Year 4 H&S Flashcards
Social & medicolegal implications of epilepsy (4)
- Driving & Employment Barriers (legal requirement to inform DVLA after 1 seizure. Cannot drive until 6 months seizure-free)
- . Social participation (e.g. photosensitive events)
- *Pregnancy *- teratogenic meds (Sodium Valproate) & providing care for baby. Note AEDs safe generally in breast-feedig.
- Mental health depression & stigma
Preventing spread of meningococcal disease (3)
- Post-exposure prophylaxis (Ciprofloxacin) to close contacts in 7 days prior to onset
- Public Health notification
- Chidhood vaccination
Define euthanasia, assisted suicide and “doctrine of double effect”
Euthanasia: deliberately ending someone’s life to to relive suffering
Assisted suicide: assisting someone to end their own life
Doctrine of Double Effect: for example giving a patient a drug to improve symptoms which inadvertedly shortens their life (not deemed immoral, not illegal and doesn’t count as euthanasia)
Distinguish palliative care and end-of-life care
Palliative: relief of a symptom/problem relating to illness without intention to cure or prolong life. Can be delivered alongside disease-directed therapy and can be started at any point in the disease process.
EoL care of paitents in the last year of their life (variable)
List 3 tools used to identify patients at EoL and how are they categorised?
SPICT, GSF-PIG, RADPAC. People at EoL are categorised 5 ways:
* 1. Advanced/incurable/progressive condition
* 2. General frailty + co-existing conditions
* 3. Chronic condition - at risk of dying from acute illness
* 4. Life-threatening acute condition
Define frailty
Distinctive health state related to the aging process where multiple body systems gradually loose their built-in reserves
List 3-4 ways of measuring frailty
- Phenotype Model (Fried) - >3 patient characteristics is predictive of frailty
- Rockwood Clinical Frailty Score - clinical score from 1-8
- Rockwood Cumulative Deficit Model - number of deficits accumulated / time = frailty index
- Electronic Frailty Index (for GPs)
What simple assessments could you do during a consultation to quickly assess frailty? (2 physical, 1 patient self-questionnaire)
- Gait speed (>5 sec to cover 4 metres)
- TUGT (>10 sec to get up, walk 3 metres, sit down)
- PRISMA 7 (>3 reqs review)
List the 4 “frailty syndromes” (geriatric giants) - aka categories of patients in elderly care
- Immobility
- Incontinence
- Falls
- Delirium/dementia
What is included in the Comprehensive Assessment for Older People?
A holistic plan with recommendations for managing geriatric patients. Includes:
1. Identifying frailty (scoring systems and assessments eg TUGT)
2. Care plan
2. Medication review
3. Referal to geriatrician/old age psych if appt
4. Address underlying physical causes
What does the Care and Support Plan include?
A personalised patient-centred plan including
* Management goals for the patient.
* Anticipatory plans - urgent care, escalation, EoL.
* Named contact
* Physical, mental and social support
What is “Fit for Frailty”
A campaign by the BGS with guidance for managing patients with frailty
Osteoporosis: primary prevention & secondary prevention
Primary: lifestyle (weight bearing exercises), optimise/strop offending meds (e.g. steorids), dietary (increase Ca2+ and Vitamin D)
Secondary: Alendronic acid (bisphosphonates) first line for diagnosed osteoporosis (T-score -2.5 from DEXA scan).
Understand the role of the multi-disciplinary team in rehabilitation
REHAB MDT
**Neurologist: **overall responsibility for patient, diagnosis & investigation, prescribing/altering medication/intervention, monitoring progress.
OT: making adaptions for home & Providing support and advice for coping with ADLs
SALT: following dysphasia caused by stroke. Swallowing assessment.
Social workers: involved in social care (managing ADLs, coping at home, family involvement)
Nursing staff: may be reqd to visit the home to give meds, do basic care, check complications
Congitive threrapy - improve memory and cognitive function after sroke
Behavioural therapy: overcoming mental health problems such as depression or PTSD
Home therapy: brain stimulating games
Physio: regain function of limbs affected, balance and co-odrination
Limitations of sucessful rehab
BARRIERS AT 3 LEVELS: PATIENT, STAFF AND ORGANISATIONAL.
- Depends heavily on patient engagement - e.g. engaging in physiotherapy and SALT requires the patient’s motivation
- Can be a long process to recovery, not always linear, may have some set-backs - some deficits may be permanent
- Patient’s comorbidities may prevent successful rehab - e.g. if recovering from surgery unable to partake in physiotherapy
- Not enough specially trained staff
- Pts are limited by access to rehab services - postcode lottery - services (e.g. social workers) are not provided equally throughout the country
Tools to assess risk of chronic back pain (2)
- Yellow flags model
- Start Back Tool
Which biopsychosocial factors does the “yellow flags” model include? (A, B, C, D, E, F, W)
Risk factors for chronicity in back pain:
* Attitudes - negative
* Beliefs - “faulty”/hypochrondriac -catastrophisation
* Compensation - are they awaiting payment for injury?
* Diagnosis - still waiting on one? or limited understanding of diagnosis from doctor? or iatrogenic with no closure on what is causing pain?
* Emotions - stress, anger etc
* Family - overbearing/undersupportive
* Work - taking time off/unable to work properly?
What is the STarT Back screening tool?
A more official version of the yelllow flags system for chronicity in back pain. Categorises it into mild, moderate and severe and gives recommendations for management
Role for physio, osteopathy and chiropractice therapy in mgnmnt of back pain
NICE GUIDELINES:
Yes:
* Manual therapy (used by osteopaths/chiropracters/physio)
* Physio
* Psychological therapy
No:
* Traction (used by osteopaths)
* Orthotics
* TENS
* Acupuncutre
MDT for inflammatory arthritis (RA, psoriatic, enteropathic)
- Rheumatologist
- Specialist nurses
- Psychologists
- Physio
- OT
- Podiatrist & Orthotist (specialist shoes/splints)
Impact of untreated inflammatory arthritis on function and QoL
Impacts:
* Physical: inflammation (worsening of pain), increased risk of heart disease and diabetes
* Psychological: stress, catastrophisation, unpredictability of flare symptoms interfering with ADLS
* Social: burden on friends/family
* Financial: taking time off work, expensie on pain relief
Options available for **complex discharge planning **
= If patients requires specialised care after leaving hospital
* Each hospital has its own policy
* treatment, support, point of contact, emergency contact, safetynetting, charges?, medication TTO 7 days
* Involves nurse in charge, discharge co-ordinator, pharmacist, consultant/doctor
DVLA - neurological disorders - must inform DVLA to have how many months off driving:
* Seizures/Epilepsy
* Syncope -single episode - treated (?) single episode unexplained (?) or 2+ unexplained (?)
* TIA - if one TIA with neurological deficit (?), if one without (?), multiple TIAs over short period (?)
* Narcolepsy - can restart once..?
* Chronic neurological disorders - complete which form?
- Must inform DVLA + 6 mo off for first seizure, for established epilepsy 12 mo off seizure free can reapply for license
- Single - no restriction. Explained and treated - 4 weeks off. Multiple - 6 months. 2+ epiosdes = 12 mo off.
- 4 weeks. 1 month off (don’t need to inform DVLA). 3 mo off & inform DVLA.
- sufficient control over sx
- PK1
Consent guidelines for 14-16
16-18
14-16 - Assess Gillick competence; cannot refuse
16-18: Assume can give consent unless obvious; cannot refuse.
