PHMP and decontamination Flashcards

Question 1

Q

What is PICO?

Answer

A

Population

intervention

comparison

outcome

Question 2

Q

What is confidence intervals and relative risk?

Answer

A

Confidence interval:
the range of values that the absolute risk difference will take in the population
A confidence interval that overlaps with the value of no difference is insufficient evidence for a difference between treated group an the control group.

relative risk:
the ratio of;
Probability of an outcome in exposed group: Probability of an outcome in an unexposed group.

Question 3

Q

What are the 5 steps/cycle of clinical audits?

Answer

A

Identify problem or issue

Set criteria and standards

Observe practice/data collection

Compare performance with criteria and standards

Implementing change

Question 4

Q

Name 2 other things you can do other than audit? (5)

Answer

A

Peer review- Getting groups of dentists together to share experiences on the aspects of practice.

Enhanced Significant Event Analysis- Meet and analyse an event to implement changes from what we have learned.

Practice based research project- Participation in an approve research project with Scottish Dental practice Based Research Network.

Quality improvement project- specific methodologies and training required for this.

Question 5

Q

What are the 6 dimensions of healthcare? briefly explain each

Answer

A

Safe – ensure no avoidable harm to patients and that healthcare is delivered in a clean and safe environment.

Effective – ensure that most appropriate services, interventions and support are provided to everyone.

Person centred – partnership between patients and those delivering healthcare, ensures individual needs/values are met via communication, compassion, continuity and shared decision making

Timely – ensures that the most appropriate services, treatment and support are delivered at the correct time for everyone

Efficient – ensure that input maximises output = avoiding waste of equipment, supplies, ideas and energy.

Equitable – Ensures high quality care is provided to everyone regardless of personal characteristics such as gender, ethnicity, location and socioeconomic status.

Question 6

Q

What 3 head, neck and oral features can occur with cocaine use? (7)

Answer

A

Perforation of nasal septum and palate

Gingival lesions &ulceration

Erosion and attrition of tooth surfaces

TMJD

Orofacial pain +/- cluster headaches

GORD

Nasal drip

Question 7

Q

What are 4 side effects of opioid use? (6)

Answer

A

Addiction/dependency
Infective endocarditis risk
Enhances sedative agents
Hyposalivation

In large quantities;
Respiratory depression
Hypotension

Question 8

Q

What chemical class of drugs does methadone belong to?

Answer

A

Opiod receptor agonist

Question 9

Q

5 Methadone can be taken orally. Two formulas exist, one which contains sugar and an alternative formula which is sugar-free.

(a) List two environmental or lifestyle factors which increase the risk of dental caries for an individual who is prescribed methadone.

Answer

A

Environmental: SIMD – employment status (unemployed), Crime rates (high), income (low)
Lifestyle: high sugar, poor OH

Question 10

Q

What is the risk of sugar free preparation of methadone?

Answer

A

More acidic - erosion
Sugar free methadone lacks chloroform- less of an irritant if injected. The patient could inject this- increasing the risk of adverse side effects e.g. HIV transmission through reusing needles.

Question 11

Q

Consent
- Give 3 types of consent?

Answer

A

Implied – patients action or lack of action clearly indicates their wishes

Verbal – patient clearly states their consent for procedure

Written – patient signs declaration that they consent to procedure

Question 12

Q

What factors must we discuss with the patient to ensure informed consent? (8)

Answer

A

Why tx is justified
What is involved in the procedure
The risks and benefits of tx
Alternatives to tx
Consequences of no tx
prognosis/outcome
time
cost

Question 13

Q

What 6 factors make up consent?

Answer

A

It must be

Valid
-Recently obtained
-Remain current and appropriate (pt still agrees)
-Specific to the proposed treatment.

Legal
-Ability (patient needs to have the capacity to make an informed condition )
Informed- Pt needs enough information to make the decision.
Voluntary- Pt has made the decision (not manipulated or coerced)

Question 14

Q

What type of person carries consent for a 3 year old patient (4)

Answer

A

Those with parental responsibility

Biological mother
Childs father if he is married to biological mother
The childs father (if not married) as long as his name is on the birth certificate after 4th May 2006
court appointed people with parental rights (e.g. adoptive parents)

Question 15

Q

What type of person carries consent for a 16 year old patient

Answer

A

In Scotland those 16 or over can consent for themselves as long as they have capacity

Or welfare guardian.
Or dentist with AWI certificate.

