Public Health Flashcards
1
Q
What social factors can influence health and disease
A
Occupation Stress Living conditions (Pollution) Education Wealth Social isolation Access to healthcare (Inverse care law) Cultural differences
2
Q
What lifestyle factors influence health and disease?
A
Food Exercise Alcohol Smoking Drugs Genetics
3
Q
What 4 mechanisms did the black report 1980 use to explain inequality
A
- Artefact
- Social selection - people in poorer health are in lower social classes so unable to to do higher class jobs
- Behaviour - people are responsible for their own health
- Material circumstances
4
Q
What did the Acheson report 1988 recommend
A
- Evaluate all policies likely to affect health in terms of their impact on inequalities
- Give high priority to health of families with children
- Government should reduce income inequalities and improve living conditions in poor households
5
Q
What are the three theories of causation
A
- neo-materialist
- Pyschosocial
- life course
6
Q
Describe the Neo-materialist theory of causation
A
Material circumstances cause poor health
Disadvantaged people more likely to be born into areas harm
7
Q
Describe the psychosocial theory of causation
A
Stresses are intensely social
Greater inequality heightens peoples social anxieties
8
Q
Describe the life course theory of causation
A
Critical periods have greater impact at certain points in your life (Measles or early bereavement)
Accumulation of hazards and impacts add up
(Hard blue collar work leads to injuries which leads to reduced work opportunities which leads to more injuries
9
Q
How can doctors close the social inequality gap
A
- Changer perspectives
- Change systems
- Change education
10
Q
What are the 4 main reasons for why men have higher mortality rates than women
A
- Men more likely to have a high risk occupation
- Risk taking behaviour
- Men tend to smoke more than women
- Men tend to drink more than women
11
Q
Define patient compliance
A
Extent to which the patients behaviour coincides with medical or health advice
12
Q
Give three disadvantages of patient compliance
A
- its passive, patients must follow doctors orders
- Professionally focused and assumed doctors know best
- ignores problems patients have managing their health
13
Q
Define patient adherence
A
The extent to which the patients actions match agreed recommendations - more patient centred
14
Q
What is the difference between patient adherence and patient compliance
A
Adherence is more patient centred, empowers patients and considers them as equals in care
15
Q
What are the 6 key principles of adherence
A
- Improve communication
- Increase patient involvement
- Understand patients perspective
- Provide and discuss information
- assess adherence
- review medicines
16
Q
Describe the necessity-concerns framework
A
Looks at what influences adherence - adherence increases when necessity beliefs are high and concerns are low
17
Q
Give 2 factors that patient centred care encourages
A
- Focus on the patient as a whole person
2. Shared control of the consultation so decisions are made by patient and doctor together
18
Q
What is concordance
A
Expectation that patients will take part in treatment decisions and have a say in the consultation
19
Q
Give 5 barriers to concordance
A
- Patient may not want to engage in discussions with doctor
- May lead to worry
- Patients may just want their doctor to tell them what to do
- Time, resources and organisational constraints
- Challenging, patient choice may differ from medical advice
20
Q
Give 4 advantages of doctor patient communications
A
- Better health outcomes 3
- higher compliances to therapeutic regimes
- higher patients and clinician satisfaction
- Decrease malpractice risk
21
Q
Name 6 examples of non-adherence
A
- Not taking prescribed medication
- Taking bigger/smaller doses than prescribed
- Taking medication more/less often than prescribed
- Stopping medicine without finishing course
- Modifying treatment to accommodate other activities
- Continuing with behaviours against medical advice (Diet, alcohol, smoking)
22
Q
What are some unintentional reasons for non adherence
A
Difficulty understanding instructions Problems using the treatment Inability to pay Forgetting Capacity and resource
