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Value may be described as the benefit to a patient of obtaining a particular outcome in terms of the costs involved (i.e., risks, pain, hospitalization, loss of time, possible Umb shortening, loss of motion, emotional and psychological trauma, socioeconomic and financial factors, etc.).
Since there may be multiple and interrelated problems, it is essential to establish priorities and weigh the importance of each problem and action individually in terms of the way in which it might condition sequential outcomes.
It is generally justifiable to procrastinate in performing a definitive operation in order to test the effect of a conservative approach up to the "point of no return," namely, when the original proposed procedure can no longer be expected to produce a satisfactory result.
The principle of "fail-safe" is fundamental in all decisions to defer treatment. Fifth Annual Meeting of the Society of Gynecologic Oncologists, Key Biscayne, Florida, January 8, 1974.
Tension in Tube and Pedicle Flaps as a Method for Measuring the Blood Circulation. In children, on the other liand, failure to recognize worsening of head-aceta- bular relationships in conservative treatment of congenital dislocation of the hip may jeopardize the capacity of a satisfactory outcome from acetabular surgery.
For example, since total hip replacement in the adult substitutes the entire joint, reasonably similar results can be expected in a wide range of hip deterioration.
The element of "timing" may be critical in choosing a treatment alternative. This information permits a patient to participate in the choice of the management, and at the same time to decrease misunderstanding, and minimize patient disappointment. A physician has the responsibility to present to the patient an objective evaluation of each alternative, the risks of intervention, and the reasons for his recommendations. When the natural history of a condition can be predicted to lead to progressive worsening, and a treatment regimen is available, the value of nonintervention may be less than taking action. S 41 ;gg-Calve-Perthes Disease Associated with Heredi- tary Multiple Exostosis: A Case Report. SIFFERT cost the patient is willing to assume, and discourages treatment and procedures if the cost-benefit relationship is disproportionate. Each action, therefore, produces a new condition, and new variables, and offers new g Jtematives which must be evaluated as to whether better choices might be available for the next sequence. D 75 LATERAL SPONTANEOUS Ur INARY EXTRAVASATION IN Hodgkins Disease. The consequences that result from each action must be evaluated in terms of how well the action accomplished the expected outcome, and whether alterations may be required in the overall program regarding future steps. Review of emergency episodes for student analysis by the decision approach are helpful in teaching principles of alternative choices. Analysis of the results of emergency actions, and exploration of consequences of other choices that might have been made, may improve future management. F., Burholt, D., Lesher, S.: Control of local tumor growth with combined fractionated radiotherapeutic and chemotherapeutic regimens. A bold surgeon, for example, may tend to "try" newly described procedures more readily than one who is conservative, and may be more likely to recommend a treatment program which, if successful, might produce better results at a higher risk. A.: An effective new 4-drug combination regimen (Cy-V-A-DIC) for metastatic sarcomas. Most people, physicians not excluded, have a tendency to be either risk-takers or risk-avoiders.