Clinical Approach to Decision-Making in Nasogastric Tube Weaning and Tracheostomy Tube Decannulation

Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.

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Person-Centered Medicine: An Existential Outline beyond the Biopsychosocial Model

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v6i3.594 ◽

2016 ◽

Vol 6 (3) ◽

pp. 146-154

Author(s):

Roger Ruiz-Moral

Keyword(s):

Decision Making ◽

Biopsychosocial Model ◽

Decisive Role ◽

Clinical Effectiveness ◽

Clinical Activity ◽

Clinical Approach ◽

Patient Relationship ◽

Medical Problems ◽

Relational Perspective ◽

Educational Challenges

Starting from the idea that “medical problems” are always “problems of living” that reflect the existence of a “vital dimension” that is different from the biological, psychological and sociocultural dimensions, this article describes central features of this dimension. From this viewpoint, its inescapable importance in the clinical act is highlighted, an importance that shapes the tasks that are inherent to it – diagnosis and decision making – but also the very process of the doctor-patient relationship. It is argued that “the subjective truth” implicit in the “vital dimension” (in the “existential self”) can only be approached through reflection and interpretation in the context of a dialogue between the professional and the patient/family with the objective of deciding on the action(s) that can better lead to reaching some concrete wishes or desires (values), that in turn require the participants to take on obligations and responsibilities. This relational perspective defines the “person centered” clinical approach as a practice based on dialogue, importantly involving deliberation and collaboration (“collaborative deliberation”). In this dialogue, the emotions, integral elements of the life dimension of its protagonists, play a decisive role both in attaining clinical effectiveness and in building and maintaining the relational process (encouraging or reducing trust) that is indispensable in a clinical activity that is an eminently moral act. Finally, the main challenges that doctors face when implementing this clinical focus and the educational challenges it entails are outlined.

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Factors affecting postoperative removal of nasogastric tube and tracheostomy tube in oral cancer: a retrospective analysis of 234 cases

Oral Cancer ◽

10.1007/s41548-018-0011-2 ◽

2018 ◽

Vol 2 (3-4) ◽

pp. 77-81

Author(s):

Prateek V. Jain ◽

Kapila Manikantan ◽

Dipanwita Roy ◽

Pattatheyil Arun

Keyword(s):

Oral Cancer ◽

Retrospective Analysis ◽

Nasogastric Tube ◽

Tracheostomy Tube ◽

Factors Affecting

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Combined molecular and clinical approach for decision making for surgery in HNPCC patients: a report on three cases in two families

International Journal of Colorectal Disease ◽

10.1007/s003840100349 ◽

2001 ◽

Vol 16 (6) ◽

pp. 402-407 ◽

Cited By ~ 12

Author(s):

Steffen R. Pistorius ◽

Michael Nagel ◽

Stefan Kruger ◽

Jens Plaschke ◽

Christian Kruppa ◽

...

Keyword(s):

Decision Making ◽

Clinical Approach

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Mo2027 - Multidisciplinary Care of Patients with Oropharyngeal Dysphagia Results in Successful Nasogastric Tube Weaning and Gastrostomy Tube Avoidance

Gastroenterology ◽

10.1016/s0016-5085(18)32988-3 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-884

Author(s):

Rachel Rosen ◽

Kara Larson ◽

Margot Lurie ◽

Eliza Fishman ◽

Elizabeth Dean ◽

...

Keyword(s):

Nasogastric Tube ◽

Oropharyngeal Dysphagia ◽

Multidisciplinary Care ◽

Gastrostomy Tube ◽

Tube Weaning

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Clinical approach to skin eruptions induced by anti-TNF agents among patients with inflammatory bowel diseases: insights from a multidisciplinary IBD-DERMA clinic

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211053112 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110531

Author(s):

Henit Yanai ◽

Hadar Amir Barak ◽

Jacob E Ollech ◽

Irit Avni Biron ◽

Idan Goren ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Inflammatory Bowel Diseases ◽

