scholarly journals Management of Pulp Canal Obliteration—Systematic Review of Case Reports

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1237
Author(s):  
Alexandra Vinagre ◽  
Catarina Castanheira ◽  
Ana Messias ◽  
Paulo J. Palma ◽  
João C. Ramos
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Watchful Waiting ◽  
Case Reports ◽  
Intervention Strategy ◽  
Permanent Teeth ◽  
Clinical Approach ◽  
Treatment Pathways ◽  
Patient Reported

Background and Objectives: This systematic review aimed to assess the literature focusing on the clinical management of traumatized teeth with Pulp Canal Obliteration (PCO) and propose an updated clinical decision-making algorithm. The present review follows the PRISMA guidelines and was registered on PROSPERO database (CRD42020200656). Materials and Methods: An electronic search strategy was performed in Pubmed, EBSCOhost and LILACS from inception to March 2021. Only anterior permanent teeth with PCO due to dental trauma were included. Regarding clinical approaches, only teeth managed with a “watchful waiting” approach, tooth bleaching or root canal treatment (RCT) were included. Quality assessment was performed using the JBI Critical Appraisal Tool for Case Reports. Results: Twenty case reports were selected, resulting in a total of 27 patients. The number of traumatized teeth diagnosed with PCO was 33. The “watchful waiting” approach was the most implemented clinical strategy. Discolored non-symptomatic PCO teeth were mostly managed with external bleaching. The prevalence of pulp necrosis (PN) was 36.4%. For teeth diagnosed with PN, non-surgical RCT was performed in 10 teeth and surgical RCT in one tooth. Guided endodontic technique was performed in six of those teeth. Conclusions: For discolored non-symptomatic PCO teeth, external bleaching is advocated and the RCT approach should not be implemented as a preventive intervention strategy. Symptomatic PCO teeth should follow regular endodontic treatment pathways. Clinical approach of teeth with PCO should follow a decision-making algorithm incorporating clinical and radiographic signs and patient-reported symptoms.

The Art of Narrative Psychiatry

2013 ◽  
Author(s):  
SuEllen Hamkins
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Narrative Therapy ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Clinical Decision ◽  
Theory And Practice ◽  
Clinical Approach ◽  
Decision Making Processes ◽  
Justice Movements

Narrative psychiatry empowers patients to shape their lives through story. Rather than focusing only on finding the source of the problem, in this collaborative clinical approach psychiatrists also help patients diagnose and develop their sources of strength. By encouraging the patient to explore their personal narrative through questioning and story-telling, the clinician helps the patient participate in and discover the ways in which they construct meaning, how they view themselves, what their values are, and who it is exactly that they want to be. These revelations in turn inform clinical decision-making about what it is that ails them, how they'd like to treat it, and what recovery might look like. The Art of Narrative Psychiatry is the first comprehensive description of narrative psychiatry in action. Engaging and accessible, it demonstrates how to help patients cultivate their personal sources of strength and meaning as resources for recovery. Illustrated with vivid case reports and in-depth accounts of therapeutic conversations, the book offers psychiatrists and psychotherapists detailed guidance in the theory and practice of this collaborative approach. Drawing inspiration from narrative therapy, post-modern philosophy, humanistic medicine, and social justice movements - and replete with ways to more fully manifest the intentions of the mental health recovery model - this engaging new book shows how to draw on the standard psychiatric toolbox while also maintaining focus on the patient's vision of the world and illuminating their skills and strengths. Written by a pioneer in the field, The Art of Narrative Psychiatry describes a breadth of nuanced, powerful narrative practices, including externalizing problems, listening for what is absent but implicit, facilitating re-authoring conversations, fostering communities of support, and creating therapeutic documents. The Art of Narrative Psychiatry addresses mental health challenges that range from mild to severe, including anxiety, depression, despair, anorexia/bulimia, perfectionism, OCD, trauma, psychosis, and loss. True to form, the author narrates her own experience throughout, sharing her internal thoughts and decision-making processes as she listens to patients. The Art of Narrative Psychiatry is necessary reading for any professional seeking to empower their patients and become a better, more compassionate clinician.