23
Q
What are some of the intentional reasons for non-adherence
A
Patient beliefs about their health and condition
Beliefs about treatments
personal preferences
Perceptual barriers
24
Q
Why is diabetes a public health issue
A
Mortality Disability Co-morbidity Reduced quality of life Increasing prevalence particularly in younger age groups
25
What are the public health approaches to managing diabetes
1. identify those at risk
2. Prevent the diabetes with early effective interventions
3. Diagnose diabetes earlier
4. Effective management and supporting self-management
26
Which groups are most at risk of diabetes
1. Sedentary job
2. Sedentary leisure activities
3. Diet high in calorie dense food and low in fruit and vegetables
4. Obesogenic environment
4. Age, Sex, Ethnicity and fam history
6. Weight, BMI
7. Hypertension/vascular disease
27
What is IGT
Impaired glucose test
28
What is IFT
Impaired fasting glucose test
29
What screening tests are currently available for testing IGT and IFT
HbA1c
Random capillary blood glucose
Fasting venous blood glucose
Oral glucose tolerance test
30
What is the diagnostic range for IGT
7.8-11.0 mmol/l
31
What is the diagnostic range for IFG
6.1-6.9mmol/l
32
What is the WHO threshold for diabetes
FBG >7.0 or 2hr Glucose >11.1mmol/l
33
What factors contribute to an obesogenic environment
Physical environment ie. TV remotes, lifts and car culture
Economic Environment ie. Cheap TV, expensive fruit and veg
Sociocultural environment ie. safety fears and family eating patterns
34
What are the physical mechanisms that cause people to remain overweight
More weight means it is difficult to exercise (Arthritis, stress and incontinence)
35
What are the psychological factors that cause people to remain overweight
Low self-esteem and guilt leading to comfort eating
36
What are the socioeconomic factors that cause people to remain overweight
Reduced employment opportunities
Relationships
social mobility
37
What are three effective interventions for preventing diabetes
Sustained increase in physical activity
Sustained change in diet
Sustained weight loss
38
What are three approaches to diagnosing diabetes earlier
1. Raise awareness of diabetes and symptoms in the community
2. Raise awareness of diabetes and symptoms in health professionals
3. Use clinical records to identify those at risk or use blood tests to screen before symptoms develop
39
How is NHS England investing in T2 diabetes
Healthier you diabetes prevention programme aimed a lifestyle education, weight loss support and group physical exercise
40
Define obesity
Abnormal or excessive fat accumulation that presents a risk to health
41
Define BMI
A crude measure of obesity determined by patients weight (Kg) over height squared
42
Waist circumference can be used to assess health risks in individuals with a BMI less than what?
35kg/m2
43
What is a low waist circumference for a male
<94cm
44
What is a very high waist circumference for a male
>102cm
45
What is a low waist circumference for a female
<80cm
46
What is a very high waist circumference for a female
>88cm
47
What are the BMI categories
```
Normal 18.5 - 25
Overweight 25 - <30
Obese 30 - <35
Severe obese 35 - <40
Morbid Obese >40
```
48
What percentage of adults In England are either overweight or obese
64.3%
49
What are some of the associated obesity health implications
```
T2 diabetes
Hypertension
Some cancers
HEart disease
Stroke
Liver disease
```
50
What are the individual factors that affect obesity
```
Lifestyle
Biological
Demographics
Skill and behaviours
Cognitions
```
51
What are the social environment affects on obesity
Family,
friends
social networks
52
Describe the obesity care pathway
Tier 1 = Universal prevention
tier 2 = lifestyle intervention
tier 3 = specialist services
Tier 4 = Surgery
53
In terms of the obesity care pathway, what does universal prevention tier 1 involve
Preventing future occurrences through information giving
Environmental health promotion
54
In terms of obesity care pathway, what does lifestyle intervention tier 2 involve
Encourage people with obesity to have healthier lifestyles
Multicomponent weight management
55
in terms of the obesity care pathway, what does specialist services tier 3 involve?
