Year 2 Flashcards
What are the main causes of death in the UK?
Cancer
IHD
Suicide: man 15-34
Where is most palliative care provided?
primary care with support from specialist practitioners and specialist palliative care units.
What is palliative care?
A philosophy of care that emphasises quality of life
What is the palliative performance scale?
Useful way of assessing and reviewing functional changes in palliative care. Lower PPS scores at initial assessment indicate poorer prognosis. Falling PPS scores increase the risk of death compared with patients whose PPS scores remained static or improved.
What symptoms are often experienced in the palliative period of time?
anxiety, insomnia and nausea, pain
What individuals may be involved in palliative care?
Macmillan nurses, CLAN, Marie Curie Nurses, Religious or Cultural
Where do most patients prefer to die?
At home
What does a low PPS score indicate?
Poor prognosis
What are demographics?
Study of populations based on factors such as race, age, gender
What factors affect population growth?
cost of education, economic growth, stability of society, availability of contraception, government policy, health care standards, net migration, cultural attitudes to family size, female labour market participation.
What is life expectancy in scotland?
Life expectancy is 79
What is the impact of an ageing population?
- Increased demand for health and social care
- Increased spending on pensions
- Increased dependency ratio
- Housing needs
- Workforce shortages
At 65, what proportion of people have at least one long term condition?
By age 65- 2/3 people have one long term condition
What percentage of GP consultations are attributed to long term conditions?
80% of GP consultations are attributable to long term conditions.
What fraction of older people have 2 or more long term conditions?
1/4 people aged 75-84 have 2 or more long term conditions
Describe the effect of deprivation on multimorbidity.
Most deprived people experience multimorbidity 10-15 years earlier that those who are least deprived.
What does polypharmacy lead to?
- Reduced adherence
- Increased chance of interactions
- Increased treatment burden
What is multi-morbidity linked to?
- reduced quality of life
- higher mortality
- higher use of health services
- polypharmacy
What are the various care services?
- At home care- family member
- Nursing home
- Sheltered housing
- Care home
Describe the legal aspect to anticipatory care planning.
- Welfare power of attorney
- Financial power of attorney
- Quardianship
Describe the medical aspect to anticipatory care planning.
- Potential problems
- Home care packages
- ‘Just in case’ medications
- Communication which has occurred with other professionals
- Electronic care summary
- Scottish palliative care guidelines
- Current aids and appliances
- Assessment of capacity
Describe the personal aspect to anticipatory care planning.
Current level of support Statement of wishes regarding treatment Next of kin Consent to pass on information to others Preferences and priorities regarding treatment Who else to consult/ inform Preferred place of death Religious beliefs Current level of support
What is Resilience?
The capacity to recover quickly from difficulties, toughness or the ability of a substance or object to spring back into shape.
A personality trait that deals with negative effects of stress and promotes adaptation
What behaviours support resilience?
- High frustration tolerance
- Self acceptance
- Self belief
- Humour
- Perspective
- Curiosity
- Adaptabilty
- Meaning
- Support network
- Reflective ability
- Avoiding procrastination
- Developing goals
- Time management
- Work- life balance
What are personal sources of burnout?
perfectionism, denial, avoidance, micromanaging, unwilling to seek help, being too conscientious
What are professional sources of burnout?
culture of invulnerability, culture of presenteeism, blame culture/ silence
What are systemic causes of burnout?
overwork, shift work, lack of oversight, chaotic work environments, lack of teamwork, fractured training
What may resilience lead to?
Reflection, improvement, returning wiser and better
What factors aid resilience?
- Intellectual interest
- Self awareness
- Time management and work life balance
- Continuing professional development
- Support including team working
- Mentors
- Professional attitudes
- Societal attitudes
- Structural changes
What is sustainability?
The ability to be able to continue over a long period of time
Describe low carbon clinical care
- Prioritise environment
- Substitute harmful chemicals with safer alternatives
- Reduce and safely dispose of waste
- Switch to renewable energy
- Reduce water consumption
- Improve travel strategies
- Purchase and serve sustainably grown food
- Safely manage and dispose of pharmaceuticals
- Adopt greener building design and construciton
- Purchase safer, more sustainable products
What is the correlation between depravation and long term health conditions?
twice as likely to suffer a long term condition if living in a deprived area vs affluent area
What is the definition of incidence?
number of new cases of a condition in a specialised time period. Helps to define the risk of the condition- what is the likelihood of being diagnosed.
What is prevalence?
total number of people in a population with a condition either at a single point in time or over a given time period. Helps to understand the burden of disease.
What are the consequences of long term conditions?
- Biographical disruption
- Stigma of long term conditions
- Burden of treatment
- Disability
- Impact on family/ community/ society
- Individual responses to LTC
Describe the burden of treatment for individuals with LTC?
- Recognising and managing symptoms
- Dealing with health care professionals
- Complex treatments
- Changing behaviour
What factors affect a person’s ability to tolerate burden of treatment?
Personal attributes and skills Life workload Financial status Physical and cognitive ability Support network Environment
What are the obligations of a doctor?
- To be highly trained
- To be motivated by concern for the patient and community
- To be objective and emotional detached
- To be bound by rules of professional conduct
What is disability?
