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Biomedical subjects

D E Jolly

Publications and source records attributed to D E Jolly.

16 recordsLinked to original sources
PubMed1999

Preradiation dental extraction decisions in patients with head and neck cancer.

OBJECTIVE: The first objectives of this international survey were to study how dental-related and radiotherapy-related risk factors influence clinicians' preradiation dental decision making in patients with head and neck cancer and to evaluate clinicians' degree of certainty in making such decisions. A further objective was to examine the correlation of clinicians' policies with a policy based on a model for dental decision support that was presented in an earlier article. STUDY DESIGN: A consensus questionnaire was mailed to 54 oral-maxillofacial surgeons and hospital-based dentists at a number of international locations. The responses were aggregated and anonymously analyzed through use of a multiple regression procedure. RESULTS: Forty-four clinicians returned the questionnaire (response rate, 81%). Nine clinicians (20%) were using printed clinical guidelines for preradiation dental screening. Eighty-eight percent of clinicians' preradiation decisions and 49% of their certainty could be explained by the studied risk factors. Not all risk factors were significant at P <.001. Clinicians' policies showed high correlation (.85) with the policy based on the model for dental decision support. CONCLUSIONS: The findings support our previous assumption that policies in this field seem to be based primarily on clinical experience and opinions rather than on evidence-based clinical guidelines. We conclude that the clinical usefulness and validity of the model for dental decision support should now be tested and that it could also serve as a training tool.

Australia↗
PubMed1998

Pretherapy dental decisions in patients with head and neck cancer. A proposed model for dental decision support.

OBJECTIVE: The proposed model was designed to function as a tool for the development and testing of evidence-based clinical guidelines for the pretherapy oral screening and dental management of patients with head and neck cancer. STUDY DESIGN: Methods of clinical decision analysis were used to analyze the decision dilemma and construct a decision algorithm and decision tree. The robustness of the model was tested by means of a probabilistic sensitivity analysis with second-order Monte Carlo simulations (n = 10.000). RESULTS: Clinical criteria for evaluating dental pathologic conditions and malignancy- and patient-related conditions were transformed in probability estimates. The tradeoffs between the benefits and drawbacks of the dental intervention were integrated into the model to identify the optimal option for dental intervention. The calculation process of "folding back and averaging out" the decision tree enabled the identification of the optimal options for dental intervention in four different pretherapy risk conditions. CONCLUSIONS: A priori testing of the proposed model with 95% confidence intervals suggests that it has a great potential for solving clinical dilemmas associated with pretherapy dental decision-making. In addition, it seems a useful tool for the development of evidence-based clinical guidelines. A posteriori clinical testing should further validate the model before its assimilation into clinical practice takes place.

Algorithms↗
PubMed1995

Interpreting the clinical laboratory.

The use of clinical laboratory (blood and other body specimens) in the general practice of dentistry is often limited because of a lack of education and training in the area. These aspects of a patient's condition can provide valuable information for diagnosis, appropriate management techniques and proper treatment. This paper will review a few of the most significant laboratory tests and discuss when to use each test and what an appropriate interpretation should be. Some management recommendations will be made. It is anticipated that this paper will be used as a ready reference for the oral health care practitioner.

Chemistry, Clinical↗
PubMed1995

Interpreting the medical history.

Oral health care for the medically compromised patient requires that the practitioner possess an ability to appropriately gather and critically analyze a patient's medical history. This paper will provide the reader with an introduction to medical history collection and analysis. The various major systems will be presented in a manner that will simplify the assessment of a patient's history. A simplified method for dental treatment planning using a dental risk assessment and prognosis evaluation scale called PARS (Prognosis and Assessment of Risk Scale) will be presented.

Dental Care for Chronically Ill↗
PubMed1994

Evaluation of the medical history.

