Pink Flashcards
What is housing?
Physical structure of dwelling
Home: psychosocial, economic and cultural construction created by household
Immediate environment: physical neighbourhood infrastructure
Community: social environment, population and services
Define decent home
Meets current statutory minimum standard for housing
Reasonable state of repair
Reasonably modern facilities and services
Provides a reasonable degree of thermal comfort
What are the main health hazards related to housing?
Cold homes: poor energy efficiency in homes and rising fuel cost, level of excess winter deaths
Overcrowding: Lack of affordable homes, lack of larger homes, respiratory problems, stress, poor mental health, children’s poor educational attainment, sleep problems, difficulty managing children’s behaviour
Damp and mould: Caused by cold and poor ventilated homes, Associated with respiratory infections, allergies and asthma
Structural defects: Caused by poor design and repair – poor lighting, lack of stair rails, steep stairs increases risk of accidents
Groups most at risk of living in unhealthy home environments are those most at risk of poverty. Who are these groups?
Disabled people and those with long-term conditions
Older adults
Families with young children, particularly if lone parent households
Black and minority groups
Young single people
Describe the health service perspective on the benefits of good housing
Improving housing quality and quantity can reduce pressures on NHS
Healthier adults and children, lower rates of disability and long-term conditions
Enables people to manage their health and care needs
Reduces demands for emergency health services
Enables timely discharge
What is a rough sleeper?
People sleeping, about to bed down or actually bedded down in open air (streets, in tents, doorways, parks, bus shelters or encampments)
People in buildings or other places not designed for habitation (stairwells, barns, sheds, car parks, cars, derelict boats, stations, or ‘bashes’)
Not people in hostels or shelters, campsites or other sites used for recreational purposes or organised protest, squatters or travellers
When do rough sleeper counts happen?
Given that rough sleepers often move between local authority areas (particularly in urban areas) it is strongly recommended that neighbouring authorities count on the same night whenever possible
Formal rough sleeper counts should take place between 1 October and 30 November. Local authorities may chooseto count more often than this but CLG will collate figures from autumn counts
What areas of life are affected by being a sofa surfer?
Relationships
Benefits
Council tax reduction (if tenant claiming as a single person)
Tenancy
Status as homeless if for more than a few nights
What criteria make someone statutory homeless?
You are eligible for public funds
Have a local connection
Are unintentionally homeless (ie it’s not your fault)
Have a priority need
What categories are covered under the term priority need?
Household with dependent children
Household with a pregnant woman
Vulnerable because of physical or mental health
Aged 16 or 17 or aged 18-20 and previously in care
Vulnerable as a result of time spent in care, custody or HM Forces
Vulnerable as a result of having to flee their home because of violence or threat of violence
IF MAIN HOMELESSNESS DUTY ACCEPTED, what needs to happen?
Authority must ensure that suitable accommodation is
available for applicant and his or her household
Duty continues until a settled housing solution becomes available for them, or some other circumstance brings duty to an end
IF MAIN HOMELESSNESS DUTY NOT ACCEPTED, what needs to happen?
Local authority must provide advice and assistance to help applicant to find accommodation for themselves
How many homeless people are there in England?
Across England 9% of adults say that they have experienced homelessness at some time
8% of under-25s say this happened in the last five years
These new data imply that around 185,000 adults experience homelessness each year in England
What are some causes of homelessness?
Welfare changes
Lack of affordable housing
Effects of Government plans for “Right to Buy” for housing association tenants
Unemployment
Closure of long-term psychiatric hospitals
List some routes into homelessness
Relationship breakdown Being asked to leave family home Drug and alcohol problems Leaving prison Mental health problems Other: eviction, problems with benefits payments
What are barriers to the health of homeless people?
How to register with a GP if you don’t have an address
Safe discharge
High emergency readmission rates within 28 days of discharge
What risk factors for longstanding health problems are often present in homeless people?
Mental health issues Drugs or recovering from a drug problem Have or are recovering from an alcohol problem Physical health problems Regular smokers
WHERE DO HOMELESS PEOPLE GET HEALTHCARE?
