Dental Hygiene Theory and Practice, 4th edition by Michele Leonardi Darby

Chapter 03: Evidence-Based Decision Making Darby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition MULTIPLE CHOICE 1. Which of the following components define evidence-based practice? a. Clinical judgment and expertise b. Client values/preferences c. Scientific research d. Both a and c e. Options a, b, and c ANS: E Clinical judgment and expertise, client values/preferences, and scientific research are all components of an evidence-based practice. REF: What is Evidence-Based Decision-Making? | 34 2. The purpose of evidence-based decision-making (EBDM) is to: a. emphasize new research findings. b. close the gap between research and practice. c. defer to clients’ wishes. d. use expert opinions. e. do none of the above. ANS: B The purpose of EBDM is to close the gap between research and practice. Emphasizing new research findings, deferring to clients’ wishes, and use of expert opinions are not part of the stated purpose of EBDM. REF: Competencies | 34 3. Being a good consumer of research literature means you: a. understand what you are reading. b. can identify the level of evidence. c. know how much confidence you can put into the findings. d. Both a and c are correct. e. Options a, b, and c are correct. ANS: E Being a good consumer of research literature means you understand what you are reading, can identify the level of evidence, and know how much confidence you can put into the findings. REF: Competencies | 34 4. Which of the following distinguishes EBDM from traditional decision making? a. Client preferences or values b. Clinical circumstances c. Clinician’s experience and judgment d. Scientific evidence e. All of the above ANS: D The use of scientific evidence distinguishes EBDM from traditional decision making. Client preferences or values, clinical circumstances, and the clinician’s experience and judgment are part of both traditional decision-making and EBDM. REF: Competencies | 34 5. Which of the following can generate questions in practice? a. Client care issues b. Client clinical condition c. Clinical problems d. Clinician’s interest e. All of the above ANS: E Client care issues, the client’s clinical condition, clinical problems, and the clinician’s interest can all generate questions in practice. REF: Principals of Evidence-Based Decision-Making | 34 6. Which of the following is a true statement? a. Evidence alone does not tell practitioners what to do. b. All evidence is equal on the hierarchy. c. The number of studies increase as you move up the hierarchy. d. The clinical relevance of studies decreases as you move up the hierarchy. e. None of the above are true statements. ANS: A Evidence alone does not tell practitioners what to do is a true statement. All of the other statements are incorrect. REF: Principals of Evidence-Based Decision-Making | 34 7. Primary research includes all of the following except: a. experimental studies. b. observational studies. c. systematic reviews. d. case control studies. e. cohort studies. ANS: C Primary research includes experimental studies, observational studies, case control studies, and cohort studies, but it does not include systematic reviews. REF: Evidence Sources and Levels of Evidence | 34-35 8. Characteristics of experimental studies include: a. testing cause and effect. b. describing already existing conditions. c. testing potentially harmful substances. d. both b and c. e. options a, b, and c. ANS: A Characteristics of an experimental study include testing cause and effect. Describing already existing conditions and testing potentially harmful substances are characteristics of observational research. REF: Evidence Sources and Levels of Evidence | 34-35 9. Characteristics of secondary research include the following except: a. filtered, preappraised research. b. meta-analyses. c. systematic reviews. d. case reports. e. research on already conducted research. ANS: D Secondary research includes filtered, preappraised research, meta-analyses, systematic reviews, and research on already conducted research. Case reports are characteristic of primary research. REF: Evidence Sources and Levels of Evidence | 35 10. Characteristics of nonexperimental research include: a. making observations between exposures and diseases. b. ability to conduct studies prospectively. c. ability to conduct studies retrospectively. d. both a and c. e. options a, b, and c. ANS: E Characteristics of nonexperimental research include making observations between exposures and diseases, the ability to conduct studies prospectively, and the ability to conduct studies retrospectively. REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 11. Which of the following are considered Level 1 evidence? a. RCTs, systematic reviews, case reports b. Systematic reviews, meta-analyses, cohort studies c. RCTs, systematic reviews, meta-analyses d. RCTs, cohort studies, case control studies e. Case series, case control studies, RCTs ANS: C RCTs, systematic reviews, and meta-analyses are considered Level 1 evidence. The remaining choices are mixtures of the levels of evidence. REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 12. The AHA Guidelines on Prevention of Infective Endocarditis changed most recently because of: a. more people dying from dental