PMHP Flashcards
Name of the 1st health promotion conference?
Ottawa Charter (1986)
What were the 5 key areas for action highlighted by the Ottawa Charter (1986)?
- building healthy public policy
- creating supportive environments
- strengthening community actions
- developing personal skills
- reorientating health services
What is evidence-based dentistry?
making clinical decisions based on good quality evidence
What are the wider determinants of health (rainbow model)?
constitutional factors (e.g. age, sex), individual lifestyle factors, social and community networks, living and working conditions, greater socio-economic/cultural/environmental conditions
What is the name of the approach which involves prevention of diseases occurring?
upstream approach (as opposed to downstream approach - treatment)
Which frameworks regulate professional ethics?
GDC (regulatory framework) and legal framework
What are the 4 pillars of ethics?
justice (fairness), autonomy, beneficence (patient’s best interests), non-maleficence (balance of risk/harm vs benefit)
What must a patient have capacity for to make an informed decision?
capacity to act, make reasoned decision, communicate decision, understand decision, retain memory of decision
What does valid and legal consent involve?
having capacity, being informed, voluntary, not coerced, not manipulated
What are the 9 GDC ethics principles?
- Put patients’ interest first
- Communicate effectively with patients
- Obtain valid consent
- Maintain and protect patient info
- Clear and effective complaints procedure
- work with colleagues for patients’ best interests
- maintain, develop, work within professional knowledge and skill
- raise concerns if patients at risk
- ensure personal behaviour maintains patients’ confidence in you and profession
What are the GDC guidelines surrounding social media?
- maintain confidentiality
- maintain appropriate boundaries in patient relationships
- do not post anything that breaches patients’ confidence in you and profession
How can you avoid breaching GDC standards surrounding social media?
- seek patient consent
- when sharing anonymised clinical photographs must gain consent and explain benefit of sharing
- log in patient clinical records and note on platform/group
- always give patient option to change their minds and remove information shared
Which organisation regulates and can ban ads which are misleading, harmful, offensive or irresponsible?
Advertising Standards Authority
What is GDPR?
General Data Protection Regulation - governs privacy and control over individual’s data
Uses of social media as a dentist
professional networking, share cases in peer group, connect with senior colleagues, professional self-promotion, self-promotion to patients
What are the 2 branches of law?
public/criminal law and private/civil law
What is the role of Hunter in Hunter vs Hanley?
Pursuer (claimant in England terms)
What is the role of Hanley in Hunter vs Hanley?
defendant (same term in England)
What does Hunter vs Hanley [1955] SC 200 mean?
Pursuer vs Defendant year 1955 session cases page 200
Function of criminal/public law
prosecute, admonish or exonerate
Function of private/civil law
determine fault and liability
Which parties are involved in public/criminal law?
Prosecutor (the state) vs defendant
Who is the prosecutor of criminal/public cases in Scotland?
Crown service and procurator fiscal (PF)
What is the standard of proof in criminal/public cases?
beyond reasonable doubt
What is the standard of proof in private/civil cases?
balance of probabilities
What is the decision in public/criminal law?
guilty or not guilty
What is the decision in private/civil law?
liable or not liable
What is the highest criminal court?
high court
What is the highest civil court?
court of session
Order of civil courts in increasing seriousness
tribunals, specialist, sheriff, court of session (outer and inner) is appealed goes to supreme court
Order of criminal courts in increasing seriousness
justice of the peace, sheriff, high court of justiciary
Which legislation defines parental responsibility in Scotland?
