bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic outcome assessment in permanent temporomandibular joint disc displacement
Authors: Kropmans TH. J. B. , Dijkstra P. U. , Stegenga B. , De Bont L. G. M.
Published: March 2003

In permanent temporomandibular disc displacement (TMJ‐DD) outcome studies many authors claim positive effects of arthroscopic surgery, arthrocentesis and physical therapy. This literature review was undertaken to analyse whether the claimed effects are based on acceptable methodology. The recorded papers were analysed by two independent observers according to (1) method of investigation, (2) therapeutic intervention studied, (3) therapeutic outcome variables used, and (4) claimed effectiveness of the intervention. Agreement between observers was calculated. Twenty‐four papers were found in which therapeutic outcome of interventions on temporomandibular disorders were studied. Six studies applied a true experimental design. Each of these six studies compared a different set of interventions. Twenty‐two papers used maximal mouth opening (MMO) as an outcome variable, nine studied pain intensity on a visual analogue scale, one paper assessed the mandibular function impairment questionnaire. Kappa for overall agreement concerning the reviewing criteria was 0·82 (P≦0·001). No distinguishing effects on MMO, pain or function impairment were reported between arthroscopic surgery, arthrocentesis and physical therapy. Results of methodological sound outcome studies evaluating the effects of arthroscopic surgery, arthrocentesis and physical therapy are needed.
Microwave polymerization of denture base materials. A comparative study
Authors: Blagojevic V. , Murphy V. M.
Published: March 2003

A comparison of some properties of denture base polymers processed by both microwave and water‐bath methods demonstrated that, in general, water‐bath polymerization with a long curing cycle and a 3‐h terminal boil produced superior properties. Although these two methods were inter‐changeable for the conventionally heat cured material, consistently superior results were produced by following the method recommended by the manufacturer. Microwaving of autopolymerizing resin improved mechanical properties and reduced residual monomer. The clinical significance of these results remains to be tested.
Fluoride recharge of aesthetic dental materials
Authors: Preston A. J. , Higham S. M. , Agalamanyi E. A. , Mair L. H.
Published: March 2003

The objective of the study was to compare the potential for fluoride recharge of two glass–ionomer cements, a resin‐modified glass–ionomer cement, a compomer and a fluoride‐containing composite in artificial saliva. Disc samples of each of the materials were placed into artificial saliva. The fluoride content of the artificial saliva was determined at various intervals up to 57 days. The discs were subjected to a 2 min exposure of NaF (500 parts/106). This recharge procedure was repeated at 64 and 120 days. The fluoride release was measured before and after recharge. The fluoride release for all of the materials increased after each exposure to NaF; however, the amount for the composite was very low. The resin‐modified glass–ionomer cement displayed the greatest potential for fluoride recharge at 57 and 64 days (P<0·05). By 120 days, the amount of fluoride released in the 24 h post‐recharge interval had decreased in all the materials. All the materials showed a potential for fluoride recharge. This effect, however, was minimal in the fluoride‐containing composite.
Wireless optoelectronic recordings of mandibular and associated head–neck movements in man: a methodological study
Authors: Zafar H. , Eriksson P.‐O. , Nordh E. , Häggman‐Henrikson B.
Published: March 2003

Human mandibular movements in space are the result of combined motions of the mandible and the head–neck. They can be simultaneously monitored by an optoelectronic recording technique via markers at different locations on the mandible and on the head. Markers can be attached to the teeth or to the facial skin. Mandibular movements relative to the head can be calculated by one‐ or three‐dimensional (1D and 3D, respectively) mathematical compensation for head movements. The present study analysed mandibular and associated head movements during maximal jaw opening–closing tasks in 10 healthy subjects using a wireless 3D optoelectronic movement recording system. The study aimed to: (i) estimate the soft tissue related displacement of skin‐attached markers at different locations on the face; (ii) compare 1D with 3D mathematical compensation for associated head movements; (iii) evaluate the influence of marker location on the recorded head and mandibular movement amplitudes; and (iv) compare skin‐attached markers with teeth‐attached markers with regard to temporal estimates of recorded mandibular and head movements. Markers were attached to the upper and lower incisors and to the skin of the forehead, nose‐bridge, nose‐tip and chin. Soft tissue related displacement of skin‐attached markers varied between locations. The displacement for the chin marker was larger than that of other markers. The least displacement was found for the nose‐bridge marker. However, relative to mandibular and head movements, respectively, the displacement of the chin marker was of the same order as that of the nose‐bridge marker. The temporal estimates were not significantly affected by displacement of the skin‐attached markers. Markers at different locations on the head and the mandible registered different amplitudes. The mandibular movement patterns calculated by 1D and 3D compensation were not comparable. It is concluded that markers attached to the chin and the nose‐bridge can be reliably used in temporal analyses of mandibular and head movements during maximal jaw opening–closing. With certain limitations, they are acceptable for spatial analyses. Selection of method of marker attachment, marker location, and method of compensation for associated head movements should be based on the aim of the study.
Reliability of some clinical parameters of evaluation in implant dentistry
Authors: Verhoeven J. W. , Cune M. S. , De Putter C.
Published: March 2003

