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How does one begin to understand the new tool box necessary to navigate the storm taking place in the health care profession? We start with our own self-assessment of our skill and knowledge base outside dentistry.

Allow me to share a recent experience with two dental students to illustrate a critical skill needed to begin planning and developing our personal tool box. Student A comes to me with a vigorous complaint that all of his patients are lousy and everyone cancels their appointment!

Student B presents to me that he has too many patients and they all want to come in as soon as possible!

This story has great implications for each of us to examine how we draw conclusions and make strategies to move forward in our practice. Student A drew the conclusion that his patients were at fault.

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Although we are all taught self-assessment in our technical skills, rarely are we engaged in the self-assessment of our leadership, communication and ability to navigate our changing environment. My challenge to Student A was examining his communication and ability to build effective relationships and value with his patients. Student B invested considerable time in development of his patient relationships and recognized delivering information does not guarantee patient understanding and ownership of the information.

Unless understanding has been created communication did not occur.

Volume 19.2

Self -Assessment is an important part of our development as a professional. Understanding our leadership style and decision-making process is often overlooked leaving blind spots that your staffs, partners or family are reluctant to point out. Unintended negative consequences of our decisions are often overlooked and are a hindrance to practice growth.

Regardless of your stage of professional growth I encourage you to be a life-long learner in development of your leadership skills. Failure to understand the development of this important skill will be the rate limiting factor in the growth of you practice and professional development. The Truth about Leadership, by James M.

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Kouzes and Barry Z. Posner, highlights ten principles: 1.

The best leaders are the best learners This is a very dangerous condition as we are unable to see the change taking place around us and the impact it will have on our practice. Just a few examples are: A. Blindly signing on as a provider with all insurance programs without understanding the financial and quality implications on your practice.

Corporate dentistry and government are impacting the delivery of health care. The experience your patient encounters will be greatly impacted not only by your dentistry but by our ability to develop your staff.

Careful examination of your employee handbook to assure compliance with the ever-changing labor law.

From that data analysis make targeted strategies to impact the metrics you want to change. Your approach to increasing your income may center on expense reduction which can also have unintended negative consequences of poor service and low morale. Cost reduction alone will not lead to prosperity. Innovative strategies must be developed with your team to increase revenue. This can be an opportunity to move outside your comfort zone and acquire new skills. The resources I am suggesting in this article have nothing to do your technical skills,but everything to do with your professional and practice development.

At 65 years old and 30 plus years in practice I would be so bold as to say they will be the rate-limiting factor to the growth of your practice. Regardless of your current practice status I encourage you and your team to do a book study over the next month. I always found change within the dental team exciting but challenging. As a leader your understanding of change is important to be effective and lasting. Often it is so consuming we fail to take the time to plan for next year in the area of growth, and examination of accurate data to make decisions on strategies that will ensure continued success.

The inability to execute a desired plan often leaves us scratching our head when we realize we are in the same place as last year. I am encouraging you to examine your glasses to assure your sight not only includes the immediate care of your patients, but the swirl of external forces exerting pressure on our profession and your practice. Critical areas for your growth and understanding to respond to this external swirl of pressures are self-assessment, leadership, planning and execution.

Please contact my office for a free personal profile to start your own self-assessment and leadership development. Help your staff develop through your book study. Schroeder practiced dentistry in Richmond and is the founder of Leadership by Design. He can be reached at , drjimschroeder gmail.

Marvin E. This includes the dentist and the physician who evaluate oral health. Inspection without palpation is an inadequate clinical examination of the mouth. There are significant lesions that cannot be visualized by the best inspection because these lesions are submucosal.

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Only thorough palpation will detect these lesions and determine what needs to be biopsied and diagnosed for treatment. The patient whom I describe is an example of a missed significant malignancy. Both doctors forgot the hard and soft tissues, intra- and extra- orally that need to be palpated. A few weeks later the patient had some very mild discomfort in her lower lip.

Since her dentist and physician recently had assured her of no mouth disease, she felt no reason to be concerned.


Somewhere between six months and one year, the lump was still present. Finally she returned to her physician, who confirmed our finding and referred her to our office. After doing a complete medical history, I did a complete inspection and palpation of the neck and mouth. I noted a very palpable mass, submucosal in the midline of the lower lip. The mass felt wellcircumscribed, heart-shaped, and measured 2. The mass was firm, but not indurated and not tender to palpation.