A and E GPs Hospital Opticians Dentist
Name some leading causes of death in homeless people
Drugs Alcohol Cardiovascular disease Suicide Respiratory problems
What is the average age of death of homeless people in the uk?
47 years old
How much more likely is a homeless person to commit suicide than the average person in the UK?
9x more likely
What partnership working is being done to help homeless people?
Inclusion of housing and housing circumstances: Health and
Wellbeing Strategy and local commissioning
Local commissioning: range of housing to meet local needs, intervention to protect and improve health in the private sector, to prevent homelessness and enable people to remain living in their ownhome should their needs change
Housing providers’ local knowledge inform plans to develop new homes and manage their existing homes to best meet needs, include working with NHS providers to re-design care pathways and develop new preventative support services in community
Provision of specialist housing, wide range of services: enable people to re-establish their lives after a crisis and to remain in their own homes as their needs change. Home improvement agencies and
handyperson services to deliver adaptations and a wide range of other home improvements
Voluntary and community: wide range of services, day centres for homeless people to information and advice to housing support services
What are key features of a healthy home?
Warm and affordable Free from hazards, safe form harm Enables movement around the home and is accessible for residents and visitors Promotes a sense of security Support available if needed
What is meant by the term sexuality?
Umbrella term: private dimension in which people live out their sexual, intimate and/or emotional desires
What factors can influence a persons sexuality?
Historical, social, cultural and political aspects of society
Relationships with ourselves, those around us, and society
What is the naturalist approach to sexuality?
Sexuality is biologically determined with minimal influence from societal structures
Traits are fixed and there is no variation
Uses anatomical differences between males and females to claim biological basis to sexuality
Heterosexuality is normal expression and identity of sexuality
Heterosexuality has no cause as it is viewed as natural
What is the nurture approach to sexuality?
Sexuality is constructed and influenced by societal structures
Gives us a potential for choice, change and diversity
Complex; reasons for engaging in sexual behaviour are varied
Sexuality is made; people are experts in own lives and therefore ‘make’ their identities, including their sexual selves
Acknowledges biological anatomical differences between men and women, but recognises that a person’s sexuality is also influenced by society’s structures
What is sexual identity/ orientation?
Focus of a person’s sexual attractions and desires
Heterosexual, lesbian, gay, bisexual and transgender
Presented as essentialist categories with fixed assumptions about sexual orientation
People’s experiences and choices not necessarily so certain; e.g. men
in relationships with women who define themselves as heterosexual
who also have sexual encounters with men
‘Men who have sex with men’ (MSM): ‘Women who have sex with
women’ (WSW) and ‘Same sex attraction’ (SSA)
Define heterosexual
Where people are exclusively or almost exclusively sexually attracted to people of the opposite sex/gender identity
Define lesbian
Woman whose primary sexual attraction is to other women
What does gay mean?
Most often used in relation to men whose primary sexual attraction is to other men
Define bisexual
Person who is sexually and/or emotionally attracted to both men and women
What is transgender?
Includes those who do not consider themselves to fit into the traditional female/male, sex/gender constructs
What is homophobia?
Intolerance, fear, hatred that people have of lesbians, gay men and bisexuals
What is internalised homophobia?
Self-loathing that lesbians, gay men and bisexuals may develop as a response to homophobia
What is a problem with the term homophobia?
Phobia implies that it is only located within individual concerned
Ignores fact that much anti-gay prejudice is perpetrated quite consciously through society’s cultural and structural institutions and values
What is heterosexism?
Set of assumptions and practices which promote
heterosexuality as only normal, acceptable and viable way to live our lives
What act changed legislation to reduce the age of consent for gay men to sixteen years?
Sexual offences act 2000
Which act allowed lesbian and gay couples to adopt?
Adoption and Children Act 2002
Which act protects against direct and indirect discrimination, victimisation and harassment in employment?
Employment Equality Act (Sexual Orientation)
Which act provided lesbian and gay partners with the option of a civil ceremony?
Civil Partnership Act
Which idealogical beliefs tend to be associated with hostility towards gay men and lesbians?