Clinical tests that are commonly used to evaluate tissues surrounding natural teeth are also used in implant dentistry. It is unclear if they are equally valid and reflect the condition of the bone surrounding an implant reliably. This study evaluates the use of a plaque index, a gingiva index, the assessment of a probing depth and the Periotest value and relates the findings to the image on a radiograph in 16 patients, involving 32 IMZ implants. All four clinical tests showed poor sensitivity and, in general, only fair specificity when observations from the image on the radiograph were interpreted as the ‘golden standard’ for the presence or absence of pathology adjacent to the implant. Frequently, based on any clinical parameter, disease was not diagnosed, while the radiograph did show pathological loss of bone at the bone–implant contact area. It is concluded that the aforementioned parameters are unreliable and unfit for clinical evaluation in implant dentistry. Radiographs are needed to evaluate critical marginal bone changes surrounding dental implants.
Chewing ability and quality of life among the elderly residing in a rural community in Japan
Authors: Miura H. , Miura K. , Mizugai H. , Arai Y. , Umenai T. , Isogai E.
Published: March 2003

The present study statistically evaluates the relationship between chewing ability and quality of life (QOL) in elderly Japanese residents. We used a subjective evaluation and a mastication score determined by the food intake status to evaluate chewing ability. The PGC morale scale was used to evaluate the QOL level. The mastication score was significantly related to the QOL level in the subject group (P<0·05). The relationship between the subjective evaluation of chewing ability and the score on the PGC morale scale showed a similar tendency. In the section of the PGC morale scale that assesses agitation, attitude towards own aging, and lonely dissatisfaction, chewing ability was correlated with attitude toward own aging in particular (P<0·05). These results have suggested that the chewing ability is closely related to the QOL of the elderly residing in a rural community in Japan.
Photoelastic stress analysis in perforated (Rochette) resin bonded bridge design
Authors: Ziada H. M. , Orr J. F. , Benington I. C.
Published: March 2003

Rochette described the perforated cast metal bonded design for splinting periodontally compromised teeth. The design was later used for replacing missing teeth. The main causes of failure of the perforated (Rochette) type design were attributed to inappropriate case selection and erosion of the composite from perforations. The aim of this study was to analyse the effect of stress magnitude and direction on failure of perforated resin bonded bridges (RBBs). The objective was to compare stress magnitudes in this design with those reported on the non‐perforated RBBs. Photoelastic modelling materials were selected to represent the relative stiffnesses of a posterior mandibular and an anterior maxillary perforated (Rochette) type design. The sizes of the models were scaled to ×2·5 in order to enhance visual analysis of the stress patterns. Stress magnitudes were quantified from isochromatic fringes and stress directions were evaluated from stress trajectories. These revealed a high‐stress concentration around the perforations, particularly for those at the proximo‐lingual/palatal (connector) areas. This experimental study revealed that the main reason for failure of Rochette designs is deformation at the perforations.
Studies on polishing of Ti and Ag–Pd–Cu–Au alloy with five dental abrasives
Authors: Hirata T. , Nakamura T. , Takashima F. , Maruyama T. , Taira M. , Takahashi J.
Published: March 2003

Titanium (Ti) and Ag–Pd–Cu–Au alloy were examined for their polishing behaviour by conducting manually controlled polishing tests using five dental abrasives [carborundum point (CR) and silicone points (R1 and R2)] driven by a high torque micromotor with rotational speeds ranging from 2000 to 15 000 r.p.m. Polishing of Ti resulted in less volume of removal upon polishing, a rougher surface and larger loss of abrasives, compared with polishing of Ag–Pd–Cu–Au alloy. Polishing of Ti with a rotational speed of 15 000 r.p.m. led to the largest volume of removal upon polishing, whilst that of 10 000 r.p.m. produced the optimal volume for Ag–Pd–Cu–Au alloy. It was concluded that Ti was much more difficult to polish, requiring special care (e.g. frequent exchange of abrasives). Development of new abrasives for polishing Ti is required.
Vascular endothelial growth factor in minor salivary glands: effect of ageing
Authors: De Oliveira L. A. M. , De Oliveira Vasconcelos F. , Gomez R. S.
Published: March 2003

