PMHP Flashcards
What are the 4 principles of biomedical ethics
autonomy
non-maleficence
justice
beneficence
9 GDC standards for practice
put patients interest 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 puts patients interests first
maintain, develop and work within your professional knowledge and skills
raise concerns if patients are at risk
make sure your dental behaviour maintains patients confidence in you and the dental profession
consent must be…
valid
patient must have capacity
patient should have enough information to give informed consent
consent must be voluntary, non-coerced and not manipulated
What information should be included when consenting patients to treatment?
options for treatment, including risks and potential benefits
reason why particular treatment is necessary and appropriate for patient
consequences, risks and benefits for the treatment you propose
the likely prognosis
the cost of proposed treatment
the outcome of no treatment
principles of the AWI act
benefit
minimum necessary intervention
take into consideration past and present wishes of the adult
consultation with adult and relevant others
encourage residual capacity
what situations can a dentist disclose patient records without their consent?
colleagues assisting with patient management
information required by police to
information required by a court
disclosure that is justified in the public interest
- where others are at risk of serious harm
dental negligence - define
a breach in the duty of care that results in damage
what factors are required to prove negligence?
dentist had a duty of care
there was a breach in duty of care
the breach in care caused or contributed to damage
the damage was reasonably foreseeable and had negative consequences
how to handle complaints
let patient state their problem
listen to patients concerns
apologise for distress caused
check understanding of problem by summarising
share thoughts and feelings
negotiate solutions with patient
attempt to reach an agreement
- be as specific as possible
what is diversity?
the differences between people
- regarding community, culture, beliefs and life experience
what is equality?
the fairness of opportunity, observing the rights of people so that differences are not discriminated against
what are the 9 protected characteristics?
age
race
sex
sexual orientation
gender reassignment
disability
religion/belief
marriage and civil partnership
pregnancy and maternity
what method should be used when dealing with suspected domestic abuse cases?
AVDR
ask
validate
document
refer
dental fear - define
normal emotional reaction to something within the dental environment perceived as threatening
what is dental anxiety?
sense of apprehension that something bad is going to happen in relation to dental treatment
what is dental phobia
clinical disorder characterised by extreme fear in relation to situations or objects related to the dental situation
how can dental anxiety be assessed?
dental anxiety scale
modified dental anxiety scale
facial image scale
modified child dental anxiety scale
how to combat mild/moderate anxiety
building trust
teaching coping strategies, relaxation, distractions
pharmacological support
- benzodiazepines
give control - rest signals, stop signals, proceed signals
6 features of quality health service
safety
effectiveness
person centred
timeliness
equity
efficiency
factors of clinical governance
education and training
clinical audit
clinical effectiveness
research and development
openness
risk management
oral implications of smoking
2-4x more at risk of oral disease
potentially malignant lesions
staining
halitosis
smokers melanosis
black hairy tongue
nicotinic stomatitis
periodontitis
general health implications of smoking
increased risk of stroke to heart attack
increased lung cancer/COPD risk
vaping advantages
cheaper
no tobacco
flavours available
more accesible
disadvantages of vaping
ay cause inflammation
no-smokers may use and move onto cigarettes
unknown long term effects
3 As smoking cessation method
ask
advise
act
5As - smoking cessation
ask
advise
assess
assist
arrange follow up
general medical implications of alcohol abuse
alcohol liver disease
hypertension
thrombocytopenia
oral implications of alcohol abuse
dry mouth
oral ulceration
gingivitis s
dental trauma
bruxism
erosion
weekly alcohol recommendations
14 units
spread evenly over 3 days or more
at least 2 alcohol free days
what are the 7 domains for SIMD
employment
income
health
education
geographic access to services
crime
housing
what is the absolute risk difference?
the difference in risk between the groups
if there was no benefit in intervention, the absolute risk difference would be….
0
what is the number needed to treat?
the number of petits requiring treatment to prevent one patient from developing the disease/outcome
how is the number needed to treat calculated
1/absolute risk difference
Features of a randomised controlled trial
gold standard
specification of participants
control group
randomisation
blinding/masking
disadvantages of a randomised controlled trial
difficult to design and conduct
risk of bias
not suitable for all research questions
benefits of systematic reviews
save readers time
provides reliable evidence
removes inconsistency
identifies gaps in research
identify when questions have been fully answered
explores differences between studies
characteristics of a systematic review
well formulated question
comprehensive data search
unbiased selection process
assessment of papers
synthesis of data
what is critical appraisal
the process of assessing and interpreting evidence through systematic consideration of its validity, relevance and results
features of a CASP checklist?
are results of trial valid?
what are the results?
are the results relevant to your clinical practice?
PICO stands for
population
intervention
comparison
outcome
5 factors affecting grade quality of a systematic review
high or unclear risk of bias
- design issues of poor conduct of studies
inconsistency between studies
indirectness
- PICO - were all studies similar in what they set out to do?
- same topic
imprecision
- numbers and CI
- wide confidence intervals
publication bias
- likely that negative/null results not published?
RR=1 or 100% means
no effect
relative risk reduction
proportion of the risk removed by treatment
absolute risk reduction divided by initial risk in control group
Absolute risk reduction - define
Absolute change in risk
the risk of an event in the control group minus the risk in the treated group
usually expressed as a percentage
if confidence interval crosses 1…
not statistically significant
What is a systematic review?
a type of literature review that uses systematic methods to collect secondary data, critically appraise research studies and synthesise studies
benefits of systematic reviews vs single studies
save readers time
- efficient way of bringing a body of literature together to answer a specific question
provide reliable evidence
- unbiased comprehensive picture of a body of evidence
resolve inconsistencies
- single studies can produce conflicting results
identify gaps
- where good studies are not available
- acts as a cattalos for better distend primary studies
identifies when questions have been fully answered
key characteristics of a systematic review
well formulated question
comprehensive data search
unbiased selection and abstraction process
assessment of papers
synthesis of data
what is publication bias
statistically significant ‘positive’ results are more likely to be published
time lag bias
more statistically significant results are more likely to be published rapidly
language bias
results more likely to be published in English
- more likely to be published faster
citation bias
statistically significant results more likely be cited by others
types of reporting biases
publication
time lag
language
citation
what is meta-analysis
process of using statistical methods to combine results of different studies
- optional part of systematic review
aim of meta analysis
integrate findings, pool data and identify overall trend of results
meta analysis advantages
an increase in power
improved precision
