Science, ideology, and facilitated communication.

Comments on a paper by J. W. Jacobson et al (see record 1996-12698-001) on the history of facilitated communication. W. Sailor states that he is not a facilitated communication proponent, and that the authors took his quote (W. Sailor, 1994) out of context in their indictment of postmodernism. Sailor claims that the point of his talk was to illustrate that facilitated communication represents a case where the postmodernist position is both positivist and subjectivist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clever hands: Uncontrolled intelligence in facilitated communication.

Five studies examined how people who are answering questions on behalf of another person may use their own knowledge to answer correctly while attributing authorship of their answers to the other. Experiments 1 and 2 found that participants instructed to answer yes/no questions randomly were unable to do so. They were more often correct on easy than hard questions, and extended opportunity and incentive did not reduce this effect. Experiments 3-5 found similar correctness for participants who were asked to answer yes/no questions by sensing either the ostensible keyboard finger movements or unvoiced inclinations of another person who had been admonished not to answer, and who was in fact a confederate and was not even given the questions. In this paradigm, the answers were often attributed to the other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Induced hypotension during anesthesia with special reference to orthognathic surgery

Since Gardner first used arteriotomy during anesthesia to improve visibility in the surgical field, various techniques and pharmacological agents have been tried for the same purpose. With reports documenting the spread of acquired immune deficiency syndrome through blood transfusions, prevention of homologous blood transfusions during surgery has also become a major concern. Induced hypotension has been used to reduce blood loss and thereby address both issues. In orthognathic surgery, induced hypotension during anesthesia has been used for similar reasons. It is recommended that hypotensive anesthesia be adjusted in relation to the patient's preoperative blood pressure rather than to a specific target pressure and be limited to that level necessary to reduce bleeding in the surgical field and in duration to that part of the surgical procedure deemed to benefit by it. A mean arterial blood pressure (MAP) 30% below a patient's usual MAP, with a minimum MAP of 50 mm Hg in ASA Class I patients and a MAP not less than 80 mm Hg in the elderly, is suggested to be clinically acceptable. Various pharmacological agents have been used for induced hypotension during orthognathic surgery. In addition, there are many drugs that have been used in other types of surgery that could be used in orthognathic surgery to induce hypotension. Recent reports using control groups do not show significant differences in morbidity and mortality attributable to induced hypotension during anesthesia. Appropriate patient evaluation and selection, proper positioning and monitoring, and adequate fluid therapy are stressed as important considerations in patients undergoing induced hypotension during orthognathic surgery.     

Microscrew and microplate systems for select osteotomies in orthognathic surgery

The use of the semirigid screw and plate systems is common place in orthognathic surgery by many oral and maxillofacial surgeons. The size of the screw and plate systems used is commonly designated as mini or osteotomy size. Screw diameter is generally 2.0 mm and plate thickness range is 0.8 mm to 1.2 mm. The systems available perform very well for the majority of osteotomies. There are circumstances when these mini systems are not appropriate. Recently developed microsystems have been applied by us in selected cases of orthognathic surgery. The smallest of the microsystem screws are 0.8 mm diameter and all are available in 2, 3, 4, 5, 6, 8 mm lengths. Some microplates are 0.3 mm thick and available in various shapes including a straight chain. The resultant profile thickness of screw plus plate system becomes 0.8 mm.     

An approach to treatment planning.

A treatment-planning framework in described along 3 dimensions: patient characteristics, treatment techniques, and treatment goals. Patient characteristics are evaluated in terms of copings skills, social support network, and sources of self-esteem, as well as Axis I and II disorders and functioning on Axis V. Treatment techniques encompass a variety of modalities and are broadly classified as reality or insight oriented. Treatment goals are defined as very brief (less than 2 mo), short-term (2 to 12 mo), or long-term (more than 12 mo). Six basic forms of treatment and the conditions under which they are recommended are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues raised by facilitated communication for theorizing and research on autism

There is considerable disagreement in the literature and among clinicians about the success of facilitated communication, a new method of augmentative communication being used with people diagnosed autistic. Some claim almost everyone exposed to it achieves success, basing their claims upon their observations and experiences of naturally occurring facilitated interactions. Others claim minimal or no success, basing their claims on their observations of facilitated interactions under controlled experimental conditions. I argue here that both claims can be valid and that FC users with autism are sometimes competent and other times incompetent, depending upon the conditions under which they are evaluated. I support my argument by offering a collaborative view of communication in place of the commonly held view that communication involves passing messages over an invisible conduit. Given the assumption that facilitated communication does allow for the expression of unexpected competence for many with autism, I describe various unusual phenomena being revealed by facilitation and FC users and offer some theoretical approaches for explaining these phenomena. I then propose some research ideas for studying the phenomena associated with FC and offer them as suggestions for how we might proceed in our efforts to develop our understanding of when and how it works for people with autism.     

