scholarly journals Decision-Making in Implantology—A Cross-Sectional Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

2021 ◽  
Vol 18 (4) ◽  
pp. 1596
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Cross Sectional Study ◽  
Bone Block ◽  
Bone Resection ◽  
Patient Age ◽  
Cross Sectional ◽  
Therapy Decision ◽  
Patient Âgé ◽  
Edentulous Mandible ◽  
Radiation Area

This cross-sectional study aimed to investigate the influence of possible factors in the patient history on decision making in the therapy for a severely atrophied edentulous mandible. A vignette-based survey among 250 maxillofacial and oral surgeons was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery, and radiotherapy in the head and neck area (the implant region is not in the direct radiation area). To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material, and bone resection. There also was the option of rejecting any therapy. The response rate was 47%. Patient age, radiotherapy, and fear of surgery did not influence the approval of a therapy. Smoking was associated with a significantly lower endorsement of a treatment. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. In summary, it can be said that, of the four determinants, only smoking influenced treatment refusal. Bone resection is the preferred therapy independent of all determinants.

scholarly journals How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Bisphosphonate Therapy ◽  
Bone Block ◽  
Patient Anxiety ◽  
Patient Age ◽  
Endocarditis Prophylaxis ◽  
Therapy Decision ◽  
Patient Âgé ◽  
Case Vignettes

Abstract Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion “Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

scholarly journals How Do Specialist Surgeons Treat the Atrophic Tooth Gap? - A Vignette-based Study Among Maxillofacial and Oral Surgeons

2020 ◽  
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Bisphosphonate Therapy ◽  
Bone Block ◽  
Patient Anxiety ◽  
Patient Age ◽  
Endocarditis Prophylaxis ◽  
Therapy Decision ◽  
Patient Âgé ◽  
Case Vignettes

Abstract BackgroundThere is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons.MethodsA total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle.ResultsA total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision.Conclusion“Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

scholarly journals Decision-Making in Implantology – A Vignette-Based Study to Determine Clinical Treatment Routines for the Edentulous Atrophic Mandible

2020 ◽  
Author(s):  
Michael Korsch ◽  
Winfried Walther ◽  
Bernt-Peter Robra ◽  
Aynur Sahin ◽  
Matthias Hannig ◽  
...  
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Response Rate ◽  
Bone Block ◽  
Invasive Procedures ◽  
Bone Resection ◽  
Bone Substitute Material ◽  
Therapy Decision ◽  
Edentulous Mandible ◽  
Radiotherapy Treatment

Abstract BackgroundThe aim of the study was to investigate the influence of possible factors on decision making in the therapy for the severely atrophied edentulous mandible.MethodsA vignette-based survey among 250 maxillofacial surgeons and oral surgeons on the edentulous narrow atrophic mandible was conducted. Determinants that could influence the therapy decision were patient age, smoking, fear of surgery and radiotherapy in the head and neck area. To achieve a suitable implant site, the options offered to the surgeons were bone split, bone block, augmentation with bone substitute material and bone resection. In addition, there was the option of rejecting any therapy.ResultsThe response rate was 46.8%. Resection was preferred by a large majority to all other forms of therapy, regardless of the four determinants. Surgeons tend to refrain from bone block transplants in older patients. Smoking led significantly more often to the rejection of an intervention. Fear of surgery had no influence on the treatment methods, previous radiotherapy treatment only for bone split.ConclusionsIn the narrow atrophic mandible, bone resection is the preferred therapy independent of all determinants. Surgeons tend to refrain from complex and invasive procedures in older patients and generally tend to refrain from interventions in smokers.

Individual Case Safety Reports Analysis for Patients with Diabetes Mellitus on Insulin in Africa and the Middle East

2021 ◽  
Vol 16 ◽  
Author(s):  
Charity R.N. Mlotshwa ◽  
Johanita R. Burger ◽  
Martine Vorster ◽  
Dorcas M. Rakumakoe ◽  
Marike Cockeran
Keyword(s):  
Diabetes Mellitus ◽  
Middle East ◽  
Microvascular Complications ◽  
Individual Case ◽  
Cross Sectional Study ◽  
Patient Age ◽  
Cross Sectional ◽  
Patient Âgé ◽  
Patients With Diabetes ◽  
Insulin Use

Background: The growing numbers of patients with diabetes mellitus in Africa and the Middle East on antidiabetic therapies necessitate an understanding of adverse event (AE) reporting in these regions. Objective: To provide an AE reporting overview in patients using insulins in Africa and the Middle East by characterizing and comparing individual case safety reports (ICSRs) features. Method: The cross-sectional study analyzed ICSR data from a global pharmaceutical company’s pharmacovigilance database for January to December 2018 to describe and compare patient demographics, report sources, reporter types, ICSR seriousness, suspect products, indication for insulin use and AE preferred terms, by country. Results: Overall 7076 ICSRs were analyzed, 63.6% from the Middle East. Most ICSRs were non-serious (91.5%), from solicited sources (83.5%), and reported by consumers (70.7%). Patients from the Middle East were, on average, 34.2 years of age, had gestational diabetes mellitus as indication (64.3%), insulin detemir as suspect product (76.5%), and exposure during pregnancy as AE preferred term (89.1%). Patients from Africa were 48.1 years old on average, a higher proportion of type 2 diabetes mellitus was observed (52.2%), human insulins the suspect product (51.6%), and blood glucose increased the AE preferred term (23.1%). Few macrovascular and microvascular complications were reported (<1% in both regions). Associations between the region and patient age, gender, report sources, reporter types, indications for insulin use, suspect products, and AE preferred term were significant (p <0.001). Conclusion: ICSRs features were region-specific and dependent on patient age, gender, report sources, reporter types, suspect products, and AE preferred terms.