Question 16

Q

You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
- Name 2 concerns you would raise with the nurses?

Answer

A

Infection control/cross infection

practice and professional reputation

Question 17

Q

You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
Name 6 key learning outcomes from a learning session on PPE?

Answer

A

Wear PPE at times when dealing with clinical procedures

Change/Wear PPE when cleaning up

Change PPE between patients

Correct disposal PPE after usage and soiling - in orange stream

Use of PPE During decontamination

Use of PPE: Protect eyes, hands and clothing

Use of PPE: Protect the patient: eyes, hands and clothing

Question 18

Q

You are working at a dental practice as a dentist, you arrived exceptionally early and saw 2 nurses getting off the bus in their uniforms.
Identify 4 Key steps you would follow when conducting an audit to ensure staff follow instructions on PPE? (4)

Answer

A

Clinical Audits are a quality improvement report.

The key steps of an audit cycle are:
* Identify the problem or issue.
* Set criteria & standards
* Observe practice/collect data.
* Compare the performance with criteria and standards
* Implement change.

Question 19

Q

Decontamination
- Why do we need to clean? (4 examples)

Q said manual cleaning but manual cleaning is being phased out

Answer

A

1. Incase of biological contamination Contamination with deposits prevents direct contact between the steam and surfaces of the instruments that is necessary for effective sterilisation. - e.g. biopsy devices may become contaminated with previous patient materials (resulting in a misdiagnosis)

2. -Functionality of the instrument (biological debris may clog the hinges in forceps and impair function of cutting tools such as burs or endodontic files)

3. Removes organic material:
Any restorative material left on instruments can adhere to the instruments (during sterilisation) making them more difficult to clean & can encourage microorganism growth. These should be removed if possible at chairside.

4. Legal requirements- It is a requirement under the medical devices directive for effective cleaning prior to sterilisation.

Question 20

Q

Why do we need to test the washer disinfector/steriliser? (4)

Answer

A

Legal requirement

Testing helps detect procedural errors and equipment malfunctions

It is important to protect the patient by making sure the machine has carried out all parameters as set up during installation or validation.

Ensure the equipment is working to its optimum and to the correct standard

Ensure validity of the cycle ( Validation is completed by a qualified personell- also does periodontic testing/maintenance)

Question 21

Q

Describe the 5 steps of the washer disinfector

Answer

A

Cleaning stages - prewash, main wash and rinse-

Flush/prewash - saturates the contaminated instruments
< 35 degrees (to prevent coagulation of proteins)

Main wash - Detergents are used at this stage to increase the effectiveness
Depends on the chemicals used (generally 45-65 degrees)

Rinse - removes residue (biological or chemical)
< 65 degrees

Removing prions/vCDJ:
Thermal disinfection - actively killing microorganisms with heated water
Between 90 - 95 degrees for a minimum of 1 minute

Drying - removes moisture before sterilisation
No specific temperature but its usually between 90 - 110 degrees

Question 22

Q

What are the differences between type B and type N sterilisers?

Answer

A

Type N:
No vacuum = Work by filling the chamber with steam and passively forcing air out of the chamber.

Cannot process wrapped, channelled or lumened instruments or hinged (due to the lack of vacuum capabilities)

instruments cannot be stored and must be used directly after sterilisation

Type B Sterilisers:
Pre-vacuum - Remove air by vacuum pump to create a negative pressure
Then chamber fills with air - allows all surfaces of the instruments to be sterilised (even wrapped instruments)
Post-vacuum - removes remaining moisture to ensure the product is not saturated

Processes wrapped, channeled and lumened instruments and porous items i.e. cotton wool swabs

Since it can process wrapped instruments the instruments will be sterile at the time of use and can be stored (for long periods of time)

Question 23

Q

Name 4 key personnel involved in the decontamination process and give a
description of each of their roles

Answer

A

Manager (generally the practice owner):
Person who is ultimately responsible for decontamination
define staff roles and responsibilities, ensure training records are present etc

Operator/user:
Person designated by the manager with the authority to operate a steriliser/washer disinfector
This includes those involved in noting of device reading and housekeeping duties

competent/Test person:
Records Test cycle readings from the machine to ensure that the parts of the machine are working correctly and that the equipment taking temperature/pressure readings are providing accurate values
Periodic testing, Maintenance and validation of equipment:
We have the equipment tested and validated by a qualified personnel so that we are assured that the decontamination responsibilities are being carried out to the correct standard.

