3rd year Flashcards
(130 cards)
1
Q
what are the most common causes of death today
A
cancer and IHD
2
Q
what are the most common causes of death in the young
A
accidents - 38% boys, 23% girl s
men 15-34 suicide
3
Q
what is meant by an expected death
A
terminal care of last phase when condition is deteriorating and death is close
4
Q
what is the reaction to an unexpected death
A
profound sense of shock - no chance to say goodbye
5
Q
what is the WHO definition of palliative care
A
palliative care improves the quality of life of patients and families who face life threatening illness, by providing pain and symptoms relief, spiritual and psychosocial support from diagnosis to end of life and bereavement
6
Q
what is the philosophy of palliative care
A
emphasis quality of life
7
Q
where is most palliative care provided
A
primary care
help form specialist practitioners and care units/ hospice
8
Q
what is the aim of the living & dying well 2008 document form the sottish government
A
palliative care not just about last few days of life, but about ensuring quality of life for both patients and families at every single stage of disease from diagnosis onward
9
Q
what different needs of the patient and carers should be met by palliative care
A
physical, practical, functional, social, emotional and spiritual
10
Q
why are doctors encourage to identify possible palliative care patients early
A
can discuss wishes
try to care for them where and in the way they want to be treated
11
Q
what tool is used to identify patients suitable for palliative care
A
supportive an palliative care indicators tool
life limiting diagnosis, worsening chronic condition
12
Q
what is the first stage of palliative care
A
anticipatory care planning
13
Q
what things are considered in an anticipatory care plan
A
where they want to be cared for
do they want resuscitated
who to inform of care and changes in condition
awareness of prognosis
14
Q
what is the point of people being placed on the palliative care register
A
if patient is admitted out of hours anyone else will know their wishes
15
Q
what does a GP practice do when a patient is on the palliative care register
A
have regular MDT meetings and review patent regularly
16
Q
after someone has made an anticipatory care plan, what its their next step
A
placed on palliative care register
17
Q
what is the palliative performance scale used for
A
evaluate how quickly the situation is changing for the patient and see if their care needs re-evaluated
18
Q
what is the palliative performance scale evaluated on
A
ambulation activity and evidence of disease self care intake conscious level
19
Q
what is the most common symptom of palliative pateitns
A
pain
20
Q
what people may be involved in palliative care
A
health & social care partnership team macmillan nurses marie curie nurses CLAN religious/ cultural groups
21
Q
what is regarded as a ‘good death’
A
pain free
open acknowledgement
at home surrounded by family and friends
resolved personal conflicts
according to personal preference and in a manner that resonates with the persons individuality
22
Q
what does WHO palliative care integrate
A
psychological and spiritual aspects of patient care
23
Q
what does the WHO palliative care provide relief form
A
pain and other distressing symptoms
24
Q
what does WHO palliative care regard death as
A
normal process
25
why does WHO palliative care offer a support system
help families cope during the pateitns illness and in their own bereavement
26
what part of palliative care may be needed after the patient has died
bereavement counselling
27
what is most people preferred place of death
home - 26% achieve
28
what framework helps primary care to provide palliative care at home
gold standards framework
| - cancer register, review patients, reflective practice
29
what are important considerations in breaking bad news
```
listening
setting the scene
find out what patient understands and wants to know
share information in a common language
review and summarise
allow questions
agree follow up and support
```
30
what are the stage in adjustment to grief
```
shock
anger
denial
bragainsing
relief
sadness
fear
guilt
anxiety
```
31
how long may grief take
months or years - individual
32
what percentage of deaths occur in hospices
15-20%
33
what is euthanasia
deliberate ending of a persons life with or without their request (voluntary/ non- voluntary)
34
is physician assisted suicide legal in the UK
no
35
how should you respond to a patient that says they want to die
```
listen
acknowledge issue
explore request reason
explore ways of giving patient more control
look for treatable problems
```
36
what is sustainability
ability to continue over a period of time
37
give 3 examples of sustainability
global sustainability
sustainability of the NHS
personal and career sustainability
38
why is global sustainability important to healthcare
```
material inequality
growing population and consumption
resource depletion
climate change
loss of biodiversity
crisis in healthcare
```
39
why is there a big material inequality in the world
world'd wealthy are getting rich while at least half the population live on less than £1.30 a day
40
why is there a crisis in healthcare due chronic health problems
with increasing ageing population, increase in chronic diseases
41
what is the carbon footprint
measure of greenhouse gases emitted through burning fossil fuels, always converted into carbon equivalent
42
what are health benefits of walking and cycling to cut emissions
reduction in diabetes, CV disease and depression
43
what are some actions that could be taken against global warming
Increase use of renewable energy resources
Modifying human behaviour, being more active
Move back to more plant based diet
Educate on carbon literacy and numeracy
Promote patient resilience
Teach healthcare students that as well as human anatomical systems we are also part of a wider ecological system
44
what is a renewable energy source
any natural energy resource that can be replenished with the passage of time
45
according to theSustainability Development Unit’s document, what % of short term reduction in emissions is technically feasible without compromising standards of care
40%
46
what are the 10 goals to make the NHS sustainable (NHS
| Sustainability Development Unit’s Strategy Document )
