This new scale, while procedurally more exacting than the Waldrop scale, more clearly defines the topography of anomalies previously suspected in individuals with schizophrenia. These findings constitute direct evidence for disturbed craniofacial development in schizophrenia and indicate origins in the foetal period during which the characteristic human facial pattern evolves in close association with brain differentiation.
Purpose of review:Provision of education to inform decision making for renal replacement
therapy (RRT) is a key component in the management of chronic kidney disease
(CKD), yet patients report suboptimal satisfaction with the process of
selecting a dialysis modality. Our purpose is to review the influencers of
RRT decision making in the CKD population, which will better inform the
process of shared decision making between clinicians and patients.Sources of information:PubMed and Google Scholar.Methods:A narrative review was performed using the main terms “chronic kidney
disease,” “CKD,” “dialysis,” “review,” “decision-making,” “decision aids,”
“education,” and “barriers.” Only articles in English were accessed. The
existing literature was critically analyzed from a theoretical and
contextual perspective and thematic analysis was performed.Key findings:Eight common themes were identified as influencers for decision making.
“Patient-focused” themes including social influence, values and beliefs,
comprehension, autonomy and sociodemographics, and “clinician-focused”
themes including screening, communication, and engagement. Early predialysis
education and decision aids can effectively improve decision making.
Patient-valued outcomes need to be more fully integrated into clinical
guidelines.Limitations:This is not a systematic review; therefore, no formal tool was utilized to
evaluate the rigor and quality of studies included and findings may not be
generalizable.Implications:Standardized comprehensive RRT education programs through multidisciplinary
health teams can help optimize CKD patient education and shared decision
making. Involving patients in the research process itself and implementing
patient values and preferences into clinical guidelines can help to achieve
a patient-centered model of care.
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