Public Health Flashcards
(271 cards)
1
Q
What are the most common type of autopsy
A
Medico-legal autopsies (NOT hospital autopsies)
2
Q
When are hospital autopsies done
A
Audit
Teaching
Governance
Research
3
Q
When are medico-legal autopsies done
A
Coronial autopsies
Forensic autopsies
4
Q
What types of deaths are referred to the coroner
A
- PRESUMED natural (cause of death not known and not seen by doctor in last 14 days)
- PRESUMED iatrogenic (Postoperative deaths, anaesthetic deaths, abortions and complications of therapy)
- Presumed unnatural (accidents, neglectiion)
5
Q
Who makes referrals to the coroner
A
- DOCTORS
- Registrar of BDM
- Relatives
- Police
6
Q
Do doctors have a statutory duty to refer to the coroner
A
No
7
Q
Who has a a statutory duty to refer
A
Registrar of BDM
8
Q
Who usually performs autopsies
A
Histopathologists: Hospital and coronial autopsies
9
Q
When do forensic pathologists perform autopsies
A
Homicide Death in custody Neglect Drowning Fire deaths
10
Q
What four questions do coroners try to answer in the coronal autopsy
A
- Who
- When they died
- Where they died
- How they died
11
Q
What is the Coroners Act of 1988
A
- Allows coroner to order an autopsy where death is due to natural causes = CAN’T AUTHORISE SPECIAL INVESTIGATIONS
- Allows coroner to order an autopsy where death is unnatural and inquest is needed = CAN authorise special investigation
12
Q
What is the Coroners Rule of 1984
A
- Autopsy as soon as possible
- By a pathologist of suitable qualification
- Report findings promptly and only to coroner
- Autopsy only on appropriate premises
13
Q
What is the Amendment Rule of 2005
A
- Pathologist must tell coroner what materials have been retained
- Coroners authorise retention and sets proposal date
- Informs family of retention
- Family choice evaluated
- Coroner informs pathologist of family’s decision
- Pathologist keeps record
- Autopsy report MUST declare retention and disposal
14
Q
What choices do the family have in regards to retention of material by the pathologist
A
- Return material back to them
- Retain for research
- Respectful disposal
15
Q
What is the Coroners and Justice Act of 2009
A
- Coroner can defer opening inquest and launch an investigation
- Inquests have conclusions and not verdicts
16
Q
What is the Human Tissue Act of 2004
A
- Autopsies can only be performed on liscenced premises
- Consent from relatives for any use of tissue at autopsy if not used of criminal justice purposes
- Public display of information requires consent from the DECEASED
17
Q
Outline the stages of an autopsy
A
- History
- External Examination
- Evisceration
- Internal Examination
- Reconstruction
18
Q
What three investigations can be done during external examination of the body
A
- Microbiology
- Toxicology
- Radiology
- PHOTOGRPAHY
19
Q
What four investigations are done in internal examinations
A
- genetics
- Photography
- Histology
- Microbiology
20
Q
What is external examination
A
- Formal identifiers: Age, body habits, jewellery, body modifications (tattoos), clothing)
- Disease + Treatment (why)
- Injuries
21
Q
How is Evisceration carried out
A
- Y-shaped incision
Open all body cavities and examine in situ
Remove abdo and thoracic organs
Remove Brain
22
Q
What is internal examination
A
- Examine organs, VESSELS, systems (CNS, GU)
Like a biopsy (cross-section samples taken)
23
Q
Why is compliance to therapy important
A
- Costs of unused medicines (have to be returned and disposed of)
- Impact life expectancy
24
Q
Define compliance
A
- Patient SHOULD follow doctors orders (passive patients)
25
Define Adherence
1. The extent to which the patient's actions match AGREED recommendation
26
Examples of non-adherence
1. Not taking prescribed medication
2. Taking bigger/smaller doses than prescribed
3. Taking more or less medication than prescribed
4. Modifying treatment to accommodate other activities
5. Continuing with behaviours against medical advice
27
Unintentional reasons for non-adherence
1. Difficulty understanding instructions
2. Problem using treatment
3. Can't Pay
4. Forgetting
CAPACITY AND RESOURCES
28
Intentional reasons for non-adherence
1. Patient belief about their condition
2. Beliefs about treatment
3. personal preferences
