Year 2 Flashcards
What is patient centred care
Where the patient is at the centre of their decision making
5 principles of patient centred care
Respect Choice and empowerment Patient involvement in health policy Access and support Information
What is incidence
the number of new cases of a disease in a population in a specified period of time (trend in causation and aetiology of disease)
What is prevalence
the number of people in a population with a specific disease at a single point in time or in a defined period of time; existing cases (assess current workload on healthcare)
What factors contribute to aetiology
Genetic factors
Environmental factors
Both/neither
What is vulnerability
individuals capacity to resist disease, repair damage, and restore physiological homeostasis.
What are the different types of natural history of a disease
Acute onset (MI stroke)
Gradual: (angina, dementia)
Relapse and remission (MS)
What Burden of Treatments are patients with long term conditions often put under by the healthcare system
Changing behaviour for lifestyle modifications
Monitoring and managing symptoms at home
Complex treatment and multiple drugs
Complex Admin systems working with uncoordinated health and social care system
What are the types of stigma
Invisible
Visible
Both
What are the treatment aims in chronic disease
Resolve disease, or treat symptoms
Come to terms with chronic condition
Admit failure in diagnosis or cure if necessary
What is meant by biographical disruption
Long term condition leads to loss of body confidence
What are the effects of biographical disruption in long term conditions
Leads to lost confidence in social
interaction/self-identity
“Re-negotiate” relationships at work and home
Need to make sense of the condition before “adjusting”
Redefine “good/bad”, to emphasis positive life and lessen negativity of illness
Give an example of visible stigma
Being in a wheelchair
Give an example of invisible stigma
mental health
Who often stigmatises
those who are unnaffected
Why might people chose to not disclose their condition or disability
Fear of stigmatisation
What are the individual effects of long term conditions
negative/positive, denial, self-pity, apathy
What are the family impacts of long term conditions
Financial
Emotional
Physical
Contagious
What are the community/social impacts of long term conditions
Isolation of individual
Community can be judged on hos it treats ill
What is the expert patient
Patient understand disease better than healthcare professional”
What are the 3 types of disability as defined by WHO
Body and structure impairment:
- Abnormalities of structure, organ or system function
Activity level:
- Changed functional performance and activity by the individual
Participation restriction:
- Disadvantage caused by disability, interaction in society/environment
What are the medical models of disability
Individual cause (accident while drunk) Pathology (obesity) Individual intervention (health professional advise) Individual change (change in behaviour)
What are the social models of disability
Societal cause (low wage)
Housing conditions
Social/political action (facilities for disabled)
Social attitude (use of politically correct language)
Which 2 acts give rights to disabled people
Disability Discrimination Acts 1995 and 2005
Equality Act 2010
What do reactions to disability depend on
Nature of disability Information Personality/mood/emotion Coping strategy Reaction of those around/support networ Time to adapt
What are the rights of the sick role
Exemption from societal norms
Not responsible for condition
What are the obligations of the sick role
Should try to get well
Should seek professional help and cooperate
What areas of life can disability affect a family
Personal
Economic
Social
Epidemiology of disability
Congenital Injury Disease Alcohol/drugs Mental illness Malnutrition/obesity Rise in UK with age: ⅓ with disability are employed
What are the responsibilities of the healthcare professional regarding disability
Attitude Listen to patients and learn Take into account age and culture Ensure empathy Don't spectate: -> Assess -> Coordinate MDT -> Intervene with rehab
Definition of disease
Symptoms
Signs
Diagnosis
Biomedical perspective
The biological view on it
Definition of illness
ICE
Patient perspective
The disease relating to the patients view on it
What factors affect care uptake (going to get care)
Lay referral: going from family -> community -> traditional/cutureal healing -> medial system
Sources of info: peers, family, media
Medical factors: new symptoms, increasing severity, duration
Issues:
Patient believe self to be healthy: physically fit, doesn’t want to use tablets
Doctor: perform additional investigation, educate self of concerns
Definition of epidemiology
Describe amount and distribution of disease in human population
Describe explanation and epidemiology
To elucidate the natural history
Identify aetiological factors for disease usually by combining epidemiological date with date from other disciplines such as biochemistry, occupational health and genetics
What are the 3 main aims of epidemiology
Description
Explanation
Disease control
Describe disease control and epidemiology
Provide basis for preventative measures/public health practices
Therapeutic strategy for disease control
Why does epidemiology compare gourps
To detect differences pointing to:
Aetiological clues (what causes the problem)
The scope for prevention
Identification of high risk or priority groups in society
What are sources of date for studies
Mortality
GP Morbidity
Health and household surveys
Cancer Statistics
Accident Statistics
Fertility rates
NHS expenditure
Hospital data
–» Reproductive, cancer, accident
Does clinical medicine deal with the individual or population
Individual
Does epidemiology deal with the individual or the population
Population
In ratios what the numerator and denominator represent
Events = numerator
Population at risk = denominator
What does relative risk measure
The strength of association between a risk factor and disease
= Incidence of disease in exposed group/incidence of disease in unexposed group
What is meant by health literacy
About people having the knowledge skills
Understanding and confidence to use health information to be active partners in their medical situation and to navigate health and social care systems
What did the Scottish government publish to make health literacy easier
Making it Easy - A Health Literacy Action Plan for Scotland
What does the CHA2DS2-VASc score calculate/estimate risk for
Atrial fibrillation
Stroke
What is a descriptive study
describe amount and distribution of disease in a given population
Pros and Cons of descriptive study
No definitive conclusions
May give clues about risk factors and aetiology
Cheap, quick, overview
What is an analytical study
Cross sectional (disease frequency, prevalence study)
In cross sectional studies observations are made at a single point in time
What is a Cohort study
When baseline data on a group, is then followed until disease developed in sufficient numbers to allow analysis
What do trials test
Ideas about aetiology or evaluate interventins
What is a randomised controlled trial
Varying intervention on patients then
Analysis of results
What is standardisation
Set of techniques used to remove (or adjust for) the effects of differences in age or other confounding variables
What is a counfounding factor
Factor associated independently with both the disease and exposure (age/sex/social class)
How are co-founding factors counteracted
Randomisation, restriction of eligibility, subject grouping, result stratification/adjustment
What is the standardised mortality ration
standardised death rate converted to ratio, e.g. standard is 100, 120 means 20% more death than expected
What does quality data ensur
That data is trustworht
What is case definition
decide if an individual has the condition of interest or not; varying definition from study maker to interpreter
What is coding and classification relevant to
Case definition in data analysis
What is bias?
