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x2 - Second Year Misc. > FPC > Flashcards

FPC Flashcards

1
Q

The international alliance of patients’ organisation (IAPO) ‘s declaration of patient centred healthcare defines patient centred healthcare as based on these principles and values…

A 
Respect
Choice and empowerment
Patient involvement in health policy
Access and support
Information
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2
Q

The definition of incidence

and what it is used for

A

The no. of new cases of a disease in a population in a specified period of time

Tells us about trends in causation and aetiology
Can help with planning when and where extra care and provisions will be needed

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3
Q

The definition of prevalence

and what it is used for

A

The no. of people in a population with a specific disease at a single point in time or a defined period of time

Useful in assessing current workload for the health service

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4
Q

Vulnerability definition

A

An individual’s capacity to resist disease, repair damage and restore physiological homeostasis

(varies between organs)

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5
Q

Examples of the “burden of treatment” on patients and carers

A

Charging their behaviour for lifestyle modifications
Monitoring and managing symptoms at home
Adhering to complex treatment regimes
Navigating complex administrative systems

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6
Q

Biographical disruption definition

A

A loss in confidence in social interaction or self-identity due to a loss in confidence in the body from a long term condition

may involve having to “renegotiate” existing relationships

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7
Q

Who do chronic conditions impact

A 
The individual (denial, self-pity, apathy)
The family (physical, emotional, financial)
The community/ society
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8
Q

Legal definition of disability

A

a physical, sensory or mental difficulty that makes it difficult for them to carry out day to day activities ongoing for more than 12 months

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9
Q

The WHO “international classification of functioning, disability and health”
divides disability into 3 levels…

A
  1. Body and structure impairment
    - organ level (e.g. damage to leg)
    - abnormalities of structure, organ or system function
  2. Activity limitation
    - personal level (e.g. mobility difficulty)
    - changed functional performance and activity by the individual
  3. Participation restrictions
    - social and environmental level (e.g. difficulty participating in sports)
    - disadvantage experienced by the individual as a result of impairments and disabilities
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10
Q

the 2 different models of disability

A

Medical model

  • individual/ personal cause
  • underlying pathology
  • individual level intervention
  • individual change/ adjustment

Social model

  • social cause
  • social/ political action needed
  • societal attitude change
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11
Q

” examples of disability legislation

A

Disability discrimination acts 1995 and 2005

Equality act 2010

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12
Q

The doctor’s role in managing disability

A

Assess disability
Co-ordinate MDT
Intervene in the form of rehabilitation

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13
Q

Personal reaction to disability depends on…

A 
The nature of the disability
The information base of the individual
The personality of the individual
The coping strategies of the individual
The reaction of others around them
The support network of the individual
Additional resources available to the individual
Time to adapt
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14
Q

Causes of disability

A 
Congenital
Injury
Communicable disease
Non-communicable disease
Alcohol
Drugs (iatrogenic or illicit)
Malnutrition
Obesity
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15
Q

The Wilson and Junger criteria for screening

A

Knowledge of the disease
- it must be important, recognisable early and well understood
Knowledge of the test
- it must be suitable, acceptable to the population and continuous
Treatment of the disease
- must be acceptable, available and have an agreed policy on who to treat
Cost considerations

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16
Q

The difference between disease and illness

A

Disease - to do with signs, symptoms and diagnosis, the medical perspective

Illness - to doo with ICE and experience, the patient perspective

(e.g. HT is often a disease without illness)
(in up to 50% of GP appointments there is no disease)

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17
Q

Factors affecting uptake of care

A

Lay referral
Sources of information
Medical factors (what the symptoms are)
Non-medical factors (ICE, beliefs, age, class, gender, culture…)

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18
Q

Aims of epidemiology

A

Description (of amount and distribution of disease)
Explanation (of natural history and aetiological factors)
Disease control (the basis for preventative measures)

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19
Q

Epidemiological studies try to point to…

A

Aetiological clues
The scope for prevention
Identification of high risk/ priority groups

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20
Q

Calculating incidence

A

Events / Population at risk

Everyone in the denominator must have the possibility of entering the numerator.
The denominator must be specific

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21
Q

Calculating relative risk (RR)

A

incidence in exposed group / incidence in unexposed group

Measures the strength of an association between a suspected risk factor and the disease being studied

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22
Q

Sources of epidemiological data

A 
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
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23
Q

Health literacy is

A

Having the knowledge, skills, understanding and confidence to…

Use health information
Be active partners in their care
Navigate health and social care systems

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24
Q

SIGN guidelines intend to…

A

Help health and social care professionals and patients understand medical evidence and use it to make decisions

Reduce unwarranted variations in practice to make sure patients get the best care available, no matter where they live

Improve healthcare across Scotland by focusing on patient-important outcomes

(they aim to aid the translation of new knowledge into action)

