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Flashcards in 581 Midterm Deck (28)
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1

Gram + bacteria characteristics

thick peptidoglycan layer that stains purple violet; allows bacteria to survive unfavorable conditions in "suspended animation." Allows you to determine how to treat certain diseases and/or what kind of treatment

2

Clostridium difficile

gram + spore forming bacillus that causes GI disease. It lives naturally in gut flora. Due to factors that disturb the gut flora environment, this opportunistic organism grows at rates causing diarrhea & abdominal pain.

3

Risk factors for c.diff

abx use: fluoroquinolone (cipro, levofloxacin) and clindamycin
age
gastric aid suppression
GI surgery
Long length of stay in hospital
serious underlying illness

4

C.diff microbiology

Gram + anaerobic spore forming bacteria that produces:
- Enterotoxin A
- Cytotoxin B

5

C.diff Toxin A

Enterotoxin that destroys tight cell junctions = INC permeability of the intestinal wall = diarrhea; nonvirulent

6

C.diff Toxin B

Cytotoxin that targets actin and destroys cellular cytoskeletons; essential for virulence

7

What does c.diff do to the gut?

- colonocyte death
- loss of intestinal barrier function
- neutrophillic colitis
- inflammation and fluid buildup
- inflamed cells burst & die
- spores leave colon via diarrhea

8

C.diff disease presentation

Watery diarrhea
Low abdominal pain, cramping
low grade fever
nausea
elevated WBC

9

Diseases caused by c.diff

psudomembranous colitis PMC
toxic megacolon
perforations of the colon
sepsis
death

10

C.diff diagnosis

toxin detection in feces; no way to distinguish active infection v carrier state
Use this test for patients in-hospital who are having symptoms

11

C.diff Treatment

stop taking abx
place in isolation precautions
oral vancomycin or fidaxomicin; if one fails try the other
fecal transplant if recurrent

12

C.diff prevention and control

contact precautions: single patient room, use of gloves/gown by those that come in
wash hands
Clean rooms with sporicidal antiseptics
Use disposable equipment

13

5 steps to drug research

1. discovery & development
2. preclinical research
3. clinical research
4. FDA review
5. post market monitoring

14

4 clinical trial phases

1. assess drug safety/dosage; 20-100 healthy volunteers with the disease/condition; 70% move forward
2. efficacy and side effects; 100s of people; 33%
3. compare new and current treatment; 100s-1000s of volunteers; 25-30%
4. safety and efficacy: several thousand volunteers

15

Genetically engineered monoclonal antibodies

specifically bind to a substance
Bezlotoxumab binds to c.diff toxin B
Actoxumab binds to c.diff toxin A

16

Hospitalist

in-patient PCP; first specialty based on patient location and not organ system

17

Hospitalist team

hospitalist, consulting MDs, advanced care practitioners, nurses, case managers, social workers, pharmacists

18

patient centered care

providing care that is respectful and responsive to individual preferences, needs & values

19

patient experience

sum of all interactions that influence patient perceptions across a continuum of care

20

patient engagement

actions taken by individuals to obtain the greatest benefit from the healthcare services available to them

21

Healthcare value should include

cost, outcomes (quality of care) and patient experience

22

Value v Cost

High cost + high value= MRI epidural abcess
High cost + low value = routine MRI LBP
Low cost + high value = universal HIV screening
Low cost + low value = preoperative testing prior to low risk sx

23

cost

actual numerical dollar value of interventions + unintended consequences like side effects or pain; INC by improving quality of care at lower cost or by reducing total cost & maintaining quality

24

Triple aim for healthcare improvement

improve the experience of care, improve the health of populations, reduce per capita cost of healthcare

25

To Err is Human

research report concluding a high number of patients dying each year due to medical error, blaming the healthcare system as a whole and brought focus to patient safety

26

IOM report

how we deliver care is just as important as what care is delivered; we need interprofessional approaches = patent centered care, timelier, more efficient

27

competency

ability or skill needed to perform a particular role, knowledge in a particular domain, or a value that can be expressed

28

4 competency domains

1. values/ethics
2. roles/responsibilities
3. communication
4. teams/teamwork