scholarly journals Decision Making Capacity or How to Accept Patient’s Refusal for Orthodontic Treatment

2021 ◽  
Vol 2 (4) ◽  
pp. 1-5
Author(s):  
Yulia Bogdanova Peeva
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Orthodontic Treatment ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Treatment Protocol ◽  
Class Iii ◽  
Decision Making Capacity ◽  
Sharing Responsibility ◽  
The Individual

Introduction: Communication in dentistry is bilateral process which usually is based on response (understanding) by the person. That’s why the Oral Healthcare Providers (OHP) should be convinced the consent given by the patient is valid. It means that at the beginning of the treatment the orthodontist will ask a lot of questions and have expectations to receive appropriate answers. There is a specific lack of awareness about the first orthodontic consultation at 7y of age, occurrence and prevention of most of the common tooth jaw discrepancies which affect the oral health, self-confidence and overall development of the child. A variety of socio-demographic, educational, personal and other factors mostly divided into objective and subjective factors influences the perception of facial attractiveness. The orthodontic treatment lays down on the personal desire and attitudes, depends from the motivation but is not without a risk for the patient. The aim of the current research is to present the most objective and subjective factors identifying the patient’s refusal. Material and methods: It’s a case report based on preliminary discussion and orthodontic consultation over the cephalometric analysis and cast models. Orthodontic treatment protocol was followed and given informed consent by the individual was received. Results and discussions: An electronic search was conducted using the Medline database (PubMed), Science Direct, and Scopus. In this case report were described the treatment options for Class III malocclusion with an emphasis on maxillary protraction and existing impacted canine 13. The decision making capacity was evaluated and also what are the objective and subjective factors and how to proceed with patient refusal. Conclusions: Despite the orthodontist’s efforts to improve the management of the dental practice and to attract new patients, these challenges should never been from the first importance. Contemporary dentistry requires that the patient’s right to refuse should be respected and this refusal must be accepted. Because orthodontic treatment is expensive, the process of returning money or sharing responsibility for the treatment depend on the socio-cultural characteristics of both the patient and the doctor. The whole situation requires a very delicate approach, as it affects the image of the dental community in society at whole.

Informed Consent for Epidural Analgesia at the Time of Labor Pain, Seems Too Late!

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Bastanhagh E ◽  
◽  
Behseresht A ◽  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Pain Management ◽  
Epidural Analgesia ◽  
Pain Treatment ◽  
Decision Aids ◽  
Treatment Options ◽  
Labor Pain ◽  
Lumbar Epidural Analgesia ◽  
Decision Making Capacity

Pain in the process of childbirth is the phenomenon mostly feared by every woman in her pregnancy, and is a major cause of dissatisfaction and embarrassing memories of labor. Usage of lumbar epidural analgesia as a very effective pain management option has solved this problem to a great extent, and its utilization has turned to common practice in most of the women hospitals worldwide. The use of lumbar epidural analgesia in labor is widespread due to its benefits in terms of effective pain relief in comparison with other labor pain treatment options [1]. Vaginal delivery is an extremely painful process accompanied with great emotional disturbance, which may not be possible for the laboring mother to focus and concentrate to understand the anesthetist explanations at that moment and sign the epidural analgesia informed consent properly. On one hand, the laboring mother expresses doubts because of uncertainty on her decision and on the other hand she desperately wants to get rid of the excruciating labor pain by any means possible. Therefore, the decision to have a neuraxial analgesia (epidural, combined spinal epidural) sounds obligatory on this condition. Each of these analgesic methods beside desirable effectiveness in pain management may have some side effects and it is obvious that each complication takes lots of time and patiently concentration for the mother to be precisely understood and the decision making is even beyond of it. Decision making process cannot get precisely completed just in labor time, so free of any upcoming complication, informed consent may not be ethically verified on labor time. Decision making capacity is a complex mental process involving both cognitive and emotional components. Sometimes this complex action is reduced to “understanding” alone. There are uncertainties about decision-making capacity (mental competence) of women in labor in relation to giving informed consent to neuraxial analgesia. Considering these parameters, sufficient information about pain management methods (advantages, side effects, the way each procedure is conducted) should be provided as part of prenatal education and the consent process must be carefully conducted to enhance mothers’ autonomy [2]. To utilize effective methods for presenting the mothers with (like multimedia modules, recorded video of the sample procedure and so on) in late pregnancy should be considered to achieve better understanding and right decision. Patient decision aids are beneficial in clinical anesthesia and studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression and decisional conflicts after using this method [3]. It has been demonstrated that using decision aids prior to the procedure can significantly reduce the decision conflict, and improve both autonomy and outcome as a united benefit in favor of laboring mothers [4]. It seems that pain-relieving methods (neuraxial and other treatment options) should be described in details at the second and third trimester of pregnancy by a team consist of midwife, anesthesia provider and obstetrician. The more time is spent on this process; the better informed consent is achieved finally. Also high quality decision aids can increase women’s familiarity with medical terminology, options for care, and an insight into personal values, thereby decreasing decisional conflicts and increase knowledge [5]. Factors like parity, pain threshold, and estimated length of labor should be considered together in the decision process to individualize the best pain treatment option for mother [6].

