TERM 2 Flashcards
whats the purpose of the mental capacity act 2005?
to provide a framework to empower and protect people who may lack capacity to make some decisions for themselves
what are the 5 statutory principles of the mental capacity act 2005?
- presumption of capacity
- right to be supportted to make their own decisions
- right to make eccentric or unwise decisions
- healthcare providers should make decisions for those without capacity according to patients best interests
- before making a decision on a person’s behalf they mst consider whether the outcome is the least restrictive option
what are the 4 abilities needed in order to have capacity?
understanding information, retaining it, weighing it up and then communicating a decision
if a patient lacks capacity what should you do?
see if there is an advanced decision refusing treatment or a lasting power of attorney appointed. and if neither, a doctor and healthcare provider must make a decision on the basis of the patient’s best interest and least restrictive
what is a lasting power of attorney?
someone who you have chosen to make decisions on someone’s behalf
what is advances care planning?
planning for a future time when a person may no longer have capacity so cannot make their own decisions
what are the 2 aspects of advanced care planning?
advances statement of wishes and advanced decisions to refuse treatment
is advanced care planning legally binding?
advanced statement of wishes is not but advanced decisions to refuse treatment are legally binding and therefore must be respected
what treatment can a patient refuse in advanced decisions to refuse treatment?
any treatment apart from basic comfort and care
what makes an advanced decision valid?
- aged >18 and had the capacity to make, understand and communicate the decision at the time
- you specify clearly what treatments you want to refuse
- you explain circumstances in which you wish to refuse treatment
- its signed by you (and a witness if you want to refuse life-sustaining treatment)
- you have made the decision of your own accord, with no co-ercion
- you havnt said or done anything that would contradict the advanced decision since you made it
how can mental health conditions like dementia interfere with a person’s capcity to make decisions?
dementia can make it difficult to understand, retain, weigh up info anf communicate decisions
what does the right to make unwise decisions mean?
a doctor should not presume a patient lacks capacity just because they view a decision as eccentric/unwise
what are ethical arguments for use of advanced decisions?
having a legal right makes it more likely for patients to feel empowered and for their decisions to be respected which leads to patient autonomy
it encourages openess and thoughtful planning
what are the ethical arguments against advanced decisions?
how do you know if these particular circumstances are what the patient meant when they created the AD
at the time of making the AD, the patient may not fully understand what it will be like when they do lose capacity and need to make use of AD
there is always a possibility of coercion
you cannot be sure that the patient has not since change their opinion so you may not be respecting patient autonomy
what is the personal identity argument against advanced decisions?
some people with dementia undergo radical personality changes so advanced decisions should not be used as the person who needs it is not numerically identical to the person who created it
CRITICAL APPRAISALS!!!!
NOT ON CARDS
what are the potential benefits of systematic reviews?
- include all the available evidence to answer a question
- include research that is unpublished or has been published in non-English language journels
- increase total sample size which also increases levels of certainty and recision
- indicates heterogeneity (variation) among studies
- can indicate the need for further research
- permit sub-group analyses
- permit sensitivity analyses
what study design is used for a diagnosis type of question?
cross-sectional analytic study
what study design is used for an aetiology question?
cohort or population-based case-control study
what type of study design is best for a prognosis question?
cohort study
what study design is best for a treatment question?
RCT or systematic review of RCT
what study design is best for an evaluation question?
qualitative research
what is a critical appraisal?
the process of carefully and systematically assessing the outcome of scientific research to judge its trustworthiness, value and relevance in a particular context.
what are the 3 discrete steps of a critical appraisal?
are the results of the study valid?
what are the results?
can i apply the results to this patients care?
what is GRADE?
a system for grading quality of evidence and making recommendations
what are the pros on a critical appraisal in practice?q
- systematic way of assessing validity, results and usefulness of published research papers
- route to closing the gap between research and practice, and as such makes an essential contribution to improving healthcare quality
- encourages objective assessment of the usefulness of information
what are the cons of using critical appraisals in practice?
- time-consuming initially
- doesnt always provide an easy answer
- can be dispiriting if it highlights a lac of good evidence
what checklists do we use for critical appraisals?