procedures. b. quality of evidence. c. dental professionals not following the guidelines. d. client compliance. e. a change in medications available. ANS: B The AHA Guidelines on Prevention of Infective Endocarditis changed most recently because of the quality of evidence. The remaining statements were not stated reasons for the change. REF: Evidence Sources and Levels of Evidence | 36 13. Which of the following organizations is solely dedicated to producing systematic reviews? a. American Academy of Pediatric Dentistry b. American Academy of Periodontology c. American Dental Association d. Centers for Disease Control and Prevention e. Cochrane Collaboration ANS: E The sole purpose of the Cochrane Collaboration is to produce systematic reviews. Systematic reviews are not the sole purpose of the American Academy of Pediatric Dentistry, American Academy of Periodontology, American Dental Association, or the Centers for Disease Control and Prevention. REF: Evidence Sources and Levels of Evidence | 36 14. EBDM is now possible due primarily to which factor(s)? a. Scientific databases b. Computer access c. Information explosion d. Both a and b e. Both a and c ANS: D EBDM is now possible due primarily to scientific databases and computer access. The explosion of information is a reason why EBDM is needed, but not a factor in making it possible. REF: EBDM Process and Skills: A Practical Application | 37 15. The first step in the EBDM process is: a. finding the best evidence. b. applying the results to client care. c. asking a good clinical question. d. evaluating the results. e. critically appraising the evidence. ANS: C The first step in the EBDM process is asking a good clinical question. Finding the best evidence is the second step; applying the results to client care is the fourth step; evaluating the results is the fifth step; critically appraising the evidence is the third step. REF: Step 1. Asking Good Questions: The PICO Process | 37 16. The second step in the EBDM process is: a. finding the best evidence. b. applying the results to client care. c. asking a good clinical question. d. evaluating the results. e. critically appraising the evidence. ANS: A The second step in the EBDM process is finding the best evidence. Applying the results to client care is the fourth step; asking a good clinical question is the first step; evaluating the results is the fifth step; critically appraising the evidence is the third step. REF: Step 2. Conduct an Efficient Computerized Search | 37 17. Select the PICO component that is either missing or incomplete from this question: For a client with attachment and bone loss due to periodontal disease, will antimicrobial therapy (minocycline HCI) with scaling and root planning, as compared to antimicrobial therapy alone, be more effective? a. P (present and complete: client with attachment and bone loss due to periodontal disease) b. I (present and complete: antimicrobial therapy [minocycline HCI] with scaling and root planning) c. C (present and complete: antimicrobial therapy alone) d. O (incomplete, more effective in doing what should be specified [e.g., more effective in stopping the progression of attachment loss]) e. No component is missing/incomplete ANS: D The “O” component of the PICO is incomplete: More effective in doing what should be specified (e.g., more effective in stopping the progression of attachment loss). The remaining components of the PICO are complete. REF: Step 1. Asking Good Questions: The PICO Process | 37 18. Which two PICO components provide the primary searching terms? a. Problem and outcome (primary focus is on the intervention treatment and comparison treatment) b. Intervention and comparison c. Intervention and outcome (partially correct; intervention needs to be compared with the comparison treatment to determine which might be more effective and appropriate) d. Comparison and outcome (partially correct; comparison needs to be compared with the intervention treatment to determine which might be more effective and appropriate) e. None of the above ANS: B Intervention and comparison are the two PICO components that provide the primary searching terms. The other choices are incorrect. REF: Step 2. Conduct an Efficient Computerized Search | 38 19. Which of the following describes a clinical practice guideline? a. Secondary evidence b. Incorporates scientific evidence from SRs and MAs c. A panel of experts makes specific recommendations d. Intended to translate the research into practical applications e. All of the above ANS: E Secondary evidence, incorporates scientific evidence from SRs and MAs, a panel of experts makes specific recommendations, and intended to translate the research into practical applications all describe clinical practice guidelines. REF: Evidence Sources and Levels of Evidence | 36 20. Which of the key critical analysis questions should be answered first so that your time is used most efficiently? a. What are the results? b. Are the results of the study valid? c. Will the results help in caring for my client? d. Why was the study conducted? e. Was statistical significance found in analyzing the data? ANS: B Whether or not the results of the study are valid should be determined first. If the study is not valid (i.e., if the methods and manner in which the study was