Clinical Studies Concerning Re-Restoration of Teeth

1990 ◽  
Vol 4 (1) ◽  
pp. 4-9 ◽  
Author(s):  
R.J. Elderton
Keyword(s):  
Decision Making ◽  
Clinical Assessment ◽  
Clinical Studies ◽  
Treatment Decision ◽  
Prima Facie ◽  
Secondary Caries ◽  
Prima Facie Case ◽  
Treatment Decision Making ◽  
Large Numbers ◽  
Enormous Variation

Re-restoring teeth is an important component of operative dentistry, and the perceived presence of Re-restoring caries is a major reason for undertaking it. In the absence of a diagnosis of secondary caries, a morphological discrepancy at the margin of a restoration commonly provides the necessary justification for replacement. However, several studies have demonstrated enormous variation among dentists, both in their diagnosis of secondary caries and in the clinical decisions they make regarding whether or not to restore or re-restore. Many of these decisions must have been wrong. Decisions to re-restore teeth have been shown to be particularly idiosyncratic, and some patients apparently become involved in a repeat restoration cycle whereby the more restorations they have, the more re-restorations they receive. The desire by some dentists to replace large numbers of restorations, for reasons other than the presence of disease, shows a fallibility of operative treatment. At the same time it suggests that these dentists have considerable faith in this aspect of dental care. There would appear to be a prima facie case for investigating more deeply the factors involved in the clinical assessment of restorations. It should then be possible to improve the standard of diagnosis and treatment decision-making, especially with respect to the need to re-restore teeth.

Does Instrumented Movement Analysis Alter, Objectively Confirm, or Not Affect Clinical Decision-making in Musicians with Focal Dystonia?

2008 ◽  
Vol 23 (3) ◽  
pp. 99-106
Author(s):  
Maurizio Ferrarin ◽  
Marco Rabuffetti ◽  
Marina Ramella ◽  
Maurizio Osio ◽  
Enrico Mailland ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Clinical Assessment ◽  
Confidence Level ◽  
Treatment Decision ◽  
Movement Analysis ◽  
Clinical Decision ◽  
Focal Dystonia ◽  
Treatment Decision Making ◽  
Instrumental Assessment

Focal dystonia (FD) is a movement disorder that frequently affects instrumental musicians. Distinguishing between primary dystonic movement and secondary compensatory abnormal movement is crucial for the correct treatment planning in FD. Such distinction is complex in musicians because of the complexity, speed, and smallness of involved movement. The goal of the current study was to assess the influence of instrumented movement analysis (MA) in treatment decision-making in musician's FD. A group of 18 musicians with FD was instrumentally analyzed in an MA laboratory equipped with optoelectronic and electromyographic (EMG) acquisition systems. The muscle(s) primarily responsible for the dystonic movement or posture (trigger muscle) was identified on the basis of clinical assessment alone and, in a second phase, with the additional information provided by instrumented assessment. Comparison between clinical and instrumented assessment outcomes and the subjective rating of found differences were then analyzed. In 67% of patients, instrumental assessment changed the decision made by clinical assessment, indicating identification of a different trigger muscle or allowing for a more specific identification. In 28% of patients, instrumental assessment confirmed the outcome of the clinical assessment, with an increase in the confidence level of the clinical decision. The most frequent change was an improved specification of which finger flexor muscle (superficialis or profundus) was triggering the dystonic movement. Although caution is needed due to the non-blinded design of the present study, our results suggest that instrumented movement analysis is a useful complementary tool to clinical assessment in treatment planning for musician's focal dystonia—its use might change the identification of the muscles primarily responsible for dystonic movements as well as increase the confidence level of the clinician in treatment decision-making.

Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations

2017 ◽  
Vol 13 (2) ◽  
pp. 169-184 ◽  
Author(s):  
Shuya Kushida ◽  
Takeshi Hiramoto ◽  
Yuriko Yamakawa
Keyword(s):  
Decision Making ◽  
Conversation Analysis ◽  
Treatment Decision ◽  
Close Inspection ◽  
Important Resource ◽  
Treatment Decision Making ◽  
The Way

In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.

Enhancing Involvement in Treatment Decision Making by Women with Breast Cancer

2007 ◽  
Author(s):  
Mary A. O'Brien ◽  
Timothy Whelan ◽  
Amiram Gafni ◽  
Cathy Charles ◽  
Peter Ellis
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Treatment Decision Making

Gene Expression Assay in the Management of Early Breast Cancer

2020 ◽  
Vol 27 (17) ◽  
pp. 2826-2839 ◽  
Author(s):  
Roberta Caputo ◽  
Daniela Cianniello ◽  
Antonio Giordano ◽  
Michela Piezzo ◽  
Maria Riemma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Decision Making ◽  
Adjuvant Chemotherapy ◽  
Early Breast Cancer ◽  
Treatment Decision ◽  
Endocrine Treatment ◽  
Expression Ratio ◽  
Treatment Decision Making ◽  
Low Sensitivity

The addition of adjuvant chemotherapy to hormonal therapy is often considered questionable in patients with estrogen receptor-positive early breast cancer. Low risk of disease relapse after endocrine treatment alone and/or a low sensitivity to chemotherapy are reasons behind not all patients benefit from chemotherapy. Most of the patients could be exposed to unnecessary treatment- related adverse events and health care costs when treatment decision-making is based only on classical clinical histological features. Gene expression profile has been developed to refine physician’s decision-making process and to tailor personalized treatment to patients. In particular, these tests are designed to spare patients the side effects of unnecessary treatment, and ensure that adjuvant chemotherapy is correctly recommended to patients with early breast cancer. In this review, we will discuss the main diagnostic tests and their potential clinical applications (Oncotype DX, MammaPrint, PAM50/Prosigna, EndoPredict, MapQuant Dx, IHC4, and Theros-Breast Cancer Gene Expression Ratio Assay).

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