Management of severe obesity through multidisciplinary intervention
56
In terms of the obesity care pathway, what does surgery tier 4 involve
Bariatric surgery only considered for people with morbid obesity
57
What steps have been taken at an national level to reduce obesity
1. Labelling of food
2. Sugar reduction- tax system for milk based drinks and ban on sale of energy drinks to kids
3. Schools - review physical activity, adopt active mile, introduce standards for school food
4. Marketing - introduce 9pm watershed on advertising HFSS products
5. Retail - Ban on price promotion of unhealthy, ban promotion of unhealthy by location such as ends of aisles
58
What is deontology
Belief that we owe a duty of care to each other
59
What is consequentialism
Consequences matter
60
What is virtue
```
Character of the person is central
Trustworthiness
Compassion
Integrity
Discernment
Conscientiousness
```
61
What are the positive of virtue ethics
Centres ethics on person
| Includes whole of a persons life
62
What are the negatives of virtue ethics
No clear guidance on moral dilemmas
No general agreement on what virtues are
Virtues relative to culture
63
What are the 4 principles of medical ethics
Autonomy
Beneficence
Non maleficence
Justice
64
What are the 4 quadrants approach
1. medical indications (Beneficence and non maleficence
2. Patient preference (Autonomy0
3. Quality of life
4. Contextual features
65
The large community of Slovakians in Sheffield has a high prevalence of what disease
Hepatitis B
66
What is major concern in the Somalian population in Sheffield
Female genital mutilation
67
Why Is FGM carried out?
1. Control over women's sexuality
2. Infibulation assumed to reduce women's sexual desire
3. Hygiene
4. Gender based factors - FGM deemed necessary for girl to be considered a women
5. Removal of labia and clitoris thought enhance a girls femininity
68
What are the immediate consequence of FGM?
1. Pain
2. Bleeding
3. Shock
4. Difficulty passing urine
5. Infection
69
What health problems might an illegal immigrant be suffering with?
```
PTSD
Depression/Suicide
Anxiety
Sleep disorder
Stigmitisation
panic
Somatisation
```
70
What is somatisation
Chronic pain
Dizziness
Tired all the time
Headache
71
What are the issues with using family members as interpreters?
Agenda/bias
Not confidential
Family members English may be poor
May limit what is interpreted
72
What are the positives of using family members as interpreters
Accessible
Cheap
Know the patient
73
When might a teacher be worried about FGM in a school girl?
1. Family members may take girls off for FGM without consent
2. When doing travel advice for families taking young girls for long holidays in Somalia
3. Recurrent UTIs
4. Withdrawn or long periods in the toilet
74
What is the inverse care law
Availability of good medical care tends to vary inversely with the need for it in the population served
75
Define race
Classification based on physical characteristics into which human kind was divided
76
Define ethnic group
A group of people whose members identify with each other through a common heritage often consisting of a common language, religion or ideology that stresses common ancestry
77
Define vulnerable
Indicates an inability to cope with a hostile environment
78
Define social exclusion
Inability of an individual group or community to participate effectively in economic, social, political and cultural life
79
Define drug misuse
Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes, implicitly non-therapeutic use
80
Name two types of opiate and their effects
Heroin and morphine
| Euphoria and pain relief
81
Name two types of depressants and their effects
Alcohol, benzodizepines ie. Valium and Xanax
| Sedation, relaxation, slow down thinking and acting
82
Name three types of stimulants and their effects
Caffeine, nicotine and cocaine
| Increased alertness and activity and elevate mood
83
Name three hallucinogens and their effects
Ectasy, ketamine and mushrooms
| Alter sensory perception and thinking patterns, loss of sense of reality
84
What are new psychoactive substances
Legal highs that mimic the effects of other substances but less predictably
85
Name some psychoactive substances
Synthetic cannaboids
Stimulant type drugs
Downer/tranquiliser
Hallucinogenics
86
What are the effects of new psychoactive substances
Increase in body temperature, heart rate, coma and risk to internal organs, intense comedown leading to sucicidal thoughts, hallucination and vomiting, aggression and violence
87
What are the mental health issues associated with new psychoactive substances
```
Psychosis
Paranoia
Anxiety
Psychiatric complications
Depression
```
88
Define addition
Physical and psychological dependance
89
Describe the 4 tiers of UK drug treatment
Tier 1 = non specialist generic substitution treatment = wean patient off the drug
Tier 2 - Open access services
Tier 3 - specialist community based drug services
Tier 4 - specialist inpatient services (Detoxification --> Naltrexone) residential rehabilitation
90
How do we prevent drug misuse?
