Dental patient education: a survey from the perspective of dental hygienists.

OBJECTIVES: The aim of this study was to describe the current patient education practices of dental hygienists by exploring their views concerning their skills and knowledge related to patient education and by determining the implementation of patient education in their work, with regard to both method and content. METHODS: The target group consisted of 416 dental hygienists (n = 222, 53%) The research strategy used was a survey. The material was gathered using questionnaire. RESULTS: According to the dental hygienists, their skills and knowledge about patient education were good. However, the implementation of education was not in line with these assessments. The content of the education given focused mostly on the functional dimension. Little use was made of various educational methods, and the dental hygienists felt that they were not in good enough command of the methods. The patient's expectations and learning were not assessed systematically. The education provided and the assessment of the need for education often focused on the professional him/herself and the standpoint of the patient empowerment was disregarded. CONCLUSIONS: These results lay the foundation for additional research aimed at developing the patient education given by these professionals and making it support the empowerment of each patient.

Tetanic stimulus of ulnar nerve as a predictor of heart rate response to skin incision in propofol remifentanil anaesthesia.

BACKGROUND: To study adequate antinociception during general anaesthesia, tetanic stimulus of 5-10 s duration has been used previously as a standardized nociceptive stimulus. However, such stimuli have been found to correlate poorly with intraoperative nociception. We hypothesized that an electrical tetanic stimulus of the ulnar nerve, lasting 30 s, would provide a reliable experimental pain model. METHODS: Thirty-three patients, undergoing open abdominal surgery, were studied. Propofol and remifentanil were used for anaesthesia. Patients were randomized to receive remifentanil at three target-controlled infusion levels (1, 3, or 5 ng ml(-1)) during short (5 s, Tet5) and a long-lasting (30 s, Tet30) tetanic (50 mA, 50 Hz) stimulus and skin incision. RR intervals (RRI) were obtained from the ECG and the mean RRI before each stimulus (Tet5, Tet30, incision) was compared with that after the stimulus. RESULTS: At remifentanil level 1 ng ml(-1), the RRI responses to tetanic stimuli and skin incision were prominent but with higher concentrations (3 and 5 mg ml(-1)), responses were very small. Tet30 (r(2)=0.780) was the best predictor of the RRI response to skin incision when compared with Tet5 (r(2)=0.611), remifentanil level (r(2)=0.340), or propofol level (r(2)=0.036). CONCLUSIONS: Long-lasting tetanic stimulus of ulnar nerve may provide a better experimental pain model for surgical pain during general anaesthesia than shorter stimuli, which have been applied in earlier studies.

The second extracellular loop of alpha2A-adrenoceptors contributes to the binding of yohimbine analogues.

BACKGROUND AND PURPOSE: Rodent alpha(2A)-adrenoceptors bind the classical alpha(2)-antagonists yohimbine and rauwolscine with lower affinity than the human alpha(2A)-adrenoceptor. A serine-cysteine difference in the fifth transmembrane helix (TM; position 5.43) partially explains this, but all determinants of the interspecies binding selectivity are not known. Molecular models of alpha(2A)-adrenoceptors suggest that the second extracellular loop (XL2) folds above the binding cavity and may participate in antagonist binding. EXPERIMENTAL APPROACH: Amino acids facing the binding cavity were identified using molecular models: side chains of residues 5.43 in TM5 and xl2.49 and xl2.51 in XL2 differ between the mouse and human receptors. Reciprocal mutations were made in mouse and human alpha(2A)-adrenoceptors at positions 5.43, xl2.49 and xl2.51, and tested with a set of thirteen chemically diverse ligands in competition binding assays. KEY RESULTS: Reciprocal effects on the binding of yohimbine and rauwolscine in human and mouse alpha(2A)-adrenoceptors were observed for mutations at 5.43, xl2.49 and xl2.51. The binding profile of RS-79948-197 was reversed only by the XL2 substitutions. CONCLUSIONS AND IMPLICATIONS: Positions 5.43, xl2.49 and xl2.51 are major determinants of the species preference for yohimbine and rauwolscine of the human versus mouse alpha(2A)-adrenoceptors. Residues at positions xl2.49 and xl2.51 determine the binding preference of RS-79948-197 for the human alpha(2A)-adrenoceptor. Thus, XL2 is involved in determining the species preferences of alpha(2A)-adrenoceptors of human and mouse for some antagonists.

