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ArabSoc.Semester 3+4 PPD Revision LectureSenan Alsanjari
Screening• Definition: “the identification of unrecognised disease or  defect by the application of tests, examinations or...
Key terminology
Measures of performance•   Sensitivity / detection rate•   False positive rate•   Specificity•   Positive predicted value•...
Example
That is all….
Ethics: Confidentiality inPractice
Ethical duties• Legal duty• Professional duty• Moral duty
Ethical Practice• What is ethics?  •   Duty  •   Utility  •   Rights  •   Virtue• Ethical principles  • Moral perception  ...
Consent• Definition: “a volountary, and uncoerced decision made by a  sufficiently competent or autonomous person, on the ...
The competency criteria• A patient must:  •   Understand the relevant information  •   Retain that information  •   Weigh ...
Negligence•   Must be a harm•   Must be a duty of care•   Must be a breach of duty of care•   Breach must have led to the ...
The information criteria• To avoid the charge of battery  • Health care professionals only need to inform the patient in  ...
Bolam test• Mr. Bolam was a patient undergoing electro-convulsive  therapy.• He was not given any muscle relaxant, and his...
Bolitho test• Mr. Bolitho’s son was admitted to hospital for respiratory  difficulties under the care of Doctor H.• Doctor...
Confidentiality• Remember the wise words of Hippocrates:  • “that what I may see or hear in the course of    treatment or ...
No breach allowed• Doctors are not allowed to breach confidentiality (unless the  patient consents) for  • Insurance compa...
Breach allowed but not required inlaw•   Sharing of information with other healthcare professionals•   Patient is a threat...
Breach required• Situations where a doctor is obliged to breach confidentiality  • Misuse of Drugs Act (1971)     • Known ...
Professionalism• ‘Medical professionalism signifies a set of values, behaviours  and relationship that underpins the trust...
Components ofProfessionalism• Composed of a doctor’s  •   Relationship with knowledge  •   Relationship with colleagues  •...
Regulation of Professionalism• The GMC has two main functions:  • It holds a list of all registered UK doctors  • It acts ...
General Medical Council• The primary statutory purpose of the GMC is:  • “to protect, promote and maintain the health and ...
The GMC and US• The GMC sets the knowledge, skills and behaviors that  medical students should learn at UK medical schools...
Communicating Risk
Decision making• “selecting health services that increase the chance of valued  outcomes and that minimise the chances of ...
Doctors must work inpartnership with patients• All decisions that are made should involve:  • The doctor listening to the ...
Exchange of information• Patient’s needs and priorities• Patient’s level of knowledge and understanding (of current  condi...
Information giving• Balance of too little and too much.• Take special care to explain numeric data
Communicating numericaldata• A woman is told her risk of developing breast cancer is 0.8%.• How would you explain this to ...
Information therapy• “The right information for the right patient at the right time as  part of the process of care”
Professional Boundaries• Good hand-out on moodle• Read itttttttttttt.
SEMESTER 3
Whistle Blowing and MedicalEthics
Errors and mistakes• Rarely due to poor performance• Generally due to systemic problem• Therefore avoid blame culture and ...
Competence• Four sub-types  •   Unconscious incompetence  •   Conscious incompetence  •   Conscious competence  •   Uncons...
Notes and Records• Notes  • Legal sub-heading in proceedings  • Good notes are ones: “that enable you to recall a consulta...
Important Acts• Health Act (1998)  • Working in the NHS must provide a statutory level of quality and    the Clinical gove...
The ethics of distribution
The ethics of distribution• Decisions  • Macroeconomy  • Midieconomy  • Minieconomy• Resources  • The economical problem: ...
Veil of ignorance• What does it actually mean?• Concept put forward by John Rawls
Approach to rationing•   Free market economics•   Need•   Lottery•   Consequentialism and QALY
Example of QALY• Intervention A would lead to two more years of perfect health  at a cost of £5000 over the two years• Int...