Morphological and physiological age changes are described in human salivary glands. Vascular endothelial growth factor (VEGF) is neoangiogenic growth factor found in normal salivary glands. Considering the neoangiogenic properties of VEGF and its important function in inflammation, repair and, probably, in oral mucosa homeostasis, the purpose of the present study was to evaluate the effect of ageing on the immunolocalization of VEGF in minor salivary glands. Paraffin‐embedded tissue blocks containing normal labial salivary glands were retrieved and classified according to the patients’ age in two groups (< 20 and > 40‐year‐old). The biotin–streptavidin–peroxidase system was used to detect the VEGF antigen. The results demonstrated that the mean level of VEGF immunoreaction in the young group was not statistically different from the old group when compared by the Mann–Whitney U‐test (P = 0·54). This may indicate that although salivary flow reduction may develop in old patients, some properties of the salivary glands may not be affected.
Structure–property relationship of cast Ti–Nb alloys
Authors: Lee C. M. , Ju C. P. , Chern Lin J. H.
Published: March 2003

The present work is a study of the microstructure, mechanical properties and corrosion behaviour of a series of binary Ti–Nb alloys with Nb contents up to 35 wt%, with emphasis placed on the structure–property relationship of the alloys. The results indicate that crystal structure and morphology of the Ti–Nb alloys are sensitive to the Nb content. The cast c.p. Ti has a hexagonal α phase with a lath type morphology. The alloys containing 15 wt% or less Nb are dominated by a hexagonal α′ phase with an acicular, martensitic structure. When containing 17·5–25 wt% Nb, the alloys are primarily comprised of an orthorhombic α′′ phase. With 27·5 wt% Nb, metastable β phase starts to be retained. With Nb contents higher than 30 wt%, the equi‐axed β phase is almost entirely retained. Small amounts of ω phase are detected in alloys containing 27·5 and 30 wt% Nb. Among all present alloys, Ti–10Nb and Ti–27·5Nb exhibit the highest strengths, while the α′′‐dominated (17·5 and 20Nb) and β‐dominated (> 30Nb) alloys have the lowest moduli. All Ti–Nb alloys show excellent corrosion resistance in Hank's solution at 37 °C. From the present data, the microhardness, bending strength and modulus of the various phases in Ti–Nb alloys are compared and tentatively summarized as follows:

Microhardness: ω > α′ > α′′ > β > α (c.p. Ti)

Bending strength: ω > α′ > α′′ > β > α (c.p. Ti)

Bending modulus: ω > α (c.p. Ti) > α′ > α′′ > β
The effect of variation in occlusal loading on the development of abfraction lesions: a finite element study
Authors: Rees J. S.
Published: March 2003

Abfraction or non‐carious cervical tooth loss is poorly understood and one factor thought to contribute to the development of these lesions is the effect of occlusal loading. The aim of this study was to examine the effect that varying the position of an occlusal load would have on the stress contour in the cervical region of a lower second premolar using a two‐dimensional plane strain finite element model. A 500 N load was applied vertically to either of the cusp tips or in various positions along the cuspal inclines. It was found that loads applied to the inner aspects of the buccal or the lingual cuspal inclines produced maximum principal stress values of up to 358 MPa that exceed the known failure stresses for enamel.
Ag, Cu, Hg and Ni ions alter the metabolism of human monocytes during extended low‐dose exposures
Authors: Wataha J. C. , Lockwood P. E. , Schedle A. , Noda M. , Bouillaguet S.
Published: March 2003

The monocyte and macrophage play an important role in the biological response to dental biomaterials. However, the effects of low‐level, extended exposures of monocytes to metal ions which are known to be released from dental alloys is not known. Thus, in the current study we characterized the metabolic activity of monocytes in the presence of low doses of Ag, Cu, Hg and Ni ions for up to 4 weeks. THP‐1 human monocytes were exposed in vitro to concentrations of metal ions at 1–10% of those known to be lethal during 24 h exposures. Mitochondrial function [succinic dehydrogenase (SDH) activity] and total cellular protein [bicinchoninic acid (BCA) assay] were assessed at weekly intervals during metal exposure. Each metal ion caused a unique pattern of effects from the monocytes. These effects were sometimes delayed until several weeks into the exposure (Cu, Ni). Large increases in total protein or SDH activity per cell were observed (Cu 150%, Hg 40–60%, Ni 50%), but these increases were always transient. The differences between concentrations with minimal effects and those which were lethal (8 versus 12 μmol L–1 for Ag, 1Ã0 versus 1Ã5 μmol L–1 for Hg) were small. Finally, concentrations which caused total suppression of cellular activity were sometimes preceded by an increased activity (Hg, Ni). We concluded that metal ions alter monocyte metabolic activity during extended exposures in vitro, but that the concentrations required are often near long‐term lethal levels. Clinically, these results imply that the levels of metals released from dental alloys may be significant to monocytic function.
The effects of bolus hardness on masticatory kinematics
Authors: Anderson K. , Throckmorton G. S. , Buschang P. H. , Hayasaki H.
Published: March 2003

