing. Moreover, population ageing in the developing countries is taking place at much lower levels of socio-economic development than was the case in developed countries.

Answer 91

80+ age bracket

Answer 92

The baby boomers born after the Second World War will be entering their early 80s by 2031 and overall mortality rates are expected to continue to improve. Older people are increasingly healthy, and there is an increasing emphasis on preserving health and fitness into old age. Many feel that this will not reduce the eventual need for health care, merely postpone it. Although older people have poorer health than younger people, ageing does not cause disease; older people with better health habits live healthier for longer. Most of our current elderly population will continue to lead a fulfilling existence

Answer 93

- increased geriatricians - increased facilities for the elderly - Care of chronic conditions may move to primary care - Increased need for palliative care - Increase in health promotion campaigns aimed at the elderly

Answer 94

- Increasing dependence on families and carers - Increased demand for home caeres - Increased emphasis on providing social care for the elderly - Changing role of grandparetns - Changes in housing demands – more single stories?

Answer 95

- Increasing retirement/pension age - May be more difficult for young to find employment as older adults stay in work for longer - Fewer taxes paid by elderly resulting in pension poverty - Increasing costs of providing free health care for the elderly

Answer 96

-May influence political decisions to apply more to the elderly

Answer 97

1. What are the issues for the carer? 2. How does the patient feel about being dependent on others for care needs? 3. What gaps are there in service?

Answer 98

o Doctors perform about 200,000 consultations in their lifetime. o It is important because it improves patient satisfaction, o outcome of care o recall, o understanding o concordance. o It turns theory into practice and bridges the gap between evidence based medicine and working with patients.

Answer 99

o Knowledge, o communication skills, o physical examination o problem solving.

Answer 100

o Content skills – what the doctors are saying to the patients – questions, responses, information gathering and giving, and treatments. o Perceptual skills – what they are thinking and feeling – internal decision-making, clinical reasoning, awareness of own biases, attitudes and distractions. o Process skills – how they do it – how the doctors communicate with the patients. This includes how they go about gathering and providing information, verbal and non-verbal skills, the structure and organization of communication.