Approach to rationing•   Personal responsibility•   Social worth•   Democracy•   PluralismTry to mention Article 2 of the ...
Pain: Theory, assessment andmanagement
Pain• “It is an unpleasant sensory and emotional experience  resulting from actual or potential tissue damage”.• Acute• Ch...
Theories of pain• Specificity theory  • Extent of pain is proportional to extent of tissue damage  • Specific stimulus  s...
Multidimensional Model ofPain• Combination of all theories• Has four components  •   Detection  •   Perception  •   Emotio...
Problem with chronic pain• Risk factors for Acute pain  Chronic pain?• How do we go from acute pain to chronic pain?  • S...
Measuring pain• Self report  • Simple, multidimensional or computerised• Observation  • Verbal, physical or postural• Phys...
Ethics: Control of Pain
Definitions•   Active euthanasia•   Physician Assisted Suicide•   Passive euthanasia•   Suicide•   Assisted suicide•   Whi...
Acts and Omissions• Suppose I wish you dead, if I act to bring about your death I  am a murderer, but if I happily discove...
Doctrine of Double Effect• Intentional killing is classed as murder• Criminal law classes intention as the performing of a...
Debby Purdy• Patient with progressive MS who went to court to seek  reassurance that her husband would not be prosecuted i...
DPP Guidance• In favour of prosecution  •   Under 18  •   Question of capacity  •   Unsettled on decision to die  •   Grou...
A view from across the northsea• Which country decriminalised volountary euthanasia in April  2001?• Legal framework  •   ...
Safeguards• Doctor must consult with at least one independent physician  who will examine the patient• All cases must be r...
Psychology of perception andmisperception• What is the difference between sensation and perception?
Theories of perception• Bottom up  • Perception is a building process that starts with the information    presented to the...
Old or young
FOR FUN :D• http://www.maniacworld.com/Spinning-Silhouette-Optical-  Illusion.html
Sorry, jokes are over now
Studying perception• Behavioural approach  • Phenomenological approach     • Descriptive  • Psychophysical method     • Qu...
Factors affecting perception• Think of the pnemonic PEMPPAD  •   Personality  •   Emotion  •   Motivation  •   Perceptual ...
Psychological Interventions
Benefits of PsychologicalIntervention• Benefits  •   Equally or more effective than drug therapies  •   Pre surgical psych...
Behavioural Mechanisms• Relaxation  • Progressive muscle relaxation• Operant conditioning  • Modification of volountary be...
Stress Inoculation Training• Conceptualisation  • Understanding nature of stress and stress response• Skills rehearsal  • ...
Cognitive Therapy• Alteration of maladaptive cognitions• Introduction of adaptive cognitions• There are two types  • Ratio...
Source of psychologicaldisturbance•   Arbitrary inference•   Selective abstractation•   Magnification and minimisation•   ...
Rational emotive therapy(RET)•   A – ctivating event•   B – eliefs in response to A•   C – onsequence of B (emotions and b...
Cognitive Behavioural Therapy(CBT)• Three components  • Identify maladaptive belief  • Remove them  • Teach new coping str...
Stress Management• Aims to:  • Understand the cause of the stress  • Develop behavioural skills to cope  • Develop appropr...
Critical Incident StressDebriefing• Steps  •   Introduction – Hi I am…  •   Facts – This happened to me…  •   Thoughts – I...
Brief Interventions•   F – eedback about risk of personal harm•   R – esponsibility to make change•   A – dvice•   M – enu...
Race and Ethnicity in Health andIllness• All definitions and not going to lie, it’s just boring if I sit and  read out.
Social Inequalities in Health• Social stratification – be aware.• Effect of social stratification on different social grous
Socioeconomic health model• Social inequalities are based on differences in risk factors  across the whole life.• Not just...
