Effect of hypnosis on masseter EMG recorded during the 'resting' and a slightly open jaw posture.

The aim of this experimental study was to determine whether minimal levels of electromyographic activity in the masseter muscle are altered when individuals are in a verified hypnotic state. Experiments were performed on 17 volunteer subjects (8 male, 9 female) all of whom gave informed consent. The subjects were dentate and had no symptoms of pain or masticatory dysfunction. Surface electromyograms (EMGs) were made from the masseter muscles and quantified by integration following full-wave rectification and averaging. The EMGs were obtained (i) with the mandible in 'resting' posture; (ii) with the mandible voluntarily lowered (but with the lips closed); (iii) during maximum voluntary clenching (MVC). The first two recordings were made before, during and after the subjects were in a hypnotic state. Susceptibility to hypnosis was assessed with Spiegel's eye-roll test, and the existence of the hypnotic state was verified by changes in ventilatory pattern. On average, EMG levels expressed as percentages of MVC were less: (i) when the jaw was deliberately lowered as opposed to being in the postural position: (ii) during hypnosis compared with during the pre- and post-hypnotic periods. However, analysis of variance followed by post hoc tests with multiple comparison corrections (Bonferroni) revealed that only the differences between the level during hypnosis and those before and after hypnosis were statistically significant (P < 0·05). As the level of masseter EMG when the mandible was in 'resting' posture was reduced by hypnosis, it appears that part of that EMG is of biological origin.

Effect of saliva and blood contamination on the bi-axial flexural strength and setting time of two calcium-silicate based cements: Portland cement and biodentine.

This study evaluated the effect of contamination with saliva and blood on the bi-axial flexural strength and setting time of pure gray Portland cement and Biodentine (Septodont, Allington, UK). A one-way ANOVA showed that contamination caused no significant difference between the cements in bi-axial flexural strength (P> 0.05). However there was a significant difference in setting time (P

The Kushida Index as a screening tool for obstructive sleep apnoea-hypopnoea syndrome.

OBJECTIVES: To test the validity of the Kushida Index for screening for sleep apnoea in a West of Scotland adult population. METHODS: Specific intra-oral measurements and respiratory polysomnography were carried out on 71 patients in this prospective study. The intra-oral measurements were applied to the Kushida formula to obtain a value for the Kushida Index. This value was compared to the diagnosis obtained using polysomnography in the conventional manner. RESULTS: The sensitivity of the Kushida Index in this present study was 68% (95% CI 50-81) and the specificity was 71% (95% CI 52-84). The positive predictive value was 71% and the negative predictive value was 67%. The Mallampati score, Epworth sleepiness score and enlargement of the tongue, soft palate or tonsils were not statistically significantly related to a diagnosis of sleep apnoea (p >0.05). CONCLUSION: With the limited sensitivity and specificity of the Kushida Index demonstrated in this study, this test cannot be recommended as a screening tool for sleep apnoea in a West of Scotland population.

The attitudes of general dental practitioners and medical specialists to the provision of intra-oral appliances for the management of snoring and sleep apnoea.

AIM: To determine the attitudes and awareness of dental and medical practitioners in Scotland to the provision of oral appliances for the management of snoring and sleep apnoea. SETTING: The questionnaire was completed by general dental practitioners randomly selected from across Scotland and by doctors specialising in sleep medicine within Scotland. METHOD: A questionnaire was devised and sent to 17 specialists in sleep medicine and 210 general dental practitioners, community dental service practitioners and hospital-based dental practitioners. A reply-paid envelope was included with each questionnaire. RESULTS: There were 14 replies (82%) from specialists and 105 (50%) from dentists. All the specialists felt that dentists had a role in the management of these patients. Of the replies from dentists, 60 (57%) stated that they provided appliances but their screening for sleep apnoea and discussion of the side-effects of appliances varied widely. Seventy-eight dentists (74%) expressed an interest in attending a course on the management of sleep apnoea and snoring. CONCLUSIONS: The current practice of specialists and dentists in the management of obstructive sleep apnoea and socially disruptive snoring with oral appliances in Scotland is varied. Many dentists expressed a wish for further training in this area.

Snoring, sleep apnoea and the role of dental appliances.

This article describes the problems of snoring and obstructive sleep apnoea, together with an outline of treatment options. The Glasgow approach, whereby patients are investigated at a sleep clinic and a custom-made mandibular advancement device is made in semi-soft material, is also described. We have demonstrated the acceptability and effectiveness of a simple appliance in patients with varying dental states, some with simple snoring and some with mild to moderate sleep apnoea. Our experience relates to around 260 patients, extending over a period of 4 years with good success. The simple intraoral device is recommended as a first line of approach for patients with problem snoring.

Physician executives breaking out of middle management.

Physician executives are slowly moving into top management jobs, holding the same stature on senior management teams as chief financial officers and executive vice presidents. Learn how the role of the physician executive is evolving and how opportunities are expanding for even more physicians to assume the top-level posts.

