Conflicts and conflict management in the collaboration between nurses and physicians - a qualitative study

In health care, optimal collaboration between nurses and physicians is crucial in the quality of the care process – but not self-generating. Little is known about how health-care professionals cope with conflicts within their collaboration. This qualitative study investigates the way nurses and physicians cope with conflict and clarifies the determinants of conflict management styles. All respondents formulate clear expectations which in their opinion are essential to collaboration. When collaboration leads to disagreement, physicians and nurses choose between ignoring the conflict or engaging in it. Choice is determined by five factors: the influence of oneself, the influence of the other, the nature of the conflict, the context of conflict, and personal motives.     

Involvement of 5-HT1C-receptors in drug-induced penile erections in rats

Drug-induced penile erections (PE) were initially suggested to be 5-HT_1B receptor mediated. However, since the discovery of the 5-HT_1C receptor a number of compounds, considered to be 5-HT_1B selective, appear to bind more strongly to the 5-HT_1C receptor and this prompted a re-evaluation of the receptor subtype involved in PE induction. PE could be induced by the 5-HT agonists mCPP (0.22–2.2 mg/kg), TFMPP (0.46–1.0 mg/kg) and MK 212 (0.1–1.0 mg/kg). The 5-HT agonist DOI (0.022–0.22 mg/kg) did not induce PE in placebo-pretreated rats but in rats pretreated with various 5-HT₂ antagonists it did. These compounds have in common a strong affinity for the 5-HT_1C receptor. mCPP (0.46 mg/kg)-induced PE could be antagonized by the 5-HT antagonists metergoline, cyproheptadine, mesulergine, mianserin, ritanserin and ketanserin. Their ED₅₀s were 0.04, 0.4, 0.03, 0.06, 0.4 and 2 mg/kg, respectively. The potency of both the agonists to induce, and the antagonists to inhibit, PE was found to be dependent on their selectivity for the 5-HT_1C receptor versus the 5-HT₂ receptor. Spiperone (0.1–1.0 mg/kg) and GR 38032F (1–10 mg/kg) did not antagonise mCPP-induced PE. 8-OH-DPAT and 5MeODMT counteracted mCPP (0.46 mg/kg)-induced PE. Their ED₅₀s were 0.03 and 0.4 mg/kg, respectively. DOI counteracted mCPP induced PE only at doses above 1 mg/kg, whereas CGS 12066B (1.0–10 mg/kg) was inactive. The results suggest that PE are induced by activation of the 5-HT_1C receptor and are functionally inhibited by activation of 5-HT_1A or 5-HT₂ receptors.     

A phase II study of carboplatin and vincristine in previously treated patients with small-cell lung cancer

Summary A total of 28 previously treated patients with small-cell lung cancer were treated at relapse with 400 mg/m² carboplatin and 2 mg vincristine on days 1 and 8, every 4 weeks. Ten partial responses (PRs) (37%) but no complete responses (CRs) were seen. Median survival after the start of second-line treatment was 120 days (range, 39–503 days). Toxicity of this regimen was moderate, including WHO grade 3/4 myelosuppression in 26% of courses (n=66). Eight PRs were seen in a subgroup of 22 patients who relapsed <3 months after firstline treatment. The responses seen in this group of patients may be due to the absence of cross-resistance between the regimens used.     

New type of end-to-side anastomosis for small arteries: a technical and scanning electron microscopic study in rats

A new type of end-to-side anastomosis between small arteries is described. The anastomosis is made for three-quarters of its circumference with a nonoccluded recipient artery. The recipient artery must be occluded for only 3 to 5 minutes to complete the anastomosis. The anastomosis site was studied with the scanning electron microscope at different times (1 hour to 3 months) after the operation in 20 rats. In every case, the anastomosis was widely patent and a gradual endothelialization of the anastomosis site was observed. After 7 to 10 days, the endothelialization was more or less complete and, during the following weeks, a further smoothing of the ridge protruding into the anastomosis was noted. As an addendum, the authors describe an improvement of this technique that was developed after the sapphire tip of the neodymium: YAG laser became available. Now the anastomosis is fully completed and the connection between the two vessels is made by the laser tip introduced via a side branch of the donor vessel. The recipient artery need not be occluded at all. The results are promising.     

Effects of thermocycling on the margins of transitional acrylic resin crowns

Transitional resin crowns were subjected to thermocycling and examined for marginal integrity since disturbance of the marginal seal is detrimental. Two groups of 10 crowns, one with a chamfer and the second with a shoulder finish line, were subjected to two series of 2500 thermocycles. In the first series, the crowns received cold thermocycling and in the second, hot thermocycling. Impressions were made of the facial margins before thermocycling, after cold thermocycling, and after hot thermocycling. The impressions were analyzed for loss of marginal integrity and changes in axial contour. Cold thermocycling resulted in only limited deterioration, but the changes after hot thermocycling were more pronounced. Tooth preparation designs did not influence the effects of thermocycling.     

The Dietary Approaches to Stop Hypertension Diet,Cognitive Function,and Cognitive Decline in American Older Women

Objectives

To examine the association between long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women.

Systematic review of orthoses for stroke-induced upper extremity deficits

Background: Orthoses for individuals with stroke is considered an integral part of the neurorehabilitation process. However, there are no universal guidelines to determine the initiation period, duration, or type of orthosis for stroke patients.

Objectives: For this study, we systematically reviewed the evidence surrounding the use of orthoses for stroke-related upper extremity deficits.

Methods: Medical librarians searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Health Technology Assessment Database, Physiotherapy Evidence Database, and OTSeeker using subject headings and keywords related to upper extremities, orthoses, and stroke. The resulting articles were evaluated for inclusion by the systematic review team. Articles that met the inclusion criteria were appraised for content and quality using the “Evaluation Guidelines for Rating the Quality of an Intervention Study” (EQIS).

Results: 14 studies were included, with the mean score of 31.29 (out of 48) for the EQIS using an ordinal scale with a range of 23–43.6 studies produced significant outcomes with effect sizes ranging from d = .52 (wrist flexion PROM) to d = 9.02 (patient satisfaction with orthosis).

Conclusion: Future studies should aim to utilize homogenous outcome measures while exploring variability in dosage and level of upper extremity impairment upon initiation. Additionally, universal guidelines for initiation period, duration, and type of orthosis for patients post-stroke need to be established.