Patient Management Flashcards
Snowball effect
involved initial subject that recommends to another subject that meets the study criteria
width of a confidence interval will _____with increased sample size and decreased standard deviation.
decrease
AP required for CD 4 and neutrophil
CD4 less than 500
neutrophil les than 1000
_____is among the most resistant microorganisms to germicides and is used as a benchmark to measure how well a disinfectant can kill microorganisms.
tuberculosis
After that is MRSA whch is resistant to beta-lactam antibiotics but not very resistant to low-level disinfectants.
OSHA covers Hep B or Hep c vaccinations
Hep B
level 1 surgical mask filteration rate
95-97%
Independent variable is manipulated by researchers, dependent variable is outcome (t/f)
t
The recommendation for Post-Exposure Prophylaxis is to take it as soon as possible and preferably within____
with maximum of
24 hrs
1-3 days
_____ is used to treat status epilepticus, which is a state of continuous, repetitive seizures.
IV diazepam (Valium®)
if seizure, if the episode is less than 5 minutes, the most appropriate next step
reassess that the patient’s airway is open.
which study is retrospective
case control
true temporal study between exposure and disease is provided by
cohort study
calculate ODDS ratio
Odds ratio = diseases / not diseased
If odds ratio = 1: does not affect the odds of disease
OR > 1, the exposure is associated with higher odds of the disease
If OR < 1, the exposure is associated with lower odds of the disease
this virus does not survive long outside the body as it cannot replicate outside a human host. It lasts on surfaces for a matter of minutes to hours.
HIV
Hepatitis B can survive on surfaces for up t
7 days
_____ can survive on surfaces for months.
M. tuberculosis
if relative risk is :
<1
= 1
>1
<1 decrease risk
= 1 no risk
>1 increase risk
if surfaces are not properly disinfected following patient care, hep C virus can survive on a surface for up to
6 weeks
outliers have least / no effect on
mode and median
outliers have large effect on ?
mean and sd
the first sign of discomfort during a dental procedure is typically
eye twitching
what is attrition in research group
Attrition is the loss of subjects throughout a study due to lack of patient compliance, the decision to withdraw, or death and illness.
randomize control trials includes components like
- it is superior group
- two or more groups at random, given different treatments, and observed for the results. The control is a baseline or comparison group, allowing researchers to measure the effect of a treatment by comparing the outcomes of the other groups. Experimental groups will be subjected to an intervention and the outcome will be studied and compared to the other groups.
-the trial is to be blinded, means subjects or researchers do not know whether they are in experimental or control group - no one is eliminated from the group
systemic review
combines resuts from 2 or more published studies to get a meta-analysis diamond
Non-randomized concurrent control group
2 groups, 2 different treatment
problems with single group “historical group”
spontaneous remission
“Hawthorne effect” : people in study behave differently
regression to the mean
“placebo effect”
single group “historical group”
non randomized patient w disease
all in one group
gets tx
result compare with historical control
response/ outcome variable
dependent/ predictor variable (y)
explanatory variable
independent/ predictor variable is manipulated by the researcher (x)
A paired data structure
by data that is being compared from the same individual in different time points.
An unpaired data structure
data that is being compared from different individuals. One group is usually the control group or gold standard, and the other groups are divided into different interventions.
there is an inherent ordering or ranking of the groups and fractions/decimals are possible.
ordinal
variables are numeric variables that are obtained by counting and taking a value based on a count from a set of distinct whole values.
discrete
variables are numeric variables that are obtained by measuring and can therefore take any value between a certain set of real numbers.
continuous
to disinfect digital sensors
spray and wipe with 70% isopropyl alchohol
In US medicare program, what’s part a, b, c, d
Part A: Inpatient or hospital-based coverage
Part B: Outpatient medical coverage
Part C: “Medicare Advantage” - similar to parts A, B, and D, but with additional coverage depending on the plan
Part D: Prescription medication
how often should an office spore test its autoclave for proper heat sterilization?
weekly
which disinfectant is best for smooth surfaces
phenol
platelet count
150,000 - 450,000
blood glucose
140 mg/dl
CD4 cound
500-1200 cells/m3
RBC count
4.7 - 6.7 million cells/uL
when to report abuse
child?
adult?
