Guidelines for Dorsum Preservation in Primary Rhinoplasty

2021 ◽  
Author(s):  
Yves Saban ◽  
Sylvie de Salvador
Keyword(s):  
Decision Making ◽  
Risk Ratio ◽  
Revision Rate ◽  
Decision Making Process ◽  
Primary Rhinoplasty ◽  
Nasal Anatomy ◽  
And Cartilage

AbstractThe multiplication of scientific articles related to the fast-growing interest in preservation rhinoplasty (PR) may lead to confusion in the decision-making process, thus requiring a need for guidelines through a focus on benefit–risk ratio and revisions. This study analyzes a 352 consecutive primary rhinoplasties series during a 3 year (2016 to 2019) period with 1-year follow-up. The evaluation of the most appropriate procedure to the patient's nasal anatomy and expectations requires to correlate (1) a convenient classification of nasal profile lines; (2) a review of the dorsum preservation techniques (DP) classified as: full DP, DP + resurfacing, bony cartilaginous disarticulation, and finally traditional rhinoplasty; (3) the role of septoplasties, subdividing this series in two main groups; (4) analyzing the revisions in the different subgroups and to the literature. Thirty-five revisions (9.94%) were done. Correlations between profile lines, surgical procedures, and revisions show (1) 129 straight noses underwent full DP in 88 cases with 5.68% revisions; however, DP+ hump resurfacing in 32 patients with no revision. (2) Among 71 tension noses, 33 underwent full DP with 6 revisions (18.18%), while 32 patients had bony cap resurfacing, 1 revision (3.13%). (3) Among 109 kyphotic noses, 64 patients underwent DP + resurfacing with 10 revisions (15.63%); 27 patients had cartilage-only DP with two revisions (7.41%). (4) In the 43 difficult noses group, revisions were done equally in DP + resurfacing and cartilage-only subgroups. Septum stability modifies the correlations, introducing Cottle's septorhinoplasty in the paradigm. The revision rate is jumping ×2.50% when a septoplasty is associated with the rhinoplasty. Correlated to the benefit–risk ratio and the revisions, the following guidelines may be suggested in primary rhinoplasty: (1) Straight noses: full DP, (2) tension noses: DP + dorsum resurfacing and/or Cottle's variations, (3) kyphotic noses: cartilage-only DP, and (4) difficult noses: traditional rhinoplasties.

scholarly journals Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

2021 ◽  
pp. 238008442110144
Author(s):  
N.R. Paul ◽  
S.R. Baker ◽  
B.J. Gibson
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Treatment Options ◽  
Study Data ◽  
Primary Objective ◽  
Major Surgery ◽  
Future Research ◽  
Decision Making Process ◽  
Theory Approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

scholarly journals NIMG-53. GLUTAMATE/GABA RATIO ON MRS IS ELEVATED IN PATIENTS WITH LOWER GRADE GLIOMAS AND SEIZURES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii159-ii160
Author(s):  
Roberta Rudà ◽  
Riccardo Pascuzzo ◽  
Francesca Mo ◽  
Alessia Pellerino ◽  
Peter B Barker ◽  
...  
Keyword(s):  
Tumor Location ◽  
Resonance Spectroscopy ◽  
Lower Grade ◽  
Lack Of Information ◽  
Baseline Evaluation ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND There is lack of information on the role of excitatory and inhibitory neurotransmitters in the development of seizures in patients with lower grade gliomas. Increase of glutamate and downregulation of GABA have been suggested in preclinical models and human surgical samples to be associated with brain tumor-related epilepsy. MATERIAL AND METHODS We prospectively investigated with the use of magnetic resonance spectroscopy (MRS) the differences in the ratio of metabolites (glutamate/GABA, glutamate/creatine and GABA/creatine) in the peritumoral areas between patients with or without seizures in a series of lower grade gliomas. Tumors were classified according to WHO Classification of 2016 as follows:11 grade II IDH mutated and 1p/19q codeleted; 3 grade III IDH mutated and 1p/19q codeleted; 6 grade II IDH mutated and 1p/19q intact; 1 grade III IDH mutated and 1p/19q intact; 1 grade II IDH wild-type. Patients received surgery alone or followed by temozolomide chemotherapy according to the presence of risk factors. RESULTS At baseline evaluation, maximum glutamate/GABA values were significantly higher (p=0.023) in the peritumoral area of patients with seizures (1.008 ± 0.368) with respect to those without seizures (0.691 ± 0.170). No other metabolites ratio showed significant differences between the two groups. Similar results were obtained when analyzing the metabolites ratio in the examinations during the follow-up. In the cohort of patients with seizures (n.14) variations of metabolite ratios were not associated with tumor location, 1p/19q codeletion, use of AEDs, concomitant chemotherapy or seizure characteristics (type, duration, frequency). CONCLUSIONS The study is ongoing with the aim of analyzing further the correlations between ratio of metabolites and status of the tumor (stable vs progressive).

