MEDS 581 Midterm Review Flashcards
Define the IPEC definition of competency
Integrated enactment of knowledge, skills, and values/attitudes that define the domains of work of a particular health profession applied in specific care context
Define
Canadian Interprofessional Health Collaborative definition
A complex “know act” that encompasses the ongoing development of an integrated set of knowledge, skills, attitudes, and judgments enabling one to effectively perform the activities required in a given occupation or function to the standards expected in knowing how to be in various and complex environments and situations
Define competency
- An ability or skill
- A skill needed to perform in a particular role, knowledge in a particular domain, or a value that can be expressed in action
Define:
Common Competencies
Those competencies expected of all health practitioners
Define:
Complementary Competencies
Unique competencies that enhance the delivery of healthcare
Define:
Collaborative Competencies
Those competencies that each profession needs to work together with others
What are the four Interprofessional Collaborative Practice Competency Domains?
- Values/Ethics
- Roles/Responsibilities
- Interprofessional Communication
- Teams and Teamwork
What is the general idea of:
Competency Domain 1 - Values and Ethics
Work with individuals of other professions to maintain a climate of mutual respect and shared values
(Idea is to focus on the underpinning values of relationships.. can be with patients, other professionals, etc)
What is the general idea of:
Competency Domain 2 - Roles/Responsibilities
Being able to clearly describe one’s own professional role and responsibilities to team members of other professions and understand others’ roles and responsibilities in relation to ones own role.
(Understand how professional roles and responsibilities complement each other in patient-centered care)
What is the general idea of:
Competency Domain 3 - Interprofessional Communication
Communicating a readiness to work together which assists in collaboration.
What is the general idea of:
Competency Domain 4 - Teams and Teamwork
Teamwork behavior involves cooperating in the patient-centered delivery of care.
Coordinating one’s care with other health professionals so that gaps, redundancies, and errors are avoided.
Define:
Hospitalist
Specialists in inpatient medicine who will be responsible for managing the care of hospitalized patients in the same way that primary care physicians are responsible for managing the care of outpatients.
Inpatient vs. Outpatient
Inpatient - means that the procedure requires the patient to be admitted to the hospital so they can be closely monitored
Outpatient - means that the procedure does not require hospital admission and may be performed outside the premises of a hospital
There are now approximately ______ hospitalist and the number is likely to reach ______ in the next decade
40,000
50,000
Describe the following in terms of “Hospitalist values”:
- Patient experience
- Patient engagement
Patient experience - is the sum of all interactions, shaped by an organization’s culture that influence patient perception across a continuum of care
Patient engagement - are actions taken by individuals to obtain the greatest benefit from the health care services available to them
How is patient experience measured
- Patient satisfaction surverys
- Patient perceptions about communication with staff about medicine and care
- Overall rating of the hospital
What are the requirements to be a hospitalist?
Training: MD or DO
Residency: 3 years in internal medicine (family medicine is acceptable)
Skills: Diagnosing
Hospitalist Values
5
- Concern for value of care
- Delivering patient centered-care
- Ensuring safe and timely discharges
- Making accurate diagnoses
- Communicating clearly
Hospitalist by virtue of their unique role in the health care system will be expected to embrace the concept of ___________ and use it in everyday clinical practice.
value (value=quality/cost)
Differing perspectives on value:
- Clinicians
- Patients
Clinicians - value may mean decreasing over use and inefficiency while improving compliance with evidence based care
Patients- value may signify enriching the patient experience and concentrating on patient-centered outcomes
Value and Example of:
High cost
High net benefit
Usually high-value, but depends on the situation and the relationship of costs and benefits
MRI for epidural abscess
Example of:
High cost
Low net benefit
Low Value
Routine MRI for low back pain
Example of:
Low cost
High net benefit
High Value
Universal HIV screening
Example of:
Low cost
Low net benefit
Usually low-value, but depends on the situation and the relationship of costs and benefits
Preoperative testing prior to low-risk surgery like cataract surgery
__________ bacteria have a thick peptidoglycan cell wall that contains teichoic and lipoteiochoic acid
Gram positive
__________ bacteria have a think peptidoglycan layer and an outer membrane that contains lipopolysacchardies, phospholipids, and proteins
Gram negative
Gram positive stain with what?
Crystal violet
remain purple
Gram negative stain with what?
Safranin red
appear red/pink
Staphylococcus aureus
Gram + or -
Gram +
Escherichia coli
Gram + or -
Gram -
Staphylococcus aureus shape?
Coccus (round)
Escherichia coli
Bacillus (rod)
Risk factors for C. Dif
6
- Antibiotic Use
- Age
- Gastric Acid Suppression
- Gastrointestinal surgery
- Long length of stay in health care setting
- Serious underlying illness
How does antibiotic use increase risk factor for C. Diff?
