Scottish Diabetes Framework

Scottish Diabetes Framework

Scottish Diabetes Framework: Annex E
Glossary of Terms

accountability The process of reporting on discharge of responsibilities and tasks incurred by the position within an organisation.

accreditation A process based on a system of external peer review using written standards, designed to assess the quality of an activity, service or organisation.

ACE inhibitors Angiotensin Converting Enzyme inhibitors are a group of drugs which lower blood pressure and expand the blood vessels.

acute myocardial infarction Scientific term for a heart attack, which occurs when a blood vessel to the heart becomes blocked, usually by a blood clot, resulting in damage to the heart muscle.

acute sector Hospital-based health services which are provided on an in-patient or out-patient basis. Also known as 'secondary care'.

amputation Surgical removal of part or all of a limb.

angina Discomfort in the chest, jaw or arm which often occurs on exercise and which is due to a reduced blood supply to the heart.

angioplasty Angioplasty is a method of treating patients suffering from arterial disease. In coronary angioplasty, narrowed or blocked arteries in or around the heart are opened by inflating a balloon at the tip of a catheter. Peripheral angioplasty is a similar procedure for the treatment of vascular disease in other areas of the body.

arteries Blood vessels which carry blood away from the heart to supply the tissues.

aspirin A medication which thins the blood to prevent clots forming. It is the most widely tested antiplatelet agent and inhibits cyclo-oxygenase-dependent platelet aggregation.

assay Determination of the purity of a substance or the amount of any particular constituent of a mixture.

assessment The process of measuring the quality of an activity, service or organisation.

audit The process of setting or adopting standards and measuring performance against those standards with the aim of identifying both good and bad practice and implementing changes to achieve unmet standards.

BDR Background Diabetic Retinopathy.

beta blocker A group of drugs which can be used to treat raised blood pressure.

blood glucose A measurement of the amount of sugar in the blood.

blood pressure Blood pressure is related to the force of the heart pumping and the resistance to the flow of blood through the body. It is the pressure of the blood in the main arteries needed to push it through the smaller vessels of the circulation.

BMI Body Mass Index. A measurement of weight in relation to height.

cardiologist Specialist doctors who treat patients with heart conditions.

cardiovascular status The status of the heart and blood vessels.

carer A person, paid or unpaid, who regularly helps another person, often a relative or friend with all forms of care as a result of illness or disability. This term incorporates spouses, partners, parents, guardians, paid carers, other relatives, and voluntary carers who are not health professionals.

case record Patient's notes; documentation of care.

CHD See coronary heart disease.

cholesterol Fatty substance needed by the body as a building block for tissues and chemical processes. Cholesterol is an important constituent of atheroma.

chronic Present over a long period of time. Diabetes is an example of chronic disease.

circulation The flow of blood through the heart and blood vessels of the body.

clinical governance A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. Source: DEPARTMENT OF HEALTH - NHS WHITE PAPER: A FIRST-CLASS SERVICE (1998).

clinical management system A collection of core information from individuals relating to their care which allows ongoing useful clinical information to be recorded for use in direct patient care and service audit. (See also Register).

clinical review A method of detecting specified disease in a targeted population at a stage where the individuals have no symptoms.

clinical service In some cases this means looking at the services provided for people with a particular condition or diagnosis (e.g. diabetes), in other cases, at those services relating to a range of manifestations (e.g. coronary heart disease).

clinical trial Research study conducted with patients, usually to evaluate a new treatment or drug. Each trial is designed to answer scientific questions and to find better ways to treat individuals with a specific disease.

CNORIS Clinical Negligence and Other Risk Indemnity Scheme. Has two principle aims: (1) financial efficiency through costs effectiveness risk pooling and claims management; (2) effective risk management by encouraging a rigorous approach to treatment of risk.

compliance A measure of how conscientiously a person carries out advice tailored for that individual's benefit. For example, a situation where clinician and patient are in agreement about the best course of action and the patient carries out the plan by taking tablets or injections.

co-morbidity The presence of co-existing or additional diseases with reference to either an initial diagnosis or the index condition that is the subject of study. Co-morbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.