scholarly journals Maxillary Protraction in an Adolescent Female Patient: A Case Report

2018 ◽  
Vol 6 (02/03) ◽  
pp. 118-121
Author(s):  
Suruchi Jatol-Tekade ◽  
Satyajit Tekade ◽  
Sachin Sarode ◽  
Vishal Patni ◽  
Vihang Naphde
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Treatment Options ◽  
Forward Direction ◽  
Face Mask ◽  
Treatment Modalities ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Growth Modulation ◽  
Skeletal Class

AbstractTandem appliance is preferred over face mask mainly because of compliance reasons. In the given case report, clinicians have used tandem appliance for correcting skeletal class III malocclusion patient in later stage of growth. Operators utilized residual growth. Facial harmony was achieved by gaining positive overjet. Adolescent class III malocclusion is challenging to treat. Occurrence of class III malocclusion is just 5% in India. If patient reports in growing stage, clinicians get many relevant treatment options. Lack of knowledge about growth modulation therapy causes loss of growing stage of patients. This situation reduces available treatment modalities. Here is a case of female patient with class III malocclusion who is near completion of her growth; maxillary growth was stimulated in forward direction taking anchorage from overgrown mandible with the help of tandem appliance.

scholarly journals Behavioral Health Provider Attitudes Toward Behavioral Health Profiles in the U.S. Army

2021 ◽  
Author(s):  
Justin M Curley ◽  
Kristina M Clarke-Walper ◽  
Katie L Nugent ◽  
Joshua E Wilk
Keyword(s):  
Decision Making ◽  
Therapeutic Alliance ◽  
Behavioral Health ◽  
Healthcare Providers ◽  
Treatment Utilization ◽  
Positive Trend ◽  
Provider Attitudes ◽  
Institutional Review ◽  
Using Data ◽  
The Individual

ABSTRACT Introduction U.S. Army healthcare providers’ use of profiles to document and communicate behavioral health (BH) condition limitations to commanders is vital to understanding both the individual soldier’s BH readiness for missions and, as an aggregate, the unit’s overall BH readiness status. Quantitative work exploring the link between soldier attitudes toward BH profiles and treatment utilization found that profiles may actually promote increases in treatment-seeking behavior in those receiving conventional BH services. BH provider attitudes on the subject, however, have not been quantitatively explored. Using data from the recently described Behavioral Health Readiness and Decision-Making Instrument (B-REDI) study, the current inquiry addresses this by examining BH providers’ pre-/post-B-REDI attitudes toward BH profiles, including therapeutic alliance, to better understand how BH profiles may impact BH treatment. Methods This study was approved by the WRAIR Institutional Review Board and is part of the larger B-REDI study. BH providers (n = 307) across five installations supporting active duty U.S. Army Divisions completed surveys longitudinally across three time points from September 2018 to March 2019. The survey specific to this study included five items, developed by WRAIR, assessing BH provider attitudes toward BH profiles. Of the providers who completed the survey, 250 (81%) consented to participate in the study and 149 (60%) completed the 3-month follow-up survey. Results Over 80% of BH providers expressed agreement with each of three items assessing rationale for issuing BH profiles in both the pre- and post B-REDI period. Specifically, most providers agreed that profiles facilitate commander support to the soldier, afford soldiers resources for recovery, and give commanders increased understanding of soldier health for mission planning. Twenty-six percent of BH providers agreed, 46% were neutral, and 28% disagreed on whether profile impact on the soldier was positive or not in the pre-B-REDI period, but there was a significant positive trend relative to baseline in the post B-REDI period. The vast majority of providers (≥94%) did not endorse agreement that BH profiles negatively impact therapeutic alliance in either the pre- or post-B-REDI period. Conclusions Assuming that therapeutic alliance and perceptions of BH profile impact on soldiers are useful proxy measures of how treatment utilization may be affected by profiling, this inquiry fails to establish any meaningful negative association between them. This may provide some additional reassurance to BH providers and policymakers that efforts to improve readiness decision-making, such as B-REDI, and increased profiling in conventional military BH settings may not negatively impact treatment utilization rates.