The right paperwork for the right audiences.

Physician executives need to exercise considerable discretion, care, and judgment when they write about their professional accomplishments in the form of a résumé or curriculum vitae (CV). This paperwork is intensely personal. It must be a true reflection of you, your achievements and goals. Others read it to learn more about you. Those you fail to convince, you're likely to lose--along with your chance to meet and charm them in a personal interview. A physician executive's thoughtfully prepared résumé and CV can result in him or her being offered terrific opportunities for career growth. The paperwork is a self-constructed gateway through which you can properly approach hiring organizations--and how it reads is totally under your control. Some suggestions to consider in developing your résumé or CV are: be succinct; don't overstate; use both documents; do your homework; and be ready for the next steps.

Relaxation rate in the assessment of masseter muscle fatigue.

The aim of this study was to assess a simple method of measuring relaxation rate in the jaw-closing system for the purpose of quantifying jaw muscle fatigue. A summary of the various different methods of measuring relaxation rate is also provided. The rates of twitch contraction and relaxation were measured in 30 symptom-free subjects following bilateral direct electrical stimulation of the masseter muscles. The resulting twitch force was recorded via a force transducer placed between the anterior teeth. The transducer was held between the teeth with as little force as possible while four single stimuli were delivered at 5-s intervals. The stimulating electrodes were then removed and replaced and the experiment was repeated. The force records of the resulting twitches were averaged and the half-contraction time, twitch amplitude and half-relaxation time were measured. There was a significant difference in half-relaxation time between males and females, being faster in females (P=0.0045, independent t-test). No significant difference was found in twitch amplitude and half-contraction time between males and females. Half-relaxation time and half-contraction time were independent of twitch amplitude. This method of measuring the relaxation rate of the masseter muscles was found to be practical and the results were reproducible between sessions.

Common denominators of success.

There is no mystery to the success stories described in this column. In addition to a lot of hard work, a few basic principles have been applied to widely differing scenarios. These common denominators provide the philosophies and dynamics that can lead to your breakthroughs in quality health care delivery: (1) Trust--among the physicians and then between them and management and the board of directors; (2) positive physician culture and attitudes; (3) effective physician leadership; (4) patient care focus; (5) strong team orientation; and (6) true accountability by all stakeholders. Your job is to help your physicians feel they are major stakeholders in your health care delivery system and be their voice in clinical and financial decision-making at the highest level.

Opportunities? Barriers? It's up to you.

This career advice column is usually directed toward those in transition--physician executives who are actively pursuing job opportunities or preparing to do so. But most of your career is actually spent in a position and on the job. So it seems appropriate to focus on the great majority of physician executives who are not currently in the job market. Take a look at opportunities to learn and grow in your present position.

Winning the interviewing game. II.

Try to gain as much knowledge as possible about the culture, tactics, psychology and sensitivity of a hiring organization before you go on the job interview. Even small slights or seemingly harmless missteps can cost you the job.

Is it our turn to be CEO yet?

Physician executives continue to have ambitions for the health care CEO role, despite the difficult economic times. And though few have yet been chosen for the position, the expectation is that this will change markedly in the next five to seven years. Today, physician executives have legitimate, relevant professional experiences that directly qualify them for CEO roles in health initiatives. And no executive is more qualified to deal with medical care management issues than the physician executive. Key elements of preparedness are: Executive thinking, bundling projects, and learning to manage managers. The opportunities will be open to those who are ready to take them on.

Getting started as a physician executive.

In clinical practice, technical skills often outweigh interpersonal and leadership skills as success factors--you can be a great doctor and a so-so person. But the reverse seems to be true in the physician executive role; it is precisely the intangible leadership skills that contribute to and determine potential success. And they can be tough to master, especially when you focus on them for the first time, partway through an already-successful career. Practicing leadership is like practicing medicine. It's not just a matter of learning some new things--if it were only that, physicians are known to be excellent learners. Nor is it just a matter of determination or application--this is not a battle that sweat and effort alone can win. Most physicians will want to "try on" the executive role before making strategic moves in that direction. But be clear about what you want to get out of any project or activity before you jump in. If you're seeking a management degree, the best approach is to tie together developing your technical and interpersonal skills, as well as the formal credentials.

High expectations mirror high stakes for physician executives.

Because the stakes in health care are high, physician executives are challenged to meet high expectations set by their CEOs and boards. These may be unrealistic--for example, demanding that physician executives possess expertise in finance or strategic planning. Job stresses for physician executives are specific to the role, but are not unlike those faced by other senior executives. It's a fact that professionals leave jobs for any number of reasons; sometimes, not through their own choice or fault. Thus, every time a physician executive leaves a job, it should not be characterized as "being fired," and not every job-leaving should be taken as a failure. Accept that you may make mistakes while doing the best job you can. Rely on your own value system and integrity to see you through.

Winning the interviewing game.