PERCEPTUAL BELIEFS
29
Consequence of non-compliance in organ transplant post-op treatment
DEATH or rejection
30
What is the Necessity-Concerns Framework
NECESSITY BELIEFS - Perception of personal need for treatment
CONCERNS - About a range of potential adverse consequences
31
What happens to Necessity beliefs and concern levels in achieving adherence
Necessity beliefs increase
Concerns DECREASE
32
What is Patient-Centredness
1. Encourages focus in consultation on patient as a whole person who has individual preferences
2. Shared control of consultation, decisions and management of health with patient
33
What ar the four imparts of good doctor-patient communication
1. Better health outcomes
2. High adherence to therapeutic regimens in patients
3. High patient and clinician satisfaction
4. Decrease in malpractice risk
34
Define Concordance
1. Doctors are not INSTRUCTING but consulting with patients as equals = on the same page as each other
35
Outline concordance
1. Take into account both yours and patient views
2. Outline options
3. Check understanding
4. Explore concerns
5. Consent
6. Review over time
36
What are some barriers to concordance
1. Patients may not want to engage in a convo with doctor
| 2. Patients might want doctors to tell them what to do
37
How can health professionals cause barriers to concordance
1. Not have time/rescources
2. Patient choice vs evidence
3. Lacking social skills
38
What is the health Act of 2006
1. Infection control is EVERY health care workers responsibility
39
What are some of the key departments which have th ereposnsibility of infection prevention and control
1. Infection prevention and control team
2. Ward teams
3. Microbiology labs
4. Estates
5. Domestic services
6. Pharmacy
40
Infection vs colonisation
1. Infection involves harm to individual
| 2. Colonisation is the presence of bacteria in the body but not harm is being done
41
What are the principles of IPC
1. Identify risk
2 .ROutes and mode of transmission
3. Virulence of organism (so how easily it spreads, likelihood of infecting and consequence of infection)
42
How can infections spread in a hospital
1. Environment (if not sterile)
2. Patient if not isolated
3. Staff
43
What bacteria produce Carbapenemase
Enterobacteriacae (Coliforms, E.coli)
44
What have we started replacing beta-lactam antibiotics with
Carbapenems
So they are becoming ineffective
45
Name the type of carbapenemases
1. Class A (KPC)
2. Class B (NDM-1, IMP)
3. Class D (OXA)
46
What does Norovirus cause in adults
GASTROENTERITIS
47
How is norovirus spread
CLOSE CONTACT
48
How do prevent most infections
HAND WASHING
49
When should we wash our hands
```
Between meeting patient s
In/Out of toilets
After handling items that are soiled
Before and after an aseptic procedure
After removing protective clothing
```
50
When should we use alcohol gel
Before and after invasive procedure
Following handwahsing
Between tasks when hands ar visibly clean
51
What are endogenous infections
Infection of a patient by their own flora
52
How do prevent endogenous infections
1. Hydration
2. Antisepsis
3. Underlying disease control
4. Remove catheters and lines asap
53
Define appetite
Desire to eat food
54
Define hunger
Need of eating
55
Define anorexia
Lack of appetite
56
Define satiety
Feeling of fullness
57
Define BMI
Weight (kg) / Height^2
58
Risks of obesity
Type II diabetes
2. Hypertension
3. CAD
4. Osteoarthritis
5. Carcinoma of breast, colon and prostate
59
Why od we eat
1. Internal physiological drive
| 2. External stimuli
60
What part of the brain is the hunger centre
LATERAL hypothalamus
61
Where is the satiety centre located
VENTROMEDIAL hypothalamic nucleus
62
Why si diabetes a public health issue
1. MORTALITY (under-reported on certificates)
2. DISABILITY (neuropathies and PAD)
3. Co-morbidity
4. Reduce QOL
5. Increasing prevalence and affecting younger people
63
Who is at risk of diabetes
1. Sedentary jobs, sedentary leisure activities
2. Diet high in calorie dense foods
3. Obesogenic neviornment
64
What is an obesogenic environment
1. TV, car culture, lifts (physical envionrment)
2. Cheap fatty foods, expensive veg (economic environment)
3. Safety fears family eating patterns (sociocultural environments)
65