Assessment of surgical stress during general anaesthesia.

BACKGROUND: Inadequate analgesia during general anaesthesia may present as undesirable haemodynamic responses. No objective measures of the adequacy of analgesia exist. We aimed at developing a simple numerical measure of the level of surgical stress in an anaesthetized patient. METHODS: Sixty and 12 female patients were included in the development and validation data sets, respectively. All patients had elective surgery with propofol-remifentanil target controlled anaesthesia. Finger photoplethysmography and electrocardiography waveforms were recorded throughout anaesthesia and various waveform parameters were extracted off-line. Total surgical stress (TSS) for a patient was estimated based on stimulus intensity and remifentanil concentration. The surgical stress index (SSI) was developed to correlate with the TSS estimate in the development data set. The performance of SSI was validated within the validation data set during and before surgery, especially at skin incision and during changes of the predicted remifentanil effect-site concentration. RESULTS: SSI was computed as a combination of normalized heart beat interval (HBI(norm)) and plethysmographic pulse wave amplitude (PPGA(norm)): SSI = 100-(0.7*PPGA(norm)+0.3*HBI(norm)). SSI increased at skin incision and stayed higher during surgery than before surgery; SSI responded to remifentanil concentration changes and was higher at the lower concentrations of remifentanil. CONCLUSIONS: SSI reacts to surgical nociceptive stimuli and analgesic drug concentration changes during propofol-remifentanil anaesthesia. Further validation studies of SSI are needed to elucidate its usefulness during other anaesthetic and surgical conditions.

Novel multiparameter approach for measurement of nociception at skin incision during general anaesthesia.

BACKGROUND: Direct indicators for the evaluation of the nociceptive-anti-nociceptive balance during general anaesthesia do not exist. The aim of this study was to combine physiological parameters to obtain such an indicator. METHODS: Fifty-five females scheduled for surgery under general anaesthesia combining target-controlled infusions of propofol and remifentanil were studied. Propofol was given to maintain state entropy (SE) at 50 and remifentanil was targeted at 1, 3 or 5 ng ml(-1). The patients' reactions and clinical signs of nociception, remifentanil levels and estimation of noxious intensity of incision were combined into a clinical score [Clinical Signs-Stimulus-Antinociception (CSSA)] to evaluate the nociceptive-anti-nociceptive balance. ECG, photoplethysmography (PPG), response entropy (RE) and SE were recorded from 60 s before to 120 s after skin incision. Differences between post- and pre-incision values of heart rate variability (HRV), PPG and pulse transition time related parameters were analysed off-line to evidence the best predictors of CSSA. Those best predictors of CSSA served to develop a response index of nociception (RN), scaled from 0 to 100. This index was further tested in 10 additional patients. RESULTS: HRV, RE, RE-SE and PPG variability were the best predictors of CSSA. The prediction probability of RN at predicting CSSA was 0.78. RN response was higher after larger incision, in movers and with lower remifentanil concentrations. CONCLUSIONS: The empirically developed algorithm of RN leads to an index that seems to adequately estimate the nociceptive-anti-nociceptive balance at skin incision during general anaesthesia. In the future, CSSA may serve as a reference for studies investigating methods aimed at evaluating this pharmacodynamic component of anaesthesia.

The occurrence of double strand DNA breaks is not the sole condition for meiotic crossing over in Drosophila melanogaster.

Analysis of the interchromosomal effects of In(2L + 2R)Cy, In(3L + 3R)LVM and their joint effect on the frequencies of single and double crossovers in the cv-v-f region of the X chromosome as well as interference showed that both inversions, occurring separately, increased the frequency of single as well as double crossovers and the coefficient of coincidence. However, when the inversions occurred together the frequencies of single crossovers no longer increased, but the frequency of double crossovers, as well as the coefficient of coincidence did increase. These results indicate firstly that the interchromosomal effects influence some precondition of exchange, but that this precondition is not an occurrence of double strand DNA breaks. Thus, the occurrence of double strand DNA breaks is not the sole condition for crossing over in Drosophila melanogaster.

Occurrence of double strand DNA breaks and pairing of homologous chromosomes are preconditions of crossing over in Drosophila melanogaster, and its timing.