elderly
disabled
child - immediately social services
adult: ideally ask them alone first and then report to DHHS
elderly and disabled: report immediately
Abuse and neglect
- recognize
- report
- record
- render treatment
for how long can retired dentist name can be on the board
1 year
repor adverse reactions to fda
veracity
DO not remove amalgam bc its toxic is an example of what ada code os ethics
veracity
Veracity
- truthfulness
- do not mislead tx fees
- do not waive copayment
- no overbilling
- submt correct fee (fee differential )
- submit correct tx date and procedure
- do not recommend or perform unnecessary tx
- advertising
Justice
- select patients fairly
be available for emergencies - do not slander on other dentists
- expert witness
- no rebates or fee splitting
Beneficence
- do good
- volunteer
- postpone elective treatment during public health emergency
- join professional dental society
- make research public
- be familiar with signs of abuse and neglect
- report suspected cases to proper authorities
- do not engage in dusruptove behavior
- provide respectful and collaborative work environment
patient abandonment
part of nonmaleficence
- do not stop treatment without giving adequate notice and opportunity to obtain dental service elsewhere
nonmaleficence
- DO CE courses
- refer when needed
- well-trained staff
- no drinking
- post-exposure evaluation
- no personal relationshp w patient
Autonomy
self-governance
must respect the patient;s rights to self-determination and confidentiality
- informed consent
- send patient’s chart to either patient or other dentist
- keep the health records private
ADA components
- Principle of ethics
- Code of professional conduct
- advisory opinion
FDA evaluates
efficacy and safety
Medicare
Medicaid
CHIP
medicare; elderly but does not cover dental
medicaid: for children under 21 and for poor
chip: children fam whose family income high for Medicaid but low for private insurance to afford
when to contact department of health and Human services
suspected elder abuse must be reported
HMO vs PPO based on premium and patients
HMO = less premium and less choice of providers
PPO = more premium and more choice of providers
PPO
Panel of providers agree to accept less than
usual fees in exchange for higher volume of
patients, since subscribers to this plan have a
financial incentive to use providers from this
panel
HMO pays ??
capitation plan (based on how many patients they see not on what procedures)
quaternary ammonium compounds (quats)
disrups cell membrane and is lethal to many microbes (doesn’t kill spores, TB- or non-enveloped viruses)
overbilling
charging more than legally or ethically
acceptable
downcoding
code changed to a less complex or lower
cost procedure than was reported
Upcoding
= reporting a more complex or higher cost
procedure than was actually performed
Bundling=
the combining of distinct dental procedures
unbundling
the separating of a dental procedure into
component parts
Fee schedule=
list of fees the dentist has agreed upon
for dental services and the insurance will cover them in full
Table of allowances=
lists maximum amount a plan
will pay for each procedure but allows dentists to
charge more if they want
– Usual, customary, and reasonable (UCR)=
reasonable
fee based on geographic location
Material Safety Data Sheet (MSDS)
- Manual made
by the manufacturer
0-4 least to most dangerous
Blue: health hazard
Red: Fire
Yello: reactivity of chemical
white: required PPE
EPA requires ____ CFU bacteria per ml of water
≤500 CFU of heterotopic bacteria
hearing loss
≥90dB
within how many feet from patient’s mouth is splatter
3 feet
acute mercury toxicity
– Muscle weakness (hypotonia)
– Loss of hair (alopecia)
– Weight loss/GI disorders
– Exhaustion
Spaulding Classification System
Critical, semi-critical and non critical
- Critical= contacts sterile tissue or vascular
system
– Requires sterilization
– Examples are needles - Semi-critical= contacts mucosa
– Minimum of high-level disinfection but sterilization if
material is heat stable
– Examples are mouth mirror - Noncritical= contacts skin
– Requires disinfection
– Examples include blood pressure cuffs
Ethylene oxide
PSP plates
Ethylene oxide is a colorless gas used to sterilize heat and moisture-sensitive medical and dental equipment.
Dry heat sterilization
– 160 ̊C for 60 min
– Only glass or metal objects can be sterilized by this method due to high temperatures
– Dry heat destroys bacteria by
COAGULATION of proteins
– Best preservation of cutting edges
Pressure sterilization/Autoclave
–
-121 ̊C at 15psi for 30 min
– Moist heat destroys bacteria by DENATURATION of proteins
– Biologic monitors
– Process indicators
Glutaraldehyde
– Cold solution used for heat-sensitive items
– Requires a long time
Health care workers should have a tuberculin
skin test at least _________
once per year
risk of trasmission
Hep B = 30 % (Vaccine availble)
Hep C = 1.8 % (no vaccine)
HIV = 0.3 % (no vaccine)
Routes of Hep A, B, C, D, E
Hep A= fecal-oral
* Hep B= contaminated blood
* Hep C= contaminated blood
* Hep D= direct contact, prior infection with HBV
* Hep E= fecal-oral
Contaminated Blood fEcAl-oral
How many seconds?