Measuring social class• Registrar-General’s Occupational Classification• National Statistics Socio-Economical Classification
Trends in health inequality• 1931 – 1991 the gap between no of deaths / 10,000 in Class 1  and 5 increased greatly• From 1...
In light of this…• Black Report  • Always Say Brup Mate     •   Artefact     •   Social selection     •   Behavioural fact...
Public Health Target• White Paper (1999)  • Government set out to reduce health inequality• NHS Plan  • Narrow health gap•...
Recent Changes• There was an improvement in absolute mortality across all  socio-economic classes between 2001-2008• Howev...
Example• 2001  • Professional has 100 deaths per 100,000 years  • Manual worker has 500 deaths per 100,000 years• 2008  • ...
Theories of loss, life events andnegative thinking
Definitions• Loss  • State of being deprived of, or being without someone which one    has had.• Grief  • Pain and sufferi...
Children’s grief• Do not underestimate how much children know and  understand• Adults are biggest barrier to children heal...
Acute and Long term Grief• Acute  • Disbelief, Anger, Agitation  • Crying, Hallucinations and Images of lost person• Long ...
Theories of Grief•   D – isbelief•   A - nger•   B - argaining•   D - epression•   A – cceptancePathological grief is eith...
Task of mourning•   Accept reality of loss•   Adapt to environment in which deceased is missing•   Work through pain of gr...
Risk factors for pathologicalgrief•   Circumstances•   Individual circumstances•   Initial reaction•   Quality of lost rel...
Physical activity• Physical activity: “this is any bodily movement produced by  skeletal muscle that leads to expenditure ...
Recommendation• Adults  • They are recommended to perform 30 minutes of at least    moderate intensity exercise five times...
Benefits of exercise• Cardiovascular  • Reduced risk of CV disease and low BP• Psychological  • Reduced risk of depression...
Psychological benefits ofexercise• Distraction• Opiates• Stress-managementWhich factors determine amount of physical activ...
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SGUL ArabSoc PPD Semester 3/4 Revision Lecture
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SGUL ArabSoc PPD Semester 3/4 Revision Lecture

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SGUL ArabSoc PPD Semester 3/4 Revision Lecture

  1. 1. ArabSoc.Semester 3+4 PPD Revision LectureSenan Alsanjari
  2. 2. Screening• Definition: “the identification of unrecognised disease or defect by the application of tests, examinations or other procedures which can be applied rapidly.”• Number of types • Mass screening • Selective screening • Opportunistic screening • Multiphasic screening
  3. 3. Key terminology
  4. 4. Measures of performance• Sensitivity / detection rate• False positive rate• Specificity• Positive predicted value• Negative predicted value
  5. 5. Example
  6. 6. That is all….
  7. 7. Ethics: Confidentiality inPractice
  8. 8. Ethical duties• Legal duty• Professional duty• Moral duty
  9. 9. Ethical Practice• What is ethics? • Duty • Utility • Rights • Virtue• Ethical principles • Moral perception • Moral reasoning • Moral action
  10. 10. Consent• Definition: “a volountary, and uncoerced decision made by a sufficiently competent or autonomous person, on the basis of adequate information and deliberation to accept rather than reject a proposed course of action”• Which situations do not require consent?
  11. 11. The competency criteria• A patient must: • Understand the relevant information • Retain that information • Weigh up the information to make a decision • Communicate that decision Can a 15 year old consent to treatment in the absence of parental consent?
  12. 12. Negligence• Must be a harm• Must be a duty of care• Must be a breach of duty of care• Breach must have led to the harm
  13. 13. The information criteria• To avoid the charge of battery • Health care professionals only need to inform the patient in “broad terms” about the nature of the procedure• To avoid the charge of negligence • A doctor is not negligent if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art [Bolam] • If there is significant risk which would affect the judgement of a reasonable patient, then in the normal course it is the responsibility of the doctor to inform the patient of that significant risk [Bolitho]
  14. 14. Bolam test• Mr. Bolam was a patient undergoing electro-convulsive therapy.• He was not given any muscle relaxant, and his body was not restrained during the procedure• He flailed about violently before the procedure was stopped and suffered serious injuries.• He sued the hospital on the basis of negligence.• Was there any negligence in this case?