Authorising Engineer (decontamination)
AE(D) ensure the work being done by you and the service partner are up to standard.
- Can sign off validation reports carried out by CP(D)
- Can advice if the testing is being carrying out correctly or not

Question 24

Q

What type of water is used for the final rinse in the AWD cycle and why use this as opposed to mains water?

Answer

A

Pure water is used. This has all the particulate filtered out and has a very low bacterial/fungal presence. (Conductivity of PW is 4.3 microsiemens)

Mains water cannot be used as we want a conductivity of less than 30 microsiemens.
Conductivity is a measure of all the particulate water has come in contact (silicates/metals/minerals) . Mains water can leave a residue on the instrument surface

Tap water cannot be used for sterilisers, have to use water of less than 30us (micro-siemens)- pure water.

Pure Water:
Distilled
Deionised
Reverse osmosis
Sterile

Question 25

Q

What is CPD? (3)

Answer

A

Continuing professional development:
- process of tracking and documenting the skills,
knowledge and experience that you gained throughout your career

It is a requirement by the GDC that a registered member must adhere to 100 hours of verified CPD training every 5 years to stay registered.
CPD helps maintaining and updating their skills, knowledge and behaviour throughout their working life, contributing to delivery of good quality care and service provision, that patients and the public trust.

Question 26

Q

How many hours of CPD are to be done in a 5 year cycle and how many are to be
verifiable?

Answer

A

At least 100 hours of Verifiable CPD every 5 years

At least 10 hours every 2 years (want to spread the CPD)

Question 27

Q

Give 3 suggested CPD topics and the hours per cycle

Answer

A

Medical emergencies (At least 10 hours)
Disinfection and decontamination (at least 5 hours)
Radiography/radiation protection (At least 5 hours)

Question 28

Q

What are the 6 components of clinical governance?

Answer

A

Clinical audit

Openness (to poor performance and practice)

Risk management (to patients and practitioners)

Clinical effectiveness - evidence based practice

Education and training (CPD)

Research and development

Question 29

Q

What is an audit?

what is the purpose of a clinical audit? (3)

List the stages of a clinical audit cycle (6)

Answer

A

It is a quality improvement process that seeks to improve patient care and outcome through systematic review of care against explicit criteria and the
implantation of change.

It is used to :
Review what should be done is being done
Highlight gaps in knowledge, learning, attitudes, protocols and training
To produce a framework for implementing change

Cycle:
-Identify problem or issue
-Set criteria and standards
-Observe practice/data collection
-analyse and compare performance with criteria and standards
-Implementing change
-re-audit

Question 30

Q

What are the stages of significant event analysis (SEA)? (7)

Answer

A

Step 1 – identify significant event

Step 2 – collect and collate as much information as possible relating to the event

Step 3 – convene a meeting – non-threatening, no blame – educational focus

Step 4 – undertake a structured analysis

Step 5 – implement changes and monitor progress of all actions agreed upon

Step 6 – write up event analysis

Step 7 – seek educational feedback – peer review

Question 31

Q

List stages in the chain of infection (6)

Answer

A

Infectious agent

reservoir

portal of exit

mode of transport

portal of entry

susceptible hosts

Question 32

Q

state the name and concentration of chlorine releasing agent

Answer

A

sodium hypochlorite (actichlor) – 10,000ppm – 3-5mins

Question 33

Q

How long is the chlorine releasing agent left for?

Question 34

Q

Give waste streams and an example for each?

