The Spirit of good nursing

Spirituality is important to many patients and nurses, yet an irrelevance to many others. This series will consider all aspects of the debate.     

Objective discrimination between mandibular open/close excursion patterns: a clinical case report

The purpose of this clinical case report was to describe the kinematic variables of movement that best discriminated between asymmetrical and symmetrical mandibular excursion patterns in a patient with myogenic temporomandibular dysfunction. Two mandibular movements (deemed to be asymmetrical and symmetrical by both patient and physiotherapist) were each recorded six times on three occasions at six, twelve, and 15 weeks after commencement of an exercise programme. The mandibular movements were captured with a 12-camera Motion Analysis System (Motion Analysis Corp., Santa Rosa, CA) with kinematic variables expressed in six degrees-of-freedom. A two-way analysis of variance (ANOVA) for repeated measures was used to analyze the data. The asymmetrical pattern was characterized by increased axial rotation and decreased sagittal rotation but with no differences in translation values when compared to those of the symmetrical pattern. The results support the clinician's and patient's judgment regarding differences in quality of mandibular excursion patterns made over the course of time.     

Changes in matrix phosphorylation during bovine dentin development

Phosphorylation of the organic matrix proteins of dentin is important for the initiation of mineralization, but its relevance in later mineralization stages is controversial. The objective of this study was to analyze changes in the total matrix phosphate content during dentin development and to identify their origin. Amino acid and total matrix phosphate analyses of microdissected developing mantle and circumpulpal fetal bovine dentin specimens were performed. The amino acid composition showed few changes during mantle and circumpulpal dentin maturation. However, the total matrix phosphate content showed a significant, positive correlation with tissue maturation in both mantle and circumpulpal dentin, with a two- and a three-fold increase, respectively, being observed. The data indicate that changes occur in the pattern of phosphorylation of matrix proteins during dentin maturation, which we suggest may play a functional role in later stages of tooth mineralization.     

Oral myiasis: a case report and literature review

Myiasis is the infestation of tissues and organs of animals and humans by certain Dipteran fly larvae. This phenomenon is well documented in the skin, especially among animals and people in tropical and subtropical areas. Oral myiasis is a rare condition and can be caused by several species of Dipteran fly larvae and may be secondary to serious medical conditions. Upon removal of the larvae, the tissues seem to recover with no subsequent complications and with no need for further treatment. Here we describe a case of oral myiasis within the gingiva of a healthy young man caused by the larvae of Wohlfahrtia magnifica (Family Sarcophagidae), in which infection may have been due to ingestion of infested flesh. Reviewing the literature revealed that most cases of oral myiasis tend to be multiple and to occur in anterior segments of the jaws rather than in posterior segments as in the case we describe here.     

Stress hormone stability: processing of blood samples collected during parabolic flight. A pre-flight comparison of different protocols

OBJECTIVES: Compare different protocols for blood processing to be used during parabolic flights. DESIGN AND METHODS: Measurement of cortisol (COR), prolactin (PRL), adrenocorticotropic hormone (ACTH), epinephrine (EP) and norepinephrine (NOR) concentrations stored at different temperatures and intervals before analysis. RESULTS: COR, PRL and NOR showed no changes in concentration between analysis protocols. ACTH dropped by 60% when not analysed within 24 h. CONCLUSION: A standardised processing protocol that includes a 4-h delay following blood collection is suitable for the assessment of serum stress hormone concentrations.     

The nurse's role in day surgery: a literature review

AIM: This paper reports a literature review to synthesize the evidence on day surgery, demonstrating its usefulness for innovative nurses. BACKGROUND: Day surgery growth has developed rapidly in recent years. Such a rapid growth has triggered a shift in nursing roles and interventions. Nursing roles are taking shape within modern day surgical units but have not been widely reviewed in developing countries. METHODS: The RCN library, BNI, CINAHL and Medline databases were searched using the terms 'day surgery and technological advantages', 'financial/economic benefits', 'patient experiences/satisfaction', 'day surgery/international comparisons', 'day surgery and developing countries'. Only papers in the English language from 1990 to 2005 were reviewed, with a predominantly adult focus. The papers examined mainly used research techniques and some opinion papers, policy documents and textbooks were examined for additional information. FINDINGS: The key strengths of day surgery are cost-effectiveness, increased patient satisfaction and low infection rates. Patients indicated that effective information provision and psychological preparation helped them cope with the experience. The use of music, story telling and distraction reduced pre-operative anxiety. Contrastingly, the deficits included poor information giving and psychological preparation resulting in high anxiety levels. Many patients encountered variable pain and nausea management and education strategies. CONCLUSION: This review highlights the importance of adequate preparation and continuous psychological support for patients undergoing day surgery. The challenges faced by practitioners involved with innovation are also emphasized.     

Experience of ICD management at a UK center: cardiovascularly stable VT presentation predicts higher risk for appropriate ICD therapy

BACKGROUND: It would be useful to identify patients at high risk of implantable cardioverter defibrillator (ICD) therapy via additional antiarrhythmic measures to minimize the morbidity of ICD therapies. OBJECTIVE: We assessed baseline characteristics for predictors of device therapy in a general ICD population. We also compared the likelihood of therapy delivery by replacement ICDs implanted for battery depletion with the original implants. METHODS: Clinical and ICD interrogation data from patients followed up at a UK center were analyzed looking for predictors of appropriate ICD therapy. Univariate and multivariate analysis was performed using Cox regression. We compared time to first appropriate therapy between first and second ICDs in patients who had undergone ICD replacement for battery depletion by log-rank testing. RESULTS: One hundred and sixty-one patients were studied (129 men, age 65.7 +/- 12.9 years, follow-up 908 +/- 676 days). Appropriate therapy was delivered in 68 patients (42%). Univariate risk factors for appropriate ICD therapy were presentation with stable ventricular tachycardia (VT) (P = 0.0002), ischemic etiology (P = 0.03), tiered therapy programmed ICDs (P = 0.01), and beta-blocker use (P = 0.001). Stable VT and beta blocker use were independent predictors of ICD therapy on multivariate analysis. Thirty-three patients (20%) had at least one ICD replacement. Time to first appropriate therapy was no different between first and second ICD implants (P = 0.8). CONCLUSION: Patients who present with cardiovascularly stable VT have a higher probability of receiving appropriate ICD therapy than those who do not. Following battery depletion of an original ICD, the replacement device is no less likely to administer therapy than the first.