Children (Scotland) Act 1995
How do mothers acquire parental responsibility?
automatically (highly unusual for child protection hearing to remove mother’s parental responsibility)
How do natural fathers acquire parental responsibility?
by being married to mother (do not lose responsibility after divorce) OR if unmarried, by being registered as father on child’s birth certificate
Definition of step-parent
related to child through marriage to parent with responsibility
Do step-parents automatically have parental responsibilities/rights?
no but can be acquired
How can a step-parent acquire parental rights/responsibilities?
parent responsibility agreement, adoption, or application to court
How are grandparents regarded in terms of parent responsibilities?
grandparents regarded as any other adult - parental responsibility application to court required
Do adoptive parents have parental rights and responsibilities?
yes
What happens to the natural parents’ parental responsibility after adoption?
natural parents lose responsibility
In what circumstances can foster carers share parental responsibility?
if they are permanent foster carers, until child turns 26, by application to court
When can someone looking after a child act on the behalf of the person with parental responsibility?
when given explicit permission to do so (spoken or written form). But parental responsibility cannot be ‘handed over’
When can dentists provide emergency treatment to child without parental consent?
if it is necessary to save the life / prevent serious deterioration to the child’s health
How can HIV impact OH?
HIV is associated with an increased prevalence of oral lesions e.g. oral candidiasis, hairy leukoplakia
Function of the GDC
protect patients, regulate the dental team
How does the GDC regulate the dental team?
- registers qualified professionals
- set standards
- assures quality of dental education
- ensures professionals keep up to date
- help patients with complaints
- patient protection
How is the GDC principally funded?
annual retention fees for dentists and dental care professionals
How does the GDC regulate whether dental professionals are up to date?
dentists must do 100 hours of CPD in 5 year cycle
What does the professional duty of candour involve?
being open and honest when something goes wrong, apologise, offer remedy/support, explain short and long term effects
What factors should the evidence-based dentistry approach integrate?
systematic assessment of clinically relevant scientific evidence, dentists clinical expertise, patient’s needs and preferences
What process is used in evidence based practice?
5 A’s - ask, align/acquire, appraise, apply, reflect
What are the 5 As used for evidence based dentistry?
ask, align, acquire, appraise, apply
What feature of a research paper shows it is valid / been under some scrutiny?
peer review
What are some possible issues with peer review?
corruption, cannot prevent plagiarism or duplication, skills of reviewer, time-consuming
What makes research bad?
not needed, poor design (control, biased), poorly/not reported
How would you ask the correct questions during the process of evidence based dentistry?
PICO - describe population, intervention, comparison, outcome
Example of using PICO to test whether the Hall technique for sealing caries offers long-term benefits over current GDP practice for a child with caries
Population - children with caries in primary teeth
Intervention - Hall’s
Comparison - fill/extract
Outcome - rate of failure
Example of how social and community networks can influence behaviour
e.g. parents brushing their children’s teeth
Example of how living and working conditions may influence an individual’s behaviour
A lack of education may mean individuals don’t know how to maintain OH
Example of general socio-economic, cultural and environmental conditions influencing health
individual may live in an area where dental practices are not accepting new NHS patients
Which model explores oral health care at an individual level?
COM-B model
What does COM-B stand for?
Capacity Opportunity Motivation - Behaviour
What does capacity in the COM-B model refer to?
physical and psychological ability to enact a healthy behaviour / stop a health risk behaviour
What does motivation in the COM-B model refer to?
reflective (pros and cons) and automatic inclination to enact a healthy behaviour
What does opportunity in the COM-B model refer to?
physical or social conditions that supports a healthy behaviour
Examples that would affect an individual’s capacity to brush their teeth
broken arm, knowing how to brush teeth and for how long
Examples that affect an individuals motivation to brush their teeth
whether they like brushing or think it is a good thing
Examples that affect an individual’s opportunity to brush their teeth
access to toothbrush and safe water, people around to encourage them
What does the STAR tool stand for?
Support, Talk through barriers, Apply, Recap
How can COM-B be used to improve behaviour?
identify which area is problem and use behaviour change techniques (BCT) - physical/psychological capability, reflective/automatic motivation, social/physical opportunity
Which legislation states that security of patient information is a legal obligation?
