Efficacy of Topical Tranexamic Acid (Cyclokapron) in "Wet" Field Infiltration with Dilute Local Anaesthetic Solutions in Plastic Surgery.

BACKGROUND: Surgical bleeding may lead to the need for blood transfusion and minimizing blood loss has been a basic principle followed by surgeons for generations. Antifibrinolytic agents are widely used to reduce perioperative haemorrhage. The present study sought to assess the efficacy of directly infiltrated tranexamic acid in ameliorating bruising in participants undergoing cosmetic plastic surgery (liposuction). MATERIALS AND METHODS: The study employed a blinded, prospective, randomized, case control design. Thirty-three patients were studied. Tranexamic acid free infiltration tumescent solution (saline, bupivacaine lignocaine and adrenalin) was infiltrated to one flank of patients undergoing liposuction of flanks. The other flank was infiltrated with the same tumescent solution (saline, bupivacaine lignocaine and adrenalin) mixed with tranexamic acid (0.1%). Bruises were photographed one and seven days after surgery and measured for size. The surface area of the bruises was calculated using ImageJ software. We compared the bruised surface are between the tranexamic acid infiltrated flank and non-tranexamic acid infiltrated flank in the same patient. The model employed involved measuring the bruises on each flank of the same patient, with surgery by a single surgeon using the same infiltration and surgical techniques for both sides. The only variable was the difference in tranexamic acid concentration between study and control flanks. RESULTS: We found that use of tranexamic acid consistently resulted in a smaller bruise area on days one and seven after liposuction of flanks. Results were statistically significant. CONCLUSIONS: This is the first study examining addition of tranexamic acid to a tumescent infiltration solution-to produce a predictable local concentration of tranexamic acid-in order to maximize surgical site effect and minimize systemic effect. The authors recommend incorporation of tranexamic acid as a routine component along with adrenaline and local anaesthetics in tumescent field infiltration solution 10-15 min before commencement of the cosmetic surgery. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of three whitening oral rinses on enamel micro-hardness.

The purpose of this study was to determine the effect on human enamel micro-hardness of three over-the-counter whitening oral rinses available in South Africa. Enamel fragments were gathered into three groups of 15 each. One group was exposed to Colgate Plax Whitening Blancheur, the second group to White Glo 2 in 1 and the third to Plus White, in each case for periods recommended by the respective manufacturers. Surface micro-hardness of all groups was measured before and after a 14 day treatment period. pH levels of the oral rinses were also determined with a combination pH electrode. Pre- and post- treatment data were analysed by the Wilcoxon Signed Rank Sum Test. According to the micro-hardness values no significant (p > 0.05) enamel damage was found as a result of treatment. However, it was observed that Colgate Pax and White Glo decreased the enamel hardness, an early sign of enamel damage, while Plus White showed a small increase in hardness. The three whitening oral rinses on the South African market do not damage the tooth enamel significantly when used as recommended by the manufacturers. However, extending the contact period and increasing the frequency of application might lead to damage of enamel.

Whitening efficacy of three over-the-counter oral rinses.

AIM: The aim of the study was to determine the whitening efficacy of three different oral rinses. MATERIALS AND METHODS: Eighty extracted teeth were randomly divided into four groups, cleaned with a slow-speed handpiece with pumice and placed in a staining broth for 14 days. Measurements of tooth shades were measured with a spectrophotometer. Three groups (20 each) were then exposed to Colgate Plax Whitening Blancheur (A), White Glo 2 in 1 (B) and Plus White (C) for 21 days for 2 minutes a day and in between stored in artificial saliva. The other group acted as a control and was only stored in the artificial saliva. RESULTS: The Kruskal-Wallis and Tukey-Kramer analysis showed no statistical significant differences (on a 5% basis) for the differences between base-line and after treatment (21 days) for deltaL*, deltaa*, deltab* and deltaE*ab median values amongst the control, Colgate Plax Whitening Blancheur, White Glo 2 in 1, and Plus White. CONCLUSION: None of the 3 commercially available oral rinses resulted in any significant bleaching effect on the teeth over a 21 day treatment period.

Compliance with infection control recommendations in South African dental practices: a review of studies published between 1990 and 2007.

In a country where the prevalence of infectious diseases ranks among the highest in the world, infection control in health care facilities should not be debatable. This unfortunately does not seem to be the case in South African oral health care facilities. This study is a systematic review of available literature on the adherence of South African oral health care professionals to infection control recommendations. Nine focus areas were investigated with regard to infection control practices: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and sound housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; as well as other special considerations. Although South African studies are limited and most of them relied on self-reports, which could have resulted in a serious overestimation of compliance, even these studies indicate serious shortcomings with regard to infection control practices in oral health care facilities in this country. This review highlights opportunity for improvement. Furthermore, it identifies possibilities for future research in infection control and also opportunities to improve infection control education for all oral health care workers in the country.