  15. 15. Bolitho test• Mr. Bolitho’s son was admitted to hospital for respiratory difficulties under the care of Doctor H.• Doctor H did not see the patient when the nurse called her, and on the second occasion, the doctor delegated the care to her junior, Doctor R.• This doctor also did not see Mr. Bolitho’s son.• This led to further complications in the patient resulting in severe brain damage from which he died.• However, this doctor found an expert who testified that intubating of this child would not have made a difference.
  16. 16. Confidentiality• Remember the wise words of Hippocrates: • “that what I may see or hear in the course of treatment or even outside the treatment in regard to the lives of persons which is not fitting to be spoken, I will keep inviolably secret”• However confidentiality is relative: • There are situations where a doctor is obliged not to breach confidentiality • There are situations where a doctor is allowed to breach confidentiality at her discretion • There are situations where a doctor is obliged to breach confidentiality
  17. 17. No breach allowed• Doctors are not allowed to breach confidentiality (unless the patient consents) for • Insurance companies • Casual breaches (doctor’ family, friends or partner) • To prevent / detect a minor crime
  18. 18. Breach allowed but not required inlaw• Sharing of information with other healthcare professionals• Patient is a threat to themselves• Patient who continues to drive when not medically fit• Detection / prevention of serious crime
  19. 19. Breach required• Situations where a doctor is obliged to breach confidentiality • Misuse of Drugs Act (1971) • Known or suspected drug addicts must be noted to the Home Office • Public Health Regulations (1988) • Certain infectious disease must be notified to health authorities • Prevention of Terrorism Act (2000) • Any person with information that might prevent an act of terrorism must report it to the police Medical students have same standard of confidentiality as qualified doctors
  20. 20. Professionalism• ‘Medical professionalism signifies a set of values, behaviours and relationship that underpins the trust the public has in doctors’
  21. 21. Components ofProfessionalism• Composed of a doctor’s • Relationship with knowledge • Relationship with colleagues • Relationship with patients • Relationship with society • Relationship with self.
  22. 22. Regulation of Professionalism• The GMC has two main functions: • It holds a list of all registered UK doctors • It acts as a professional regulator.• Why are medical students always threatened when we act like normal students?
  23. 23. General Medical Council• The primary statutory purpose of the GMC is: • “to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine” The Medical Act (1983) gives the GMC its five main functions of:
  24. 24. The GMC and US• The GMC sets the knowledge, skills and behaviors that medical students should learn at UK medical schools.• The GMC also sets standards for teaching, learning and assessment.
  25. 25. Communicating Risk
  26. 26. Decision making• “selecting health services that increase the chance of valued outcomes and that minimise the chances of undesired consequences according to the best scientific evidence”• Principles to consider when making a decision about patient care • Timing of situation • Seriousness • Complexity • Consequence of intervention • Availability of evidence
  27. 27. Doctors must work inpartnership with patients• All decisions that are made should involve: • The doctor listening to the patient and respecting their views about health • Discussion of the patients diagnosis, prognosis, treatment and care • Share information that patient needs to make decisions • Respect the patient’s decision.
  28. 28. Exchange of information• Patient’s needs and priorities• Patient’s level of knowledge and understanding (of current condition)• The nature of the patients condition• The complexity of treatment
  29. 29. Information giving• Balance of too little and too much.• Take special care to explain numeric data
  30. 30. Communicating numericaldata• A woman is told her risk of developing breast cancer is 0.8%.• How would you explain this to a patient?• Mammogram screening reduces mortality from breast cancer by 25%.
  31. 31. Information therapy• “The right information for the right patient at the right time as part of the process of care”
  32. 32. Professional Boundaries• Good hand-out on moodle• Read itttttttttttt.