Answer 101

``` • site and environment • adequacy of medical records • time constraints • patient status (known or unknown patient –new or old problem) o Personal factors – • age, • sex, • background and origin, • knowledge and skills, • beliefs • the illness itself (difference between breaking a bad news with breaking a news about a curable/minor illness) ```

Answer 102

o Authoritarian – patient doesn’t feel any autonomy as the doctor has taken full authority. No patient participation – only obeys doctor’s advice. o Guidance/co-operation – Physician still exercising authority and patient is obedient but with a greater feeling of autonomy and somewhat active participation. o Mutual partnership relationship – usually for patients with chronic illness; involves active participation from the patient.

Answer 103

o Open ended question o Listening and silence o Facilitation – encourages communication by using manner, gesture or words that do not specify the kind of information needed. This suggests that the doctor is interested and allows the patient to continue. Change of facial expresser or posture displaying greater interest in facilitation. o Confrontation – the doctor mentions something that the patient might not be aware of – like when they sound angry, sad or look uncomfortable. o Support and reassurance

Answer 104

o Medical factors – new symptoms, visible symptoms, severity, durations, psychological impact of symptoms o Non-medical factors – personal/family crisis, peer pressure (my wife told me to), patient beliefs, expectations, social class, economic implications, cultural, ethnic, age, gender, media factors, interference with social activities and access.

Answer 105

o GP likely to have been responsible for care for much longer (cradle to grave). Secondary care only involved once cardiac symptoms developed o GP responsible for all his medical care, not just cardiac illness. Cardiac clinic only deals with his cardiac failure. i.e. GP provides breadth of care compared with depth of care provided by secondary care consultant o GP likely to look after other family members; unlikely that secondary care will be dealing with other family members o Secondary care doctors have easier access to investigations than GP o Risk and uncertainty relating to Andrew’s health more likely to be accepted by GP than secondary care doctors e.g. GP more likely to use time, try empirical treatment o Quality of doctor/patient relationship likely to be improved by continuity of care in general practice, although patient with long term condition such as Andrew also likely to have good quality relationship with secondary care o Opportunistic health care and health promotion more likely to occur in General Practice setting o Multiple short appointments in General Practice versus longer less frequent appointments in secondary care o GP looks after Andrew even when his condition is stable. Likely to be discharged from secondary care once condition stable o GP acts as gatekeeper to secondary care. Secondary care doctors rarely employ a gatekeeper role.

Answer 106

o Pathophysiology - Defines the pathological basis of the underlying disease process o Clinical disease - Occurs when the pathophysiological process leads to a specific consequence o Illness episode - The time between the onset and offset of illness o Recovery - A sustained period of health following an episode of illness when signs or symptoms of illness are no longer present o Response - A pattern of decrease in symptoms or signs following an episode of illness - could indicate that there has been a decrease in the severity of underlying pathological process. o Remission - period following an illness that cannot be regarded as recovery, - but there has been decrease in the intensity of the signs and symptoms. - They don’t require further investigations or a change of treatment. o Recurrence - The reinstatement of a new illness - following an abatements of signs and symptoms of sufficient duration to warrant the term ‘recovery’ o Body and structure impairment – any disturbance in the body structure, organs or organ system function that has risen from birth or due to an injury/disease. Basically this is the presence of clinical disease. o Activity limitation – Restriction or lack of ability for an individual to perform an activity in a manner or within a range that is considered normal. o Participation restriction – Social disadvantage for a given individual resulting from an impairment or activity limitation which has stopped the person from fulfilling a role that is normal to them.

Answer 107

o Can be positively or negatively affected – for example, self-pity, denial and apathy. o Their family might suffer emotional/financially. o If it is contagious, other family members might become ill too. o Individual might be isolated

Answer 108

o Pattern recognition – the doctor uses experience to recognize a pattern of clinical characteristic. It is mainly based on certain symptoms or signs being associated with certain diseases or conditions and not necessarily involving more cognitive processing involved in differential diagnosis. This is used for obvious diseases. o Differential diagnosis o Hypothetico-deductive reasoning – relating to being or making use of the method of hypothesis and testing their acceptability or falsity by determining whether their logical consequences are consistent with observed data. Doctor’s experience generates a differential diagnosis from presenting symptoms. Specific questions are used to establish diagnosis, giving consideration to conditions requiring urgent attention e.g. MI. Examination and investigation are used as appropriate to help establish diagnosis. o Inductive reasoning – you know nothing about something and you start systematically thinking about what might be wrong. You use the comprehensive inductive model. Benefits include:  Can be used for patients with vague/unexplained symptoms  Can be used by inexperienced doctors  Involves systematic and comprehensive history and examination  Often involves investigations e.g. blood tests, scan  Evidence is then assessed to find an explanation for symptoms

Answer 109

o GP partners – First point of contact for patients. They deal with problems that combine physical, psychological and social components. o Practice nurse – Jobs like obtaining blood samples, doing ECG’s, minor and complex wound management (leg ulcers) travel heath advice and vaccinations, immunizations, family planning and women’s health such as cervical smear, sexual health services, men’s health screening, smoking cessation o District nurse – They visit people in their own homes/care homes to provide complex care for the patients and their family members. They have a teaching and supporting role – they work with patients to allow them to look after themselves or help family members look after them. They professionally account for the delivery of care. o Midwife – Provide care for all stages of pregnancy, labour and early postnatal period. They can either work in the community or be hospital based. o Health visitor – Lead and deliver child and family health services (pregnancy through to 5 years). They provide ongoing additional services for vulnerable children and families, and they also contribute to MDT in safeguarding and protecting children. o Macmillan nurse – Specialised in cancer and palliative care. They provide support and information to people with cancer, their familties and carers from the point of diagnosis. They provide help with pain and symptom control, emotional support, care in a variety of settings, co-ordinate care between hospital and patients home. Advice on forms of support such as financial support.

Answer 110

o Physiotherapist – They treat people with physical problems caused by illness, accident or ageing. They identify and maximize movement through health promotion, preventative healthcare, treatment and rehabilitation. o Dietetics – Dietetics is the interpretation and communication of nutrition science to allow people to make informed and practical choices about food and lifestyle in health and disease. They work with people with dietary needs, inform general public about nutrition, offer unbiased advice, evaluate and improve treatments, educate patients and clients etc. o Podiatry o Pharmacist – They work to ensure that the patients get the maximum benefit from their medicines. They advice medical and nursing staff on the selection and appropriate use of medications. Also advice patients on how to manage their medication to get the benefit of the treatment. o Occupational Therapist – Assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independent functions in all aspect of daily life. They help overcome the effects of disability caused physical or psychological illness, ageing or accident. o care manager (Social Work) – coordination the provision of carers and financial aid for Brenda o Receptionist – coordinating care and messages between members of the team and being a first point of contact for Brenda or Jill o NHS 24 – out of hours care

Answer 111

o Medical – Personal problem, pathology | o Social – Societal problem, limitations are only one of many factors, concerns about discrimination

Answer 112

o Asses disability o Co-ordinate the MDT o Intervene in form of rehabilitation o Different approaches – therapeutic (change the nature of disability like treat osteoarthritis with anti-inflammatories). Prosthetic (Change the environment – e.g. – taxi card, OT, rails at home etc.)

Answer 113