Prevent substance abuse by reducing risk factors and increasing protective factors
91
What are the family risk factors for drug misuse
Family history of substance misuse
Family management problems ie. poor parenting
Family conflict including domestic abuse
Being in care
92
What are the school and community risk factors for drug misuse
Low academic attainment and commitment
Availability of drugs
Community norms favourable to drug use
Community disorganisation
Transitions/mobility
Low neighbourhood attachment
93
What are the individual and peer risk factors for drug misuse
Sensation seeking risk factors
Rebelliousness and alienation
Friends who use drugs and peer recognition
Favourable attitudes towards anti-social behaviour
Experience of trauma
94
What are the protective factors for drug misuse
Family attachment
Academic achievement
opportunities, recognition and reward for positive involvement
Opportunities to develop self-confidence, feelings of self-worth and resilience
95
Define physical dependence
Body adapts to the presence of the substance over time and needs more and more of the same effect (tolerance)
Stopping leads to withdrawal symptoms (Runny nose, stomach cramps and muscle aches)
96
Define psychological dependence
Feeling that life is impossible and challenges cannot be overcome without the drug
Emotional effect of fear, pain, shame, guilt and loneliness if not on drug
97
Describe the ICD-10 diagnostic code for drug misuse
0. Acute intoxication = disturbances in level of consciousness, cognition, perception
1. Harmful use = pattern of use that is causing damage to health (Physical and mental)
2. Dependence = cluster of hehavioural, cognitive and psychological phenomena that includes a strong desire to take the drug, persisting in use despite harmful consequences
98
What is community prescribing for drug misuse
Delivered by GPs and specialist services
Substitution treatment to help the patient come off the drugs gradually or long term replacement
Goal is to stop patient using illicit drugs and enable a more stable life
99
Describe detoxification
Patient gradually reduces the drug dose, medication to ease the withdrawal symptoms
100
What is residential rehabilitation
Treatment for those who wish to maintain abstinence
Duration 3-12 months gives opportunity to address underlying issues and work on solving social, employment, financial and legal problem
101
What are benefits of alcohol consumption
1. mildly euphoriant
2. Socialisation
3. Cardioprotective in low doses
102
What are the psychosocial effects of excessive alcohol consumption
Interpersonal relationship problems (Violence, rape, depression)
Criminality/violence
Problems at work and unemployment
Social disintegration (Poverty )
Driving offences
103
What are the withdrawal symptoms of alcohol misuse
```
Tremulousness
Activation syndrome (Tremulousness, agitation, rapid heart beat, high Bp)
Seizures
Hallucinations
Delirium tremens
```
104
What are the UK alcohol limits
14 units a week for both men and women ideally spread over three days or more if you drink as much as 14 units a week
105
How much alcohol does one unit of alcohol contain
8g/10ml of pure alcohol
106
How do you calculate the amount of alcohol in a drink
Strength of drink (%ABV) x amount of liquid (ml) /1000
107
Describe the consequences of foetal alcohol syndrome
Pre-post natal growth retardation
CNS abnormalities (Mental retardation, irritability, incoordination, hyperactivity)
Craniofacial abnormalities
Congenital defects of the eyes, ears, mouth, cardiovascular system, GIT and skeleton
Increase in incidence of birthmarks and hernias
108
Describe the alcohol harm paradox
Low socio-economic status groups consume less alcohol than higher social economic groups but experience greater alcohol related harm
109
What are the acute effects of excessive alcohol/ethanol
```
Accidents and injury
Coma and death from respiratory depression
Aspiration pneumonia
Oesophagitis/gastritis
Pancreatitis
Cardiac arrhythmias
Cerebrovascular accidents
Hypoglycaemia
```
110
What are the chronic effects of excess alcohol intake
```
Pancreatitis
CNS toxicity
- dementia
- Wernicke-korsakoff syndrome
- cerebellar degeneration
- Central pontine myelinolysis
Liver damage