Clinical Approach ◽

Shared Decision ◽

Tertiary Referral Center ◽

Treatment Interruptions ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

The Impact

Background and Aims: Skin eruptions are prevalent among patients with inflammatory bowel diseases (IBD), often associated with therapies and frequently leading to dermatological consults and treatment interruptions. We aimed to assess the impact of joint shared decision-making in a multidisciplinary (MDT) IBD-DERMA clinic. Methods: This retrospective cohort study assessed a consecutive group of patients with IBD who were referred for consultation in an MDT clinic at a tertiary referral center in Israel. Results: Over 1 year, 118 patients were evaluated in the MDT-IBD-DERMA clinic: 68 (57.6%) males; age – 35.2 ± 13.5 years, disease duration – 7.1 (interquartile range: 3.7–13.9) years; Crohn’s disease – 94/118 (79.6%). Skin eruption induced by an anti–tumor necrosis factor (TNF) were the most common diagnoses [46/118 (39%)], including psoriasiform dermatitis (PD) – 31/46 (67.4%) and inflammatory alopecia (IA) – 15/46 (32.6%). Of these, 18 patients (39.1%) continued the anti-TNF agent concomitantly with a topical or systemic anti-inflammatory agent to control the eruption. The remaining 28 patients (60.9%) discontinued the anti-TNF, of whom 16/28 (57.1%) switched to ustekinumab. These strategies effectively treated the majority [38/46 (82.6%)] of patients. Continuation of the anti-TNF was possible in a significantly higher proportion of patients with PD: 12/31 (38.7%) than only one in the IA group, p = 0.035. There was a higher switch to ustekinumab among the IA 7/15 (46.6%) compared with the PD 7/31 (22.6%) group, P = .09. Following IBD-DERMA advised intervention, IBD deteriorated in 9/4 6(19.5%) patients, 5/9 on ustekinumab (PD versus IA, P = NS). Conclusion: Shared decision-making in an integrated IBD-DERMA clinic allowed successful control of skin eruptions while preserving control of the underlying IBD in more than 80% of cases. Patients with IA profited from a switch to ustekinumab.

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The Art of Narrative Psychiatry

10.1093/oso/9780199982042.001.0001 ◽

2013 ◽

Author(s):

SuEllen Hamkins

Keyword(s):

Mental Health ◽

Decision Making ◽

Narrative Therapy ◽

Clinical Decision Making ◽

Case Reports ◽

Clinical Decision ◽

Theory And Practice ◽

Clinical Approach ◽

Decision Making Processes ◽

Justice Movements

Narrative psychiatry empowers patients to shape their lives through story. Rather than focusing only on finding the source of the problem, in this collaborative clinical approach psychiatrists also help patients diagnose and develop their sources of strength. By encouraging the patient to explore their personal narrative through questioning and story-telling, the clinician helps the patient participate in and discover the ways in which they construct meaning, how they view themselves, what their values are, and who it is exactly that they want to be. These revelations in turn inform clinical decision-making about what it is that ails them, how they'd like to treat it, and what recovery might look like. The Art of Narrative Psychiatry is the first comprehensive description of narrative psychiatry in action. Engaging and accessible, it demonstrates how to help patients cultivate their personal sources of strength and meaning as resources for recovery. Illustrated with vivid case reports and in-depth accounts of therapeutic conversations, the book offers psychiatrists and psychotherapists detailed guidance in the theory and practice of this collaborative approach. Drawing inspiration from narrative therapy, post-modern philosophy, humanistic medicine, and social justice movements - and replete with ways to more fully manifest the intentions of the mental health recovery model - this engaging new book shows how to draw on the standard psychiatric toolbox while also maintaining focus on the patient's vision of the world and illuminating their skills and strengths. Written by a pioneer in the field, The Art of Narrative Psychiatry describes a breadth of nuanced, powerful narrative practices, including externalizing problems, listening for what is absent but implicit, facilitating re-authoring conversations, fostering communities of support, and creating therapeutic documents. The Art of Narrative Psychiatry addresses mental health challenges that range from mild to severe, including anxiety, depression, despair, anorexia/bulimia, perfectionism, OCD, trauma, psychosis, and loss. True to form, the author narrates her own experience throughout, sharing her internal thoughts and decision-making processes as she listens to patients. The Art of Narrative Psychiatry is necessary reading for any professional seeking to empower their patients and become a better, more compassionate clinician.