Contraindication Any condition, past or present, which makes a particular line of treatment unsuitable or undesirable.

coronary arteries The blood vessels that supply the blood and oxygen to the heart muscle.

coronary heart disease CHD. Disease, such as angina, coronary thrombosis or heart attack, caused by the narrowing or blockage of the coronary arteries by atheroma.

CRAG Clinical Resource and Audit Group.

criteria/criterion Criteria provide the more detailed and practical information on how to achieve the standard and can be described as structure, process and outcome criteria.

CSBS Clinical Standards Board for Scotland.

data source The source of evidence to demonstrate whether a standard or criterion is being met.

DCCT compatible assay Diabetes Control and Complications Trial compatible assay. A standardisation which allows comparison of glycated haemoglobin (HbA1c) results between different laboratories.

default Failure to participate in something which is required.

desirable (criteria/criterion) Good practice that is being achieved in some parts of the service and demonstrates levels of quality to which other providers of a similar service should strive.

diabetes mellitus A condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use it properly.

diabetic emergency An acute diabetic episode including hypoglycaemia and diabetic ketoacidosis resulting in admission to hospital.

diabetic ketoacidocis A life-threatening metabolic emergency resulting from absolute insulin deficiency. Lack of insulin results in abnormal metabolism of carbohydrate and fat, and accumulation of by-products called ketones, which are acidic. The acidosis may lead to coma and death if not promptly treated.

diagnosis Identification of an illness by means of its signs and symptoms. This involves ruling out other illnesses and causal factors for the symptoms.

diastolic (blood pressure) Two levels of blood pressure are measured: the higher, or systolic, pressure, which occurs each time the heart pushes blood into the vessels, and the lower, or diastolic, pressure, which occurs when the heart rests. In a blood pressure reading of 120/80, for example, 120 is the systolic pressure and 80 is the diastolic pressure.

dietitian An expert in nutrition who helps people with special health needs plan the types and amounts of foods to eat.

digital camera A camera which captures images which can be digitised, stored and transmitted using microprocessor technology.

discharge summary A letter, usually sent from a hospital to a patient's GP once the patient has been discharged, containing information relating to the patient's admission to hospital such as the reason for admission, diagnosis and what happened to the patient whilst in hospital.

DKA See diabetic ketoacidocis.

end organ damage The results of a disease process that affects the structure and function of a number of body organs.

end stage renal disease When a person's kidneys fail to work. The treatment options for ESRD are: heamodialysis, peritoneal dialysis, and kidney transplantation. Untreated, severe renal disease leads to death. (See also 'nephropathy')

essential (criteria/criterion) A criterion that should be met wherever a service is provided.

evidence-based The process of systematically finding, appraising, and using contemporary research findings as the basis for clinical decisions.

fibrovascular proliferation One result of a disease process which affects blood vessels and surrounding tissue.

funduscopy Examination of the fundus (the retina) of the eye through the pupil using a hand-held instrument.

gangrene The death of body tissue. It is most often caused by a loss of blood flow, especially in the legs and feet.

generic standards Standards that apply to most, if not all, clinical services.

gestational diabetes A form of diabetes which begins during pregnancy and usually disappears following delivery.

glomerular filtration rate Measure of the kidneys' ability to filter and remove waste products.

glycated A test that sums up how well controlled diabetes has

haemoglobin been in the preceding three to four months. (HbAlc)

GP General Practitioner.

GPASS General Practice Administration System for Scotland.

guideline Systematically developed statements to guide treatment decisions.

HbA1c See glycated haemoglobin.

HDL Health Department Letter. Superseded previous series of MELs - Management Executive Letters.

healthcare professional A person qualified in a health discipline.

heart attack Non-medical term for a sudden serious disorder of the heart when part of the heart muscle can be damaged. Usually this refers to coronary thrombosis.

heart failure A condition in which the pumping action of the heart is inadequate.

HEBS Health Education Board for Scotland.