What mechanisms maintain being overweight
1. Physical (more weight = more difficulty in exercising and changing diet)
2. Psychological (low self-esteem and guilt = comfort eating)
3. Socioeconomic (reduced opportunities of employment, relationships and social mobility)
66
How do we prevent diabetes
1. Sustained increase in physical activity
2. Sustained change in diet
3. Sustained weight loss
67
how can we diagnose diabetes earlier
1. Raise awareness in community
2. Raise possible symptom awareness in health professionals
3. Using clinical records to identify those at risk
68
How is NHS England investing in type II diabetes prevention
1. Healthier You: NHS Diabetes Prevention Programme
| 2. Programme of lifestyle education : Weight loss support
69
Supporting self-care for diabetes
1. Self-monitoring
2. Diet
3. Exercise
4. Drugs (taking medications)
5. Education
6. Peer support
70
Outline the four stages of managing diabetes
1. Identify those at risk
2. Early prevention
3. Diagnosing diabetes earlier
4. Management and support
71
What are the characteristics of a virtuous doctors
1. Flexible
| 2. Compassionate
72
Define a virtuous doctors
One who decides which opportunities of goo neighbourliness respond to the basis of need than favouring people of a particular race religion or charm
73
What is the four quadrant approach of medical ethics
1. Medical Indications (Beneficence and Nonmaleficience)
2. Patinet preferences
3. QoL (Beneficence and Nonmaleficience)
4. Contextual features (loyalty and fairness)
74
What is medical indications
Include a review of diagnosis and treatment options
75
What is patient preferences
Patient values are integral to encounter
76
What is QoL
Objective of all clinical encounters is to improve QoL for patient
77
What are contextual features
Encounters involve family, law, policy and insurance companies etc
78
What is the complexity theory
Requirement to understand why we need to consider the 'connectedness' of the living world
79
Define connectivity and interdependence
Behaviour of one individual may affect others or wider systems
80
Define co evolution
Adaptation or changes by one organism alters other organisms (patient and doctor coevolve)
81
Define far from equilibrium
Exploring possibilities of being pushed away from equilibrium is essential for surviving and flourishing (string away from your comfort zone)
82
What makes a good doctor
1. Connectivity and interdependence
2. Co evolution
3. Far from equilibrium
4. History
5. Feedback
83
Define history
Patient and doctors are influenced from pas events
84
What is Gestalt principle
Whole is more than the sum of paths (self-organisation and creation of new order)
85
Define the inverse care law
Availability of good medical care tends to vary inversely with th need for it in th population served
86
IN what community is type II diabetes most common in in sheffield
Pakistani
87
Why is this the case
1. No Community Diabetes Education courses)
88
What community has a large prevalence of hep B
Roma Slovak
89
What are BAME groups
Diverse and heterogenous group with varying experiences of inequity
90
What is the difference between Race and ethnicity
Race: Based on physical characteristics on which human kind was divided
Ethnicity: Group of people whose members identify with each other through common heritage (language, culture and ideology)
91
Define BME
1. Umbrella term to describe people from minority groups who share common experiences of discrimination of inequality because of their ethnic origin, language and religion
92
Define inequity
Lack of fairness of justice (factors controlling health lead to disadvantages of a group of people- health inequity)
93
Difference between inequity and inequality
Inequity = how things shouldn't be
Inequality = descriptive concept
94
3 features of socioeconomic positions
1. Income
2. Class
3. Status
95
Define vulnerable
Inability to cope in a hostile environment
96
Define social exclusion
Inability of an individual group to participate effectively in economic, social, political and cultural life
97
What factors affect health
1. Gender
2. Geography
3. Disability
4. Age
5. Ethnicity
6. Artefact
98
What genes are reposnsible for increased cancer risks in jewish community