Answer

A

Waste streams:
1. Black
2. Orange
3. Yellow
4. Red

Black stream:
Household/domestic waste/non-infected waste
e.g. paper towels, wrappers

Disposal = put in an outdoor bin and collected by the council for landfill

Orange stream:
Low risk items that come into contact with the patient
e.g. PPE, swabs

Disposal = secured with ratchet tag, removed by specialise services to be heat disinfected

Yellow stream:
High risk/HAZARDOUS items
e.g. teeth (no amalgam), SHARPS, contaminated metal instruments, drugs and medicines

disposal = removed by specialist services for incineration

Red stream:
e.g. Amalgam, teeth containing amalgam fillings, lead foils

disposal = removed by specialist services and undergoes specialised waste reprocessing and centrifuging so that the mercury does not harm the environment

Brown confidential - confidential documents e.g. letters, px notes

Question 35

Q

Tooth with extracted amalgam what stream does it go into?

Answer

A

red stream

disposal = removed by specialist services and undergoes specialised waste reprocessing and centrifuging so that the mercury does not harm the environment

Amalgam Disposal
● Amalgam waste is put in a rigid white container which is has a screw top (red) lid and is spill proof
● It contains a mercury vapour suppressant
● it is clearly labelled as amalgam and is easily distinguished from other waste streams
● Amalgam waste is centrifuged to remove mercury (which is recycled)

Amalgam licensing law:
consignment note - kept for 3 years

Question 36

Q

What document is a legal/GDC requirement that needs to be kept regarding waste disposal?

How long does this need to be kept for?

What information has to be recorded? (5)

Answer

A

consignment note - kept for 3 years

Description of waste
Quantity of waste
Destination of waste
Origin of waste
Transport of waste

Question 37

Q

Describe clinical governance.

Answer

A

It is a systematic approach to maintaining and improving the standard of patient care within the health system.

Question 38

Q

What are the divisions of NHS Scotland dental services?

Answer

A

Primary care
general dental services/practices
Public dental services – community services
Secondary care – hospital/dental hospital services

Question 39

Q

List the 9 GDC standards for dental professionals

Answer

A

Put patient’s interests first
Communicate effectively with patients
Obtain valid consent
Maintain and protect patients information
Have a clear and effective complaints procedure
Work with colleagues in a way that is in patients best interests
Maintain, develop, and work within your professional knowledge and skills
Raise concerns if patients are at risk
Make sure your personal behaviour maintains patients confidence in you and the dental profession

Question 40

Q

List the sinner circle (5)

Answer

A

Time
Over time blood or biological matter can dry in and adhere to the instrument.
Limit time between use and processing.

Chemical:
Detergent depends on purpose:
Enclosed process- High and low alkaline detergent (not touching skin)
Ultrasonic- enzymatic detergent
Manual washing- pH neutral detergent (less harmful for operator skin)
Chemicals must be validated against the cycle and revalidated if they are altered.

Temperature
Influenced by the chemicals used/ stage of AWD (wash stage <65 degrees & thermal disinfection (90-95 degrees)

Energy - The force applied when cleaning
Manual = brush
Ultrasonic = cavitation via sound waves
Washer disinfect = high pressure jet sprays
Since the force generated in the WD is less than the others we have to add stronger chemicals i.e. high/low alkaline (this can be used as its an enclosed process).

Also, Water - Various types can be used;
Potable/tap water can be used for;
Ultrasonic (hot or cold)
Manual washing (hot or cold)
Washer disinfect (hot or cold)
Tap water cannot be used for sterilisers, have to use water of less than 30us (micro-siemens)- pure water.

Question 41

Q

Name the 10 SiCPs

Answer

A

patient placement and assessment for infection risk
hand hygiene
PPE
respiratory & cough etiquette
safe management of linen
safe management of blood & bodily fluids spillages
safe management of care environment
safe management of care equipment
safe waste disposal (including SHARPS)
Occupational safety - prevention and exposure management of SHARPS

Question 42

Q

What are the 4 pillars of ethics?

Answer

A

o Respect for autonomy
o Non-maleficence
o Beneficence
o Justice

Question 43

Q

What is negligence?

Answer

A

The omission to do something which a reasonable practitioner would do
(something which a reasonable practitioner would not do)

Dentist fails to meet standards of ordinary care which can ultimately result in px harm.
Negligence could be not doing something or doing something you shouldn’t have done.

