Complications in Endodontics

Difficulties encountered during endodontic treatment can be a cause of frustration for both clinician and patient. Complications such as iatrogenic perforation, ledge formation, canal blockage, instrument separation and untreated anatomy may impact the outcome of endodontic treatment. Clinicians should understand how each of these complications can occur, be prevented and predictably rectified. It is also important for clinicians to understand the impact of a specific complication on treatment prognosis and to appreciate how this may differ in each case. There may be scenarios where a complication does not significantly affect the prognosis, whereas in other situations, the same complication will be detrimental to the outcome of treatment. An appreciation of the clinical factors which determine prognosis is important, so that the correct intervention is chosen, and the patient is correctly informed of the likely sequelae.

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Understanding Surgical Decision Making in Early Hepatocellular Carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2010.30.8650 ◽

2011 ◽

Vol 29 (6) ◽

pp. 619-625 ◽

Cited By ~ 37

Author(s):

Hari Nathan ◽

John F.P. Bridges ◽

Richard D. Schulick ◽

Andrew M. Cameron ◽

Kenzo Hirose ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Decision Making ◽

Independent Effect ◽

Clinical Factors ◽

Surgical Decision ◽

Early Hepatocellular Carcinoma ◽

Early Hcc ◽

The Impact ◽

Surgical Decision Making ◽

Choice Of Therapy

Purpose The choice between liver transplantation (LT), liver resection (LR), and radiofrequency ablation (RFA) as initial therapy for early hepatocellular carcinoma (HCC) is controversial, yet little is known about how surgeons choose therapy for individual patients. We sought to quantify the impact of both clinical factors and surgeon specialty on surgical decision making in early HCC by using conjoint analysis. Methods Surgeons with an interest in liver surgery were invited to complete a Web-based survey including 10 case scenarios. Choice of therapy was then analyzed by using regression models that included both clinical factors and surgeon specialty (non-LT v LT). Results When assessing early HCC occurrences, non-LT surgeons (50% LR; 41% LT; 9% RFA) made significantly different recommendations compared with LT surgeons (63% LT; 31% LR; 6% RFA; P < .001). Clinical factors, including tumor number and size, type of resection required, and platelet count, had significant effects on the choice between LR, LT, and RFA. After adjusting for clinical factors, non-LT surgeons remained more likely than LT surgeons to choose LR compared with LT (relative risk ratio [RRR], 2.67). When the weight of each clinical factor was allowed to vary by surgeon specialty, the residual independent effect of surgeon specialty on the decision between LR and LT was negligible (RRR, 0.93). Conclusion The impact of surgeon specialty on choice of therapy for early HCC is stronger than that of some clinical factors. However, the influence of surgeon specialty does not merely reflect an across-the-board preference for one therapy over another. Rather, certain clinical factors are weighed differently by surgeons in different specialties.

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Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

International Journal of Molecular Sciences ◽

10.3390/ijms22115808 ◽

2021 ◽

Vol 22 (11) ◽

pp. 5808

Author(s):

Annalisa Giandalia ◽

Alfio Edoardo Giuffrida ◽

Guido Gembillo ◽

Domenico Cucinotta ◽

Giovanni Squadrito ◽

...

Keyword(s):

Gender Differences ◽

Kidney Disease ◽

Diabetic Kidney Disease ◽

Clinical Manifestations ◽

Current Evidence ◽

Sex And Gender ◽

Clinical Factors ◽

Diabetic Kidney ◽

And Gender ◽

The Impact

Diabetic kidney disease (DKD) is one of the most serious complications of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Current guidelines recommend a personalized approach in order to reduce the burden of DM and its complications. Recognizing sex and gender- differences in medicine is considered one of the first steps toward personalized medicine, but the gender issue in DM has been scarcely explored so far. Gender differences have been reported in the incidence and the prevalence of DKD, in its phenotypes and clinical manifestations, as well as in several risk factors, with a different impact in the two genders. Hormonal factors, especially estrogen loss, play a significant role in explaining these differences. Additionally, the impact of sex chromosomes as well as the influence of gene–sex interactions with several susceptibility genes for DKD have been investigated. In spite of the increasing evidence that sex and gender should be included in the evaluation of DKD, several open issues remain uncovered, including the potentially different effects of newly recommended drugs, such as SGLT2i and GLP1Ras. This narrative review explored current evidence on sex/gender differences in DKD, taking into account hormonal, genetic and clinical factors.

