ODS831: Management of Medically Complex Patient

Transcription

1 ODS831 Management of Medically Complex Patient / Spring Year 3 ODS831: Management of Medically Complex Patient 1. Course Directors 2. Administrative Details Dr. Albert Primary Course Designation: Clinical 355 Squire Hall Course Type: Required Department of Oral Diagnostic Sciences Year/Semester: D3/2 (3 rd year/spring) Credit Hours: 1 acantos@buffalo.edu Office Hours: By appointment 3. Participating Faculty Dr. John Campbell Dr. David Croglio 112 Squire Hall 235 Squire Hall , jc294@buffalo.edu , dmjcro@aol.com Dr. Maureen Sullivan Roswell Park Hospital , Maureen.sullivan@roswellpark.org Dr. Guy Ditursi VA Hospital, Bailey Ave , guy.ditursi@va.gov 4. Keywords Oral Medicine, Dentistry, Mental Retardation, Geriatric Dentistry, Dental Care for the Aged, Autistic Disorder, Pediatric Dentistry, Communication, Informed Consent, Third-Party Consent, Mouth Neoplasms, Nursing Homes, Heart Diseases 5. Course Meeting Days, Times & Locations 1 credit hour meeting 16 times on Tuesdays at 2PM in Kimball Tower Course Description The evaluation of the medically, complex, developmentally disable or geriatric patient is integrated with management techniques for appropriate treatment planning and treating of those patients in this course. 7. Course Purpose Along with the changing demographics of our population and advances in medical and social systems, the number of people with special needs who need oral health services is rising dramatically. Evidence continues to mount suggesting that there is interdependency between systemic health and oral health. The increased need for oral health services for these medically complex patients and the aforementioned interdependency make the care of special care patients and patients with complex medical conditions a high priority in modern dentistry. It has been reported that a large percentage of practicing dentists actively avoid treating this population. It has been demonstrated that dentists exposed to special care dentistry in dental school choose to treat this population in greater numbers and with greater comfort.. The purpose of this course is to expose the student to the special techniques, management skills, communication skills and treatment planning modifications essential for the modern dentist to serve this ever-larger subset of his community. 8. Course Goals The goals of this course are: a. To expose the students to the features and needs of patients with Alzheimer s disease, Parkinson s disease, Autism, Mental retardation and other developmental disabilities. b. To instruct students in the proper evaluation of medically complex patients and to learn when to ODS831 Management of Medically Complex Patient / Page 1 of 6 June 15, 2010

2 ODS831 Management of Medically Complex Patient / Spring Year 3 refer patients to other specialized clinics/practitioners. c. To review and emphasize proper management of patients with multiple medical conditions and medications d. To acquaint students with the techniques available to manage Special Care patients e. To familiarize students with the special approaches necessary for patients with AIDS and post cancer treatment 9. Learning Objectives Upon completion of this course, students will: a. Be familiar with the changing demographics of Special Care and medically complex patients in the U.S. b. Be familiar with physical, verbal and pharmacologic techniques for management of Special Care Patients c. Be familiar with special equipment utilized to treat patients in non-traditional settings d. Be familiar with the evaluation of patients with multiple medical problems on numerous medications e. Understand when and if to refer patients to specialized clinics/practitioners f. Understand the principles of rational treatment planning and know when to modify traditional treatment plans g. Be exposed to the regulations governing dental treatment in Skilled Nursing Facilities 10. Associated Competencies The DDS program is focused on the attainment of competency in 36 different areas. The competencies are listed in the Student Handbook. ODS831 contributes to the dental students attainment of the following competencies (numbers as listed in the competency document). Learning Objective SDM Competency from Appendix 1 9a 11 9b 3, 4, 5, 28, 36 9c 28 9d 1, 2, 17, 18, 21 9e 3, 8, 20 9f 11, 17, 21, 24, 28 9g 8, Student Evaluations Methods Students are responsible for material covered in the lectures, films & posted on UBlearns. Students are required to attend all sessions Grades will be based on the following: Grading Criteria Evaluation Types* % Weight Written Quiz Uannounced Quizzes 10% Midterm Written Examination 30% Final Exam Written Examination 60% *Evaluation Types (see Appendix 2 for full descriptions) 100% Grading A= B=89-80 C=79-70 D=69-65 F=below 65 *Exams may be curved to standard bell curve ODS831 Management of Medically Complex Patient / Page 2 of 6 June 15, 2010

