H&S, MDM, HQPS Flashcards
Trends in physical activity in US from 1960 to 2008
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)
2008 Physical Activity Guidelines for America
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
Explain the built environment and its implications for engaging in physical activity
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
Describe encounters in which MI could be helpful
MI- A patient-centered guiding method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
For contemplators, not pre-contemplators
Define MI spirit
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
Use OARS
Open-ended questions
Affirmations
Reflective listening
Summarizing
Discuss the signs and symptoms of stress
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)
Discuss coping strategies and the relaxation response
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
Describe how to assess stress in the clinical setting
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?
Define community stress and indicators of community stress
Need to do
Allostatic load
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
Understand Eastern compared to Western cultural stress perceptions and coping
Read article
Purpose and role of case-control study
Does cohort study more efficiently, can assess confounding variables, efficient for studying diseases with very long latent periods
Key methods/design
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
Epidemiology of Sustance Abuse Drinking
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
Epidemiology of Alchohol Use
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
Basic features and diagnostic criteria of substance abuse
Not just using alcohol/drugs, Compulsive seeking and taking, Loss of control in limiting use, Negative emotional state no use, Usually after prolonged use
Personality Traits associated with substance abuse
a. Sensation seeking
b. Impulsivity
c. Lack of conscientiousness
d. Negative mood
e. Mood liability
Types of motivation for substance abuse
social, enhancement, conformity, coping
Psychosocial Treatment
Motivational interviewing, cognitive behavioral therapy,contingency management, 12 step facilitation, couples and family therapy
Limits for at-risk alcohol use
For women: Drinks per occasion ≤ 3 Drinks per week ≤ 7 For men: Drinks per occasion ≤ 4 Drinks per week ≤ 14
List and define topics on quality and safety improvement
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
List and define effective methods for improvement of quality and safety challenges including measures to assess that a change is an improvement
Define, measure (identify potential sources of variation), analyze, improve, control (monitor performance and control plan)
Describe the range of quality and safety challenges and potential interventions to address these
Shoulder Dystocia- Improve protocol and documentation
Contrast ingestion time
Antibiotic delivery
Patient wait time for diagnostic testing
Identify objectives for taking a medication history and performing medical reconciliation
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?
Forms of error that lead to patient harm
Inadvertent errors (wrong medication or improper use),Deliberate non-adherence
List some system changes that have been used to improve medication safety (CLQI-5a, Patient Safety)
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
Basic Terms related to medication safety and medication error
Adverse drug event
Potential Adverse drug event
Preventable Adverse drug event
Ameriorable adverse drug event
What’s wrong with EHR
Low specificity of medication interaction alert
Differentiate between association and cause
Correlation is not equivalent to causation for three reasons
1) Confounders
2) False association
3) Chance
Contrast risk or harm data obtained by cohort and case-control studies
Gradient of risk (dose resopnse) Harm studies (cohort studies)
Criteria for determining causation (primary)
- Demonstrating association
- Temporality
- Altering cause affects probability of effect
Calculate measures of association (RR, AR,NNH)
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
