Year 3 Flashcards
What are the two most common causes of death?
Cancer and IHD
What is the name of the national action plan in Scotland for palliative care?
‘Living and Dying Well’
How do you know if a patient is at a palliative stage? (What tool is used?)
‘Supportive and Palliative Care Indicators Tool’
What is the overall goal of palliative care?
Emphasise quality of life
What should be considered when thinking about a patient’s palliative care and what they want?
Where do they want to be cared for?
Do they want resuscitation?
Who do they want informed of their care and changes in their condition?
Are they/their family fully aware of their prognosis?
Who is the palliative care team made up of?
Health and Social Care partnership
+ MacMillan nurses, CLAN, Marie Curie nurses
Religious groups
What might be considered ‘A Good Death’?
Pain-free
Acknowledgement of its imminence
At home with family and friends
No personal conflicts or unfinished business
In a manner that resonates with person’s individuality
What are possible different reactions to bad news?
Shock Anger Denial Bargaining Relief Sadness Fear Guilt Anxiety Distress
How is a patient’s current functional level in palliative care measured?
‘Palliative Performance Scale’
- has prognostic value
What are the social/socio-economic influences on our health?
Gender Ethnicity Housing Education Employment Financial security Health system Environment
How does the WHO define ‘Health Inequality’? What is the key determinant factor?
Differences in health status or in distribution of health determinants between different population groups
Deprivation is the key factor
What might you expect to see in the general health of children from deprived areas?
Low birth weight
Poorer dental health
Higher obesity
Higher rates of teenage pregnancy
What are some examples of ‘vulnerable groups’?
The homeless Those with learning difficulties Refugees Prisoners LGBT
What health challenges do the homeless face?
- Average age of death ~45
- Unnatural causes of death 4x more likely
- Suicide 35x
- Alcohol/drug problems increased
- Increased prevalence of infectious diseases
- Poorer oral health
- Decreased access to healthcare
What health challenges do those with learning difficulties face?
- Staff having poor understanding
- If learning disability hasn’t been formally identified
- Failure to recognise when those with learning difficulties are unwell
- Inadequate aftercare/follow-up
- Lack of joint working from different healthcare professionals
- Anxiety/lack of confidence
What health challenges do refugees face?
- Family integrity and social adjustments larger than medical issues
- Competing demands of distinct services such as social welfare, housing, education, transport, public health, mental health, primary care, specialty care
- Language barriers
- Previous poorly controlled chronic conditions
- exposure to violence/warfare
- prevalence of PTSD, depression, anxiety
What health challenges do prisoners face?
- High levels of alcohol use
- higher levels of smokers
- Less interest in socialising
- more drug use
What health challenges do LGBT face?
- Higher rates of depression - increased self-harm
What is the ‘Inverse Care Law’?
1971 - Julian Tudor Hart
‘Those who most need medical care are least likely to receive it, and conversely those with least need of health care tend to use health services more and more effectively
What range of factors can reduce health inequalities?
- Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
- Evaluate and refine integration of health and social care
- Government policies and legislation e.g. smoking ban, Keep Well campaign
- Time to invest in the more vulnerable patient groups
- Improve access to health and social care services and professionals
- reduction in poverty
- social inclusion policies
- improved employment opportunities for all
- ensuring equal access to education in all areas
- improved housing in deprived areas
What is the difference between equity and equality?
Equality - everyone gets the same
Equity - everyone gets enough to bring everyone to the same level
What are the role of third sector organisations in health?
Provide a means of engaging effectively with communities and individuals
Deliver a range of services which may help to reduce health inequalities, including:
- promoting healthy living to groups of people who may not use mainstream services
- supporting people to access the relevant services of NHS Health Scotland
What are the benefits to individuals who volunteer?
Gain confidence Make a difference Meet people Be part of a community Learn new skills Take on a challenge Have fun
What factors may lead to global unsustainability? How might this affect healthcare?
Material inequality - rich getting richer Population and consumption - growing Resource depletion - oil, water Climate change Loss of biodiversity - animal depletion Crisis in healthcare - ageing population
What is the definition of sustainability?
“The ability to be maintained at a certain rate or level”
How is climate change expected to affect health and healthcare?
- Loss of healthy life years as a result of global
environmental damage is predicted to be 500x greater amongst poor Africans - Half of world’s population could face severe food shortages as rising temperatures affect crops
- Sea level rise could displace up to 1bn people
What actions may be taken to address climate change?
- Increase renewable energy sources
- modifying human behaviour to be more active
- plant-based diet
- educate on carbon
- promote patient resilience
- teach that we are part of an ecological system
How is sustainability relevant to the NHS?
