The impact of nurse managers' leadership styles on ward staff.

AIM: to explore the nature of leadership styles used by the nursing management team, as perceived by nurses working at the bedside. BACKGROUND: leadership style is related to job satisfaction, staff retention, costs, and quality of care. The leadership styles of managers can be crucial in the healthcare setting, but very few studies have focused on them. METHOD: the study employed qualitative methodology, involving 35 nurses working in different specialties of a medical city in Saudi Arabia. Data collection consisted of completing demographic and professional information and a semi-structured interview using open-ended questions. ANALYSIS: a phenomenologic-hermeneutic approach was used to identify major themes. RESULTS: the findings showed that participants described four types of leadership styles: relational leadership, preferential leadership, communication chain leadership, and ineffectual leadership. CONCLUSION: the leadership style employed by nurse managers has a major impact on nurses' satisfaction, turnover, and the quality of patient care they deliver.

A novel mechanism for variable phenotypic expressivity in Mendelian diseases uncovered by an AU-rich element (ARE)-creating mutation.

BACKGROUND: Variable expressivity is a well-known phenomenon in which patients with mutations in one gene display varying degrees of clinical severity, potentially displaying only subsets of the clinical manifestations associated with the multisystem disorder linked to the gene. This remains an incompletely understood phenomenon with proposed mechanisms ranging from allele-specific to stochastic. RESULTS: We report three consanguineous families in which an isolated ocular phenotype is linked to a novel 3' UTR mutation in SLC4A4, a gene known to be mutated in a syndromic form of intellectual disability with renal and ocular involvement. Although SLC4A4 is normally devoid of AU-rich elements (AREs), a 3' UTR motif that mediates post-transcriptional control of a subset of genes, the mutation we describe creates a functional ARE. We observe a marked reduction in the transcript level of SLC4A4 in patient cells. Experimental confirmation of the ARE-creating mutation is shown using a post-transcriptional reporter system that reveals consistent reduction in the mRNA-half life and reporter activity. Moreover, the neo-ARE binds and responds to the zinc finger protein ZFP36/TTP, an ARE-mRNA decay-promoting protein. CONCLUSIONS: This novel mutational mechanism for a Mendelian disease expands the potential mechanisms that underlie variable phenotypic expressivity in humans to also include 3' UTR mutations with tissue-specific pathology.

Minimizing trauma during tooth removal: a systematic sectioning approach.

A prerequisite for immediate implant placement is fully intact osseous and soft tissue, which can only be achieved by a careful and less-traumatic tooth removal that minimizes damage to the soft and hard tissue structures of the extracted tooth socket. Traditional methods of tooth extraction using forceps and elevators often results in some degree of soft and hard tissue damage, which ranges from slight soft tissue laceration to complete loss of the buccal bony plate and interdental bone crest. This paper describes an extraction technique that utilizes a systematic tooth sectioning approach to help minimize soft and hard tissue loss in the extracted tooth socket.

Implant placement accuracy when using stereolithographic template as a surgical guide: preliminary results.

PURPOSE: The aim of this study is to evaluate implant placement accuracy using the coordinate measure machine (CMM) and to assess how accurate implant angulations and point of entrance can be transferred when using a stereolithographic surgical template as a guide during implant placement. MATERIAL AND METHODS: Angulations, entrance points of 40 implants placed in 6 edentulous jaws using stereolithographic surgical template were evaluated. The angulations were noted in both mesio-distal and bucco-lingual planes. The central axis of each treatment-planned implant was determined using the CMM by locating 3 points along the hollow channel of the drill guide stainless steel sleeve of the stereolithographic surgical template and the central axis of the actual implant, evaluated postsurgically, were determined. Three points along the guide pins were noted after mounted to the implant fixture analogs on the working cast. The differences between the proposed and actual implant point of entrance and angulations were calculated and the data were analyzed using the paired t test. RESULTS: The mean mesio-distal angle deviation of the actual implant from the planned position was 0.7 +/- 5.02 degrees, and the mean bucco-lingual angle deviation was 0.46 +/- 4.43 degrees. Thirty implants (88%) and 31 implants (91%) recorded a <7 degrees angle deviation for the mesio-distal and bucco-lingual plane angle, respectively. No statistical significant difference was found for the angle deviation. The mean difference of the entrance point was within 0.2 +/- 0.72 mm, 29 implants (85%) were within <1 mm from the intended position. Statistically significant difference was shown for the entrance point deviation. CONCLUSION: When measured using the CMM, the stereolithographic surgical template was sufficiently accurate in transferring the planned implant position to the surgical field relative to the implant angulations and point of entrance. Further clinical studies using a greater number of patients are needed to confirm the results of this study.

Preservation of soft tissue contours with immediate screw-retained provisional implant crown.

When a patient with a missing or failing maxillary anterior tooth desires immediate tooth replacement, fabrication of a provisional restoration can be challenging. Due to individual anatomical variations in tooth shape, size, and supporting soft and hard tissue structures, there are no premanufactured components with an anatomical emergence profile that universally suits all individual situations. This article describes the fabrication of a screw-retained immediate provisional restoration that fulfills anatomic, biologic, and esthetic requirements.

Microleakage of Ormocer-based restorative material in primary teeth: an in vivo study.

This in vivo study aimed to compare, by means of dye penetration, the microleakage values of an Ormocer-based material (Admira) and a commonly-used composite resin (Restorative Z-100) and to assess the differences in the degree of microleakage according to the cavity wall location for both tested materials. No statistically significant differences were found in the degree of microleakage between the 2 materials or the location of cavity walls. Additional preventive measures should be considered to minimize leakage since none of the restorative systems used, eliminated microleakage.

Fabrication of a stable surgical template using staged tooth extraction for immediate implant placement.

When a patient with a nonrestorable dentition desires an immediate restoration, fabrication and use of a stable surgical template can be challenging. Conventionally made surgical templates may lack stability and may, therefore, be less predictable. This article describes the fabrication of a surgical template that permitted the use of staged tooth extraction to facilitate predictable immediate implant placement in a patient with a nonrestorable dentition.

Nonsurgical management of interdental papilla associated with multiple maxillary anterior implants: a clinical report.

An approach is described for the management of missing interdental papillae associated with multiple adjacent maxillary anterior implants. The use of 1 implant instead of multiple implants to support a cantilivered fixed partial denture with an ovate pontic successfully enhanced the soft tissue contours to satisfy the patients esthetic needs and desires.