Mercy Juma Flashcards
Childhood immunisation schedule
look it up and memorise
What is a notifiable disease?
any disease that is
required by law to be reported to
government authorities.
The aim is to allow governments to monitor
diseases and respond quickly to possible
outbreaks. This should help prevent
epidemics.
Who governs the reporting of notifiable diseases?
Public Health (Control of Disease) Act 1984
- imposes a legal duty to report patients suffering
from a communicable disease as defined by the
Act and subsequent regulations (SIs).
The above was amended by Health & Social Care Act 2008)
- which introduces additional
public health measures, including powers in
respect of:-
- Isolation outside hospitals.
- Quarantine.
- Wearing of protective equipment/clothing.
- Attendance at disease/risk counselling and training.
- Provision of healthcare information.
- Border control and disease monitoring.
How are notfiable diseases communicated in the UK
- adoctor has a clinical suspicion (i.e. does not
need to be sure of diagnosis) that a patient has
a Notifiable Disease. - The doctor has a statutory duty to notify a “proper Officer” of the local authority (i.e. a
Consultant in Communicable Disease Control)
using an appropriate form. (Urgent cases should be notified by phone too.)
3. The Proper Officer sends a report to the Centre for Infections which is part of the Health Protection Agency (HPA).
- The HPA collates all reports and publishes an analysis of trends.
Details required when notifying suspicion of a notfiable disease
Details required:
Patient’s name, date of birth, sex, and home address with
postcode.
Patient’s NHS number.
Ethnicity (used to monitor health equalities).
Occupation, and/or place of work or educational establishment
if relevant.
Current residence (if it is not the home address).
Contact telephone number.
Contact details of a parent (for children).
The disease or infection, or nature of poisoning/contamination
being reported.
Date of onset of symptoms and date of diagnosis.
Any relevant overseas travel history.
Which diseases are notifiable?
Acute encephalitis
Acute meningitis
Acute poliomyelitis
Acute infectious hepatitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease and scarlet fever
Legionnaires’ Disease
Leprosy
Which diseases are not notifiable
HIV
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
SARS
Smallpox
Tetanus
Tuberculosis (TB)
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
Describe the ‘all hazards’ approach
The amendment of the main legislation governing ND
makes it clear that in addition to the specified list of
infectious diseases, there is a requirement to notify
cases of other infections or contamination which could
present a significant risk to human health. This has be
dubbed the “all hazards” approach.
Consequences of not reporting a notifiable disease
1984 act:
criminal offence
civil action based on failure to warn
Power of detention in the case of a notiable disease
An application can be made under section 37 of the
1984 Act to a Justices of Peace (who can act
ex parte if required) to detain a patient
where:-
- Proper precautions to contain a notifiable
disease are not being taken. - There is a serious risk of infection to others.
- That accommodation in a suitable NHS hospital
can be made available.
S 38 of the 1984 Act provides that a patient
who is already in hospital and suffering from
a notifiable disease can be detained if:
On leaving the hospital the patient would not
have accommodation in which proper precautions
could be taken to prevent risk of infection.
In the UK there is statutory provision
allowing for compulsory examination and
detention, but no statutory provision
allowing treatment.
Articles of the human rights act 1998
- Applies to the NHS
Art 1 respect rights
Art 2 life
Art 3 torture and
degrading treat.
Art 4 slavery
Art 5 liberty and
security
Art 6 fair trial
Art 7 punish.without
law
Art 8 private/family life
Art 9 thought
Art 10 expression
Art 11 assembly
Art 12 marry and found
a family
Art 14 no discrimination
How does the HRA contradict the detention of patients
Articles of the HRA 1998 which have a bearing on the detention of
non-adherent patients
Art 5 (liberty) & Art 8 (privacy).
Coker (2000, 2004, 2007) has consistently argued PHA 1984, ss 37
and 38 unlikely to be compatible with HRA and should be replaced.
An automatic review system has been proposed and more rigorous
requirements of proof of serious risk.