``` o Communicable disease o Non-communicable disease o Alcohol o Drugs-iatrogenic o Drugs-illicit drug use o Tobacco use o Mental illness o Malnutrition o Injury o Obesity o Congenital ```

Answer 114

* Open ended – not seeking specific answer just signaling to tell their story * Closed – can only be answered yes or no * Direct – asks about a specific item * Leading - presumes the answer * reflected – allows the doctor to avoid answering a direct question

Answer 115

• When body language and verbal language do not match

Answer 116

* The hospital is the tip of the iceberg of care. * You will see a narrow spectrum of presentations in hospital * may gain a distorted view of the presentation of illness.

Answer 117

• Health is the state of complete physical, mental and social well-being and not merely the absence of disease and infirmity

Answer 118

* The nature of the disability * The information base of the individual, ie education, intelligence and access to information * The personality of the individual * The coping strategies of the individual * The role of the individual – loss of role, change of role * The mood and emotional reaction of the individual * The reaction of others around them * The support network of the individual

Answer 119

Parents * Mother and/or father may not be able to combine work with the demands of caring for disabled child-financial implications for family * Guilt at having passed on the causative gene if genetic disorder * Psychological strain * Caring for disabled child may be detrimental to parent’s physical health * Some parents may have difficulty bonding with disabled child * Marital problems * Increased risk of child abuse * Over-protection of disabled child Siblings • Resentment at time parents spend caring for disabled child • Resentment at restrictions to normal family life • May have to develop carer role • Grow up with greater understanding of disability Peers • May “look out” for disabled child • Friend may be stigmatised along with disabled child • May grow up with greater understanding of disability • May need to adapt activities to include disabled friend • Teasing by other peers Teachers • May have lack of understanding of disability/lack of training • May have tendency to over-protect disabled child • May be lack of willingness to integrate in mainstream activities • May be additional challenges in personalising education for disabled child • Stress of managing both mainstream and additional support needs pupils in the same class

Answer 120

Patient advantages • Convenience e.g. no travelling • May be essential-unfit to leave the house • Social contact e.g. if patient lives alone/isolated • May be able to let GP see difficulties they have in home environment (Any 2x1=2 marks) Patient disadvantages • Invasion of privacy • Some will feel compelled to “tidy” even if feeling very unwell • Confidentiality issues e.g. family member, carer, neighbour present • Not every examination can be performed at home, so may be delay in diagnosis • Lack of ability to see doctor of choice • Lack of defined time for visit

Answer 121

* Instinctive – laughing, crying, expressions of pain * Learned – from life experiences or training * Clinical observation – recognizing signs of illnesses

Answer 122

* Culture * Context – (eg change in posture due to back pain or due to poor hearing) * Gesture clusters – reinforces the message as single gesture may be misinterpreted * Congruence – when body language and verbal words match.

Answer 123

* Hippiocratic oath | * Declaration of Geneva physicians oath

Answer 124

* Disease – symptoms, signs – diagnosis. Bio-medical perspective * Illness – ideas, concerns, expectations – experience. Patients perspective

Answer 125

* Arranging for the provision of all necessary health-care * Representative or advocate for patients * General health and well-being of a defined population ,not only care for an individual

Answer 126

* Incidence – the number of new cases | * Prevalence – the number of existing cases

Answer 127

* Resist disease * Repair damage * Restore physiological homeostasis

Answer 128

* obtaining blood samples * ECGs * minor and complex wound management including leg ulcers * travel health advice and vaccinations * child immunisations and advice * family planning & women’s health including cervical smears * men’s health screening * sexual health services * smoking cessation

Answer 129

* Specialised pain and symptom control * Emotional support both for the patient and their family or carer * Care in a variety of settings – in hospital (both inpatient and outpatient), at home or from a local clinic * Information about cancer treatments and side effects * Advice to other members of the caring team, for example district nurses and Marie Curie nurses * Co-ordinated care between hospital and the patient's home * Advice on other forms of support, including financial help.

Answer 130

* working with people with special dietary needs * informing the general public about nutrition * offering unbiased advice * evaluating and improving treatments * educating patients/clients, other healthcare professionals and community groups.