This study investigated how jaw kinematics, including cycle duration, three‐dimensional (3‐D) excursive ranges and velocities, and cycle shape, changed with increasing hardness of chewing gum. Twenty‐six subjects (13 males and 13 females; mean age 23·6 ± 2·5 years) with Class I normal occlusion were asked to chew two brands of gum with differing hardness. Jaw motion during chewing was tracked with an Optotrak® camera at 100 Hz, and all movements were recorded as pure 3‐D mandibular movements relative to Frankfort horizontal. Cycle duration did not change significantly with harder gum, but 3‐D excursive ranges and velocities increased, except during the occlusal phases of the chewing. Cycle shape was similar for hard and soft gum, but the overall size of the cycle was larger with hard gum. These results suggest that greater muscular effort when chewing harder gum produces a greater acceleration of the mandible in all phases except when the harder gum slows the mandible during the occlusal phases.
Human peripheral blood monocytes versus THP‐1 monocytes for in vitro biocompatibility testing of dental material components
Authors: Heil T. L. , Volkmann K. R. , Wataha J. C. , Lockwood P. E.
Published: March 2003

Monocytes play a central role in the response of tissues to biomaterials. Monocytic cell lines such as the THP‐1 cell line have been used extensively as models for primary monocytes (directly from blood) in biocompatibility research. However, little information exists about the appropriateness of these cell lines as models. Thus, the current study compared the biological response of both primary peripheral blood monocytes (PBMs) and the THP‐1 cell line to four common components of dental materials known to be released into the oral environment: nickel ions, 2‐hydroxyethyl methacrylate (HEMA), triethylene glycol dimethacrylate (TEGDMA), and 2,2‐bis[4(2‐hydroxy‐3‐methacryloloxy)‐phenyl]propane (Bis‐GMA). Comparisons were made by constructing dose–response curves for each type of monocyte and the four components. The 50% cytotoxicity values (TC50 values) were then statistically compared. In addition, the response of the monocytes to the materials with and without lipopolysaccharide (LPS) stimulation were assessed by measuring TNF‐α secretion from the monocytes. The results showed that the PBMs were 5–10 times less sensitive than the THP‐1 monocytes to these dental components, but that both cell lines ranked the components identically. TNF‐α secretion from both types of monocytes often showed similar trends, although some inconsistent results were noted. The current study supports the use of THP‐1s as a model for ranking the cytotoxicity of components of dental biomaterials. Furthermore, the secretory activity of PBMs appears to be generally well represented by the THP‐1s. However, sufficient differences between these cell types exist to recommend confirmation of any critical results obtained with THP‐1s using PBMs.
Dental anxiety and regularity of dental attendance in younger adults
Authors: Quteish Taani D. S. M.
Published: March 2003

Dental anxiety constitutes a major problem for patients and dental care providers alike. The aim of this study was to examine the relationship between dental anxiety and regularity of dental attendance among young adults. A random sample of 15 course directors (1:50) was asked to participate in the study. Of these, only 10 course‐directors agreed to handout the 500 questionnaires. All undergraduate students who participated in this study were asked to complete a questionnaire modified from Dental Fear Survey (DFS) questionnaire and 368 (73·6%) filled forms were returned for statistical analysis. The results showed that only 20·9% were regular dental attendee while the majority (79·1%) were irregular attendee. The reasons given for irregular attendance were `lack of time' (36%), `treatment not needed' (34·1%), `fear from dentist' (13·3%) and ‘cost’ (16·6%). The sight and sensation of the injection and sight, sound, and sensation of the drill were the most common fear‐eliciting stimuli. Increased heart rate was the commonest reported physiological response. Females had higher mean ratings, therefore tended to be more anxious than males. Dental anxiety represented by the mean responses to the items, was found to be higher in irregular dental attendee than regular attendee. In conclusion, this suggests that dental anxiety may affect the seeking of dental care, therefore to be taken into account when training dental care providers.
The distribution of occlusal contacts in the intercuspal position and temporomandibular disorder
Authors: Ciancaglini R. , Gherlone E. F. , Redaelli S. , Radaelli G.
Published: March 2003

SUMMARY  The aim of this study was to describe the distribution of occlusal contacts in subjects with signs or symptoms of temporomandibular disorder (TMD), and to assess whether any difference exists with healthy subjects. Twenty‐five university dental students with complete natural dentition who exhibited TMD (13 females and 12 males, age from 19 to 30 years) and 25 age‐ and sex‐matched controls entered the study. Occlusal contacts were evaluated in the intercuspal position and wax registrations were made in all subjects. Occlusal contacts were classified according to location and intensity. No differences were found between TMD and control groups for the overall number and distribution of contacts or for any side and intensity of contact. An intra‐subject analysis showed that TMD subjects had significantly greater bilateral asymmetry in the number of contacts than controls. Median absolute difference of the number of contacts on right and left sides was 3 (95% CI, 2–4) in TMD subjects and 2 (95% CI, 1–2) in controls. In TMD subjects with mono‐lateral TMD there was a significant concordance (88·9%) between the side of disorder and the side of higher number of contacts. These findings, while confirming that a significant relationship exists between distribution of occlusal contacts and TMD, further suggest that in young adults it may be primarily expressed by asymmetries in occlusal contact patterns. Existence and aetiology of any association of TMD with occlusal contacts should be further investigated.
Prevalence study of signs and symptoms of temporomandibular disorders in university students
Authors: Pedroni C. R. , De Oliveira A. S. , Guaratini M. I.
Published: March 2003

