Year 3 Flashcards
What are the most common causes of death?
Cancer
IHD
What are some of the implications of unexpected death?
Shock
Accidents with multiple deaths, legal involvement & press coverage
What are some of the implications of expected death?
Terminal care in last phase of death
What is the term for the management of conditions in terminal phase?
Palliative care
Where is palliative care provided?
Primary care
Specialist practitioners
Specialist palliative care units
What is the name of the Scottish Government End of life action plan?
Living & Dying Well
WHO states that palliative care…
Improves Q of L of patient & families who face life-threatening illnesses by providing pain & symptom relief, spiritual & psychological support from diagnosis to end of life & bereavement
What are the concepts of palliative care?
End of life care regardless of cause of illness
Consider patients who would benefit from palliative planning & treatment earlier in illness
What can you use to assess whether a patient is palliative?
Support & Palliative Indicator Tools
What does the Support &Palliative Indicator Tools allow doctors to do?
Consider patients who have life-limiting diagnosis or worsening chronic illness & highlight if they are at a stage where palliative care should take place
What is the name of the document which can help plan patients future care?
Anticipatory Care Plan
What does the ACP contain?
Where cared for? Resuscitated? DNA CPR Die naturally? Do they want to be informed of changes to their care? Are they fully aware of their prognosis?
What register is a person placed on after ACP produced?
Palliative Care Register
What scale is used to evaluate how quickly a patients end of life care is progressing?
Palliative Performance Scale
What are the different categories assessed in PPS?
Ambulation Activity & Evidence of Disease Self-care Intake Conscious level
What does the PPS hep assess?
Helps to describe patients current functional situation
Value for criteria for workload assessment
Prognostic value
How do primary care maintain care of PC patient?
Once on PC register, have MDT meeting (communication between team members)
Out of Hours informed
Regularly reviewed
According to WHO, what are the 7 core concepts to palliative care?
- Provides relief from pain & other distressing symptoms
- Affirms life & regards dyning as normal process
- Intends to neither hasten or postpone life
- Integrates psychological & spiritual aspects f patient care
- Offers support system to help familiarise live as actively as possible until death
- Offers support system to help family cope during patient illness & in their bereavement
- Uses team approach to address the needs of patient & families including bereavement counselling
How are the members of the PC team ?
Health & Social Care Partnership team
Macmillan nurses
Marie Curie Nurses
CLAN
What are the main factors of a ‘good death’?
Pain-free
Open acknowledgement of imminence of death
Death at home surrounded by family & friends
An ‘aware’ death in which personal conflicts & unfinished business are resolved
Death as personal growth
Death according to personal preference & in manner the resonates with persons individuality
Where is the preferred place of care?
Preferred home death
What framework offers tools to enable primary care to provide palliative care at home?
The Gold Standards Framework
What are the main points to breaking bad news?
Listen Set the scene Find out what the patient knows Find out how much the patient wants to know Share information using common language Review & summarise Allow opportunities for questions Agree follow up & support
What are the main reactions to bad news?
Shock Anger Denial Relief Sadness Fear Guilt Anxiety Distress
What does euthanasia mean?
Gentle or easy death
What is the definition of voluntary euthanasia?
Patient request
What is the definition of non-voluntary euthanasia?
Non request
What is the definition of physician assisted suicide?
Physician provides the means & advice for suicide
What are the most common reasons for euthanasia?
Unrelieved symptoms
Dread of further suffering
What are the main responses to euthanasia request?
Listen Acknowledge issue Explore reasons for request Explore ways of giving more control to patient Look for treatable problems Remember spiritual issues Admit powerlessness
What are the key concepts of realistic medicine?
Build a personalised approach to care Change our style to shared decision-making Reduce unnecessary variation in practice Reduce harm & waste Manage risk better Become improvers/ innovators
What makes a good doctor?
Knowledge/ qualifications
Good listener
Friendly & approachable
What makes a good consultation according to patient?
Feeling listened too/ not being rushed
Clear communication
Resolution/ diagnosis
What kind of conditions are over diagnosed?
Prostate cancer
Asthma
CKD
ADHD
Choose Wisely UK devised 5 questions to prompt better conversations between clinicians & patients, what are they?
Is this test, treatment or procedure really necessary?
What are the potential risks/ benefits?
What are the possible side effects?
Are there simpler, safer or alternative treatment options?
What would happen if I did nothing?
What is health effected by?