Authoritarianism
Religious fundamentalism
Why do LGBT people often report low expectations of medical services?
Prejudice, stereotyping and invisibility
Describe some best practice guidelines for dealing with issues around LGBT discrimination in medical practice
Be aware and challenge discrimination around sexuality
Do not to make any assumptions about a person’s sexuality
Ensure that history taking and assessments are conducted in such a way as to facilitate disclosure: e.g. asking open questions
Develop a language of sexual expression and be able to talk about sexuality comfortably and explicitly
What characteristics are babies born to teenage mothers more likely to have?
Low birth weight
Born prematurely
Higher risk of dying during infancy
What social factors are associated with teenage pregnancy?
Social disadvantage
Poor educational outcome
Lack of aspiration
What is the most commonly diagnosed STI?
Chlamydia
Which groups of sexual orientation are at most risk of contracting HIV?
Gay, bisexual men and men who have sex with men (MSM)
Why are STI diagnoses increasing?
Increased sexual activity particularly amongst younger people People more aware of STIs Easier to access services Better diagnostic tests e.g. Chlamydia Artefact
Give some examples of STIs which can be asymptomatic
Chlamydia, Genital Warts, Genital Herpes, Hepatitis, Syphilis, Trichomonas, HIV
What clinical problems can arise from a chlamydia infection?
Complete occlusion of fallopian tube
Pelvic inflammatory disease
Risk factor for cervical cancer
Which STIs are highly protected against with correct condom use?
Chlamydia, Gonorrhoea, Hepatitis B/C, HIV, Syphilis, Trichomonas
Which STIs are slightly protected against with correct condom use?
Herpes Simplex Virus (HSV), Human Papilloma Virus (HPV)
Which STIs are not protected against at all with correct condom use?
Hepatitis A, Pubic Lice
Why is partner notification important for STIs?
Protect the patient from re-infection
Offer sexual partners tests for STIs
Offer sexual partners treatment
Inhibit further spread into the community
Give examples of STIs which don’t require partner notification as they have no effective treatment?
Herpes and genital warts
Give some main differences regarding sexual health care in primary care and GUM clinics
GUM attenders tend to perceive themselves at risk
GUM attenders expect questions about sex
Primary care attenders do not necessarily perceive themselves at risk or expect questions about sex
Testing in GUM clinics can be anonymous
In General Practice all tests appear in the patients notes
Give some advantages of providing sexual healthcare services within general practice
People who are asymptomatic are unlikely to present at a GUM clinic/ they may not know they have an STI
GP practice may be more accessible
Patient may prefer to talk about sexual health with someone they know
Patient may feel uncomfortable about attending a GUM clinic
Patients may feel that they would be better supported in GP practice
Possible to test for STIs at the same time as providing other care e.g. cervical smears
How might you introduce the topic of sex into a consultation?
Ask pt what they think
Make it routine
Introduce by making a statement
Followed by one or two questions which asks person for permission to go on to talk about persons sexual health
How can you establish that someone is at no apparent risk of STI?
Not sexually active
Monogomy: not had sex with anyone else
Condom use
Been tested and not had sex since then
What is a DNAR order?
A do not attempt resuscitate order
Medical order instructing health care providers not to do cardiopulmonary resuscitation (CPR) if breathing stops or if the heart stops beating
What is an advance care plan?
Structured discussion with patients and their families or carers about their wishes and thoughts for the future
Processes which enable individuals to be involved in decisions
regarding future care. It is a voluntary process of discussion and review. Identifies a person’s preferences in the context of an anticipated deterioration in their condition
What needs to be done with regards to an advanced care plan when it is put in place?
Documented
Regularly reviewed
Communicated to key persons involved in their care
What issues should you discuss with a patient when determining their advance care plan?
What they want to happen
What they don’t want to happen
Who will speak for them
What are triggers to people seeking medical help?
Interpersonal crisis
Interference with social or personal relations
Sanctioning by others
Interference with vocational or physical activity
Temporalizing of symptomatology
What is the prognosis for someone with bronchiectasis?