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A Literature Survey on Data Mining Approach to Effectively Handle Cancer Treatment

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i2.7.10933 ◽

2018 ◽

Vol 7 (2.7) ◽

pp. 729 ◽

Cited By ~ 1

Author(s):

Sri Hari Nallamala ◽

Siva Kumar Pathuri ◽

Dr Suvarna Vani Koneru

Keyword(s):

Data Mining ◽

Decision Making ◽

Data Analysis ◽

Cancer Treatment ◽

User Interaction ◽

Medical Practitioner ◽

Vital Role ◽

Healthcare Management ◽

Clinical Approach ◽

Internet Resource

The effective treatment of cancer is not very easy since diagnosis of cancer involves many stages of treatment with gradually changing lifestyles. Physicians play vital role in identifying the correct cause and feel ambiguity for making perfect decisions about hundreds of data available from the internet resource. IDA (Intelligent Data Analysis) which is a part from Data Mining techniques is quiet useful to most of the physicians for decision making about types of cancers. IDA facilitates physicians to classify, detect and analyze the cancer outcome to patients. Healthcare Management System also aids the practitioners to practically search, analyze and compare the result analysis of the patient with existing data in the HMS and guide proper treatment to the cancer affected patient. Health care data analysis comprises enormous data with diversity of health information. One among the most important points that pull down the practitioner’s confidence is that utility of latest software and most sophisticated computing machines. This put them in to the state of confusion for proper and elegant decision making for treating the cancer affected patients. Problems in user interaction, lack of awareness in data mining, improper knowledge in electronic guidelines makes physicians to work with old methods of treatment. Traditional medical practicing and modern methods of computing do not match either because of ignorance. IDA and HMS have significant impact for cancer treatment with speedy diagnosis and faster recovery. This also shows great impact on costs, clinical outcomes and proper guidelines for clinical approach. The prime motto of this survey article is to analyze the survey application, bring out the importance of comparison strategies of IDA to improve decision making for medical practitioner for effective cancer treatment.

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Current appeal system for those detained in England and Wales under the Mental Health Act needs reform

Journal of Medical Ethics ◽

10.1136/medethics-2018-104947 ◽

2018 ◽

Vol 45 (3) ◽

pp. 173-177

Author(s):

Paul Gosney ◽

Paul Lomax ◽

Carwyn Hooper ◽

Aileen O’Brien

Keyword(s):

Mental Health ◽

Decision Making ◽

Current System ◽

Clinical Approach ◽

England And Wales ◽

Mental Health Act ◽

Psychiatric Conditions ◽

The Individual ◽

The Right

The approach to managing the involuntary detention of people suffering from psychiatric conditions can be divided into those with clinicians at the forefront of decision-making and those who rely heavily on the judiciary. The system in England and Wales takes a clinical approach where doctors have widespread powers to detain and treat patients involuntarily. A protection in this system is the right of the individual to challenge a decision to deprive them of their liberty or treat them against their will. This protection is provided by the First-tier Tribunal; however, the number of successful appeals is low. In this paper, the system of appeal in England and Wales is outlined. This is followed by a discussion of why so few patients successfully appeal their detention with the conclusion that the current system is flawed. A number of recommendations about how the system might be reformed are offered.

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Characterisation of hospital-produced guidelines regarding management of temporary tube feeding care in general paediatric patients

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2020.0002 ◽

2021 ◽

Vol 28 (11) ◽

pp. 1-10

Author(s):

Maryanne Syrmis ◽

Nadine Frederiksen ◽

Claire Reilly

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Electronic Publishing ◽

Tube Feeding ◽

Oral Feeding ◽

Tube Placement ◽

Health Staff ◽

Tube Weaning

Background/Aims There is significant variation in the implementation of temporary tube feeding management in children and a paucity of associated clinical practice guidelines covering all phases of care, from decision making regarding tube insertion through to tube weaning. Development of clinical practice guidelines should consider levels of evidence other than randomised control trials. Examining hospital-produced guidelines used by frontline health staff, for example, could distinguish areas of application of evidence-based recommendations, as well as domains of care in need of increased implementation. This article describes the content of existing hospital-produced guidelines relating to tube feeding care in a general paediatric population. Methods Hospital-produced guidelines were sought by mailing 200 health services worldwide and searching Queensland Health's Electronic Publishing Service in Australia and Google. A content analysis was then performed. Results The 13 collected hospital-produced guidelines from Australia, the UK and Canada generally comprehensively reported on processes related to the decision-making, tube placement and tube maintenance phases. However, reporting on oral feeding while tube feeding, tube feeding dependency, tube feeding exit planning, and the social and emotional aspects of tube feeding were areas within these phases that had limited coverage. Recommendations for the phase of tube weaning were also infrequently included. Conclusions Development of formal clinical practice guidelines covering all tube feeding phases should assist in optimising patient and health service outcomes.

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