Public Health Learning(ECP) Flashcards
A diagnosis is a social label with what potential negative consequences?
Psychiatry, sick notes, legal claim making, labels with social, moral and financial consequences
Goffman definition for stigma? Where does it reside in relation to Goffman?
The taken for granted ways in which people organise their lives and ‘normal’ identity
In the person- consider the ex-convict
In the audience/ or the observer
In the relationship between the attribute and the audience
3 types of stigma?
1) Abominations of the body such as blemishes/ deformities
2) Character defects such as mentally ill or the criminal
3) Tribal stigma(social collectives)
What is felt and enacted stigma?
Feel you have an attribute compared to those who you think who don’t
Discrimination- unfair treatment by others
Further definition of stigma(Goffman)? Other types?
Distinction between virtual social identity(normative expectations) and actual social identity(attributes an individual possesses)
Discreditable e.g. someone with a mastectomy/ ileostomy
Discredited e.g. someone with an amputation or in a wheelchair
Weight stigma
People first language does what for people?
Avoids discrimination to people who are overweight/ obese e.g. people with obesity rather than obese people- avoids labelling people by their disease, more common for obesity than other diseases
Medicines associated with abuse and dependency?
Prescription: opioids, benzodiazepines, Z-drugs, SSRIs, all OTC meds listed, GABAergics (gabapentin, pregabalin)
OTC: analgesic codeine with paracetamol/ ibuprofen nurofen plus, solpadeine, opiate cough medicines, sedative antihistamines, laxatives, nicotine replacement therapy, decongestant stimulants
RFs for opiate abuse?
Genetic predisposition, personal psychosocial profile, personal or family history of addiction, psychiatric disorders, younger age, high opioid doses, use of short-acting opioids, high pain level, multiple pain complaints, self-reported craving, concurrent use of tobacco, alcohol and benzodiazepines
How to deal with OTC addictions?
Pharmacy-based, harm-reduction intervention pilot- GP referral, proposed contract/ reduction scheme in pharmacies e/g/ reduced packs, indications only for pain, pack warnings, training for doctors/ nurses/ AHPs
Prevention- awareness of at risk patients, good prescribing and monitoring
Treatment: opiates- substitution tx, benzos- tapering, GP management possible- shared care encouraged
Internet support groups, informal approaches e.g. social media
Things that can makes thing go wrong?
Latent conditions can line up–> accidents/ adverse events, increased likelihood of errors at the end
Some holes due to active failures
System defences (strategies to minimise risk)?
System design, patient safety alerts, simiplification and standardisation of clinical processes e.g. checking drugs + identity prior to administration, marking surgical site before an operation, SBAR/ checklists and aide memoirs, information technology, tools to improve uptake of evidence based tx, supporting better team working
What does a care bundle contain? Institute for Healthcare Improvement recommends that fidelity with care bundles should be at least what for appropriate patients?
3-5 evidence-informed practices, which need to be delivered collectively and consistently e.g. urinary catheter, c.difficile, central venous catheter, peripheral IV cannula
95%
Watchfulness and foresight are means of what? What is foresight?
Preventing and recovering incidents
The ability to identify, respond to, and recover from the initial indications that a patient safety incident could take place- involves frontline healthcare staff recognising the potential safety risks in the healthcare system, and considering intervening to prevent an incident
3 buckets in three bucket model for assessing risky situations?
Self, context, task- fuller the buckets= the more likely something will go wrong but their never empty
Context>self>task
Nutritional concerns in older adults?
Change in body composition, decreased energy requirements, sarcopenia/ obesity, bone loss, chronic disease, protein, B12 and B6, folic acid, vitamin D, calcium
% energy intake for carbs, free sugars, total fat, saturated fat?
Vitamin D in micrograms? Requirement for what increases? Females or males?
50%, <5%, <35%, <11%
10
Iron- more in women due to periods
What is malnutrition?
A state of nutrition in which deficiency or excess of energy, protein and other nutrients causes effects on tissue/ body function and clinical outcome- over + undernutrition, older adults= increased risk of both
Can’t afford, other health conditions, can’t make food, dietary factors
Reduced intake, variety, costs–> micronutrient deficiency–> decreased immune function
Consequences of malnutrition?
Loss of muscle tissue + strength; resp muscles, cardiac function
Mobility
Reduced immune response
Poor wound healing
Loss of mucosal integrity
Psychological decline
Poor prognosis and increased mortality and morbidity
What is sarcopenic obesity? Sarcopenia causes?
Sarcopenia(decreased in lean body mass associated with ageing) + obesity
Reduced physical activity, change in body composition, malnutrition, increased cytokine production, reduced sex hormones, chronic disease
Factors affecting nutritional intake?
Isolation, neglect, psychological- bereavement, depression, dementia, economic- cost, access, social support
Physiological factors affecting nutritional intake in older adults?
Visual impairment, mobility, dexterity, dental health, illness/ polypharmacy, GI changes- taste- hormonal-CCK-gut motility- atrophic gastritis
Assessment of nutritional status?
Anthropometric measures e.g. waist circumference, skin fold thickness, BMI
Physiological function?
Hand grip strength, timed up and go, 30 second chair stand test
Nutritional screening tools?
MUST/ MNA- mini nutritional assessment (MNA)= >65 and older, 18 Qs/ shorter= 6