HTBS Health Technology Board for Scotland.

hormone A circulating chemical messenger made in one part of the body and acting on other parts.

hyper- cholesterolaemia High level of cholesterol.

hyperlipidaemia High level of fats (lipids) in the blood.

hyperosmolar non-ketotic state A complication of diabetes caused by a lack of insulin and dehydration. It is diagnosed when the patient has: 1. very high levels of glucose (sugar) in the blood; 2. absence of ketoacidocis; 3. severe dehydration.

hypertension High blood pressure which, if uncontrolled, can increase the risk of heart disease or stroke.

hypoglycaemia Hypoglycaemia (hypo) occurs when blood glucose levels are low; below 4mmol/l.

IM&T Information Management and Technology.

incidence How often a disease occurs; the number of new cases of a disease among a certain group of people over a specific period of time.

infarct Part of an organ which has died because its blood supply is cut off. Usually refers to the dead part of the heart muscle after a coronary thrombosis.

informed consent Consent obtained freely and without coercion, after appropriate and understandable information has been given and questions answered.

insulin A hormone secreted by the pancreas. Insulin regulates the blood glucose level, and is important for growth and tissue repair.

insulin therapy Treatment using insulin in patients with diabetes following trauma to the body such as a heart attack.

integration Shared or overlapping processes which result in a stronger whole. For example, a situation where all aspects of care are connected and all healthcare professionals are working together.

ischaemia Poor blood supply, usually because of narrowing or blockage of an artery.

Joint British SocietiesCoronary Risk Prevention Chart Validated information produced in the form of a chart which is used by healthcare professionals to predict a person's risk of developing coronary heart disease taking into account several different risk factors.

ketoacidosis See diabetic ketoacidosis.

ketones A breakdown product of fat that accumulates in the blood as a result of inadequate insulin or inadequate calorie intake.

laser treatment Using a special strong beam of light of one colour (laser) to heal a damaged area. A person with diabetes might be treated with a laser beam to heal blood vessels in the eye.

lead consultant Clinician with administrative responsibilities for a specific service.

LHCC In Scotland, Local Health Care Co-operatives are voluntary groupings of GPs and other local health care professionals intended to strengthen and support the primary health care team in delivering local care.

Local diabetes service advisorygroup (LDSAG) A strategic planning group of local diabetes service users, carers and providers who advise NHSScotland Boards in matters relating to services for individuals with diabetes.

macula The area of the retina that is the centre of sight.

macular oedema Fluid in the part of the retina that is at the centre of sight. It may be a result of leaking small vessels causing fluid to accumulate around the cells of the retina or may be a result of sick and dying cells ballooning up because they are starved of oxygen and food.

managed clinical networks Linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and NHS Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.

medication Drugs prescribed to treat a condition.

medicines management Organisation of various medications involving the timing, frequency and period of treatment.

meta-analysis Statistical method to combine the outcomes of more than one randomised clinical trial.

micro-albuminuria Leakage of small amounts of protein (albumin) into the urine. An early warning of kidney damage.

micro-vascular Something that concerns small blood vessels.

macro-vascular Something that concerns large blood vessels.

mmhg Millimetres of mercury: A measurement of blood pressure.

mmol/l Millimoles per litre. Unit for measuring the concentration of glucose, lipids (fats) and other substances circulating in the blood.

morbidity The incidence of a particular disease or group of diseases in a given population during a specified period of time.

mortality The number of deaths in a given population during a specified period of time.

multidisciplinary A multidisciplinary team is a group of people from different disciplines (both healthcare and non-healthcare) who work together to provide care for patients with a particular condition. The composition of multidisciplinary teams will vary according to many factors. These include: the specific condition, the scale of the service being provided and geographical/ socio-economic factors in the local area.

multidisciplinary system of working A method of working in a multidisciplinary team with protocols in place for most, if not all, eventualities.

mydriasis Dilation of the pupil of the eye by the insertion of drops.

nephropathy Kidney damage from any cause; quite often diabetes. (See also 'end stage renal disease')

neuropathy Nerve disease. Neuropathy is one of the long-term complications of diabetes. Nerve damage can affect many parts of the body. The most common form is called peripheral neuropathy, and usually affects the longest nerves first: those that supply the feet and legs. Neuropathy may cause numbness, tingling or pain in the feet or legs. Other types of neuropathy may impair digestive or sexual function, or cause pain.

