H&S, MDM, HQPS

Question 1

Trends in physical activity in US from 1960 to 2008

Answer 1

Increase from 37% to 55% in light (2-2.9 Mets)
Decrease from 50% to 20% in moderate (>3 mets)
Increase from 15% to 23% in sedentary (< 2 mets)

Question 2

2008 Physical Activity Guidelines for America

Answer 2

Regular physical activity reduces the risk of many adverse health outcomes.
Some physical activity is better than none.
For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.
Most health benefits occur with at least 150 minutes (2 hours and 30 minutes) a week of moderate intensity physical activity, such as brisk walking. Additional benefits occur with more physical activity.
Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial.
Health benefits occur for children and adolescents, young and middle-aged adults, older adults, and those in every studied racial and ethnic group.
The health benefits of physical activity occur for people with disabilities.
The benefits of physical activity far outweigh the possibility of adverse outcomes

Question 3

Explain the built environment and its implications for engaging in physical activity

Answer 3

The built environment can either hinder or facilitate physical activity and healthy eating
Ex. Safety
Urban design/neighborhoods
Land use
Available public transportation
Available options for people within that space

Question 4

Describe encounters in which MI could be helpful

Answer 4

MI- A patient-centered guiding method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
For contemplators, not pre-contemplators

Question 5

Define MI spirit

Answer 5

Collaboration, Evocation, Autonomy
Interpersonal style characterized by the absence of confrontation or persuasion and by the acceptance of the person, expressed by empathy, respect and support

Question 6

Use OARS

Answer 6

Open-ended questions
Affirmations
Reflective listening
Summarizing

Question 7

Discuss the signs and symptoms of stress

Answer 7

Cognitive (Memory problems, Inability to concentrate, Poor judgment, Seeing only the negative, Anxious or racing thoughts, Constant worrying)
Behavioral (Eating more or less, Sleeping too much or too little, Isolating yourself from others, Procrastinating or neglecting responsibilities, Using alcohol or drugs to relax, Nervous habits (nail biting))
Emotional (moodiness, irritibility, agitation, inability to relax, sense of loneliness or depression)
Physical (aches, pains, diarrhea, constipation, chest pain, loss of sex drive)

Question 8

Discuss coping strategies and the relaxation response

Answer 8

Coping: positive (problem support, positive reinterpretation, social support)
Negative (problem avoidance, wishful thinking, social withdrawal, self-criticism)
Relaxation response: studied how to induce autonomic processes, meditation can shift body to parasympathetic reponse to bring heart rate down

Question 9

Describe how to assess stress in the clinical setting

Answer 9

Checklist Measures of Major Life Events
Perceived Stress Measures (PSS)
Negative Affect Measures
What events have put demands on the patient and caused need for adjustment?
What is their perception of these demands?
What is their affect? Does the patient verbally express anxiety, irritability or depressed mood? What does their body language convey?

Question 10

Define community stress and indicators of community stress

Answer 10

Need to do

Question 11

Allostatic load

Answer 11

A state in which the normal allostatic processes wear out or fail to disengage or shut off. Frequent or chronic challenges produce dys regulation of several major physiologic systems, including SNS, HPA axis, immune system, and CV system

Question 12

Understand Eastern compared to Western cultural stress perceptions and coping

Answer 12

Read article

Question 13

Purpose and role of case-control study

Answer 13

Does cohort study more efficiently, can assess confounding variables, efficient for studying diseases with very long latent periods

Question 14

Key methods/design

Answer 14

Identify source population (must be at risk), pick cases, controls must be representative of the population out of which the cases arose and independent of exposure status

Question 15

Epidemiology of Sustance Abuse Drinking

Answer 15

AUDIT score:

20+ - 5 pct - probable alcohol dependence
8-19 - 20 pct - high-risk drinkers
1-7 - 35 pct - low-risk drinkers
0 - 40 pct - abstainers

Question 16

Epidemiology of Alchohol Use

Answer 16

American Indian highest proportion of binge drinking, Hawaians highest proportion of heavy drinking
Increase in non-prescription of tranquilizers and pain relievers over the last 10 years

Question 17

Basic features and diagnostic criteria of substance abuse

Answer 17

Not just using alcohol/drugs, Compulsive seeking and taking, Loss of control in limiting use, Negative emotional state no use, Usually after prolonged use

Question 18

Personality Traits associated with substance abuse

Answer 18

a. Sensation seeking
b. Impulsivity
c. Lack of conscientiousness
d. Negative mood
e. Mood liability

Question 19

Types of motivation for substance abuse

Answer 19

social, enhancement, conformity, coping

Question 20

Psychosocial Treatment

Answer 20

Motivational interviewing, cognitive behavioral therapy,contingency management, 12 step facilitation, couples and family therapy

Question 21

Limits for at-risk alcohol use

Answer 21

For women:
Drinks per occasion	≤ 3 
Drinks per week		≤ 7
For men:
Drinks per occasion	≤ 4 
Drinks per week		≤ 14

Question 22

List and define topics on quality and safety improvement

Answer 22

Customer Expectation- Measurable characteristic(s) of a service or process that must be met to satisfy patient or customer requirements
A charter is a document that:
Describes the project and its purpose
Clarifies team expectations and helps to keep them focused
Aligns the project to organizational priorities
Lists the resources required to complete the project
Process metric- one of many variables affecting outcome of a process
Outcome metric- end result of this process
Identifying straifications- 5 why’s
Histogram and Pareto chart

Question 23

List and define effective methods for improvement of quality and safety challenges including measures to assess that a change is an improvement

Answer 23

Define, measure (identify potential sources of variation), analyze, improve, control (monitor performance and control plan)

Question 24

Describe the range of quality and safety challenges and potential interventions to address these

Answer 24

Shoulder Dystocia- Improve protocol and documentation
Contrast ingestion time
Antibiotic delivery
Patient wait time for diagnostic testing

Question 25

Identify objectives for taking a medication history and performing medical reconciliation

Answer 25

What medications is the patient actually taking?
Are the medications being used properly? If not, why not?
Are there discrepancies between data sources
Are there medications the patient is using for which the indication is not clear?

Question 26

Forms of error that lead to patient harm

Answer 26

Inadvertent errors (wrong medication or improper use),Deliberate non-adherence

Question 27

List some system changes that have been used to improve medication safety (CLQI-5a, Patient Safety)

Answer 27

Avoid problematic abbreviations
Do not hand write prescriptions
Double checking
Computerized provider order entry
Pay attention to different formulations
Limit administration frequency/ limit number of pills

Question 28

Basic Terms related to medication safety and medication error

Answer 28

Adverse drug event
Potential Adverse drug event
Preventable Adverse drug event
Ameriorable adverse drug event

Question 29

What’s wrong with EHR

Answer 29

Low specificity of medication interaction alert

Question 30

Differentiate between association and cause

Answer 30

Correlation is not equivalent to causation for three reasons

1) Confounders
2) False association
3) Chance

Question 31

Contrast risk or harm data obtained by cohort and case-control studies

Answer 31

Gradient of risk (dose resopnse)
Harm studies (cohort studies)

Question 32

Criteria for determining causation (primary)

Answer 32

1. Demonstrating association
2. Temporality
3. Altering cause affects probability of effect

Question 33

Calculate measures of association (RR, AR,NNH)

Answer 33

Risk ratio= (risk for people with risk factor)/(risk for people without risk factor)
Attributable risk= (outcome with risk factor)- (outcome before/without risk factor)
NMH (number of people that need to be exposed to get one more outcome)= 1/AR