Serveur d'exploration sur le patient édenté

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Pretherapy dental decisions in patients with head and neck cancer

Identifieur interne : 009806 ( Main/Exploration ); précédent : 009805; suivant : 009807

Pretherapy dental decisions in patients with head and neck cancer

Auteurs : Hubert H. Bruins [Pays-Bas] ; Ron Koole [Pays-Bas] ; Daniel E. Jolly [États-Unis]

Source :

RBID : ISTEX:54142E2FBC4486687C1F541F9C9798E2A0BFC7DF

Descripteurs français

English descriptors

Abstract

Abstract: 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.

Url:
DOI: 10.1016/S1079-2104(98)90169-X


Affiliations:


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Le document en format XML

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<term>American cancer society</term>
<term>Base case analysis</term>
<term>Baseline</term>
<term>Baseline decision algorithm</term>
<term>Baseline estimates</term>
<term>Bone loss</term>
<term>Broad terms</term>
<term>Bruin</term>
<term>Calculation process</term>
<term>Cancer therapies</term>
<term>Cancer therapy</term>
<term>Caries</term>
<term>Clinical criteria</term>
<term>Clinical decision analysis</term>
<term>Clinical dilemmas</term>
<term>Clinical experience</term>
<term>Clinical guidelines</term>
<term>Clinical practice</term>
<term>Clinical trials</term>
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<term>Dental</term>
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<term>Dental intervention</term>
<term>Dental management</term>
<term>Dental treatment</term>
<term>Different pretherapy risk conditions</term>
<term>Drfs</term>
<term>European society</term>
<term>Extraction</term>
<term>Follicle enlargement</term>
<term>Gingival recession</term>
<term>Greater probability</term>
<term>Guideline</term>
<term>Head neck</term>
<term>Health outcomes</term>
<term>Hierarchic rankings</term>
<term>High weighting</term>
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<term>Medical decision analysis</term>
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<term>Monte carlo simulations</term>
<term>More crfs</term>
<term>Mrrf</term>
<term>Mrrf score</term>
<term>Mrrf scores</term>
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<term>Neck cancer</term>
<term>Neck cancer patients</term>
<term>Neck radiationtherapy</term>
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<term>Node</term>
<term>Nonstrategic</term>
<term>Nonstrategic teeth</term>
<term>Nonstrategic tooth</term>
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<term>Optimal choices</term>
<term>Optimal decision alternative</term>
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<term>Optimal option</term>
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<term>Oral health</term>
<term>Oral hygiene</term>
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<term>Oral outcomes</term>
<term>Oral pathol</term>
<term>Oral surg</term>
<term>Oral surgery</term>
<term>Osteitis</term>
<term>Osteoradionecrosis</term>
<term>Outcome values</term>
<term>Pain rarefying osteitis</term>
<term>Pathol</term>
<term>Pathology september</term>
<term>Pathology volume</term>
<term>Periapical</term>
<term>Periapical lesions</term>
<term>Periodontal</term>
<term>Periodontal disease</term>
<term>Periodontal ligament</term>
<term>Periodontal ligament space</term>
<term>Positive outcome</term>
<term>Positive outcomes</term>
<term>Pretherapy</term>
<term>Previous endodontic treatment</term>
<term>Probabilistic</term>
<term>Probabilistic sensitivity analyses</term>
<term>Probabilistic sensitivity analysis</term>
<term>Prosthet dent</term>
<term>Pulpal involvement root caries</term>
<term>Radiation necrosis</term>
<term>Radiation therapy</term>
<term>Radiol endod</term>
<term>Rarefying osteitis</term>
<term>Risk condition</term>
<term>Risk conditions</term>
<term>Risk factors</term>
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<term>Root tips</term>
<term>Sensitivity analyses</term>
<term>Simulation</term>
<term>Special care</term>
<term>Standard deviation</term>
<term>Strategic teeth</term>
<term>Strategic tooth</term>
<term>Surg</term>
<term>Table viii</term>
<term>Tooth extraction</term>
