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Phase2 > Socpop phase2 > Flashcards

Socpop phase2 Flashcards

1
Q

what is surveillance

A

• “surveillance is the ongoing systematic collection, collation, analysis and interpretation of data, and the dissemination of information (to those who need to know) in order that action may be taken”. Ie “Information for action”

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2
Q

Reasons for surveillance systems?

A
  • monitor trends (allowing time to plan)
  • early warning for outbreak (allowing time for response)
  • plan and monitor intervention
  • control measures
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3
Q

what are notifiable diseases?

A

• 31 notifiable diseases

o e.g. meningitis, measles, TB, food poisoning, malaria, mumps, rubella, tetanus, HUS, polio, hepatitis, cholera, Ecoli

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4
Q

who to notify?

A
  • Public health england
  • RCGP for influenza
  • NHS 111
  • GP
  • Emergency Department Syndromic surveillance
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5
Q

Who does what in communicable disease control?

A

• Public Health England
o Takes notifications of infectious disease and manages outbreaks & chemical/environmental incidents
• NHS England
o Leads NHS response to an outbreak
• CCGs
o Supports NHS England
• Primary Care trust
o Supports outbreak investigation and management by taking samples, treating, and providing prophylaxis
• Acute hospital trust
o Provides microbiological advice. In hospital incident manages outbreak.
• Local Authorities
o Environmental Health Offices support investigation of outbreak. Food questionnaires, stool samples, inspection of food premises. Powers to prosecute.
o Director of Public Health provides plans, supports outbreak response.

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6
Q

what agent/host/environmental factors affect disease spread?

A

• Agent
o Organism: virus/bacteria/fungus/rickettsia/protozoa
• Host
o Factors: age/gender/ethnicity/lifestyle/socioeconomic/immune
• Environment
o Climate/crowding/sanitation

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7
Q

name 5 direct and 3 indirect modes of transmission?

A

Direct modes of transmission
• Touching – (scabies)
• Sexual contact
• Droplet spread – (measles, mumps, flus, meningococcal)
• Transplacental – (HIV)
• Faeco-oral – (campylobacter, salmonella, Ecoli 0157, Hep A)

Indirect modes of transmission
• Vehicle borne (flu) surfaces, food, water, blood, tissues
• Vector borne (malaria)
• Airborne (TB, fungi)

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8
Q

define sporadic, endemic, hyperdendemic, cluster, epidemic/outbreak, pandemic

A

Sporadic
o Irregular pattern of disease, occasional cases

Endemic
o Persistent low/moderate level of disease

Hyperendemic
o Persistent higher level of disease

Cluster
o Occurrence exceeds the expected level for a given population and/or in a given area and/or in a given time period. Cases have a possible but unconfirmed link.

Epidemic / Outbreak
o Occurrence exceeds the expected level for a given population and/or in a given area and/or in a given time period. Cases have a highly probably or confirmed link. An outbreak is a localised epidemic, 2 or more cases, or a single case of a rare or serious disease eg rabies, diphtheria, polio

Pandemic
o Epidemic occurring worldwide or crossing international boundaries, usually affecting a large number of people

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9
Q

Ways to break the chain of transmission?

A
  • Control the source
  • Interrupt transmission
  • Protect susceptible population
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10
Q

Stages in managing an outbreak?

A
  • Confirm
  • Immediate control
  • Convene Outbreak Control Team
  • Review Epidemiological and microbiological info
  • Case finding
  • Definitive Control measures
  • Descriptive epidemiology (curves)
  • Analytical study (case control or cohort)
  • Declare outbreak over
  • Communicaiton throughout
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11
Q

describe epidemic curves:

  • point outbreak
  • propagated outbreak
  • continuous source
A
  • Point – all cases arise with one incubation period, suggesting that no cases arose from person-to-person contact. Example: BBQ diarrhoea
  • Propagated outbreak- starts with index case, then primary cases, then secondary cases infecting new people who in turn infect others. Successively taller peaks, which then merge into waves. Epidemic continues until number of susceptible individuals declines or until interventional measures take effect.

• Continuous source: abrupt start suggests many people exposed simultaneously rather than spreading person-to-person. Group of people exposed to a single noxious influence like a contaminated water supply.

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12
Q

What is statutory homelessness?