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Impact of Seniors Centers on oral health-related quality of life of older adults

Revista de Saúde Pública ◽

10.11606/s1518-8787.2020054001648 ◽

2020 ◽

Vol 54 ◽

pp. 7

Author(s):

Fernanda W. Machado Luz ◽

Alexandre Emídio Ribeiro Silva ◽

Ana Paula Perroni ◽

Marília L. Goettems ◽

Noéli Boscato

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Oral Health ◽

Family Income ◽

Health Related Quality ◽

Clinical Factors ◽

Related Quality ◽

Health Related ◽

The Impact

OBJECTIVE: This study evaluated the oral health-related quality of life (OHRQoL) of older adults participating or not in Seniors Centers (SC). METHODS: Two independent samples were compared: older adults who participate in SC (n = 124) and older adults who visited Primary Healthcare Centers (PHC) and do not participate in SC (n = 164). The data collected consisted of sociodemographic (sex, age, educational level, marital status, family income) and psychosocial characteristics—Sense of Coherence (SOC), anxiety and depression using HADS, happiness—, and oral clinical evaluation—use and need of dental prosthesis and decayed (D), missing (M), or filled (F) teeth. The resulting OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14). The Mann-Whitney test was used to assess the associations between the independent variables and the OHIP-14. Poisson regression models were also used in the analyses (α=0.05). RESULTS: In the PHC, of the 270 individuals invited to participate in the study, 164 (60.7%) were interviewed and clinically examined; while in the SC, of the 166 individuals invited to participate in the study, 124 (74.7%) were interviewed and clinically examined. After adjustments for sociodemographic, psychosocial and clinical factors, we found that the impact on OHRQoL was 2.8 times higher (95%CI 2.0–4.2) for older adults who did not participate in SC. CONCLUSION: Older adults who participated in SC showed better perception on OHRQoL, independently of sociodemographic, psychosocial and clinical factors.

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2164 The impact of radiotherapy dose and other treatment-related and clinical factors on control of Stage I and II non-Hodgkin's lymphoma in irradiated sites

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(97)80931-5 ◽

1997 ◽

Vol 39 (2) ◽

pp. 322

Author(s):

Sachin S. Kamath ◽

Robert B. Marcus ◽

James W. Lynch ◽

Nancy Price Mendenhall

Keyword(s):

Hodgkin’S Lymphoma ◽

Stage I ◽

Hodgkin's Lymphoma ◽

Clinical Factors ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Radiotherapy Dose ◽

The Impact

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Factors influencing general practitioners decisions to refer Paediatric patients to the emergency department: a systematic review and narrative synthesis

BMC Family Practice ◽

10.1186/s12875-020-01277-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Ciara Conlon ◽

Emma Nicholson ◽

Beatriz Rodríguez-Martin ◽

Roisin O’Donovan ◽

Aoife De Brún ◽

...

Keyword(s):

Systematic Review ◽

Decision Making ◽

Emergency Department ◽

Paediatric Patient ◽

General Practitioners ◽

Clinical Decision Making ◽

System Level ◽

Clinical Factors ◽

Paediatric Patients ◽

The Impact

Abstract Background Clinical guidelines are integral to a general practitioner’s decision to refer a paediatric patient to emergency care. The influence of non-clinical factors must also be considered. This review explores the non-clinical factors that may influence general practitioners (GPs) when deciding whether or not to refer a paediatric patient to the Emergency Department (ED). Methods A systematic review of peer-reviewed literature published from August 1980 to July 2019 was conducted to explore the non-clinical factors that influence GPs’ decision-making in referring paediatric patients to the emergency department. The results were synthesised using a narrative approach. Results Seven studies met the inclusion criteria. Non-clinical factors relating to patients, GPs and health systems influence GPs decision to refer children to the ED. GPs reported parents/ caregivers influence, including their perception of severity of child’s illness, parent’s request for onward referral and GPs’ appraisal of parents’ ability to cope. Socio-economic status, GPs’ aversion to risk and system level factors such as access to diagnostics and specialist services also influenced referral decisions. Conclusions A myriad of non-clinical factors influence GP referrals of children to the ED. Further research on the impact of non-clinical factors on clinical decision-making can help to elucidate patterns and trends of paediatric healthcare and identify areas for intervention to utilise resources efficiently and improve healthcare delivery.

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Predictors of dose limiting toxicities in phase I clinical trials: The impact of age, comorbidity, and other clinical and non-clinical factors

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.9525 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 9525-9525 ◽

Cited By ~ 1

Author(s):

N. K. LoConte ◽

J. F. Cleary ◽

J. Bozeman ◽

G. Wilding ◽

D. Alberti ◽

...

