Fracture behavior of short fiber-reinforced CAD/CAM inlay restorations after cyclic fatigue aging.

The aim of this study was to assess the fracture behavior of molar teeth restored with MOD inlays made of experimental short fiber-reinforced CAD/CAM composite block (SFRC CAD) before and after cyclic fatigue aging. Standardized MOD cavities were prepared on 60 intact mandibular molars. Three groups of CAD/CAM made inlay restorations (Cerasmart 270, Enamic, and SFRC CAD) were fabricated (n = 20/group). All restorations were luted with self-adhesive dual-cure resin cement (G-Cem One). Half of restored teeth per each group (n = 10) were quasi-statically loaded until fracture without aging. The other half underwent cyclic fatigue aging for 500,000 cycles (Fmax = 150 N) before being loaded quasi-statically until fracture. Then, the fracture type was visually inspected. The microstructure and elemental content of CAD/CAM materials were assessed using SEM and EDS. Two-way analysis of variance (ANOVA) was used to statistically examine the data, and it was followed by the Tukey HSD test (α = 0.05). ANOVA demonstrated that both material type and aging had a significant effect (p < 0.05) on the load-bearing capacity values of the restorations. Teeth restored with SFRC CAD showed significantly the highest (p < 0.05) load-bearing capacity (2535 ± 830 N) after fatigue aging among all groups. SEM images showed the ability of short fibers in SFRC CAD composite to redirect and hinder crack propagation. With regard to fracture mode, Enamic group revealed 85% of catastrophic failure (vs. 45% and 10% for Cerasmart 270 and SFRC CAD, respectively). Large MOD cavities on molar teeth were most favorably restored with SFRC CAD inlays, yielding the highest load-bearing capacity and more restorable failures.

Comparison of the auditory and visual privacy of emergency department treatment areas with curtains versus those with solid walls.

STUDY OBJECTIVE: The design and function of emergency departments may allow breaches of privacy that could adversely affect patient satisfaction and medical care. We sought to determine whether patients perceive less privacy in ED treatment areas with curtains than in rooms with solid walls. METHODS: Patients 18 years and older at a university hospital ED who received care in a room with solid walls and a door, a curtained area next to the nurses' station, or a curtained area away from the nurses' station were surveyed. Patients responded on a 5-point Likert scale to 11 questions regarding privacy. Differences between areas were determined by using the Kruskal-Wallis and Mann-Whitney tests and were considered significant at P values of less than.05. RESULTS: Structured interviews were conducted with 108 ED patients. Responses from those in the curtained areas were similar. Compared with those in the rooms with walls, these patients more often believed that they could overhear others and that others could hear them, view them, hear personal information, and view personal parts of their bodies (P < or =.04 for all). They also perceived a lower overall sense of privacy (P <.01). Of all those surveyed, 85.2% reported "a lot of" or "complete" respect for privacy by the staff, and 92.6% experienced at least as much privacy as they expected, with no difference between areas. CONCLUSION: Patients perceive significantly less auditory and visual privacy in ED treatment areas with curtains compared with a room with solid walls. Consideration of these findings in current practice and in future ED design and construction is suggested.

How well do patients obtain short-term follow-up after discharge from the emergency department?

STUDY OBJECTIVE: We sought to determine the follow-up rate of discharged emergency department patients who were instructed to obtain reevaluation within 48 hours at our ED, a clinic, or a private physician's office and to determine the reasons why patients do not obtain short-term follow-up when instructed. METHODS: Emergency physicians prospectively enrolled a convenience sample of patients discharged from a university hospital ED who were believed to be at risk for clinical deterioration. Patients were instructed to obtain reevaluation within 48 hours at a public clinic, private physician's office, or our ED (without charge). A telephone interview was conducted after 48 hours had elapsed. RESULTS: Three hundred twenty-five patients were enrolled, 300 were included in data analysis, and 203 (67.7%) of these obtained follow-up as instructed. Those referred to the ED had a higher follow-up rate (105/127 [82.7%]) than those referred to clinics (59/99 [59.6%]) or private physicians (39/74 [52.7%]). Inability to obtain an appointment was cited by 34.3% of those who did not obtain follow-up care as instructed. CONCLUSION: Many patients discharged from the ED who were believed to be at risk for clinical deterioration did not obtain medical follow-up within 48 hours when so instructed. Free ED follow-up resulted in a better rate of short-term follow-up than that for clinics and private physicians and may be especially useful if a patient's ability to obtain follow-up is uncertain or if timely reevaluation is particularly imperative.

In vivo tissue temperature comparison of cryotherapy with and without external compression.

STUDY OBJECTIVE: To compare the tissue-cooling efficiency of external cryotherapy with and without adjunctive compression. METHODS: We conducted an experimental repeated-measures study in which each of the 11 anesthetized subject dogs served as its own control. A chemical instant cold pack was applied to each subject's ventral thighs. One pack was held in position by gravity, and the other was compressed against the musculature with a tubular elastic wrap. Baseline and subsequent temperature measurements were taken every 10 minutes for 1 hour with the use of an IM temperature probe percutaneously inserted into each subject's hind legs. RESULTS: IM temperatures were not significantly different at baseline and were coldest at 20 minutes; they increased slowly thereafter. The recorded temperature was lower under the compressed cold pack (P = .003), and changes over time for both groups were also significant (P = .005). The instantaneous temperature difference at 10, 30, 40, 50, and 60 minutes was also significant. CONCLUSION: Externally applied instant cold packs in a dog model caused local tissue hypothermia that peaked by 20 minutes, persisted for at least 1 hour, and was significantly augmented by adjunctive compression. Further research is needed to evaluate the clinical efficacy and safety of these interventions in the management of acute soft-tissue injuries.

Enhancing the value of journal club: use of a structured review instrument.

A study was undertaken to determine if use of a structured review instrument (SRI) increased the perceived overall satisfaction with a journal club in a group of emergency medicine residents. Before and 6 months after the introduction of a structured checklist format for article review, a 5-point Likert scale (1 = worst, 5 = best) was used to assess residents' satisfaction with the journal club, as well as the following subsidiary outcome parameters resident and leader workload, educational value in interpreting the medical literature, and application of the information to clinical practice. Additional measured outcome variables included resident attendance and number of articles read per attendee. Continuous and categorical data were compared using the Wilcoxon Rank Sum test and Fisher's exact test, respectively. Following introduction of the SRI, residents were more satisfied with the journal club (3.8 v 3.2, P < .05). There was no change in resident attendance (92% v 71%, P = .65), total articles read (75% v 70%, P = .33), or perceived workload (3.3 v 3.1; P = .3). The use of a SRI was found to increase resident satisfaction and improve the perceived educational value of a journal club without increasing residents' workload or decreasing attendance.