Genetics
Access
Environment
Lifestyle
What is health promotion?
Any planned activity designed to enhance or prevent disease
What aspects which affect health are also affected by health promotion?
Access
Lifestyle
Enivronment
Where can health promotion occur?
Workplace
School
Hospital
Community development
What are the theories of Health Promotion Action?
Educational
Socioeconomic
Psychological
What does the educational theory of health promotion involve?
Provides knowledge & education to enable skills to rate informed choices eg. smoking, diet
What does the socioeconomic theory of health promotion involve?
Makes health choice easy choice - national policies re unemployment & sugar tax (radical)
What does the psychological theory of health promotion involve?
Complex relationships between behaviour knowledge, attitudes & beliefs. Activities start from individual attitude to health & readiness to change. (Emphasis on whether person ready to change eg. smoking/alcohol
What is the definition of health promotion?
Overarching activity which enhances & includes disease prevention, health education, & health protection. May be planned or opportunistic
What is the definition of health education?
An activity involving communication with individuals or groups aimed at challenging knowledge, beliefs, attitudes & behaviours in a direction which us conductive to improving health.
What is the definition of health protection?
Involves collective activities directed at factors which are beyond control of individual. Health protection activities tend to be regulations or policies or voluntary code of practice aimed at prevention of ill health or positive enhancement of well-being
How is effective health promotion able to occur?
Primary care system
Pharmacies
Use of media
Why is health promotion relevant?
Benefits of preventing disease rather than treating established disease
Reduced healthcare costs
What are the disadvantages of health promotion?
Medicalising healthy people
May not effectively target the most at risk groups
Difficult to assess impact
What is the definition of empowerment?
Refers to the generation of power in those individuals & groups which previously considered themselves unable to control situations nor act on basis of their own choice
What are the benefits of empowering individuals?
An ability to resist social pressures
An ability to utilise effective coping strategies when facing by an unhealthy environment
A heightened consciousness of action
What is the model for changing behaviour?
Cycle of Change
What is the cycle of change useful for?
Identifying whether someone is ready to change behaviour
Useful for smoking, alcohol, weight loss, diet or exercise
What are the different aspects of the cycle of change?
Pre-contemplation Contemplation Action Maintainence Either maintain healthier lifestyle or regression
What are some examples of planned HP in primary care?
Posters
Vaccinations
CD clinics
What are some examples of opportunistic HP in primary care?
Advice within consultation
What governmental measures can be done for HP?
Legislation, Economic, Education
What legislation can be enforced to do HP?
Legal age limits
Smoking ban
Health & safety
What economic factors can be made to do with HP?
Tax on cigarettes/ alcohol
What educational factors can be made to do with HP?
Media/ adverts
What is primary prevention with regards to HP?
Measures taken to prevent onset of illness or disease (reduced severity/ probability of disease) eg smoking cessation or vaccination
What is secondary prevention with regards to HP?
Detection of disease at early stage (preclinical stage) in order to cure, prevent or lessen symptomatology.
Earliest opportunity when disease becomes detectable
What is the name of the screening criteria?
Wilson & Junger
What are the criteria for screening?
Knowledge of disease
Knowledge of test
Treatment for disease
Cost consideration
What are the main goals for screening?
Illness
Test Treat
What knowledge of disease required for screening test?
Important public health concern
Recognisable latent or early symptomatic stage
Recognisable natural course of condition
What knowledge of test is required for screening?
Suitable test or examination
Acceptable for population
Test sensitive & specific
What knowledge of treatment of disease required for screening?
Accepted treatment for patients with recognised disease
Facilities for diagnosis & treatment available
Agreed policy concerning whom to treat as patient
What regarding cost consideration is associated with screening?
Costs of case finding economically balanced in relation to possible expenditures on medical care as whole
In scotland, what screening programmes are undertaken?
Breast, Bowel, Cervix
AAA
Diabetic retinopathy
What screening tests are undertaken in pregnancy?
Pre-eclampsia & diabetes
Anaemia & blood group
Viral infections (HIV, Hep B, Syphilis, Rubella)
Downs syndrome & other chromosomal abnormalities
Baby & placental position
What newborn screening tests are undertaken?
Hearing Guthrie tests: PKU, CF, Hypothyroidism, SC Hip dysplasia Congenital heart defects Cataracts Undescended testes
What is tertiary prevention in relation to HP?
Measures to limit distress or disability caused by disease (any intervention after disease onset that limits the effect of the disease
When assessing new patient think of what 3 separate processes?
