pmph Flashcards
- Below is an abstract from a research study evaluating the effectiveness of powered toothbrushes:
Produce a PICO for this study
population - adults attending GDP
intervention - sonic powered toothbrush
comparison - reduction in plaque score between sonic vs manual
outcome - plaque reduction effectiveness
- What is the most appropriate primary study design for this study?
(1 mark)
randomised controlled trial (RCT)
- List TWO ways in which the researchers might minimise bias in this study?
Explain in what ways they reduce bias
(4 marks)
- randomised allocation
2.blinding = participant and assesor
participants shouldn’t know which brush they re using // assessor don’t know what brush participants used when checking for plaque
- Based on Table 1 above, what is the Absolute Risk Difference (ARD) for a reduction in plaque scores between the two toothbrush groups?
(1 mark)
o calculate the Absolute Risk Difference (ARD), we need to find the difference in the percentage of participants experiencing a reduction in plaque scores between the two toothbrush groups.
For the sonic power toothbrush group:
Percentage reduction = 62%
For the manual toothbrush group:
Percentage reduction = 54%
ARD = Percentage reduction with sonic power toothbrush - Percentage reduction with manual toothbrush
= 62% - 54%
= 8%
- The 95% confidence interval for the ARD = [ 3% to 13%]. Is there sufficient evidence for the effectiveness of the sonic power toothbrush compared to the manual toothbrush in reducing plaque scores?
(1 mark)
yes, there is
95% confidence interval for the Absolute Risk Difference (ARD) does not include zero (it ranges from 3% to 13%), it suggests that there is a statistically significant difference in plaque reduction between the two toothbrush groups
this indicates that the sonic power toothbrush is more effective than the manual toothbrush in reducing plaque scores.
- List TWO additional pieces of information you would wish to know before drawing firm conclusions on whether or not you would consider recommending Sonic power toothbrushes to your patients
(1 mark)
long term effectiveness
adverse effects
how would you calculate absolute risk reduction (ARR)
risk (failure) in control group - risk (failure) in intervention group
number needed to treat
1/ ARR (absolute risk reduction)
- What is the most appropriate primary study design to “to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment”?
(1 mark)
randomised control trial (RCT)
- List the FOUR main features of this study design: (2 marks)
randomisation
control group
blinding
follow up
- Choosing ONE of these features, describe how you would implement it in the above study:
(2 marks)
blinding = outcome assessors
evaluation assessors shouldn’t be aware who got which treatment
- In relation to the Absolute risk difference and the 95% Confidence Interval, (-0.8% to 18.9%) what conclusion would you draw from the table? Explain your answer.
(2 marks)
The confidence interval includes both positive and negative values, indicating that there is uncertainty about the true effect of the ultrasonic device compared to the bur in apical surgery.
Given the wide range and the inclusion of zero within the interval, it suggests that the difference in outcomes between the ultrasonic device group and the bur group may not be statistically significant. In other words, there is insufficient evidence to conclude that the ultrasonic device provides a significant benefit or harm compared to the bur in apical surgery based on the data provided. Further studies with larger sample sizes or different methodologies may be needed to draw more definitive conclusions.
- List FOUR patient-related factors which should be considered when interpreting the results:
(2 marks)
- pre-existing MH = diabetes or CVS affects healing
- OH habits
- anatomy of the surgical site
- compliance with post op instructions
- Name the standards developed to improve the reporting of randomized controlled trials?
(1 mark)
CASP
critical appraisal skills programme
- A 56 year old male patient comes to the dental practice for a routine dental examination.
You can see from the notes that he smokes 20 cigarettes per day. What other questions would you ask him around his tobacco use and to ascertain whether he would be interested in quitting?
(4 marks)
how many years he has been smoking for?
age when started smoking?
quitting history -
has he tried before?
how many attempts? if so, what methods were used?
any interest to quit?
trigger for smoking?
is he aware of health concerns?
would the patient be interested in getting further help and support?
motivation to quit?
- He admits that he feels that he is very dependent on tobacco. Give a definition of dependence.
(1 mark)
a state of physiological and psychological reliance on nicotine, the addictive substance in tobacco.
it is characterized by a strong craving for nicotine, difficulty controlling or stopping tobacco use, and experiencing withdrawal symptoms when attempting to quit or reduce tobacco consumption.
- Name one model/approach that could be used to help him quit?
(1 mark)
ASK, ADVISE, ACT
Ask your patient about smoking
Advise your patient about smoking
Act by offering individualised help and referral to stop smoking services if appropriate.
- There are various evidence- based treatments that can be used to help support patients who want to quit smoking. Give TWO examples
(2 marks)
NRT - nicotine replacement therapy - controlled dose of nicotine to reduce withdrawal symptoms and cravings - patches, gum, lozenges
behavioural counselling - cognitive behavioural therapy
- After you gathered your information on his smoking and quitting habits, your patient tells you that now is not the right time for him to quit due to personal circumstances. What should you do now?