Ty-Sachs gene
99
Define consanguinity
Reproductive union between two relatives
100
Define social prescribing
Helping patients to improve their own health by connecting them to community services
101
Define meritocracy
Certain things such as power or economic goods should be vested din individuals on the basis of talent, effort and achievement than sexuality ,race, gender age or wealth
102
Define egalitarianism
Quality for all people (all people should be treated the same)
103
Define libertarianism
AUTONOMY (stresses freedom of choice)
104
Define utilitarianism
Actions are right if they benefit a majority
105
Define health literacy
Degree to which individuals have the capacity to obtain, process and understand basic health information to make appropriate decision
106
What fie principles of truth-telling do doctors have to consider
1. Do no harm
2. Do not kill
3. DO not bear false witness
4. Keep patient's secrets
5. Don't have inappropriate relationships with patients
107
Define medical ethics
1. Critical evaluations of assumptions and arguments
| 2. Inquiry into norms and values (what is good or bad, right or wrong)
108
Define clinical truth
Contextual, circumstantial and person truth that is objective
109
Define deontology
We owe a duty of care to each other
110
Define formula of universal law
Before acting, consider: could I live in a world where everyone acted this way
111
Define formula of humanity
People are always treated as ends themselves not as means to an end
112
How do deontology and truth-telling relate
Compels whole truth telling in a way that is not necessarily the most helpful (telling a patient they are terminal when relatives said he would kill himself if the news was bad)
113
Cons of deontology in truth telling
Ignores consequences
114
Define consequentialism
Consequences are important, actions are not
115
Con of consequentialism
Hard to predict consequence of one's actions
Actions can be wrong even if consequences are good
116
Define virtue ethics
Characteristics that promote human flourishing
117
Name some virtue ethics
1. Compassion
2. Patience
3. Kindness
4. Fidelity
118
Pros of virtue ethics
Centres ethics on the person and what it means to be human
119
Cons of virtue ethics
1. No clear guidance on moral dilemmas
2. No agreement on what constitutes a good virtue
3. Relative to the culture
120
Define autonomy
Right to self-determination
121
What can limit autonomy
Lack of mental capacity or in children
122
Con of autonomy in truth-telling
Reduces doctor to information-provider
123
How does autonomy link to truth telling
Insist on telling whole truth without delay
124
Define beneficence
Medical practice always seeks to benefit patients
125
Define non-maleficience
Medicine aims to do no harm to patients
126
When can non-maleficence be broken
1. Medication side-effects
2. Surgical wounds
3. Infections risks
127
Define justice
1. Discrimination should not be done on basis of race, gender or disability
2. Efforts should be directed without reference to our likes or dislikes
128
Why should we tell patients they are about to die
Can prepare physically, emotionally and spiritually
129
What ethical principles are we considering when disclosing death to patient
1. Beneficence
| 2. Non-maleficence
130
What is hippocratic paternalism
When bad news could be taken as destroying hope so concealment might be in the patient's interest
131
What is candour
Openness without compulsion
Used to disclose error or uncertainty to patient
1. Put matters right
2. Apologise
3. Explain to the patient what has happened and its effects
132
Define aleatory uncertainty
I can't know anymore
133
Define Epistemic uncertainty
I don't know any more
134
Define ethical uncertainty
I don't know what I should do
135
Define choice uncertainty
I don't know what I want to do
136
What is whistle-blowing
Raising concerns about a person, practice or organisation (going to the press etc)
137
What is the plant in a team
Solves difficult problems
138
What is a source investigator
Develops contacts
139
What is a co-ordinator
Clarifies goals, promotes decision making
140
What is the shaper
1. Tries to overcome obstacles
141
What is a monitor evaluator
Sees all options
142
What is a teamworker