Normal development & ageing
Environment & lifestyle
Disease
What is the role of parenting when establishing lifelong health?
Habits & lifestyle established in adolescence
Neglect & abuse
What are common presentation of children in Primary care?
Feeding problems Pyrexia UTIs Cough Diarrhoea & vomiting Behavioural problems
When consulting with child what is important to do?
Listen, watch, observe, examine properly
Put child & parent at ease & explain in clear language
Why do parents bring children to doctors?
Child unwell Someone urged them to act Anxiety re normal illness Single parent with no support Parental depression/anxiety Child abuse by parent Social issues
What aspects of health promotion are encouraged?
Diet
Exercise (60mins of mod/vigorous per day)
Sleep (8-10 sleep/day)
Social issues
Child protection (childs health is affected by their environment & illness presentation may be first presentation of child protection issue)
Screen time
What is the definition of sociology?
The study of development, structure & functioning of human society
What does medical sociology include?
Studies peoples interaction with those engaged in medical occupations
Studies the way people make sense of illness
Identifies the behaviour & interactions of health care professionals in their work setting
Sociologists identified what characteristics of professions?
Systematic Theory Authority recognised by its clientele Broader community sanctions Code of ethics Professional culture sustained by formal professional sanctions
What is the Patient perspective of the Sick Role?
SR exempts ill people from their daily responsibilities
Patient is not responsible for being ill & regarded as unable to get better without help of professional
Patient must seek help from healthcare professional
Patient is under social obligation to get better as soon as possible to be unable to take up social responsibility again
What is the healthcare perceptive of the Sick Role?
Professional must be objective & not judge patients morally
Professional must not act of self-interest or greed but patients interests first
Professional must obey professional code of practice
Must have & maintain the necessary knowledge & skills to treat patients
Professional have the right to examine patient intimately, prescribe treatment & had wide autonomy in medical practice
What is the example of Socio-economic Classification NS-SEC?
- 1 - Large employers & higher managerial & admin occupation
- 2 Higher professional occupation
- Lower managerial, admin & professional occupations (nurses, sales managers)
- Intermediate occupations (secretaries, technicians)
- Small employers & account workers (restaurant, hairdressers, builder)
- Lower supervisory & technical occupations
- Semi-routine occupations (security guards, cooks, porters)
- Routine occupations (waiters, bar staff, cleaners)
- Never work & long term unemployed
What are the socio-economic influences on health?
Gender Ethnicity Physical environment/ housing Education Employment Income/ social status/ financial security Health system Social environment
The structure of socio-economic & position of person in normal society is also a predictor of what?
Health
Educational outcomes
Source of income, economic security & prospects of economic advancement
What health differences are observed with gender?
Increased mortality in males
Increased morbidity in females
What are the effects of ethnicity on health?
Increased CHD in Pakastani/ Bangladesh
Prevalence of T2DM in south asian population
Increased prevalence of SCD in African groups
At a patient level, what are some disparities in health which lead to barriers in health care?
Language barrier
Understanding the system
Beliefs
At a provider level, what are some disparities in health which lead to barriers in health care?
Understanding the differences due to ethnicity, provider skills & attitudes
At a system level, what are some disparities in health which lead to barriers in health care?
Organisation of appointments & referrals
What is the definition of culturally competent?
Combination of attitudes, skills, knowledge that allows an understanding & therefore better care of patients with different backgrounds
What are the effects of housing on health?
Cold housing - increased risk of respiratory conditions or mental health disorders
What affect does education have on health?
Increased educational status tend to be healthier than those of similar income who are less well educated
Why? - Better understanding of health, more effective engagement with healthcare services eg screening programmes, better engagement with health related advice
What effects does employment have on health?
Provides income & financial security Provides social contacts Provides status in society Provides purpose in life Unemployment is associated with increased morbidity & premature death
What effect can transport have on health?
Adverse effects on health with expansion of car use eg RTAs & pollution
Active transport has number of health benefits (increase mental health aspects, reduced risk of premature death, prevention of chronic disease)
What effect does media have on health?
Shape & stereotypes our views
Shapes our expectations
Consider the change in media attitude to mental health
What is the definition of health inequalities by WHO?
Differences in health status or in the distribution of health determinants between different population groups
What is the key determinant in health inequalities?
Deprivation (also age, gender & ethnicity)
In deprived areas more likely to experience what?
