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Dentistry in a Nutshell > pmhp > Flashcards

pmhp Flashcards

1
Q

9 gdc principles

A
  1. put pt’s interests first
  2. communicate effectively with pts
  3. obtain valid consent
  4. maintain & protect pt information
  5. clear & effective complaints procedure
  6. work with colleagues in a way that is in pt best interests
  7. maintain, develop & work within your professional knowledge & skills
  8. raise concerns in pt at risk
  9. make sure your behaviour maintains pt’s confidence in you and the dental profession
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2
Q

5 As of EBD

A

Ask
Align
Acquire
Appraise
Apply

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3
Q

PICO

A

Population
Intervention
Comparison
Outcome
used to ask questions

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4
Q

neglect

A

persistent failure to meet a child’s basic physical / psychological needs resulting in serious impairment

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5
Q

dental neglect

A

persistent failure to meet a child’s basic oral health needs likely to result in serious impairment of child’s oral / general health & development

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6
Q

if you suspect child abuse (4)

A
  1. observe - child’s behaviour & injuries
  2. record - conversations & findings in pt notes
  3. communicate; with parent / carer - ask how they got injuries, does it match description, reason for delayed presentation
  4. refer (for assessment) - if still concerned speak to child protection for advice, follow up in writing & speak with health visitor if u5 and school nurse if >5
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7
Q

3 stages to managing dental neglect

A
  1. preventative dental team mx = single unit approach, set targets, keep records & monitor process
  2. preventative multiagency approach = liaise with other HCPs, child may be subject to common framework assessment, agree joint plan of action, r/v at set intervals, letter to health visitor if child u5 not attending
  3. child protection referral = in complex / deteriorating situations, follow local guidelines, refer to social services if required
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8
Q

prevalence

A

individuals affected by disease within particular period of time / point in time

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9
Q

incidence

A

no of new cases of a disease during a particular period of time

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10
Q

ottawa charter 5 key areas for action

A
  1. building healthy public policy
  2. creating supportive environments
  3. strengthening community action
  4. developing personal skills
  5. reorienting health services
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11
Q

clinical negligence

A
  1. dentist owed duty of care
  2. duty was breached
  3. which cause / materially contributed to damage
  4. this damage was reasonably foreseeable & had negative consequences
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12
Q

capacity

A

AMCUR
ACT
MAKE
COMMUNICATE
UNDERSTAND
RETAIN

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13
Q

consent (6)

A

voluntary
not coerced
not manipulated
informed
with capacity
valid

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14
Q

principles of AWI act 2000

A
  1. benefit adult
  2. minimum intervention
  3. take into account present & past wishes of adult
  4. consultation with relevant others
  5. encourage adult to exercise residual capacity
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15
Q

residual capacity

A

any decisions which the pt can make for themselves

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16
Q

who can consent for dental tx under AWI

A
  1. welfare power of attorney
  2. welfare guardian
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17
Q

what is risk

A

no of events of interest / total no of observations

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18
Q

what is odds

A

no events of interest / no without the event

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19
Q

relative risk ratio

A

probability of an outcome in exposed group : probability of outcome in unexposed group

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20
Q

absolute risk difference

A

0 is the value of no difference i.e. no benefit
it is the difference between groups (risk of the tx - risk of control)
to calculate it is the risk in the tx - risk in control of getting the outcome

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21
Q

odds ratio

A

1 is the value of no difference i.e. no benefit
calculated by dividing no who experience effect over no who don’t for both tx and control groups then divide these two to get odds ratio

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22
Q

confidence interval

A

a CI that embraces / overlaps / contains the value of no difference between treatments means there is INSUFFICIENT EVIDENCE for a difference between tx and control group.

