The Herbst appliance and the Activator: influence of the vertical facial pattern.

AIM: To compare the effects of the Herbst appliance and the Activator at the completion of two-phase treatment, with respect to the vertical facial pattern (VFP) and to identify possible predictors of treatment effect. MATERIALS AND METHODS: Pretreatment, post-treatment and overall cephalometric change data were used to assess the dental and skeletal effects. Results for the change in mandibular length were also compared with changes reported for an untreated external control group. RESULTS: Clinically significant dental and skeletal changes (including mandibular incisor proclination and overjet reduction) were characteristics of both treatment methods. Any increases in mandibular length and chin prominence were not greater than those expected following natural growth. The pretreatment VFP remained essentially unaltered, while mean changes as a result of treatment were similar for brachyfacial, mesofacial, and dolichofacial subjects. No predictive factors were identified. CONCLUSIONS: Clinicians are advised to expect significant overlet reduction and mandibular incisor proclination with either treatment method. Significant skeletal change may be observed in growing subjects; however, any increase in mandibular length or chin projection is not likely to be beyond the limit set by nature. While there will be some individual variation, no significant long-term alteration in the pretreatment vertical facial pattern should be expected with either treatment. Long faces will remain long and short faces will remain short.

A study examining the impact of 12-hour shifts on critical care staff.

BACKGROUND: Twelve-hour shifts contribute to flexible patterns of work, but the effects on delivery of direct care and staff fatigue are important topics for deeper examination. AIMS: To examine the impact and implications of 12-hour shifts on critical care staff. METHODS: A staged dual approach using two focus groups (n = 16) and questionnaires (n = 147) with critical care staff from three critical care units. RESULTS: Positive effects were found with planning and prioritizing care, improved relationships with patients/relatives, good-quality time off work and ease of travelling to work. Less favourable effects were with caring for patients in isolation cubicles and the impact on staff motivation and tiredness. Acceptable patterns of work were suggested for 'numbers of consecutive shifts' and 'rest periods between shifts'. CONCLUSIONS: Most participants believed 12-hour shifts should continue. The challenge is to ensure existing systems and practices develop to improve on the less positive effects of working 12-hour shifts. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides nurse managers with important and relevant staff views on the impact of working 12-hour shifts. In particular to those working within a critical care environment and suggests the challenge is to ensure existing systems and practices develop to improve on the less encouraging effects of working 12-hour shifts. It adds an understanding of the senior nurse's view on the positive and negative effects of managing and organizing staff off duty to safely run a department with 12-hour shifts.

A comparison of sleep assessment tools by nurses and patients in critical care.

AIM: The aim of this critical care sleep assessment pilot study was to evaluate the usefulness of three sleep assessment tools to identify which, if any, provided the closest comparison between the nurses' judgement and the patients' experience of their sleep. The study objectives were to: (i) compare patients' and nurses' assessment of sleep using three different rating tools. (ii) Ascertain patients' preferences with non-interventional, user friendly, practical tools in critical care. (iii) Recommend changes and improvements to the way that sleep is assessed and documented. BACKGROUND: Sleep is important for promoting critical care recovery and sleep disturbance is known to cause irritability, aggression and increased stress levels. The availability and use of valid critical care sleep assessment tools is limited. DESIGN: A descriptive comparative study using three sleep assessment-rating scales were constructed to provide easy to understand tools for completion by both patients and nurses in critical care. METHODS: Structured interviews were undertaken with 82 patients and 82 nurses using a convenience sample from four multispecialty critical care units in one large teaching trust. Patients were included in the study if they met a list of pre-defined criteria to obtain responses from lucid orientated patients. RESULTS: No tool produced a close association between the nurses' assessment of the patients sleep and the patients' assessment of their sleep. Patients found two of the three tools easy to use when rating their sleep. Discussion. Objective invasive measurements of sleep as well as complex subjective tools appear inappropriate to be used as a part of daily critical care practice. The application of simple rating scores has a high degree of error when nurses assess patients' sleep, even though high levels of patient observation and assessment are practiced in critical care. CONCLUSIONS: More research is needed to examine the assessment of sleep in critical care, particularly linking rating scales to alternative methods of physiological assessment of sleep. Findings indicate nurses are unable to accurately assess critical care patients' sleep using rating assessment tools. However patients were found to prefer two sleep assessment tools, one banded in hours to assess sleep quantity and one as a comparison against normal sleep to assess sleep quality. RELEVANCE TO CLINICAL PRACTICE: This study reviews the importance of sleep assessment and the diverse methods available for assessing sleep focussing on the critically ill patient. More noteworthy it highlights how nurses sole judgements of patients sleep is not a reliable method in clinical practice, however it provides some indication on the application of 'easy to use' tools to assist in the patients assessments of their sleep.

An evaluation of critical care lecturer practitioners.

The aim of this study was to evaluate the educational value and impact upon staff of critical care lecturer practitioners. Data were collected through three staff focus groups (n=21) and a questionnaire completed by 70 members of trust or university staff. A majority of respondents felt that the lecturer practitioner roles had considerable effect upon adult critical care services. Six main categories of findings were derived from analysis and integration of both focus group and questionnaire data--development of knowledge; staff support; being a teacher; developing and maintaining the workforce; role improvement plus removal of the lecturer practitioner role. Many of these findings concur with the limited quantity of evaluative literature on the lecturer practitioner role. The authors produced a report recommending continued funding for existing lecturer practitioner posts; introduction of more lecturer practitioner posts should be considered, and further role evaluation should be conducted at both a local and national level.