Hand wash
* Flush ultrasonic
= 15 seconds minimum
= 20-30 seconds minimum
studies in descending order respectively
cohort study, case-control study, cross-sectional study, and case report.
ANOVA (analysis of variance)
used to test differences between two or more means
Z-test
= measures the statistical difference between two means, large sample size, variance is known
T-test
= measures the statistical difference between two means, small sample size
Chi-squared test (X2)=
measures the association between two categorical values
Correlation coefficient (r)
= statistical measure that
represents the strength of relationship between two
quantitative variables
– Always between -1 and +1
– 0 means no linear relationship
what is type 2 error (beta true)
false positive
when we accept the null hypothesis and H0 is false
what is type 1 error (alpha error)
false positive when we reject the null hypothesis and H0 is true
IIf p>.05
accept / fail to reject the null hypothesis = not significant
If p<.05
reject the null hypothesis statistically significant
Specificity (TN, FN)
increase in true negative and decrease false negative
sensitivity and specificity calculation
sensitivity = TP/ (TP+FN)
Specificity = TN / (TN+FP)
Sensitivity (TP and FP)
increase in true positive and decrease in false positive
Sensitivity
Specificity
- Sensitivity= to correctly identify the disease
- Specificity= health, to correctly identifying people who DOnt have the disease (healthy)
accuracy
how close the final results of an experiment are to the correct or accepted value.
(80% or 90%)
what does reliability and validity mean in quality of diagnostic tests
reliability = precision are you getting consistent results from the tests?
validity = accuracy
how close to the truth are the results?
bell curve and numbers of standard deviation
Normal distribution= bell-shaped
– 68% is within 1σ
– 95% is within 2σ
– 99.7% is within 3σ
range, variance, standard deviation
- Range= max minus min
- Variance= how spread out individual values
are from the mean - Standard deviation= square root of variance
mean, median, mode
Mean= average value
* Median= middle value
* Mode= most frequent measurement in a set
of data
higher the standard deviation
more spread the numbers are
Retrospective cohort study=
Look back after following
the cohort and decide what disease you want to look
for, incidence & relative risk
INCIDENCE AND RELATIVE RISK
Prospective cohort study=
cohort followed through
time to see who develops a disease, incidence &
relative risk
INCIDENCE AND RELATIVE RISK
Case-control study=
people with a condition (cases) are
compared to people without it (controls) in the past,
odds ratio
ODDS RATIO
Cross-sectional study=
survey or measurement taken to
represent a snapshot in time, prevalence
PREVALANCE
Analytical/Observational Studies
To determine the etiology of a disease
Descriptive/Epidemiological Studies
To quantify disease status in a community
Rule of 5s for fluoride toxicity
TOXIC DOSE IS
5MG/KG
LETHAL DOSE IS
5G FOR AN ADULT
rule of 6
Rule of 6’s states that no supplemental systemic
fluoride if:
– Fluoride level in drinking water is >0.6ppm
– Patient is <6 months old OR
– Patient is >16 years old
explain fluoride supplements
≤3 years old = fluoride drops, because children this young have difficulty chewing and swallowing
tablets
* >3 years old = fluoride tablets and lozenges
* >6 years old = fluoride mouth rinse
– 0.2% NaF solution weekly
– 0.05% NaF solution daily
What US population lives in fluoridated
communities
210 million
what is the optimal amount of fluoride in community water fluoride
1 ppm
0.7 mg/L
what is the most cost effective adn most practical way to prevent tooth decay
communty water flouride
define Early childhood caries
and when does it occur
Defined as 1 or more dmfs between birth and
71 months of age
– Mostly occurs in ages 3 to 5
– Mostly involves maxillary incisors and molars
Simplified Oral Hygiene Index (OHI-S)
Quantifies the amount of debris (DI-S) and
calculus (CI-S)
* Oral hygiene
– Good
– Fair
– Poor
periodontal index
– 0= healthy
– 1= bleeding
– 2= calculus
– 3= shallow pockets
– 4= deep pockets
Why does AAP doesn’t like periodontal index?