Those who don't "interview well" are not likely to receive the job offer, despite their qualifications. A job interview is actually a fierce competitive activity that offers only two grades: an A or F. By nature, physicians are competitive; they like to win. Infrequent interviewees are prone to making easily corrected mistakes, such as showing no enthusiasm or having poor eye contact. The key for interviewing success is preparation--doing research, developing a personal statement, and role-playing practice interviews. View the interview as a sales call whose bottom-line goal is to achieve an offer, or at least to let you leave with the option to return for future discussions.

Delegation can make (or break) your career.

Delegation is not a soft skill. Physician executives who do not delegate well and strategically cannot expect to achieve the top jobs now or in the future. It's not enough to have great communications skills to convey your vision. You won't achieve that vision alone; you must have a great team to bring that vision to fruition. However, you can't delegate your first and most important step--self-assessment. To maximize your strengths and minimize your weaknesses, you'll need a clear view of what makes you tick. Then start thinking about your executive role in these terms: Conceptualize work mandates as projects; choose people who are better than you for your team; and try to work yourself out of a job. By learning to delegate, physician executives can make their own careers (as well as those on their team) richer and more fulfilled.

Bouncing back.

If you have taken a career sidetrack, realize that you are still marketable. You have skills, traits, and knowledge that are transferable to many new opportunities. Fortunately, many leaders today in health care and executive search are familiar with your plight, given that they all have their own version of initiatives that did not fly. They will not judge you unfairly because they understand all too well the complex pressures of today's health care environment, filled with risk, cost constraints, and unrealistic profit targets. If you're bouncing back from an unfortunate career move, these steps may keep you focused on your search for new opportunities: (1) recognize that you are not alone, (2) realize that the entity failed, not you, (3) discuss the former position in a positive light, (4) don't give in to cynicism or self-pity, (5) don't let it happen to you again, and (6) play an active role in structuring your next position.

Becoming a company person.

Physicians face a management challenge in adjusting to being part of a larger organization. By nature, physicians are not "company people." For physician executives, whose instincts can still lean toward being ferociously independent and individualistic--therein lies the struggle. Here are a few suggestions to help physician executives make the adjustments that are required of a "company person": (1) Be in the right place; (2) abandon critical/negative thinking; (3) focus on the issues; (4) maintain solidarity; and (5) make your boss look good.

The immediate effect of hard and soft splints on the EMG activity of the masseter and temporalis muscles.

The aim of this study was to compare the effects of hard and soft splints on the activity of the anterior temporalis and masseter muscles. Surface EMG recordings were made from these muscles during clenching at 10% of maximum, 50% of maximum and at maximum clench, both before and after insertion of a hard splint. This sequence was then repeated with a soft splint. The relative level of activity in the anterior temporalis and masseter muscles at all three activity levels was quantified by means of an Activity Index, which provides a measure of the balance of activity in the masseter relative to the activity in the anterior temporalis muscle. It was found that hard splints led to a decrease in EMG activity in relation to activity with no splint in both muscles at maximum clench and particularly the anterior temporalis. Soft splints produced a slight increase in activity of both muscles, but particularly the masseter muscle. The Activity Index indicated a shift in the balance of activity away from the anterior temporalis muscles with both splints, particularly at 10% of the maximum clenching level. It is possible that the decrease in activity of the temporalis muscles relative to the masseter muscles may be a factor in the therapeutic effect of both a hard and a soft splint, although the decrease is clearly greater with the hard splint.

The study of jaw reflexes evoked by electrical stimulation of the lip: the importance of stimulus intensity and polarity.

The aim of this study was to investigate whether reported differences in the patterns of jaw reflexes which can be evoked by electrical stimulation of the lip might be related to the intensity or polarity of the stimuli. Constant-current stimuli were applied through bipolar electrodes clipped across the lower lip of 14 subjects while EMG recordings were made from a masseter muscle. During stimulation, the subjects sustained a level of masseter activity equivalent to 10% of their maximum. The stimuli were applied as multiples of sensory threshold. The EMGs were analysed following rectification, averaging and smoothing. A sequence of inhibitory, excitatory, inhibitory and excitatory responses could be produced in the muscle by both polarities of stimuli. The latencies of these four responses were generally in the ranges 10-20, 25-40, 40-55 and 80-100 ms, respectively. These latencies, particularly for the last two responses, tended to decrease at higher intensities of stimulation. The threshold for the long-latency inhibition was significantly lower than that for the short-latency inhibition when the cathode was outside the mouth but not when it was inside the mouth. In addition, the long-latency excitation had the lowest threshold of the four responses regardless of stimulus polarity. Since nerves are excited particularly around a cathode, we interpret these results as showing that stimulation of nerves supplying the skin outside the mouth evokes predominately long-latency jaw reflexes whereas shorter latency responses can be evoked by stimulating nerves supplying oral mucosa. Furthermore, long latency excitatory reflexes seem to be the most easily evoked by stimulation of the lip.