Any trend in collection, analysis, interpretation, publication, or review that leads to conclusions different from the truth
What is selection bias?
When the sample is not representative of whole study population
What is information bias
Systematic errors in measuring exposure/disease e.g. researcher knowing “case”vs“control”, and working harder on “case”
What is follow up bias?
one group of subjects is followed up more assiduously
What is systematic error
measurement bias where measurements tend to fall on one side of the truth e.g. machine calibrated incorrectly, poorly written survey
What is ageism
stereotyping and discriminating against people just because they are old
Has data shown that recent with in life expectancy will slow down or speed up
Slow down
What is the current life expectancy for males and females
Males -63yrs
Females - 64yrs
How many people will be carers in their lifetime
3 in 5
What are potential roles of carers
Practical help – preparing meals, doing laundry or shopping
Keep an eye on the person they care for
Provide company
Take them out
Help with financial matters
Personal care
Who do carers care for
Grandparents Parents Parents in law Spouse/Partner Disable children Friends Neighbour
What are the consequences for the carer of being a carer
Financial drop: cut back on essentials like food and heating
Health drop: caring was affecting their health
Impact on relationships: not getting out as much/seeing friends
Feel society doesn’t care/ feel isolated
What is multi-morbidity
The coexistence of 2 or more long-term conditions in an individual
What does multi-morbidity increase?
Complexity
What are old age care options
Living in home with support from family
Living in own home with support from social services
Sheltered housing
Residential housing
Nursing Home Care
What is an anticipatory care plan
Advance and anticipatory care planning as a philosophy promotes discussion in which individuals their care providers and often those close to them make decisions with respect to their future health or personal and practical aspects of care
What are the legal aspects of anticipatory care plans
Power of attorney welfare
Power of attorney financial
Guardianship
What are personal aspects of anticipatory care plans
Statement of wishes regarding treatment/advance directive
Next of kin
Consent to pass on info to relevant others
Who else to consult/inform
Religious and cultural beliefs re death
Current level of support
What are medical aspects of anticipatory care plans
Potential problems
Wishes regarding boy use e.g organ donation or body use in science
Wishes regarding DNA CPR
Electronic care summary
Assessment of capacity/competence
Current functional level
Name members of the Primary healthcare team
GP Practice nurses District nurses Midwifes Health visitor Macmillan nurse
Name members of the allied health professional
Pharmacists Dietician Physio. OT Care manager Complementary therapist Social services Health promotion
Who is the core of the MDT team
Patient
Which factors can affect the primary health care team
Economy:
Moving to larger primary care premises
Wider range of services
Political pressure:
Pressure to reduce cost of treatments
Provide treatments closer to patients
Development of new and extended:
professional roles
Nurses now prescribe and triage
Pharmacists now manage medicines and minor illnesses
Growing number of ageing population:
more long term conditions
Greater demand for healthcare
What are the principles of teamwork
Patient is core member of team
Agree on a team leader
Ensures everyone understands and acknowledges the skills and knowledge from each team member
Ensure communication (communication is vital!!) between members of team including patient
Ensure sharing of patients information within the team is accordance with current legal and professional requirements
Assure interprofessional collaboration
What is the public bodies (Joint Working) (Scotland) Act 14
Scottish Gov plan to integrate adult health and social care
Created Integration Authorities
Roles of GP
First point of contact for most patients
Work by consultations/home visits
Deal with combined physical, psychological and social problems
Independent contractors to NHS; employ own staff and have own premises
Roles of practice nurse
Work in surgeries, supervise healthcare assistants
Blood samples, ecg, wound management(leg ulcer), vaccination, family planning
Roles of district nurse
Visit homes/care homes
Teaching and support role with patients and families
Minimize potential hospital admissions
Assess healthcare needs
Role of midwife
Care during pregnancy, labour and early post natal period
Work in community (home, children’s centres) surgeries hospitals
Role of health visitor
Lead child and family health service (pregnancy to 5yr)
Additional service to vulnerable children and families
Role of Macmillan Nurse
Cancer and palliative care, in variety of settings
Pain and symptom control, emotional support, providing info about treatment, coordinate with hospital
Role of pharmacist
Medicine and use, advise medical/nursing staff and patients, can prescribe
Work in hospital, primary care or community
Role of dietician
Work in hospital and community
Inform about nutrition, work with special dietary need patients
Role of physiotherapist
Help and treat physical problems: manual therapy, exercise, electro-physical
Maximise movement; rehab, preventative healthcare, health promotion
Role of OT
Assessment and treatment of physical and psychiatric conditions to prevent disability an promote independent function
Physical rehab, mental health help, learning disability, environment adaptation
Role of care manager
Work with individuals to identify their goals and find specific support services
Role of complementary therapist
Acupuncture
Homeopathy