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23
Q

4 design elements of RCT

A
  1. specification of participants (inclusion / exclusion criteria)
  2. control of comparison groups
  3. randomisation
  4. blinding
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24
Q

cross sectional study

A

observation of defined population at single point in time
disadv - confounding / recall bias / casuality

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25
Q

confounding variable

A

a factor other than the one being studied that may distort or mask the effects of another variable on the disease in question e.g. age

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26
Q

case control study

A

retrospective study of people with disease vs people without disease
looks back in time at exposure to particular risk factor
disadv - recall or selection bias / confounding / time relationships

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27
Q

case report

A

report on single pt or series of pts
no control group & no valid statistical associations

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28
Q

cohort study

A

establish group of individuals in population, measure exposures, follow up over period of time, identify those who have the disease
disadv controls difficult to identify / confounding / blinding difficult / large sample if disease rare / time consuming

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29
Q

rct

A

strongest evidence on effectiveness of tx

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30
Q

p value

A

used in stats to help determine significance of results
if <0.05 you reject the null hypothesis & your results are statistically significant
note - want narrow CI as larger the sample, smaller the CI

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31
Q

confidence interval

A

range of values that a true population tx effect is likely to lie
estimate of the amount of uncertainty of a sample

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32
Q

NNT

A

number needed to treat
no of pts needed to tx to get 1 pt to experience outcome so you want low NNT

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33
Q

4 main communication skills for guiding style

A

OARS
open questions
affirmations
reflective listening
summary

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34
Q

cycle of behaviour change

A

precontemplation
contemplation
preparation
action
maintenance

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35
Q

what is domestic abuse

A

any form of physical, verbal, sexual, psychological or financial abuse which might amount to criminal conduct & which takes place within the context of a relationship

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36
Q

types of abuse (5)

A

verbal
emotional
financial
physical
sexual

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37
Q

how to deal with domestic violence in practice

A

AVDR
ask - in non judgemental way
validate - removes blame, believing & taking seriously
document - specifically what pt says in notes in own words
refer - signpost to where they can seek help

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38
Q

why alcohol abuse causes problems in dentistry

A

decreased synthesis of clotting factors in damaged liver combined with reduced absorption of vit k dependent ones
thrombocytopenia due to splenomegaly associated with portal hypertension
megakaryocyte maturation decreased leading to fewer platelets
platelet aggregation reduced leading to prolonged bleeding
reduced drug metabolism for LA / analgesia / sedatives

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39
Q

alcohol limit M & F

A

<14 units / week spread evenly over 3+ days

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40
Q

screening tools for alcohol

A
  1. AUDIT - gold standard
  2. FAST - most practical
  3. PAT - used in A&E
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41
Q

what has reduced alcohol intake in scotland

A

ban on multi buy promotions
minimum pricing per unit
framework for action plan
increased investment in alcohol tx & care services
lower scottish drink drive limit
restricted hours of purchase

42
Q

chairside interventions

A

5A’s - ask advise assess assist arrange
2A’s 1R - ask advise refer
ABIs - alcohol brief interviews

43
Q

community based dentistry

A

population
I
community
I
individual
this goes from upstream -> downstream
upstream egs - childsmile, sugar tax
downstream - toothbrushing, FV, 8 elements of caries prevention

44
Q

8 elements of caries prevention

A
  1. radiographs
  2. toothbrushing instruction
  3. strength of F in tp
  4. f varnish
  5. f supplementation
  6. diet advice
  7. fissure sealants
  8. sugar free meds
45
Q

oral health impact of smoking

A
  1. increase in perio, alveolar bone loss, attachment loss, pocket formation
  2. increased risk of dry socket
  3. halitosis & xerostomia
  4. 2-4x increased risk of oral cancer
  5. black hairy tongue, smoker’s keratosis, nicotine stomatitis
46
Q

general health implications of smoking

A
  • narrows arteries & increased atherosclerosis
  • increased risk of stroke
  • increased chest infections / COPD / lung cancer / emphysema / bronchitis / increased stomach ulcers & cancer
  • increased CHD / heart attacks
  • macular degeneration & PVD
47
Q

stress

A

acute pressure leads to specific reactions from nervous / endocrine system
hypothalamus responds by increasing cortisol
chronic stress leads to longer term high cortisol levels
thus effects on BP / immune system / hippocampus / memory / emotions

48
Q

symptoms of stress

A

physical - exhaustion / GI problems / headaches / SoB / sleeplessness
psychological - touchy / irritable / lethargy / anger

49
Q

summary of stress risk factors (6)

