Failure and Management of Direct Restorations

2021 ◽  
Vol 13 (2) ◽  
pp. 37-38
Author(s):  
Dr. Madhu Pujar ◽  
Dr. Pallavi Gopeshetti ◽  
Dr. Veerendra Uppin ◽  
Dr. Seema B Hanjagi ◽  
Dr. Athulchandra
Keyword(s):  
Decision Making ◽  
Clinical Assessment ◽  
Cause Of Failure ◽  
Natural Tooth

The clinical assessment of a failing restoration plays an imperative role in recognising the cause of failure and helps in decision making for replacement or repair of the restoration. This paper describes about how to appropriately diagnose a failing restoration and either replace or repair the restoration as soon as possible without causing more damage to the natural tooth.

Evidence-based Assessment

2010 ◽  
pp. 76-98
Author(s):  
John Hunsley ◽  
Eric J. Mash
Keyword(s):  
Decision Making ◽  
Clinical Assessment ◽  
Assessment Process ◽  
Evidence Based ◽  
The Past ◽  
Specific Assessment ◽  
The Many ◽  
Selection Of ◽  
Made In

Evidence-based assessment relies on research and theory to inform the selection of constructs to be assessed for a specific assessment purpose, the methods and measures to be used in the assessment, and the manner in which the assessment process unfolds. An evidence-based approach to clinical assessment necessitates the recognition that, even when evidence-based instruments are used, the assessment process is a decision-making task in which hypotheses must be iteratively formulated and tested. In this chapter, we review (a) the progress that has been made in developing an evidence-based approach to clinical assessment in the past decade and (b) the many challenges that lie ahead if clinical assessment is to be truly evidence-based.

Impact of Child and Maternal Weight on Healthcare Trainee Clinical Assessment Decision Making: A Virtual Human Study

2019 ◽  
Vol 15 (1) ◽  
pp. 63-70
Author(s):  
Sarah Mayer-Brown ◽  
Molly C. Basch ◽  
Michael E. Robinson ◽  
David M. Janicke
Keyword(s):  
Decision Making ◽  
Clinical Assessment ◽  
Human Study ◽  
Virtual Human ◽  
Maternal Weight

Communication skills and tips for Part 3 MRCOG Examination

2017 ◽  
Keyword(s):  
Decision Making ◽  
Communication Skills ◽  
Clinical Assessment ◽  
Clinical Skills ◽  
Real Life ◽  
Information Gathering ◽  
Shared Decision ◽  
Good Communication ◽  
Information Giving ◽  
Treatment Information

Good communication skills form a fundamental principle of the patient- centred clinical consultation. The new Part 3 of the MRCOG, assesses candidates based on their ability to apply the core clinical skills in the context of real- life scenarios. It assesses five core skills domains, with three relating to communication skills; i) Communicating with patients and their families, ii) Communicating with colleagues and iii) Information gathering. Communication skills in the Part 3 clinical assessment can be assessed in many forms: … ● Exploring patient symptoms or concerns (information gathering) ● Explaining a diagnosis, investigation or treatment (information giving) ● Involving the patient in a decision (shared decision making) ● Health promoting activities ● Obtaining informed consent for a procedure ● Breaking bad news ● Communicating with relatives ● Communicating with other members of the health care team … In order to provide patient- centred care, doctors must treat their patients as partners, involving them in the decision making regarding their care and instilling in them a sense of responsibility for their own health. When the patient feels that they are part of the team it increases their satisfaction with care, increases treatment adherence and improves clinical outcomes. It is these skills that are assessed in clinical assessment tasks involving communication. Clinical assessment candidates are often assessed in two communication domains; Process and Content. In order to do well in the information gathering stations, you must be aware of the differential diagnoses that may arise with various presentations and how to explore each one independently and as a collection. When it comes to information giving or shared decision marking, candidates need to be familiar with the most recent Royal College of Obstetrics and Gynaecology guidelines and know how to interpret their meaning to the patient and their families. The Calgary- Cambridge Model is one of the most recognized communication theories in medical education (Kurtz, 1996). This theory can be adapted to fit into most clinical scenarios. Using the Calgary- Cambridge Model, you should be able to obtain the majority of the points related to process.

Pain Emergencies and Complications of Pain Treatments

2019 ◽  
pp. 221-240
Author(s):  
Isaac Tong ◽  
R. Jason Yong ◽  
Beth B. Hogans
Keyword(s):  
Decision Making ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Clinical Assessment ◽  
Associated Factors ◽  
Clinical Decision Making ◽  
Acute Chest Pain ◽  
Clinical Decision ◽  
Common Occurrence ◽  
Pain Characteristics

Chapter 13 reviews some common pain-associated emergencies and also discusses some complications of pain treatments that require immediate attention. Pain is a common occurrence in emergent illness, and some complications of pain treatments require emergent management. Chest pain is an excellent example of clinical decision-making following a process of organized, rapid pain assessment and then diagnostic and treatment reasoning based on the findings and observations of the clinical assessment. Providers assessing patients for acute chest pain elicit basic pain characteristics of region, quality, severity, and timing as well as usually associated factors and then pursue testing and treatment for elements in the differential diagnosis accordingly. The chapter illustrates this same process applied to conditions of acute abdominal, limb, headache, and spine emergencies. In the second part of the chapter, emergencies arising in the context of pain treatments are discussed, including overdose and withdrawal from opioids, benzodiazepines, and other pain-active medications as well as pump and device complications.

