Three‐Dimensional Accuracy of Guided Implant Placement: Indirect Assessment of Clinical Outcomes

Purpose: Precise preoperative implant planning and its exact intraoperative transfer are crucial for successful implant‐supported rehabilitation of partially or completely edentulous patients. In the present pilot study, optical laser scanning was used to evaluate deviations between three‐dimensonal computer‐assisted planned and actual implant positions by indirect methods. Material and Methods: Five patients receiving a total of 15 implants were included in this study. The used planning software was SimPlant 12.0 (Materialise Dental, Leuven, Belgium) to visualize the implant positions, and with an appropriate guided surgery protocol (Navigator?, Biomet 3i, Palm Beach Gardens, FL, USA) implant positions were implemented via tooth‐supported stereolithografic surgical guides. All implants (Osseotite?, Biomet 3i) were inserted in a flapless approach and immediately provided with prefabricated temporary splinted restorations. Intraoral pickup impressions were taken postoperatively, and the implant positions of the master casts were compared with presurgical casts. Implant replica deviations were evaluated by three‐dimensional optical laser scanning providing distances and angulations between implant replicas. Results: Overall, the postsurgical implant replica positions were found to deviate from the positions in the preoperative cast by a mean of 0.46 ± 0.21 mm (range: 0.09–0.85 mm). Positional deviations were 0.27 ± 0.19 mm (range: 0.04–0.60 mm) along the x‐axis representing the buccal‐lingual directions, 0.15 ± 0.13 mm (range: 0.0–0.34 mm) along the y‐axis representing the ventrodorsal direction, and 0.28 ± 0.19 mm (range: 0.02–0.59 mm) along the z‐axis representing cranial and apical directions. Rotational deviations amounted to 14.04 ± 11.6° (range: 0.09–36.47°). Conclusions: The results of this pilot study demonstrate precise transfer of implant replica position by means of simulated guided implant insertion into a preoperative cast and a postoperative cast obtained from impressioning. Further studies are needed to identify appropriate evaluation techniques and mechanisms to increase the transfer precision of three‐dimensional planning and guiding systems.     

EXPLORING SYMPTOMS IN PATIENTS MANAGED WITHOUT DIALYSIS: A QUALITATIVE RESEARCH STUDY

Little is known about the prevalence and burden of symptoms in patients managed without dialysis. This study was the result of a larger study exploring the experiences of 30 such patients and their trajectories to death. Data were analysed relating to symptoms once the patients had been referred to a Renal Supportive Care Service based in the East End of London, UK. A high symptom prevalence was found with 30 different symptoms reported at first consultation. Widely reported symptoms impacting on daily living included breathlessness, oedema, pruritus, nausea and vomiting and pain. Findings indicate that as symptoms escalate and death approaches, some symptoms, such as fluid overload and lethargy become difficult to treat indicating that death is close. This new knowledge can help staff as they attempt to determine when the end of life is approaching in order to support and care for patients appropriately. This paper highlights a need for effective identification and management of symptoms as they arise and further exploration of the effects of these symptoms on daily living.     

Nurse leaders and competition – are the blind leading the blind to market?

Marketisation of health care provision in the UK will result in a ‘seismic’ culture shift for many organizations and their nurse leaders. This short item explores the role nurse leaders will need to play in a world where increasingly, competition is becoming as important as collaboration.     

An evaluation of communication strategies during the process of incorporating a college of health studies into a university

This paper reports on an evaluation of communication strategies employed by management during the incorporation of a college of health care studies as a new faculty of a university. Mindful of the stress and anxiety that organizational change can evoke, from the earliest stages of the projected incorporation senior managers at the college and the university employed a wide variety of methods to communicate to staff in the college the changes that were in progress and at the same time to set up mechanisms for evaluating the effectiveness of the communication. The method of inquiry was a questionnaire to all the staff of the college in March and June of the year preceding incorporation. This was supported by interviews with a 10% sample of the college to explore in greater depth issues identified in the questionnaires. The findings indicated that in general communication had been perceived as effective; and that of the various methods used the two most valued by staff were: (a) a regular newsletter; and (b) an advisory and consultative committee of staff drawn from all areas of the work of the college up to and including senior lecturer.