Teenage pregnancies Poorer dental health Low birth weight Obesity Less likely to breastfeed Increased % of smokers
In most deprived areas, what are some of the health disparities observed?
Overall more disease present Earlier age of onset of disease Increased level of disability following conditions Drug use higher Mental health conditions Alcohol dependance & cirrhosis Self harm & suicide
In the least deprived areas what health disparities are observed?
Increased number of years living with non-fatal conditions (increased morbidity)
Longer life expectancy
Why are homeless people described as a vulnerable group?
Decreased life expectancy Increased suicide rates Assaulted, drug/alcohol risk Prevalence of blood born disease Access to healthcare poorer (not registered with GP therefore A & E attendance higher)
Why are those with learning difficulties described as vulnerable group?
Worse physical & mental health
Reduced life expectancy
Barriers that stop people with LD getting good healthcare:
Patient not identified as having LD Staff having little understanding of LD Failure to make correct diagnosis Failure to recognise that someone with LD is unwell Lack of accessible healthcare links
Why are refugees regarded as vulnerable group?
Language barrier impedes adjustment process
May have poorer controlled or undiagnosed chronic medical conditions as country of origin had underdeveloped healthcare systems
Mental health conditions due to exposure to conditions
Why are prisoners regarded as vulnerable groups?
Alcohol misuse Smokers Illicit drugs Violence Accidents & suicides
When tackling health inequalities, what organisations require input?
Government NHS Schools Employers Third sector
What is the Inverse Care Law?
Those that are in most need of medical care are least likely to receive it & conversely those wit least need of healthcare tend to use the healthcare system more & more effectively
What factors can reduce health inequalities?
Effective partnership across range of sectors & organisations
Evaluate & refine integration of health & social care
Government policies & legislation
Improve access to health & social care services & professionals
Reduction in poverty
Improves employment opportunities for all
Ensuring equal access to education in all areas
Improving housing in deprived areas
Role of third sector?
Help address wider factors underlying health inequalities
What services do voluntary sector organisations provide or deliver?
Promoting healthy living to groups of people who may not use mainstream services
Supporting people to access relevant NHS services
What are some of the benefits of volunteering?
Gain confidence (try something new/ sense of achievement)
Make a difference (real positive affect on people)
Meet people
Be part of community
Learn new skills
Take on challenge
Name some of the Third Sector Organisations
CAB (Citizens Advice Bureau) Penumbra Somebody Care ADA (Alcohol & Drugs Action) Clan
What is the role of CAB?
Help people negotiate finances, benefits & debts
Support witnesses in court
What is the role of penumbra?
Mental health charity
Promote mental health & well-being for young people.
Reduce self-harm
What is the role of Somebody cares?
Provides food, clothing, furniture for poor or marginalised people in society
What is the role of ADA?
Access to support, advice & provide targeted intervention for anyone affected by alcohol misuse.
Harm reduction services (support for families & sexually exploited women)
What is the role of Clan?
Support across NE Scotland for those affected by cancer
Information, support & counselling, complementary therapies & family support
What mild/moderate mental health conditions commonly affect the public?
Depression GAD Panic disorder Social anxiety disorder Obsessive compulsive disorder Post-traumatic stress disorder
How can medical schools promote well-being?
Delivering group learning exercises focusing on how to deal with stress
Provide & promote online resources
Provide sessions on techniques such as mindfulness/ meditation & physical activity
What is the definition of resilience?
The capacity to recover quickly from difficulties; toughness, or the ability of a substance or object to spring back into shape; elasticity
What is resilience?
An emotional competence or a personality characteristic that deals with negative effects of stress & promotes adaption
Can be an acquired virtue or behaviour & requires continuous improvement
It encompasses several dimensions including self-efficacy, self -control, self- regulation, planning & perseverance
What similarities are drawn between elite athletes & medical students?
High internal & external expectations Win at all costs attitudes Parental pressures Excessive time demands Perfectionism
What personal strengths underpin resilience?
High frustration tolerance Self acceptance Self belief Humour Perspective Curiosity Adaptability Meaning
What behaviours support resilience?
Building/ having support network (Positive relationships)
Reflective ability
Assertivness
Avoiding procrastination
Developing goals (realistic plans & ability)
Time management
Work/life balance
What are the challenges to resilience in medical career- sources of burnout?