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.

scholarly journals Evaluation of the Military Functional Assessment Program for Return-to-Duty Decision Making: A Longitudinal Study

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 160-167
Author(s):  
Amanda M Kelley ◽  
Mark Showers
Keyword(s):  
Decision Making ◽  
Construct Validity ◽  
Functional Assessment ◽  
Clinical Assessment ◽  
Well Being ◽  
Program Participant ◽  
Assessment Program ◽  
Informal Assessment ◽  
Return To Duty ◽  
The Military

Abstract Following concussion, return-to-duty decisions are made by medical providers and leaders using informal assessment, review of symptom resolution, and clinical assessments. In an effort to provide military-specific tasks for use in the decision making regarding return-to-duty, a battery developed from the set of basic soldier skills, the Military Functional Assessment Program (MFAP), was evaluated for construct validity using clinical assessment outcomes as well as the relationships between MFAP performance and indicators of long-term performance and satisfaction. A total of 48 participants were enrolled in the study providing baseline and post-treatment clinical assessment, and MFAP performance data. Twenty participants provided follow-up data at 6-month post-MFAP. Correlational analyses suggest significant relationships between MFAP performance ratings and clinical measures of vestibular and cognitive functions and psychological well-being. These findings are consistent with those from previous research on construct validity of the MFAP tasks. Performance on one MFAP task related to perceptions of performance and overall MFAP ratings related to satisfaction reported at 6 months. These findings provide preliminary, however limited, support for these tasks being indicative of the motivation and mental state of the program participant.

Feasibility of computer-based self-administered cancer-specific geriatric assessment (SA-CSGA) in older pts with gastrointestinal malignancy (GIM).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19586-e19586
Author(s):  
Nadine Jackson McCleary ◽  
Devin Wigler ◽  
Donna Lynn Berry ◽  
Kaori Sato ◽  
Arti Hurria ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Assessment ◽  
Clinical Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Touch Screen ◽  
Gastrointestinal Malignancy ◽  
Time To Completion ◽  
Computer Based ◽  
Touch Screen Computer

e19586 Feasibility of computer-based self-administered cancer-specific geriatric assessment (SA-CSGA) in older pts w/ gastrointestinal malignancy (GIM) Background: The CSGA (Hurria, JCO 2011) is a brief geriatric assessment consisting of validated measures primarily self-administered using paper format. We developed & tested feasibility of a computer-based SA-CSGA in pts ≥70 yrs w/ GIM. Methods: From 12/2009 - 6/2011, pts ≥70 yrs receiving treatment (rx) for GIM at Dana-Farber Cancer Institute were consented to complete SA-CSGA at baseline (T1= new or change rx) & follow-up (T2 = w/in 4 wks of completing rx). Feasibility endpts are (1) proportion of eligible pts consenting; (2) proportion completing SA-CSGA at T1 & T2; (3) time to completion of SA-CSGA; (4) proportion of MDs reporting change in clinical decision-making due to SA-CSGA. Results: Of the 49 eligible pts, 38 consented (55% female, 89% White, 76% enrolling prior to new rx). Mean age was 77yrs (range 70-89), 38% completed college, 49% married, 27% live alone, and 78% retired. 50% were diagnosed w/ colorectal cancer (ca). Mean MD-rated Karnofsky Performance Status was 87.5 at T1(range 60-100), 83.5 at T2 (range 70-100). At T1, 92% used a touch screen computer; 97% completed the SA-CSGA (51% independently). At T2, all pts used a touch screen computer; 71% completed the SA-CSGA (41% independently). Reasons for not completing SA-CSGA were withdrawal of consent (n=1 at T1 & T2), transfer of care (n=3; T2) or death (n=7; T2). The dominant reason for needing assistance was lack of computer familiarity (n=17 T1, n=14 T2). Mean time to completion was 23min at T1 (range 15-58); 20min at T2 (range 13-35). Among the 8 MDs who consented to participate, SA-CSGA added information to clinical assessment for 75% at T1 (n=27) and 65% at T2 (n=17) but did not alter immediate clinical decision-making. Conclusions: The computer-assisted SA-CSGA feasibility endpt was met for older pts w/ GIM although approximately half required assistance. While the SA-CSGA added information to clinical assessment, results did not impact clinical decision-making. Reasons for this may include relatively high-functioning patients enrolled in this study.

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.

Improving postgraduate clinical assessment tools: The introduction of video recordings to assess decision making

2012 ◽  
Vol 34 (5) ◽  
pp. 404-410 ◽  
Author(s):  
E.A. Webb ◽  
L. Davis ◽  
G. Muir ◽  
T. Lissauer ◽  
V. Nanduri ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Assessment ◽  
Assessment Tools ◽  
Video Recordings
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