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

2021 ◽  
pp. 136345932199674
Author(s):  
Rikke Torenholt ◽  
Henriette Langstrup
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Patient Reported ◽  
Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

scholarly journals Benefits and Disadvantages of Electronic Patient-reported Outcome Measures: Systematic Review

10.2196/15588 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e15588 ◽  
Author(s):  
Jill Meirte ◽  
Nick Hellemans ◽  
Mieke Anthonissen ◽  
Lenie Denteneer ◽  
Koen Maertens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Quality ◽  
Outcome Measures ◽  
Symptom Management ◽  
Completion Time ◽  
Clinical Decision Making ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Health Technologies ◽  
Patient Reported

Background Patient-reported outcome measures (PROMs) are important in clinical practice and research. The growth of electronic health technologies provides unprecedented opportunities to systematically collect information via PROMs. Objective The aim of this study was to provide an objective and comprehensive overview of the benefits, barriers, and disadvantages of the digital collection of qualitative electronic patient-reported outcome measures (ePROMs). Methods We performed a systematic review of articles retrieved from PubMED and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during all stages. The search strategy yielded a total of 2333 records, from which 32 met the predefined inclusion and exclusion criteria. The relevant ePROM-related information was extracted from each study. Results Results were clustered as benefits and disadvantages. Reported benefits of ePROMs were greater patient preference and acceptability, lower costs, similar or faster completion time, higher data quality and response rates, and facilitated symptom management and patient-clinician communication. Tablets were the most used ePROM modality (14/32, 44%), and, as a platform, Web-based systems were used the most (26/32, 81%). Potential disadvantages of ePROMs include privacy protection, a possible large initial financial investment, and exclusion of certain populations or the “digital divide.” Conclusions In conclusion, ePROMs offer many advantages over paper-based collection of patient-reported outcomes. Overall, ePROMs are preferred over paper-based methods, improve data quality, result in similar or faster completion time, decrease costs, and facilitate clinical decision making and symptom management. Disadvantages regarding ePROMs have been outlined, and suggestions are provided to overcome the barriers. We provide a path forward for researchers and clinicians interested in implementing ePROMs. Trial Registration PROSPERO CRD42018094795; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=94795

scholarly journals Call for action: how to improve use of patient-reported outcomes to guide clinical decision making in rheumatoid arthritis

2018 ◽  
Vol 38 (6) ◽  
pp. 935-947 ◽  
Author(s):  
Bruno Fautrel ◽  
Rieke Alten ◽  
Bruce Kirkham ◽  
Inmaculada de la Torre ◽  
Frederick Durand ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Patient Reported Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Reported

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

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.

scholarly journals Definition and characteristics of acute exacerbation in adult patients with chronic rhinosinusitis: a systematic review

2020 ◽  
Vol 49 (1) ◽  
Author(s):  
Dawei Wu ◽  
Benjamin Bleier ◽  
Yongxiang Wei
Keyword(s):  
Systematic Review ◽  
Chronic Rhinosinusitis ◽  
Case Reports ◽  
Percentage Increase ◽  
Clinical Issue ◽  
Patient Reported ◽  
Acute Exacerbations ◽  
Quantitative Changes ◽  
Definition Of ◽  
Snot 22

Abstract Background Acute exacerbations (AE) in chronic rhinosinusitis (CRS) have been increasingly recognized as an important clinical issue. The purpose of this study is to summarize the current definitions and evaluation parameters of AE and then identify and quantify the clinical and immunopathologic characteristics of AE in CRS. Methods A systematic review of the literature was performed on PubMed, Scopus, and Cochrane databases from January 1990 through August 2020 to identify studies relating to AE in CRS. Exclusion criteria included non-English and non-human studies, and case reports. Results The definitions of AE in CRS among all the studies were based on a description of short-term worsening sinonasal symptoms. Patient-reported sinus infection and exacerbation related medical treatment during the preceding 3 months to 1 year were used to evaluate the frequency of AE in CRS. The average decline in 22-item Sino-Nasal Outcome Test (SNOT-22) score during an exacerbation was 7.83 points relative to baseline. Comorbid asthma, SNOT-22 scores ≥24, allergic rhinitis, eosinophil count ≥150/μL and autoimmune disease were positively associated with an exacerbation-prone CRS phenotype. AE in chronic rhinosinusitis with nasal polyps (CRSwNP) was associated with increased expression of mucus cytokines including myeloperoxidase (percentage increase [PI] = 101%), IL-5 (PI = 125%), and IL-6 (PI = 162%) and could be predicted by the increasing mucus cystatin and periostin. Conclusion The definition of AE in CRS is largely driven by patient-reported symptoms and is associated with several risk factors. Quantitative changes in mucus cytokines associated with AE in CRSwNP and may be used to predict events. The development of a consistent definition of AE in CRS is critical to help define disease control and treatment efficacy.