  33. 33. SEMESTER 3
  34. 34. Whistle Blowing and MedicalEthics
  35. 35. Errors and mistakes• Rarely due to poor performance• Generally due to systemic problem• Therefore avoid blame culture and focus on systemic improvement.
  36. 36. Competence• Four sub-types • Unconscious incompetence • Conscious incompetence • Conscious competence • Unconscious competence
  37. 37. Notes and Records• Notes • Legal sub-heading in proceedings • Good notes are ones: “that enable you to recall a consultation without referring to any other source”.• Prescriptions • Person who signed is legally responsible if they sign the prescription, even on the advice of another.
  38. 38. Important Acts• Health Act (1998) • Working in the NHS must provide a statutory level of quality and the Clinical governance is responsible for monitoring clinical performance and ensuring competence• Public Interest disclosure Act (1998) • Protection of whistleblowers from dismissal / victimisation
  39. 39. The ethics of distribution
  40. 40. The ethics of distribution• Decisions • Macroeconomy • Midieconomy • Minieconomy• Resources • The economical problem: “how do we satisfy unlimited wants with limited resources”? • Distribution must be fair
  41. 41. Veil of ignorance• What does it actually mean?• Concept put forward by John Rawls
  42. 42. Approach to rationing• Free market economics• Need• Lottery• Consequentialism and QALY
  43. 43. Example of QALY• Intervention A would lead to two more years of perfect health at a cost of £5000 over the two years• Intervention B would increase quality of health from 0.7 – 0.99 for 10 years at a cost of £10000• Therefore in A it costs £2500 per QALY• In B it costs £3448 per QALY
  44. 44. Approach to rationing• Personal responsibility• Social worth• Democracy• PluralismTry to mention Article 2 of the Human Right Act (1998): “theright to live”
  45. 45. Pain: Theory, assessment andmanagement
  46. 46. Pain• “It is an unpleasant sensory and emotional experience resulting from actual or potential tissue damage”.• Acute• Chronic• What is the difference between Pain threshold and pain tolerance?
  47. 47. Theories of pain• Specificity theory • Extent of pain is proportional to extent of tissue damage • Specific stimulus  specific receptors  brain  pain perception• Pattern theory • Opponent to specificity theory • Pain results from patterns in neural transmission rather than a single unique pathway to the brain• Gate control • Emphasises the dynamic role of the brain in which there is psychological interaction in pain processing. • Example of things which will open and close the gate? Problems with theories 1 and 2?
  48. 48. Multidimensional Model ofPain• Combination of all theories• Has four components • Detection • Perception • Emotions • Behaviour
  49. 49. Problem with chronic pain• Risk factors for Acute pain  Chronic pain?• How do we go from acute pain to chronic pain? • Stage 1 – initial fear and anxiety • Stage 2 – depression and low self esteem • Stage 3 – acceptance of sick role• All of this results in lower quality of life
  50. 50. Measuring pain• Self report • Simple, multidimensional or computerised• Observation • Verbal, physical or postural• Physiological • EMG
  51. 51. Ethics: Control of Pain
  52. 52. Definitions• Active euthanasia• Physician Assisted Suicide• Passive euthanasia• Suicide• Assisted suicide• Which ones are legal?
  53. 53. Acts and Omissions• Suppose I wish you dead, if I act to bring about your death I am a murderer, but if I happily discover you in danger of death, and fail to act to save you, I am not acting, and therefore, according to the doctrine, not a murderer.• But if an omission and act lead to the same consequence is there a moral distinction?• Does the morality lie in the behaviour or the consequence?
  54. 54. Doctrine of Double Effect• Intentional killing is classed as murder• Criminal law classes intention as the performing of an act which is virtually certain to cause death• Medical law distinguishes between intention and foresight• Benefits of treatment are intended, side-effects are foreseen but not intended
  55. 55. Debby Purdy• Patient with progressive MS who went to court to seek reassurance that her husband would not be prosecuted if he accompanied her to a dignitas clinic.• The conclusion of that case was that it highlighted the ambiguity of the prosecution guidance and variable response of the Crown Prosecution Service (CPS) in the past.