scholarly journals Sex differences in intensive care unit admissions in Australia and New Zealand

2021 ◽  
Vol 23 (1) ◽  
pp. 86-93
Author(s):  
Lucy Modra ◽  
◽  
David Pilcher ◽  
Michael Bailey ◽  
Rinaldo Bellomo ◽  
...  
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Diagnostic Category ◽  
Cross Sectional Study ◽  
Geographic Region ◽  
Patient Age ◽  
Cross Sectional ◽  
Icu Patients ◽  
Diagnostic Categories ◽  
Patient Âgé

Introduction: Fewer women than men are admitted to intensive care units (ICUs) worldwide. Objectives: To quantify the relative contribution of each major diagnostic category to the overall sex balance in ICU admissions in Australia and New Zealand, and to describe changes in the sex balance over time and with patient age. Methods: Retrospective cross-sectional study of Australian and New Zealand ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2005 and 2018. Multivariate logistic regression for the likelihood of female admission considered key explanatory variables: diagnostic category, patient age, admission year, geographic region, hospital type, and planned versus unplanned ICU admission. Results: Overall, 42.3% of 1 616 856 Australian and New Zealand ICU patients were women (99% CI, 42.2–42.4%). 247 988 more men than women were admitted to an ICU during the 14-year study period. There was a sex imbalance in most diagnostic categories: less than 48% women in 15 of 23 diagnostic categories, and greater than 52% women in four diagnostic categories (P < 0.001). Admissions following cardiovascular surgery accounted for over half of the total sex imbalance. The percentage of ICU patients who are women increased linearly from 40.8% in 2005 to 43.6% in 2018 (R2 = 93.1%; P < 0.001). Compared with admission in 2005, the adjusted odds ratio for female admission in 2018 was 1.03 (99% CI, 1.01–1.06). Conclusion: There is a significant sex imbalance in ICU admissions in Australia and New Zealand, widespread across the diagnostic categories. Cardiovascular admissions contribute most to the observed preponderance of men. The proportion of female ICU patients is steadily increasing.

scholarly journals Burden and Depression among Jordanian Caregivers of Hemodialysis Patients: A Cross-sectional Study

2021 ◽  
Vol 15 (1) ◽  
pp. 29-37
Author(s):  
Eman Khamis Alnazly
Keyword(s):  
Travel Time ◽  
Family Caregivers ◽  
Caregiver Burden ◽  
Multinomial Logistic Regression ◽  
Cross Sectional Study ◽  
Patient Age ◽  
Cross Sectional ◽  
Caregiving Burden ◽  
Patient Âgé ◽  
The Family

Introduction: Caring for patients receiving hemodialysis places a burden on caregivers. Objectives: To examine caregiving burden and depression in the family caregivers of patients receiving hemodialysis and associated factors. Methods: A cross-sectional design was used. Participants were 204 adult caregivers of patients receiving hemodialysis. Questionnaires included sociodemographic characteristics, the Oberst Caregiving Burden Scale-Difficulty (OCBS-D) subscale, Bakas Caregiving Outcomes Scale (BCOS), and the Patient Health Questionnaire-9 to measure the burden and depression of caregivers. Descriptive statistics, two linear regression analyses, and multinomial logistic regression were used in data analysis. Results: The majority (59.0%, n = 120) of caregivers had a moderate level of depression with scores ranging from 11 to 16. The analysis showed that the mean score of OCBS-D was 42.0 (SD = 4.7) with scores ranging from 26.9 to 58.9 (range = 32.0), while the caregivers' mean score of BCOS was 52.1 (SD = 9.3) with scores ranging from 38.0 to 82.5 (range = 44.5). Given that the expected score of OCBS-D and BCOS ranged from 15 to 75 and 15 to 105, respectively, the analysis indicated a moderate to a high level of burden among caregivers. Age and travel time were associated with a higher likelihood of negative outcomes in the family caregivers, while higher patient age was associated with a greater caregiver burden. Relevance to Clinical Practice: It is important to assess and address the practical issues that caregivers experience, such as employment-related responsibilities, financial difficulties, and the need to learn specific skills related to patients’ chronic illnesses. Conclusion: Caregivers of patients receiving hemodialysis are likely to experience moderate depression and burden. Caregiver burden increases with patient age and travel time to the hemodialysis units.

