The policy & procedure manual: development of a computer-assisted process for review

This article documents the successful development of a computer-assisted process for systematic review of nursing policies and procedures at The Queen Elizabeth Hospital, Toronto, Ontario. Through broad staff input, policies and procedures are research-based yet grounded in the reality of the facility's nursing practice. Client-related standards are written as measurable, realistic statements of desired client outcomes, and as such are standards for client care. Policies and procedures have been rated according to the Canadian Council on Health Facilities Accreditation criteria (client centered, high risk, high volume, problem prone, interservice, outcome-related), so that important policies are easily identified to provide focus for quality assurance activities. The review process is structured so that over the course of a year, all policies are circulated for review by all levels of nursing staff.     

A review of instruments for assessing family history

The influence of family history on one's development has long been a focus of psychological theory, research, and practice. In recent years, however, conceptualizations of family influences on development have evolved considerably, and there has also been increased concern about the reliability of individuals' memory for their childhoods in general. Current knowledge regarding these and other issues are applied to reviewing the instruments that have been developed to assess aspects of family history. The complexity of this type of assessment is emphasized, and a variety of problems with the reliability and validity of the currently available instruments are discussed. Suggestions for future research are also offered.     

Methods for assessing the physical demands of manual lifting: a review and case study from warehousing

Assessment of the physical demands of potentially hazardous manual material handling (MMH) activities is fundamental to the prevention of disabilities from occupationally related low back pain, a problem costing the nation billions of dollars annually. Although there is a variety of ergonomic assessment methods available for assessing MMH activities, there is a lack of practical information to assist users in choosing the most appropriate assessment methods of a particular job. This article reviews currently available assessment methods and presents case study results of a physically demanding repetitive manual lifting job in two grocery warehouses. The case study will provide a framework for a comparison of the methods and a discussion of relevant application issues designed to assist users in selecting appropriate methods for assessing MMH jobs. Based on the results of the study, it is concluded that all of the ergonomic methods were in agreement that the job of grocery selector has a high level of risk for low back pain. Differences between the methods were noted, however, that should be considered when choosing a specific method for a specific application.     

Estrogen use and cancer risk: a review

The role of estrogens as carcinogens, cocarcinogens or tumor promoters, as well as their mechanism(s) of action on cancer cells, are thoroughly reviewed. Although there is ample evidence that estrogens (natural and synthetic) can induce multiple benign and malignant tumors in animals, and most of these tumors are histologically similar to that in humans, there is no direct evidence that natural estrogens (estradiol-17 beta, estrone) are carcinogenic in humans. Recent evidence in cellular and molecular oncology revealed that estrogens act by genetic and epigenetic mechanisms on cancer cells, and a close relationship between estrogens, growth factors, and oncogenes is important for human cancer. Long-term exposure to estrogens should always be regarded as increased cancer risk. Estrogen replacement therapy (ERT) by unopposed estrogens in postmenopausal women with high familial cancer risk or existent premalignant lesions should be avoided, since estrogens may act as tumor promoters. Combination of estrogens with progesterone (or other progestins) cyclically or sequentially, significantly reduce and prevent the cancer risk.     

Root canal treatment of a mandibular first molar with three mesial root canals

A phlebotomist with nosocomially acquired human immunodeficiency virus infection developed tuberculosis 10 months after exposure to multidrug-resistant Mycobacterium tuberculosis during a nosocomial outbreak. Healthcare workers with immunosuppression are at increased risk of tuberculosis if infected and, if exposed, should be considered for preventive therapy regardless of tuberculin skin-test status.     

Microencapsulation of bovine spermatozoa for use in artificial insemination: a review

A technique for microencapsulation of bovine spermatozoa has been developed with minimal spermatozoal injury and thus of potential use in artificial insemination. The polymers poly-l-lysine, polyvinylamine and protamine sulfate have proven best for membranes. Encapsulation has been successful with capsules ranging in size from 0.75 to 1.5 mm, and with sperm concentrations from 45 to 180 x 10(6) cells mL-1. Successful extenders include CUE, CAPROGEN, and egg yolk-citrate-glycerol (maximum 10% v/v egg yolk for normal capsular shape). Capsule fragility (ability to rupture under ageing and physical stress) is negatively related to membrane thickness which ranges from 1.92 to 5.32 microns (depending on the concentration of polymer used) and positively related to concentration of sperm encapsulated. Heterospermic studies have shown that encapsulated sperm are capable of fertilization in vivo, but are at a disadvantage to unencapsulated sperm when cows are inseminated at conventional times. Uterine retention of inseminates is favoured by capsules having a 'sticky' membrane. Using current procedures, preliminary homospermic fertility studies indicate that sperm encapsulated with poly-l-lysine or protamine sulfate may achieve normal fertility.     

Root instrumentation. Power-driven versus manual scalers, which one?

