To become part of the team-patient experiences of participating in decision-making for a new treatment (proton beam therapy).

PURPOSE: The aim of this study was to explore patients' experience of participation in the treatment decision of proton beam therapy versus conventional radiotherapy. BACKGROUND: Proton beam therapy (PBT) has become a treatment option for some cancer patients receiving radiotherapy. The decision to give PBT instead of conventional radiotherapy (CRT) needs to be carefully planned together with the patient to ensure that the degree of participation is based on individuals' preferences. There is a knowledge gap of successful approaches to support patients' participation in the decision-making process, which is particularly important when it comes to the situation of having to choose between two treatment options such as PBT and CRT, with similar expected outcomes. METHOD: We conducted a secondary analysis of qualitative data collected from interviews with patients who received PBT for their brain tumor. Transcribed verbatims from interviews with 22 patients were analyzed regarding experiences of participation in the decision-making process leading to PBT. FINDINGS: Participants experienced their participation in the decision-making process to a varying degree, and with individual preferences. Four themes emerged from data: to be a voice that matters, to get control over what will happen, being in the hand of doctors' choice, and feeling selected for treatment. CONCLUSION: A decision for treatment with PBT can be experienced as a privilege but can also cause stress as it might entail practical issues affecting everyday life in a considerable way. For the patient to have confidence in the decision-making process, patients' preferences, expectations, and experiences must be included by the healthcare team. Including the patient in the healthcare team as an equal partner by confirming the person enables and facilitates for patients' voice to be heard and reckoned with. Person-centered care building on a partnership between patients and healthcare professionals should provide the right basis for the decision-making process.

Radiographers' perception of patient safety culture in radiology.

INTRODUCTION: Radiographers play a central role in patient safety because of their knowledge of and responsibilities in relation to the imaging process. To maintain safe care, the workplace must create a safety culture that enables sustainable safety work. AIM: This study aims to describe radiographers' perceptions of the patient safety culture in radiology units in Sweden. METHODS: The Swedish Hospital Survey of Patients' Safety Culture (S-HSOPSC) was used to gather descriptive data from 171 Swedish registered radiographers working in five radiology clinics distributed across 15 units. Fifty-one questionnaire items and one open-ended question were analysed, comprising perceptions of the overall safety grade, the frequency of number of reported risks and events, and 14 composites regarding patient safety dimensions. RESULTS: The radiographers' concerns surrounding the patient safety culture in their workplaces related to weaknesses regarding the safety dimensions "Staffing", "Frequency of error reporting", "Organizational learning - continuous improvement" and "Executive management support for patient safety". They perceived "Teamwork within the unit" to be a strength. CONCLUSION: Despite some weaknesses in the patient safety culture, the radiographers perceived that the overall patient safety level was good, in part because of their ability to spot risks in time. The executive management, however, needed to improve their feedback on safety measures; and another reason for some weaknesses in the patient safety culture could be staffing issues such as lack of time for meetings for continuous improvement. Managers and leaders have a great responsibility to establish a patient safety culture through support and good leadership. IMPLICATIONS FOR PRACTICE: An understanding of what creates a safety culture is important to prevent patient safety incidents.

Evaluating patient reported outcomes and experiences in a novel proton beam clinic - challenges, activities, and outcomes of the ProtonCare project.

BACKGROUND: The ProtonCare Study Group (PCSG) was formed with the purpose to develop and implement a framework for evaluation of proton beam therapy (PBT) and the related care at a novel clinic (Skandionkliniken), based on patient reported data. METHOD: A logic model framework was used to describe the process of development and implementation of a structured plan for evaluation of PBT for all diagnoses based on patient reported data. After the mission for the project was determined, meetings with networks and stakeholders were facilitated by PCSG to identify assumptions, resources, challenges, activities, outputs, outcomes, and outcome indicators. RESULT: This paper presents the challenges and accomplishments PCSG made so far. We describe required resources, activities, and accomplished results. The long-term outcomes that were outlined as a result of the process are two; 1) Improved knowledge about health outcomes of patients that are considered for PBT and 2) The findings will serve as a base for clinical decisions when patients are referred for PBT. CONCLUSION: Using the logical model framework proved useful in planning and managing the ProtonCare project. As a result, the work of PCSG has so far resulted in long-lasting outcomes that creates a base for future evaluation of patients' perspective in radiotherapy treatment in general and in PBT especially. Our experiences can be useful for other research groups facing similar challenges. Continuing research on patients´ perspective is a central part in ongoing and future research. Collaboration, cooperation, and coordination between research groups/networks from different disciplines are a significant part of the work aiming to determine the more precise role of PBT in future treatment options.

