When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient's mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.
Humans ; Mouth ; Dental Implantation, Endosseous/methods* ; Incisor ; Clinical Decision-Making ; Dental Implants

clinical decision-making in the management of patients with orbital blowout fractures is challenging, and various aspects of orbital fracture management are uncertain. Numerous approaches have been used for reduction of blowout fracture. Controversies exist regarding indications for surgery, timing of surgery, and optimal reconstruction material. Recently, with expanding use of and indications for endoscopy in orbital blowout fracture surgery, otolaryngologists participate more often in facial trauma surgery, including blowout fracture. In this review, several controversial issues of surgical indication, surgical timing, method of approach, and choice of reconstruction material are discussed from the perspective of otolaryngology surgeons.]]>
Clinical Decision-Making ; Diagnosis ; Diplopia ; Endoscopy ; Enophthalmos ; Humans ; Incidence ; Methods ; Orbit ; Orbital Fractures ; Otolaryngology ; Paranasal Sinuses ; Prolapse ; Surgeons

STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. OVERVIEW OF LITERATURE: Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. METHODS: We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40–77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan–Meier method, and groups were compared using the log-rank method. RESULTS: The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71–39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. CONCLUSIONS: Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.
Clinical Decision-Making ; Follow-Up Studies ; Humans ; Kidney ; Liver ; Methods ; Neoplasm Metastasis ; Operative Time ; Recurrence ; Retrospective Studies ; Spine ; Survival Rate ; Thyroid Gland

Adult ; Aged ; Canada ; Child ; Decision Making ; Decision Support Systems, Clinical ; Emergency Medical Services ; methods ; Emergency Service, Hospital ; Emergency Treatment ; methods ; Female ; Humans ; Pneumonia ; diagnosis ; Retrospective Studies ; Severity of Illness Index ; Singapore

PURPOSE: This study aimed to develop a triage competency scale (TCS) for emergency nurses, and to evaluate its validity and reliability. METHODS: Preliminary items were derived based on the attributes and indicators elicited from a concept analysis study on triage competency. Ten experts assessed whether the preliminary items belonged to the construct factor and determined the appropriateness of each item. A revised questionnaire was administered to 250 nurses in 18 emergency departments to evaluate the reliability and validity of the scale. Data analysis comprised item analysis, confirmatory factor analysis, contrasted group validity, and criterion-related validity, including criterion-related validity of the problem solving method using video scenarios. RESULTS: The item analysis and confirmatory factor analysis yielded 5 factors with 30 items; the fit index of the derived model was good (χ2/df =2.46, Root Mean squared Residual=.04, Root Mean Squared Error of Approximation=.08). Additionally, contrasted group validity was assessed. Participants were classified as novice, advanced beginner, competent, and proficient, and significant differences were observed in the mean score for each group (F=6.02, p=.001). With reference to criterion-related validity, there was a positive correlation between scores on the TCS and the Clinical Decision Making in Nursing Scale (r=.48, p < .001). Further, the total score on the problem solving method using video scenarios was positively correlated with the TCS score (r=.13, p=.04). The Cronbach's α of the final model was .91. CONCLUSION: Our TCS is useful for the objective assessment of triage competency among emergency nurses and the evaluation of triage education programs.
Clinical Competence ; Clinical Decision-Making ; Education ; Emergencies* ; Emergency Nursing ; Emergency Service, Hospital ; Factor Analysis, Statistical ; Methods ; Nursing ; Problem Solving ; Reproducibility of Results ; Statistics as Topic ; Triage*

PURPOSE: This study aims to investigate how competitive orientation influences unethical decision-making (UDM) through relationship conflict and the moderating effect of hostile attribution bias. METHODS: This study was conducted using a self-report questionnaire. Data were collected from 727 employees in Chinese hospitals. For each variable, measures were adopted or adapted from existing literature. Data were analyzed using descriptive statistics, correlation analysis, confirmatory factor analysis, and hierarchical regression analysis. Common method variance was established using Harman's single-factor test. RESULTS: Competitive orientation is significantly and positively associated with relationship conflict (β = .36, p < .001) and UDM (β = .35, p < .001). Relationship conflict is significantly and positively associated with UDM (β = .51, p < .001). Relationship conflict partially mediates the relationship between competitive orientation and UDM. In addition, hostile attribution bias strengthens the positive relationship between competitive orientation and UDM through relationship conflict. CONCLUSION: This study provides some implications for hospital employees to deal with ethical dilemmas in decision-making. Hospital employees including nurses, physicians, and other health-care professionals should raise awareness of competitive orientation and adopt a cooperative approach to human relations. Effective training programs should be utilized to direct all hospital employees to depress hostile attribution bias whenever possible to everything in clinical practice.
Asian Continental Ancestry Group ; Bias (Epidemiology) ; Conflict (Psychology) ; Decision Making ; Education ; Ethics, Clinical ; Hostility ; Humans ; Methods