3 ODS831 Management of Medically Complex Patient / Spring Year Learning Resources Texts: Lippincott s Illustrated Reviews Pharmacology, McDonald, Ralph E. McDonald. Dentistry for the Child and Adolescent, 8th Edition. Elsevier, 2004 D-Termined video & workbook from Specialized Care Company 206 Woodland Road, Hampton NH Instructional Media a. Instructional Modes: Verbal auditory 50% Visual 50% b. Instructional Tools: Handouts/Manuals, Video, Slideshow (i.e. PowerPoint) c. Instructional Methods: Lecture, Case Presentations 14. Course Schedule *All classes meet on Tuesday at 2pm in 125 Kimball Date Topic Readings Faculty 1/5/10 Introduction/Demographics An introduction to the course, which includes statistics regarding the ageing of the US population, number of disabled residents in the US broken down by disability, future trends in growth of disabled and elderly population. Also discussed is the history of Special Care dentistry and career paths within the field. 1/12/10 Alzheimers/Autism Features of both Alzheimers disease and Autism are presented. The suspected causes and features, demography of both conditions are explored and issues related to dental problems and treatment are introduced. 1/19/10 1/26/10 2/2/10 2/9/10 D-Termined Method An approach to the management of Autistic patients is presented. The approach is extensible to many Special Care groups. A workbook is provided which details the program and provides prescreening and evaluation forms for treating patients. Developmentally Disabled Needs and features of Down syndrome, mental retardation, Fragile X, and Cerebral Palsy are presented. Definitions of behavioral resistance are explored as an aid to management. Algorithms for initial evaluation and treatment are presented along with armamentarium of equipment which will be useful. An initial introduction to the modification of treatment approaches for Special Care patients is presented. Oral Surgery/Oral Sedation Medical evaluation of patients with attention to history taking is presented and guidelines are provided as to which medical problems may be unsafe to treat in traditional or dental school clinic settings. Hospital clinic and specialist referral options are explored. The second half of this lecture covers sedation methods of behavior management, safety and medicolegal issues are discussed. Oral Medicine Topics I Review of the management of the hypertensive patient with emphasis on mechanisms of common anti-hypertensive medications. Review of the management of the diabetic patient, which includes lab value interpretation, and the use of a glucometer. Current information on management of patients who are currently or have been on bisphosphonate therapy and current theories regarding risk reduction and identificationt of bisphosphonate related osteonecrosis. D-Termined workbook McDonald, Ralph E. McDonald. Dentistry for the Child and Adolescent, 8th Edition. Elsevier, Chapter 23 Campbell Lippincott s Illustrated Reviews Pharmacology Chapter 19 Osteonecrosis of the Jaws and Bisphosphonate Therapy S.L.Ruggiero and S. J. Drew J Dent Res 86(11): ,2007 ODS831 Management of Medically Complex Patient / Page 3 of 6 June 15, 2010

4 ODS831 Management of Medically Complex Patient / Spring Year 3 Date Topic Readings Faculty 2/16/10 Oral Medicine Topics II Pharmacology and oral medicine are reviewed specifically addressing the most common conditions encountered such as salivary disorders, orofacial pain, antibiotic therapies, treatment of ulcerations and vesiculobullous conditions, antivirals and antifungals. Integration with the course theme of treatment of Special Care patientsis emphasized. 3/2/10 Post Oral CA TX The management of patients who have undergone radiation or chemotherapy is presented. Mucositis is discussed in some depthits histology, symptoms, appearance and treatment. Xerostomia causes, symptoms and treatment are covered as well as management of fungal infections. 3/23/10 3/30/10 High risk pt/general Practice I &II Evaluation and treatment methodology is explored for the high-risk patient presenting in a general practice. Cardiac conditions such as arthymias, congestive heart failure, post MI, post bypass or post valve replacement arediscussed. Premedication is reviewed. Use of ultrasonic instrumentation and epinephrine is reviewed for this class of patients. Case histories are utilized throughout the presentation to illustrate and highlight the important points. Croglio 4/6/10 Communication Skills and useful insights into communication with Special Care patients are presented. Introspective consideration is given to reactions to patient s inappropriate comments and unusual presentations. Case histories are reviewed to demonstrate the points presented in the lecture. 3/16/10 Oral Ca Oral cancer incidence, identification, lymphatic spread and diagnosis are covered. Oral examination is emphasized as well as identification of the most common and most overlooked locations within the maxillo-facial region. When to biopsy lesions is discussed An extensive number slides of cases handled by Dr. Sullivan are reviewed. Sullivan 4/13/10 4/20/10 4/27/10 Geriatric I&II An overview of the management of the geriatric patient is provided. A discussion of Dementia in all its forms andis differentiated from delirium. Management of common oral conditions found in the elderly is presented. The stages of Alzheimer s disease are reviewed and the different treatment approaches recommended for each stage are elucidated. The medico-legal issue of consent is presented in some depth. NH regs/rational TX Planning/Review Both State and federal regulations regarding the dental care of residents of Skilled Nursing Facilities is provided. The course is concluded with a discussion of the concept of the rational treatment plan. Specific parameters for rational treatment planning and patient triage as described by Ettinger and Kamen are presented and illustrated with case studies. 15. Course Policies & Procedures Policies and procedures of the course are written in accordance with the Faculty Handbook and Academic Policies. Course Policies are written to clarify expectations of the course director regarding attendance, behavior, grading, academic integrity, professionalism, disabilities, remediation, etc. Refer to the student handbook for more detailed information DiTursi ODS831 Management of Medically Complex Patient / Page 4 of 6 June 15, 2010