CASP
why do we have waiting lists in the NHS?
because there is a limitless demand for health as people can always be healthier
but there are limited resources
what is the price mechanism?
where the forces of demand and supply determine the prices of commodities and the changes therein
whats the problem with waiting lists?
waiting times are a major source of dissatisfaction for patients
lists are used to prioritise but who should take priority
outline the theories of NHS waiting lists?
it allows the NHS resources to be fully employed - no waste of resources as all in full use
waiting lists act as a price to deter frivolous use
waiting lists are caused by underfunding and inefficiency
what are some ways in which we can reduce waiting lists?
have more doctors
pay doctors per item of service they provide
pay hospitals per activity
what was the 2000-2008 policy to reduce wait times in the NHS?
hospitals recieved an overall performance score and amnagers would lose their jobs if targets were missed
what were the outcomes of the 2000-2008 policy to reduce NHS wait times?
no inpatients were waiting longer than 3 months
outpatient reductions
however..
this sacrificed professional autonomy as doctors may be forced to treat less urgent cases because of wait times
things that dont have a target time suffered as were left to last
adverse behavioural responses e.g. emergency patients having to wait in ambulances so they were not yet classed as being in A&E
data manipulation and fraud
what are some possible criteria for prioritising in the management of waiting lists?
clinical urgency, sevrrity, potential health gain, productivity and economic loss, equity waiting, length of time waiting
what is the maximum waiting time for non-urgent, consultant-led treatments?
18 weeks
whats the maximum wait time for urgent cancer referrals?
2 weeks
how much higher is the incidence rate of falls in institutions compared to elsewhere?
3 times higher
outline how incidence of falls increases with age
35% of 65-80 yo
45% of 80-90 years olds
55% of 90+ yos
what is the most common cause of injury in older people?
falls with 10% of them resulting in serious injury
of those who fall and fracture a hip, how many die within a year?
and how many cannot live independantly afterwards?
> 20% die within a year
50% no longer live independantly
other than injuries, what are the other consequences of falls?
psychological - fear of falling, self-imposed activity restriction, social isolation and depression
increase in dependancy
disability
anxiety and time impact on carers
what are the clinical risk factors for hip fractures?
low bone mineral density increasing age female low body weight Fhx hip fractures prior history of hip fractures smoking ethnicity- afrocarribeans have a very low fracture risk corticosteroid use medications e.g. psychotropic drugs
what are some risk factors for falls?
muscle weakness history of falls gait deficit balance deficit visual deficit arthritis impaired ADL cognitive impairment age >80
how can we prevent fractures?
bone protection e.g. bisphosphonates, vit D and calcium supplements, HRT, terparatide, denosumab
hip protectors
how can we decrease the risk of falls?
weekly walks
education
balance exercises
gradual withdrawal of active psychotropic medication
occupation therapists assessing the home environment and trying to reduce the fall risk e.g. putting in lifelines
podiatry inventions
what are the 4 Bowlbys stages of grief?
numbness
yearning
disorganisation and despair
reorganisation
what are symptom of grief?
feeling sad, angry, anxious, lonely, tired, helpless, shockerd, yearning or numb
stomach chest or throat pain, sensitivity to noise, depersonalisation, breathless, weak
impaired concentration, hallucinations
sleep and appetite disturbance, social withdrawal, avoidance or reminders, crying, carrying reminders of sentimental value
what are Worden’s tasks for mourning to be complete?
to accept the reality of the loss
to process the pain of grief
to adjust to a world without the deceased
emotionally relocate the deceased and move on with life
what factors affect grief severity?
closeness of relationship meaningfulness of relationship nature of relationship prior to death expectedness and manner of death age and development stage of griever individual resislience attachment and dependancy religious belief social support
what is the psychological impact of a close death?
loss of presence of a person
foced to confront own mortality
traumatic underminding of the persosns view of thr world
what is a sign that a person is in denial about the loss of a loved one?
mummification e.g. not changing things in a dead persons room
globally, what is the largest cause of death
CVD
is CVD more common in men or women?
men
if obesity, diabetes and phsyical inactvity are rising, why are CVD deaths still declining?
because smoking, cholesterol levels, bp and deprivation are decreasing at a greater rate
what are risk factors for CVD?
social deprivation age male FHx deletion polymorphism in ACE gene hyperlipidemia smoking hypertension DM lack of exercise blood coagulation fators homocystenaemia obesity gout drugs such as HRT and contraceptive pill heaty alcohol consumption
what is risk?
the probability of an event in a given time period