A

o 1. If you are eligible for public funds
o 2. Have a local connection
o 3. Are unintentionally homeless
o 4. Have a priority need
♣ household with dependent children
♣ household with pregnant woman
♣ vulnerable bc of physical or mental health
♣ aged 16, 17 or 18-20 and previously in care
♣ vulnerable bc was in care, custody, HM Forces
♣ vulnerable bc fled home due to violence or threat

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13
Q

What are some causes and routes into homelessness?

A 
o	Structural factors
o	Welfare changes
o	Sanctions 
o	Cuts to legal aid
o	Lack of affordable housing
o	Right to buy
o	Unemployment
o	Closure of psychiatric hospitals
o	Routes (sometimes mutil)
o	Relationship breakdown
o	Being asked to leave family home
o	Drug & alcohol
o	Leaving prison
o	Mental health
o	Eviction
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14
Q

What are some common health problems of homeless people?

A 
o	Mental illness
o	Substance abuse
o	Smoking
o	Longstanding physical conditions
o	MSK
o	Resp 
o	Dental
o	Eyes
o	GI
o	CV
o	Urinary
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15
Q

what are the top UK and global infectious diseases?

A

UK Top Infectious Diseases (WHO data 2012)

  1. Respiratory infections
  2. Diarrhoeal diseases
  3. HIV
  4. STDs
  5. TB

Global Top Infection Diseases

  1. Respiratory infections
  2. Diarrhoeal diseases
  3. HIV
  4. Parasitic/vector diseases
  5. TB
  6. Meningitis
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16
Q

Malaria - name of parasite, size of the problem, transmission?

A

o Protozoa infection
o Plasmodium falciparum – Africa and New Guinea
o Plasmodium vivax – Indian suncontinent
o Plasmodium ovale – Africa and S America
o Plasmodium malaria – Africa and S America
o 300 mio people contract in annually
o 1 mio people die, mostly children <5 in Africa
o 10,000-30,000 residents of developed countries contract malaria through travel
o 2,000 cases in UK with 10 deaths per year

vector transmission through mosquitoes

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17
Q

what are some common migrant health issues?

A

o Infectious disease: HepB/C/HIV/syphilis/TB/leprosy/parasitic
o Malnutrition
o Exposure to conflict, detention & torture
o Trafficking & modern slavery
o FGM

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18
Q

what are refugees screened for?

A 
o	TB – interferon gamma assay blood 
o	Haemoglobinopathies – sickle cell or thalassaemia
o	Hep C
o	Hep B
o	Syphilis
o	HIV
o	Chlamydia
o	Others as indicated eg HbA1c
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19
Q

what are non-disease (or social) factors that can contribute to delays in getting a diagnosis?

A

o Temporalizing of symptomology: placing a time limit before taking action “bring her back in a fortnight”
o Discrediting: defining parent as lacking credibility - “an anxious mum:

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20
Q

Key features of children’s accounts of having childhood cancer

A

distressing symptoms
o pain most distressing
o itchiness, lack energy, nausea, mouth problems, insomnia, hair loss, altered appearance

disruption of identity & relationships
o changes to appearance – hair loss, steroids, scarring, Hickman lines, ventilator
o treated differently by family & peers
o infantilisation – help with toilet, feeding, bathing
o biographical disruption
o threat to self-identity

uncertainty & fear

strategic management 
o	adopting normalisation strategies 
o	passing as normal
o	then redesignation of new normal
o	young children don’t have everything available to adults and older children; less able to resist the things they don’t want
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21
Q

what is health inequality?

A

o systematic differences in health outcomes between social groups

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22
Q

what is health inequity?

A

o differences in opportunity between social groups – ie different access to health services, food, housing. This can lead to health inequalities.
o

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23
Q

what is equitable access and equal access?

A

Equitable access is providing services according to need

Equal access is providing same services to everyone regardless of need

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24
Q

what is horizonal and vertical inequity?

A

horizontal
o when people with the same needs do not have the same access to the same resources

vertical
o when people with greater needs are not provided with greater resources to meet those needs

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25
Q

Reasons why inequity in health care should be addressed?

A

o justice & fairness
o equitable access contributes to reductions in health inequalities
o stopping widening of health inequalities
o duty under Equality Act 2010: (all public sector bodies)

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26
Q

examples of inequitable health care in secondary settings?