Perceptions of registered nurses in four state health insititutions on continuing formal education.

This study investigated registered nurses in four selected state health institutions' perceptions with regard to continuing formal education. The relevance of continuing formal education is being emphasised globally by the increasing quest for quality assurance and quality management systems within an ethos of continuous improvement. According to Tlholoe (2006:5), it is important to be committed to continual learning, as people's knowledge become less relevant because skills gained early in a career are insufficient to avoid costly mistakes made through ignorance. Continuing formal education in nursing is a key element to the maintenance of quality in health care delivery. The study described: registered nurses' views on continuing formal education. Registered nurses' perceived barriers to continuing formal education. A quantitative descriptive survey design was chosen using a questionnaire for data collection. The sample consisted of 40 registered nurses working at four state health institutions in the Western Cape Province, South Africa. Convenience sampling was selected to include registered nurses who were on duty on the days during which the researcher visited the health institutions to distribute the questionnaires. The questionnaire contained mainly closed-ended and a few open-ended questions. Content validity of the instrument was ensured by doing a thorough literature review before construction of items and a pretest. Reliability was established by the pretest and providing the same information to all respondents before completion of the questionnaires. The ethical considerations of informed consent, anonymity and confidentiality were adhered to and consent to conduct the study was obtained from relevant authorities. Descriptive statistics, based on calculations using the Microsoft (MS) Excel (for Windows 2000) programme, were used to summarise and describe the research results. The research results indicated that most registered nurses perceive continuing formal education as beneficial to their personal and professional growth and that it could lead towards improving the quality of patient/client care, but barriers exist which prevent or deter them from undertaking continuing formal education programmes. The main structural barriers included lack of funding and lack of coherent staff development planning and physical barriers including job and family responsibilities.

Oral health management of a medically compromised patient with medication induced xerostomia--a case study.

An ageing population requires dental professionals to be aware of the oral effects of medications taken by their patients. This case study will present the challenges faced by the hygienist in the oral health management of a 79-year-old medically compromised patient over a 2-year period. The interrelationship between the ageing process, medical conditions and medications taken, and specific treatment modalities are considered.

Student nurses' experiences during clinical practice in the Limpopo Province.

A qualitative, exploratory, descriptive and contextual study was conducted to explore student nurses' experiences during clinical practice at a nursing college in the Limpopo Province. Purposive sampling was used and phenomenological interviews were held with eleven (11) student nurses who were in their final year of the four year basic nursing programme. The interviews were analysed by using Tesch's method of data analysis for qualitative research. The findings indicate that there are aspects which impact negatively on student nurses' clinical learning experiences, such as lack of teaching and learning support, lack of opportunities for learning, poor theory-practice integration, and poor interpersonal relationships between the students, college tutors and ward staff. Recommendations to enhance the clinical learning experiences of student nurses were outlined.

Patients' and family members' knowledge and views regarding diabetes mellitus and its treatment.

Diabetes mellitus affects millions of people worldwide and its related complications continue to be of great concern. The outcome of diabetes depends mainly on the patient's self-management. Health care professionals therefore have a major responsibility to assist patients to acquire the essential knowledge, skills and attitudes towards self-management. A quantitative survey was conducted to identify diabetic patients and family members' knowledge and views about diabetes and its treatment regimen. A convenient sample of 32 diabetics and 32 family members who attended two health care facilities in the Mopani district, Limpopo Province, was drawn. Two similar questionnaires, one for each group respectivevly, were completed by the subjects. The data was analysed by a computer programme, the Statistical Package for Social Sciences. Findings revealed that the diabetics and family members lack adequate knowledge on diabetes and its treatment. Recommendations regarding the required health education and assistance to be given to these patients and their family members were made.

Relatedness among penicillin-binding protein 2b genes of Streptococcus mitis, Streptococcus oralis, and Streptococcus pneumoniae.