- Hepatits
- Cirrhosis
- Hepatic carcinoma
Hypertension
Peripheral neuropathy
Cardiomyopathy
Malabsorption
Skin Disorders
Coronary heart disease
```
111
What is the primary prevention (Health promotion) of alcoholism
Drinkaware = alcohol labelling
THINK! - drink driving campaign
Know your limits - binge drinking campaign
Restriction on alcohol advertising
Minimum pricing
Legislation - age limit and opening hours
112
What is the secondary prevention of alcoholism
Screening and intervention - ask about drinking routinely using screening questions and tools - includes lab tests
113
What can doctors do for alcoholics
Screening = CAGE
Alcohol use disorders identification tests = AUDIT
Brief interventions = FRAMES
FAST alcohol screening test
114
What is the CAGE questionnaire
1. Have you ever felt you should cut down
2. Have people annoyed you by criticising your drinking
3. Have you ever felt bad or guilting about your drinking
4. Have you ever taken a drink in the morning (Eye-opening) to steady your nerves or get rid of a hangover
2< positive responses = problem
115
Name the criteria that defines alcohol abuse
```
Any 1 or more from
1. Role failure
2 relationship problems
3. Run in with law
4. Risky of bodily harm
```
116
Name the criteria that defines alcohol dependence
3 or more in the last 12 months
1. Withdrawal symptoms
2. Tolerance
3. Keep drinking despite problems
4. Cannot keep within drinking limits
5. Spend lot of time drinking/recovering from drinking
6. Spend less time on other important matters
117
Name some alcohol dependency treatments
medical
- Acamprosate calcium (Campral)
- Disulfiram (Antabuse)
- Nalmefene (selincro)
- Naltrexone
Psychosocial
- Therapy - cognitive and behavioural
- Social support
118
Describe FRAMES motivational interviewing for alcoholism
1. Feedback - risk of personal harm or impairment
2. Stress personal responsibility for making change
3. Advice - cut down/stop drinking
4. Provide a menu of alternative strategies for changing drinking patterns
5. Empathetic interviewing style
6. Self-efficacy - leaves patient enhanced feeling able to cope with the goals they have agreed
119
How does naltrexone treat alcoholism
Competitive antagonist for opioid receptors = rapid detox
120
How does disulfiram treat alcoholism
Produces sensitivity to alcohol - worse hangover
121
How does acamprosate treat alcoholism
Stabilises chemical balance
122
Define medical ethics
Critical evaluation of assumptions and arguments
Inquiry into norms and values - what is good, bad, right or wrong in the context of medical practice
system of moral principles and branch of philosophy which defines that is good for individuals and society
123
What is clinical truth
Contextual, circumstantial and personal
- Cannot ignore objective truth
- Must not be relegated to it either
124
What is deontology
based on the belief that we own a duty of care to each other
125
What is consequentialism
Consequences are what matters, the means are unimportant
- Hard to know what the consequences will be
SOme actions are evidently wrong even if consequences are good
126
What is virtue
Virtues are characteristics that promote Human flourishing
(Compassion, patience, kindness, fidelity)
Derived from the notion that it is the character of a person that is central
127
What are the positive of virtue ethics
It centres ethics on the person and what it means to be human
It included the whole of a person’s life
128
What are the negatives of virtue ethics
Doesn’t provide clear guidance on what to do in moral dilemmas
No general agreement on what virtues are
Any list of virtues may be relative to the culture in which it is being drawn up
129
What are the 4 principles of medical ethics
1. Autonomy
2. Non maleficence
3. Beneficence
4. Justice
130
Define autonomy
Right to self determination and must be respected
131
When may autonomy not apply
lack of mental capacity or children
132
What is beneficence
Medical practice always seeks to benefit patient and diligence must be shown in avoiding harm
133
What is non-maleficence
Medicine aims to do no overall harm to patients but reasonable harms are justified including drug side effects, surgical wounds and infection risks
134
What is justice