A 
Soceioeconomically deprived areas have 
o	less referrals for hip and knee replacements
o	less dyspepsia referrals
o	less Lung cancer active treatment
o	less Breast reconstruction

Older people
o Less hip and knee replacement

South Asian
o Less coronary angiographs

Disabled
o Higher number of avoidable deaths

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27
Q

what are some causes of inequitable access?

A

o Availability of access (appointment times, ability to register)
o Geographical access (rural, car ownership, ability to drive)
o Financial costs (prescriptions and dental charges)
o Cultural access (interpreters, LGBT & female led services)
o Navigation
o Clinical attitude
o Lack of responsive services

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28
Q

define sex and gender?

A

Define sex:
o The characteristics between males and females that are biologically determined

Define gender:
o The social and cultural meanings assigned to being male and female

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29
Q

define sexuality

A

o Umbrella term that relates to the private dimension in which people live out their sexual, intimate and/or emotional desires.
o Complex and fluid
o Experience and expressed by (all or some of) beliefs, acts, behaviour, desires, values, practices, relationship and identities
o Influenced by historical, social, cultural, political. Legal, religious, spiritual aspects of society
o WHO: “central aspect of being human…encompasses sex, gender identity, sexual orientation, eroticism, pleasure, intimacy and reproduction. “

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30
Q

explain nature versus nurture debate on sexuality

A

o Naturalist: sexuality is biologically determined with minimal influence from societal structures. Traits are fixed and there is no variation. Sexuality is concerned with reproduction. Uses anatomical differences between sexes to claim there is biological basis to sexuality. Heterosexuality is normal expression, presumed to have no cuase as it is viewed as natural.
o Nurture: sexuality is constructed and influenced by societal structures. Gives us a potential for choice, change and diversity. Sexuality is complex, people’s reasons for engaging in sexual behaviour are varied. Sexuality is “made”, people are experts in their own lives.

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31
Q

what did the Equality Act 2007 legislate for?

A

o Prohibited discrimination in providing goods facilities and services

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32
Q

Key elements of best medical practice relating to sexuality?

A

o Be aware and challenge discrimination
o Do not make assumptions about a person’s sexuality
o Ask open questions
o Develop a language of sexual expression and be able to talk about sexuality comfortably and explicitly
o Reflect on your on personal attitudes values and beliefs; personal unease about human sexuality is not acceptable reason to remain ill-informed

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33
Q

Epidemiology of HIV in the UK?

A

o 107k people with HIV in the UK
o 25% unaware of infection
o 6k incidence per year
o MSM at highest risk

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34
Q

Epidemiology of STIs in the UK?

A

o 440k diagnoses of STIs in 2014 in England
o most common is chlamydia – 207k
o biggest increases for syphilis & gonorrhoea
o mostly MSM

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35
Q

Possible explanations for increase in sexually transmitted infections?

A 
o	Increased sexual activity
o	People more aware of STIs
o	Easier access to servies
o	Better diagnostic tests
o	Artefact
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36
Q

Reasons for partner notification?

A

o To protect the patient from re-infection
o To offer sexual partners tests for STIs
o To offer sexual partners treatment
o To inhibit further spread

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37
Q

Main differences for sexual health care provided in primary care and in GUM clinics?

A

o GUM users tend to perceive themselves at risk
o Attenders expect questions about sex
o Testing can be anonymous in GUM – won’t appear in patient notes
o GP may be more accessible, more supportive
o GP can provide more care at same time

38
Q

Top three leading global causes of death?

A 
o	Male:
o	IHD
o	Stroke
o	COPD
o	Female:
o	Stroke
o	IHD
o	LRTI
39
Q

Top three leading global causes of death?

A 
Male:
o	IHD
o	Stroke
o	COPD
Female:
o	Stroke
o	IHD
o	LRTI
40
Q

Risk factors for disease globally?

A 
o	HTN
o	Tobacco
o	High cholesterol
o	Underweight
o	Unsafe sex
o	High BMI
o	Physical inactivity
o	Alcohol
o	Indoor smoke from solid fuels
o	Iron deficiency
41
Q

Define primary, secondary & tertiary prevention?

A

Primary
o Removing primary causative agent
o Interrupting transmission of infective agent
o Protecting individual from environmental hazards
o Improving host resistance

Secondary
o Early detection of pre-clinical disease (screening)
o Treatment to prevent progression

Tertiary
o Treatment to prevent complications or relieve distress

42
Q

Difference between population and high risk strategies for reducing cardiovascular disease and pros and cons for each?