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes. Historically, it was also generally agreed that aggressive scaling and root planing with hand instruments was necessary to remove tenacious calculus deposits to produce roots as smooth as possible for removal of the endotoxins previously thought to be deeply embedded into the root surfaces. Based on current evidence in the literature, it is now known that endotoxin is a weakly adherent surface phenomenon and that sonic and ultrasonic (power-driven) instruments can be used to accomplish definitive root detoxification and maximal wound healing without overinstrumentation of root and without extensive cementum removal. Power-driven scalers may have unique advantages because of the cavitational activity associated with ultrasonics thought to supplement removal of root surface plaques. In addition, the constant flushing activity of the lavage used to cool the tips results in disruption of the unattached and weakly attached subgingival plaques. The ability to flush the pocket during subgingival instrumentation with water or other chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been shown to enhance pocket depth reduction and gain in clinical attachment beyond that achieved with hand scaling. The added benefit of chemical lavage during ultrasonic instrumentation shows great promise and may enhance the overall effect of nonsurgical anti-infective periodontal therapy. Other major advantages of power-driven scalers may include better access to difficult areas, such as deep narrow defects, root grooves, and furcations, using newly designed microultrasonic tips, which are smaller in diameter and able to penetrate the pocket approximately 1 mm farther than hand instruments. Taken together, it appears that use of ultrasonic or sonic scalers for periodontal débridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.     

A review of methods and instruments for assessing externalizing disorders: theoretical and practical considerations in rendering a diagnosis

This review addresses the most current and widely used methods of assessing childhood and adolescent externalizing disorders. Interviews, rating scales, and self-report instruments are described, and their strengths and weaknesses are discussed. Direct observational techniques in naturalistic and analogue settings are also reviewed. Throughout the article, commentary is offered regarding the psychometric adequacy and clinical validity of these instruments. It is suggested that, although the instruments presently used to assist in diagnosing externalizing disorders generally possess adequate reliability and representational validity, evidence of elaborative validity is lacking. Clinicians and researchers are encouraged to adopt a broader conceptualization of the diagnostic process, to question existing standards for establishing validity, and to consider alternative means of demonstrating diagnostic utility.     

The use of seclusion in psychiatry: a literature review

This article reports on a literature review of the practice of seclusion in psychiatric inpatient facilities. Attention is paid to the moral debate on seclusion. Most publications consider seclusion as a necessary intervention to manage problem behavior. The first part of the article deals with definitional aspects leading toward concept clarification. The review shows differences in definitional aspects, motives for seclusion, hospital characteristics, and patient characteristics. Data on frequency, incidence, and duration appear to be widely divergent. The experiences of patients who have been secluded are mostly negative, but positive reactions are also reported. In the publications of the last decade, there is emphasis on the contribution of hospital characteristics to trends in use of seclusion. Finally, it is concluded that seclusion is an effective way to manage (potentially) dangerous behavior and that seclusion is an intervention that may create therapeutic possibilities for care.     

Evaluating counselor effectiveness: A critical review of rating scale instruments.

Critiques 6 frequently used counselor rating scales: the Counselor Rating Form (A. Barak and M. B. LaCrosse; see record 1976-07806-001), the Counselor Rating Form—Short Version (J. D. Corrigan and L. D. Schmidt; see record 1983-09385-001), the Barrett-Lennard Relationship Inventory, the Counselor Evaluation Inventory (J. D. Linden et al; see record 1966-04251-001), the Counselor Effectiveness Scale (A. E. Ivey, 1971), and the Counselor Effectiveness Rating Scale (D. R. Atkinson and G. Carskaddon; see record 1975-25352-001). The validity, reliability, and pragmatic utility of each scale are critically examined, and the frequency of scale use across 3 counseling journals is recorded for an 11-yr period (1974–1984). Reliability and validity issues are raised, and it is suggested that use of these instruments has been based more on convention than on sound psychometric evidence. (50 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metoclopramide: a review of its pharmacological properties and clinical use

Metoclopramide, 4-amino-5-chloro-2-methoxy-N-(2-diethyl-aminoethyl) benzamide, is advocated for use in gastro-intestinal diagnostics, and in treating various types of vomiting and a variety of functional and organic gastro-intestinal disorders. Published data have indicated that metoclopramide assists radiological identification of lesions in the small intestine, facilitates duodenal intubation and small intestine biopsy, and eases emergency endoscopy in upper gastro-intestinal haemorrhage. Metoclopramide reduces post-operative vomiting and radiation sickness, and ameliorates some types of drug-induced vomiting. It may provide symptomatic relief in dyspepsia and possibly in vertigo, reflux oesophagitis and hiccups, but further controlled trials are needed to confirm the efficacy of metoclopramide in these proposed areas of use. It promotes gastric emptying prior to anaesthesia. Its effects in healing gastric ulcer and preventing relapse of duodenal ulcer remain unproven. Side-effects are few and transient, though alarming extrapyramidal reactions can occur in a small proportion of patients receiving therapeutic doses but more usually following excessive doses in young subjects. They respond rapidly to withdrawal of the drug.     