AAP doesn’t like it because it doesn’t account for
recession so attachment loss is inaccurate
Gingival Index
Uses four surfaces on six indicator teeth
* 0= normal gingiva
* 1= mild inflammation
* 2= moderate inflammation
* 3= severe inflammation, ulcerated tissue with tendency
toward spontaneous bleeding
In epidemiologic measures, what is irreversible
DMFT (caries): decayed, missing, and filled permanent teeth
what med to give:
mild, moderate, and sever pain.
Rx
– Mild ibuprofen or acetaminophen
– Moderate ibuprofen and acetaminophen
– Severe ibuprofen and/or acetaminophen and opioid
Anxious patients are more likely to report pain
and discomfort (T?F)
true
what scale is used to assess pain experience in children
Wong-Baker Faces Pain Rating Scale
what is:
controllability
familiarity
predictability
imminence
- Controllability—how controllable the situation
seems to be - Familiarity—how familiar the situation is
- Predictability—how predictable the situation is
- Imminence—if the situation seems to be
approaching near
which coping method is very effective in peds
tell-show-do
which coping strategy is least effective for a hypervigilant anxious patient
distraction
Systematic desensitization/graded exposure—
exposing patient to items from an agreed upon hierarchy of
slowly increasing feared stimuli allowing them to pair a
relaxation response with a feared stimuli
3 steps of stress management
- trust
- comfort
- coping
Motivational Interviewing (OARS)
- Person-centered counseling style to assist in the resolution from ambivalence to change
- OARS= open questions, affirmations, reflective
listening, summarizing
Premack Principle
making a behavior that has a
higher probability of being performed contingent on a
behavior that has a lower probability of being
performed
3 typeso of behavior learning
- classical conditioning (pavlov’s dogs)
- operant conditioning
- observational learning
Health belief model
- Perceived susceptibility= to given disease or
problem - Perceived costs and benefits= severity of
consequences - Cues to action= prompts to engage or not
engage in certain behavior
Social cognitive theory
- Self-efficacy= cognitive perception that you
can execute behaviors necessary for a given
situation - Behavioral modeling= learn proper behavior
from models around you - Social reinforcement= positive social
consequences
The stages of change
- precontemplation
- contemplation
- preparation
- action
- maintenance
Behavior Change (ABC)
- Antecedent= factor that facilitates behavior
- Behavior= the behavior itself
- Consequences= consequences of the behavior
Present treatment alternatives in what order
descending order of desirability
Laundry list à
ask patient to respond from a list
of choices
Probing
à gather additional information
Leading questions
à direct the patient to
respond a certain way, DO NOT USE
Closed questions à
elicit more specific
information
Open-ended questions
allow patient to explain
what is important to them
veracity
Be honest and trustworthy in dealings with
the public
* Respect the position of trust inherent in the
dentist-patient relationship
* Must not represent care being rendered, fees
being charged, or any form of advertising in a
false or misleading manner
justice
Be fair in dealings with patients, colleagues,
and society
* Deal with people justly and deliver dental care
without prejudice
* Never slander another dental professional
beneficence
Professionals have a duty to act for the benefit
of others
* Provide service to the patient and the public
at large
* Promote patient’s welfare
* The same ethical standard exists no matter
the financial arrangement
Nonmaleficence
Primum non nocere= first do no harm
* Keep skills and knowledge up-to-date through
continuing education
* Know your limitations and refer difficult cases
to a specialist
what is the most essential component for risk management
documentation
how long to keep all the documents for?
Keep all documents for as long as possible
what is the exception for a minor to sign the consent form
Exception if they are emancipated (freed from care and
control of parents) or in an emergency situation
– Married
– Parent
– Pregnant
– Military
what if not inform about informed consent
assault and battery
what is not included in informed consent
Fee (cost of treatment )
Must inform patient about nature of procedure, benefits, risks, and alternative treatment options including no treatment—
not cost of treatment
informed consent
Based on ethical principle of autonomy
Name all ada principles of ethics
- autonomy = self-governance
- nonmaleficence = do no harm
- beneficence = do goof
- justice = fairness
- veracity = truthfulness
how many ADA principles of ethics
5
which sample has lowest errors and reduced bias
stratified random sampling
