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21.
Karan R. Chhabra Kathryn I. Pollak Stephanie J. Lee Anthony L. Back Roberta E. Goldman James A. Tulsky 《Patient education and counseling》2013
Objective
To characterize practices in subspecialist physicians’ communication styles, and their potential effects on shared decision-making, in second-opinion consultations.Methods
Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists.Results
Physicians frequently “broadcasted” information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients’ goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation.Conclusions
Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation.Practice implications
Techniques such as open-ended questions, affirmations of patients’ expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations. 相似文献22.
Chhaya V Verma Rachna D Arora Hetal M Mistry Swati V Kubal Nandini S Kolwankar Pranali C Patil Anushka A Dalvi Sonal A Vichare Akhila Natesan Anagha N Mangaonkar Dolly D Kanakia Gayatri S Jere Karan Y Bansode Madhura R Patil Rajvi D Sheth Sandhya D Dudhavade Sayali D Mhatre Suresh K Patel Akanksha G Mohite Ankita N Bhavsar Jessica E Alfonso Maryam NA Syed Nidhi P Savla Riya N Rajgond Rutuja A Bute Samiksha M Mane Shubham R Jaiswal Vibhawari A Parab Abhiram M Kasbe Mohan A Joshi Ramesh N Bharmal 《Indian Journal of Critical Care Medicine》2021,25(3):317
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Background:Many pediatric forearm fractures can be treated in plaster following closed reduction. The cast index (CI, a ratio of anteroposterior to lateral internal diameters of the cast at the fracture site) is a simple, reliable marker of quality of molding and a CI of >0.8 correlates with increased risk of redisplacement. Previously, CI has been applied to all forearm fractures. We hypothesize that an acceptable CI is more difficult to achieve and does not predict outcome in fractures of the proximal forearm.Results:The mean CI was 0.77. Remanipulation was required in five cases (6%), all distal half fractures – mean CI 0.79. CI was higher in proximal half forearm fractures (0.83 vs. 0.76, P = 0.006), nonetheless these fractures did not re-displace more than distal fractures.Conclusion:Cast index is useful in predicting redisplacement of manipulated distal forearm fractures. We found that in proximal half forearm fractures it is difficult to achieve a CI of <0.8, but increased CI does not predict loss of position in these fractures. We therefore discourage the use of CI in proximal half forearm fractures. 相似文献
25.
Shruti Anand Siddhi Tripathi Anubhav Chopra Karan Khaneja Swatantra Agarwal 《Journal of Indian Prosthodontic Society》2015,15(2):125-130
Purpose:
The purpose was to examine the existence of divine proportions among the Indian faces in Moradabad population.Materials and Methods:
Totally, 100 patients (50 males; 50 females) aged 25-45 years were selected for the study. All facial photographs were analyzed based on the method of Ricketts assessing the divine proportions in vertical and transverse facial planes. Six horizontal and seven vertical ratios were determined, which were then compared with the phi ratio.Results:
The horizontal ratio results showed that three male and female ratios were not significantly different from each other (P > 0.05), and interchilion/nose width ratio was highly significant (P < 0.001). The horizontal mean ratios for females as well as males were highly significant from the phi ratio (P < 0.001) except for interchilion/interdacryon ratio, which was significant (P < 0.05) for females and not significant (P > 0.05) for males. The vertical ratio results showed that there was a highly significant difference (P < 0.001) for forehead height/stomion-soft menton ratio and no significant difference for two ratios between the mean ratios of males and females. All the vertical mean ratios for both the groups were highly significant (P < 0.001), except for the intereye-soft menton/intereye-stomion ratio, which was significant (P < 0.05) for female group and not significant (P > 0.05) for the male group.Conclusion:
Although, the golden proportion is a prominent and recurring theme in esthetics, it should not be embraced as the only method by which human beauty is measured to the exclusion of others factors. 相似文献26.
27.
Modern population based oral health management requires a complete understanding of the impact of disease in order to provide efficient and effective oral health care and guidance. Periodontitis is an important cause of tooth loss and has been shown to be associated with a number of systemic conditions. The impact of oral conditions and disorders on quality of life has been extensively studied. However, the impact of periodontitis on quality of life has received less attention. This review summarizes the literature on the impact of periodontitis on oral health‐related quality of life (OHRQoL). Relevant publications were identified after searching the MEDLINE and EMBASE electronic databases. Screening of titles and abstracts and data extraction was conducted. Only observational studies were included in this review. Most of the reviewed studies reported a negative impact of periodontitis on OHRQoL. However, the reporting standards varied across studies. Moreover, most of the studies were conducted in developed countries. 相似文献
28.
29.
Lars E. Hagander Christopher D. Hughes Katherine Nash Karan Ganjawalla Allison Linden Yolanda Martins Kathleen M. Casey John G. Meara 《World journal of surgery》2013,37(1):14-23
Background
The critical shortage of surgeons in many low- and middle-income countries (LMICs) prevents adequate responses to surgical needs, but the factors that affect surgeon migration have remained incompletely understood. The goal of this study was to examine the importance of personal, professional, and infrastructural factors on surgeon migration from LMICs to the United States. We hypothesized that the main drivers of surgeon migration can be addressed by providing adequate domestic surgical infrastructure, surgical training programs, and viable surgical career paths.Methods
We conducted an internet-based nationwide survey of surgeons living in the US who originated from LMICs.Results
66 surgeons completed the survey. The most influential factors for primary migration were related to professional reasons (p ≤ 0.001). Nonprofessional factors, such as concern for remuneration, family, and security were significantly less important for the initial migration decisions, but adopted a more substantial role in deciding whether or not to return after training in the United States. Migration to the United States was initially considered temporary (44 %), and a majority of the surveyed surgeons have returned to their source countries in some capacity (56 %), often on multiple occasions (80 %), to contribute to clinical work, research, and education.Conclusions
This study suggests that surgically oriented medical graduates from LMICs migrate primarily for professional reasons. Initiatives to improve specialist education and surgical infrastructure in LMICs have the potential to promote retention of the surgical workforce. There may be formal ways for LMICs to gain from the international pool of relocated surgeons. 相似文献30.
Goyal M Marya K Jhamb A Chawla S Sonoo PR Singh V Aggarwal A 《The British journal of oral & maxillofacial surgery》2012,50(6):556-561
Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars. 相似文献