scholarly journals What is multidisciplinary cancer care like in practice? a protocol for a mixed-method study to characterise ambulatory oncology services in the Australian public sector

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031179
Author(s):  
Bróna Nic Giolla Easpaig ◽  
Gaston Arnolda ◽  
Yvonne Tran ◽  
Mia Bierbaum ◽  
Klay Lamprell ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Multidisciplinary Care ◽  
Outpatient Clinics ◽  
Local Health ◽  
Outpatient Services ◽  
Or Efficiency ◽  
Ambulatory Oncology ◽  
Patient Reported ◽  
Roll Out

IntroductionAn understanding of the real-world provision of oncology outpatient services can help maintain service quality in the face of escalating demand and tight budgets, by informing the design of interventions that improve the effectiveness or efficiency of provision. The aims of this study are threefold. First, to develop an understanding of cancer services in outpatient clinics by characterising the organisation and practice of multidisciplinary care (MDC). Second, to explore the key areas of: (a) clinical decision-making and (b) engagement with patients’ supportive needs. Third, to identify barriers to, and facilitators of, the delivery of quality care in these settings.Methods and analysisA suite of mixed-methods studies will be implemented at six hospitals providing cancer outpatient clinics, with a staged roll-out. In Stage One, we will examine policies, use unstructured observations and undertake interviews with key health professionals to characterise the organisation and delivery of MDC. In Stage Two, observations of practice will continue, to deepen our understanding, and to inform two focused studies. The first will explore decision-making practices and the second will examine how staff engage with patients’ needs; both studies involve interviews, to complement observation. As part of the study of supportive care, we will examine the implications of an introduction of patient-reported measures (PRMs) into care, adding surveys to interviews before and after PRMs roll-out. Data analysis will account for site-specific and cross-site issues using an adapted Qualitative Rapid Appraisal, Rigorous Analysis approach. Quantitative data from clinician surveys will be statistically analysed and triangulated with the related qualitative study findings.Ethics and disseminationEthical approval was granted by South Eastern Sydney Local Health District Human Research Ethics Committee (no. 18/207). Findings will be shared with participating hospitals and widely disseminated through publications and presentations.

scholarly journals Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review

CJEM ◽  
2010 ◽  
Vol 12 (05) ◽  
pp. 435-442 ◽  
Author(s):  
Brian E. Grunau ◽  
Matthew O. Wiens ◽  
Jeffrey R. Brubacher
Keyword(s):  
Systematic Review ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Data Extraction ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Poison Control ◽  
Published Data ◽  
Published Evidence

ABSTRACTObjective:The use of dantrolene in the treatment of hyperpyrexia related to MDMA (3,4-methylenedioxymethamphetamine) is controversial, with little data available to guide clinical decision-making. Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments. We conducted a systematic review to investigate the published evidence regarding the safety and benefits of dantrolene for MDMA-related hyperpyrexia in humans.Data sources:A systematic search of Embase and MEDLINE was conducted from the earliest possible date to November 2008.Study selection:All human trials and case reports of MDMA-related hyperpyrexia were considered.Data extraction:Data were abstracted systematically and characteristics including use of dantrolene, adverse reactions attributed to dantrolene, peak temperature, complications from MDMA-related hyperpyrexia and survival were recorded.Data synthesis:Our search yielded 668 articles of which 53, reporting 71 cases of MDMA-induced hyperpyrexia, met our inclusion criteria. No clinical trials, randomized controlled trials, observational studies or meta-analyses were identified. Dantrolene was used in 26 cases. Patient characteristics were similar in the dantrolene and no dantrolene groups. The proportion of survivors was higher in the dantrolene group (21/26) than in the no dantrolene group (25/45). This difference was especially pronounced in those with extreme (≥ 42°C) and severe (≥ 40°C) fever, with a survival rate of 8 of 13 and 10 of 10, respectively, in the dantrolene group compared with 0 of 4 and 15 of 27 in the no dantrolene group. There were no reports of adverse events attributable to dantrolene with the exception of a possible association with an episode of transient hypoglycemia.Conclusion:Our systematic review suggests that dantrolene is safe for patients with MDMA-related hyperpyrexia. Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42°C) or severe (≥ 40°C) hyperpyrexia, although this conclusion must be interpreted with caution given the risk of reporting or publication bias.

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