conducted are not correct), then the results do not matter. There may be a good reason for conducting the study; however, if the methods and manner in which the study was conducted are not valid, then the purpose will not be met. If the study is not valid (i.e., if the methods and manner in which the study was conducted are not correct), then the data obtained may be biased and inappropriate to analyze. Also, statistical significance does not imply clinical relevance. REF: Step 3. Critically Appraise the Evidence for Its Validity and Usefulness (Clinical Applicability) | 40 21. Critical analysis requires that you understand: a. research design and level of evidence. b. statistical and clinical significance. c. formulating a PICO question. d. both a and b. e. both b and c. ANS: D Critical analysis requires that you understand research design and level of evidence and statistical and clinical significance. The PICO question directs the search. REF: Step 3. Critically Appraise the Evidence for Its Validity and Usefulness (Clinical Applicability) | 40 22. Which of the PubMed clinical queries options finds citations such as systematic reviews, meta-analyses, reviews of clinical trials, and consensus development conferences? a. Clinical study categories: Therapy and Narrow scope b. Clinical study categories: Therapy and Broad scope c. Systemic reviews d. Medical genetics searches e. Both a and b ANS: C Systematic reviews find citations such as systematic reviews, meta-analyses, reviews of clinical trials, and consensus development conferences. REF: Step 2. Conduct an Efficient Computerized Search | 38 23. Benefits of using PubMed include: a. the clinical queries feature. b. using evidence-based filters to retrieve articles. c. searching electronically across hundreds of journals at the same time. d. finding relevant clinical evidence when it’s needed. e. all of the above. ANS: E The benefits of using PubMed include the clinical queries feature, using evidence-based filters to retrieve articles, searching electronically across hundreds of journals at the same time, and finding relevant clinical evidence when it’s needed. REF: Step 2. Conduct an Efficient Computerized Search | 37-38 MATCHING Put the levels of evidence order of their ability to demonstrate causality and limit bias, with answer 1 as the highest level and 5 as the lowest level. a. Case control study b. Cohort study c. Systematic review d. Randomized controlled trial e. Case report 1. 1 2. 2 3. 3 4. 4 5. 5 1. ANS: C REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 2. ANS: D REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 3. ANS: B REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 4. ANS: A REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 5. ANS: E REF: Figure 3-2: Hierarchy of Research Designs and Levels of Scientific Evidence | 35 Match the PICO component with its definition. a. P b. I c. C d. O 6. What you plan to do 7. Main concern or chief complaint 8. Measurable result 9. Alternative 6. ANS: B REF: Step 1. Asking Good Questions: The PICO Process | 37 7. ANS: A REF: Step 1. Asking Good Questions: The PICO Process | 37 8. ANS: C REF: Step 1. Asking Good Questions: The PICO Process | 37 9. ANS: D REF: Step 1. Asking Good Questions: The PICO Process | 37 Chapter 06: Cultural Competence Darby & Walsh: Dental Hygiene: Theory and Practice, 4th Edition MULTIPLE CHOICE 1. Statement 1: Symbols can play an important role in culture. Statement 2: Culture is set by historical developments and will not change. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: A Symbols, rituals, and practices are prominent features of cultures. Cultures are complex and their basic characteristics quite often are historically determined, but cultures are developing and changing continuously. REF: Culture, Cultural Competence, and Cultural Sensitivity | 71 2. Statement 1: Ethnic identity describes the common cultural, historic, and geographic experiences of a group. Statement 2: Individuals of a group who share an ethnic identity also share the same attitude, interests, and dialects. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: A A larger group may share common cultural, historic and geographic experiences (ethnic identity), but the individuals within the primary culture may belong to various different subcultures. Within any group, heterogeneity is more likely than homogeneity. REF: Culture, Cultural Competence, and Cultural Sensitivity | 71 3. Statement 1: Complex societies are homogenous. Statement 2: Immigrants of the first generation share the same culture as the second or third generation of immigrants. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: D Complex societies are never homogenous; people will almost always form separate subgroups with their own features. Culture is a dynamic process, and traditional cultures (first immigrants) can differ from newly acquired cultures of the second or third generation of immigrants). REF: Culture, Cultural Competence, and Cultural Sensitivity | 71 4. Statement 1: Beliefs and practices within a culture do not influence the access to healthcare services. Statement 2: The way people make sense of illness is in part culturally determined. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: B Health and illness are not only physical conditions. Culture can contribute to how members of a specific group determine how causes of illness can be explained and to whom they turn to if they become ill. These beliefs can facilitate or act as barriers to accessing healthcare services. REF: Culture and Health | 71 5. At the first oral care visit, the culturally sensitive oral health professional should: a. first assess the core values of the group to which the client belongs. b. base his or her judgment on the characteristics of the specific culture to which the client belongs. c. assesses the core cultural values for each client individually rather than focusing on the group to which the client belongs. d. apply stereotyping as a tool to determine the possible core values of the client. ANS: C It is important to assess the core values for each individual client to identify the areas of potential cultural differences with the clients and not just those who appear to belong to different groups. It is the opposite of stereotyping. REF: Box 6-2: Guidelines for Cross-Cultural Dental Hygiene | 77 6. Stereotyping: a. is effective in a strange environment with new people to ascertain the characteristics of a member of a particular group. b. can be described as an inaccurate, biased assessment of another human being based on group characteristics. c. is an essential step in analyzing cultural differences. d. recognizes the uniqueness of the individual and allows an accurate perception of the individual. ANS: B Stereotyping fails to recognize the uniqueness of the individual and prevents an accurate perception of those who appear different. It is a biased opinion. Stereotyping should not be promoted as a strategy. REF: Culture and Health | 72 7. Cultural competence starts with: a. awareness of the client’s background and cultural beliefs and values. b. understanding the client’s perspective and social context. c. applying a variety of communication skills to appeal to the client’s identity. d. awareness of one’s own cultural beliefs and practices. ANS: D Cultural competence begins with the awareness of one's own cultural beliefs and practices, and the recognition that others believe in different truths/realities than one's own. Cultural competence starts with self-exploration, as well as awareness and elimination of one’s own biases. REF: Developing Cultural Competence | 72 8. Statement 1: Patients are usually willing to share their ideas and customs with those who express a willingness to understand them. Statement 2: The clinician should assume the presence of cultural differences, and therefore, the clinician needs extensive knowledge of every cultural practice and belief. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: A “If you don’t ask, you won’t know.” By displaying genuine interest in the client and by asking a client to share beliefs, clinicians can increase their cultural knowledge as they practice. Extensive knowledge is not needed. It is most important to develop the understanding that each client’s preferences and values are unique. REF: Culture and Health | 72 9. An equitable, culturally sensitive environment is characterized by: a. the care provider initiating a cultural encounter. b. reciprocal inquiry between the client and care provider. c. the client initiating sharing information about his or her cultural beliefs. d. the care provider tailoring the information to the mindset of the client. ANS: B The goal of effective communication is to maximize the understanding between the communicators. To communicate effectively, both parties have to move beyond cultural biases that could create barriers in care. In the most ideal situation, cross-cultural communication is a means of reciprocal inquiry. This means that both the care provider and client inform each other about their beliefs and expectations. REF: Maximizing Effectiveness of Cross-Cultural Communication | 74 10. A client from a collectivist environment: a. makes decisions about the proposed treatment on his or her own. b. likes to discuss the treatment options with the healthcare provider alone. c. prefers a “doctor-centered” approach. d. might not display the characteristics of the group and therefore might make a decision on his or her own. ANS: D It is important to realize that individual clients from both collectivist and individualist cultures might have different point of views. It is the responsibility of the clinician to identify the client’s preference for shared decision making and to incorporate those preferences into the care provided. REF: Shared Decision Making in Cross-Cultural Settings | 75 11. Ignoring or devaluing the models and practices embedded in other cultures can be described as: a. evidence-based practice. b. ethnocentrism. c. stereotyping. d. bias. ANS: B Demonstrating willingness to cooperate with alternative healers or incorporate traditional treatments can be important. Ignoring or devaluing the models and practices embedded in other cultures can be described as ethnocentrism and leads away from best practices in healthcare. REF: Culture and Health | 72 12. A mother is standing beside her child in the dental office. The child is experiencing a terrible toothache. The mother is crying. She wants to know why God is doing this to her child. What would be the best response of the