Variables affecting the spectral transmittance of light through porcelain veneer samples.

The spectral transmittance of porcelain laminate veneers was measured at three different thicknesses (0.50, 0.75, and 1 mm) and three different opacities (25%, 75%, and 100%). The results indicated that the thickness of the porcelain veneer was the primary factor affecting light transmission and not the opacity. The measured values of transmittance were then used to estimate the setting time for light-cured luting agents of a porcelain veneer.     

Human gingival lymphocytes. I. Methodology for the isolation of human gingival lymphocytes.

Various methodologies were examined for the isolation of inflammatory cells from diseased human gingiva. The best recovery of viable gingival lymphocytes (gMNC) was achieved by a method which combined initial collagenase digestion followed by gentle teasing with an 18-gauge needle.     

Using nurse leader development to improve nurse retention and patient outcomes: a framework

With many factors converging, it is critical that nurse leaders have the knowledge and competency to develop outstanding relationships with registered nurses in order to retain them and thus improve patient outcomes. Senior nurse leaders of Methodist Le Bonheur Healthcare, a 7-hospital system based in Memphis is addressing these issues through a comprehensive leader development framework. Through organizational commitment and supported by a federal grant, a program that focuses on creation of individual development plans, provision of development education, and one-to-one on-site coaching has been implemented.     

Influence of ethanol and gender on methylphenidate pharmacokinetics and pharmacodynamics

This study explores the hypotheses that: (1) ethanol will interact with dl-Methylphenidate (MPH) to enantioselectively elevate plasma d-MPH, and primarily yield l-ethylphenidate as a transesterification metabolite; (2) women will exhibit lower relative bioavailability of MPH than men; and (3) sex-dependent differences in subjective effects will exist. dl-MPH HCl (0.3 mg/kg) was administered orally 30 min before ethanol, 30 min after ethanol (0.6 gm/kg), or without ethanol, in a randomized, normal subject three-way crossover study of 10 men and 10 women. Pharmacokinetic parameters were compared. Subjective effects were recorded using visual analog scales. One subject was a novel poor MPH metabolizer whose data were analyzed separately. Ethanol after or before MPH significantly (P<0.0001) elevated the geometric mean for the maximum d-MPH plasma concentration (C(max) (+/-SD)) from 15.3 (3.37) ng/ml to 21.5 (6.81) and 21.4 (4.86), respectively, and raised the corresponding geometric mean for the area under the concentration-time curve values from 82.9 (21.7) ng ml/h to 105.2 (23.5) and 102.9 (19.2). l-MPH was present in plasma only at 1-3% of the concentration of d-MPH, except in the poor metabolizer where l-MPH exceeded that of d-MPH. The metabolite l-ethylphenidate frequently exceeded 1 ng/ml in plasma, whereas d-ethylphenidate was detected only in low pg/ml concentrations. Women reported a significantly greater stimulant effect than men when questioned "Do you feel any drug effect?" (P<0.05), in spite of lower mean plasma d-MPH area under the response-time curves in women. Ethanol elevates plasma d-MPH C(max) and area under the concentration-time curve by approximately 40% and 25%, respectively. If the poor metabolizer of MPH proves to be a distinct phenotype, determining the genetic mechanism may be of value for individualizing drug therapy. The more pronounced stimulant effects experienced by women have sex-based abuse liability implications.     

The role of information technology in healthcare communications, efficiency, and patient safety: application and results

The authors document the development and deployment of technology that serves to enhance healthcare communications, efficiency, and patient safety at an 881-bed, level 2 trauma center. This technology includes a patient-centric call process using real-time, rules-based task assignments and tracking software that guides personalized and timely response to the individual patient' needs and allows the mining of data for outcome analysis.     

Utilization of technologies to reduce allogeneic blood transfusion in the United States

Concern over safety of the blood supply has led to the use of technologies to reduce allogeneic blood transfusion. The objective of this research was to determine the utilization of these technologies in the United States. We evaluated the following techniques: preoperative autologous donation (PAD), cell salvage (CS) and acute normovolemic haemodilution (ANH); and the following pharmaceuticals: aprotinin (APR), epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), desmopressin (DDAVP) and recombinant human erythropoietin (EPO). In 1997, we conducted a cross-sectional mail survey of service chiefs at 1000 US hospitals randomly selected and stratified by status as a provider of open-heart surgery, geographical location and hospital bed size. Sixty-nine per cent (690) of hospitals responded to at least one of the four surveys sent to each hospital. Hospitals reported use of techniques more than pharmaceuticals (P < 0.001); PAD (83%, n = 206) and CS (82% n = 420) were used most frequently. Lack of familiarity was the most common reason cited for infrequent use of pharmaceuticals. Organizational characteristics (e.g. provision of open-heart surgery, size, geographical location, teaching status and type of hospital) were differentially associated with technology use. There is greater use of techniques than pharmaceuticals in US hospitals to reduce the need for allogeneic blood in the peri-operative setting. Providing open-heart surgery is strongly associated with the utilization of these technologies.