A 
Population strategy
o	Aimed at everyone
o	Aimed at small reduction of risk factor in everyone
o	Reduces incidence and prevalence
o	Eg reduction of BP or cholesterol

High risk strategy
o Treats those with defined disease status
o Does not produce lasting population changes

43
Q

what are the drivers increasing cardiovascular disease in developing countries?

A

Diet
o Fatty foods, process foods
o Soft drinks
o Sodium: regarding HTN (5g per day Na reduction, reduces stroke by 23%)

Physical activity
o Obesity
o Car ownership
o Cultural changes

Tobacco

44
Q

Upstream (legislative) approaches to reducing population salt intake are more effective than downstream (awareness) approaches - list approaches from upstream to downstream (which coincidentally is in order of effectiveness)?

A 
regulation and marketing control
taxation
reformulation
labelling
social marketing
primary care advice
45
Q

Factors affecting concordance?

A 
Patient-centred
o	Demographic 
♣	The older, the better concordance
♣	If married, better concordance 
♣	Ethnicity, gender, education: equivocal

o Psychological
♣ Patient beliefs and motivation
♣ Patient attitudes towards therapy

o	Patient-prescriber relationship
♣	Communication
♣	Trust
♣	Empathy of prescriber 
♣	Multiple prescribers 
o	Health literacy
o	Patient knowledge
o	Other 
♣	Smoking &amp; alcohol
♣	Forgetfulness 
Therapy related
o	Route of adminisation (PO best)
o	Complexity of dosing
o	Side effects
o	Degree of behaviour change needed

Social & economic
o Time commitment for appointments
o Prescription costs
o Social support system

Healthcare system
o Availavility of appointments
o Waiting times
o Quality of consultations

Disease
o Fluctuation symptoms – concordance reduces
o Absent symptoms (HTN) – concordance reduces
o Marked improvement of symtpoms – concordance increases
o perceived poor health status – concordance increases

46
Q

Define social stigma

A

o Attributes, behaviours or pathological states that set people apart from others, that mark them as less acceptable or inferior beings in some way

47
Q

What are some issues with diagnosis?

A

o Medical labels are also social labels (affect people’s identity)
o Medical diagnoses is helpful for access to treatment, but can also have serious and unwelcome social consequences for patients when conditions are stigmatising

48
Q

define enacted, felt, discreditable and discrediting stigma

A

Enacted stigma
o Real experience of negative attitudes

Felt stigma
o Fear that prejudice or discrimination may occur

Discreditable stigma
o Condition that is not immediately obvious eg mastectomy

Discrediting stigma
o Obvious & visible condition

49
Q

describe stigma of mental illness when well and when ill

A

o When well, may experience felt and discreditable stigma

o When ill, may experience enacted and discrediting stigma

50
Q

what are strategies for dealing with stigma?

A

o Passive absorption – very negative effect
o Normalisation
o Withdrawal
o Active – seeking support (often from others with same condition) can challenge stigma and change social values. Doctors can help with challenging stigma

51
Q

what is a health needs assessment?

A

o A systematic method of identifying unmet health and healthcare needs of a population and making changes to meet these unmet needs

52
Q

when does a health need exist?

A

o Exists when an individual has an illness for which these is effective and acceptable treatment or care. Ie a population’s capacity to benefit from healthcare

53
Q

Three approaches for HNA (Stevens & Raftery model)?

A

o Epidemiological
o Epidemiology of health condition & RFs
o What Tx works
o Description of current services
o Comparative
o Compare service between different populations
o Corporate
o Ask stakeholders what they would like included

54
Q

Three approaches for HNA (Stevens & Raftery model)?

A

Epidemiological
o Epidemiology of health condition & RFs
o What Tx works
o Description of current services

Comparative
o Compare service between different populations

Corporate
o Ask stakeholders what they would like included

55
Q

describe some planning cycles?

A
  1. Traditional rational planning: where are we, where do we want to be, how do we get there?
  2. Plan, do, study, act
  3. Knox planning cycle
    o Situation analysis
    o Setting objectives
    o Deciding strategies
    o Operational plan
    o Plan implementation
    o Evaluation
56
Q

How do you deliver a brief intervention on smoking?