PURPOSE: Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb; a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice. METHODS: A retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making. RESULTS: Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1-80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%). CONCLUSION The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Child ; Child, Preschool ; Clinical Decision-Making ; Female ; Humans ; Infant ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Treatment Outcome ; Upper Extremity ; Young Adult

OBJECTIVES: The present study aimed to estimate the survival rate of teeth after non-surgical root canal treatment and to investigate the effect of income on the tooth survival rate. METHODS: The study included 1,414.668 endodontically treated teeth from 1,193.666 persons enrolled in the National Health Insurance Service in 2002. A survival analysis of the teeth was performed using the Kaplan-Meier method. The survival rates were calculated using a follow-up period of 11 years after the root canal treatment. RESULTS: In the present study, the 11-year cumulative survival rate of teeth after non-surgical endodontic treatments was 86.90%. The survival rates of teeth tended to decrease for the posterior teeth; the maxillary teeth showed a lower survival rate than that of the mandibular teeth. The teeth with the highest survival rates were the mandibular left lateral incisor, maxillary right incisor, mandibular right lateral incisor, and maxillary left central incisor, in that order. The lowest survival rates were shown by the mandibular second molar, maxillary second molar, maxillary first molar, and mandibular first molar, in that order. The survival rate of the first molar (#16, #26, #36, #46) was higher in the low-income group than in the high-income group (P<0.001). CONCLUSIONS: This study represents the outcome pattern of root canal treatment among South Korean individuals. These study findings can be used as comparative data for clinical decision making about endodontic treatment.
Clinical Decision-Making ; Dental Pulp Cavity ; Follow-Up Studies ; Humans ; Incisor ; Methods ; Molar ; National Health Programs ; Survival Rate ; Tooth Extraction ; Tooth*

PURPOSE: We evaluated the clinical role of rapid next-generation sequencing (NGS) for identifying BRCA1/2 mutations compared to traditional Sanger sequencing. METHODS: Twenty-four paired samples from 12 patients were analyzed in this prospective study to compare the performance of NGS to the Sanger method. Both NGS and Sanger sequencing were performed in 2 different laboratories using blood samples from patients with breast cancer. We then analyzed the accuracy of NGS in terms of variant calling and determining concordance rates of BRCA1/2 mutation detection. RESULTS: The overall concordance rate of BRCA1/2 mutation identification was 100%. Variants of unknown significance (VUS) were reported in two cases of BRCA1 and 3 cases of BRCA2 after Sanger sequencing, whereas NGS reported only 1 case of BRCA1 VUS, likely due to differences in reference databases used for mutation identification. The median turnaround time of Sanger sequencing was 22 days (range, 14–26 days), while the median time of NGS was only 6 days (range, 3–21 days). CONCLUSION: NGS yielded comparably accurate results to Sanger sequencing and in a much shorter time with respect to BRCA1/2 mutation identification. The shorter turnaround time and higher accuracy of NGS may help clinicians make more timely and informed decisions regarding surgery or neoadjuvant chemotherapy in patients with breast cancer.
Breast Neoplasms* ; Breast* ; Clinical Decision-Making* ; Drug Therapy ; High-Throughput Nucleotide Sequencing ; Humans ; Methods ; Prospective Studies

In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.
Area Under Curve ; Asian Continental Ancestry Group* ; Clinical Decision-Making ; Consensus* ; Coronary Artery Disease ; Echocardiography ; Electrocardiography ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Methods ; Positron-Emission Tomography ; Radionuclide Imaging ; Tomography, Emission-Computed