An umbrella term for impairments, activity limitations and participation restrictions. It is the interaction between individuals with a health condition and personal and environmental factors.
What is the medical model of disability?
Disability is a feature of the person, directly casued by the disease, trauma or other health conditions which requires medical care provided in the form of individual treatment by professionals. Disability calls for medical or other treatment or intervention to correct the problem with the individual.
What is the social model of disability?
Disability is a socially created problem and not at all an attribute of an individual. In this model, disability demands a political response, since the problem is created by an unaccommodating physical environment brought about by attitudes and other features of the social environment.
What is the definition of screening?
the presumptive identification of unrecognised disease or defect by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not.
What is evidence based medicine?
Evidence based medicine is the use of mathematical estimates of the risk of benefit and harm, derived from high- quality research on population samples, to inform clinical decision making the diagnosis, investigation or management of individual patients.
What is epidemiology?
Clinical epidemiology is the science of applying the principles of population based evidence to the management of individual patinets
How are populations studied?
- Observing them: can show association between one variable and another
- Intervening: can be used to test a new treatment or intervention
What are the type of observational studies?
- Cohort study: used for looking at causality
- Case control study: used for looking at causality
- Cross- sectional/ longitudinal studies: useful for looking at trends
What is bias?
any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from truth.
What is the difference between bias and errors?
Bias is different to errors because errors occur randomly. Bias is a systematic deviation from the truth.
What is a confounding factor?
a factor that is associated with both the exposure of interest and the outcome of interest.
What are the types of bias?
- Selection bias: sample does not represent the population
- Detection bias: observations in treatment group pursued more than those in control group
- Observer bias: subjectivity of observer, variance in their decisions
- Recall bias: patients know which group that are in, and may be more likely to report symptoms
- Response bias: patients enrolling themselves/ self- selecting
- Publication bias: positive trials more likely to be published
What is incidence?
The number of new cases of a disease in a population in a given time period, also known as occurrence rate. Usually reported as a percentage
Incidence helps to understand the RISK of disease.
What is prevalence?
The total number of cases of a disease in a population, either in a time period or at a specific point in time.
Prevalence helps to understand the BURDEN of disease.
What is relative risk?
Relative risk is the outcome measure reported in cohort studies. It is a measure of the risk of the outcome of interest in the exposed group, relative to the unexposed group
- Risk in exposed group ÷ risk in unexposed group= RR
- If the relative risk is 1, it indicates that there is no difference in effect between the groups.
What is a case control study?
A comparison between individuals with a disease (outcome) of interest (cases) and those without the disease (outcome) of interest (controls). The cases and controls are each assessed to ascertain if they have had exposure to the variable of interest.
Almost always retrospective
What are the disadvantages of a case control study?
Disadvantages- prone to bias, can be difficult to prove causation, not possible to calculate incidence, selecting controls can be difficult.
What is the odds ratio?
measure of outcome used in case control studies. It is defined as the ratio of the odds of exposure in those with the outcome to those without the outcome.
Odds of exposure in those with the outcome ÷ odds of exposure in those without the outcome= odds ratio
What is a longitudinal study?
If a cross sectional study is repeated multiple times
What is a cross sectional study?
Looks at outcome and exposure in a population or an individual, at a specific point in time- they look at a cross section of society
What trial is used to assess new treatments?
Randomised control trial
Describe the hierarchy of evidence.
- systematic reviews
- Randomised control trials
- Cohort studies
- Case reports
- Expert opinions
What are the criteria for causality?
- Strength of association - statistical significance
- Consistency
- Specificity - exposure only cuases one disease
- Temporality - exposure must precede onset of disease
- Biological gradient- dose- response relationship
- Plausability - existing models explain how exposure causes disease
- Coherence - association should make overall sense
- Experiment - manipulation of exposure should affect the disease
- Analogy - analogy one casual agent is known standards of evidence are lowered for a second agent that is similar
Describe the stages of an audit cycle.
Stage 1: prepare audit
Stage 2: select criteria for audit
Stage 3: measure level of performance
Stage 4: make improvements
Stage 5: sustaining improvements
What is meant by power in a study?
The probability of detecting a statistically significant difference
Also the power could be described as the liklihood of correctly rejecting the null hypothesis.
List allied health professionals.
- Dieticians
- Occupational therapists
- Paramedics
- Physician associates
- Physiotherapists
- Podiatrists
- Radiographers
- Speech and language therapists
List members of the wider primary care team.
- Practice nurses
- District nurses
- Advanced nurse practitioners
- Community mental health nurses
- Health care assistants
- Community midwives
- Health visitors
- Allied health professionals
- Pharmacy technicians
- Dental workforce
- Optometry workforce
What is the role of an occupational therapist?
Help people of all ages overcome the effects of disability caused by illness, aging or accident.
An occupational therapist will consider all of the patient’ needs: physical, psychological, social and environmental.
- What is the role of a podiatrist?
Treat problems with a patient’s foot or lower leg.
What is the role of a physician associate?
Work under the supervision of a doctor and carry our many similar tasks
What is the role of a health visitor?
Supporting children from 0-5 years and their families, providing antenatal and postnatal support, assessing growth and development needs, teaching parents about the nutritional needs of infants and young children.