A

o 3 As: Ask, Advise, Act
o Ask: about smoking status
o Advise: on how to stop – combination of support and medication (referral to in-house or local NHS cessation services and offer prescription)
o Act: offer help. If patient doesn’t want smoking cessation services, medication is acceptable(better with support) but book follow up appointment. Signpost NHS smoke-free website and helpline. Prescribe Champix and Nicotine Replacement Therapy. Return every two weeks for 2-3 months.

57
Q

How do you deliver a brief intervention on alcohol?

A

o Alcohol Identification and Brief Advice (IBA)

  1. Initial screening (AUDIT-C) (3 questions)
  2. Ask the remaining 7 questions of AUDIT (10 questions in total)
  3. Delivering brief advice to patients who are drinking above the low-risk levels
  4. Referring or signposting possible dependent drinkers to GP or local alcohol support service
58
Q

Audit-C scores, what they mean, and what to do?

A

0-4 is low risk, explain, congratulate
5-10 is increasing and higher risk, explain, advise on cutting down
11 or 12 is dependence - refer

59
Q

what advice can you give to increasing and higher risk drinkers?

A

o Have several ‘drink-free’ days, when you don’t drink at all
o When you do drink, set yourself a limit and stick to it
o Quench your thirst with non-alcohol drinks before and in-between alcoholic drinks
o Avoid drinking in rounds or in large groups
o Eat when you drink -have your first drink after starting to eat
o Switch to lower alcohol beer/lager
o Avoid going to the pub after work
o Plan activities and tasks at those times you would usually drink
o When bored or stressed do something physical instead of drinking
o Avoid or limit the time spent with “heavy” drinking friends

60
Q

what is FRAMES?

A 
o	Feedback on risk
o	Responsibility
o	Advise
o	Menu (give options)
o	Empathy
Self-efficacy
61
Q

what are efficacy expectations ?

what are outcome expectations?

A
  • belief in our own ability to carry out a particular action
  • expectation that a particular goal will be achieved
62
Q

The 3 enablers of self-management?

A
  1. agenda setting
  2. goal setting
  3. goal follow-up
63
Q

The 3 enablers of self-management?

A
  1. agenda setting (clinic can send agenda sheet in advance)
  2. goal setting (small and achievable - mastery experiences build momentum for bigger success)
  3. goal follow-up (within 14 days)
64
Q

Barriers to self-management?

A
  • Behavioural beliefs
  • Subjective beliefs
  • Control beliefs & self-efficacy
  • Depression, obesity, poor mobility, fatigue, communication, family, pain, finances
65
Q

What are some harms of alcohol to others?

A 
o	Injury, intentional or unintentional
o	Neglect or abuse
o	Default on social role
o	Property damage
o	Toxic effects eg FAS
o	Loss of peace of mind
66
Q

Top 3 diseases for alcohol attributable deaths (Global)?

A

o CV deaths
o Unintentional injuries
o GI disease

67
Q

January 2016 alcohol guidelines (weekly drinking, single episode, pregnancy), and why they have changed from the 1995 guidelines?

A

o Men & women should not drink >14 units per week and spread over at least 3 days, with alcohol free days
o Single episode: limit total amount, drink slowly, avoid risky places
o Pregnant women: no alcohol
o New evidence of cancer risk, and CV protection evidence is now weaker (previous studies prone to confounding and selection bias)

68
Q

Definition of learning disability?

A

• A condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence ie cognitive, language, motor and social abilities.

69
Q

Characteristics of learning disability?

A
  • Difficulties in understanding new information
  • Difficulties in communication
  • Difficulties in learning new skills (impaired intelligence all above)
  • Reduced ability to cope independently (impaired social functioning)
  • Must be present from childhood and have lasting effect
  • Higher rates of certain physical problems
70
Q

what is normal IQ?
what is borderline?
what is mild learning difficulty IQ?

A

85 and over
70-84
50-69

71
Q

what is normal IQ?
what is borderline?
what is mild learning difficulty IQ?
profound LD?

A

85 and over
70-84
50-69
less than 20

72
Q

Most common causes of learning disability?

A

Unknown in majority

Inherited chromosomal
o Fragile X syndrome
o Down’s syndrome

Acquired
o Antenatal: Neural tube defect, infection, FAS
o Perinatal: hypoxia, hypoglycaemia, LBW
o Postnatal: Malnutrition, injury, infections

73
Q

Reasons why patients with LD may get inferior or inappropriate medical care ?