1. Listens
2. Builds
3. Averts friction
143
What is the implementer
Turns ideas to action
144
What is a completer
Searches out errors and omissions and delivers on time
145
What is a specialist
Provides knowledge and skill in rare supply
146
5 problems in teamwork
1. Lack of teamwork
2. Lack of leadership
3. Lack of effort
4. Lack of communication
5. Lack of challenge
147
What is the SBARR framework
1. Situation (what is it)
2. background (what is it)
3. Assessment (what is the problem)
4. Request
5 - Recommendation (what should be done)
148
What is a steep authority gradient
Fear of challenging the leader
149
What is a shallow authority gradient
Familiarity in opinions (no devil's advocate)
150
3 stages of situational awareness
1. What (noticing)
2/ So what's? (understanding)
3. Now what (predicting)
151
Outline the four-step graded assertiveness
1. Express concern
2. Offer solution
3. Seek explanation
4. Directly challenge
152
3 aspects of consent
1. Voluntary
2. Informed
3. Made by someone with capacity
153
What do you need to tell people about their treatment
1. What
2. How
3. Risks
4. Benefits
5. Alternatives
154
What is the mental capacity act 2005
1. A person must be presumed to have capacity unless it is established they lack it
2. An act done on behalf of this person must be made in their best interest
155
How do we assess mental capacity
1. 2 part test (S2)
156
How do we treat people who are incompetent
1. Check is someone can make a decision on their behalf
| 2. Healthcare professional can act in connection with patient's care and treatment
157
When do healthcare professionals decide to treat in patient's best interest
1. Relatives are refusing consent
| 2. no one is consenting
158
What is Gillick competence
1. Making sure a child understands the consequence o their decision, including social and emotional implications
159
Primary prevention of alcoholism
1. Know your limits binge drinking campaign - targeted at 18-24 year old binge drinkers
2. Drinkaware - alcohol labelling
3. THINK! drink driving campaign
4. Ofcom alcohol advertising campaign (antisocial behaviour awareness)
5. Minimum unit pricing
160
Secondary prevention of alcoholism
1. Ask about consumption routinely
2. Ask about consumption using screening questions/tools
3. Detect problem (liver enzymes, MACROCYTOSIS and high carb deficient transferrin)
161
How do we screen for alcoholism
1. Clinical interview
2. FAST (Fast Alcohol Screening Test)
3. AUDIT (Alcohol Use Disorders Identification Test)
4. CAGE
162
Define at risk drinking
A pattern of drinking which brings about risk of physical and psychological harm
163
Define Alcohol Abuse
A pattern of drinking which likely causes physical or psychological harm
164
Define alcohol dependance
1. Set of behavioural, cognitive and physiological repossess that can develop at repeated substance use
165
Guidelines to ALchol Abuse
1. Roel Failure
2. Risk of bodily harm
3. Run ins with the law
4. Relationship trouble
166
Guidlines to Alcohol Dependance
3 of the following:
1. Tolerance
2. Withdrawal
3. Failed attempts to stay in limits
4. Spent less time on other matters
5. Keep drinking despite problems
167
How is alcohol dependance treated
1. Acamprosate Calcium
2. Disulfiram
3. Nalmedene
THERAPY
Social support - ALCHOLICS ANONYMOUS
168
What is the FAST test
FAST positive - 3 or more scored
169
Intervention of at-risk drinking
FRAMES
F - Feedback about the risk of personal harm or impairment
R - Responsibility for making change
A - Advice to cut down on drinking
M - Menu of alternative strategies for changing drink patterns
E - Empathetic interviewing style
S - Self efficacy
170
Treatment of alcoholism
1. Behavioural Change
2. Motivational-Enhancement Therapy
3. Motivational Interviewing by GP or NHS specialist provider
171
Significance of the following AUDIT score and intervention used for them
0-7: Lower risk + Positive reinforcement
8-15: Increased risk + Brief Intervention Level 1
16-19: Higher Risk + Biref Intervention Level 2
20-40: Possible dependance + Further assessment
172
What is the Severity of Dependence Questionnaire (SADQ)
1. 20 Qs
```
Physical withdrawal symptoms
Affective withdrawal symptoms
Relief drinking
Frequency of alcohol consumption
