Patient education: pre- and post-procedure upper endoscopy.

In this article, the author describes the responsibility of the admitting nurse to inform the patient about the procedure before the consent form is signed. The importance of an informed patient in relation to the legal implications and also the increased comfort level that the patient will experience are described. Results of a research program on pre-procedure patient education will be referenced.

The benefits of patient education.

In this article, the role of the nurse in patient education is described, as well as the benefits of patient education, such as improved quality of care, improved patient satisfaction, increased compliance, improved staff satisfaction, and effective use of resources. Strategies for effective patient teaching also are presented.

Analysis of the dental morphology of Plio-Pleistocene hominids. IV. Mandibular postcanine root morphology.

The subocclusal morphology of 168 permanent mandibular premolars (N = 77) and molars (N = 91) of Plio-Pleistocene hominids has been investigated. The taxonomic allocation of the teeth, which represent at least 46 individuals, was based on nondental evidence. Specimens were allocated to one of two major taxonomic categories, (EAFROB or EAFHOM), East African Homo erectus (EAFHER), or their taxonomic affinity was regarded as 'unknown' (N = 17). Information about the root system was derived from radiography and direct observation. Morphometric data were in the form of nine linear and two angular measurements based on eighteen reference points. Root form was also assessed using a scheme which recognised four classes of root morphology. Data were compared using both univariate and multivariate techniques, including Principal Component and Canonical Variate analysis. Posterior probabilities derived from the latter were used (in a two-taxon design model) to assess the affinities of the 'unknown' specimens. The variation in hominid mandibular premolar root form was interpreted as two morphoclines, based on the presumed primitive condition of the P3 (with mesiobuccal and distal roots, 2R: MB and D) and P4 (with mesial and distal root, 2R: M and D) root systems. One trend apparently leads towards root reduction (i.e. P3 = 1 R; P4 = 1 R), and the other to root elaboration (i.e. P3 and P4 = 2R: M and D). The extreme form of the latter is the 'molarisation' of the premolar roots seen in EAFROB. Despite major differences in root form there was relatively little taxonomic variation in root metrics, except for a more robust distal root system in EAFROB. Molar root form showed little interspecific variation except for M2 in which the roots in EAFROB were larger and more robust, with differences in root height being greater for the distal than for the mesial roots. Root form and metrics enable four of the 'unknown' specimens (KMN-ER 819, 1482, 1483 and 1801) to be tentatively allocated to EAFHOM, and a single specimen, KMN-ER 3731, to EAFROB. Published assessments of the root morphology of the 'robust' australopithecines from Swartkrans suggest that the premolar root form of Australopithecus (Paranthropus) robustus is not obviously intermediate between the presumed ancestral condition, and the 'molarised' mandibular premolar root systems of Australopithecus (Paranthropus) boisei.

Analysis of the dental morphology of Plio-Pleistocene hominids. II. Mandibular molars--study of cusp areas, fissure pattern and cross sectional shape of the crown.

Accurate measurements of the absolute and relative size of individual cusps, the arrangement of the primary fissure system and the shape of coronal cross sections of the tooth crown have been used to investigate the pattern of variation in Plio-Pleistocene hominid mandibular molar teeth. Teeth were either grouped into one of six taxonomic categories or considered as individual cases. Univariate analysis of relative cusp areas shows that the two taxonomic categories of 'robust' hominids from East and Southern Africa have relatively small mesial cusps, but a relatively large entoconid and hypoconulid and Principal Component plots of the data show that the 'robust' categories can be distinguished on the basis of relative cusp size. Other evidence suggests that these differences are not likely to be the result of allometric phenomena. Fissure pattern was analysed using the X/Y coordinates of defined reference points. Patterns were compared by Procrustes analysis and the relationships between teeth contained in the resulting similarity matrix were portrayed using Principal Coordinates plots and a nearest neighbours table. The positions of the posterior fovea and the mesial longitudinal fissure were important for distinguishing taxonomic categories. The shape of the coronal profiles proved difficult to quantify, but there were consistent and distinct differences between the South African 'robust' sample and teeth included within the East African Homo category. When these results are combined with those of a previous study of overall crown size and the distribution of extra cusps, they allow the affinities of isolated teeth or contentious specimens to be assessed. For example, our results show that KNM-ER 1506 and 1802 are more similar to the East African Homo group than any other category, and they indicate that though SK 1587 and 1588 are small teeth, they nonetheless are closest to the South African 'robust' category in terms of relative cusp size, fissure pattern and crown profile shape. The closest affinities of the Taung First mandibular molars are also with the South African 'robust' sample.

Analysis of the dental morphology of Plio-pleistocene hominids. I. Mandibular molars: crown area measurements and morphological traits.

This study has used accurate measurements of crown area and precise assessments of the morphological traits of mandibular molars in an attempt to define the metrical and morphological characteristics of early hominid taxa. A total of 196 Plio-Pleistocene hominid molars were either allocated to one of six informal taxonomic groups or considered as individual cases. Accurate measurements of crown base area made from occlusal photographs have enabled us to estimate the effects of interproximal wear on crown areas. The average correction factor over the three molar types is around 2-4% with a maximum of 6%. The patterns of distribution of extra cusps show interesting differences between taxa. None of the M-1S in the two groups of 'gracile' hominids from East and South Africa bears a C6, but it is common in the two 'robust' taxa. The distribution of a C7 is the reverse of this, it being rare in the robust' taxa, and more common in the 'gracile' groups. There is thus no simple relationship between cusp number and tooth size. Our observations on the protostylid suggest that though it is more common in the 'robust' australopithecines than the 'graciles', when it does occur it is more strongly expressed in the 'gracile' group. The combination of simple metrical data, and the assessment of morphological traits, can help in the classification of enigmatic or incomplete specimens. Some isolated teeth from the collection at Koobi Fora can confidently be assigned to Australopithecus boisei, and useful guides have been provided for taxonomic assessment of the skull KNM-ER 1805, and the mandibles KNM-ER 1506 and 1820.