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25
Q

Descriptive studies

A

Attempt to describe the amount and distribution of disease in a given population

does not provide definitive conclusions about causation

Do not test hypotheses

Usually quick and cheap

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26
Q

Cross-sectional studies

A

Observations are made at a single point in time
Provides results quickly
Conclusions are drawn about the relationship btw diseases and other variables in a defined population
Usually impossible to infer causation

e.g. venous reflux scanned and a questionnaire about risk-factors given to participants to assess risk factors for venous reflux

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27
Q

Case-control studies

A

A group of individuals with the disease (cases) are compared to a control group
Data is gathered on each individual to determine if they have been exposed to each aetiological factor

Results are expressed as relative risks, sometimes with P values (confidence intervals)

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28
Q

Types of analytic studies

A

Cross-sectional studies
Case control studies
Cohort studies

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29
Q

Cohort studies

A

Baseline data is collected from a group of people who do not have the disease
This group is followed until enough of them have developed the disease to allow analysis
- the group is split into subgroups with different exposures

Results are usually expressed as relative risks with confidence intervals (p values)

30
Q

Trials

A

Experiments used to test ideas about aetiology or to evaluate interventions

31
Q

The definitive method of assessing any new treatment in medicine is…

A

The randomised controlled trial

32
Q

The randomised controlled trial

A

Two groups at risk of developing a condition are assembled
An alteration is made to the intervention group (e.g. stop smoking)
The control group has no intervention
Data is collected on subsequent outcomes and relative risk is calculated

33
Q

Factors to consider when interpreting results

A

Standardisation
- a set of techniques used to remove the effects of differences in age, sex etc…

Standardised mortality ratio (SMR)
- a standardised death rate converted into a ratio
- SMR 120 = 20% more deaths than expected
Quality of data
- you must be sure data is trustworthy
Case definition
- important to know exactly what terms mean
Coding and classification
- must understand codes used in data storage and analysis
Ascertainment
- is the data complete (are subjects missing etc…)

34
Q

Bias definition

A

Trends in data collection, analysis, interpretation, publication or review that can lead to conclusions that are different from the truth

35
Q

Types of bias

A

Selection bias
information bias (happens when trial is not double blind)
Follow-up bias (one group is followed up more assiduously)
Systematic error (tendency for measurements to fall one side of the true value)

36
Q

Confounding factor definition

A

A factor that is independently associated with the disease and the risk-factor under investigation so distorts the relationship (e.g. age, sex, social class)

37
Q

Confounding factors are dealt with using…

A

Randomisation
Restriction of eligibility
Results can be stratified
Results can be adjusted

38
Q

Criteria that prove causality

A

Strength of association (measured by relative risk/ odds ratio)
Consistency (under different circumstances)
Specificity (single exposure leading to single disease)
*Temporality (exposure comes before disease)
Biological gradient (risk increases as exposure increases)
Biological plausibility (agrees with known biology)
Coherence (doesn’t conflict with known biology)
Analogy (another relationship can act as a model)
Experiment (can be proven by controlled experiment - rare in humans)

*only absolute criterion

39
Q

Healthy life expectancy is

A

The number of years spent in self-assessed good health

Since 2000, the number of years spent in poor health has increased but the proportion has remained stable

40
Q

Responsibilities of carers

A

Practical help such as cooking, laundry, shopping
Keeping an eye on them
Keeping them company
Taking them out
Help with finances
Help them deal with care services and benefits
Help with aspects of personal care

41
Q

Being a carer impacts on the person’s…

A

Finances
Personal health
Relationships with friends and family

42
Q

Multi-morbidity definition

A

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

(the norm in primary care patients)
(complex as the preferred treatment for one condition may worsen another)

43
Q

Options for care

A 
Living in a family member's home
Living in own home with support from family
Living in own home with support from social services
Sheltered housing
Residential home
Nursing home
Specialist unit
Admission to hospital
44
Q

Purpose of advance and anticipatory care planning (ACP)

A

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

45
Q

Aspects of advance and anticipatory care planning (ACP)

A

Legal aspects

  • welfare power of attorney
  • financial power of attorney
  • guardianship

Personal aspects

  • wishes regarding treatment
  • next of kin
  • consent to pass info to others
  • who else to consult/ inform
  • preferred place of death
  • current level of support

Medical aspects

  • potential problems
  • home care package
  • DNA CPR
  • details of “just in case” medicines
  • assessment of capacity/competence
  • current aids and appliances
46
Q

Roles of the practice nurse…

A 
Obtaining blood samples
ECGs
Minor + complex wound management including leg ulcers
Travel health advice and vaccinations
Child immunisations and advice
Family planning and women's health (in. cervical smears)
Men's health screening
Sexual health services
Smoking cessation
47
Q

Roles of the district nurse

A

Visit people in their own homes/ residential homes
provide direct, complex care
Teaching + support role with patients and carers
Keep hospital admissions and readmissions to a minimum
Assess healthcare needs
Monitor the care patients are receiving
Professionally accountable for the delivery of care