Depends on the cause:
Ciliary dysfunction- progressive damage and respiratory failure
Not related to ciliary dysfunction- relatively good if physiotherapy is performed regularly and antibiotics are used aggressively
10% of adults with non-CF bronchiectasis die within 5-8 years of diagnosis, with the cause of death being respiratory in over half of those
In a community acquired pneumonia in a child, what are the likely causative organisms?
Strep pneumonia is the most likely bacterial pathogen
Viruses must also be considered. e.g. rhinovirus
In children with recurrent chest infections, what factors might you want to explore in the home and with the family?
Condition of housing Smokers in the house Family history of chest problems Prematurity Immunisation records
What are some long term effects of recurrent childhood chest infections?
Some pneumonias are destructive (eg, adenovirus) and can cause permanent changes, most childhood pneumonias have complete radiologic clearing. If a significant abnormality persists,
consideration of an anatomic abnormality e.g. abnormally narrowed airways or muscular problems, is appropriate and appropriate radiological investigations should be performed
Define immigrant
Anyone who moves to another country for at least a year
Define asylum seeker
Person who claims asylum in the UK due to persecution in their country of origin
Define refugee
Person fleeing their country due to conflict
Also a person who has been granted asylum
Asylum seekers can apply for basic housing and monthly subsistence payments. Who provides this?
National Asylum Support Service (NASS), dept. within the UK Border Agency
Discuss GP services for asylum seekers
May be no special service in their area: difficult to access GP – language, can’t register
In dispersal areas usually specialised provision for asylum seekers - either: A service which screens, then registers asylum seekers with local GPs, or a service which screens and keeps them as registered patients
What are some migrant health issues?
Infectious diseases: hepatitis B, hepatitis C, HIV, syphilis, TB, leprosy
Malnutrition, anaemia, parasitic infestation
Untreated major and minor conditions
Female genital mutilation
Trafficking and modern slavery
Effects of detention and torture, physical and mental
Effects of exposure to conflict
Describe the meridian practice in Coventry
Asylum seekers from Iran, Iraq, Afghan, Syria
Mostly aged 20–40 years old
After registering, detailed nursing assessment, which includes asking why they seek asylum
Two GPs, need to understand asylum process
Professional interpreters for over 50% of appointments
What happens at a nursing assessment for asylum seekers?
Lasts 60-90 minutes
Current and past medical history
TB screen/mental health screen/sexual health
Women are asked about history of FGM, relates to own health and safeguarding daughters
Asked in outline why they are seeking asylum
Referral to GP re any issues identified
What are some TB screening questions?
Persistent cough? Coughing blood? Significant weight loss? Night sweats? In contact with TB?
What screening tests are done for asylum seekers?
Blood tests for: HIV, hepatitis B, hepatitis C, syphilis, haemoglobinopathies (sickle cell, thalassaemia)
Interferon gamma assay test for TB – T-spot
Chlamydia (under-25s) – national policy
FBC
Other blood tests as indicated eg HbA1c
What annual things should be put into place for HIV positive patients?
Cervical smears for female HIV +ve patients
Annual flu vaccs, and pneumococcal vaccination
What are problems with illegal immigrants in relation to health care?
No access to health care, no NHS number, can’t register with GP. Use A and E
What is being done to eradicate female genital mutilation in the local area?
Regular multi-agency group meeting to research, raise awareness, plan strategy
Community groups and men groups crucial
All GPs must now document FGM and safeguard girls at risk
Reporting to Health Service
What medical malpractice may lead to a criminal prosecution?
Gross negligence
Manslaughter
Criminal battery
What medical malpractice may lead to a civil action?
Civil battery
Negligence
Breach of contract
What is the aim of a legal course of action in battery?
Compensate a person for uninvited invasion of bodily integrity
What is the aim of a legal course of action in negligence?
Compensate a patient for harm caused by negligent conduct of the doctor
What are the elements of battery?
Non-consensual physical contact
Patient must prove lack of consent
No need to prove damage
Defendant may be liable for all damage flowing from the battery
What are the elements of negligence?