Practice of computer use in radiotherapy planning

The main problems of radiotherapy planning are discussed with respect to use of computers now being available for a greater number of centers. One of the most essential premises is apart from clear ideas on a modern target volume concept - a sufficiently high speed in producing realistic summarized isodose contours for any radiation therapy arrangement in any individual patient's cross section outline. This problem being solved, those individual summarized isodose figures have to be critically evaluated and therefore the importance of applicable meaningful optimization criteria come into account. The properties of such criteria, which must be quantifiable, generally applicable and really relevant for judgement on quality of a plan, had to be accepted, before automatic optimization procedures could be developed; principles involved are presented. By means of a short series of examples, namely 60Co fixed field combinations with and without use of wedges, combinations of arc therapy for a number of clinical tasks. It has been pointed out, that most experienced estimate by the eye would have been by far insufficient when compared to the automized computer optimization when using such simple criteria as 1. homogeneity of absorbed dose within target volume, 2. numerically limited absorbed dose within areas of risk, 3. as low as possible radiation effects to all "outside areas". It seems to be a real danger, that so called isodose libraries, how high their merits might be estimated, may change into an "isodose bcemetery", unless we'll be successful for each individual clinical case by use of computers, which are now prepared to supply the best possible variant of the standard plan or the primary radiotherapy idea. Regular use of computers in such a way will furthermore give an incomparable documentation material.     

Masticatory function in patients with mandibular prognathism before and after orthognathic surgery

Masticatory function was analyzed in 54 patients with mandibular prognathism before or after orthognathic treatment and in 40 adults with normal occlusion. Masticatory efficiency was evaluated spectrophotometrically by measuring the amount of adenosine triphosphate eluted from masticated adenosine triphosphate granules. Occlusal contact was evaluated by calculating the number and area of occlusal contacts from the illuminated images of a silicone record of the occlusion that was stored in the image analysis system with the aid of a charge-coupled device camera. The mean masticatory efficiency of the preoperative group was approximately half that of the control group. The value for the postoperative group was slightly higher than that for the preoperative group, but there was no statistical difference between the two groups. Likewise, the number and area of occlusal contacts in the preoperative group were also approximately half or less as compared with those of the control group, and they did not show significant changes postoperatively. Statistically, there were correlations between the masticatory efficiency and the number and area of occlusal contacts. The results indicate that although the occlusal relationship of the upper and lower teeth were greatly improved by orthognathic treatment, the postoperative occlusion is not tight enough and may need further adjustment at the end of the treatment.     

Ethical issues related to the use of facilitated communication techniques with persons with autism.

Addresses the ethical issues concerning the benefits and the risks involved with the use of facilitated communication techniques (F/C), particularly with autistic clients. F/C involves the physical support of a client by a facilitator in order to enable the client to use equipment for the purposes of communication. Much controversy stems from the fact that the validity of messages communicated when using a facilitator remains to be established empirically. The principles of respect for the client's dignity, informed consent, confidentiality, responsible caring, and the issue of the risk of inadvertant misuse and misinterpretation are discussed from an ethical viewpoint. Well controlled research is recommended in order to further understand the processes involved in the widespread acceptance of this technique. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safe and cost-effective approach to carotid surgery