1. Prioritise Environmental Health
2. Substitute harmful chemicals with safer alternatives.
3. Reduce and safely dispose of waste
4. Use energy efficiently and switch to renewable energy.
5. Reduce water consumption
6. Improve travel strategies
7. Purchase and serve sustainably grown food
8. Safely manage and dispose of pharmaceuticals
9. Adopt greener building design and construction.
10. Purchase safer more sustainable products
47
what is the national target for carbon reduction by the health service
more than 80% reduction in emissions over the next 30 years.
48
what is the greatest carbon emission form NHS england
purchasing of goods and services,
| 22% is from purchase of pharmaceuticals
49
what will low carbon clinical care be
Be better at preventing conditions
Give greater responsibility to patients in managing their health.
Be leaner in service design and delivery
Use the lowest carbon technologies
50
why should effective contraception be more widely and easily available worldwide
help reduce the financial, social and environmental effects of unwanted pregnancies
51
what are strategies to decrease the deaths worldwide from malnutrition, diarrhoea and infectious disease
Increasing access to clean water, proper sanitation and education on hygiene techniques such as hand washing
52
how should the NHS be better at preventing conditions
Specialities should aim to tackle underlying causes of disease ; the social, economic and environmental determinants of health
53
give an example of how we could give greater responsibility to patients in managing their health
the use of information prescriptions instead of medication prescription
54
give examples of how the NHS could Be leaner in service design and delivery
combine clinics for diabetes, cardiovascular and stroke
eliminate duplication and poorly targeted investigations
Reduce steps in patient pathway of referral to treatment
Greater use of online records, email and telephone can reduce travel emissions by moving information
More effective prescribing
increase compliance - reduce disposal of unused drugs
55
how does the NHS plan to use the lowest carbon technologies
allow service planners, clinicians and patients to choose clinically effective treatments with the best environmental profile eg green nephrology project
56
how much is the NHS scotland increasing to stop privatisation
2 billion
57
what to things have been integrated in scotland since 2016 to share funding
health and social care
58
how much is being invested by the government in GP practice resilience programmes
56million
59
what are some changed to the G contract
reduce workload, improve recruitment
| additional members to practice teams
60
what is the WHO definition of health and what might it be changed to
a complete state of physical, mental and social wellbeing and not merely the absence of disease’
to
‘resilience, adaptation and self management in the face of physical, social and emotional challenges’
61
what is resilience
ability to quickly return to a previous good condition.”
62
list some positive factors contributing to a sustainable career
Job Security
Financial Security
Stable Terms and Conditions
Respect for Professionalism and Knowledge.
Appreciation for being in the role of a doctor.
Working with a team over time.
Ability to develop knowledge and interests.
Ability to fit work around interests and lifestyle choices.
63
list some challenges to a sustainable career
Considerable and rapid workload – for example 10 minute appointments
Time management.
Increasingly complex care over time.
Relentless arrival of mail/ results, and having enough time to action them diligently.
Care versus cure - long term conditions
Perhaps running a business over time.
Need to ensure the team is harmonious and effective.
64
what is an occupational history
An occupational and environmental history is a chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, exacerbated an existing health problem or has ill health had an impact on the patient’s capacity to work.
65
what does an occupational history contain
description of the present and previous jobs from leaving school.
Identifying any exposure to chemicals or other hazards ( may need to see confirmation from labels).
Did the symptoms improve when not exposed e.g. at weekends, holidays?
Determine the duration and intensity of exposure e.g. was it so noisy it was impossible to communicate
Is personal protection used e.g. what kind of mask?
What maintenance is in place for the protection measures?
Do others suffer similar symptoms?
Are there known environmental hazards in use?