(2 marks)
validate his feelings
provide education
offer support
set future goals
follow-up
This chart shows age standardized incidence rates per 100,000 person-years at risk for oral cancer by deprivation quintiles using the Scottish Index of Multiple Deprivation (SIMD) for 2000-2010
1.Define SIMD and describe how it is derived: (2 marks)
The Scottish Index of Multiple Deprivation (SIMD) is a tool used to measure relative deprivation across different areas in Scotland. It is derived from multiple indicators across seven domains of deprivation:
Income
Employment
Health
Education, Skills, and Training
Geographic Access to Services
Crime
Housing
Describe the relationship between the variables in the bar chart:
(3 marks)
rate is higher in males than females
as deprivation increases, cancer rate increases
From a recent meta-analysis of studies assessing socioeconomic risk factors for oral cancer the following findings were reported:
Compared with individuals from high socioeconomic status, the pooled odds ratios (with 95% Confidence Intervals) for the risk of developing oral cancer were:
(i) 1.85 (1.60 to 2.15) for those who had low educational attainment
(ii) 1.84 (1.47 to 2.31) for those with low occupational social class
(iii) 2.41 (1.59 to 3.65) for those with low income
- Which, if any, of the above odds ratios are statistically significant? (1 mark)
o determine if the odds ratios are statistically significant, we need to check if the confidence intervals include the value of 1.
(i) For low educational attainment:
The odds ratio is 1.85 with a 95% confidence interval from 1.60 to 2.15. Since the confidence interval does not include the value 1, the odds ratio is statistically significant.
(ii) For low occupational social class:
The odds ratio is 1.84 with a 95% confidence interval from 1.47 to 2.31. Since the confidence interval does not include the value 1, the odds ratio is statistically significant.
(iii) For low income:
The odds ratio is 2.41 with a 95% confidence interval from 1.59 to 3.65. Since the confidence interval does not include the value 1, the odds ratio is statistically significant.
Therefore, all three odds ratios are statistically significant.
- Explain your conclusion? (2 marks)
These findings suggest that individuals with lower socioeconomic status, as indicated by lower educational attainment, occupational social class, and income, have a significantly higher risk of developing oral cancer compared to those with higher socioeconomic status.
- The relationship between increased risk of oral cancer with low socioeconomic status is partly explained by smoking behaviors amongst those in lower socioeconomic circumstances.
Give TWO other potential explanations: (2 marks)
access to healthcare
environmental exposures (asbestos, industrial chemicals, air pollutants)
- A 30-year-old female patient who comes regularly to your dental practice, has decided to stop smoking. List FOUR pieces of information you would elicit from her to help you decide what advice you would give to her?
(4 marks
smoking history - duration, intensity, start
motivation to quit - what prompted it
previous quit attempts - what methods or strategies
support systems available
- List TWO services that are available for dental team members to refer patients to for help in stopping smoking?
(2 marks)
NHS smoking cessation services
Quit Your Way
- Name ONE model/approach that can be used to give a dental patient advice.
(1 mark)
brief intervention - aim to trigger a quit attempts
- List THREE pieces of advice that you would give your patient regarding e-cigarettes?
(3 marks)
- understand potential risks - nicotine and chemicals
- use only as a cessation aid
- monitor usage
Give other study design types and their explanations (6 Marks)
cross section = variables at a single point = predict the prevalence
case-control study = individuals with disease to control comparison = recall bias
cohort study = observation one time to assess outcomes and influence of exposures
- What are 2 roles of epidemiology? (2 marks)
disease surveillance and monitoring = prevalence, incidence and distribution of oral diseases
identifying risk factors and determinants
to develop preventative programs
to evaluate interventions
d) Define incidence (1 mark)
rate of new cases within the population during a specified period of time
e) Define prevalence (1 mark)
proportion of individuals in a population who have a particular condition at the specific point in time or within a specified period
smoking 3 general health effects
increased risk of CVS, COPD and cancer
smoking 3 oral health effects
perio
oral cancer risk
staining
2 recent health promotion approaches in Scotland to reduce smoking
quit your way
smoke free legislation and tobacco control policies
An example of an approach to smoking cessation in dental practice
ask
advise
assess
assist
arrange
A 25 year old female patient presents to your practice for a routine check-up with bruising and swelling around her left eye. This is the second time this year she has presented to you with obvious facial injuries.
- What is the most common cause of facial trauma in a female patient?
(1 mark)
domestic abuse = gender based violence
- Aside from physical violence list FOUR other forms of abuse that might be involved in domestic abuse (2 marks)
verbal
emotional
sexual
financial
- What process should you follow to ask about the possibility of domestic abuse and briefly describe?
(4 marks)
AVDR
Ask
Validate
Document Refer
Ask about the abuse
Validate their feelings - way of showing that you are concerned
“You do not deserve to be hurt”
“I am concerned about your safety”
- List FOUR physical signs you might see in domestic abuse? (2 marks)
injuries to head and neck
facial trauma
unexplained bruising
strangle marks around the neck or behind the ears
TMJ pain
Orofacial pain
- List TWO categories of patient who may be considered to be more at risk in terms of domestic abuse than others (1 mark)
age 16-24
long term illness or disability
pregnant women