scholarly journals Perawatan Ortodontik Inkonvensional Gigi Atas Berjejal Dengan Keberadaan Kista

2013 ◽  
Vol 20 (1) ◽  
pp. 99
Author(s):  
Timothy Soewito ◽  
Darmawan Sutantyo ◽  
Cendrawasih A Farmasyanti
Keyword(s):  
Case Report ◽  
Active Treatment ◽  
Orthodontic Treatment ◽  
Treatment Plan ◽  
Orthodontic Brackets ◽  
Lateral Incisor ◽  
Class Iii ◽  
Incisor Tooth ◽  
Knowing That

Keberadaan kista dapat menghambat perawatan ortodontik konvensional yang diberikan pada pasien. Tujuan artikel ini adalah menyajikan laporan kasus perawatan ortodontik alternatif seorang pasien perempuan berusia 17 tahun dengan kondisi gigi atas berjejal berat dan kista jinak di antara gigi insisivus lateral dan kaninus kiri atas. Setelah menetapkan diagnosis ortodontik, perawatan pertama yang dilakukan adalah pengangkatan kista. Kista dikirim untuk biopsi dan didiagnosis sebagai kista jinak. Orang tua dan pasien memutuskan untuk mencabut gigi insisivus lateral atas setelah mengetahui bahwa gigi insisivus lateral kiri atas nekrosis. Setelah gigi dicabut, bracket ortodontik dipasang di gigi bawah pasien. Tiga bulan kemudian, bracket ortodontik dipasang di gigi atas pasien. Kondisi gigi atas yang berjejal terkoreksi dan kaninus atas menggantikan posisi insisivus lateral. Saat ini, perawatan aktif masih dilanjutkan dan terpasang bracket ortodontik dengan elastik kelas III pada pasien. Kesimpulan artikel ini adalah pendekatan perawatan ortodontik inkonvensional dapat menjadi pertimbangan ketika ditemukan hambatan seperti adanya kista. Pasien dan orang tua harus diberi informasi mengenai konsekuensi perawatan sebelum perawatan dimulai.Unconventional Orthodontic Treatment for Upper Teeth Crowding with Benign Cyst. The presence of a cyst can provide an obstacle to the conventional orthodontic treatment given to the patients. The purpose of this article is to describe a case report of a seventeen year-old girl with a severe crowding of maxilla and presence of benign cyst between lateral incisor teeth and upper left canine treated with an alternative orthodontic treatment plan. After orthodontic diagnosis, the first treatment to be conducted was the removal of the cyst. The cyst was sent for biopsy and diagnosed as non-malignant cyst. The patient and her parents decided to extract upper laterals incisor tooth after knowing that the upper left lateral incisor tooth was necrotic. After the extractions, orthodontic brackets were bonded on the mandible. Then three months later the maxilla was bonded. The upper crowding of teeth condition was resolved very promptly and the upper canines were used to replace the laterals incisor position. Currently, active treatment is still in progress, and the patient has full upper and lower orthodontic brackets with class III elastics. After the treatment so far, it can be concluded that unconventional orthodontic treatment is worth considering when an obstacle such as a cyst is present. Patients and parents must be informed about the consequences of the treatment before active treatment is started.