Any hobbies, pets, worked overseas, moonlighting?
66
are fit notes job specific
no - fit or not to work in general
67
what is the purpose of a fit note
to facilitate earlier discussion about returning to work and about rehabilitation
68
who can complete a fit note
only a doctor
69
what do the new fit notes now include
items of consideration for employers when signing a patient’s return to work.
70
when is a fit note requires
the patient has been off more than 7 consecutive days ( including non working days)
71
what is the role of occupational health specialists
to support and help people stay in work and live full and healthy lives.
preventing work-related ill health and providing specialist rehabilitation advice.
72
what are the roles of occupational health services
Help prevent work-related ill health
Advise on fitness for work, workplace safety, the prevention of occupational injuries and disease
Recommend appropriate adjustments in the workplace to help people stay in work
Improve the attendance and performance of the workforce – for example by assisting in the management of sickness absence
Provide rehabilitation to help people return to work, and give advice on alternative suitable work for people with health problems
Promote health in the workplace and healthy lifestyles
Recommend and implement appropriate policies to maintain a safe and healthy workplace
Conduct research into work related health issues
Ensure compliance with health and safety regulations including minimising and eliminating workplace hazards
Advise on medical health and ill-health retirement
73
what proffesions are involved in modern occupational health
doctors
occupational health specialists
nurses, ergonomists, hygienists, occupational health advisors, physiotherapists, psychiatrists, psychologists and therapists
74
what does re-emplyment lead to
improved self-esteem, improved general and mental health, and reduced psychological distress and minor psychiatric morbidity.
(same magnitude as job loss)
75
what are effects of unemployment of health
higher mortality;
poorer general health, long-standing illness, limiting longstanding illness;
poorer mental health, psychological distress, minor psychological/psychiatric morbidity;
higher medical consultation, medication consumption and hospital admission rates
76
what 4 things affect health and what 3 can be targeted by health promotion
Access,
Environment and
Lifestyle.
NOT genetics
77
how does health promotion work
It promotes health through a combination of legislation, the provision of preventative services such as immunisation and the development of activities to promote and maintain change to a healthier lifestyle.
78
what are the 3 different theories of health promotion
Educational
Socioeconomic (radical)
Psychological
79
what is the educational theory of health promotion
Provides knowledge and education to enable necessary skills to rate informed choices re health – may be menone –to-one group workshop
e.g. smoking, diet, diabetes
80
what is the socioeconomic theory of health promotion
‘Makes healthy choice the easy choice’
| National policies e.g. re unemployment, redistribute income.
81
what is the psychological theory of health promotion
Complex relationship between behaviour, knowledge, attitudes and beliefs. Activities start from an individual attitude to health and readiness to change. Emphasis on whether individual is ready to change. (e.g. smoking, alcohol).
82
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.
83
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.
84
what is health protection
-involves collective activities directed at factors which are beyond the control of the individual. Health protection activities tend to be regulations or policies, or voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being.
85
what is primary prevention of heath aimed at
preventing the onset of the disease by removing or altering aetiological factors e.g. immunisation
86
what is secondary prevention aimed at
to detect a disease at an early (pre-clinical) stage to achieve cure, prevent recurrence or reduce complications e.g. cervical screening
87
what is tertiary prevention aimed at
-measures which aim to limit the disability or distress caused by a disease (encompasses rehabilitation) e.g. OT following a stroke
88
what is empowerment
the generation of power in those individuals and groups which previously considered themselves to be unable to control situations nor act on the basis of their choices.
89
what are 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.
90
give some challenges to health promotion
doctors cynical if resources are well spent
| not good evidence
91
describe the cycle of change
precontemplation > contemplation > ready for action > action > maintenance /> regression
92
what are some examples of health promotion in primary care
Planned – Posters, Chronic disease clinics, vaccinations, QOF
Opportunistic – Advice within surgery, smoking, diet, taking BP
93
what are some government examples of health promotion
Legislation – Legal age limits, Smoking ban, Health and safety, Clean air act, Highway code
Economic – Tax on cigarettes and alcohol
Education – HEBS (ask students to recall adverts they’ve seen)
94
what is primary prevention
Measures taken to prevent onset of illness or injury
Reduces probability and/or severity of illness or injury
e.g. Smoking Cessation or Immunisation
95
what is secondary prevention
Detection of a disease at an early (preclinical) stage in order to cure, prevent, or lessen symptomatology”
96
what is wilsons criteria for screening
Illness – important, natural history understood, pre-symptomatic stage
Test – easy, acceptable, cost effective, sensitive and specific
Treatment – acceptable, cost effective, better if early
97
what is tertiary prevention
“measures to limit distress or disability caused by disease” e.g. OA, motor neurone disease eg OT physio care manager
98
what is homeostasis
a tendency to stability
99
what is the role of parenting on lifelong health
Habits and lifestyles established in adolescence
Smoking is more than twice as likely if your parents smoke
Neglect and abuse recur.
