Masticatory efficiency of implant-supported mandibular overdentures retained with attachments compared with conventional dentures: an in vitro digital colorimetric image analysis.

Despite the patient-reported advantages of implants in improving quality of life, satisfaction, and mastication, objective evaluations of the masticatory function and performance of implant-supported dentures are not well represented in the literature. The aim of the present study was to compare the masticatory efficiency of patients with conventional dentures with that of patients with mandibular overdentures retained by implants with 2 Locator attachments. A randomized clinical trial including 20 edentulous patients was conducted. The participants were randomly recruited into 2 groups, a group of 10 patients wearing conventional prostheses in both the maxilla and mandible, and a group of 10 patients wearing a conventional maxillary prosthesis opposite an implant-supported overdenture. To be included in the study, the patients had to have a well-formed ridge (Class I according to the Atwood classification). Their masticatory efficiency, assessed a minimum of 6 months after they received the denture, was evaluated through a color-mixing test using 2 colors of a commercially available chewing gum and ViewGum software, which calculated the variance of hue in the masticated specimens. The masticatory efficiency of the 2 groups was compared using repeated-measures analysis of variance (α = 0.05), which revealed no statistically significant difference between the implant-supported overdenture and conventional denture groups (P > 0.05). Within the limits of this study, the results suggest that a mandibular implant overdenture has no advantage over a conventional complete denture with regard to masticatory efficiency or food comminution in patients who have a well-formed mandibular ridge.

A modified technique for anterior multilevel cervical fusion.

Anterior cervical fusion with interbody bone graft and anterior plating is commonly performed. Unfortunately, the plate has been reported to shield the graft from loading, thus reducing fusion rates. Interbody fusion cages have been effective in the lumbar spine and have gained acceptance in the cervical spine. Twenty-five patients underwent anterior cervical fusion with this modified technique. All patients received anterior diskectomy and corpectomy, placement of an interbody fusion cage packed with corpectomy bone, and application of an anterior cervical plate. Fusion was defined by radiographic evidence of trabecular bone bridging through the cage. No external bracing was used except soft collars as needed. Pre- and postoperative pain scales were completed and statistically analyzed using paired t tests. There were no cases of pseudoarthrosis or major neurological, vascular, or wound complications. There was one case of mild dysphagia that remained unresolved. Mean operative time was comparable to standard instrumented multilevel cervical fusion surgeries. Visual analogue pain scales were significantly improved following surgery. The advantages of using interbody cages with anterior plating include immediate stability and support, elimination of donor site pain from iliac crest bone autograft, and a decrease in pseudoarthrosis by halving the number of fusion surfaces.

Excerpts from Managing CQI in Radiology and Diagnostic Imaging Services: A CQI Handbook.

Continuous quality improvement (CQI) is currently the most popular and influential quality management program used in healthcare organizations. It is an effective methodology for identifying and acting on opportunities to improve the efficiency, effectiveness and value of services provided to customers. CQI implementation can be broken down into four components: (1) achievement objectives and goal identification, (2) system process analysis, (3) action planning and implementation, and (4) performance measurement and follow-up. As the project team establishes goals, it should consider customer and staff needs, what constitutes "quality," existing guidelines and regulations, and how results will be measured. Many techniques can be used to analyze the procedure or function targeted for improvement, including charts and diagrams, formal monitoring, data collection and statistical analysis. After the project team has identified potential service improvements, they develop an action plan, which may include education, recruitment, reassignment or equipment acquisition. The team must consider the impact of proposed changes and the financial and logistical feasibility of various proposals. The dynamic challenges of radiology and diagnostic imaging cannot be addressed through single, isolated actions; efforts to improve quality should be continuous. Accordingly, the project team should measure and analyze results of the action plan, reappraise goals and look for opportunities to further improve service.

Instituting a concurrent process for monitoring the clinical risk of physicians' practice.

By implementing a more concurrent program for identifying and responding to situations that put patients at risk, such as the approach described in this article, hospital quality assurance and risk management professionals, as well as the medical staff and administration, may finally achieve the complementary goals of increasing the quality of clinical care while simultaneously reducing claims and suits against the hospital and its physicians.

The consciousness of being conscious.

Starting with the therapeutic advantage gained when insight acquires consciousness, an investigation of the nature and function of consciousness is undertaken. Consciousness is a state of awareness, having a range of higher mental functions serving a regulatory, controlling, and integrating role in mental activity. There are high levels of thinking, reality testing, experiencing, judging, anticipating; self-awareness and self-reflection enter into these controlling activities. Psychoanalysis has rightly been a science that studies the workings and contents of the unconscious portions of the mind. It has perhaps overlooked the important role that consciousness plays in ordinary life and in providing the levels of control and self-awareness individuals both experience and require. That pathology and disturbances of function may accompany normal states of consciousness as well as altered states of consciousness is a common clinical phenomenon. Psychoanalysis as a therapy widens the scope of the conscious control systems.

Passing JCAH muster, or, six essential ingredients for a successful quality assurance program.

Quality assurance deficiencies result in more contingency-based accreditation decisions than any other factor. The authors examine how trustees can ensure that their hospitals' quality assurance programs meet all necessary standards.

Presidential address: normal in psychoanalysis.

This paper is an attempt to spell out some of the usages of 'normal' in psychoanalysis in respect to the concepts lying behind such usage, and to attempt to see how various of these usages and concepts have been and can be employed in present day psychoanalysis. This started out as a seemingly simple exploration of the meaning of a term but turned into a puzzling exposition, the dimensions of which were not anticipated, and perhaps, were not fulfilled in the course of this presentation. In the final section, the author returns to the concept of normality as progressing over time and links this with the concept of average and expectable. This concept, as defined by research and experience, is the most operationally useful one when applied to the individual. From this point of view, the same seems to apply to psychoanalytic societies and groups.

The therapeutic aspects of affect.

A satisfactory psychoanalytic definition and theory of affects has not yet been evolved. In spite of this, analysts work with affects using, for practical purposes, a common-sense definition leading to a therapeutic advantage in coordinating affective and cognitive structures as they appear in the course of a prolonged analysis. Undoing of defenses facilitates this process, allowing the ego's integrative capacities to function more adequately and satisfactorily in relation to inner and outer reality. A developmental hierarchy of affects emerges in this way ranging from primitive--all or none--affective experiences to adult, modified expression of such ego experiences. A brief historical survey of the changing forms of the theory of affects is included, as are clinical vignettes illustrating the therapeutic aspects of dealing with affective expression in the psychoanalytic situation. The therapeutic gains of such work comes about through the integration of earlier affective experiences into more developed cognitive structures allowing a variety of ego functions greater control over adult experiences.

Symposium on The Ego and the Id after fifty years. Clinical formulations and research.

The Ego and the Id has served as an organizing model which has advanced psychoanalysis as a science and as a therapy. The paradigm offered by the structural formulations provided a framework for many developmental and clinical studies as well as an approach to a general psychology of human behavior. Therapeutic advances have been made, but the art of therapy has not kept pace with the scientific advances. Dissatisfaction with psychoanalysis and psychoanalytic theory is discussed. Theories have become too far removed from their clinical base; a changing sociologic climate that has reduced the impact of the rational attitude offered by psychoanalysis and the failure of psychoanalytic therapy to cure all ills have contributed to the dissatisfaction.