Multidetector CT Dentascan evaluation of bone regeneration obtained with deproteinised bovine graft in residual cavity after mandibular cyst enucleation.

PURPOSE: This study compared spontaneous bone healing and regeneration obtained with deproteinised bovine graft in residual cavities after mandibular cyst enucleation using computed tomography (CT) Dentascan. MATERIALS AND METHODS: Eighty patients with a radiological diagnosis of mandibular cyst underwent surgical enucleation. Patients were divided into a control group (spontaneous healing, 40 patients) and a test group (deproteinised bovine graft, 40 patients). All patients underwent follow-up CT Dentascan 12 months after the procedure. For each residual cavity, apical-coronal and mesial-distal distance, average pixel intensity and volume were calculated and results compared between two groups using the t test. RESULTS: The control group showed mean volume, apical-coronal and mesial-distal distance of 703.2 ± 185.3 mm(3), 28.6 ± 9.4 mm and 25 ± 2.84 mm, respectively. In the test group, values were 738.2 ± 189.2 mm(3), 27.5 ± 3.6 mm and 25.3 ± 2.97 mm, respectively. There was no statistically significant difference between groups. Average pixel intensity was 1,102.8 ± 124.3 in the test group and 624.9 ± 133.3 in the control group, with a significant difference between groups (p<0.0001). CONCLUSIONS: The significantly higher average pixel intensity observed in the test group demonstrates the cavalue of treatment with biomaterials to obtain earlier bone regeneration.

Nonlinear dynamics: chaos and catastrophe theory.

Nonlinear relationships are attracting much attention in nursing. Nonlinear dynamics are used abstractly as theory and also may be applied in a concrete sense to explain data. There is often confusion and misunderstanding about aspects of nonlinear dynamics. This article explores two of the more well known areas of nonlinear dynamics--chaos and catastrophe theory. A summary of each is given, areas of commonality and distinction are explored, and guidelines for application are identified.

Community meeting: review, update, and synthesis.

The community meeting is a frequent regular meeting in a psychiatric ward or institution that is attended by all staff and patients. It meets for the purpose of communication, ward management, or psychiatric treatment. The conditions of the current hospital psychiatric treatment environment are very different from the treatment environment where the therapeutic community concept was first established, particularly in terms of the shortened length of hospital stay and the emphasis on pharmacologic rather than psychotherapeutic methods of treatment. However, even with these changes, an admixture of psychopharmacologic treatment and therapeutic community principles has been advocated as an effective, realistic, and desirable treatment modality in today's hospital environment. A synthesis of an extensive literature review from both a theoretical and research perspective on the community meeting is presented. A schema has been developed listing elements for practice in today's hospital climate.

Consumer contributions in developing clinical practice guidelines.

Clinical practice guidelines are designed for use with consumers. However, consumers are rarely consulted about their development. This paper describes a research project to develop clinical practice guidelines for a community meeting to prevent and intervene with assaultive behavior. The research included consumer input from psychiatric inpatients. The two-phase approach with the consumers included a focus group, followed by survey research. Results, problems, and recommendations are presented.

A multidisciplinary course to teach staff to conduct psychodynamic group psychotherapy for assaultive men.

TOPIC: A course in leading psychodynamic psychotherapy groups for assaultive men. PURPOSE: To teach multidisciplinary staff members to lead these groups, using both didactic and experiential learning. SOURCE: The author's own experience. CONCLUSIONS: Multidisciplinary staff members learned about the process of leading psychotherapy groups for assaultive men by attending lectures and observing the author lead a group over a 6-month period. The author's openness about her own thoughts, feelings, fantasies, and countertransference allowed students to explore their own reactions and to empathize with the patients, observing that they were not so different from them.

Quality plan for a product line.

Continuous Quality improvement (CQI) has undergone radical change as health care facilities merge, expand, and modify their existing services. CQI has shifted from a centralized position in health care organizations, to unit based, to product lines. This paper describes one product line's endeavors to develop a Quality Plan to direct CQI activities. One particular strength of our innovation is that the Quality Plan was developed with attention to the important balance of interdisciplinary cooperation and maintenance of appropriate discipline boundaries.

Power and leadership in psychiatric nursing: directions for the next century. Part II.

TOPIC: The application of power and leadership to psychiatric nursing in the next century PURPOSE: To suggest strategies for empowering psychiatric nursing. SOURCE: Review of the literature and authors observations of the discipline CONCLUSIONS: Empowerment of our discipline rests with individuals committed to changing the societal problems holding us back. This will be accomplished through consciousness-raising, coalition-building, transformation, feminist leadership, political action, public relations, development of a new language, and research.

Feminist leadership through total quality management.

