Complete dentures: an update on clinical assessment and management: part 2.

The ability to provide high quality complete dentures remains an important skill for general dental practitioners. The prevalence of edentulism is increasingly concentrated within an older patient cohort and general dental practitioners may face challenges associated with providing care for these patients. This two-part series explores various aspects of complete denture provision and is designed to act as a refresher on the management of edentulous patients. This second part focuses on the copy denture technique as well as discussing strategies for assessing and managing gag reflexes, prominent palatal and lingual tori and microstomia.

Complete dentures: an update on clinical assessment and management: part 1.

The ability to provide high-quality complete dentures has been a key skill for general dental practitioners throughout the history of dental care. The prevalence of edentulism is becoming increasingly concentrated in an older patient cohort and general dental practitioners may more commonly face challenges associated with providing care for these patients. This two-part series explores various aspects of complete denture provision and is designed to act as a refresher on core aspects of managing these patients, while also covering common challenges associated with anatomical or patient factors. This first part will explore changes in the provision and teaching of complete denture care in the UK and will describe important aspects of patient examination. It will discuss the management of unstable lower dentures and fibrous replacement ridges. Part two will cover management of the gag reflex, tori, microstomia and copy dentures.

Orofacial manifestations of systemic sclerosis.

Systemic sclerosis (SSc) is a multisystem disease of unknown aetiology characterised by microangiopathy, dysregulated immune function and tissue remodelling, which commonly involves the oral cavity. Orofacial manifestations of SSc contribute greatly to overall disease burden and yet are regularly overlooked and under-treated. This may reflect a pre-occupation amongst rheumatology clinicians on potentially life-threatening internal organ involvement, but is also a consequence of insufficient engagement between rheumatologists and dental professionals. A high proportion of SSc patients report difficulty accessing a dentist with knowledge of the disease and there is recognition amongst dentists that this could impact negatively on patient care. This review shall describe the clinical features and burden of orofacial manifestations of SSc and the management of such problems. The case is made for greater collaborative working between rheumatologists and dental professionals with an interest in SSc in both the research and clinical setting.

Restorative dentistry for the older patient cohort.

The ageing UK population presents a number of challenges to the restorative dentist as a result of complex treatment needs and a significant maintenance burden. This paper discusses how ageing may influence the provision of dental treatment and outlines a variety of conservative, periodontal, endodontic and prosthodontic considerations that are important in the management of the older patient cohort.

First Report of Plum pox virus on Plum in New York State.

Plum pox, also known as Sharka, is one of the more significant viral diseases of stone fruit trees such as plum, peach, and apricot. It was first reported in Europe in the early 1900s and more recently in Chile in 1992, the United States (Pennsylvania) in 1999, Canada (Ontario and Nova Scotia) in 2000, China in 2001, and Argentina in 2004. Plum pox virus (PPV) was recently detected in two plum (Prunus domestica) trees in an orchard in Niagara County, NY, located within 5 miles from a Canadian plum pox eradication zone. Typical symptoms of chlorotic rings and spots were observed on some of the leaves from these trees. No symptoms were reported prior to the survey collection in July 2006. Survey samples were screened for the presence of PPV by ELISA using the Agdia PPV (Agdia, Elkhart, IN) specific kit that recognizes all strains but C of PPV. Approximately 5% of the survey samples were additionally analyzed by a validated immunocapture reverse transcription (IC-RT)-PCR TaqMan assay in a Cepheid SmartCycler (Cepheid, Sunnyvale, CA). Both replicates of the two New York plum trees produced a positive ELISA reaction in two consecutive tests. The ELISA-positive samples also produced positive results when subjected to the real-time IC-RT-PCR test. The PPV-positive trees were sampled again and an additional 53 samples were collected from trees in the surrounding area. Suspect trees again tested positive, while all the trees in the surrounding area tested negative. The methods used for confirmation included two ELISA tests (Durviz [Valencia, Spain] DAS indirect monoclonal ELISA and Agdia DAS polyclonal ELISA). Confirmatory real-time IC-RT-PCR was performed using universal 3' nontranslated region (NTR) primers (2,3) in a SYBR Green assay format and a coat protein (CP) primers/probe TaqMan assay (3,4). Further, the New York PPV isolate was identified as PPV D group using a subgroup specific conventional IC-RT-PCR (1). A 1.4-kb sequence fragment from the 3' end of the New York PPV was sequenced (GenBank Accession No. DG 883816). Comparison of the sequence with the database confirmed this isolate as subgroup D and exhibited a high degree of identity with other PPV D accessions (PPV D Teycheney [Accession No. X16415]; Penn4 [Accession No. DQ465243] Cnd 123-1 [Accession No. AY9553267]; and Cnd 3 [Accession No. AY953262]). To our knowledge, this is the first report of PPV in New York. References: (1) T. Candresse et al. Phytopathology. 88:198, 1998. (2) L. Levy et al. J. Virol. Methods. 49:295, 1994. (3) V. Mavrodieva and L. Levy. Acta Hortic. 657:141, 2004. (4) T. Wetzel et al. J.Virol. Methods 33:355, 1991.

