RESUMO
Providing restorative dental care for patients with tooth wear can, at times, seem complex and demanding. The key to this process lies in a systematic approach that breaks down the component parts. In this chapter, the importance of a comprehensive assessment at the outset will be highlighted. This should include identification of the patient's chief complaint, taking a thorough history, completing the clinical examination, undertaking any special tests and arriving at clinical diagnoses. Together, this information will influence the treatment planning process, identify appropriate treatment concepts and options available and the individual stages that may be involved. The process should be both holistic and thorough to enable the patient and clinician to build a clear pathway and vision. In parallel, and with patient input throughout, it is essential to manage patient expectations as best as possible whilst remaining pragmatic and honest about treatment outcomes, longevity of restorations and the risks of failure.
Assuntos
Atrito Dentário , Desgaste dos Dentes , Humanos , Desgaste dos Dentes/diagnóstico , Desgaste dos Dentes/terapia , Planejamento de Assistência ao Paciente , Assistência Odontológica , Restauração Dentária PermanenteAssuntos
Simulação por Computador , Militares/educação , Ciência Militar/instrumentação , Ciência Militar/métodos , Interface Usuário-Computador , Amputação Cirúrgica/reabilitação , Simulação por Computador/estatística & dados numéricos , Humanos , Medicina Militar/instrumentação , Medicina Militar/métodos , Terapia de Relaxamento/instrumentação , Terapia de Relaxamento/métodos , Software , Veteranos/educação , Saúde dos Veteranos , Jogos de VídeoRESUMO
Patients with chronic obstructive pulmonary disease report a symptom burden similar in magnitude to terminal cancer patients yet service provision and access has been reported as poor. In the absence of a specific national chronic obstructive pulmonary disease service framework the gold standards framework might support service developments. We surveyed 239 UK acute hospital units admitting chronic obstructive pulmonary disease patients, comprising 98% of all acute trusts, about their current and planned provision for palliative care services. Only 49% of units had a formal referral pathway for palliative care and only 13% had a policy of initiating end-of-life discussions with appropriate patients. Whilst 66% of units had plans to develop palliative care services, when mapped against the gold standards framework few were directly relevant and only three of the seven key standards were covered to any significant degree. We conclude that service provision remains poor and access is hindered by a lack of proactive initiation of discussion. Planned developments in chronic obstructive pulmonary disease palliative care services also lack a strategic framework that risks holistic design.