Fracture strength of ceramic overlays with immediate dentin sealing and same-day delivery.

Limited research is available evaluating whether the reported in vitro benefit of immediate dentin sealing (IDS)-namely, increased bond strength to tooth structure-can be acquired in the era of same-day (SD) dentistry. The purpose of this study was to compare the fracture strengths of ceramic overlays fabricated with a delayed dentin sealing (DDS) technique or an IDS technique under 1-hour SD or 2-week multiple-day (MD) delivery conditions. Forty extracted, healthy maxillary third molars were prepared for a lithium disilicate overlay restoration and divided into 4 groups of 10 teeth each. In the SD-DDS group, the teeth were prepared and then stored for 1 hour in artificial saliva, and the adhesion protocol (bonding agent and resin cement) was applied at the time of delivery of the ceramic overlay. In the SD-IDS group, the teeth were prepared, the adhesive protocol was applied immediately, and the teeth were stored for 1 hour before delivery of the overlay. The protocols for the MD-DDS and MD-IDS groups were identical to SD-DDS and SD-IDS, respectively, except that the teeth were provisionalized and stored for 2 weeks prior to delivery of the overlay. Specimens were thermocycled and subjected to cyclic functional loading before they were loaded to failure in a universal testing machine using a rod resting on the buccal incline of the palatal cusp. Two-way analysis of variance tests revealed no statistically significant differences in fracture strength between the groups based on dentin sealing (P = 0.331) or delivery time (P = 0.314). The specimens demonstrated 2 fracture types; either a portion of the ceramic cohesively fractured, leaving the tooth intact, or the ceramic and part of the tooth fractured. There were no instances in which the restoration itself delaminated during fracture testing. A Kruskal-Wallis test indicated there were no statistically significant differences in fracture modes between the groups. In this in vitro study, IDS did not provide a significant increase in the fracture strength of overlay restorations compared with DDS, regardless of whether the restorations were delivered the same day or after 2 weeks of storage.

The Rewarding Experience of Serving as a US Air Force Dentist.

Providing care to service members and veterans as an active duty United States Air Force (USAF) dentist is a unique and rewarding experience that can be quite different from the private sector. As a USAF officer, I balance military and dental responsibilities, which has taught me to be flexible and adaptive. Virtually every dentist in the dental corps (DC), unless they are a resident, holds some form of a leadership position, whether that be overseeing clinic operations, the laboratory, an infection control program, or so on. The USAF doesn't just build clinicians, it builds leaders.

Do trained nurses feel more psychologically safe?-Results from a multi-level modelling approach.

AIM: To analyse the associations between a nurse's psychological safety and her/his additional training. DESIGN: A cross-sectional survey conducted between September 2015 and August 2016. METHODS: A multi-level modelling approach was used considering unit membership. We used data from 1,239 questionnaires completed by nurses on 75 different German neonatal intensive care units, and 75 questionnaires completed by the corresponding leading nurse. RESULTS: We found the additional managerial training as a charge nurse to be a positive predictor for psychological safety (ß = .346, p ≤ .05). Surprisingly, the additional clinical training in paediatric intensive care is negatively associated with psychological safety (ß = -.192, p ≤ .01). Our model estimates that this negative association can be inhibited if the team's share of nurses with an additional clinical training increases (ß = .313, p ≤ .05).

Last Year of Life Study-Cologne (LYOL-C) (Part II): study protocol of a prospective interventional mixed-methods study in acute hospitals to analyse the implementation of a trigger question and patient question prompt sheets to optimise patient-centred care.

INTRODUCTION: The Last Year of Life Study-Cologne Part I (LYOL-C I) has identified general hospital units as the most important checkpoints for transitions in the last year of life of patients. Yet, satisfaction with hospitals, as reported by bereaved relatives, is the lowest of all health service providers. Thus, the LYOL-C Part II (LYOL-C II) focuses on optimising patient-centred care in acute hospitals for patients identified to be in their last year of life. LYOL-C II aims to test an intervention for hospitals by using a two-sided (healthcare professionals (HCPs) and patients) trigger question-based intervention to 'shake' the system in a minimally invasive manner. METHODS AND ANALYSIS: Prospective interventional mixed-methods study following a two-phase approach: phase I, individual interviews with HCPs and patient representatives to design the intervention to maximise ease of implementation and phase II, exploratory study with two arms and a prepost design with patients in their last year of life. The intervention will consist of the Surprise Question and the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE) for HCPs to identify patients and provide patient-centred care, plus question prompt sheets for patients, encouraging them to initiate discussions with their HCPs. Data on transitions, changes in therapy, quality of care, palliative care integration and death of patients will be analysed. Furthermore, a staff survey (pre/post) and guided interviews with staff, patients and relatives (post) will be conducted. Finally, a formative socioeconomic impact assessment to provide evidence regarding the sustainability of the intervention will be performed. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of the Faculty of Medicine of the University of Cologne (#20-1431). Results will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: DRKS00022378.

Exploring leading nurses' work values and their association with team safety climate: Results from a questionnaire survey in neonatal intensive care units.

AIM: To explore leading nurses' work values and their effect on the safety climate in neonatal intensive care units (NICUs). BACKGROUND: Despite their significance for behaviour, the work values of leading nurses are still insufficiently studied. We explore the impact of work value dimensions (self-transcendence, self-enhancement, conservation, and openness to change) on the safety climate. METHODS: A cross-sectional study was conducted in 86 German NICUs between September 2015 and August 2016. Our analyses relate questionnaire data from 75 leading nurses to the shared perceptions regarding safety among their team members (n = 1,277). We used fractional response modelling to identify important work values. RESULTS: The analysis showed differences between the dimensions of work values and their association with the safety climate. A significant positive association was found between the work value dimension self-transcendence (including the work values relationships with others and altruism) and safety climate (ß = 0.255, p = .001). A large team size has a negative impact on the safety climate. CONCLUSION: The findings indicate that the leading nurse's score on self-transcendence is positively related to the safety climate. IMPLICATIONS FOR NURSING MANAGEMENT: The results demonstrate that it might be useful to consider work values in the selection of nurse leaders.