Question 44

Q

What is the criteria for clinical negligence? (4)

Answer

A

The dentist** owes the patient a duty of care** (if he has accepted the person as a patient- if you have not accepted the person you have no duty of care towards them)
Duty of care is breached. This would be if your practice has not met the accepted standards (taken from expert witnesses e.g. other dentists)
as a result of the breach, harm has been caused i.e. damage.
The damage has to be reasonably foreseeable and have had negative consequences and effects. Therefore, the dentist should have seen that this could happen and so put measures in place to prevent it from happening.

Question 45

Q

How long should Notes be kept for - adults and children.

Answer

A

Adults = A minimum of 2 years and up to 10 years

Children = 10 years or up to the 25th/26th birthday rule. (whichever is longer for children)

Question 46

Q

What should Notes be? (8)

Answer

A

Confidential
Concise
Accurate
Legible
Complete
Current
Retrievable
Retained

Question 47

Q

What type of study provides the highest level of evidence?

List 4 aspects of this type of study?

Answer

A

We thinking Randomised Control Trial
randomised, inclusion/exclusion criteria, control group, double blinding.

Systematic reviews/meta analysis of RCT - Cochrane review
* Well formulated question (PICO)
* Comprehensive data search - using electronic databases/ongoing/unpublished non english studies
* Unbiased selection and abstraction process- at least 2 reviewers & a data extraction form to select relevant papers
* Assessment of papers- at least 2 reviews assessing quality (components of study) and risk of bias
* Synthesis of data- metanalysis calculates the treatment effect based on the pooled data.

Question 48

Q

Give 3 other study designs (other than the one with the highest evidence).

Answer

A

Cohort study - prospective

case control study - retrospective

cross sectional study

case study - one patient

ecological study

Question 49

Q

What is SiMD?

Answer

A

Scottish index of multiple deprivation

Area based index which uses data zones to rank neighbourhoods based on social determinants i.e employment status, crime, housing conditions, income, education (skills, training), geographic access to services, health/healthcare services

1-5 (1= poor area, 5 = affluent)

Question 50

Q

Give 7 factors influencing deprivation?

Answer

A

employment status
crime
housing conditions
income
education (skills, training)
geographic access to services
health/healthcare services

Question 51

Q

Split mouth study designs
- What are the advantages of a split mouth study design? (2)

Answer

A

Both control and intervention group are exposed to same environment.

Each of the 2 treatments are randomly assigned to either the right or left halves of the dentition in the same environment.

Question 52

Q

What are the disadvantages of a split mouth study design (3)

Answer

A

Patient can not be blinded

Adds more bias into the reporting

Incorrect reporting risk

Question 53

Q

What is a P value?**

Answer

A

Used to determine the significance of your results. (Hypothesis testing)
P value is a probability
P <0.05 is used to indicate statistical significance
This would mean you reject the null hypothesis & your results are statistically significant.

Question 54

Q

Describe the decontamination cycle? (9)

Answer

A

acquitisation (buying them)

cleaning

disinfection

inspection

packaging

sterilisation

transport

storage

use

Question 55

Q

Name 4 legislations for decontamination.

Answer

A

SDCEP health & safety - practice support manual

SHTM 0101

BSEN - British standards European norm

MDR

Question 56

Q

Give 5 common reasons for Handpiece faults

Answer

A

Incorrect compression setting and lack of maintenance
Damaged/oversized bur fitted
Incorrect use/not used for its intended use
Poor/inadequate cleaning and incorrect processing
Incorrect/inadequate lubrication (most common)

Question 57

Q

Briefly describe manual washing (2)
- PPE, Process, Drying

Answer

A

Requires PPE:
Apron
Face shield
Nitrile rubber gloves and heavy duty gloves over the top of them.

Immersion:
Dedicated sink for manual washing and Separate sink for rinsing
Water cannot > 35 degrees C
proteins coagulate above this temp and can also damage the chemicals we are using to clean

Chemical detergent with a neutral pH
Follow manufactures guidelines
Usually in ml/L i.e. 5ml per 1 litre

Use a long handled, soft bristled, non-metallic brush which can be processed through a thermal washing cycle.

Scrub the instruments below the surface of the water
Increases the contact of the instrument and the detergent in the water
It minimises splashing
Prevents aerosols being produced

Using sterile, dry, non linting disposable towel to aid drying process.