Medical and dental interdisciplinary cooperation is critical in appropriate assessment of the medical history and the subsequent management of the medically compromised dental patient. This interdisciplinary, rather than multidisciplinary, cooperation must extend beyond the physician and include the patient, family, caregivers, therapists, and anyone else involved in the life of the particular individual. This article has discussed numerous medically compromising conditions that require cooperative efforts between dental health professionals and other health care professionals. Specific recommendations were made regarding certain medical problems that affect dental care. The patient with a medical condition has a significant disability affecting many facets of life, essentially no different than a person with a physical or mental disability. The critical activity on the part of the dentist in managing the medically compromised dental patient is the cognitive skill ability. Cognitive skills permit appropriate use of the proper technique and behavioral skills. Proper oral health care can contribute significantly to a person's quantity and quality of life. The concept of optimum dental treatment planning differs from ideal dental treatment planning but should not be considered compromised dental treatment planning. Finally, an evaluation tool, the DRAPE Scale, is a means to aid dental treatment planning for the medically compromised dental patient. Remember that optimum care may not be ideal and is influenced by patient-specific and situation-specific circumstances. When this approach to treatment is followed in the appropriate interdisciplinary fashion, the patient benefits, and an individual's quantity and quality of life should benefit. Dental care for the patient with medically compromising conditions can be difficult and infinitely challenging but ultimately rewarding.

Decision Making↗
PubMedDate not supplied

Parkinson's disease: a review and recommendations for dental management.

Parkinson's disease is one of a group of extrapyramidal diseases characterized by rigidity and tremor. The disease affects about 1 million persons in this country, and is most common in persons older than 55. Parkinson's is disabling and usually progresses from mild to severe, often in less than a decade, and may preclude an individual from accomplishing many activities of daily living, even with current drug therapy. In addition to problems caused by age, dental complications arise from the inability of the individual with Parkinson's to accomplish routine oral hygiene, from changes in salivary flow and due to dysfunction in swallowing. Dental management of individuals with Parkinson's is a multifaceted challenge involving areas of preventive, restorative, and prosthetic dentistry. Support is also required for the psychosocial and behavioral aspects of this common progressive disorder.

Dental Care for Persons with Disabilities↗
PubMedDate not supplied

Informed consent and the geriatric dental patient.

Dental professionals are increasingly aware of their ethical responsibility to permit patients to participate in treatment decisions through the informed consent process. At the same time, growing numbers of geriatric patients present special challenges that can jeopardize the use of informed consent. Consequently, the use of informed consent with geriatric patients warrants special analysis due to complicating factors such as patient passivity and questionable competency. This article establishes the relationship between the ethical principle of autonomy and informed consent while examining factors that must be present in order for a valid informed consent to be obtained. Additionally, the article addresses informed consent issues regarding competent patients, geriatric patients with fluctuating or uncertain competency, and patients who are clearly incompetent.

Aged↗
PubMedDate not supplied

Technique for construction of dental molds for high-dose-rate remote brachytherapy.

High-dose-rate remote (HDR) brachytherapy eliminates radiation exposure hazard to personnel, allows for optimum dosage planning (dosimetry), and delivers high radiation dose close to the tumor in only a few minutes. The catheters can be incorporated into a fixed geometry within a mold, allowing for repeated treatments without the need for repeated implantation of radioactive isotopes or repeated dosimetry. This article presents the use of HDR brachytherapy in three patients to illustrate the advantages of HDR brachytherapy for the treatment of head and neck cancers in the following circumstances: (a) for outpatient therapy, (b) as an addition to or potentiation of external beam irradiation, (c) for preservation of function of regional structures, (d) for optimization of dosimetry, and (e) for palliation. It requires close interaction among the radiation oncologist, head and neck surgeon, and the dental oncologist and/or maxillofacial prosthodontist in order for optimum benefit for the patient to be achieved.

Acrylic Resins↗
PubMedDate not supplied

Relationship of oral microflora with oral health status in Parkinson's disease.

Parkinson's disease (PD) patients report an increased craving for sweets, which may have an effect on microflora. We compared patients of PD who crave sweets with PD patients who do not. Age- and sex-matched control subjects were used, with 14 subjects in each group. A plaque sample was taken from tooth #18 with a curette and placed into RTF, homogenized, and plated onto selective and non-selective media. Microflora were expressed as % CFU's of total anaerobes. Statistical analysis was performed by ANOVA and Newman-Keuls on log-transformed data. No statistical difference was observed among the three groups for lactobacilli, bacteroides, fusobacteria, veillonella, and actinomyces. S. mutans was lower in controls than in PD patients. Apparently, the craving for sweets in PD patients does not result in a significant increase in % of total anaerobes of certain microflora. PD patients showed a significant increase in mucositis compared with the control groups.

Aged↗