I advised an excisional biopsy within the next week. Apparently I did not advise the patient that this could be a very serious lesion, as she did not return to the office until six weeks later.

At this visit I did an excisional biopsy and much to my surprise, the pathology report revealed a malignant mucoepidermoid carcinoma — intermediate grade. The excisional biopsy did not remove the lesion completely as the margins contained malignant cells.

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I did the usual consultations with the pathologist, radiation oncologist, medical oncologist, and surgical oncologist. They all agreed that a wide local resection would be the procedure of choice.

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This was accomplished under general anesthesia. The area was excised wide and deep — even involving skin. To be certain, the patient was worked-up again to rule out regional or distant metastases.

She was strongly advised to have an oral and maxillofacial surgeon or surgical oncologist to continue close observation of her mouth, head and neck, plus chest. Fortunately, she did this, because four years later, she developed metastases to the right and left submandibular regions of her neck.

The surgical oncologist did a bilateral suprahyoid resection and found malignant lymph nodes on both sides. These lymph nodes were diagnosed as metastatic adenosquamous carcinoma. Post-operatively both sides of her neck were irradiated.

Following irradiation she was followed closely by her surgical oncologist. Her oncologist wrote me after following her three years after irradiation and there were no complications since.

He also advised me that he would follow her indefinitely and if there were any changes he would inform me. I practiced 16 years before retiring and have not received any communication from the oncologist. This is a very unusual malignancy of the lip.

If it was noted and diagnosed earlier, and the mass was smaller, the excisional biopsy could have excised the entire tumor then, and perhaps it would have not metastasized. In retrospect, now I would follow with irradiation after surgery, even if it is a controversial modality for this cancer. It is a generally accepted fact that early diagnosis and treatment leads to a better prognosis. That is why it is important to palpate as well as inspect the hard and soft tissues in the mouth and neck.

Who knows what evil lurks in the submucosa of our domain of expertise? References: 1.

Mucoepidermoid carcinoma of the lower lip. Mucoepidermoid carcinoma of salivary origins: classification, clinical- pathologic correlation and results of treatment. Cancer ; The Storm Dr. I would hope that the plan is reviewed at all levels of progress and tweaked from time to time as goals are re-assessed and as priorities change. Please keep the membership involved at all levels.

I did not see anything in the plan with the BOD mentioned. Did I miss something? The dental school is included, as it should be. The patients that need dentistry at the most fundamental levels have no money. Overall HIV prevalence remained high This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV infected people.

Introduction In low-income countries LICs , the burden of cervical cancer is a serious health problem and predominantly affects women of reproductive age [ 1 ]. The prevalence of HPV infection in women varies greatly in the African continent where some of the highest prevalences are found [ 6 ].

Both hr-HPV and HIV are sexually transmitted infectious agents, and infection by one of the viruses may accelerate transmission of the other [ 7 ]. The latter is more likely to be persistent in HIV-infected women, and results in a higher incidence of high-grade squamous intraepithelial lesion HSIL [ 9 ]. The high prevalence of HPV infection among women in several African countries may be explained by the presence of risk factors such as early age sexual debut, the number of sexual partners of women and of their partners, and other STIs, including HIV, as discussed above [ 10 — 13 ].

Previous studies have shown that the prevalence of HPV infection rises soon after the onset of sexual activity [ 14 , 15 ] and peaks in adolescence and early adulthood after which it declines during later decades of life [ 16 ]. The high prevalence of HPV infection among young women has been found to be due to the absence of adaptive immune response and the relatively larger area of cervical epithelium undergoing squamous metaplasia [ 17 ].

Studies estimating HPV infection are limited in African countries [ 4 ]. Information on country-specific HPV genotype prevalence is needed to inform local policy, screening and prevention programmes.MCP , 18, Of hr-HPV infected women, He can be reached at , drjimschroeder gmail.

MCP , 5, Adipose-fin membrane black or with dark brown area on distal portion. The high prevalence of HPV infection among young women has been found to be due to the absence of adaptive immune response and the relatively larger area of cervical epithelium undergoing squamous metaplasia [ 17 ].