Answer 131

* physical rehabilitation * mental health services * learning disability * primary care * paediatrics * environmental adaptation * care management * equipment for daily living

Answer 132

* Recognise and include the patient, carer, or their representative, as an essential member of the primary healthcare team at individual patient-centred team level or at practice level. * Establish a common agreed purpose (share understanding of teamworking). * Agree set objectives and monitor progress towards them. * Agree teamworking conditions, including a process for resolving conflict. * Ensure that each team member understands and acknowledges the skills and knowledge of team colleagues (and regularly reaffirms). * Pay particular attention to the importance of communication between its members, including the patient. * Take active steps to ensure that the practice population understands and accepts the way in which the team works within the community. * Select the leader of the team for his or her leadership skills (rather than on the basis of status, hierarchy or availability) and include in the membership of the team all the relevant professions serving a practice population. * Promote teamwork across health and social care. * Evaluate all its teamworking initiatives on the basis of sound evidence. * Ensure that the sharing of patient information within the team is in accordance with current legal and professional requirements. * Take active steps to facilitate inter-professional collaboration and understanding through joint conferences, education and training initiatives. * Be aware of other measures involving national organisations, educational measures, research and general guidance which impact on teamworking.

Answer 133

* Knowledge of the disease (must have a pre-symptomatic phase.aimed at a defined target population) * Knowledge of the test (which needs to be acceptable to the population,sensitive and specific) * Treatment for disease (proven effectiveness) * Cost considerations

Answer 134

• Description o To describe the amount and distribution of disease in human populations. (risk) • Explanation o To elucidate the natural history and identify aetiological factors for disease usually by combining epidemiological data with data from other disciplines such as biochemistry, occupational health and genetics. (surveillance) • Disease control o To provide the basis on which preventive measures, public health practices and therapeutic strategies can be developed,implemented, monitored and evaluated for the purposes of disease control.

Answer 135

• The numerator is the top line, the number of events (in this example deaths). The denominator is the bottom line, the population at risk.

Answer 136

* Incidence - is the number of new cases of a disease in a population in a specified period of time. Incidence tells us something about trends in causation and the aetiology of disease. * Minor illnesses might have a high incidence but low prevalence e.g. a cold

Answer 137

* Prevalence - is the number of people in a population with a specific disease at a single point in time or in a defined period of time. Prevalence tells us something about the amount of disease in a population. It is useful in assessing the workload for the health service but is less useful in studying the causes of disease. * Other illnesses might be chronic with low incidence but high prevalence i.e. diabetes.

Answer 138

• Relative risk (RR) = incidence of disease in exposed group /incidence of disease in unexposed group

Answer 139

* Mortality data * Hospital activity statistics * Reproductive health statistics * Cancer statistics * Accident statistics * General practice morbidity * Health and household surveys * Social security statistics * Drug misuse databases * Expenditure data from NHS

Answer 140

* Descriptive studies attempt to describe the amount and distribution of a disease in a given population * This kind of study does not provide definitive conclusions about disease causation, but may give clues to possible risk factors and candidate aetiologies. * Such studies are usually cheap, quick and give a valuable initial overview of a problem.

Answer 141

* Identifying emerging public health problems through monitoring and surveillance of disease patterns. * Signalling the presence of effects worthy of further investigation. * Assessing the effectiveness of measures of prevention and control (eg, screening programmes). * Assessing needs for health services and service planning. * Generating hypotheses about disease aetiology.

Answer 142

* (disease frequency, survey, prevalence study) * In cross-sectional studies, observations are made at a single point in time. * Conclusions are drawn about the relationship between diseases (or other health-related characteristics) and other variables of interest in a defined population. * A strength of this method is its ability to provide results quickly; however, it is usually impossible to infer causation.

Answer 143

* cross sectional * case control * cohort

Answer 144

• two groups of people are compared: o a group of individuals who have the disease of interest are identified (cases), o and a group of individuals who do not have the disease (controls). • Data are then gathered on each individual to determine whether or not he or she has been exposed to the suspected aetiological factor(s) • and whether or not a conclusion can be drawn that the suspected aetiological agent is a likely cause of the disease in question.