Patients' perception of health-related quality of life during the first year after autologous and allogeneic stem cell transplantation.

Little attention has been paid to examine health-related quality of life (HRQoL) the first year post-transplant, despite that this period is crucial for returning to normal life and functioning and to prevent delayed psychosocial adjustment. The purpose of the present study was to describe HRQoL after autologous versus allogeneic stem cell transplantations during the first year post-transplant. The allogeneic group was further divided into two groups: allogeneic stem cell transplantation after reduced intensive conditioning and allogeneic stem cell transplantation after myeloablative conditioning. All together 202 patients were enrolled in the study. HRQoL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the treatment-specific module High-Dose Chemotherapy (HDC-19). The questionnaires were filled out at six occasions (from inclusion to 12 months after transplantation). The reduced intensive conditioning group seemed to recover in the same way as the autologous group and these two groups were closer in their scoring compared with the myeloablative conditioning group. One month after the transplantation there were no significant differences in change scores between the autologous and reduced intensive conditioning group, and 1 year after the transplantation levels of symptoms and functioning were back to baseline or better. The myeloablative conditioning group, who perceived more symptoms and lower levels of functioning during the whole period, was still impaired in 10 out of 29 scales 1 year after the transplantation and no significant improvements compared with baseline were observed for this group.

Awareness of tooth grinding and clenching from adolescence to young adulthood: a nine-year follow-up.

How bruxism develops from adolescence to early adulthood remains unclear. A previous database was revisited to evaluate the natural course of self-reported tooth grinding and clenching among young Finns aged 14-23 using four assessments. Overall, the self-reported frequencies of both grinding and clenching increased during the examination period: from 13.7% to 21.7% and from 9.2% to 14.8%, respectively. There were significant increases (without a statistically significant difference between genders) in both grinding (P = 0.002) and clenching (P = 0.015) between 15 and 23 years. A significant rise in grinding between 18 and 23 years was also found (P = 0.011). It is concluded that self-reported bruxism increases from adolescence to young adulthood. Moreover, there are large differences between individuals, and fluctuations may occur in the natural course of bruxism.

Daily assessment of stressful events and coping among post-menopausal women with breast cancer treated with adjuvant chemotherapy.

The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (>or=55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: 'nausea and vomiting', 'fatigue', 'other symptoms', 'isolation and alienation', 'fear of the unknown' and 'being controlled by the treatment'. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. 'Nausea/vomiting' was the most frequently observed stressful event (21.6%). 'Isolation and alienation' and 'fear of the unknown' were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy.

Bruxism and sleep efficiency measured at home with wireless devices.

The present study comprised 101 (48 men) employees of the Finnish Broadcasting Company with or without irregular shift work, but all with a work week of five shifts in a row followed by 2 days off. The mean age of the subjects was 41.0 years (SD = 9.9). The BiteStrip, a single-use disposable EMG device was used for one night during the work week to detect sleep bruxism. The Actiwatch Plus actigraph was worn on the non-dominant wrist for the entire week to evaluate sleep. Total sleep time and fragmentation index, the latter as a measure of sleep efficiency was calculated for the present study. The BiteStrip scores among the participants were: 0- no bruxism: 52.2% (according to the manufacturer, comparable to a sleep laboratory bruxism count of up to 39 over 5 h), 1- mild: 29.3% (40-74 counts), 2- moderate: 12.0%: (75-124 counts) and 3- severe: 6.5% (>125 counts). Severe bruxers slept less during the work week than non-bruxers (P = 0.009), but severe bruxers slept slightly more than non-bruxers during days off. The group means of the sleep fragmentation index decreased from start towards the middle of the work week and increased during days off (P = 0.016). The levels of the fragmentation indices were consistently higher in accordance with bruxism severity (P = 0.013). It was concluded that bruxism has a coherent relationship with sleep efficiency and it can be detected at home with a low cost device.

Filgrastim treatment of acute myelogenous leukemia (M7) relapse after allogeneic peripheral stem cell transplantation resulting in both graft-versus-leukemia effect with cytogenetic remission and chronic graft-versus-host disease manifesting as polyserositis and subsequent bronchiolitis obliterans with organizing pneumonia.