  56. 56. DPP Guidance• In favour of prosecution • Under 18 • Question of capacity • Unsettled on decision to die • Grounds for death has possibility of gain • Evidence of coercion• Against prosecution • Clear, settled and informed decision to die • Consistent about dying • No evidence of coercion • Evidence that suspect motivated purely by compassion
  57. 57. A view from across the northsea• Which country decriminalised volountary euthanasia in April 2001?• Legal framework • Doctor convinced that the request is volountary • Patient is in unbearable suffering • Doctor must discuss with patient all the options • Doctor and Patient should conclude there is no reasonable alternative
  58. 58. Safeguards• Doctor must consult with at least one independent physician who will examine the patient• All cases must be reported to the public committee comprised of a doctor, lawyer and ethics expert• Those who do not follow the safeguards are punishable by law
  59. 59. Psychology of perception andmisperception• What is the difference between sensation and perception?
  60. 60. Theories of perception• Bottom up • Perception is a building process that starts with the information presented to the sensory organ • No use of prior knowledge• Top down • Sensory information is insufficient to interpret a stimulus. • Interpretation is based on our knowledge and expectation of the world. • Integration of prior knowledge
  61. 61. Old or young
  62. 62. FOR FUN :D• http://www.maniacworld.com/Spinning-Silhouette-Optical- Illusion.html
  63. 63. Sorry, jokes are over now
  64. 64. Studying perception• Behavioural approach • Phenomenological approach • Descriptive • Psychophysical method • Quantitative relationship between stimulus and perception
  65. 65. Factors affecting perception• Think of the pnemonic PEMPPAD • Personality • Emotion • Motivation • Perceptual set • Physiology • Attention • Demographics
  66. 66. Psychological Interventions
  67. 67. Benefits of PsychologicalIntervention• Benefits • Equally or more effective than drug therapies • Pre surgical psychological interventions can reduce intervention • Psychological intervention can help with things like addiction • Make patients cope better with treatment • Can help control high blood pressure (emotional state)
  68. 68. Behavioural Mechanisms• Relaxation • Progressive muscle relaxation• Operant conditioning • Modification of volountary behaviour by consequence• Systemic desensitisation • Eliminate fears by substituting a response that is incompatible with anxiety• Biofeedback • Target physiological measures of stress
  69. 69. Stress Inoculation Training• Conceptualisation • Understanding nature of stress and stress response• Skills rehearsal • Relaxation techniques, social support• Application • Practice the coping skill with imagined stress situation
  70. 70. Cognitive Therapy• Alteration of maladaptive cognitions• Introduction of adaptive cognitions• There are two types • Rational emotive therapy (RET) • Cognitive behavioural therapy (CBT)
  71. 71. Source of psychologicaldisturbance• Arbitrary inference• Selective abstractation• Magnification and minimisation• Personalisation
  72. 72. Rational emotive therapy(RET)• A – ctivating event• B – eliefs in response to A• C – onsequence of B (emotions and behaviours)• D – ispute the irrational belief• E – ffect of therapy
  73. 73. Cognitive Behavioural Therapy(CBT)• Three components • Identify maladaptive belief • Remove them • Teach new coping strategies
  74. 74. Stress Management• Aims to: • Understand the cause of the stress • Develop behavioural skills to cope • Develop appropriate attitudes
  75. 75. Critical Incident StressDebriefing• Steps • Introduction – Hi I am… • Facts – This happened to me… • Thoughts – In the moment, I did not know what was going on • Emotions – I feel terrible… • Normalisation – It was a life or death situation • Future planning / coping – Don’t blame yourself • Disengagement – Carry on your life
  76. 76. Brief Interventions• F – eedback about risk of personal harm• R – esponsibility to make change• A – dvice• M – enu of alternative strategies• E – mpathetic interview style• S – elf efficacy
  77. 77. Race and Ethnicity in Health andIllness• All definitions and not going to lie, it’s just boring if I sit and read out.
