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Clinical Circumstances (clinical + circumstance)
Selected AbstractsFabrication of Direct Fiber-Reinforced Posts: A Structural Design ConceptJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 4 2001DOUGLAS A. TERRY DDS ABSTRACT As the clinician continues the quest for optimal functional and esthetic success of a tooth-restorative complex, the current selection of restorative materials and techniques may prove overwhelming. Although no single system provides the ideal restorative solution for every clinical circumstance, understanding of general design criteria and the components for the various post and core systems available allow the clinician to appropriately select the method and materials compatible with the existing tooth structure and desired result. This article provides a discussion of the various post and core systems, the methods and materials inherent in these systems, and general design principles. Using that basic information and clinical experience, the authors offer an alternative procedure for the rehabilitation of the intraradicular anatomy of the post-endodontic channel with a direct composite resin,the fiber-reinforced post and core system. CLINICAL SIGNIFICANCE Using improved restorative materials that simulate the physical properties and other characteristics of natural teeth in combination with the proper design principles, the clinician can develop a tooth-restorative complex with optimal functional and esthetic results. [source] Therapeutic options for Bowen's diseaseAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2007Gilberto Moreno SUMMARY Multiple therapeutic options are available for treatment of Bowen's disease. The choice of therapy depends on clinical circumstance and medical practitioner experience. Newer therapies have more extensive support from the literature, but more established therapies may be preferred because of accessibility, cost and efficacy. An overview of the current therapeutic options for Bowen's disease is presented. [source] Implementing Clinical Practice Guidelines in occupational therapy practice: Recommendations from the research evidenceAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2010Mary Stergiou-Kita Background:,Clinical Practice Guidelines (CPGs) are prominent tools in evidence-based practice which integrate research evidence, clinical expertise and client input to develop recommendations for specific clinical circumstance. With the push to use research evidence in health care, it is anticipated that occupational therapists will become increasingly involved in implementing CPGs in practice. The research evidence has revealed several factors that can affect guideline uptake, and a variety of strategies that can facilitate implementation. Methods:,This narrative review examines the health-related literature in CPGs to answer the following questions. Based on the research evidence, (i) what are the factors that may influence guideline implementation? (ii) What implementation strategies may enhance guideline implementation? Results:,Factors within the guideline itself (e.g. quality, complexity and clarity), within the practitioner (e.g. experience, perceptions and beliefs), the patient (e.g. expectations and preferences) and the practice context (e.g. resource availability, organisational culture and opinion leaders) can all affect implementation success. Currently, there is no conclusive evidence to support the use of one implementation strategy over another, in all situations. The choice of implementation strategy must take into account the guideline to be implemented, the practice context and the anticipated challenges to implementation. Conclusions:,By understanding the factors that can influence implementation and the strategies for successful implementation, occupational therapists will be better prepared to implement guidelines. Recommendations to assist with guideline uptake and implementation are provided. [source] Therapy of other viral infections: herpes to hepatitisDERMATOLOGIC THERAPY, Issue 6 2004Arun Chakrabarty ABSTRACT:, Over the past several years, there has been an increase in knowledge pertaining to the diagnosis and management strategies for the herpes family (Types 1,8), the pox viruses, mumps, measles, rubella, and parvovirus B19 as well as the viral etiologies of hepatitis. Various antiviral treatments, such as nucleoside analogs and interferon therapy, have been available to reduce the signs and symptoms of these common viral infections. This article summarizes the preferred treatment strategies to be employed for each of the viruses for reducing severity, duration, recurrences (notably in the herpes family), transmission rates, as well as preventive alternatives. The majority of the therapeutic options attenuate the course of disease. Treatment decisions are driven by knowledge of the natural history and often are tailored to incorporate clinical circumstances for individual patients. Promotion of community awareness and the development of vaccines should be emphasized in the battle against these common viruses, particularly the herpes simplex viruses, the pox viruses, and hepatitis B. [source] Volumetric analysis of extraction sockets using cone beam computed tomography: a pilot study on ex vivo jaw boneJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2007Jimoh Olubanwo Agbaje Abstract Aim: The aim of this study was to determine the accuracy of volumetric analysis of extraction sockets using cone beam computed tomography (CBCT). Material and Methods: The volume of 40 dental alveoli in nine dry skull specimens (four mandibles and five maxillae) was determined by measuring the volume of the tooth socket impression using the water displacement technique. This was considered as the gold standard. Then, the tooth socket was scanned with CBCT and data were uploaded in the semi-automated Livewire® segmentation software. The software segments the tooth socket in consecutive 1 mm-thick two-dimensional slices. After segmentation, the total volume of the delineated socket was computed. The statistical difference between direct volumetric measurements and those obtained with CBCT imaging was assessed using the Student paired t -test. Result: The mean socket volume of the skull specimens was 227±91 mm3 when obtained by direct measurement and 225±90 mm3 when obtained by CBCT imaging. Student paired t -test showed no significant differences between both volume measurements (p>0.1). Conclusions: CBCT permits imaging of anatomical structures in three planes and allows for reliable volume estimates. The results should be verified in clinical circumstances and might have potential applicability for evaluation of extraction socket healing under different conditions. [source] Medical students' first clinical experiences of deathMEDICAL EDUCATION, Issue 4 2010Emily Kelly Medical Education 2010: 44: 421,428 Objectives, Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Methods, Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results, Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of ,young', ,old' or ,unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ,Preparation' touches on personal experience and pre-clinical instruction. ,The event itself' could be categorised as referring to a ,young' patient, an ,old' patient or a patient in whom death was ,unexpected'. In the ,resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The ,lessons learned' shape medical students' experiences of future patient deaths and their professional identity. Conclusions, A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing. [source] Beyond body mass indexOBESITY REVIEWS, Issue 3 2001A. M. Prentice Summary Body mass index (BMI) is the cornerstone of the current classification system for obesity and its advantages are widely exploited across disciplines ranging from international surveillance to individual patient assessment. However, like all anthropometric measurements, it is only a surrogate measure of body fatness. Obesity is defined as an excess accumulation of body fat, and it is the amount of this excess fat that correlates with ill-health. We propose therefore that much greater attention should be paid to the development of databases and standards based on the direct measurement of body fat in populations, rather than on surrogate measures. In support of this argument we illustrate a wide range of conditions in which surrogate anthropometric measures (especially BMI) provide misleading information about body fat content. These include: infancy and childhood; ageing; racial differences; athletes; military and civil forces personnel; weight loss with and without exercise; physical training; and special clinical circumstances. We argue that BMI continues to serve well for many purposes, but that the time is now right to initiate a gradual evolution beyond BMI towards standards based on actual measurements of body fat mass. [source] Anesthetic implications of ornithine transcarbamylase deficiencyPEDIATRIC ANESTHESIA, Issue 7 2010ANDREA P. DUTOIT MD Summary Background:, Ornithine transcarbamylase deficiency (OTCD) is an X-linked urea cycle disorder associated with potentially fatal episodes of hyperammonemia. Children with OTCD often require anesthesia. There is insufficient information regarding perioperative complications and optimal management of anesthesia in these patients. Aim:, To retrospectively review the medical records of children with OTCD to ascertain the nature and frequency of peri-procedural complications. Methods/Materials:, The electronic medical records of Mayo Clinic patients with OTCD who underwent anesthesia between the dates of January 2003 and September 2009 were reviewed. Results:, Nine patients with OTCD underwent 25 anesthetics using a variety of anesthetic techniques, including four major surgeries. Eleven procedures were performed prior to OTCD diagnosis and those patients were not receiving therapy for a urea cycle disorder. In the other cases, patients were on a variety of therapies for OTCD. Fourteen patients were outpatient procedures. Clinical signs of postoperative metabolic decompensation did not occur. Conclusions:, In this series, patients with OTCD tolerated anesthesia well. Choice of perioperative management of OTCD and the choice of anesthetic technique should be individualized and based on clinical circumstances, but should have the underlying aim of minimizing protein catabolism. It appears patients with stable OTCD may undergo minor procedures as outpatients safely. [source] Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratificationCANCER, Issue 