FRIDAY AFTERNOON SESSIONS Flashcards
What is the most common inflammatory arthritis?
Gout
Why is it important to explore prognosis with patients?
It can affect lives in different ways e.g. occupation loss
Impprtant for involving the MDT
Gives pt closure
Assess trends
What is medical pluralism?
The consistence of both conventional, complementary and alternative medicine for health and illness
What did pts with an inflammatory arthritis identify as things they need support with?
Disease impact and pharm treatment
Care continuity and relations with HCP
Non-pharm treatment
Need for support from family and friends
Support needs relating to work
Self-management support e.g. educational sessions, information
What are yellow flags?
The psychosocial factors associated with the development of persistent debilitating pain
Examples of yellow flags?
Attitudes - belief that pain is harmful, catastrophic thinking, belief that pain must be abolished before returning to work
Behaviours - use of extended rest, poor compliance with physical activity, poor sleep, high intake of substances
Compensation issues - lack of incentive to return to work, disputes over access to benefits
Disability - unfamiliar medical language
Emotions - fear of increased pain with activity, depression, anxiety, stress, social anxiety
Family - over protective partners, lack of someone to talk to
What is the STarT back risk prediction tool?
a short questionnaire that GPs can use to assess an individual’s physical, psychosocial and psychological risk factors for chronic back pain that can be improved with treatment
Score of 4 or more = high risk of chronic back pain
What has been the benefits of using the STarT back risk prediction tool for back pain?
This new approach enables GPs to quickly and easily group patients according to the treatment likely to work best for them
It has led to 50% fewer days off work and 30% fewer sickness certificates
Substantial cost-savings to NHS
On average what is the % chance of any pt in hospital currently dying in the next year?
30%
What is the doctrine of double effect? how does this apply to euthanasias?
This doctrine says that if doing something morally good has a morally bad side-effect, it’s ethically OK to do it providing the bad side-effect wasn’t intended.
Although euthanasia is illegal in the UK, doctors are allowed to administer potentially lethal doses of painkilling drugs to relieve suffering, provided they do not primarily intend to kill the patient.
What is assisted suicide?
This usually refers to cases where the person who is going to die needs help to kill themselves and asks for it. It may be something as simple as getting drugs for the person and putting those drugs within their reach.
What is indirect euthanasia?
This means providing treatment that has the side effect of speeding the patient’s death.
Since the primary intention is not to kill, this is seen by some people as morally acceptable.
What is voluntary euthanasia?
Voluntary euthanasia occurs at the request of the person who dies.
What is non-voluntary euthanasia?
Non-voluntary euthanasia occurs when the person is unconscious or otherwise unable (for example, a very young baby or a person of extremely low intelligence) to make a meaningful choice between living and dying, and an appropriate person takes the decision on their behalf.
Non-voluntary euthanasia also includes cases where the person is a child who is mentally and emotionally able to take the decision, but is not regarded in law as old enough to take such a decision, so someone else must take it on their behalf in the eyes of the law.
What is active euthanasia?
In active euthanasia a person directly and deliberately causes the patient’s death e.g. giving an OD of painkillers
What is passive euthanasia?
In passive euthanasia they don’t directly take the patient’s life, they just allow them to die e.g. withdrawing treatment
Why did we change from DNACPR to ReSPECT forms?
The ReSPECT form has more than just the DNACPR decision
Provides a more holistic approach that is more patient-centred
It promotes shared decision-malig between patients
What is the role of the GMC?
set the standards of patient care and professional behaviours doctors need to meet.
make sure doctors get the education and training they need to deliver good, safe patient care.
check who is eligible to work as a doctor in the UK and check they continue to meet the professional standards we set throughout their careers.
give guidance and advice to help doctors understand what’s expected of them.
investigate where there are concerns that patient safety, or the public’s confidence in doctors, may be at risk, and take action if needed.
What is the Medical Act 1983?
A piece of legislation in the United Kingdom that governs the regulation of the medical profession, particularly the registration and oversight of doctors. It establishes the General Medical Council (GMC), the body responsible for regulating medical practitioners in the UK. The act outlines the following key elements:
Registration
Educationa nd training
FTP
Revalidation
Ethical guidelines
Disciliplnary actins
What are the 5 themes of good medical practice in 2024?
• creating respectful, fair and compassionate workplace
• Promote pt centred care
• Help to tackle discrimination
• Championing fair and inclusive leadership
• Supporting continuity of care and safe delegation
What is a bystander duty?
Being an active bystander means being aware of when someone’s behaviour is inappropriate ans choosing to challenge it
all doctors have a duty to raise concerns where they believe that pt safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work.
If you have reason to believe pt are at risk of death or serious harm you should report concerns to the appropriate person without delay.
Principles of research ethics?
Is it useful? Does it provide values that outweigh any risk or harm?
Is it necessary?
What risks?
Consent? Is there capacity and legal documentation?
Confidentiality?
Is it totally voluntary? No coercion or inappropriate incentives. Autonomy must be respected and protected
Does it have approval if required?
Research should be conducted with integrity and transparency
Which type of research requires approval?