Feminist leadership in nursing can be achieved through Total Quality Management. Total Quality Management (TQM) is a philosophy and technology that represents the foundation of a continuously improving organization. The feminist leadership ideas practiced by nurses, such as empowering staff and decision by consensus, are also central to TQM. Feminist leadership utilizing TQM enables employees to creatively contribute to the system without fear or intimidation. Employees at all levels in the organization are then empowered. The role of the feminist leader using TQM is one of facilitator rather than authority figure. Feminist leadership in nursing can spearhead the opportunity for improvement to provide high-quality, cost-effective health care in a troubled and complex economic environment.

Power and leadership in psychiatric nursing. Directions for the next century: Part I.

TOPIC: Power and leadership in psychiatric nursing. PURPOSE: To describe power, leadership, and their relationship to psychiatric nursing, with suggestions for the future of the discipline. SOURCE: Review of literature and author's observations of the discipline. CONCLUSIONS: The relationship of power and leadership focuses on leader qualities, a model for the interrelationship of leaders and colleagues, and the leader's achievement of a power position.

Validation of a vignette simulation of assault on nurses by patients.

PURPOSE: To determine the degree to which causal attribution ("blame") scores obtained from written vignettes of assault incidents, simulations of reality, reflect results that would be obtained from victims of actual assaults. DESIGN: Correlational study. Data were collected, 1990-1993, from a convenience sample of 59 RNs who had been assaulted verbally or physically at one neuropsychiatric hospital in the United States. METHODS: Victims used the Causal Attribution Scale to assign blame for their assault. Three judges then used the same scale to attribute cause for the assault based on a written description of the assault by the victim. FINDINGS: No significant differences in mean causal attribution levels were found between victims and the average ratings for the three judges for mild or severe assaults, nor between victims, judges, and the response levels obtained in two previous vignette studies. CONCLUSIONS: Mean causal attribution ("blame") scores observed in simulations that are carefully constructed assault vignettes are nearly the same as those observed in actual assaults. Vignettes appear promising as a simulation to study actual or hypothetical responses to assault.

Money: personal issues affect professional practice.

Money is a taboo subject. Clinicians have much ambivalence about money, both personally and professionally, and are often more comfortable discussing clients' issues around money than examining their own. As a result, how clinicians handle money with clients is often determined by the clinicians' personal feelings about money; however, they do not explore the meaning and origin of these feelings or determine how these feelings affect their practices. This article explores the conscious and unconscious issues surrounding money, case examples of therapists' dilemmas in handling money, and implications for practice.

Developing psychodynamic group treatment methods for aggressive male inpatients.

Group psychotherapy is one intervention that can be used for aggressive male inpatients. This paper reports relevant literature and clinical applications for conducting a psychodynamic psychotherapy group designed to help patients (a) identify, understand, and deal with underlying problems resulting in aggressive behavior; (b) improve interpersonal relationships; and (c) find more appropriate ways of expressing feelings, particularly those associated with aggressive behavior. The review of literature focuses on therapeutic approaches for dealing with aggressive feelings in group therapy; men's issues in group psychotherapy, including stages of group development for men and the expression of aggression; and the outcome of aggressive behavior in response to group therapy. Clinical applications discussed are preparation for the group; the group contract, including the "group as a whole" approach; patient selection; modeling authority; and countertransference and projective identification.

The relationship of behavioral cues to assaultive behavior.

The purpose of this 2-year, case control study was to determine whether differentiation between assaultive and nonassaultive patients can be made based on behavioral assessments and/or sociodemographic variables. For each assault incident, the chart of the patient who assaulted and a randomly chosen patient who did not assault on that day were reviewed (N = 72 subjects or 26 pairs). Various scales were used to evaluate the subjects retrospectively (the day prior to the assault), and patients who assaulted staff were interviewed when possible. An analysis found no differences between patients who assaulted and controls on sociodemographic variables. Those who assaulted had significantly more prior assaults (p = .04) and more difficulty verbalizing angry feelings appropriately on their units (p < .01). Prior to the assault, assaultive patients were more verbally hostile (p = .037) and showed more increased motor activity (p = .001) than controls.

Bibliotherapy and beyond.

TOPIC: Using literature and television to promote mental health. PURPOSE: To expand readers' awareness of how literature can be used therapeutically. SOURCE: The author's personal experience hosting a TV program entitled, "Best Books in Town". CONCLUSIONS: Discussing literature can promote emotional catharsis, active problem solving, and personal insight in those who chose to participate.

The "ups" and "downs" of getting published.

One stumbling block to writing is the variety of emotional reactions a prospective author must negotiate: the "ups" and "downs" of publishing. An impressive publishing track record does not necessarily mean an author will avoid anxiety, self-doubt or the fear of rejection. A conceptual schema outlines the phases in the publishing process and the associated potentially problematic emotional reactions.