Making clinical decisions for dental care: concepts to consider

Clinical decisions are often made with incomplete information, yet patient care decisions are made every day. Patients vary clinically, uncertainty exists in diagnostic and prognostic information, and many preventive and treatment alternatives have not been formally assessed for their effectiveness. Because scientific information will never answer all clinical questions, clinical decisions are partially based on probabilistic information.
This paper describes how to apply clinical decision making to diagnosing and managing dental caries and periodontal diseases. By using explicit information to quantify probabilities and outcomes, clinical decision making analyzes decisions made under uncertain conditions and the uncertain impact of clinical information.
Clinical decision making incorporates concepts for preventing, diagnosing and treating dental caries and periodontal diseases: risk assessment, evidence-based dentistry, and multiple oral health outcomes. This information can serve as a tool for clinicians to augment clinical judgment and expertise.     

社会支持对企业员工工作倦怠的影响

目的了解企业员工的工作倦怠状况，探讨社会支持对企业员工工作倦怠的影响并提出组织管理建议。方法以社会支持问卷和MBI-GS问卷对588名企业员工进行调查。结果企业员工的工作倦怠程度并不高，但仍存在．且以情绪耗竭的程度教高；社会支持与工作倦怠及共各构面部分呈显着负相关，社会支持对工作倦怠及其各构面具有显着的预测力，结论社会支持对企业员工工作倦怠有一定的影响．应引起管理者的重视。     

Cancer support groups – are they effective?

Cancer causes significatlt emotional distress to a considerable majority of patients. Many of these patients typically receive little formal psychological intervention. Support groups, however, have provided one forum from which patients can attempt to gain help and can use to overcome some psychological trauma that accompanies the cancer hagnosis, subsequent treatment and relapse. This article reviews past studies of professionally run cancer support groups as opposed to psychological intervention groups. These studies are considered in light of the proposed benefits and the methodological limitations frequently inherent in such studies.     

Dopaminergic transmission in the hypothalamic arcuate nucleus to produce acupuncture analgesia in correlation with the pituitary gland

Acupuncture analgesia (AA) caused by low frequency stimulation of the acupuncture point (AP) was abolished by hypophysectomy and adrenalectomy. Termination of the AA producing pathway from the AP to the pituitary gland was in the medial hypothalamic arcuate nucleus (M-HARN). The origin of the descending pain inhibitory system associated with AA was in the posterior HARN (P-HARN). AA in the hypophysectomized rats, and enhanced neuronal activity in the P-HARN that were abolished during acupuncture stimulation, were both restored by intraperitoneal microinjection of 0.5 mg/kg morphine or 0.1 micrograms beta-endorphin into the P-HARN during acupuncture stimulation. Of the analgesia produced by dopamine or beta-endorphin injected into the P-HARN, that caused by beta-endorphin disappeared after denervation of the M-HARN. The P-HARN neurons that responded to acupuncture stimulation also responded to iontophoretic dopamine, but not to iontophoretic morphine nor ultramicroinjected beta-endorphin. The transmission between the M-HARN and P-HARN may be dopaminergic, and beta-endorphin might presynaptically modulate this transmission. Reduction of sodium ions may have been the reason for abolition of AA after adrenalectomy.     

The relational underpinnings of quality internal auditing in medical clinics in Israel

Internal auditing is a key mechanism in enhancing organizational reliability. However, research on the ways quality internal auditing is enabled through learning, deterrence, motivation and process improvement is scant. In particular, the relational underpinnings of internal auditing have been understudied. This study attempts to address this need by examining how organizational trust, perceived organizational support and psychological safety enable internal auditing. Data collected from employees in medical clinics of one of the largest healthcare organizations in Israel at two points in time six months apart. Our results show that organizational trust and perceived organizational support are positively related to psychological safety (measured at time 1), which, in turn, is associated with internal auditing (measured at time 2).     

Analysis of the circumstances at the end of life in children with cancer: Symptoms, suffering and acceptance

BACKGROUND: In an effort to improve the quality of life of children with cancer, this study analyzes the signs and symptoms at the end of life in such children. It is hoped that these data will contribute to the development of appropriate programs to address the challenges faced by these children. PROCEDURE: Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital, Japan. The circumstances, signs and symptoms at the end of life of these children were analyzed through their medical records. RESULTS: Of the 28 children, the underlying diseases were leukemia/lymphoma (LL group; n=11), brain tumors (BT group; n=7), and other solid tumors (OST group; n=10). Records showed poor appetite (100%), dyspnea (82.1%), pain (75.0%), fatigue (71.4%), nausea/vomiting (57.1%), constipation (46.4%) and diarrhea (21.4%) among these children. Anxiety was reported in 53.6% of the entire group of 28 children; however, no child in the BT group manifested anxiety. However, disturbance of consciousness was reported in all children in the BT group, which was significantly greater than in the other groups. Awareness, fear or acceptance of the imminence of his/her own death as indicated by verbal expression was reported in nine children (32.1%). CONCLUSIONS: Using the data obtained in the present study, we describe situations faced in the terminal care of children. It is important to address the problems revealed by this analysis in order to achieve improvements in both the physical and psychological care of children with terminal cancer.     

Laparoscopic Medial-to-lateral Colon Dissection: How and Why

Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right- and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges of laparoscopic colectomy.     

宁波普通高中教师职业压力、社会支持与亚健康躯体症状的典型相关分析

目的 探讨宁波市普通高中的教师心理压力,社会支持与亚健康状态的相关关系.方法 采用职业压力问卷、社会支持量表与亚健康躯体症状自评量表对随机抽取的128名宁波市普通高中教师进行相关关系分析.结果 当存在社会支持变量时,2组变量的典型相关系数达0.563,0.471( P <0.01).职业压力的增大与社会支持水平的减少都将导致教师亚健康躯体症状的增多.当撤去社会支持变量后,典型相关系数为0.497( P <0.01).典型变量ξ中"考试压力","工作负荷"与"职业期望"的因子负载分别增大为0.801,0.855,0.726.典型变量η中的"疲劳感觉"与"睡眠障碍"的因子负载分别增大为0.774,0.859.结论 社会支持水平在职业压力与亚健康躯体症状之间可能具有中介调节作用.