If it involves vulnerable groups e.g. children, disability
If it involves those who lack capacity
If it involves sensitive topics
If it involves access to records of personal or confidential information
If it involves intrusive interventions or data collection methods
Where safety of researcher may be in question
When it may involve data sharing of confidential infromation
What is the human tissues act 2004?
It regulates activities concerning the removal, storage, use and disposal of human tissue.
Why is research ethics approval needed?
in order to protect the dignity, rights and welfare of research participants.
Ensures informed consent
Ensures a risk-benefit assessment is carried out
Compliance with laws
Ensures studies are designed with scientific integrity
Who gives research ethics approval?
Research Ethics COmmittees (RECs)
Health Research Authority (HRA)
What are offences under the Human Tissue Act 2004?
1
Removing, storing or using human tissue for Scheduled Purposes without appropriate consent.
2
Storing or using human tissue donated for a Scheduled Purpose for another purpose.
3
Trafficking in human tissue for transplantation purposes.
4
Carrying out licensable activities without holding a licence from the HTA (with lower penalties for related lesser offences such as failing to produce records or obstructing the HTA in carrying out its power or responsibilities).
5
Having human tissue, including hair, nail, and gametes, with the intention of its DNA being analysed without the consent of the person from whom the tissue came or of those close to them if they have died.
Is abortion a criminal offence in the mainland UK?
If it does not meet the criteria of being before 24 weeks gestation and not approved by 2 independant doctors
How was the 1990 abortion act amended?
Lowered the term limit from 28 to 24 weeks for abortion in cases of mental or physical injury
It also clarified the circumstances under which abortion could be obtained at a later stage
Rules on telemedicine abortions?
For women up to gestations of 9 weeks and 6 days
Woman must go through a thorough assessment
Sufficient safe gaurding must be done
What proportion of women will have an abortion?
1 in 3
How are decisions of abortion made when women dont have capacity?
Decisions are made in the pts best interests
If there are conflicts in making this decision then the Court of protection cn be involved to ensure decisions are being made appropriately within the context of the MCA and abortion act
What are some reasons for pts presenting for an abortion after the first trimester?
• delay in recognising pregnancy
• Foetal anomaly
• Significant changes in circumstances
• Difficulties in accessing the are
• Marginalised/vulnerable or complex and challenging circumstances
• Woman may be unsure if she wants to be pregnant and needs time to think
What is done in the final examination to certify death?
This must be all done for a minimum of 5 minutes…
A/B - auscultation lungs for >1 minute
C - palpate for a pulse for >1 minute and auscultation the heart for >1 minute
D - check for pupillary response/corneal reflex and motor response to pain using supra-orbital pressure
E - pt my be peripherally cold
Time of death is recorded as the time at which all of these criteria have been confirmed
What is the definition of death?
Irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe
When can ‘old age’ be used as 1a cause of death on a death certificate?
If the pt was at least 80 years of age and certain conditions are met
Use of this is discolouraged
What are examples of notifiable deaths?
unexpected or sudden deaths
when the doctor attending the deceased did not see them within 28 days before death
if a death occurs within 24 hours of hospital admission
accidents and injuries
suicide
industrial injury or disease (e.g. asbestosis)
deaths occurring as a result of ill treatment, starvation or neglect
the death occurred during an operation or before recovery from the effect of an anaesthetic
poisoning, including taking illicit drugs
stillbirths - if there is doubt as to whether the child was born alive
prisoner or people in police custody
service disability pensioners
Outline what happens when a death is reported to a coroner?
If the cause of death is clear they will issue a certificate to the registrar saying a post-Mortem or inquest is not needed and the registrar can register the death
They may decide a post-mortem is needed to find out how the pt died. No one can object to this! After this the body can be released for the funeral
A coroner can hold an inquest if the cause of death is still unknown or the pt might have died in a violent/unnatural death or the pt might have died in prison or police custody
What is the ‘great man’ theory?
A theory that suggests that some individuals are born with traits that naturally make them skilled leaders
What is the trait theory?
A theory that leadership traits could be learned or you can be born with them
What are some traits of a good leader according to the trait theory?
Intelligence
Self-confidence
Determination
Integrity
Sociability
Outline the Duke Healthcare Leadership Model?
A model which demonstrates the 5 competencies that leaders should have to be most effective in a healthcare setting: emotional intelligence, teamwork, selfless service, integrity, critical thinking
All of this is around the focus which is being patient centered
What is the authoritarian leadership style?
Aka autocratic leadership
Characterised by centralised power, decisions being made without input from others, controlling and directive
What is the democratic leadership style?
Characterised by the leader actively seeking the views of others in making decisions, encouraging others to be engaged actively in setting direction and providing honest praise and criticism
What is the Laissez-faire leadership style?
Characterised by a lack of direction by the leader, non-participation in most work activities and little or no feedback from leader to followers
Viewed by some as non-leadership rather than a style!
What is the full range of leadership model?
By bass and avolio
A model which identifies 3 leadership processes:
- transactional (uses rewards and punishments to promote compliance/incentivise)
- transformational (motivating anc empowering others)
- laissez-faire (absence of leadership)