OBJECTIVES: In treating critically ill neonates, situations occasionally arise in which aggressive medical treatment prolongs the inevitable death rather than prolonging life. Decisions as to limitation of neonatal medical intervention remain controversial and the primary responsibility of the generally unprepared family. This research was designed to study response patterns of expectant mothers towards treatment of critically ill and/or malformed infants. DESIGN/SETTING: Attitudes were studied via comprehensive questionnaires divided into three sections: 1-Sociodemographic data and prior personal experience with perinatal problems; 2-Theoretical philosophical principles used in making medical ethical decisions; and 3-Hypothetical case scenarios with choices of treatment options. SUBJECTS AND RESULTS: Six hundred and fifty pregnant women were studied. Maternal birthplace (p = 0.005) and level of religious observance (p = 0.02) were strongly associated with the desire for maximally aggressive medical intervention in the hypothetical case scenario. Specific personal experiences such as infertility problems, previous children with serious mental or physical problems were not correlated with the selection of different treatment choices. Of the theoretical principles studied, only the desire to preserve life at all costs was significantly associated with the choice for maximal medical treatment (p = 0.003). CONCLUSIONS: Maternal ethnocultural background and philosophical principles more profoundly influenced medical ethical decision-making than did specific personal life experiences.     

Comparing prospective and retrospective evaluations of temporomandibular disorders after orthognathic surgery

The authors conducted a study to document agreement between prospective examinations performed by trained clinical trial examiners and retrospective surgical chart reviews in identifying signs and symptoms of temporomandibular disorders, or TMD. Only a small fraction of the signs and symptoms identified by clinical trial examiners were documented in the surgical charts. Studies relying on retrospective chart reviews may seriously underestimate signs and symptoms of TMD.     

Long-term evaluation of the use of coralline hydroxyapatite in orthognathic surgery

PURPOSE: This prospective study was designed to evaluate the long-term clinical and radiographic results of porous block hydroxyapatite (PBHA) used as a synthetic bone graft in orthognathic surgery and craniofacial augmentation. PATIENTS AND MATERIALS: A total of 245 consecutive patients were treated initially. Inclusion criteria for this study included a minimum clinical and radiographic follow-up of 5 years. In addition, all patients with known implant failures were included regardless of whether they met the study criteria. There were 111 patients that met the criteria for inclusion in this study. All patients had undergone orthognathic surgery with rigid fixation and had had inlay or onlay PBHA implants placed. Ninety-six percent of the implants were placed through an intraoral approach. Long-term postoperative radiographs were visually compared with immediate postoperative radiographs for implant position, stability, resorption, and other significant radiographic changes. The clinical examination evaluated for signs and symptoms of infection, wound dehiscence, implant exposure, implant displacement, changes in the overlying mucosa, and development of oronasal or oroantral fistulae. RESULTS: Four hundred seventy-one implants were placed: 403 in the maxilla, 44 in the mandible, and 24 in the periorbital region. There were 289 implants placed in direct communication with the maxillary sinus. The average follow-up time was 7.2 years (range, 5.0 to 10.3 years). Twenty-three implants (4.9%) were removed during the evaluation period. Lateral maxillary wall grafting had 95.7% success, with nine implants being lost in three patients. One chin implant was removed because of dissatisfaction with the aesthetics. Seven (14%) midpalatal implants used for maxillary expansion were lost, primarily because of exposure of the implant to the oral or nasal cavity at the time of surgery. When PBHA was used for alveolar cleft grafting, there was a 100% failure rate. CONCLUSION: The use of PBHA as a bone graft substitute in orthognathic surgery and for facial augmentation showed a high percentage of success and efficacy. However, adequate soft tissue coverage in the nasal floor and on the palate are paramount for success of midpalatal implants. PBHA should not be used for alveolar cleft grafting. Rigid fixation for inlay implants in the maxilla is important to provide stress shielding of the material and minimize micromovement during the initial healing phase.     

A comprehensive business planning approach applied to healthcare

The White Paper The New NHS: Modern, Dependable (DoH 1997) clearly expects nurses, in partnership with other professionals, to contribute to the planning and shaping of future healthcare services. This article proposes that comprehensive models of alternative planning frameworks, when applied to healthcare services, can provide nurses with an understanding of the skills they require to participate in the planning process.     

The use of computer systems dedicated to day surgery

As a management consulting firm and a system house which has developed computer systems specifically to support Day Surgery activities, we are often asked by nurses, doctors and managers of Day Surgery units to help clarify their needs for an information system. This article summarises the key questions which are asked, together with answers which we have given, based on our in-depth reviews at many hospitals which are reorganising and making significant investments in Day Surgery facilities.     

