Research in the community hospital.

Research is an essential component in professional nursing practice. Although nursing research efforts have increased, there is little evidence of a consistent infrastructure within the community hospital to promote research utilization and the conduct of nursing research. There are multiple mechanisms for nurse administrators to support research efforts in the community hospital. We discuss the value of research and research utilization in the community hospital and suggest some practical strategies for nurse administrators to support research efforts.

Vertical systems integration.

Healthcare organizations are vertically integrating into systems for operational, economic, and quality incentives. These system transformations require that the nurse executive assume new roles, responsibilities, and skills. The authors review the trends in system integration and discuss implications for nurse administrators based on literature and structured interviews with nurse executives who have experience in integrated systems or who are engaged in integrated system planing and development.

Human periodontal ligament fibroblast response to PDGF-BB and IGF-1 application on tetracycline HCI conditioned root surfaces.

The purpose of this study was to investigate the effect of 2 growth factors, platelet-derived growth factor-BB (PDGF-BB) and insulin-like growth factor-1 (IGF-1), alone or in combination, on the adherence of human periodontal ligament fibroblast (PDL) to tetracycline HCl (TTC) conditioned and nonconditioned periodontally involved root surfaces. There were 80 root dentine chips from 80 patients, ranging from 35 to 70 years of age, each with one periodontally involved tooth requiring extraction. A root dentine chip was obtained from the subgingival surface opposite to the periodontal pocket of each extracted tooth. The dentine chips were randomly distributed into one of 8 groups. In group 1, PDL fibroblasts were cultured and allowed to attach on the dentine surface. In group 2, PDL fibroblasts were cultured on a PDGF-BB pre-treated dentine surface and in group 3, they were cultured on a IGF-1 pre-treated dentine surface. In group 4, PDL fibroblasts were cultured on a dentine surface pretreated with a combination of PDGF-BB and IGF-1. In group 5, PDL fibroblasts were cultured and allowed to attach on the TTC conditioned dentine surfaces. In groups 6 and 7, surface of dentine chips were conditioned with TTC and then were treated with PDGF-BB or IGF-1 respectively, followed by placement of PDL fibroblast and cultured. In group 8, dentine surfaces were conditioned with TTC and then pre-treated with a combination of PDGF-BB and IGF-1 before the fibroblasts were cultured. After 24 h of incubation, the media was removed and samples were fixed and processed for SEM at magnifications of x34, x750, x2000. Photographing and evaluation of samples was performed at x750 in which fibroblast adherence was measured by counting cells within a standard test area. The results of the non-TTC conditioned root surfaces demonstrated a significant increase in fibroblasts adherence in the PDGF-BB and combination PDGF-BB/IGF-I treatment groups (groups 2, 4) when compared to the control (group 1) as well as the TTC control (group 5). The combination of PDGF-BB/IGF-1 (group 4) did not significantly improve the adhesion of cells compared to PDGF-BB alone (group 2), but did significantly improve adhesion when compared to IGF-1 alone (group 3). There were no significant differences in cell morphology between the growth factor groups (groups 2, 3, 4) and control (group 1). In general, the cells demonstrated a flat, stellate-shaped morphology. The results of the TTC conditioned root surfaces, showed a statistically significant increase of cellular adherence in the PDGF-BB group (group 6) when compared to the TTC control (group 5), similar to the non-TTC group (group 2). However, the morphology of the cells in groups 5, 6, 7, and 8 demonstrated generally a rounded or oval shape with only an occasional cell exhibiting a flat form. In the experimental system of this study, the inclusion of PDGF-BB on the surface of dentine chips increased the number of adhering PDL cells, and the addition of TTC conditioning had little effect except to change the morphology of adhering cells.

Adenosquamous carcinoma: a case report with immunohistochemical evaluation.

