adobe captivate friday, september 16, 2016€¦ · text captions: old & new sayings an ounce of...

Adobe Captivate Friday, September 16, 2016

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Slide 1

Text Captions: apple a day, doctor away


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Slide 2

Slide notes: Module 1 covers several definitions and concepts, the history of clinical prevention in the U.S., and

the 3 P's, protection, promotion, and prevention. Module 2 will get into more details on prevention.

These session objectives relate to the following M2 ICE Core Objective:

#3. The student will apply clinical disease prevention and health promotion activities appropriate to the patient based on age, gender, and other risk factors.

Text Captions: Objectives

The student will:

Define/discuss clinical preventive medicine, periodic health examination, health care maintenance, opportunistic prevention, risk factors (modifiable and non-modifiable) and risk assessment.

Discuss the history of the periodic health examination since 1900.

Define/discuss and give examples of health care strategies, including health promotion, health protection and disease prevention.

Define/discuss and give examples of levels of disease prevention, including primordial prevention, primary prevention, secondary prevention, and tertiary prevention.

List/discuss the principles of screening for both the disease and its screening test.

When presented with data about a disease/condition and its corresponding screening test, determine whether the condition and its test meet the criteria for screening.

Discuss/utilize the U.S. Preventive Services Task Force age-specific guidelines when presented with a real or standardized patient or written patient scenario.


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Slide 3

Slide notes: However, before we get to the content, a word about preparing for the OSCE.

In physical diagnosis small group, you will have an opportunity to practice doing an efficient screening physical exam.

In the first two regular small groups, you will practice taking a complete history with an emphasis on prevention.

You'll also have several opportunities to practice the H&P write up.

Text Captions: Prepare for the OSCE

Physical Diagnosis Small Group

Practice screening exam

CPM Small Groups

Practice complete history & HCM (adult male & female)

Bring Adult Screening H&P Booklet

Summary of HCM Recommendations

H&P Write-ups

One of two patients from CPM small groups


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Slide 4

Slide notes: Also, you will have several other lectures that will help you to provide preventive services to your patients. Some of these are listed here.

Text Captions: Other CPM-Related Topics

Pediatric HCM

Immunizations

Patient Adherence/Motivational Interviewing

Tobacco Cessation

Nutrition


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Slide 5

Slide notes: Old Ben Franklin gave us the saying about an ounce of prevention being worth a pound of cure.

Text Captions: Old & New Sayings

An ounce of prevention is worth a pound of cure

Benjamin Franklin


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Slide 6

Slide notes: Paul Frame, who is actually still alive and somewhat famous in the field of preventive medicine,

added his comment about the difficulty of actually doing prevention.

Text Captions: Old & New Sayings

An ounce of prevention is worth a pound of cure

Benjamin Franklin

but it’s a ton of work!

Paul Frame


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Slide 7

Slide notes: Compared to the last session when we discussed population approaches to prevention,

this session covers the preventive services that we as clinicians provide individual patients.

Text Captions: Clinical Preventive Medicine

Application of preventive interventions or services in clinical settings*

Emphasis on the individual

*Can be done in community settings, such as health fairs


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Slide 8

Slide notes: Always gotta have a little history...

The concept of periodic health exams came from Europe to the U.S. around 1900.

After the adoption of the concept in the U.S., a campaign was started to encourage people to get a check up on their birthdays.

I'm not sure patients really want to spend their birthdays in the doctor's office, but maybe it would be good to get a check up during their birth month.

A couple of major disasters or events slowed down the movement, but after the war, it came back with a vengeance.

In the 50's the "executive" physical became the "in" thing. It included everything that insurance would pay for,

whether it was proven beneficial or not.

Text Captions: History...

1900 Periodic health examinations in U.S.

1922 AMA endorsed concept

1923 National Health Council: “Have a Health Examination on Your Birthday”

Depression and WW II brought decreased interest

1950’s Executive physical became popular; multiphasic screening—”everything for everyone”


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Slide 9

Slide notes: It wasn't until the mid 70's, that a couple of family physicians (one of whom was Paul Frame of "ton of work" fame)

did the first evidence-based research to see if all those chest x-rays, treadmills, chemistry panels, etc. were of any value.

Well, surprise, most of them had not been proven to be effective, other than a few things like blood pressure and height and weight.

In the mid 70's there was a migration of Canadian physicians to the U.S. What do you imagine was happening in Canada at that time?

The answer is that the Canadians were "nationalizing" their health care.

As a result, as a nation they looked at the evidence for preventive services to determine what to cover and provide for the Canadian population.

It was not until the mid 80's that a similar task was undertaken by the U.S.

The first two reports from the USPSTF were printed as books, but now their recommendations are updated on their online site.

Text Captions: More History

1975 Frame and Carlson (literature review; individualize based on risk factors)

1977 Breslow and Somers (Lifetime Health Monitoring)

1979 Canadian Task Force (rigorous methodology)

1989 U.S. Preventive Services Task Force

1996 U.S. Preventive Services Task Force, second report

Now…third report (on-line)


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Slide 10

Slide notes: This is a tricky one to define without using the word "risk" in the definition.

So, we substituted the word "likelihood" for risk.

It's important to note that there is not a 1 to 1 correlation between risk factors and developing disease.

Another important concept is that many risk factors can be changed but some cannot.

Text Captions: Risk Factor

Characteristic that identifies a person as having an increased likelihood of developing a condition or disease, i.e., susceptible BUT

Person with risk factor will not necessarily get condition

Person without risk factor may still get condition

Modifiable: Can change

For example, lose weight, stop smoking

Non-Modifiable: Can't change

For example, family history of premature heart disease, age, gender


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Slide 11

Slide notes: When you're looking for risk factors, you're doing a risk assessment.