Medical imaging and registration in computer assisted surgery

Imaging, sensing, and computing technologies that are being introduced to aid in the planning and execution of surgical procedures are providing orthopaedic surgeons with a powerful new set of tools for improving clinical accuracy, reliability, and patient outcomes while reducing costs and operating times. Current computer assisted surgery systems typically include a measurement process for collecting patient specific medical data, a decision making process for generating a surgical plan, a registration process for aligning the surgical plan to the patient, and an action process for accurately achieving the goals specified in the plan. Some of the key concepts in computer assisted surgery applied to orthopaedics with a focus on the basic framework and underlying technologies is outlined. In addition, technical challenges and future trends in the field are discussed.     

Blood flow changes after orthognathic surgery: maxillary and mandibular subapical osteotomy

Subapical osteotomies were performed in the left quadrant of the mandibles and maxillas of five dogs and six monkeys. Two indirect methods, the isotope fractionation (diffusible tracer) and particle distribution (nondiffusible tracer--15mu microspheres) were used to quantitate local blood flow. To examine the effect of the surgery, blood flows in the alveolar bone, mucosa, and dental pulp of the segmented left quadrant and the corresponding tissues in the right quadrant were calculated and compared. It was assumed that the blood flows to the nonoperated right quadrant could serve as the controls to those observed in the osteotomized segment. The fractional decrease in blood flows to tissues in the operated sides were similar in both experimental animals. The decrease was largest in the dental pulp, ranging from 54% to 82% on the average, and least for the mucosal tissue, ranging from 18% to 40%. Blood flows decreased by 48% to 74%, on the average, in the alveolar bone. In some animals, blood flow to mucosal tissue that served as the pedicle was actually greater than the blood flow in the corresponding tissue on the right side. After surgery, the cardiac output in the dogs averaged about 156 ml/min/kg as calculated from both the diffusible and nondiffusible data. In the monkeys in which only the microspheres were injected, the cardiac output averaged 99 ml/min/kg. The arterial blood pressure dropped 8 to 13 mm Hg on the average (dog, 108 to 100 mm Hg; monkeys, 94 to 81 mm Hg). The heart rate also decreased slightly in dogs, 158 to 139 beats/min on the average; however, it increased slightly after the surgery in the monkeys, 144 to 161 beats/min. Blood losses during surgery were replaced wtih lactated Ringer's solution and the transient decreases in blood pressure of about 20 to 35 mm Hg were not sufficient to produce any shut down of renal blood flow.     

Interdisciplinary collaboration and discharge planning communication for elders

The effects of personal characteristics and perceptions of interdisciplinary collaboration on discharge planning communication were examined for nurses, physicians, and social workers in two hospitals. The model for the study explained 61.7% of the variance in discharge planning communication for nurses. For all 142 health professionals, communication openness with social workers, problem solving between nurses and physicians, and collaboration with social workers were important to discharge planning communication. For nurses, communication satisfaction with patients and families also was important.     

Early prediction of the need for orthognathic surgery in cleft lip and palate patients

OBJECTIVES: To assess the accuracy of Duplex ultrasound in the assessment of aortoiliac disease. DESIGN: Prospective, semi-blind study. SETTING: Vascular laboratory and radiology departments, University Hospital. MATERIALS AND METHODS: Ninety-two patients underwent assessment of the aortoiliac segment by femoral pulse palpation, Duplex ultrasound and biplanar arteriography. Of these 184 aortoiliac segments, 68 were also assessed by intraarterial pressure measurements and 80 by magnetic resonance angiography (MRA). MAIN RESULTS: Femoral pulses were abnormal in all 32 occluded aortoiliac segments. Of 152 patent segments, femoral pulse palpation was misleading in 50 (33%). MRA detected all occlusions and had a sensitivity of 71% and specificity of 68% for stenoses, compared to arteriography. Colour flow Duplex misdiagnosed four occlusions as stenoses. Duplex had a sensitivity of 91% and specificity of 93% for stenoses when compared to arteriography. Two stenoses, detected by Duplex and confirmed by pressure gradients, were missed by arteriography. CONCLUSIONS: Pressure measurements remain the gold standard for aortoiliac examination, arteriography providing only morphological information. The limitations of femoral pulse palpation should be appreciated. Although MRA was faster, Duplex examination proved slightly more sensitive to stenoses. At present, colour Duplex provides the best non-invasive assessment of aortoiliac disease and could prevent unnecessary arteriograms.