In vitro comparison of different reciprocating systems used during endodontic retreatment

The present study evaluated the effectiveness of two reciprocating systems for the removal of root‐filling material during endodontic retreatment. One hundred extracted mandibular premolars were prepared and root‐filled with gutta‐percha and sealer. Root fillings were removed with K‐files according to the following techniques: Group A – hand instrumentation; Group B – Endo‐Gripper system driven by compressed air; Group C – INTRAmatic 29CH + INTRA‐LUX 3LD driven by compressed air; Group D – Endo‐Gripper system driven by electric engine; Group E – INTRAmatic 29CH + INTRA‐LUX 3LD driven by electric engine. The amount of filling debris on root canal walls was assessed radiographically and analysed using Auto CAD 2000 software. One‐way anova and Duncan’s test revealed statistically significant differences only in the middle third (P = 0.01); the best results being reached in group D. The apical third displayed the greatest amount of filling material debris, regardless of the technique used.     

Positron emission tomography/computed tomography introduction in the clinical management of patients with suspected recurrence of ovarian cancer: a cost-effectiveness analysis

Aim of this study was to evaluate the economic impact of the introduction of positron emission tomography/computed tomography (PET/CT) in the early detection of recurrent ovarian cancer through a cost-effectiveness analysis of different diagnostic strategies. Thirty-two consecutive patients with suspected ovarian cancer recurrence, studied by both contrast enhanced abdominal CT and PET/CT, were retrospectively included in the study. Three different diagnostic strategies were evaluated and compared: (1) CT only or baseline strategy; (2) PET/CT for negative CT or strategy A; (3) PET/CT for All or strategy B. For each one, expected costs, avoided surgery and incremental cost-effectiveness ratio (ICER) were calculated to identify the most cost-effective strategy. The number of positive patients increased from baseline strategy (20/32) to strategy A and B (30/32 and 29/32 respectively). Positron emission tomography/computed tomography reoriented physician choice in 31% and 62% of patients (strategies A and B respectively). Strategy A is dominated by strategy B, which is more expensive (2909€ vs. 2958€), but also more effective (3 cases of surgery avoided) and presents an ICER of 226.77€ per surgery avoided (range: 49.50–433.00€). Positron emission tomography/computed tomography introduction in this population is cost-effective and allowed to redirect the clinical management of patients towards more appropriate therapeutic choices.     

Doomed to fail: the persistent search for a modernist mental health nurse identity

The perennial issue of the distinctiveness of the mental health nurse (MHN) is once again to the fore. Previous attempts to resolve this apparent identity crisis in the discipline have included proposals for new models, new research and new educational preparation as well as new alliances, and new ways of practising. Now the politically driven concept of the generic nurse is gaining enough momentum to potentially end the discussion once and for all. This paper takes a postmodernist approach to MHN identity that questions the requirement for MHNs to articulate their distinctiveness, and offers alternative constructions of this identity to those promulgated by policy makers and by other health disciplines.