Penicillin-binding protein (PBP) 2b similarities among Streptococcus mitis, S. oralis, and S. pneumoniae using DNA fingerprinting and sequencing were investigated. The polymerase chain reaction (PCR) was performed on 41 penicillin-susceptible and -resistant clinical isolates of S. mitis and S. oralis using the susceptible S. pneumoniae R6 PBP 2b primers. PCR products were then analyzed using Hinf I and Sty I restriction enzymes. Of 41 S. mitis/S. oralis isolates studied 15 strains produced a PCR product of a similar size to that of S. pneumoniae R6. On fingerprinting these 15 strains, 11 different patterns were seen using Sty I restriction enzyme and 12 different patterns with Hinf I. The PBP 2b genes of the S. mitis and S. oralis isolates studied were found to be very heterogenous. The PBP 2b genes of two S. mitis isolates, MICs 0.5 and 2 micrograms/ml, were sequenced. These PBP 2b genes were found to possess a mosaic structure when compared to those of other S. pneumoniae and viridans streptococcal species. Analysis of these mosaic blocks indicates that both S. mitis strains contain areas that originated from S. pneumoniae as well as regions of unknown origin. PBP 2b sequence comparisons of a susceptible S. oralis with reported sequences of S. pneumoniae R6 and S. mitis NCTC 10712 revealed what appears at this stage to be nucleotide regions unique to S. oralis. A penicillin-resistant S. oralis strain contained a pneumococcal region of 272 bp that was flanked by S. oralis sequences. These specific S. oralis regions have been located in PBP 2b genes of penicillin-resistant S. oralis and S. pneumoniae isolates described from Europe and South Africa.

Relatedness between Streptococcus pneumoniae and viridans streptococci: transfer of penicillin resistance determinants and immunological similarities of penicillin-binding proteins.

The occurrence of highly variable penicillin-binding proteins (PBPs) in penicillin-resistant Streptococcus pneumoniae suggested that transfer of homologous genes from related species may be involved in resistance development. Antiserum and monoclonal antibodies raised against PBPs 1a and 2b from the susceptible S. pneumoniae R6 strain were used to identify related PBPs in 41 S. mitis, S. sanguis I and S. sanguis II strains mostly isolated in South Africa with MIC values ranging from less than 0.15 to 16 mg/ml. Furthermore, the possibility of genetic exchange was examined with 30 penicillin-resistant strains of this collection (MIC greater than 0.06 mg/ml) as donors using S. pneumoniae R6 as recipient in transformation experiments. The majority of S. mitis and S. sanguis II strains but none of the S. sanguis I strains could transform penicillin resistance genes into S. pneumoniae R6. All positive donor strains and all susceptible isolates of S. mitis and S. sanguis II strains contained PBPs which cross-reacted with the anti-PBP 1a and/or anti-PBP 2b antibodies. On the other hand, only five of the 14 S. sanguis I strains contained a PBP that reacted with one of the antibodies. This strongly suggested the presence of genes homologous to the pneumococcal PBP 1a and 2b genes in viridans streptococci, and documents that penicillin resistance determinants can be transformed from viridans streptococci into the pneumococcus.

Wound modulation via sclerotherapy and tissue adhesion. Observations and discussion.

Fluid accumulation in a 'dead space' after surgery or trauma predisposes the area involved to delayed healing. The fluid may promote inflammatory mediators and other wound-modulating factors, which encourages the continued existence of the dead space. Tissue adhesion by means of agents such as tetracyclines has long been described. With this concept, tissue adhesion has been accomplished with varying success in diverse clinical situations involving non-healing wounds and prophylactically in seroma-prone areas. A total of 69 patients were treated and monitored. The most impressive response to tetracycline tissue adhesion in this study was seen in intra-oral sites, with rapid closure of wounds. More complex wounds such as orocutaneous fistulas or wounds of a more chronic nature such as pressure sores did respond but took longer to resolve. The lateral thigh was found to be the most difficult and unresponsive area to treat (particularly after delayed presentation). Successful prophylactic use of tetracycline in seroma-prone areas (latissimus dorsi/parascapular flaps, etc.) is also described.

Relationship between the Whole Brain Creativity Model and Kolb's experiential learning model.

The aim of this article is to illustrate the relation between the cognitive styles in Kolb's experiential learning model and dominance in brain functioning. A descriptive analytical study of the literature on creativity and the development of creative thinking, explored various theories and definitions of creativity, and the nature of creative learning. Congruences between cognitive styles and the four quadrants of the Whole Brain Model were detected. This article focuses specifically on Kolb's cognitive styles in relation to the Whole Brain Model and the implications thereof for nursing education.

The Whole Brain Creativity Model: implications for nursing education and practice.

Recent nursing literature has repeatedly proclaimed the need for creativity in nursing. Effective nursing practice in the new millennium will require innovative and creative nurses who can adapt to change and have the courage to take risks in order to provide holistic, individualised, context-specific care. An analytical study of the literature revealed interesting information on the concept creativity and teaching for creativity. The aim of this article is to describe the Whole Brain Creativity Model and its implications for nursing education and practice.

Extent of East-african nurse leaders' participation in health policy development.