<term>Useful tool</term>
<term>Weighting</term>
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<term>Adverse effects</term>
<term>American cancer society</term>
<term>Base case analysis</term>
<term>Baseline</term>
<term>Baseline decision algorithm</term>
<term>Baseline estimates</term>
<term>Bone loss</term>
<term>Broad terms</term>
<term>Bruin</term>
<term>Calculation process</term>
<term>Cancer therapies</term>
<term>Cancer therapy</term>
<term>Caries</term>
<term>Clinical criteria</term>
<term>Clinical decision analysis</term>
<term>Clinical dilemmas</term>
<term>Clinical experience</term>
<term>Clinical guidelines</term>
<term>Clinical practice</term>
<term>Clinical trials</term>
<term>Clinician</term>
<term>Complementary decision factors</term>
<term>Confidence interval</term>
<term>Confidence intervals</term>
<term>Consensus report</term>
<term>Decis</term>
<term>Decision alternative</term>
<term>Decision alternatives</term>
<term>Decision analysis</term>
<term>Decision dilemma</term>
<term>Decision dilemmas</term>
<term>Decision node</term>
<term>Decision nodes</term>
<term>Decision problem</term>
<term>Decision support</term>
<term>Decision tree</term>
<term>Dental</term>
<term>Dental awareness</term>
<term>Dental care</term>
<term>Dental conditions</term>
<term>Dental disease</term>
<term>Dental health</term>
<term>Dental intervention</term>
<term>Dental management</term>
<term>Dental treatment</term>
<term>Different pretherapy risk conditions</term>
<term>Drfs</term>
<term>European society</term>
<term>Extraction</term>
<term>Follicle enlargement</term>
<term>Gingival recession</term>
<term>Greater probability</term>
<term>Guideline</term>
<term>Head neck</term>
<term>Health outcomes</term>
<term>Hierarchic rankings</term>
<term>High weighting</term>
<term>Koole</term>
<term>Lower limits</term>
<term>Maxillofacial surgery</term>
<term>Mdds</term>
<term>Medical decision analysis</term>
<term>Medium weighting</term>
<term>Monte carlo simulations</term>
<term>More crfs</term>
<term>Mrrf</term>
<term>Mrrf score</term>
<term>Mrrf scores</term>
<term>Mrrfs</term>
<term>Neck cancer</term>
<term>Neck cancer patients</term>
<term>Neck radiationtherapy</term>
<term>Negative outcome</term>
<term>Node</term>
<term>Nonstrategic</term>
<term>Nonstrategic teeth</term>
<term>Nonstrategic tooth</term>
<term>Objective data</term>
<term>Optimal choices</term>
<term>Optimal decision alternative</term>
<term>Optimal decisions</term>
<term>Optimal option</term>
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<term>Oral complications</term>
<term>Oral function</term>
<term>Oral health</term>
<term>Oral hygiene</term>
<term>Oral maxillofac surg</term>
<term>Oral outcomes</term>
<term>Oral pathol</term>
<term>Oral surg</term>
<term>Oral surgery</term>
<term>Osteitis</term>
<term>Osteoradionecrosis</term>
<term>Outcome values</term>
<term>Pain rarefying osteitis</term>
<term>Pathol</term>
<term>Pathology september</term>
<term>Pathology volume</term>
<term>Periapical</term>
<term>Periapical lesions</term>
<term>Periodontal</term>
<term>Periodontal disease</term>
<term>Periodontal ligament</term>
<term>Periodontal ligament space</term>
<term>Positive outcome</term>
<term>Positive outcomes</term>
<term>Pretherapy</term>
<term>Previous endodontic treatment</term>
<term>Probabilistic</term>
<term>Probabilistic sensitivity analyses</term>
<term>Probabilistic sensitivity analysis</term>
<term>Prosthet dent</term>
<term>Pulpal involvement root caries</term>
<term>Radiation necrosis</term>
<term>Radiation therapy</term>
<term>Radiol endod</term>
<term>Rarefying osteitis</term>
<term>Risk condition</term>
<term>Risk conditions</term>
<term>Risk factors</term>
<term>Root circumference</term>
<term>Root tips</term>
<term>Sensitivity analyses</term>
<term>Simulation</term>
<term>Special care</term>
<term>Standard deviation</term>
<term>Strategic teeth</term>
<term>Strategic tooth</term>
<term>Surg</term>
<term>Table viii</term>
<term>Tooth extraction</term>
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<div type="abstract" xml:lang="en">Abstract: 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.</div>
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