The histogenetic origin of adenosquamous carcinoma, a high-grade variant of malignant epithelial neoplasm, has long been debated. We report a case that clearly demonstrated a mucosal surface epithelial origin. This concept was supported through histologic analysis of hematoxylin- and eosin-stained sections, as well as by the pattern of immunohistochemical reactivity with antibodies directed against low and high molecular weight cytokeratins, cell adhesion molecules (CAM 5.2), and carcinoembryonic antigens. The histologic differential diagnosis, biological behavior, and prognosis of adenosquamous carcinoma are also examined.

A comparison of propofol with methohexital and isoflurane in two general anesthetic techniques.

The purpose of this study was to compare two general anesthetic techniques involving oral intubation for use in outpatient third molar surgery. Fifty American Society of Anesthesiologists I or II patients were randomly allocated to two groups. Group 1 received methohexital, isoflurane, nitrous oxide, and alfentanil, while group 2 received propofol, alfentanil, and nitrous oxide. An analysis of the results showed that although the technique used in group 2 cost more, had a slightly longer induction time, and produced a similar duration of apnea, it did not cause significant hypotension (as previously reported), and had a significantly better overall recovery. It was concluded that the use of propofol in the outpatient surgery setting may be a valuable addition to the oral and maxillofacial surgeon's anesthetic armamentarium.

Simultaneous orthognathic surgery and cervicomental liposuction. Clinical and survey results.

Adjunctive soft tissue surgical procedures to enhance facial esthetics can be performed simultaneously with orthognathic surgery. Submental-submandibular liposuction was performed with orthognathic surgical procedures in 22 patients from April 1989 to May 1990. Patients ranged in age from 18 to 48 years. Fourteen patients had submental and eight patients had both submental and infralobular incisions. The average estimated amount of fat removed was 40 to 50 cc. In this series of patients there was a marked improvement in facial esthetics. Liposuction created greater definition of the submandibular region and a more distinct jawline, with an improved cervicomental angle. Patients appeared younger. No significant complications occurred, and patient satisfaction was high. A survey of oral and maxillofacial surgery training programs in the United States was conducted to determine experiences with liposuction. Survey results are presented. Our survey results are consistent with our clinical experiences with this procedure.

Benign cementoblastoma: report of a case.

A case of a benign cementoblastoma involving the maxillary right first, second, and impacted third molars is presented. A review of the literature reveals the lesion is relatively rare in the maxilla, with only 13 previously reported cases.

Sector iridectomy in the management of prolonged attacks of acute congestive glaucoma.

Clinicians still encounter patients suffering from prolonged episodes of primary angle-closure glaucoma. These patients often have been misdiagnosed or neglected initially. While laser iridotomies have proven most effective in the treatment of acute angle-closure glaucoma, there is a diversity of opinion regarding the treatment of chronic forms, in particular when the congestive phase has been of long duration (e.g., 3 to 14 days). The fact that ophthalmologists must still contend with the dreaded complication of malignant glaucoma attests to the difficulty of treating this condition. A series of cases have been collected during the past 15 years, all having prolonged episodes of primary angle-closure glaucoma, where the anterior-chamber angles could not be opened medically before surgery. We found that laser iridotomy is not efficacious in this situation, and indeed often impossible to perform due to corneal edema. Our patients were treated surgically with sector iridectomies, with an extremely high degree of success, and a minimal complication rate. The results are presented in tabular form. The mechanism of action is described, and the reasons for the success of this procedure explained.

Hypotony as a late complication of trabeculectomy.

A young man with pigmentary glaucoma was treated successfully by trabeculectomy in one eye. Approximately 13 months later, relatively minor trauma produced hypotony. Despite repeated examinations, the causative factor, a minute wound leak in the filtering bleb, was not detected until the hypotony had been present for six months. During this time, vertical choroidal folds developed in the macular region, associated with a marked loss of central vision. Successful cryogenic repair of the leaking bleb and subsequent normalization of tension was achieved; however, pigmentary changes noted in the macula as induced by the choroidal folds persisted.