Duty of Care: Whenever one can reasonably foresee that one’s conduct may cause harm to another
Breach of duty: claimant must show that defendant fell below required standard of care
Causation: claimant must establish that his condition was worsened or unimproved condition was caused by doctor’s negligence
All 3 required to prove negligence
What is duty of care?
You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour
Describe the scope of duty in relation to duty of care
In order for a duty of care to arise, a sufficiently proximate relationship must exist to make imposition of such a duty fair
In medical context, duty arises when doctor assumes responsibility for the patient, e.g. undertakes the task of treating the patient
How is it decided what the standard of care is in relation to a negligence claim?
Doctor cannot be found liable in negligence if she can find a responsible body of medical opinion that might have done as she did in those circumstances
If other reasonable doctors might have done as the defendant doctor did then doctor is not negligent
What are criticisms of Bolam in terms of how negligence is determined?
Makes doctors themselves the final arbiters of what is or is not negligent
Prevents judges from having any right of oversight, not allowed to assess expert evidence themselves, only check whether or not it existed
This is different to the way standard of care operates for all other professions
What was the outcome of the Bolitho case in relation to medical negligence?
House of Lords held that it was open to the courts to find negligence even where defendant doctor could provide some expert evidence on her own behalf
However, only in rare case that evidence provided by defendant’s experts was unable to withstand logical analysis
Describe what measures are in place to protect patients from medical negligence
Requirement of peer support: If doctors can find other doctors to testify on their behalf, then that is strong evidence that they are acting responsibly (Bolam)
Possibility of court oversight: judge can review evidence and assess whether it is logical. In the very rare case that it isn’t, the judge can
intervene and find negligence anyway (Bolitho)
Which legal case lead to a change in the requirements for risk disclosure and consent to protect against negligence?
Montgomery v Lanarkshire Health Board
Woman with diabetes, had severely disabled child due to mechanical complications arising during delivery due to shoulder dystocia. She was not warned about the risk
Describe how causation has to be shown in a negligence claim
Breach of duty is not in itself actionable. Claimant must also demonstrate that defendant’s negligence caused his injuries
Traditional ‘but for’ test is appropriate where it can be simply applied
What are the rules on failure to examine in relation to negligence?
Where a defendant fails to attend a patient, and patient suffers injury, it must be demonstrated that defendant had she attended would have made a Bolam-compliant decision
House of Lords held that two doctors who negligently failed to examine a patient with severe respiratory problems did not ‘cause’ patient’s injuries and death because they claimed they would not have intubated and thus acted in accordance with requirements of Bolam
What is different in negligence if there are multiple causes?
Breach of duty sounds in negligence if, on the ‘balance of probabilities’, it causes, or ‘materially contributes’ to the injury
What is lost chance in relation to negligence?
Doctor does not ‘cause’ the injury per se but removes chances of a patient recovering from a pre-existing condition
How does lost autonomy relate to negligence claims?
Courts have held that a claim can be established if a medical professional negligently fails to warn of a risk as a result of which the claimant agrees to undergo an operation, and the risk materialises, even when if properly advised, she would have undergone the operation eventually, but not at that time
What happened in the Simms vs Simms case?
Court considered an application that two persons suffering
from variant Creutzfeld Jakob disease should be given innovative treatment which was new and untested on humans. Court decided that first question was whether the doctors would be acting in accordance with a responsible and competent body of relevant
professional opinion as per Bolam, and the court held that there was a responsible body of professional opinion that supported the innovative treatment
What is the GMC guidance on prescribing unlicensed medications?
Commonly used in some areas of medicine such as in paediatrics, psychiatry and palliative care
Should usually prescribe licensed medicines in accordance with terms of their licence. However, you may prescribe unlicensed medicines where, on the basis of an assessment of the individual patient, you conclude, for medical reasons, that it is necessary to
do so to meet the specific needs of the patient
What is the medical innovation bill?
Purpose of this Act is to encourage responsible innovation in medical treatment
Not negligent for a doctor to depart from existing range of accepted medical treatments for a condition if decision to do so is taken responsibly
Responsible innovation will not be negligent, even in circumstances where no responsible body of medical opinion would support that departure, provided he takes that decision responsibly
What is procedural responsibility in relation to medical innovation?