100
what are the common reasons for a child seeing their GP
Feeding problems (new babies especially) pyrexia, URTI, coughs/colds, rashes, otalgia, sore throat, vomiting +/- diarrhoea, abdominal pains, behavioural problems (older infants and will depend on area / parent(s) situation).
101
what are important aspects of consultations with children
Listening, watching, observing, examining properly, putting child at ease as well as parent / guardian, be seen to take it seriously, parental understanding, explain in clear language what your thinking is and plans are
Ethnic issues, language issues, referring if necessary, reporting if necessary [child protection issues])
102
why might parents present a child to GP that is actually well
someone else urging them to act, anxiety re a normal illness, inexperience, single parent with no support, parenting difficulty manifesting as child illness, parent depression / anxiety, social issues, child presenting to them with difficult symptoms to interpret, child abuse by a partner
103
how might a GP manage an overly anxious patient
listening, examining, considering ICE, rapport, explaining properly, consensus, allowing questions, offering second opinion, no dogma, facilitating a return visit.
104
what percentage of families eat together on weekdays and weekends
weekdays - 58%
| weekends - 61%
105
how much sleep do teenagers need a night
8-10 hours
106
what % of teenegers report getting 8 1/2 hours sleep on school nights
15%
107
what affects does screen time have on us
detrimental effect on sleep quality, and physical and cognitive ability. It can result in poorer mental health.
108
what are the NHS guidelines on exercise for teenagers
at least 60 minutes of moderate to vigorous exercise daily for teenagers.
109
what is the average weekly screen time in children
24 hours a week
110
what are the 6 principles of realistic medicine (2015)
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
111
what is a citizens panel
large, demographically representative group of citizens regularly used to assess public preferences and opinions
112
what are the 5 questions from choosing wisely UK to prompt better conversations between clinicians and patients
is this test/ treatment/ 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?
113
according to the survey by Our Voice's panel, what makes a good doctor
knowledge / qualifications
good listener
friendly/ approachable
114
according to the survey by Our Voice's panel, what are the most important elements of a consultation
feeling listened to/ not rushed
clear communication
resolution/ diagnosis/ outcome
115
what is the role of the scottish intensive care society audit group
informs and design ways that routine data can be used to design routine quality monitoring and improvement systems across the country
116
define sociology
The study of the development, structure and functioning of human society
117
what things does sociology study in health
peoples’ interactions with those engaged in medical occupations
the way people make sense of illness
the behaviour and interactions of health care professionals in their work setting
118
what are health care professional role in the sick role
be objective and not judge patients morally
not act out of self-interest or greed but put patient’s interests first
obey a professional code of practice
have and maintain the necessary knowledge and skills to treat patients
has the right to examine patient intimately, prescribe treatment and has wide autonomy in medical practice
119
give some benefits of volunteering
```
gain confidence
make a difference
met people
be part of a community
learn new skills
take on a challenge
```
120
what things to voluntary sector organisations do
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 relevant services NHS Health Scotland
121
are well educated people likely to be more or less heathy than less educated
more healthy
| better understanding of health, more effective engagement with health care services such as screening programmes
122
what things does employment provide for people
financial security
social contacts
status in society
purpose in life
123
how is GP not equal in scotland
distribution of GPs across Scotland does not reflect the levels of deprivation
124
what are health benefits of active travel such as cycling and walking
improved mental health, reduced risk of premature death, prevention of chronic diseases such as coronary heart disease, stroke, type 2 diabetes, osteoporosis, depression, dementia and cancer
125
how does the media influence our health
Shapes and stereotypes our views
| Shapes our expectations
126
what is the key determinant of health inequalities
deprivation
| age, gender, ethnicity also
127
what health affects are children in the most deprived areas likely to have
more likely to have lower birth weight, poorer dental health, higher obesity and higher rates of teenage pregnancy
128
list some vulnerable groups
```
homeless
learning disability
refugees
prisoners
LGBT
```
129
what is meant by inverse care law
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
130
give factors that 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