  78. 78. Social Inequalities in Health• Social stratification – be aware.• Effect of social stratification on different social grous
  79. 79. Socioeconomic health model• Social inequalities are based on differences in risk factors across the whole life.• Not just in adulthood, childhood or just before catching an illness.• The exposure is simply an accumulation of the risks throughout life.
  80. 80. Measuring social class• Registrar-General’s Occupational Classification• National Statistics Socio-Economical Classification
  81. 81. Trends in health inequality• 1931 – 1991 the gap between no of deaths / 10,000 in Class 1 and 5 increased greatly• From 1972-2005 life expectancy rose for everyone, but again, the gap between Class 1 and 5 increased
  82. 82. In light of this…• Black Report • Always Say Brup Mate • Artefact • Social selection • Behavioural factors • Material circumstances• Acheson Report • Medicine Is Incredibly Pants • Medical care • In workplace • In social structure • Preventative approach
  83. 83. Public Health Target• White Paper (1999) • Government set out to reduce health inequality• NHS Plan • Narrow health gap• Department of Health • Target reduction in health inequality
  84. 84. Recent Changes• There was an improvement in absolute mortality across all socio-economic classes between 2001-2008• However, looking at relative changes highlighted an increase in mortality rate for the least advantaged.
  85. 85. Example• 2001 • Professional has 100 deaths per 100,000 years • Manual worker has 500 deaths per 100,000 years• 2008 • Professional has 75 deaths per 100,000 years • Manual worker has 450 deaths per 100,000 years Work out the relative risk of dying if you were a manual worker in 2001 and 2008.
  86. 86. Theories of loss, life events andnegative thinking
  87. 87. Definitions• Loss • State of being deprived of, or being without someone which one has had.• Grief • Pain and suffering experienced after a loss.• Mourning • Period in which signs of grief are visible and these are culturally specific• Bereavement • Process of losing a close relationship
  88. 88. Children’s grief• Do not underestimate how much children know and understand• Adults are biggest barrier to children healing
  89. 89. Acute and Long term Grief• Acute • Disbelief, Anger, Agitation • Crying, Hallucinations and Images of lost person• Long term • Social withdrawal and sleeplessness • Anxiety, mood changes and appetite changes
  90. 90. Theories of Grief• D – isbelief• A - nger• B - argaining• D - epression• A – cceptancePathological grief is either abnormally severe or abnormallyprolonged (> 6 months)
  91. 91. Task of mourning• Accept reality of loss• Adapt to environment in which deceased is missing• Work through pain of grief• Emotionally relocate deceased and move on
  92. 92. Risk factors for pathologicalgrief• Circumstances• Individual circumstances• Initial reaction• Quality of lost relationship• Disenfranchised grief
  93. 93. Physical activity• Physical activity: “this is any bodily movement produced by skeletal muscle that leads to expenditure of energy”. • Structural - sport • Lifestyle - gardening
  94. 94. Recommendation• Adults • They are recommended to perform 30 minutes of at least moderate intensity exercise five times a week• Children • They are recommended to perform 60 minutes of at least moderate intensity exercise seven times a week. Statistically men are more likely to reach the national guidelines on exercise than women, and boys are more likely to reach it than girls.
  95. 95. Benefits of exercise• Cardiovascular • Reduced risk of CV disease and low BP• Psychological • Reduced risk of depression and increased self esteem• Other • Increased immunity and bone mineralisation
  96. 96. Psychological benefits ofexercise• Distraction• Opiates• Stress-managementWhich factors determine amount of physical activity?How do we stay motivated?
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  99. 99. Congratulations, you reached100 slides.

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