care provider? a. Explain to her that God has nothing to do with the cause of this toothache. b. Explain to her that she is making the child anxious. c. Listen actively and allow her to express her feelings. d. Do not pay too much attention to her crying, but focus on the child and try to examine the cause of the toothache. ANS: C By allowing the client to express her feelings, the oral health professional learns more about the client’s perspective and beliefs. This allows respectful communication and a suitable explanation of the possible causes. Culturally sensitive care is based on mutual respect and understanding. The other alternatives do not display respect to the cultural beliefs of the mother. REF: Building Relationships | 74 13. Nonverbal communication is important in a culturally sensitive environment. The clinician should be sensitive to: a. gestures. b. eye contact. c. personal space. d. all of the above. ANS: D Cultural differences might be experienced in relation to various forms of nonverbal communication including gestures, handshakes, eye contact, or physical proximity. Follow the client’s lead and explore his or her expectations and beliefs. REF: Nonverbal Communciation | 74-75 14. If a client does not speak the language of the care provider, the best strategy to interact would be to: a. use a medical interpreter with no relationship to the client. b. speak slowly and ask client if he or she understands the instructions. c. ask a family member to translate. d. use body language to communicate you care. ANS: A When language is a barrier, it is most appropriate to use a medical interpreter with no relationship to the client. REF: Verbal Communication | 70 15. Statement 1: Health care literacy is the ability to understand health or disease. Statement 2: Poverty is not a barrier to access healthcare. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: A Health care literacy refers to understanding of the ability to understand how the healthcare system works. Poverty is a major barrier to healthcare access and prevents individuals from meeting their basic human needs for systemic and oral health. REF: Healthcare Literacy | 77 16. Statement 1: Poverty is associated with poor oral health. Statement 2: Being part of an ethnic majority group leads a person to have poor oral health. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: A Children with the most advanced oral disease are found within minority, poor, homeless, and immigrant populations. Therefore, poverty has a strong association with poor oral health. It is important to realize that within all racial/ethnic groups that there are substantial differences in beliefs and behaviors. This inevitably leads to varying degrees of health status. REF: Healthcare Literacy | 77 17. When adapting behavioral interventions for minorities, it is important to: a. use community recourses to publish the intervention and to increase accessibility. b. identify barriers to access and participation. c. couple the initiatives with culturally accepted values or respected figures. d. do both a and c. e. do a, b, and c. ANS: E It is very important to identify barriers to access and participation before implementing behavioral interventions using community resources. When possible, coupling initiatives with culturally accepted values and respected figures maximizes uptake and efficacy. All alternatives are correct. REF: Implementation Phase | 77 18. Statement 1: Culturally sensitive care starts with the care provider exploring the cultural beliefs of the client. Statement 2: Cultural differences occur in every clinical encounter. a. Statement 1 is correct; statement 2 is incorrect. b. Statement 1 is incorrect; statement 2 is correct. c. Statements 1 and 2 are both correct. d. Statements 1 and 2 are both incorrect. ANS: B The care provider should become aware of her or his own bias and perceptions before the clinical encounter with a client. Since oral health professionals have their own professional culture, it is expected that there will always be some sort of cultural difference between the care provider and the client. REF: Developing Cultural Competence | 72-73 19. A 42-year-old female client brought her 14-year-old son to a first appointment with an oral health professional. The oral health professional plans to obtain a medical history, but the client and the clinician do not speak the same language. The client’s son offers to be the interpreter. Which answer is the most appropriate solution? a. The clinician agrees with the proposal and is happy with this efficient solution. b. The clinician prefers an official interpreter, which can be arranged by phone. c. The clinician uses a medical history in the language of the client and asks the client to complete the questionnaire. d. The clinician refers the client to a different dental office at the other side of the city, where the oral health professional speaks the language of the client. ANS: B A family member as interpreter can be unreliable due to personal and confidentiality issues. In some cases, the client or the family member in the role of interpreter can be embarrassed with the information provided. Misinterpretation of the information by family members can also occur, which can lead to incorrect diagnoses. REF: Verbal Communication | 74