Obtain views of one or more qualified doctors with a view to ascertaining whether treatment would have support of a responsible body of medical opinion
Take full account of views obtained and do so in a way in which any responsible doctor would be expected to
Obtain any consents required by law to carrying out of proposed treatment
Consider any opinions or requests expressed by the patient
Consider risks and benefits that are associated with proposed treatment, treatments that fall within the existing range of accepted medical treatments for condition, and not carrying out any of those treatments
Take such other steps as are necessary to secure that decision is made in a way which is accountable and transparent
What sources of organs for transplantation are available?
Xenotransplantation
Living donation: Directed donation (To a specified person, Paired donation, Pooled donation). Altruistic (non directed) donation
Cadaveric donation: Donation after circulatory death, Donation after brain death
What are the circumstances under which solid organ donation can occur?
Ventilated and cared for on Intensive Care or in Accident and Emergency
When death has been confirmed by Brain Stem Death Tests
When death is the expected outcome
Describe the organ donation referral process
Potential Organ Donors can be referred by anyone to on call Specialist Nurse for Organ Donation who will check Organ Donor Register
What proportion of the population are organ donors?
30%
Who can register to be an organ donor?
Self registration: No age restriction for self registration or withdrawal from Register
Third Party Registration: Person aged under 16 years of age, parent can register their child or a child for whom they have parental responsibility
Person with Capacity aged 16 years and over, no-one can register another person on ODR
Person without Capacity aged 16 years and over, Mental Capacity Act, an authorised person can send a copy of Lasting Power of Attorney then they can register the person
Registration on ODR register is considered as Consent to Organ Donation under which act?
Human tissue act 2004
What makes a consent valid?
Given voluntarily by an appropriately informed person who has capacity to consent to intervention in question (patient, someone with parental responsibility for a patient under 18,
someone authorised to do so under an LPA or someone who has authority to make treatment decisions as a court appointed deputy)
Acquiescence where person does not know what the intervention entails is not consent
What is the time scale on a valid consent?
When a person gives valid consent to an intervention, in general that consent remains valid for an indefinite duration, unless it is
withdrawn by the person
What is the difference between donation after brain stem death and donation after cardiac death?
Donation after Brain-stem Death (Heart Beating Donation), retrieval of organs and eye tissue for purposes of transplantation after death confirmed using neurological criteria
Donation after Cardiac Death, retrieval of organs and eye tissue for purposes of transplantation after death is confirmed using traditional cardio-respiratory criteria. This refers exclusively to ‘controlled’ DCD – donation which follows a cardiac death that is result of withdrawal or non-escalation of cardio-respiratory support therapies that are considered to be no longer in a patient’s best interests
What does the human tissue act do in relation to organ donation?
Regulates storage and use of human organs and tissue from living individuals, and removal, storage and use of human organs and tissues from deceased
Lists purposes for which consent is required (Scheduled Purposes)
Specifies who may give consent for Scheduled Purposes
Makes it lawful to take minimum steps to preserve organs of a deceased person for use in transplantation while steps are taken to determine wishes of deceased, or, in absence of their known wishes,
obtaining consent from someone in an appropriate relationship
Describe the process of organ donation
Entering electronic donor information Obtaining bloods tissue typing virology Donor management Patient assessment Contact GP Coroners consent Transport of Organs Perfusion, removal and packing of organs Transfer to theatres Liaising with theatres Placing organs
What support is available for the family of organ donors?
Offer Keepsakes
Letter of thanks & information about recipients
Donor Family Network
Liaison between donor and recipient families
Offer formal bereavement care
What are the different types of living organ donation?
Directed donation: To a specified person, Paired donation, Pooled donation
Altruistic (non directed) donation
What is paired or pooled organ donation?
Through national living kidney sharing scheme
Donor and recipient are incompatible or mismatched
Pair may be matched to another couple in similar situation so that both people in need of transplant can get one
Pooled is where more than two pairs are involved in swap
What are ethical problems with living organ donation?
Concerns about undue pressure on donor
Risk to donor of process of donation