A

control
support
relationships
role
change
demand

50
Q

burnout

A

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

51
Q

3 scales of burnout

A
  1. emotional exhaustion
  2. depersonalisation
  3. personal accomplishment
52
Q

what is resilience

A

process of adapting well in face of adversity / trauma / tragedy / threats

53
Q

4 key ingredients of resilience

A
  1. reaching out
  2. rational thinking
  3. awareness
  4. fitness
54
Q

critical appraisal

A

process of assessing & interpreting evidence through systematic consideration of its validity, relevance & results
use PICO to determine if trial addressed a clearly founded issue

55
Q

CASP tool

A

critical appraisal skills programme
set of questions allowing us to go through paper asking if set results were valid & whether they apply for primary which is 1 paper on 1 study

56
Q

systematic review

A

type of literature review that uses systematic methods to collect 2ndary data, critically appraise research studies & synthesise studies
designed to provide complete summary of current evidence relevant to research question

57
Q

adv of SR

A

saves time
provides reliable evidence
resolves inconsistencies
explores differences between studies
identified when questions have been fully answered
identifies gaps

58
Q

how does SR reduce bias

A

in gathering, summarising, presenting, interpreting & reporting of research evidence

59
Q

key characteristics of SR (5)

A
  1. well formulated q (PICO)
  2. comprehensive data search
  3. unbiased selection & abstraction process
  4. assessment of papers
  5. synthesis of data
60
Q

risk of bias assessment for RCT (6)

A
  1. sequence generation
  2. blinding
  3. selective outcome reporting
  4. other i.e. funding
  5. incomplete data outcome
  6. allocation concealment
61
Q

reporting bias

A

publication
citation
time lag
language

62
Q

what is blinding

A

concealment of group allocation from 1 or more of the individuals involved in trial

63
Q

what is meta analysis

A

process of using statistical methods to combine results of different studies
aim is to integrate findings, pool data & identify overall trend of results it is an optional part of SR

64
Q

what does meta analysis do (4)

A
  1. calculates tx effect based on pooled data from group of studies
  2. estimates common tx effect across studies
  3. improves precision of a point estimate by using all available data
  4. increases sample size
65
Q

2 different types of data

A
  1. dichotomous - binary (is or is not) i.e. odds ratio, risk ratio, ARD, NNT
  2. continuous - bp / weight / amount of pain
66
Q

vertical line on forest plot

A

where the tx and control have the same effect i.e. the value of no difference

67
Q

diamond on forest plot

A

relative risk which is outcome of intervention / outcome of control
i.e. % who died with steroid / % who died with placebo

68
Q

horizontal line at bottom of forest plot

A

the scale measuring tx effect
caution - read labels as to the left does not always mean that treatment to the left is better than the control

69
Q

heterogeneity

A

differences between studies that may produce different results
3 types:
- clinical
- methodological
- statistical

70
Q

to identify heterogeneity visually

A

if studies estimating the same thing we would expect CIs to overlap to a large extent so may appear in forest plot as poor overlap of CIs

therefore, can’t draw line through CIs as they don’t overlap so wouldn’t want to pool these

71
Q

to test for heterogeneity

A
  1. chi squared test = P<0.1 demonstrates statistically significant heterogeneity so may not be appropriate to pool data
  2. I squared statistic = % variation due to heterogeneity rather than chance (<50% acceptable)
72
Q

what does cochrane use to evaluate quality of body of evidence

A

GRADE
Grading of Recommendations Assessment Development & Evaluation

73
Q

5 factors that lower the quality of GRADE

A
  1. high / unclear risk of bias
  2. inconsistency between studies i.e. heterogeneity
  3. indirectness i.e. PICO
  4. publication bias
  5. imprecision i.e. numbers & CIs
74
Q

what is clinical governance

A

systematic approach to maintaining & improving standard of pt care within health system

75
Q

6 factors of clinical governance

A
  1. clinical audit
  2. openness
  3. risk management
  4. clinical effectiveness
  5. education & training
  6. research & development
76
Q

what is an audit

A

quality improvement process that seeks to improve pt care and outcome through systematic review of care against explicit criteria & implementation of change