Disadvantages of detention
Compulsory detention/treatment is ineffective,
or at least unproven, so therefore a
disproportionate infringement of patient rights
and places clinicians in invidious position
(Coker 1999, 2000 and Van Den Bosch et al
1999).
Appropriate education, support and allocation
of resources and facilities is both more
effective and more ethical.
Advantages of detention
Coercion/compulsory detainment can be
morally acceptable if viewed in wider
context than simply short-term potential
effectiveness (Doyal 2001).
Communitarian ethics require us all to
accept moral responsibility for spread of
infections like TB.
Is coercion sufficiently successful to justify
the infringement of autonomy?
Social stigmas assoc. with HIV
- Sexuality–Homosexuality
- Drugs
- Death
Outcomes of counselling a person wth HIV
- Feel better
- Think clearer
- Relate better with others
- Stop feeling stuck
- Less stressed
- More from life
Which elements should be incorporated into aids counselling
•Psychoeducation
an evaluation of personal risk; facilitation of preventative behaviour;
•Counselling
to cope with stress; take personal decisions
•Psychotherapy
dealing with depression, negative thoughts, anxiety, stress, introspection of life
style etc.
HIV counselling approaches
- Crisis Intervention
- Client Centred Approach
- Psychodynamic
- Cognitive Behavioural Therapy
- Schema Focus Therapy
Client centred approach to HIV
- Establishing Rapport
- Empathy
- Promotes Feelings of Safetyand Security
- Allows client to talk in a freeand non-critical environment
- Gives client the opportunity to Reflecton his difficulties, anxieties, worries.
Reasons why people get tested for HIV
- Sexual risk
- Injecting risk
- Partner tested HIV positive
- Antenatal screening
- Physical symptoms
- New relationship/stopping condom use
- Sexual assault
- Medical examination
- Occupational exposure
- IVF
- Worried about their Well Being
Considerations during pre-test counselling (psychoeducation)
Emotions associated with the pre-test period:
Anxiety, Worry, Regret, Fear, Shame, Numbness
•Reasons for the test
•Benefits of testing iechronic manageable condition, normal life span if test early
•Identify/quantify risks
•Seroconversion period
•Expectation of results
•Capacity to deal with result
•Support networks
•Details of how and when result will be given
Steps when diagnosis is positive
•Psychoeducation •Re–testnecessary •Safersex/injectingdruguse •Givecondoms •gettingpartnerscreened Referralre-TestCounselling
Post test consultation for positive patients
Awareness of shock factor
•Keep information to a minimum
•Clarify patient understands
•Focus on coping today, tonight, next few days
•Who knows that person is receiving result today
•Arrangements for confirmatory HIV test
•Follow up appointment ongoing support and counselling
•Safer sex partners/onward transmission/legal aspects
Discussion in subsequent consultations
- Counselling Support
- Partner Notification
- Support Networks
- Further Psychoeducation
- Lifestyle balance, keeping well
- Sexual health
- Socioeconomic issues
Which psychological disorders of HIV positive people at increased risk of
- Depression
- Anxiety (GAD)
- Panic Attacks
- Post Traumatic Stress Disorder
Why is CBT preferred in patients with HIV
•it follows a model making the course of treatment manageable by the patient •it can be of short duration •it can be symptom targeted therapy •it is evidence based
mETHODS AND TREATMENTS IN cbt
Establishing Collaborative Therapist-patient relationship
•Socratic Questioning
•Understanding the relationship between thoughts-emotions-biology-
behaviour
•Relaxation Techniques
•Identifying Negative Automatic Thoughts
•Evaluation and Challenging Negative Automatic Thoughts
•Thought Modification
•Diaries (recording activity and emotions)
•Daily/Weekly Activity Schedules
•ABC Charts (linking particular thoughts and behaviours to specific situations/
stimulations) and establishing Patterns
Kibler Ros smodel of grief
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What is chemsex
- Having sex whilst using drugs
- Gay, bisexual, MSM
- Specific intention to meet to use and have sex
- Three main drugs: mephedrone, GHB/GBL, crystal methamphetamine