summary  The aim of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in university students from 19 to 25 years old, male and female, through the distribution of frequency of the data obtained from a questionnaire and physical examination. The results showed that 68% of the subjects exhibited some degree of TMD, and the women were the most affected. Signs and symptoms such as articular sounds, pain to palpation of the masticatory, cervical and scapular girdle musculature, subjective sensation of emotional stress, and postural and occlusal changes were more evident in the group with TMD, although they were also present in subjects classified as TMD‐free. Limitations in the mandibular movements were not found. The association of the obtained data allowed identifying a high prevalence of signs and symptoms of TMD in the Brazilian university population.
The relationship between the occlusal interference side and the symptomatic side in temporomandibular disorders
Authors: Fujii T.
Published: March 2003

summary  This study aimed to investigate the relationship between the facial side of pain or clicking symptoms and the side of occlusal interference, and to examine the features of pain and clicking patients in terms of frequencies of occlusal interferences in relation to the symptomatic side. Occlusal conditions in 31 pain patients and 40 clicking patients were investigated just after the relief of pain or clicking solely by means of bite plane therapy. The symptomatic side did not associate with the side of fewer occlusal contacts in intercuspal position, no canine contact on the working side, occlusal contact on the non‐working side, or unilateral contact in retruded contact position. The results of this study suggest that pain or clicking does not necessarily tend to appear on the side of these occlusal interferences. Additionally, characteristic inclination for pain and clicking patients in terms of frequencies of occlusal interferences in relation to the symptomatic side was not identified.
Effectiveness of an oral health promotion programme at the workplace
Authors: Morishita M. , Sakemi M. , Tsutsumi M. , Gake S.
Published: March 2003

summary  The purpose of the study was to evaluate the effectiveness of an oral health promotion programme at the workplace. The programme was given once a year at offices or factories, which was voluntary and free for all employees. The programme consisted of clinical examinations followed by oral health guidance, oral hygiene instruction and oral prophylaxis of anterior lower teeth. Oral health status was compared by the times of participation in the programme. It was shown that three times or more participants in the programme had fewer decayed, missing and filled teeth (DMFT) and lower percentage of Community Periodontal Index (CPI) sextants 3 and 4. The oral health promotion programme was effective in keeping or maintaining good oral health among workers. In addition to current activities, the programme should include education to motivate subjects to receive regular check‐ups.
Effect of scanning level and muscle condition on ultrasonographic cross‐sectional measurements of the anterior masseter muscle
Authors: Bertram S. , Bodner G. , Rudisch A. , Brandlmaier I. , Emshoff R.
Published: March 2003

summary  With the disadvantage of computed tomography showing cumulative biological effects and magnetic resonance imaging posing a problem in clinical availability and cost, several authors described the technique of ultrasonography to measure non‐invasively local cross‐sectional dimensions (LCSDs) of masseter muscle sites. However only few studies addressed the issue of ‘technique‐related factors for intra‐ and inter‐observer reliability’ to gain more consistent testing and diagnosis. The purpose of the present study was to determine (1) whether the scanning level and/or the muscle condition may affect LCSD measurements and (2) whether measurements made at identical levels may be reproducible. The study included 35 subjects with signs and symtoms of temporomandibular diorders. Bilateral ultrasonographic investigation was performed with a linear (B‐scan) 7ḃ5 Mhz small‐part transducer to register LCSDs of the anterior masseter muscle on three different levels. Scans were made on the relaxed and contracted muscle. Measurements were made in two sessions with a time interval of at least 5 min. Data were analysed for reproducibility by using the intra‐class correlation coefficient (ICC) and the method error (ME). Scanning level and muscle condition had a significant effect on muscle measurements (P = 0ḃ000). There was no difference in LCSD between the right and left muscle (P = 0ḃ531). Measurements recorded at a given site were consistent across the testing sessions (P = 0ḃ058). The scanning level with highest reproducibility was halfway between the origin and insertion (ICC = 0ḃ92; ME = 6ḃ2%). The data suggest that ultrasonography is a reliable method for measuring LSCDs of the anterior masseter muscle.
Interpersonal mental health nursing: research issues and challenges
Authors: Chambers
Published: March 2003