Looked at in terms of environment and low carbon use
- or the NHS’s ability to continue over time
- ‘Realistic Medicine’ relates to this
How does/can the NHS continue sustainability in terms of carbon/climate change?
- Prioritise environmental health
- Substitute harmful chemicals with safer alternatives
- Reduce and safely dispose of waste
- Improve travel strategies
- Purchase and serve sustainably grown food
- Safely manage and dispose of pharmaceuticals
- Adopt greener building design and construction
- Purchase safer, more sustainable, products
What are some examples of overall health issues that may result from climate change?
Malnutrition
Diarrhoea
Infectious diseases
What questions may be asked to determine a patient’s career sustainability in terms of their health?
Identify any exposure to chemicals or other hazards
Have symptoms improved when not working
Duration and intensity of exposure
Is PPE used?
What protective measures are in place
Do others suffer similar symptoms?
Any hobbies, pets, worked overseas, moonlighting
What are some possible general overall effects of being unemployed, in terms of all types of health?
- Higher mortality
- Poorer general health, long-standing illness
- Poorer mental health, psychological distress, minor psychiatric morbidity
- Higher medical consultation, medication consumption and hospital admission rates
What is the purpose of a ‘Fit Note’? When would it be required?
‘To facilitate earlier discussion about returning to work and about rehabilitation
Includes items of consideration for employers when signing a patient’s return to work
Can only be completed by a doctor
It is advice to patient as an employee
It is required if the patient has been off for more than 7 consecutive days (including non-working days)
What is health promotion?
An overarching principle/activity which enhances health and includes disease prevention, health education and health protection
It may be planned or opportunistic
What is health education?
An activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health
What is health protection?
Involves collective activities directed at factors which are beyond the control of the individual. Health protection activities tend to be aimed at the prevention of ill health or the positive enhancement of well-being
What are the three areas of health promotion?
Educational - enables informed choices
Socioeconomic - makes healthy choices the easy choice e.g. national policies
Psychological - e.g. person’s desire to change
What is empowerment?
Power in individuals and groups which previously considered themselves unable to control situations nor act on the basis of their choices
What are the benefits of empowerment?
An ability to resist social pressure
An ability to utilise effective coping strategies when faced by an unhealthy environment
A heightened consciousness of action
What are the stages in the cycle of change?
Pre-contemplation
Contemplation
Action
Maintenance > regression/maintaining healthier lifestyle
What are some examples of health promotion in primary care and by the government?
Primary care
- planned: posters, chronic disease clinics, vaccinations
- opportunistic: advice within surgery, smoking, diet, BP
Government
- legislation: legal age limits, smoking ban, health and safety
- economic: cigarette/alcohol tax
- education: Health Education Board for Scotland
What is the definition of prevention and what are the different types of prevention?
Primary prevention
- measures taken to prevent onset of illness/injury
- reduces probability and/or severity of illness/injury
Secondary prevention
- detection of a disease at an early (preclinical) stage in order to cure, prevent or lessen symptoms
Tertiary prevention
- measures to limit distress or disability caused by disease
What are Wilson’s criteria for screening?
Illness - must be important, its natural history understood, and have presymptomatic stage
Test must be easy, acceptable, cost effective, sensitive and specific
Treatment - acceptable, cost effective, better if early
What are some early effects on lifelong health?
Diet leading to heart disease
Smoking more likely if parents smoke
Neglect/abuse
What are some common reasons for children presenting to primary care?
Feeding problems Pyrexia URTI Coughs/colds Rashes Otalgia Sore throat D and V Abdominal pains Behavioural problems
What advice can be given to parents/children to improve their health?
Diet and reasons for suboptimal diet
Exercise - 60 minutes per day of moderate/vigorous exercise
Sleep - 8-10 hours
Screen time - importance in sleep quality and mental health
What law relates to Child Protection in Scotland?
National Guidance for Child Protection SCOTLAND 2010
What are the goals of realistic medicine?
- build a personalised approach to care
- change our style to shared decision-making
- reduce unnecessary variation in practice and outcomes
- reduce harm and waste
- manage risk better
- become improvers and innovators
“In striving to provide relief from disability, illness and death, modern medicine may have overreached itself and is now causing hidden harm – or at best providing some care that is of lesser value.
Doctors generally choose less treatment for themselves than they provide for their patients.”
What 5 questions are patients being encouraged to ask their doctor?
- is this test, treatment or procedure really needed?
- what are the potential benefits and risks?
- what are the possible side effects?
- are there simpler, safer or alternative treatment options?
- what would happen if I did nothing?