76
Q

5 steps of clinical audit

A
  1. identify problem
  2. set criteria standards
  3. observe practice / data collection
  4. compare performance with criteria / standards
  5. implement change
77
Q

6 dimensions of health care

A

timely
efficient
effective
equitable
person centred
safe

78
Q

consent must be

A
  1. valid -> recently obtained / remain current / specific to proposed tx
  2. legal -> ability i.e. capacity / informed / voluntary
79
Q

7 factors influencing SIMD category

A

employment status
crime
housing
income
education
geographical access
health / health care services

80
Q

what is an addiction

A

chronic, primary, neurobiological condition influenced by genetic, psychosocial and environmental factors

81
Q

risk factors for drug misuse & addiction

A

genetic
socioeconomic
male
environmental
personality - low self esteem
social circles who are also drug users
method of drug admin
early exposure
stress
abuse
trauma

82
Q

reward pathway

A

activated by rewarding stimulus i.e. food / water / sex information travels from VTA (ventral tegmental area) to nucleus accumbens and then up to prefrontal cortex
dopamine mediated transmission allows us to feel pleasure

83
Q

2 variables on fluoride toxicity

A
  1. weight of child
  2. strength of toothpaste
84
Q

management of fluoride overdose

A

<5mg/kg = calcium orally & observe for a few hrs
5-10mg/kg = calcium orally (milk / calcium gluconate) and admit to hospital
>15mg/kg = admit to hospital immediately, cardiac monitoring & like support, IV calcium gluconate

85
Q

what is the position called for seating

A

balance / neutral position
- 90 degree angle at hip & bone
- thighs roughly parallel to floor
- feet on floor, back & neck upright
- shoulders relaxed
- move with chair, do not bend / twist / stoop

86
Q

zones for right handed operator

A

imagine pt head is at 12 o’clock
7-11 = operating zone
11-2 = static zone
2-4 = nurse’s zone
4-7 = transfer zone

87
Q

direct aspiration

A
  • adjacent to tooth being treated
  • aspirator placed slightly distal
  • do not obscure view of operator
  • bevel should be adjacent to tooth
  • remove excess fluid at back of mouth
  • do not go over tongue to access back of mouth
88
Q

indirect aspiration

A
  • useful if access limited or aspirator obscures view
  • anterior 3-3 position aspirator on side closest to you
  • if operator on LHS this would then be on lower right quadrant
  • if operator on RHS this would then be on lower left quadrant
  • remove water / debris without obscuring view
89
Q

if dental dam on

A

3in1 should still be used
required for washing & drying teeth
keeps mirror clean and clear for indirect vision

90
Q

5 methods of soft tissue retraction

A

aspirator
dental mouth mirror
tongue depressor
3in1
cheek retractor

91
Q

for UR quadrant

A

3in1 retract & supports cheek
aspirator on palatal surface distal to tooth

92
Q

for LR quadrant

A

3in1 retracts & supports cheek
aspirator between tongue and lingual surfaces

93
Q

for UL quadrant

A

3in1 retracts & supports lower lip & cheek
aspirator retracts & supports cheek & is placed in buccal sulcus

94
Q

for LL quadrant

A

3in1 retracts & supports lower lip
careful not to press lip onto teeth
aspirator retracts & supports cheek

95
Q

anterior region

A

ensure lips retracted & protected
CW rolls
mouth mirror
support CW rolls with 3in1

96
Q

to calculate NNT

A

1 / ARD

97
Q

audit

A

quality improvement process which seeks to improve pt care and outcomes through systematic review of care against specific criteria and implementation of change

98
Q

PEEEST dimensions of health care quality

A

person centred
equitable
efficient
effective
safe
timely

99
Q

clinical governance

A

systematic approach to monitoring and improving quality of patient care / a framework which holds NHS accountable for continuously improving their services and safeguarding wellbeing

100
Q

8 components of clinical governance

A
  1. education & training
  2. research & development
  3. clinical audit
  4. clinical effectiveness
  5. risk management
  6. enhanced significant event analysis
  7. openness
  8. peer review

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