Speed of onset of withdrawal symptoms
```
173
What SADQ score indicates severe alcohol dependance
31 or higher
174
Treatment for alcoholics who score 16+
Chlordiazepoxide Detoxification
175
How does alcohol cause withdrawal physiologically
1. Potentiates GABA
| 2. Inhibits Glutamate and NMDA
176
Treatment of patients dependant on alcohol
1. Community based assisted withdrawal
2. ORAL BENZODIAZEPINE (anxiety)
3. ORAL CHLORDIAZEPOXIDE (Muscle spasm and relief of withdrawal)
177
Pharmacokinetic (ABSORPTION) properties of ORAL CHLORDIAZEPOXIDE
1. Highly lipophilic
2. Half life of 6-30 hours
3. Protein Bound
4. well absorbed at small intestine
178
Distribution and metabolism properties of ORAL CHLORDIAZEPOXIDE
1. Metabolised by liver
2. Crosses BBB
3. Activein CNS grey matter
179
What is the active metabolite of ORAL CHLORDIAZEPOXIDE
Des methyl-chlordiazepoxide
180
How is ORAL CHLORDIAZEPOXIDE
1. Excreted in the urine
2. Conjugated with glucuronide and sulphate
3. No biliary excretion)
181
Pharmacodynamic of ORAL CHLORDIAZEPOXIDE
1. Enhances action of GABA
182
Contraindications of ORAL CHLORDIAZEPOXIDE
1. Hypersensitivity to benzodiazepines
2. Chronic psychosis
3. Pregnancy
4. Hepatic insufficiency
6. MG
183
Side-Effects of ORAL CHLORDIAZEPOXIDE
1. Drowsiness
2. Ataxia
3. Agression
4. Headache
5. Amnesia
6. Respiratory depression
7. Impaired liver function
184
What causes Wernicke's encephalopathy
1. Deficiency of Thiamine
2. Poor diet
3. Poor intake of vitamins
4. Gastritis
185
Describe the bristol stool chart
```
Type I: Separate hard lumps (like nuts) - hard to pass
Type 2: Sausage shaped and lumpy
Type 3: Sausage but cracks on surface
Type 4: Smooth sausage
Type 5: Soft blobs
Type 6: Fluffy, mushy pieces
Type 7: Water
```
186
What are non-infective causes of diarrhoea
1. Neoplasms
2. Inflammatory
3. Hormonal
4. Chemical
5. Anatomical
187
What are notifiable diseases
Legal obligation for any doctor to suspect a case of a specific disease to the proper officer of the local authority
188
Name some notifiable diseaes
1. Acute encephalitis
2. Acute meningitis
3. Acute poliomyelitis
4. Meningococcal septicaemia
5. Whooping cough
189
Why do we notify the authorities of certain diseases
1. Outbreak detection
2. Early warning
3. Forecasting
4. Track extent and severity of disease
5. Allows development of interventions targeted at vulnerable groups
190
What is passive natural immunity
Protection provided from the transfer of antibodies (cross-placental)
191
How long does passive immunity last
A few weeks or months
192
What is passive artificial immunity
Injection of human immunoglobulins containing antibodies to target infection (already pre-made)
193
What patients are usually given passive artificial immunity
Children who are immunocompromised
194
What is active natural immunisation
1. Vaccination stimulates immune response and memory to a specific antigen or infection
195
What are vaccines made of
1. Inactivated
2. Attenuated live
3. Secreted products
4. Constituents of cell walls
5. Recombinant components
196
Cons of polysaccharide vaccines
1. Not long-lasting
| 2. Response in children is poor
197
Cons of live attenuated vaccines
1. Mild form of the disease could manifest
| 2. Takes time to work
198
Define primary vaccin effilure
Person doesn't develop immunity from vaccine e
199
Define secondary vaccine failure
Initially responds and protection wanes over time
200
What is Sequela
Chronic condition from disease, injury or trauma
Brian abscess, brain damage, organ failure, gangrene, death from illness
201
How to we prevent spread of notifiable disease
1. NOTIFICATION
2. CONTACT TRACING
3. PROPHYLAXIS
202
What is the STI/HIV transmission model
```
R = BCD
R = Reproductive rate
B = Infertility Rate
C = Partners over time
D = Duration of infection
```
203
Primary prevention of stopping STIs (change behaviour of patient)
Reduce risk of acquiring STI:
One to one risk reduction discussion
Vaccination (Hep B)
Pre and post exposure prophylaxis
204
Secondary prevention of STIs
Find and treat undetected cases of infection, reducing problem in community pool
205
Tertiary prevention of STIs
Reducing morbidity and mortality
206
Anti-retroviral primary prevention techniques (3)