Brood pattern analysis of the effect of a heat shock (35 degrees C 24h) given to the parental females in presence and absence of In (2L + 2R) Cy in heterozygous condition in the second chromosome on recombination and interference in the cv-v-f region of the X chromosome showed the following: (i) In the absence of the inversion recombination frequencies in both gene intervals increased in the daily broods, which represent oocytes in which premeiotic DNA synthesis was occurring during the heat shock treatment. (ii) In the presence of the inversion recombination frequencies did not increase in any of the daily broods. (iii) The frequencies of double crossovers did not increase in any broods either in the presence or in the absence of inversion. (iv) The coefficient of coincidence changed in virtually all broods both in the presence and absence of the inversion, indicating that the heat shock affects the distribution of single crossovers. (v) The results showed that the effect of the heat shock on the coefficient of coincidence was similar during premeiotic DNA synthesis both in the absence and presence of the inversion, but different in the broods representing oocytes which were undergoing the first meiotic division, suggesting that crossing over occurs during this division, probably during pachytene.

Genetic evidence that Notch affects independently the development of machrochaeta and wing venation in Drosophila melanogaster.

Temperature sensitive experiments on the interaction of Abruptex mutations of the Notch locus and Enhancer of split indicate that the effect of temperature on the development of macrochaeta and wing venation is different. This suggest that Notch affects the development of macrochaeta and wing venation in different and independent ways being in accordance with the proposition that the signal pathway from the Notch receptor at the cell membrane to Enhancer of split complex in the nucleus is different in the case of the development of macrochaeta and wing venation. The Abruptex mutations as gain-of-function mutations of the Notch locus cannot rescue the Enhancer of split phenotype.

A selective method for studying primary sex chromosome non-disjunction in females and males and X-Y exchange in males of Drosophila melanogaster including a demonstration of euchromatic X-Y exchange.

A selective method was developed, based on negative complementation of the Abruptex alleles of the Notch locus, for studying primary sex chromosome non-disjunction in females and males of Drosophila melanogaster and X-Y exchange in males. The results show that the frequency of primary non-disjunction of structurally normal X chromosomes was lower than the frequency of X-derY non-disjunction in males. Double exchange between the X and the derY chromosome in the male occurs with a frequency of at least 0.091%. Single exchanges are naturally expected to occur with even higher frequency. Exchanges were interestingly at least partly of euchromatic nature. The origin of these exchanges is at least partly of gonial origin.

Further studies on the interchromosomal effect on crossing over in Drosophila melanogaster affecting the preconditions of exchange.

The second chromosome inversion In (2L+2R) Cy in a heterozygous condition was studied for its effect on frequency and interference of crossing over in three different regions of the X chromosome of Drosophila melanogaster. A significant increase in crossing over frequency was observed in the proximal and distal regions of the X chromosome while in the middle of the chromosome crossing over frequency remained unaltered. The effect on interference remained unaltered at both ends of the X chromosome while a significant decrease was observed in the middle of the chromosome. These results suggest that the interchromosomal effect on crossing over affects the preconditions of exchange differently in different regions of the X chromosome, and possibly the duration of chromosome pairing.

Suppression of the TSH response to TRH by thyroxine therapy in differentiated thyroid carcinoma patients.

Absent response of serum thyrotrophin (TSH) after stimulation with 200 micrograms synthetic thyrotrophin-releasing hormone (TRH) was used as a criterion of adequate suppression of TSH in the treatment of thyroid carcinoma patients with thyroxine. The mean causing total suppression of the response was 223 micrograms of thyroxine per day. At this dose level about 40% of the patients had serum thyroxine concentrations above the upper reference interval and only 10% had elevated triiodothyronine concentrations. In some patients the TSH response to TRH varied between absent and low normal when tested at long intervals. The ideal dose of thyroxine is obviously slightly higher than the smallest one causing total suppression of the TSH response to TRH, i.e. about 250 micrograms a day. The individual dose must be found using the TRH stimulation test because serum thyroid hormone levels cannot be used as a guideline for adequate dosage. In some patients the thyroid remnant of apparently normal thyroid tissue was not totally suppressed although the thyroxine dose was definitely above the level causing suppression of the response to TRH.