scholarly journals Analyzing clinical characteristics of patients with different cumulative hemodialysis durations: a cross-sectional study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10852
Author(s):  
Xu Chen ◽  
Li Yuan ◽  
Yuan Zhang ◽  
Houyong Dai ◽  
Yaping Fan ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Clinical Characteristics ◽  
Cross Sectional Study ◽  
Background Information ◽  
Chronic Glomerulonephritis ◽  
Sectional Study ◽  
Patient Age ◽  
Cross Sectional ◽  
Patient Âgé ◽  
Average Patient

Background The objective of this study was to examine the clinical characteristics of patients with different cumulative hemodialysis (HD) durations, so as to improve their survival rate. Methods In this cross-sectional study, we extracted background information and relevant clinical data from 145 patients who were undergoing maintenance HD three times a week at the Affiliated Hospital of Nantong University between January 1998 and January 2019. The study subjects were divided into four groups according to the duration of their HD: <5 years, 5–10 years, 10–15 years, and >15 years of HD. We collected the medical history and relevant clinical parameters for each subject, and measured the urea reduction ratio (URR), hemoglobin (Hb), serum calcium, phosphorus, parathyroid hormone (iPTH), and serum albumin (ALB) levels for each group. Results The average patient age was 52.06 ±  11.93 years old. The average patient age in the 10–15 years and >15 years groups was significantly lower than in the <5 years and 5–10 years groups (P = 0.002, P < 0.001, P = 0.012, and P = 0.0025, respectively). The most common cause of end-stage renal disease (ESRD) was chronic glomerulonephritis. We found no significant differences in URR, Hb, serum calcium, serum phosphorus, iPTH, and ALB levels. Conclusion A prolonged HD duration was related to a younger mean age at the start of HD treatment. The leading cause of ESRD was chronic glomerulonephritis. We predominantly found diabetic nephropathy in the group with a duration of <5 years cumulative HD. Most of the indexes related to hemodialysis almost satisfied the recommended values in these patients.

scholarly journals Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

2021 ◽  
Vol 18 (4) ◽  
pp. 2128
Author(s):  
Marta Maes-Carballo ◽  
Manuel Martín-Díaz ◽  
Luciano Mignini ◽  
Khalid Saeed Khan ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Societies ◽  
New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

2020 ◽  
Vol 41 (1) ◽  
pp. 51-59
Author(s):  
Gisèle Diendéré ◽  
Imen Farhat ◽  
Holly Witteman ◽  
Ruth Ndjaboue
Keyword(s):  
Decision Making ◽  
Family Medicine ◽  
Risk Communication ◽  
Shared Decision Making ◽  
Cross Sectional Study ◽  
Clinical Encounter ◽  
Values Clarification ◽  
Shared Decision ◽  
Cross Sectional ◽  
Medical Consultations

Background Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients’ and observers’ ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations. Methods In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item “observing patient involvement” score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient). Results Agreement was low between observers’ and patients’ ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; P = 0.38). Observers’ ratings using RCVC-observer were correlated to patients’ ratings using either SDM-Q9 ( rpb = −0.16; P = 0.01) or RCVC-patients ( rpb = 0.24; P = 0.03). Observers’ OPTION-5 scores and patients’ ratings using RCVC-questions were moderately correlated ( rφ = 0.33; P = 0.04). Conclusion There was moderate to no alignment between observers’ and patients’ ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.

scholarly journals Prelicensure Nursing Students’ COVID-19 Attitude Impact on Nursing Career Decision during Pandemic Threat in Taiwan: A Cross-Sectional Study

2021 ◽  
Vol 18 (6) ◽  
pp. 3272
Author(s):  
Shu-Chun Lin ◽  
Lee-Fen Ni ◽  
Yu-Ming Wang ◽  
Shu Hsin Lee ◽  
Hung-Chang Liao ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Students ◽  
Perceived Control ◽  
Career Decision ◽  
Cross Sectional Study ◽  
Attitude Scale ◽  
Sectional Study ◽  
Career Decision Making ◽  
Cross Sectional ◽  
Prelicensure Nursing

The COVID-19 pandemic may cause a nursing shortage. Prelicensure nursing students who are exposed to high-stress COVID-19 events are related to defective career decision-making. This study validated the COVID-19 attitude scale and clarified how their attitudes about COVID-19 affected their behavioral intentions toward career decision-making. We conducted a cross-sectional study and recruited a convenience sample of 362 prelicensure nursing students from Northern and Central Taiwan. Two measurements were applied, including the Nursing Students Career Decision-making instrument and COVID-19 attitude scale. We used AMOS (version 22.0) to perform a confirmatory factor analysis. The Cronbach α of the COVID-19 attitude scale was 0.74 and consisted of four factors. The most positive attitude was the nursing belief factor, and the least positive factor was emotional burden. Prelicensure nursing students’ COVID-19 attitudes were significantly positively associated with their career decision-making attitudes and perceived control (ß = 0.41 and ß = 0.40, respectively; p < 0.001). All the key latent variables explained significantly 23% of the variance in the career decision-making behavioral intentions module. In conclusion, the COVID-19 attitude scale is valid. Although the prelicensure nursing students’ COVID-19 attitudes had no direct effect on career decision-making intentions, they had a direct effect on career decision-making attitudes and the perceived control.

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