Patient information strategies for decision-making and management of osteoarthritis

2016 ◽  
Author(s):  
Gillian Hawker ◽  
Anne Lyddiatt ◽  
Linda Li ◽  
Dawn Stacey ◽  
Susan Jaglal ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Disease ◽  
Disease Management ◽  
Patient Information ◽  
Chronic Disease Management ◽  
Decision Aids ◽  
Healthcare Providers ◽  
Information Strategies ◽  
Shared Goal ◽  
The Individual

Osteoarthritis (OA) is a chronic, disabling disease that warrants care that aligns with the principles of ‘chronic disease management’. Central to the success of chronic disease management is the ‘informed, activated patient’. Patient information strategies, including the use of patient decision aids, are essential to enabling patients with OA to self-manage their disease and engage in informed, shared decision-making. Such strategies are best delivered by a multidisciplinary team of healthcare providers and adapted to the characteristics, preferences, and values of the individual OA patient. Patients actively involved in their own disease management, that is, ‘self-management’, including shared goal-setting and decision-making about treatment interventions, are, on average, more adherent to treatment recommendations, have enhanced self-efficacy and, ultimately, experience better health outcomes.

scholarly journals Orthodontic Treatment of Class III Malocclusion : A Case Report

2013 ◽  
Vol 1 (1) ◽  
pp. 22-23
Author(s):  
SN Rita ◽  
SMA Sadat ◽  
MZ Hossain
Keyword(s):  
Case Report ◽  
Orthodontic Treatment ◽  
Open Bite ◽  
Class I ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Anterior Open Bite

Reported case of a 19 years old male, with Class III malocclusion, bilateral cross bite associated with anterior open bite, which was treated by fixed orthodontic treatment. After treatment there was a class I Molar and incisor relation as well as the open bite was corrected with accepted aesthetic and functional satisfaction of the patient. DOI: http://dx.doi.org/10.3329/bjodfo.v1i1.15974 Ban J Orthod & Dentofac Orthop, October 2010; Vol-1, No.1, 22-23

scholarly journals Qualitative exploration of factors associated with shared decision-making in diabetes management: a health care provider’s perspective

2020 ◽  
Vol 32 (7) ◽  
pp. 464-469
Author(s):  
Amena Moazzam Baig ◽  
Ayesha Humayaun ◽  
Sara Mehmood ◽  
Muhammed Waqar Akram ◽  
Syed Abbass Raza ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Research ◽  
Grounded Theory ◽  
Shared Decision Making ◽  
Cultural Context ◽  
Diabetes Management ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Depth Interviews

Abstract Objective Internationally, patient–doctor interaction has shifted from the paternalist model to the shared decision-making (SDM) model, which is an essential part of effective management of chronic illnesses, especially diabetes. It is a relatively new concept in Pakistan, and data about healthcare providers’ perspectives are lacking. The aim was to explore significant facilitators and barriers to effective SDM as perceived by endocrinologists. Design A qualitative research using in-depth interviews based on grounded theory was done. It was written in line with the Consolidated Criteria for Reporting Qualitative Research checklist. Setting The interviews were conducted at the workplace of the endocrinologist between April and July 2019. Participants Prominent endocrinologists of Pakistan residing in Lahore were approached for in-depth interviews. The transcripts were analyzed simultaneously, and theme saturation was achieved in 11 interviews. Main outcome measures Thematic analysis of data done using grounded theory. Results Four major and two minor themes were identified. The most cited barriers to effective SDM from the doctors’ side were the shortage of time during consultations and the absence of formal training of clinicians in communication skills. However, the patients’ hesitation in questioning the doctor, perceiving him as a paternalist ‘messiah’ in society and lack of education limits their ability to understand and comprehend treatment options. Conclusion There are many barriers perceived by providers as well as clients/patients by effectively using SDM. Local cultural context is influencing a lot.

Sign in / Sign up

Export Citation Format

Share Document