Personal - perfectionism, avoidance, unwilling to seek help, micromanage (being too conscientious)
Professional - culture of invulnerability, culture of presenteeism, blame culture/ silence
Systemic - overwork, shift work, lack of insight, chaotic work environments, lack of teamwork, fractured training
What may a student presenting with stress/ burnout face?
Repeatedly failing Handing in work late Poor attendance Absence due to illness Behavioural issues Fitness to practice issues Lack of enagagment in course Poor communication with staffs, peers, patients
According to the conceptual model of MS wellbeing: promoting resilience & presenting burnout, What are some of the positive inputs?
Psychological support
Social/ healthy activities
Mentorship
Intellectual stimulation
According to the conceptual model of MS wellbeing: promoting resilience & presenting burnout, What are some of the negative inputs?
Stress
Internal conflict
Time & energy demands
What factors help to build resilience?
Intellectual interest (job satisfaction, career progression)
Self awareness & self reflection (recognise personal limits)
Time management & work life balance
Continuing professional development
Support (teamwork)
Mentors (help trainees adapt to change)
Instead of personal change in order to increase resilience what other aspects can to profession can change?
Professional attitudes - changing sense of perfectionism & better support for those struggling
Societal attitudes - change culture of blame, reduce perceived threat of complaints. Patients personal responsibility for health
Structural changes - improving shift pattern, better work-life balance & regular breaks
What is an occupational history?
A chronological list of patients employment with the intention to determine whether work has caused ill health, exacerbated an existing health problem or has ill health has impact on patients capacity to to work
What questions may you ask someone in order to take occupational history?
Description of present & previous jobs from leaving school
Do the symptoms improve when not exposed/ not at work (weekends/ holidays)
Determine duration & intensity of exposure
Is personal protection used (mask, desk, chair)
Do other suffer similar symptoms
Are there known environmental hazards in use
What is a “Fit Note”?
Evidence of assessment by a Dr as to whether a patient is fit to work in general not job specific
Only completed by Dr
Includes items of consideration for employees when signing patient’s return to work
It is advice to patients employers, not legally binding on employer & does not affect Statutary sick pay
It is required if patient has been off more than 7 consecutive days (including non-working)
What is the role of Occupational Health in FIT NOTE ?
For patients off work for longer periods of time/ more complex needs
Are placed to support & help people stay in work & live full lives
Key role in ensuring health & well-being of working population by preventing work-related ill health & providing specialist rehab advice
What are the main achievements of OH?
Help prevent work related ill-health
Advise on fitness for work, workplace safety, the prevention of occupational injuries & disease
Recommend appropriate adjustments in workplace to help people stay in work
Improve attendance & performance of workforce
Provide rehab to help people return to work
Promote health in workplace & healthy lifestyle
Conduct research into work related health issues
What are the different FIT Note options?
Phased return to work (start with reduced hrs & build u) Altered hours (work at different times of day) Amended duties (change in work place or content eg less time sitting) Workplace adaptation (change to seating to support back better)
What is the effect of unemployment on health?
Strong association between wordlessness & poor health (unemployment harmful to health)
Increased mortality
Poorer general health, long standing illness
Poorer mental health, psychological distress
Increased medical consultations, medication consumption & hospital admission rates
What effect does re-employment have?
Increased self-esteem, improved general & mental health, decreased psychological distress
What is the definition of sustainability?
Able to continue over period of time
What is sustainability with regards to the NHS?
In relation to low carbon clinical care & environment
In relation to the ability of NHS continuing overtime
“Realistic Medicine”- Scottish policy
What are the aims for Low Carbon Care & NHS Sustainability?
Prioritise environmental health
Substitute harmful chemicals with safer alternatives
Reduce & safely dispose of waste
Use energy efficiently & switch to renewable energy
Reduce water consumption
Improve travel strategies
Purchase & serve sustainability grown food
Self- manage & dispose of pharmaceuticals
Adopt greener building design & construction
What will Low Carbon Clinical Care look like?
Be better at preventing conditions
Give greater responsibility to patients in managing health
Be leaner in service design & delivery
Use the lowest carbon technologies
What ways can you reduce the need to travel (reduce 25% of fossil fuel greenhouse gas emissions)?
Walking/ cycling Multiple clinics on same day Care sharing, fuel efficient vehicles Incentive active travel (cycle to work scheme) Teleconferencing Car pooling Reduce no. of free car parking spaces Liase with council to promote bus links
Which factors may be changing child health & well-being?
Diet
Exercise
Sleep
Screen time