Our efforts should be directed without reference to our likes or dislikes
Discrimination is unlawful on basis of race, gender and disability
moral obligation to act on the basis of fair adjudication between competing claims; utility, need vs benefit
135
What are a doctors obligations
Duty to patient
Accountable to employer and regulator
Responsible to each other, profession and matters of public health
Moral obligations
136
What are the 5 C's of ethics in practice
```
Candour
Consent
Capacity
Confidentiality
Communication
```
137
What should you do if you make a mistake on a patient
Put matters right if possible
Offer an apology
Explain fully and promptly what has happened and likely short term and long term effects
138
What are the end of life decisions for a patient
```
Euthanasia (Active or passive)
DNAR
Advance directives
Withholding and withdrawing treatment
Assisted suicide
```
139
What is whistleblowing
Raising concerns about a person, practise or organisation
140
What is teamwork
Work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole
141
What are some teamwork problems
1. Lack of team work
2. Lack of leadership
3. Lack of effort
4. Lack of communication
5. Lack of a challenge
142
What is SBARR
```
Situation
Background
Assessment
Request
Recommendation
```
143
What are the components of teamwork
```
Communication - SBARR
Leadership
Authority gradient
Situational awareness
Declaring an emergency
Training together
```
144
What are the 5 virtue ethics
1. Compassion
2. Discernment
3. Trustworthiness
4. Integrity
5. conscientiousness
145
What is distributive justice
Fair distribution of scarce resources
146
What is rights based justice
Respect for people's rights
147
What is legal justice
Respect for the law
148
What are the factors affecting patient compliance
Socioeconomic - long distance from healthcare
Health system - supply of medication
Condition - memory impairment
Therapy - complex treatment regimes
Patient - denial of diagnosis
149
What are the steps for sharing decision making with patients
1. define problem
2. Convey professionals may not have a set opinion about the best treatment
3. Outline the options
4. Provide information in preferred format
5. Check patient’s understanding of the options
6. ICE
• Ideas, concerns and expectations
7. Check patient accepts decision sharing process
8. Involve patient in decision to the extent they wish
9. Review needs & preferences
10. Review treatment decisions over time
150
What is population attributed fraction
Proportion of the incidence of a disease in the exposed and non-exposed population that is due to exposure
Exposure eliminated = disease incidence eliminated
151
Describe the 4 quadrants approach
1. Medical indications
- Beneficence and non-maleficence
2. Patient preferences
- autonomy
3. Quality of life
- beneficence and non-maleficence
4. Contextual features
- Loyalty and fairness
152
How do you challenge authority
Express concern
Enquire or offer a solution
Seek explanation
Direct challenge
153
What is Wernicke's encephalopathy
Deficiency in thiamine as metabolism of alcohol depends on thiamine
154
What are the symptoms of wernicke's encephalopathy
Ataxia
Confusion
Nystagmus
155
What is anorexia nervosa
Restriction of energy intake leading to low body weigh in the context of age, sex, developmental trajectory and physical health
BMI <17.5
Fear of gaining weight even though already underweight
156
What are the subtypes of anorexia nervosa
Restricting
| Binge eating-purging
157
What is bulimia nervosa
Episodes of binge eating characterised by
- Eating large amounts of food within a small amount of time (Within 2 hour period)
- Lack of control over eating during an episode
This is followed by compensatory recurrent behaviour to prevent weight gain (Purging)
158
In bulimia nervosa, how often do the binge eating and purging behaviours occur
At least once a week for three months
159
What is binge eating disorder
Recurrent episodes of binge eating in a discrete period of time more than most would eat during a similar period
- a lack of sense of control over eating during the period = subjective binges
160
What are episodes of binge eating disorder associated with
Rapid eating
Eating until uncomfortably full
Eating large amounts of food when not physically hungry