- Disrupt the barrier function of the normal colonic flora
- Make more virulent by increasing antibiotic resistance
- Associated with fluoroquinolong (cipro, levofloxacin) and clindamycin use
Prevention and Control for C. Diff
5
- Collaborative effort
- Infection Control
- Enforcing hand hygiene
- Contact precautions (single patient room with dedicated bathrooms; use of gloves and gowns in room)
- Rooms with patients cleaned with sporicidal antiseptic agents
- Use of disposable equipment
Clinical Trial Phases
1 - Assess drug safety and find dosage
2 - Efficacy and side effects
3 - Compare new treatment with current treatment to see which is better
4 - Safety and efficacy
Describe the Modify trial I and II in the article
MODIFY I - had all conditions
MODIFY II - removed Actoxumab alone because patients were dying at high numbers
True or false
Medical ethics delineate “right vs. wrong”
False
They GUIDE decision making but do not explicitly state what is right and wrong, as they sometimes oppose one another
What are the four accepted facts of medical ethics
- Autonomy
- Beneficence
- Nonmaleficence
- Justice
Describe:
Autonomy
- The patient has the right to refuse or choose their treatment
- (contrast to paternalist where the physicians knows best and dictates care)
Describe somethings needed for:
Autonomy
- Informed consent
- Medical confidentiality
- Listening to patient/answering questions
Describe:
Beneficence
- A clinician should act in the best interest of the patient at all times and has a moral obligation to provide net medical benefit with minimal harm
Describe:
Nonmaleficence
- All decisions must be made with respect to the risk/harms that a patient can face (physical, financial, psychological)
- To do no harm
Describe:
Justice
- Refers to the fair and equitable distribution of limited healthcare resources
What are the principles to follow when using antibiotics
5
- Empiric therapy (start based on clinical evaluation)
- Tailoring therapy (change the antibiotics in response to clinical data like lab culture)
- Convert from IV to PO
- Use shortest effective duration
- Monitor pharmacokinetcs
Full name
IDSA ASP
Infectious Diseases Society of America - Antibiotic Stewardship Programs
IDSA ASP Recommendations
- Core members of a MULTIDISCIPLINARY team:
1. ID physician
2. Clinical Pharmacist
3. Clinical Microbiologist
4. Information system specialist
5. Infection control professional
6. Epidemiologist
The action that the ASP can take typically includes the following two stragies
- Prospective Audit and Feedback (PAF) - ASP staff reviews antibiotic orders and provide recommendation to prescribes regarding optimazaiton of antibiotic use
- Preauthorization - approval is required by an ID specialist before an antibiotic can be administered
What are the three categories for CDC Bioagents
Category A - highest priority. High mortality, easily grown, resistant to destruction, suitable to airborne dissemination
Category B - second highest priority. Moderately easy to spread but generally cause less morbidity and mortality than Cat A
Category C - Agents that include pathogens that could be engineered efor mass dissemination
Examples of Category A agents
8
- Anthrax (B. anthracis)
- Smallpox (Variola major)
- Plaque (Y. pestic)
- Viral hemorrhagic fevers
- Toxin of C. botulinum
- Tularemia (F. tularensis)
- Clostridium botulium
- Hemorrhagic fever viruses
Examples of Category B agents
8
- Brucellosis (B. melitensis)
- Q fever (C. burnetti)
- Glanders (B. mallei)
- Burkholderia
- Alphaviruses (VEE, EEE, WEE)
- Ricin toxin
- C. perfringens E toxin
- Staphylococcus enterotoxin B (SEB)
Examples of Category C agents
8
- Hantavirus group
- Nipah virus
- Tick-borne hemorrhagic fever agents
- Tick-borne encephalitis agents
- Yellow Fever
- Influenze
- Rabies
- MDR TB
Factors that impede effective communication
5
- Profession Culture (assumptions about communication)
- Time constraints and heavy work loads
- Interpersonal conflict
- Unclear definition of roles
- Improper Patient Hand Offs
What are the components of “Pure Communcication” in health care?
- Timely
- No negative emotion
- Clear and accurate
- Pure purpose (good of the patient)
- Messages are received in the same spirit
Why was the IPASS Study started?
- Concern for medical errors in cases of poor communication
- Great variability among sites for hand-off practices
- No formal curriculum
IPASS mnemonic
I - Illness severity P - Patient summary A - Action items S - Situation awareness and contingency planning S - Synthesis by receiver
What are the four pillars for Effective Primary Care
- First contact Care
- Continuity of Care
- Comprehensiveness of Care
- Coordination of Care
Describe the pillar “First Contact Care”
- Primary care should be delivered at the first contact to the system
(Reducin healthcare cost for the system, ED cost more than primary care office)
Describe the pillar Continuity of Care
Maintaining a relationship with the same provider ver time
high patient satisfaction, reduced cost, records kept together
Describe the pillar Comprehensiveness of Care
Requires that primary care be capable of addressing a wide scope of issues
Describe the pillar Coordination of Care
Primary care takes responsibility for managing patient’s health needs through the full spectrum of settings where care is delivered
(communication with specialist and transitioning care)
Describe the pillar Coordination of Care
Primary care takes responsibility for managing patient’s health needs through the full spectrum of settings where care is delivered
(communication with specialist and transitioning care)
Central Line Associated Bloodstream Infections (CLABSI)
- Bacteria in blood
- Cutaneous microflora of the insertion site
- Pathogens migrating extraluminally to catheter tip
Catheter Associated Urinary Tract Infections (CAUTI)
- Most common Hospital Aquired Infection*
- Bacteriuria (bacteria in urine)
- Correlation w duration of catheter placement
Ventilator Associated Pneumonia (VAP)
- Develops 48-72 hours after endotracheal intubation
- Caused by aspiration of flora
- Highest mortality of all infections*
Surgival Site Infection
- Wound infections
- Typically caused by staphylococcus and streptococcus
- Severity of infection depends on site
