Immediate implant-supported fixed restoration in edentulous jaws demonstrates a success rate comparable to that of conventional implant restoration. However, this approach still presents a certain degree of technique sensitivity. In the field of immediate implant-supported fixed restoration in dentistry, a repeatable and stable jaw relation is the prerequisite for the design and fabrication of prostheses. It also reduces chairside denture placement and occlusal adjustment time and lowers the risk of occlusion-related complications. For patients with terminal dentition, the precise transfer of jaw relation following full-arch implantation serves as the fundamental basis for implant-supported occlusal reconstruction and functional restoration. This process is also a key research focus and challenge in the area of implant-supported occlusal rehabilitation. This review summarizes the procedures and methods for determining and transferring jaw relation in immediate implant-supported fixed restoration. It aims to serve as a basis for clinical decision making in implant-supported fixed restorations for terminal dentition patients.
Humans ; Dental Prosthesis, Implant-Supported ; Clinical Decision-Making ; Immediate Dental Implant Loading ; Jaw, Edentulous/surgery*

Artificial intelligence (AI) is revolutionizing the current approach to medicine. AI uses machine learning algorithms to predict the success of therapeutic procedures or assist the clinician in the decision-making process. To date, machine learning studies in the andrological field have mainly focused on prostate cancer imaging and management. However, an increasing number of studies are documenting the use of AI to assist clinicians in decision-making and patient management in andrological diseases such as varicocele or sexual dysfunction. Additionally, machine learning applications are being employed to enhance success rates in assisted reproductive techniques (ARTs). This article offers the clinicians as well as the researchers with a brief overview of the current use of AI in andrology, highlighting the current state-of-the-art scientific evidence, the direction in which the research is going, and the strengths and limitations of this approach.
Humans ; Artificial Intelligence ; Andrology ; Machine Learning ; Male ; Clinical Decision-Making ; Reproductive Techniques, Assisted

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

Intra-abdominal desmoid tumor (IADT) and gastrointestinal stromal tumor (GIST) are both mesenchymal tumors mostly found in gastrointestinal tracts and easily misdiagnosed, which would directly damage the survival prognosis and quality of life of patients. With the advent of the era of precision medicine, the understanding of the above two diseases is more in-depth, and the requirements for accurate diagnosis and individualized precision treatment are more stringent. Moreover, there seems to be some internal relationship between IADT and GIST, and the lack of systematic research and discussion makes clinical decision-making and patient management easy to fall into traps and misunderstandings. Therefore, this paper reviews the clinical characteristics, pathogenesis and treatments of the two, and explore their differences and internal relations, so as to provide research and practical reference for promoting more precise and individualized diagnosis and treatment regimens.
Clinical Decision-Making ; Fibromatosis, Aggressive/diagnosis* ; Gastrointestinal Stromal Tumors/diagnosis* ; Humans ; Prognosis ; Quality of Life

clinical decision making. Furthermore, we compare different image-fusion techniques such as PSMA-PET vs. F-/C-Choline-PET scans vs. PSMA-single photon emission computed tomography/CT. Finally, we touch upon the contemporary role of radio-guided-PSMA salvage lymphadenectomy.]]>
Clinical Decision-Making ; Humans ; Lymph Node Excision ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Membranes ; Neoplasm Metastasis ; Positron-Emission Tomography ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Recurrence ; Salvage Therapy

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

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

Clinical decision support systems are interactive computer systems for situational decision making and can improve decision efficiency and safety of care. We investigated the role of these systems in enhancing prehospital care. This narrative review included full-text articles published since 2000 that were available in databases/e-journals including Web of Science, PubMed, Science Direct, and Google Scholar. Search keywords included “clinical decision support system,” “decision support system,” “decision support tools,” “prehospital care,” and “emergency medical services.” Non-journal articles were excluded. We revealed 14 relevant studies that used such a support system in prehospital emergency medical service. Owing to the dynamic nature of emergency situations, decision timing is critical. Four key factors demonstrated the ability of clinical decision support systems to improve decision-making, reduce errors, and improve the safety of prehospital emergency activity: computer-based, offer support as a natural part of the workflow, provide decision support in the time and place of decision making, and offer practical advice. The use of clinical decision support systems in prehospital care resulted in accurate diagnoses, improved patient triage and patient outcomes, and reduction of prehospital time. By improving emergency management and rescue operations, the quality of prehospital care will be enhanced.
Computer Systems ; Decision Making ; Decision Support Systems, Clinical ; Diagnosis ; Emergencies ; Emergency Medical Services ; Humans ; Triage

BACKGROUND: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. METHODS: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. RESULTS: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. CONCLUSION: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.
Clinical Decision-Making ; Consensus ; Kidney Transplantation ; Kidney ; Korea ; Transplant Recipients

OBJECTIVES: The current study covers a secondary revision of the guidelines for the pharmacotherapy of schizophrenia issued by the Korean Medication Algorithm for Schizophrenia (KMAP-SCZ) 2001, specifically for co-existing symptoms and antipsychotics-related side-effects in schizophrenia patients. METHODS: An expert consensus regarding the strategies of pharmacotherapy for positive symptoms of schizophrenia, co-existing symptoms of schizophrenia, and side-effect of antipsychotics in patients with schizophrenia was retrieved by responses obtained using a 30-item questionnaire. RESULTS: For the co-existing symptoms, agitation could be treated with oral or intramuscular injection of benzodiazepine or antipsychotics; depressive symptoms with atypical antipsychotics and adjunctive use of antidepressant; obsessive-compulsive symptoms with selective serotonin reuptake inhibitors and antipsychotics other than clozapine and olanzapine; negative symptoms with atypical antipsychotics or antidepressants; higher risk of suicide with clozapine; comorbid substance abuse with use of naltrexone or bupropion/ varenicline, respectively. For the antipsychotics-related side effects, anticholinergics (extrapyramidal symptom), propranolol and benzodiazepine (akathisia), topiramate or metformin (weight gain), change of antipsychotics to aripiprazole (hyperprolactinemia and prolonged QTc) or clozapine (tardive dyskinesia) could be used. CONCLUSION: Updated pharmacotherapy strategies for co-existing symptoms and antipsychotics-related side effects in schizophrenia patients as presented in KMAP-SCZ 2019 could help effective clinical decision making of psychiatrists as a preferable option.
Antidepressive Agents ; Antipsychotic Agents ; Aripiprazole ; Benzodiazepines ; Cholinergic Antagonists ; Clinical Decision-Making ; Clozapine ; Consensus ; Depression ; Dihydroergotamine ; Drug Therapy ; Humans ; Injections, Intramuscular ; Metformin ; Naltrexone ; Propranolol ; Psychiatry ; Schizophrenia ; Serotonin Uptake Inhibitors ; Substance-Related Disorders ; Suicide ; Varenicline