5 ODS831 Management of Medically Complex Patient / Spring Year 3 A. Course Failure and Remediation Students who earn an "F" grade in this course may be given the opportunity to remediate. Remediation will be permitted only at the discretion of the School of Dental Medicine's Executive Council. If permitted, remediation will take the form of a second final exam A grade of C on this exam will be required to remediate this course. The resulting grade will be listed on the transcript as "F/P". Incomplete grades will be awarded under those conditions as described in the student handbook B. Disabilities This institution supports the goals and requirements of Section 504 of the Rehabilitation Act of 1973, which mandates academic adjustments, commonly called reasonable accommodations, be provided for students with documented disabilities. If you have a disability and may require some type of instructional and/or examination accommodation, please contact me early in the semester so that I can provide or facilitate in providing accommodations you may need. If you have not already done so, you will need to contact the Disability Services office, the designated office on campus to provide services for students with disabilities. The office is located at 25 Capen Hall and the telephone number is (716) C. Attendance As described in the student handbook, "attendance at scheduled classes, laboratory sessions, clinical assignments and examinations is mandatory. Absence can negatively affect both knowledge and grades. Students are expected to arrive on time to class. Late arrival is disruptive for both students and faculty, and interferes with effective learning. Absences fall into two general categories: planned and unplanned. Please review the student handbook for how to proceed in these instances, and advise me accordingly, or the Office of Student Affairs if there is an emergency or medical illness. D. Canceled Classes If, for any reason, a scheduled session is not held, the scheduled event will occur at the next session unless otherwise announced. E. Course Evaluation Comprehensive evaluation of this course will be administered online at the end of the course through the Office of Academic Affairs. Eliciting feedback and constructive criticism is important so that Course Directors may take action to improve the course. Students are expected to participate fully in this important process. F. Changes in the Course No changes have occurred in this course since the last time it was offered. G. Distractions in the Classroom/Behavioral Expectations As students in a health professions school, students are expected to display conduct consistent with their status as entering members of the profession. Specifics of expected conduct are listed in both the university "Student Conduct Rules, University Standards and Administrative Regulations" and in the School of Dental Medicine "Student Handbook". In recent years, cell phones, pagers, and other electronic devices have been sources of disruption in classrooms. All electronic devices except those specifically required by the course director or lecturer are not permitted in class. If these devices go off during class, the student with the device will be asked to leave. H. Professional Conduct The University has a responsibility to promote academic honesty and integrity and to develop procedures to deal effectively with instances of academic dishonesty. Students are responsible for the honest completion and representation of their work, for the appropriate citation of sources, and for respect for others academic endeavors. By placing their name or student identifier on quizzes and ODS831 Management of Medically Complex Patient / Page 5 of 6 June 15, 2010

6 ODS831 Management of Medically Complex Patient / Spring Year 3 examinations, students certify that the work is theirs and theirs alone. Students may not refer to any material or look at other student's papers during quizzes or examinations. Students observed so doing will receive a grade of zero for that quiz or examination. In addition, such incidents of academic dishonesty will be addressed as described in the university "Student Conduct Rules, University Standards and Administrative Regulations" the complete text of which can be found at and as described in the School of Dental Medicine Student Handbook, the complete text of which can be found at: ODS831 Management of Medically Complex Patient / Page 6 of 6 June 15, 2010