Eating alone because of embarrassment by how much one is eating
Feeling guilty afterward
161
Does binge eating disorder come with purging or compensatory behaviour
No
162
What are other specified feeding and eating disorders
Presents with symptoms of other eating disorders but do not meet full criteria for diagnosis
- Atypical anorexia nervosa (Wt loss but within normal range for above range for individual)
- Bulimia nervosa or binge eating disorder (Low frequency/duration )
- Purging
- Night eating syndrome
163
What is the prevalence of eating disorders
```
Highest among females between 14 and 40
Atypical cases most common (3-4%)
Anorexia (0.5-1%)
Bulimia nervosa (1-2%)
Similar levels across ethnic groups and socioeconomic groups
```
164
What are the causes of eating disorders
```
Gene/temperament
Family interaction
Social pressures
Trauma
Core model (Slade, 1982)
```
165
Describe the core model (Slade, 1982)
Combination of low self-estee and perfectionism lead to a need for control
- Trigger to use food as a mans of self control so they restrict their food intake which provides them with positive reinforcement but then you become hungry or starve and develop fear of loss of control leading to physical consequences
166
What factors maintain and progress the eating disorder
Initially +ve comments about weight loss which enhances the over evaluation of eating, shape and weight
Terror of losing control when
- Physiological reaction to starvation
- Forced to eat
- Body image disturbance
- Emotional instability
- Cognitive rigidity
- Own body, family, professionals try and take control and make you eat
167
What are the important things to look out for when managing someone with an eating disorder
1. Severe restriction of food/fluid
2. Electrolyte imbalance
3. Bone deterioration
4. Physical damage (Oesophageal tear, blood in vomit)
5. Alcohol/drug intake
168
What are the urgent signs to look out for when managing someone with an eating disorder
```
Muscular weakness
Breathing problems, cardiac signs (Ectopic beats, tachycardia, bradycardia and low blood pressure)
Deterioration of consciousness
Rapid weight loss
Suicidal
```
169
What is the management of someone with eating disorder
Motivation interventions - explore the pros and cons of staying ill
CBT
Specialist supportive clinical management
Family therapy
No evidence based medicines
170
What 3 things are required for valid consent
Voluntary
Informed
Made by someone with capacity
171
What do you need to tell patients about their treatment
```
What
How
Risks
Benefits
Alternatives and their risks and benefits
Duty to answer questions
```
172
Describe the mental capacity act 2005
Person must be presumed to have capacity unless it is established they lack capacity
Act done or decision made under this act on behalf of a person who lacks capacity must be made in best interest
Mental capacity is not blanket statement and is task/decision focussed
173
When is someone unable to make a decision
if they cannot
- Understand the relevant information (Consequences)
- Retain information for long enough to decide
- Use or weight it to make a decision
- Communicaate the decision
174
If someone is unable to make a decision, how do you treat them?
Check if there is someone who can make the decision on the patients behalf (Lasting power of attorney or advanced directive)
S5 of act allows healthcare progessfional to act in patients best interests
175
The best interests (section 4) of the MCA requires consideration of what
1. Whether the patient could have capacity and when
2. Patients past and present wishes and feelings
3. Patients beliefs and values that may influence a decision
4. Other factors they might consider
5. Consultation about points 2-4 with anyone needing to be consulted
176
When does the healthcare professional have to the right to act in the patients best interests
Relatives are not providing/refusing consent
No one is consenting to the treatment
177
How does consent work in children under 16
Gillick competence - does the child understand the consequences of the decision including the emotional and social implications - if yes then they can consent to treatment - if no then parents consent in best interests