This paper reports part of a bigger study whose aim was to develop an empowerment model that could be used to enhance nurse leaders' participation in health policy development. A Delphi survey was applied which included the following criteria: expert panelists, iterative rounds, statistical analysis, and consensus building. The expert panelists were purposively selected and included national nurse leaders in leadership positions at the nursing professional associations, nursing regulatory bodies, ministries of health, and universities in East Africa. The study was conducted in three iterative rounds. The results reported here were gathered as part of the first round of the study and that examined the extent of nurse leaders' participation in health policy development. Seventy-eight (78) expert panelists were invited to participate in the study, and the response rate was 47%. Data collection was done with the use of a self-report questionnaire. Data analysis was done by use of SPSS and descriptive statistics were examined. The findings indicated that nurse leaders participate in health policy development though participation is limited and not consistent across all the stages of health policy development. The recommendations from the findings are that health policy development process needs to be pluralistic and inclusive of all nurse leaders practicing in positions related to policy development and the process must be open to their ideas and suggestions.

Strategic framework for increasing accessibility and utilization of voluntary counseling and testing services in Uganda.

Despite the usefulness of VCT service as an entry point to prevention for the HIV-uninfected people and care, treatment and support for those who test HIV positive, VCT service remains poorly utilized among the fishing communities. The aim of the study was to identify factors influencing VCT service delivery and utilisation among fishing communities in Uganda and consequently, formulated a strategic framework for improving VCT service delivery and utilisation in the fishing communities. The study followed a 3-phased approach, collecting and analyzing quantitative data from Kasenyi fishing community under phase I, collecting and analyzing qualitative data from hospital managers and VCT counselors in phases II and III, respectively. Results indicate that VCT services delivery and utilisation is affected by factors at government (macro) level, the institution (meso) level, and at the individual (micro) level. Based on this, a strategic framework was designed, expected to increase VCT service availability, accessibility, and acceptability if applied. The researcher recommends the use of this useful tool in the design of VCT programs.

Chromosomally mediated high-level gentamicin resistance in Streptococcus mitis.

Four blood culture isolates of Streptococcus mitis were found to be resistant to penicillin (MIC, 16 to 32 micrograms/ml) and gentamicin (MIC, 128 or 1,000 micrograms/ml), and the two antibiotics demonstrated a lack of in vitro synergy. As shown by polymerase chain reaction assays, the structural gene known to encode high-level gentamicin resistance in Enterococcus faecalis, Enterococcus faecium, and Streptococcus agalactiae was also present in all four S. mitis strains. Attempts to isolate plasmids were unsuccessful, but an oligonucleotide probe derived from the gentamicin resistance gene hybridized to distinct restriction fragments of genomic DNA, suggesting that the resistance genes in these strains are integrated into the bacterial chromosome.

Nasal middle vault support: a new technique.

A novel technique for maintaining internal nasal valve anatomic and physiologic integrity at the time of hump reduction is proposed. The procedure involves mobilizing the anterior edge of the upper lateral cartilage after submucosal dissection. Reduction of the anterior border of the septal cartilage and reconstruction of the middle vault of the nose is accomplished by placing the upper lateral cartilage medial border on the reduced edge of the septum using a vest-over technique. The technique was successfully used for 32 nonconsecutive patients over a 4-year period.

Zygomaticus major advancement as an adjunct to lower blepharoplasty.

Sagging of the mid-face, deep nasolabial folds, and flat malar eminence often compromise the rejuvenation effect produced by upper and lower blepharoplasty. A simple surgical technique based on advancement of the zygomaticus major origin was developed as an adjunct to lower blepharoplasty to address this problem. The technique is predominantly suitable for ambulatory surgery setup and can be easily performed under local anesthesia and sedation. It offers rejuvenation of the midface and correction of the nasolabial fold.

In vitro antimicrobial susceptibility of viridans streptococci isolated from blood cultures.

The susceptibility of 211 viridans streptococci isolated from blood cultures to eight antimicrobial agents was determined. All the isolates were susceptible to cefotaxime, ceftriaxone, imipenem and vancomycin. Thirty eight percent of the isolates were resistant to penicillin (MICs greater than or equal to 0.25 micrograms/ml). Tetracycline resistance was found in 41% of the isolates and in 7% of these strains tetracycline resistance was combined with erythromycin resistance. Five Streptococcus mitis isolates exhibited increased (MIC 64 micrograms/ml and 128 micrograms/ml) or high-level (MIC greater than or equal to 500 micrograms/ml) resistance to gentamicin, kanamycin and tobramycin. Four of these isolates were also resistant to penicillin (MICs 16-32 micrograms/m). In vitro synergy was not demonstrated for combinations of penicillin and gentamicin against three Streptococcus mitis isolates with gentamicin MICs of 1000, 128 and 64 micrograms/ml. Results of this study indicate the importance of monitoring antibiotic resistance trends in viridans streptococci particularly with respect to penicillin and aminoglycoside resistance.