Answer 145

* In cohort studies, baseline data on exposure are collected from a group of people who do not have the disease under study. * The group is then followed through time until a sufficient number have developed the disease to allow analysis. * The original group is separated into subgroups according to original exposure status and * these subgroups are compared to determine the incidence of disease according to exposure. * Cohort studies allow the calculation of cumulative incidence, allowing for differences in follow up time

Answer 146

* Trials are experiments used to test ideas about aetiology or to evaluate interventions. * The “randomised controlled trial” is the definitive method of assessing any new treatment in medicine. ``` 60. What are factors to consider when interpreting results? • Standardisation • Standardised Mortality Ratio • Quality of Data • Case Definition • Coding and Classification • Ascertainment ```

Answer 147

• Bias is any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth • Selection bias o Occurs when the study sample is not truly representative of the whole study population about which conclusions are to be drawn. For example, in a randomised controlled trial of a new drug, subjects should be allocated to the intervention (study) group and control group using a random method. If certain types of people (eg, older, more ill) were deliberately allocated to one of these groups then the results of the trial would reflect these differences, not just the effect of the drug. • Information bias o arises from systematic errors in measuring exposure or disease. For example, in a case control study, a researcher who was aware of whether the patient being interviewed was a 'case' or a 'control' might encourage cases more than controls to think hard about past exposures to the factors of interest. Any differences in exposure would then reflect the enthusiasm of the researcher as well as any true difference in exposure between the two groups. • Follow up bias o arises when one group of subjects is followed up more assiduously than another to measure disease incidence or other relevant outcome. For example, in cohort studies, subjects sometimes move address or fail to reply to questionnaires sent out by the researchers. If greater attempts are made to trace these missing subjects from the group with greater initial exposure to a factor of interest than from the group with less exposure, the resulting relative risk would be based on a (relative) underestimate of the incidence in the less exposed group compared with the more exposed group. • Systematic error o A form of measurement bias where there is a tendency for measurements to always fall on one side of the true value. It may be because the instrument (eg, a blood pressure machine) is calibrated wrongly, or because of the way a person uses an instrument. This problem may occur with interviews, questionnaires etc, as well as with medical instruments.

Answer 148

* A confounding factor is one which is associated independently with both the disease and with the exposure under investigation * and so distorts the relationship between the exposure and disease. In some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration. • There are several ways to deal with confounding, depending on the particular study design: • In trials, the process of randomisation (in effect the play of chance leads to similar proportions of subjects with particular confounding in the intervention and control groups). • Restriction of eligibility criteria to only certain kinds of study subjects • Subjects in different groups can be matched for likely confounding factors. • Results can be stratified according to confounding factors. • Results can be adjusted (using multivariate analysis techniques) to take account of suspected confounding factors.

Answer 149

* Strength of association * As measured by relative risk or odds ratio. * Consistency * Repeated observation of an association in different populations under different circumstances. * Specificity * A single exposure leading to a single disease. * Temporality * The exposure comes before the disease. It should be noted that the only absolute criterion is temporality. * Biological gradient * Dose-response relationship. As the exposure increases so does the risk of disease. * Biological plausibility * The association agrees with what is known about the biology of the disease. * Coherence * The association does not conflict with what is known about the biology of the disease. * Analogy * Another exposure-disease relationship exists which can act as a model for the one under investigation. * For example, it is known that certain drugs can cross the placenta and cause birth defects * - it might be possible for viruses to do the same. * Experiment * A suitably controlled experiment to prove the association as causal - very uncommon in human populations.

Answer 150

* assist in making diagnosis * assess which services are required ofr prevention, diagnosis, primary care,secondary care rehabilitation * ensure a quality of these services * carry out healthcare needs assessments

Answer 151

* primary – vaccines * secondary – screen tests * tertiary – medication and surgeries to reduce consequences of disease and disability

Answer 152

* over-arching principle/activity which enhances health * and includes disease prevention, health education and health protection. * It may be planned or opportunistic

Answer 153

• (1) Educational o Provides knowledge and education to enable necessary skills to rate informed choices re health – may be. one –to-one group workshop e.g. smoking, diet, diabetes • (2) Socioeconomic (Radical) o ‘Makes healthy choice the easy choice’ o National policies e.g. re unemployment, redistribute income. • (3) Psychological o Complex relationship between behaviour, knowledge, attitudes and beliefs. o Activities start from an individual attitude to health and readiness to change. Emphasis on whether individual is ready to change. (e.g. smoking, alcohol).

Answer 154

• activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.

Answer 155

• involves collective activities directed at factors which are beyond the control of the individual. Health protection activities tend to be regulations or policies, or voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being.