NHS 24 National, nurse-led triage and health information service.

NHS boards The role of NHS boards is to ensure the efficient, effective and accountable governance of the local NHS system. There are 15 NHS boards in Scotland.

obesity Condition of being grossly overweight at least 20% heavier than the heaviest weight in the 'ideal' range for that person's height. Obesity is defined as BMI greater than 25 kg/m ² or waist greater than 32" for women, 37" for men.

oedema A collection of fluid.

ophthalmologist A medical doctor specially trained to diagnose and treat disorders of the eye. An ophthalmologist is qualified to prescribe medication, prescribe and adjust spectacles and contact lenses and is usually qualified to perform laser treatment and surgery.

optician Fits, supplies and adjusts spectacles and contact lenses. An optician cannot examine the eyes or prescribe spectacles or medication.

optometrist Although not a doctor of medicine, an optometrist is specifically trained to diagnose eye abnormalities and prescribe, supply and adjust spectacles and contact lenses.

outcome The end result of care and treatment. In other words, the change in health, functional ability, symptoms or situation of a person, which can be used to measure the effectiveness of care and treatment.

outpatient A patient reviewed in a hospital but who does not need to be admitted to the hospital.

PAF Performance Assessment Framework.

PAM See professions allied to medicine.

Partners in Change A programme of national and local projects designed to promote the involvement of patients throughout NHSScotland.

patient A person who is receiving medical treatment (especially in a hospital). Also, a person who is registered with a doctor, dentist, etc and is treated by him/her when necessary. Sometimes referred to as user.

patient journey The pathway taken through the healthcare system by the patient and as viewed by the patient.

PCMG Primary Care Modernisation Group. Scottish Executive group supporting the development of LHCCs.

PCRG Primary Care Reference Group. Established to help the CSBS ensure that the component of care delivered to patients outside hospitals is included in its standards and to promote the accreditation of general practices.

PCT Primary Care Trust.

peer review Review of a service by those with expertise and experience in that service, either as a provider, user or carer.

peripheral vascular disease Disorder affecting the blood vessels in the body preventing the ready supply of oxygenated blood to the peripheral parts of the body.

photo-coagulation Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy.

placebo Dummy treatment which is given to some of the volunteers participating in a clinical trial. Patients can feel better even when the treatment they are given is a 'sugar pill' or placebo.

plan of care A written agreement which is developed with the user, and which details the roles and responsibilities of all individuals involved in the person's care and when their care arrangements are to be reviewed.

podiatrist/chiropodist Person with expert knowledge in foot care.

polyuria The passing of large volumes of urine usually due to excess glucose in the bloodstream. It is hence a symptom of untreated diabetes.

prescription Usually a written recipe of treatment.

pressure relief A means of redistributing gravitational force to prevent further tissue damage.

prevalence The number of existing cases of a disease among a detain group of people, usually at a specified point in time.

primary care The conventional first point of contact between a patient and the NHS. This is the component of care delivered to patients outside hospitals. It is typically, though by no means exclusively, delivered through general practices, and is the service most often used by a patient.

primary prevention The prevention of the development of a condition, such as coronary heart disease, by avoidance of factors known to contribute to its development, for example, smoking and lack of exercise.

professions allied to medicine Healthcare professionals directly involved in the provision of primary and secondary healthcare. Includes several groups such as physiotherapists, occupational therapists, dietitians, etc.

prognosis An assessment of the expected future course and outcome of a person's disease.

proliferative retinopathy Diabetes can cause small blood vessels to block off resulting in the retina being starved of food and oxygen. If enough small blood vessels block, then the eye tries to grow new blood vessels (proliferative retinopathy) that are prone to bleeding and pulling of the retina.

prophylactic medication Drugs prescribed to prevent something happening.

prophylaxis The prevention of disease; preventive treatment.

protein One of the three main classes of food. Proteins are made of amino acids, which are called the building blocks of the cells. The cells need proteins to grow and to mend themselves. Protein is found in many foods such as meat, fish, poultry, and eggs.

proteinuria Too much protein in the urine. This may be a sign of kidney damage.

protocol A policy or strategy which defines appropriate action. Also covers the adoption, by all staff, of national or local guidelines to meet local requirements in a specified way.

psychological Relating to human behaviour.

quality assurance Improving performance and preventing problems through planned and systematic activities including documentation, training and review.

randomised Randomly allocated to one of more than one different choices.

rationale Scientific/objective reason for taking specific action.