Discovering asthma in the older adult.

New-onset asthma may occur at any time in the life cycle, but it is often difficult to diagnose in older adults. The symptoms of asthma are strikingly similar to the symptoms of many cardiac and pulmonary diseases prevalent in this age group. This article discusses the presentation of undiagnosed asthma in the older adult, key management issues for this population, and techniques for assisting clinicians in identifying triggers that precipitate or worsen symptoms.

Before the storm: informing and involving stakeholder groups in workplace biomarker monitoring.

The social, legal and ethical implications of advances in biomarker indentification have been discussed by scholars and environmental researchers, but not by the "everyday" professionals and workers who may eventually make and be affected by decisions about their workplace applications. Through the use of a hypothetical scenario, this study introduced members of various professional and occupational groups to the potential uses of biomarkers research on biological monitoring in the workplace. The purpose was to obtain opinions about how events would proceed based on the scenario, leading to a broad discussion of potential uses and abuses of biomarker-based health monitoring. Six professionally homogeneous focus groups, comprised of 1) company health professionals, 2) third-party payers, 3) attorneys, 4) human resource managers, 5) non-unionized workers, and 6) unionized workers, participated in focus groups presented as "think-tank" discussions in Greenville and Charleston, S.C. Participants were given a fictitious "newspaper article" about the use of biomarker-based monitoring at a chemical plant and were asked to comment on what they thought would happen next. The discussion expanded to a general consideration of biological monitoring and its legal, social and ethical ramifications. Data was analyzed through the "immersion/crystallization" method. Few participants reported any knowledge of biological monitoring prior to the focus group session. Some had initial difficulty understanding the concept and how it differs from other means of measuring environmental risk. Although biological monitoring was previously unknown to many participants, occupational groups were relatively consistent in the issues they raised about its use in the workplace. In all groups, questions about potential discrimination against employees were raised. The general consensus was that the use of biomarker-based monitoring would result in conflict and litigation without regulations to protect employees from discrimination. Although most participants saw potential health benefits resulting from the preventive advantages associated with this technology, their concerns about its misuses were paramount. Perceptions varied as a function of occupation. Non-unionized workers expressed the most concern about discriminatory uses of biological monitoring. Unionized workers, who said they believed the union would support their interests, expressed much less concern. Health professionals (company physicians and nurse practitioners) were most alarmed about the "extra work" a monitoring program would create for them. Human resource managers concentrated on the company's "damage control" efforts. Attorneys emphasized that the reliable use of such tests would establish a causal relationship between exposure and personal injury. The results of this project illustrate that people who are most likely to be affected by biomarker-based biological monitoring in the workplace readily understand and are alarmed by its legal and ethical implications. It is unlikely that this technology will be fully accepted as an environmental risk assessment tool or as a prevention strategy without stringent protection of workers' rights. This study demonstrated the value of focus groups in obtaining opinion data about an environmental risk issue that it not yet well known to the general public.

Effect of three teaching methods on a nursing staff's knowledge of medication error risk reduction strategies.

The authors' purpose in this study was to (1) compare the effects of three teaching methods on registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies, and (2) to compare registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies using a pretest/posttest design. Registered nurses (n = 129) and licensed practical nurses (n = 21) employed by two hospitals constituted the study sample. Subjects were assigned alternately to three intervention groups: videotape (n = 50); instructional booklet (n = 50); and lecture (n = 50). A 38-item test, including true-false, multiple choice, matching items and dosage calculation problems, was administered to subjects in each group before and after the teaching intervention. On the basis of the results, there was no statistically significant difference in total knowledge scores for the three intervention groups (F = 2.07, P = 0.130). Staff development instructors should consider the advantages of a videotape and instructional booklet over the time-intensive lecture strategy.

Nurses' perceptions of harmful outcomes from medication errors.

To determine if factors associated with medication errors explained perceived harmful outcome from such errors, perceptions of vividly recollected medication errors were reported by a convenience sample of 206 hospital-employed RNs and LPNs who completed the Medication Error Risk Profile (MERP). Symptoms related to the error, radiology studies performed, the toxicity of the medication given, adverse drug reaction unrecognized at first, and transfer of the patient to another unit explained 38% of the variance in perceived harmful outcome. The implications of the this study for medical-surgical nurses are explored.

Long-term nasal mucosal tissue expansion use in repair of large nasoseptal perforations.