Non-immersion:
Used for likened hand pieces and items that would be damaged or inhibit sterilisation by immersion technique
Non limiting disposable wipes are used to wipe down instruments

Question 58

Q

Briefly describe ultrasonic bath

Answer

A

Uses sound waves at a high frequency to generate microbubbles.
The fluctuation in pressures generated by the waves causes the bubbles to expand and then collapse which has a scouring effect against the surface of the instruments = cavitation

Question 59

Q

What maintenance and tests are carried out for an AWD?

Answer

A

 Checking the spray arms rotate and spray jets are not blocked
 Checking the door seal for damage or contamination
 Verifying the condition of the load carrier
 Checking there are no instruments (parts) from pervious cycles
 Making sure the strainer/filter is clear
 Making sure there is enough chemical
 Carrying out a protein detection test and soil test
 Noting disinfection temperatures on daily cycles
 Carrying out a full ACT (automatic control test - weekly)

Question 60

Q

What temp, pressure and time is sterilisation carried out (Sterilisers)?

Answer

A

134-137 degrees and must be maintained for 3 minutes
2.05-2.35 bar

Question 61

Q

What maintenance and tests are carried out for sterilisers - daily and weekly? (3 each)

Answer

A

Daily:
ACT
drain and fill the reservoir (standing water is the perfect place for harbouring bacteria)
Steam penetration test (bowie dick- checmical indicator to see that steam penetrates )

weekly:
ACT - automatic control test
Air leakage test (sucking all the air out to check chamber integrity- that no air can get back in)
Air Detector Function tests- puposefully puts air in to check the machine can detect it.

Question 62

Q

Give 4 factors in the aetiology of fear?

Answer

A

Past negative medical/dental experiences.
e.g. painful, frightening, embarrassing.

Influence of family/peers. (transference)

Expectation of pain.

Media representations.

Poor knowledge of the dental environment/procedures

Question 63

Q

How may an anxious patient present? (7)

Answer

A

High neuroticism

pessimism and negative expectations/outcomes

fidgeting

stuttering

Low pain threshold

hypervigilant

poor concentration

Physiological & Somatic sensations:
Breathlessness
Perspiration
Palpitations
Feelings of unease
Tell them that this is a normal response for someone who is worried/nervous

Cognitive Features
Interference in concentration
Hypervirgilance (looking around all the time)
Inability to remember certain events whilst anxious
Imagining the worst outcome

Behavioural Reactions
Avoidance
Escape
Aggressive behaviour

Question 64

Q

What is the cycle of behaviour change? (5)

Answer

A

precontemplation - not interested in change at this moment

contemplation - keen for change in the future

preparation - wants to make change now

action

maintenance

(relapse can occur at any stage)

Answer 64

A

Reducing anxiety via general attitude/try to reduce anxiety via your treatment style;
- Explain the fight or flight response
- Let the patient know that they are in control.
- Establish trust.
- Provide realistic information.
- Provide a high level of predictability - i.e. at the start of the appointment tell the patient exactly what you have planned, ask them their thoughts and concerns.
- Can also establish stop/rest signals
- Positive reinforcement
- Tell, show, do
- Acclimatisation
- voice control
Teach them coping strategies:
Relaxation exercises
Distraction activities = Pleasant/relaxing thoughts, counting.

Moderate/severe dental anxiety:
3. Exposure based treatment programmes = systematic desensitisation.

Pharmacological Support:
They can prescribe an oral sedative e.g. benzodiazepines from GP

referral - May need professional psychological/psychiatrist treatment where the anxiety is a manifestation of underlying emotional problems/serious mental difficulties.

Answer 65

A

interpretation/evaluation of stressors - is it significant

harmful / threat
or
irrelevant / a challenge

Answer 66

A

Reaction to primary appraisal to adress any percieved threats.
1. alarm stage (initation of fight or flight)
2. Resistance - if it continues the body stays activated but this cannot be maintained
3. Exhaustion.- prolonged exposure to the stressor depletes the body’s resources (leading to a variety of health issues)

Answer 67

A

Direct action
Seek information
Do nothing
Coping

Answer 68

A

A process whereby a previously committed professional disengages from his or her work in response to stress and strain experienced in the job

Maslach burnout inventory:
Scale:
1. Emotional exhaustion measures feelings of being emotionally overextended and exhausted by one’s work
2. Depersonalization measures an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction
3. Personal accomplishment measures feelings of competence and successful achievement in one’s work

Answer 69

A

Work/life balance
exercise
education on stress
set own goals
know own limits.

