Psychiatric mental health nursing: challenge and change

. We invited Dr Peplau to provide a personal reflection on the recent history of psychiatric nursing and her thoughts on immediate challenges facing the profession. The paper is an individual scholar's commentary on the way that psychiatry has waxed and waned over the years, in relation to nursing. This historical review discovers and reports a challenge to current practice. Dr Peplau describes a professional shift that is pulling nurses toward the subordinate role observed earlier this century. The paper draws attention to how contemporary practice can be positively influenced, e.g., by giving a structure to the allocation and conduct of nurse–patient time.     

The effect of amalgam bonding on the stiffness of teeth weakened by cavity preparation.

OBJECTIVE: The objective of this study is to evaluate the effect of amalgam bonding on the stiffness of teeth weakened by cavity preparation. METHODS: Strain gages were bonded to maxillary premolars. The rigidity was tested by applying a load to a sequence of sound, prepared and restored teeth as follows: sound tooth, MOD preparation, amalgam restoration, amalgam removed recovering the MOD preparation, bonded amalgam restoration, bonded amalgam removed recovering the MOD preparation, bonded composite restoration. The relative stiffness (RS) and relative deformation (RD) of each condition for each cusp to that of the sound tooth was determined. RESULTS: The premolar cusps were deformed 1.80, 2.14, and 2.32 times more than the cusps of the sound tooth for the three succeeding MOD preparations. For these three preparations, the stiffness of the premolar cusps was 0.58, 0.48, and 0.46 relative to a stiffness of 1.00 for the sound tooth. The deformation was 1.77, 1.27, and 1.16 for the non-bonded amalgam, the bonded amalgam, and the bonded composite, respectively, corresponding to a mean RS of 0.59, 0.80, and 0.88. The calculated mean stiffness parameter C (standard deviation) was 2.6% (6.9) for the amalgam restoration, 62.5% (12.8) for the bonded amalgam restoration, and 77.8% (15.8) for the bonded composite restoration. The stiffness parameter C measured the extent to which the procedure returned the stiffness of the restored tooth to the original stiffness of the intact tooth (100%). SIGNIFICANCE: Cavity preparation reduced the stiffness and weakened the tooth. Restoring the prepared tooth with unbonded amalgam did not restore the lost tooth stiffness. Restoring the prepared tooth with bonded amalgam or with bonded composite recovered a significant portion of the lost tooth stiffness. It was concluded that bonding amalgam to tooth structure could partly restore the strength and rigidity lost by the cavity preparation. This might lead to a reduction in cuspal flexure and the incidence of tooth fracture due to fatigue.     

Evaluation of the integrated 3-hour plasma cortisol concentration as a test for Cushing's syndrome

Twenty-four hour urinary free cortisol and mean and integrated 13h00-16h00 plasma cortisol levels were measured in 9 patients with proven Cushing's syndrome (5 with Cushing's disease, 2 with ectopic adrenocorticotrophic hormone production due to bronchial carcinoma and 2 with adrenal adenomas) and in 21 patients without Cushing's syndrome. The 24-hour urinary free cortisol levels and mean and integrated 13h00-16h00 plasma cortisol estimations clearly distinguished patients with Cushing's syndrome from those without. However, adequate suppression on dexamethasone suppression tests (false negatives) were obtained in 3 of the 9 patients with Cushing's syndrome. Since the integrated 13h00-16h00 plasma cortisol estimation is cheaper and simpler than the mean 13h00-16h00 plasma cortisol estimation, we recommend it as an adjunct in the diagnosis of Cushing's syndrome.     

Glatiramer acetate in the treatment of multiple sclerosis

Glatiramer acetate is an immunomodulating drug used in the treatment of multiple sclerosis. It consists of a copolymer of amino acid residues in the same stoichiometric proportions as in myelin basic protein. Its mechanism of action is not entirely known and is probably multifaceted, with deletion of some immune cell populations and stimulation of others in these patients. Some mechanisms involve neuroprotectant effects. There is ample evidence of its efficacy in relapsing-remitting disease, using both clinical and imaging measures of disease activity, and in this paper we review the clinical and basic studies of this drug. Finally we discuss how some of its neuroprotectant effects may be useful in neurodegeneration such as is seen in more advanced cases of multiple sclerosis and other diseases such as amyotrophic lateral sclerosis and Parkinson’s disease.