Filgrastim (granulocyte colony-stimulating factor) has recently been reported to successfully treat patients with leukemic relapse after allogeneic peripheral stem cell transplantation (PSCT). However, the majority of the patients who responded also developed graft-versus-host disease (GVHD). Polyserositis as a manifestation of GVHD is a rare phenomenon. We report the first case of polyserositis following the use of filgrastim to treat a patient with acute myelogenous leukemia (M7), who had relapsed after an initially successful allogeneic PSCT. The polyserositis manifested with effusions and was initially controlled with high doses of steroids and pericardial stripping; however, after a quiescent period the patient eventually developed bronchiolitis obliterans with organizing pneumonia that required additional immunosuppressive therapy. We review the literature on GVHD-associated polyserositis and offer potential explanations for its pathogenesis.

Hematological effects of a low-prime neonatal cardiopulmonary bypass circuit utilizing vacuum-assisted venous return in the porcine model.

Limiting hemodilution in neonates is difficult when extracorporeal circuits require priming volumes that are 2 to 3 times the blood volume of the newborn patient. This extreme hemodilution contributes to the development of significant postbypass coagulation disturbances. The purpose of this project was to design a low-prime neonatal bypass circuit and evaluate the coagulation status after reduced hemodilution. The null hypothesis stated there is no significant difference in the measured coagulation parameters between the low-prime circuit and the standard high-prime circuit. Four neonatal piglets (2-4 kg) were divided into two groups and placed on cardiopulmonary bypass using either a low- (200 ml) or high-prime (500 ml) circuit. Both groups were cooled to 20 degrees C, and, following cardioplegic arrest, underwent circulatory arrest for 20 minutes. The low-prime circuit used vacuum-assisted venous drainage, which permitted the circuit to be at the patient level. The high-prime circuit required fresh washed donor red blood cells to maintain the hematocrit in the desired range of 15-20%. The platelet count on bypass decreased by 60 +/- 1.0% in the low-prime group versus 79.6 +/- 0.1% in the high-prime group. Following bypass, the platelet count was reduced by 38.3 +/- 14.3% in the low-prime versus 60.2 +/- 2.6% in the high-prime group. During rewarming, the mean heparinase activated clotting time (ACT) increased 5.1% above baseline in the low-prime group and 53.5% above baseline in the high-prime group. Mean plasma-free hemoglobin levels increased 40.4 mg/dl in the low-prime group versus 62.1 mg/dl in the high-prime group during bypass. This laboratory evaluation of a low-prime neonatal circuit demonstrates that coagulation disturbances often present in neonates can be reduced with the use of a low-prime circuit.

A methacrylate-based cement used as a root canal sealer.

In this study, a methacrylate-based orthopaedic bone cement was modified for use as a root canal sealer by changing the monomer from n-butyl methacrylate to tetrahydrofurfuryl methacrylate. The sealing and bonding capabilities, solubility and handling properties of the resin were evaluated. Seventy-three extracted mature human teeth with single canals were used. The teeth were randomly divided into two experimental groups each of 30 teeth; three control teeth were set aside for the leakage tests. Ten teeth were reserved for the scanning electron microscope studies. All the experimental teeth were root filled with gutta-percha and the resin sealer. The particle size of the polymer was limited in Group 1 to 75 microns or less and in Group 2 to 45 microns or less. The controls were filled with gutta-percha only. Silver nitrate solution was used as the leakage indicator. In Group 1 the mean linear penetration of the indicator was 1.10 mm +/- 1.04; four roots showed no leakage. In Group 2 the mean linear penetration of the indicator was 0.57 mm +/- 0.65; 12 roots showed no leakage. The test bodies showed no weight change after 1 and 3 months' storage in saline at 37 degrees C. The scanning electron microscope examination revealed a bond both between the resin and the dentine and between the resin and the gutta-percha. The working time of the new resin composition was normally about 50 min, and handling was found to be easy.

A comparison of the apical dye penetration patterns shown by methylene blue and india ink in root-filled teeth.