Since Peplau outlined her perceptions of psychiatric/mental health nursing in (1952) interpersonal relationships has been considered by many as the core of practice. In the intervening period of almost a half century many researchers and theorists have endeavoured to develop and integrate Peplau's framework into day‐to‐day nursing activity. However, more recently, as a result of the fusion between the professional nursing agenda and the wider political agenda, the importance of interpersonal relationships and the individuality of psychiatric/mental health nursing is being questioned. This questioning is represented in the debate about the aetiology of mental illness, the choice of research methods to determine treatment outcomes and by association the role and value of the psychiatric/mental health nurse. This paper will focus on the interpersonal nature of psychiatric/mental health nursing and explore possible research approaches aimed at explicating its core. Attention will be given to the necessity of using pluralistic methodology in order to do so.
An ethnographic study of psychiatric nursing
Authors: Bray
Published: March 2003

There is a well documented continuing anomaly between what is expected of a psychiatric nurse and observations of practice. This paper presents an ethnographic study carried out in three acute psychiatric in‐patient units over one year. Methods used were participant observation and semistructured interviews of 15 trained nurses. Three themes were isolated during and following data analysis: the difficulty of working closely with mentally disturbed individuals; maintaining distance and congruent care. There was a notable dichotomy, that of wanting to work with the patients but constantly feeling that what they intuitively wanted to do was not right.
A new paradigm in patient education: a four‐part model using videotape production
Authors: Davis Bryn , MEYMANDI A. , DEAVER E. L.
Published: March 2003

In this article, the effectiveness of an instructional videotape for newly admitted hospitalized psychiatric patients is discussed and evaluated. It is suggested that by using ‘actors’ with whom the patient is familiar (hospital staff), the educational and therapeutic benefit of the video is enhanced. This paper provides a method for preproduction planning of an effective videotape based on a four‐part model. In this model, the educational subject matter is divided into four categories; facts, procedures, support, and mastery. An attempt is made to match various styles of presentation by each member of the treatment team to the nature of the part being presented. The short attention span common to newly admitted depressed patients, for example, is remedied by the use of concise messages delivered by each treatment team member. Although videotapes are not a substitute for one‐to‐one professional interaction, they can provide some basic understanding of the therapeutic environment and allay some of the fears that often plague the newly admitted patient. This paper also demonstrates how the use of videotaped instruction allows the treatment team to administer organized information using unlicensed personnel or the patient himself, thus conserving the professional staff's time.
3. Absconding: outcome and risk
Authors: Davis Bryn , BOWERS L. , JARRETT M. , CLARK N. , KIYIMBA F. , MCFARLANE L.
Published: March 2003

Absconding by patients from acute psychiatric wards is known to be linked to self harm and harm to others. Previous research has focused only on officially reported absconds, thus missing out many patients who although they abscond and pose a risk, are never officially processed. This paper reports the findings of a large prospective study of absconding in the East End of London using an objective definition of absconding not linked to official bureaucratic processes. Absconders are considered by staff to be high risk patients, and many have histories of violence and/or suicide attempts. Nevertheless nurses only request the aid of the police in returning patients on 47% of occasions. The actions of the police are very variable, and range from two policemen calling at the patient's house, to an entire team in riot gear appearing at the patient's door in the early hours of the morning. Most absconds result in no harm to anyone, and most absconders return by themselves. Relatives and carers also play a significant role in persuading the patient to return or bringing them back. Nurses should develop more sophisticated ways of working with the police and with relatives to maintain absconding patients' safety.
Community, culture and character: the place of the virtues in psychiatric nursing practice
Authors: Mckie A. , Swinton J.
Published: March 2003

In this paper, the authors address the serious neglect of the ‘classical’ virtues in ethical reflection upon mental health nursing. The virtues are offered as a possible alternative paradigm for mental health nursing in its search for new models and approaches. Embodied in the notion of a moral community, the virtues have important implications in addressing problems adherent in various ‘dualisms’ so described. By invoking the concepts of practical wisdom and praxis, the interrelationship between theory and practice, action and reflection and self and community, is shown. The contextual nature of the virtues is shown in a number of examples and their potential for the transformation of practice is shown. The opportunity is now present for mental health nursing to strengthen its basis for practice by distancing itself from scientific models. In so doing, it can embrace an approach which is consensual and contextual and which places ethical reflection at the centre of practice.
Reflective practice and its role in mental health nurses’ practice development: a year‐long study
Authors: Graham I. W.
Published: March 2003

The study reported in this paper lasted over a year, and identifies a conceptual framework of nursing practice based upon a relationship‐building process. It also identifies six characteristics of nursing roles inherent within the practice of mental health nurses on a Nursing Development Unit. The paper presents a structure and process of reflection for nursing practice as illustrated by the work of a group of nurses working in a NDU. The purpose of the study was to help them better understand their work with patients. The findings from the study are used to explore how the nurses described and implemented individualized, patient‐focused care. This care was based upon the ability of the nurse to communicate well and to build a relationship with a patient, bound within a context of change.
The development and piloting of a patient held record with adult mental health users
Authors: Greasley P. , Pickersgill D. , Leach C. , Walshaw H.
Published: March 2003