RCGP Royal College of General Practitioners.

RCT Randomised, controlled trial

referral The process by which a patient is transferred from one professional to another, usually for specialist advice.

register At its simplest, a list. However, the term is often used interchangeably in 'clinical management system'.

renal A term that means relating to the kidneys.

renal failure An abnormality resulting from the inability of the kidneys to function and resulting in a build-up of poisons in the body.

renal function A measure of how well a person's kidneys are working to remove waste products from the body.

renal impairment A reduction in the ability of the kidneys to carry out their functions.

retinal photography Use of a camera to take pictures of the surface of the retina.

retinopathy Damage to the retina at the back of the eye. Retinopathy is one of the possible long-term complications of diabetes. The retina contains many small blood vessels that can be injured by high blood glucose and high blood pressure.

risk factor A clearly defined occurrence or characteristic that increases the possibility that a person will get a disease.

SCI-DC Scottish Clinical Information Diabetes Collaboration.

Scottish Diabetes Survey A Scottish Executive initiative attempting to build a national register of people with diabetes and to monitor diabetes care, with the aim of facilitating better healthcare.

Scottish ExecutiveThe devolved government for Scotland. It is responsible for most of the issues of day-to-day concern to the people of Scotland, including health, education, justice, rural affairs and transport.

secondary prevention Encompasses the identification and modification of risk factors following an acute event, in order to reduce the likelihood of recurrence.

SEHD Scottish Executive Health Department.

self-assessment Assessment of performance against standards by individual clinical teams and/or Trusts providing the service to which the standards are related.

serum creatinine A biochemical measurement or test of one of the body's waste products which is an indicator of renal function.

side-effect A side-effect is an unpleasant and unwanted effect of drug treatment.

SIGN Scottish Intercollegiate Guidelines Network.

slit lamp A method of examining the structures of the eye using a special microscope.

SPICE-PC Scottish Programme for Improving Clinical Effectiveness in Primary Care.

standard statement An overall statement of desired performance.

statutory Enacted by statute; depending on statute for its authority; as a statutory provision.

St Vincent Declaration The main aim of the St Vincent Declaration is to reduce the serious health problems linked to diabetes, such as blindness, renal failure, amputation and coronary heart disease, through governmental and healthcare team initiatives.

systolic Two levels of blood pressure are measured: the higher,

(blood pressure) or systolic, pressure, which occurs each time the heart pushes blood into the vessels, and the lower, or diastolic, pressure, which occurs when the heart rests. In a blood pressure reading of 120/80, for example, 120 is the systolic pressure and 80 is the diastolic pressure.

tractional retinal detachment When the surface of the back of the eye becomes separated from the underlying structures by new blood vessels.

type 1 (insulin -dependent) diabetes Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually presents before the age of 40. It is treated by insulin injections and diet.

t ype 2 (non-insulin- dependent) diabetes Type 2 diabetes develops when the body can still make some insulin, but not enough, or when insulin that is produced does not work properly (known as insulinresistance). This type of diabetes usually appears in people over the age of 40, though often appears before the age of 40 in the South Asian and African-Caribbean population. It is treated by diet alone or by diet and tablets or, sometimes, by diet and insulin injections.

ulceration Breaks or deep sores in the skin.

urinary albumin A measure of how much albumin (protein) leaks from

concentration the blood into urine as a result of one or more disease processes in the kidneys.

visual acuity A measure of how well a person sees distant and close objects.

vitrectomy An operation to remove the blood that sometimes collects at the back of the eyes when a person has eye disease.

vitreous haemorrhage Bleeding into the fluid in the middle of the eye from new blood vessels arising from a disease process at the back of the eye.