Invisalign(®) treatment of patients with craniomandibular disorders.

The temporomandibular joint is one of the most complex joint systems in the human body. Craniomandibular disorders (CMD) are a common condition in which symptoms and signs may vary within a single individual and from one person to another. As anatomic and functional aspects of the craniomandibular system (CMS) and the upper cervical spine are closely interconnected, CMD need a close interdisciplinary approach combining orthopedics, manual medicine, orthodontics and dentistry. Splints as a therapeutic treatment instrument in CMD patients are widely accepted. The association of splint therapy and the Invisalign(®) system not only provides comfortable and almost invisible treatment but also constitutes a powerful instrument for the orthodontic treatment of the CMD patient. To this end, precise knowledge of the temporomandibular joint, temporomandibular disorders and treatment using removable and fixed splints is indispensable.

Broadening the patient safety agenda to include safety in long-term care.

The recent patient safety literature has included less of an emphasis on long-term settings than on research in the acute care sector. Recognizing this knowledge gap in our understanding of safety in the long-term care sector, the Canadian Patient Safety Institute, Capital Health (Edmonton) and CapitalCare (Edmonton) have collaborated to create a research and action agenda for improving resident safety in Canadian long-term care settings. This collaboration resulted in the development of a background paper highlighting the current state of the science and 14 key-informant interviews with stakeholders across Canada. The background paper subsequently informed an invitational round-table discussion. Key findings from the key-informant interviews as well as implications for research are described in this article.

A longitudinal evaluation of restraint reduction within a multi-site, multi-model Canadian continuing care organization.

While American literature on sustaining restraint reduction is relatively robust, there is a lack of research published on the same issue in Canadian continuing care (CC) settings. Statistics from Canada's largest publicly funded and operated CC organization have revealed telling patterns in mechanical restraint use. Over a 4-year study period during a campaign to reduce mechanical restraint use, the organizational prevalence dropped from 24.68 per cent to 16.01 per cent. There was substantial variability in restraint prevalence among the organization's 11 centres (range: 0-39.86% of residents restrained) and all but 1 was able to achieve mechanical restraint reduction. Specific facilitators to achieving and sustaining restraint reduction are identified, including small facility size, provision of specialized care (e.g., Alzheimer's disease), and an on-site champion . Specific barriers, such as large facility size and an off-site champion are also discussed.

What motivates managers to coordinate the learning experience of interprofessional student teams in service delivery settings?

This article addresses the realities of providing interdisciplinary student team placements (i.e., experiential team learning for students) in healthcare settings. Three site coordinators from different clinical settings in Alberta (a geriatric assessment unit, a geriatric dementia care unit, and a primary healthcare centre), who facilitated Student Team Placements from the University of Alberta (UofA) in 2004, comment on their experiences and incentives for participating in interdisciplinary teamwork with students. The coordinators suggest that students provide input into the sites' continuous quality improvement cycle, contribute to host organizations, and confer benefits for the student preceptors, the staff and the patients who participate. The site coordinators also recognize and accept the responsibility common to all service providers, to model a unique site culture that promotes learning/teaching of team skills for health science students. The experience of others in the literature supports our findings that two systems--the system to educate health professionals and the system that influences the health of the community--can interact so that each realizes a mutual benefit.

Appropriateness of invasive cardiovascular interventions in German hospitals (2000-2001): an evaluation using the RAND appropriateness criteria.

OBJECTIVE: Germany has the highest per capita rate of percutaneous transluminal coronary angioplasties (PTCAs) in Europe and the third highest per capita rate of heart surgeries requiring a heart-lung machine. The goal of this study was to evaluate the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals using RAND appropriateness criteria. METHODS: A retrospective study in 121 randomly selected German hospitals (52% of all hospitals contacted) was performed from December 2000 to August 2001. A total of 361 patients were enrolled providing information on the appropriateness of 128 PTCAs, 92 CABGs, and 141 CEAs. RESULTS: Inappropriateness rates were 2% (95% CI 0-5%), 4% (95% CI 1-9%), and 3% (95% CI 1-7%) for PTCA, CABG, and CEA, respectively. The overall rate of uncertain procedures was 42% (95% CI 36-47%). Only 38% (95% CI 32-45%) of patients who received a coronary intervention had had a pre-interventional stress test. CONCLUSIONS: The study yielded little overt overuse in the performance of PTCAs, CABGs, and CEAs, but potentially large underuse of stress tests. Despite a high per capita rate of invasive cardiovascular interventions in Germany, the rate of inappropriate procedures was not larger than in other countries.