Most of the time you will be seeing patients with a disease, and your risk assessment will be oriented to the present time.

An example is asking the 60 year-old male in the ED with chest pain about smoking, hypertension, cholesterol, diabetes mellitus, etc.

When we talk about prevention, the risk assessment has a "future' focus, looking to modify or eliminate those risk factors that could lead to a disease down the line.

Text Captions: Risk Assessment

Detection of risk factors in patients with respect to target conditions:

Future oriented (asymptomatic) or

Present oriented (symptomatic)

Collection of information about risk factors occurs during the history & physical exam and by performing tests. For example:

Tobacco use

Carotid bruit

High LDL-cholesterol

FH premature heart disease


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Slide 12

Slide notes: I'm going to define health care maintenance very broadly to include all the clinical preventive services.

Besides the risk assessment, it also includes the actual provision of preventive services,

which includes screening tests, counseling for behavior change, preventive medications, and immunizations.

Text Captions: Health Care Maintenance

Apply prospective set of preventive services based on age, gender, and other risk factors

For asymptomatic or apparently well individuals as well as those with chronic conditions to screen for or prevent complications from their chronic problems

Occurs at appropriate intervals throughout life

Includes:

Risk assessment

Screening

Counseling

Preventive medications

Immunizations


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Slide 13

Slide notes: Health care maintenance or HCM itself can be provided in several different settings.

The first one listed here, is when HCM is performed at a visit specifically for prevention.

That sounds like a good deal, but what about all those people who don't come in for the "annual exam"?

Most people do get sick periodically, whether for a cold or injury, and that visit to the doctor may be your only opportunity.

I'm referring to this as "opportunistic" prevention, namely taking advantage of the opportunity when it presents itself.

Text Captions: Clinical Prevention Opportunities

Periodic Health Exam

Visit specifically for HCM

For example, Pap & pelvic, school physical, “annual” checkup

Opportunistic Prevention\*

Preventive services performed while patient is being seen for unrelated problem(s)

If screening, aka case finding

For example, counsel to stop smoking, give Td, or order lipids during visit for skin rash or URI

\*Medderism


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Slide 14

Slide notes: Next, some more definitions and concepts.

I'll warn you up front, that these concepts (the 3 P's) overlap and may seem to be similar, but it's the situation or context that makes the difference.

Text Captions: Intervention Strategies (3P’s)

Health Protection

Health Promotion

Disease Prevention


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Slide 15

Slide notes: But before we discuss the definitions, you may already know them. Let's see! Please match the 3 P's with their definitions.

Text Captions: Match the following

Health Protection

Health Promotion

Disease Prevention

Health Prevention

Disease Promotion

A) Prevention in clinical setting

B) Individual health behaviors

C) Population regulations

D) Do you really want to prevent health?

E) And promote disease?


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Slide 16

Slide notes: This one will be short and hopefully sweet. It's what we spent the entire first session discussing, population prevention.

The two key concepts to remember are: 1) population and 2) regulation, law, or general recommendation for the health of the public.

Text Captions: Health Protection

Strategies related to environmental or regulatory measures that maintain or enhance well-being or health at the population or community level

For example:

Food and drug safety regulations

Laws requiring seat belt use

Public campaigns/advertisements to not drink and drive; also, not phone/text while driving

Provision of basic necessities of life


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Slide 17

Slide notes: And now this special warning from the surgeon general:

"Don't hit yourself in the head with a hammer!"

Text Captions: An example of health protection, carried to the extreme.


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Slide 18

Slide notes: Two key concepts for health promotion: 1) individuals and 2) behaviors or lifestyle.

Text Captions: Health Promotion

Strategies related to individual behavior or lifestyle that maintain or enhance well-being or health

Personal choices made in social or clinical context

For example:

Exercise program

Dietary modification to lose weight

Tobacco cessation


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Slide 19

Slide notes: What's wrong with me doc?


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Slide 20

Slide notes: You drink too much, you eat too much, you're short of breath, you don't get enough sleep,

you don't exercise, you have bad knees and a bad back, you need glasses,

your teeth are bad, your hearing is going, you have a sinus condition,

your hair is dirty and you have dandruff.


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Slide 21

Slide notes: And after all that, what does the average patient ask for?

Text Captions: And what do you think Hagar says?


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Slide 22

Slide notes: Can you write me a prescription?


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Slide 23

Slide notes: The final P (prevention) will be covered in the second module,

but it refers to doing prevention in the clinical setting one-on-one.

That's it for this module. A review of the objectives is all that is left.

Text Captions: Disease Prevention

Strategies related to provision of

clinical services

that strive to maintain, enhance,

or restore well-being

or health of an

individual


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Slide 24

Text Captions: Objectives

The student will:

Define/discuss clinical preventive medicine, periodic health examination, health care maintenance, opportunistic prevention, risk factors (modifiable and non-modifiable) and risk assessment.

Discuss the history of the periodic health examination since 1900.

Define/discuss and give examples of health care strategies, including health promotion, health protection and disease prevention.

Define/discuss and give examples of levels of disease prevention, including primordial prevention, primary prevention, secondary prevention, and tertiary prevention.

List/discuss the principles of screening for both the disease and its screening test.

When presented with data about a disease/condition and its corresponding screening test, determine whether the condition and its test meet the criteria for screening.

Discuss/utilize the U.S. Preventive Services Task Force age-specific guidelines when presented with a real or standardized patient or written patient scenario.


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Slide 25

Text Captions: Quiz Results

You Scored:

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Maximum Score:

{max-score}

Correct Questions:

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Total Questions:

{total-questions}

Accuracy:

{percent}

Attempts:

{total-attempts}

adobe captivate friday, september 16, 2016€¦ · text captions: old & new sayings an ounce of...

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