Answer 70

A

14 units spread evenly across 3 days with 2 alcohol free days per week

Answer 71

A

using screening tools like;

AUDIT - (gold standard) isn’t recommended in the GDP setting as it is time consuming

FAST - (recommended) the most practical and relevant in the GDP setting

CAGE - can be used in GDP but not on young people

CRAFFT - can be used in GDP specifically on young people

Answer 72

A

We use behaviour change counselling
We should be non-judgemental
Should last between 5 - 2 minutes
We should encourage people to recognise their conflicting feelings towards their actual and ideal behaviour
We should encourage people to recognise that the responsibility of change lies with them

A one off intervention:
Short
Non-judgemental
Motivational
Aimed at changing behaviour
conversation

FRAMES Framework:
F-eedback is given to patient about their drinking
R-esponsibility for change is placed on the patient
A-dvice for change is given to the patient
M-enu of options -Self directed change options are given
E-mpathetic style using warmth, respect and understanding
S-elf-efficacy to encourage change - empowering the patient

Answer 73

A

20 cigs in 1 pack

number of packs per day x number of years smoked

Answer 74

A

The 3 A’s
Ask:
Establish and record smoking status Is the patent a non/current/ex? how many per day? how long for? what products? quitting attempts? desire to quit now/future?

Advise:
Personal benefits - use what you’ve found in the mouth to provide supporting evidence

Act:
Offer to help and signpost services
Phone trained advisor that will provide advice, Specialist services, Pharmacy services

or
The 5 A’s
Ask:
Establish and record smoking status (as above)

Advise:
Personal benefits - use what you’ve found in the mouth to provide supporting evidence

Assess:

Assist:

Arrange follow up:

Answer 75

A

It must be

Valid
-Recently obtained
-Remain current (pt still agrees)
-Specific to the proposed treatment.

Legal
-Ability (patient needs to have the capacity to make an informed condition )
Informed- Pt needs enough information to make the decision.
Voluntary- Pt has made the decision (not manipulated or coerced)

Answer 76

A

o Options for treatment, their risks and potential benefits
o Why you think a particular treatment is necessary and appropriate for them? o The consequences, risks and benefits of the treatment you propose
o The likely prognosis
o Your recommended option
o The cost of proposed treatment
o What might happen if the proposed treatment Is not carried out
o Whether the treatment is guaranteed, how long it is guaranteed for and nay
exclusions that apply

Answer 77

A

Segregation

Storage

Disposal

Document

Answer 78

A

Implement changes, Repeat the audit

Answer 79

A

a sterile non-linting disposable towel
(doesn’t shed fabric/material)

Answer 80

A

Person centred
Safe
Effective
Efficient
Equitable
Timely.
PSEEET

Answer 81

A

obtained recently

consent is specific

consent remains appropriate

Answer 82

A

Incidence:
Number of new cases over a specific period of time.

prevalence:
Number of cases at a point in time. (snapshot)

Answer 83

A

Short term memory loss
Inability to manage everyday tasks
Confusion/poor judgement
Communication problems (Gradual loss of speech)
Distress aggression/anger/mood changes/ frustration
Risk of wandering/leaving taps running/cooking unattended.
Increased physical frality
Difficulty eating and swallowing (causing weight loss)
Social withdrawl
Apathy (lack of interest)
Loss of confidence

Answer 84

A

bradykinesia (Slow movement and initiation of movement)

rigidity (increased muscle tone- causing pt to be stiffer & move in jerks)

resting tremor

mask like appearance

Drooling (problems with swallowing)

Cognitive changes/hallucination

Answer 85

A

Benefit

Minimum necessary intervention

Take account of the wishes/past wishes of the adult

Consult with relevant others i.e. family members, friends, carers

Encourage the adult to exercise what capacity they have (residual capacity)

Answer 86

A

The ability to;
* Give consent

Make reasoned and informed decisions
Understand decisions (Understand the tx, benefits&risks, consequences of no tx and alternatives)
Communicate decisions (Tell you what they want e.g. language barrier)
Retain memory of decisions

Answer 87

A

welfare POA

welfare guardian

Medical and dental practitioners - who have has specific training - under section 47 of AWI act with general authority to treat.