This study compared the linear leakage patterns shown by 5% aqueous solution of methylene blue (MB) and India ink (II). One-hundred and twenty-five roots with single canals from extracted human teeth were used. The canals were cleaned and shaped using the step-back technique under copious irrigation. Three groups were arranged to receive root fillings of gutta-percha and one of three proprietary sealers using standard lateral condensation techniques: Sealapex (40 roots), Tubli-Seal (40 roots) and Ketac-Endo (20 roots). The remaining roots were used as controls: positive with gutta-percha and no sealer and negative with the apices sealed with nail varnish. The roots were randomly selected for 7-day immersion in either MB or II, then sectioned longitudinally; dye penetration was assessed using a Wild Leitz stereomicroscope. In all groups MB showed more penetration than II. The results were statistically significant at the P = 0.01 level, with the exception of the positive control groups. Negative controls showed no penetration. It is concluded that MB, which has a low molecular weight penetrated more deeply along root canal fillings than II, which has a large particle size.

Undergraduate endodontic teaching at the London Hospital Dental Institute.

Integration, whole patient care and small group teaching are concepts which set the pattern for undergraduate teaching at 'The London'. This system promotes co-operation between disciplines, enables students to see the basic teaching in a wider clinical context, activates the learning process and gives students an opportunity to learn responsibility by running their own 'mini-practices'. Unfortunately, the system also has some undesirable effects, which are discussed with special reference to the teaching of endodontics.

The careers of women dentists in the university.

Since 1866 when Lucy Beaman Hobbs graduated from the Ohio College of Dental Surgery as the first woman dentist in the world, many women have followed her example. In this paper, the first to be given in the Symposium, 'Women In Dentistry - Any Room At The Top?', the place of women dentists in universities is discussed. In many countries, despite the rapid growth in the proportion of women compared with men qualifying in dentistry, men still hold the majority of senior university posts. Evidence supports this observation and suggestions are given as to the reasons why it may persist.

Periapical status in subjects with regular dental care habits.

This study covered 250 subjects aged 21-60 yr subdivided into four age groups. Oral hygiene status and dental care habits were above average and the number of teeth remaining was high in all age groups (range 24.1-27.3). All subjects were radiographically examined by means of an intraoral full mouth survey. From the radiographs periapical lesions and root fillings were recorded. A total of 117 subjects (46.8%) presented with one or more periapical lesions distributed between 294 roots (2.9%) or 229 teeth (3.5%). Two-thirds of the periapical lesions were related to endodontically treated roots. Of all endodontically treated roots 28.8% were associated with a periapical lesion. Irrespective of the relative length 17.2% of the homogeneous and 37.9% of the inhomogeneous root fillings were associated with a periapical lesion. It is concluded that periapical lesions although rare in these subjects were most frequent in root filled teeth.

Long-term evaluation of autotransplanted maxillary canines with completed root formation.

Autotransplantation of 33 maxillary canines was followed up in 29 patients with an average age of 27.5 years. The mean follow-up period was 6.0 years. Endodontic treatment was performed in 23 teeth. Signs of root resorption were found in an increasing number of canines during the follow-up period. At the last examination eight canines showed no signs of resorption. External and internal resorption of inflammatory type were the most frequent forms of resorption and were also found to be the most hazardous factors for the prognosis of the transplanted tooth. Extraction of the transplant was necessary in four cases because of root resorption or poor bone regeneration.

Influence of local noxious heat stimulation on sensory nerve activity in the feline dental pulp.

The present investigation was undertaken to develop an experimental model in which noxious heat stimulation was used to produce increased intradental sensory nerve activity in canine teeth of anesthetized cats. Two techniques were evaluated in which both the method of recording and the nature of the stimulus varied. Slow heating (approx 1 degree C/s) to 47 degree C of the tooth surface (combined with recording from electrodes in open dentinal cavities) did not produce any persistent nerve activity. Repeated periods of brief intense heating (approx 60 degrees C/s) (combined with recording from amalgam electrodes placed on cavity floors) resulted in an immediate response and an afterdischarge (phase 3) generally persisting for 20--60 min. Maximum phase 3 activity was characteristic for the individual cat and ranged from 0.2 to 50.2 imp/s. mean value 10.6 imp/s (S.D. +/- 9.2). A systematically higher phase 3 activity was recorded in lower compared to upper canine teeth (p less than 0.05). The maximum phase 3 response generally occurred after 3-8 stimulations; the median number of required stimuli was 3. Repeated brief heat stimulations combined with the closed cavity recording technique may be used as an experimental model by which the mechanisms behind increases in intradental sensory nerve activity associated with tissue damage can be studied.