FOPC YR 3 Flashcards
1
Q
most common causes of death?
A
cancer and IHD
2
Q
most common cause of death in men 15-34?
A
suicide
3
Q
terminal care
A
last phase of care when patient is close to death
4
Q
Scotland’s national action plan for Palliative care?
A
living and dying well
5
Q
WHO state that palliative care provides
A
pain and symptom relief, spiritual and psychological support from diagnosis to end or life as well as bereavement care
6
Q
palliative care is a philosophy that emphasises
A
quality of life
7
Q
how can you tell when a patient needs palliative care?
A
supportive and palliative care indicators tool
8
Q
what is the first aspect of the palliative care tool?
A
ACP
9
Q
palliative care in GP practice
A
register of patients
meet to discuss cases
OOH are notified
10
Q
WHO aims of palliative care
A
provide relief from pain affirms life dying is a natural process doesn't hasten or postpone death psychological and spiritual care support to life as actively as possible family support team approach bereavement counselling
11
Q
team involved in palliative care?
A
macmillan nurses
CLAN
marie curie
religious groups
12
Q
what is a good death?
A
pain -free death open acknowledgment at home with friends and family 'aware' death - resolved unfinished business death as personal growth death according to personal preference
13
Q
Gold standards framework
A
offers tools to help primary care to provide good palliative care at home
14
Q
breaking bad news - how
A
listen setting understanding what do they want to know? don't use jargon review and summarise allow questions agree follow up and plan
15
Q
reactions to bad news
A
Anger, Anxiety, Bargaining, denial, distress, fear, guilt, relief, sadness
16
Q
stages of grief in Elizabeth Kubler model?
A
stability, immobilisation, denial, anger, bargaining, depression, testing, acceptance
17
Q
15-20% of deaths occur in
A
hospices
18
Q
gentle or easy death?
A
euthanasia
19
Q
types of euthanasia
A
voluntary - patient request
noon voluntary - no request
physician assisted - provides the mean s and advice
20
Q
most common reasons to request euthanasia?
A
fear of suffering
unrelieved symptoms
21
Q
How can you respond if a patient requests euthanasia
A
listen, acknowledge the issue try to understand why look for treatable problems or ways to help the patient feel more in control remember spiritual issues admit that you are powerless
22
Q
what is sociology
A
study of development, structure and function of human society
23
Q
what does medical sociology look at?
A
interactions with HCP
how people make sense of illness
behaviour and interactions of HCP
24
Q
why is sociology important
A
can only promote healthy behaviour if we understand the way that different groups operate within society
25
the sick role
```
exempt from daily duties
not responsible for being ill
needs the help of a professional
must seek help
social obligation to get better ASAP
```
26
Role of the HCP according to the sick role?
```
objective - don't just patients
put the patient first
obey professional code of practice
maintain competence and skills
right to examine, prescribe and has wide autonomy in medical practice
```
27
how many social classes and how is this worked out?
8
| based on income and position within employment
28
social influences on health
```
gender
housing
health system
ethnicity
education
employment
environment
financial security
```
29
gender and morbidity and mortality?
men have higher mortality
| women have higher morbidity
30
how does education effect health?
healthier
| understanding, more engagement with screening and health care promotion
31
employment provides
income and financial security
social contacts
status in society
purpose in life
32
what may be the effect of services designed to improve the whole population health?
cervical screening
widens health inequalities
(poor uptake in those who would benefit most)
33
WHO definition of health inequality?
difference in health status or distribution of health determinants between different population groups?
34
what is the key determinant of health inequalities?
deprivation
| also age, gender and ethnicity
35
examples of health inequalities in deprived areas?
```
low birthweight
breastfeeding - less
poor dental health
obesity- higher
teenage pregnancy
```
36
mortality in homeless people?
4x - death by unnatural causes
| suicide - 35 x
37
alcohol and drugs - effect on homeless?
less likely to be able to sustain their tenancy
38
which diseases are higher in the homeless population?
TB, HIV, Hep C
| poorer oral health
39
Health care contact for homeless people?
1/3 not registered with GP
| 8x higher attendance at A&E
40
what factors stop a person with LD accessing healthcare?
transport (not accessible)
not identified as having a LD
staff not understanding
failure to recognise illness or make the correct diagnosis
care professions not communicating or working together
not enough involvement from carers
inadequate follow up
41
challenges for refugees?
- more concentrated on family and social issues (ignore medical problems)
- competing demands of different services
- language barriers
- struggle to establish care and referral for complex conditions
- don't understand the system of primary care or preventative medicine
- poor care previously has exaggerated problems
- PTSD, depression and anxiety
- anti-immigrant sentiments make it even more difficult
42
vulnerable groups?
learning disability
refugees
prisoners
LGBT
43
inverse care law
those that need are less likely to receive medical care and vice versa
44
how can we reduce health inequalities?
```
effective partnerships (promote health, improve education)
evaluate and refine integration of health and social care
government policy and legislation
invest in more vulnerable patient
improve access
reduce poverty
social inclusion policies
improve employment opportunities
equal access to education
improve housing
```
45
sustainability
ability to continue over a period of time
46
three levels of sustainability relating to healthcare?
global
is the NHS sustainable?
personal and career sustainability
47
why is global sustainability important to healthcare?