A 
Patient
o	Cognitive
o	Communication
o	Heatlh literacy
o	Phobia 
o	Sensory imp
o	Late presentation
Clinician
o	assumption of QOL
o	educational needs 
o	communication skills with PWLD
o	reasonable adjustments lack

Service
o institutional discrimination
o accessibility – reasonable adjustment
o long enough appointments - reasonable adjustment
user friendly information – reasonable adjustment

74
Q

What is a clinical audit?

A

• Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.

75
Q

How is research and service evaluation different to clinical audit?

A
  • Research is designed to derive new knowledge, to test an hypothesis, addresses a clearly defined question. Research involves allocating patients to intervention groups and requires Ethics review
  • Service evaluation asks what standard does this service achieve? Measures this without a reference to a pre-established standard.
76
Q

what are 4 stages of an audit?

A

preparation and planning
measuring performance
implementing change
sustaining improvement through re-audit

77
Q

define risk

A

• Probability that a hazard will give rise to harm

78
Q

why do risks need to be communicated?

A

Risks need to be communicated with the patient to enable them to make informed decisions.

Communication is highly correlated with patient adherence.

79
Q

define relative risk reduction and absolute risk reduction

A

Relative risk reduction
• The reduction of risk in the intervention group relative to the risk in the control group
Absolute risk reduction
• The difference between risk in the intervention and control group

80
Q

what is number needed to treat?

A

• The number of patients who need to be treated to prevent one additional adverse outcome

81
Q

how can perception of risk be manipulated?

A
  • Mismatched framing
  • Ratio bias (using bigger denominators)
  • Emotional tactic
82
Q

Name some domains of the QOF

A

clinical (93 indicators)
public health (18 indicators)
patient experience (1)
quality and productivity (9)

83
Q

What would be included in a holistic assessment of a palliative-care patient? (PEPSICOLA)

A 
Physical
Emotional
Psychological
Social/spiritual
Information
Control
Out of hours
Living with illness
Aftercare / bereavement
84
Q

What is the criteria to be referred to a specialist palliative care team in the community/hospital/hospice?

A 
o	Advanced disease for which prognosis is limited and focus of care is QOL
o	AND one or more of:
♣	Uncontrolled symptoms
♣	Specialised nursing requirements
♣	Complex psycho needs
♣	Complex family issues
♣	Difficult decision making
85
Q

what are people approaching end of life?

A

when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:
• Advanced, progressive, incurable conditions
• General frailty and co-existing conditions that mean they are expected to die within 12 months
• Existing conditions if they are at risk of dying from a sudden acute crisis in their condition
• Life-threatening acute conditions caused by sudden catastrophic events.

86
Q

what framework is used now optimise care of patients at the end of their life?

A

gold standards framework

87
Q

What is used to identify patients likely to die within 12 months?

A

SPICT TOOL
Supportive and Palliative Care Indicators Tool

Look for two or more general indicators of deteriorating health:-
• Performance status poor or deteriorating, with limited reversibility.
(Needs help with personal care, in bed or chair for 50% or more of the day).
• 2 or more unplanned hospital admissions in the past 6 months.
• Weight loss (5 – 10%) over the past 3 – 6 months
• Persistent, troublesome symptoms despite optimal treatment of any underlying condition(s).
• Lives in a nursing care home or NHS continuing care unit, or needs care to remain at home.
• Patient requests supportive and palliative care, or treatment withdrawal.

88
Q

what is RESPECT?

A

recommended summary plan for emergency care and treatment (purple)

89
Q

what documentation is important at end of life?

A

RESPECT, DNACRP decision, ACP documentation

90
Q

what issues are important to communicate with patient and family at end of life?

A

Check the understanding of the patient and their family and address any concerns.
This may involve:
• Giving bad news to patient/family member
• Discussing shift in management approach
• Discussing important EOL decisions such as place of death
• Discussing home/hospice referral
• Discussing DNACPR status if not already done
• Discussing difficult issues (e.g. fluids and food, death rattle)

91
Q

what do people die from?

A
  • 1/4 cancer
  • 1/3 frailty / dementia
  • 1/3 organ failure
92
Q

name 3 key features of the epidemiological transition (from developing to developed country)?

A
  • less infectious death
  • lower birth rate
  • longer lives

Phase2 (13 decks)

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