This article reports on the development and piloting of a patient held record for adult mental health users. Development of the format and content of the record was determined in consultation with a user group. Piloting and subsequent evaluation of the record with users revealed a number of issues which need to be addressed in the promotion of a patient held record.
A pilot project to determine the demand for and utility of an out‐of‐hours psychiatric service run by on‐call psychiatric nurses in an A&E department
Authors: Beech B. , Parry L. , Valiani D.
Published: March 2003

This paper presents the results of a 12‐week pilot project that studied the demand for and utility of an out‐of‐hours on‐call psychiatric service delivered by two experienced psychiatric nurses in an A&E department. It also considers some of the implications for a possible permanent, substantive service. An initiative to reduce the on‐call hours worked by junior medical staff harked back to literature which has long suggested that health professionals, other than medical staff, can competently perform risk assessments and determine the immediate needs of patients who self‐harm. The project's aims were to determine: (i) whether an on‐call psychiatric nurse could satisfactorily reduce the pressures on on‐call junior doctors; and (ii) the absolute demand for and nature of requested out‐of‐hours psychiatric assistance. Summarized details of referred patients include data on time and duration of contact, reasons for referral, outcome and other professionals involved. Of the 88 patients referred during the pilot period, 33 (37.5% of the total) were admitted to psychiatric wards and four to medical wards. Although a range of professionals was needed during the 12‐week period, the nurses dealt with 42 (47.7%) of the referrals without any other professional involvement.
A plea for respect: involuntarily hospitalized psychiatric patients’ narratives about being subjected to coercion
Authors: Olofsson B. , Jacobsson L.
Published: March 2003

Eighteen involuntarily hospitalized psychiatric patients narrated their experiences of being subjected to coercion and their thoughts on how to prevent the coercion. A qualitative content analysis identified recurring themes, which were incorporated in two core themes describing the participants’ experience. The core themeNot being respected as a human beingincluded most of their narrated experiences, described in the themesNot being involved in one’s own care,Receiving care perceived as meaningless and not good, andBeing an inferior kind of human being. The core themeBeing respected as a human beingincluded a minor part of the narrated experiences and how the participants wanted things to be, described in the themesBeing involved in one’s own care,Receiving good care, andBeing a human being like other people. The participants’ plea for respect is discussed in relation to the ongoing deinstitutionalization of psychiatric care and the need for attitude changes in care and community, leading to the treating of mentally disordered people with more respect.
HoNOS: is there any point in training clinicians?
Authors: Rock D. , Preston N.
Published: March 2003

This study examines the impact of training and clinical experience on the inter‐rater reliability of the HoNOS. Following either standard or modified HoNOS training, two groups of registered mental health nurses (RMHNs) were tested for inter‐rater reliability (IRR) using a standard case vignette. In addition, another group of nurses and two nonclinical comparison groups had their IRR tested using the same vignette but without receiving any HoNOS training. There was no significant difference between IRR scores post‐training compared with the pre‐training scores. This is the case whether the recommended or modified training programmes were used. In addition, there is no significant difference between nurses and the comparison group, characterized by nonclinical work experience in a mental health setting. All four groups achieved adequate IRR. Finally, the comparison group with no regular exposure to mental health patients but experience using rating scales are significantly less reliable than the other four groups. The results suggest two possible interpretations. The first is that the HoNOS scales are so well designed that only familiarity with psychiatric patients and no experience with rating scales is sufficient to achieve adequate IRR even without training. Alternatively, the use of written vignettes does not provide a valid measure of HoNOS IRR.
Considering the care of the suicidal client and the case for ‘engagement and inspiring hope’ or ‘observations’
Authors: Cutcliffe J. R. , Barker P.
Published: March 2003

Psychiatric/mental health (P/MH) nursing has rightly been described as a ‘broad church’, and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the ‘engagement and hope inspiration’ position and the ‘observations’ position. Given the P/MH nurse's unique position in providing 24‐hour, day‐to‐day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on ‘observations’ and concludes that there is a range of well‐established, empirically based problems or drawbacks to this approach. Following this, it focuses on ‘engagement, inspiring hope’ and points out the key processes of engagement: forming a relationship, a human–human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement–inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace ‘observations’ with ‘engagement–hope inspiration’ as the principal approach to caring for suicidal mental health clients.
Effects of medium‐ and long‐chain triglycerides on sleep and thermoregulatory processes in neonates
Authors: TELLIEZ FREDERIC , BACH VERONIQUE , DEWASMES GERARD , LEKE ANDRE , LIBERT JEAN‐PIERRE
Published: March 2003