Reperforation rates of large, surgically closed nasoseptal perforations remain unacceptably high (30% to 70%). With the advent of newer surgical techniques, including external decortication rhinoplasty and midface degloving, excellent exposure of the intranasal anatomy is afforded. The limiting factor of these approaches is the deficiency of local intranasal mucosal lining, which is used to close large septal perforations. The paucity of nasal mucosal lining results in excessive tension on the perforation closure suture line that leads to distal flap ischemia, anastomosis breakdown and, ultimately, reperforation of the septum. Alternatively, using intraoral mucosal flaps of sufficient length and width to close large perforations results in significant and unacceptable donor-site morbidity. We present our technique of harvesting additional local endonasal mucosa using long-term soft-tissue expanders. Long-term nasal mucosal expansion was used in the closure of large septal perforations in five patients. Complications included one case of expander exposure and the morbidity of prefacial expander injections. Total closure of all five septal perforations was documented at the 1-year postsurgical visit. Histologic and electron-microscopic examinations of the expanded nasal floor mucosa are presented.

Needs assessment for a patient education program in a nursing department. A Delphi approach.

Nursing staff members reported patient education activities in a teaching hospital during a needs assessment conducted as a three-round modified Delphi study. Members of the clinical practice committee and nursing staff members from all patient units were surveyed during three consecutive rounds. Results include the characteristics and priorities of nursing staff members' current interventions related to patient education. Programmatic directions for the nursing service organization, including the development of inservice education programs for creating a formal teaching plan, were identified.

Basilar arteries of the brain in raccoon dog (Nyctereutes procyonoides (Gray, 1834)).

Observations carried out on 43 brains of raccoon dogs show that the system of basilar arteries of the brain is similar to that in other carnivores. The observed differences were manifested in different vessel connections and occurrence of some variations. In 53.4% cases the basilar artery in raccoon dogs develops from the combination of the even ventral spinal arteries and the vertebral arteries entering them. An unusual case of the reduction of spinal artery was also found.

Nasal reconstruction using split calvarial grafts.

The reconstruction of nasal deformities after trauma or surgical procedures presents an arduous task for the reconstructive surgeon. The anatomic alteration of supporting cartilage and nasal bones, as well as scar formation, compound the difficult nature of this type of reconstruction. In the past, multiple autogenous and alloplastic implants have been used in nasal reconstruction. Autogenous implants include auricular and septal cartilage as well as rib and iliac crest bone grafts. Alloplastic materials include acrylic, supramid mesh, Gortex, and silicone rubber. Autogenous grafts have been shown to provide excellent long-term reliable results in nasal reconstruction. In our study, autogenous split calvarial bone grafts were used in the nasal reconstruction of 17 patients. Among the corrective procedures were dorsal augmentation for saddle-nose deformities, insertion of columella struts for nasal tip ptosis, and insertion of nasal battens for nasal valve collapse. Patient followup has been from 1 to 5 years, with no significant resorption noted during that time. Complications were limited to one seroma at the donor site before wound drains were routinely used. No major complications, including hematoma formation, CSF leak, or infection, have been observed.

[Analysis of the volume of the cerebral circle and basal artery in the blue fox]. / Analiza pojemnosci kola tetniczego mózgu i tetnicy podstawnej u piesaka (Alopex lagopus L., 1758).

Observations were performed on 30 brains of blue foxes, whose arteries were filled with synthetic latex. The measurements of volume, length and diameter of the basal artery and arteries that made cerebral circle were done using digital image analysis system. It has been indicated that an average volume of the cerebral circle in that species was 12.96 mm3 and was statistically highly important correlated with the weight of the brain (0.83). The total volume of the cerebral nasal arteries was estimated as 4.96 mm3 and the volume of the communicating caudal arteries was 8.08 mm3. No statistically important correlation has been indicated between the weight of brain and the volume of the basal artery (8.84 mm3). The volume of the basal artery was negatively correlated with the length of the vessel (-0.42).

Characterization of cholesterol hemisuccinate and alpha-tocopherol hemisuccinate vesicles.

Cholesterol hemisuccinate (CHS) and alpha-tocopherol hemisuccinate (alpha-THS) were found to be capable of forming liposomes of multi- or single lamellar character. Such vesicles formed spontaneously, did not require the use of organic solvents and yielded high trapping efficiencies and captured volumes. Both CHS and alpha-THS systems greatly restricted the motion of intercalated spin labelled fatty acids, yet were more osmotically responsive than similar vesicle types comprised of phosphatidylcholine. Small angle X-ray diffraction measurements were consistent with vesicles possessing extremely weak interlamellar forces. CHS vesicles were found to remain intact in vivo, yet followed a pattern of distribution dissimilar to phosphatidylcholine vesicles.