1. Post-exposure prophylaxis at A+E
2. Pre-exposure prophylaxis
3. Treatment as prevention
207
Secondary prevention strategies for STIs
1. Easy access to STIs/HIV
2. Partner Notification (contact tracing!)
3. Targeted Screening
208
What type of prevention is contact tracing
SECONDARY
209
Tertiary prevention for STIs/HIV
1. Anti-retrovirals
2. Prophylactic antibiotics
3. ACYCLOVIR for genital herpes e.g.
210
Why do we trace partners of people with STIs
1. Break chain of transmission
| 2. Prevent re-infection
211
How are partners traced for STIs
1. Patient referral
2. Provider referral
3. Conditional or contract referral
212
What are the challenges faced in partner notification
1. Hard to reach client groups (homeless, social exclusion, jail)
2. How to get those contact details is hard
213
What is the polypharmacy stopp/start guidance
1. Guidance of assessing if medication to older people is potentially inappropriate
214
Benefits of Polypharmacy STOPP/START guidance
1. Prevent adverse drug effects
| 2. Reduce drug costs
215
What is the loss-aversion theory
1. People's tendency to prefer avoiding losses to gaining (patients would rather keep a medication than to lose the side-effects of it)
216
How do we approach older people
1. Eye contact
2. Avoid medical jargon
3. Ask if patient understands
4. What doe the patient want
5. CHECK HEARING AID
217
Examples of primary health care
Walk in centres, GP, Dentists and opticians
218
Define primary care neurology
1. GPs as expert medical generalists
| 2. Work in MDTs to diagnose and manage neurological illness
219
What are the challenges we face in trying to care for patients in a complex health system
1. ERRORS to be expected
220
What causes adverse events
Factors
221
How do we solve the challenges of errors
1. View errors as a result of problematic mental process
2. Focus on unsafe acts of sharpeners
3. Need a detailed analysis and no covering up of the truth
222
Define culture
1. Shared values and beliefs that interact with an organisation's structure and control systems to produce behavioural norms
223
Define a positive safety culture
1. Where staff have a constant and active awareness of potential for things to go wrong
224
4 characteristics of a positive safety culture
1. Open and fair environment: encourages people to speak up about mistakes
2. Shared values and responsibilities
3. Beliefs that interact with an organisation's structure and control systems
4. To produce behavioural norms where everyone takes responsibility for patient safety and acts when necessary
225
Define Just culture
1. Healthcare workers treated fairly, with empathy when they have been involved in an incident
226
Define informed culture
Organisation has learnt from past experience and has the ability to now identify and prevent future incidents
227
Name some vaccine preventable neurological infections
1. POLIOMYELITIS
2. TB
3. MENINGOCOCCUS
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Define epidemiology
Study of distribution and determinants of health-related statements or events in specified populations and application of this study to control health problems
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Define clinical epidemiology
Uses information about distribution and determinants in a clinical setting - ESPECIALLY IN DIAGNOSIS
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What are the key issues in euro-epidemiology
CASE DEFINITION: clinical, imaging, pathological
CASE ASCERTAINMENT: Diagnosis, reporting
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Define cerebral palsy
Non-Progressive brain damage before or during neonatal period causing wide spectrum of physical and mental impairment
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What is Creutzfeldt-Jakob Disease (of public health importance apparently)
1. Rapidly progressive dementia with no identifiable cause (prion accumulation unexplained)
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Clinical presentation of CJD
1. Dementia
2. Cerebellar signs
3. Myoclonus
4. Ataxia
5. Depression/anxiety
6. Positive tonsil biopsy
LASTS longer than 6 months
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Difference between CJD and variant CJD
Variant CJD effects people in their 20s (peak at 27) whilst CJD effects 55-75
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Risk factors for CJD
1. AGE
| 2. Prion protein gene mutation
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How is CJD diagnosed
1. Electroencephalography (periodic sharp wave complexes)
2. CSF (elevated proteins)
3. MRI of the brain (caudate nucleus affected)
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How is CJD managed
Palliative care
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Define palliative care
Care for the terminally ill and their families by an MDT
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Specialist palliative care vs general palliative care
Specialist: Involves professionals who have training in more complex problems (e.g. doctors, nurse specialists and counsellors, physiotherapists and dieticians)
General: Day to day palliative care from people who will not provide specific things to the patient (GP, district or community nurses, social worker, care worker)
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Define occupational medicine
Branch of medicine concerned with interaction between work and health
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What are some work-related ill healths
1. Occupational stress
2. Occupational lung disease
3. Hand arm vibration
4. Noise-induced hearing loss
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Where is occupational illness data collected from
1. Labour force Survery
2. Death certificate
3. Disablement benefit
4. Surveillance Schemes
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What study design is best suited to calculating attributable risk