Evolution of EC Institutions and Role of France (1990–2000)

2011 ◽  
pp. 58-70
Author(s):  
P. Timofeev
Keyword(s):  
Decision Making ◽  
Decision Making Process ◽  
The Eu

The gradual enlargement of the EEC has necessitated an adaptation of European supranational structures established in the 1950-1970s to the needs of the time. Under these circumstances one of the key priorities of France's participation in the EU is he struggle for preserving her influence on the EU decision-making process. The article is devoted to the interaction of France with its partners in the EU institutions. This implies not only the implementation of its own interests, but also the search for compromise more or less satisfactory to all participants.

The role of a shared decision-making process in paediatric epilepsy surgery

2021 ◽  
Vol 429 ◽  
pp. 119162
Author(s):  
Michelle Gratton ◽  
Bonnie Wooten ◽  
Sandrine Deribaupierre ◽  
Andrea Andrade
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Epilepsy Surgery ◽  
Decision Making Process ◽  
Shared Decision ◽  
Paediatric Epilepsy

Impact of Similarity of Interviewer-Interviewee and Interviewer-Interviewer on Ratings in a Selection Interview

1980 ◽  
Vol 47 (3_suppl) ◽  
pp. 1087-1092 ◽  
Author(s):  
Katherine F. Shepard ◽  
Maureen Hallinan
Keyword(s):  
Decision Making ◽  
Additional Data ◽  
Social Approval ◽  
Background Characteristics ◽  
Selection Interview ◽  
Ideal Candidate ◽  
Selection Interviews ◽  
Actual Selection

This study aimed to determine whether similarity of interviewer and interviewee or interviewer and interviewer influenced applicant interview ratings. Data on background characteristics, relative interests and need for social approval were secured from 21 faculty interviewers and 296 applicants during actual selection interviews. Contrary to prior findings based on simulated activity, the results did not uphold the role of similarity. Additional data gathered from follow-up interviews with faculty interviewers point to preconceived conceptions of an “ideal” candidate as a stronger reference point for decision making in selection interviews than similarity to self.

Sharing is caring: the role of voter-candidate similarities in intra-party electoral competition

2018 ◽  
Vol 11 (1) ◽  
pp. 75-89 ◽  
Author(s):  
Patrick F. A. van Erkel
Keyword(s):  
Decision Making ◽  
Electoral Competition ◽  
Decision Making Process ◽  
Supply Side ◽  
Voting Behaviour ◽  
Party Leaders ◽  
Presidential Candidates ◽  
Underrepresented Groups ◽  
Candidate Characteristics

AbstractPrevious studies have found similarities with presidential candidates or party leaders to be an important factor in explaining voting behaviour. However, with the exception of gender, few studies have structurally studied voter-candidate similarities in intra-party electoral competition. This study investigates the Belgian case and argues that voter-candidate similarities play a role in the decision-making process of citizens when casting preferential votes. Moreover, it investigates whether underrepresented groups, and especially women, are more guided by these voter-candidate similarities than overrepresented groups. To achieve this aim voter and candidate characteristics are modelled simultaneously. This enables an investigation of the decision-making process of voters while taking into account structural inequalities at the supply side. The results demonstrate that citizens are indeed more likely to cast preferential votes for candidates similar to themselves and that these effects are stronger for underrepresented groups. Hence, preferential voting could ultimately pave the way for better descriptive representation.

scholarly journals Wind Power Deployment: The Role of Public Participation in the Decision-Making Process in Ontario, Canada

2021 ◽  
Author(s):  
Anahita A. Jami ◽  
Philip R. Walsh
Keyword(s):  
Decision Making ◽  
Renewable Energy ◽  
Public Participation ◽  
Wind Power ◽  
Knowledge Broker ◽  
Decision Making Process ◽  
Energy Investment ◽  
The Public ◽  
Public Opposition

A wider use of renewable energy is emerging as a viable solution to meet the increasing demand for global energy while contributing to the reduction of greenhouse gas emissions. However, current literature on renewable energy, particularly on wind power, highlights the social barriers and public opposition to renewable energy investment. One solution to overcome the public opposition, which is recommended by scholars, is to deploy a collaborative approach. Relatively little research has specifically focused on the role of effective communication and the use of a knowledge-broker in collaborative decision-making. This study attempts to fill this gap through the proposition of a participatory framework that highlights the role of the knowledge-broker in a wind project decision-making process. In this paper, five illustrative wind projects in Ontario are used to highlight the current situation with public participation and to address how the proposed framework could have improved the process. Based on the recommended collaborative framework, perception must shift from the dominant view of the public as “a risk to be managed” towards “a resource that can be tapped”. The developers need to improve sharing what they know and foster co-learning around questions and concerns.

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