48
Q

Roles of the midwife

A

Provide care during all stages of pregnancy, labour and early post-natal period
Work in the community (GP, children’s centres, women’s homes, local clinics) and hospital

49
Q

Roles of the health visitor

A

Child and family health services from pregnancy to 5 years
Ongoing additional services for vulnerable children and families (practical support, referral)
Safeguard and protect children
Support and advice on minor illnesses, feeding and weaning, dental health, physical development checks, post-natal depression)

50
Q

Roles of the Macmillan nurse

A

Specialised pain + symptom control
Emotional support for patient, family and carers
Care in a variety of settings
Info on cancer treatments and side effects
Advice to other members of the caring team
Advice on other forms of support including financial

51
Q

Roles of the pharmacist

A

Expert in medicines and their use
Ensure patients gat maximum benefit from medicines
Advise other staff on selection and appropriate use of medicines
Provide info to patients on how to manage medicines
May undertake additional training to be able to prescribe for specific conditions

52
Q

Roles of the dietician

A

Working with people with special dietary needs
Informing the general public about nutrition
Offering unbiased advice
Evaluating and improving treatments
Educating patients and other healthcare professionals

53
Q

Roles of the physiotherapist

A

Help and treat people with physical problems caused by illness, accident or ageing
Maximise movement through health promotion, preventative healthcare, treatment and rehabilitation

Core skills include:

  • manual therapy
  • therapeutic exercise
  • application of electrophysical modalities
  • appreciation of physiological, cultural and social factors influencing their clients
54
Q

Roles of the occupational therapist

A

Assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independent function in all aspects of daily life
Help people overcome the effects of disability (maximise independence)

work in many areas including:

  • physical rehabilitation
  • mental health services
  • learning disability
  • primary care
  • paediatrics
  • environmental adaptation
  • care management
  • equipment for daily living
55
Q

Roles of the care manager

A

Experts in working with individuals to identify their goals and locate the specific support services that enhance well-being
Provide support to find the best solutions
Highly trained social workers who work with the patient to advise on social and financial support services

56
Q

Challenges affecting the PHCT

A

Economic factors
- larger buildings often owned by private companies
Political pressure
- to reduce costs of treatment
Development
- Development of new and extended professional roles
Ageing patients

57
Q

“The forum on teamworking in primary healthcare” recommends guidelines for establishing a successful PHCT.
The team should…

A

Recognise and include the patient, carer or representative as an essential member of the PHCT
Establish a common agreed purpose
Agree set objectives and monitor progress towards them
Agree teamworking conditions, including a process for resolving conflict
Ensure each team member understands and acknowledges the skills and knowledge of colleagues
Pay particular attention to the importance of communication btw its members including the patient
Select the team leader for their leadership skills

58
Q

The integration of health and social care aims to…

A

reduce unnecessary admissions to hospital + reduce delayed discharges
Make more efficient and affective use of limited resources

59
Q

The legislative framework for integrating health and social care was set out in…

A

The public bodies (Joint working) (Scotland) Act 2014

60
Q

2 frameworks for integrating health and social care services

A

Integrated joint board (body corporate) model

Lead agency model

61
Q

which is more important, actual risk or relative risk?

A

Actual risk

62
Q

Purpose of the odds ratio

A

Approximated the relative risk

63
Q

Relative risk can only be properly calculated from…

A

prospective studies

64
Q

The audit cycle

A

Set standards
Measure current practice
Compare results of practice to standards set
Reflect, plan change and implement change
Re-audit

65
Q

An audit asks…

A

“Are we actually doing the right thing and in the right way?”

They should be transparent and non-judgemental

66
Q

Audits can be used to evaluate…

A

Structure of care (e.g. clinic availability)
Process of care (e.g. waiting times)
Outcome of care (e.g. success rates)

67
Q

The royal college of GPs states (about audits) …

A

They should be full cycle
There should be at least one complete audit in each 5 year revalidation cycle
They must be undertaken by several GPs working as a team

68
Q

The description of an audit should include…

A

Title
Reason for choice
Dates of 1st and 2nd data collection
Criteria to be audited and standards set with justification
Results of first data collection and comparison with standards
Summary of plan of change agreed
Changes implemented
Results of 2nd data collection and comparison with standards
Quality of improvements achieved
Reflection of audit on principles of good medical practice

69
Q

Criteria definition

A

A definable, measurable item of healthcare

e.g. the number of people with IHD who have their lipids checked per year

70
Q

Standards definition

A

The level of healthcare to be achieved for a specific criterion
e.g. 80% (often described as a statement)

71
Q

Different types of standards

A

Minimum standard = lowest acceptable standard of performance
Ideal standard = care that should be possible under ideal conditions

Optimum standard = lies between the minimum + ideal, the standard most likely to be achieved under normal conditions

x2 - Second Year Misc. (4 decks)

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