Answer 156

• primary prevention: o Measures taken to prevent onset of illness or injury o Reduces probability and/or severity of illness or injury • secondary prevetion: o Detection of a disease at an early (preclinical) stage in order to cure, prevent, or lessen symptomatology

Answer 157

• tertiary prevention: o measures to limit distress or disability caused by disease (eg joint replacement for those with severe arthritis) • primordial prevention: o a more fundamental level of prevention which addresses the broader social and environmental circumstances that predispose to disease in society (eg government taxing other goods)

Answer 158

o Illness – important, natural history understood, pre-symptomatic stage o Test – safe, acceptable, cost effective, sensitive and specific o Treatment – acceptable, cost effective, better if early, are the facilities to treat and diagnose avialable

Answer 159

• government: o legislation o economic o education • primary care: o planned - postes,chronic disease clinics,vaccinations o opportunistic – advice within surgery,smoking,diet,taking BP

Answer 160

* Some doctors are cynical about health promotion and question if the resources allocated to it are money well spent. * It is worth noting that the majority of health activities in secondary and primary care have never been adequately evaluated

Answer 161

* decreasing fertility * decreasing premature mortality/increased life expectancy * migration * health education programmes * greater availability of contraception * malaria prevention * improvements in public health in relation to housing,clean water etc * (for in 2031, baby boomers after2nd world war will be turning 80)

Answer 162

* Increased numbers of geriatricians and health professionals involved in care of the elderly will be required. * Increased facilities for elderly health care will be required. * The care of many long term conditions e.g. diabetes, CVD, neurological conditions, renal disease is moving from secondary care to primary/community care. * The end stage of these diseases requires as much palliative care as cancer. The prevalence of such diseases will increase as the population ages. * Specific health promotion campaigns aimed at the elderly

Answer 163

* As the population ages, they will be increasingly dependent on families and/or carers who are also ageing. * The demand for home carers and nursing home places is likely to increase. * Within local communities, there will be increasing emphasis on providing social activities for the elderly. * The role of the elderly as grandparents and carers of grandchildren is likely to change. * Housing demands are likely to change as more elderly people live alone.

Answer 164

* Retirement/Pension age is already increasing. * Finding employment may become harder for young people, as older people being required to work for longer blocks the “top end” of the employment sector. * Proportionately less people will be paying into tax and pension funds, making it increasingly difficult to obtain an adequate return from pension funds. * Those elderly who have not contributed to a private pension fund may find that the state pension is inadequate, resulting in poverty. * Increasing cost of “free personal care for the elderly” policy (Scotland)

Answer 165

* Current decision making and workforce planning must take account of the ageing population. * The increasing elderly population will potentially have the power to influence political decision making in relation to their specific concerns

Answer 166

• the co-existence of two or more long-term conditions in an individual

Answer 167

• living in own home with support from family o Different families have different levels of support they are willing or able to provide. • living in own home with support from social services o Social work often can only provide care for a short spell up to three times a day, leaving her alone for long periods of time • sheltered housing o often a useful option for people who wish to live independently, but to know there are others nearby to help when needed • residential home o have greater 24hr support but no medical cover on site. • nursing home care o have resident nurses on site.

Answer 168

* What is it like to be a carer? * What help is available? * What gaps are there in the service? * What is the impact of being a carer on the carer’s own physical and mental health? * Find out from the patient how they feel about being dependent on others for care needs? * What would they like from the service that is not available? * Poor mental health e.g. stress, anxiety, depression, emotional demands * May have to give up work/work less hours * Financial implications e.g. due to impact on work, extra expense of caring for her mother * Lack of privacy for Kathy and her family * Restriction on social activities/social isolation * Less time for hobbies * Adaptation to Kathy’s house e.g. bathroom modifications, stair lift * Positively-may gain satisfaction from/enjoy her role

Answer 169

* Effect of work on health and health on work * Maximising people’s opportunities to benefit from healthy and rewarding work while not putting themselves or others at unreasonable risk

Answer 170

* Hazard: something with potential to cause harm * Risk: the likelihood of harm occurring * Risk factor: increases the risk of harm * Protective factor: decreases the risk of harm * Susceptibility: influences the likelihood that something will cause harm

Answer 171

* Demands of the job: physical, intellectual * Environment: shop floor/office, risk factors * (e.g. dusts, chemicals) * Temporal: shift working, early start * Travel: business travel – between sites, overseas * Organisational: lone-working, customers * Layout: ergonomic aspects of workstation, work equipment

Answer 172

* Stamina * Mobility: walking, bending, stooping * Agility: dexterity, posture, co-ordination * Rational: mental state, mood * Treatment: side-effects, duration of * Intellectual: cognitive abilities * Essential for job: food handlers, driving * Sensory aspects: safety – self and others

Answer 173

a. Identify hazards – by clinical approach,workplace visit or epidemiology b. Who might be harmed and how c. Evaluate risks and decide on precautions d. Record findings and implement controls e. Review and update when necessary

Answer 174

* elimination * substitution (eg toluene instead of benzene or weldinginstead of rivting) * engineering controls (eg fitting silencers) * administrative controls(eg task rotation) * personal protective equipment