5 2004Martin Radespiel-Tröger M.D. Abstract BACKGROUND Patients who are at high risk of recurrence after undergoing curative (R0) resection for colon carcinoma may benefit most from adjuvant treatment and from intensive follow-up for early detection and treatment of recurrence. However, in light of new clinical evidence, there is a need for continuous improvement in the calculation of the risk of recurrence. METHODS Six hundred forty-one patients with R0-resected colon carcinoma who underwent surgery between January 1, 1984 and December 31, 1996 were recruited from the Erlangen Registry of Colorectal Carcinoma. The study end point was time until first locoregional or distant recurrence. The factors analyzed were: age, gender, site in colon, International Union Against Cancer (UICC) pathologic tumor classification (pT), UICC pathologic lymph node classification, histologic tumor type, malignancy grade, lymphatic invasion, venous invasion, number of examined lymph nodes, number of lymph node metastases, emergency presentation, intraoperative tumor cell spillage, surgeon, and time period. The resulting prognostic tree was evaluated by means of an independent sample using a measure of predictive accuracy based on the Brier score for censored data. Predictive accuracy was compared with several proposed stage groupings. RESULTS The prognostic tree contained the following variables: pT, the number of lymph node metastases, venous invasion, and emergency presentation. Predictive accuracy based on the validation sample was 0.230 (95% confidence interval [95% CI], 0.227,0.233) for the prognostic tree and 0.212 (95% CI, 0.209,0.215) for the UICC TNM sixth edition stage grouping. CONCLUSIONS The prognostic tree showed superior predictive accuracy when it was validated using an independent sample. It is interpreted easily and may be applied under clinical circumstances. Provided that their classification system can be validated successfully in other centers, the authors propose using the prognostic tree as a starting point for studies of adjuvant treatment and follow-up strategies. Cancer 2004;100:958,67. © 2004 American Cancer Society. [source] Lymphangiectasias of the skin: victims of confusing nomenclatureCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2009S. B. Verma Summary Lymphangiectasias are known by a variety of names, in the dermatology literature, including lymphangiectasis, acquired lymphangiomas, secondary lymphangiomas and acquired lymphangioma circumscriptum, which has led to confusion. The condition itself, especially in the genital region, is difficult to diagnose. This article attempts to resolve the issues of the confusing nomenclature and reviews the condition, which can arise under a variety of clinical circumstances. The relevant anatomical and histological details are described, with relevant clinical illustrations, to facilitate understanding of the aetiopathogenesis of this enigmatic condition. The available medical and non-medical treatments are discussed. [source] Bacterial translocation in a non-lethal rat model of peritonitisCOLORECTAL DISEASE, Issue 5 2001V. Yao Background Bacterial translocation from the gut may occur under a variety of different clinical circumstances and has been implicated in the development of multiple organ failure. The aim of this study was to determine the distribution of bacterial translocation occurring in a model of chemically induced peritonitis. We also sought to document the degree of the associated immune and inflammatory response. Methods Though a midline laparotomy, rats were injected with 5 mg of zymosan (in 0.2 ml of saline) into the subomental space. After 4, 18, 24, 48 and 96 h, a number of endpoints evaluated: intraperitoneal cellular influx, TNF-, and interleukin-6 concentrations and myeloperoxidase activity. Bacterial cultures were initiated from the free peritoneal fluid, mesenteric lymph nodes, liver, lung, and kidney. Imprints were also made of the peritoneal mesothelial surface to determine its integrity. Results When comparing rats injected with zymosan with the controls, there was evidence of a peritoneal inflammatory response within 4 hours. Facultative gram negative bacteria were found to be growing in the mesenteric lymph nodes and in the peritoneal fluid at 48 h. Anaerobic organisms were also cultured from the peritoneal fluid at 48 h. No organisms were cultured from the liver, lung or kidneys. In addition there was a significant increase in intraperitoneal cell numbers (predominantly neutrophils, P < 0.05), myeloperoxidase activity (P < 0.05) and TNF-, and IL-6 concentrations (P < 0.05). There was extensive loss of the peritoneal mesothelial cells. The peritoneal inflammatory changes and bacterial translocation had resolved by 96 h. Conclusion Bacterial translocation can be induced by the presence of an acute inflammatory focus in the peritoneal cavity. The translocation and inflammatory changes were associated with extensive loss of mesothelial cells. Nonetheless, these changes all resolved, indicating that the peritoneal cavity has a significant capacity to deal with such insults. A clearer understanding of the cellular and molecular events involved in the resolution phase could lead to improvements in the treatment of peritonotis. [source] | ||||||||||