Data Protection Act 2018
What steps should be taken following a confidentiality breach e.g. patient record card on reception desk?
- apology
- investigate what happened
- offer meeting with patient
- staff training and review
- inform patient of steps being taken to prevent recurrence
When is disclosure of patient information lawful?
- patient has consented
- required by law
- compelling public interest
When may patients give their consent for disclosure of their information?
to support their own care (e.g. referrals) or for secondar purposes (e.g. education)
What type of consent is required when disclosing patient information for the purpose of their own care?
implicit consent is sufficient
What type of consent is required when disclosing patient information for a purpose secondary to their care?
explicit consent
How are patient’s able to access their dental records?
written request required - can either view record or receive a copy (record belongs to practice)
How long does a practice have to comply with a subject access request (SAR)?
30 days (set by Data Protection Act 2018)
Is a subject access request (SAR) free?
yes but if ‘excessive’ administrative fees can be charged
When can the dental records of a patient who has complained via their solicitor be disclosed?
with signed authorisation from patient (usually supplied by solicitors)
When are police allowed access to patient records?
when information is necessary to
- prevent/detect crime
- apprehend/prosecute offenders
- assess/collect tax or duty
But dentist should enquire further details to assess whether disclosure if necessary
What are the exceptions to requiring explicit consent for patient disclosure?
public interest/third party harm, court order, police with warrant
What are the 4 pillars of value based health & care (VBH&C)?
personal value, technical value, allocative value, societal value
What are the 6 main principles of realistic medicine?
- shared decision making
- personalised approach
- reduce harm and waste
- reduce unwarranted variation (leads to access inequity)
- manage risk appropriately
- become improvers and innovators
What acronym can be used with shared decision making to ensure patient is informed?
BRAN
What does BRAN stand for?
Benefits, Risks, Alternatives, Nothing (consequences)
What acronym can be used to when helping the patient made a decision?
DECIDE model. Define, Explain, Consider, Invite, Decide, Evaluate
Examples of wasteful care
referring ‘just in case’, not getting things right first time, provide care of little value to patient
Example of realistic care
utilising MDTs, patient information, patient recorded outcome/experience measures (PROMs/PREMs - survey)
What indicators are used to assess the Scottish Index of Multiple Deprivation (SIMD)?
income, employment, education, health, access to services, crime, housing
What is Childsmile?
a national programme designed to improve oral health of children in Scotland and reduce inequalities both in dental health and access to dental services
Who plays an important role in delivering the Childsmile programe?
Extended Duties Dental Nurse (EDDN) and Dental Health Support Worker (DHSW)
Roles of extended duties dental nurse (EDDN)
toothbrush demo, OH promotion, fluoride varnish application
Role of Dental Health Support Worker
community links and support, links with health visitor, toothbrushing, facilitation into dental practice
What are the 3 main parts of the Childsmile Programme?
toothbrushing (universal and targeted), nursery and school fluoride varnish (targeted), community and practice (targeted)
What is meant by proportionate universalism?
whilst wanting everyone to improve (universal), also want to flatten gradient to reduce inequality (targeted)
What are universal resources all children are supplied with?
toothbrush and toothpaste (1450ppm F) on at least 6 occasion by age 5, free flow drinking cup in first year, and baby box brush
How much toothpaste does a child up to the age of 3 require?
a smear
How much toothpaste should be used for people over age of 3?
pea-size
Example of universal supervised toothbrushing
all 3 and 4 year olds attending nursery
Example of targeted supervised toothbrushing
available to at least 20% most deprived P1 and P2 children
How much fluoride varnish is applied to nursery and P1 children?
0.25ml
How much fluoride varnish is applied to children P2 and above?
0.4ml
Is Childsmile fluoride varnish targeted or universal?
targeted
Which children receive fluoride varnish?
20% most deprived nursery and P1-4 populations, whose parents have consented
Who applies fluoride varnish?
EDDNs twice a year