Answer 175

a. storage b. replacement c. training d. usage e. compatibility f. “one size fits none” g. inappropriate selection

Answer 176

* diagnosis * investigation * treatment * modify work procedures * modify workplace * health surveillance * RIDDOR reportable condition

Answer 177

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

Answer 178

* improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support... from diagnosis to the end of life and bereavement. * provides relief from pain and other distressing symptoms * affirms life and regards dying as a normal process * intends neither to hasten nor postpone death * integrates the psychological and spiritual aspects of patient care * offers a support system to help patients live as actively as possible until death * offers a support system to help the family cope during the patients illness and in their own bereavement * uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated

Answer 179

* Where do they want to be cared for? * Do they want to be resuscitated in the event of cardiac arrest? * Or do they want to be allowed to die naturally? * Who do they want to be informed of their care and any changes in their condition? * Are they fully aware of their prognosis? * Is their family aware of their prognosis?

Answer 180

* Pain-free death * Open acknowledgement of the imminence of death * Death at home surrounded by family and friends * An 'aware' death, in which personal conflicts and unfinished business are resolved * Death as personal growth * Death according to personal preference and in a manner that resonates with the person's individuality * Takes account of religious and cultural preferences * Where dignity is maintained

Answer 181

* Shock – eg news in completely unexpected * anger – eg maybe angry at self for earlier bad health behaviour * denial – eg patient does not beilive it and fail to acknowledge the reality * bargaining – eg * relief – eg glad to finally know what is wrong and can plan for future * sadness – eg * fear - eg fear of pain,dying etc * guilt – eg not be able to provide for family any more * anxiety – eg patient unable to cope with news * distress

Answer 182

• actual and relative

Answer 183

* mechanical * chemical * physical * biological * psychosocial

Answer 184

* verbally * using fractions * illustrations

Answer 185

* descriptive studies * cross sectional studies * cohort studies * case-control studies * randomized controlled trials (RCTs)

Answer 186

* Reason for the audit * Criteria or criterion to be measured * Standard(s) set * Preparation and planning * Results and date of collection one * Description of change(s) implemented * Results and date of data collection two * Reflections

Answer 187

• what people experience when they are unwell, how they interpret or define those symptoms and what actions they take in response to them

Answer 188

• the signs which a doctor detects and interprets, and the actions which he or she suggests are appropriate responses

Answer 189

* exempts ill people from their daily responsibilities * patient is not responsible for being ill, she is regarded as unable to get better without the help of a professional * patient must seek help from a healthcare professional * patient is under a social obligation to get better as soon as possible to be able to take up social responsibilities again

Answer 190

* an ageing population with disease and care needs * relatively fewer younger people to pay taxes and support the country financially and fewer to provide care for the older population

Answer 191

• an anticipatory care plan

Answer 192

• “Advance and anticipatory care planning, as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care

Answer 193

* Legal details – power of attorney etc * Contact details for close friends and carers. * A strategy for managing illness without admissions – perhaps a home supply of antibiotics. * Advance statements. * A resuscitation status. * Details for the out of hours team – treatment plans etc

Answer 194

* Teleconferencing and videoconferencing * Switch to local food suppliers for hospitals * Car pooling ( where more than one person occupies the same vehicle, sharing costs and taking it in turn to be driver) * Car sharing (where people hire cars for short periods of time) * Fuel efficient vehicles eg hybrids * Health services to have their own fleet of vehicles eg NHSG mini buses * Reduce the number of free car parking spaces * Reward multiple vehicle occupancy, lower carbon emission vehicles and bikes * Pool of fleet vehicles, could be electric * Health boards to consider reimbursement for travel at higher rate for use of low carbon options, public transport * Have an institutional travel plan e.g. providing facilities for cyclists, measure carbon emissions * Liaise with Councils to promote bus links

Answer 195

may have to face? • Anxiety re travel • Depression perhaps secondary to loneliness/away from family • Stress due to shift pattern • Pressure to maintain standard of living • Difficulty adjusting back in to family life when onshore • Abuse of drugs or alcohol • “Misses” Russian culture/ethnic isolation • Anxiety re job security

Answer 196

* Lack of knowledge about some health issues/NHS * Fear and distrust * Racism * Bias and ethnocentrism * Stereotyping * Ritualistic behaviour * Language barriers * Presence of third party e.g. family member/translator in the room * Differences in perceptions and expectations * Examination taboos * Gender difference between doctor and patient * Religious beliefs * Difficulties using language line

Answer 197

• people grouped to some attribute which they have in common

Answer 198

• resources individuals bring to their lives,connections and experiences which they can fall back on when necessary