Answer 88

A

Mental Capacity Act 2005

Answer 89

A

problems with consent - lack of capacity

Swallowing problems

Impaired use of upper limbs.

Tremor at rest- often reduces on purposeful movements- but patient may need iV sedation wth midazolam for muscle relaxation to reduce movement and enable safe provision of dentistry.

Problems with tx compliance and communication

Dry mouth from the anticholinergic side effects of the drugs

Drug interactions

hard to recognise pain

Answer 90

A

-Functionality of the instrument (biological debris may clog the hinges in forceps and impair function of cutting tools such as burs or endodontic files)
-Incase of biological contamination (Biopsy devices may become contaminated with previous patient materials. This can result in a mis-diagnosis.
-Restorative materials- cements can adhere to the instruments making them more difficult to clean. Cements and restorative materials should be removed at chairside.
-Legal requirements- It is a requirement under the medical devices directive for effective cleaning prior to sterilisation.

Answer 91

A

Prewash - remove easy to remove contamination
**Wash- to remove difficult to remove contamination & to wash the instruments and inside of the machine.
** rinse- to remove detergents from previous stage
Thermal disinfection- to disinfect the instruments and inside of the machine
Drying- to drain and dry the instruments and the inside of the machine ready for the next load.

Answer 92

A

P – population = smokers
I – intervention = shiny sheen
C – comparison = brand market leader
O - outcome = tooth staining prevention

Answer 93

A

Randomised control trial

Answer 94

A

Random allocation of the toothpaste.
Blinding of the person assessing the level of tooth staining after.
Randomisation prevents the researcher picking patients they think will do better/ provide better results.
Blinding of the assessor- They are not aware of which toothpaste is causing the result (prevents assessor being more lenient to achieve the result they want)

Answer 95

A

Amalgam waste is put in a rigid white container which is has a screw top (red) lid and is spill proof
It contains a mercury vapour suppressant
(it is clearly labelled as amalgam and is easily distinguished from other waste streams)

Answer 96

A

This gives us the effect of the intervention.

Answer 97

A

No
The risk ratio overlaps the value of 1, therefore not significant.

Answer 98

A

Who funded the research- was it shiny sheen (could there be a conflict of interest)?
Drop outs- was this equal on both sides (could indicate another problem with the toothpaste making patients non-complaint.
What was the inclusion exclusion criteria
o Smoker- but what? How long for?
o Anything else that may have impacted their shade- Coffee/ previous whitening)
When was the toothpaste used? Were they both used the same amount of times i.e. twice daily.

2020 p1

Answer 99

A

Increase in blood pressure
Risk of heart attack

Answer 100

A

1.Identify problem/ issue
2.Set criteria & standards
3. Observe practice (collect data)
4. Compare performance with criteria and standards
5. Implement change

Audit cycle came up twice.

Answer 101

A

1.Apply pressure and allow it to bleed (Squeeze)
2. Wash don’t scrub (soap and water)
3. Assess type of injury-
High risk material (blood/bodily fluid)
Significant injury (Through the skin/ superficial graze)
4. Risk of blood source- is the patient known to have HIV/HEP B/C
5. Establish contact- senior member of staff/ occupational health/ record injury.

Answer 102

A

The patient is given Hepatitis B surface antigens (active immunisation) but antibody levels need to be checked to see the response.
-Adjuvants are also in the vaccine to enhance the immune reponse to vaccine antigens e.g. aluminium adjuvant/ syththetic adjuvant

Answer 103

A

The nurse should be at virtually no risk of infection (according to the CDC)

surface antibody level >12 is classed as effective so very small risk of contracting the disease.

I don’t know what surface antibody 320 means? Type/ level?

Answer 104

A

Occupational health.

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PHMP and decontamination Flashcards

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