Keyword(s):

Clinical Trials ◽

Phase I ◽

Clinical Factors ◽

Phase I Clinical Trials ◽

The Impact

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The effect of gaps in chemotherapy on survival in patients with high-risk stage II and stage III colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.180 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 180-180

Author(s):

Yvonne Sada ◽

Zhigang Duan ◽

Hashem El-Serag ◽

Jessica Davila

Keyword(s):

Colon Cancer ◽

High Risk ◽

Stage Ii ◽

Stage Iii ◽

Clinical Factors ◽

Stage Iii Colon Cancer ◽

Risk Of Mortality ◽

Increased Risk ◽

Multivariable Regression ◽

The Impact

180 Background: Current guidelines recommend six months of chemotherapy (CT) for stage III colon cancer and consideration for high-risk stage II colon cancer. No previous studies have examined the impact of CT gaps on survival. This retrospective study examines determinants of CT gaps and the effect of gaps on survival. Methods: Using national Surveillance, Epidemiology, and End Results registry-Medicare linked data, high-risk stage II and stage III colon cancer patients diagnosed between 2000-2007 who received surgery and CT were identified. CT duration and gaps were calculated. CT gap was defined as 30 to 90 days between two CT claims. Data on demographics, clinical factors (comorbidity, tumor grade), and treatment factors (time to CT initiation, toxicity, hospitalization) were collected. Multivariable regression was used to examine factors associated with gaps. Cox proportional hazards analysis examined the effect of gaps on risk of mortality. Results: 7,371 patients were identified. Median age was 75 (IQR: 71-79); 47% were male. Among all patients, 1,803 (24%) had a gap. 2,674 patients (36%) received 5 to 7 months of CT, of which 469 (18%) had a gap. Multivariable regression analysis showed that patients who were black (OR 1.3, 95% CI: 1.1-1.7), stage III (1.2, 1.0-1.3), had toxicity (1.3, 1.1-1.4), or had 3 to 4 months of CT (vs. 5-7 months, 2.6, 2.3-3.0) were more likely to have a gap, while patients with a more recent diagnosis in 2007(vs. 2000, 0.6, 0.5-0.8) were less likely to have a gap. 3-year cancer-specific survival was the same in all patients with CT gaps compared with no gaps (80%, 95% CI: 78%-82% vs. 81%, 95% CI: 80%-82%). Cox proportional hazard models showed that patients with gaps did not have increased risk of mortality (HR 0.99, 0.89-1.1) adjusting for patient and clinical factors. Among those who received 5 to 7 months of CT, 3-year survival was 8% lower in patients with gaps compared to those with no gaps (80%, 95% CI: 75%-83% vs. 88%, 95% CI: 87%-90%). Conclusions: Nearly 25% of high-risk stage II and III patients who received CT had a gap. CT gaps were associated with worse survival in patients who received 5 to 7 months of CT. Interventions to improve CT toxicity management and reduce gaps are needed to maximize the benefit of CT.

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Factors that influence oncologists' decisions about administering late chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.31 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 31-31

Author(s):

Minnie Bluhm ◽

Cathleen M. Connell ◽

Kathleen Elizabeth Bickel ◽

Maria Silveira

Keyword(s):

Treatment Decisions ◽

Structured Interview ◽

Clinical Factors ◽

Emotional Symptoms ◽

Incurable Cancer ◽

Individual Interviews ◽

Dying Patients ◽

Clinical Benefits ◽

Nuanced Understanding ◽

The Impact

31 Background: An estimated 20-50% of incurable cancer patients receive chemotherapy in the last 30 days of life, although there is little data to support this practice. Continued use of chemotherapy typically precludes hospice enrollment. It may also result in more symptoms, increased use of aggressive treatments, and worsening quality of life. Despite this, few studies have explored oncologists' rationales for administering chemotherapy during the last weeks of life. The purpose of this study is to examine factors that oncologists report influence their decisions about late chemotherapy. Methods: In-depth individual interviews were conducted with 17 oncologists using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded and content analyzed for themes and patterns in the data. Results: Participants reported three key findings. 1) Clinical factors drive oncologists’ late chemotherapy decisions when they point to clear treatment choices, along with patient preferences. When clinical factors are ambiguous, non-clinical factors become more salient. 2) Late chemotherapy is patient-driven. It is used to palliate physical and emotional symptoms and maintain patient hope, even when physical benefit is not expected. 3) Caring for dying patients is difficult and impacts oncologists and their treatment decisions. Difficulties that are cited as influences favoring treatment include: emotional exhaustion, difficulty communicating about stopping or not starting chemotherapy, an overwhelming sense of responsibility for life and death, feeling badly about the limits of oncology to heal, and prognostic uncertainty. Conclusions: Findings reveal a nuanced understanding of why it can be so difficult for oncologists to refuse chemotherapy treatment to patients near death. Doing so adds to the existing burden of caring for dying patients. This means that at times, oncologists prescribe chemotherapy to simply help everyone feel better, regardless of expected clinical benefits or costs. Future work is needed on the impact of caring for dying patients on oncologists and on supportive interventions that assist them in making optimal treatment decisions.

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