Sleep processes and body temperature regulation of neonates are never taken into account in the evaluation of nutrients, although these functions are implicated in the regulation of energy metabolism and are influenced by the nutritional state and its metabolic consequences. Medium‐chain triglycerides (MCT) are currently used in paediatric units during the first weeks of because they are considered to be a rapid source of energy, easy to assimilate for growing premature infants, whose digestive function is immature. However, no study has described the thermic effect of these nutrients on body temperature regulation and sleep. The present study aimed at analysing the influence of three feeding formulas with different content of MCT on sleep processes and on thermoregulation of neonates fed until desired intake was reached. Whatever the thermal conditions (thermal equilibrium or cool environment), the MCT‐fed groups had higher body temperatures and than groups fed without MCT, for whom total sleep time was reduced at thermal equilibrium. In this group, the large amount of quiet sleep seems to favour a strategy of conserving energy. Higher energy expenditure in MCT‐fed groups is not harmful to growth rate since nutritional efficiency is even better reflected by a larger body mass gain. The thermic effect of MCT contributes to lessening the vulnerability of neonates exposed to low incubator temperatures.
Behavioural treatment for sleep problems in children with severe learning disabilities and challenging daytime behaviour: Effect on sleep patterns of mother and child
Authors: WIGGS LUCI , STORES GREGORY
Published: March 2003

Children with sleep problems present serious management problems to their parents. Such children are also more likely to have additional problems, behavioural disturbance being particularly common. This randomized controlled trial of behavioural interventions for the children's sleep problems was conducted to explore the efficacy and mechanisms of treatment in children with the most extreme forms of problems: severe learning disabilities, severe sleep problems and severe daytime challenging behaviour.

Fifteen index families received behavioural advice for the child's sleep problem and were compared with 15 matched controls who received no such advice. Repeat assessments of the children's and mothers’ sleep were made by parental report as well as actometry. Objective changes in the children's sleep quality and quantity were not seen after treatment. However, mothers in the treatment group reported improvements in the children's sleep problems and had an increased sleeping time themselves following treatment.

The results indicate that sleep problems can be successfully treated in this group of children, although the mechanisms of treatment may not be as direct as supposed. This has implications for understanding of sleep problems in children with learning disabilities and also for clinical practice, when considering ways of offering help to these highly ‘challenged’ families.
Promoting alertness with a short nap during a night shift
Authors: SALLINEN MIKAEL , HÄRMÄ MIKKO , ÅKERSTEDT TORBJÖRN , ROSA ROGER , LILLQVIST OUTI
Published: March 2003

The use of a short (< 1 h) nap in improving alertness during the early morning hours in the first night shift was examined under laboratory conditions. The study contained four experimental, non‐consecutive night shifts with a nap of either 50 or 30 min at 01.00 or 04.00 hours. An experimental night shift without a nap served as a control condition. Each experimental shift was followed by daytime sleep. Fourteen experienced male shift workers went through all of the experimental conditions. The results showed that the naps improved the ability to respond to visual signals during the second half of the night shift. Physiological sleepiness was alleviated by the early naps, as measured 50 min after awakening, but not at the end of the shift. Subjective sleepiness was somewhat decreased by the naps. The naps produced sleep inertia which lasted for about 10–15 min. Daytime sleep was somewhat impaired by the 50 min naps. The study shows that a nap shorter than 1 h is able to improve alertness to a certain extent during the first night shift.
Brain temperature dependent changes in the electroencephalogram power spectrum of humans and animals
Authors: DEBOER TOM
Published: March 2003

In animals, changes in brain temperature induce a shift in frequencies in the electroencephalogram (EEG). Given the large decreases in body and brain temperature that occur during hibernation, putative functions that were previously ascribed to certain EEG frequencies are no longer valid because of the progressive shift away from the original frequency. In the present review it is proposed that even moderate temperature changes in humans and animals, such as those across the circadian or menstrual cycle, or induced by drugs, have a significant effect on EEG frequencies and the corresponding power spectrum. Alterations in the relative EEG power spectrum, in studies where body temperature also changes, may not be a direct cause of the treatment under investigation, but a consequence of effects on body or brain temperature. However, these effects on the EEG power spectrum are usually interpreted to result directly from the experimental treatment.
Cognitive function and treatment of obstructive sleep apnea syndrome
Authors: LOJANDER J. , KAJASTE S. , MAASILTA P. , PARTINEN M
Published: March 2003

Among patients with obstructive sleep apnea syndrome (OSAS), impairment of cognitive function, i.e. deficits in memory, attention, and visuconstructive abilities are common. We applied different forms of treatment for patients with newly diagnosed OSAS in a randomized study with a one‐year follow‐up. Patients with BMI > 40 kg/m4 and the Bourdon‐Wiersma (r=0.36). Success in treatment of OSAS did not affect neuropsychological outcome. We concluded that the standard cognitive test battery is insufficiently sensitive to identify positive changes in patients with OSAS, especially among those with a high level of overall mental functioning.