```
material inequality
population and consumption
resource depletion
climate change
loss of biodiversity
crisis in healthcare
```
48
action that could be taken to limit the impact of global sustainability
```
increased use of renewable energy
modify human behaviour
plant based diets
educate about carbon use
promote patient resilience
think of humans as part of a wider ecological system
```
49
lowering carbon use as part of the NHS?
```
prioritise environmental health
use safer chemicals
reduce and safely dispose of waste
efficient use of energy - or switch to renewables
reduce water consumption
improve travel strategy
safe disposal of pharmaceuticals
adopt greener building design and construction
```
50
changes under the new GP contract?
- reduce workload and improve recruitment (says BMA)
- additional members of the GP team
- changes in staffing and funding --> sustainability
- reduce risk and promote sustainability
51
resilience
quickly return to previous good condition
52
what positive factors contribute to a sustainable career in medicine?
```
job security
financial security
stable terms and conditions
respect professionalism and knowledge
appreciated for being in role
working with a team
ability to develop knowledge and interests
ability to fit work are interests and lifestyle choices
```
53
challenges to a sustainable career in medicine?
- considerable and rapid workload
- time management
- care becoming more complex
- results coming in too fast to have time to act on them in a well thought out way
- care vs cure (challenges of long term conditions)
- running a business
- ensuring the team all work together effectively
54
questions to ask in an occupational history?
present and previous jobs
exposure to chemicals or hazards (how long and how much?)
symptoms improve when not exposed?
did they use PPE?
is there measures to maintain PPE?
do others have similar symptoms?
are there known environmental hazards in use?
any hobbies, pets, overseas work, moonlighting?
55
FIT note
evidence of assessment by doctor as to whether a patient is fit to work (not job specific)
56
purpose of a FIT NOTE
- allow earlier discussion about returning to work
- items of consideration for employers on return to work
- only completed by a doctor
- it is meant as advice - not binding on the employer
- does not affect statutory sick pay
57
when is a fit note required?
patient has been off work for more than 7 consecutive days (including non working days)
58
role of OH
ensure the health and wellbeing of the working population by preventing ill health and providing specialist rehabilitation advice
59
what do OH do?
- prevent work-related ill health
- advise on fitness for work and workplace safety
- recommend adjustments to ensure people stay in work
- assist management of sickness absence
- provide rehab to help people return to work
- implement policies to maintain and healthy and safe workplace
- conduct research into work related health issues
- advise on medical health and ill-health retirement
60
impact of unemployment on health?
poorer general health, long-standing illness
mental health problems, psychological distress
more medical consultations and hospital admissions
61
benefits of re-employment?
improved self-esteem
improved general and mental health
reduced psychological distress and psychiatric morbidity
62
any planned activity designed to enhance health or prevent disease?
health promotion
63
name four areas affecting health and identify which are affected by health promotion?
```
genetics
access
environment
lifestyle
(last 3 influenced by health promotion)
```
64
three approaches to health promotion?
educational - provide knowledge
socioeconomic - makes healthy the easy choice - national policies
psychological - cycle of change, willingness and individual attitude
65
what is the difference between health promotion, health education and health protection?
promotion - enhances health (included helath education and protection) can be planned or opportunistic
- education = communication aimed to change knowledge, beliefs or behaviour in a way which is conducive to good health
- protection = policies which are aimed at things beyond the control of the individual
66
benefits of empowerment?
- ability to resist social pressure
- ability to utilise effective coping strategy when in an unhealthy environment
- heightened consciousness of their actions
67
examples of planned and opportunistic health promotion in primary care?
planned - posters, clinics, vaccinations
| opportunistic - advice in consultation, smoking diet, take BP
68
three ways the government can carry out health promotion?
legislation - legal age limits, smoking ban
economic - sugar tax
education - adverts on TV
69
role of primary prevention
prevent onset of illness
| reduces probability and/or severity
70
annual flu vaccine is given from?
age 65 onwards
71
secondary prevention is
detection of a disease at an early (preclinical) stage in order to cure, prevent or lessen symptoms
72
Wilson's criteria for screening
illness - is it important, is the natural history understood, is there an identifiable pre-clinical stage?
test - easy, acceptable, cost effective, sensitive and specific
treatment - acceptable, cost effective, better if given early
73
tertiary prevention
measures to limit distress or disability caused by a disease (OT, Physio)
74
why health promotion in childhood?
establish a healthy lifestyle early
| role of parents
75
factors to consider in adolescent consultations?
diet
exercise
sleep
social issues
76
the UK has the highest number of what in Europe?
single parent families
77
examples of social issues that children face?
single-parent families
| screen time
78
core principles of realistic medicine?
- build a personalised approach to care
- change our style to shared decision making
- reduce unnecessary variation in practice and outcomes
- reduce harm and waste
- manage risk better
- become improvers and innovators
79
what makes a good doctor
knowledge
good listener
friendly and approachable
clear communication
80
how can we reduce unnecessary variation in practice?
Randomised control trials
| guidelines
81
diseases where over diagnosis may be an issue? and which aim of realistic medicine does this relate to?
```
prostate and thyroid cancer
asthma,
CKD
ADHD
(reduce harm and waste)
```
82
5 questions promoting better conversation between clinicians and patients?
- is the test, treatment or procedure needed?
- what are the risks and benefits
- what are the side effects?
- are there simpler, safer or other options?
- what would happen if I did nothing?