COHORT STUDIES
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What are cohort studies
Individuals are assembled based on exposure status and followed over a period of time
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4 ways health is effected during work
1. Acute
2. Cumulative
3. Progressive after exposure ceases
4. Diseases with latencies
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Positive effects of work on health
1. Work is better than unemployment for mental health
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Ten key components to 'good work'
1. Precariousness
2. individual control
3. Work Demands
4. Fair employment
5. Opportunities
6. Prevents social isolation
7. Share information
8. Work/Life balance
9. Reintegrates disabilities into society
10. Promotes health and wellbeing
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What is an occupational cause for an illness
Illness that fails to reposed to standard treatment, doe snot fit typical demographic profile or is of unknown caused
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What questions would you ask someone who you suspect is having an occupation-based disease
1. What type of work do you do
2. Are your symptoms different at work and home
3. Exposures at work
4. Are any of your co-workers experiencing similar symptoms
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What is the GP role in occupational Health
1. Have to issue sickness certificates authorising leave of absence from work
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What details are seen on a sickness certificate
1. Not fit for work
2. Whether patient will benefit form return to work
3. Amended duties request
4. Altered hours
5. Workplace adaptations
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Cons of sickness certificate
1. Spend time finding out nature of patient's work
| 2. Requires knowledge and understanding of workplaces
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What is the definition of disability
A physical or mental impairment which has substantial long-term adverse effects on a person's ability to carry out normal activities
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How should employers adjust for disabilities
1. Alter working hours
2. Allows absences for medical treatment
3. Give additional training
4. Getting special equipment or changing existing
6. Making adjustments to premises
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Primary, secondary and tertiary prevention to occupational health
1 - Monitor risk, control hazards, promotion
2 - Screening, early detection, task modification
3 - Rehabilitation and support
256
Define mental health
1. State of balanced mental functioning which comes up naturally and spontaneously when we are not in a stressed state
257
Define Mental Health Issues
State of feeling vulnerable and anxious, leading to symptoms and further problems if not alleviated
258
What is considered mild to moderate mental health issues
1. Depression
2. Anxiety
3. PTSD
INTERNALLY CREATED STRESS which can lead to more conditions or be prevented
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What are considered severe mental health issues
1. SEVERE DEPRESSION
2. BIPOLAR
3. PSYCHOSIS
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Clinical Presentation of Anxiety
1. Feeling nervous
2. Not being able to stop worrying
3. Trouble relaxing
4. Agitated and restless
5. Easily annoyed
6. Feeling afraid
7. Tachycardia
8. Racing thoughts
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Clinical Presentation of Depression
1. Poor concentration
2. Low self-esteem
3. Low energy
4. Low motivation
5. Feeling sad and hopeless all the time
6. Guilt
7. Suicidal
8. Irritability
9. Anxiety
10. Low appetite
11. Weight loss
12. Loss of libido
13. Sleep problems
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How do we try maintain our mental health
1. Life balance
2. Handling unrealistic expectations
3. Holding up with peer pressure
4. Using less alcohol
6. Reduce academic worries
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Treatment of Anxiety
Progressive Muscular Relaxation
Activity Scheduling
Compassion-Focused Therapy
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How does PMR help reduce anxiety
1. Calms down sympathetic NS
| 2. Parasympathetic NS is activated which calms the body down
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Three aspects of Compassion Focused Therapy
1. Manage distress and promote bonding (soothing)
2. Incentive and resource focused (DRIVE)
3. Threat detection and protection (THREAT SYSTEM)
266
What is the stress particle theory (OUTSIDE-IN)
When people try to deal with perceived stress outside when it is actually coming from inside (we are creating our experience form the inside out and projecting it out and what we feel as a consequence is what we think is actually happening when it isn’t.
)
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What is the Inside-Out theory
1. We cannot solve our problems with the same thinking we used to create them - new thinking is needed so we have to get out of our thought bubble)
268
What is the state of mind theory
1. We can't control our thoughts
| 2. We can't stop thoughts coming up but we choose which ones to take seriously
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Signs of a burnout
1. Overworking
2. Diminished personal contacts
3. Work avoidance
4. Increased minor illnesses
5. Objectification (distancing)
270
Benefits of talking about mental health issues
1. More self-understanding and feel back in control of your life
2. Feel caring and kindness for yourself
3. Help you become more self-accepting
271
Define emotional resilience
People who are self-aware emotionally and believe they are in control of their lives