Answer 199

* sitter services * home carers to assist with her mother’s personal care * elderly frozen food deliveries * day care centre * respite care * benefits eg attendance allowance, carers allowance * psychological support eg carer’s centres,counselling * disabled badge scheme * physiotherapy/OT assessment and support * medication review * additional help from family members,friends and neighbours

Answer 200

* Listen to the patient and their carers * Set the scene * Check whether to speak to the patient to them self or with family/friend * Find what the patient already understands * Find out how much the patient wants to know * Share the information using a common language/avoid jargon * Review and summarise the information * Allow opportunities for questions * Agree follow up and support

Answer 201

• The ability to be able to continue over a period of time

Answer 202

* Work life balance * Autonomy * Flexibility of role * Job satisfaction * Team working and development of the team * Good relationship with colleagues * Manageable workload * Ability to develop knowledge and deivsify interests,intellectual stimulation. Maximal use of personal abilities and skills * Outside interests for example hobbies – may promote resilience * Professional respect from colleagues and patients * Reasonable occupational health provision * Potential for educational role * Job security

Answer 203

• is a complex whole which includes knowledge, belief, arts, morals, law, customs, etc.

Answer 204

* refers to cultural practices and out looks that characterize and distinguish a certain group of people. * characteristics identifying an ethnic group may include a common language, common customs and beliefs and tradition. the term I referred over ‘race’.

Answer 205

• a group of people linked by biological or genetic factor. the term should not be used to describe different social groups. see ‘ethnicity’

Answer 206

``` what are modifiable factors that influence health? • - Personal behaviour - Medical care - Living conditions - Working conditions - Socio-economic factors ```

Answer 207

• - Democracy - International rivalry - Civil conflict - Ethno-religious cleavages - Income inequality - Rapid urbanisation - Level of educational attainment - Level of economic development - Resources

Answer 208

• - Life expectancy - Breast feeding - Educational attainment - Alcohol-related hospital admissions - Smokers - GP consultations for anxiety

Answer 209

* 1 – professionals * 2 – managerial and technical * 3a – skilled:non manual * 3b – skilled: manual * 4 – partly killed manual * 5 – unskilled

Answer 210

* individual characteristics and behavior * economic environment * social support networks * income and social status * health services * genetics * gender * physical environment * social environment * education

Answer 211

``` • culture: o health beliefs o behaviours o expectations • material: o resources o income o housing o working conditions o social environment o education • genetic: o gender o ethnicity • artefact: o may not be real but due to how measurements are conducted ```

Answer 212

• seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change

Answer 213

* identify audit topic * set standard * collect data * analyse data * implement change

Answer 214

* advance in science and technology * changes in the population * changes in the way care is delivered * change in patients expectations of healthcare and health services

Answer 215

* inadequate information on prevelance * inadequate data on effectiveness * lack of agreement on the threshold levels for intervention * complex and ill-defined pathways through NHS System * political and media pressures * competing concerns

Answer 216

* sexual contact * direct skin or mucosal contact * injection * inhalation * ingestion * cross placental

Answer 217

* notification systems * microbiology lab reports * sentinel systems (collection and interpretation of data)

Answer 218

• local increase in the numbers of the specific condition compared to the background endemic level

Answer 219

* provide an advice service * conduct an audit * produce guidelines for all staff * provide input to the education programmes * be involved in the research to improve infection * liase with staff involved in purchasing and planning infection control * communicate to the media

Answer 220

• a process of systematic sterotyping and discrimination against people just because they are old.

Answer 221

* legal * personal * medical

Answer 222

* GP Registration * social and financial help for patient and carers * GP suppot visit/phone calls * assessment of symptoms,partnership with specialists * care assessed including espite and psychological * preferrec place of care organized * careplan and medication for home * end of life pathway * family bereavement support * staff reflect

Answer 223

• use the supportive and palliative care indicators tool

Answer 224

* cognitive – anxious thoughts * emotional – low mood * physical – dizziness * behavioural – avoiding stressful situations

Answer 225

* problem solving * support seeking * escape-avoidance * distraction * cognitive restructuring based on positive thinking

Answer 226

MEDICAL - disability as a consequence of a health condition, disease or caused by trauma. disrupt the functioning of a person in a physiological or cognitive way FUNCTIONAL - disability is caused by physical, medical or cognitive deficits. limits functioning or the ability to perform functional activities SOCIAL MODEL - a persons activities are limited not by the impairment or condition but by environment. barriers are consequence of a lack of social organisation

Answer 227

provides advice regarding care packages available and costs of care. They could help link with sheltered housing or nursing homes if needed