Clinical performance of three restorative materials for non-undercut cervical abrasion lesions

A bstract — One hundred non-undercut cervical abrasion lesions were restored with either a glass ionomer cement, an adhesive composite system, or a composite with a dentine adhesive, according to manufacturer's instructions. The restorations were examined at six months, one year and two years post-placement. The cumulative loss rates at two years were 8, 47 and 12 per cent for glass ionomer, the adhesive composite system, and the dentine adhesive retained restorations, respectively.     

Addressing service deficits for the physically disabled in New Zealand: An action research study

As a consequence of the global trend towards new managerialism the New Zealand government undertook reforms of the health-care system during the 1980s and 1990s. These reforms, to a system that had functioned essentially unchanged since the 1930s, improved fiscal accountability at the expense of ensuring continuity of care. The restructuring particularly affected vulnerable populations with permanent disability and long-term health needs. This study sought to address the service deficits of the current health service delivery system and to identify strategies to ensure continuity of care for this group. The development of a clinical pathway and the appointment of a clinical care coordinator to oversee the delivery of comprehensive seamless health-care services were the major recommendations resulting from this study.     

Stillbirths in Western Australia 1980–1983: Influence of Race, Residence and Place of Birth

All stillbirths in Western Australia from 1980-83 weighing 1,000 g and over were identified from perinatal death certificates, and their causes and demographic correlates described. The stillbirth rate was 4.91 per 1,000 total births; nearly 65% were antepartum, 25% intrapartum and in 10% the time of death was unknown. The cause of death of most stillbirths was unknown (52%) or associated with lethal congenital malformations (13%), antepartum haemorrhage (12%) or maternal hypertension (8%). Whilst Aboriginal women had much higher stillbirth rates (10.80) than non-Aboriginal women (4.57), their patterns of time and causes of death were similar. Both antepartum and intrapartum stillbirth rates were much higher at low birth-weights and low gestational ages in both racial groups. Women living in rural areas who delivered in the metropolitan area had much higher antepartum (11.02) and intrapartum (3.31) stillbirth rates than either rural women delivering in rural areas (1.89 and 1.34) or metropolitan women delivering in the metropolitan area (2.72, 0.98). This reflects the transfer of rural high risk pregnant women or those with fetal death in utero, for delivery in metropolitan specialist hospitals.     

农村妇女产后失血防治探讨：附1506例分析

于1990～1991年,在宁夏吴忠市、中宁县两地农村接生中,应用产后2小时失血量的测定,利用产前、产时1506例失血评分法,预测产后失血量。根据评分与失血量的关系,订出住院分娩的界线以≥3分为宜。采取了系统的综合措施减少产后失血,对加强系统管理、降低臀位发生率以及减少软产道损伤方面也采取了若干积极的预防、控制措施。     

Tunnel Restorations: A Review

Conventional cavity designs are coming under increased scrutiny because of an increased emphasis on preservation of tooth substance. The tunnel restoration, when used with glass ionomer, may overcome some of the disadvantages of conventional cavity preparations. Justification for the use of the tunnel restoration is from a limited number of short-term clinical observations and destructive laboratory testing of marginal ridge strength. The technique is not without shortcomings. Long-term clinical and nondestructive laboratory trials examining the strength of teeth with tunnel restorations should be undertaken prior to its acceptance as a replacement for techniques in which the marginal ridge is removed.     

Frequency of Aspirating Gastric Tubes for Patients Receiving Enteral Nutrition in the ICU

Background: Enteral nutrition (EN) tolerance is often monitored by aspirating stomach contents by syringe at prescribed intervals. No studies have been conducted to assess the most appropriate time interval for aspirating gastric tubes. We compared gastric tube aspirations every 4 hours (usual care) with a variable regimen (up to every 8 hours aspirations). Methods: This randomized controlled trial (RCT) enrolled patients who stayed in the intensive care unit (ICU) for >48 hours, had a gastric tube, and were likely to receive EN for 3 or more days. Patients were randomized (computer‐generated randomization) to either the control (every 4 hours) or intervention group (variable regimen). The primary outcome was number of gastric tube aspirations per day from randomization until EN was ceased or up to 2 weeks postrandomization. Results: Following Institutional Ethics Committee approval, 357 patients were recruited (control group, n = 179; intervention group, n = 178). No differences were found in age, sex, worst APACHE II score, or time to start of EN. In the intention‐to‐treat analysis, the intervention group had fewer tube aspirations per day (3.4 versus 5.4 in the control group, P < .001). Vomiting/regurgitation was increased in the intervention group (2.1% versus 3.6%, P = .02). There were no other differences in complications. Conclusion: This is the first RCT to examine the frequency of gastric tube aspirations. The frequency of gastric tube aspirations was reduced in the variable‐regimen group with no increase in risk to the patient. Reducing the frequency of aspirations saves nursing time, decreases risk of contamination of feeding circuit, and minimizes risk of body fluid exposure.     

Creating an environment to implement and sustain evidence based practice: A developmental process

Background

Elements of evidence based practice (EBP) are well described in the literature and achievement of EBP is frequently being cited as an organisational goal. Despite this, the practical processes and resources for achieving EBP are often not readily apparent, available or successful.

Purpose

To describe a multi-dimensional EBP program designed to incorporate evidence into practice to lead to sustainable improvement in patient care and ultimately patient outcome.

Implementation strategies

A multi-dimensional EBP program incorporating EBP champions and mentors, provision of resources, creation of a culture to foster EBP and use of practical EBP strategies was implemented in a 22-bed intensive care unit (ICU) in a public, tertiary hospital in Brisbane, Australia. The practical EBP strategies included workgroups, journal club and nursing rounds.

Achievements

The multi-dimensional EBP program has been successfully implemented over the past three years. EBP champions and mentors are now active and two EBP workgroups have investigated specific aspects of practice, with one of these resulting in development of an associated research project. Journal club is a routine component of the education days that all ICU nurses attend. Nursing rounds is now conducted twice a week, with between one and seven short-term issues identified for each patient reviewed in the first 12 months.

Conclusions

A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.