Root canal morphology of maxillary permanent first molar teeth at various ages

The root canal anatomy and pulp chamber morphology of 216 maxillary permanent first molar teeth of known age was examined using a radiographic technique after infusion of the root canal system with a radiopaque sodium iothalomate gel. This technique proved to be a rapid and effective method for the examination of root canal morphology and is recommended when root canal anatomy needs to be examined before further investigations are carried out. Over 95% of palatal and disto-buccal roots contained a single root canal. The mesio-buccal root was more complex. All types of configurations were seen. Only 26% of mesio-buccal roots showed a single canal. The pulp canal in all roots appeared to narrow at an early age. In the mesio-buccal root, a definite two-directional calcification pattern was apparent in most teeth by the age of 10. The rate of progress of root formation was very variable. There was no apparent relationship between the type of canal system in the mesio-buccal root and the type of canal orifice present. The transverse cross-sectional shape of the pulp chamber was trapezoidal in 81% of teeth.     

ABILHAND: a Rasch-built measure of manual ability

BACKGROUND: Dexamethasone decreases chemotherapy-induced emesis when added to an antiemetic regimen. This study was undertaken to evaluate the efficacy of granisetron-dexamethasone combination for the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing general anaesthesia for breast surgery. METHODS: In a randomized, double-blind manner, 135 ASA I patients, aged 40-65 years, were assigned to receive placebo (saline), granisetron 40 micrograms.kg-1 or granisetron 40 micrograms.kg-1 plus dexamethasone 8 mg i.v. (n = 45 of each) immediately before the induction of anaesthesia. A standard general anaesthetic technique and postoperative analgesia were used. The PONV and safety assessments were performed continuously during the first 3 h (0-3 h) and the next 21 h (3-24 h) after anaesthesia. RESULTS: A complete response, defined as no PONV and no administration of rescue antiemetic medication, during 0-3 h after anaesthesia was 51%, 82% and 96% in patients who had received placebo, granisetron and granisetron-dexamethasone combination, respectively; the corresponding incidence during 3-24 h after anaesthesia was 56%, 84% and 98% (P < 0.05; overall Fisher's exact probability test). No clinically important adverse events were observed in any of the groups. CONCLUSION: Prophylactic use of granisetron-dexamethasone combination is more effective than granisetron alone for the prevention of PONV after breast surgery.     

Finasteride: a review of its use in male pattern hair loss

The 5alpha-reductase inhibitor finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT), the androgen responsible for male pattern hair loss (androgenetic alopecia) in genetically predisposed men. Results of phase III clinical studies in 1879 men have shown that oral finasteride 1 mg/day promotes hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. Evidence suggests that the improvement in hair count reported after 1 year is maintained during 2 years' treatment. In men with vertex hair loss, global photographs showed improvement in hair growth in 48% of finasteride recipients at 1 year and in 66% at 2 years compared with 7% of placebo recipients at each time point. Furthermore, hair counts in these men showed that 83% of finasteride versus 28% of placebo recipients had no further hair loss compared with baseline after 2 years. The clinical efficacy of oral finasteride has not yet been compared with that of topical minoxidil, the only other drug used clinically in patients with male pattern hair loss. Therapeutic dosages of finasteride are generally well tolerated. In phase III studies, 7.7% of patients receiving finasteride 1 mg/day compared with 7.0% of those receiving placebo reported treatment-related adverse events. The overall incidence of sexual function disorders, comprising decreased libido, ejaculation disorder and erectile dysfunction, was significantly greater in finasteride than placebo recipients (3.8 vs 2.1%). All sexual adverse events were reversed on discontinuation of therapy and many resolved in patients who continued therapy. No other drug-related events were reported with an incidence > or =1% in patients receiving finasteride. Most events were of mild to moderate severity. Oral finasteride is contraindicated in pregnant women because of the risk of hypospadias in male fetuses. CONCLUSIONS: Oral finasteride promotes scalp hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. With its generally good tolerability profile, finasteride is a new approach to the management of this condition, for which treatment options are few. Its role relative to topical minoxidil has yet to be determined.     

From the history of surgical instruments: 6. Sauerbruch's instruments for thoracic surgery

The historical development of thoracic surgery, which was established in Germany in the years 1904/1905 and the armamentarium of the chest designed by Ferdinand Sauerbruch (1875-1951) are described. Sauerbruch designed between 1904 and 1920 many instruments to facilitate thoracic surgery, e.g. several rib retractors, a special rib shear for the first rib, a rib shear for all ribs other than the first. Furthermore he designed a special lung grasping forceps with rubber covered jaws, a lung compression forceps and a fenestrated lung retractor to facilitate lung resections.     

The use of alcohol by lesbians: a review and research agenda

This article reviews the literature on alcohol use by lesbians. Comparisons of data on lesbians and women from the general population show that lesbians tend to drink more than other women; that rates of drinking do not decline with age as is true for general population women; and that even when levels of drinking are equivalent between lesbians and general population women, lesbians report greater difficulties related to alcohol consumption. Differences in sampling techniques and differences in definitions of drinking among the papers made comparisons of results difficult. These issues are discussed and recommendations are made concerning standardization of data collection.